Tor Jakob Reitan is municipal director in Stjørdal. He has had two of his own lawyers assess the contract with Helseplattformen, the new patient record for the health service in central Norway. The conclusion from the lawyers does not make the municipal director any more confident about an introduction. – I cannot recommend the Health platform now. We need more time to assess the case, says Reitan. Christer Mjåset, Deputy Managing Director of the Health Platform, says he does not know of any other municipalities that have raised the same concerns as Stjørdal in relation to the agreement: – The work on it has been well rooted in the region, he says. The health platform The health platform is responsible for implementing the introduction of a new and common patient record for the health service in central Norway If everything goes according to the health platform’s plan, the solution will be used by 40,000 employees in the health service 720,000 residents will then be able to access their own records digitally through the solution The project is owned by Helse Midt-Norge RHF and Trondheim municipality. The health platform is the region’s largest IT project and has a cost frame of NOK 4.2 billion. The health platform was introduced in Trondheim municipality in April. In November, St. Olav and six other municipalities in Trøndelag will introduce the record system. Then follows the hospital in Levanger and two new Trønder municipalities, and eventually Helse Møre and Romsdal and Ålesund municipality. So far, 19 out of 66 municipalities have signed the agreement, thereby becoming owners of the company. The aim is to get all municipalities in central Norway on the team, but for now several are waiting. Minister of Health and Care Ingvild Kjerkol has encouraged all municipalities in central Norway to join the Health Platform. Concerned about costs after introduction Preben Dahle is one of the two lawyers who have reviewed the ninety-page cooperation agreement, with a focus on any risk for Stjørdal. He points out that the assessment was made in May, with information from the contract as it was then available. His overall assessment of the contract is that it raises concerns about the cost responsibility of becoming a co-owner of the Health Platform. – We are unsure how the municipality is secured in real terms, says Dahle, about the possible additional costs after the introduction. Dahle believes that there are several uncertainty factors in the contract: Additional costs after introduction are not fully clarified Unclear decision-making structure among owners Still uncertain what real participation the municipality will get in the Health Platform Unclear who will bear extra costs for GPs No cap on how big the extra expenses could be for the municipality after introduction Many important matters must be clarified after entering into a contract. Preben Dahle is a municipal lawyer in Stjørdal. He believes the contract with the Health Platform gives uncertainty about questions related to additional costs. Photo: Lene Fjellstad / Stjørdal municipality “The structure of the agreement is its weakest point overall. There are recurring matters which are intended to be clarified later,” write the lawyers in their conclusion. – But the municipalities can terminate the contract, with one year’s notice if they want to? – The problem with this is that it results in a large entry cost, for our municipality approximately NOK 43 million. We will not get these back if we withdraw from the agreement. When you first enter into the collaboration, it seems financially very unsound to go out again, even if this possibility exists, says Dahle. Cost distribution Helseplattformen The service agreement is a cooperation agreement between the actors who become co-owners of Helseplattformen AS and shall regulate the cooperation between the parties. The service agreement has been negotiated and the municipalities must therefore agree to it without negotiations. Upon signing, the municipality commits itself to the purchase of shares and thus becomes an owner participant in Helseplattformen AS All additional costs will be distributed between the owners of this company Costs up to 7% of the fixed framework must be distributed between the municipalities . 70% of these costs are distributed according to population and 30% is distributed evenly between the municipalities. The general meeting decides how costs above 7% of the set limit are to be covered The lawyers in Stjørdal have carried out a legal assessment of the service agreement and its annexes, and the cooperation agreement of 2019 which is incorporated as part of the service agreement, on a total of 90 pages. Advice on waiting After assessing the contract between the Health Platform and the municipalities, the lawyers advise Stjørdal to wait as long as possible before committing to an agreement. – It is recommended to continue investigation work and reap the benefits of experience with the cooperation from “first mover” municipalities, says Dahle. Dahle also advises the municipal director to provide a real alternative for other record systems that Stjørdal can use, ahead of a political consideration. The lawyer says that any introduction of a new system entails a certain risk, and that it is not the agreement alone that should be decisive for what Stjørdal chooses: – It is the technical solution that will be decisive for whether the municipality should choose the Health Platform or another system. It is this task that the municipality must work on clarifying going forward, he says. Municipal director: – Up to date Tor Jakob Reitan is municipal director in Stjørdal, which is the second largest municipality in Trøndelag. He says the municipality always gets lawyers to assess contracts of a certain size and risk. He is afraid of remaining in office as the owner of a system that does not deliver, and says that the same requirements for law and cost-benefit must be set in this project as in other acquisitions. Ole Jakob Reitan is municipal director in Stjørdal. He believes the time has not come to introduce the Health Platform in the municipality. Photo: Eir-J. Bue Municipal Director Reitan says people in Stjørdal agree to wait a while before decisions are made on the matter. – We are on the weather. I aim to present a case to the municipal council in the spring, if I then have a good enough basis, he says. Until then, the municipal director must investigate alternative records systems and details of additional costs after introduction. – My assessment is that the time to take a stand on possibly becoming a co-owner has not yet come. The lawyers’ analysis shows that we need to acquire more knowledge, and then we need to keep a close eye on the introduction in St. Olav and Trondheim municipality as well, he says. Having arrived at the agreement together, Christer Mjåset in the Helseplattformen, says there is no deadline for committing to the agreement and that the Helseplattformen has rigged a project that will last until the summer of 2025, in order to share the costs. – When the project period is over, there will be no one else to share the bill with, and then it will be more expensive for those who want to connect, he says. – The lawyers are concerned about the responsibility for costs and the distribution of any additional costs after introduction. Is this something to be concerned about? – The service agreement and the conditions for it are something that has been arrived at together with a committee set up by the cooperation council for the municipalities in central Norway. Several municipal lawyers and municipal directors have been involved in the work, and the document that has been produced is well thought out, says Mjåset. Christer Mjåset is Deputy Managing Director of the Health Platform. He says it will be more expensive to join the Health Platform if you wait a long time. Photo: Helseplattformen The cooperation has exceeded all expectations In response to the lawyers’ claim about unclear decision-making structure among co-owners, Mjåset says that the municipalities are already cooperating on decisions related to the Helseplattformen. – That collaboration has exceeded all expectations, both now in relation to go live preparations but also in connection with the design of the service agreement. – How will it affect the Health Platform if several municipalities sit on the fence and wait? – This platform was established after receiving a loan with a grant from the state. If there is a municipality that does not want to join the platform, the state pays the bill, not the municipalities that connect. In addition, the residents of Stjørdal will come to the Health Platform regardless of the fact that the specialist health service comes on. So it is the residents who will be most affected if Stjørdal fails to join, says Mjåset. Yes municipalities feel safe Indre Fosen is one of the municipalities that has signed a cooperation agreement and will introduce the Health Platform in November. They feel confident that the choice to join early in the course was the right one. Municipal director Kjetil Mjøsund says the municipalities that are now introducing the Health Platform together have taken several quality assurance assessments. Lawyers have been involved. – We have had quality assurance of the substrate material and feel comfortable with the choice we have made, says Mjøsund. Overview of the municipalities that have so far decided to introduce the Health Platform. The blue municipalities are yes municipalities. Photo: The health platform Indre Fosen is prepared for some additional costs after introduction and this has already been included in the budget proposal for 2023. – We believe that we are handling the introduction costs and experience will show how the costs will be in the future, says Mjøsund. The municipal director in Holtålen also feels confident about the choice to join the Health Platform. – A worst case scenario where everything goes down and home no one can guarantee against. But then you are involved in a risk analysis which, in our view, goes too far, says municipal director Marius Jermstad. Municipal director in Holtålen Marius Jermstad, managing director of the Health Platform Torbjørg Vanvik and municipal director in Røros Kjersti F. Jensås. Both Holålen and Røros have decided to introduce the Health Platform. Photo: The Jermstad health platform considers the risk of additional financial costs after introduction to be low: – We think it is so small that we have not emphasized it. in all projects like this there is a risk at the back end, but if you emphasize it, little or nothing would happen, he says.
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Lawyers advise Stjørdal to wait to introduce the Health Platform – news Trøndelag
