The development of the electronic health record in Denmark

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1 The development of the electronic health record in Denmark Poul Erik Hansen, Vice president Ministry of Health The National Institute of Health Data and Disease Control

2 Agenda 1. A very short introduction to the Danish health care system 2. The focus areas and status for Electronic Patient Records (EPR s) and Information and Communications Technologies (ICT) 3. Facts and priorities for a new digitalization strategy Every day-use and benefit realization Connected care and better use of data Citizen involvement and telemedicine Governance, standards and mobility 4. Choices and dilemmas to be handled in the coming years

3 Agenda 1. A very short introduction to the Danish health care system 2. The focus areas and status for Electronic Patient Records (EPR s) and Information and Communications Technologies (ICT) 3. Facts and priorities for a new digitalization strategy Every day-use and benefit realization Connected care and better use of data Citizen involvement and telemedicine Governance, standards and mobility 4. Choices and dilemmas to be handled in the coming years

4 The Danish Health Care system There are 3 levels in the public system in Denmark The central government The regions Local municipalities

5 Regions Geography Facts 5 Regions Politically elected leadership No taxing power financed by state grant and co-payment by municipalities

6 Regional responsibilities Hospital and psychiatric treatment Primary health care / public health care scheme General Practitioners (family doctors) Private practicing specialists Adults dental services Physiotherapy

7 Municipalities (Kommuner) Geography Facts 98 Municipalities Politically elected leadership Taxing powers

8 Municipal responsibilities Preventive care and health promotion Rehabilitation outside hospital Treatment of alcohol and drug abuse Co-financing regional health care Child nursing Child dental services and special dental care School health care Home nursing

9 Agenda 1. A very short introduction to the Danish health care system 2. The focus areas and status for Electronic Patient Records (EPR s) and Information and Communications Technologies (ICT) 3. Facts and priorities for a new digitalization strategy Every day-use and benefit realization Connected care and better use of data Citizen involvement and telemedicine Governance, standards and mobility 4. Choices and dilemmas to be handled in the coming years

10 The main strategies a long journey IT-political Action Plan National strategy for IT at Hospital level National strategy for digitalization in the health care sector Making ehealth Work - National Strategy for Digitalization of the Danish Healthcare Sector Action Plan for Electronic Patient Record National IT-strategy for the health care sector National strategy for telemedicine

11 Prerequisites for ehealth in Denmark An IT-ready population: Broadband penetration is the among the highest in Europe - 95% of the population have internet access. A unique personal identifier is issued to all Danish citizens at birth and a digital signature is widely used National Health Databases maintained for more than 30 years Law revisions in recent years have established a broader access to personal health data for medical staff liberal use of data BIG DATA

12 Prerequisites for ehealth in Denmark National Service Platform Business support Shared Medication Record Consent Vaccinations etc. Registry support Danish Civil Registration System (civil personal registration number ) Registry of General Practitioners Authorized health personal etc.

13 Prerequisites for ehealth in Denmark General platform services National Health Organization Registry General Practitioners Specialist outside the hospitals Hospitals Municipality health institutions Common standards, classification and terminology (accepted and used) ICD10 Radiology Lab-codes Snomed etc.

14 Prerequisites for ehealth in Denmark But local independence is accepted Legacy of many systems - different levels of maturity No one system-strategy interoperability has been (and is) the key, not uniformity differences in the local systems is accepted in

15 The focus areas Electronic Health records At GP level and specialist outside the hospitals In hospitals Communication between GP Hospitals Pharmacies Municipalities

16 How does ICT look inside of hospitals? Number of regional EHR landscapes September 2012 Ultimo 2012 Ultimo 2013 Region Hovedstaden Region Sjælland Region Syddanmark Region Midtjylland Region Nordjylland

17 Single sign-on in place in the regions Nord Hovedstaden Syd Midt Sjælland Antal Number hospitaler of hospitals i alt Antal Number hospitaler of hospitals med with single implementeret sign-on ESA

18 Registrations in the regions done within 24h 22 hospitaler hospitals med doing højest best andel Gennemsnit The average af regionens hospitaler 2 hospitaler 2 hospitals med doing lavest worst andel 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Nord Hovedstaden Syd Midt Sjælland

19 Electronic registration boards for emergency care in all hospitals

20 ecommunication between sectors Electronic messages have to a large extent replaced handwritten messages between GPs and hospitals: Type of message Referrals from GPs to specialized treatment Discharge letters from hospitals to GPs Lab test orders and resultats between GPs and labs % digital 81 pct. 99 pct. 99 pct.

21 Communication between local municipalities and hospitals Messages sent to municipalitites Messages sent from municipalities Nord Hovedstaden Syd Midt Sjælland Nord Hovedstaden Syd Midt Sjælland

22 ecommunication between hospitals and municipalities by Q exp. 90 pct. green No. of received messages,, pr inhabitants No. of sent messages, pr inhabitants Bornholm Hjørring Bornholm Frederikshavn Læsø 45- Hjørring Frederikshavn Brønderslev Læsø Brønderslev Jammerbugt Hørsholm Thisted Aalborg Allerød Rudersdal Thisted Jammerbugt Aalborg Allerød Hørsholm Rudersdal Morsø Lemvig Struer Holstebro Skive Vesthimmerland Viborg Rebild Mariagerfjord Randers Favrskov Syddjurs Norddjurs Furesø Lyngby-Taarbæk Gentofte Gladsaxe Herlev Ballerup Glostrup Frederiksberg Albertslund Rødovre København Høje-Taastrup Brøndby Hvidovre Vallensbæk Ishøj Tårnby Dragør Greve Morsø Lemvig Struer Holstebro Skive Vesthimmerland Viborg Rebild Mariagerfjord Randers Favrskov Syddjurs Norddjurs Furesø Lyngby-Taarbæk Gentofte Gladsaxe Herlev Ballerup Glostrup Frederiksberg Albertslund Rødovre København Høje-Taastrup Brøndby Hvidovre Vallensbæk Ishøj Tårnby Dragør Greve Herning Silkeborg Århus Skanderborg Ringkøbing-Skjern Ikast-Brande Odder Horsens Samsø Hedensted Vejle Billund Varde Fredericia Nordfyns Vejen Kolding Middelfart Kerteminde Fanø Esbjerg Odense Assens Nyborg Haderslev Faaborg-Midtfyn Gribskov Helsingør Halsnæs Fredensborg Hillerød Frederikssund Odsherred Egedal Kalundborg Holbæk Lejre Roskilde Solrød Køge Sorø Ringsted Stevns Slagelse Næstved Faxe Herning Silkeborg Århus Skanderborg Ringkøbing-Skjern Ikast-Brande Odder Horsens Samsø Hedensted Vejle Billund Varde Fredericia Nordfyns Vejen Middelfart Kolding Kerteminde Fanø Esbjerg Odense Assens Nyborg Haderslev Faaborg-Midtfyn Gribskov Helsingør Halsnæs Fredensborg Hillerød Frederikssund Odsherred Egedal Kalundborg Holbæk Lejre Roskilde Solrød Køge Sorø Ringsted Stevns Slagelse Næstved Faxe Tønder Svendborg Vordingborg Tønder Svendborg Vordingborg Aabenraa Sønderborg Ærø Langeland Aabenraa Sønderborg Ærø Langeland Lolland Guldborgsund Lolland Guldborgsund

23 23 Shared Medication Record

24 Shared Medication Record implementation, status PCT. Hospitals GPs Specialists Doctors on call Region Hovedstaden Region Sjælland Region Syddanmark Region Midtjylland Region Nordjylland Municipalities

25 Agenda 1. A very short introduction to the Danish health care system 2. The focus areas and status for Electronic Patient Records (EPR s) and Information and Communications Technologies (ICT) 3. Facts and priorities for a new digitalization strategy Every day-use and benefit realization Connected care and better use of data Citizen involvement and telemedicine Governance, standards and mobility 4. Choices and dilemmas to be handled in the coming years

26 Activity aims towards year 2020 Number of patients treated outside the hospitals increases Out patient treatment up with 50 percent Number of beds down with 20 percent Bed days down from approx. 5 days to approx. 3 days

27 New Digitalization Strategy HIS is key to efficient, coordinated, reliable and equal health services: 1. Focus on use of HIS - benefit realisation - no paper journals 2. Connected care: Cross sector cooperation and better use of data 3. Patient empowerment - treatment at home and patient-centred data 4. Transparency on progress/commitment - Business case-driven strategy - pragmatic case by case

28 Treatment at home and patient empowerment Large potential in involving patients and relatives in own treatment, care, rehabilitation and prevention. Collecting and use of data at home Building national infra structure for data up take of new solutions Logistics and ownership related to devices and data Presentation and sharing of data end-to-end New ways of organising tasks and responsabilities > how?

29 Ulcer treatment a good example Now: Patients with leg and foot ulcers due to diabetes, obesity and cardiac problems are treated by a specialized doctor in a hospital. Daily care is provided by home nurse (municipality) in patients own home. Patients travel to see doctor in hospital. After national implementation in 2017: The nurse photographs the ulcer with her cell phone and mails the image to the doctor, who prescribes new treatment or new medication. Communication between nurse and doctor is based on a shared web based patient record. The patients will travel to the hospital less frequently.

30 Communicating with Citizens Sundhed.dk - the official Danish ehealth Portal for public healthcare services. Citizens have access to personal health data such as: Info on prescription medicine Selected information from Electronic Health Records Organ Donor Registration Citizens can participate: Building My dairy with data and stories shared national platform

31 Public acceptance health.dk HealthTech Counsil

32 Agenda 1. A very short introduction to the Danish health care system 2. The focus areas and status for Electronic Patient Records (EPR s) and Information and Communications Technologies (ICT) 3. Facts and priorities for a new digitalization strategy Every day-use and benefit realization Connected care and better use of data Citizen involvement and telemedicine Governance, standards and mobility 4. Choices and dilemmas to be handled in the coming years

33 Some real choices and dilemmas We have a history of collecting and sharing data on patients and treatment that are second to none internationally. In a new area of intelligent health what does it take to keep that position? We base our infrastructure on international standards We want to make full use of data between sectors this puts high demands on shared definitions and standards both when it comes to local systems, local work processes, competences etc. We want to cooperate internationally. We are too small to do it our selves we need broad mandate, speed to compete and a pull also from the industry

34 The data collection for other purpose than treatment The target: Easy and equal access to all data recorded in the Danish health sector (including written medical records, etc.).

35 Patient treatment BI informations systems REAL-TIME Electronic Patient Records in regions, Electronic Care Records at the municipalities and messages from MedCom etc.) Central NEAR REAL-TIME transformation of health data on activity, economy and outcome etc. Microbiology Written information Pathology Lab. Data for local use Structured transformation Somatic data (LPR) ETC. ETC. Pharmaceuticals Lab.bank Other registries NSP National Service Platform esundhed Platform for health data

36 The future-proof model for planning etc. 45 Biopsi 129 Clinical examination Prolap.S MR-scanning Bone marrow examination Conculattion at the GP Unemployment benefits 448 Home care 6 mmol/l 189 Cholesterol measurement pr.gang Chemotherapy - n number of doses 466 X- ray 135/80 78 Blood pressure 566 Visit at the dermatologist Unemployment benefits Change of marital status Radiation planning pr. gang Radiotherapy - n number of fractions Bone marrow examination 8 mmol/l 643 Hemoglobin Results Costs in Dkk Services Time

37 Thank you for your attention For more info:

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