A Danish Health Care Data Network in Two Years

MedCom - the Danish Health Care Data Network

A Danish health care data network in two years

The Danish Ministry of Health The National Board of Health Danish Centre for ●●●●●●●●●●●●●●●●●●●●●●●● ● ● ● ● ● ● The Association of ● ● Health Telematics ● ● County Councils in Denmark ● ● ● ● Copenhagen Hospital ● ● Heden 18 DK-5000 Odense C ● ● Corporation ● ● Telephone +45 6613 3066 Fax +45 6613 5066 ● ● The Danish Medical Association ● ● The Danish ● Pharmaceutical Association The Danish Ministry of Health Kommunedata I/S Holbergsgade 6 DK-1057 Copenhagen K Tele Danmark Telephone +45 3392 3360 Fax +45 3393 1563 The MedCom project

The modern health service is characterised by pronounced MedCom main and increasing specialisation timetable dated 14 November 1994 and division of labour between the parties in the health sector: MedCom hospitals, general practitioners, PROJECT SPECIFICATION pharmacies, etc. MANUAL PROJECT CO-ORDINATION STANDARDISATION TOOLS Consequently there is intensi- STANDARDS ve, routine communication of STANDARDS MANUAL everyday messages between CO-ORDINATION INSTRUCTIONS the parties in the form of pre- STANDARDISATION TOOLS scriptions, laboratory and X- ray results, referrals, discharge PILOT PROJECTS letters, etc. In total around 30 PROJECTS CREATED 1ST PILOT PROJECTS million routine messages are 2ND PILOT PROJECTS sent every year and these EURO STANDARDS IMPLEMENTATION make up around 90% of the daily structured communication MedCom performed its task in the munication in question was tried to and from general practi- period from May 1994 to December out for the first time, and 2nd pilot tioners. The total direct costs in 1996 and was run in two phases: projects, involving “the rest” of the connection with this communi- system suppliers. The 1st pilot pro- In the first phase of the project the jects were carried out in the period cation are estimated at approx. common EDIFACT standards for from 1 March 1995 to 1 May 1996 DKK 1 billion a year. communication were elaborated, and the 2nd pilot projects in the along with various tools to assist in subsequent period up to 1 October Accurate, fast and secure com- the standardisation work (EDI- 1996. munication of these messages TUTOR, EDI-MANAGER and EDI- has therefore not only become CODES) together with a project crucial for costs, better quality handbook. The handbook gave the project participants general and and patient service in the Purpose specific information about the con- health care sector overall, but tent and techniques of the project. is also essential for the crea- In the second phase of the project The purpose of MedCom was to tion of a coherent health care 25 regional pilot projects were establish over a two-year period a sector. started, which together involved all sustainable, coherent health care of MedCom’s messages. 29 different data network comprising the most IT systems supplied by 24 different frequently occurring messages in the IT suppliers - 80% of all the IT health care sector and based on systems in the Danish health care international EDIFACT standards. sector - took part. The project involved building up a standardised market for electronic For practical reasons the pilot pro- communication (EDI) in which the jects were divided into two groups: individual system suppliers 1st pilot projects, in which the com-

2 From local trials to a nationwide network

During the second phase of the pro- During the 1990s data ject MedCom acted as an “umbrella communication has organisation” which co-ordinated the regional pilot projects, the seriously made its entry suppliers’ technical standards, etc. into the Danish health In this period experience from the pilot projects was accumulated in care sector. “version revisions” of the standards The first trial was used. “Version 0.0” was the starting carried out at the begin- point, which was used for the first time in the first pilot projects. Based ning of the decade. Today on this experience “version 1.0” was - five years later - a issued on 1 February 1996 for use in nationwide health the 2nd pilot projects and the final “version 2.0” of 10 December 1996 care data network has contains all experience gained - and been established in is the permanent standard for use in Denmark in future. which communication is based on interna- The last three months of the project tional standards. A whole were used to bring together experience from the 2nd pilot projects and range of software provi- for drawing up the final standard, ders have become capable “version 2.0”. The internationalisation of the temporary standards of delivering system soluti- (“version 0.0” and “version 1.0”) has ons to the various users of been postponed until February the health care data 1997, after which the actual dissemination and use of MedCom’s stan- network thanks to the dards can begin. development work. developed and marketed communi- ● Referrals from general practi- ● Booking of examinations from cation modules capable of com- tioners to hospitals. general practitioners to hospitals municating with each other via one ● X-ray results from radiology in local pilot projects. or more VANS suppliers. departments to general practitioners. The messages mentioned were im- The project comprised the following ● Reimbursement from general plemented widely in 1995 and 1996 messages: practitioners and pharmacists to in 25 pilot projects in various places the national health insurance. in Denmark - however, the booking ● Prescriptions from general practi- ● Laboratory requisitions from project has been postponed until tioners to pharmacies. general practitioners to clinical MedCom II, and the transition from ● Results from clinical chemistry, chemistry, pathology and micro- the existing Danish “standard pre- pathology and microbiology labo- biology laboratories. scription” to the European “MED- ratories to general practitioners. ● X-ray requests from general prac- PRE standard” will be carried out in ● Discharge letters from hospitals to titioners to radiology depart- a project under the auspices of the general practitioners. ments. Danish Pharmaceutical Association.

3 How did it go?

Target achievement: 81% the use of these grew explosively to be used “in practice” as a single nonetheless. On the other hand, we communication standard for com- “An EDI project, similar to any other achieved the “CoCo project” and a munication “from Gedser to Ska- project, is considered successful if it time measurement project for pre- gen” - or from Land’s End to John is completed on time, within budget scriptions. O’Groats as we would say in Britain. and the end-product does the job That means between the communi- without sacrificing quality.” Were we within budget? cation parties, without local modifi- C. Bentley: “A guide to structured Yes, there is approx. DKK 500,000 cations. project management” left of the DKK 15 million. Quality has been the crux of the Did we complete on time? Does the end-product do the job? matter in MedCom and was more Yes, apart from the fact that the Yes, 81% of the planned communi- difficult than expected. After the implementation of “version 2.0” will cation modules were developed and introduction of “consensus data not take place until February ’97. tested in everyday operations - 92% lists” and the implementation of the However, the booking project was on the hospitals side and 74% on round of experience gathering after not delivered and neither were the practitioners side. the 2nd pilot projects, the standards formalised test procedures used in are now described in such detail and connection with conclusion of the Was the quality adequate? so accurately and precisely that the pilot projects. Nor did we implement Within the context of MedCom ad- overwhelming opinion is that Med- a “dissemination project” for the equate quality means that the stan- Com’s standards can indeed be used old standards - for it emerged that dards are good and precise enough “from Gedser to Skagen”.

It is necessary to develop 175 “communications interfaces” in order for all IT systems in the Danish health care sector to be able to communicate all messages “from everyone to everyone”. The table shows that a total of 175 pated in MedCom and by far the tioners’ side it is estimated that the “interfaces” must be developed in majority of all users on the hospitals 76 “interfaces” cover a good third Denmark if all the IT systems are to and laboratories side are covered by of all practices which have intro- be able to communicate all of Med- these suppliers today. On the practi- duced a medical record system. Com’s messages to everyone else.

76 “interfaces” were developed in Total IT systems Required Planned Actually Target in Denmark communi- according developed achieve- MedCom, equivalent to 43%. Thus cations to project in ment in 99 “interfaces” remain to be devel- interfaces specifica- MedCom’s % oped before everyone can communi- tion of pilot cate everything. The greatest 14.11.94 projects number of messages by far will be communicated by the practitioners’ 5 Hospital systems 10 9 8 89 systems, and hence they have the 5 Lab. systems 10 9 6 67 greatest “development burden” in 3 X-ray systems 6 6 6 100 building up a health care data net- 3 Pathology systems 6 5 6 120 2 Microbiology systems 4 3 2 67 work. These suppliers are to develop 3 National health 132 “interfaces” of the total 175 insurance systems 3 3 3 100 within the context of MedCom. 4 Pharmacy systems 4 1 2 200 12 Practitioners’ systems 132 58 43 74 On the hospitals side, it is the major 37 Systems in total 175 94 76 81 suppliers in particular which partici-

4 What did it cost? This successful establishment of the health care data network was carried out through wide involvement of MedCom’s central budget is DKK 15 million - paid 1/3 by the state, 1/3 by Danish expertise and joint financing by the state, the the hospital owners and 1/3 by county councils, the institutions and organisations in private organisations and firms. the health care sector and suppliers of information Of the DKK 15m, DKK 14.2 million technology. has been spent as follows: The health care data network has already been taken into use in many parts of the health care sector and Expected account for MedCom. (Forecast as at 25.10.96) the ground has been prepared for many others to get connected and enjoy the benefits of electronic com- 1000 kr. munication. This applies not only within the Danish Wages and salaries 3288 health care sector but also at international level, Office, travel, IT 1442 Consultants 701 where there is very great interest in the Danish Standardisation 3097 handling of the health care sector’s communication EDI group 1105 Information and needs. meetings 824 EU participation 1378 Pilot projects 2270 Other 117

Total 14222

The account estimate is based on accounts up to 25.10.96 and expected spending in the remaining period up to 31.12.96. Like I dreamed of

In addition to the costs financed “It has been a fantastic ex- centrally, both the pilot projects (in perience working with the new other words, the counties) and the technology,” says GP Finn IT suppliers made considerable in- Klamer. vestments which were not financed “It’s actually difficult to describe centrally. These costs vary greatly how fundamentally my work from one pilot project to another has changed. The consultations and from company to company, but are entirely different compared if the costs of these parties are to how they were before. I have estimated at between DKK 100,000 much more time to look after and 200,000 per pilot project for the the patients. The nature of the counties and between DKK 20,000 work is like I dreamed of being able to realise one day when I and 50,000 per “interface” develop- was younger. I get greater job satisfaction and I can warmly ed for the suppliers, total invest- recommend the information technology and the health care data ments by all parties in MedCom network with a clear conscience.” continued on page 6

5 continued from page 5 comprise between DKK 19m and EDI-manager, 24m (including MedCom’s original EDI-tutor budget of DKK 15m). and EDI-codes

These investments are to be recoup- In order to reinforce and quality- ed through the use of MedCom’s assure the standardisation work standards. MedCom started the development of three “standardisation tools”: In the Danish Hospital Institute’s “EDI-MANAGER”, EDI-TUTOR” and evaluation of the FynCom project in “EDI-CODES”. All the tools will be everyday operation through 1994 it developed further in MedCom II. was calculated that on average 3.35 minutes are saved in a clinical hospi- EDI-manager tal department in the dispatch of MedCom’s EDI-MANAGER is an EDI one discharge letter and 5.1 minutes converter and a communications in GP’s practice. A further 1.2 program specially designed for the minutes are saved in the dispatch of needs of the health care sector, for a prescription and 3.7 minutes in the use in doctors’ surgeries and pharm- receipt of results from a laboratory. acies. The system is updated on an The time statements are roughly the ongoing basis with MedCom’s same as the time savings calculated standards, can cope with several on the basis of the “Odder project” parallel versions and handles auto- in Århus County in 1993. On the matic acknowledgement and re- basis of the FynCom evaluation, it cording of communications in can also be estimated that the total accordance with the prescription operating and investment costs requirements of the Danish National amount to around DKK 2 per Board of Health. In addition, a message in total for both recipient “minimal” syntax check is carried and sender. The aim of MedCom II is out in accordance with the official shooting, testing of own systems for 75% of all messages in the prim- UN standard. and version management of the ary health care sector to be trans- developed communications modu- ferred using MedCom’s standards in EDI-MANAGER is supplied by Kom- les. EDI-TUTOR is supplied by both the year 2000 - equivalent to around munedata I/S under the name “EDI- Dan Net (EDI-TUTOR) and Kommu- 23 million messages annually. MANAGER” and by Dan Net under nedata (EDI-TEST-TJENESTE). Both the name “EDI-CARE®”. MedCom products are free to those suppliers If we assume a low average time granted the pilot projects an ear- participating in MedCom or in the saving, e.g. 4 minutes per message marked sum to assist in the Danish National Board of Health’s for both recipient and sender com- purchase of these, amounting to prescription test. Dan Net acts as the bined, the 23 million messages will DKK 700,000 in total. EDI-TUTOR secretariat and receives, mean the annual release of re- quality-assures and distributes the sources in the health care sector EDI-tutor test messages. worth around DKK 250 million - EDI-TUTOR is a simulator which solely caused by time savings. In enables the system houses to com- EDI-codes addition, there are postage savings municate within themselves - they EDI-CODES has the task of promot- and clinical, security and service can send and receive MedCom’s ing and supporting the use of com- improvements. This is the context in standards which are stored in EDI- mon nationwide classifications and which MedCom should be seen. TUTOR. EDI-TUTOR is designed to of elaborating an electronic form of facilitate development, trouble- distribution. EDI-CODES are main-

6 Great need

The data network is meeting a great need for communication in the health care sector. Information and messages are frequently exchanged between the parties of the health sector in conjunc- tion with the treatment of patients. The need for communications is increasing still further in view of increasing specialisation within the sector. As a result, there is intensive communication of everyday messages in the form of prescriptions, laboratory and X-ray results, referrals, discharge letters, etc. It is estimated that around 100,000 - 200,000 of these types of messages are sent every single day - and the total direct costs connected with this communication alone are estimated at around DKK 1 billion a year. Another major trend in the health care sector over the past ten years or so has been the widespread introduction of IT in the health care sector - e.g. the hospitals’ patient administration systems, laboratory systems and general practitioners’ medical record tained and distributed by the EDI systems. secretariat placed in the National Board of Health. They include the ICD 10 classification system, the TAC The time is ripe drugs classification system and the surgery and treatment classification The status of the health care system, radiological procedures and data network around the the hospital classification system. In country is that some counties the future the National Board of are going under way, others Health hopes to expand the distribu- are in the process of joining tion system to be carried out elec- whilst yet others have not tronically via the network. MedCom even started yet. has financed the work to the tune “The time is ripe - even for the of DKK 300,000 in total, including last counties,” says Per Grinsted, paying for the use of the codes in general practitioner and practice MedCom’s pilot projects. co-ordinator. “In the course of time so much positive experience has been achieved with electronic communication that there shouldn’t be that much to weigh up any more. Moreover, hardware and software which are ready to use have now been developed.”

7 MedCom’s pilot projects - the actual health care data network

It is of great importance that elec- sector. Only then were the standards ger project, FynCom, the Odder pro- tronic communication is used to a able to be tested and modified, and ject and KLAP). Seen in this context, considerable extent if it is to be only then was an extent of com- MedCom has acted as an “umbrella economic and suitable for all parti- munication which would make it organisation” which has supplied es. A number of regional pilot economic for all parties in the short the local pilot projects with stan- projects have therefore been im- term able to be secured. dards, instructions and co-ordination plemented in which communication whilst, otherwise, they have been of the messages in question has The pilot projects were carried out independently managed and, as a been implemented in pilot projects as local regional projects, in exactly starting point, locally financed. which together involve the major IT the same way as in most previous suppliers to the Danish health care Danish EDI trials to date (the Ama-

Referral MEDREF

X-ray request MEDREF Discharge letter MEDDIS Discharge letter MEDDIS X-ray request Laboratory result Frederiksborg County MEDREF MEDRPT X-ray result The Danish MEDDIS Lab. requisition Lab. requisition MEDREQ MEDREQ Pharmaceutical Association North Jutland County Laboratory result Roskilde County MEDRPT Prescriptions MEDPRE X-ray result MEDDIS Copenhagen Hospital Corporation Nat.Health insurance MEDRUC Mikrobiology result MEDRPT Aarhus County Mikrobiol. requisition MEDREQ

Nat.Health insurance MEDRUC Vejle County Discharge letter Referral MEDDIS MEDREF

Discharge letter Copenhagen MEDDIS General Practitioners’ Laboratory Pathology requisition MEDREQ Lab. requisition MEDREQ Pathology result MEDRPT Storstrøms County Ribe County Laboratory result Referral MEDRPT MEDREF Lab. requisition Discharge letter MEDREQ MEDDIS

Laboratory result South Jutland County MEDRPT Funen County X-ray request Nat.Health insurance MEDREF MEDRUC Referral MEDREF X-ray result MEDDIS Pathology requisition MEDREQ

Pathology result MEDRPT

8 Noticeable advantages

Terms of the pilot projects Many of the parties in the health care sector have their own IT systems, but until a few years ago the According to the co-operation agreement entered into between systems could not communicate with each other. MedCom and the pilot projects, the Thousands of messages were therefore printed out on individual projects shall: paper, sent by post and typed into a new system. It is ● be independently managed and a way of working which takes time, costs resources financed and results in a great risk of errors. ● carry out their own project organisation and appoint a Electronic communication is fast, saves resources and project manager minimises the risk of errors. The message is keyed in ● themselves make agreements and conclude contracts with partici- only once. It is transferred within seconds and is pants and software houses immediately ready for further processing in the re- ● apply MedCom’s standards cipient’s IT system. ● use acknowledgements (positive CONTRL is always sent on error- The users of the network achieve economic and time free receipt) - but this has not rationalisation gains whilst, at the same time, the been able to be maintained in quality of the work is improved. practice ● follow the timetable and report In the final event the patient notices the advantages milestones in the form of better quality, service and coherence in ● participate very constructively in national co-ordination the treatment of sickness. ● receive DKK 50,000 from MedCom per pilot project carried out.

Advantages for the patient

Tove Kaae, senior consultant at Odense University Hospital, has no doubts that the health care data network provides great advantages for the individual patient: “Their own GP will be informed much more quickly than before of the treatment they have had in hospital. The same applies to laboratory tests. There is less potential for mistakes because the same data doesn’t have to be keyed in time and time again and because the communication standards used ensure that the document is completed with the relevant information.”

9 MedCom’s 1st pilot projects - how did it go? MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR

There is a great difference between B1: VEJLE - REFERRAL B2: VEJLE - DISCHARGE LETTER implementing a pilot project in B4: FUNEN - REFERRAL which the EDIFACT message concer- B5: ROSKILDE - CLIN. CHEM. ned is introduced in Denmark for B6: COP.GPs’ LAB.- LAB.REQ. the first time, and subsequent pro- B7: SOUTHERN JUTL.-X-RAY B9: ÅRHUS - PATHOLOGY closed jects in which other places and other B10: VEJLE - PATHOLOGY B11: COPENH. HOSP.CORP.- suppliers implement the EDIFACT MICROBIOL. message. For this reason the pilot B12: COP.-NAT.HEALTH INS. B13: ÅRHUS - NAT.HEALTH projects were divided into two INSURANCE groups, with the 1st pilot projects THE ORIGINAL PROJECT SCHEDULE being one project for each of the chosen European messages (PRE-CEN 1: PROJECT ORGN. 3: TECHNIQUE PILOT 2: SPEC.OF REQTS. 4: SOFTWARE OPER. standards) in which the message was 7: REMOTE 9: PILOT OPERATION tried out in Denmark for the first time. operation within the period and the case of a few, not until February. MedCom’s 11 1st pilot projects were hence a “1st contingency plan” was When it became clear in mid-Febru- originally to have been completed drawn up which would mean the ary that the “1st contingency plan” at the end of ’95, but only three start-up of pilot operation in all the could not be met either, a “2nd con- pilot projects managed to start pilot pilot projects in January ’96 - or, in tingency plan” was drawn up in-

MedCom’s 2nd pilot projects - how did it go? JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV

MedCom’s 2nd pilot projects started C1: N. JUTL.- REF./DISCH.LETTER C2: RIBE -REF./DISCH.LETTER as planned on 1 January - despite the fact that the 1st pilot projects C3: FREDERIKSB. - DISCH.LETTER C4: STORSTRØM - LABORATORY were not yet complete. This caused C5: NAT. SERUM INSTITUTE - LAB. CLOSED co-ordination problems, since it was C6: COPENH. HOSP. CORP- REF. not possible actually to accumulate C7: RIBE - LAB. RESULTS experience which could be incorpor- C8: ÅRHUS - X-RAY ated into “version 1.0” of the C9: N. JUTL.- X-RAY standard. This is why the 2nd pilot C10: FUNEN - PATH. REQN. C11: COPENH. HOSP. CORP.- projects were launched in various MICROBIOL. REQN. versions. However, the 2nd pilot C13: FUNEN - PATH. RESULTS projects did succeed in meeting the C14: RIBE - NATIONAL HEALTH INS. C15: ÅRHUS - LABORATORY deadline, which had been deferred by one month to 1 October. All the PROJECT SCHEDULE PROJECT ORGN. PILOT pilot projects except one were off SPEC. OF REQTS. OPERATION the ground by this date - most of them just in time.

10 Many small networks...

volving start-up of all the pilot pro- Local trials in various places in the early 1990s jects by April - and succeeded! documented the great advantages which could be

All the pilot projects except one achieved through electronic communication. The were off the ground by this date - budding of various projects involving electronic com- albeit Funen, Copenhagen General Practitioners’ Laboratory and Roskil- munication was a contributory factor to the fact that de just a few days before the dead- a large number of parties in the health care sector line. Only pilot project B9 - the came together in the MedCom project. pathology project in Århus - was then unable to start pilot operation, The aims and results of the trials were in accordance as a result of which MedCom’s with the overall health policy objectives of co-opera- steering committee cancelled the tion, service and quality within manageable economic co-operation agreement for the project. frameworks. However, there was a need for co-ordination. The aim was to have one nationwide network. It As a minimum, a pilot project involves four parties: one hospital would not have been appropriate for the regions of department/laboratory and its IT the country to form isolated islands in terms of com- supplier and one GP and his IT munication for the sake of both the patients and the supplier. However, most of the pilot projects involved both more individual parties in the health care sector. recipients and more senders. At the end of 1994 the project organisation MedCom was mandated to establish a nationwide health care data network based on the EDI (Electronic Docu- ment Interchange) concept. The project was to be completed within a period of two years.

Need for coherence

“The Danish Ministry of Health was involved because we want- ed to ensure coherence in the development of a nationwide health care data network. The need was there because of the many local initiatives. However, at the same time we also have a clear expectation that the data network will offensively be able to make a contribution to the realisation of the overall health policy aims, i.e. co-operation, service and quality within manageable economic frameworks,” concludes John E. Pedersen, office manager at the Danish Ministry of Health.

11 EDI and the health care data network

MedCom - the Danish health care Dan Net Kommunedata data network - is a “logical” data Mailbox Mailbox network, not a physical network. Not a single new telephone line was established in connection with its implementation. MedCom uses the Modem Modem lines which already exist: normal telephone lines, ISDN connections, Communication software Communication software etc. - depending on the technology which is most appropriate in the EDI Conversion EDI Conversion individual case. SystemIntegration SystemIntegration

Electronic mailboxes Doctor’s System Hospital’s System Electronic mail or “E-mail” is un- formatted information which is sent from one person to another, or recipient’s system to be ready to VANS (Value Added Network possibly to many others, via an IT receive messages Services). Here in Denmark there are network. E-mail communication ● that the recipient’s system can two such suppliers, Dan Net and takes place between people as “collect” its messages at any time Kommunedata. opposed to EDI, Electronic Docum- ● that the sender’s system can send ent Interchange, which is the trans- a message to several recipients at Components of a “Store and fer of standardised documents be- once forward” system for EDIFACT: tween two computer systems. ● that the sender and recipient do not have to maintain fixed, de- ● An IT system - single user or In the health care data network fined communication channels multi-user there are health care-specific EDI- between them. ● A conversion system for con- FACT messages (a UN syntax for EDI) structing EDIFACTs and ensuring which are exchanged between the In connection with the EDI messages they are correct systems in the health care sector this processing is carried out in (pharmacies, general practitioners, laboratories, radiology departments, The main components of an EDI solution hospital departments).

In order to be able to ensure the smoothest possible method of transfer, it was decided to use electronic Application system Application system mailboxes. Both types of messages (e.g. doctor’s system) (e.g. pharmacy’s system) Interface (API) Interface (API) are based on the Store and Forward EDI module EDI module (conversion, administration, (conversion, administration, principle, in which the messages are management, etc.) management, etc.) stored along the way until they can Interface (API) Interface (API) Data communication and VANS supplier A VANS supp. B Data communication and be delivered to the next stage - and data transmission EDI service EDI serv. data transmission finally delivered to the recipient.

Comms. Comms. This method ensures: so. IV so. III

Comms. Comms. ● that the sender’s system can de- solution solution I II liver messages for forwarding without having to wait for the

12 ...and one large one

● Communications software on this The network is to communicate messages directly IT system between different IT systems within the health care ● An electronic link to a supplier of electronic mailboxes sector using existing technology. Communication is ● An electronic mail address/mail- based on international CEN standards and covers box - which is obtained following agreement with the supplier. the most frequently used messages in the health care sector: The conversion system is used to place the message in an electronic envelope and to add an electronic Referrals from general practitioners to hospitals. address, after which the message is Discharge letters from hospitals to general practi- sent by the communication system tioners. Laboratory requisitions from general practi- to an electronic “post office” (VANS). This “post office” then en- tioners to clinical chemistry, pathology and micro- sures that the electronic item of biology laboratories. Laboratory results from clinical mail is sent by the most appropriate route through the electronic net- chemistry, pathology and microbiology laboratories to work to the recipient’s mailbox. general practitioners. X-ray requests from general The recipient can then collect the practitioners to radiology departments. X-ray results message as needed. from radiology departments to general practitioners. System integration in the Reimbursement from general practitioners and health care data network pharmacies to the national health insurance. In order to communicate with each other it is necessary for the individual IT suppliers to develop a standardised “interface” with other Project success in Funen IT systems. The major work for the IT supplier lies in arranging such a The FynCom project established system so that it can work function- the Funen health care data ally (screens, etc.) and then to devel- network in 1993 and has been a op “mapping” to the EDI converter. great success from the start. In In this mapping the system house’s terms of the volume of commu- in-house format is converted to the nication, the Funen health care fixed EDIFACT format which is sent data network now makes up a out to other users. Standard commu- very large part of the Danish nications software and a standard health care data network. modem are used to send it out. The Project manager Tove Lehrmann rest of the system is built up around of FynCom: two “mailbox” systems belonging to “It is essential to have a large organisation behind you - prefer- the two VANS suppliers, Kommune- ably an organisation which crosses the traditional boundaries data and Dan Net - and, in principle, within the health care sector in terms of both geography and the system works in exactly the specialist areas. At the same time, you need the fiery souls who, same way as when transferring e- with their enthusiasm and pioneering spirit, make extraordinary mail. efforts to get the project to succeed. These are not necessarily IT people,” she stresses, “in fact, quite the reverse.”

13 EDI national statistics

In the period from 1988 to 1991 the took several years for prescription In 1992 three major regional pro- “Amager project” was carried out in communication to become wide- jects were carried out which devel- Copenhagen. In this project a stan- spread, the Amager project formed oped and implemented two new dard was developed for communica- a school for the subsequent projects standards in the health care sector: tion of prescriptions - “RECEPT” and all EDI projects in Denmark “EPIKRI” (“DISCHARGE LETTER”) for (“PRESCRIPTION”) - which has since then have used the same discharge letters from hospitals to functioned since that time with just “technology”: EDIFACT syntax and general practitioners, and “LABRES” a single version update. Although it “mailbox” technology. for laboratory results from labora-

EDI communication in THOUSAND the pilot projects, 819 doctors’ practices - 46% 346.291 - 26% September 1996 92 specialists’ practices - 10% 293 pharmacies - 95% Pilot project 67 hospitals - 66%

PRESCRIPTIONS B1: Vejle County B2: Vejle County B4: Funen County B5: Roskilde County LAB. RESULTS B5: Roskilde County 113.591 - 30% B6: Copenhagen GPs’ Lab. (KPLL) B7: South Jutland County 59.522 - 17% B7: South Jutland County B10: Vejle County DISCH. LETTERS B10: Vejle County B11: Hvidovre B12: Copenhagen Dep. of Health Prescriptions Discharge letters etc. Lab. results B13: Århus County C1: North Jutland County C1: North Jutland County Number of messages per and whether this module is also C2: Ribe County used for outpatient discharge letters C2: Ribe County month, October 1996 C3: Frederiksborg County etc. The “old” Danish standards are C4: Storstrøm County In October 1996 approximately half also used for X-ray results and, to a C4: Storstrøm County of the general practitioners (around lesser extent, for communication in- C6: Copenhagen Hospital Corp. 819 practices) had invested in EDI ternally in the hospital and between C7: Ribe County C8: Århus County communication along with around the general practitioner and the C8: Århus County 90 specialist practices. Almost all specialist. In October 1996 a total of C9: North Jutland County pharmacies and over half of the 519,404 messages were sent, of C9: North Jutland County C10: Funen County hospitals and laboratories also used which 346,291 were prescriptions, C11: Copenhagen Hospital Corp. “the Danish health care data net- 113,591 laboratory results and C13: Funen County work”. Whilst a laboratory can 59,522 discharge letters. If we trans- C14: Ribe County C15: Århus County normally send almost all its results fer the calculations from the C15: Århus County electronically as soon as it is con- FynCom evaluation to these figures, nected, this is often not the case this is equivalent to the monthly with discharge letters. Thus there is release of resources in the health normally a great difference between care sector in Denmark worth DKK the degree to which the “discharge 5.5m in total - merely for the month letters module” is used in the indivi- of October 1996. dual departments in the hospital,

14 Pilot projects prepare the ground

tories to general practitioners. The The development of the health care data network is three major projects were “The co-ordinated at national level through the MedCom Copenhagen General Practitioners’ Laboratory Project” (the KPLL pro- project. However, local, independent project organi- ject) in the Copenhagen region, the sations remain the core of the work. “Odder Project” in Århus County and “FynCom” in Funen County. In 1995/96 11 pilot projects were carried out, each with the aim of testing out communication of one of

The level of communication in the for the final standard to be pilot projects is still low at present, implemented in February 1997 since most suppliers decided to wait before connecting new users.

Message Suppliers MIG Sent via Sent via Dan Net Kommunedata

Referral Kommunedata, Multimed, Æskulap MEDREF 4 25 Discharge letter Kommunedata, Multimed, Æskulap MEDDIS 7 112 Referral FynSys, Medex MEDREF 6 Lab. requisition Labka, PC-Praksis, Midoc MEDREQ 66 Lab. results Labka, PC-Praksis, Midoc MEDRPT 135 Lab. requisition DECLAB, PC-Praksis, PLC, Midoc, Novax MEDREQ 7 X-ray request Kommunedata, Æskulap MEDREF 34 34 X-ray result Kommunedata, Æskulap MEDDIS 60 60 Pathology requisition IBM, Multimed MEDREQ 114 Pathology results IBM, Multimed MEDRPT 87 Microbiology result ADBakt, EM-data, PC-Praksis, PLC, Midoc, Novax, Æskulap MEDRPT 1190 Nat. Health Serv. ins. Kommunedata, EM-data, PC-Praksis, Midoc, S.Thygesen MEDRUC 26 26 Nat. Health Serv. ins. BEMA, Cito-Data, Midoc, Novax, Æskulap MEDRUC 9 Referral B-DATA, I-Praksis, Medex, PLC, Æskulap MEDREF 8 5 Discharge letter B-DATA, Æskulap MEDDIS 29 8 Referral EDB-gruppen Herning, Æskulap MEDREF 11 Discharge letter EDB-gruppen Herning, Æskulap MEDDIS 6 Discharge letter SIS/SIBE, Æskulap MEDDIS 16 10 Lab. requisition B-Data, Novax MEDREQ 90 Lab. results B-Data, I-Praksis, Midoc, Novax, PC-Praxis, PLC, Æskulap MEDRPT 10 Discharge letter Grønt System, Novax, PC-Praxis, PLC, Æskulap MEDDIS 25 28 Lab. results EDB-gruppen Herning, Æskulap MEDRPT 9 X-ray referral KODAK, Novax, PLC, Æskulap MEDREF 8 1 X-ray result KODAK, Novax, PLC, Æskulap MEDDIS 1 1 X-ray referral B-DATA, Æskulap MEDREF 14 1 X-ray result B-DATA, Æskulap MEDDIS 46 9 Pathology requisition FynSys, Medex MEDREQ 1 Microbiol. requisition ADBakt, Novax, PC-praksis, PLC, Æskulap MEDREQ 75 Pathology results FynSys, Medex MEDRPT 12 Nat. Health Serv. ins. Cito-Data, RVFR-medicin, RVFR-sygesikring, Æskulap MEDRUC 16 Lab. requisition Labka, Novax, Æskulap MEDREQ 30 10 Lab. results Labka, Novax, Æskulap MEDRPT 507 335

MEDREQ 393 MEDRPT 2285 MEDREF 151 MEDDIS 418 MEDRUC 77

Total messages 3324 2659 665

15 EDI peak, August 1996 Number of messages and number of EDI-linked doctors’ practices and pharmacies Assuming that the use of prescriptions, laboratory results and dis- Counties Dis- Lab. Pre- Doctors Pharm- Dis- charge letters is evenly distributed charge results scrip- acies charge across the country (in accordance letter tions letters with the population in each county), 1 Funen 8420 26884 42990 137 29 27 we can estimate how great a pro- 2 Vejle 9561 12014 34173 68 20 42 portion of these messages are ac- 3 North Jutland 7484 20870 55844 117 33 23 tually sent using EDI in each county. 4 Århus 13325 13805 56570 136 32 33 5 Viborg 5252 3226 16070 60 13 33 The figure shows, amongst other 6 Roskilde 472 4529 12525 29 7 3 7 Copenhagen things: Hospital Corp. 257 14430 16505 82 33 1 ● that 14% of all discharge letters, 8 South Jutland 5011 0 10521 53 14 29 26% of all laboratory results and 9 Ribe 108 240 12465 22 14 1 23% of all prescriptions are sent 10 Ringkøbing 0 2769 6497 26 11 0 by EDI 11 Storstrøm 12 779 11485 32 15 0 ● that in the counties in which most 12 Bornholm 0 0 1955 4 2 0 13 Frederiksborg 0 0 9374 23 18 0 communication takes place, 14 Copenhagen 5 0 16628 83 31 0 between a third and a half of all 15 West Zealand 2 157 4125 13 13 0 the messages in question are sent electronically I alt 49909 99703 307727 885 285 14 ● that communication of more messages supports its spread. Two or three times as many prescriptions are communicated electroni- Mill. per year cally in the counties which also 16 send hospital results electronically Results ● that there are now only five Blood Results Radiology counties which do not yet Prescrip- Micro- tions Casualty transfer hospital results electroni- 4 biology cally. Pathology

X-ray Clinical The potential of 3 chemistry MedCom’s messages Requisi- Out- tions patient MedCom’s five EDIFACT standards Blood Referrals Radiology are directly intended to replace the Micro- approx. 30 million messages sent 2 X-ray biology between hospitals, pharmacies and Pathology general practitioners every year. The Out- 30 million messages are divided into patient Discharge National 1 Clinical Health 16 million prescriptions (MEDPRE), 2 chemistry Insurance million referrals and X-ray requests Reimburse- ment (MEDREF), 4 million discharge letters Referrals and X-ray results (MEDDIS), 4.5 0 million laboratory results (MEDRPT) MEDPRE MEDREF MEDDIS MEDRPT MEDREQ MEDRUC

16 the different types of messages for the first time. As a percentage of all As a result, much valuable experience was gained of those possible the use of international communications standards Lab. Pre- Doctors Pharm- and of working methods and work organisation as a results scrip- acies tions whole.

79 36 68 88 At the end of 1996 a further 15 pilot projects were 49 40 49 87 carried out in which standards and working methods 58 44 58 92 31 37 48 97 were finally tested. When these are complete it will be 19 27 59 65 possible for all counties, doctors’ practices, hospitals, 28 22 31 64 laboratories and pharmacies to link up individually 35 11 25 92 0 165470 with the health care data network and to communi- 1 222793 cate freely with all the other parties connected. This is 14 9 25 69 4 173865 the case because the majority of the IT suppliers to 0 162467 the Danish health care sector have created a range of 0 111795 0 112597 software solutions for use on the data network in 161372 connection with the MedCom projects. The software 26 23 38 84 suppliers quite simply participated in the pilot projects and in this context carried out the necessary product development. New users are therefore able to choose between different system solutions which and 230,000 billing sheaves to the National Health Insurance (contain- immediately enable them to communicate via the ing a total of 30 million bills) health care data network. (MEDRUC). However, in addition, 1.3 million referrals are sent from general practitioners to specialists and around 3 million discharge letters the opposite way, approx. 10 million emergency service records Co-operation and a large number of similar messages are sent to and from the “Users and suppliers have to- local authority sector, physio- gether developed a concept, a therapists, etc. The total com- system and a product range, munication which could take place which enable all interested using MedCom’s standards is thus doctors’ practices and hospitals over 50 million messages per year. to link up with the health care data network so as to benefit from EDI,” says Henrik Bjerre- gaard Jensen, MedCom’s project manager.

17 Who can do what on 1 October 1996? System houses which participated in MedCom’s pilot projects

Pilot project As at 1 October 1996

Referrals from GPs to hospitals I-Praksis, Medex, PLC, Æskulap, B-Data, EDB-gruppen Herning, Kommunedata, FynSys, Multimed

Discharge letters from hospitals to GPs (discharge letters) B-Data, Æskulap, EDB-gruppen Herning, SIS/SIBE, Grønne System, Novax, PC-praksis, PLC, Multimed, Kommunedata,

Laboratory requisitions to clinical chemistry laboratories Novax, B-Data, Æskulap, Labka, DEClab, PLC, PC-praksis, Midoc

Laboratory results from clinical chemistry laboratories B-Data, I-praksis, Midoc, Novax, PC-Praksis, PLC, Æskulap, EDB-Gruppen Herning, Labka

X-ray requests to radiology departments Novax, PLC, Æskulap, Kodak, B-Data, Kommunedata

X-ray results from radiology departments Kodak, Novax, PLC, Æskulap, B-Data, Kommunedata

Laboratory requisitions to pathology laboratories Medex, FynSys, Multimed, IBM

Laboratory results from pathology laboratories FynSys, Medex, Multimed, IBM

Laboratory requisitions to microbiology laboratories Novax, PC-Praksis, PLC, Æskulap, ADBakt

Laboratory results from microbiology laboratories ADBakt, PLC, Æskulap, Midoc, EMAR, Novax

National health insurance reimbursement from pharmacies Cito-Data, RVFR-medicin, Kommunedata, S.T.Data, BEMA

National health insurance reimbursement from GPs Æskulap, RVFR-sygesikring, Kommunedata, EMAR, Midoc, Novax, PC-Praksis

18 Many people involved

Many people have already been connected to the health care data network. Over 900 doctors’ practices, nearly all pharmacies and 67 hospitals and laboratories currently use electronic communication. The number of messages communicated has risen by around 500 per cent since MedCom started, and today between 15 and 30 per cent of all discharge letters, laboratory results and prescriptions are sent electronically. In the most advanced counties 30-40 per cent of all messages are sent electronically. Of the counties which are not yet on the network, many have plans to join within the foreseeable future.

Considerable improvements

“Used correctly, the new technology provides opportunities for considerable improvements,” says John Ravndam, financial manager of the Copenhagen General Practitioners’ Laborato- ry (KPLL). The laboratory carries out 3.5 million analyses for 340,000 patients every year. “In the final event it always comes down to ensuring that the GP has access to the right information as quickly and easily as at all possible. The health care data network is a very important tool in this context.”

19 Who can do what? MedCom messages and IT systems Pilot operation completed as at 1 October 1996

175 communications interfaces in total - Referral Discharge Laboratory Microbiology Patho 3/4 of which are in the GPs’ system letter

1st and 2nd pilot projects: MED MED MEDREQ/ MEDREQ/ MED 76 (dark green) REF DIS MEDRPT MEDRPT MED Rest: 99 (light green)

Req. Resp. Req. Resp. Req. Resp. Req. Hospital systems Kommunedata B-Data EDB-Gruppen Fyn-Sys Frb-Sys (SIS/SIBE) Laboratory systems Labka DeClab B-Data VGLIMS EDB-Gruppen X-ray systems Kommunedata B-Data Kodak Pathology systems Kommunedata IBM Fyn-Sys Microbiology systems AdBakt FynSys National Health Insurance Kommunedata Bema Kommunedata - local / EDB-Gruppen Pharmacy systems Datapharm CiTo-Data S.T. Data Apoteksdata Doctors’ systems Æskulap Novax PC-Praksis PLC Midoc Multimed Medex EMAR I-praksis Apex Docbase Ganglion

20 What is EDI?

EDI (Electronic Document Interchange) is the logy X-ray Nat. exchange of documents electronically between IT Health Insurance systems in structured form. The computer receiving REQ/ MEDREF/ MED information can forward it on directly. For example, RPT MEDDIS RUC information can be transferred directly from the hospital into the general practitioner’s records. Resp. Req. Resp. In order for the sender and recipient to be able to communicate and in order for the receiving computer to be able to process the information transferred, the messages are standardised. The parties agree which information a message must contain and which it may contain, how it is to be presented, how long the message can and must be, in which order the information of the message must be read, etc. The sender and recipient respectively can then set up their systems so that communication can take place as intended, and any person using the standards described can link up to the data network.

21 Standardisation in MedCom

The standardisation in MedCom is amendments during the actual im- However, the development of the based on the “simultaneous” de- plementation process - since “local standards was more resource- velopment of communications agreements” directly between the intensive than expected and standards for the health care sector suppliers should not be necessary. necessitated more activities than “on paper” and “in practice” in the anyone had foreseen. same organisation and in the same Neither was MedCom any exception. process. This is not normally the case Here, too, it proved necessary to Amongst other things, in the course in standardisation work, which is have a number of emergency of 1995 and 1996: often first developed “on paper” by standardisation and co-ordination ● permanent co-ordination groups an organisation, after which others measures in order to ensure that the were appointed for the labora- must examine “in practice” whether communication could be implement- tory and referral/discharge letters the standards can be used. However, ed “in practice” and the standards area experience from the four large specified accordingly. This process ● MMM correction letters for the regional EDI projects in Denmark was planned to the extent that a MIGs were elaborated had shown that it was not possible process of development involving ● a consensus data list for the use to develop functioning EDIFACT three subsequent versions of the of the standards was drawn up communication standards for the standards and two subsequent ● specifications of requirements health care sector “solely on paper”. groups of pilot projects was were harmonised in the 2nd pilot The subsequent implementation ne- planned. projects (“do likewise”) cessitated further specification and

MedCom’s standards, consensus data lists may be sent A joint guide for both MEDRPT and version 2.0 since it cannot be expected that the MEDREQ. receiving systems will be able to MedCom’s standards are made up of process this information in a rele- MEDDIS for discharge letters from two parts: vant way. hospitals to general practitioners and X-ray results from radiology de- A: A Message Implementation In addition, a set of “validating test partments to general practitioners. Guide (MIG) for each message messages version 2.0” has been drawn up, which meets the require- MEDREF for referrals from general B: A consensus data list for each ments of the two documents men- practitioners to hospitals and X-ray message. tioned and which can therefore be requests from general practitioners used for the suppliers’ testing to radiology departments. Future version revisions will cover during the development of the com- both documents. The MIG specifies munications interfaces. A joint guide for both MEDDIS and the structure and describes the sub- MEDREF. set of the CEN standard applied in MEDRPT for laboratory results from Denmark. The consensus data list clinical chemistry, pathology and MEDRUC for national health insur- clearly states which part of this sub- microbiology laboratories to general ance reimbursement by general set is used in Denmark, including practitioners. practitioners and pharmacies to the what all sending systems must send national health insurance. each time, what the sending systems MEDREQ for laboratory requisitions may choose to send - and thus from general practitioners to clinical CONTRL for acknowledgement together what all receiving systems chemistry, pathology and micro- message for messages received. must be able to receive. No inform- biology laboratories. ation other than that shown in the

22 International standards- EDIFACTs

● a “tutor secretariat” was To avoid a large number of closed systems for EDI established for quality assurance communication being established, standards - which of test messages ● operational EDIFACT messages are recommended for electronic communication - were compiled from the 1st pilot have been laid down under the auspices of the UN. projects ● “loose ends” rounds were held The name for these standards is “EDIFACT” and it is for the project participants possible to draw up EDIFACTs for all types of EDI ● consensus data lists were communication based on the guidelines (syntax ISO “elevated” to form part of the official standard. 9735) adopted. These are drawn up gradually as the need arises. However, the process succeeded in EDIFACTs adopted are international and the use of the end: “version 2.0” was assessed by all to be precise enough to the standards opens up EDI communication in a function as an “everyone to every- given area for everyone communicating in accordance one” communication standard in the health care sector. with these standards without prior negotiations and agreements. The pilot projects in MedCom use five EDIFACTs. These EDIFACTs have been adapted to Danish circumstances by MedCom’s EDI group, which The messages mentioned are expected to be able to be used unchanged translated and processed the international standards. for similar messages in a great In the MedCom project the major standardisation number of cases, e.g. communica- work was carried out by the EDI group, the members tion between hospitals, internally within hospitals, between general of which were responsible for modification of the EU practitioners and specialists, to and or UN standards to Danish circumstances within from local authority, home nurses, etc. their field.

MedCom’s standardisation Mark of Kommunedata. MIG standard “version 0.0” was authors: ● CONTRL was drawn up by Anders released in spring 1995 and was for K. Jørgensen of Dan Net. use in the 1st pilot projects. ● MEDRPT and MEDREQ were ● CODES maintained and distribut- MIG standard “version 1.0” was drawn up by Niels Jørgen ed by Stig Korsgaard of the released in spring 1996 and was for Christensen of Århus County National Board of Health. use in the 2nd pilot projects. Hospital. NJC is also chairman of ● The consensus data list was drawn MIG standard “version 2.0” was the EDI group. up by Mogens Schlamovitz of released on 10 December 1996 and ● MEDREF and MEDDIS were drawn MOS Informatik. is for permanent use after the up by Jesper Theilgaard, a ● Electronic test messages are MedCom period. general practitioner. maintained and distributed by ● MEDRUC was drawn up by Jan Thomas Hensing of Dan Net.

23 Two methods of to cover the circumstances in a standardisation number of countries with compre- Normal Edifact: Bottom up hensive functionality. On the basis Common concrete Edifact standard In the development of the “old” of this broad model a national MIG is created based on actual forms ➜➜ Danish communication standard (Message Implementation Guide) is “EPIKRI” a traditional “bottom-up” created which defines the parts Result: process was used. The existing forms which are relevant in the country in Becomes common EU standard for discharge letters were taken as question. the starting point and were describ- EU process: Top down ed as an EDI document stating the However, since both the definitions A broad “framework” standard data content, formats, field lengths, and the data model are very is created based on general etc. The standard was made gener- general, the CEN standards have the definition framework ally applicable by taking account of nature of a “framework” or “maxi- the circumstances in various hospi- mum” standards which provide Result: tals. many options for their concrete Becomes the de facto standard implementation. It is estimated that The European CEN standards are only 10% of the Danish MIGs are developed the opposite way using a used in actual communication. This was not possible for the suppliers to “top down” approach. First a gener- results in a risk of “local variants”. implement the full MIG, i.e. the full al definition apparatus and data MedCom’s standardisation practice “sub-set” of the standard which had model are created at European therefore included ongoing specifi- been chosen for use in Denmark. level, in which both the terminology cation and clarification of the and the structure are wide enough standard - as it became clear that it The need for further specification

Transition to version 2.0 Randers October 1996 decided to between which the receiving convert to the final “version 2.0” by systems must be able to accept both In MedCom’s pilot projects tempo- February 1997. This means that all “old” and “new” standards. rary standards (“version 0.0”, receiving systems will be able to “version 1.0” and variants) were receive the new standard from Internationalisation tried out, and these are still in oper- 1 February, and that all sending Principle of version revision ation in the pilot projects. Since it is systems must use only the final ● All receiving systems must be able a precondition for the rapid spread standard after 1 March 1997. After to receive both old and new of MedCom’s standards that all MedCom the intention is for future versions in the transitional period. suppliers use exactly the same version updates to be carried out ● All recipients shall support version standard, the suppliers who took according to the same principle - i.e. 2.0 from 1 February 1997. part in the “loose ends” round in based on dates laid down centrally ● All senders shall make the transition to version 2.0 after 1 February 1997 1 March 1997 1 February 1997 and before 1 March 1997. Sending systems ● All recipients shall be entitled not Old versions (0.0 and 1.0) to receive the older version after New version 2.0 1 March 1997. ● All senders must stop using the Receiving systems older version after 1 March 1997. Old versions (0.0 and 1.0) New version 2.0

24 was therefore satisfied by “elevat- Several members of the group are also members of the ing” the Danish consensus data lists international standardisation bodies and have thus to form an actual part of the standard, which therefore consists been involved in the elaboration of the standards in of two parts: a MIG and an associ- this capacity. ated consensus data list. There has been similar experience in Norway In connection with the implementation of MedCom’s and Britain, which countries have pilot projects, the EDI group had the task of co- also been working on the European ordinating the work involved in a final adjustment of standardisation process for several years. The idea of the European the various standards from a version 0.0 (draft) via CoCo project is therefore also to version 1.0 (provisional) to version 2.0 (permanent implement a “bottom up” process standard). by taking as a starting point the national consensus data lists and “adding” each time the circumstances in another country require further functionality. If this process succeeds, CoCo’s standards will be able to be used as an actual Europe- an communication standard which is capable of functioning “from North Cape to Gibraltar”.

How do the suppliers ● Further information which is not ● It can be expected that no other produce one version shown in the consensus data list information will be sent than which is able to be used must not be sent, since it cannot that shown in the consensus data throughout the country? be expected that the receiving list. systems will be able to process it ● However, other MIG information 1. Sending systems in the relevant way. must preferably be able to be ● Users must accept screen inform- handled - possibly in an error list. ● It must be possible for all man- ation which is used in only a few datory information in the con- places in Denmark, e.g. same day sensus data list (M, R and D) to surgery. be keyed in (if relevant), as some may be formed automatically. 2. Receiving systems Mandatory information must be present in every message. ● It must be possible for all man- ● All non-mandatory information datory and non-mandatory in- in the consensus data list (A and formation in the consensus data O) must be able to be keyed in list to be received and displayed (if relevant) and must be able to (if relevant) as the display of be sent. some information may not be relevant to certain systems.

25 CoCo-a MedCom in Europe?

Experience from the Danish (co-) fourth framework programme for the area of information technology operation within standardised elec- medical informatics which is to be in the health care sector. tronic communication in the primary carried out in the three-year period health care sector has been so posi- from 1996 to 1999. Who? tive that for a long time it has seem- During the establishment of the ed natural to establish contacts with Thus, in co-operation with Funen CoCo consortium the intention was similar activities in Europe, including County Council, MedCom took the to make contact with those regions Norway, the Netherlands and initiative to establish an EU project in Europe which had most experien- Britain. Since summer 1992 Funen based on building up regional ce within EDI in the primary health County Council has therefore been health care data networks in 10 care sector in each country. All the working on a number of European regions in Europe using the same participating CoCo regions are links within the field with the aim of technical and organisational princip- therefore either officially appointed achieving wider participation in a les as were used in Denmark. national test areas, or leading pro- larger European project in the area. jects in the area. And it is therefore In spring 1994 Funen County Council The project was called CoCo - also the long-term strategy to designated DKK 1.5 million for this “Continuity and Co-ordination in build up a national health care work, and on the formation of Med- Primary Health Care. The Regional data network in the participa- Com in the summer of the same Health Care Data Network”. In May ting countries, based year MedCom’s steering committee 1995 the project received 4 million partly on the experiences decided to contribute half this in- ECU in a grant from the EU’s fourth of the CoCo regions. vestment (DKK 775,000) in order to IT framework programme. CoCo is be able to participate in the EU’s thus the largest EU project within

26 MedCom’s EDIFACTs

In total over 100 GPs, over 30 hospi- The five EDIFACTs used in the Danish health care tals, 20 health centres, 12 universiti- data network are: es, 7 national telecommunications companies and 50 IT system houses MEDREQ for requisitions and MEDRPT for the are taking part in CoCo. results of bio-chemical laboratory investigations, continued on page 28 further microbiological investigations, and some histo-pathological and nuclear medical investigations. MEDREF for referrals and MEDDIS for discharge letters. This also applies to referrals for, and the results of, X-ray investigations, ultrasound diagnostics, nuclear medical investigations and clinical physio- logical investigations and the areas of casualty and obstetrics. MEDRUC for the submission of reimbursement messages, including reimbursement between GP’s and the national health insurance, between pharmacies and the national health insurance, reimbursement between the municipality of Copenhagen and the local pharmacies, notification of information to the National Board of Health’s drug statistics, and the drug statistics database between the National Board of Health and the Danish Pharmaceutical Association. MedCom also uses an acknowledgement message, CONTRL, which was not specifically designed for messages in the health care sector. The acknowledgement message can be used to approve or reject a message or part of such and to acknowledge receipt of the message following a syntax check.

27 continued from page 27 What? tion here - but, since the starting treatment of certain patient point is largely the Danish MedCom groups between a GP and In exactly the same way as occurred standards, the European CoCo hospital laboratories, etc. in the big regional Danish EDI pro- standards are not expected to be jects and in MedCom, the intention vastly different. ● Finally, communication standards is to build up regional health care will be developed for image and data networks in the individual re- CoCo also includes a three-stage multimedia communication. gions in Europe. And just as happen- strategy for the long-term developed in MedCom, a number of central ment of a regional health care data CoCo LINK activities have been network. In the strategy the “heavi- Why? established accordingly to provide est” existing information flows in The majority of communication in the regions with standards, the health care sector (prescriptions, the health care sector is regional standardisation tools, etc. In the laboratory results, etc.) will be used and only a negligible part takes light of the standardisation experi- to provide a market lift for a grad- place across national borders. So ence from MedCom (and similar ex- ual introduction of new and more why take part in building up a perience in Norway and Britain), the advanced communication flows: European health care data network? standards will be based on a CEN And why develop common Europe- sub-sub-set from the start. These ● First, standards will be developed an standards for this communica- standards are as pragmatic, narrow, and implemented for the most tion? Why devote Danish resources concrete and simple as possible, frequently used messages in the to this task? Although the CoCo pro- based on the national MIGs and health care sector: prescriptions, ject has received EU support, the data lists which have already been laboratory results, discharge economic benefits for Denmark are tested in some of the participating letters, etc. small. countries. The aim is to “expand” these national standards so that, in ● The next standards will be devel- On the minus side, it has been the course of the process, a single oped which cover previously necessary to invest considerable European CoCo standard is develop- unmet communication needs in resources in order to take part. ed which is capable of functioning the health care sector: communi- in all regions. Pilot projects will be cation with the home nurses, On the plus side, the EU has granted established in Denmark to test out communication of excerpts from DKK 5.7 million in total to the whether these standards can func- records in connection with joint Danish partners and thus Denmark will receive financing for some of the activities it had already planned.

CoCo regions: This means that the EU is financing: Denmark: Some of MedCom’s pilot projects, Funen County ● Denmark becoming visible in a and the municipality of Odense high-tech field and being able to Northern Ireland: S&E Belfast Health Trust influence the European standard- Eire: NW & NE Health Board isation process. Greece: Rhodes Holland: Zwolle ● Denmark making European con- Italy: Lombardy tacts and gaining experience England: Oxford, Suffolk and Ipswich within research and development Canada: Prince Edward Island in an important area for future Norway: Western Health Region expansion (telematics and tele- Spain: Catalonia and the Balearic Islands communication).

28 ● Danish trade and industry being A. The same data may be shown differently in different able to utilise its head-start to systems. establish exports of services to B. Data, e.g. the name of the patient in a GPs’ system regional health care data file. networks, the European market C. Information on the type, size and position in the being worth something in the EDIFACT is added. order of 1-2 billion ECU. The com- D. Placed in a predetermined position in the pany RAMBOLL has established EDIFACT. exports to Ireland on the basis of E. Type and size are read off. Extra information is this. removed. F. Data is placed in the receiving file. ● the development of a European G. Data is displayed in the recipient’s system. market for health telematics, which would mean electronic communication in the health care Files Mapping Edifact Mapping Files sector becoming radically cheaper.

● we, as professionals in the Danish health care sector, can learn a lot from the contact with colleagues in the other European countries.

● the fact that European contacts can assist in obtaining further funds from the EU, e.g. Funen county has received DKK 1m in connection with the Prestige A B C D E F G project and DKK 0.7m for the Primacom project, and MedCom DKK 0.8m for the WISE project; moreover, CoCo will have great opportunities to obtain extra Automatic grants in connection with the communication planned top-up grants from the EU in May 1999. Data in the IT systems connected to the data network is automatically reformatted to the EDIFACT format. The reformat- ting is carried out using mapping tables which vary from one IT system to another, ex- plains Steen Mariboe, MedCom’s project co-ordinator. “Protocol conversion is necessary in order for communication to be possible between different types of IT systems. This part of the communication is carried out by a network supplier - a VANS supplier - who is thus the link between the parties on the network.”

29 MedCom II

MedCom’s steering committee has organisation should have the task of New standards decided to propose to the granting providing advice in connection with organisations that a three-year con- concrete projects within the sector As an extension of the MedCom tinuation of the MedCom project be in which EDI communication is intro- project carried out to date, continu- established, known as MedCom II, duced. ous consideration should be given to with a total budget of DKK 25m. developing and testing new com- MedCom II would have the follow- MedCom II’s first priority in the munication standards. Amongst the ing main tasks: initial years is thus to secure the types of messages/areas of commu- rapid spread of the communication nication which may be relevant are: 1. To encourage the rapid spread in standards developed in 1995-96, the Danish health care sector of with a view to achieving usage of ● sending information on waiting the communication standards 75% - equivalent to over 23 million times at hospitals to general prac- developed in the period 1995-96. messages per year - by the year titioners 2000. ● communication standards in rela- 2. To develop further communication to electronic patient records tion standards and test these in In concrete terms, this means: ● booking pilot projects as an extension of ● gathering of data for clinical the first MedCom project, in- A. Implementation of a project for databases cluding standards for use in con- transition to the new standards in ● statistical reports nection with the introduction of spring ’97. ● administrative information electronic health care records, between the IT systems of health hospital waiting times and elec- B. Implementation of a number of specialists, including patient ID tronic scheduling (booking). dissemination projects in co-oper- ● internal information between IT ation with interested counties, systems in the hospital which Spread etc. The task will be to implement were supplied by different MedCom II is to encourage the electronic communication betw- suppliers spread of electronic communication een the parties in the health care ● death certificates in the health care sector by provid- sector using MedCom’s standards. ● image and multimedia communi- ing information material concerning cation. the possibilities and advantages of C. Ongoing quality assurance and EDI communication. In addition, the co-ordination.

It is important ● that MedCom’s standards are attempted to be used unchanged ● that the MedCom standards are in connection with other similar supported by the health authori- communication needs in the ties health care sector, e.g. for equivalent communication between ● that a nationwide transition to hospitals, between specialists and the new MedCom standards is general practitioners, between completed in 1997 laboratories, hospitals and so on.

● that the MedCom standards developed remain unchanged until substantial use of these has been achieved

30 “The Mailbox” - a node

The National Board of The electronic mailbox provided by the network Health to act as the supplier acts as a node in the health care data net- authority work, where the messages can be delivered and collec- The development and project orien- ted when the sender and recipient wish. tation tasks connected with the establishment and development of a The use of the mailbox means that users of the data Danish health care data network network are not restricted to sending or receiving if or will be carried out by MedCom II, when the other party is ready or has the computer whilst the tasks which fall to the authorities and maintenance tasks, turned on. including “adoption” in connection Another advantage of building up the health care data with EDI communication and the message standards applied, will be network around a common node is that independent carried out by the EDI Secretariat links do not have to be established between a great placed in the National Board of number of parties who communicate with some or all Health. of the others. The tasks of the authority include: Each party establishes one connection to the common platform, the health care data network’s mailbox, and ● Participation in EDI standardisation work at national and inter- through this is linked to all users of the agreed national level EDIFACTs. ● Development and distribution of codes and classifications ● Safety aspects ● Development and implementation of test and certification procedures ● Expert maintenance, updating, user profiles and version management of MedCom’s EDI standards ● Assignment and administration of location numbers ● General overall co-ordination and information regarding the tasks of authorities

31 Organisation and participants

The Steering Committee fields of EDI, standardisation, technology and the Hjerresen, Kristian, medical areas involved. The advisory group con- South Jutland County Council MedCom’s steering committee is made up of the sists of experts and users of various subject areas, Hvolris, Henrik, IT-coordinator, Hvidovre Hospital financing parties. The committee has had overall e.g. standardisation, technology, medical speciali- Jensen, Frank I., head of department, responsibility for the execution of the project. ties, etc.; in addition, all the key people from the Vejle County Council The Danish Ministry of Health has acted as secre- previous Danish regional projects were also Jørgensen, Henrik Munk, IT co-ordinator, tariat and chair of the steering committee. members. Køge Hospital Larsen, Ib Alfred, IT Manager, Hillerød Hospital Members: Members: Lehrmann, Tove, project leader, Nielsen, Vagn, head of department, Jensen, Henrik Bjerregaard, Danish Centre for Health Telematics Ministry of Health (Chairman) project manager, Danish Centre for Health Madsen, Peer Sloth, IT co-ordinator, specialist, Vestergård, Leif, head of administration, Telematics (Chairman) Hillerød Hospital Vejle County Council (deputy chairman) Bernstein, Knut, project leader, Nielsen, Birgit, Storstrøm County Council Gylling, Svend, consultant, Copenhagen Danish Centre for Health Telematics Nielsen, Grethe, systems planner, Hospital Corporation Christensen, Niels Jørgen, cand.scient., North Jutland County Council Jensen, Henrik Bjerregaard, project manager, Århus County Hospital Nielsen, Lis Lund, IT assistant, Horsens Hospital MedCom Erbs, Kjeld, head of section, Århus County Council Parker, Jens, GP, The Health Centre, Copenhagen Jensen, Ida Sofie, head of department, Grinsted, Per, GP-coordinator, Pedersen, Peter, consultant, Bispebjerg Hospital the Association of County Councils in Denmark Odense University Hospital Porsborg-Smith, Jeffrey, departmental manager, Jensen, Keld Gert, development manager, Jensen, Frank I., head of department, North Jutland County Council Tele Danmark Vejle County Council Poulsen, Frank V., deputy head of section, Korsgaard, Stig, cand.polyt., Jensen, Michael Voel, IT manager, the Department of Health National Board of Health the Danish Pharmaceutical Association Ravndam, John, financial manager, Copenhagen Lund, Palle, director, Funen County Council Johansen, Ib, consultant, General Practitioners’ Laboratory Mark, Agner, director, Dan Net A/S Danish Centre for Health Telematics Sprøgel, Ole, National Serum Institute Mikkelsen, Ole, director, Kommunedata I/S Jørgensen, Anders Kristian, departmental Svanholm, Åge, Storstrøm County Council Munk, Karsten, special consultant, manager, Dan Net A/S Svendsen, Bente R., Vejle County Council Ministry of Health Klamer, Finn, GP, Øster Jølby Øtoft, Elly, senior clerk, Ribe County Council Nielsen, Kresten, GP, the Medical Association Korsgaard, Stig, cand.polyt., Olesen, Lene Hübertz, pharmacist, National Board of Health The EDI group the Danish Pharmaceutical Association Korsholm, Niels, director, Fischer & Lorenz A/S carried out all the standardisation work in Med- Pedersen, John Erik, office manager, Lehrmann, Tove, project leader, Com, including the elaboration of the EDIFACT Ministry of Health Danish Centre for Health Telematics STANDARDS used and associated implementation Mariboe, Steen, project co-ordinator, guidelines (MIGs - Message Implementation Project management and Danish Centre for Health Telematics Guides). In addition, a code group was appointed Mark, Jan, consultant, Kommunedata I/S with the purpose of facilitating the use of codes project staff Munk, Karsten, special consultant, and classifications in MedCom and supporting the Everyday management was carried out by a pro- Ministry of Health Board of Health’s work on getting uniform, ject manager who had responsibility for the Parker, Jens, GP, The Health Centre, Copenhagen nationwide codes and classifications established implementation of the project and for planning Ring, Peder, consultant, the Association of in the Danish health care sector. The EDI group and prioritisation of the tasks, including internal County Councils in Denmark was made up of all the Danish members of the organisation, accounts and maintenance of the Theilgaard, Jesper, GP, The Health Centre, international standardisation bodies CENT251- budget. Bramdrupdam WG3 and EPOS-MD9.

Staff: The project management group Members: Jensen, Henrik Bjerregaard, project manager was MedCom’s basic co-ordination group during Christensen, Niels Jørgen, cand.scient., Henriksen, Gitte, secretary the execution of the project. The project manage- Århus County Hospital (chairman) Johansen, Ib, consultant ment group was made up of the project mana- Eriksen, Poul Willy, consultant, Novax Bernstein, Knut, consultant, physician gers from each of the participating regions in Hensing, Thomas, consultant, Dan Net A/S Mariboe, Steen, project co-ordinator MedCom. The project managers were locally Jensen, Henrik Bjerregaard, project manager, Hansen, Maj-Britt Meyer, secretary responsible for the implementation of the regio- Danish Centre for Health Telematics nal projects - and the pilot projects’ contact with Korsgaard, Stig, cand.polyt., Working parties and MedCom. The project managers were typically IT National Board of Health managers from the participating county councils Mariboe, Steen, project co-ordinator, co-ordination groups and laboratories. Danish Centre for Health Telematics Three advisory groups were set up in connection Mark, Jan, consultant, Kommunedata I/S with the implementation of the project, along Members: Schlamovitz, Mogens, consultant, MOS Informatik with an “EDI group” and a “code group”, which Christensen, Bente, IT co-ordinator, Theilgaard, Jesper, GP, The Health Centre, carried out standardisation tasks for MedCom. Kolding Hospital Bramdrupdam Erbs, Kjeld, head of section, Århus County Council The advisory group Gylling, Svend, consultant, Copenhagen Suppliers had the aim of advising the project in the start- Hospital Corporation up phase with a view to the elaboration of a pro- Henriksen, Tom Onsberg, IT consultant, A total of 24 IT suppliers representing 29 diffe- ject description and project handbook. The ad- Ribe County Council rent IT systems took part in MedCom - accounting visory group consists of specialists within the for 80% of all IT systems relevant to communica-

32 The development continues

tion in the Danish health care sector. The IT It is realistic to believe that the remaining parties in suppliers were involved in the individual pilot projects and were active in the standardisation the Danish health care sector will connect to the work, attending supplier meetings, courses and “loose ends” rounds in MedCom. In addition, the health care data network in the coming years and that VANS firms Dan Net and Kommunedata were suppliers of EDI-MANAGER and EDI-TUTOR pro- a substantial part of the communication in the ducts as well as VANS services, and both were particularly active in the standardisation. primary health care sector will take place electroni-

Suppliers cally before the year 2000. Denmark is thus the first ADBakt, the County Hospital in Herlev, Peter Steenberg country in Europe to establish a functioning, nation- Apex, Datasupport A/S, Henrik Thuren Jensen wide health care data network. B-Data A/S, Ivan Christensen BEMA, Jesper Egebak Jensen After 1996 communication will also be expanded to Cito Data A/S, Bo Nielsen Dan Net A/S, Anders Kristian Jørgensen include new forms. EDIFACT trials have already Dansk Datalab ApS, Henrik Ishøj Datapharm A/S, Allan Giese been started for communication between local DEClab/CRI, Mogens Schlamovitz Docbase A/S, John Aggerholm authorities and hospitals, GPs and pharmacies. In EMAR, EM-data A/S, Jens Traberg EDB-gruppen Systems, Knud Erik Hovgaard addition, there is great interest in “interactive EDI” in Frb-Sys, Hillerød Hospital, Ib Alfred Larsen Fyn-Sys, Funen County Council, Ole Søndergaard the form of the booking of treatment and investiga- Ganglion, Aver & Lauritzen ApS, Jens Christian Lauritzen tions at hospitals directly from the GPs. And finally, I-praksis, RAMBOLL, Morten Bruun-Rasmussen IBM DANMARK A/S, Stig Pedersen image and multimedia communication will also be Kodak, Per Iversen highly important in the health sector in the future. Kommunedata I/S, Jan Mark Kommunedata I/S, Mogens Koefoed An existing health care data network will probably Kommunedata I/S, Per Frey LABKA, Dansk Datalab ApS, Uffe Christiansen mean that this development takes place considerably Medex, RAMBOLL, Morten Bruun-Rasmussen MIDOC, Michael Johansen, EG Data Inform faster than in other countries. Multimed, Datagruppen Vejle A/S, Erik Jacobsen NOVAX, Nordteamgruppen A/S, Erling Abildgaard PC-Ide/PC Praxis, Jørgen Block-Petersen PLC, A-Data ApS, Jørgen Granborg S.T. Data, Søren Thygesen Data, Søren Thygesen Odense has started VGLIMS, Datacentralen A/S Æskulap, Ascott Software A/S, Ivan Andersen “The idea of involving the local Key people in authorities as an active part of the pilot projects the health care data network Around 200 key people took part in MedCom’s led to Funen County Council pilot projects from nine counties, the National contacting Odense Local Autho- Serum Institute, Copenhagen General rity and the Association of Local Practitioners’ Laboratory, 12 hospitals, 80 doctors’ practices and 10 pharmacies. Authorities in Denmark,” relates Anne-Mette Oudrup, Bispensgade Practice, Aalborg project manager of FynCom Torvestræde 8 Practice, Næstved Østerbrogade 33 Practice, Nykøbing F Municipality. Spentrup Practice, Spentrup “Both parties were positive. Dommervænget Health Centre, Roskilde Where Odense Local Authority has become involved in the de- Adeler, Haagen, GP, Århus C Andersen, Henning Ejbye, GP, Frederikshavn velopment of the actual data network solution, the National Andersson, Britt Sylvester, secretary, Association of Local Authorities is involved in the project first Horsens Hospital, Horsens Andreassen, Erling, senior physician, and foremost in order to ensure that the solution can be ex- Kolding Hospital, Kolding tended to other local authorities, both large and small.” continued on page 34

33 Organisation and participants

continued from page 33

Ankjær, Annelise, IT consultant, Hillerød Hospital, Hansen, Janne Voss, senior secretary, Leth, Inge, The IT Centre, Esbjerg Hillerød Aalborg Hospital South, Aalborg Lindskov, Jørgen, managing senior physician, Arends, Peter, pharmacist, Bagsværd Pharmacy, Hansen, Margaretha H, IT Centre, Esbjerg Farsø Hospital, Farsø Bagsværd Hansen, Per Blicher, The Health Centre, Vejby Lindskov, Rune, Gerda Frentz, Willy Wolf Avrach, Arendtsen, Lise, senior laboratory technician, Hansen, Peter Würgler, GP, Odder Mads Nielsen, The Skin Clinic, Copenhagen V Hvidovre Hospital, Hvidovre Haugbølle, Nils, GP, Copenhagen K Lund, F.N., Swane & K. Billekop, T Arvelind, Finn, GP, Copenhagen K Hauge & Grove, The Health Centre, Farsø he Health Centre, Nykøbing F Baandrup, Ulrik, senior physician, Hedemand, Niels, senior physician, Madsen, Anders Gram, IT consultant, Århus Municipal Hospital, Århus C Haderslev Hospital, Haderslev Hillerød Hospital, Hillerød Bak, Ole, GP, Rødding Hem, Johannes, GP, Odense SV Madsen, Finn, the Danish Pharmaceutical Banke, John, GP, Vejle Henningsen, Poul, RAMBOLL, Odense NV Association, Copenhagen K Bencke, Susanne, Randers Central Hospital, Henriksen, Hans Erik, IBM, Kolding Madsen, John, BEMA, Hjørring Randers Henriksen, Karen, senior secretary, Madsen, Søren, GP, Oksbøl Bisjær, Niels, senior physician, Århus Municipal Hospital, Århus Mathiassen, Elkær, director, EM-data A/S, Vejle Ø Randers Central Hospital, Randers Henriksen, Marianne, The Central Hospital, Mayntzhusen, Pia, senior laboratory technician, Bjørnshave, Thomas, The Health Centre, Års Nykøbing-Falster Århus Municipal Hospital, Århus C Borgen, Gitte, Næstved Central Hospital, Henriksen, Rita, IT user consultant, McNair, Peter, senior physician, dr.med., Næstved the IT Centre, Esbjerg Hvidovre Hospital,, Hvidovre Borum, Torben, Århus County Council, Højberg Hjortkjær, H., J. Kongstad, Medical Practice, Messerschmidt, Birger, National Serum Institutute, Bundgård, Minna, secretary, Farsø Hospital, Farsø Copenhagen N Copenhagen S Campell, Kirsten Skov, systems planner, Hvid-Hansen, Ole, The Health Centre, Tommerup Michaelsen, Peter, Hvidovre Hospital, Hvidovre IT department, Esbjerg Høst, Arne, managing senior physician, Mikkelsen, Else, National Serum Institute, Christensen, Anni, IT technician, Odense University Hospital, Odense C Copenhagen S Esbjerg Central Hospital, Esbjerg Ibsen, Vera, Vejle County Council, Vejle Møller, Karin & Torben, The Health Centre, Christensen, Ole, Esbjerg Krone Pharmacy, Esberg Jacobsen, Klaus Berggren, GP, Copenhagen S Copenhagen K Christensen, Ole Holst, GP, Vordingborg Jakobsen, Jakob R., Vejle County Council, Vejle Nielsen, Bente, GP, Copenhagen V Christensen, Peter, Skødstrup Medical Practice, Jensen, Anette Palm, National Serum Institute, Nielsen, Birthe, the IT Centre, Esbjerg Skødstrup Copenhagen S Nielsen, Jan Bruhn, Kaas Health Centre, Pandrup Christoffersen, Claus, gynaecologist, Brønshøj Jensen, Flemming, GP, Greve Nielsen, Jan Erik, GP, Copenhagen V Damsgaard, Kristine, senior secretary, Jensen, Hans Jacob, GP, The Health Centre, Nielsen, Jørgen, Vamdrup Health Centre, Odense University Hospital, Odense C Odense C Vamdrup Dernecke, Rungø & Nilsson, The Health Centre, Jessing, Lone, secretary, Kolding Hospital, Kolding Nielsen, Kresten, GP, Malling Svendborg Johnsen, Bodil, GP, Copenhagen V Nygård, Anne, secretary, Aalborg Hospital North, Dissing, Helle, secretary, Hvidovre Hospital, Jøhnk, Hanne, GP, Copenhagen N Aalborg Hospital Hvidovre Jørgensen, Hilburg, Smutten Health Centre, Nyland, Nick, GP, Esbjerg V Dybdahl, Knud, GP, Esbjerg Hjørring Nørregaard, Flemming, GP, Copenhagen N Edelmann, Ulrik, GP, Randers Jørgensen, H. Ask & F.E. Kaup, the Health Centre, Olsen, Dorthe, Odder Central Hospital, Odder Eg, Bodil & Jørgen Winther, Medical Practice, Næstved Olsen, Paul P., GP, Esbjerg Randers Kaae, Tove, head consultant, Oxholm, Anne Mette, GP, Frederiksberg C Engelholm, Anni, GP, Brønshøj Odense University Hospital, Odense C Pedersen, Berrit, senior secretary, Engsig-Karup, Mogens, Århus County Council, Kastfeldt, Stine, IT assistant, Hjørring Hospital, Hjørring Højberg National Serum Institute, Copenhagen S Pedersen, Frank, IT manager, Erin-Madsen, Jes, senior physician, Kirkegaard, Jens, GP, Nykøbing Falster Århus Municipal Hospital, Århus Horsens Hospital, Horsens Kjær, Ole W., GP, Vejle Pedersen, Poul, pharmacist, Fjeldgård, Bruno, programmer, Klestrup, Lene, consultant, Kommunedata I/S Svane Pharmacy, Århus C North Jutland County Council, Aalborg East Kundsen, Ulf, head of section, Pedersen, Susanne, laboratory technician tutor, Frederiksen, Lars, Nygårdsvej Practice, Esbjerg Randers Central Hospital, Randers Hvidovre Hospital, Hvidovre Frimodt-Møller, Hans & Hans-Christian Møller, Knudsen, Hans-Jørgen Vendelbo, GP, Petersen, Marianne, laboratory technician, Medical Practice, Copenhagen K Copenhagen Ø Hvidovre Hospital, Hvidovre Frydenlund, Elise, senior secretary, Kolby, Peter, GP, Næstved Petersen, Poul Henrik, consultant, Odense University Hospital, Odense C Kold, Niels, radiographer, Aalborg Hospital North, Kommunedata I/S, Århus N Fryd & Gunnersen, Medical Practice, Aalborg Pilgaard, Dorthe, Ribe County Council IT Centre, Copenhagen N Korsgaard, Ove, Esbjerg Central Hospital, Esbjerg Esbjerg Gade, Janni, Aalborg Hospital, Aalborg Kowacs, Ferenc, GP, Copenhagen Ø Poulsen, Ole Eckhardt, GP, Jyllinge Grøn, Anna, secretary, Hjørring Hospital, Hørring Krarup, Ole, GP, Nakskov Poulsen, Stig Hempel, GP, Copenhagen NV Gudiksen, Ann Lilholt, IT assistant, Farsø Hospital, Kristiansen, Jane, assistant, Poulsen, Ulla, pharmacist, Vejen Pharmacy, Vejen Farsø North Jutland County Council, Aalborg East Rasmussen, Jan, senior physician, Gøtzsche, Henrik, The Health Centre, Brædstrup Kristiansen, Kirsten, the IT Centre, Esbjerg Vejle Hospital, Vejle Hansen, Anette Gadegaard, GP, Copenhagen Ø Kruse, Verner, senior physician, Rost, Dan, GP, Christiansfeld Hansen, Anni, Copenhagen General Practitioners’ Aalborg Hospital North, Aalborg Ruhwald, Jørgen, GP, Copenhagen V Laboratory, Copenhagen K Landt, Bodil, laboratory technician, Rønhof, Kim, GP, Svendborg Hansen, Ernst, GP, Haderslev Hvidovre Hospital, Hvidovre Samsig, Paul D., A-DATA ApS, PLC, Frederiksberg Hansen, Ingelise, pharmaceutical assistant, Larsen, Jane, secretary, Give Hospital, Give Schlarbusch, Christian, senior physician, the Danish Pharmaceutical Association, Larsen, Preben, GP, Køge Give Hospital, Give Copenhagen K Lassen, Torben, GP, Vanløse Schroll, Henrik, GP, Odense M

34 MedCom II in Odense

Schulsinger, Charlotte, GP, Copenhagen K On conclusion of the first MedCom project at the Siboni, Knud, senior physician, professor, dr.med., Odense University Hospital, Odense C end of 1996 it was decided that, in purely physical Sigh, Poul, GP, Viuf Silbye, Hanne & Peter, The Health Centre, Køge terms, MedCom II should be located at MedCom’s Sinding, Ruth, ontologist, Copenhagen K Skjold, Per, GP, Copenhagen S previous address at the Danish Centre for Health Skov, Bjarke, GP, Skanderborg Sparre, Jørn, GP, Copenhagen S Telematics in Odense, where MedCom II will share Stabel, Niels J., GP, Give Stenvald, Henrik, GP, Horsens premises with the FynCom county and local authori- Svensson, Niels, GP, Maribo Sølvkjær, Martin, doctor, Højbjerg ty projects. Søndergaard, Ole G., development manager, At the same time it was decided that MedCom II the IT office, Odense University Hospital, Odense C should be manned by a project manager, three con- Søndergaard, Ole, GP, Frederikshavn Sørensen, Bodil, secretary, sultants and two administrative assistants. The project Esbjerg Central Hospital, Esbjerg Theilgaard, Jesper, GP, Kolding manager is expected to be appointed early in 1997. Thomassen, Helle, Randers Central Hospital, Randers Thomsen, Leo, GP, Sulsted Tilmam, Axel, senior physician, Frederikshavn-Skagen Hospital, Frederikshavn Torrild, Ole, Kommunedata I/S, Århus N Vinther, Lis, secretary, Smutten Health Centre, Hjørring Vork, Anne, Svendborg Hospital, Svendborg Walsøe, Ida, GP, Brønshøj Walther, Margrethe, secretary, Frederikshavn-Skagen Hospital, Frederikshavn Westergaard, Jes, managing senior physician, Odense University Hospital, Odense C Winther, Jan, A-Data ApS, Roslev Wriedt, Lene, laboratory technician, Århus County Hospital, Århus C Würtz, Rudy, Ribe County Council, Ribe Øland, Bent, IT manager, DADL, Copenhagen K The future is here

GP Finn Klamer has taken the first of many steps towards the practice of the future. For example, he has facilities for Further information receiving digital images which The MedCom Secretariat Danish Centre for Health Telematics are loaded directly into electro- Heden 18, DK-5000 Odense C nic patient records. With ex- Telephone +45 6613 3066 tended data communication he Fax +45 6613 5066 e-mail address: [email protected] will quickly be able to send the same pictures to a specialist to The Danish Ministry of Health get an opinion and advice on Holbergsgade 6, DK-1057 Copenhagen K Telephone +45 3392 3360 the further treatment of the patient. Fax +45 3393 1563 Finn Klamer is also able to transmit the readings for a patient with heart problems directly from their home to the patient’s Colophon Editor: Steen Mariboe, project co-ordinator records in the clinic, via a portable computer. Journalistic input: Kim Jørstad, arki•tekst “Naturally, the same readings should be able to be transferred Graphics: Christen Tofte Grafisk Tegnestue through the health care data network to specialists who can Circulation: 3000 Printed by Expres-Trykkeriet, Odense advise on treatment,” says Finn Klamer.

35 ●● ●●

●● ● ●● ●

●● ●● ●● ●● ●● ●● ●●

●● ●● ●

●●

Danish Centre for ●●●●●●●●●●●●●●●●●●●●●●●● ● ● ● ● ● ● ● ● Health Telematics ● ● ● ● ● ● ● ● Heden 18 DK-5000 Odense C ● ● ● ● Telephone +45 6613 3066 Fax +45 6613 5066 ● ● ● ●

● The Danish Ministry of Health Holbergsgade 6 DK-1057 Copenhagen K Telephone +45 3392 3360 Fax +45 3393 1563