MedCom – the Danish Healthcare Data Network / Dec. 2003 / MC-S177 MedComMedCom IV IV Status,Status, plans plans andand projectsprojects Healthcare Healthcare portal DIX Local County authority Internet Pharmacy Dan Net network Doctors’ KMD systems network KPLL Primary sector Medical Nursing Home Specia- practice homes care lists c. 13% Other hospitals c. 10% Clinical service Clinical Other c. 40% treatment clinical treatment unit units EPR c. 23% Other service c. 13% HOSPITAL Administration c. 4% ● Internet strategy ● Local authorities and healthcare communication ● Hospitals and healthcare communication ● International activities 2 MedCom IV – status, plans and projects Contents Aims of MedCom 2 The local authorities and healthcare communication 20 Introduction 3 The Hospital-Local Authority XML project 20 Healthcare on the move 3 The Hospital-Local Authority project and Common Language 22 History 4 Commentary: The Minister of Social Affairs, Henriette Kjær 22 The MedCom steering group 6 The LÆ form project 23 Commentary: The Minister of the Interior and Commentary: The Chairman of the National Health, Lars Løkke Rasmussen 7 Association of Local Authorities, Perspective: MedCom certifies communication 8 Ejgil W. Rasmussen 24 Perspective: The IT Lighthouse’s local authority- The Internet strategy 9 medical practice communication 24 The infrastructure project 9 The hospitals and Commentary: The Chairman of the Association of healthcare communication 25 County Councils, Kristian Ebbensgaard 12 Perspective: The Internet strategy and the From hospital to hospital 25 Healthcare Portal 12 The XML EPR project 27 Web lookup of laboratory data 12 Perspective: XML EPR 27 Web requesting of tests for clinical biochemistry Commentary: Head of Department in the Ministry and clinical immunology 14 of the Interior and Health, Vagn Nielsen, Web lookup of X-rays images and descriptions 16 chairman of the MedCom steering group 32 Teledermatology network 17 Perspective: The XML EPR communication EDI via the Internet 19 project and G-EPR 32 MedCom’s SUP project 33 International activities 36 International interaction 37 International projects 1996-1999 37 Aims of Commentary: Ilias Iakovidis, Ph.D. Deputy Head of Unit-eHealth, European Commission, DG Information Society 38 MedCom International projects 2000-2002 38 International projects 2002-2004 39 MedCom aims to contribute Nordic co-operation 39 to the development, testing, Perspective: Nordic Health care Network group 40 dissemination and quality assurance of electronic com- Statistical material 41 munication and information Good EDI letters 41 in the healthcare sector What can the counties do now? 42 with a view to supporting coherent treatment, nursing Danish Centre for Health and care. Telematics 43 Introduction 3 Introduction cation across the regions. The around a million messages a Healthcare idea was to develop joint month. The figure is now twice national communication stan- that level. communica- dards for the most important Alongside all this develop- forms of messages and to make ment, there has been intensive tion on the the regional healthcare data net- work on the consolidation and works building-blocks in a quality assurance of communica- move national healthcare data network. tion. There has also been consid- Coordination, development and erable positive experience of the exchange of experience became significant work involved in car- Communication is a key word in important tasks for MedCom in rying out organisational changes a healthcare sector, which reflects the efforts made to promote IT under the impact of the new specialisation and division of communication in the healthcare informational technology. Only labour between a large number sector. if organisational changes are of specialists and specialist A particular dimension of the made can the improved commu- groups across sectors. Quality development work throughout nication really prove effective. and efficiency in patient treat- the period has been interaction ment are entirely dependent on with private business. At first the New perspectives rapid, reliable and error-free market for the IT solution in this exchange of information between area was virtually non-existent. The dentists, physiotherapists all parties concerned with the A market of this kind has been and occupational therapists are patient. built up alongside the develop- relatively new users of the health- It was therefore natural for ment of the healthcare data net- care data network. Promising the healthcare sector at the end work under close and construc- trials are underway with tele- of the eighties to start examining tive co-operation between users, medicine, and the Internet has the options for using data com- suppliers and MedCom. come into the picture. The ex- munication. It started with a few pansion and development of the enthusiasts, who could see the From the doctor Internet has made it appropriate sense in transferring standard to the whole health- to look at the opportunities to messages electronically. The idea care sector use Internet technology to meet quickly caught on, and the use of some of the communication electronic communication devel- In the first phase of develop- needs of the healthcare sector. oped in both breadth and depth ment, the general practitioner And this is where one of the – more and more users joined in, was the pivotal point in commu- principal focal areas of MedCom and the potential applications nication, which primarily passed IV has been. The Internet opens were extended to include new between medical practices, hospi- up completely new opportunities types of messages. tals, laboratories and pharmacies. both in relation to the patient Then the local authorities also and in dialogue with healthcare One healthcare data joined in and became an impor- professionals. It is important to network, several tant partner in cooperation, in gather experience with this com- regional networks home care and other areas. munication through a large Messages in the form of pre- number of practical projects. At The small, dispersed projects scriptions, laboratory results, X- the same time, MedCom IV has were soon brought together in ray results, discharge letters etc. been concerned with the expan- actual regional healthcare data were exchanged in steadily in- sion and quality assurance of networks, the project organisa- creasing numbers between more EDI communication, as well as tion MedCom was founded back and more users. By the end of the development and implemen- in 1994, both to control devel- the nineties, the healthcare data tation of communication to and opment and to ensure communi- network was already forwarding from electronic patient records. 4 MedCom IV – status, plans and projects al involving communication between 10 pharmacies and 11 History ●● medical practices was held on ●● Amager in 1989-90. The trial It started in the was pioneering in EDI commu- nication in Denmark, and the eighties ●● same technological platform has ● ●● The history of the healthcare been used for communication ● ●● data network goes back to the right up to the present day. ●● ●● ●● ●● ● ●● end of the 1980s, when interest ●● ● ●● in electronic communication The first regional ● between the various parties in projects ●● the healthcare sector grew. Local ●● projects were launched on the Three large regional EDI pro- Pilot projects in initiative of the Association of jects started in 1992: Medcom I County Councils, at the hospi- tals in Vejle and Silkeborg and ● FynCom in Funen County MedCom I: elsewhere. The projects, together ● The Odder project in Århus 1994-1996 with the DSI report EDB over County (sektor) grænser (Computing Across ● KPLL in Copenhagen To counteract the tendency for (Sector) Boundaries) helped to the counties each to “re-invent draw attention to the need for All three projects were based on the wheel”, Funen County in cross-sector communication from the technology used in the 1992 submitted a proposal to 1991 on. “Amager trial”. organise a joint nation-wide pro- Alongside these projects, a tri- ject bringing together national government, the counties, private Millions of messages companies and healthcare 25 organisations under the name of: 24 “MedCom – The Danish 23 22 Healthcare Data Network”. 21 The purpose of MedCom was 20 to develop nation-wide standards 19 for the most common communi- 18 cation flows between medical 17 16 practices, hospitals and pharma- 15 cies: referrals and discharge let- 14 ters, laboratory results, X-ray let- 13 ters, prescriptions and hospital 12 billing, totalling over 30 million 11 10 messages a year. 9 The development projects ran 8 from 1994 to 1996 as 25 pilot 7 projects spread across the whole 6 country, which together involved 5 4 the majority of the suppliers of 3 IT to hospitals and medical prac- 2 tices. However, the dissemination 1 of the standards went slowly. A 0 decision was therefore made to 92 93 94 95 96 97 98 99 00 01 02 carry out a second project – The spread and use of the healthcare data network has developed MedCom II. appreciably over the last ten years. Today, 2.3 million messages a month are communicated. History 5 MedCom II: the standards were used differ- 1997-2000 ently by the various suppliers. At the same time, a decision The primary purpose of Med- was taken to launch four smaller Com II was to ensure rapid and project lines: the Hospital Area, large-scale dissemination of the Telemedicine/Internet, Local- standards developed under the Authority Communication