Intended for healthcare professionals


Patient access to health records: striving for the Swedish ideal

BMJ 2017; 357 doi: (Published 02 May 2017) Cite this as: BMJ 2017;357:j2069
  1. Stephen Armstrong, freelance journalist, London, UK
  1. stephen.armstrong{at}

All patients in Sweden will shortly have access to their full medical records. Stephen Armstrong reports on the the country’s 20 year struggle to achieve this and what the UK can learn

This spring Stockholm, the last of Sweden’s 22 counties to implement patient accessible electronic health records, is rolling out the country’s Journalen patient portal service.1 The portal is part of the national e-health strategy, which states that “all residents from 16 years should by 2020 have access to all information documented in county funded health and dental care.2

Sweden is leading the way in offering all patients universal access to medical records—all its hospitals, primary care centres, and psychiatric facilities already use electronic health records. The figure in Europe is 65% overall and 81% in hospitals.3 By February 2017, 3 773 178 Swedes, or 37.9% of the population, had set up accounts.

Patients can log in to the Journalen system using either an electronic identifier or their Swedish personal identity number.1 They are able to see notes from all healthcare professionals, a list of prescribed medications, test results, warnings, diagnosis, maternity care records, referrals, and vaccinations as well as a log of everyone who has accessed the record. The can also add comments to notes if, for example, information is incorrect.

Clinician concern

The process was long and fraught, necessitating legal changes and research to allay a series of concerns, raised mostly by clinicians.3

The journey began in 1997 in the Uppsala region, a county north of Stockholm, with a project called Sustains 4—an attempt to set up an “internet health account,” much like an online bank account. Sustains was initially hampered by Swedish data protection laws, which did not allow patients to access records.5 It took the introduction of the Patient Data Act in …

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