Implementation of eHealth

Interoperability.

Perspectives of a Member State

Denmark

Niels Rossing, M.D.

MedCom

www.nr@medcom.dk

Denmark

•5.45 mil. Citizens

•Area: 43.000 km²

•Highest point:171 m!

•High Broadband

Penetration (35%)

•Extensive access to

internet

•Unique personal

identifier

•SW based PKI

5 Regions: Health Care

98 Municipalities: Home

care

-60 Public hospitals

-Small private hospitals

- 2000 GP clinics

- 1100 Specialists

- 330 Pharmacies

Largely Tax paid

Co-payment for Dentistry and medicines

eHealth movers in Denmark

• High Connectivity

• Uniform healthcare provision

• Fairly simple insurance system

• 15 years of development and implementation

• Market driven approach

Challenges

• Shortage of Skilled Human Resources

• Combat against Patients’ Waiting Lists

• Investm’t Plans but no Change of Mind Set

• And on the IT side:

• Interoperability, scalability, modularity and

compatibility

Major Services

• We have:• - National Hosp. Pat. Regist. (1977)

• - MedCom (1994)

• - Telemedicine (2000)

• - National Health Portal (2002)

• - Nat. Prescr and Disp Rec (PMP)(2004)

• - National eRecord (2006)

• We plan hopefully epSOS compatible

• - Improved Medication Record

• - Nat. Patient Index and Summary

International reports

• “Our analysis of available English-language literature and data indicate that three developed countries—Denmark, Finland, and Sweden—are definitively aheadof the United States and most other countries in moving forward with their health IT systems. These three Nordic countries have nearly universal usage of EHRs among primary care providers, high rates of adoption of EHRs in hospitals, widespread use of health IT applications, including the ability to order tests and prescribe medicine electronically, advanced telehealth programs, and portals that provide online access to health information.”

Hospital

EPR

PAS

LABRAD

EPR

HCR

Clinical

Service

Treatment

Primary Care

100%

50%

IT use among GPs (empirica)

december 2009 Medcom15 8

Connected Health

Public

authorities

Industry

Hospital

Practising

doctors

Internet-

based

Network

Home

care

Pharmacies

Interoperability at National Level

• - 12 Hospital PAS/EPR vendors

• - 12 Primary EPR vendors

• - 11 Laboratory vendors

• - 8 X-ray vendors

• - 5 Specialist EPR vendors

• - 4 Pharmacy vendors

60 IT vendors with 100 IT systems that communicate nationwide across sectors

The Health Portal

National and RegionalDen fælles offentlige sundhedsportal

Side33

4c. Portal i portalen – ubegrænset struktur og indhold

Access for Citizens

Medication Profile

Consent

• Patients consent is needed whenever

confidential information is shared with other

health care professionals

• Patients written consent is needed to disclose

information to people and institutions outside

health care

Access for Professionals

eRecord

The Health Data Network

Secure Health Data Network

• Connecting existing secure networks with Virtual Private Network (VPN) to a central node.

• Using existing internet connections and not disrupt the EDIFACT communication

• The “central node” adjusted to the existing network – reuse of network structure and equipment

• A central connection agreement system that takes care of the control of the connections between the participants.

The Danish Domain of Trust

• Three level of ”access” on the Danish Health Data

Network:

1. VPN network:

Everyone gets access to nothing!

2. The Connection Agreement System:

Select IP addresses get access to select services (IP

addresses)

3. User control:

Chosen users get access to select services and there is

a manual and local user control.

Efficiency of Infrastructure

• Today, more than 70 organisations within healthcare is connected to the IP-based Health Data network:

• All hospitals

• All pharmacies

• All GPs

• All municipalities (homecare, preschool care)

• A large number of private hospitals and IT vendors

• Today there are more than 1600 agreements in the system -each one replacing a point to point VPN connection

• Interoperable secure connections to Norway, Sweden and two Baltic hospitals through the Baltic eHealth project.

• Backbone for the national eHealth portal for citizens Sundhed.dk

Over 5 million messages/month

Danish Lessons over 15 years

• Start with the basic needs

• Make consensus projects Get Users, IT industry and health authorities unite!

• Profiles are necessaryOff-the-shelf products

All-to-all communication

• Dissemination projects neccessecary

• Keep it simple, stupid!

• Keep going: Steady pursuit of goals, patience,political will,financing and championship

• Driven by demands and not by technology

The EU Interoperability

Recommendation, 2008

Goal: Full interoperability by 2015

• Agreement of principles of cooperation

• Enabling interoperability

• Resolving Challenges

• Assessment of benefits and obtacles

The EU Interoperability

Recommendation, 2008

• In the Context of:

• Connectivity

• Data protection, fundamental rights and personal

data

• Local consensus as a basis for PP partnerships

The EU Interop Recom’dation,

epSOS SPECs + Calliope Roadmap

Action at 5 levels:

• Overall political and financial

• Organizational

• Technical

• Semantic

• Education an awareness raising

Danish lessons agree with recommendation

We need epSOS specifications!

We welcome the Calliope Roadmap!