Health Informatics Strategy in Denmark. Arne Kverneland National Board of Health Denmark

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1 Health Informatics Strategy in Denmark Arne Kverneland National Board of Health Denmark

2 The Danish Health Care System National Health Service serves all 5,3 mill. Citizens (tax financed) 3500 GPs >90% of GPs use EHR 65 public hospitals (14 Counties +Copenhagen) hospital beds 1.3 mill. annual discharges HISI & Eurorec 2003 Arne Kverneland 2

3 HISI & Eurorec 2003 Arne Kverneland 3

4 The Danish EHR model Process Information Diagnostic consideration Evaluation Diagnosis Goal Outcome Planning Executing Plans HISI & Eurorec 2003 Arne Kverneland 4

5 Different scenarios in IT in Denmark Effective use of IT, degree of ambition 4 3 Optimistic: Common concept model structured data makes reusable information 2 1 0? Pessimistic: Different concept models Only few or low structuring No reuse of data HISI & Eurorec 2003 Arne Kverneland 5

6 Background 1994: MEDCOM, EDIFACT-messages (25 mill messages per year) : Action Plan for EHR decentralized, pilots There is need for standards and common terminology 1999: National Strategy for Information Technology in Hospitals EHRs shall become the core of IT systems in hospitals 2003: National Strategy for Information Technology in the Health Care System ( ) Shared information is the foundation for seamless care and patient involvement HISI & Eurorec 2003 Arne Kverneland 6

7 HISI & Eurorec 2003 Arne Kverneland 7

8 HISI & Eurorec 2003 Arne Kverneland 8

9 Observed HEP EHR sites Observed (EPR-observatory,1999) EPR sites North Jutland Psychiatry Viborg Pediatrics, Viborg Psychiatry Roskilde Roskilde Hospital Copenhagen Herning Hospital Århus Gentofte Hospital Hvidovre Hospital Vejle Hospital Aabenraa Hospital South Hospitals Funen HISI & Eurorec 2003 Arne Kverneland 9

10 Copenhagen 20. februar 2001 Parterne er på den baggrund enige om de overordnede principper for standardisering og udbredelse af EPJ, der er beskrevet i vedlagte notat. Principperne vedrører fælles ansvar for udviklingen, fælles mål for funktionaliteten og fælles standardspecifikation for EPJ, som udvikles af Sundhedsstyrelsen i samarbejde med sygehusejerne. Parterne opfordrer til, at de beskrevne principper lægges til grund for det videre arbejde med EPJ i Danmark. Arne Rolighed Kresten Philipsen Sundhedsminister Formand for Amtsrådsforeningen Jens Kristian Gøtrik Peter Martinussen Medicinaldirektør Bestyrelsesformand for H:S HISI & Eurorec 2003 Arne Kverneland 10

11 What did they sign in 2001? Episode of care based Structured information Report to clinical databases for quality Standardized terminology & classifications Shared responsibility for testing & pilots HISI & Eurorec 2003 Arne Kverneland 11

12 Why make a National IT-Strategy Try to achieve agreement about the vision Try to keep shortsighted goals in focus together with the future needs Point out the needed initiatives and who is responsible HISI & Eurorec 2003 Arne Kverneland 12

13 Initiatives of the strategy Concepts / terminology (20) Integration Platform (8) B-EHR systems (1,2) QI Pilot NQR Classifications (22,23) B-EHR pilots (3-6) NHCR (14) DGMA IQR (17) Basic EHR standard XML-EPJ messages (25) Medicationmessages in XML (4) Pilot NHCR (14) Convertion New -> Old (14) New-DRG NPI (15) Old-DRG accounting HealthCareportal (18) Legalsafety clarification (7) SDN on internet (26) Primary EHR (21) PKI for GPsystems & Eurorec 2003 profile (16) Arne Kverneland management professionals 13 Medicatio- User- Health HISI (24)

14 3 Major initiatives of the strategy Coordinated development, test & implementation of EHRs based on The National Basic Conceptual Model for EHR The Clinical Processes and its elements A national terminology server and organization (NBH) Web-access to web-application National Concept Council & working groups Common classifications International & national classification SNOMED CT? HISI & Eurorec 2003 Arne Kverneland 14

15 Many stakeholders Ministry of Health and Interior National Board of Health 14 Counties and County Concil Copenhagen Hospital corp. HISI & Eurorec 2003 Arne Kverneland 15

16 Many Operators The National Health Portal Center for Health Telematics Vendors Hospitals Professional societies Labour organisations Ministry of Science Medicin Agency HISI & Eurorec 2003 Arne Kverneland 16

17 Can the strategy be carried through? Compiled in a close cooperation (10 months) Many initiatives Follow-up group Revision of the work plan after 2½ year Strategic pilot-project HISI & Eurorec 2003 Arne Kverneland 17

18 c c c Roskilde Amts Sygehus c Amtssygehuset i Gentofte c Amtssygehuset i Herlev c c c c c Centralsygehuset Esbjerg Varde c Sygehus Viborg c c c c HISI & Eurorec 2003 Arne Kverneland 18 c

19 The proces of real common information. Medical Record Medical record interventionsresultat Nurserecord Nurserecord sundhedstilstand operationelt sundhedsmål Each profession has their own record if I can see yours, you can see mine! sundhedsaktivitet Real common information HISI & Eurorec 2003 Arne Kverneland 19

20 Doctor s notes Structured clinical documentation with a multiprofessional procesmodel Nurse s notes A general process Meaningful for clinicians Multi-professional understood Klinisk clinical dokumentation documentation of i dag today Physiotherapist s notes Multiprofessional documentation about diagnostics Multiprofessional documentation about planning Multiprofessional documentation about evaluation clincal clinical documentation of of tomorrow Multiprofessional documentation about perfomance HISI & Eurorec 2003 Arne Kverneland 20

21 The steps of the clinical process Process Information Diagnostic consideration Evaluation Diagnosis (Condition) Goal Outcome Planning Executing Plans HISI & Eurorec 2003 Arne Kverneland 21

22 How much can a strategy include? HISI & Eurorec 2003 Arne Kverneland 22

23 AN ICEBERG - A METAPHOR FOR A STRATEGY The visible part over water The supporting part invisible, under water How much of an ITstrategy is under water? 60 %? 80 %? Is it only the strategy can describe? HISI & Eurorec 2003 Arne Kverneland 23

24 Strategic planning.50 years of experience HISI & Eurorec 2003 Arne Kverneland 24

25 When does a strategy have effect? HISI & Eurorec 2003 Arne Kverneland 25

26 It takes 5 years before the benefit begins to materialise... Stage 1 Stage 2 Stage 3 PLANNING METHODOLOGY OBJECTIVE Inexperience Inadequate business plan Complexity apparent Bottom-up, experts Top-down, Management run Bottom-up Top-down, prototyping Management understanding Agreeing priorities Strategy plan shaping up Stage 3 is in general a chaotic period. Selection of structured methodology to lead into stage 4. Stage 4 Stage 5 Impatience for benefits Maturity Indside-out management and users in control Multiple methods accepted. Partnerskip Finding opportunities Integrated IT and business strategy HISI & Eurorec 2003 Arne Kverneland 26

27 Challenges HISI & Eurorec 2003 Arne Kverneland 27

28 Part of the strategy: The Danish EMR-project Modelling and documenting at 3 levels 1. Conceptual level modelling real world concepts using UML notation 2. Logical level modelling class diagrams and use cases using UML notation applying datalogical restrictions 3. Physical level modelling implementation models XML schemes Testing the model in major pilot project throughout Link: (Danish only) HISI & Eurorec 2003 Arne Kverneland 28

29 Danish Conceptual Model vs. CEN/ENV CEN/ENV 13606, Part 1 contains the extended reference architecture for communicating health related information partly or solely by EHR Both models use object oriented analysis documented in UML notation focuses on the composition of the EHR as a documentation system inspired by traditional paper files The Danish model addresses the information processing in clinical situations, including relations and structure of the information components HISI & Eurorec 2003 Arne Kverneland 29

30 Further development Modelling and documenting at 3 levels 1. Conceptual level modelling real world concepts using UML notation 2. Logical level modelling class diagrams and use cases using UML notation applying datalogical restrictions 3. Physical level modelling implementation models XML schemas Major pilots are testing the model in clinical settings throughout Link: (Danish only) HISI & Eurorec 2003 Arne Kverneland 30

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