MedCom – the Danish Healthcare Data Network The healthcare communication ofthe future G Change-over to the Internet – new opportunities for everyone G MedCom’s EPR communication project December 2001 MC-S152 MedCom in brief Increased division of work and speciali- The first pioneers in the area started sation have been characteristic of the with a few specific niches in communi- healthcare sector over the last few de- cation. The next step in development cades. The sector has always involved a came when the first counties decided to number of specialist groups and players carry out co-ordinated and targeted with a mutual specialisation. This way of development of a regional healthcare organising work has been accentuated in data network. A need for co-ordination, recent years, partly by substantial specia- development and exchange of experience lisation within the individual specialist very soon arose in this situation. The group. A surgeon, for example, is not objective was to ensure that the regional just a surgeon but a highly trained healthcare data networks together made specialist in a narrow field of surgery. up a nationwide network. It was against this backdrop that MedCom was estab- Specialisation and division of work in- lished as a project organisation in 1994. crease the need for flexible and effective communication between the players in MedCom’s own history mirrors the the healthcare sector. This is of vital im- development that has taken place in the portance to technical quality, efficiency area since 1994. and how the patient experiences rela- tionships in nursing, care and treatment. MedCom 1 worked over the period from 1994 to 1996 on the development At the same time, enormous develop- of communication standards for the ments have taken place in information most common communication flows technology. Advanced data communica- between medical practices, hospitals and tions have become prevalent in many pharmacies. sectors, and around 1990 the healthcare sector too started responding to the new MedCom 2, running from 1997 to opportunities that were being created. 1999, broadened the communication The benefits are obvious, but a major between medical practices, hospitals and task has to be faced, both technically and pharmacies, developed communication organisationally, before information tech- standards for the most important com- nology can be applied to communication munication flows and carried out pilot between GPs, hospitals, pharmacists, projects in the areas of the Internet, tele- laboratories, national health insurance medicine and dentistry. schemes, local authorities and others. While MedCom 1 and 2 were projects running for limited periods, a decision Purpose of MedCom was taken in 1999 that MedCom should continue as a permanent organisation. At the same time, it was decided the per- “The purpose of MedCom is to contribute to the develop- manent MedCom should continue to ment, testing, dissemination and quality assurance of elec- organise its work in the form of projects tronic communication and information in the healthcare over limited periods. sector with a view to supporting coherent treatment, nursing and care.” MedCom 3, running from 2000 to 2001, has worked towards consolidating Defined in 1999, when the MedCom organisation the communication between medical became permanent practices, hospitals and pharmacies, broadening the communication between 2 MedCom in brief 87-90839-41-2 Contents MedCom in brief IT strategy for the hospital service Background and purpose . 2-3 Change-over to the Internet – The national IT strategy for the new opportunities for everyone hospital service lays down the overall objectives and strategies From VANS to the Internet . 4-7 in the area of information technology. The tasks of Med- Seven forms of communication . 8-17 Com are summed up below in three bullet points: Many players, many opportunities 18-19 G EDI communication – continu- Organisation and security . 20-21 ed broadening and quality assurance of existing and new MedCom’s EPR EDI communication flows communication project G Electronic patient record – development and implemen- MedCom’s EPR communication tation. project . 22-25 G Change-over to the Internet – development and expansion EDIFACT, XML and HL7 . 26-27 d, arki•tekst kommunikation. Layout: Christen Tofte. Photographs: PhotoDisc. Printed by: one2one, Odense. Print run: 5000. ISBN d, arki•tekst kommunikation. Layout: Christen Tofte. of the infrastructure in the healthcare data network What is the problem? . 28-29 using Internet technology. Status of EPR in 2001. 30-31 The data consultant – hospitals and local authorities as well as troubleshooter and IT mediator preparing for the change-over to Internet technology, continued broadening of tele- Data consultant scheme . 32-35 medicine solutions and the enhancement of communication in the hospital area. Who can do what now? MedCom 4 is a natural continuation of Status in counties. 36-37 the previous MedCom projects and is fully in line with the general develop- EDI top. 36-37 ment in the area of information techno- logy. The focal areas are now the change- Names and addresses over to the Internet, continued broaden- ing and quality assurance of EDI com- Steering group, project managers, munication and development and im- data consultants, MedCom staff . 38-39 plementation of communication to and from electronic patient records. This brochure describes the vision for MedCom 4. Published by MedCom, December 2001. Edited by: Claus Duedal Pedersen and Lars Hulbæk Fog, MedCom. Journalistic work: Kim Jørsta Contents 3 Change-over to the Internet – new opportunities for everyone The establishment of the healthcare data network messages, which could ensure smooth has meant substantial advances in relation to communication between the parties and quality and efficiency in work processes and there- direct transfer of the messages from one fore also in relation to the patients’ experience of system to another. EDIFACT standards coherence and continuity in their encounters with were developed as the form of message the various parties in the health service. for a large number of the most impor- tant communication flows, such as dis- The most essential point in this context, charge summaries, prescriptions, labora- it should be noted, is not the days or tory results etc. hours by which data communication re- duces communication time in compari- With regard to the infrastructure of the son with the time when internal or network, everything was in favour of a external mail by letter was the way in VANS-based data network, where a which it was done. To a far greater ex- VANS provider acts as a contact link tent, time and quality can be gained between the sender and the recipient. from the fact that the message, once it The sender puts his message in a mail- has been keyed in, is immediately trans- box at the VANS provider, where the ferred from the sender’s computer system recipients can collect it at their con- to that of the recipient. In addition, all venience. This principle is referred to as experience has shown that the introduc- push, where the sender pushes his mes- tion of information technology has led sage towards the recipient, in contrast to to work processes being reviewed and pull, where the recipient retrieves the the organisation being made more flex- information from the sender’s system. ible in order to obtain the maximum yield from the new opportunities. When the healthcare data network star- ted, there was no market for software The need for data communication in the specially developed for such a network. healthcare sector was already evident in One of the tasks of MedCom was there- Organisationally, elec- the infancy of the healthcare data net- fore to involve potential software sup- tronic communication has work. Many barriers had to be overcome pliers, establish co-operation with them led to great changes and at the outset, however, primarily in re- and the VANS suppliers, define specifi- simplifications. The illu- lation to technology and traditions. cations for the suppliers and carry out stration shows the pro- projects and trial runs with the indivi- cedure for a discharge The VANS-based healthcare dual EDIFACT messages. In that way, summary before and after data network success was achieved in establishing a set the healthcare data net- of communication options on the work. The answer was firstly to standardise the healthcare data network and a range of system solutions for medical practices, hospitals, pharmacies, laboratories etc. To a considerable extent, the healthcare data network was supported by enthusi- asts and pioneers, who saw new oppor- tunities and worked assiduously to put them into practice and disseminate them. The enthusiasts are still exceptio- nally important to the healthcare data network, where an underlying principle has always been that it is the needs of 4 Change-over to the Internet – new opportunities for everyone the user that represent the basis for de- fining the solution. General practice was and still is an im- portant hub for many of the most im- portant communication flows. It is the GP who is the patient’s firm point of reference and contact with the rest of the healthcare sector. The GP has therefore also had an important role throughout the dissemination of the healthcare data network – and continues to do so. Gene- ral practice has, however, been closely followed by the other parties in the health service – the data network has become a part of everyday life in the healthcare sector. The dissemination in itself goes towards providing the basis for the success of the healthcare data network and is therefore self-reinforcing. Today around 75% of parties in the health service use the healthcare data network. Overall, the project has succeeded to such an extent that at the start of MedCom 4 it is realistic to imagine that the healthcare data network will attain close on 100% spread in 2002, as also expressed in the In the existing healthcare data network, a VANS provider acts as a target for MedCom.