Status Report, Medcom 6 (Pdf)

MC-S000MC-S218 December 2009 MedCom 15 years Status report, MedCom 6

strategy service information cooperation efficiency the citizen healthcare 15years communication the patient development ITsecurity Internet dialogue digitisation cohesion VANS the future MedCom 15 years

MedCom

edCom is a cooperation between Mauthorities, organisations and private companies involved in the Danish healthcare sector. The partnership was established as a temporary healthcare IT project in 1994, but was later made permanent through the 1999 financial agreement between the Government and the former counties.

MedCom’s purpose: MedCom will contribute to the development, testing, dissemination and quality assurance of electronic communication and information in the healthcare sector, with the aim of supporting good patient progress.

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

Photograph: Helle Moos

Standardisation Consolidation International issues SDN It began in a true pio- Pilot projects became International coopera- In time, a need arose to neering spirit with the permanent arrange- tion has more or less supplement the VANS- idea that electronic ments. Dissemination always been a special based message com- communication had the gained pace, and the part of the develop- munication with a new potential to become a MedCom standards ment effort in the field sundhed.dk network for telemedi- good tool for the have long been part of of healthcare IT. Over the years, Health- cine and other forms of Danish Healthcare everyday working life. Standardisation, infra- care IT has become a communication in System. It ought to be Perhaps not everywhere structure and tele- very wide term. An image and dialogue possible to convert in the healthcare sector, medicine have been important partner for format. The idea arose fixed forms such as but almost. some of the major areas MedCom is the eHealth to base a new national prescriptions, referrals, of focus, and the EU has portal sundhed.dk, network on Internet etc., to standard elec- Find out more on played – and continues which is the entry door technology, and the tronic forms and then pages 6 –7 to play – an important to the Danish Health- idea was then put into to send them directly role. care System for the citi- real life. from one IT system to zens and also an im- another. Find out more on portant communication Find out more on pages 18 –21 interface for healthcare pages 16 –17 Find out more on professionals. pages 4 –5 Find out more on pages 12 –13

2 Foreword / Contents

efficiency in the services to the Digitisation – a core element population. For the population, a in the development rapid development is taking place of access to information about of the healthcare sector themselves and the Danish Health- care System in general at the ealthcare IT is an absolutely communication has become routine eHealth portal sundhed.dk. Hvital tool in efforts to equip in general practice, in local authori- Looking back, developments the Danish Healthcare System to ties, hospitals, pharmacies, labora- over the past few years have been face the challenges of the future. tories, etc. impressive, not least thanks to the Digitisation needs to be used in an Over the years, further measures current MedCom projects and their efficient and targeted way in the have taken place towards exploit- predecessors. And they are poin- efforts to create a Healthcare ing to an even greater degree the ting forwards. Towards dissemina- System that will deliver a high level latest information technology, tion of the good solutions, for of treatment and service. It is about thus strengthening the power of example the MedCom standards supporting better communication cohesion internally in the Danish becoming fully utilised in all local with the citizens, and it is about a Healthcare System and in respect authorities, regions and surgeries cohesive Healthcare System charac- of the population. Through the and telemedicine being implemen- terised by successful organisation Health Data Network, system ted to its full capacity in suitable of work procedures and routines. development and standardisation, areas so that healthcare staff can Denmark is at the forefront in the IT engine room of the Danish make efficient use of their time this area, not least by virtue of the Healthcare System has been devel- and energy for the benefit of efforts delivered by MedCom over oped and optimised, and this work patients. the past 15 years, for example in is continuing all the time. At the terms of the standardisation, imple- same time, specific tools such as Jakob Axel Nielsen mentation and dissemination of telemedicine are showing huge po- Minister of Health and Prevention electronic messages between all tential as a means both of making parties within the Danish Health- the Healthcare System more effi- care System. Today, this part of cient and flexible and of improving

E-records Telemedicine Digital Health Contents e-records is one of the Telemedicine includes Much water flowed Foreword 2 many new functions. the expansion of under the bridge in the Articles 4 The idea here is to pro- healthcare IT to include years before healthcare Projects 24 vide healthcare pro- images and sound. This IT. Organisations came Toolkit 37 fessionals and citizens provides the facility to into being based on Statistics 42 alike with direct Local authorities involve citizens directly specific tasks, and Names 50 access to patient re- The local authority in their own treatment MedCom is just one of cords via sundhed.dk. reforms and creation of and the method in them. The task of SDSD, new, larger authorities which specialised sup- Digital Health, is to Find out more on and five regions to port is provided irres- gather the threads to- pages 8 –9 replace the counties pective of geographical gether and set out the provided completely distances. The first steps markers showing the new partnership were taken well before path for the future. relationships within the 2008, but now the new healthcare sector. The opportunities provided Find out more on local authorities now by IT have really had pages 14–15 came into the picture in their breakthrough earnest. nationally.

Find out more on Find out more on pages 10 –11 pages 22 –23

3 MedCom 15 years eCm5years MedCom15 Self-appointed nerds and IT pioneers

ack in 1994, a group of professional IT experts Bgot together with doctors and healthcare staff with an interest in IT to develop electronic communication standards. One of the members of the group was Niels Jørgen Christensen, who today is IT Project Manager in the Central Jutland Region. “We were six self-appointed nerds with masses of pioneering spirit and drive who said that we would be perfectly capable of developing some standards like this. We were all different and there were many disagreements, but we always managed to reach a decision that everyone would support,” he recalls. The standard electronic forms, EDIFACTs, were developed based on international standards and by examining the actual requirements of doctors and healthcare staff who would need to use the forms. The technical challenge consisted of transferring a paper form into an electronic system. “A computer, of course, cannot decide whether one thing is more relevant than another, or whether a date specified is a creation date or discharge date,” explains Anders Kristian Jørgensen, who was working at the time for Dan Net and who was responsible for getting the systems to work in practice. “We needed to ensure that the system could sort all the data in a meaningful way. And the EDIFACTs developed by the standardisation group in ‘96 are, at their core, the same as the ones used in the healthcare system today.”

In this department, “we reduced the work processes from 18 to just 5 by switching to purely electronic communication. Niels Jørgen Anders Kristian Christensen Jørgensen

4 Standardisation, dissemination, consolidation

Efficiency at Important for maximum and error management to be

rate at minimum forward-looking Photograph: Colourbox

e are almost 100% digital in this department, and efore the MedCom standards were Wthat has changed our day-to-day work accordingly,” Bimplemented on a large scale in the explains Finn Mathiesen at the Radiology Department of country’s hospitals, local authorities and Vejle Hospital, which is part of the Lillebælt Hospital. surgeries, they were pilot tested in real life “Previously – and, in fact, it wasn’t so very long ago – we at selected hospital departments and sur- would be standing there with paper records in our hands geries throughout the country. What was while we looked at X-rays in the light box and read out then Vejle County worked together with notes into the Dictaphone, which the secretary would then MedCom to test a number of standards in write up. Then, it wasn’t beyond the bounds of possibility radiology and pathology departments, for papers to get lost or mixed up. That situation doesn’t several clinical departments and a number occur today, when all documents, notes and images are held of GP surgeries, among other places. on the patient’s electronic record. In this department, we re- “It was a positive and exciting process, duced the work processes from 18 to just 5 by switching to even though getting the organisation of purely electronic communication. So, we have significantly the projects approved and granted inter- improved efficiency and, at the same time, sealed off the nally was a challenge,” says Tove Charlotte chain of security, thus improving patient security.” Nielsen, who from 1997 until 2007 worked In practice, digitisation has released so many resources as a coordinator for the standardisation that today the department can offer drop-in examinations, projects in the county. which the patient can come to straight away. Another ad- “When MedCom were ready to launch vantage is that geography is no longer a barrier to coopera- a new project within their two-year pro- tion. ject periods, it could easily be six months “Everyone can see all the information everywhere in the before the project was approved in our hospital, and soon in the region, too. The plan is obviously organisation and the resources found. to make it a national thing. I hope individual users in the So we were already a little way behind,” future will be able to adapt the system to their own needs, she recalls. and that everyone will be able to read the same formats. “However, the most important thing I think it is important to stress that what is vital for com- was that, in spite of everything, manage- munication are the common standards, not whether or not ment backed the projects and could see the record systems in the departments are the same,” Finn the long-term benefits of developing Mathiesen points out. some electronic standards for the whole healthcare sector.”

Finn Mathiesen Tove Charlotte Nielsen Radiology Department, Vejle Hospital

5 MedCom 15 years

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

6 Standardisation, dissemination, consolidation

e have come a really long in our own success,” he points Wway – further, indeed, out. than anyone dared dream of “In the long first period we when we started the standardi- in general practice have accep- sation projects 15 years ago,” ted the opportunities because says Jens Parker, a GP who has we could see clear benefits to been actively involved in the electronic communication. MedCom work right from the Generally, it has been the reci- pioneering years. pients of the communication “Today, there isn’t a single who have enjoyed the biggest agreement between various benefits.” professional healthcare practi- Many of the more recent Jens Parker tioners and the Danish Regions measures, however, are about General practitioner that doesn’t specify that Med- delivering information which Com standards must be used. benefits others yet makes more That is great, I think, not least demands on our time. There are taking into account the fact that several examples of measures it succeeded despite there being where the GPs find that it was so many GP and specialists’ actually easier when they used systems. Try seeing how difficult paper. That sort of thing is hard it is to establish interdisciplinary to sell, although of course we communication in relation to do understand that we are not the hospital systems! That the only ones who should bene- brings the results from general fit from the communication. practice into relief.” At the time at which Jens Limited resources Parker became involved in the MedCom projects it was done “Another aspect pulling in the on the basis of a belief that same direction is that the sup- communication could be orga- pliers of GP and specialists’ nised both more smartly and systems must develop and im- quickly by using the new infor- plement the many new solu- mation technology as a work tions. Resources are limited, tool. That conviction led him, and there is only one place to over the years, to take an active which to send the bills, but part in project work and also as who will want to pay for solu- a type of ambassador to his tions that require more time colleagues for the new opportu- and work? In that way, you nities. Today, he acts as an need to understand that GPs observer for the Danish Medical and their suppliers work under Association in MedCom’s different conditions than the steering group, and he also sits hospitals, local authorities and on the project group for the many of the other players. Common Medication Card. There needs to be a sensible business model. This is often Must not drown in forgotten.” success So, even though the opportunities are tempting, it may “The success has been secured, be necessary just to take a step but I also think we must be back before we launch our- mindful of the risk of drowning selves into too many large

new projects. Photograph: Colourbox

7 MedCom 15 years With e-records I feel better prepared when I visit the doctor

hen, like Benjamin Fugl- Wsang Breum from Tjele, you have been through a leng- thy illness involving hospital admissions and numerous examinations by various specialists, being able to follow the process via e-records is a great help. In 2004, Benjamin under- went an operation on his stomach, and the illness has now lasted for 3½ years. “In particular, I used e-records to keep myself up-to- date with my test results. In this way, I have been able to pre- pare myself better for my meetings with the doctors,” he explains, adding that the access to e-records will place greater requirements on the ability of doctors to communicate with their patients.

“I believe that it is a genuine- Photograph: Lars Holm ly healthy thing all round for us as patients to have more opportunity to get involved in our own course of treatment. How- ever, I also believe it will be a challenge to those doctors who have been used to patients simply listening and not asking so many questions.” As far as the actual e-records system is concerned, he is happy about the information which the system allows him to access, but still feels there is room for improvement in terms of user-friendliness and design. Peter Behrendt Lau Vera Ibsen Leif Vestergaard Pedersen

8 e-records

Good start for A unique, Why make e-records, tailored format it harder but room for than it is? improvement

eople were enthusiastic t quickly became apparent to he need to exchange record Pabout the possibility of be- Ius that we needed to develop a Tdata within the Danish Health- ing able to look at the data in new standard, one that was able to care System was obvious, and there their own records, particularly extract the desired information were different solution models on as it offered them a better from the various existing systems the table, as Leif Vestergaard opportunity to arrive well pre- and present it in a clear and user- Pedersen, Healthcare Manager, pared for their treatment and friendly way,” explains Vera Ibsen, Central Jutland Region, recalls. consultations, as Peter Beh- who at the start of the e-records “We had a good solution in rendt Lau of Rambøll Manage- project was Chief of Section at Vejle and Viborg Counties. Gradu- ment Consulting and Project Vejle County. ally, this spread to the whole of Manager during the evaluation “One of the major challenges Western Denmark, and MedCom of e-records in 2008 explains: was to design and develop a user facilitated a number of the proces- “Hospital staff were also interface that would take into ses in this regard. They did a good positive. Their main wish was account the varying requirements job of this, and showed their flair simply for the system to be ex- of different target groups. This for developing simple solutions to tended nationwide as quickly wasn’t exactly easy.” complex tasks. In principle, every- as possible. When the first standard was de- thing is possible when it comes to “The GPs were more reser- veloped, MedCom was given the IT. It’s just that sometimes solutions ved about it, mainly because responsibility of commissioning the are so complex that the IT task it- the introduction of new IT sys- system, professionalising its main- self swallows up more resources tems often proves a challenge tenance and keeping it up-to-date. than it frees up. for small practices and because Vera Ibsen says of this cooperation: “So, you may of course be ask- some doctors had found that “MedCom has the resources and ing yourself whether we gained the information in e-records skills to run and update systems of just a temporary solution with was not always up-to-date on that size, and the cooperation e-records. We did indeed, but, then the part of the hospital.” works out fairly harmoniously.” again, all IT solutions are tempo- It is her opinion that e-records rary! should be regarded as a forerunner “It could easily be the case that of a more advanced system, which e-records will be developed further. is also described in the Digital Perhaps, in the immediate term, What is e-records? Health organisation’s strategy for a there is room for improvement in National Patient Index (NPI). All terms of the patients’ access. My The record retrieves data from information – records, laboratory opinion is just that, while the pati- the existing electronic patient results and image data – from all ents by all means can take a look, records at the country’s hospi- sectors of the healthcare system too, e-records is primarily a work tals. Access is provided to clini- will be available in this index. tool for healthcare professionals. cians at the hospitals and to all “Speaking of professionals, GPs general practitioners. Citizens in should by all means have easier most of the country also have access to e-records. It is also of access to e-records via Digital decisive importance for the hospi- Signature at the eHealth portal tals to be given equally easy access sundhed.dk. to the GP’s records. It needs to work both ways.”

9 MedCom 15 years When Christmas took second place to the structural reform

hristmas 2006 will not be easily Cforgotten by those working in the country’s largest IT company, KMD. The reason is that the new structural reform with its merging of local authorities and abolition of counties was due to take effect on 1 January 2007. Marianne Knudsen, Service Consultant at KMD, was responsible at the time for getting the interfaces between the local authorities’ healthcare information systems and the KMD Sygehusophold system to work. It may have been a hectic period, but today she looks back on it as a good experience: “It was so fantastic to see how good cooperation can give ‘flow’ to a project. Everyone worked hard to ensure the system would work, and both the suppliers of healthcare information systems and MedCom were really good players throughout the whole process,” says Mari- anne Knudsen. The project advanced according to plan, and she managed to cele- brate a relatively peaceful Christ- mas with her family. After the turn of the year, a three month transi- tion period followed, during which communication between hospitals and local authorities proceeded as in the ‘old days’, i.e. by telephone or fax. During that period, the new KMD Sygehusophold system was implemented in the local authorities. According to Marianne Knud- sen, this proceeded relatively free of problems. She attributes this, too, to good preparation and teamwork.

Peter Simonsen Vivienne Ottosen

10 The structure reform

Healthcare agree- Three local An indispens- ments are ‘born’ authorities - one able work tool with IT support common system

egion of Southern Denmark is uring the local authority mer- y virtue of the structure re- Rthe region that has come fur- Dgers in 2007, what was then Bform, the local authorities thest in the implementation of the Svendborg Municipality merged have gained a much more cen- strategy for healthcare IT across local with Gudme and Egebjerg Munici- tral role in the healthcare sec- authorities, hospitals and general palities. In terms of healthcare, tor than before. This applies practice. And, according to the Head they had three different systems. not least in terms of rehabilita- of Department for local authority Svendborg’s solution was entirely tion, prevention, health promo- collaboration, Peter Simonsen, there IT-based, Egebjerg’s partially so, tion and measures for the are numerous reasons for this: while Gudme still communicated chronically ill. It is, therefore, “In the first instance, from the via paper forms and letters. With both natural and necessary for start we have ensured that our stra- Svendborg the most advanced in local authorities to be deeply tegy was supported and prioritised this regard, it was quickly decided involved in our efforts to en- politically in all local authorities and that the best solution would be sure there is communication in the region. This has meant that all for everyone in future to use the between the other parties in parties have been willing to priori- same system for healthcare infor- the Danish Healthcare System – tise and invest the necessary resour- mation that they had good expe- a communication that works ces in the project. Secondly, right riences of in Svendborg. Among flexibly, securely, efficiently and from the start we have incorporated the project managers for the mer- is free of errors. Here, health- IT support as an integral part of the ger was Vivienne Ottosen, and she care IT is an indispensable work healthcare agreements between the does not remember the process tool, both in terms of messages local authorities and the region. being particularly frustrating or about admissions, discharges, And, thirdly, we have been very problematic. rehabilitation plans, etc., and aware that the implementation of “We had a whole year in which with regard to the exchanging new IT systems and standards across to plan the merger, and because of information between the all sectors of the Danish Healthcare we got started right away and home care sector and general Service and the local authority sy- had set aside the necessary resour- practice. New information tech- stem is a huge organisational task ces, we were actually doing well nology measures, too, will gain that requires a special unit to attend against the timetable,” she recalls. great importance – telemedi- to coordination, training, technical However, she admits there was cine, for example. As we see it, support and communication. We pressure: healthcare IT can both support therefore set up an IT secretariat, “We had additional people successfully functioning proce- jointly financed by the region and sitting and entering information dures and, to a large degree, local authorities, to act as ‘coordina- from Egebjerg and Gudme into also enhance the quality of the tor’,” explains Peter Simonsen. our systems, and our administra- service we provide to citizens. The overall aim of the cross- tive staff also had to make use of sector healthcare IT strategy is to a few weekends. However, we Peter Kjærsgaard Petersen create an electronic link to the indi- made it – both the purely techni- Head of Division, vidual citizen/patient, so that health- cal part and also in terms of Social and Healthcare Policy, care information can be exchanged getting all the new users of the Local Government Denmark from records at hospitals, in general system trained before the merger practice, in the local authority home took effect on 1 January 2007.” care sector and rehabilitation unit – in other words, all bodies with which the patient comes into contact during a course of treatment and throughout the whole of his or her life.

Photograph: Nils Lund Pedersen 11 MedCom 15 years

It was just the two of us

hen we started, the situation “Since then, a fantastic amount rent sets of responsibilities. Wwas more or less that we felt has happened. Everything has be- it was just the two of us, the come a lot more complicated, with Major tasks completed eHealth portal sundhed.dk and a number of active players in the MedCom, and no-one else. It was area of digitisation. Our two orga- “There are many good examples natural for us to cooperate, be- nisations have grown, and the tasks of how our two sister organisa- cause it was clear to everyone that have definitely done so, too. tions have completed even very we complemented each other: “The cooperation has developed large tasks along the way. Opera- sundhed.dk with its user interface accordingly and has become more tions, support, maintenance and to the whole of the Danish Health- formalised and with more obliga- the dissemination of e-records are care System and all the citizens, tions. There was also a need for good examples from the MedCom MedCom as coordinator of the greater professionalism. Naturally 6 period. Of course, there have standardisation work and Health enough, this development must been discussions among us, but Data Network. continue and lead to even more that, too, has led to development “Then, it was a case of two fixed frameworks of well-defined and I think we have found reason- small organisations, and there was models and procedures for the co- ably well-defined interfaces for a sort of ‘free play’ about our cooperation. The aim for me is to see the apportionment of work and operation. the apportionment of tasks so skills between us. “There was a pioneering spirit, clearly defined and the cooperation “The expansion of e-records to and the two or three people invol- between the two organisations run- 600,000 citizens in the Copen- ved on each side knew each other. ning so well that it may well appear hagen Capital Region in autumn They could always talk their way to the outside world that MedCom 2008 was somewhat of a test through things and, to an extent, and sundhed.dk are one organisa- piece in this regard. It was a huge improvise their way forward. tion, though with completely diffe- challenge, and the project requi-

Photograph: Nils Lund Pedersen

12 sundhed.dk

Involved all the way

red very close cooperation with Some of the very first tentative attempts at the suppliers and MedCom. And electronic communication of messages with- it was a success! in the Danish Healthcare System were con- “Now in 2009, sundhed.dk has cerned with the forwarding of prescriptions been through a process which between GPs and pharmacies. A very great also included the reestablishment deal has happened since then, fortunately – of the record system. Following and the pharmacies have naturally been this, we expanded to include the deeply involved in the day-to-day use of the Central Jutland Region and digital tools and in the development work. Region of Southern Denmark. GPs, the home care sector, hospitals, pharma- These events have told me that cies and others have a common interest in the cooperation is getting better Morten Elbæk Petersen making use of the opportunities offered by and better, and that is how it digitisation. It creates the foundation for should be! If we look at what the greater efficiency, minimising errors and pro- future has to offer, there will be viding better service to our customers. Com- even more major projects on the munication needs to be developed further so programme, and we will need an that it extends beyond the standard messa- even greater degree of professio- ges – and this is happening. The correspon- nalisation. But we will manage dence messages are a good example of this. that, too!” The next target is an electronic dosage card as part of the common medication card, for use in the more secure and efficient transmission of information about dose dispensing, where we also expect It may well appear to the outside world that MedCom to play an important role. “MedCom and the eHealth portal sundhed.dk are one organisation, though with completely Niels Kristensen different sets of responsibilities. Chairman, Danish Pharmaceutical Association

13 MedCom 15 years

Successfully managed -sofar!

14 Digital Health

edCom can take a lot of the sion, my opinion is that the whole Mcredit for the fact that Den- area is still to a large extent mar- mark has advanced as far as it has in ked by budding. There are a large terms of healthcare IT – no doubt number of players in the game about it,” states Otto Larsen, Direc- and organisations have come into tor of Digital Health, which in the being that live their own lives words of the organisation “forms and have their own objectives. the framework for the digitisation The consequence of this is that of the Danish Healthcare System.” there is some degree of uncer- “It was done well by MedCom, tainty in terms of common and it is good that it has been done strategies, skills and authorities. in a way whereby the players in the MedCom, Digital Health and Danish Healthcare System have sig- many organisations are operating nificant ownership of the solutions. in the wake of this, and the That is precisely the main explana- question is whether or not it is tion of how we have succeeded in time for some new thinking. The disseminating and consolidating the tasks still need to be completed, solutions as extensively as we have.” number of standards and then but perhaps this can be done gradually distributed them exten- more simply and efficiently. Various bases sively. There are a lot of positive “I certainly do not wish to say things to say about that process. by this that fewer resources will “All the same, it is clear that our “The rather less positive angle need to be used in the develop- organisation, Digital Health, on this is that it took a relatively ment of healthcare IT. On the represents a different line to long time, and that from time to contrary, it is my belief that there MedCom’s in developments with- time resources were used on pro- is a tendency to underestimate in healthcare IT. That is only jects that did not succeed, and it the task involved in developing a natural, as the two organisations was not always the most long- national IT architecture. The pro- were created on a different basis. term, holistic solution that was blem lies partly in that there are “When MedCom was founded sought. not necessarily any direct rationa- in 1994, people said: ‘Here is a “Digital Health came into be- lisation gains to be had. Health- problem. How do we solve it?’ We ing three years ago from the de- care IT increases quality, produc- talked to the users, developed a sire to create greater cohesion in tivity and security, but we cannot developments within healthcare use the argument that we save IT. The structural reform with five money. And so perhaps what if regions and fewer, larger local we change the problem around authorities is pulling in the same and think of the alternative? How direction, and the Danish Health would we manage to complete Act has provided the minister the healthcare tasks in future with a firmer handle with which without the joint IT solution? It to drive developments in a more would be expensive, not just in uniform direction.” terms of money but also absolutely in terms of quality and se- Need for new thinking curity. Really, it is an impossible thought.” “Despite the centralisation Otto Larsen trends, of which this is an expres-

15 MedCom 15 years “I would like to order a DIX, a healthcare DIX”

Important for someone to steer the vehicle

an Kold, who on a day-to-day basis is the IT Manager for the Copenhagen Capital Region, anticipates that there Jwill be technical challenges if the operation of all network connections on the common node in future is to be part of the central Health Data Network. “Depending on how far the operational responsibility extends for the Health Data Network, there will be a number of critical responsibility interfaces for the players’ operational organisations and these could cause very major problems if they don’t work. However, it is quite natural for responsibility to be located in one place, and I see no problem in principle for a central organisation like MedCom to take responsibility for the operation of such a network,” says Jan Kold.

16 Internet-based Health Data Network

t cannot be done.” This was the Much has been Ireply when Lars Hulbæk from MedCom telephoned Martin Bech, achieved, and Division Director at Uni-C, eight or the potential nine years ago to order a healthcare DIX. “There is only one DIX.” remains great “Nevertheless, the healthcare DIX today has become a reality, he regions consider IT to be though to be absolutely correct Ta vital requirement in order this is a little bit disingenuous,” to equip the Danish Healthcare explains Martin Bech. System for the challenges of the “What we have is a central node Martin Bech future, which among other for the Health Data Network, not a things will be marked by more true DIX – an Internet exchange tions just for fun. There was a need elderly and chronically ill pati- point, but does it matter? After all, to connect the regional networks ents and less manpower. The all babies need a name.” together, and for the facilities that regions are thus also actively in- For Martin Bech, the telephone Internet technology provides. The volved in the development of call from Lars Hulbæk was the start alternative would be chaos. Ima- healthcare IT. This includes colla- of an extensive and very unusual gine if all the regional networks, boration with MedCom. Much process to construct the Internet- each with perhaps ten different has been achieved over the past based Health Data Network. services, should be connected in 15 years, while at the same time “At the time, I had already been pairs. It would be fairly unmanage- it is clear that there is consider- working on communications in able. able potential for further parts of the healthcare sector, but “We explained this a great strengthening both efficiency this took me right into the belly of many times at innumerable meet- and quality using IT. There is al- the system,” he explains. ings. We also asked the sceptics to most a queue of options waiting “The thing is, when people tell us what requirements they to be realised, including in come to us to have a task comple- would have of the new network in terms of direct communication ted, they more or less always have order for them to surrender some between the Danish Healthcare the solution defined in advance. It of their sovereignty. System and the patients. The is then a matter of putting it into “We built a pilot system on the healthcare agreements between real life. That wasn’t the case here! basis of all the input received. Of the regions and the local autho- You see, the starting point was that course, it has been upgraded in rities also bear witness to this, there were a number of regional every way since, but it has actually and from the regions’ point of networks, which many people had been in continuous operation since view there is every possible spent time and effort to build up. day one. And I really believe that reason to continue working One of their most important aims everyone would agree that the so- determinedly in these areas. all the time had been to create se- called healthcare DIX has lived up curity, to keep strangers out. Now, to expectations. No-one’s scepticism in layman’s terms, we were coming has been confirmed – quite the re- up with a plan to keep strangers in. verse, in fact.” Not just anyone, of course, but you see the point. Naturally enough, this generated a deal of scepticism. Fortunately, we were able to argue that security would be intact, and that to cap it all the network would There was a need to con- be able to deliver documentation “ nect the regional networks of all transactions. together, and for the “And then, of course, we didn’t facilities that the Internet- Bent Hansen want to build the new construc- technology provides Chairman of the Danish Regions

17 MedCom 15 years Next generation will be ready Photograph: Yilmaz Polat / Fyens Stiftstidende Photograph: Yilmaz

18 International

here is a touch of ‘Brave New of the readings are communica- TWorld’ about it when people ted directly to us, and if some- need to use electronic equipment thing looks wrong we receive an in the home, and they tend to get alarm. The citizen can also con- a little scared when we show them tact us directly, and we can talk the possibilities, as home nurse together at a miniature video Helle Holm explains: conference using a webcam and “The drawback is precisely that their TV. many people in the target group “As far as I see it, there are of the over 65s are not used to many benefits to the public. They using new technology. That situ- become actively involved in their ation will most definitely change own treatment, and perhaps visit in time. The next generation will their doctor less frequently be- be ready. They will simply expect cause they gain more control of to have that sort of technology their illness. They feel a greater available.” sense of security and are always in such good control that they Active citizens will probably be admitted less frequently to hospital. At the Helle Holm is employed by Lan- same time, they are not so tied geland Municipality, where she is into having to be at home when Project Manager for the munici- we come.” pality’s part in the international Dreaming project, which is about Six countries in the project harvesting experiences of information technology in the service The pilot project is being carried of healthcare. out simultaneously in six coun- “The project covers citizens tries – Sweden, Italy, Spain, Ger- aged over 65 who are relatively many, Estonia and Denmark. well and who are covered by the Forty-four people will take part home care sector,” she explains. in Langeland Municipality. Half “They have chronic illnesses of them will have the equipment such as diabetes, COPD and poor in their own home. The others heart conditions, and they are will receive traditional treat- given equipment in their homes ment. The results will be exami- so they can measure their blood ned using questionnaires and sugar, blood pressure or lung interviews and experiences will capacity themselves. The results be collated.

he energy which international recognition Tgives in a cooperation situation provides strong motivation to continue the innovative work in this country and overcome possible resistance. The ‘H.C. Andersen effect’ – being better known abroad than in your own back yard – convinces people that it is worthwhile persevering and continuing the work.

Peder Jest Director, OUH

19 MedCom 15 years

Small organisation – major influence

evin Dean, Director of Con- “One of MedCom’s major Knected Health’s Internet Busi- strengths is that the organisation ness Solution Group in the inter- is based on the network mode of national IT Group Cisco Systems Li- thinking, and therefore they have mited, sees a number of major chal- gradually created for themselves lenges to the European healthcare a gigantic network of internatio- system in the coming years, with nal specialists both in IT and the the rise in the proportion of elderly field of medical knowledge. citizens. This places enormous They manage to gather the best pressure on resources, and it is people for each project, and they therefore extremely important to create relationships for further increase productivity in the health- development.” care sector. Better, more efficient IT communication and technological You need to act quickly aids can help free up resources for those tasks that require people to MedCom is deeply involved in de- carry them out. veloping solutions that will meet At the same time, it is very im- the challenges of the future in portant to avoid a ‘brain drain’ of the European healthcare system, experts, especially from Eastern to and Kevin Dean believes that Western Europe. The development MedCom is very modest conside- of telemedicine may help avoid ring the amount of work and in- this, as experts can now be challen- fluence that the organisation ged, and rewarded, in a professio- really has. nal way wherever they may be Where he does see the chal- located geographically. lenges to MedCom in the future is in terms of the speed of devel- Good example opment. Time requires, and technology enables, people to act Since the start of the new millen- faster in future than they have so nium, Kevin Dean has worked far been used to. with MedCom in a number of different connections. He is impres- sed that such a small organisation has had – and still does have – such major influence on the development of IT healthcare communications at an international level. “I often use MedCom as an example when I want to illustrate how a very practical, methodical approach can allow technology and communications to reach a higher level,” he says, and he continues: Kevin Dean

20 International

care sector to impose requirements or orders on the systems of individual member countries, and therefore developments in the area of healthcare IT within the EU become both slower and more unsystematic than you find, for example, in the environmental sector, where the EU has a mandate to impose requirements on individual countries.” Ilias Iakovidis MedCom is a shining nvesting in better IT technology example Iin the healthcare sector is a sensible prioritisation which in the long Ilias Iakovidis has been involved term will save resources, and it is for longer than most. He has something which all governments worked on healthcare IT within in the EU should be interested in the EU since 1993. At that time, carrying out. This is the opinion of he was involved in formulating Ilias Iakovidis, Chief Delegate for and examining the principles of the Department of Healthcare IT at developing common standards the EU Commission. for electronic healthcare com- “What people, whether in ma- munication in the EU, a project nagement or in national Govern- that led to the foundation of ment, need to be fully clear about MedCom. MedCom has a special is that the technology in itself is place in his heart because of the not the solution and cannot stand forward vision that the project on its own. The investments have then represented. to be followed up by an extensive “For me, there is absolutely no reorganisation of working proces- doubt that MedCom is the exam- ses and functions. You need to en- ple of how to develop and orga- sure that the users understand the nise a functionally competent technology and can see the act of IT system for healthcare IT. becoming familiar with the new MedCom’s working methods are systems in perspective. Otherwise based on the ‘trial and error’ the new technology just leads to principle, where testing and mo- frustration and difficulties.” difications are a continuous process. We are not as afraid to No mandate on healthcare make mistakes, and the focus is on getting the users involved as But would having all healthcare early in the process as possible. IT systems in the EU based on the We are on the threshold of the same standards not be the most next wave, where the break- sensible thing to do? through in technology and com- “Yes, definitely, but the EU does munication will be used in not have a mandate in the health- healthcare, for the benefit of all citizens of the EU. I hope the Danes will be just as forward- Healthcare IT requires looking this time as they were organisational changes then with MedCom.”

21 MedCom 15 years

Copenhagen University Hospital took the first steps

he system was very simple, but Tit worked, as Ole Bergsten, Technical Manager at Medicotek- nik, explains about Copenhagen University Hospital’s first measures in telemedicine back in 1995–96. He remembers the attention surroun- ding its inauguration, including from the press. “We worked on an ISDN2 connection and used only standard systems. It worked fine for echocardiography and X-rays, where all we did was to place a video camera on an overhead projector. We then also managed to convince the doctors that the image quality was acceptable. Otherwise, they were somewhat sceptical.” The reason why Copenhagen Uni- versity Hospital took the first steps into the world of telemedicine was a degree of pressure from the Faroe Islands. When it came down to it, they did not have a need for it. In- stead, a connection was set up to Greenland, which included echocardiography and X-ray imaging. The echocardiography works the same way today as then, while of course the technique in the field of radiology is totally different. Telemedici From projects to routine us better a “Today, echocardiography is routinely communicated between all hospitals in the region, and videoconferences have, for example, also become routine,” explains Ole Bergsten. “Actually, I have never doubted the possibilities, but from hen the doctors in the Cardiological De- a development point of view the many independent projects Wpartment at Roskilde Hospital need to de- in the area have been a problem. They are initiated without cide whether a patient is suitable for an operation people having taken the necessary organisational factors for a new heart valve, for example, they like to into account. These days, we start by getting the organisa- seek advice from heart surgeons in other hospi- tion in place before we make a start on telemedicine pro- tals. This is done at a weekly teleconference invol- jects. ving doctors and surgeons from various hospitals “At the same time, we have learned that the initiation in the country. At the teleconference, all partici- into new work equipment is very important. For example, pants have the chance to see images and ultra- we got MedCom staff to run a training session before we sound recordings, e.g. of patients’ coronary embarked on a new collaborative effort in telemedicine with arteries, and a discussion is held as to whether an Bornholm. It gave us a really good start and showed the operation is appropriate, based on the images. importance of making things easy for the users.” “The teleconferences have saved us a great

22 Telemedicine

Strategy for telemedicine

he ABT Fund is a fund whose Taim is to invest in innovative projects throughout the whole public sector. In overall terms, this means projects that increase

Photograph: Thierry Wieleman efficiency and productivity in public sector service and care without this being at the ex- pense of quality. In this regard, telemedicine projects are right up its street. They can help ensure that specialised functions last longer and that quality im- proves. At the same time, we consider the healthcare sector ready to make use of the new types of tools in IT. The challenge to us is first and foremost to choose the right projects to support. The investments made must match the results, and from society’s perspective the projects must point in the right direction. In other words, it is a matter of making a decision as to which strategic areas of effort within telemedi- ine makes cine we should invest in. Then, we need to establish some conditions which the projects need and faster Klaus Klausen to meet. MedCom is helping us with this exercise, and they certainly work quickly so we are ex- pecting to be in a position to deal of time,” says departmental doc- a degree of technical understanding to have the basis of our decision in tor Klaus Klausen. get the systems to perform to best place by the spring. “Now we no longer need to plan to effect. The user interface itself could We see great opportunities in meet in person, and we have the benefit from being more intuitive and telemedicine. We have reached chance to give and receive professional visually well thought out. And, of the years of discretion. Now, the support quickly and without any com- course, it is a ‘must’ that the connec- strategy needs to play its part in plications.” tion works. We probably would like a gathering together the forces However, in terms of the technical more stable, error-proof system, and for the action that provides the set-up of the telemedicine systems, here, too, technical improvements are best result. Klaus Klausen believes there is still continually being made. All in all, tele- room for improvement. medicine is a really major benefit to Ulrich Schmidt-Hansen “In some places, the systems are both patients and healthcare profes- Secretariat Manager, very ‘nerdy’, in the sense that you need sionals.” The ABT Fund

23 Projects eCm7 2010-2011 7, MedCom MedCom’s standards today are widely distributed in the healthcare sector. However, there are still regions and local authorities that do not make use of all relevant communication solutions. For example, a number of MedCom standards have not been implemented in full.

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

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

G National implementation of central MedCom standards that have not yet been adopted by all regions and local authorities, including in particular: – Communication of local authorities with hospitals and doctors. – The use of the Common Medication Card in the surgery. – The dissemination of e-records to citizens, hospitals and surgeries. – Development and national implementation of package referral. – Laboratory medicine communication.

G National implementation of tele-interpretation and ulcer assessment by telemedicine as part of Digital Health’s Tele- medicine programme.

Six project lines in MedCom 7

Specifically, this means that MedCom 7 includes implementation nationally within six project lines:

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

Local authority projects. Dissemination of communication in the home care sector, rehabilitation, LÆ form and referral area. Find out more on pages 28–29

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

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

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

International projects. Participation in EU projects, primarily in the areas of standards, telemedicine and welfare technology. Find out more on pages 34–35

The MedCom 7 projects are all a direct extension of the activities in MedCom 6. The project descriptions on the following pages contain both a description of the development hitherto of the projects in MedCom 6 and the expectations for MedCom 7.

24 Consolidation and dissemination

Consolidation and dissemination

Consolidation and expansion projects in the MedCom 6 period has focused on dissemination of ‘old’ projects to such a degree Correspondence that these electronic communication flows will be used ex- clusively in the future. Also, a number of new, smaller projects message Pharmacies have been initiated to supplement the existing ones. The pharmacist systems pre- dual pharmacies and con- viously developed a module tacted all of the local autho- for correspondence messages rities in the country in order for communicating with to get them to use it. doctors and local authorities REFHOST – the regarding supplementary The pharmacist began work information for ordering on 1 February 2009. The referral database medicines, etc. graph on page 47 shows the results! med supplier, the Danish The module has not been En brugervejledning til praktiserende læger, speciallæger, Association of Medical Spe- widely used, but thanks to a It is therefore expected that, fysioterapeuter og psykologer cialists, Danish Physiothera- grant from the Danish Phar- in 2010, there will be much Henvisningshotellet pists and the Danish Psycho- macy Foundation to MedCom greater dissemination of the REFHOST logical Association. MedCom a project has been initiated: message facility, which is project managed the imple- Rollout of the correspon- now both known and used mentation project. dence message facility, where by pharmacies. a pharmacist visited indivi- The introduction of a univer- sal digital employee signa- Nu også til ture was a challenge, which fysioterapeuter og psykologer was overcome in the course Dissemination of of just two months. package referrals Next step MC-S215 / JANUAR 2009 The project ends in 2009. The Referrals from doctors and developed in MedCom 7, technical solution now opens specialist practitioners for while solutions are being im- REFHOST: A successful up the possibility for other hospital treatment are stea- plemented that allow en- MedCom 6 project, which specialities to take part, such dily increasing, and the pro- closures to be sent with refer- allows all doctors to send as podiatry and local autho- portion is now around 50%. rals. In addition, MedCom’s referrals electronically to rity preventive facilities. With the ‘Cancer Packages’, lists of EDI recipients in hospi- specialists, physiotherapists there is a need for a revision tals are being resumed. and psychologists. of the electronic referral so that in future it reflects the It is expected that a referral The dissemination took place need of the individual specia- database solution will be as a collaboration between lity for relevant information. established with REFPARC, the Danish Regions, the five where all referrals can be regions’ practice units and Next step completed based on a dia- data consultants, the Multi- A dynamic referral is being logue, as in WebReq.

90000 REFHOST referrals to 80000 70000 September Spe- Physio- Psycho- Pod- 60000 2009 cialists therapy logists iatry 50000 40000 South Denmark 19575 6614 616 400 30000 Central Jutland 19266 7533 449 0 20000 North Jutland 8333 3871 374 0 10000 Zealand 18100 5481 563 0 0 Copenhagen Capital 65200 11276 1408 0 01 02 03 04 05 06 07 08 09

Total 130484 34775 3410 400 Referrals to hospitals per month 2001–2009.

25 Projects

Laboratory medicine projects, including support by sundhed.dk

The projects are coherent and form subcomponents of an overall, certification as well as with departments can order tests fully electronic communication internally between the labora- start-up meetings and monito- and the individual laboratory tories and between the laboratories and the users. The projects’ ring through statistics and retrieve requests automatically common title is Laboratory Medicine. workshops for users. via the web service when the patient arrives. Dissemination The topics are both laboratory results and requests between is expected at the end of 2010 Subproject 3 laboratories and support of laboratory functions which can be and in 2011. displayed using sundhed.dk. A total of 13 subprojects were initiated in 2008–2009. The project was not fully disseminated in Request database Subproject 4 the MedCom 6 period due to time-consuming tasks with the implementation of new laboratory systems. The status of the Requests from specialists and projects is currently: hospital outpatient depart- Results between laboratories ments can be saved to the request database. Patients are All laboratories send samples Subproject 1 Subproject 2 then able to go to their GP or on for analysis by other labora- a laboratory in order to have tories. The results are normally WebReq dissemination Electronic dispatch slip: New the tests carried out. The result on paper, but a large number standard – REQ01 – R0131K is correct testing and a request are now sent electronically. 93% of all laboratory tests that can be used irrespective of from GPs can now be request- The trilateral problem has which laboratory the doctor Results ed electronically. More than been developed and imple- uses. 23 laboratories send results to 3000 surgeries implemented mented in a number of labo- a total of 35 laboratories. When the system over four years. ratory systems. The remaining Many specialists and some out- all laboratories are sending to This must be considered a suc- systems have been delayed. patient departments are now all others, there will be around cess. Implementation expected in on the database. MedCom has 40 laboratories sending results 2010. developed a web service solu- and around 60 laboratories Next step: tion for direct, automatic able to receive results. In Sep- The last clinical immunological Next step: access. It is ready on WebReq. tember 2009, a total of 17,622 laboratories will join WebReq, In 2010 and 2011, it is expec- So far, no laboratory systems results were sent. This equates and the use of the new func- ted that all laboratories will have managed to develop it. to around 25% of all results. tion, Web-Quality, will form procure the dispatch note mo- Not all laboratory systems are part of the quality assurance dule and thus make the transi- Next step: able yet to receive results. Mo- process for laboratory tests in tion from paper to electronic The laboratories will enter into dules are under development. GP surgeries. dispatch slips. MedCom will agreements for the delivery of provide help with testing and the module. Then, outpatient The future A natural consequence of the implementation of dispatch notes in subproject 2 will be that all results are sent electronically. MedCom provides assistance to the laboratories with start-up meetings, testing, certification and the staging of workshops for the users.

Subprojects 5, 6 and 7

5. Manufacturer and manufacturer code: The statutory requirement that it must be possible to see which laboratory carried out the analysis is now met by all major GP and specialists’ systems. Many laboratories also meet these requirements by including the manufacturer and manufacturer

26 Consolidation and dissemination

formed by doctors themselves. Development of the solution is complete, so it is easy and ef- fective for GP surgeries to use. It will come into use in selected laboratories at the turn of the year 2009/2010. The plan is that laboratories wishing to use this service will be able to do so immediately. MedCom provides assistance with the introduction, among other things, of start-up meetings at the laboratory and workshops.

10. Improved display of laboratory results on sundhed.dk. In 2007, MedCom’s professional healthcare laboratory group drew up a proposal to improve the display of the results, targeted at the users. On this basis, a display module has been developed for all types of laboratory results. Develop- ment of the module is complete, but there has been a de- lay in putting it into use pen- ding clarification of the technical solution for presentation on the new sundhed.dk. It is expected that the system will become operational in April 2010. code in the dispatch. The rest ved the desired impact. All GP and discussed at a national are expected to join in 2010. and specialists’ systems have laboratory seminar. Final esta- 11. Test tube reception was in- developed the functionality. blishment will take place in troduced at a number of hospi- 6. The short names for IUPAC However, a number of labora- December 2009. The web ser- tals in 2009. Following adapta- or, now, NPU codes have been tories have stopped publishing vice for the assignment of tion of laboratory systems and drawn up and sent to the cli- on sundhed.dk, as they need numbers and establishment of the introduction of changes to nical laboratory companies for to be maintained both on re- the numbers server was drawn work procedures, it will gradu- consultation. These will be gional systems and on sund- up at the end of the year. ally come into use at a number approved before the end of hed.dk. of laboratories over the next the year and published on the In 2010 and 2011, the systems few years. National Board of Health’s In MedCom 7, the solution is will gradually be able to trans- Labterm website. based on regional databases fer to this numbers series, and 13. The Microbiology bank has which can then be exported to from 2012 all laboratories are been established and will be The project has been delayed sundhed.dk, or alternatively expected to use this solution, fully operational in January at MedCom. It is expected by using a direct link to the re- which will ensure that all tests 2010. It will not be possible to that all laboratories and sund- gional database. have a unique national num- display microbiology results on hed.dk will use the short ber. This will prevent mix-ups sundhed.dk until the new dis- names in the course of the and renumbering. The numbe- play module (subproject 10) is Subprojects 8 to 13 next few years. ring system will last for more complete. than 100 years and can be 7. The appearance of labora- 8. A common national num- used in almost all existing ana- Next step tory guidelines on sundhed.dk bering system for all laborato- lysis machines. Will be started during spring by use of the manufacturer ries based on 12 unique digits 2010, once a new display solu- code (subproject 5) is obvious, and assigned from a central 9. WebQuality for quality tion is ready on sundhed.dk. but the project has not achie- server has now been described assurance of the analyses per-

27 Projects

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

In 2008–2009, the focus was on getting the home care services to capacity can be described on a care/hospital standards will be use the correspondence message facility when working with form. Practical agreements in completed during autumn 2009 pharmacies and GPs. Many local authorities are now active in terms of discharge can be and made available in MedCom these areas. 75% of local authority home care units use electronic noted. to regions and local authorities. communication with GPs. With pharmacies, this is 56%. Electro- A pilot project will be conduc- nic communication with hospitals has begun, but major dissemi- Local Government Denmark ted for regions and local autho- nation in this regard will only come with the new versions of the will finance two project con- rities wishing to take part. home care/hospital standards, which were updated during sultants in 2009–2012 to work 2008–2009. on dissemination and support. The dissemination of correspondence will continue in the line with developments in the In future communication between the Status healthcare agreements: MedCom’s documentation of home care sector, pharmacies the new versions of the home and GPs. 91 local authorities are con- 1. The admission report has nected to the Health Data been changed. Functional ca- Message type Number of local authorities Network, with access to simple pacity can be described on a notification and/or healthcare- form in the admission report. Correspondence 81 related communication via the In addition, the services recei- Variation from one local authority to another as to whether correspondence message and ved by the individual citizen correspondence used for GPs, hospitals, pharmacies prescription renewal, etc. The are indicated. Correspondence with GP surgery 73 expansion of the message faci- 2. Discharge warnings are lity can be seen in the table on being changed to a nursing Correspondence to pharmacies 55 this page. Some local authori- care plan. The contents and Discharge warnings 16 ties are in the pilot stage, fields are related to the admis- Some local authorities receive discharge warnings by while others are operational. sion and discharge report. correspondence; these 16 use MedCom's warning standard 3. Notification of discharge is Notification 91 Home care/hospital support a new administrative service Not all local authorities send admission replies by healthcare agreements message. The message will be Prescription renewal 32 2010–2011 automatically sent off upon Rambøll Care local authorities use the EDIFACT standard; discharge from the hospital CSC VITAE local authorities can use prescription renewal via PEM The standards between the system. Total number of local authorities on the Healthcare home care sector and hospi- 4. The discharge report has Data Network 91 tals were updated in 2009 in been changed. Functional

Referral for prevention 1.Doctor's Local Government Denmark (LGDK) and MedCom are collabora- consultation ting on a pilot project for local authority preventive facilities. The 5.Local 2.sundhed.dk/ existing MedCom standards for hospital referrals and discharge authority service regional page letters will be used. For this reason, experiences with the pilot project are being collated in the use of the local authorities’ preventive facilities. These are available at sundhed.dk or the regional portals. The aim is also to clarify whether phrases for 4.Message 3.Service healthcare-related content can be used in terms of local authorities’ preventive facilities. Step 1: Discussion with the citizen Step 2: Doctor searches for a service used, the project focuses on Status Step 3: Doctor finds description, assessment criteria and, where widening awareness of the applicable, phrases standards and making the op- Step 4: Doctor fills in electronic referral. Send and receive electroni- Three pilot local authorities tions for prevention visible to cally and their suppliers are taking GPs. Appointment confirma- Step 5: Feedback to doctor (booking and discharge letter) part in the pilot implementation will possibly be implemen- tion of electronic communicated in order to support the tion between the GP and GP's function as coordinator. In future the long-term aim is to make healthcare centre. As the exist- The hospitals can also make As far as referral for preven- the whole work process elec- ing MedCom standards are use of local authority preventive measures is concerned, tronic. tive facilities.

28 Local authority projects

DGOP – LÆ project rehabilitation plans

Hospitals and local authorities work together with rehabilitation The project covers the so-called LÆ forms, which are ex- procedures, and the communication is supported electronically with changed between the local authority and GP, typically in the help of the communication standard for rehabilitation plans. connection with the processing of cases of early retire- ment pensions, sickness benefit, etc.

Status Status

All regions can send rehabilita- the professional content of the tion plans electronically in DGOP. MedCom has worked with being disseminated to ge- DGOP format – several are in the suppliers of GP and neral practice. The option operation with selected hospi- Central Jutland Region specialists’ systems, selec- of electronic communica- tals. At the same time, all The plan is for all hospitals to ted local authorities and tion of LÆ forms is fully in- regions are working on the be able to send in DGOP format Kommuneinformation A/S tegrated in three GP and organisational expansion to all by the end of 2009. The local on the development and specialists’ systems, and hospitals. The technical set-up authorities are taking part in pilot testing of the electro- several are undergoing remains complicated. DGOP is succession. Six local authorities nic communication of LÆ implementation. technically based in the dyna- today receive electronically. forms. Communication will mic form format (DDB 0.99), (Aarhus, Silkeborg, Herning, be done using MedCom’s In future while in practice only the XML Viborg, Skive and Favrskov). standard for the Dynamic part is used as a traditional Form. MedCom message. Several local Zealand Region At the same time as the authority parties can receive in Has not participated in the Standards have been esta- suppliers of GP and specia- DGOP format, but it is still per- MedCom DGOP pilot project. blished for six types of lists’ systems are dissemina- mitted to receive in correspon- However, the region has form. Kommuneinforma- ting the solution, a cam- dence format. GPs can only nonetheless pilot implemented tion’s NetForvaltning Sund- paign will be required to receive in correspondence the DGOP standard. The region hed software solution pro- ensure that the electronic format. is in the process of testing using vides local authority admi- communication of forms several pilot local authorities nistrators with access to becomes used in general Copenhagen Capital Region (Kalundborg and Odsherred the electronic communica- practice. There is also a Has drawn up an implementa- Municipalities). tion of the LÆ forms. Net- need for the design, test- tion package – professionally Forvaltning Sundhed is at ing and quality assurance and technically. All hospitals North Jutland Region present used in 19 local of new forms. must be on board by the end of The hospitals send in DGOP for- authorities and is currently 2009. As working procedures mat. An organisational dissemi- vary from department to de- nation is in progress. Four local 3,000 partment, the organisational authorities currently receive in implementation will be exten- electronic format. (Ålborg, 2,500 sive. Several local authorities Brønderslev, Rebild and receive rehabilitation plans Jammerbugt Municipalities). electronically (Hillerød, Helsing- 2,000 ør, Herlev, Gribskov, Copen- In future hagen). 1,500

Region of Southern Denmark G During the period of the From the start of 2010 the plan MedCom 7 project, the ho- 1,000 is for all hospitals and local spitals will also be able to authorities to operate the receive DGOP electronically. DGOP format. Today, all local G Several local authority sup- 500 authorities receive rehabilita- pliers implement the DGOP tion plans electronically in format. 0 correspondence format. The G There is a requirement to be July May June region works alongside Central able to forward DGOP to April March August

Jutland Region in sending physiotherapists in private January October February

across the regional border. The practice in a converted cor- September region is also underway with respondence format. I Number of cases sent electronically from the local the ‘Good Electronic Rehabili- G The technical format for authorities, January to October 2009. tation Plan’, which focuses on DGOP needs to be evalua- I Number of cases received and replied to electronically ted. in GP surgeries, July to October 2009.

29 Projects

The following GP and hospital systems are Common Medication included in the Common Medication Card Card (FMK) GP and specialists’ G Ganglion systems: G Profdoc Darwin G Profdoc XMO/ G MedWin lægevagt The Common Medication Card is a further development of the service that Æskulap has been available through the Prescription server, where GPs can see G Win PLC Hospital systems what prescription-only medication has been supplied to the patient from G MedWin G Columna/Århus EPJ the pharmacy during the past two years. G Novax G Logica-Cosmic G MyClinic G Acure-EPM 3.0 The Common Medication Card provides an overall view of a patient's full, G Emar G Acure Harmoni/EMS current medication. The Medication Card is a virtual card that resides on a G Ganglion G IBM-IPJ server at the Danish Medicines Agency. All parties, i.e. doctors in both the G Multimed-Web G CSC-Opus Medicin primary and secondary sector, clinicians, home care workers and patients G PC-praxis-Web G Theriak themselves, will receive access to an up-to-date Medication Card. The card G Docbase G Logica Viborg EPJ obviates the need to supply lists of medicines manually, which are often deficient and not up-to-date.

The GP receives up-to-date information from the Common Medication The Common Medication Card is being developed Card server automatically in their own version of the patient's medication in partnership as follows: card once the patient is activated or placed on the appointment order form. All prescriptions for medication to which changes have been made Digital Health is res- The Danish Medicines are marked. At the end of the consultation with the doctor, the medica- ponsible for ensuring Agency is responsible tion data that has been changed by the doctor, for example in the form of completion of the pro- for the operation and a new drug, will automatically be transferred to the Common Medication gramme in collabora- maintenance of the Card server. The same will occur during hospital treatment, with the on- tion with the involved central part of the call doctor and in the home care sector whenever the patient's medication parties and contribu- Common Medication is adjusted. tors. Card.

The technique is based on SOA, Service-Oriented Architecture, in which The Danish regions are MedCom is responsible the individual GP and specialists' system is connected to the Common Me- responsible for the for contacting and dication Data server via the Health Data Network, the SDN. implementation of the developing the GP and Common Medication specialists’ systems in Card in both the pri- Denmark which will in- Requirement for access Who is involved, and when mary and secondary tegrate with the Com- sector. mon Medication Card. In order to have access to the Timetable FMK server, the GP surgery needs to have a high speed In- MedCom has entered into an agree- New words ternet connection and a digital ment for the development of the Com- signature. It must also be con- mon Medication Card solution with all Common Medication Prescription for nected to the SDN, MedCom’s GP and specialists’ systems with more Card (FMK) medication Health Data Network. than 10 installations. G Is a depiction of the G The doctor’s pre- person's current medi- scription on the Medi- Under the SOSI component, all G XMO/Æskulap, Medwin and Win- cation. cation Card. the doctor and healthcare staff PLC are involved in the development G Each person will G Recording of a deci- have to do is to log in once a project – wave 1 – in which the Com- have their own medi- sion on medication. day using a digital signature. In mon Medication Card module is devel- cation card in the medi- the event of technical problems, oped along with selected GP surgeries; cation profile. Prescription request the doctor will be able to work this will be ready in December 2009. G The Medication Card G Orders to the phar- using their own system’s Medi- From May 2010, the remaining GP and contains the relevant macy to supply medication Card, just like today. specialists’ systems – wave 2 – will also medication. cation based on a have developed their Common Medica- prescription for medi- The hospitals have medication tion Card solutions. Following this, all Execution cation. systems which perform corres- doctors will be able to make use of the G Whatever the doctor G Corresponds to a ponding data transfers via the system. It is expected that MedCom will gives to the patient is single-item prescrip- Health Data Network to the provide assistance to the regions with transferred directly to tion. FMK server. The information is this rollout to the GP surgeries. the Medication Card via G Sent to the phar- updated on admission and dis- G The hospitals are expected to start the GP’s own system. macy via the prescrip- charge. using the Common Medication Card G Dispensing by tion server as is the during 2010 and 2011. the pharmacy to the case today. Over the coming years, the G The local authorities’ ECR system will patient via the pre- local authorities’ home care develop the functionality for the Com- scription server. systems will also be connected. mon Medication Card in 2011.

30 Common Medication Card (FMK) / SIP

SIP: Standardised Report from the Primary Sector

As the Internet has expanded, in recent years a number of cen- pany certificate. from the GP and specialists’ tral authorities have established a number of online reporting system: Docbase. solutions targeted at GP surgeries. What these solutions have in All local authority child record common is that they have been set up without being coordina- systems have developed the 3. Death certificate ted with, or integrated into, the GP and specialists’ systems. The module and implemented it in consequence of this is that GPs have to work on reports in a a number of local authorities. number of different IT systems and do not have the option of In addition, the Ministry of automatic reuse of data from their own record system, nor the Health and Prevention has 2. Adverse Reactions option to store copies of the reports produced as part of the asked MedCom to initiate Report overall documentation in their own record system. integration between the GP systems and the National The standard for the Good local authority child records The Danish Medicines Agency Board of Health’s Cause of Web Service (DGWS) from Med- and a child database at the has asked MedCom to ensure Death Register. How-ever, it Com’s perspective has been National Board of Health. there is integrated reporting was technically difficult to de- launched as the new standard of adverse reactions between velop this solution now, and it for integrated data exchange When children are examined, the GP and specialists’ systems is no longer part of the project. between IT systems, including heights and weights are auto- and the Danish Medicine electronic reports. The time is matically collected from the GP Agency’s database. Technical Solution therefore ripe to begin stan- and specialists’ system’s Child dardisation of GPs’ reports to Card and sent via DGWS to the An integrated module is being the central authorities. Cur- National Board of Health’s developed which will allow The Good Web Service (DGWS) rently, there are two specific reporting system. The SDN the doctor to designate the projects run by MedCom that (Health Data Network) is also drugs for which a report on The MedCom standard for on- form part of the SIP project: used here. The data collected is adverse effects is required. line exchange of data in the checked against corresponding Data is captured automatically healthcare sector. Specifies the data gathered from local and comments can be added. ‘envelope’ for the data ex- 1. Child Database authority child record systems. The completed report is then change, including the security Most GP and specialists’ sent using DGWS directly to level when using OCES certifi- Local Government Denmark systems have implemented the the Danish Medicines Agency cates. Recommended by Digital has asked MedCom to ensure solution, but a single clarifica- via the SDN, the Health Data Health as an element in the fu- there is integration between tion remains outstanding Network. The first live reports ture technical infrastructure in the GP and specialists’ systems, regarding the use of the com- have now been performed the Danish Healthcare System.

FMK (Common Medication Card) and SIP GP and specialists' systems Child record Next step systems

Status 26 November 2009 In the MedCom 7 period, it is expected that the Adverse Re- actions Report and Child Data- base Report will be disseminated to all GP surgeries in paral- lel with the coming into use of Profdoc XMO/Æskulap Novax Win PC-Praxis-Web Win PLC MedWin Multimed-Web Emar Win Docbase Ganglion Profdoc Darwin MyClinic Ålborg Kommune DSI SUND Novax Læge/ Novax Sundhed TM Sund the Common Medication Card. Calls to the Adverse Reactions Database The GP and specialists’ systems Version taking part in the Common

1.0.1 1.0.1 1.0.1 URL 1.0.1 1.0 1.0.1 1.0.1 URL 1.0.1 Medication Card project are RegisterDrugSideEffect (medication) also taking part in SIP. RegisterDrugSideEffect (vaccine) G MedCom approved G Calls to the Child Database: Ready 30/11 G Ready 08/12 G CreateChildMeasurementReport Ready 14/12 G ModifyChildMeasurementReport Not possible/not approved G DeleteChildMeasurementReport Ready 26/11 G SetExclusivelyBreastFeedingPeriodEndReport 2010 G SetExposedToPassiveSmokingReport URL G Not rel.

31 Projects

e-records Fact box

e-records extracts record data from electronic patient records and patient administrative The e-records project creates access to electronic record data from Danish hospitals for professional systems at hospitals and healthcare workers in hospitals and in general practice, as well as to citizens who have been admit- makes this available to ted to the hospitals. The aim is to provide access to relevant information concerning the patient’s clinicians in hospitals, previous treatments, examination results and information about allergies and adverse reactions surgeries and to the (medication intolerances, etc.). As far as the citizens are concerned, the idea is that being able to see population. their own patient records may increase their awareness of their own illness and encourage more active involvement and better self-care. At the same time, the aim is to create a technical solution so At the annual confe- that clinicians can only access record data if there is a relation between the patient and the treat- rence of the E-Health- ment provider. It is also an aim to be able to show the citizen all accesses made by clinicians to the care Observatory in citizen’s record data. October 2009, the major dissemination of e-re- carried out of the use of e- to the hospitals. For surgeries, cords among the popu- Status records by hospitals, in surge- MedCom is seeking to dissemi- lation was named as the ries and among the population. nate a short-cut solution from second most important At the end of 2009, data from In short, it showed that hospital all suppliers of surgery systems. event of the year in the the records of around 80% of users are very satisfied, while Discussions are currently taking area of e-health. the Danish population was re- users in the surgeries also like place with on-call doctors and corded on the e-records data- the solution, even though it specialists about establishing base. takes too long to log in. The access. Dissemination among citizens were very satisfied. the population has also been e-records, where people will There is access to this data in People using e-records consider given a high priority, and there be able to find explanations the hospitals and here, at the themselves to be ‘the well- are plans to coordinate efforts of difficult clinical terms. Ef- moment, a short-cut solution is prepared patient’. In a minia- to inform people through bro- forts are also being made to being disseminated from the ture survey, around 50 clinicians chures and exposure in the establish a link from diagnosis established hospital systems. at the Lillebælt Hospital then media in collaboration with codes to Lægehåndbogen at This means that a clinician who provided good examples of the the five regions. the website sundhed.dk. has access to a patient’s data in value of using e-records, and the local hospital system is able the number of doctors using At present, work is being done e-records forms part of the to access data from other hos- e-records here is on the rise. on various measures, including data source of the forthco- pitals in the country. In the in the form of an improved ming National Patient Index, same way, GPs who have a di- presentation of data. These im- which will create a summary The future gital employee signature will provements are expected to be of data from e-records, the also have access to all this data. completed in spring 2010. National Register of Patients, There is the foundation for a Work is also taking place to electronic medication profiles Citizens have access to record relatively rapid dissemination establish a superstructure for and laboratory data. data supplied by the hospitals in the Copenhagen Capital Re- gion, Zealand Region and the Data supplier Citizen GP surgery Hospitals hospitals in the former counties of Viborg, Aarhus, Vejle and South Jutland. From 1 All All February 2010, citizens in the

Region County regions regions Copenh. Capital Zealand Central Jutland South Denmark Viborg N.Jutland former county of North Jutland will be given access, and Funen Copenhagen Bornholm 1/10/2008 will follow suit once the Cosmic Capital Frederiksborg 1/10/2008 EPR system at OUH has sup- H:S 1/10/2008 plied record data at the start Copenhagen 1/10/2008 of 2010. Zealand Roskilde Storstrøm Security of use is at a high West Zealand level, and patients themselves South Denmark Fyn will be able to identify unauth- Ribe orised entries in the system in South Jutland 1/9/2009 sundhed.dk’s MinLog, in which Vejle 1/9/2009 all entries from GPs and hospi- Central Jutland Ringkøbing tal systems will be registered. Aarhus 1/9/2009 Viborg 1/9/2009 A major evaluation has been North Jutland North Jutland I Full access I Access soon I No access

32 e-records / Telemedicine

Telemedicine

The Board at Digital Health decided in April 2008 to initiate a programme for the increased use of telemedicine, home monitoring and self-care in connection with the implementation of the national strategy for the digitisation of the Danish Healthcare Service. Practical implementation of the programme has been delegated to MedCom.

The purpose of the telemedicine programme is to: G ensure national implementation and dissemination of advanced telemedicine solutions G advance telemedicine concepts for subsequent national dissemination G assess national telemedicine concepts in respect of their benefit potential and adaptation to the Danish infrastructure G gather and share knowledge of national and international telemedicine concepts in relation to current clinical and healthcare policy challenges in Denmark, including running a number of experience forums

Tele-interpretation Tele-ulcer treatment

Providing access to interpreters etc. The implementation project Establishing the possibility of tion saves on manpower, as using video conference equip- is financed by the ABT Fund and exchanging digital images of staff resources in the hospi- ment instead of the interpre- covers the period 2009–2012. diabetic foot ulcers by mobile tals can be freed up, and im- ter’s physical attendance at a telephone from home care proves resource usage in the patient consultation provides The project, here and now nurses in the patient’s own primary sector. The solution new opportunities for better or- home to ulcer specialists at was initially demonstrated in ganisation of interpreting servi- All five regions are actively par- the hospitals frees up staff the Region of South Den- ces in the Danish Healthcare ticipating in the project resources at hospitals and in mark, Zealand Region and System, including ensuring bet- through cooperation agree- the home care sector, while eight local authorities. ter use of interpreter resources. ments with MedCom, and are also increasing the quality of Testing was coordinated with initiating testing in spearhead ulcer treatment. a similar project in Aarhus The purpose of the project is to departments at the end of Municipality. The long-term ensure national dissemination 2009. This includes testing of The solution ensures more strategy is national dissemi- of tele-interpreting by video tele-interpretation in up to ten rapid and better coordinated nation. conference throughout the local authorities and surgeries, treatment, allowing several whole of the healthcare sector. where the concept has not yet patients to avoid complica- The spearhead project is In this way, video conferences been tested. tions and admission. The solu- financed by the ABT Fund. will be regarded as a normal tool in day-to-day clinical prac- Dissemination plan for tele-interpretation Timetable for tele-ulcer treatment tice, increasing accessibility to interpreter support services and Once spearhead departments have imple- The project is subject to the following lessening the amount of time mented tele-interpretation, the individual main timetable: spent planning the interpreta- region will plan the regional dissemination. tion session and the waiting January–March 2010: Project start-up time in the event of delays. The dissemination plan for the hospitals’ April–September 2010: Technical imple- use of tele-interpretation is as follows: mentation As part of the tele-interpretation project, the aim is to esta- December 2010: 25% of hospital October–November 2010: Organisational blish a national infrastructure departments with patient contact implementation for video conferences, one that December 2011: 75% of hospital December–January 2011: Operation can be reused in other clinical departments with patient contact situations, for example monito- February–March 2011: Evaluation ring, interdisciplinary conferen- December 2012: 90% of hospital ces, discharge conferences departments with patient contact After the spearhead project, the plan is between the secondary and pri- to initiate national dissemination. mary healthcare sector, training,

33 Projects

MedCom’s international projects

MedCom has an international project line whose main focus is on There is a wide range of activities in the department: Project telemedicine, welfare technology, infrastructure for the use of management and participation in European projects, expert telemedicine services and standardisation of electronic communi- support to both Danish and foreign partners, the drawing up of cation in the healthcare sector. The projects’ hallmark is that they new project applications, etc. meet a specific healthcare-related or social need while at the same time providing a solution to this. The results from the inter- MedCom is represented in several partnerships under European national projects can often be transferred to national projects, and international control. These activities, and participation in which thus further build on existing experiences. specific projects, have led to extensive expertise and participation in a successful network within international healthcare IT.

International telemedicine projects

The international department The most recently completed Several telemedicine solutions Healthy Growth – a project at MedCom has contributed to projects include, among that were part of these pro- where a range of telemedi- a range of projects, in which others: jects have now been dissemi- cine, welfare technology solu- telemedicine solutions have nated and are operational, tions and aids are being been tested and disseminated. Health Optimum – a project including preparation for ope- developed, including the focusing on healthcare servi- rations from the Health Opti- patient briefcase for COPD Telemedicine is about those ces and clinical cooperation mum project and the patient patients and robot technology situations where information over long distances using digi- briefcase for chronic patients rehabilitation chips for apo- and communication techno- tal images/systems and video from Better Breathing. plexy patients. logy can be used to provide a conference equipment. healthcare service digitally One of the new projects over short or long distances, Better Breathing – a project worthy of mention is: including providing support where a ‘patient briefcase’ with diagnosis, treatment, given to patients with smo- prevention, research and trai- ker’s lung (COPD) enabled

ning. Home monitoring covers them to be discharged earlier Photograph: Niels Nyholm those solutions where the from hospital. The patient telemedicine service is sup- briefcase allowed the health- plied to the patient in their care professionals to monitor own home. the patient's condition and carry out consultations over Experience and commitment shorter or longer distances. have enabled the international team to contribute to buil- R-Bay – a project where radio- ding up an extensive portfolio logical assignments and expert of telemedicine solutions. knowledge are offered across European national borders.

34 International projects

International welfare technology projects

Welfare technology is user- DREAMING project, which oriented technology, especial- covers home monitoring of ly for elderly people and/or elderly people with chronic ill- persons with chronic illnesses nesses in Langeland Municipa- Photograph: Geir Haukursson or disabilities. The technology lity and the PERSONA project, makes it possible to deliver which tests advanced welfare welfare services in a new way technology services in Odense that can both increase security Municipality. and guarantee mobility and day-to-day tasks. The aids may Challenges be sensors, fall alarms or robot technology such as robot Telemedicine and welfare vacuum cleaners, etc. In this technology are more than just way, welfare technology at a technological solution and the same time can contribute there are therefore certain to more efficient public or challenges involved. The ob- private service production. stacles includes organisational challenges, among others The aim of welfare technology those due to new clinical pro- is for the cold technology to cesses in the delivery of new provide more resources to the treatment options. warm hands of the social sector. On the one hand, the The culture, too, especially in technology will help to im- international projects, is a fac- prove working conditions and tor which needs to be conside- free up time for staff in the red in telemedicine and wel- service professions and, on the fare technology solutions, as other, improve the quality of training, nationality, social technological solutions to be The future public sector welfare services network, etc., affect access to tested, from telemedicine and at the same time as providing new technology. There are standardisation to welfare economic improvements in also the legal aspects, in which The international projects will technology. The projects will the area. patient rights, responsibility continue to be conducted as a be targeted at some of the and the granting of licences close collaboration between specific challenges facing the MedCom is already involved in are the key words. regions or local authorities, healthcare and social sector in various welfare technology and will therefore remain the coming years, and it is to projects. These include the close to the local and/or natio- be hoped that the interna- nal measures taking place tional projects can be involved elsewhere in MedCom. in resolving these. Evaluation opportunities with telemedicine From 2010, there will be 12 Among other things, welfare Resolution of the many challenges and accompanying new international projects in technology is an area which aspects of telemedicine is being attempted, among other MedCom. Many of these have the international projects in places, in the Metho-Telemed EU project, in which MedCom the status of pilot projects, MedCom will focus on in the is a partner. which with EU funds will future. allow new, wide-reaching The Metho-TeleMed project gathers knowledge and skills from international academic expertise, European networks and the WHO in order to develop guidelines for the metho- dologies used in investigating telemedicine solutions in Europe. The main purpose of the project is to propose me- thodologies for the examination of telemedicine solutions for use in academic trials and policy decisions. The method devised in MethoTeleMed will be tested, among other places, in the forthcoming EU project, RENEWING HEALTH.

35 Technology, key figures, names

Toolkit names figures, key Technology,

Communication standards Approved standards Testing and certification Health Data Network (SDN) Video node

Statistics

MedCom – the Danish Health Data Network MedCom projects – dissemination as a percentage Number of messages, September 2009 Laboratory requests and referrals per month Providers with EDI, September 2009 Correspondence, pharmacies GP and specialists’ systems, all doctors Correspondence messages, all-to-all, September 2009 Development at local authority level Health Data Network’s node e-records

Names

Steering Group Primary Group Infrastructure Group MedCom

Back cover

Total number of messages per month

36 Toolkit

Toolkit

MedCom provides a range of different services to the healthcare sector. As well as project organisation and management, this includes:

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

Communication standards

Since 1994, MedCom has devised a wide range of standards for data exchange between parties in the healthcare sector. Today, there are over 60 different standards, which for the most part are based on international UN-EDIFACT standards. Once they have been adapted to Danish conditions they are available in both an OIO-XML version and an EDIFACT version. They all follow the national OIO standardisation rules. tion required for developing and implementing the relevant messages, along with a reference to a number of test examples. All new standards are based on OIO-XML. In future, no EDIFACT versions will be developed. An XML standard

To support the national strategy based on SOA, Service-Oriented The document ‘Good XML letters’ contains an XML translation of Architecture, a number of web service standards have been devel- the EDI documentation for the protocol for standardising data in oped, all of which support DGWS (the Good Web Service) and the public sector, OIO. DDB (the Dynamic Form). The PLO-XML format Maintenance and further development of DGWS and DDB is handled by SDSD, Digital Health. The PLO format is used to exchange records between GP and specialists’ systems. The suppliers of GP and specialists’ systems have Good EDI and XML letters entered into an agreement for the joint use of this. A new version based on OIO-XML is under development by MedCom and is ex- The document ‘Good EDI letters’ provides a detailed description pected to be ready in 2010. of MedCom’s EDIFACT standards, which have gone through quality assurance and a technical review with the aim of improving EDI communication in the healthcare sector. All the standards will be subject to modernisation and updating in 2009 and 2010, thus consolidating all the corrections and good ideas of the past ten years.

Under each message type you will find the complete documenta-

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

37 Toolkit

Approved standards

Letter type EDIFACT XML Letter type EDIFACT XML

Discharge letter DIS01 XDIS01 Trigger message PID01 Outpatients discharge letter DIS02 XDIS02 Personal master data message PID02 Casualty discharge letter DIS03 XDIS03 Patient master data message PID03 Radiology report DIS05 XDIS05 Allergies and adverse reactions On-call GP service summary DIS06 XDIS06 message PID04 Specialist discharge letter DIS07 XDIS07 Continuing state of health PID05 Appointment confirmation DIS13 XDIS13 Physiotherapy discharge letter DIS08 XDIS08 Prescription PRE01 XPRE01 Letters of correspondence DIS91 XDIS91 System prescription renewal PRE60 XPRE60

Hospital referral REF01 XREF01 Negative VANS acknowledgement CTL01 XCTL01 X-ray referral REF02 XREF02 Negative acknowledgement CTL02 XCTL02 Specialist referral REF06 XREF06 Positive acknowledgement CTL03 XCTL03

Laboratory results RPT01 XRPT01 Physiotherapy referral REF07 XREF07 Pathology results RPT04 XRPT04 Cervical cytology results RPT03 XRPT03 Podiatry referral REF08 Microbiology results RPT02 XRPT02 Binary document transmission BIN01 XBIN01 Laboratory request REQ01 XREQ01 Pathology request REQ03 XREQ03 Psychology referral REF10 XREF10 Psychology discharge letter DIS10 XDIS10 Laboratory repertoire of analyses DAO01 XDAO01 Administrative correspondence DIS90 XDIS90 GP billing RUC01 Specialist billing RUC02 The Dynamic Form Dentist billing RUC03 Request for status certificate LÆ121 Physiotherapy billing RUC04 Status certificate LÆ125 Pharmacy billing RUC05 Request for general health certificate LÆ141 Chiropractor billing RUC06 General health certificate LÆ145 Laboratory billing RUC07 Request for specific health certificate LÆ131 On-call GP billing RUC08 Specific health certificate LÆ135 Nationwide billing RUC09 Request for certificate confirming ability to Psychologist billing RUC10 take on work LÆ251 Podiatry billing RUC11 Certificate confirming ability to take on work LÆ255 Request for certificate confirming chronic illness LÆ221 Admission notification DIS20 XDIS20 Certificate confirming chronic illness LÆ225 Admission reply DIS14 XDIS14 Request for certificate confirming illness in Discharge notification DIS17 XDIS17 connection with pregnancy LÆ231 Admission report DIS16 XDIS16 Certificate confirming illness in connection Discharge report DIS18 XDIS18 with pregnancy LÆ235 Notification of discharge DIS19 XDIS19 Nursing care plan DIS21 XDIS21 Rehabilitation plan DGOP XDGOP Home care status DIS95

Web Services Notification of birth DIS32 The Good CPR Consultation Access The Good Adverse Reactions Report The Good Child Database Report Laboratory access, sundhed.dk The Good Patobank Web Service The Good Request Database

38 Toolkit

Testing and certification MedCom offers

EDI/XML test, hotline and support centre G Testing When using MedCom messages and web services to communi- G Assistance with investigation into issues of doubt cate, it is vitally important that both the sender and recipient use G Help to suppliers and users in solving EDI/XML communi- MedCom’s standards and that the syntax and content are exactly cation problems identical. If this is not the case, errors or a misunderstanding will G Information and guidelines to new suppliers and new arise when the message is received. technicians G EDI/XML courses To guarantee this consistency, it used to be necessary to test the G Maintenance of tables standards in local pilot projects, for each provider in turn, and then gradually adapt the systems. Testing and Support can be contacted at: [email protected] or by telephone on +45 6543 2030 on all working days. This process was particularly time- and resource-consuming for all the parties involved. However, the introduction of the Good EDI letters, the Good XML letters and the Good Web Services guides marks an attempt to make the documentation of standards so sary standardisation process for the sender and recipient systems accurate that it would basically be possible to carry out the neces- during testing before commissioning.

MedCom offers testing and certification of all systems that need Testing and approval to communicate in the healthcare sector, as well as help in implementing the MedCom standards and support in solving EDI/XML Testing and approval is supported by: communication problems.

G Online testing tools for all MedCom’s EDIFACTs and XML Approved systems standards. G Online access to testing and documentation tools in the Systems approved by MedCom are published at www.medcom.dk form of the SDSD validator of web service solutions. under the menu item ‘MedCom – godkendte systemer’ (‘MedCom G Appropriate test examples for each individual standard. – approved systems’). G Test scripts reflecting the tests which a system must undergo to obtain MedCom approval. G Summaries of which systems and versions are approved for current messages. G Support/hotline from MedCom on all working days.

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

1. Syntax check in MedCom performs checks, perform check yourself. Does it comply with recommendations/ does it work? 2. Semantics check, screen dump, examples. Input/create test examples. Is all the content present? Is it displayed in the correct context? Is data being retrieved correctly? 3. User interface, on-site. Is it logical? Is data being retrieved correctly? Run through the test script. Good advice, guidelines on layout. 4. Live test, on-site. Process production data. Run through test script using this data. 5. Publication of approved system on MedCom’s website.

39 Toolkit

sundhed.dk Health Data Network’s node VDX

DNS Healthcare Router Router Region Agency Copenhagen Capital

The Danish Medicines Region Agency Zealand

Internet Fixed (Encrypted Region Form server connections VPN) South (KI) Denmark

e-records Region (CSC) Central Jutland

Region NIP North Jutland

Pharmacy GP and speci- Private Foreign Local KPLL KMD network alists’ system hospital cooperation authorities partners

Specialist Chiropractor Local GP surgery surgery surgery authorities

Health Data Network (SDN) The SDN comprises a single central node which all the traffic pas- ses through between the various agencies. This node is monitored The Health Data Network (SDN) can offer the entire healthcare 24/7 and is redundant. To connect to the SDN, users need to esta- sector new opportunities for communication in matters of health- blish an encrypted VPN (Virtual Private Network) connection via care. The SDN can be used, for example, to establish web service the Internet or a permanent connection from their own secure communication, consult external databases, exchange images and network to the SDN’s node. hold video conferences. There is also the fact that the common public eHealth portal sundhed.dk uses the SDN as a channel for Migrating from message-based to online communication in the connecting to the basic systems in the healthcare sector. healthcare sector will, by its very nature, impose major, ever- growing demands on the capacity, stability, speed and central This allows the SDN to supplement the VANS-based Health Data monitoring capability of the entire Health Data Network (SDN). Network, which offers the option of using EDIFACT for communi- This means that a radical upgrade will be required of the current cating text messages. Health Data Network.

The philosophy behind the SDN is that the parties in the health- The practical possibilities here are being dealt with in a new con- care sector will have all their communication needs met via the tract for the operation and further development of the SDN; this single same network connection. This makes the network the will run in the period 2010–2015, with the option of extending electronic collection point for communication in the healthcare for up to a further two years. The contract takes into account: system, regardless of whether the users belong to the public or private sector. G enhancement of the SDN node (basic service) G central responsibility for SDN connections to the node (option) G prioritisation of SDN traffic/quality of service (option)

40 Toolkit

Video node VDX will also include the option to allow more than two parties to take part in a video conference at the same time, MCU. Prima- In November 2009, MedCom established VDX, a national node for rily, VDX will communicate with local video conferencing gate- video conferences in the healthcare sector. The solution is based ways through the Health Data Network (SDP) via IP, but it will on the standard products already available in this field. also include gateway functionality to the Internet in general, with the option of expanding to the 3G mobile network and ISDN if VDX has been set up in order to be able to reuse to the greatest there is a demand for this. As far as the user is concerned, it will extent possible local video communication solutions, irrespective be possible to use standard video conferencing equipment that of the platform on which they are established. VDX will primarily supports standard video conferencing protocols, such as H.323 or support the H.323 and SIP video standards, with the option of ex- SIP. panding to cover other video conferencing protocols. VDX will coordinate the application of a common addressing and numbering The users will, therefore, have a free rein when purchasing video system (URI, ENUM, GDS) and will make a common address book conferencing equipment, provided they adhere to the usual stan- available via H.350. dards. This also makes the best possible use of video conferencing equipment already purchased.

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

41 Statistics

MedCom – The Danish Health Data Network

Number of messages per month

1,500,000

Prescriptions 1,400,000

1,300,000

Discharge

1,200,000

1,100,000

Lab results 1,000,000

900,000

800,000

700,000

600,000 Lab requests

500,000

400,000

300,000

Referrals 200,000

100,000

Billing

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

42 Statistics

MedCom projects – dissemination as a percentage

Position at 31 October 2009 North Jutland Region Central Jutland Region Region of Southern Denmark Zealand Region Copenhagen Capital Region KPLL SSI Unilabs

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

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

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

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

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

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

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

25 Doctors’ prescriptions 100 90 90 90 75 17 On-call doctors’ prescriptions 100 100 100 100 100

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

Dissemination > 50% Project started Not started

43 Statistics

Number of messages, September 2009

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

% No. Region Discharge Referral Lab results Lab req. GP billing Prescrip- tion Local authorities

99.22 1 South Denmark98 98 99 95 99 97 100 98.53 2 Central Jutland 97 72 99 95 90 94 65 97.54 3 North Jutland 98 83 99 90 99 100 65 92.79 4 Zealand 94 70 99 98 99 84 70 73.80 5 Copenh. Capital 75 43 99 98 99 63 81 99.00 A KPLL – – 99 98 100 – – 56.46 B SSI – – 59 10 100 – – 77.39 C Unilabs – – 80 0 100 – –

Total92739996968876

Number of messages sent from hospitals

% No. Region Discharge letter Outpatients disch. letter Casualty discharge letter Radiology report Biochemistry results Microbiology results Pathology results Correspond. sent Prescriptions Appointment confirmation Referrals forwarded Forwarded X-ray referrals local To authorities

99.22 1 South Denmark 31087 136856 18476 36354 210509 38431 21443 19185 5135 52433 2751 4345 46459 98.53 2 Central Jutland 31924 95938 16203 24045 210582 21951 12028 472 7804 17813 326 2 31048 94.81 3 North Jutland 10643 42502 5651 11908 140551 10844 5383 980 133 16895 0 0 21807 90.74 4 Zealand 17193 55099 9698 13313 96382 8766 7410 167 10553 15835 231 0 25966 79.49 5 Copenh. Capital 55806 43979 29579 8794 72279 40761 20744 211 20789 4229 1516 1 64291 99.00 A KPLL – – – – 153988 – – 0 – – – – 56.46 B SSI – – – – 9931 20526 – – – – – – 60.00 C Unilabs – – – – 7159 – – – – – – –

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

Number of messages sent by GPs

% No. Region GP letters Correspon- dence Lab test requests Microbiol. requests Pathology requests Referrals to hospital X-ray referrals Billing BIN document Prescrip- tions

99.22 1 South Denmark 1039 11635 95170 21493 14370 26468 14884 1197 5240 327471 98.53 2 Central Jutland 2397 6743 87068 18661 12612 20918 8679 1560 5079 317460 97.54 3 North Jutland 1449 6087 31500 7181 3916 10482 6706 837 3150 170486 92.79 4 Zealand 1399 3005 57.023 7829 6928 10.853 8494 1230 3286 191513 73.80 5 Copenh. Capital 2669 6564 37267 32269 19976 15653 5267 2852 7928 273315 99.00 A KPLL – – 73662 – – – – 4 – – 56.46 B SSI – – 6430 0 – – – 16 – – 77.39 C Unilabs – – 0 – – – – 16 – –

Total 8953 34034 388120 87433 57802 84374 44030 7712 24683 1280245

44 Statistics

Number of messages, September 2009

Number of messages sent by specialists

% No. Region Ref. from REFHOST Discharge summaries Correspon- dence Lab test requests Microbiol. requests Pathology requests Hospital referrals X-ray referrals Billing BIN document Prescrip- tions

99.22 1 South Denmark 19575 29816 11915 438 3616 1987 159 107 5031 98.53 2 Central Jutland 19266 23560 1754 47 2440 597 167 78 7580 97.54 3 North Jutland 8333 10152 605 1274 453 53 1 2396 92.79 4 Zealand 18110 20808 1399 98 1429 776 133 22 5207 73.80 5 Copenh. Capital 65200 63705 2173 88 4393 1434 527 24 14499 99.00 A KPLL – – – – – – – – – 56.46 B SSI – – – – – – – – 77.39 C Unilabs – – – – – – – – –

Total 130484 148041 17846 671 13152 5247 1039 232 34713

Messages to/from On-call doctors Pharmacies Dentists

% No. Region Discharge letter Hospital referrals X-ray referrals Prescrip- tions Billing Correspon- dence Dose dispensing Local authority prescript. renewals Billing

99.22 1 South Denmark 84705 2097 102 10818 1085 403 5016 10820 170 98.53 2 Central Jutland 46830 184 158 9785 1264 52 9041 3691 160 97.54 3 North Jutland 24162 3 726 5549 556 132 3181 4491 80 92.79 4 Zealand 32475 364 15 7783 877 76 4572 1061 119 73.80 5 Copenh. Capital 57946 250 0 16480 1702 133 9232 2862 1367 99.00 A KPLL – – – – – – 56.46 B SSI – – – – – – 77.39 C Unilabs – – – – – –

Total 246118 2998 1001 50415 5484 796 31042 22925 1896

Messages to/from Physiotherapists Chiropractors Psychologists Local auth.

% No. Region Discharge letter Referral received Billing Correspon- dence Correspon- dence Discharge letter X-ray referral Billing Discharge letter Referral received Billing Correspon- dence To hospitals

99.22 1 South Denmark 1789 6614 284 191 237 0 20 26 217 616 33 217 5743 98.53 2 Central Jutland 2439 7533 348 74 93 0 14 36 190 449 37 325 3010 97.54 3 North Jutland 1130 3871 121 48 20 0 0 4 102 374 7 122 3389 92.79 4 Zealand 854 5481 156 98 72 0 19 12 195 563 23 238 2938 73.80 5 Copenh. Capital 1710 11276 271 60 121 0 0 353 290 1408 582 429 12338 99.00 A KPLL – – – – – – 56.46 B SSI – – – – – – 77.39 C Unilabs – – – – – –

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

45 Statistics

Laboratory requests per month and referrals per month

Number per month 600,000 Laboratory requests per month 550,000

500,000

450,000

400,000

350,000

300,000

250,000

200,000 Referrals per month 150,000

100,000

50,000

0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Providers with EDI, September 2009

100 90 80 70 60 50 40 30 20 10 0 North Jutland Central Jutland South Denmark Zealand Copenhagen Capital

I Percentage of GPs I Percentage of part-time specialists I Percentage of chiropractors I Percentage of full-time specialists I Percentage of physiotherapists I Percentage of psychologists

46 Statistics

Correspondence, GP and specia- pharmacies lists’systems, all doctors

Correspondence message DIS91 11 12 13 10 5,500 Messages per month 9 1 from pharmacies 5,000 8

4,500 7

4,000 6 3,500

2 3,000 5

2,500 4 2,000 3 1,500 I I Messages per 1. MedWin 653 10. Docbase 103 month to pharmacies I 2. Æskulap 615 I 11. MultiMed 94 1,000 I 3. Novax 489 I 12. MyClinic 46 I 4. PLC 210 I 13. Total others 19 500 I 5. Emar 207 Dan-Med-soft 2 I 6. Darwin 205 Patina 7 I 7. Ganglion 151 I Medol 1 Mths. 3579111357911 I 8. PC-Praksis 140 Formatex 1 Year 2008 2009 I 9. MediCare 109 Other 8

Correspondence messages, all-to-all, September 2009

Sender Recipient Pharmacy Physio- therapist Local authority General practitioner Specialist practitioner Psychologist Hospital Main total

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

Total 4734 802 29530 53306 6091 102 17613 112178

47 Statistics

Development at local authority level

200,000 Home care to surgery communication 2007–2009. 180,000 Number of messages per year.

160,000 I Correspondence to GPs I 140,000 Correspondence from GPs I Prescription renewal 120,000

100,000

80,000

60,000

40,000

20,000

0 2007 2008 2009

100,000 Home care-hospital communication 2007–2009. 90,000 Number of messages per year.

80,000 I Correspondence from hospitals I 70,000 Correspondence to hospitals I Admission report 60,000

50,000

40,000

30,000

20,000

10,000

0 2007 2008 2009

25,000 Home care-pharmacy communication 2007–2009. Number of messages per year.

20,000 I Correspondence from pharmacy I Correspondence to pharmacy

15,000

10,000

5,000

0 2007 2008 2009

48 Statistics

Health Data Network’s node

Bn.12 Traffic volume via the Health Data Network’s (SDN) 11 node in billions of kbytes per quarter 2006–2009. 10 A list of those connected to the network is available 09 at: www.medcom.dk/wm110045 08 07 Detailed statistics about the SDN’s usage are available at: www.medcom.dk/wm110451 06 05 04 03 02 01

Quarter 123412341234123 Year 2006 2007 2008 2009 e-records

30,000 Number of consultations I Hospital consultations per quarter Number of patients 6,000,000 I Citizen consultations per quarter

5,500,000 Number of records in database Unique persons in database 25,000 5,000,000

4,500,000

20,000 4,000,000

3,500,000

15,000 3,000,000

2,500,000

10,000 2,000,000

1,500,000

5,000 1,000,000

500,000

Quarter 123412341 2 3 4 1 2 3 4 123412341 2 3 4 1 2 3 4 1231 2 3

Year 200505 200606 200707 200808 200909

49 Names

Title Name Organisation

Head of Department Vagn Nielsen Ministry of Health and Prevention Chief of Section Mogens Køllner Ministry of Health and Prevention Director Otto Larsen Digital Health Chief of Section Peter Kjærsgaard Pedersen Local Government Denmark Development Manager Sven-Åge Westphalen National Board of Social Services Chief Consultant Maria Antonsen Ministry of Finance

Chief of Section Lisbeth Nielsen Danish Regions Group IT Director Jan Kold Copenhagen Capital Region Hospital Adm. Director, OUH Jane Kraglund Region of Southern Denmark Steering Chief of Section Mogens Engsig-Karup Central Jutland Region IT Development Manager Henrik Bruun Danish Pharmaceutical Association Director Morten Elbæk Petersen sundhed.dk Doctor Jens Parker Lægehuset Director Henrik Bjerregaard Jensen MedCom

IT Consultant Karin Hedegaard North Jutland Region Information Officer Claus Bendtsen North Jutland Region Vice Director Ole Filip Hansen Central Jutland Region Consultant Thomas Koldkur Bitsch Central Jutland Region Deputy Chief of Section Tove Lehrmann Region of Southern Denmark Product Manager Morten Hansen Region of Southern Denmark IT Consultant Lene Paulin Thomsen Region of Southern Denmark IT Special Consultant Jens Henning Rasmussen Zealand Region Special Consultant Peter Jan Pedersen Copenhagen Capital Region Special Consultant Annette Lyneborg Nielsen Copenhagen Capital Region Special Consultant Mette Harbo Copenhagen Capital Region IT Group Manager Kirsten Skovrup Aalborg Municipality Special Consultant Hanne Linnemann Aarhus Municipality Consultant Dorthe Juul Andersen Odense Municipality IT Specialist Søren Skafte Jensen Lolland Municipality

Project Manager Merete Halkjær Copenhagen Municipality Primary Group Consultant Physician Steen Hoffmann Statens Serum Institut IT Manager Niels Hornum KPLL Section Manager Karin Rokvist Unilabs Chief of Section Jørgen Nørskov Nielsen Central Jutland Region Delivery Manager Jeppe Højholt Nielsen CSC Scandihealth A/S Business Development Manager Ole Lauridsen Systematic Software Engineering A/S System Planner Michael Johansen Logica Danmark A/S Team Manager Anne-Mette Oudrup CSC Scandihealth A/S Director Freddy Christensen Profdoc Head Technical Consultant Niels Heikel Vinther KMD Key Account Manager Tine Guldbæk PROGRATOR | gatetrade Consultant Charlotte Meyer Henius Local Government Denmark Doctor Jens Parker Lægehuset Anaesthetics Specialist Jens Nørreslet Vejle Anaesthesia and Pain Clinic IT Development Manager Henrik Bruun Danish Pharmaceutical Association Project Team Member Jens Rastrup Andersen sundhed.dk Administration Manager Martin Bagger Brandt Danish Regions Project Manager Ivan Lund Pedersen Digital Health Secretary Benthe Dahl National Board of Health Project Manager Lene Asholm National Board of Health Academic Executive Claus Bo Jørgensen Danish Medicines Agency Data Consultant Anfinn Leivsson Hansen Zealand Region Director Henrik Bjerregaard Jensen MedCom Deputy Manager Ib Johansen MedCom Chief Consultant Lars Hulbæk MedCom Chief Consultant Christina E. Wanscher MedCom Consultants Jens Rahbek Nørgaard MedCom Dorthe Skou Lassen MedCom Rikke Viggers MedCom Karin Demkjær MedCom Secretary Iben Søgaard MedCom Project Team Member Gitte Henriksen MedCom

50 Names

Title Name Organisation

Network Administrator Jan Mørkholt Pedersen North Jutland Region Operations Manager Erling Wad Sørensen Central Jutland Region – RM-IT Network Specialist Peter Vej Nørgaard Central Jutland Region IT Consultant John Berthelsen Region of Southern Denmark System Consultant Jan Stokkebro Hansen Copenhagen Capital Region IT Architect Anders Skovbo Christensen Copenhagen Capital Region IT Special Consultant Søren Bonde-Andersen Copenhagen Municipality IT Architect Esben Poulsen Graven Digital Health Consultant Charlotte Meyer Henius Local Government Denmark Consultant Martin Thor Hansen Danish Regions IT Development Manager Henrik Bruun Danish Pharmaceutical Association IT Service Manager Steen Hernig Danish Medicines Agency Operations Coordinator Jakob Uffelmann sundhed.dk Steen K. Christensen KMD A/S Service Delivery Manager Bente Jensen KMD A/S Key Account Manager Tine Guldbæk PROGRATOR | gatetrade Marketing Manager Claus Roost-Ørsnæs EG Data Inform MedWin Director Freddy Christensen Profdoc Director Erik Jacobsen Datagruppen Vejle MultiMed ApS Technical Architect Lars Haugaard CSC Scandihealth A/S Division Director Martin Bech UNI-C Chief Consultant Ib Lucht UNI-C Infrastructure Group Infrastructure Chief Consultant Lars Hulbæk MedCom Consultant Peder Illum MedCom Secretary Iben Søgaard MedCom

Director Henrik Bjerregaard Jensen Deputy Manager Ib Johansen Chief Consultants Lars Hulbæk Christina E. Wanscher Consultants Jens Rahbek Nørgaard Peder Illum Karin Demkjær Dorthe Skou Lassen Rikke Viggers

Kate Kusk MedCom Anne Danborg Susanne Noesgaard Lone Høiberg Stina Lou Sørensen Jane Clemensen Jacob Glasdam Janne Rasmussen Signe Dyrehauge Niels Rossing Margit Rasmussen Lone Staun Poulsen Charlotte Beck Project Team Member Gitte Henriksen Project Secretary Mie Matthiesen Project Assistant Jennie Søderberg Finance Specialist Anita Folleraas Secretaries Iben Søgaard Pia Reinhardt Juel Student Assistants Sille Annette Larsen Casper Marcussen Mette Atipei Craggs Assistants Alis Jørgensen Diana Lund Andersen

51 Status report, MedCom 6

The columns show the total number of messages per month.

5,500,000

5,000,000

4,500,000

4,000,000

3,500,000

3,000,000

2,500,000

2,000,000

1,500,000

1,000,000

500,000

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

MedCom Rugårdsvej 15, 2.sal DK-5000 Odense C, Denmark Telephone no.: +45 6543 2030 Fax no.: +45 6543 2050 www.medcom.dk

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