Svevac is a national project where the purpose is to develop a vaccination register, which is to be used by governmental authorities, healthcare centres and patients that need to know about vaccinations. The system has been under development since 2001 and has been in use since October 2002. Up to now the system has been improved and today it has most of the desired functionality. There are only a module for ordination of vaccinations an and up scaling to take care of about 400 000 000 vaccinations for the total Swedish population under a lifetime.

The system can be used for free, for all users in Sweden. It is owned by the Swedish Institute for Infectious Disease Control, all the way down to source code. This means that SMI can use it and design it independent of different development companies, which makes it very flexible.

For different authorities there is a need for different analyses about vaccines, coverage, contradictions and national statistics about vaccinations. It is system that is used for pandemic planning and can also be used for mass vaccinations.

For healthcare centres (regional, local and private) there is a need for registrations and local follow-ups. But it is also important to see what vaccinations that have been given on other healthcare centers. It has been identified that a lot of vaccinations are given because there is nobody that knows the real situation. This means that the system has to be flexible and easy to use, but also handle all legislations about privacy and integrity.

For the patient there is a need to see their own vaccinations maybe to realise what protection that is needed for a travel. This module is ready for use, but is waiting for an national e-id for the Swedish citizen

By working in the same IS there will be advantages in cooperation, real-time analyses and coordination about vaccinations all over the country. This web-based IS allows every stakeholder to particpate in the system and it is today used in about 900 healthcare centers. The developing is still going on for the patients and for the authorities.

The system is prepared for connection with medical journal information systems, but until now there is only one of those systems integrated with Svevac. The concept used is web-services, which are ready for connection. 

One of the main focus has been to make it very user-friendly. Therefore there are very short time for introducing new users. It takes between 5 minutes to at a maximum 2 hours to introduce a new user. It depends on the user knowledge about computer work. These correspond with a basic fact, that it is important to register the vaccination as near the real vaccination as possible.

The system has been presented for ECDC, who were very positive to make it possible to be used in other countries. It is possible to add different languages. Today it is only available in Swedish and English.

It is possible to test the system on the following link: https://www.svevac.smittskyddsinstitutet.se/Demo/PublicArea/Gateway.asp…

User name is: demo and password is: demo

Policy Context

Svevac is working in a nationwide area, where it is stated as a national system for vaccinations that shall be used in cooperation between authorities and the whole healthcare sector. Therefore the strategy with the system is to be an effective tool for every party in the area, which means the one developed nationwide system will be cost-efficient and effective by using the same information for all different purposes.

The concept of Svevac is to be a linkage between several organisations, where they by using the same toll, will be able to be more efficient in the total handle of vaccinations. This will have great impact for the vaccinated persons, because today almost nobody know about their vaccinations and the effects of vaccine.

There is also a policy to be used all over Europe. Therefore it has been presented for ECDC and it has been decided that other countries in Europe can use the system as well. They found it interesting and the proccess for starting this has just started.  

There is an evaluation set up by the Swedish government to evaluate Svevac and decide about a nationwide system for vaccinations. In that case they shall use Svevac as a reference for their decision.

Svevac is relevant for the citizens, because it will give them a possibility to see what vaccinations they have got. The healthcare centres know what vaccinations that is necessary for the single patient, not depending of where the other vaccinations were given. At a national level it is possible to get analyses about the effects of vaccine and adverse advents, which gives the citizen improved safety about their vaccinations. These analyses will be research results for the whole EU.

When used in several countries in EU it is possible to make European cooperated analyses, but the way to this is long, but it is a possible future.  

The planning to use the system for register and analyse vaccinations in the pandemic situation has been decided. Therefore it will be a special set-up for mass vaccinations. This is important for the vaccinated person, because the new vaccine maybe is not enough tested, which means that analysing effects are very important.

Description of target users and groups

The target users are of different kind from several kind of organisations. This depends on that Svevac shall be used from everyone, that has to work with vaccinations. Below the different users is described. They are sorted in an order, that is connected to they have been focused in the project.

Health care centres. Here the users are nurses and doctors that are register or analysing vaccinations. They are daily users and they are feeding the system with information. It is important for them to see all the vaccinations for one patient, to do their work in a proper way. It is also very important that the registration work has a minimum of workload. This has been focused in a special manner with usefulness and easy to learn and use. These users can work in all kind of healthcare centres and in a lot of different situations. This part of the system is working in real-time.

The authorities shall use the information for just their special purpose, which means different use for different work. These users shall be able to select the information, that is important for them and then use their own tools for work. They are not allowed to register any information. Here we also find the different research project i. e about HPV-vaccinations, where every registration are analysed an counted to see the coverage of that vaccine. All these users have different authorities to information, depending on the regulations about the authority and what they are allowed to do. This part of Svevac is updated each 24 hour.    

The patient shall be able to use Svevac for information about their vaccinations. They shall also be able to change consent, se who has looked at his/hers vaccinations. There is also a function under development that will give the patient opportuninty to tell about contradictions connected to a vaccination. It is also possible to register an anamnesis befor going to be vaccinated. That will save time for everyone. This module is ready, but can not be used before we have an e-identifcation for the Swedish population.

Description of the way to implement the initiative

The implementation strategy has been to design such a good system with a real interesting concept, so it is difficult for the different parities to refuse. This is an initiative from SMI and because of the Swedish laws no one can decide to and force any other authority to use a special system in their organisation. Therefore it is important that the concept is too good to be refused. The main problems to build a system like this are not ICT design, but instead there are organisational and legal problems to solve. Below the different aspects are followed to explain about Svevac.

1. The vision is to let everyone that is connected to vaccinations to be a user of the system. This need a lot of coordination with every organisation at local, regional and central level in Sweden. This is coordinated in the project group at SMI. The decisions are taken in meetings by the steering committee, where all the main stakeholders are represented. The legal issues are very big, which means that we have a special assigned legal expert assigned to the project.

The system is prioritized to be designed and used of the healthcare sector as much as possible, because they are feeding the system with information. The the different authorities solutions has been started to be designed, for their special purposes and legal rights. Other prioritized issues are HPV-vaccinations as a special project, because this will be a recommended vaccination in Sweden from 2010. Pandemic solution is on analyse, for being ready to use in fall 2009.

2. The strategy is to have partnership with MPA, Board of Health and Welfare, the council of cooperation between counties and municipality. There are also direct contacts with local healthcare centres. The main strategy is to be available for all parties interested I Svevac. One main interest is to shape partnership with medical record providers, but there is today just one provider that has integrated its system with Svevac.

3. There is one development for all users, because it is a web based technology, which means that the system is changed for all users at the same time.

The change management strategy is the users and the steering committee get proposals about what is need to be changed. Then the changes are prioritised and developed by the project group. All programming is bought from IS-development companies. The project group test the solution before it is going live.

4. The project is directly lead my the General Manager of SMI, with a steering committee. Then there are a project group for development and operations. There we have all ICT-competence, both technical and admininstrative.

5. The multi-channel strategy has been described above, where SMI have different strategies for different approaches. It is important to catch up the cooperation issues and also the legal issues to reach the solution as a nationwide system.

The resources are managed by the project manager in yearly budgets and follow-up. Special investigation are decided by the steering committee. This has made Svevac extremely cheap until now about 750 000 EUR

6. The knowledge management are inside the project group especially in systems development and IS operation. This means that real knowledge about the system and its construction is spread to different paries, when they participating in different activities.

7. The human resource management is rather easy, because it is all handled inside SMI, with its ordinary human resource management department. The risk are identified and is discussed in  the steering committee. They are prioritised and they are focused in near time and long time. The main risks are missing coordination between authorities and not good enough legislation for this kind of cooperating systems

Technology solution

The system is design and developed by the project group in SMI. Then programming has been done by an outside vendor. The tools used are Microsoft Visual Studio, Microsoft SQL Server 2005, C#. The system is running on three balanced web servers connected to the database. There are two ways accessing Svevac it is via web interface and via web-service. Web service is designed to be used by medical journal systems.

This means that the system is has connected users via Internet and Sjunet (an intranet for medical services). All users are using the same data from the database, regarding to what they are authenticated to. In SQL Server there are a business Intelligence module, that makes it possible for users to design their own applications for analysing.

The system is divided inot two parts. The first one is for the healthcare area and is called Svevac Jounal. Here is also the interface for patient located. All records stored here are medical records for vaccinations and this part can be sued for medical service and medical analyses. From this part information goes over to Svevac Analysis, but only information that patients has given consent to be used. This is the tool for analyses and work by the participating authorities and also for decided research projects.

There are a lot of special design modules as language translating module, organisational module and a special security module.

This means that standard products are used and the architecture is rather similar to a data warehouse concept.

Technology choice: Standards-based technology

Main results, benefits and impacts

The patients can for the first time get their vaccinations registered and documented.

The healthcare centers can see which vaccination a patient have got and decide about the continuing vaccinations. They can also make a better planning for vaccinations i.e. in a pandemia. They also can aviod unneccesary vaccinations.

The authorities can make analyses of different kind. SMI can see coverage to see the protection about different diseases. MPA can control effets of vaccine and about their contradictions.

Every user works with the same information and can get results about their work from it.

Then there are at least 10 more authorities that has been identified as users, but how they can and shall use the system is not ready yet

Return on investment

Return on investment: Not applicable / Not available

Track record of sharing

There is a big possibility to learn from this project and we are very open for studies to the system and its development. The project started as cooperation between SMI and Lund University for development and research in combination. The first development was founded from EU. Therefore it has been an open and invitational aspect of sharing information with different organisations.

The purpose of Svevac makes it natural to share this knowledge with everyone that wants to know about it. Therefore a lot of time is spend just presenting Svevac. The Swedish government has just now a special interst in Svevac, to make legislation for complete support of the system. ECDC has shown special interst for use of Svevac in more coutries in Europe.

Information about this development has been hold in different EU-meetings about vaccinations. It has also been used in the education in Lund University, department of Informatics. Then it has been informed to a lot of organisations in Sweden i.e. Vinnova hearings.

There have been two master thesis at Lund University about Svevac. There has also been one accepted abstract to a conference in Copenhagen in June 2009.

From Svevac has a research project Vacsam been accepted from Vinnova. This a partly founded project. It has a purpose to design a service that recommend a vaccination programme for children coming to Sweden from other countries, getting full vaccinated regarding to the Swedish vaccination programme.This service shall be used in the whole healthcare sector and shall be design by using rule-based technology.

Lessons learnt

It is difficult to make a IS for several different authorities and get it accepted.

With good user interface it is easy to implement it at the healthcare centers, but they really need a easy system to use. We focused that from the beginning, which has been real valuabel in the implementation.

Legislation is a big problem, which learnt the lesson, that it can take a long time to identify and meet the differnet requirement from different laws, especially if there is no law that can handle nationwide IS of this kind in Sweden.

 

Scope: National, Regional (sub-national)