Big Data in the Health System the Danish Experience Hans Erik Henriksen CEO, Healthcare DENMARK E- mail: heh@healthcaredenmark.dk
Healthcare DENMARK is a public- private partnership
Her Royal Highness Crown Princess Mary is patron for Healthcare Denmark In Denmark, our focus on pufng the pahent first combined with constant efforts to improve efficiency and quality has resulted in a wide array of innovahve healthcare soluhons. I sincerely believe Danish technologies, products and experhse can have a posihve impact on global health. 07.03.16 3
Healthcare DENMARK Danish healthcare visitor programs Conferences Danish delegahon visit to other countries CommunicaHon and press achvihes The Healthcare DENMARK homepage
Agenda The Danish Healthcare strategy and inihahves NaHonal Health Data - background and status Big Data in Denmark today Future Big Data perspechves Big Data pre- requisites 07.03.16 5
The Danish Healthcare System Basic Features Universal Coverage Free & Equal Access Here Financed by general taxes A high degree of decentraliza=on
OrganizaHon of the Healthcare System NaHonal Level Regional Level Local Level Here Ministry of Health 5 Regions 98 MunicipaliHes
Where to go to if you get ill? Specialist Private Hospitals Patient Here General Prac==oner Hospitals Emergency ward Den=st
Financing Healthcare Collect direct taxes Block Grant Municipali=es OrganizaHon of the State Collect direct taxes Central Government Co- financing (20%) Here DRG registrahons on achvity for administrahve purposes and nahonal databases on quality of treatment Regions
All countries face the same healthcare challenges Healthcare challenges Demographics Life style New treatments Denmarks ini=a=ves Early detec=on of cri=cal diseases, popula=on health ini=a=ves and pa=ent empowerment Early detechon of diseases and immediate start of treatment NaHonwide screening Fast access to diagnoshcs PopulaHon health and prevenhon inihahves Primary healthcare clinics E- health, telehealth and pahent empowerment Ambient Assisted Living Personalized Medicine High quality and effec=ve hospital treatment High quality treatment Just- in- Hme coordinahon and logishcs More outpahent treatment 07.03.16
Danish ci:zens are happy with their lives and with healthcare services Danish Hospital produchvity PaHent sahsfachon Healthcare Expenditure Denmark ranking, Quality of life in Europe report 2012 Hospital Standardized Mortality RaHo (HSMR) 11
Ongoing work in the Ministry of Health The right to fast diagnose and treatment Maximum waihng of 30 days Cancer Strategy IV HolisHc and coherent approach to cancer treatment Targeted effort for the elderly medical pahents New achon plan. Focus among other on prevenhon, treatment and follow- up at home. AcHon plan for demenha Denmark as a demenha- friendly country. Individual tailored soluhons. Focus on relahves. Personalised Medicine NaHonal Telehealth by 2019
The Danish ehealth and Telehealth plan NaHonal EHR and E- health architecture InternaHonal standards HL7 ConHnua Health Allicance First fully regional telehealth implementahons Coordinated strategy: Ministry of Health Danish Regions Danish MunicipaliHes 07.03.16 13
The ehealth and telehealth strategy will align with the 2013 2020 Assisted Living strategy Full scale implementahon of proven soluhons Ceiling lijs Digital rehabilitahon Selected robot technology Full scale Smart Home implementahon Smart Home technology for disabled cihzens Coordinated strategy: Ministry of Health and PrevenHon Danish Regions Danish MunicipaliHes 07.03.16 14
16 new hospitals will be the backbone of pa:ent centric healthcare Public- private partnerships New innova=ons Danish design Green technology
Personalised Medicine will increase treatment efficiency and reduce adverse effects: 07.03.16 The Danish NaHonal Biobank offers 16+ mio. samples for research. 16
Agenda The Danish Healthcare strategy and inihahves NaHonal Health Data - background and status Big Data in Denmark today Future Big Data perspechves Big Data pre- requisites 07.03.16 17
A long term focus on health data networks and on e- health provide efficient access to healthcare informa:on Sundhed.dk E-health Portal 2003 - MedCom Health Data Network 1994 - Who is behind? Ministry of Health, Danish Regions, Ministry of Interior, National Association of Local Authorities, National Board of Health, Copenhagen Hospital Corporation, Danish Pharmaceutical Association
SERVICES FOR CITIZENS Access to personal health data on treatment E.g. e-record from hospitals and GPs and Shared Medication Card Communication with health care providers E.g. Contact information and e-services like booking, prescription renewals and electronic communication General information on health service E.g. quality in health care, patient rights Accurate and updated information on health, disease and treatment E.g. medical handbook Personal home care/hospital solutions E.g. diabetes and anticoagulant therapy Patient to patient dialogue
SERVICES FOR HEALTH CARE PROFESSIONALS Access to personal health data on patients E.g. e-record, laboratory data and Shared Medication Card Contact and service information on other health care providers General information on health service E.g. waiting lists, quality in health care, health and prevention programs, visitation Accurate and updated information on health, disease and treatment E.g. medical handbook, treatment feedback and benchmarking Personal home care/hospital solutions E.g. diabetes and anticoagulant therapy
EHR overview GP Medicine The na:onal EHR today (e- journal) Hospital EHR GP EHR Hospital episodes GP con- sulta=on Donor status GP EHR Lab results Referrals GP name GP Medicine Hospital episodes Specialists GP name and address Hospital EHR 07.03.16 21
Central user interface pa:ent overview:
Central user interface medica:on details
Data for the NaHonal E- health plamorm is delivered by the regional E- health soluhons e.g. the SystemaHc ehealth plamorm Columna is a full blown ehealth plaxorm consis=ng of The PaHent Record PaHent AdministraHon (ADT) Booking With Columna, Systema=c has developed an integrated ehealth plaxorm Order/Result MedicaHon Management LogisHcs Facts about Columna ü Columna is used in Central Denmark Region (Denmark s second largest region with 1.3 million cihzens) covering18 hospitals including University Hospitals ü 10,000 different users per day, 25,000 registred users ü 6.7 million cihzens are registered in Columna, of whom 1.2 million are pahents with registered data. ü RegistraHon of 2,400 admiped pahents and 5,500 outpahents per day. More than 25,000 medicahon prescriphons per day. ü ü 40,000 lab results per day. 6,500 per hour in peak.
The Na:onal Service PlaVorm
The National Service Platform and new services 2014: Na=onal Image Index Radiology Ultrasound Telehealth 2015- : Na=onal Telehealth Device data General (e.g. weight) DiagnosHc (e.g. ECG)
Government NaHonal Databases X 98 Municipal IT NaHonal Healthportal Healthcare Network ConHnua/XDS/HL7 EU systems NSP Master 3600 GP s 5 Regions
Agenda The Danish Healthcare strategy and inihahves NaHonal Health Data - background and status Big Data in Denmark today Future Big Data perspechves Big Data pre- requisites 07.03.16 28
The Shared Medica:on Record Specialist GP Ci=zen Hospital Energency Clinics Home Nurse Pharmacy
Type 2 diabetes distribu:on in municipatli:es
Medica:on compliance
ORDIPRAX example, seda:ves
ORDIPRAX example, cost curve
ORDIPRAX example, ATC distribu:on (cost)
Na:onal healthcare databases AdministraHve CiHzen Number Register (MPI) NaHonal PaHent Register DRG Register RehabilitaHon Register Drug Abuse Register Clinical Proff. AuthorizaHon Reg. Billing AuthorizaHon Register Research Cancer Register Diabetes Register Pathology Register Mental Research MedicaHon StaHsHcs Army Health Register 07.03.16 35
The Na:onal Pa:ent Register Diagnose related Diagnose Groups O.D./suicide Diagnose related Surgeries Radiology 07.03.16 36
Agenda The Danish Healthcare strategy and inihahves NaHonal Health Data - background and status Big Data in Denmark today Big Data in the future Big Data pre- requisites 07.03.16 37
Personalised Medicine A simple view The complexity of Personalised Medicine Both for diagnoshcs and for treatment Biomarkers and genehcs in use already Rapidly increasing number of new medicine from pharma companies More demand for Built to order substances RelaHons between different genehc findings and medicine IdenHfying and correchng new, individual genehc defects which occur over Hme Next of kind and relahves which can benefit from Personalised Medicine 07.03.16 38
Big Data in the future - and analy:cs Personalised Healthcare Wearable diagnos=cs IOT Personalised Medicine Clinical Genomics 07.03.16 Biobank 39
Social Media and Big Data? 07.03.16 40
Danish Center for Big Data Analytics driven Innovation DABAI The aim of the DABAI is: To develop general technics and methods within: Algorithms for data analysis, Machine learning and Interactive visual analysis. To deploy and verify the usability and potentials of Big Data Analysis within 3 application domains: Social data Food Supply Chain Education page 41 SSE/XXXXX/YYY/ZZZZ $Revision: xx.xx $ Alexandra institute Copenhagen University DTU Technical University of Denmark Aarhus University Systematic Participants: VISMA Consulting BusinessMinds Danish Business Authority Central Denmark Region Danish Agency for Digitisation COMMERCIAL IN CONFIDENCE
DABAI within the Social data area Use of Big Data analysis to gain more efficient and better patient flows within Healthcare page 42 SSE/XXXXX/YYY/ZZZZ $Revision: xx.xx $ Background: Patient flows related to complicated diagnosis and treatment of chronic diseases are to be treated across multiple specialties and departments and cause coordination issues for healthcare providers. Approx. 75% of the total healthcare budget is spend on treatment of chronic diseases. Objective: To support enterprise wide optimization of the entire patient pathway. COMMERCIAL IN CONFIDENCE Municipality Hospital A Patient flow B C... Specialists Figure 1 - Generic model of a healthcare system with patient flow and care providers interacting and consuming services. The arrows between the patient flow and the care providers illustrates that the patient flow is influenced by and depended on the providers and their interactions To provide enterprise-wide real-time cockpit of information and insight on both current capacity and the status of active pathways at a hospital. Deployed Analytic tools: The tree research themes (Analysis algorithms, Machine Learning and Visual Analytics) with the focus of: Real-time analysis of inefficiency of patient pathways Identification and prediction of unforeseen bottlenecks and delays that eventually prolongs the pathway Providing evidence based and enterprise wide optimization GP
Agenda The Danish Healthcare strategy and inihahves NaHonal Health Data - background and status Big Data in Denmark today Big Data in the future Big Data pre- requisites 07.03.16 43
Some pre- requisites for the future Big Data vision ClassificaHons e.g. from symptom ICD10 to profile diagnose classificahon StandardizaHon: HL7 CDA XDF PHMR Strong program algorithms for analysis Ethical challenges Data security 07.03.16 44
Hans Erik Henriksen, CEO Healthcare DENMARK heh@healthcaredenmark.dk 07.03.16 45