Implementation of eHealth
       Interoperability.
Perspectives of a Member State
           Denmark

          Niels Ross...
Denmark

          •5.45 mil. Citizens
          •Area: 43.000 km²
          •Highest point:171 m!
          •High Broadba...
5 Regions: Health Care
 98 Municipalities: Home
          care
   -60 Public hospitals
 -Small private hospitals
     - 20...
eHealth movers in Denmark

•   High Connectivity
•   Uniform healthcare provision
•   Fairly simple insurance system
•   1...
Challenges


•   Shortage of Skilled Human Resources
•   Combat against Patients’ Waiting Lists
•   Investm’t Plans but no...
Major Services

• We have:
  •   - National Hosp. Pat. Regist. (1977)
  •   - MedCom (1994)
  •   - Telemedicine (2000)
  ...
International reports

                 •         “Our analysis of available
                     English-language literat...
Hospital
50%


                                 LAB RAD
                      EPR
      Primary Care
                     ...
IT use among GPs             (empirica)




  december 2009   Medcom15                8
Connected Health



                     Internet-
                      based               Public
 Practising          N...
Interoperability at National Level

•   - 12 Hospital PAS/EPR vendors
•   - 12 Primary EPR vendors
•   - 11 Laboratory ven...
The Health Portal
National and Regional
                                      Den fælles offentlige sundhedsportal
       ...
Access for Citizens
Medication Profile
Consent


• Patients consent is needed whenever
  confidential information is shared with other
  health care professional...
Access for Professionals
eRecord
The Health Data Network
Secure Health Data Network

• Connecting existing secure networks with
  Virtual Private Network (VPN) to a central node.
...
The Danish Domain of Trust

• Three level of ”access” on the Danish Health Data
   Network:
1. VPN network:
   Everyone ge...
Efficiency of Infrastructure

• Today, more than 70 organisations within healthcare is
  connected to the IP-based Health ...
Over 5 million messages/month
Danish Lessons over 15 years

 • Start with the basic needs
 • Make consensus projects
       Get Users, IT industry and h...
The EU Interoperability
Recommendation, 2008

Goal: Full interoperability by 2015
  •   Agreement of principles of coopera...
The EU Interoperability
Recommendation, 2008

• In the Context of:
  • Connectivity
  • Data protection, fundamental right...
The EU Interop Recom’dation,
epSOS SPECs + Calliope Roadmap
Action at 5 levels:
  •   Overall political and financial
  • ...
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How to move Forward the Implementation of the EU Interoperability Recommendation to Establish Trust and user Acceptance Part 1: Perspective of a Member State

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How to move Forward the Implementation of the EU Interoperability Recommendation to Establish Trust and user Acceptance Part 1: Perspective of a Member State. Rossing N. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

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How to move Forward the Implementation of the EU Interoperability Recommendation to Establish Trust and user Acceptance Part 1: Perspective of a Member State

  1. 1. Implementation of eHealth Interoperability. Perspectives of a Member State Denmark Niels Rossing, M.D. MedCom www.nr@medcom.dk
  2. 2. Denmark •5.45 mil. Citizens •Area: 43.000 km² •Highest point:171 m! •High Broadband Penetration (35%) •Extensive access to internet •Unique personal identifier •SW based PKI
  3. 3. 5 Regions: Health Care 98 Municipalities: Home care -60 Public hospitals -Small private hospitals - 2000 GP clinics - 1100 Specialists - 330 Pharmacies Largely Tax paid Co-payment for Dentistry and medicines
  4. 4. eHealth movers in Denmark • High Connectivity • Uniform healthcare provision • Fairly simple insurance system • 15 years of development and implementation • Market driven approach
  5. 5. Challenges • Shortage of Skilled Human Resources • Combat against Patients’ Waiting Lists • Investm’t Plans but no Change of Mind Set • And on the IT side: • Interoperability, scalability, modularity and compatibility
  6. 6. Major Services • We have: • - National Hosp. Pat. Regist. (1977) • - MedCom (1994) • - Telemedicine (2000) • - National Health Portal (2002) • - Nat. Prescr and Disp Rec (PMP)(2004) • - National eRecord (2006) • We plan hopefully epSOS compatible • - Improved Medication Record • - Nat. Patient Index and Summary
  7. 7. International reports • “Our analysis of available English-language literature and data indicate that three developed countries—Denmark, Finland, and Sweden—are definitively ahead of the United States and most other countries in moving forward with their health IT systems. These three Nordic countries have nearly universal usage of EHRs among primary care providers, high rates of adoption of EHRs in hospitals, widespread use of health IT applications, including the ability to order tests and prescribe medicine electronically, advanced telehealth programs, and portals that provide online access to health information.”
  8. 8. Hospital 50% LAB RAD EPR Primary Care Clinical PAS Service EPR Treatment HCR 100%
  9. 9. IT use among GPs (empirica) december 2009 Medcom15 8
  10. 10. Connected Health Internet- based Public Practising Network authorities doctors Industry Pharmacies Home care Hospital
  11. 11. Interoperability at National Level • - 12 Hospital PAS/EPR vendors • - 12 Primary EPR vendors • - 11 Laboratory vendors • - 8 X-ray vendors • - 5 Specialist EPR vendors • - 4 Pharmacy vendors 60 IT vendors with 100 IT systems that communicate nationwide across sectors
  12. 12. The Health Portal National and Regional Den fælles offentlige sundhedsportal Side33 4c. Portal i portalen – ubegrænset struktur og indhold
  13. 13. Access for Citizens
  14. 14. Medication Profile
  15. 15. Consent • Patients consent is needed whenever confidential information is shared with other health care professionals • Patients written consent is needed to disclose information to people and institutions outside health care
  16. 16. Access for Professionals eRecord
  17. 17. The Health Data Network
  18. 18. Secure Health Data Network • Connecting existing secure networks with Virtual Private Network (VPN) to a central node. • Using existing internet connections and not disrupt the EDIFACT communication • The “central node” adjusted to the existing network – reuse of network structure and equipment • A central connection agreement system that takes care of the control of the connections between the participants.
  19. 19. The Danish Domain of Trust • Three level of ”access” on the Danish Health Data Network: 1. VPN network: Everyone gets access to nothing! 2. The Connection Agreement System: Select IP addresses get access to select services (IP addresses) 3. User control: Chosen users get access to select services and there is a manual and local user control.
  20. 20. Efficiency of Infrastructure • Today, more than 70 organisations within healthcare is connected to the IP-based Health Data network: • All hospitals • All pharmacies • All GPs • All municipalities (homecare, preschool care) • A large number of private hospitals and IT vendors • Today there are more than 1600 agreements in the system - each one replacing a point to point VPN connection • Interoperable secure connections to Norway, Sweden and two Baltic hospitals through the Baltic eHealth project. • Backbone for the national eHealth portal for citizens Sundhed.dk
  21. 21. Over 5 million messages/month
  22. 22. Danish Lessons over 15 years • Start with the basic needs • Make consensus projects Get Users, IT industry and health authorities unite! • Profiles are necessary Off-the-shelf products All-to-all communication • Dissemination projects neccessecary • Keep it simple, stupid! • Keep going: Steady pursuit of goals, patience,political will,financing and championship • Driven by demands and not by technology
  23. 23. The EU Interoperability Recommendation, 2008 Goal: Full interoperability by 2015 • Agreement of principles of cooperation • Enabling interoperability • Resolving Challenges • Assessment of benefits and obtacles
  24. 24. The EU Interoperability Recommendation, 2008 • In the Context of: • Connectivity • Data protection, fundamental rights and personal data • Local consensus as a basis for PP partnerships
  25. 25. The EU Interop Recom’dation, epSOS SPECs + Calliope Roadmap Action at 5 levels: • Overall political and financial • Organizational • Technical • Semantic • Education an awareness raising Danish lessons agree with recommendation We need epSOS specifications! We welcome the Calliope Roadmap!

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