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The Office of the Auditor General's investigation of electronic messaging in the health and care sector

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Background and objective of the audit

For many years, Norway's parliament, the Storting, has emphasised the importance of information and communications technology (ICT) for achieving health and care policy goals relating to quality, patient safety, efficiency and use of resources. Electronic messaging is one method of electronic coordination and has been a priority solution since 1997 in all national ICT strategies in the health and care sector.

National programmes under the auspices of the Norwegian Directorate of Health and Norsk Helsenett SF (Norwegian Health Network) have been carried out since 2008 to improve the management of work in the sector and contribute to the adoption of necessary technical solutions for exchanging messages. The original goal was that the electronic exchange of patient information was to dominate the coordination between health trusts and medical offices by 2010, and be operating between health trusts by 2011 and between health trusts and municipalities by 2013. The goals have been adjusted, and the current goal is that all municipalities, doctors and health trusts shall have established electronic messaging by the end of 2014.

The purpose of the audit has been to assess the status of the introduction of electronic messaging and discontinuation of parallel paper routines in the health and care sector, and the national authorities' management, facilitation and follow-up of goals for safe and efficient electronic coordination.

Findings and recommendations

The exchange of messages between health trusts, municipalities and medical offices continues to be characterised by the extensive use of paper

There are particularly three overriding circumstances causing the continued use of paper:

  • requisite message standards have not been developed
  • the message address system does not work satisfactorily
  • already developed technical solutions have not been put into service or are not being used in line with national coordination architecture


There are clear weaknesses with the Ministry of Health and Care Services' planning, management and follow-up of the work on electronic messaging

The Ministry of Health and Care Services' use of policy instruments has not been adapted to objectives, status and challenges in the field

The Ministry of Health and Care Services has not formally required all players to use electronic messaging in their interaction with each other. Along with a fragmented division of responsibilities, this has meant that the players are free to prioritise the introduction of electronic messaging differently. Information and attitude shaping have been seen as a very important tool, but the Directorate of Health has no systematic knowledge of the players' benefit and use of the guidance documents and guidelines that are issued.

Electronic messaging is a technically demanding measure that must be implemented as coincident in time as possible with the players to ensure that the solutions function effectively. The survey indicates that the current organisation of the introduction is contributing to a situation in which the players lack incentives to be among the first to invest in the necessary technology.

To achieve the Storting's goals, the Office of the Auditor General (OAG) recommends that:

  • The Ministry of Health and Care Services should strengthen the overall use of policy instruments to help ensure the progress of the work, and the development and use of standardised technical solutions. Through the use of policy instruments, the Ministry should ensure that municipalities and medical offices have sufficient incentives to adopt electronic messaging in line with the Storting's requirements for secure and effective coordination.
  • The Directorate of Health should ensure the development of all necessary national standards for electronic messaging between health trusts, municipalities and medical offices.
  • Norsk Helsenett SF should redouble its efforts to improve the Address Register to enable a well-functioning register for the players as soon as possible.
  • The regional health authorities should ensure that the technical solutions that are developed are introduced and adopted at all underlying health trusts so that other players wishing to establish electronic messaging do not have to wait for the health trusts.

Riksrevisjonen, Storgata 16, P.O. Box 6835 St. Olavs plass, 0130 Oslo, Norway

Phone: +47 22 24 10 00 974 760 843