Medcom IV Medcom V

MedCom IV MedCom V

Standardisation 16 Standardisation The XML-EPR standards 16 EDI-XML conversion 16 Existing EDI/PLO format 17 Names 29 The primary group 29 group 29 infrastructure MedCom’s MedComs local-authority group 30 SUP steering group 30 MedCom’s Mini-IRSK- MedCom’s project leader group 30 Danish Centre for 31 staff Health Telematics, The SUP project 11 The SUP project Mini-IRSK 13 why! 13 Mini-IRSK – that’s Before – After 14–15

Yes

Now

Yes

Æskula

epikrise

Yes letter

Æskulap

Udv ej Udv

epikrise

Disk. ervice letter ervice

Æskulap Disk.

Yes

iallægeepikrise

ialist letter ialist

Korrespondancebrev

Fysioterapiepikrise

Correspondence message Correspondence

teledermatology Bookingsvar Physiotherapy letter Physiotherapy

teledermatology Speciallægeepikrise WebReq WebReq

Booking result Booking – teledermatologi –

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r. 2.30 + bj. + 2.30 r.

vikles ikke vikles vningsepikrise destueepikrise

æger Ja Ja Ja Ja Ja Ja

ulantepikrise lleddiagnostisk epikrise lleddiagnostisk

lists

The local-authority 3 projects Advice communication 3 of completion of treatment 3 Correspondence message and warning Medical practice – home care 4 LÆ forms 5 levant

ette

rge letter rge atient letter atient Specialist letter Specialist

Lægevagtsepikrise Minicall Mini kald Mini elevant – teledermatologi –

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On-call GP service letter service GP On-call mage diagnostics letter diagnostics mage MedCom V (2006-2007) 19 MedCom V (2006-2007) services and Service-Oriented Architecture 19 Web MedCom V and the structural reform 19 Local-authority projects 20 Cooperation with Sundhed.dk 21 The SUP/WEB-EPR project 21 The medicines project 22 Consolidation – standards and Healthcare Data Network 23 MedCom IV projects 32

Doctors’ systems – who can do what? 25 What can the counties do now? 26 Local-authority suppliers – who can do what? 27 Local authorities-hospital communication 27 Internet strategy 28 SUP statistics 28 Statistics 25 The Internet strategy 6 The infrastructure project 6 lookup of clinical biochemistry Web laboratory results at Sundhed.dk 6 X-ray lookup 7 7 Teledermatology The telemedicine cooperation platform: The Collaboration server 8 9 Videoconferencing – requesting of WebReq laboratory tests 9 Aims of MedCom 2 Aims of MedCom group 2 The MedCom steering Introduction: MedCom V takes over 2 V takes over MedCom Introduction: MedCom – the Danish Healthcare Data Network / December 2005 / MC-S204 2005 / December Network Data Healthcare Danish the – MedCom

– how it turned out MedCom IV 2 MedCom IV-V

MedCom V takes over

Over the last 13 years electronic to the local authorities will sub- communication has been making stantiate this trend. The MedCom inroads in the Danish healthcare The weighting of good con- steering group sector. From a small beginning tact with patients is not just a with the exchange of prescrip- matter of geographical proximity MedCom’s steering group is tions between general practice but also of openness, where the the top-level body in Med- and pharmacies, communication patients have easy and quick Com cooperation and con- has gradually been expanded in access to all relevant information sists of the parties who both content and volume. Today about their own treatment. finance MedCom, together with selected observers. Denmark is one of the countries All these development trends to have gone furthest in this area. endow electronic communication ● Vagn Nielsen, Ministry of Several million messages are with a very central role, as an in- the Interior and Health exchanged every single month dispensable aid in the everyday (Chairman) between all the parties concerned work of the health service. There ● Leif Vestergaard Pedersen, in the primary and secondary is strong evidence for this in the Århus County (Deputy healthcare sectors. many measures taken during the Chairman) It should be noted that elec- MedCom IV period. In all their ● Lars Hagerup, Association tronic communication has never diversity, they speak their clear of County Councils ● been an end in itself, but solely a languages about greater dissemi- Anders Kristian Jørgensen, PROGRATOR means of boosting quality, effi- nation, more actors, new forms ● Arne Kverneland, National ciency and service. of communication. A common Board of Health The Healthcare Data Net- feature of the projects is increas- ● Niels Mortensen, Funen work has been introduced and ed use of the new opportunities County expanded in a healthcare sector presented by the Internet-based ● Flemming Engstrøm, undergoing dynamic develop- Healthcare Data Network. The Copenhagen Local ment, characterised in particular close interaction with the new Authority by a high degree of specialisa- aids, such as the electronic ● Claus Nielsen, National tion, but also by a need for and patient record and Sundhed.dk, Association of Local willingness to preserve a decen- is also characteristic of the cur- Authorities ● tralised structure in the health- rent development of the Health- Sven-Åge Westphalen, National Board of Social care sector with significant proxi- care Data Network. Services mity to patients. The structural MedCom V takes over where ● Sten Christophersen, reform with the transfer of a MedCom IV left off – not essen- H:S Informatik whole series of healthcare tasks tially different in nature, but a ● Gitte Hansen, Ministry of natural continuation of the work Finance carried out over the years and at ● Henrik Bruun, Danish Aims of MedCom. MedCom the same time innovative in rela- Pharmaceutical Association aims to contribute to the tion to the utility electronic com- ● Morten Rosted Vang, development, testing, disse- munication will provide for the Ministry of the Interior and Health mination and quality assuran- healthcare sector of the future. ● Morten Elbæk Petersen, ce of electronic communica- This brochure first describes Sundhed.dk tion and information in the the status of the projects in the ● Jens Parker, Organisation healthcare sector with a view MedCom IV period (2002– of General Practitioners to supporting coherent treat- 2005). The principal features of ● Henrik Bjerregaard ment, nursing and care. tasks for the next two years in Jensen, MedCom MedComV are then outlined.

Published in December 2005 by MedCom, Rugårdsvej 15, 2., 5000 Odense C. Editor: Lars Hulbæk, MedCom. Text: arki•tekst kommunikation. Layout: Christen Tofte Grafisk Tegnestue. Printed by: one2one. Print run: 1000. ISBN: 87-90839-97-8 The local-authority projects 3

Local-authority projects

92 local authorities were connec- Both technical and organisatio- Advice ted to the Healthcare Data Net- nal processes have to be arranged communication work, and advice communica- and coordinated. This work is tion covers 44% of the Danish continuing at hospitals, local population. All the counties, the authorities and suppliers. The advice communication Copenhagen Hospital Corpora- comprises a simple automated tion and the Bornholm Regional orientation between a hospital Municipality have activities rela- Correspondence and local authority on whether a ting to electronic hospital-local message and citizen is admitted or discharged. authority communication in co- If the citizen receives home-care operation with a constantly ris- warning of services, the local authority addi- ing number of local authorities. completion of tionally supplies contact infor- There is a high level of inter- mation to the hospital depart- est in advice communication. treatment ment in the admission result. The local authorities see benefits Advice thus comprises advice of in advice of admission/discharge. There is strong national interest admission, admission result and However, there is a need for con- in establishing electronic com- advice of discharge. tinuous optimisation of auto- munication between the local At the end of October 2005, mated advice communication. authorities and the partners they

★ Local authority connected to the Healthcare Data Network ■ Spearhead county: All municipalities on the way ■ All local authorities connected ■ County taking part in the local-authority project The diagram shows those local authorities and counties that have implemented advice communication. The counties of Frederiksborg, Funen and Storstrøm have been spearhead counties in the Hospital-Local Authority XML projects. These counties have had a target of attaining 80–100% local-authority connection in advice communication. 4 MedCom IV

cooperate with in the healthcare Care systems in Denmark broken down by sector. In particular, there is a number of local authorities. November 2005 widespread wish to exchange data on care, training and medi- M-Care (2) cation. Two messages – the corre- Lyngsø (11) Rambøll Care (72) spondence message and electronic version of the warning of KMD Omsorg (15) completion of treatment – were pilot-tested and pilot-implemented in the MedCom IV project period. VITAE (39) The pilot implementation of the correspondence message, at the end of 2005, covers hospi- Uniq Omsorg (77) tals, local authorities, pharmacies and general practitioners. The correspondence message is free- dissemination. dence standard. Some hospitals text-based, and can be used for Pilot testing of the correspon- are working in the same way by the exchange of data between the dence message and warning of sending a discharge report and parties until it becomes possible completion of treatment has rehabilitation plan via the corre- to exchange structured data. In been concluded. Several ECR spondence message. addition, the correspondence suppliers have adapted or are in There is thus a solid founda- message can serve as a bridge- the process of adapting the corre- tion for the dissemination of the builder between the electronic spondence message, so that the correspondence message in specialist systems, which vary local authorities can send data 2006–2007, as this form of widely in terms of content, data relating to an admission report message may meet a communica- structure, technical structure and to the hospitals in the correspon- tion need in conjunction with the structural reform. At the same time, MedCom is monitoring development in the EPR and ECR systems, as there may prove to be a need for implementation of the “Admission and Discharge Report” standards in these systems. Warning of completion of treatment can only be disseminated to a limited extent. Only a few hospitals have chosen to implement the message in their PAS systems. When the hospitals have implemented the notes module of the electronic patient record, greater dissemination may become appropriate. Med- Com is currently gathering experience of the warning message.

Svendborg Local Authority uses the correspondence message to send admission reports to hospital personnel. The admission report is automatically generated in the local authority’s ECR system and contains contact data and information on care, training and medication. The local-authority projects 5

Medical practice – home care

The lighthouse project “Electro- nic information exchange in the healthcare sector” comprised Aalborg Hospital, home care in Aalborg Local Authority and four medical centres. Initial experience with regard to electronic communication between home care and medical practice has been gathered through this project. The correspondence message, prescription renewal and home- OIO (Public Information care status standards were used in LÆ forms Online) is involved in the work the lighthouse project. in order to contribute skills rela- Several local authorities in ting to web services and security various counties have subse- The project relating to LÆ forms policy. The web service area is quently established electronic is intended to ease the written relatively untried in relation to communication between home communication between the the problems associated with care and medical practice, by local authorities and general form integration. Kommune- using the correspondence practitioners and between the information and suppliers of message and prescription renewal local authorities and specialists doctors’ systems have also pro- messages. both in hospitals and in private vided active input. Use of the correspondence practice. The strategy is to draw up a message between general practice LÆ forms are used in many specific proposal for the “good and home care is being rapidly areas in municipal administra- web service” as a foundation for implemented, as the correspon- tion, for instance in connection communication in the area of dence message at the outset is with early-retirement pension web service. The expectation is technically possible in many GP and sickness benefit. Electronic that it will be possible to use this practices. The message is used for versions of the forms are a natu- foundation on many different the exchange of information on ral part of doctors’ practice web services, for instance LÆ examinations, test results, infor- systems, but at present the forms forms. mation on medication and en- are sent on paper. A supplementary area of quiries. The procedure in using LÆ effort is the issuing of an integra- Local-authority statistics show forms comprises two steps. A tion recipe book for the “Dyna- that three times as many corre- request is first sent from the local mic Form” with a description of spondence messages are sent authority requesting completion XML data content and struc- from general practice to home of a certificate. The application tured data capture. The concept care as from home care to gene- can be sent to a GP or to a spe- is to make it possible to broaden ral practice. cialist in private practice. The the same web service to new Some local authorities and latter then sends the relevant form areas. some medical practices have the information back to the local The LÆ project itself will be option of using the electronic authority on a certificate. The implemented on the basis of the standard for prescription renewal LÆ form project makes it possi- results of this work. rather than using fax or phone. ble to carry out this communication electronically. 6 MedCom IV

Internet strategy

cation arises. local authorities, pharmacies and The Infrastructure The Network supplements private laboratories as well as IT project the already extensive EDIFACT suppliers to these parties are communication in the Danish approved in advance for VPN healthcare sector with other connection to the Healthcare A nationwide Internet-based forms of communication, inclu- Data Network’s node. When network has been established ding secure access to looking up they join the network, they enter through the project which the in external IT systems, exchang- into a cooperation agreement parties in the health service can ing images and setting up video- with MedCom. They can then use for secure communication. conferencing. The public Danish freely use the network for This Healthcare Data Network is eHealth Portal, Sundhed.dk uses exchange of information in the designed to link the existing the network to establish secure healthcare sector. secure intranets in counties, local connection between the portal authorities and other organisa- and the basic systems in the tions. As a result, the parties in healthcare sector. Web lookup the healthcare sector avoid hav- Counties/CHC, public and of clinical ing to establish new secure links private hospitals, practitioners every time a need for communi- under the national health service, biochemistry laboratory results at Sundhed.dk Institutions with VPN connection to the Healthcare Data Network’s node. When a patient is admitted to November 2005 the hospital or is undergoing Government Local authorities Other parties treatment with a specialist, it is institutions ● Herning Local ● Apoteksnettet often appropriate for the doctor ● Ministry of the Authority ● BeKTtra, to have access to the results of Interior and Health ● Copenhagen Local Patient transport the laboratory tests the patient ● Danish Medicines Authority ● Carelink, Sweden Agency ● Lyngby-Taarbæk Local (Västmanland) has previously undergone. This ● National Board of Authority ● Diako Flensburg means that the patient receives Health ● Odense Local ● East Tallinn Central better treatment and avoids re- Authority Hospital peated tests. At the same time Counties etc. ● Research Unit for both time and money are saved. ● Bornholm Regional IT suppliers General Medicine, Municipality ● A-data SDU Using MedCom’s Internet- ● Århus County ● Datagruppen ● Franziskus-Hospital, based Healthcare Data Network, ● Frederiksborg County Multimed Kiel it is possible to obtain access to ● Funen County ● Docbase (via external) ● Varde Heart Centre clinical biochemistry laboratory ● Copenhagen Hospital ● Emar (via external) ● Copenhagen General Corporation ● Ganglion/Servers. Practitioners’ data at the public Danish ● Copenhagen County Online Laboratory eHealth Portal, Sundhed.dk. All ● North Jutland County ● KMD net ● Norwegian Health doctors who have a digital signa- ● Ribe County ● MedWin/ Net ture has access to a particular ● Ringkjøbing County EG datainform ● Hamlet Private ● Roskilde County ● Novax/NordTeam Hospital patient’s laboratory data. For this ● Storstrøm County ● NovoNet ● Rehab Varde (Falck) to be possible, all clinical bio- ● South Jutland County ● PC-Idé (via external) ● Steno Diabetes chemistry laboratories have to be ● Vejle County ● Profdoc/Darwin/ Center connected to the solution. Med- ● West Zealand County Medicare ● Sundhed.dk Com, in cooperation with Sund- ● Viborg County ● PROGRATOR ● Vilnius University ● Team Online/Bosted Hospital hed.dk, has entered into agree- ● Æskulap/Ascott ments on joining with almost all the counties. From the end of Internet strategy 7

At Sundhed.dk, doctors with digital signature can gain access to clinical biochemistry laboratory data.

PACS or RIS servers to the Internet-based Healthcare Data Network during the project period and in more or less defined pilot projects have made the information available to partners outside their own organisations. The information has been available using web lookup via the closed Healthcare Data Network. Provisional experience sug- gests that X-ray lookup solutions are particularly useful for cases between the hospital service and February 2006, all doctors in access to central patient informa- private clinics and for teaching Denmark will therefore be able to tion, which is stored in another purposes in general medical prac- obtain an overview of all the tests county or in the hospital’s own tice. Urgent need for exchange of performed on every patient at RIS (Radiography Information X-ray information between hos- virtually all the laboratories in the System) or PACS (Picture Archi- pitals is based instead on actual country, just by keying in the ve Communication System), teleradiology transfer of X-rays, patient’s civil registration number. including in conjunction with in several places via the Health- urgent admissions, treatment of care Data Network. These counties are involved: free-choice patients or in the pre- paration of treatment of a new X-ray lookup, Number of patient. The healthcare professio- PACS/RIS (servers) agreements nal can obtain the information quickly via Web lookup, so that Frederiksborg County (PACS) 6 the patient’s treatment is effective Bornholm Regional Municipality (RIS/PACS) 5 and of the highest quality. Frederiksborg County (RIS) 4 Web lookup also makes it Funen Hospital, Ærø (PACS) 4 possible to establish different Odense University Hospital (PACS) 3 telemedicine services, such as Ribe County (PACS) 2 Aabenraa (PACS) – test 1 asking an expert for a second West Zealand Hospital opinion. As the shortage of (RIS/PACS) – test 1 experts in the area of radiology Odense University Hospital (RIS) 1 clinics increases, this type of Total 27 telemedicine solutions will steadily gain ground, perhaps in Connected X-ray systems as of Web lookup of clinical cooperation between the hospital November 2005. The number of biochemistry laboratory results. service and specialists in private agreements refers to IP agreements practice or private radiology with external parties that have access clinics. via the Healthcare Data Network. X-ray lookup Finally the lookup solution will be useful for GPs when they have to inform patients about Teledermatology The aim of the “lookup of X- their illness and treatment, as X- rays and descriptions via the rays can encourage dialogue with Internet” project has been to give the patient. Teledermatology is based on the healthcare professionals direct Seven counties have linked sending of digital images of skin 8 MedCom IV

conditions, as a supplement to dations on practical condi- ● Pilot projects. Eight counties the traditional cooperation and tions in connection with and Copenhagen Hospital patterns of patient referral cooperation between general Corporation have had teleder- between medical practice and medical practice and dermato- matology activity on a varying specialists in dermatology. logy specialists have been scale over the project period. drawn up, including the con- In several places the project The overall aims of the teleder- tent of patient referrals and has been based on local Sec- matology project have been to: discharge letters in telederma- tion 2 and Section 3 agree- tology cooperation. The ments between the local na- ● Replace/supplement general recommendations are drawn tional health service unit and referrals to skin specialists up in cooperation with the practitioners on fees to be paid with telemedicine consulta- Danish College of General for general practice and specia- tions. Practitioners and the Danish list dermatology practice. ● Assure patients of equal and Society of Dermatology and quick access to specialist Venereology. ● The MedBin standard. Digi- assessments of skin images tal images of skin conditions through their own doctor. ● Digital photography course. have to date been sent in the ● Support continuing training In cooperation with Niels Vei- vast majority of cases by ordi- of GPs through communica- en, an Aalborg-based derma- nary e-mail, with anonymised tion with skin specialists. tology specialist, MedCom image material attachments, ● Establish nation-wide provi- has issued the instruction cd while the patient referrals are sion for telemedicine skin “How to take a good skin sent as EDI. This procedure image consultation. photograph in two minutes”, entails a number of manual with practical advice on procedures at both the sender The following activities have photographic technique and and the recipient. been carried out in the project patient setups for photo- The intention is for image period: graphy during the consulta- exchange in future to be done tion. This material has pro- using MedBin standards, ● Healthcare recommenda- vided the basis for several where the sender’s record tions. Healthcare recommen- photography courses for GPs. system automatically links the image material to the patient referral, and the recipient’s record system automatically stores images and referral to- Viborg County Copenhagen gether in the patient’s record. 17 GP practices County Århus County 2 specialist practices 12 GP practices All significant suppliers of 10 GP 1 hospital record systems for specialist practices Ringkjøbing County department 1 specialist dermatology practice and by 20 GP practices practice far the majority of suppliers of 4 specialist practices CHC record systems to general prac- 1 GP practice Ribe County 1 hospital tice now support the MedBin 6 GP practices department standard for use in telederma- 1 specialist practice + Greenland tology cooperation.

Roskilde County 1 hospital department The telemedicine Funen County + Faroe Islands 5 GP practices cooperation plat- 2 specialist practices West Zealand County form: The Colla- 1 hospital department 8 GP practices 1 specialist practice boration server Eight counties and CHC (Copenhagen Hospital Corporation) have carried out teledermatology activities in MedCom IV. The project for the establishment Internet strategy 9

of a secure and cheap telemedici- in Funen County, Kiel, South ● Technical consolidation of the ne Collaboration server is based Jutland County and two hospi- possibility of videoconferen- on solutions developed in two tals in Flensburg, as well as Kiel cing via the Healthcare Data international projects, PICNIC University Hospital. Network. and ciTTis. ● Construction of a list of The overall aim of the project Hospital-Local Authority com- numbers for videoconferen- was to make the telemedicine co- munication. The project was to cing at the healthcare portal, operation platform, the Collabo- try out the Collaboration server Sundhed.dk ration server, available to all par- for communication between ● Gathering and passing-on of ties in the Danish health service. home care and hospitals. The experience relating to video- In addition, the project was in- preliminary analyses of the trial conferencing on the Health- tended to continue the develop- have shown that the Collabora- care Data Network. ment of the Open Source com- tion server will be able to impro- ● Dissemination of clinical use ponents the solution is based on, ve the communication between of videoconferencing via the and make them available for all the parties in a number of cases. Healthcare Data Network, for IT suppliers. The Collaboration server can example between cooperating This was to be done through replace part of the communica- hospital departments, be- a number of pilot projects, tion that takes place by fax, tween the practice sector and which were to ensure the neces- phone, letter or on little yellow hospital sector and between sary clinical validation of the notes. island communities and the Collaboration server. healthcare sector on the main- Overall, there have turned out Establishment of the Collabo- land. to be far more opportunities to ration project. The develop- use the Collaboration server than ment of a cooperation platform Videoconferencing can be estab- was originally anticipated. The and cooperation agreements lished today via the Healthcare Collaboration server can be put began in 2004, while the actual Data Network, but the technical to use, regardless what IT system pilot testing took place in 2005. quality will not be satisfactory the individual organisation has, The participants involved in the for clinical use until the end of and subsequently – when the pilot project were Copenhagen 2005. Eight videoconferencing actual communication need has County, Gentofte Hospital to sites had been connected as of been determined – proper inte- Lyngby-Taarbæk and Søllerød November 2005, all of which are gration can be made. This makes Local Authorities, Hvidovre being used for test purposes. the solution very attractive for Hospital to Copenhagen Local use in connection with widely Authority, Frederiksborg County, differing projects in the Health Hillerød Hospital to Frederiks- WebReq – Service. værk and Stenløse Local Authori- requesting of The Collaboration server can ties, Funen County, Odense Uni- serve as a bridgebuilder for elec- versity Hospital to Odense Local laboratory tests tronic communication between Authority, Ringkøbing County healthcare parties that use elec- to Herning Local Authority and The purpose of the WebReq tronic systems at different levels. South Jutland County to hospi- programme is to offer general tals in Flensburg and Kiel. practitioners web-based access to In the MedCom projects the requesting laboratory tests in Collaboration server has been clinical biochemistry, clinical tested with varying degrees of Videoconferencing immunology, clinical microbiolo- success in the following areas: gy and pathology. The purpose of the videoconfe- Doctors can use WebReq to Hospital-Hospital communica- rencing project has been to pro- send an electronic request in tion. In the international project mote the use of videoconferen- MEDREQ format as a normal ciTTis, the Collaboration server cing between counties and across file to the laboratories. WebReq was tried out as an Internet- sector boundaries in the health- enables the connected doctors’ based “resource agent” in support care sector. The project compri- systems to have laboratory-speci- of specialised healthcare activity ses: fic information stored in a cen- 10 MedCom IV

tral place, so that they are free to record and maintain this information in the local doctors’ system. This provides a number of benefits:

● Easy access for doctors to set up their own profiles and their own tests. ● Provision for easy re-ordering of previous tests. ● Provision for printing out PTB (sampling forms), with barcode labels. ● Great certainty of correct sample marking. ● Same interface at the doctor regardless of laboratory. Samples are marked with locally printed barcode labels on a Sampling ● Independence in choice of Form (PTB). This is printed directly from the WebReq system, and con- laboratory and laboratory tains all the necessary information, together with the barcode labels to be system. used in the relevant taking of samples. The PTB additionally contains a ● Ease of use for all doctors’ label with address information for the laboratory to which the samples are systems without major pro- to be sent. A study shows that incorrect marking of samples is reduced from gramming effort. 18% to just 2% of all requests on changing over from paper requests to ● Provision for changes in labo- the electronic WebReq. In November 2005, 19,000 requests or 6% of all ratory systems and doctor’s laboratory requests in Denmark were on WebReq. systems without involving all users. ● Same procedure in the labora- their own homes. repertoire of the individual labo- tory for both EDI and web An SSL-encrypted broadband ratory on the WebReq server. requesting. connection is used between the The same PTB is used in all ● Cheap, no further investments doctor and the WebReq server. Danish laboratories, so that the in comparison with EDI re- The WebReq server forwards a doctors only have to hold one questing. traditional EDIFACT request to form for all laboratory tests. the laboratory. The system is constructed in All the items of information such a way that access codes and are controlled individually by the master data are automatically transferred directly from the patient side in the doctor’s record Clinical Microbiology Pathology system to a central server, where Biochemistry the WebReq program is located. The doctor orders the required tests at the selected laboratory and prints out the necessary barcode labels to mark the samples. The requests can be sent automatically to the chosen laboratory. The samples can then be taken at the doctor’s clinic, or patients can be sent to have samples taken in the laboratory or in ■ Not included ■ On way in 2006 ■ In progress in 2005 The SUP project 11

The SUP project

The purpose of the SUP project (PAS) and existing electronic is to make electronically register- patient records (EPR). ed patient data available across From the technical point of county boundaries (SUP: Stan- view, data are extracted in the dardised Extracts of Patient systems of the supplier county Data). The project is thus a look- and supplied in XML format to up project and does not cover ac- a common SUP database, which tual electronic sending of patient the participating counties run data. jointly. From here it is possible The philosophy behind the to do lookups via an Internet SUP solution is that as hospital browser in the data available for owner it is possible to make a given patient at a given time. clinical data on currently and At the beginning of the search an previously admitted patients inter-county overview is sup- available to other hospitals in the plied, showing where the patient The following counties have same county or in other coun- has available data, and the search adopted the SUP solution to date: ties. It is thus to be possible to is targeted accordingly. ■ Vejle, Viborg, Funen and Århus make the patient’s data available All data communication re- Counties joined in 2004. with a view to treatment in an- lating to SUP takes place in en- ■ South Jutland, Ribe and North other county and afterwards to crypted form on the MedCom Jutland Counties have joined have access to clinical data on Healthcare Data Network, and in 2005. the treatment carried out. lookup can proceed either via Data are supplied from existing local user control or via the joint Dissemination of SUP patient administration systems public portal Sundhed.dk As of mid-November 2005, Viborg County has supplied 100%, Vejle County 90% and Funen County approximately 40% of electronically accessible data, equivalent to around 750,000 patients or 16% of the Danish population. In October 2005, 690 SUP users have been logged on and have done lookups on 450 patients in separate procedures. It has been difficult for Med- Com to disseminate the SUP solution, as all data deliveries have been delayed. At the same time it has proved difficult to find inter-county cooperating The SUP food chain consists of clinical data from existing PAS and EPR departments which have had systems, which are made available in a common server environment. relevant data available to support Healthcare professionals can access SUP – through the Healthcare Data SUP-based cooperation. Network – via an Internet browser either via local user control or via Actual dissemination is taking lookup at Sundhed.dk. In the longer term, the Web EPR modernisation place at the end of November will additionally make it possible to access data from local authorities, GP 2005 on a large scale in Vejle practices and specialists, as well as members of the public, see page 22. County. The dominant element 12 MedCom IV

here is intra-county lookup in then be made continuously from two existing EPR systems. When the same system from Vejle and Funen data are available in a Århus Counties, which will large quantity, it will be possible provide the foundation for the for agreements already entered support of both intra- and inter- into between Vejle County and county procedures. Ribe and Funen County to be supported North Jutland Counties will not by the SUP solution. deliver until the beginning of In mid-December 2005 there 2006. will be data deliveries from The SUP project is also being Grønt System (PAS) from South broadened on a pilot basis to Jutland County. Deliveries will GPs and specialists in Vejle and Viborg Counties, so that family doctors can use and evaluate the Facts about SUP SUP solution in their daily work. ● SUP (Standardised Extracts of Patient Data) is a pragmatic solution, which on the basis of existing data can be made available with relatively few resources. ● SUP has fulfilled the wish for a complete solution for older systems and those due to be phased out shortly. ● SUP has been developed so that it can make web services available for existing and future systems. ● SUP is accessible at Sundhed.dk for healthcare professionals and can be made available here to local-authority healthcare and for use in rehabilitation and to Danish citizens using digital signature. Mini-IRSK 13

Mini-IRSK Inter-Regional Hospital Communication Project

proportion of them – to be able Mini-IRSK – in a short period of time to ex- that’s why! change a small number of heavily used messages in electronic form. Complete digitisation of the By virtue of the Mini-IRSK Pro- communication between the ject, some of the communication hospitals is an immense task at a in the hospital sector will be con- time when there is a focus on the verted from manual to electronic introduction of EPRs and adap- management. The number of tation of IT systems within the types of messages is small, but future regions. But it is impor- they are heavily used. The pur- tant at the same time to exploit pose is to create uniform and less the opportunities offered by The project comprises: time-consuming procedures information technology – parti- combined with greatly increased cularly at a time when everything ● Discharge letters between security in patient treatment. points towards more intensive hospitals. The background to Mini- cooperation between hospitals. ● Patient referrals between pub- IRSK is that electronic commu- All the counties have joined lic and private hospitals. nication over the last decade has the project, which will be exclu- ● Correspondence messages. greatly expanded in the primary sively carried out in relation to ● Clinical biochemistry labora- sector and between the primary IT systems which are in use to- tory results between laborato- sector and secondary sector, but day. This means: ries. electronic communication between hospitals is nowhere near ● PAS, Patient Administration By virtue of the project, the as widespread. The Mini-IRSK Systems. hospitals of the counties involved project is aimed at rectifying this ● Clinical Biochemistry. will be able to communicate dis- situation, and the strategy is for ● Existing EPR. charge letters and patient refer- all Danish hospitals – or a large rals to each other regardless what Timetable for expansion in 2005

April May June July August Sept. October Nov. Dec.

Cooperation agreement with the counties. Contracts with suppliers. The project organisation has been established, and an implementation plan has been drawn up.

MedCom tests communication solutions. The necessary communication modules are installed. Launch meeting with the departments involved.

Pilot departments conduct trials with the new communication. Implementation is carried out in all departments, including training of users.

Total expansion. 14 MedCom IV

system is used in the individual tion of the necessary modules. In county. Hospital departments will addition, MedCom provides Before be able to correspond with other financial grants for acquisition departments, local authorities, and implementation. MedCom A large proportion of the messa- pharmacies, general practitioners, additionally ensures the testing ges concerned in the Mini-IRSK specialists, physiotherapists, of modules, coordination of pro- project are at present communi- chiropractors and psychologists ject activities at national level cated on paper or by phone. throughout the country. Bioche- and makes implementation mistry laboratories will be able to assistance available throughout Patient referrals and exchange electronic laboratory the course of the project. discharge letters results. From 1 January 2006, Each county has established private hospitals which have an its own project organisation, Today no hospitals can send elec- agreement with the Association of appointed a project manager and tronic patient referrals, nor can County Councils will be able to drawn up an implementation they forward electronic referrals exchange the same messages. plan. The implementation inclu- to other hospitals/departments or des agreement with a supplier on private clinics. Messages of this Expansion on a installation of modules, imple- type are sent on paper. Despite large scale mentation of the pilot depart- many different IT systems, all ment and subsequent extension hospitals today can send electro- To attain the full benefits in com- to all departments. nic discharge letters to the prima- munication, it is essential that the The whole process is carried ry sector. The hospitals in the new opportunities are seized in all out in close cooperation between individual counties cannot receive counties and that a large-scale MedCom and counties through- electronic referrals, but they will dissemination takes place over a out the country. gain this capability under the short period. To prepare the way It is possible to track the pro- Mini-IRSK project. for the project, MedCom has gress of the project at national entered into an agreement with level and in each individual Correspondence the system suppliers on acquisi- county on the MedCom website. message The correspondence message can only be used for relatively few Messages in Mini-IRSK hospitals, and it is used to a very Mini-IRSK focuses on communication between hospitals across limited extent. regions and specifically on four types of messages – patient See facts box on page 15. referrals, discharge letters, correspondence messages and biochemistry laboratory results. By virtue of Mini-IRSK, the Biochemistry results hospitals and private clinics will be able to: All biochemistry departments at ● Set up, receive and send clinical hospital referrals. present forward rare or infrequent ● Forward patient referrals to all other departments, hospitals, samples for analysis in service clinics. laboratories or the laboratories of ● Send and receive discharge letters after admission or out- other counties. The results of patient treatment. these tests are received in the vast ● Store discharge letters electronically with a view to later majority of cases on paper, and searching. they are not included either in ● Exchange the correspondence message with the whole health- the generally used cumulative re- care sector. sults or in the electronic records. ● Receive clinical biochemistry laboratory results from other The department which receives biochemistry departments directly into their own laboratory the laboratory result therefore has system, so that they are included in cumulative results. to subsequently transfer the result These messages at present make up 10% of all inter-county manually to an electronic system communication or more than one million documents a year. or to the paper record. Mini-IRSK 15

After

Patient referrals

The project covers clinical patient referrals to departments that use these in communication with the primary sector. When a hospital department receives a referral, most counties send a booking result in return as acknowledgement. At the same time a referral result goes to the patient’s doctor. One of the clear benefits of the electronic referral is that it is automatically stored in the system. It never disappears. Data from a patient referral sent electronically can be automatically transferred to the waiting list. X-ray referrals are not included in the project. Discharge letters

The project covers discharge letters after admission and outpatient The correspondence treatment in clinical departments. X-ray and Accident and Emergency message in brief letters are not included. By far the majority of hospital departments send out electronic discharge letters to the primary sector. The new The correspondence message aspect will be that discharge letters can be sent between hospital de- opens up the possibility of partments when a department refers a patient for treatment in another secure and lawful electronic department. In departments that use EPRs, the fact that the discharge communication of informa- letter is integrated into the electronic record will be a clear benefit. tion related to the individual patient. The information con- Correspondence message cerned is additional to the standardised contact in the Correspondence messages makes possible secure communication on form of discharge letters, patient-sensitive information, information over and beyond the patient referrals etc. The cor- formalised contact in the form of patient referrals, discharge letters etc. respondence message may, Use of the correspondence messages thus requires fewer resources. for example, be concerned The correspondence message can work right down to the level of with follow-up or questions individual wards and 24 hours a day. See the box on the right. relating to the individual patient’s treatment. In the Biochemistry results case of emergency admissions, it may for example in- Biochemistry laboratories send laboratory results electronically to the volve queries from a hospital primary sector. The communication of laboratory results between department to a GP’s practice laboratories takes place on paper, however. Under Mini-IRSK, the on medication, investigation results will automatically enter the laboratory’s computer system. The or treatment in progress, so- results are then automatically included in the cumulative paper replies cial circumstances etc. It may or directly in the electronic replies which the laboratories send to their also be a matter of gathering users. supplementary information in the case of patient referrals, information to the patient, which is to be forwarded from general practice. The correspondence message thus replaces many time-consuming phone calls and exchanges of letters. 16 MedCom IV

Standardisation

XML standards were developed. However, a start was made on The XML-EPR They were all adjusted so that use of the XML standards during standards they can contain future GEPJ the course of 2005, and they are (Basic Structure for Patient now being used in a large num- Records) elements. ber of contexts: An extensive project began in the MedCom’s XML standards MedCom IV period involving the have been developed in accor- ● The WebReq project, which is development of XML standards dance with the OIO concept based on MedCom’s labora- for future hospital communica- (Public Information Online), tory standards. tion. The aim behind the project and have been posted on the ● Lookup of laboratory results was to ensure cohesion in daily MedCom website and on the via Sundhed.dk routine communication between health service’s XML server: ● Ambulance records. the clinical diagnosis departments www.sundcom.dk. This is the ● Local-authority care records. and the departments providing website for the healthcare sector’s ● Diabetes records. treatment in the hospitals. XML domain committee. ● Together with a number of In this project, all the Med- The project was probably other applications, including Com EDI standards were devel- ahead of its time, and no coun- in the LÆ form project, oped in an XML version in ties implemented specific pro- which is under development. accordance with agreements on jects using the XML standards. healthcare-related content and The project was therefore halted A new feature being developed with technical review for all rele- and replaced by the Mini-IRSK by MedCom is a national web vant suppliers. A total of 36 project. service standard for general application in the healthcare SOAP Request sector based on these XML standards. Development of the web service standard, MedComWS, will be completed at the end of 2005, and it is planned to be implemented in a number of pilot projects in 2006. Client WS system provider any EDI-XML Webservice conversion Client server system SOAP Response (FrontEnd) MedCom tests and approves Under- computer systems in the health- lying care sector for the reception and dispatch of EDIFACT and XML documents as well as XML Web- Service solutions. any Testing was done previously by the individual supplier sending in files to MedCom, which tested them using an internal test tool. This process was time-con- The MedCom Webservice standard, which is under development, uses suming and demanding, and a MedCom’s XML standards with XXX as “function call”. test tool the suppliers can use Standardisation 17

free of charge directly on the Internet has therefore now been developed. This offers a number of advantages, for instance that the suppliers themselves can per- form tests continuously in the development process. The test tool can try out EDIFACT and XML in accordance with MedCom standards. All the XML messages comply with current OIO standards and can be found on OIL.dk (Public Information Online). All the documentation of the new XML standards is built into the test tool and can be downloaded from here. This unique solution works so effectively that it is has been copied in Norway. To support the work of the IT suppliers on XML EDIFACT conversion, The suppliers can also use the MedCom has developed a web-based converter, available via www.med- tool to test conversion from com.dk or directly at the address http://web.health-telematics.dk/xmledi EDIFACT to XML and vice- versa. tion has risen by 25% since unknown in any other country. Using what are known as 2003, so that more than 3.0 mil- Electronic patient referrals for stylesheets, the suppliers can lion EDI documents are now hospital treatment and to specia- additionally see in the test tool sent every month. This is equiva- lists have not yet been used on a how a particular message can be lent to more than one document massive scale, nor has the use of presented in a record system. a second being sent throughout laboratory requests, webreq, so the year. far become particularly wide- Ninety-seven per cent of spread. Existing general practitioners now use In the local-authority area, EDI/PLO format EDI, and almost all hospitals are the number of local authorities now able to send electronic X- that exchange EDI with the ray results and hospital discharge hospitals has risen from 12 to 92 The volume of EDI communica- letters. This is unique coverage during the course of the Med-

Site numbers MedCom status Percentage of possible messages

■ Doctors site numbers ■ Full-time specialists ■ Doctors site no. ● Prescription ̃ Discharge ̆ Lab result ■ Part-time specialists ൻൺBill Patient referral ■ Lab. req. ● Local authorities 18 MedCom IV

Com IV period. Efforts must General practitioners. 1 November 2005 continue to be made to persuade the remaining local authorities to join. ■ Have comp. syst. A number of new actors have ■ Have EDI made a start on electronic communication over the last few years. Agreements have been entered into with specialists, physiotherapists, dentists, chiropractors, psychologists and private hospitals on mandatory use of EDI communication. All the actors are to make a start within the next year on using computerised systems EDI communication which are able for instance to send correspondence messages, Spread Number % on EDI All on EDI by discharge letters, patient referrals and bills. The expectation is that General practice 2140 97 1.1.05 all the most common paper Specialists full-time 583 74 1.1.07 Specialists part-time 132 53 1.7.07 streams at the end of 2007 will Physiotherapists 348 63 1.1.06 have been replaced by integrated Chiropractors 117 52 1.7.06 EDI solutions. Dentists 680 50 1.1.06 Psychologists 44 7 1.1.06

The PLO format Pharmacies 331 100 Local authorities 271 44 When there is a change of doctor Hospitals 64 100 or a doctor ceases practising, there is a need to move record Electronic 3.1 million messages per month. communication total 80% of all communication in the primary healthcare information from the present sector. doctor’s computer system to the new doctor’s computer system. The ‘PLO format’, which all Doctors’ systems in Denmark broken down by suppliers of doctors’ systems have number of providers. October 2005 adopted and use, has been developed for this purpose. MedCom tests and approves the doctors’ systems with regard to compliance of the format and form of transport. The existing EDIFACT solutions using the MEDBIN standard are employed in the transfer of the records in PLO format. Today record information can be exchanged between 14 different record systems. MedCom V 19

MedCom V (2006-2007)

Proposal for envelope ties. There is a need for Med- Web services and Com to assist towards meet- Service-Oriented Web services are already to a ing the communication needs large extent accepted for com- that contribute to creating Architecture munication in the healthcare optimum patient progression sector. However, the term web across the sectors. This applies services is defined very broadly for instance to the area of re- On the basis of a “White Paper and is used differently in diffe- habilitation, where responsibi- on IT Architecture” and a rent projects. MedCom has lity in future will to a greater “Manual for Architecture in e- therefore appointed a group of extent rest with the local Government”, the Ministry of suppliers who have been com- authorities, as well as in the Science, Technology and Innova- missioned to draw up a proposal establishment of healthcare tion (MVTU) is working on the for a common standard interface centres in the local authori- development of reference models – a common envelope – in the ties. for the various architectural ele- use of web services in the Danish MedCom’s focus on stan- ments described in the manual. healthcare sector. dardised exchange of informa- One of the priority areas is The “good web service” enve- tion between local authorities the formulation of operational lope is to ensure that suppliers and hospitals or GP practices instructions for a Service-Orien- can implement web services is thus updated by the struc- ted Architecture (SOA). The more quickly in the IT solutions tural reform. OIO Web service Architecture offered to the healthcare sector. models (Public Information On- The envelope makes it possible ● Secondly the counties have to line) provide instructions on how for instance for doctors’ systems look at how best to create to integrate service components to communicate web services in coherence between the IT based on the web service stan- a completely different way with systems to be used in the new dards. different central providers of web regions from January 2007. In cooperation with the Mini- services, for example with This is a major task for the stry of Science, Technology and Sundhed.dk, the National Board hospital owners, who have to Innovation (MVTU) and suppli- of Health and Kommuneinfor- both create coherence in the ers of IT systems to the health- mation. transverse communication of care sector, among others, Med- patient data and at the same Com has drawn up a proposal time think ahead and intro- for the “Good Web Service” for MedCom V and duce electronic patient use in the healthcare sector. The the structural records based on GEPJ. proposal is based on a service- It is logical in this situation oriented IT architecture, and the reform to utilise MedCom’s existing recommendation is for this and tried-and-tested standards architecture to be common to MedCom V will be carried out for the exchange of record the public sector. in a period in which the health- contents and nation-wide The purpose of the Good care sector is implementing the lookup solutions via the Inter- Web Service is to support com- structural reform. The reform net-based Healthcare Data munication between different thus sets new limits in terms of Network and Sundhed.dk parties in the healthcare sector – organisation and tasks which are (SUP – Standardised Extract regardless what IT products and of significance for the prioritisa- of Patient Data – as well as IT systems the parties concerned tion of MedCom V’s activities: laboratory and X-ray lookup). use. ● Firstly a number of areas of ● Thirdly there will be pressure healthcare pass from the on the resources of major counties to the local authori- parts of the IT organisations 20 MedCom V

The good correspondence message can be number of pilot local authorities used for secure patient-attributable clinical have implemented a project for Mobile Homecare. These initia- communication tives contribute to preparing the area of the elderly for the use of Internet technology with web service according to the principles of SOA. As a result of the structural reform, MedCom’s efforts in the area should be strengthened, for instance in relation to local-authority tasks in rehabilitation and the establishment of healthcare centres. From the local-authority side, there is emphasis on the need for a change-over to new technology in the area in the form of OIO XML Web services (Public Information Online), SOA, data brokers and telemedicine to the home. The choice of technology should be coordinated in future local-authority projects. There will probably be a need for a transition period, in which the The correspondence message is distinguished by being relevant to commu- existing EDIFACT technology is nication between many of the healthcare sector parties. used, at the same time as XML- based Web services are developed and implemented. of the regions and local The following possible speci- authorities in the period Local-authority fic projects may be mentioned: during which the structural projects reform is being implemented. ● Continued expansion of exis- It may therefore be appropria- ting standards in hospital- te to create greater flexibility Local-authority projects cover local authority communica- in implementation of the communication between hospi- tion. MedCom V projects than has tals and local authorities and ● Start-up and expansion of been the case in previous between GP practices and local local authority-GP practice MedCom projects. authorities. In addition, there is communication. MedCom provides regular provision for electronic commu- ● Development of standard for advice and testing of EDI- nication with the pharmacies. rehabilitation plan. FACT, XML, web services Work is being done in the ● Healthcare centre: survey of and web lookup solutions on existing local-authority-hospital communication needs. the Healthcare Data Network, project on EDIFACT and XML ● Development of standards for as regions, local authorities based messages. The use of XML electronic billing between and other healthcare actors can be regarded as one of the local authority and hospitals. become ready. first steps towards working accor- ● Joint medication project; inte- ding to the principles of Service- gration of home care. Oriented Architecture (SOA). ● Expansion of LÆ form com- At the same time, the suppli- munication with OIO XML ers of ECRs together with a and SOA technology. MedCom V 21

link from record systems, Sundhed.dk lookup solutions and requesting systems to the laboratory The public Danish eHealth Portal, Sundhed.dk will provide a way guidelines located at Sund- for doctors to discuss the treatment of patients electronically. At hed.dk. the same time, patients will have an opportunity to keep track of their records from home. ● Three-in-one communica- All information on patients’ course of treatment has to be tion with citizens. available – but only for the patients themselves and personnel who Tree modules – appointment are responsible for the treatment. booking, date book and se- The parties behind Sundhed.dk are the Association of County cure e-mail communication – Councils, the Ministry of the Interior and Health, Copenhagen can provide the patient with a Hospital Corporation, Copenhagen Local Authority, Frederiksberg direct and integrated commu- Local Authority and the Danish Pharmaceutical Association. The nication interface in dialogue National Association of Local Authorities has observer status. on a case.

● Telemedicine at Sundhed.dk It is a common challenge to The objective in the context Cooperation with ensure adoption and financing of telemedicine is to utilise a Sundhed.dk by counties, local authorities and number of existing functiona- other parties in relation to the lities and data at Sundhed.dk. specific joint projects. In addi- In addition, the infrastructure Since Sundhed.dk was launched tion, many relevant project surrounding Sundhed.dk and at the end of 2003, MedCom has opportunities can be seized on in the underlying Healthcare increasingly cooperated with this connection with MedCom, for Data Network will be able to organisation, both in general and example: support telemedicine coopera- in connection with specific pro- tion, for example in the area jects. The efforts of the two orga- ● Laboratory lookup via of radiography. nisations to a large extent supple- Sundhed.dk and the Health- ment and complement one an- care Data Network. other, and it is natural for the The purpose is to give doctors The SUP/WEB-EPR cooperation to become closer. access to test results from project Current activities relate, for laboratories in the specialities example, to access for doctors to of biochemistry, microbiology laboratory results and to SUP and pathology, using digital In its latest annual report, dated (Standardised Extracts of Patient signature at Sundhed.dk. October 2005, the EPR Obser- Data). In both cases relevant data vatory has judged that SUP/ will be available directly via ● Laboratory guidelines and WEB-EPR (Standardised Ex- Sundhed,dk, access to which the link portal. tracts of Patient Data) faces a otherwise has necessitated a sepa- Establishment of automatic number of challenges over the rate VPN connection to the next few years, when the method Healthcare Data Network. is to be moved from a pilot stage The way in which the work is to an operational environment. distributed in essence is that In many cases, MedCom or the Sundhed.dk deals with display counties have launched initia- and user administration, and tives to respond to the challeng- MedCom deals with standards, es, for instance with respect to web services, implementation performance (presentation of and expansion, while a third data) and stability. party – for example a county or SUP data were initially on a local authority – is in charge of single database server. This has development in its own applica- caused problems related to per- tion. formance, and an inappropriate 22 MedCom V

backup method for the solution technical modernisation of SUP that closer integration is created has been established at the same to what is referred to as a WEB- between the SUP databases and time. In order to improve per- EPR solution should be carried Sundhed.dk. The WEB-EPR formance, data are being divided out. In the modernisation, the may consequently become iden- between several database servers counties – over and beyond the tical to the technical solution in the autumn of 2005. Searches communication between the established for the clinics’ access across the counties result in high hospitals – can provide access to to Medicinprofilen. server loading, and it has there- EPR data for members of the It appears that the formation fore been decided that inter- public, GPs, specialists and the of regions will benefit from a county searches should by de- local authorities’ home care. This WEB-EPR solution, as the new fault be restricted to the most solution means that data are regions will be able to achieve recent cases. This loading will made available via Sundhed.dk increased specialisation of treat- obviously rise when more coun- using digital signature. ment to take place at fewer hos- ties start to supply data. The newly established SUP pitals with a subsequent need for access for healthcare professionals greater communication across Modernisation of SUP is additionally to be improved so systems and old county boundaries. The Association of County In conjunction with mergers Councils has proposed that a due to the local-authority reform, some PAS and EPR systems will have to be phased out. Old data from these systems Awards can be stored in the SUP database, and access to them will be On behalf of MedCom, possible via the WEB-EPR solu- Henrik Bjerregaard Jensen tion. received the EU “Honourable WEB-EPR can additionally Mention” award from Euro- support a growing need for ex- pean Commissioner Byrne and change across sectors. The solu- European Commissioner Lika- tion can provide general practi- nen in 2003. In 2004, Med- tioners and specialists with access Com and Sundhed.dk was to lookup in the hospitals’ EPRs awarded the prestigious EU and can open up new opportuni- “eHealth Award” for the best ties for communication with the proposal for the eHealth ser- local-authority sector. For exam- vice of the future in Europe. ple, the transfer of the area of rehabilitation to the local authorities will necessitate new communication between the hospitals and local authorities. Finally WEB-EPR can make record information available to members of the public with digital signature.

The medicines project

There have been regular contacts in recent years between the Danish Medicines Agency and MedCom V 23

MedCom, primarily on prescrip- It is proposed that the content of development of code tables, sta- tions communication and testing the individual projects and their tistics and other forms of docu- of this communication. Two organisational position should be mentation etc. meetings have been held in the clarified in cooperation between At the same time there are autumn of 2005 on functions the Danish Medicines Agency, requirements for constant techni- and common interest with a the National Board of Health cal modernisation. This is the view to the establishment of the and MedCom. It is therefore case, for example, as a result of prescription server and data proposed that: the recommendations contained communication with Medicin- in the Ministry of Science, Tech- profilen. Here MedCom can ● The projects be described by nology and Innovation White contribute great experience in the parties referred to above Paper on change-over to a com- the development of standards in the first quarter of 2006. mon service-oriented IT and the dissemination of com- The parties may, according to architecture for the public sector. munication solutions. need, bring in other interested Against this background, A large number of ideas and parties in the area of medica- there are proposals to establish a options have been discussed, but tion. project area which is to focus on it is difficult to come up with ● The project descriptions be continuous consolidation, con- specific suggestions for coopera- submitted to the MedCom tinued expansion of the commu- tion and development projects, steering group in April/May nication and constant technical as a number of activities relating 2006. modernisation. to the prescription server have ● The projects be implemented already been started and establi- in the remaining MedCom V Relevant activities that can be shed. period. mentioned are: Among the projects proposed, ● Projects relating to prescrip- MedCom and the Danish Medi- tion renewal and information ● Ad-hoc dissemination pro- cines Agency have, however, on medicines also be clarified jects in selected areas of the agreed that cooperation can be between the parties and primary sector. established on proposals 1, 2 and submitted to the MedCom The Mini-IRSK project is 3: steering group in April/May completed. The aim is for all 2006. departments in all hospitals to 1. Implementation projects for be included by 1 April 2006. the transfer of medication A dissemination project is information between the Consolidation – established with regard to hospitals’ medicines systems standards and patient referrals. and PEM. Efforts will continue to be 2. Connection of the Danish Healthcare Data made to extend WebReq to all Medicines Agency’s prescrip- Network counties. tion server to the Healthcare Electronic requesting from Data Network. lab system to service lab 3. Information activity relating MedCom’s standards and the under the development and to use of the Danish Medici- Healthcare Data Network are implementation of individual nes Agency’s interactions data- used in daily operation by nearly modules for the sending of base. 3,000 GP practices, hospitals, requests for these “samples” to 4. Continued development of pharmacies, local authorities etc., service laboratories. prescription renewal standard and by all IT suppliers in the from care systems and doc- healthcare sector. ● Documentation, mainte- tors’ systems. As a result of this wide distri- nance and enhancement of 5. Standard development in con- bution, MedCom constantly MedCom standards. nection with transfer of infor- receives patient referrals relating The XML standards are com- mation on medicines, inclu- to use of the standards, testing, pleted and implemented in ding information on discon- further expansion, connection to suitable pilot projects. New tinuation between medicines the Healthcare Data Network, ones are developed for exam- database and doctors’ systems. certification of suppliers and ple in the area of medicines, 24 MedCom V

the local-authority area and care Data Network for secure for the linking of various transfer of data between their point-of-care equipment to own local network and Sund- EPRs. hed.dk. The connection is The EDIFACT standards established via the Healthcare are maintained and moderni- Data Network’s system of sed with new fields. Supple- agreements. Broad use of digi- mentation with individual tal employee certificates in the new standards. Web service healthcare sector is addition- standards are developed and ally to ensure that user access tested in pilot projects in the can be employed for all look- laboratory area. ups in external data.

Topics for other development In connection with the coope- projects may be: ration agreements with the linked institutions, MedCom – Consolidation of the use of work is the network of the faces a number of tasks in the IUPAC codes. whole healthcare sector and period 2006–2007: – Development of standards therefore a logical place to and web services for nation- establish local projects and – Renewal of cooperation wide common bloodbank solutions in relation to elec- agreements with all associated systems. tronic communication and parties, including in connec- – Use of MEDBIN for tele- information in the healthcare tion with the formation of dermatology should be speed- sector. The moment the VPN regions. ed up. connection to the healthcare – Revision of the financing – Standards for a new patient network is set up, local net- model in connection with any referral host for specialist work administrators can freely activation of further options referrals and physiotherapy connect relevant services to in the operating contract, fol- referrals. the network via the Health- lowing a specific decision by – New standards in the area care Data Network’s system of the MedCom steering group. of billing. agreements. The connection – Support in connection with – Projects relating to standar- of new services is described in new organisations joining. disation in the ECG area with the system of agreements. – Analysis work relating to the establishment of common The public Danish eHealth the correlation between the standards and development of Portal, Sundhed.dk, is con- Healthcare Data Network and ECG viewer as Open Source nected to the Healthcare Data the future RegionsNet, in co- and application free of charge. Network. The vision behind operation with the five future – Booking projects with SMS Sundhed.dk is to create a regions. alert. common entry point for look- – Continued strengthening of up in patient data for both the cooperation with Sund- ● Testing and certification of members of the public and hed.dk on use of the Health- suppliers. healthcare professionals. The care Data Network. Test tools are enhanced and plan is therefore for it to be – Test function in relation to documented. In this connec- possible with time for all newly connected servers on tion, more effort will be put lookups in external healthcare the Healthcare Data Network. into greater self-service in data to be performed at Sund- testing. hed.dk, which retrieves data ● Automation and enhance- in the basic systems in the ment of the operational ● Administration, as well as healthcare sector via the statistics. technical and security Healthcare Data Network. Monthly usage statistics and enhancement of the Health- Organisations wishing to overview of connected solu- care Data Network. make data available via Sund- tions and their contents. The Healthcare Data Net- hed.dk thus use the Health- Statistics 25

Statistics

Doctors’ systems – who can do what?

Overview of doctors’ All doctors’ systems undergo November 2005, are highlighted testing for each of the MedCom in green in the chart below. systems capable of standards relevant to a GP prac- Doctors’ systems that are not sending/receiving tice. The types of messages for approved are marked in red on MedCom’s Good EDI which the doctors’ system in the messages concerned. Letters question is approved as of 1

KanCan detdo athos IkkeNot relevantrelevant alleall EDI EDI-læger doctors Disk. DisketteDisc KanCannot ikke do Udv ej UdviklesNot developed ikke meddelelsenmessage MiniK MiniMinicall kald WebR WebReq Æskulap WebReq Æskulap Win Æskulap spec. Nowax Win PC.Praxis PLC Win PLC MedWin MultiMed Medicare Darwin EMAR EMAR WIN Docbase Ganglion My Clinic WINEDI Patina

GrantTilskudsberettiget entitlement tilfor speciallæger specialists Yes JaYes JaYes JaYes JaYes JaYes JaYes JaYes JaYes JaYes JaYes JaYes JaYes JaYes JaYes Ja NejNo Yes Ja Send MedBin ver. 2.30 + bj. Disk. Disk.

PLO Recip.Modt. MedBin ver. 2.30 + bj. Disk. Disk. Send MedBin – teledermatologyteledermatologi Udv ej Udv ej

BIN Recip.Modt. MedBin – teledermatologyteledermatologi Udv ej Udv ej Modt.Recip. UdskrivningsepikriseDischarge letter AmbulantepikriseOutpatient letter SkadestueepikriseCasualty letter BilleddiagnostiskImage diagnostics letter epikrise LægevagtsepikriseOn-call GP service letter SpeciallægeepikriseSpecialist letter BookingsvarBooking result DIS DIS FysioterapiepikrisePhysiotherapy letter KorrespondancebrevCorrespondence message Send SpeciallægeepikriseSpecialist letter LægevagtsepikriseOn-call GP service letter BilleddiagnostiskImage diagnostics letter epikrise KorrespondancebrevCorrespondence message Send SygehushenvisningHospital referral Billeddiag.Image diag. henvisningreferral REF REF SpeciallægehenvisningSpecialist referral Modt.Recip. SpeciallægehenvisningSpecialist referral Modt.Recip. LaboratoriesvarLaboratory results PatologisvarPathology results MikrobiologisvarMicrobiology results RPT RPT CervixcytologisvarCervix cytology results ImmunologisvarImmunology results Send LaboratorierekvisitionLaboratory request MiniK WebR WebR WebR WebR WebR WebR WebR WebR WebR WebR PatologirekvisitionPathology request WebR WebR WebR WebR

REQ WebR WebR WebR WebR WebR WebR WebR WebR REQ MikrobiologirekvisitionMicrobiology request WebReq MiniK Send AlmenGP læger RUC RUC SpeciallægerSpecialists Send ReceptPrescription gl. version old version ReceptPrescr. new ny udenw/o dose-d. dosisdisp. PRE PRE ReceptPrescr. new ny medw. dose-d. dosisdisp. Modt.Recip. NegativNegative kvitteringacknowledgement PositivPositive kvitteringacknowledgement Neg. VANSVANS acknowledgement kvittering CTL CTL Send NegativNegative kvitteringacknowledgement PositivPositive kvitteringacknowledgement 26 MedCom

What can the counties do now?

Overview of EDIFACT Green indicates that the Yellow indicates that the messages in operation messages are underway and have message has been started and is been disseminated to more than being disseminated. in the individual 50% of possible messages. The counties and CHC numbers in the boxes indicate Red indicates that the mes- what percentage of messages are sage has not yet been put into sent electronically. use.

Counties KPPL Viborg Århus Ringk. Ribe Vejle S.Jutl. W.Zeal. St.Str. Rosk. Fr.borg CHC Cop. Bornh. SSI Capio N.Jutl. Funen Vejle CHC Bornh. N.Jutl. Viborg Århus Ribe Funen W.Zea. St.Str. Fr.bor. Capio Ringk. S.Jutl. Cop. KPPL SSI Rosk. Statistics 27

Local-authority suppliers – who can do what?

The electronic communication implementation status of Med- to and from the local-authority Com standards in these systems. home-care service involves both KMD Sygehusophold (S&A) Message possible and electronic care record Message soon possible (ECR). The chart shows the Message not possible

Local authorities-hospital communication

Number of electronic messages between local authorities and hospitals in October 2005. 28 MedComMedCom IV – V

Before the institution can use the lish on IP addresses who are Internet strategy VPN connection to the Health- allowed to attain connection care Data Network, it is necessa- with one another and for what 619 IP agreements, ry to enter into bilateral agree- purpose. The IP agreements are ments with other interested par- technically entered into with the broken down by ties which are connected to the server to which access is to be types of server, Healthcare Data Network’s node. obtained/data are to be exchan- November 2005 The bilateral agreements estab- ged.

Sundhed.dk Record lookup Clinical databasesLaboratory lookupShared care Technical use Teleradiology X-ray lookup VideoconferencingCardiology Other clinical useReporting Administrative useService functions

Trend in number of IP agreements

May/03Jun/03 Jul/03 Aug/03Sep/03Oct/03 Nov/03Dec/03Jan/04 Feb/04 Mar/04Apr/04 May/04Jun/04 Jul/04 Aug/04Sep/04Oct/04 Nov/04Dec/04Jan/05 Feb/05 Mar/05Apr/05 May/05Jun/05 Jul/05 Aug/05Sep/05Oct/05 Nov/05

SUP statistics

Number of consents per month Monthly statement of ■ South Jutland number of consents ■ Århus given, i.e. patients on ■ Viborg whom clinical infor- ■ Vejle mation is sought. ■ Funen Names 29

Names

The Primary Group ● Peter Pedersen, Copenhagen MedCom’s Hospital Corporation infrastructure group ● Rose-Marie Jensen, Bornholm The purpose of the Primary Group Regional Municipality The aim of MedCom’s permanent is to monitor and carry out Med- ● Merete Halkjær, Copenhagen infrastructure group is to monitor Com projects under the Internet Local Authority the operation of the Internet- strategy and in the area of local ● Anne Danborg, Skibby based Healthcare Data Network authorities. In addition, it fulfils Local Authority and ensure relevant technical and tasks in relation to problem-solving ● Helle Stockfleth Olsen, safety enhancement of the net- and enhancement in conjunction Statens Serum Institut work. The infrastructure group is with the EDI communication alrea- ● Niels Hornum, Copenhagen an advisory body for the MedCom dy in existence. The Group consists General Practitioners’ steering group. of project leaders and other key Laboratory individuals from counties, CHC, ● Karin Argir, Capio Diagnostik ● Erik Jacobsen, DataGruppen local authorities and other organi- ● Karin Rokvist, Capio Diagnostik MultiMed sations in the healthcare sector. ● Joan Madsen, CSC Scandihealth ● Freddy Christensen, ● Michael Johansen, WM-data EG Datainform ● Anne-Marie Falch, ● Karin Husballe Munk, ● Ib Lucht, UNI-C North Jutland County Lyngsoe Systems ● Martin Bech, UNI-C ● Jens Grønlund, Viborg County ● Ivan Andersen, Ascott Software ● Torben Kvistgaard Jensen, ● Hans Henrik Bøttger, ● Thomas Wejs Møller, PROGRATOR Århus County Association of County Councils ● Sten K. Christensen, KMD ● Gert Fjord Olesen, ● Susanne Duedal Pedersen, ● Jan Petersen, National Board of Ringkjøbing County National Board of Health Health ● Tove Charlotte Nielsen, ● Jens Rastrup Andersen, ● Ronnie Eriksson, Sundhed.dk Vejle County Sundhed.dk ● Ole Widriksen, Sundhed.dk ● Bente Christensen, Vejle County ● Ronnie Eriksson, Sundhed.dk ● Claus Nielsen, National ● Kim Østerbye, Ribe County ● Claus Nielsen, National Association of Local Authorities ● Lone Behnfeld, South Jutland Association of Local Authorities ● Søren Bonde-Andersen, County ● Jens Parker, Organisation of Copenhagen Local Authority ● Tove Lehrmann, Funen County General Practitioners ● Henrik Bruun, Danish ● Lisbeth Jørgensen, Funen County ● Hans Ersgaard, Danish Associa- Pharmaceutical Association ● Birgit Nielsen, Storstrøm County tion of Medical Specialists ● Holger Pind Probst, Storstrøm ● Jette Malling Rosbæk, ● Henrik Bruun, Danish County West Zealand County Pharmaceutical Association ● Leif Hagen Christiansen, ● Simon Krogh, West Zealand ● Kjeld Erbs, representative of the Copenhagen County County National Health Service Scheme ● Jens Henning Rasmussen, ● Claus Duedal Pedersen, Roskilde County ● Claus Duedal Pedersen, MedCom MedCom ● Lene Meyer Grosen, ● Dorthe Skou Lassen, MedCom ● Finn Roth Hansen, MedCom Frederiksborg County ● Finn Roth Hansen, MedCom ● Henning Voss, MedCom ● Søren Lorentzen, Frederiksborg ● Gitte Henriksen, MedCom ● Iben Søgaard, MedCom County ● Henrik Bjerregaard Jensen, ● Jens Rahbek Nørgaard, ● Sue Bech, Copenhagen County MedCom MedCom ● Jan Stokkebro Hansen, ● Ib Johansen, MedCom ● Lars Hulbæk, MedCom Copenhagen County ● Iben Søgaard, MedCom ● Peder Illum, MedCom ● Susanne Larsen Grøntoft, ● Jens Rahbek Nørgaard, MedCom Copenhagen Hospital ● Karin Demkjær, MedCom Corporation ● Lars Hulbæk, MedCom 30 MedCom

MedCom’s MedCom’s MedCom’s Mini-IRSK local-authority group SUP steering group project leader group

● Carsten Stanley Mortensen, ● Ole Schou Rasmussen, ● Anne Kjærluff, West Zealand Aalborg Local Authority North Jutland County County ● Kirsten Skovrup, Aalborg ● Ole Filip Hansen, Viborg County ● Bente Christensen, Vejle County Local Authority ● Søren Thing Pedersen, ● Gert Fjord Olesen, Ringkjøbing ● Isabelle Andersen, Læsø Århus County County Local Authority ● Vera Ibsen, Vejle County ● Gitte Ditlevsen, Copenhagen ● Jonna Refstrup, Ørbæk ● Morten Hansen, Vejle County County Local Authority ● Dorthe Wøldike, Vejle County ● Grethe Annie Jensen, ● Alice Kristensen, Svendborg ● Esben Dalsgaard, Ribe County Frederiksborg County Local Authority ● Claus Toftgaard, South Jutland ● Hanne Søndergaard, ● Søren Skafte Jensen, County North Jutland County Nakskov Local Authority ● Rikke Viggers, Funen County ● Hans Henrik Bøttger, Århus ● Agnete Seidelin, Roskilde ● Peer Frøkjær Smed, County Local Authority CSC Scandihealth ● Helle Stockfleth Olsen, Statens ● Margit Kure, Skovbo Local ● Thomas Wejs Møller, Serum Institut Authority Association of County Councils ● Jane Boss, Bornholm Regional ● Marianne Strand, Stenløse ● Jens Rastrup Andersen, Local Authority Local Authority Sundhed.dk ● Jens Henning Rasmussen, ● Kim Snekkerup, Frederiksværk Roskilde County Local Authority ● Dorthe Skou Lassen, MedCom ● Joan Madsen, CSC Scandihealth ● Merete Halkjær, Copenhagen ● Finn Roth Hansen, MedCom ● Karin Argir, Capio Diagnostik Local Authority ● Henrik Bjerregaard Jensen, ● Kim Bjørn Hansen, WM-data ● Grethe Simonsen, Funen MedCom ● Lene Meyer Grosen, Svendborg Hospital ● Iben Søgaard, MedCom Frederiksborg County ● Anne-Marie Falch, North ● Jens Rahbek Nørgaard, ● Lisbet Ramsvatn, Frederiksborg Jutland County MedCom County ● Tine Korsholm, Ringkjøbing ● Lisbeth Jørgensen, FynCom County ● Lise Tangaa, Ribe County ● Kim Østerbye, Ribe County ● Lone Behnfeld, South Jutland ● Maja Stephansen, Storstrøm County County ● Maja Stephansen, Storstrøm ● Jens Henning Rasmussen, County Roskilde County ● Niels Hornum, KPLL ● Lene Meyer Grosen, ● Ole Filip Hansen, Viborg County Frederiksborg County ● Peter Pedersen, Copenhagen ● Susanne Larsen Grøntoft, Hospital Corporation Copenhagen Hospital ● Pia Dandanell, West Zealand Corporation County ● Claus Nielsen, National ● Rose-Marie Jensen, Bornholm Association of Local Authorities Regional Local Authority ● Verner Hansen, National Board ● Sue Bech, Københavns Local of Social Services Authority ● Gitte Hansen, Ministry of ● Søren Rosenørn Jakobsen, ACURE Finance ● Søren Lenau, Bornholm Regional Local Authority ● Dorthe Skou Lassen, MedCom ● Henning Voss, MedCom ● Gitte Henriksen, MedCom ● Iben Søgaard, MedCom ● Ib Johansen, MedCom ● Iben Søgaard, MedCom ● Tove Kaae, MedCom Staff 31

Danish Centre for Health Telematics

Centre manager Henrik Secretary Consultant Bjerregaard Jensen Anita Folleraas Rikke Viggers MedCom MedCom FynCom Tel. direct 6543 2010 Tel. direct 6543 2013 Tel. direct 6543 2033 hbj@ anf@ riv@ health-telematics.dk health-telematics.dk health-telematics.dk

Deputy manager Secretary Secretary Ib Johansen Pia Reinhardt Juel Karina Hasager MedCom Medcom FynCom/Telemedicine Tel. direct 6543 2019 Tel. direct 6543 2022 Tel. direct 6543 2012 ijo@ prj@ khs@ health-telematics.dk health-telematics.dk health-telematics.dk

Consultant Project assistant Consultant Niels Rossing Gitte Henriksen Lisbeth Jørgensen International MedCom FynCom/Telemedicine Tel. direct 6543 2034 Tel. direct 6543 2015 Tel. direct 6543 2011 nr@ ghe@ lij@ health-telematics.dk health-telematics.dk health-telematics.dk

Project assistant Secretary House assistant Jennie Søderberg Iben Søgaard Alis Jørgensen International Medcom Danish Centre for Tel. direct 6543 2014 Tel. direct 6543 2021 Health Telematics jsb@ ibs@ Tel. direct 6543 2018 health-telematics.dk health-telematics.dk

Project consultant Consultant Christina Wanscher Finn Roth Hansen International MedCom Tel. direct 6543 2032 Tel. direct 6543 2027 Part-time consultants: cew@ frh@ health-telematics.dk health-telematics.dk Peder Illum MedCom Consultant Consultant Tel. direct 6543 2035 Henning Voss Lars Hulbæk pih@ International/MedCom MedCom/Telemedicine health-telematics.dk Tel. direct 6543 2017 Tel. direct 6543 2031 hvo@ Lhf@ Lene Norgren Hansen health-telematics.dk health-telematics.dk MedCom Tel. direct 6543 2026 Consultant Claus Consultant lno@ Duedal Pedersen Dorthe Skou Lassen health-telematics.dk International/MedCom MedCom/FynCom Tel. direct 6543 2029 Tel. direct 6543 2023 Margit Rasmussen cdp@ dsl@ MedCom health-telematics.dk health-telematics.dk Mobile 2348 6914 mar@ Consultant Consultant health-telematics.dk Jens Rahbek Nørgaard Karin Demkjær MedCom MedCom/FynCom Bente Falk Tel. direct 6543 2028 Tel. direct 6543 2024 FynCom jrn@ kde@ Mobile 2963 7713 health-telematics.dk health-telematics.dk bfa@ health-telematics.dk Consultant Deputy chief of section Jacob Glasdam Tove Lehrmann Tove Kaae MedCom FynCom MedCom Tel. direct 6543 2016 Tel. direct 6543 2020 Tel. direct 6543 2026 jag@ tle@ tok@ health-telematics.dk health-telematics.dk health-telematics.dk MedCom IV – how it turned out

MedCom IV ➊➋➌ projects ➐➒➋ ➊➋➊➋ ➒➊➋

➊➊➋➍ ➊➊➋➍ ➐➒➊➋ ➊➊➋ ➐➑➒➋ Cph County ➍➐➒ ➊➊➍➎ ➊➋➍➐ ➊➋ ➐➒➋ CHC ➑➒➋ ➊➊➌ ➊➊➋ ➐➑➒ ➏➐➑ ➋ ➊➊➋ ➒➊➋ ➍➏➐ ➊➊➋ ➊➊ ➒➊➋ ➌➍➐ ➋➐➑ ➒➋ ➊➋➊➌ ➒➋ ➍➎➏➑ ➊➋➊ ➒➊➋ ➋➌➐ ➊➋ ➒➊➋ ➊➋ ➐➋

The local-authority projects ➊ Hospital-Local Authority ➋ Medical practice-home care Internet strategy ➊ Infrastructure project FUNEN COUNTY ➋ Lab lookup via Sundhed.dk ➌ Rugårdsvej 15, 2.sal, 5000 Odense C X-ray lookup ➍ Teledermatology Telephone 6543 2030, Fax 6543 2050 ➎ Collaboration www.medcom.dk ➏ Videoconferencing ➐ WebReq – Clinical Biochemistry Ministry of the Interior and Health ➑ WebReq – Microbiology ➒ WebReq – Pathology Slotsholmsgade 10 -12, 1216 Copenhagen K SUP and Mini-IRSK Telephone 7226 9000, Fax 7226 9001 ➊ SUP project www.im.dk ➋ Mini-IRSK