THE DANISH GOVERNMENT LOCAL GOVERNMENT DENMARK DANISH REGIONS

MAKING eHEALTH WORK NATIONAL STRATEGY FOR DIGITALISATION OF THE DANISH HEALTHCARE SECTOR 2013-2017 CONTENTS PREFACE

PREFACE 2 Citizens should be able to receive high-quality Because of an ageing population, there will and coherent patient care from a modern be more people with chronic diseases in A DIGITAL HEALTHCARE SYSTEM 4 and efficient Danish healthcare system. the future who will require cross-sectoral An important element in achieving this treatment. This increases demand for more HEALTHCARE SERVICES DELIVERED IN NEW WAYS 6 is to actively involve patients in their own – and better – collaboration across hospitals, treatment, and to organise treatment homecare and general practitioners. DIGITAL WORKFLOWS AND PROCESSES 10 in accordance with the needs, possibilities and schedule of the individual. Therefore we have taken steps to fundamen- COHERENT PATIENT PATHWAYS 14 tally change the Danish healthcare system by We want a healthcare system that is concentrating treatments at fewer but more BETTER USE OF DATA 20 coherent, and in which healthcare providers specialised hospitals; by ensuring that more collaborate across sectors and specialist treatments are performed on an outpatient GOVERNANCE 24 groups to deliver the best service to patients. basis; and by having more patients treated in – or close – to their home. Increased specialisation emphasises the mutual dependence between players in the health- care sector.

Digitalisation is key to a citizen-centric healthcare system which is coherent and efficient. However, if we are to harness the benefits of digitalisation, everyone must participate, as many of the benefits require cross-sectoral efforts. Danish eHealth is top of its class internation- WE HOPE YOU WILL FIND IT THE EXTENT OF eHEALTH USE IN HOSPITALS IN THE EU ally, see figure 1. We already have a number of AN INTERESTING READ ICT systems in support of patient treatment, workflow, and cross-sectoral collaboration. Astrid Krag The challenge ahead is to fully exploit the Malta* 2012 Minister for Health Denmark 2010 potential of these digital solutions in the Estonia treatment of patients, to ensure greater Sweden 2012 EU-27+3 Erik Nielsen Finland coherence between digitalisation efforts 2010 EU-27+3 Chairman of Local Government Denmark UK across the healthcare sector, and to ensure Netherlands Luxembourg greater visibility of outcomes. Austria Bent Hansen Belgium Chairman of Danish Regions Iceland With this National Strategy for Digitalisation Norway of the Danish Healthcare Sector 2013-2017, Spain Ireland the Danish government, Local Government Italy Cyprus Denmark and Danish Regions continue their France collaboration for digitalisation. The strategy Germany Portugal was prepared by the National Board Croatia of eHealth and it outlines the ambitious­ Czech Rep. Romania and binding common commitment for Hungary future work. We have named the strategy Bulgaria Latvia Making eHealth work. Slovakia Lithuania Slovenia Greece Poland 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8

Figure 1. The extent of eHealth use in hospitals in the EU, based on an indicator comprising four parameters: ICT infrastructure; ICT solutions; exchange of health data; and ICT security and privacy. Source: Joint EC - OECD Workshop "Benchmarking Information and Communication Technologies in Health Systems", Brussels, 18-19 April 2013. *Malta was only represented with data from a single hospital and therefore is not represented with the same validity as the other participants.

DIGITALISERING MED EFFEKT 3 A DIGITAL HEALTHCARE SYSTEM

The vision of the Danish government, Local National Action Plan for Dissemination it requires unified log-on solutions and stable Digitalisation must contribute to raising the Government Denmark and Danish Regions for of Telemedicine further, in order to deploy ICT systems. quality of services and to releasing resources a digital healthcare system in Denmark is: and implement the successful solutions that may be prioritised to benefit patient and models for collaboration at large scale. When raising awareness about the use and care. Patients and citizens should experience To make coherent, efficient and standardised effect of ICT, we need to shift our focus away the benefits of digitalisation. digital solutions available to health profes- This will give patients better tools to from seeing digitalisation and the use of ICT sionals in their delivery of healthcare services understand their condition and to manage as only being about documenting data and THE STRUCTURE OF THE STRATEGY to the public. their own treatment. information as part of daily work procedures. We need to become better at comparing The strategy comprises five focus areas: The aim of this new National Strategy for Access to healthcare is made easier when data, avoiding double entries, and assisting Digitalisation of the Danish Healthcare Sector patients can book an appointment with relevant work processes. For example, ICT • healthcare services delivered in new ways 2013-2017 is to ensure that the many ICT their general practitioner online. Similarly, must provide valuable overviews as well • digital workflows and processes projects launched within the healthcare healthcare services are made less dependent as support for decisions and planning in • coherent patient pathways system benefit patients and staff. We need on opening hours when the public has online the daily treatment of patients. • better use of data to ensure better and more efficient care, access to submitting data about their • governance increased patient safety and easier ­workflows condition. In some cases, this will mean MORE COST-EFFECTIVE HEALTH for staff. During the lifetime of the strategy, they avoid having to go through time-­ Each section provides a brief status on SOLUTIONS we will increase our focus on ensuring full consuming routine check-ups. This the area, describes challenges, and sets out deployment and use of existing ICT solutions, ­exemplifies how the use of patient and We must ensure greater visibility of the goals for efforts within the individual area. e.g. by phasing out paper-based workflows. staff resources can be optimised, so that benefits of digitalisation, and we must use Each section also contains descriptions efforts can be strengthened where the digital solutions to create greater awareness of specific initiatives that are to be carried need is greatest. about progress and achievements in the out in the short term in order to realise HEALTHCARE SERVICES DELIVERED healthcare sector. The Danish government, the strategy. IN NEW WAYS in collaboration with local and regional MORE TIME FOR CORE TASKS We need to use ICT and digitalisation to governments, will therefore establish Additional goals for digitalisation towards involve patients. The digital possibilities We need ICT and digitalisation to enhance ambitious indicators for digital workflows 2017 will be set in the budget agreements to involve the individual citizen as an active the quality of care and to ease the work and coherent patient pathways in the for 2015 and onwards. player must be better utilised, e.g. by using of health professionals. This is crucial in healthcare sector. telemedicine or the citizen's own data. ensuring digitalisation is used to deliver more We will take the actions outlined in the cost-effective health solutions. Moreover,

4 MAKING eHEALTH WORK BOX 1 BOX 2 BOX 3

KEY GOALS OF THE STRATEGY RECOMMENDATIONS ON eHEALTH • Efforts by the regions to accelerate work THE LINK TO OTHER STRATEGIES IN THE SHORT TERM FROM EVALUATION OF to establish and put into use clinical This strategy takes further the tracks set THE STRUCTURAL REFORM ICT workstations, to ensure systematic • Deployment and use of consolidated out in the out in the eGoverment strategy follow-up on the phase-out of manual clinical ICT workstations in all regions There is need for: 2011 - 2015. The common regional digitali­ workflows, and to phase out the use before the end of 2014, based on nine sation strategy and the municipal strategy • Greater progress and focus on the use of incompatible ICT solutions. indicators. for telehealth will be realised within this of ICT solutions in hospitals and munici­ • Better efforts by the National eHealth framework. • Objectives set for the use of ICT in support palities. Authority and the regions to establish of key workflows in municipalities before • Strengthened efforts to promote cross- a common public sector ICT infrastructure The parties will launch a public sector the end of 2014, based on clear indicators. sectoral communication, improved for the healthcare sector. strategy for digital welfare services in 2013, • Deployment and use of the Shared monitoring and harnessing the benefits which will ensure the right conditions for • Greater priority by the regions on joint Medication Record in all regions by 2013, from ICT systems across all sectors. more efficient delivery of services by the procurement, development and operation including deployment in all municipalities public sector and for new ways to involve • Identification of indicators and goals at of common regional ICT solutions. by 2014 with a view to full use by mid-2015. citizens – also in the healthcare area. regional and municipal levels for the use • The National Board of eHealth to enhance Some of the initiatives in this strategy • Support of full digital communication of relevant ICT systems in the daily delivery its role in binding collaboration on the for digitalisation of the healthcare system between healthcare providers, including of services. overall coordination of eHealth in Denmark. will therefore be included in the strategy full use of text-based clinical MedCom • Strengthened efforts by the the regions for digital welfare services. messages by the end of 2014. to use ICT solutions with a documented • Continued deployment of the use of benificial effect, and launch initiatives This strategy for digitalisation of the telemedicine on the basis of an overall to promote the use of ICT solutions healthcare system sets the framework national programme. across the regions. for those public sector and strategic assign- ments that will characterise future digitalisa- • Deployment of Fælles Sprog III (project tion efforts; efforts that will benefit citizens, to introduce the use of a common termi- patients and healthcare providers. nology) in all municipalities up to 2017.

MAKING eHEALTH WORK 5 FOCUS AREA 1 HEALTHCARE SERVICES DELIVERED IN NEW WAYS

We should exploit the digital opportunities to For our telemedicine solutions to provide the change the way healthcare services are being desired outcome, we need to gain experience delivered. For example, using digitalisation about what is required of the patient, and to involve patients and their relatives in of the new services. prevention and treatment in new ways, and in the patient's own home. The aim is One expected outcome is that patients to release time and resources for both avoid always having to consult with the citizens and healthcare providers. specialist in person and may receive part of their treatment in their home. Telehealth is expected to help prevent the patient's TELEMEDICINE AND TELEHEALTH condition from deteriorating and thereby — NEW WAYS OF DELIVERING reduce the number of admissions, just as HEALTHCARE SERVICES the patient may be discharged sooner after Telemedicine makes it possible to manage a hospital admission. the healthcare service in new ways. An ageing population, greater numbers The Danish government, Danish Regions and of citizens with chronic conditions and tight Local Government Denmark set the course budgets all require new thinking. The for further work in their 2012 National Action challenge is to ensure that telemedicine Plan for Dissemination of Telemedicine, solutions provide the desired outcomes see box 4. for patients and do not put unnecessary ­pressure on healthcare spending. This An important goal in the strategy period is requires that we design the telemedicine to ensure implementation and full use of solutions in a way such that patients not the telemedicine solutions launched with only can, but also will use them. It is in this the Action Plan; at the same time it is context that we should examine the effect important to verify the anticipated benefits. of telemedicine across the healthcare sector.

6 MAKING eHEALTH WORK Where experience dictates, local projects NUMBER OF ACTIVE PATIENTS IN THE TELEMEDICAL ULCER RECORD – MAY 2013 BOX 4 must be matured as part of the scaling-up for national deployment. INITIATIVES IN THE TELEMEDICINE ACTION PLAN A framework for a national telemedicine ICT • National deployment of telemedical infrastructure will be established as a part of ulcer assessment (nationwide the National Action Plan. The infrastructure deployment) will be developed and deployed in the coming Sygehus Thy-Mors years. • Telepsychiatry (nationwide ­deployment) There is a need for piloting new telemedicine • Clinically integrated home initiatives at smaller scale during the Regionshospitalet Viborg monitoring (large-scale test) strategy period, so that new solutions can be developed and made ready for national Aarhus Universitetshospital • TelecareNorth (large-scale test ­deployment at a later stage. This applies Regionshospitalet Silkeborg and evaluation) both to projects that are launched under Hillerød Hospital • Online psychiatry (demonstration) this strategy, as well as to local projects that Vejle Sygehus Herlev Hospital the parties want to monitor in order to gain Kolding Sygehus Bispebjerg Hospital new experience and possibly with a view Roskilde Sygehus to deployment. A national programme for Sydvestjysk Sygehus Odense Universitetshospital telemedicine will form the frame of reference for telemedicine initiatives. This programme will be managed by a programme steering committee. Sygehus Sønderjylland

0 1-5 Over 5 The map shows the number of patients with a telemedical ulcer record, by each municipality, and for whom activity was recorded in May 2013. The initiative for national deployment of telemedical ulcer assessment commenced in 2013 and will be completed by the end of 2015.

MAKING eHEALTH WORK 7 SELF-SERVICE SOLUTIONS AND should also make it easier for relatives to BOX 5 BOX 6 COMMUNICATING WITH THE INDIVIDUAL provide assistance and support. CITIZEN EXAMPLES OF SELF-SERVICE NEW TECHNOLOGY ENSURES For example, this could be by giving relatives SOLUTIONS, DIGITAL GREATER EQUALITY With new digital solutions, citizens with legal authority on behalf of the patient to COMMNUNICATION, ETC. chronic conditions can measure and submit New technology can help ensure more access the patient's personal health data. information about their condition for use in • Via the official eHealth Portal (sundhed.dk), equality in patient care. At the Similarly, parents should have access to the organising their treatment. This provides new citizens can gain access to their own Department of Immigrant Medicine health data on their children. opportunities but also introduces new health data, including their health records at Odense University Hospital, the use challenges. Although the new opportunities from hospitals, vaccination records, of video interpreting for interviews with The extent of digital communication with the do not shift responsibility for treatment away and medication data. patients that are non-native speakers public should be increased. We know digital from the health professional, there is a need of Danish reveals that the situation communication saves postage and time. • There is already some experience from to clarify who will be responsible if a patient's is experienced as more 'professional' Furthermore, important information for the using the citizens' own data to assess measurement device fails when the patient because the interpreter is not physically patient reaches the patient faster if sent their individual needs for routine medical self-reports health data. present but interprets from a distance. electronically instead of via the postal service, appointments and aftercare visits. This enhances trust between patient and just as digital reminders mean that more Citizens already have digital access to the • The use of text message appointment physician and therefore ensures a basis patients remember their appointments. healthcare system, see box 5. reminders has reduced non-attendance. for more openness in interviews, more accurate diagnoses and medication, and • At some hospitals, citizens can book The digital healthcare system needs to be HEALTHCARE SERVICES DELIVERED improved clinical pathways for patients appointments via the internet. expanded, so that citizens have better IN NEW WAYS: GOALS UP TO 2017 who may already feel insecure when self-service tools available to them. For dealing with the healthcare services. • Telemedical ulcer assessment, tele­ example, tools which provide a general Use of the technology has halved psychiatry, and two to three other tele­ picture of home monitoring data and which non-­attendance at interviews medicine solutions will be fully deployed. provide greater possibility for booking or at the department. changing appointments over the internet. • A national infrastructure for telemedicine has been established. Citizens should have better access to their own data in the healthcare system, and • Pilot projects on booking of appointments better access to find information about at hospitals will be carried out by the health and diseases as well as to navigate Danish regions. The projects will ultimately between healthcare services. Digitalisation lead to self-booking for the most common patient appointments at hospitals. 8 MAKING eHEALTH WORK INITIATIVES

IMPLEMENTATION OF THE NATIONAL NATIONAL MODEL FOR THE NATIONAL HEALTH RECORD ONLINE BOOKING OF HOSPITAL ACTION PLAN FOR THE TELEMEDICAL HOME MONITORING 1.2 – DIGITAL ACCESS TO HEALTH DATA APPOINTMENTS 1.7 DISSEMINATION OF TELEMEDICINE 1.1 FOR CITIZENS AND CLINICIANS 1.5 Before the end of 2015, a model will be At regional level, citizens will be able to book On the basis of the National Action Plan for outlined for the dissemination of telemedical Citizens should be able to view their own and change their hospital appointments Dissemination of Telemedicine from 2012, home monitoring on the basis of previous health data on the internet. From 2014, online in a number of selected areas. Before the objectives of the activities are to experience in the area in Denmark and The National Health Record on the eHealth the end of 2015, a pilot project will be carried maintain momentum in the individual abroad. Portal (sundhed.dk) will provide a general out in all five regions on online booking of initiatives; concentrate on benefits and overview of the individual citizen's health own appointments in an area with a good infrastructure; and to carry out an evaluation, information from for instance prescription volume of appointments, for example so that the decision concerning possible MATURING NEW AREAS history, laboratory test results, and data pregnancy scans. national deployment of initiatives under FOR NATIONAL DEPLOYMENT 1.3 on allergies and adverse reactions. A further the Action Plan will be on an informed basis. objective of the National Health Record is During the second half of the strategy period, that, from 2014, it will serve as a common GIVING RELATIVES AUTHORITY By the end of 2015, the following projects maturing the next telemedicine areas will point of access to search and share patient ON BEHALF OF THE PATIENT 1.8 under the telemedical action plan will have commence, including several large-scale data across the clinical workstations been completed: Clinically Integrated Home projects aimed at subsequent national at hospitals and general practitioners. With a view to allowing a patient to provide Monitoring, Telecare North, National dissemination. The parties behind the The regions will be expanding the National relatives access to his or her personal health dissemination of telemedical assessment strategy will identify these areas jointly, Health Record in the period from 2014 data and take part in the communication of ulcers, Demonstration and dissemination and large-scale projects will be described to 2016. with health professionals, a public sector of telepsychiatry, and Demonstration of and implemented. legal authority solution will be developed internet psychiatry under the National Action before the end of 2013. Plan for Dissemination of Telemedicine. COMMUNICATION BETWEEN CITIZENS MATURING THE TELEMEDICINE AND THE HEALTHCARE SECTOR INFRASTRUCTURE 1.4 WILL BE MADE DIGITAL 1.6

With a view to assisting the deployment Before the end of 2015, 80% of all referrals, of telemedicine solutions in the healthcare reporting, formal letters and other written sector, the telemedicine infrastructure will communication between individual citizens be tested, matured and developed, on the and the healthcare services will be digital. ­basis of the existing eHealth infrastructure. This initiative will be completed by 2015.

MAKING eHEALTH WORK 9 FOCUS AREA 2 DIGITAL WORKFLOWS AND PROCESSES

Digitalising the healthcare system will The full benefits of digital workflows and pro- ultimately render patient pathways paperless cesses across the healthcare system can only at hospitals, in municipal healthcare services, be harnessed if everyone involved takes part. and at the general practitioner, including Therefore, full use and consolidation across practising medical specialists. Therefore, the healthcare sector is a challenge that the use of paper-based health records, forms, needs to be dealt with during the strategy notes, etc. should be phased out to the period. Central, regional and local govern- widest possible extent. This requires that ments will be launching fewer projects, the paper-based exchange of patient data and we will focus on reaping the benefits internally at hospitals is abandoned, for of planned and already launched projects. example when patients are transferred from one department to another for examinations At regional level digital solutions will have and tests. to be found which underpin the hospital structure and the establishment of ‘joint Safety for patients will be increased if there acute admissions’. This requires that greater is only one, current and up-to-date version emphasis is placed on fast diagnostic of a patient's health record (i.e. the electronic evaluation, standardised workflows and version). Furthermore, the staff will have patient pathways, as well as improved a better general overview of a patient's data. resource and capacity utilisation, planning At the same time, the possibility for staff and logistics. to record data directly in the system will stream­line procedures and make the work Similarly, the municipalities will advance processes more effective. digitally, because the new hospital structure requires strengthening of the primary This will not only ensure real-time data; healthcare system and requires that it will also ensure a greater use of data and communication with hospitals takes place digitalisation to support workflows, planning electronically. and documentation.

10 MAKING eHEALTH WORK DIGITAL WORKFLOWS AND DIGITAL WORKFLOWS AND BOX 7 PROCESSES AT REGIONAL LEVEL PROCESSES AT REGIONAL LEVEL: GOALS UP TO 2017 ICT UNDERPINNING CLINICAL The Danish government and the regions PLANNING made an agreement in 2010 on eHealth; • Paper-based workflows at hospitals will an agreement that for example will ensure be eliminated to the widest possible The use of electronic boards that provide coherent ICT tools for hospital staff. During extent, the clinical workstations will be an overview of capacity and resources the strategy period, the goals in this eHealth fully utilised and will have been developed has boosted the production planning agreement will be met, the systems will be further than today. and logistics functions at joint acute put into use and the benefits will be reaped. admissions throughout Denmark. • Indicators have been identified for the Over the coming years, the regions will be introduction of ICT to support clinical At the same time, there has been working to optimise the introduction of ICT planning at the joint acute admissions a clarification of the possibility to to underpin clinical planning with regard on the basis of the components included introduce ICT in logistics at hospitals. to for instance joint acute admissions, in the clinical workstation. Results from Central Denmark Region see box 7. show that benefits can be gained in • Further to the 2011 budget agreement, the form of optimised processes, more The planned 21 joint acute admissions will be the regions will conduct a number of effective use of resources, and increased important hubs in the new hospital structure joint calls for tender and will deliver joint reliability. Examples include automated and will therefore be key to ensuring a solutions. This applies for example tracking by which objects and persons well-functioning and modern healthcare to the acquisition and implementation can be tracked across hospitals. Such system. The aim of joint acute admissions of shared pre-hospital health records. tracking can be used to automate work is to optimise clinical pathways, starting from processes as well as to supply staff with acute admission. The result will be reduced information to allow them to make waiting times and fewer unnecessary informed decisions and limit resource admissions. waste.

MAKING eHEALTH WORK 11 DIGITAL WORKFLOWS AND PROCESSES while less focus has been afforded to digital DIGITAL WORKFLOWS AND PROCESSES BOX 8 IN MUNICIPALITIES support of coherent workflows and data AT MUNICIPAL LEVEL: GOALS UP TO 2017 sharing. More specifically, this means that INDICATORS FOR THE USE OF ICT In the municipal healthcare system, health • During the strategy period, the municipali- for example nurses have to enter and retrieve SYSTEMS IN HEALTHCARE data is today primarily recorded and regis- ties will target digital solutions to better data in long text documents using free-text tered in electronic care records systems support standardised registration and In connection with the budget agreements search. There are only a limited number as well as in municipal child-health records coherent workflows. for 2014, the Danish government, Local of registration standards for data about systems. Government Denmark and Danish Regions patients' blood pressure, body temperature, • The municipalities will ensure full digitali- agreed to apply a series of indicators to well-being, etc. An essential challenge will be to provide sation of selected workflows central report and follow up efforts. These better support for patient pathways and to achieving an effective, efficient, and indicators include: Another challenge arises from the need for for the delivery of municipal healthcare unified delivery of healthcare services more coherence in the delivery of services services, including homecare and home in the municipalities. Regions to citizens. In elderly care, the needs of the nursing services. Better data is needed that • Use of the Shared Medication Record: individual are becoming ever more complex. can enhance and standardise the quality • It will be decided how the data central to Percentage of medication-reconciled Staff of varying backgrounds are therefore of services, as well as data that can ensure municipal healthcare services is to be made Shared Medication Records per discharge. needed, including nursing staff, social and systematic documentation in municipal available – through the individual munici- health staff, physiotherapists and occupa- • Use of note systems: Percentage of efforts. pality's own electronic care record system, tional therapists. The interplay between patients for whom recording has been through communication with the regional the relevant authority and those actually completed at discharge. At the same time, the digital solutions electronic health record systems and delivering the service is therefore an issue in support of workflows and processes in through the it-systems used by general Central government that cuts across the whole of the social and the municipalities have so far been aimed practitioners. The National Health Record • Reliability of national health registries healthcare area. at recording and documenting activities, via the eHealth Portal (sundhed.dk) is one and infrastructure solutions, such as the option. Electronic patient record data and Shared Medication Record, the National

data from general practitioner data is Service Platform, and the National already being shared here. Patient Registry. • Traffic figures for the National Service Platform.

Municipalities • Use of MedCom messages. • Percentage of relevant citizens covered by telemedical ulcer assessment. 12 MAKING eHEALTH WORK INITIATIVES

FULL USE OF THE CLINICAL JOINT PRE-HOSPITAL EFFICIENT DIGITAL ANALYSIS OF MUNICIPAL WORKSTATION AND ENHANCED HEALTH RECORDS WORKFLOWS LINKAGE TO THE NATIONAL PLANNING 2.1 IN REGIONS 2.2 IN MUNICIPALITIES 2.3 HEALTH RECORD 2.5

The regions have established a set of Before the end of 2015, the regions will During the strategy period, the municipalities In 2014, a benefit analysis will be launched indicators for how hospitals are using eHealth acquire and implement joint health records will identify five to seven workflows which as well as technical and financial require- in a number of core functions (patient in the pre-hospital settings. The purpose of are to be made fully digital by the end of 2017. ments for municipal linkage to the National management systems, notes, medications, introducing the pre-hospital health record The digitalisation effort will start with the Health Record in the eHealth Portal ­ order/result, appointment booking, discharge will be to improve the treatment for the largest workflows, workflows that are vital (sundhed.dk). In the beginning of 2015 summaries, referrals from general practition- individual patient, from when the emergency in ensuring unified and high quality in the a progress report will be presented with ers, rehabilitation plans, and discharge operations centre receives an assignment municipal services, and workflows which can a view to ensuring possible agreement reports). Before the end of 2013, the regions until the patient has been signed over to be digitalised. Against this backdrop, possible on this under the 2016 budget agreement. will perform a baseline measurement with a the joint acute admission at a hospital, objectives will be developed in the area at view to ensuring full use by the end of 2014. for instance through sharing patient data municipal level, as well as a plan up to 2017. Up to the 2015 budget agreement, the between the unit transporting the patient IMPROVED COLLABORATION regions will prepare indicators and targets and the hospital receiving the patient. WITH GENERAL PRACTICTITIONERS for digitalisation efforts in clinical planning. DEPLOYMENT OF THE THROUGH A NEW PUBLIC ’FÆLLES SPROG III’ HEALTH INSURANCE IT-SYSTEM 2.6 IN THE MUNICIPALITIES 2.4 In collaboration with the municipalities, In order to ensure structured recording of before the end of 2016, the regions will health data at municipal level, the Fælles acquire and implement a joint public health Sprog III (A common language III) project insurance system. This system will perform will be deployed in all municipalities before a number of administrative tasks in relation the end of 2017. to general practice activities, including payment. The objective is to ensure more efficient operation through better planning, follow-up and quality assurance of general practice activities, including connections to other parts of the healthcare system.

MAKING eHEALTH WORK 13 FOCUS AREA 3 COHERENT PATIENT PATHWAYS

Patient pathways will often involve contact SHARING PATIENT DATA ACROSS Healthcare system resources are clearly not with many different actors across the THE HEALTHCARE SYSTEM being used efficiently when health profes- healthcare system. sionals collect and pass on information During the strategy period, communication manually. between hospitals, municipal healthcare and Good digital solutions in support of commu- general practitioners will be fully digitised. nication, collaboration and delivery of services Therefore, the parties behind the strategy Today, much communication in the health- are vital for coherent patient pathways and will take steps to ensure that a number of care sector is already taking place electron­ patient planning. solutions that have already been launched ically (electronic prescriptions, referrals, are deployed fully. These primarily discharge letters, etc.) and this is of Increased coherence between data and include the Shared Medication ­considerable benefit. However, we have processes means well planned, faster and Record and MedCom not yet crossed the finish line in terms safer transitions between different parts standards. of full digitalisation, see box 9. of the healthcare system. For example, it means the general practitioner knows In certain cases, health data is still being sent which treatment the patient received at the via post and fax between regions, municipali- hospital and the municipal home nurse has ties and general practitioners. The mental up-to-date information about the patient's health sector is still only rarely using digital medication record care plan. The result is communication, for example. reduced risk of re-admission, medication error, uncalled-for home visits, etc. As a consequence, errors may occur because the right information is not available to the Fast and secure access to relevant infor­ relevant health professional at the right time mation during the entire process is essential along the treatment pathway. for a good patient pathway. Moreover, the data that is recorded can form the basis for follow-up and lead to improvements in overall efforts.

The challenge is to establish more uniform solutions and more standardised and coherent exchange of patient data.

14 MAKING eHEALTH WORK Messages received in municipalities - individual municipalities

250

200

150 SHARING PATIENT DATA ACROSS THE BOX 9 HEALTHCARE SECTOR: GOALS UP TO 2017 100 STATUS FOR THE INTRODUCTION • Full deployment of MedCom standards. OF DIGITAL, MESSAGE-BASED 50 COMMUNICATION IN SUPPORT • Full deployment of the Shared Medication OF WORKFLOWS Record. 0 Figures on the number of messages Capital Region North Denmark Southern Denmark • Sharing data through the National Health sent between regions and municipalities Central Denmark Zealand Record at clinical workstations in all show large differences in use. hospital settings. Municipalities differ by up to a factor of 12 within the individual region with Messages sent from municipalities - individual municipalities • Determining possible targets for future regard to the volume of messages demands for digitalisation of workflows, received. In four municipalities, 100 processes and procedures, and data no messages were sent electronically sharing in the healthcare sector, flexibly to the hospitals during the period 80 and standardised across the entire sector. studied. 60 With the local government digitalisation strategy, the municipalities are in 40 the process of implementing the use of MedCom messages. 20

0

Capital Region North Denmark Southern Denmark Central Denmark Zealand

ELECTRONIC MESSAGES FROM AND TO MUNICIPALITIES, PER 1,000 INHABITANTS

Note: The data indicates the sum of the number of messages per 1,000 inhabitants in November and December 2012, and January 2013. Source: MedCom.

MAKING eHEALTH WORK 15 MONITORING DEPLOYMENT AND USE OF eHEALTH IN DENMARK – AN EXAMPLE

USE OF THE SHARED MEDICATION RECORD MAY 2013

NORTH DENMARK STATUS MILESTONES 2013 (%) CAPITAL REGION STATUS MILESTONES 2013 (%) (%) Q2 Q3 Q4 (%) Q2 Q3 Q4 Hospitals Technical implementation 100 Hospitals Technical implementation 0 Use 46 (46)** 50 75 100 Use 0 0 20 100 General Technical implementation 53 (46)** General Technical implementation 49 (47)** practitioners Use 51 (43)** 50 75 100 practitioners Use 43 (41)** 50 70 100 Medical Technical implementation 44 (42)** Medical Technical implementation 32 (30)** specialists Use 39 (39)** 50 75 100 specialists Use 28 (26)** 40 60 100 Munici- Technical implementation Munici- Technical implementation palities* Use palities* Use

CENTRAL DENMARK STATUS MILESTONES 2013 (%) ZEALAND STATUS MILESTONES 2013 (%) (%) Q2 Q3 Q4 (%) Q2 Q3 Q4 Hospitals Technical implementation 85 Hospitals Technical implementation 100 Use - 70 85 100 Use 56 (56)** 70 90 100 General Technical implementation 28 (26)** General Technical implementation 56 (52)** practitioners Use 25 (23)** 35 65 100 practitioners Use 53 (49)** 60 80 100 Medical Technical implementation 38 (37)** Medical Technical implementation 33 (33)** specialists Use 36 (36)** 45 75 100 specialists Use 30 (28)** 40 70 100 Munici- Technical implementation Munici- Technical implementation palities* Use palities* Use

SOUTHERN DENMARK STATUS MILESTONES 2013 (%) (%) Q2 Q3 Q4 Hospitals Technical implementation 20 Use - 50 75 100 General Technical implementation 33 (31)** practitioners Use 29 (27)** 35 60 100 Technical implementation 46 (46)** Medical Capital Region North Denmark Southern Denmark * According to its implementation plan, Local Government specialists Use 40 (40)** 50 75 100 Central Denmark Zealand Denmark will carry out mobilisation in 2013 and implementation Munici- Technical implementation in 2014. palities* Use The ongoing development can be followed at www.ssi.dk/nsi ** Figures shown in brackets indicate status as of April 2013.

16 MAKING eHEALTH WORK INFRASTRUCTURE AND STANDARDS There is a need for standards for telemedicine The ICT infrastructure of the healthcare BOX 10 solutions, for example, to make it easy, system comprises a number of common The various ICT systems used in the health- cost-effective and manageable to share data solutions in the form of components and VARIOUS WAYS OF SHARING HEALTH care sector must be able to function together from one system to another, and to acquire services, see box 12. DATA IN THE HEALTH SECTOR and communicate with each other. equipment and integrate it into the standard Infrastructure, standards and interfaces Access to other players' data ICT solutions already in use. The common ICT infrastructure will be make it easier and less costly to link ICT At this tier, there is access to reading extended during the strategy period. systems in the healthcare sector across the data stored by other contributors, Across central, regional and local govern- An important element in achieving this many parties involved. Standards and a for example, the electronic health ments, work will be carried out in the will be to further develop the Danish Health common infrastructure also contribute to records used by hospitals. strategy period to ensure a more coherent Data Network, the video hub, the National reducing maintenance and replacement data and ICT architecture, which meets the Service Platform and the public sector costs, as clients and suppliers have clarity of Electronic messages between providers healthcare system's different requirements ICT security solutions. In this connection, requirements and costs. Consequently, there At the second tier, there is access to for data sharing, see box 10. a mobile security component will be is a market for standard solutions. sending electronic messages, point ­established and there will be an analysis to point. Denmark is using MedCom The further development of the data and ICT of security standards and security solutions The challenge is to build and maintain an messages with great success, to send architecture will have to be balanced with the in the healthcare sector. Plans concerning infrastructure that is demand-driven and health data electronically across the needs arising from strategically important this must be cost-effective and based on which accommodates the differing opera- entire healthcare sector. projects such as the Healthcare Platform business needs. A road map will be prepared tional needs of the healthcare sector. project in the Capital Region of Denmark for the public sector infrastructure. Data retrieved as needed and Region Zealand, as well as the large At the third tier, physicians or nurses can telemedicine projects. retrieve data from across the healthcare system into their own ICT systems on a need-to-have basis. This is possible for example via services such as the Shared Medication Record. The long-term goal is to share more data in this way.

MAKING eHEALTH WORK 17 ICT INFRASTRUCTURE BOX 11 BOX 12 AND STANDARDS: GOALS UP TO 2017 DETERMINING STANDARDS THE COMMON ICT INFRASTRUCTURE • Demand-driven identification and modern­ FOR THE USE OF ICT IN HEALTHCARE COMPRISES E.G. isation of standards that will make for stronger cross-sectoral coherence, Pursuant to section 193a of the Danish • The Danish Health Data Network. including follow-up on compliance. Health Act, the Minister for Health may • The video hub (video interpreting establish requirements for ICT systems services). • Data from local ICT systems will be shared in healthcare, including requirements across sector borders. New local record for electronic health records. • The National Service Platform and systems must therefore be able to deliver security components. data to the national registries. This provision is outlined in Executive • NemID (digital signature solution) Order no. 160 of 12 February 2013 and NemLogin (common log-in • The need for sharing patient data will (ref. BK001364), which establishes that solution). be identified on the basis of a thorough the National eHealth Authority under analysis and a roadmap for determining the Ministry of Health is responsible for • NemSMS (appointment reminder new targets. approving standards (including data solution using text messaging). standards, classifications and interface • eHealth Portal (sundhed.dk) • In order to underpin an efficient, effective standards) for the use of ICT in the – providing­ access to health data. and coherent healthcare service, the healthcare sector after consulting common ICT infrastructure and standards the National Board of eHealth. • Digital Post (free, personal digital will be incorporated into all relevant ICT ­mailbox service for secure corre­ projects. spondence with for instance public authorities).

18 MAKING eHEALTH WORK INITIATIVES

FULL DEPLOYMENT AND FULL DEPLOYMENT AND USE OF DIGITAL SOLUTIONS IN SUPPORT OF ANALYSIS CONCERNING SECURITY USE OF THE SHARED ELECTRONICAL MESSAGE-BASED RELEVANT WORKFLOWS ACROSS STANDARDS AND SOLUTIONS MEDICATION RECORD 3.1 COMMUNICATION 3.2 THE HEALTHCARE SECTOR 3.3 IN THE HEALTHCARE SECTOR 3.4

By 2013, the Shared Medication Record is By the end of 2013, all relevant MedCom By 2017 we will have full digital solutions in During the first quarter of 2014, the parties to be rolled out completely and to be fully in messages will be fully technically implement- support of relevant cross-sectoral workflows behind the strategy will perform a cost-­ use by regions and by general practitioners. ed for patients, at regional as well as by sharing relevant data across the health- benefit analysis of aligning security stand- The Shared Medication Record is to be municipal levels. Linked to the health services care sector. By mid 2014, an analysis of health ards and security solutions in the healthcare technically implemented by 2014 and fully agreements between the regions and the data and communication patterns in the sector with other relevant public sector in use in the municipalities by 2015. municipalities, models for structural support healthcare sector will be prepared along collaboration. A deployment plan for the Shared Medication of cross-sectoral collaboration will be in with a joint plan by phases for achieving the Record will be agreed in the municipalities full use by the end of 2014. Up to the 2015 2017 targets. As a first step, the analysis at all residential homes for adult patients budget agreement, a decision basis will will clarify investment needs to ensure ESTABLISHING A DIGITAL under the care of the mental services, be established for deploying the use of sustainable technology behind MedCom SIGNATURE (NEMID) except where electronic care records are electronic messages relating to patient communications. FOR MOBILE SERVICES 3.5 used instead. pathways in the regions’ mental health services and for social care services in With a view to providing a basis for access the municipalities. for citizens to the digital healthcare system via smartphones and tablets, a mobile NemID (digital signature solution) will be established by no later than 2014.

MAKING eHEALTH WORK 19 FOCUS AREA 4 BETTER USE OF DATA

We must use data to improve the quality of EXISTING KEY CHALLENGES: • Better data provides the basis for more DATA MUST BE AVAILABLE TO GUIDE care for citizens and patients and to assist individualised and real-time treatment and DECISIONS, RESEARCH, DEVELOPMENT • In some situations, delivery of data to employees in their daily work routines. For care, however there has been no decision AND PLANNING national registers is still done manually, example through efficient access to national as to how we should manage and share which leads to double registration. The Ministry of Health has formed a new clinical guidelines and support for decisions the new types of data and information organisation where governance of the health in daily planning and treatment. Similarly, obtained from telemedicine solutions etc. • Registered data is difficult to access and data on the Danish population and data in the future, data will be used to improve updates of national registers are relatively concerning all healthcare activities, economy quality, in administration and for research The possibilities are increasing for collecting slow. and quality is organised under the same activities. and working with data for planning and administration. Key data is collected at the research purposes. Strategically, there is • Data to improve quality and to guide Statens Serum Institut, as well as analysed Danish health data and registries are world a need for an overall framework for how decisions must be real-time and easy and communicated to all relevant parties. class. The high quality and relevance of we will work with data in the coming years. to access, and there must be legal clarity This means that a good framework is already Danish registries are closely linked to the fact about terms of use. in place for the secure storage and sharing of that much of the data is acquired as a part data. of daily routines in the healthcare sector. If Denmark is to maintain its position in this However, there is still a need to improve field, we have to develop the way we submit, the collection and onward communication store, share and use data, to the benefit of data. Health professionals must have a of patients, health professionals, researchers better data-informed basis for decisions on and businesses. efficient prevention, treatment and planning.

The national clinical guidelines are a good example of how data can be used in support of daily routines. These guidelines have been established from evidence-based research and therefore contribute to ensuring promotion of the correct and most efficient and effective choices in daily patient treatment and care.

20 MAKING eHEALTH WORK At the same time, we can make these learning for the physician, who can follow up BOX 13 BOX 14 guidelines available through digitalisation on a possible diagnosis or treatment he or and thus make them readily usable for health she has been involved in. This enables better SUPPORT OF CLINICAL DECISIONS DATA CAPTURE IN professionals in their daily work. This could treatment for future patients. IN INTENSIVE CARE THE GENERAL PRACTICE SECTOR also contribute to a framework for practi­ Digital solutions are today used to guide With a data-capture module, general tioners to include patients in decisions where, The existing legislation will have to be decisions at a great number of intensive practitioners can report on a set of indicators for example, a given choice of treatment reviewed to ensure that it does not unneces- care departments throughout Denmark, developed for diabetes, chronic obstructive depends on the patient's own requirements sarily prevent access to the use of data for including at Rigshospitalet (i.e. pulmonary disease, cardiac insufficiency, and options. education purposes and thus the possibility Copenhagen University Hospital) and ischaemic heart disease, stress, anxiety and for improving patient treatment in the future. Aalborg University Hospital. Real-time depression. The indicator data is submitted The guidelines should be readily accessible Work on an EU regulation on data protection and easy-to-access data is collected to the Danish General Practice Database via healthcare providers' ICT workstations will be monitored throughout the strategy from digital monitoring of e.g. vital body and the general practitioner receives at hospitals and in municipalities, for period. functions and the patient's general feedback on the data submitted on an example through apps. This will make it condition. This ensures overview, and ongoing basis. In other words, general easier for municipal nurses on home visits Data can be used to screen patients under the data is used to systematically develop practitioners can use this feedback to make use of the guidelines and help treatment and ensure that the latest best practices for treatments, resource to continuously improve the quality ensure uniform quality in cross-­sectoral evidence comes into use for the individual planning, etc. of patient treatment. patient pathways. patient.

Information reported by the patient can, HEALTH DATA IS IMPORTANT IN for example, be used systematically to clarify TREATMENT AND FOR LEARNING whether the patient's condition is stable Relevant health data must be available in or whether the patient needs to be called order to increase patient safety and the in for further treatment. In this way, quality of care and treatment. It is important ­unnecessary treatment can be avoided that we have access to real-time patient or possibly replaced by an interview over the data. Moreover, information from the phone. Moreover, patients and nurses can patient's health record can provide valuable prioritise resources and efforts accordingly.

MAKING eHEALTH WORK 21 BETTER USE OF DATA: GOALS UP TO 2017 BOX 15 • The national clinical guidelines will be DATA STRATEGY Denmark can become a central site for made easily accessible for clinicians research and development activities in the at hospitals and in the municipalities. Denmark is a frontrunner in digitalising health area. Consequently, there should be The guidelines will be made available the healthcare service. Today, we have enhanced focus on the commercial potential electronically as they are developed and some of the most advanced national of using data and systems to manage and as part of efforts to standardise quality registries of data on population health. underpin the use of data. Amongst other and improve coherence in patient Data is acquired as a part of daily things, this requires easy and secure access ­treatment and care. operations in the healthcare sector. to relevant and valid data, as well as This allows for high-quality research competence and consultancy on the use, • It must be easy for health professionals and analyses across the entire Danish management and production of data. to document their observations and to population and for selected cohorts re-access the data after recording it. or patient groups, without having to During 2013, the agencies under the Ministry Data must be retrievable by practitioners carry out time-consuming and costly of Health will outline a data strategy to in real-time and it must be easy-to-access. preliminary data collection. help ensure that the potential of the data At the same time, double recordings must is harnessed. This strategy will be prepared be reduced to an absolute minimum. Access to health data of high quality in consultation with the other parties in the provides a wide potential for developing healthcare sector. • An overall framework will be prepared the healthcare service and industry. for how we can best collect store, share The issue of 'big data' is about how we and use data in future years. can work with large amounts of data. It is assessed that Denmark should • Data will be used to improve the decision secure its position through more support for clinicians and administrators in targeted and coordinated efforts. connection with routine planning and care.

• Data reported by citizens will be included in treatments in several treatment areas in order to reduce the number of admission days and the number of outpatient visits for citizens with chronic disorders.

22 MAKING eHEALTH WORK INITIATIVES

DIGITAL ACCESS TO LEGAL FRAMEWORK FOR SHARING ANALYSIS OF THE USE CLINICAL GUIDELINES 4.1 AND ACCESSING HEALTH DATA 4.2 OF SELF-REPORTED DATA 4.3

The purpose of clinical guidelines is to ensure Prior to the 2015 budget agreement, it will be Before the end of 2014, there will be an analy- continuous priority-making in healthcare, clarified whether current regulations for the sis of the potentials of systematic use of focussing on the most cost-effective health exchange of patient data in the healthcare self-reported data in the healthcare sector. solutions. Digitalisation efforts should sector provide sufficient support for the Self-reported data enables easy and efficient provide support for rapid deployment and digital exchange and acquisition of health screening of whether patients that are implementation of common guidelines, and patient data by the parties that need following treatment really need a planned for example via apps, which can be used such data, while taking full account of outpatient consultation. For example, by municipal homecare nurses from 2014. aspects of patient safety. Furthermore, epilepsy patients are typically called in this initiative will clarify the liability of health for life-long routine visits. In such cases professionals in relation to any data which screenings based on the patient's self-­ the patient himself chooses to share with reported data will provide the physician the healthcare service or provide access to. with a stronger basis for deciding whether the individual patient actually needs to be called in for a visit, or whether the patient's status is stable and an outpatient appointment is not required.

MAKING eHEALTH WORK 23 FOCUS AREA 5 GOVERNANCE

Large and rapid digital changes need to be data is shared across the healthcare sector, • Successful implementation of joint projects practice systems, while suppliers have implemented in the healthcare system in the as well as for realising cross-sectoral ICT requires coordination between regions, to receive order entries from five regions, coming years. This requires clear goals and projects and national infrastructure. municipalities and general practitioners. 98 municipalities and 3600 general a clear division of responsibilities, along with practitioners. This challenges the rate actual capacity to implement the changes In this National Strategy for Digitalisation • Work to establish a national public sector of introduction and cost-effectiveness and transparency about progress and results. of the Danish Healthcare Sector 2013-2017, ICT infrastructure must be strengthened of eHealth development. the municipalities will be included in the and made clearer. The de-centralised The parties behind the strategy have agreed same governance and will follow the same projects lack sufficient coordination with • There is a growing need for a uniform to retain the division of responsibilities that basic principles as the regions and central the development of a national ICT implementation effort because the was decided between the Danish government government. infrastructure. introduction of more eHealth solutions will and Danish Regions in the 2010 eHealth bind the healthcare sector closer together, agreement and which was also recom- The course agreed in the regional 2011 budget • There is no overview of the most important and because the benefits will not be mended in the evaluation of the municipal agreement will be strengthened and digitalisation projects in the healthcare achieved until the solutions have been structural reform. This division of respon­ expanded, so that the development across area, and this makes it difficult to follow taken into use by all parties. sibilities means that the regions will be local, regional and central governments up and adjust projects in time. ­responsible for ensuring efficient and is coordinated from a shared perspective. A stronger digitalisation effort requires closer effective eHealth at all Danish hospitals, The primary challenges include: • The development of common eHealth and more binding coordination and priority- including responsibility for procurement, solutions is made difficult by the fact that setting. Projects and initiatives that affect development and operation of ICT solutions • Ensuring that the National Board of ICT systems in the healthcare sector use all parts of the healthcare system must as well as for optimal ICT solutions in support eHealth to a greater extent constitutes different standards. New solutions must be planned and coordinated across the public of workflows and patient treatment. Central the framework for binding collaboration be implemented via five regional system sector to take account of the challenges government will be responsible for deter­ on overall coordination of eHealth environments, three municipal electronic linked to having to work closely together mining the legal framework and standards in Denmark. care record systems and about ten general across sectors. for use of the ICT, for ensuring that relevant

24 MAKING eHEALTH WORK On this basis, collaboration and overall governance of public sector digitalisation initiatives will be strengthened in four areas:

STRONGER PRIORITISATION AND OVERVIEW AT NATIONAL LEVEL

STRONGER PROGRESS, COORDINATION AND STABILITY OF DELIVERY

PROJECT OVERVIEW AND DOCUMENTATION THAT STRATEGY GOALS ARE BEING MET

CLEAR FINANCING AND GOVERNANCE MODEL FOR SOLUTIONS IN USE

MAKING eHEALTH WORK 25 STRONGER PRIORITISATION STRONGER PROGRESS, AND OVERVIEW AT NATIONAL LEVEL COORDINATION AND STABILITY OF DELIVERY

The National Board of eHealth serves as The National Board of eHealth is The parties behind the strategy have Initially, the work of the steering committee the central hub for central-, regional- and responsible for overall coordination agreed that the National Board of will include: local-government efforts to ensure efficient and prioritisation of efforts, follows up eHealth is to set up a project portfolio and coherent digitalisation of the healthcare on progress and is responsible for any steering committee. The committee • Shared Medication Record system. The National Board of eHealth is corrective action with regard to priorities is to ensure progress, coordination and • Deployment of MedCom standards responsible for realising the initiatives set and goals for efforts, and for addressing stability of delivery in the implemen­ • National Service Platform out in the annual budget agreements, for cross-sectoral challenges. tation of selected public-sector projects • Clinically integrated home monitoring following up on realisation of the initiatives with critical dependencies. • National Health Record. in this strategy and for ­monitoring other Before the end of 2013, the National strategically important projects, see table 1. Board of eHealth will establish an The project portfolio steering committee As a general rule, the committee will solve overview of progress in the projects and will work with clearly defined tasks on tasks and challenges at the lowest possible initiatives under this digitalisation the basis of terms of reference deter- level, which is in the relevant project's own strategy, as well as in other initiatives mined by the National Board of eHealth. steering committee and/or in the project of cross-cutting and strategic interest. organisations implementing the project. The project portfolio steering committee will ensure clarity of commissions for project implementers, including ensuring harmoni­ sation of any conflicting requirements and requests for the development and timing of solutions within specific goals and budgets.

Implementation efforts also need to be made more uniform and the health services agreements should be used to boost implementation efforts locally.

26 MAKING eHEALTH WORK The municipalities will effectuate large visibility of progress and outcomes in BOX 16 changes in connection with the deployment the individual municipality, a municipal of Fælles Sprog III (project to introduce ­implementation capacity will be developed MODERNISATION BASED ON The aim is to ensure room for manoeuvre to a common terminology), implement the under MedCom. First, the Shared Medication EFFICIENT GOVERNANCE deliver tasks through trust, professionalism, Shared Medication Record (by the end of Record will be implemented up to 2014 on good management and less red tape. Digitisation of the various welfare areas 2014), and deploy a number of telemedicine the basis of agreements with the individual This requires constant focus on simplifying is part of the current modernisation solutions. In order to promote coordinated municipality. rules and efficient governance, for example of the Danish public sector. The National municipal implementation efforts and through conducting governance inspections Strategy for Digitalisation of the Danish in the various welfare areas. This, in turn, Healthcare Sector 2013-2017 should entails keeping focus on whether the rules, therefore be considered in the context TABLE 1 the financial incentives and the recommend- of other modernisation measures aimed ed methods support the goals stipulated. at developing and preparing public CASES FOR THE NATIONAL BOARD OF eHEALTH The aim is to ensure correlation between services for the future. An important the desired outcomes, knowledge about goal of modernising the public sector what works, and the relevant rules. TYPE OF CASE GOVERNANCE is to ensure that governance of public This means that rules which do not Cross-sectoral digitalisation, such as the Shared Goals, prioritisation and plans will be determined service delivery is based on outcomes support the goals have to be withdrawn. Medication Record, the National Action Plan jointly and will be the overall responsibility rather than on meeting process require- for Dissemination of Telemedicine and a national of the National Board of eHealth. ments. public sector infrastructure.

Greater and/or strategically important digitalisation Mutual reporting and ongoing reporting in initiatives internally at regional-, local- or central- accordance with a common project portfolio government levels, for example clinical workstations overview. and telehealth.

MAKING eHEALTH WORK 27 CLEAR INDICATORS AND GOALS CLEAR FINANCING AND GOVERNANCE FOR PROGRESS AND OUTCOMES MODEL FOR SOLUTIONS IN USE

It is evident from the evaluation of the • Creating awareness about the basis This strategy will contribute to releasing As a part of the 2013 regional and municipal previous structural reform that transparency of prioritisation and decisions, a considerable potential, e.g. though budget agreement, a governance and about the development within eHealth in including business cases, risk profiles, effective and efficient workflows, financing model for operation and further Denmark can be improved, including trans- etc. for the digitalisation projects increased involvement of the public and development of public sector eHealth was parency about decision basis and about the in the healthcare sector prior to any further focus on realising large-scale established. This financing and governance progress and status of projects. A focussed decision regarding deployment. benefits, including across municipal and model will be the framework for closer effort is therefore needed in relation to: regional borders. Expenditure on realising collaboration in the public sector on opera- • Measuring progress in digitalisation the initiatives agreed in the strategy will tions and development of cross-sectoral ICT. projects in the healthcare sector. be met within existing budgets. In 2014, the model will cover the National • Measuring the deployment and use It has been agreed to set additional goals Service Platform infrastructure component, of key ICT systems and workflows for the healthcare sector's digitalisation as well as the Shared Medication Record. in the healthcare sector, including efforts up to 2017. Revenues derived from measuring the benefits realised. realising the strategy will be incorporated in connection with the 2015 budget • Overall roadmap for projects prioritised agreements. in the forthcoming period.

28 MAKING eHEALTH WORK BOX 17

EXAMPLES OF ANALYSIS SHOWING Analyses by the Regional eHealth THAT eHEALTH LEADS TO BETTER Organisation indicate that a cross-section USE OF RESOURCES of the regional ICT projects could release resources for patient treatment correspond- The consultancy firm McKinsey & Co ing to DKK 150 million annually. To this should concluded in 2010 that the regions had be added the benefits of a number of new spent DKK 2.1 billion on eHealth in 2009 projects which have not yet been estimated. and that the savings potential through coordination of ICT efforts and through Fully deployed telemedical ulcer assessment consolidation could amount to DKK is expected to release up to DKK 262 million 330-490 million annually. annually in municipalities and DKK 45 million in regions. An analysis from 2012 by the consultancy firm Boston Consulting Group concluded that digitalising communication with patients could release DKK 174 million annually at regional level.

MAKING eHEALTH WORK 29 FURTHER WORK ON REALISING THE STRATEGY

• The National Board of eHealth has overall responsibility for following up on this strategy.

• The parties behind the strategy agree that further initiatives will be included in the ­annual budget agreements in future, and that they will be based on business cases and agreements on operations and financing of public sector eHealth.

• There will be continuous monitoring of the progress of projects in the portfolio as well as of the status of key initiatives.

• The National eHealth Authority will publish indicator status reports regularly on www.ssi.dk/nsi

30 MAKING eHEALTH WORK

MAKING eHEALTH WORK

National Strategy for Digitalisation of the Danish Healthcare Sector 2013-2017 August 2013

Enquiries about this publication should be addressed to: SSI The National eHealth Authority Artillerivej 5 2300 Copenhagen Denmark www.ssi.dk/nsi

Design: BGRAPHIC Photos: Shutterstock, Colorbox, Thomas Søndergaard, Tuala Hjarnøe, SSI Billeddatabase, University College Lillebælt, Denmark

Print: pekema danmark as Printed copies: 1,000 ISBN: 978-87-89148-53-3

This publication may be freely quoted with reference to source.

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