service strategy information cooperation -...

MC-S000 December 2009

MedCom15 yearsStatus report, MedCom 6

MC-S218 December 2009

cooperation

Internet

service

dialogue

efficiency

strategy

securityITVANS

15years

developmentthe patient

healthcarecommunication

the citizen

information

digitisation

the futurecohesion

MedCom 15 years

StandardisationIt began in a true pio-neering spirit with theidea that electroniccommunication had thepotential to become agood tool for the Danish Healthcare System. It ought to bepossible to convertfixed forms such asprescriptions, referrals,etc., to standard elec-tronic forms and thento send them directlyfrom one IT system toanother.

Find out more on pages 4 –5

ConsolidationPilot projects becamepermanent arrange-ments. Disseminationgained pace, and theMedCom standardshave long been part ofeveryday working life.Perhaps not everywherein the healthcare sector,but almost.


International issuesInternational coopera-tion has more or less always been a specialpart of the develop-ment effort in the fieldof healthcare IT. Standardisation, infra-structure and tele-medicine have beensome of the major areasof focus, and the EU hasplayed – and continuesto play – an importantrole.


sundhed.dkOver the years, Health-care IT has become avery wide term. An important partner forMedCom is the eHealthportal sundhed.dk,which is the entry doorto the Danish Health-care System for the citi-zens and also an im-portant communicationinterface for healthcareprofessionals.

Find out more on pages12 –13

SDNIn time, a need arose tosupplement the VANS-based message com-munication with a newnetwork for telemedi-cine and other forms ofcommunication inimage and dialogue format. The idea aroseto base a new nationalnetwork on Internettechnology, and theidea was then put intoreal life.


2

MedCom

MedCom is a cooperation betweenauthorities, organisations and pri-

vate companies involved in the Danishhealthcare sector. The partnership wasestablished as a temporary healthcare IT project in 1994, but was later madepermanent through the 1999 financialagreement between the Governmentand the former counties.

MedCom’s purpose: MedCom will con-tribute to the development, testing,dissemination and quality assurance ofelectronic communication and informa-tion in the healthcare sector, with theaim of supporting good patient pro-gress.

The parties behind MedCom today are:the Ministry of Healthcare and Preven-tion, the National Board of Health, Danish Regions, Local Government Den-mark, the Ministry of the Interior andSocial Affairs and the Danish Pharma-ceutical Association.

Photograph: Helle Moos

Foreword / Contents

Healthcare IT is an absolutelyvital tool in efforts to equip

the Danish Healthcare System toface the challenges of the future.Digitisation needs to be used in anefficient and targeted way in theefforts to create a Healthcare System that will deliver a high levelof treatment and service. It is aboutsupporting better communicationwith the citizens, and it is about acohesive Healthcare System charac-terised by successful organisationof work procedures and routines.

Denmark is at the forefront inthis area, not least by virtue of theefforts delivered by MedCom overthe past 15 years, for example interms of the standardisation, imple-mentation and dissemination ofelectronic messages between allparties within the Danish Health-care System. Today, this part of

communication has become routinein general practice, in local authori-ties, hospitals, pharmacies, labora-tories, etc.

Over the years, further measureshave taken place towards exploit-ing to an even greater degree thelatest information technology, thus strengthening the power ofcohesion internally in the Danish Healthcare System and in respect of the population. Through the Health Data Network, system development and standardisation,the IT engine room of the DanishHealthcare System has been devel-oped and optimised, and this workis continuing all the time. At thesame time, specific tools such as telemedicine are showing huge po-tential as a means both of makingthe Healthcare System more effi-cient and flexible and of improving

efficiency in the services to the population. For the population, arapid development is taking placeof access to information aboutthemselves and the Danish Health-care System in general at the eHealth portal sundhed.dk.

Looking back, developmentsover the past few years have beenimpressive, not least thanks to thecurrent MedCom projects and theirpredecessors. And they are poin-ting forwards. Towards dissemina-tion of the good solutions, forexample the MedCom standardsbecoming fully utilised in all localauthorities, regions and surgeriesand telemedicine being implemen-ted to its full capacity in suitableareas so that healthcare staff canmake efficient use of their timeand energy for the benefit of patients.

Jakob Axel NielsenMinister of Health and Prevention

E-recordse-records is one of themany new functions.The idea here is to pro-vide healthcare pro-fessionals and citizensalike with direct access to patient re-cords via sundhed.dk.


Local authoritiesThe local authority reforms and creation ofnew, larger authoritiesand five regions to replace the countiesprovided completelynew partnership relationships within thehealthcare sector. Thelocal authorities nowcame into the picture inearnest.


TelemedicineTelemedicine includesthe expansion of healthcare IT to includeimages and sound. Thisprovides the facility toinvolve citizens directlyin their own treatmentand the method inwhich specialised sup-port is provided irres-pective of geographicaldistances. The first stepswere taken well before2008, but now the newopportunities providedby IT have really hadtheir breakthrough nationally.


Digital HealthMuch water flowedunder the bridge in theyears before healthcareIT. Organisations cameinto being based onspecific tasks, and MedCom is just one ofthem. The task of SDSD,Digital Health, is to gather the threads to-gether and set out themarkers showing thepath for the future.

Find out more on pages 14–15

ContentsForeword 2Articles 4Projects 24Toolkit 37Statistics 42Names 50

3

Digitisation – a core elementin the development of the healthcare sector

“In this department,we reduced thework processes from 18 to just 5 by switching to purely electroniccommunication.

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MedCom 15 years

Niels Jørgen Christensen

Anders Kristian Jørgensen

Back in 1994, a group of professional IT expertsgot together with doctors and healthcare staff

with an interest in IT to develop electronic commu-nication standards. One of the members of thegroup was Niels Jørgen Christensen, who today is ITProject Manager in the Central Jutland Region.

“We were six self-appointed nerds with massesof pioneering spirit and drive who said that wewould be perfectly capable of developing somestandards like this. We were all different and therewere many disagreements, but we always managedto reach a decision that everyone would support,”he recalls.

The standard electronic forms, EDIFACTs, weredeveloped based on international standards and byexamining the actual requirements of doctors andhealthcare staff who would need to use the forms.The technical challenge consisted of transferring apaper form into an electronic system.

“A computer, of course, cannot decide whetherone thing is more relevant than another, or whethera date specified is a creation date or dischargedate,” explains Anders Kristian Jørgensen, who wasworking at the time for Dan Net and who was res-ponsible for getting the systems to work in practice.

“We needed to ensure that the system could sortall the data in a meaningful way. And the EDIFACTsdeveloped by the standardisation group in ‘96 are,at their core, the same as the ones used in the healthcare system today.”

Self-appointed nerds and IT pioneers

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Standardisation, dissemination, consolidation

Before the MedCom standards were implemented on a large scale in the

country’s hospitals, local authorities andsurgeries, they were pilot tested in real lifeat selected hospital departments and sur-geries throughout the country. What wasthen Vejle County worked together withMedCom to test a number of standards inradiology and pathology departments, several clinical departments and a numberof GP surgeries, among other places.

“It was a positive and exciting process,even though getting the organisation ofthe projects approved and granted inter-nally was a challenge,” says Tove CharlotteNielsen, who from 1997 until 2007 workedas a coordinator for the standardisationprojects in the county.

“When MedCom were ready to launcha new project within their two-year pro-ject periods, it could easily be six months before the project was approved in our organisation and the resources found. So we were already a little way behind,”she recalls.

“However, the most important thingwas that, in spite of everything, manage-ment backed the projects and could seethe long-term benefits of developingsome electronic standards for the wholehealthcare sector.”

Tove Charlotte NielsenFinn Mathiesen Radiology Department, Vejle Hospital

Important for management to beforward-looking

Efficiency at maximum and error rate at minimum

We are almost 100% digital in this department, andthat has changed our day-to-day work accordingly,”

explains Finn Mathiesen at the Radiology Department ofVejle Hospital, which is part of the Lillebælt Hospital.

“Previously – and, in fact, it wasn’t so very long ago – wewould be standing there with paper records in our handswhile we looked at X-rays in the light box and read outnotes into the Dictaphone, which the secretary would thenwrite up. Then, it wasn’t beyond the bounds of possibilityfor papers to get lost or mixed up. That situation doesn’toccur today, when all documents, notes and images are heldon the patient’s electronic record. In this department, we re-duced the work processes from 18 to just 5 by switching topurely electronic communication. So, we have significantlyimproved efficiency and, at the same time, sealed off thechain of security, thus improving patient security.”

In practice, digitisation has released so many resourcesthat today the department can offer drop-in examinations,which the patient can come to straight away. Another ad-vantage is that geography is no longer a barrier to coopera-tion.

“Everyone can see all the information everywhere in thehospital, and soon in the region, too. The plan is obviouslyto make it a national thing. I hope individual users in the future will be able to adapt the system to their own needs,and that everyone will be able to read the same formats. I think it is important to stress that what is vital for com-munication are the common standards, not whether or notthe record systems in the departments are the same,” FinnMathiesen points out.

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MedCom 15 years

Things have gone well,but perhaps it is time to take a step back?

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Standardisation, dissemination, consolidation

We have come a really longway – further, indeed,

than anyone dared dream ofwhen we started the standardi-sation projects 15 years ago,”says Jens Parker, a GP who hasbeen actively involved in theMedCom work right from thepioneering years.

“Today, there isn’t a singleagreement between variousprofessional healthcare practi-tioners and the Danish Regionsthat doesn’t specify that Med-Com standards must be used.That is great, I think, not leasttaking into account the fact thatit succeeded despite there beingso many GP and specialists’ systems. Try seeing how difficultit is to establish interdisciplinarycommunication in relation tothe hospital systems! Thatbrings the results from generalpractice into relief.”

At the time at which JensParker became involved in theMedCom projects it was doneon the basis of a belief thatcommunication could be orga-nised both more smartly andquickly by using the new infor-mation technology as a worktool. That conviction led him,over the years, to take an activepart in project work and also asa type of ambassador to his colleagues for the new opportu-nities. Today, he acts as an observer for the Danish MedicalAssociation in MedCom’s steering group, and he also sitson the project group for theCommon Medication Card.

Must not drown in success

“The success has been secured,but I also think we must bemindful of the risk of drowning

in our own success,” he pointsout.

“In the long first period wein general practice have accep-ted the opportunities becausewe could see clear benefits toelectronic communication. Generally, it has been the reci-pients of the communicationwho have enjoyed the biggestbenefits.”

Many of the more recentmeasures, however, are aboutdelivering information whichbenefits others yet makes moredemands on our time. There areseveral examples of measureswhere the GPs find that it wasactually easier when they usedpaper. That sort of thing is hardto sell, although of course wedo understand that we are notthe only ones who should bene-fit from the communication.

Limited resources

“Another aspect pulling in thesame direction is that the sup-pliers of GP and specialists’ systems must develop and im-plement the many new solu-tions. Resources are limited,and there is only one place towhich to send the bills, butwho will want to pay for solu-tions that require more timeand work? In that way, youneed to understand that GPsand their suppliers work underdifferent conditions than thehospitals, local authorities andmany of the other players.There needs to be a sensiblebusiness model. This is oftenforgotten.”

So, even though the oppor-tunities are tempting, it maybe necessary just to take a stepback before we launch our-selves into too many largenew projects.

Jens ParkerGeneral practitioner

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MedCom 15 years

Leif VestergaardPedersen

Vera IbsenPeter Behrendt Lau

With e-records I feel betterprepared when I visit the doctorWhen, like Benjamin Fugl-

sang Breum from Tjele,you have been through a leng-thy illness involving hospital ad-missions and numerous exami-nations by various specialists,being able to follow the pro-cess via e-records is a greathelp. In 2004, Benjamin under-went an operation on his stomach, and the illness hasnow lasted for 3½ years.

“In particular, I used e-records to keep myself up-to-date with my test results. In thisway, I have been able to pre-pare myself better for my meetings with the doctors,” heexplains, adding that the accessto e-records will place greaterrequirements on the ability ofdoctors to communicate withtheir patients.

“I believe that it is a genuine-ly healthy thing all round for usas patients to have more op-portunity to get involved in ourown course of treatment. How-ever, I also believe it will be achallenge to those doctors whohave been used to patientssimply listening and not askingso many questions.”

As far as the actual e-recordssystem is concerned, he ishappy about the informationwhich the system allows him toaccess, but still feels there isroom for improvement in termsof user-friendliness and design.

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e-records

People were enthusiasticabout the possibility of be-

ing able to look at the data intheir own records, particularlyas it offered them a better opportunity to arrive well pre-pared for their treatment andconsultations, as Peter Beh-rendt Lau of Rambøll Manage-ment Consulting and ProjectManager during the evaluationof e-records in 2008 explains:

“Hospital staff were also positive. Their main wish wassimply for the system to be ex-tended nationwide as quicklyas possible.

“The GPs were more reser-ved about it, mainly becausethe introduction of new IT sys-tems often proves a challengefor small practices and becausesome doctors had found thatthe information in e-recordswas not always up-to-date onthe part of the hospital.”

Good start for e-records, but room forimprovement

It quickly became apparent to us that we needed to develop a

new standard, one that was able toextract the desired informationfrom the various existing systemsand present it in a clear and user-friendly way,” explains Vera Ibsen,who at the start of the e-recordsproject was Chief of Section atVejle County.

“One of the major challengeswas to design and develop a userinterface that would take into account the varying requirementsof different target groups. Thiswasn’t exactly easy.”

When the first standard was de-veloped, MedCom was given theresponsibility of commissioning thesystem, professionalising its main-tenance and keeping it up-to-date.Vera Ibsen says of this cooperation:

“MedCom has the resources andskills to run and update systems ofthat size, and the cooperationworks out fairly harmoniously.”

It is her opinion that e-recordsshould be regarded as a forerunnerof a more advanced system, whichis also described in the Digital Health organisation’s strategy for aNational Patient Index (NPI). All information – records, laboratoryresults and image data – from allsectors of the healthcare systemwill be available in this index.

A unique, tailored format

The need to exchange recorddata within the Danish Health-

care System was obvious, and therewere different solution models onthe table, as Leif Vestergaard Pedersen, Healthcare Manager,Central Jutland Region, recalls.

“We had a good solution inVejle and Viborg Counties. Gradu-ally, this spread to the whole ofWestern Denmark, and MedComfacilitated a number of the proces-ses in this regard. They did a goodjob of this, and showed their flairfor developing simple solutions tocomplex tasks. In principle, every-thing is possible when it comes toIT. It’s just that sometimes solutionsare so complex that the IT task it-self swallows up more resourcesthan it frees up.

“So, you may of course be ask-ing yourself whether we gainedjust a temporary solution with e-records. We did indeed, but, thenagain, all IT solutions are tempo-rary!

“It could easily be the case thate-records will be developed further.Perhaps, in the immediate term,there is room for improvement interms of the patients’ access. Myopinion is just that, while the pati-ents by all means can take a look,too, e-records is primarily a worktool for healthcare professionals.

“Speaking of professionals, GPsshould by all means have easier access to e-records. It is also of decisive importance for the hospi-tals to be given equally easy accessto the GP’s records. It needs towork both ways.”

Why make it harder than it is?

What is e-records?

The record retrieves data fromthe existing electronic patientrecords at the country’s hospi-tals. Access is provided to clini-cians at the hospitals and to allgeneral practitioners. Citizens inmost of the country also haveaccess to e-records via DigitalSignature at the eHealth portalsundhed.dk.

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MedCom 15 years

When Christmas took secondplace to the structural reform

Vivienne OttosenPeter Simonsen

Christmas 2006 will not be easilyforgotten by those working in

the country’s largest IT company,KMD. The reason is that the newstructural reform with its mergingof local authorities and abolition ofcounties was due to take effect on1 January 2007. Marianne Knudsen,Service Consultant at KMD, was res-ponsible at the time for getting theinterfaces between the local autho-rities’ healthcare information sy-stems and the KMD Sygehusopholdsystem to work. It may have been ahectic period, but today she looksback on it as a good experience:

“It was so fantastic to see howgood cooperation can give ‘flow’ toa project. Everyone worked hard toensure the system would work, andboth the suppliers of healthcare in-formation systems and MedComwere really good players through-out the whole process,” says Mari-anne Knudsen.

The project advanced accordingto plan, and she managed to cele-brate a relatively peaceful Christ-mas with her family. After the turnof the year, a three month transi-tion period followed, during whichcommunication between hospitalsand local authorities proceeded asin the ‘old days’, i.e. by telephoneor fax. During that period, the newKMD Sygehusophold system wasimplemented in the local authori-ties. According to Marianne Knud-sen, this proceeded relatively freeof problems. She attributes this,too, to good preparation andteamwork.

An indispens-able work tool

B y virtue of the structure re-form, the local authorities

have gained a much more cen-tral role in the healthcare sec-tor than before. This appliesnot least in terms of rehabilita-tion, prevention, health promo-tion and measures for thechronically ill. It is, therefore,both natural and necessary forlocal authorities to be deeplyinvolved in our efforts to en-sure there is communicationbetween the other parties inthe Danish Healthcare System –a communication that worksflexibly, securely, efficiently andis free of errors. Here, health-care IT is an indispensable worktool, both in terms of messagesabout admissions, discharges,rehabilitation plans, etc., andwith regard to the exchangingof information between thehome care sector and generalpractice. New information tech-nology measures, too, will gaingreat importance – telemedi-cine, for example. As we see it,healthcare IT can both supportsuccessfully functioning proce-dures and, to a large degree,also enhance the quality of theservice we provide to citizens.

Peter Kjærsgaard PetersenHead of Division, Social and Healthcare Policy, Local Government Denmark

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The structure reform

Healthcare agree-ments are ‘born’with IT support

Region of Southern Denmark isthe region that has come fur-

thest in the implementation of thestrategy for healthcare IT across localauthorities, hospitals and generalpractice. And, according to the Headof Department for local authoritycollaboration, Peter Simonsen, thereare numerous reasons for this:

“In the first instance, from thestart we have ensured that our stra-tegy was supported and prioritisedpolitically in all local authorities andin the region. This has meant that allparties have been willing to priori-tise and invest the necessary resour-ces in the project. Secondly, rightfrom the start we have incorporatedIT support as an integral part of thehealthcare agreements between thelocal authorities and the region.And, thirdly, we have been veryaware that the implementation ofnew IT systems and standards acrossall sectors of the Danish HealthcareService and the local authority sy-stem is a huge organisational taskthat requires a special unit to attendto coordination, training, technicalsupport and communication. Wetherefore set up an IT secretariat,jointly financed by the region andlocal authorities, to act as ‘coordina-tor’,” explains Peter Simonsen.

The overall aim of the cross-sector healthcare IT strategy is tocreate an electronic link to the indi-vidual citizen/patient, so that health-care information can be exchangedfrom records at hospitals, in generalpractice, in the local authority homecare sector and rehabilitation unit –in other words, all bodies with whichthe patient comes into contact during a course of treatment andthroughout the whole of his or herlife.

Three local authorities - onecommon system

During the local authority mer-gers in 2007, what was then

Svendborg Municipality mergedwith Gudme and Egebjerg Munici-palities. In terms of healthcare,they had three different systems.Svendborg’s solution was entirelyIT-based, Egebjerg’s partially so,while Gudme still communicatedvia paper forms and letters. WithSvendborg the most advanced inthis regard, it was quickly decidedthat the best solution would befor everyone in future to use thesame system for healthcare infor-mation that they had good expe-riences of in Svendborg. Amongthe project managers for the mer-ger was Vivienne Ottosen, and shedoes not remember the processbeing particularly frustrating orproblematic.

“We had a whole year in whichto plan the merger, and becausewe got started right away andhad set aside the necessary resour-ces, we were actually doing wellagainst the timetable,” she recalls.However, she admits there waspressure:

“We had additional people sitting and entering informationfrom Egebjerg and Gudme intoour systems, and our administra-tive staff also had to make use ofa few weekends. However, wemade it – both the purely techni-cal part and also in terms of getting all the new users of thesystem trained before the mergertook effect on 1 January 2007.”

Photograph: Nils Lund Pedersen

12

MedCom 15 years

When we started, the situationwas more or less that we felt

it was just the two of us, the eHealth portal sundhed.dk andMedCom, and no-one else. It wasnatural for us to cooperate, be-cause it was clear to everyone thatwe complemented each other:sundhed.dk with its user interfaceto the whole of the Danish Health-care System and all the citizens,MedCom as coordinator of thestandardisation work and HealthData Network.

“Then, it was a case of twosmall organisations, and there wasa sort of ‘free play’ about our co-operation.

“There was a pioneering spirit,and the two or three people invol-ved on each side knew each other.They could always talk their waythrough things and, to an extent,improvise their way forward.

It was just the two of us“Since then, a fantastic amount

has happened. Everything has be-come a lot more complicated, witha number of active players in thearea of digitisation. Our two orga-nisations have grown, and the taskshave definitely done so, too.

“The cooperation has developedaccordingly and has become moreformalised and with more obliga-tions. There was also a need forgreater professionalism. Naturallyenough, this development mustcontinue and lead to even morefixed frameworks of well-definedmodels and procedures for the co-operation. The aim for me is to seethe apportionment of tasks so clearly defined and the cooperationbetween the two organisations run-ning so well that it may well appearto the outside world that MedComand sundhed.dk are one organisa-tion, though with completely diffe-

rent sets of responsibilities.

Major tasks completed

“There are many good examples of how our two sister organisa-tions have completed even verylarge tasks along the way. Opera-tions, support, maintenance andthe dissemination of e-records aregood examples from the MedCom6 period. Of course, there havebeen discussions among us, butthat, too, has led to developmentand I think we have found reason-ably well-defined interfaces for the apportionment of work andskills between us.

“The expansion of e-records to600,000 citizens in the Copen-hagen Capital Region in autumn2008 was somewhat of a test piece in this regard. It was a hugechallenge, and the project requi-

Photograph: Nils Lund Pedersen

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sundhed.dk

“It may well appear to the outside world thatMedCom and the eHealth portal sundhed.dk are one organisation, though with completelydifferent sets of responsibilities.

red very close cooperation withthe suppliers and MedCom. Andit was a success!

“Now in 2009, sundhed.dk hasbeen through a process whichalso included the reestablishmentof the record system. Followingthis, we expanded to include theCentral Jutland Region and Region of Southern Denmark.These events have told me thatthe cooperation is getting betterand better, and that is how itshould be! If we look at what thefuture has to offer, there will beeven more major projects on theprogramme, and we will need aneven greater degree of professio-nalisation. But we will managethat, too!”

Morten Elbæk Petersen

Involved all the way

Some of the very first tentative attempts atelectronic communication of messages with-in the Danish Healthcare System were con-cerned with the forwarding of prescriptions between GPs and pharmacies. A very greatdeal has happened since then, fortunately –and the pharmacies have naturally been deeply involved in the day-to-day use of thedigital tools and in the development work.GPs, the home care sector, hospitals, pharma-cies and others have a common interest inmaking use of the opportunities offered bydigitisation. It creates the foundation forgreater efficiency, minimising errors and pro-viding better service to our customers. Com-munication needs to be developed further so that it extends beyond the standard messa-ges – and this is happening. The correspon-dence messages are a good example of this.The next target is an electronic dosage card as part of the common medication card, for use in the more secure and effi-cient transmission of information about dose dispensing, where we also expect MedCom to play an important role.

Niels Kristensen Chairman, Danish Pharmaceutical Association

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MedCom 15 years

Successfully managed- so far!

15

Digital Health

MedCom can take a lot of thecredit for the fact that Den-

mark has advanced as far as it has interms of healthcare IT – no doubtabout it,” states Otto Larsen, Direc-tor of Digital Health, which in thewords of the organisation “formsthe framework for the digitisationof the Danish Healthcare System.”

“It was done well by MedCom,and it is good that it has been donein a way whereby the players in theDanish Healthcare System have sig-nificant ownership of the solutions.That is precisely the main explana-tion of how we have succeeded indisseminating and consolidating thesolutions as extensively as we have.”

Various bases

“All the same, it is clear that ourorganisation, Digital Health, represents a different line to MedCom’s in developments with-in healthcare IT. That is only natural, as the two organisationswere created on a different basis.

“When MedCom was foundedin 1994, people said: ‘Here is aproblem. How do we solve it?’ Wetalked to the users, developed a

number of standards and thengradually distributed them exten-sively. There are a lot of positivethings to say about that process.

“The rather less positive angleon this is that it took a relativelylong time, and that from time totime resources were used on pro-jects that did not succeed, and itwas not always the most long-term, holistic solution that wassought.

“Digital Health came into be-ing three years ago from the de-sire to create greater cohesion indevelopments within healthcareIT. The structural reform with fiveregions and fewer, larger localauthorities is pulling in the samedirection, and the Danish HealthAct has provided the ministerwith a firmer handle with whichto drive developments in a moreuniform direction.”

Need for new thinking

“Despite the centralisationtrends, of which this is an expres-

sion, my opinion is that the wholearea is still to a large extent mar-ked by budding. There are a largenumber of players in the gameand organisations have come intobeing that live their own livesand have their own objectives.The consequence of this is thatthere is some degree of uncer-tainty in terms of common strategies, skills and authorities. MedCom, Digital Health andmany organisations are operatingin the wake of this, and the question is whether or not it istime for some new thinking. Thetasks still need to be completed,but perhaps this can be donemore simply and efficiently.

“I certainly do not wish to sayby this that fewer resources willneed to be used in the develop-ment of healthcare IT. On thecontrary, it is my belief that thereis a tendency to underestimatethe task involved in developing anational IT architecture. The pro-blem lies partly in that there arenot necessarily any direct rationa-lisation gains to be had. Health-care IT increases quality, produc-tivity and security, but we cannotuse the argument that we savemoney. And so perhaps what ifwe change the problem aroundand think of the alternative? Howwould we manage to completethe healthcare tasks in future without the joint IT solution? Itwould be expensive, not just interms of money but also abso-lutely in terms of quality and se-curity. Really, it is an impossiblethought.”

Otto Larsen

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MedCom 15 years

“I would like to order a DIX,

a healthcare DIX”

Important for someone to steer the vehicle

Jan Kold, who on a day-to-day basis is the IT Manager for the Copenhagen Capital Region, anticipates that therewill be technical challenges if the operation of all network connections on the common node in future is to be

part of the central Health Data Network. “Depending on how far the operational responsibility extends for the Health Data Network, there will be a

number of critical responsibility interfaces for the players’ operational organisations and these could cause verymajor problems if they don’t work. However, it is quite natural for responsibility to be located in one place, and Isee no problem in principle for a central organisation like MedCom to take responsibility for the operation of sucha network,” says Jan Kold.

tions just for fun. There was a needto connect the regional networkstogether, and for the facilities thatInternet technology provides. Thealternative would be chaos. Ima-gine if all the regional networks,each with perhaps ten differentservices, should be connected inpairs. It would be fairly unmanage-able.

“We explained this a greatmany times at innumerable meet-ings. We also asked the sceptics totell us what requirements theywould have of the new network inorder for them to surrender someof their sovereignty.

“We built a pilot system on thebasis of all the input received. Ofcourse, it has been upgraded inevery way since, but it has actuallybeen in continuous operation sinceday one. And I really believe thateveryone would agree that the so-called healthcare DIX has lived upto expectations. No-one’s scepticismhas been confirmed – quite the re-verse, in fact.”

Much has beenachieved, andthe potentialremains great

The regions consider IT to bea vital requirement in order

to equip the Danish HealthcareSystem for the challenges of thefuture, which among otherthings will be marked by moreelderly and chronically ill pati-ents and less manpower. The regions are thus also actively in-volved in the development ofhealthcare IT. This includes colla-boration with MedCom. Muchhas been achieved over the past15 years, while at the same timeit is clear that there is consider-able potential for furtherstrengthening both efficiencyand quality using IT. There is al-most a queue of options waitingto be realised, including interms of direct communicationbetween the Danish HealthcareSystem and the patients. The healthcare agreements betweenthe regions and the local autho-rities also bear witness to this,and from the regions’ point ofview there is every possible reason to continue working determinedly in these areas.

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Internet-based Health Data Network

It cannot be done.” This was thereply when Lars Hulbæk from

MedCom telephoned Martin Bech,Division Director at Uni-C, eight ornine years ago to order a health-care DIX. “There is only one DIX.”

“Nevertheless, the healthcareDIX today has become a reality,though to be absolutely correct this is a little bit disingenuous,” explains Martin Bech.

“What we have is a central nodefor the Health Data Network, not atrue DIX – an Internet exchangepoint, but does it matter? After all,all babies need a name.”

For Martin Bech, the telephonecall from Lars Hulbæk was the startof an extensive and very unusualprocess to construct the Internet-based Health Data Network.

“At the time, I had already beenworking on communications inparts of the healthcare sector, butthis took me right into the belly ofthe system,” he explains.

“The thing is, when peoplecome to us to have a task comple-ted, they more or less always havethe solution defined in advance. Itis then a matter of putting it intoreal life. That wasn’t the case here!You see, the starting point was thatthere were a number of regionalnetworks, which many people hadspent time and effort to build up.One of their most important aimsall the time had been to create se-curity, to keep strangers out. Now,in layman’s terms, we were comingup with a plan to keep strangers in.Not just anyone, of course, but yousee the point. Naturally enough,this generated a deal of scepticism.Fortunately, we were able to arguethat security would be intact, andthat to cap it all the network wouldbe able to deliver documentationof all transactions.

“And then, of course, we didn’twant to build the new construc-

“There was a need to con-nect the regional networkstogether, and for the facilities that the Internet-technology provides

Bent HansenChairman of the Danish Regions

Martin Bech

18

MedCom 15 years

Next generation will be ready

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International

There is a touch of ‘Brave NewWorld’ about it when people

need to use electronic equipmentin the home, and they tend to geta little scared when we show themthe possibilities, as home nurseHelle Holm explains:

“The drawback is precisely thatmany people in the target groupof the over 65s are not used tousing new technology. That situ-ation will most definitely changein time. The next generation willbe ready. They will simply expectto have that sort of technologyavailable.”

Active citizens

Helle Holm is employed by Lan-geland Municipality, where she isProject Manager for the munici-pality’s part in the internationalDreaming project, which is aboutharvesting experiences of infor-mation technology in the serviceof healthcare.

“The project covers citizensaged over 65 who are relativelywell and who are covered by thehome care sector,” she explains.

“They have chronic illnessessuch as diabetes, COPD and poorheart conditions, and they aregiven equipment in their homesso they can measure their bloodsugar, blood pressure or lung capacity themselves. The results

of the readings are communica-ted directly to us, and if some-thing looks wrong we receive analarm. The citizen can also con-tact us directly, and we can talktogether at a miniature videoconference using a webcam andtheir TV.

“As far as I see it, there aremany benefits to the public. Theybecome actively involved in theirown treatment, and perhaps visittheir doctor less frequently be-cause they gain more control oftheir illness. They feel a greatersense of security and are alwaysin such good control that theywill probably be admitted lessfrequently to hospital. At thesame time, they are not so tiedinto having to be at home whenwe come.”

Six countries in the project

The pilot project is being carriedout simultaneously in six coun-tries – Sweden, Italy, Spain, Ger-many, Estonia and Denmark.Forty-four people will take partin Langeland Municipality. Halfof them will have the equipmentin their own home. The otherswill receive traditional treat-ment. The results will be exami-ned using questionnaires andinterviews and experiences willbe collated.

The energy which international recognitiongives in a cooperation situation provides

strong motivation to continue the innovativework in this country and overcome possibleresistance. The ‘H.C. Andersen effect’ – beingbetter known abroad than in your own backyard – convinces people that it is worthwhilepersevering and continuing the work.

Peder Jest Director, OUH

MedCom 15 years

Small organisation – major influence

Kevin Dean, Director of Con-nected Health’s Internet Busi-

ness Solution Group in the inter-national IT Group Cisco Systems Li-mited, sees a number of major chal-lenges to the European healthcaresystem in the coming years, withthe rise in the proportion of elderlycitizens. This places enormous pressure on resources, and it is therefore extremely important toincrease productivity in the health-care sector. Better, more efficient ITcommunication and technologicalaids can help free up resources forthose tasks that require people tocarry them out.

At the same time, it is very im-portant to avoid a ‘brain drain’ ofexperts, especially from Eastern toWestern Europe. The developmentof telemedicine may help avoidthis, as experts can now be challen-ged, and rewarded, in a professio-nal way wherever they may belocated geographically.

Good example

Since the start of the new millen-nium, Kevin Dean has workedwith MedCom in a number of dif-ferent connections. He is impres-sed that such a small organisationhas had – and still does have –such major influence on the de-velopment of IT healthcare com-munications at an internationallevel.

“I often use MedCom as anexample when I want to illustratehow a very practical, methodicalapproach can allow technologyand communications to reach ahigher level,” he says, and hecontinues:

“One of MedCom’s majorstrengths is that the organisationis based on the network mode ofthinking, and therefore they havegradually created for themselvesa gigantic network of internatio-nal specialists both in IT and thefield of medical knowledge. They manage to gather the bestpeople for each project, and theycreate relationships for furtherdevelopment.”

You need to act quickly

MedCom is deeply involved in de-veloping solutions that will meetthe challenges of the future inthe European healthcare system,and Kevin Dean believes thatMedCom is very modest conside-ring the amount of work and in-fluence that the organisationreally has.

Where he does see the chal-lenges to MedCom in the futureis in terms of the speed of devel-opment. Time requires, and tech-nology enables, people to actfaster in future than they have sofar been used to.

Kevin Dean

20

International

Healthcare IT requires organisational changes

Investing in better IT technologyin the healthcare sector is a sensi-

ble prioritisation which in the longterm will save resources, and it issomething which all governmentsin the EU should be interested incarrying out. This is the opinion ofIlias Iakovidis, Chief Delegate forthe Department of Healthcare IT atthe EU Commission.

“What people, whether in ma-nagement or in national Govern-ment, need to be fully clear aboutis that the technology in itself isnot the solution and cannot standon its own. The investments haveto be followed up by an extensivereorganisation of working proces-ses and functions. You need to en-sure that the users understand thetechnology and can see the act ofbecoming familiar with the new systems in perspective. Otherwisethe new technology just leads tofrustration and difficulties.”

No mandate on healthcare

But would having all healthcareIT systems in the EU based on thesame standards not be the mostsensible thing to do?

“Yes, definitely, but the EU doesnot have a mandate in the health-

care sector to impose requirementsor orders on the systems of indivi-dual member countries, and there-fore developments in the area ofhealthcare IT within the EU becomeboth slower and more unsystematicthan you find, for example, in theenvironmental sector, where the EUhas a mandate to impose require-ments on individual countries.”

MedCom is a shining example

Ilias Iakovidis has been involvedfor longer than most. He has worked on healthcare IT withinthe EU since 1993. At that time,he was involved in formulatingand examining the principles ofdeveloping common standardsfor electronic healthcare com-munication in the EU, a projectthat led to the foundation of MedCom. MedCom has a specialplace in his heart because of theforward vision that the projectthen represented.

“For me, there is absolutely nodoubt that MedCom is the exam-ple of how to develop and orga-nise a functionally competent IT system for healthcare IT. MedCom’s working methods arebased on the ‘trial and error’principle, where testing and mo-difications are a continuous pro-cess. We are not as afraid tomake mistakes, and the focus ison getting the users involved asearly in the process as possible.We are on the threshold of thenext wave, where the break-through in technology and com-munication will be used inhealthcare, for the benefit of allcitizens of the EU. I hope theDanes will be just as forward-looking this time as they werethen with MedCom.”

Ilias Iakovidis

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MedCom 15 years

Copenhagen University Hospital took thefirst steps

The system was very simple, butit worked, as Ole Bergsten,

Technical Manager at Medicotek-nik, explains about CopenhagenUniversity Hospital’s first measuresin telemedicine back in 1995–96. Heremembers the attention surroun-ding its inauguration, includingfrom the press.

“We worked on an ISDN2 connec-tion and used only standard systems.It worked fine for echocardiographyand X-rays, where all we did was toplace a video camera on an overheadprojector. We then also managed toconvince the doctors that the imagequality was acceptable. Otherwise,they were somewhat sceptical.”

The reason why Copenhagen Uni-versity Hospital took the first steps intothe world of telemedicine was a degreeof pressure from the Faroe Islands.When it came down to it, they did not have a need for it. In-stead, a connection was set up to Greenland, which includedechocardiography and X-ray imaging. The echocardiographyworks the same way today as then, while of course the tech-nique in the field of radiology is totally different.

From projects to routine

“Today, echocardiography is routinely communicated be-tween all hospitals in the region, and videoconferences have,for example, also become routine,” explains Ole Bergsten.

“Actually, I have never doubted the possibilities, but froma development point of view the many independent projectsin the area have been a problem. They are initiated withoutpeople having taken the necessary organisational factorsinto account. These days, we start by getting the organisa-tion in place before we make a start on telemedicine pro-jects.

“At the same time, we have learned that the initiationinto new work equipment is very important. For example, we got MedCom staff to run a training session before weembarked on a new collaborative effort in telemedicine withBornholm. It gave us a really good start and showed the importance of making things easy for the users.”

When the doctors in the Cardiological De-partment at Roskilde Hospital need to de-

cide whether a patient is suitable for an operationfor a new heart valve, for example, they like toseek advice from heart surgeons in other hospi-tals. This is done at a weekly teleconference invol-ving doctors and surgeons from various hospitalsin the country. At the teleconference, all partici-pants have the chance to see images and ultra-sound recordings, e.g. of patients’ coronaryarteries, and a discussion is held as to whether anoperation is appropriate, based on the images.

“The teleconferences have saved us a great

Telemedicius better a

23

Telemedicine

deal of time,” says departmental doc-tor Klaus Klausen.

“Now we no longer need to plan tomeet in person, and we have thechance to give and receive professionalsupport quickly and without any com-plications.”

However, in terms of the technicalset-up of the telemedicine systems,Klaus Klausen believes there is stillroom for improvement.

“In some places, the systems arevery ‘nerdy’, in the sense that you need

a degree of technical understanding toget the systems to perform to best effect. The user interface itself couldbenefit from being more intuitive andvisually well thought out. And, ofcourse, it is a ‘must’ that the connec-tion works. We probably would like amore stable, error-proof system, andhere, too, technical improvements arecontinually being made. All in all, tele-medicine is a really major benefit toboth patients and healthcare profes-sionals.”

ine makesand faster

Strategy for telemedicine

The ABT Fund is a fund whose aim is to invest in innovative

projects throughout the wholepublic sector. In overall terms, this means projects that increaseefficiency and productivity inpublic sector service and care without this being at the ex-pense of quality. In this regard,telemedicine projects are rightup its street. They can help en-sure that specialised functionslast longer and that quality im-proves. At the same time, weconsider the healthcare sectorready to make use of the newtypes of tools in IT.

The challenge to us is first and foremost to choose the rightprojects to support. The invest-ments made must match the re-sults, and from society’s perspec-tive the projects must point inthe right direction. In otherwords, it is a matter of making adecision as to which strategicareas of effort within telemedi-cine we should invest in. Then,we need to establish some con-ditions which the projects needto meet. MedCom is helping uswith this exercise, and they cer-tainly work quickly so we are ex-pecting to be in a position tohave the basis of our decision inplace by the spring.

We see great opportunities intelemedicine. We have reachedthe years of discretion. Now, thestrategy needs to play its part ingathering together the forces for the action that provides thebest result.

Ulrich Schmidt-Hansen Secretariat Manager, The ABT Fund

Klaus Klausen

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MedCom’s standards today are widely distributed in the healthcare sector. However, there are still regions and localauthorities that do not make use of all relevant communica-tion solutions. For example, a number of MedCom standardshave not been implemented in full.

At the same time, new solutions have been developed on anational scale with regards to the Common Medication Card(FMK) and Telemedicine. These are solutions that will be im-plemented at national level within the next few years.

The nature of MedCom 7 will, therefore, first and foremost bethat of an overall dissemination project, with two main areasof effort:

� National implementation of central MedCom standardsthat have not yet been adopted by all regions and localauthorities, including in particular:– Communication of local authorities with hospitals and

doctors.– The use of the Common Medication Card in the surgery.– The dissemination of e-records to citizens, hospitals and

surgeries.– Development and national implementation of package

referral.– Laboratory medicine communication.

� National implementation of tele-interpretation and ulcerassessment by telemedicine as part of Digital Health’s Tele-medicine programme.

Six project lines in MedCom 7

Specifically, this means that MedCom 7 includes implementa-tion nationally within six project lines:

Surgeries and laboratories. Dissemination of laboratory medi-cine, the PLOXML format, of EDI/XML Partnership informationand development and dissemination of package referrals.Find out more on pages 25–27

Local authority projects. Dissemination of communication inthe home care sector, rehabilitation, LÆ form and referralarea.Find out more on pages 28–29

The Common Medication Card in the primary sector.Dissemination of the Common Medication Card in surgeries.Find out more on page 30

e-records. Dissemination of citizens’ access to e-records anddissemination of e-records to GPs and hospitals.Find out more on page 32

Telemedicine. Dissemination of tele-interpretation and im-plementation of ulcer assessment by telemedicine.Find out more on page 33

International projects. Participation in EU projects, primarilyin the areas of standards, telemedicine and welfare techno-logy.Find out more on pages 34–35

The MedCom 7 projects are all a direct extension of the activities in MedCom 6. The project descriptions on the following pages contain both a description of the develop-ment hitherto of the projects in MedCom 6 and the expecta-tions for MedCom 7.

Projects

24

Med

Co

m7,2010

-2011

Referrals from doctors and specialist practitioners for hospital treatment are stea-dily increasing, and the pro-portion is now around 50%.With the ‘Cancer Packages’,there is a need for a revisionof the electronic referral sothat in future it reflects theneed of the individual specia-lity for relevant information.

Next stepA dynamic referral is being

REFHOST: A successful MedCom 6 project, which allows all doctors to send referrals electronically to specialists, physiotherapistsand psychologists.

The dissemination took placeas a collaboration betweenthe Danish Regions, the fiveregions’ practice units anddata consultants, the Multi-

Dissemination ofpackage referrals

REFHOST – the referral database

developed in MedCom 7,while solutions are being im-plemented that allow en-closures to be sent with refer-rals. In addition, MedCom’slists of EDI recipients in hospi-tals are being resumed.

It is expected that a referraldatabase solution will be established with REFPARC,where all referrals can becompleted based on a dia-logue, as in WebReq.

med supplier, the Danish Association of Medical Spe-cialists, Danish Physiothera-pists and the Danish Psycho-logical Association. MedComproject managed the imple-mentation project.

The introduction of a univer-sal digital employee signa-ture was a challenge, whichwas overcome in the courseof just two months.

Next stepThe project ends in 2009. Thetechnical solution now opensup the possibility for otherspecialities to take part, suchas podiatry and local autho-rity preventive facilities.

25

Consolidation and dissemination

900008000070000600005000040000300002000010000

001 02 03 04 05 06 07 08 09

Referrals to hospitals per month 2001–2009.

dual pharmacies and con-tacted all of the local autho-rities in the country in orderto get them to use it.

The pharmacist began workon 1 February 2009. Thegraph on page 47 shows theresults!

It is therefore expected that,in 2010, there will be muchgreater dissemination of themessage facility, which isnow both known and usedby pharmacies.

Correspondence message Pharmacies


Consolidation and expansion projects in the MedCom 6 periodhas focused on dissemination of ‘old’ projects to such a degreethat these electronic communication flows will be used ex-clusively in the future. Also, a number of new, smaller projectshave been initiated to supplement the existing ones.

HenvisningshotelletREFHOST

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fysioterapeuter

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En brugervejledning til praktiserende læger, speciallæger, fysioterapeuter og psykologer

MC-S215 / JANUAR 2009

REFHOST referrals to

September Spe- Physio- Psycho- Pod-2009 cialists therapy logists iatry

South Denmark 19575 6614 616 400Central Jutland 19266 7533 449 0North Jutland 8333 3871 374 0Zealand 18100 5481 563 0Copenhagen Capital 65200 11276 1408 0

Total 130484 34775 3410 400

The pharmacist systems pre-viously developed a modulefor correspondence messagesfor communicating with doctors and local authoritiesregarding supplementary information for ordering medicines, etc.

The module has not been widely used, but thanks to agrant from the Danish Phar-macy Foundation to MedComa project has been initiated:Rollout of the correspon-dence message facility, wherea pharmacist visited indivi-

26

Projects

Laboratory medicine projects, including support by sundhed.dk

The projects are coherent and form subcomponents of an overall,fully electronic communication internally between the labora-tories and between the laboratories and the users. The projects’common title is Laboratory Medicine.

The topics are both laboratory results and requests between laboratories and support of laboratory functions which can bedisplayed using sundhed.dk. A total of 13 subprojects were ini-tiated in 2008–2009. The project was not fully disseminated inthe MedCom 6 period due to time-consuming tasks with the implementation of new laboratory systems. The status of theprojects is currently:

WebReq dissemination

93% of all laboratory testsfrom GPs can now be request-ed electronically. More than3000 surgeries implementedthe system over four years.This must be considered a suc-cess.

Next step: The last clinical immunologicallaboratories will join WebReq,and the use of the new func-tion, Web-Quality, will formpart of the quality assuranceprocess for laboratory tests inGP surgeries.

Electronic dispatch slip: Newstandard – REQ01 – R0131K

The trilateral problem hasbeen developed and imple-mented in a number of labo-ratory systems. The remainingsystems have been delayed.Implementation expected in2010.

Next step:In 2010 and 2011, it is expec-ted that all laboratories willprocure the dispatch note mo-dule and thus make the transi-tion from paper to electronicdispatch slips. MedCom willprovide help with testing and

certification as well as withstart-up meetings and monito-ring through statistics andworkshops for users.

Request database

Requests from specialists andhospital outpatient depart-ments can be saved to the re-quest database. Patients arethen able to go to their GP or a laboratory in order to havethe tests carried out. The resultis correct testing and a requestthat can be used irrespective ofwhich laboratory the doctoruses.

Many specialists and some out-patient departments are nowon the database. MedCom hasdeveloped a web service solu-tion for direct, automatic access. It is ready on WebReq.So far, no laboratory systemshave managed to develop it.

Next step:The laboratories will enter intoagreements for the delivery ofthe module. Then, outpatient

departments can order testsand the individual laboratoryretrieve requests automaticallyvia the web service when thepatient arrives. Disseminationis expected at the end of 2010and in 2011.

Results between laboratories

All laboratories send sampleson for analysis by other labora-tories. The results are normallyon paper, but a large numberare now sent electronically.

Results23 laboratories send results toa total of 35 laboratories. Whenall laboratories are sending toall others, there will be around40 laboratories sending resultsand around 60 laboratoriesable to receive results. In Sep-tember 2009, a total of 17,622results were sent. This equatesto around 25% of all results.Not all laboratory systems areable yet to receive results. Mo-dules are under development.

The futureA natural consequence of theimplementation of dispatchnotes in subproject 2 will bethat all results are sent electro-nically. MedCom provides assis-tance to the laboratories withstart-up meetings, testing, certification and the staging ofworkshops for the users.

5. Manufacturer and manufac-turer code: The statutory re-quirement that it must be pos-sible to see which laboratorycarried out the analysis is nowmet by all major GP and speci-alists’ systems. Many laborato-ries also meet these require-ments by including the manu-facturer and manufacturer

Subproject 1

Subproject 3

Subprojects 5, 6 and 7

Subproject 2

Subproject 4

and discussed at a national laboratory seminar. Final esta-blishment will take place inDecember 2009. The web ser-vice for the assignment ofnumbers and establishment ofthe numbers server was drawnup at the end of the year.

In 2010 and 2011, the systemswill gradually be able to trans-fer to this numbers series, andfrom 2012 all laboratories areexpected to use this solution,which will ensure that all testshave a unique national num-ber. This will prevent mix-upsand renumbering. The numbe-ring system will last for morethan 100 years and can beused in almost all existing ana-lysis machines.

9. WebQuality for quality assurance of the analyses per-

ved the desired impact. All GPand specialists’ systems havedeveloped the functionality.However, a number of labora-tories have stopped publishingon sundhed.dk, as they needto be maintained both on re-gional systems and on sund-hed.dk.

In MedCom 7, the solution isbased on regional databaseswhich can then be exported tosundhed.dk, or alternativelyby using a direct link to the re-gional database.

8. A common national num-bering system for all laborato-ries based on 12 unique digitsand assigned from a centralserver has now been described

27


code in the dispatch. The restare expected to join in 2010.

6. The short names for IUPACor, now, NPU codes have beendrawn up and sent to the cli-nical laboratory companies forconsultation. These will be approved before the end ofthe year and published on theNational Board of Health’sLabterm website.

The project has been delayedat MedCom. It is expected that all laboratories and sund-hed.dk will use the shortnames in the course of thenext few years.

7. The appearance of labora-tory guidelines on sundhed.dkby use of the manufacturercode (subproject 5) is obvious,but the project has not achie-

Subprojects 8 to 13

formed by doctors themselves.Development of the solution iscomplete, so it is easy and ef-fective for GP surgeries to use.It will come into use in selectedlaboratories at the turn of theyear 2009/2010. The plan isthat laboratories wishing touse this service will be able todo so immediately. MedComprovides assistance with the in-troduction, among otherthings, of start-up meetings atthe laboratory and workshops.

10. Improved display of labora-tory results on sundhed.dk. In2007, MedCom’s professionalhealthcare laboratory groupdrew up a proposal to improvethe display of the results, tar-geted at the users. On thisbasis, a display module hasbeen developed for all types oflaboratory results. Develop-ment of the module is com-plete, but there has been a de-lay in putting it into use pen-ding clarification of the techni-cal solution for presentation onthe new sundhed.dk. It is ex-pected that the system will be-come operational in April 2010.

11. Test tube reception was in-troduced at a number of hospi-tals in 2009. Following adapta-tion of laboratory systems andthe introduction of changes towork procedures, it will gradu-ally come into use at a numberof laboratories over the nextfew years.

13. The Microbiology bank hasbeen established and will befully operational in January2010. It will not be possible todisplay microbiology results onsundhed.dk until the new dis-play module (subproject 10) iscomplete.

Next stepWill be started during spring2010, once a new display solu-tion is ready on sundhed.dk.

Projects

Referral for prevention

Three pilot local authorities and their suppliers are takingpart in the pilot implementa-tion of electronic communica-tion between the GP andhealthcare centre. As the exist-ing MedCom standards are

28

Local Government Denmark (LGDK) and MedCom are collabora-ting on a pilot project for local authority preventive facilities. Theexisting MedCom standards for hospital referrals and dischargeletters will be used. For this reason, experiences with the pilotproject are being collated in the use of the local authorities’preventive facilities. These are available at sundhed.dk or the regional portals. The aim is also to clarify whether phrases forhealthcare-related content can be used in terms of local authorities’ preventive facilities.

Communication between the home care sector, GP, pharmacy and hospital

91 local authorities are con-nected to the Health DataNetwork, with access to simplenotification and/or healthcare-related communication via thecorrespondence message andprescription renewal, etc. Theexpansion of the message faci-lity can be seen in the table onthis page. Some local authori-ties are in the pilot stage,while others are operational.

Home care/hospital supportby healthcare agreements2010–2011

The standards between thehome care sector and hospi-tals were updated in 2009 in

capacity can be described on aform. Practical agreements interms of discharge can benoted.

Local Government Denmarkwill finance two project con-sultants in 2009–2012 to workon dissemination and support.

In future MedCom’s documentation ofthe new versions of the home

Status

Status

In 2008–2009, the focus was on getting the home care services touse the correspondence message facility when working withpharmacies and GPs. Many local authorities are now active inthese areas. 75% of local authority home care units use electroniccommunication with GPs. With pharmacies, this is 56%. Electro-nic communication with hospitals has begun, but major dissemi-nation in this regard will only come with the new versions of thehome care/hospital standards, which were updated during2008–2009.

used, the project focuses on widening awareness of thestandards and making the op-tions for prevention visible toGPs. Appointment confirma-tion will possibly be implemen-ted in order to support theGP's function as coordinator.The hospitals can also makeuse of local authority preven-tive facilities.

In futureAs far as referral for preven-tive measures is concerned,

the long-term aim is to makethe whole work process elec-tronic.

care/hospital standards will becompleted during autumn 2009and made available in MedComto regions and local authorities.A pilot project will be conduc-ted for regions and local autho-rities wishing to take part.

The dissemination of corre-spondence will continue in thecommunication between thehome care sector, pharmaciesand GPs.

line with developments in thehealthcare agreements:

1. The admission report hasbeen changed. Functional ca-pacity can be described on aform in the admission report.In addition, the services recei-ved by the individual citizenare indicated.2. Discharge warnings arebeing changed to a nursingcare plan. The contents and fields are related to the admis-sion and discharge report.3. Notification of discharge isa new administrative servicemessage. The message will beautomatically sent off upondischarge from the hospital system.4. The discharge report hasbeen changed. Functional

Message type Number of local authorities

Correspondence 81Variation from one local authority to another as to whether correspondence used for GPs, hospitals, pharmacies

Correspondence with GP surgery 73

Correspondence to pharmacies 55

Discharge warnings 16Some local authorities receive discharge warnings by correspondence; these 16 use MedCom's warning standard

Notification 91Not all local authorities send admission replies

Prescription renewal 32Rambøll Care local authorities use the EDIFACT standard; CSC VITAE local authorities can use prescription renewal via PEM

Total number of local authorities on the Healthcare Data Network 91

Step 1: Discussion with the citizenStep 2: Doctor searches for a serviceStep 3: Doctor finds description, assessment criteria and, where

applicable, phrasesStep 4: Doctor fills in electronic referral. Send and receive electroni-

callyStep 5: Feedback to doctor (booking and discharge letter)

1.Doctor'sconsultation

3.Service4.Message

5.Localauthority service

2.sundhed.dk/regional page

being disseminated to ge-neral practice. The optionof electronic communica-tion of LÆ forms is fully in-tegrated in three GP andspecialists’ systems, and several are undergoing implementation.

At the same time as thesuppliers of GP and specia-lists’ systems are dissemina-ting the solution, a cam-paign will be required toensure that the electroniccommunication of formsbecomes used in generalpractice. There is also aneed for the design, test-ing and quality assuranceof new forms.

Status

In future

Local authority projects

DGOP – rehabilitation plans

All regions can send rehabilita-tion plans electronically inDGOP format – several are inoperation with selected hospi-tals. At the same time, all regions are working on the organisational expansion to allhospitals. The technical set-upremains complicated. DGOP istechnically based in the dyna-mic form format (DDB 0.99),while in practice only the XMLpart is used as a traditionalMedCom message. Several localauthority parties can receive inDGOP format, but it is still per-mitted to receive in correspon-dence format. GPs can only receive in correspondence format.

Copenhagen Capital RegionHas drawn up an implementa-tion package – professionallyand technically. All hospitalsmust be on board by the end of2009. As working proceduresvary from department to de-partment, the organisationalimplementation will be exten-sive. Several local authoritiesreceive rehabilitation planselectronically (Hillerød, Helsing-ør, Herlev, Gribskov, Copen-hagen).

Region of Southern DenmarkFrom the start of 2010 the planis for all hospitals and local authorities to operate theDGOP format. Today, all localauthorities receive rehabilita-tion plans electronically in correspondence format. The region works alongside CentralJutland Region in sendingacross the regional border. Theregion is also underway withthe ‘Good Electronic Rehabili-tation Plan’, which focuses on

29

Hospitals and local authorities work together with rehabilitationprocedures, and the communication is supported electronically withthe help of the communication standard for rehabilitation plans.

LÆ project

The project covers the so-called LÆ forms, which are ex-changed between the local authority and GP, typically inconnection with the processing of cases of early retire-ment pensions, sickness benefit, etc.

MedCom has worked withthe suppliers of GP andspecialists’ systems, selec-ted local authorities andKommuneinformation A/Son the development andpilot testing of the electro-nic communication of LÆforms. Communication willbe done using MedCom’sstandard for the DynamicForm.

Standards have been esta-blished for six types ofform. Kommuneinforma-tion’s NetForvaltning Sund-hed software solution pro-vides local authority admi-nistrators with access tothe electronic communica-tion of the LÆ forms. Net-Forvaltning Sundhed is atpresent used in 19 localauthorities and is currently

� During the period of theMedCom 7 project, the ho-spitals will also be able toreceive DGOP electronically.

� Several local authority sup-pliers implement the DGOPformat.

� There is a requirement to beable to forward DGOP tophysiotherapists in privatepractice in a converted cor-respondence format.

� The technical format forDGOP needs to be evalua-ted.

Status

In future

3,000

2,500

2,000

1,500

1,000

500

0

Jan

uar

y

Feb

ruar

y

Mar

ch

Ap

ril

May

Jun

e

July

Au

gu

st

Sep

tem

ber

Oct

ob

er

� Number of cases sent electronically from the local authorities, January to October 2009.

� Number of cases received and replied to electronicallyin GP surgeries, July to October 2009.

the professional content of theDGOP.

Central Jutland RegionThe plan is for all hospitals tobe able to send in DGOP formatby the end of 2009. The localauthorities are taking part insuccession. Six local authoritiestoday receive electronically.(Aarhus, Silkeborg, Herning, Viborg, Skive and Favrskov).

Zealand Region Has not participated in theMedCom DGOP pilot project.However, the region has nonetheless pilot implementedthe DGOP standard. The regionis in the process of testing usingseveral pilot local authorities(Kalundborg and OdsherredMunicipalities).

North Jutland RegionThe hospitals send in DGOP for-mat. An organisational dissemi-nation is in progress. Four localauthorities currently receive inelectronic format. (Ålborg,Brønderslev, Rebild and Jammerbugt Municipalities).

Projects

30

Common MedicationCard (FMK)

In order to have access to theFMK server, the GP surgeryneeds to have a high speed In-ternet connection and a digitalsignature. It must also be con-nected to the SDN, MedCom’sHealth Data Network.

Under the SOSI component, allthe doctor and healthcare staffhave to do is to log in once aday using a digital signature. Inthe event of technical problems,the doctor will be able to workusing their own system’s Medi-cation Card, just like today.

The hospitals have medicationsystems which perform corres-ponding data transfers via theHealth Data Network to theFMK server. The information isupdated on admission and dis-charge.

Over the coming years, the local authorities’ home care systems will also be connected.

Timetable

MedCom has entered into an agree-ment for the development of the Com-mon Medication Card solution with allGP and specialists’ systems with morethan 10 installations.

� XMO/Æskulap, Medwin and Win-PLC are involved in the developmentproject – wave 1 – in which the Com-mon Medication Card module is devel-oped along with selected GP surgeries;this will be ready in December 2009. From May 2010, the remaining GP andspecialists’ systems – wave 2 – will alsohave developed their Common Medica-tion Card solutions. Following this, alldoctors will be able to make use of thesystem. It is expected that MedCom willprovide assistance to the regions withthis rollout to the GP surgeries.� The hospitals are expected to startusing the Common Medication Cardduring 2010 and 2011. � The local authorities’ ECR system willdevelop the functionality for the Com-mon Medication Card in 2011.

The Common Medication Card is a further development of the service thathas been available through the Prescription server, where GPs can seewhat prescription-only medication has been supplied to the patient fromthe pharmacy during the past two years.

The Common Medication Card provides an overall view of a patient's full,current medication. The Medication Card is a virtual card that resides on aserver at the Danish Medicines Agency. All parties, i.e. doctors in both theprimary and secondary sector, clinicians, home care workers and patientsthemselves, will receive access to an up-to-date Medication Card. The cardobviates the need to supply lists of medicines manually, which are oftendeficient and not up-to-date.

The GP receives up-to-date information from the Common MedicationCard server automatically in their own version of the patient's medicationcard once the patient is activated or placed on the appointment orderform. All prescriptions for medication to which changes have been madeare marked. At the end of the consultation with the doctor, the medica-tion data that has been changed by the doctor, for example in the form ofa new drug, will automatically be transferred to the Common MedicationCard server. The same will occur during hospital treatment, with the on-call doctor and in the home care sector whenever the patient's medicationis adjusted.

The technique is based on SOA, Service-Oriented Architecture, in whichthe individual GP and specialists' system is connected to the Common Me-dication Data server via the Health Data Network, the SDN.

Requirement for access Who is involved, and when

Digital Health is res-ponsible for ensuringcompletion of the pro-gramme in collabora-tion with the involvedparties and contribu-tors.

The Danish regions areresponsible for the implementation of theCommon MedicationCard in both the pri-mary and secondary sector.

The Danish MedicinesAgency is responsiblefor the operation andmaintenance of thecentral part of theCommon MedicationCard.

MedCom is responsiblefor contacting and developing the GP andspecialists’ systems inDenmark which will in-tegrate with the Com-mon Medication Card.

The Common Medication Card is being developed in partnership as follows:

Common MedicationCard (FMK)� Is a depiction of theperson's current medi-cation. � Each person willhave their own medi-cation card in the medi-cation profile. � The Medication Cardcontains the relevantmedication.

Execution� Whatever the doctorgives to the patient istransferred directly tothe Medication Card viathe GP’s own system. � Dispensing by the pharmacy to the patient via the pre-scription server.

Prescription for medication� The doctor’s pre-scription on the Medi-cation Card. � Recording of a deci-sion on medication.

Prescription request� Orders to the phar-macy to supply medi-cation based on aprescription for medi-cation.� Corresponds to asingle-item prescrip-tion.� Sent to the phar-macy via the prescrip-tion server as is thecase today.

New words

GP and specialists’ systems:� Profdoc XMO/

Æskulap� Win PLC� MedWin� Novax� MyClinic� Emar� Ganglion� Multimed-Web� PC-praxis-Web� Docbase

� Ganglion� Profdoc Darwin� MedWin lægevagt

Hospital systems� Columna/Århus EPJ� Logica-Cosmic� Acure-EPM 3.0� Acure Harmoni/EMS � IBM-IPJ� CSC-Opus Medicin� Theriak � Logica Viborg EPJ

The following GP and hospital systems are included in the Common Medication Card

pany certificate.

All local authority child recordsystems have developed themodule and implemented it ina number of local authorities.

The Danish Medicines Agencyhas asked MedCom to ensurethere is integrated reportingof adverse reactions betweenthe GP and specialists’ systemsand the Danish MedicineAgency’s database.

An integrated module is beingdeveloped which will allowthe doctor to designate thedrugs for which a report onadverse effects is required.Data is captured automaticallyand comments can be added.The completed report is thensent using DGWS directly tothe Danish Medicines Agencyvia the SDN, the Health DataNetwork. The first live reportshave now been performed

The standard for the GoodWeb Service (DGWS) from Med-Com’s perspective has beenlaunched as the new standardfor integrated data exchangebetween IT systems, includingelectronic reports. The time istherefore ripe to begin stan-dardisation of GPs’ reports tothe central authorities. Cur-rently, there are two specificprojects run by MedCom thatform part of the SIP project:

Local Government Denmarkhas asked MedCom to ensurethere is integration betweenthe GP and specialists’ systems,

2. Adverse Reactions Report

1. Child Database

from the GP and specialists’ system: Docbase.

In addition, the Ministry of Health and Prevention hasasked MedCom to initiate integration between the GP systems and the NationalBoard of Health’s Cause ofDeath Register. How-ever, itwas technically difficult to de-velop this solution now, and itis no longer part of the project.

The Good Web Service (DGWS)

The MedCom standard for on-line exchange of data in thehealthcare sector. Specifies the‘envelope’ for the data ex-change, including the securitylevel when using OCES certifi-cates. Recommended by DigitalHealth as an element in the fu-ture technical infrastructure inthe Danish Healthcare System.

In the MedCom 7 period, it isexpected that the Adverse Re-actions Report and Child Data-base Report will be dissemina-ted to all GP surgeries in paral-lel with the coming into use ofthe Common Medication Card.

The GP and specialists’ systemstaking part in the CommonMedication Card project arealso taking part in SIP.

� MedCom approved� Ready 30/11� Ready 08/12� Ready 14/12� Not possible/not approved� Ready 26/11� 2010� URL� Not rel.

31

Common Medication Card (FMK) / SIP

SIP: Standardised Report from the Primary Sector

As the Internet has expanded, in recent years a number of cen-tral authorities have established a number of online reporting solutions targeted at GP surgeries. What these solutions have incommon is that they have been set up without being coordina-ted with, or integrated into, the GP and specialists’ systems. Theconsequence of this is that GPs have to work on reports in anumber of different IT systems and do not have the option of automatic reuse of data from their own record system, nor theoption to store copies of the reports produced as part of theoverall documentation in their own record system.

Technical Solution

Next step

3. Death certificate

FMK (Common Medication Card) and SIP GP and specialists' systems Child recordsystems

Status 26 November 2009

Calls to the Adverse Reactions Database

Version

RegisterDrugSideEffect (medication)RegisterDrugSideEffect (vaccine)

Calls to the Child Database:

CreateChildMeasurementReportModifyChildMeasurementReportDeleteChildMeasurementReportSetExclusivelyBreastFeedingPeriodEndReportSetExposedToPassiveSmokingReport

Pro

fdo

c X

MO

/Æsk

ula

p

No

vax

Win

PC-P

raxi

s-W

eb

Win

PLC

Med

Win

Mu

ltim

ed-W

eb

Emar

Win

Do

cbas

e

Gan

glio

n

Pro

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c D

arw

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MyC

linic

Ålb

org

Ko

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DSI

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ND

No

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Læg

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ova

x Su

nd

hed

TM S

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1.0.

1

1.0.

1

1.0.

1

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1.0.

1

1.0

1.0.

1

1.0.

1

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1.0.

1

local authority child recordsand a child database at the National Board of Health.

When children are examined,heights and weights are auto-matically collected from the GPand specialists’ system’s ChildCard and sent via DGWS to theNational Board of Health’s reporting system. The SDN (Health Data Network) is alsoused here. The data collected ischecked against correspondingdata gathered from local authority child record systems.Most GP and specialists’ systems have implemented thesolution, but a single clarifica-tion remains outstanding regarding the use of the com-

carried out of the use of e-records by hospitals, in surge-ries and among the population.In short, it showed that hospitalusers are very satisfied, whileusers in the surgeries also likethe solution, even though ittakes too long to log in. The citizens were very satisfied. People using e-records considerthemselves to be ‘the well-prepared patient’. In a minia-ture survey, around 50 cliniciansat the Lillebælt Hospital thenprovided good examples of thevalue of using e-records, andthe number of doctors using e-records here is on the rise.

There is the foundation for arelatively rapid dissemination

to the hospitals. For surgeries,MedCom is seeking to dissemi-nate a short-cut solution fromall suppliers of surgery systems.Discussions are currently takingplace with on-call doctors andspecialists about establishingaccess. Dissemination amongthe population has also beengiven a high priority, and thereare plans to coordinate effortsto inform people through bro-chures and exposure in themedia in collaboration withthe five regions.

At present, work is being doneon various measures, includingin the form of an improvedpresentation of data. These im-provements are expected to becompleted in spring 2010.Work is also taking place toestablish a superstructure for

Projects

32

e-records

At the end of 2009, data fromthe records of around 80% ofthe Danish population was re-corded on the e-records data-base.

There is access to this data inthe hospitals and here, at themoment, a short-cut solution isbeing disseminated from theestablished hospital systems.This means that a clinician whohas access to a patient’s data inthe local hospital system is ableto access data from other hos-pitals in the country. In thesame way, GPs who have a di-gital employee signature willalso have access to all this data.

Citizens have access to recorddata supplied by the hospitalsin the Copenhagen Capital Re-gion, Zealand Region and thehospitals in the former coun-ties of Viborg, Aarhus, Vejleand South Jutland. From 1 February 2010, citizens in theformer county of North Jutlandwill be given access, and Funenwill follow suit once the CosmicEPR system at OUH has sup-plied record data at the startof 2010.

Security of use is at a highlevel, and patients themselveswill be able to identify unauth-orised entries in the system insundhed.dk’s MinLog, in whichall entries from GPs and hospi-tal systems will be registered.

A major evaluation has been

e-records, where people willbe able to find explanationsof difficult clinical terms. Ef-forts are also being made toestablish a link from diagnosiscodes to Lægehåndbogen atthe website sundhed.dk.

e-records forms part of thedata source of the forthco-ming National Patient Index,which will create a summaryof data from e-records, theNational Register of Patients,electronic medication profilesand laboratory data.

The e-records project creates access to electronic record data from Danish hospitals for professionalhealthcare workers in hospitals and in general practice, as well as to citizens who have been admit-ted to the hospitals. The aim is to provide access to relevant information concerning the patient’sprevious treatments, examination results and information about allergies and adverse reactions(medication intolerances, etc.). As far as the citizens are concerned, the idea is that being able to seetheir own patient records may increase their awareness of their own illness and encourage more active involvement and better self-care. At the same time, the aim is to create a technical solution sothat clinicians can only access record data if there is a relation between the patient and the treat-ment provider. It is also an aim to be able to show the citizen all accesses made by clinicians to thecitizen’s record data.

Status

The future

e-records extracts recorddata from electronic patient records and patient administrativesystems at hospitals andmakes this available toclinicians in hospitals,surgeries and to the population.

At the annual confe-rence of the E-Health-care Observatory inOctober 2009, the majordissemination of e-re-cords among the popu-lation was named as thesecond most importantevent of the year in thearea of e-health.

Fact box

Co

pen

h.

Cap

ital

Zeal

and

Cen

tral

Jutl

and

Sou

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ark

Vib

org

N.J

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and

Data supplier Citizen GP surgery Hospitals

All All Region County regions regions

Copenhagen Bornholm 1/10/2008Capital Frederiksborg 1/10/2008

H:S 1/10/2008Copenhagen 1/10/2008

Zealand RoskildeStorstrømWest Zealand

South Denmark FynRibeSouth Jutland 1/9/2009Vejle 1/9/2009

Central Jutland RingkøbingAarhus 1/9/2009Viborg 1/9/2009

North Jutland North Jutland

� Full access � Access soon � No access

e-records / Telemedicine

Telemedicine

33

Providing access to interpretersusing video conference equip-ment instead of the interpre-ter’s physical attendance at apatient consultation providesnew opportunities for better or-ganisation of interpreting servi-ces in the Danish HealthcareSystem, including ensuring bet-ter use of interpreter resources.

The purpose of the project is toensure national disseminationof tele-interpreting by videoconference throughout thewhole of the healthcare sector.In this way, video conferenceswill be regarded as a normaltool in day-to-day clinical prac-tice, increasing accessibility tointerpreter support services andlessening the amount of timespent planning the interpreta-tion session and the waitingtime in the event of delays.

As part of the tele-interpreta-tion project, the aim is to esta-blish a national infrastructurefor video conferences, one thatcan be reused in other clinicalsituations, for example monito-ring, interdisciplinary conferen-ces, discharge conferencesbetween the secondary and pri-mary healthcare sector, training,

Establishing the possibility ofexchanging digital images ofdiabetic foot ulcers by mobiletelephone from home carenurses in the patient’s ownhome to ulcer specialists atthe hospitals frees up staff resources at hospitals and inthe home care sector, whilealso increasing the quality ofulcer treatment.

The solution ensures morerapid and better coordinatedtreatment, allowing severalpatients to avoid complica-tions and admission. The solu-

tion saves on manpower, asstaff resources in the hospi-tals can be freed up, and im-proves resource usage in theprimary sector. The solutionwas initially demonstrated inthe Region of South Den-mark, Zealand Region andeight local authorities. Testing was coordinated witha similar project in AarhusMunicipality. The long-termstrategy is national dissemi-nation.

The spearhead project is financed by the ABT Fund.

Dissemination plan for tele-interpretation

Once spearhead departments have imple-mented tele-interpretation, the individualregion will plan the regional dissemination.

The dissemination plan for the hospitals’ use of tele-interpretation is as follows:

December 2010: 25% of hospital departments with patient contact



The project is subject to the followingmain timetable:

January–March 2010: Project start-up

April–September 2010: Technical imple-mentation

October–November 2010: Organisationalimplementation

December–January 2011: Operation

February–March 2011: Evaluation

After the spearhead project, the plan isto initiate national dissemination.

Timetable for tele-ulcer treatment

Tele-interpretation Tele-ulcer treatment

The Board at Digital Health decided in April 2008 to initiate a pro-gramme for the increased use of telemedicine, home monitoringand self-care in connection with the implementation of the nationalstrategy for the digitisation of the Danish Healthcare Service. Practical implementation of the programme has been delegated toMedCom.

The purpose of the telemedicine programme is to: � ensure national implementation and dissemination of

advanced telemedicine solutions � advance telemedicine concepts for subsequent national

dissemination � assess national telemedicine concepts in respect of their

benefit potential and adaptation to the Danish infrastructure � gather and share knowledge of national and international

telemedicine concepts in relation to current clinical and healthcare policy challenges in Denmark, including running anumber of experience forums

etc. The implementation projectis financed by the ABT Fund andcovers the period 2009–2012.

The project, here and now

All five regions are actively par-ticipating in the projectthrough cooperation agree-ments with MedCom, and areinitiating testing in spearheaddepartments at the end of2009. This includes testing oftele-interpretation in up to tenlocal authorities and surgeries,where the concept has not yetbeen tested.

34

Projects

MedCom’s internationalprojects

International telemedicine projects

MedCom has an international project line whose main focus is ontelemedicine, welfare technology, infrastructure for the use of telemedicine services and standardisation of electronic communi-cation in the healthcare sector. The projects’ hallmark is that theymeet a specific healthcare-related or social need while at thesame time providing a solution to this. The results from the inter-national projects can often be transferred to national projects,which thus further build on existing experiences.

There is a wide range of activities in the department: Project management and participation in European projects, expert support to both Danish and foreign partners, the drawing up ofnew project applications, etc.

MedCom is represented in several partnerships under Europeanand international control. These activities, and participation inspecific projects, have led to extensive expertise and participa-tion in a successful network within international healthcare IT.

The international departmentat MedCom has contributed toa range of projects, in whichtelemedicine solutions havebeen tested and disseminated.

Telemedicine is about those situations where informationand communication techno-logy can be used to provide ahealthcare service digitallyover short or long distances,including providing supportwith diagnosis, treatment,prevention, research and trai-ning. Home monitoring coversthose solutions where the telemedicine service is sup-plied to the patient in theirown home.

Experience and commitmenthave enabled the internatio-nal team to contribute to buil-ding up an extensive portfolioof telemedicine solutions.

Several telemedicine solutionsthat were part of these pro-jects have now been dissemi-nated and are operational,including preparation for ope-rations from the Health Opti-mum project and the patientbriefcase for chronic patientsfrom Better Breathing.

One of the new projectsworthy of mention is:

Healthy Growth – a projectwhere a range of telemedi-cine, welfare technology solu-tions and aids are beingdeveloped, including the patient briefcase for COPD patients and robot technologyrehabilitation chips for apo-plexy patients.

The most recently completedprojects include, among others:

Health Optimum – a projectfocusing on healthcare servi-ces and clinical cooperationover long distances using digi-tal images/systems and videoconference equipment.

Better Breathing – a projectwhere a ‘patient briefcase’given to patients with smo-ker’s lung (COPD) enabledthem to be discharged earlierfrom hospital. The patient briefcase allowed the health-care professionals to monitorthe patient's condition andcarry out consultations overshorter or longer distances.

R-Bay – a project where radio-logical assignments and expertknowledge are offered acrossEuropean national borders.

Pho

tog

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h: N

iels

Nyh

olm

35

International projects

Welfare technology is user-oriented technology, especial-ly for elderly people and/orpersons with chronic illnessesor disabilities. The technologymakes it possible to deliverwelfare services in a new waythat can both increase securityand guarantee mobility andday-to-day tasks. The aids maybe sensors, fall alarms or robottechnology such as robot vacuum cleaners, etc. In thisway, welfare technology atthe same time can contributeto more efficient public or private service production.

The aim of welfare technologyis for the cold technology toprovide more resources to thewarm hands of the social sec-tor. On the one hand, thetechnology will help to im-prove working conditions andfree up time for staff in theservice professions and, on theother, improve the quality ofpublic sector welfare servicesat the same time as providingeconomic improvements inthe area.

MedCom is already involved invarious welfare technologyprojects. These include the

The international projects willcontinue to be conducted as aclose collaboration betweenregions or local authorities,and will therefore remainclose to the local and/or natio-nal measures taking place elsewhere in MedCom.

From 2010, there will be 12 international projects in MedCom. Many of these havethe status of pilot projects,which with EU funds willallow new, wide-reaching

International welfare technology projects

The future

DREAMING project, which covers home monitoring of elderly people with chronic ill-nesses in Langeland Municipa-lity and the PERSONA project,which tests advanced welfaretechnology services in OdenseMunicipality.

Challenges

Telemedicine and welfaretechnology are more than justa technological solution andthere are therefore certainchallenges involved. The ob-stacles includes organisationalchallenges, among othersthose due to new clinical pro-cesses in the delivery of newtreatment options.

The culture, too, especially ininternational projects, is a fac-tor which needs to be conside-red in telemedicine and wel-fare technology solutions, astraining, nationality, socialnetwork, etc., affect access tonew technology. There arealso the legal aspects, in whichpatient rights, responsibilityand the granting of licencesare the key words.

Resolution of the many challenges and accompanying newaspects of telemedicine is being attempted, among otherplaces, in the Metho-Telemed EU project, in which MedComis a partner.

The Metho-TeleMed project gathers knowledge and skillsfrom international academic expertise, European networksand the WHO in order to develop guidelines for the metho-dologies used in investigating telemedicine solutions in Europe. The main purpose of the project is to propose me-thodologies for the examination of telemedicine solutionsfor use in academic trials and policy decisions. The methoddevised in MethoTeleMed will be tested, among other pla-ces, in the forthcoming EU project, RENEWING HEALTH.

Evaluation opportunities with telemedicine

technological solutions to betested, from telemedicine andstandardisation to welfaretechnology. The projects willbe targeted at some of thespecific challenges facing thehealthcare and social sector inthe coming years, and it is tobe hoped that the interna-tional projects can be involvedin resolving these.

Among other things, welfaretechnology is an area whichthe international projects inMedCom will focus on in thefuture.

Pho

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son

36

Technology, key figures, names

Toolkit

Communication standardsApproved standardsTesting and certificationHealth Data Network (SDN)Video node

Statistics

MedCom – the Danish Health Data NetworkMedCom projects – dissemination as a percentageNumber of messages, September 2009Laboratory requests and referrals per monthProviders with EDI, September 2009Correspondence, pharmaciesGP and specialists’ systems, all doctorsCorrespondence messages, all-to-all, September 2009Development at local authority levelHealth Data Network’s nodee-records

Names

Steering GroupPrimary GroupInfrastructure GroupMedCom

Back cover

Total number of messages per month

Techn

olo

gy,key

figu

res,nam

es

37

Toolkit

Toolkit

MedCom provides a range of different services to the healthcaresector. As well as project organisation and management, thisincludes:

� Communication standards� Testing and certification� The Health Data Network, SDN� Video node

Communication standards

Since 1994, MedCom has devised a wide range of standards fordata exchange between parties in the healthcare sector. Today,there are over 60 different standards, which for the most part arebased on international UN-EDIFACT standards. Once they havebeen adapted to Danish conditions they are available in both anOIO-XML version and an EDIFACT version. They all follow the national OIO standardisation rules.

All new standards are based on OIO-XML. In future, no EDIFACTversions will be developed.

To support the national strategy based on SOA, Service-OrientedArchitecture, a number of web service standards have been devel-oped, all of which support DGWS (the Good Web Service) andDDB (the Dynamic Form).

Maintenance and further development of DGWS and DDB ishandled by SDSD, Digital Health.

Good EDI and XML letters

The document ‘Good EDI letters’ provides a detailed descriptionof MedCom’s EDIFACT standards, which have gone through quality assurance and a technical review with the aim of impro-ving EDI communication in the healthcare sector. All the stan-dards will be subject to modernisation and updating in 2009 and2010, thus consolidating all the corrections and good ideas of thepast ten years.

Under each message type you will find the complete documenta-

To support the work done by IT suppliers and regional supportstaff in the implementation and maintenance of standards andthe conversion between XML and EDIFACT, MedCom has devel-oped a web-based testing and conversion tool. It can be found at www.medcom.dk or directly at the address, http://web.healthtelematics.dk/xmledi

tion required for developing and implementing the relevant mes-sages, along with a reference to a number of test examples.

An XML standard

The document ‘Good XML letters’ contains an XML translation ofthe EDI documentation for the protocol for standardising data inthe public sector, OIO.

The PLO-XML format

The PLO format is used to exchange records between GP and spe-cialists’ systems. The suppliers of GP and specialists’ systems haveentered into an agreement for the joint use of this. A new versionbased on OIO-XML is under development by MedCom and is ex-pected to be ready in 2010.

38

Toolkit

Letter type EDIFACT XML

Discharge letter DIS01 XDIS01Outpatients discharge letter DIS02 XDIS02Casualty discharge letter DIS03 XDIS03Radiology report DIS05 XDIS05On-call GP service summary DIS06 XDIS06Specialist discharge letter DIS07 XDIS07Appointment confirmation DIS13 XDIS13Physiotherapy discharge letter DIS08 XDIS08Letters of correspondence DIS91 XDIS91

Hospital referral REF01 XREF01X-ray referral REF02 XREF02Specialist referral REF06 XREF06

Laboratory results RPT01 XRPT01Pathology results RPT04 XRPT04Cervical cytology results RPT03 XRPT03Microbiology results RPT02 XRPT02

Laboratory request REQ01 XREQ01Pathology request REQ03 XREQ03

Laboratory repertoire of analyses DAO01 XDAO01

GP billing RUC01Specialist billing RUC02Dentist billing RUC03Physiotherapy billing RUC04Pharmacy billing RUC05Chiropractor billing RUC06Laboratory billing RUC07On-call GP billing RUC08Nationwide billing RUC09Psychologist billing RUC10Podiatry billing RUC11

Admission notification DIS20 XDIS20Admission reply DIS14 XDIS14Discharge notification DIS17 XDIS17Admission report DIS16 XDIS16Discharge report DIS18 XDIS18Notification of discharge DIS19 XDIS19Nursing care plan DIS21 XDIS21Home care status DIS95

Notification of birth DIS32

Approved standards

Letter type EDIFACT XML

Trigger message PID01Personal master data message PID02Patient master data message PID03 Allergies and adverse reactions

message PID04Continuing state of health PID05

Prescription PRE01 XPRE01System prescription renewal PRE60 XPRE60

Negative VANS acknowledgement CTL01 XCTL01Negative acknowledgement CTL02 XCTL02Positive acknowledgement CTL03 XCTL03

Physiotherapy referral REF07 XREF07

Podiatry referral REF08

Binary document transmission BIN01 XBIN01

Psychology referral REF10 XREF10Psychology discharge letter DIS10 XDIS10

Administrative correspondence DIS90 XDIS90

The Dynamic Form

Request for status certificate LÆ121Status certificate LÆ125Request for general health certificate LÆ141General health certificate LÆ145Request for specific health certificate LÆ131Specific health certificate LÆ135Request for certificate confirming ability to

take on work LÆ251Certificate confirming ability to take on work LÆ255Request for certificate confirming chronic illness LÆ221Certificate confirming chronic illness LÆ225Request for certificate confirming illness in

connection with pregnancy LÆ231Certificate confirming illness in connection

with pregnancy LÆ235

Rehabilitation plan DGOP XDGOP

Web Services

The Good CPR Consultation AccessThe Good Adverse Reactions ReportThe Good Child Database ReportLaboratory access, sundhed.dkThe Good Patobank Web ServiceThe Good Request Database

39

Toolkit

� Testing � Assistance with investigation into issues of doubt � Help to suppliers and users in solving EDI/XML communi-

cation problems � Information and guidelines to new suppliers and new

technicians� EDI/XML courses� Maintenance of tables

Testing and Support can be contacted at: [email protected] by telephone on +45 6543 2030 on all working days.

MedCom offers

Testing and approval is supported by:

� Online testing tools for all MedCom’s EDIFACTs and XMLstandards.

� Online access to testing and documentation tools in theform of the SDSD validator of web service solutions.

� Appropriate test examples for each individual standard.� Test scripts reflecting the tests which a system must

undergo to obtain MedCom approval.� Summaries of which systems and versions are approved

for current messages.� Support/hotline from MedCom on all working days.

A typical course of testing for obtaining approval of a MedCom standard takes the following form:

1. Syntax check in MedCom performs checks, performcheck yourself. Does it comply with recommendations/does it work?

2. Semantics check, screen dump, examples.Input/create test examples.Is all the content present?Is it displayed in the correct context?Is data being retrieved correctly?

3. User interface, on-site.Is it logical?Is data being retrieved correctly? Run through the testscript.Good advice, guidelines on layout.

4. Live test, on-site.Process production data.Run through test script using this data.

5. Publication of approved system on MedCom’s website.

Testing and approval

Testing and certification

EDI/XML test, hotline and support centre

When using MedCom messages and web services to communi-cate, it is vitally important that both the sender and recipient useMedCom’s standards and that the syntax and content are exactlyidentical. If this is not the case, errors or a misunderstanding willarise when the message is received.

To guarantee this consistency, it used to be necessary to test thestandards in local pilot projects, for each provider in turn, andthen gradually adapt the systems.

This process was particularly time- and resource-consuming for allthe parties involved. However, the introduction of the Good EDIletters, the Good XML letters and the Good Web Services guidesmarks an attempt to make the documentation of standards so accurate that it would basically be possible to carry out the neces-

sary standardisation process for the sender and recipient systemsduring testing before commissioning.

MedCom offers testing and certification of all systems that needto communicate in the healthcare sector, as well as help in imple-menting the MedCom standards and support in solving EDI/XMLcommunication problems.

Approved systems

Systems approved by MedCom are published at www.medcom.dkunder the menu item ‘MedCom – godkendte systemer’ (‘MedCom– approved systems’).

Health Data Network’s node

Pharmacy network

GP surgery Specialistsurgery

Chiropractorsurgery

NIP

e-records(CSC)

Form server(KI)

The DanishMedicines

Agency

HealthcareAgency

sundhed.dk

Router

DNS

RegionNorth Jutland

RegionCentral Jutland

RegionSouth

Denmark

RegionZealand

RegionCopenhagen

Capital

VDX

GP and speci-alists’ system

Privatehospital KPLL

Foreigncooperation

partners

KMD

Local authorities

Local authorities

Internet(Encrypted

VPN)

Router

Fixed connections

40

Toolkit

Health Data Network (SDN)

The Health Data Network (SDN) can offer the entire healthcaresector new opportunities for communication in matters of health-care. The SDN can be used, for example, to establish web servicecommunication, consult external databases, exchange images andhold video conferences. There is also the fact that the commonpublic eHealth portal sundhed.dk uses the SDN as a channel forconnecting to the basic systems in the healthcare sector.

This allows the SDN to supplement the VANS-based Health DataNetwork, which offers the option of using EDIFACT for communi-cating text messages.

The philosophy behind the SDN is that the parties in the health-care sector will have all their communication needs met via thesingle same network connection. This makes the network theelectronic collection point for communication in the healthcaresystem, regardless of whether the users belong to the public orprivate sector.

The SDN comprises a single central node which all the traffic pas-ses through between the various agencies. This node is monitored24/7 and is redundant. To connect to the SDN, users need to esta-blish an encrypted VPN (Virtual Private Network) connection viathe Internet or a permanent connection from their own securenetwork to the SDN’s node.

Migrating from message-based to online communication in thehealthcare sector will, by its very nature, impose major, ever-growing demands on the capacity, stability, speed and central monitoring capability of the entire Health Data Network (SDN).This means that a radical upgrade will be required of the currentHealth Data Network.

The practical possibilities here are being dealt with in a new con-tract for the operation and further development of the SDN; thiswill run in the period 2010–2015, with the option of extendingfor up to a further two years. The contract takes into account:

� enhancement of the SDN node (basic service)� central responsibility for SDN connections to the node (option)� prioritisation of SDN traffic/quality of service (option)

41

Toolkit

Video node

In November 2009, MedCom established VDX, a national node forvideo conferences in the healthcare sector. The solution is basedon the standard products already available in this field.

VDX has been set up in order to be able to reuse to the greatestextent possible local video communication solutions, irrespectiveof the platform on which they are established. VDX will primarilysupport the H.323 and SIP video standards, with the option of ex-panding to cover other video conferencing protocols. VDX will co-ordinate the application of a common addressing and numberingsystem (URI, ENUM, GDS) and will make a common address bookavailable via H.350.

VDX will also include the option to allow more than two partiesto take part in a video conference at the same time, MCU. Prima-rily, VDX will communicate with local video conferencing gate-ways through the Health Data Network (SDP) via IP, but it willalso include gateway functionality to the Internet in general, withthe option of expanding to the 3G mobile network and ISDN ifthere is a demand for this. As far as the user is concerned, it willbe possible to use standard video conferencing equipment thatsupports standard video conferencing protocols, such as H.323 orSIP.

The users will, therefore, have a free rein when purchasing videoconferencing equipment, provided they adhere to the usual stan-dards. This also makes the best possible use of video conferencingequipment already purchased.

The types of video conference equipment expected is from suchas Tandberg, Polycom, Cisco or LifeSize, ranging from software-based webcam solutions through dedicated hardware-based solu-tions to comprehensive telepresence solutions. In terms of quality,video streams up to HD quality are supported.

42

Statistics

1,500,000

1,400,000

1,300,000

1,200,000

1,100,000

1,000,000

900,000

800,000

700,000

600,000

500,000

400,000

300,000

200,000

100,000

Year 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

MedCom – The Danish Health Data Network

Number of messages per month

Discharge

Prescriptions

Lab results

Lab requests

Referrals

Billing

43

Statistics

MedCom projects –dissemination as a percentage

No

rth

Ju

tlan

d R

egio

n

Cen

tral

Ju

tlan

d R

egio

n

Reg

ion

of

Sou

ther

n

Den

mar

k

Zeal

and

Reg

ion

Co

pen

hag

en C

apit

al

Reg

ion

KPL

L

SSI

Un

ilab

s

Positionat 31 October 2009

Dissemination > 50%Project startedNot started

EDI GPs % 100 100 99 100 100EDI full-time specialists % 85 95 95 96 97

Discharge letter 100 100 100 100 100Outpatients discharge letter 100 100 99 100 80Casualty discharge letter 100 100 90 100 100Radiology report 100 100 100 100 100On-call GP service summary 100 100 99 100 100Specialist discharge letter 85 95 95 96 97Physiotherapy discharge letter 55 55 55 55 55Appointment confirmation 90 75 100 80 15

Admission referral 75 80 95 60 40X-ray referral 90 85 99 90 40Specialist referral 100 100 100 100 100Physiotherapy referral 95 95 95 95Psychology referral 50 50 50 50

Clinical chemistry results 100 100 99 100 100 100 100 100Pathology results 100 100 99 100 100Clinical microbiology results 100 100 99 100 100 75Clinical immunology results 0 100 90 100 60

Clinical chemistry request 75 90 98 98 98 98Pathology request 75 90 100 100 98Clinical microbiology request 75 90 100 100 98 20

GP billing 100 100 100 100 100Specialist billing 100 100 100 100 100Pharmacy billing 95 95 95 95 95Dentist billing 100 100 100 100 100On-call GP billing 100 100 100 100 100Physiotherapy billing 100 100 100 100 100

SSI billing 100 100 100 100 100 100Unilabs billing 100 100 100 100 100 100KPLL billing 100 100 100

25 Doctors’ prescriptions 100 90 90 90 7517 On-call doctors’ prescriptions 100 100 100 100 100

Pos. acknowledgement hosp. referralPos. acknowledgement X-ray referral

44

Statistics

Number of messages,September 2009

Number of electronic messages as percentage of possible messages (Total number: 5,042,346)

% No. Region

99.22 1 South Denmark 98 98 99 95 99 97 10098.53 2 Central Jutland 97 72 99 95 90 94 6597.54 3 North Jutland 98 83 99 90 99 100 6592.79 4 Zealand 94 70 99 98 99 84 7073.80 5 Copenh. Capital 75 43 99 98 99 63 8199.00 A KPLL – – 99 98 100 – –56.46 B SSI – – 59 10 100 – –77.39 C Unilabs – – 80 0 100 – –

Total 92 73 99 96 96 88 76

Dis

char

ge

Ref

erra

l

Lab

res

ult

s

Lab

req

.

GP

bill

ing

Pres

crip

-ti

on

Loca

l au

tho

riti

es

Number of messages sent by GPs

% No. Region

99.22 1 South Denmark 1039 11635 95170 21493 14370 26468 14884 1197 5240 32747198.53 2 Central Jutland 2397 6743 87068 18661 12612 20918 8679 1560 5079 31746097.54 3 North Jutland 1449 6087 31500 7181 3916 10482 6706 837 3150 17048692.79 4 Zealand 1399 3005 57.023 7829 6928 10.853 8494 1230 3286 19151373.80 5 Copenh. Capital 2669 6564 37267 32269 19976 15653 5267 2852 7928 27331599.00 A KPLL – – 73662 – – – – 4 – –56.46 B SSI – – 6430 0 – – – 16 – –77.39 C Unilabs – – 0 – – – – 16 – –

Total 8953 34034 388120 87433 57802 84374 44030 7712 24683 1280245

GP

lett

ers

Co

rres

po

n-

den

ce

Lab

tes

tre

qu

ests

Mic

rob

iol.

req

ues

ts

Path

olo

gy

req

ues

ts

Ref

erra

ls

to h

osp

ital

X-r

ay

refe

rral

s

Bill

ing

BIN

d

ocu

men

t

Pres

crip

-ti

on

s

Number of messages sent from hospitals

% No. Region

99.22 1 South Denmark 31087 136856 18476 36354 210509 38431 21443 19185 5135 52433 2751 4345 4645998.53 2 Central Jutland 31924 95938 16203 24045 210582 21951 12028 472 7804 17813 326 2 3104894.81 3 North Jutland 10643 42502 5651 11908 140551 10844 5383 980 133 16895 0 0 2180790.74 4 Zealand 17193 55099 9698 13313 96382 8766 7410 167 10553 15835 231 0 2596679.49 5 Copenh. Capital 55806 43979 29579 8794 72279 40761 20744 211 20789 4229 1516 1 6429199.00 A KPLL – – – – 153988 – – 0 – – – –56.46 B SSI – – – – 9931 20526 – – – – – –60.00 C Unilabs – – – – 7159 – – – – – – –

Total 146653 374374 79607 94414 901381 141279 67008 21015 44414 107205 4824 4348 189571

Dis

char

ge

lett

er

Ou

tpat

ien

tsd

isch

. let

ter

Cas

ual

ty d

is-

char

ge

lett

er

Rad

iolo

gy

rep

ort

Bio

chem

istr

yre

sult

s

Mic

rob

iolo

gy

resu

lts

Path

olo

gy

resu

lts

Co

rres

po

nd

.se

nt

Pres

crip

tio

ns

Ap

po

intm

ent

con

firm

atio

n

Ref

erra

ls

forw

ard

ed

Forw

ard

ed

X-r

ay r

efer

rals

To lo

cal

auth

ori

ties

45

Statistics

Messages to/from On-call doctors Pharmacies Dentists

% No. Region

99.22 1 South Denmark 84705 2097 102 10818 1085 403 5016 10820 17098.53 2 Central Jutland 46830 184 158 9785 1264 52 9041 3691 16097.54 3 North Jutland 24162 3 726 5549 556 132 3181 4491 8092.79 4 Zealand 32475 364 15 7783 877 76 4572 1061 11973.80 5 Copenh. Capital 57946 250 0 16480 1702 133 9232 2862 136799.00 A KPLL – – – – – –56.46 B SSI – – – – – –77.39 C Unilabs – – – – – –

Total 246118 2998 1001 50415 5484 796 31042 22925 1896

Dis

char

ge

lett

er

Ho

spit

alre

ferr

als

X-r

ay

refe

rral

s

Pres

crip

-ti

on

s

Bill

ing

Co

rres

po

n-

den

ce

Do

se

dis

pen

sin

g

Loca

l au

tho

rity

pre

scri

pt.

ren

ewal

s

Bill

ing

Number of messages,September 2009

Ref

. fro

mR

EFH

OST

Dis

char

ge

sum

mar

ies

Co

rres

po

n-

den

ce

Lab

tes

tre

qu

ests

Mic

rob

iol.

req

ues

ts

Path

olo

gy

req

ues

ts

Ho

spit

alre

ferr

als

X-r

ay

refe

rral

s

Bill

ing

BIN

d

ocu

men

t

Pres

crip

-ti

on

s

Dis

char

ge

lett

er

Ref

erra

l re

ceiv

ed

Bill

ing

Co

rres

po

n-

den

ce

Co

rres

po

n-

den

ce

Dis

char

ge

lett

er

X-r

ay

refe

rral

Bill

ing

Dis

char

ge

lett

er

Ref

erra

l re

ceiv

ed

Bill

ing

Co

rres

po

n-

den

ce

To ho

spit

als

Number of messages sent by specialists

% No. Region

99.22 1 South Denmark 19575 29816 11915 438 3616 1987 159 107 503198.53 2 Central Jutland 19266 23560 1754 47 2440 597 167 78 758097.54 3 North Jutland 8333 10152 605 1274 453 53 1 239692.79 4 Zealand 18110 20808 1399 98 1429 776 133 22 520773.80 5 Copenh. Capital 65200 63705 2173 88 4393 1434 527 24 1449999.00 A KPLL – – – – – – – – –56.46 B SSI – – – – – – – –77.39 C Unilabs – – – – – – – – –

Total 130484 148041 17846 671 13152 5247 1039 232 34713

Messages to/from Physiotherapists Chiropractors Psychologists Local auth.

% No. Region

99.22 1 South Denmark 1789 6614 284 191 237 0 20 26 217 616 33 217 574398.53 2 Central Jutland 2439 7533 348 74 93 0 14 36 190 449 37 325 301097.54 3 North Jutland 1130 3871 121 48 20 0 0 4 102 374 7 122 338992.79 4 Zealand 854 5481 156 98 72 0 19 12 195 563 23 238 293873.80 5 Copenh. Capital 1710 11276 271 60 121 0 0 353 290 1408 582 429 1233899.00 A KPLL – – – – – –56.46 B SSI – – – – – –77.39 C Unilabs – – – – – –

Total 7922 34755 1180 471 534 0 53 431 994 3410 682 1331 27418

Number per month

46

Statistics

Laboratory requests per month

Referrals per month

100

90

80

70

60

50

40

30

20

10

0North Jutland Central Jutland South Denmark Zealand Copenhagen Capital

600,000

550,000

500,000

450,000

400,000

350,000

300,000

250,000

200,000

150,000

100,000

50,000

0

Providers with EDI, September 2009

� Percentage of GPs� Percentage of full-time specialists

� Percentage of part-time specialists� Percentage of physiotherapists

� Percentage of chiropractors� Percentage of psychologists

Laboratory requests per monthand referrals per month

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Correspondence message DIS91

Phar

mac

y

Phys

io-

ther

apis

t

Loca

l au

tho

rity

Gen

eral

p

ract

itio

ner

Spec

ialis

t p

ract

itio

ner

Psyc

ho

log

ist

Ho

spit

al

Mai

n t

ota

l

Rec

ipie

nt

47

Statistics

5,500

5,000

4,500

4,000

3,500

3,000

2,500

2,000

1,500

1,000

500

� 1. MedWin 653� 2. Æskulap 615� 3. Novax 489� 4. PLC 210� 5. Emar 207� 6. Darwin 205� 7. Ganglion 151� 8. PC-Praksis 140� 9. MediCare 109

� 10. Docbase 103� 11. MultiMed 94� 12. MyClinic 46�� 13. Total others 19

Dan-Med-soft 2Patina 7

� Medol 1Formatex 1Other 8

GP and specia-lists’systems,all doctors

Correspondence,pharmacies

Correspondence messages, all-to-all, September 2009

Correspondence messages, all-to-all, September 2009

Sender

Other 3 3842 820 72 4737Pharmacy 18 545 226 4 793Physiotherapist 71 337 59 4 471Chiropractor 2 512 7 13 534Local authority 4653 48 78 12650 7 13746 31182General practitioner 63 84 16324 14114 1258 8 2038 33889Specialist practitioner 668 79 11860 3794 94 1323 17818Private hospital 24 269 19 104 416Psychologist 1285 44 1 1330Hospitals 12406 8211 79 312 21008

Total 4734 802 29530 53306 6091 102 17613 112178

Mths.Year

3 5 7 9 11 1 3 5 7 9 112008 2009

Messages per month to pharmacies

Messages per monthfrom pharmacies

1

2

6

7

8

910

11 12 13

5

3

4

48

Statistics

Development at local authority level

Home care to surgery communication 2007–2009.Number of messages per year.

� Correspondence to GPs� Correspondence from GPs� Prescription renewal

Home care-hospital communication 2007–2009.Number of messages per year.

� Correspondence from hospitals� Correspondence to hospitals� Admission report

25,000

20,000

15,000

10,000

5,000

0

2007 2008 2009

100,000

90,000

80,000

70,000

60,000

50,000

40,000

30,000

20,000

10,000

0

2007 2008 2009

200,000

180,000

160,000

140,000

120,000

100,000

80,000

60,000

40,000

20,000

0

2007 2008 2009

Home care-pharmacy communication 2007–2009.Number of messages per year.

� Correspondence from pharmacy� Correspondence to pharmacy

Number of patientsNumber of consultations � Hospital consultations per quarter� Citizen consultations per quarter

Number of records in databaseUnique persons in database

49

Statistics

Bn.12

11

10

09

08

07

06

05

04

03

02

01

6,000,000

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

0

30,000

25,000

20,000

15,000

10,000

5,000

051 2 3 4

061 2 3 4

071 2 3 4

081 2 3 4

091 2 3

Health Data Network’s node

e-records

Traffic volume via the Health Data Network’s (SDN)node in billions of kbytes per quarter 2006–2009.

A list of those connected to the network is available at: www.medcom.dk/wm110045

Detailed statistics about the SDN’s usage are availableat: www.medcom.dk/wm110451

QuarterYear

QuarterYear

1 2 3 4 1 2 3 4 1 2 3 4 1 2 32006 2007 2008 2009

1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 32005 2006 2007 2008 2009

50

Names

Title Name Organisation

Head of Department Vagn Nielsen Ministry of Health and PreventionChief of Section Mogens Køllner Ministry of Health and PreventionDirector Otto Larsen Digital HealthChief of Section Peter Kjærsgaard Pedersen Local Government DenmarkDevelopment Manager Sven-Åge Westphalen National Board of Social ServicesChief Consultant Maria Antonsen Ministry of FinanceChief of Section Lisbeth Nielsen Danish RegionsIT Director Jan Kold Copenhagen Capital RegionHospital Adm. Director, OUH Jane Kraglund Region of Southern DenmarkChief of Section Mogens Engsig-Karup Central Jutland RegionIT Development Manager Henrik Bruun Danish Pharmaceutical AssociationDirector Morten Elbæk Petersen sundhed.dkDoctor Jens Parker LægehusetDirector Henrik Bjerregaard Jensen MedCom

IT Consultant Karin Hedegaard North Jutland RegionInformation Officer Claus Bendtsen North Jutland RegionVice Director Ole Filip Hansen Central Jutland RegionConsultant Thomas Koldkur Bitsch Central Jutland RegionDeputy Chief of Section Tove Lehrmann Region of Southern DenmarkProduct Manager Morten Hansen Region of Southern DenmarkIT Consultant Lene Paulin Thomsen Region of Southern DenmarkIT Special Consultant Jens Henning Rasmussen Zealand RegionSpecial Consultant Peter Jan Pedersen Copenhagen Capital RegionSpecial Consultant Annette Lyneborg Nielsen Copenhagen Capital RegionSpecial Consultant Mette Harbo Copenhagen Capital RegionIT Group Manager Kirsten Skovrup Aalborg MunicipalitySpecial Consultant Hanne Linnemann Aarhus MunicipalityConsultant Dorthe Juul Andersen Odense MunicipalityIT Specialist Søren Skafte Jensen Lolland MunicipalityProject Manager Merete Halkjær Copenhagen MunicipalityConsultant Physician Steen Hoffmann Statens Serum InstitutIT Manager Niels Hornum KPLLSection Manager Karin Rokvist UnilabsChief of Section Jørgen Nørskov Nielsen Central Jutland RegionDelivery Manager Jeppe Højholt Nielsen CSC Scandihealth A/SBusiness Development Manager Ole Lauridsen Systematic Software Engineering A/SSystem Planner Michael Johansen Logica Danmark A/STeam Manager Anne-Mette Oudrup CSC Scandihealth A/SDirector Freddy Christensen ProfdocHead Technical Consultant Niels Heikel Vinther KMDKey Account Manager Tine Guldbæk PROGRATOR | gatetradeConsultant Charlotte Meyer Henius Local Government DenmarkDoctor Jens Parker LægehusetAnaesthetics Specialist Jens Nørreslet Vejle Anaesthesia and Pain ClinicIT Development Manager Henrik Bruun Danish Pharmaceutical AssociationProject Team Member Jens Rastrup Andersen sundhed.dkAdministration Manager Martin Bagger Brandt Danish RegionsProject Manager Ivan Lund Pedersen Digital HealthSecretary Benthe Dahl National Board of HealthProject Manager Lene Asholm National Board of HealthAcademic Executive Claus Bo Jørgensen Danish Medicines AgencyData Consultant Anfinn Leivsson Hansen Zealand RegionDirector Henrik Bjerregaard Jensen MedComDeputy Manager Ib Johansen MedComChief Consultant Lars Hulbæk MedComChief Consultant Christina E. Wanscher MedComConsultants Jens Rahbek Nørgaard MedCom

Dorthe Skou Lassen MedComRikke Viggers MedComKarin Demkjær MedCom

Secretary Iben Søgaard MedComProject Team Member Gitte Henriksen MedCom

Ste

eri

ng

Gro

up

Pri

mary

Gro

up

51

Names

Title Name Organisation

Network Administrator Jan Mørkholt Pedersen North Jutland RegionOperations Manager Erling Wad Sørensen Central Jutland Region – RM-ITNetwork Specialist Peter Vej Nørgaard Central Jutland RegionIT Consultant John Berthelsen Region of Southern DenmarkSystem Consultant Jan Stokkebro Hansen Copenhagen Capital RegionIT Architect Anders Skovbo Christensen Copenhagen Capital RegionIT Special Consultant Søren Bonde-Andersen Copenhagen MunicipalityIT Architect Esben Poulsen Graven Digital HealthConsultant Charlotte Meyer Henius Local Government DenmarkConsultant Martin Thor Hansen Danish RegionsIT Development Manager Henrik Bruun Danish Pharmaceutical AssociationIT Service Manager Steen Hernig Danish Medicines AgencyOperations Coordinator Jakob Uffelmann sundhed.dk

Steen K. Christensen KMD A/SService Delivery Manager Bente Jensen KMD A/SKey Account Manager Tine Guldbæk PROGRATOR | gatetradeMarketing Manager Claus Roost-Ørsnæs EG Data Inform MedWinDirector Freddy Christensen ProfdocDirector Erik Jacobsen Datagruppen Vejle MultiMed ApSTechnical Architect Lars Haugaard CSC Scandihealth A/SDivision Director Martin Bech UNI-CChief Consultant Ib Lucht UNI-CChief Consultant Lars Hulbæk MedComConsultant Peder Illum MedComSecretary Iben Søgaard MedCom

Director Henrik Bjerregaard JensenDeputy Manager Ib JohansenChief Consultants Lars Hulbæk

Christina E. WanscherConsultants Jens Rahbek Nørgaard

Peder IllumKarin DemkjærDorthe Skou LassenRikke ViggersKate KuskAnne DanborgSusanne NoesgaardLone HøibergStina Lou SørensenJane ClemensenJacob GlasdamJanne RasmussenSigne DyrehaugeNiels RossingMargit RasmussenLone Staun PoulsenCharlotte Beck

Project Team Member Gitte HenriksenProject Secretary Mie MatthiesenProject Assistant Jennie SøderbergFinance Specialist Anita FolleraasSecretaries Iben Søgaard

Pia Reinhardt JuelStudent Assistants Sille Annette Larsen

Casper MarcussenMette Atipei Craggs

Assistants Alis JørgensenDiana Lund Andersen

Infr

ast

ruct

ure

Gro

up

Med

Co

m

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

Status report, MedCom 6

93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09

MedComRugårdsvej 15, 2.salDK-5000 Odense C, DenmarkTelephone no.: +45 6543 2030Fax no.: +45 6543 2050www.medcom.dk

The columns show the total number of messages per month.

Published by MedCom December 2009 Editors: Susanne Noesgaard Writing, editing and design: arkitekst kommunikationGraphic design: Christen Tofte Grafisk Tegnestue Printed by: one2one A/S Print run: 1500 ISBN no. 9788791600135

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