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Experience from implementing health care informatics in Denmark.

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Christian Nohr, Professor Department of Development and Planing. Aalborg University. Denmark

Published in: Health & Medicine
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Experience from implementing health care informatics in Denmark.

  1. 1. Experience from implementing health care informatics in Denmark Christian Nøhr Aalborg University12 1
  2. 2. Health care in Denmark • 5,302.876 inhabitants (February 21th 2007) • Free at point of delivery, (87 % tax paid) • Covering both primary and secondary health care sector • Free medicine in hospitals, subsidised outside hospitals • General practitioners 1 : 1200 people • Private, but > 99 % have contracts with public health • Health is around 9 % of GNP • Mean duration of hospital stays is 5,3 days • Health care provided by Regions • 5 with 500.000 – 1.200.000 inhabitants3 Healthcare in Denmark 57 public hospitals – 21000 beds 8 private hospitals - < 150 beds 3500 General practitioners 800 Practicing Specialists 11000 MDs employed by hospitals 331 Pharmacies 2700 Dentists 1700 Physiotherapists 250 Chiropractors 5 Regions – payors • 98 Municipalities • 1 private Health Insurance Company4 2
  3. 3. 5 Background National IT strategy 2003-2007 for the health sector • Initiatives must support health policy goals – High quality in health care delivery – Short waiting times and free choice of provider – High user satisfaction – Better information on service and quality – Efficient6 3
  4. 4. Background National IT strategy 2003-2007 for the health sector Strategy goals: • 100% coverage of EHR in hospitals by the end of 2005 • …based on a Basic Model for EHR • Large scale national XML communication between & inside hospitals by 2005 • Internet based secure health network by 2005 • National health portal by 20047Status of IT in the primary sector 18 different GP systems (stand alone) MedCom National health network 30 different types of messages standardised (EDI) Implemented in 40 different systems • 15 GP systems • 9 hospitals systems • 12 laboratory systems • 4 pharmacy systems8 4
  5. 5. Medcom status EDI has overtaken daily communication Number % GPs offices 2143 100 % Specialists 697 86 % Pharmacies 331 100 % Hospitals 57 100 % Local Authorities 127 48 % December 20069 MEDCOM communication Number of documents pr. month Prescriptions 1139992 79% 1039105 = 73% Disch. Letters 826258 98 682923 = 85 % Lab. reports 653974 98% 543040 = 82 % Referrals 64845 = 78 % Reimbursement 15637 = 96 % Updated December 200610 5
  6. 6. Practitioners Discharge % of all messages Lab results Prescription Referral Reimbursement Lab order Municipality11 Health Portal Service for Service for citizens health providers12 6
  7. 7. Services for the citizen: • Information about medicine • Buy medicine at the pharmacy on-line • Information about hospitals: • location, staff, services • waiting lists • quality indicators • Personal information: (require log in) • appointments • medication • diagnosis and procedures13 Visions: Establish communications and common information structure14 7
  8. 8. Visions: Establish communications and common information structure15 Visions: Establish communications and common information structure16 8
  9. 9. Further strategic goals Provide (structured) data for: • Clinic • Administration - management • staff • work • financing • Quality assurance • Research - epidemiology • …….. Avoid monopolies Multi vendor17 Application 3 tier model with interchangeable layers SOA architecture Integration Technology18 9
  10. 10. Medi- Clinical Booking Imaging cation process 3 tier model with interchangeable components (modules and functionalities) Integration Technology19 The basic EHR model What is the What is the Term: "Diagnose"? "Problem"? af handling Resultat the Was Term: "Diagnose"? "Problem"? af handling Resultat the Was situation??? situation??? outcome as Def: En manifest eller potentiel meget opfattes meget outcome as opfattes Def: En manifest eller potentiel intended? bredt som: intended? bredt som: sundhedsrelateret tilstand udtrykt på sundhedsrelateret tilstand udtrykt på Diagnostic grundlag af en faglig vurdering information grundlag af en faglig vurdering information conside Evaluation Def: ... Def: ... om en patients om en patients This is how I see This is how I see ration tilstand ii forbindelse tilstand forbindelse Operationelt mål - Operationelt mål - the situation! the situation! med ikkeudført med en udført dvs en hensigt dvs ikke hensigt handling handling eller formål! eller formål! Diagnosis Goal Def: Beskrivelse af Def: Beskrivelse af Result en forventet eller en forventet eller ønsket værdi af en ønsket værdi af en What is my plan? What is my plan? parameter it This is how it This is how parameter Term: "Plan"? Term: "Plan"? What is my What is my went... went... formuleret ii formuleret "Ordination"? "Ordination"? intentions? intentions? målbare termer målbare termer "Handlingsplan"? "Handlingsplan"? Planning Execution Def: Et program for Def: Et program for udførelse af en udførelse af en Intervention And now I And now I bestemt type bestemt type do it!!! do it!!! handling This is what I This is what I This is what I This is what I handling20 want to achieve! want to achieve! am going to do! am going to do! 10
  11. 11. Terminology system ICPC ICD10 SKS “Home made” codes Snomed CT21 Terminology system Translated into Danish. Contains: Concepts (364.400) Terms (984.000) Synonyms Hierarchies Relations (1,45 mill)22 11
  12. 12. Clinical Content ~ guidelines Clinical Content provides: • Documentation support • Process support • Decision support23 Clinical Content ~ guidelines Standard plan Standard activity Standard result Standard documentation Describes how to configure an EHR system Operational goal Decision point24 12
  13. 13. Terminology system Process Clinical model content A25 EHR-Observatory A project funded by the Ministry of Interior and Health, The Association of Danish Regions and The Copenhagen Hospital Corporation. Monitoring the dissemination of EHR systems in Danish hospitals26 13
  14. 14. Nordjyllands Amt Bruger- Bruger- Bruger- Bruger- Bruger- Fælles EPJ brugergrænseflade grænse- grænse- grænse- grænse- grænse- (bliver en del af flade flade flade flade flade klinisk procesmodul) Klinisk proces Applikationsplatform In- RIS/ LAB- Blod Medicin struks- PACS Booking syste- bank system system system mer27 KAS Lab- GS Portal bruger- bruger- Fælles brugergrænseflade flade flade Fælles- Rekvisi- Medicin Klinisk komp. Booking tion modul proces (print, log, mail, etc.) /svar Applikationsplatform (J2EE Websphere) Dataintegrationsplatform Flexi- GS! Yder- CPR Andre Lab Åben register28 14
  15. 15. Bruger- Bruger- Bruger- grænse- grænse- grænse- flade flade flade Fælles brugergrænseflade Bruger- Bruger- (fælles rammesystem) grænse- grænse- flade flade Rekvisition Medicin- Booking- PAS Billed Notat- og svar modul modul modul modul modul modul Pato- Mikro- GEPJ-lag Apotek logi biologi Integrationsplatform (EPJI) Rønt- Klinisk gen kemi CPR CPR opslag nyfødte29 H:SBruger- Bruger- Bruger- Bruger- Portalgrænse- grænse- grænse- grænse- Fælles brugergrænseflade flade flade flade flade Fælles- Medicin- Klinisk komp. Booking, modul Proces (print, log, rekv/svar mail, etc.) Applikationsplatform (J2EE) LAB Dataintegrationsplatform RIS/ Klinisk kemi Apotek PAS PACS Patologi Mikrobiologi Data Klassifi- Yder- CPR kationer register30 15
  16. 16. Background National IT strategy 2003-2007 for the health sector Strategy goals: • 100% coverage of EHR in hospitals by the end of 2005 • …based on a Basic Model for EHR • Large scale national XML communication between & inside hospitals by 2005 • Internet based secure health network by 2005 • National health portal by 200431 Background National IT strategy 2003-2007 for the health sector Strategy goals: • 100% coverage of EHR in hospitals by the end of 2008 • …based on a Basic Model for EHR • Large scale national XML communication between & inside hospitals by 2005 • Internet based secure health network by 2005 • National health portal by 200432 16
  17. 17. National EHR Diffusion100 80 2001 60 2002 2003 40 2004 2005 2006 20 0 2001 2002 2003 2004 2005 2006 2007 2008 200933 Dissemination of EHR based on number of beds covered 100,0 90,0 80,0 70,0 60,0 % 50,0 40,0 30,0 20,0 10,0 0,0 01 03 05 07 09 11 13 15 17 19 21 20 20 20 20 20 20 20 20 20 20 2034 17
  18. 18. What happened ? The minister of health announced a centrally controlled action • National on-line infrastructure • Systems based on a common integration platform • A few modules must be chosen – criteria: best practice35 Latest news The regions will still be in charge of the development and implementation The health ministry has formed an office to coordinate the decentralized development of the EHR A Director for the office has not been appointed yet36 18
  19. 19. Conclusion I Harmonize political and health informatics professional goals Determine the adequate level for structure and granularity Involve the future users Plan for an iterative development process and Evaluate every step37Conclusion II • Make sure to have a well described architecture • Open estimates for time and resources • Reserve 20% of the budget for unanticipated needs • Divide into many small projects • Buy standard software where possible – development (home growing) is expensive and difficult • Be aware of intedependencies • Make sure that no single project can jeopadize the whole project • Plan for iterations and in a way that enable you to stop single projects • Make the core business your point of departure38 and stick to them! 19
  20. 20. International conference on Human Factors Engineering and Usability June 7 and 8, 2007 in Aarhus, Denmark http://www.HFEinHI.org39 20

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