MC-S238 . 21 May 2014

MedComThe Danish Health Data Network

1994-2014

Years

”MedCom plays an important role in the

creation of a connectedhealthcare system inDenmark. MedCom is

congratulated, and rightly so, with the anniversary and

the good results the organisation hasachieved since it was

founded 20 years ago.”Nick Hækkerup

Minister for Prevention and Health

2 MedCom

The Minister congratulates MedCom

21 May 2014

1994–2014 3

Published on the occasion of MedCom’s 20 year anniversary 21 May 2014

MedCom . Forskerparken 10 . DK-5230 Odense M . Denmark Phone +45 6543 2030 . Fax +45 6543 2050 . E-mail: medcom@medcom.dk

www.medcom.dk

Text: Kim Jørstad/Tekstsnedkeriet . Layout: Christen Tofte Grafisk Tegnestue Illustrations: Mogens Jensen, Christen Tofte . Translation into English: Mie Hjorth Matthiesen

Years

Preface

Thank you for “Tour de IT”

20 years is a very long time in the IT world. It is a longlife for an IT organisation

and it is an extremely long periodwithin the world of technology. Therefore, it is not without pride thatwe, at our 20 year anniversary, canestablish that we are still here andthat drive and devotion is still aliveand well. Even more, we are proud tosay: We did it!!!

We took on a huge challenge in thebeginning of the 90s when we started realising the vision of a con-nected health data network whereall actors in the Danish healthcare system could exchange the most im-portant messages. Thousands of messages every hour, all year round.It could be compared to our own version of Tour de France in theshape of an IT project of fear-provoking dimensions. As in the realTour de France, we predicted a lot ofsteep mountain climbs and tough trials. Not a lot of days freewheelingand not a lot of tail wind. Naturally,

4 MedCom

Statusrapport, MedCom 5

MC-S211 / December 2007

På tærsklen til en ny tids sundheds-it

MC-S000 December 2009

MedCom15 årStatusrapport MedCom 6

MC-S217 December 2009

samarbejde

internet

service

dialog

effektivitet

strategi

sikkerheditVANS

15år

edbudvikling

patientensundhedkommunikation

borgeren

information

digitalisering

fremtidensammenhæng

MC-S232 / December 2011

MedComs syvende projektperiode har især fokuseret på øgetanvendelse af løsninger til kommunikation af meddelelser påkommune-, sygehus- og lægepraksisområdet, til webservice-kommunikation af Fælles Medicinkort og til tværsektoriel internetadgang til sygehusjournaler i E-Journal. Derudover har MedCom afprøvet nye kommunikationsmåderpå telemedicinområdet og i internationale projekter.

MedCom7

Projektstatus

2010-2011Udbredelse og teknologisk fremtidssikring2012–2013

MC-S233 . Marts 2012

MedCom8

Center for

Sundheds-telematikHeden 18 DK-5000 Odense CTelefon 6613 3066 Fax 6613 5066

Sundhedsministeriet Holbergsgade 6 DK-1057 København KTelefon 3392 3360 Fax 3393 1563

● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●●

●●

●●

●●

●●

●●

●●

●●

●●

●

●

Et dansk sundhedsdatanet på to år

Sundhedsministeriet Sundhedsstyrelsen

Amtsrådsforeningen Hovedstadens

SygehusfællesskabDen Almindelige

Danske Lægeforening Danmarks

Apotekerforening KommunedataTele Danmark

MedCom- det danske sundhedsdatanet

Marts 1998

MedCom-det danske sundhedsdatanet

frem mod år 2000

MC-S86

MedCom-det danske sundhedsdatanet

frem mod år 2000Sundhedsministeriet ● Socialministeriet ● Sundhedsstyrelsen ● AmtsrådsforeningenKommunernes Landsforening ● Hovedstadens Sygehusfællesskab ● Københavns og Frederiksberg Kommuner ● Danmarks Apotekerforening ● Dansk Tandlægeforening

Den Almindelige Danske Lægeforening ● Kommunedata ● Tele Danmark

MC-S112 / December 1999 MedCom-det danske sundhedsdatanet

Sundhedsministeriet ● Socialministeriet ● Sundhedsstyrelsen ● AmtsrådsforeningenKommunernes Landsforening ● Hovedstadens Sygehusfællesskab ● Københavns og Frederiksberg Kommuner ● Danmarks Apotekerforening ● Dansk Tandlægeforening Den Almindelige Danske Lægeforening ● Kommunedata ● Tele Danmark ● Dan Net

MedCom2

på trykMedCom2

på tryk

MedCom IV Status, planer og projekter

MedCom – det danske sundhedsdatanet / Oktober 2003 / MC-S175

● Internetstrategi ● Kommunerne og sundhedskommunikationen● Sygehusene og sundhedskommunikationen ● Internationale aktiviteter

Klinisk service

ca. 40%

Andre sygehuse

ca. 10%

Øvrig service

ca. 13%

Administration

ca. 4%

Primær- sektor

ca. 13%Læge-praksis

Pleje-hjem

Hjemme-pleje

Special-læger

Andrekliniskebehandlings-afdelinger

EPJca. 23%

Kliniskbehandlings-afdeling

SYGEHUS

MedCom IV Status, planer og projekter

KPLL

KommuneAmt

Sundheds-portal

Sundheds-DIX

Dan Net

KMDnet

Læge-system

Apoteks-net

Internet

MedCom’s project periods are regularly documented – and not just digitally.

we also hoped for days with smalland big wins to keep our spirits up.And we hoped for a helping handalong the way in the shape of users,healthcare professionals and vendorswho could, hopefully, see the bene-fits of the project and the creation ofthe health data network.

Most of the dream came through. As expected, Tour de IT met massivechallenges along the way. However, itwas also a journey with small and bigwins that showed us that we were onthe right track and it gave both MedCom and our partners the will tokeep on fighting.

Our many partners have been a keyto our success. Passionate peoplearound the country have done muchof the hard work when it comes tomotivating colleagues or definingproper solutions. Not only in the ITworld but also in the general practice, at the hospitals and in themunicipalities.

Preface

1994–2014 5

The essence of the health data net-work lies in the collaboration between the partners. This is the secret behind the success. We have awell-functioning network which thewhole healthcare sector has em-braced and which leaves the rest ofEurope and the world speechless.

Have we reached our goals then?Compared to our goals and expecta-tions 20 years ago, we have reachedbeyond our goals. In many aspects,the health data network anno 2014exceeds our initial expectations. Still,in this world of health IT, it would bearrogant to claim that our work isdone.

20 years ago it was impossible to pre-dict where we would end up. Today,our crystal ball cannot tell us wherewe will be in 20 years and what the

5,500,000

5,000,000

4,500,000

4,000,000

3,500,000

3,000,000

2,500,000

2,000,000

1,500,000

1,000,000

500,000

Year 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13

Danish health data network will looklike. So for now, we just establishthat we are off to a great startthanks to a lot of hardworking spiritswithin and outside MedCom.

Henrik Bjerregaard JensenCEO

Since 1994, the number of messagesbased on MedCom standards has increased significantly. The graphshows the total number of messagesin average per month.

MedCom for 20 years

ADanish ITsuccess of international proportions

6 MedCom

In the past 20 years, Denmark has seen a significant roll-out of IT services within the whole healthcare sector with the hospitals,

general practitioners and municipalities leading the way.The daily life of healthcare professionals has changed, millions of Danish kroner have been saved and patients have better insight,

more quality and efficiency. All of this has happened quietly withoutthe scandals which often go along large IT projects.

The first ideas to use information tech-nology for communication within thehealthcare sector started around 20

years ago. The first step was to exchangeprescriptions between a general practitio-ner on Amager and the local pharmacy. Thesuccess of the experiment inspired others.The County of Funen, which it was called atthe time, liked the idea and had great ambitions.

IT had long been introduced at many work-places together with emails and the use ofthe internet. Why not use information tech-nology within the healthcare sector as well?Attention was directed towards the largenumber of messages which flow betweengeneral practitioners, hospitals and pharma-cies. Apart from prescriptions, focus was onreferrals from the general practitioner tothe hospitals and on discharge letters fromhospitals to the general practitioner. Thecounty could have flown solo of course. However, ambitions were bigger alreadyback then. In the long term, a national solu-tion was the goal.

The idea which was born in the County ofFunen surfaced at the same time as a group

of enthusiastic users of IT in the healthcaresector gathered to develop some of theground pillars which enable digital com-munication today. The ground pillars wereand are today a number of standards forkey messages which led the way for digitalcommunication to be rolled out followingthe same recipe all over the country.

Significant digital progresses

Today, 20 years later, even the wildest visions for the healthcare sector from backthen have been realised. A long range ofthe most common messages are now digita-lised and mountains of paper forms are nolonger necessary. These messages include,for example, prescriptions, discharge lettersfrom the hospitals, referrals from generalpractitioners to hospitals, admission messa-ges and discharge letters from hospitals tomunicipalities.

At the same time, information technology isused in areas one could only dream of backin the beginning of the 90s. In hospitals,video conferences are used for translationand the community nurse is able to look up,for example, specialist knowledge aboutulcer treatment via telemedicine solutions.

Another significant advance worth noting isthat health professionals all over the coun-try are able, at any time, to look up onlineinformation about the patient they are

MedCom for 20 years

1994–2014 7

treating, information like medicine, pre-vious treatments etc. The patients are alsoincluded. Via the e-health portal, Sund-hed.dk, which was established in 2003, allcitizens have access to health record infor-mation from their general practitioner andvisits to hospitals.

A special attention has been given to thehealth data network which continuouslyadds more types of users. Involvement ofthe municipalities was a natural step as theyhave a significant role in the healthcare sector. The role of the municipalities wasstrengthened when the structual reformwas implemented in 2007. An obvious stepwas to implement standards for messagesabout admissions and discharges betweenhospitals and municipal home care servicesfor citizens who need care at home.

Physiotherapists and medical specialists arealso using the health data network. Referrals from the general practitioner tospecialists are delivered as an IT message toa kind of “message hotel” where the specialist can collect the referral when thepatient contacts them.

From letters to ICT

An added bonus when using informationtechnology is that some procedures, likemeasuring blood pressure for example, canbe done by the patient at home. Similarly,

consultations between doctor and patientcan be done over a distance. This possibilityis especially relevant when distance, tosmaller islands for example, makes it diffi-cult and time consuming for the patient tovisit the doctor.

This communication is extremely efficient. Iteradicates manual working procedures andpostal inconveniences and following the digitalised communication, organisationsoften make adjustments that will result ineven bigger gains and savings.

Furthermore, because of the standardisedmessages the users, doctors and others, areforced to send all required information.They do it via their IT system, and therefore,previous problems with reading incompre-hensible handwriting are history. This way,many errors are undoubtedly avoided, forexample in situations where the doctorsends a requisition for a lab test and re-ceives the result afterwards.

The messages are automatically integratedinto the IT systems of the receiver. Whenthe general practitioner sends a requisitionfor a lab test with the correct information,the information is automatically integratedinto the IT system of the lab.

Whereas communication systems used tofocus on exchange of information betweenthe different actors within the healthcaresector, the solution is now to enable a search for relevant information via the health data network – similar to the wayyou search the internet. An example is theShared Medication Record, which enableshealthcare professionals to search for a patient’s current medication etc.

A digital success

Along with the digitalisation, working pro-cedures within most of the healthcare sector have changed. Administrative proce-dures for general practitioners have becomemore efficient and the doctor and his or herstaff can focus on better patient care. Com-pared to other countries, the spread of IT at

HenvisningshotelletREFHOST

En brugervejledning til praktiserende læger, speciallæger, fysioterapeuter og psykologer

MC-S214 / APRIL 2008

Henvisningshotellet REFHOST

En brugervejledning til praktiserende læger og fodterapeuter

MC-S226 / APRIL 2011

Henvisningshotellet REFHOST

En brugervejledning til praktiserende læger og kiropraktorer

MC-S227 / AUGUST 2011

Faglig Guidetil de fire nye hjemmepleje-sygehus standarder.

MC-S231 / REVIDERET UDGAVE JUNI 2013

Indlæggelsesrapport XDIS16

Plejeforløbsplan XDIS21

Melding om færdigbehandling XDIS19

Udskrivningsrapport XDIS18

MedCom for 20 years

8 MedCom

general practitioners’ office today definitelyleaves Denmark at first place.

Several factors are keys to the success of thisgigantic IT project. First of all, the startingpoint was of great importance. When theidea of the use of IT in the healthcare sectorwas born, without even imagining where itwould lead, the reality was that no suitablesoftware products were available on themarket.

What do you do in this situation? You usethe drive which exists within the devotedforces who are able to express their require-ments and wishes for a solution. Luckily, agroup of engaged general practitioners andhospital staff willingly put a lot of workinto the quest. The so-called EDI team was

created. At the other side of the table youhad the IT experts who knew how to de-velop the solutions requested by the users.Often, these experts worked for the IT system vendors. More than 60 vendors par-ticipated. Consequently, alone the coordina-tion of the development and implementa-tion of IT solutions was a huge challenge.

MedCom was established in 1994 as a pro-ject organisation in order to coordinate thiswork. MedCom was the voice of the users inthe collaboration with the IT specialists andwas to implement the solutions which weredeveloped.

MedCom worked closely together with thecounties and later the regions as well as themunicipalities to convince people thatenergy and effort should be invested in im-plementing IT solutions. MedCom was inthe lucky position that the definition of theIT need and approval of the solutions wasgrown in the users’ own backyards, as itwere. It was a bottom-up implementationof IT communication. The users might nothave created the solutions but they had defined the needs and approved the end results.

A joint initiative

Another explanation of the success of thehealth data network is probably that therewas no idea of how far this could go fromthe beginning. In other words, the startingpoint was not an ambitious and long-termproject. Instead, focus has been on small advances – or small victories – and throughopenness towards the necessity for inclu-ding new technological and need basedpossibilities once they present themselves.Telemedicine solutions are examples of this.

Video interpreting and ulcer assessmentwere spearhead projects within telemedi-cine. In the 90s, it was unimaginable thatthese solutions would be part of the healthdata network. However, MedCom was ableand willing to take on the challenge to de-velop, test and implement these solutions.

Since it’s foundation, MedCom’s rolehas been to:

“contribute to the development, testing, dissemination and quality assurance of electronic communicationand information in the healthcare sector in order to support excellentcontinuity of care.”

With the regional financial agreementfor 2011, MedCom’s profile was en-hanced. The text states that:

“MedCom is continued based on thepolitically established goals and mile-stones concerning cross-sector com-munication and with a particular roleas executing organisation”.

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MedCom for 20 years

1994–2014 9

Simultaneous with this work, the area ofICT progressed tremendously. The internethas become a natural part of people’s life.Video communication is a reality and mostpeople are comfortable with online commu-nication. This development has probablyhelped MedCom in deploying IT solutionsbecause there has been a general under-standing that of course the health care sec-tor should be able to take advantage of thenew technological advances.

Dessimination of solutions which improveefficiency, service levels and quality forusers in the healthcare sector have receivedpolitical appreciation and support. Politicaldecisions that national solutions should bedeveloped within this field to enable seam-less communication between the differentparts of the country, naturally has madeMedCom’s work with deploying these solu-tions easier.

International attention

From being a two-year based project orga-nisation, MedCom became a permanent organisation in 1999. This of course in thelight of that MedCom had proved its worth.

MedCom’s work also has an internationaldimension. Early on, it was clear that collaboration with international partnerswould benefit all partners in the work to-wards better IT solutions within the health-care sector. Over the years, Denmark andMedCom have been very active on the

international scene and has strongly con-tributed to the success of numerous inter-national projects. Inspiration and know-ledge sharing has naturally also benefitedthe Danish development of IT solutions.

MedCom has received great internationalrecognition, also from the European Com-mission. An honour which should be sharedwith the hundreds of enthusiastic enthusi-asts from the regions, municipalities, GPsand IT vendors who have been an essentialand integrated part of the MedCom co-operation through the years.

The distinguished state of the health datanetwork today has almost gone unnoticed.The media has found no interest in the net-work, perhaps this is due to the fact thatbad investments and scandals have beenavoided long the way. In that sense, the Danish society has, in a period of 20 years,created a unique IT success.

MedCom is a national cross-public project organization that is involved

in the development, testing, distributionand quality assurance of electronic communication and information in

the healthcare sector.

The Danish Health Data Network

Hospital

GP

Citizen

LaboratoryPharmacy

Physio-therapist

Municipality

X-ray

Chiropractor

Dentist

Psychologist

eHealth Portal

“Denmark leads the way in digital care.”

The New YorkTimes

“Denmark’s Electronic Health Records Program is a Lesson for the U.S.”

Time.com

“Denmark,Finland,and Sweden show the trans-formations possible in healthcare today throughthe greateruse of IT.”

Health IT, The Information Technology and Innovation Foundation

Nothing to sell orbuy–we just tellyou the good story!

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/NIM

The Danish Health DataNetworkyear by year

1990–2014

10 MedCom

Pioneers lay the first tracksThe SEDI group – the EDI group of the National Board of Health

starts coordinating projects and standards for the most importantmessages – discharge summaries, lab reports and prescriptions.

Electronic prescription from the general practitioner to the pharmacy

The Amager project tests the electronic prescription. Today, all

pharmacies and doctors use electro-nic prescriptions.

MedCom – the Danish Health Data Network

The County of Funen suggests toestablish a nationwide project

with the purpose of developing andimplementing standards for commu-nication between GP’s and hospitals.

The majority approvesMore than 60% of the GPs has implemented electronic medical

records in general practitioners’ offices. Consequently, their normalpractice has changed completely.However, the systems cannot inter-communicate.

Working together to create the firststandards

In the first MedCom project, 37vendors of hospital systems and

systems for general practitioners participate in the development ofEDI standards for the most important messages.

During MedCom 2, the municipalities take their first stepsinto cyberspace

Several municipalities initiatepilot projects within basis com-

munication with doctors, pharma-cies and hospitals. The first tele-medicine projects are initiated.

Pioneers test the idea of cross regional cooperation

Two counties in Jutland started aSUP project with the purpose of

enabling communication betweenhospital departments’ electronic health records and establishing onecommon database in which the health information could be searched and retrieved.

Communication about the goodmessages

The “Good EDI letter” wasdefined by MedCom.

Around 60 vendors were involved inthe work.

Citizens’ access to their own prescriptions

The Danish Health and Medicines Authority set up the

prescription server where all pre-scriptions are stored. This way, all citizens have access to their ownprescription data and pharmacieshave access to information aboutmedication dispensed at other pharmacies.

sundhed.dk – the Danish e-HealthPortal

Suggestion to creating a com-mon public internet portal for

health data. The internet based health data network is launched.

2000

1997

1994

1992

1992

1990

1990

2003

2000-01

2003

1990–2014

1994–2014 11

MedCom takes over the responsibility to deploy access tohealth record data

MedCom becomes project manager for the e-Journal

project which supports the refine-ment and dissemination of the useof the health record database.

EDI becomes XMLXML-standards are developed as a supplement to the old EDI

standards.

NSI – the National Board of e-Health The national coordination of e-health is strengthened with the

birth of the organisation Digital Health in Denmark which changesname to the National Board of e-Health after three years. NSI is re-sponsible for national strategy andcoordination.

Wider access to journal data for citizens

Under the e-journal project, citi-zens in one county and the GPs

in the whole country get access to journal data using digital signaturevia Sundhed.dk

The first healthcare agreementsfocus on e-communication

The counties are dissolved andmunicipalities signed a health-

care agreement with the new regions about cross sector communi-cation for admissions, discharges and rehabilitation.

Telemedicine is deployed nationwide

The dissemination of video inter-pretation is initiated by the

Danish Agency for Digitalisation asthe first telemedicine implementa-tion project. At the same time, across-sectorial national video infra-structure is established.

RSI – Danish Regions Health IT Danish Regions strengthen theircoordination and adopt 15 indi-

cators which all regions must worktowards.

European recordClose to a 100% of theGPs has ITsystems which can exchange in-

formation with the other parts ofthe healthcare sector. IT is part ofmost of the general practitioners’workflows. An EU study of the useof IT in the GP offices places Den-mark at first place.

Communication is constantly deployed and expanded

The municipalities are importantactors on the health data net-

work when it comes to communica-tion with hospitals, pharmacies andthe GPs. Communication includesareas of prevention, rehabilitation,home care as well as the paediatricarea. Henceforward, communica-tion will be extended to cover thepsychiatric and social area as well,and a new generation of healthcareagreements are on their way.

TelemedicineThe national action plan for extensive deployment of tele-

medicine focuses on video con-ferencing, image sharing and homemonitoring.

The Shared Medication RecordThe vision of online access to patients’ current medicine record

is currently being implemented.Within the next couple of years, allGPs, hospitals and municipalitieswill use the same shared medicationrecord.

Ready for test and certificationMedCom is ready with test andcertification tools which are used

by vendors, also as self-service. Newstandards are underway in the formof HL7-IHE profiles.

2007

2004

2005

2007

2014

2014

2011

2010

2009 2014

2006

2014

In the consolidation project, documentation in the form of ”the Good EDI letter” for all used messages have been created.The documentation which is available on paper, on CD and onwww.medcom.dk includes:

00 Syntax and communication rules 01 The Good discharge letter02 The Good correspondence03 The Good referral04 The Good KKA/KIA lab report05 The Good pathology report06 The Good microbiology report07 The Good KKA/KIA lab requisition08 The Good microbiology requisition09 The Good pathology requisition10 The Good analysis register11 The Good the good health insurance

reimbursement claim 12 The Good municipality notification note14 The Good municipality reports15 The Good prescription16 The Good CONTRL17 The Good physiotherapy referral18 The Good podiatry referral

Test guidesTest protocol for MEDREQ, MEDREF, MEDRUC Test examplesCorrections

Standards

The history of

the ground pillars of theHealth Data Network

12 MedCom

Communication aboutthe good messages

The Good EDImessage was

defined by MedCom. About 60vendors were involved in thework.

2000-01

Collaboration on the first standards

About 37 vendors of hospital systemsand systems for the GP offices were in-

volved in the development of EDI standards for themost important messages.

1994

Ready for test and certification

MedCom is ready with test andcertification tools which are

used by suppliers, also as self-service. New standards are underway in the form of HL7-IHE profiles.

GOD

KENDT

AP P R OVED

MedCom®

EDI becomes XML

XML standardsare being de-

veloped as a supplement to the old EDI standards.

2005

2014

In order to support the IT suppliers’ work on XML-EDIFACTconversion, MedCom has developed a web based con-verter which is available viawww.medcom.dk or directly viathe address http://web.health-telematics.dk/xmledi

Discharge summaries and lab reports

Two cornerstones in the foundation of the Health Data Network

Commendable results

MedCom receives the Danish and European e-health prize. A big part of the explanation is

found in the successful deployment of discharge summa-ries and lab reports.

2007

Focus on deployment

The standards are devel-oped and in MedCom 2

the standards are disseminated. Discharge letters and lab reportsbecome electronic all over thecounty as a result of more than 200sub-projects with focus on these types of messages in thecounties.

1997

Development of standardsfor the most importantmessages

MedCom is founded as atwo-year project with focus

on development of standards for themost frequently used messages bet-ween GPs and hospitals, namely dis-charge letters and lab reports.

1994

Implementation of modern e-health solutionsis an important part of thedigitalisation of the wholepublic sector. As a token ofappreciation, MedCom wasawarded the Danish Digitalisation Prize 2007.The prize is found to promote IT projects and visions which are of valueto citizens and the com-munity.

Photo: Torben Nielsen

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90 91 92 93 94 95 96 97 98

300

250

200

150

100

50

0

More than 1000 actorsi the health care sector:

800 GPs274 pharmacies50 hospitals

Prescriptions

Lab results

Discharge lettes

296.456

84.134

40.519

Discharge summaries and lab results

1994–2014 13

Almen praksis 2012. Sammenlignings-index efter land og sundhedssystem.Offentligt sundhedssystemForsikringsbaseret sundhedssystemOvergangsordning mellem de 2 systemer

De stiplede linjer viser gennemsnittet i hver gruppe.

Kilde:European Commission & OECD: Benchmarking Information and Communication Technologies in Health Systems, 2013.

NB. Diagrammerne medtager – ud over de 27 EU-lande –også Norge, Island og Tyrkiet.

DenmarkNorwayEstonia

NetherlandsSpain

United KingdomFinlandSweden

ItalyIcelandFrance

PortugalCzech Republic

IrelandGermanyHungary

TurkeyAustria

BelgiumCroatia

RomaniaCyprus

LuxembourgBulgaria

GreeceSlovenia

PolandLatvia

SlovakiaMalta

0 0,25 0,50 0,75 1,00 1,25 1,50 1,75 2,00 2,25 2,50 2,75 3,00

General practitioners

IThas changed the everyday practice in the GPoffice

Tentative beginnings Prescriptions are exchanged asthe first electronic message.

World record

100% of the GPs has IT, and IT is part of almost all daily practices and processesof the general practitioner. An international study places Denmark at first place.

2011

The majority approves

More than 60% of the GPs has im-plemented IT and, consequently, the

daily practice in the GP offices has changedcompletely. Work processes are made more efficient. 120 forms have been reduced to ahandful of electronic forms for example.

1993

Local EDI projects

Lab reports, discharge letters, reimbursement claims, x-ray reports and prescriptions are sent electronically in local EDI projects, KPLL – Odder – Fyncom.

1992

1990

Enthusiasts lay down the first tracks

The SEDI group – the coordination group of theNational Board of Health, a group of enthusiasts

from the primary and secondary sector, starts developing national standards for the most important messages –discharge summaries, lab reports and prescriptions.

1991

14 MedCom

The Municipalities

Communication is disseminated and is continuously expanded

All municipalities have electronic communicationwithin several social and healthcare areas.

Communication includes areas of prevention, rehabilitation,home care as well as the paediatric area. Currently, com-munication are being extended to cover the psychiatric andsocial areas as well, and a new generation of health agree-ments are on their way.

2014

The first healthcareagreements focus one-communication

The counties aredissolved and

municipalities signed a health-care agreement with the regions about cross regionalcommunication for admissions,discharges and rehabilitation.

2007

The municipalities take theirfirst steps into cyberspace

Several municipalities initiatepilot projects about basic

communication with hospitals as well ascorrespondence and renewal of prescrip-tions with GPs and pharmacies.

1997

In October 2007, 65 municipalities usedelectronic communication: The North

Denmark Region: 7 municipalities,The Central Denmark

Region: 7 municipalities,Region Zealand: 9 municipalities, Region

of Southern Denmark:18 municipalities and Capital Region: 24 municipalities.

Naturally, the municipali-ties are also joining

1994–2014 15

Photo: Bengt Olof Olsson/Billedhuset

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2013 20142014

ersoner

Health records are shared knowledge

Access to data for the GPs and citizens

The project changes name toe-Journal and citizens in one

county and the GPs in the whole countryare granted access to health record datavia Sundhed.dk using digital signature.

Two common national data-bases, the e- and p-journalwith data from health recordsfrom the public hospitals andthe general practices respec-tively are a reality today.

Clinicians and citizens haveaccess to all this information.E- and p-journal are part ofthe Sundhedsjournalen (health journal) which, among other things, also contains data from lab data-bases and the Shared Medication Record.

2007

MedCom enters the scene

MedCom becomesproject manager

for the further developmentand deployment of the use ofthe database with health record data.

2004

Pioneers test the good idea

Three counties in Jutland starteda project with the purpose of

enabling communication between hospitaldepartments’ electronic health records andestablishing one common database in whichthe health record information could be searched for and retrieved.

2000

A very large proportion of the paper records at the hospitals consisted of lab reports, lab requisitions, referrals, dischargeletters, reports and correspondence withother departments, other hospitals and theprimary sector.

LÆS MED I DIN UDVIDEDE JOURNAL

Du skal kun bruge en computer og NemID.

Du kan læse med i alle journalnotater fra din kontakt med offentlige sygehuse.

Du kan også læse med i de udvalgte data (undtagen journalnotater) fra din egen

læge og praktiserende speciallæge.

Dig

e-journal

Sender data og journalnotater

Kan læse med

Kan læse medSender udvalgte data

Læs med efter 14 dage

Sygehus

Egen læge/Praktiserende speciallæge

journae--j

journal

Du har direkte

adgang til

din patients

E-Journal

Hvilke kliniske informationer og data er der på

din patient på andre sygehuse i Danmark?

Brug genvejen i dit journalsystem til at tilgå

patientens E-Journal.

Skaber sammenhæng i informationerne

mellem sygehusene i Danmark

A5kort-Syg

ehuslæge

28/11/11

15:48 Sid

e 1

Du har direkte adgang til din patients E-Journal

Hvilke kliniske informationer og data er der på din patient fra sygehuse i Danmark? Brug genvejen i dit læge-system for at gå direkte til patientens E-Journal på sundhed.dk

Skaber sammenhæng i klinisk information på tværs af sektorer i Danmark

– den åbne dør til sundhedsvæsenet

The e-Journal

16 MedCom

1994–2014 17

The Shared Medication Record

Online informationabout medicine

A future with access to a shared and complete overview of citizens’ current medication

The Shared Medication Record

Online access to patients’ current medication is now being implemented.

Within the next couple of years, all GPs, hospitalsand municipalities will use the same shared medication record.

2014

Citizens’ access to own prescriptions

The Danish Health and MedicinesAuthority sets up the prescription

server where all prescriptions are stored. Thisway, all citizens have access to their own prescription data and pharmacies have accessto information about medication dispensed atother pharmacies.

2006

Electronic prescription from the general practitioner to the pharmacy

The Amager project tested the electronicprescription. MedCom was in charge of the

dissemination. Today, all pharmacies and doctors useelectronic prescriptions.

1991

Fælles MedicinkortEn fremtid med adgang til et fælles og samlet overblik over borgernes aktuelle medicinering

November 2011

Layout 1 03/11/11 11:57 Side 1

�Så kører

Fælles Medicinkort...

– nu også i

kommunerne

2014/2015

Time for Face-time!!!After 16 years of preparations, the Danish healthcare sector is

ready for telemedicine cooperation via video conference, exchangeof images and collection of data from the home of the citizen.

18 MedCom

Telemedicine

Action plan for national use

The government, Danish Regions and Local Government Denmark implement the tele-

medicine visions in a shared action plan which highlights five concrete telemedicine concepts which, through clinicaluse, will mature enough to be deployed on a national scale.

We face a whole new generation of digital health communicationwhich directly involves thepatient in the cooperationbetween the different actors within the health-care system. The national strategy for digitalisation of the healthcare sector from 2013 makes tele-medicine a main-stream approach withinthe whole public sector.

2012

From local to nationalWith the funding from the Danish Agency for Digitalisation,

interpretation via video conferencing willbe the first telemedicine concept which willgo from local project to nationwide scale upwithin all hospitals.

2009

Possibilities are endless.You only have to use them

The Ministry of Health conducted a survey which

concluded that the potential for tele-medicine solutions is enormous. However, we have a long way to go.

Today, MedComplays a central role as anexecuting organization in

relation to national dissemina-tion of cross-sector telemedicine

solutions, including securing the technical infrastructure

supporting – amongst others –video conferencing and

data collection in the citizen’s home.

Doctor

?

Inter-preter Patient

2001

The first step into the futureBy the end of the 90s, MedCom started the first national projects on imagetransmission. Focus was on dermatology, radiology and pathology. Through

the 00s, video conferencing between different parts of the health care sector gave the first technical experiences and, in the beginning, home monitoring of COPD patients was tested ininternational projects.

90’erne

Foto

: Yilm

az P

ola

t/Fy

ens

Stif

tsti

den

de

The Future

1994–2014 19

“MedCom is continued based on the politically established goals and milestones

concerning cross-sector

communication and with a particular

role as executing organisation.”

The regional financial agreement for 2011

sundhed.dk

Hospital

GP

Citizen

LaboratoryPharmacy

Physio-therapist

Municipality

X-ray

Chiropractor

Dentist

Psychologist