MC-S000MC-S218 December 2009 MedCom 15 years Status report, MedCom 6 strategy service information cooperation efficiency the citizen healthcare 15years communication the patient development ITsecurity Internet dialogue digitisation cohesion VANS the future MedCom 15 years MedCom edCom is a cooperation between Mauthorities, organisations and pri- vate companies involved in the Danish healthcare sector. The partnership was established as a temporary healthcare IT project in 1994, but was later made permanent through the 1999 financial agreement between the Government and the former counties. MedCom’s purpose: MedCom will con- tribute to the development, testing, dissemination and quality assurance of electronic communication and informa- tion in the healthcare sector, with the aim of supporting good patient pro- gress. The parties behind MedCom today are: the Ministry of Healthcare and Preven- tion, the National Board of Health, Danish Regions, Local Government Den- mark, the Ministry of the Interior and Social Affairs and the Danish Pharma- ceutical Association. Photograph: Helle Moos Standardisation Consolidation International issues SDN It began in a true pio- Pilot projects became International coopera- In time, a need arose to neering spirit with the permanent arrange- tion has more or less supplement the VANS- idea that electronic ments. Dissemination always been a special based message com- communication had the gained pace, and the part of the develop- munication with a new potential to become a MedCom standards ment effort in the field sundhed.dk network for telemedi- good tool for the have long been part of of healthcare IT. Over the years, Health- cine and other forms of Danish Healthcare everyday working life. Standardisation, infra- care IT has become a communication in System. It ought to be Perhaps not everywhere structure and tele- very wide term. An image and dialogue possible to convert in the healthcare sector, medicine have been important partner for format. The idea arose fixed forms such as but almost. some of the major areas MedCom is the eHealth to base a new national prescriptions, referrals, of focus, and the EU has portal sundhed.dk, network on Internet etc., to standard elec- Find out more on played – and continues which is the entry door technology, and the tronic forms and then pages 6 –7 to play – an important to the Danish Health- idea was then put into to send them directly role. care System for the citi- real life. from one IT system to zens and also an im- another. Find out more on portant communication Find out more on pages 18 –21 interface for healthcare pages 16 –17 Find out more on professionals. pages 4 –5 Find out more on pages 12 –13 2 Foreword / Contents efficiency in the services to the Digitisation – a core element population. For the population, a in the development rapid development is taking place of access to information about of the healthcare sector themselves and the Danish Health- care System in general at the ealthcare IT is an absolutely communication has become routine eHealth portal sundhed.dk. Hvital tool in efforts to equip in general practice, in local authori- Looking back, developments the Danish Healthcare System to ties, hospitals, pharmacies, labora- over the past few years have been face the challenges of the future. tories, etc. impressive, not least thanks to the Digitisation needs to be used in an Over the years, further measures current MedCom projects and their efficient and targeted way in the have taken place towards exploit- predecessors. And they are poin- efforts to create a Healthcare ing to an even greater degree the ting forwards. Towards dissemina- System that will deliver a high level latest information technology, tion of the good solutions, for of treatment and service. It is about thus strengthening the power of example the MedCom standards supporting better communication cohesion internally in the Danish becoming fully utilised in all local with the citizens, and it is about a Healthcare System and in respect authorities, regions and surgeries cohesive Healthcare System charac- of the population. Through the and telemedicine being implemen- terised by successful organisation Health Data Network, system ted to its full capacity in suitable of work procedures and routines. development and standardisation, areas so that healthcare staff can Denmark is at the forefront in the IT engine room of the Danish make efficient use of their time this area, not least by virtue of the Healthcare System has been devel- and energy for the benefit of efforts delivered by MedCom over oped and optimised, and this work patients. the past 15 years, for example in is continuing all the time. At the terms of the standardisation, imple- same time, specific tools such as Jakob Axel Nielsen mentation and dissemination of telemedicine are showing huge po- Minister of Health and Prevention electronic messages between all tential as a means both of making parties within the Danish Health- the Healthcare System more effi- care System. Today, this part of cient and flexible and of improving E-records Telemedicine Digital Health Contents e-records is one of the Telemedicine includes Much water flowed Foreword 2 many new functions. the expansion of under the bridge in the Articles 4 The idea here is to pro- healthcare IT to include years before healthcare Projects 24 vide healthcare pro- images and sound. This IT. Organisations came Toolkit 37 fessionals and citizens provides the facility to into being based on Statistics 42 alike with direct Local authorities involve citizens directly specific tasks, and Names 50 access to patient re- The local authority in their own treatment MedCom is just one of cords via sundhed.dk. reforms and creation of and the method in them. The task of SDSD, new, larger authorities which specialised sup- Digital Health, is to Find out more on and five regions to port is provided irres- gather the threads to- pages 8 –9 replace the counties pective of geographical gether and set out the provided completely distances. The first steps markers showing the new partnership were taken well before path for the future. relationships within the 2008, but now the new healthcare sector. The opportunities provided Find out more on local authorities now by IT have really had pages 14–15 came into the picture in their breakthrough earnest. nationally. Find out more on Find out more on pages 10 –11 pages 22 –23 3 MedCom 15 years MedCom15 years Self-appointed nerds and IT pioneers ack in 1994, a group of professional IT experts Bgot together with doctors and healthcare staff with an interest in IT to develop electronic commu- nication standards. One of the members of the group was Niels Jørgen Christensen, who today is IT Project Manager in the Central Jutland Region. “We were six self-appointed nerds with masses of pioneering spirit and drive who said that we would be perfectly capable of developing some standards like this. We were all different and there were many disagreements, but we always managed to reach a decision that everyone would support,” he recalls. The standard electronic forms, EDIFACTs, were developed based on international standards and by examining the actual requirements of doctors and healthcare staff who would need to use the forms. The technical challenge consisted of transferring a paper form into an electronic system. “A computer, of course, cannot decide whether one thing is more relevant than another, or whether a date specified is a creation date or discharge date,” explains Anders Kristian Jørgensen, who was working at the time for Dan Net and who was res- ponsible for getting the systems to work in practice. “We needed to ensure that the system could sort all the data in a meaningful way. And the EDIFACTs developed by the standardisation group in ‘96 are, at their core, the same as the ones used in the healthcare system today.” In this department, “we reduced the work processes from 18 to just 5 by switching to purely electronic communication. Niels Jørgen Anders Kristian Christensen Jørgensen 4 Standardisation, dissemination, consolidation Efficiency at Important for maximum and error management to be rate at minimum forward-looking Photograph: Colourbox e are almost 100% digital in this department, and efore the MedCom standards were Wthat has changed our day-to-day work accordingly,” Bimplemented on a large scale in the explains Finn Mathiesen at the Radiology Department of country’s hospitals, local authorities and Vejle Hospital, which is part of the Lillebælt Hospital. surgeries, they were pilot tested in real life “Previously – and, in fact, it wasn’t so very long ago – we at selected hospital departments and sur- would be standing there with paper records in our hands geries throughout the country. What was while we looked at X-rays in the light box and read out then Vejle County worked together with notes into the Dictaphone, which the secretary would then MedCom to test a number of standards in write up. Then, it wasn’t beyond the bounds of possibility radiology and pathology departments, for papers to get lost or mixed up. That situation doesn’t several clinical departments and a number occur today, when all documents, notes and images are held of GP surgeries, among other places. on the patient’s electronic record. In this department, we re- “It was a positive and exciting process, duced the work processes from 18 to just 5 by switching to even though getting the organisation of purely electronic communication. So, we have significantly the projects approved and granted inter- improved efficiency and, at the same time, sealed off the nally was a challenge,” says Tove Charlotte chain of security, thus improving patient security.” Nielsen, who from 1997 until 2007 worked In practice, digitisation has released so many resources as a coordinator for the standardisation that today the department can offer drop-in examinations, projects in the county.