E-health in Denmark
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This presentation gives an overall introduction to innovative e-health initiatives in Denmark.
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E-health in Denmark
- 1. E-health in Denmark Healthcare DENMARK - January 2017
- 2. Agenda • E-health and Healthcare IT • Telehealth 2
- 3. A long term focus on health data networks and on e- health provide efficient access to healthcare information MedCom Health Data Network 1994 - Sundhed.dk E-health Portal 2003 - Who is behind? Ministry of Health, Danish Regions, Ministry of Interior, National Association of Local Authorities, National Board of Health, Copenhagen Hospital Corporation, Danish Pharmaceutical Association
- 4. SERVICES FOR CITIZENS • Access to personal health data on treatment • E.g. e-Record from hospitals and GPs and Shared Medication Card • Communication with health care providers • E.g. Contact information and e-services like booking, prescription renewals and electronic communication • General information on health service • E.g. quality in health care, patient rights • Accurate and updated information on health, disease and treatment • E.g. medical handbook • Personal home care/hospital solutions • E.g. diabetes and anticoagulant therapy • Patient to patient dialogue
- 5. SERVICES FOR HEALTH CARE PROFESSIONALS • Access to personal health data on patients – E.g. e-Record, laboratory data and Shared Medication Card • Contact and service information on other health care providers • General information on health service – E.g. waiting lists, quality in health care, health and prevention programs, visitation • Accurate and updated information on health, disease and treatment – E.g. medical handbook, treatment feedback and benchmarking • Personal home care/hospital solutions – E.g. diabetes and anticoagulant therapy
- 6. The national EHR today (e-journal) 6 EHR overview GP Hospital EHR GP EHR Hospital episodes GP con- sultation Medicin e Donor status GP name and address GP Medicin e Hospital EHR GP EHR Hospital episodes Specialists GP name Lab results Referrals
- 7. Columna is a full blown eHealth platform consisting of The Patient Record Patient Administration (ADT) Booking Order/Result Medication Management Logistics Data for the National E-health platform is delivered by the regional E-health solutions – e.g. the Systematic eHealth platform With Columna, Systematic has developed an integrated eHealth platform Facts about Columna Columna is used in Central Denmark Region (Denmark’s second largest region with 1.3 million citizens) covering18 hospitals including University Hospitals 10,000 different users per day, 25,000 registered users 6.7 million citizens are registered in Columna, of whom 1.2 million are patients with registered data. Registration of 2,400 admitted patients and 5,500 outpatients per day. More than 25,000 medication prescriptions per day. 40,000 lab results per day. 6,500 per hour in peak.
- 8. The National Service Platform
- 9. The National Service Platform – and new services 2014: National Image Index • Radiology • Ultrasound • Telehealth 2015- : National Telehealth • Device data • General (e.g. weight) • Diagnostic (e.g. ECG)
- 10. Healthcare Network 5 Regions NSP Master Municipal IT X 98 Continua/XDS/HL7 Government National Databases EU systems National Healthportal 3600 GP’s
- 11. Agenda • E-health and Healthcare IT • Telehealth 11
- 12. Are elderly people able to use Telehealth solutions ? • The Danish Digitalization strategy – electronic mailbox by Nov. 2014 • Patient Empowerment and quality of life • Integrated Care 12
- 13. 13 Personalised Healthcare – and Telehealth • All COPD patients in Region North • Highest number of research projects • Evidence • OpenTelehealth – open source platform The EPITAL project • Personalised Healthcare • Call center and new support organisation • Patient Empowerment
- 14. 14
- 15. 15
- 16. 26-09-2017 16
- 17. 17
- 18. 18 As simple as possible – based on Open Source
- 19. 19 Towards Integrated Care Local patient related services Regional operating services
- 20. 26-09-2017 20
- 21. 21 SIMPLE, SCALABLE, STANDARDIZED PROCESS FORM Posture Q&A Data Time SEND FORM REVIEW & INTERVENE OR PERHAPS… GO TO HOSPITAL OPTIONAL VIDEO CONFERENCE OPEN TELE SIMULATED CONSULTATION DESIGN FORM Posture Q&A Data
- 22. OpenTelehealth REMOTE PATIENT MONITORING - solution “OTHER” DISEASE CHF COPD DIABETES PREGNANCY 22 Generic platform with flexibility to adapt Medical device class 2
- 23. Hans Erik Henriksen, CEO Healthcare DENMARK heh@healthcaredenmark.dk 23
Hinweis der Redaktion
- This presentation contains an introduction to the Danish approach to E-health and Healthcare IT as well as Telehealth.
- More than 20 years ago, Denmark decided to establish a country wide Health Data Network, the MedCom network. MedCom was established in 1994 as a public funded, non-profit cooperation. MedCom facilitates the cooperation between authorities, organisations and private companies linked to the Danish healthcare system. MedCom is financed and owned by the Ministry of Health, Danish Regions and Local Government Denmark. Today, all test results from e.g. Lab and radiology are communicated electronically and so are all referrals, discharge letters, prescriptions and reimbursements. In 2003 the national e-health portal sundhed.dk went live, and this portal takes advantage of all the electronic data, to provide access to e.g. the patients EHR for all citizens and healthcare professionals.
- On the Danish eHealth portal Sundhed.dk citizens can access a number of personal services and data such as patient records from hospitals (e-journals) as well as general information on health, diseases and patient rights. Citizens can access their own medical history, going back to 1977, when the first Danish data repositories were created. Citizens can look up their own EHR information, renew prescriptions, book appointments with GPs and have e-consultation with their GP, just to mention a few of the services available to citizens.
- The e-health portal also provides strong support for the needs of the healthcare professionals. Here they get the latest on education and new research for clinicians so they can use it as a tool in order to keep their knowledge up to date. Clinical professionals can access the same data as the citizens so if they have a patient in treatment, they are able to see all the clinical notes, lab results and medicine information. In Denmark we have a national medication database, where we share all medication information in the whole healthcare system in Denmark.
- This is how the national EHR looks today. As a citizen I can access my own medical history – going back to 1977, when the first Danish data repositories were created. I can look up my own EHR information, renew prescriptions, book appointments with my GP and have e-consultation with my GP, just to mention a few of the services available to citizens.
- In Denmark the 5 healthcare regions are responsible for the public hospitals. Local e-health platforms in the healthcare regions ensure that all clinical data can be shared within the region. The company Systematic has delivered the e-health platform in Central Denmark Region, where 10 hospitals share the same information, so clinicians have full access to all clinical data, regardless of which hospital or outpatient clinic, a patient is visiting. The local e-health platforms deliver data to sundhed.dk – and sundhed.dk data from other regions is replicated back to the local e-health platforms. It is e.g. possible to access the nationwide EHR and to view and modify medicine prescriptions from other regions, in the context of the local system. This is a big advantage for the clinicians who have all the data they need within the same IT-system.
- This is the national service platform. At the time when Medcom began GPs (among others) were sending messages to a hospital e.g. a prescription. Then we found out that it would be better to put all the prescriptions in one database, because then we would be able to get knowledge about how we prescribe medicine and we could create a system where we share the medicine information to all our electronic patient records. That lead to the idea to gather all the data sources we use in the healthcare system in one national service platform. In this system, which is managed by the national eHealth authority, we have our patient master index, the civil registration number register – where we identify the patient, we have the medical authorisation register, we have a register of providers, we have a shared medication record which is actually the national database with all the prescription and medicines and so forth.
- This national architecture was one of the reasons why we could upscale our telehealth projects. What do you do when you work with telehealth and you find out that we have a new data source namely devices delivering data ? With this national architecture we could add a database that gather these data, in that way we were able to share data from devices and take the step to make telehealth national. It has been fundamental to Denmark to have this architecture of a distributed national service platform which has allowed us to share these data on a national level.
- Here you can see how data are delivered to the National Service Platform. The data are delivered by the five regions. They have their own local copy of the national service platform. Data also come from municipalities, the Shared Medicine system, the Open telehealth system and from the GPs. In that way we can have local data and we can replicate it to a national service platform where we share it.
- This presentation contains an introduction to the Danish approach to E-health and Healthcare IT as well as Telehealth.
- Studies from different Danish telehealth projects indicate healthcare savings up to 30% through patient empowerment, because empowered chronic patients clearly tend to reduce their use of hospital services. And at the same time, their involvement in their own disease increase their insight and quality of live. The question we often hear is: Chronic patients are often elderly patients – and can elderly chronic patients use modern technology like tablets and devices to monitor their own health ? As of 1. November 2014 every Danish citizens has been requested to communicate with public authorities through an electronic mail box. It was interesting to see, that when the switch to electronic communication was made on the 1. November, a larger proportion of elderly citizens than expected, were able to use the electronic mail box. They typically also found out that the tablet they got, in order to use the mailbox, could also be used to have video meetings with their grand children. Many of the citizens, which are later enrolled in telehealth projects, are already using tablets for other reasons and they are therefore happy to use telehealth tools to become involved and compliant with treatment of their chronic disease.
- In recent years, Denmark has moved away from many small telemedicine pilot projects to a more coordinated effort to establish large-scale studies reflecting telemedicine in actual operation. The National Telemedicine Action Plan from 2012 operates with five specific telemedicine initiatives, which form the basis for a telemedicine programme to pioneer future telemedicine initiatives. Examples of cross-sectorial large-scale telemedicine studies that are being rolled out is the TeleCare Nord project. The TeleCare Nord project focus on offering home monitoring to COPD patients - as simple as possible in order to reach out to all COPD patients in the region and achieve a full and large scale implementation in the region. The EPITAL project, which was a pilot project in the Municipality of Lyngby-Taarbæk had a different ambition. In this project the ambition was to establish a new healthcare organization within the municipality which should provide extensive support to COPD patients.
- The TeleCare Nord project aims at ensuring close monitoring of patients with chronic obstructive pulmonary disease (COPD). Patients measure their oxygen saturation, heart rate, blood pressure and weight a couple of times a week, and the results are transmitted electronically to healthcare professionals at the local hospitals who analyse the data and adjust medication and treatment if needed. By measuring their health, patients also become aware of how they can ease life with COPD – for example by seeing the effects of exercise and diet on oxygen saturation and heart rate. The project helps to bring down the number of hospital admission days, and telemedicine is less time-consuming than ordinary treatment methods.
- The Tele-Care Nord project is a joint partnership between municipalities, the regions and the GPs. This large-scale project, in which all stakeholders in the healthcare system collaborate across organisational levels, is unprecedented in Europe. Results from this project contributed to the national decision to roll out tele-health for COPD patients in all municipalities and regions by 2019.
- The TeleCare Nord project was implemented in Region North, the smallest of the 5 Danish healthcare regions. The project managed to roll-out telehealth support to all 1.256 COPD patients in the region, who were able to use telehealth support. The project included participation from all 11 municipalities in the region, from the 4 hospitals and from GP’s in the region. And the project was followed by 4 research projects at Aalborg University with the objective to build the evidence for Telehealth.
- As mentioned the scope of the project was to provide telehealth support in the simplest way possible. Therefore the patients were asked to do home monitoring by means of questionnaires and a few selected devices, like oxymeter and bloodpressure devices. Depending on the situation of the patient, there could be different intervals for home monitoring – e.g. every day or every 3. day. Reported results from the patients would be checked by a COPD nurse in an asynchronous way – i.e. this may be done the day after the patient reported the results. If patient results indicated a need for adjustments or further treatment, the COPD nurse would then reach out to the patients. The technical setup is based on the National Danish Helthcare-IT architecture, which involves the National Service Platform and sundhed.dk. In order to ensure the necessary flexibility the telehealth platform, which was chosen for the project, is an open source platform – the OpenTele platform. Denmark was among the first countries to adapt the Continua Health Alliance standard for devices in patients homes, and the project was based on these standard – and in general on the HL/7 standards used in Danish healthcare.
- The OpenTele platform both support very simple and more complex telehealth projects and the main functionality is based on a questionnaire which can be defined by clinicians. The patients can report measurements based on the questionnaire in combination with different devices. The platform support direct registration of device data in the system. The flexible questionnaires in combination with use of devices based on the newest standards has proven to be a key element because it allows clinicians to define measurements and feedback from patients, which is specific to the patients conditions. This flexibility is also the reason why the platform can support a range of different chronic patients.
- In order to implement the large scale telehealth project in Region North, it was necessary to establish a new way of cooperating between the healthcare region, the hospitals, the municipalities and primary care. Also, experience from the project revealed the need to establish an organization which can handle all the practicalities – i.e. ensure that tablets and devices are delivered to patients who are enrolled in the project and also support the patients, if devices break down or if there are other technical issues. An important result of the project – apart from realizing the need for an operating service center - was therefore an organizational setup and experience, kind of Integrated Care, on how the whole region and the involved stakeholders and actors should work together in a new way, in order to support chronic patients with telehealth technology. This setup is now contributing to the Region taking the next steps towards also offering telehealth support for diabetes and heart patients.
- TeleCare Nord suggests that the economic potential of telemedicine is largest for patients with more severe COPD (GOLD 3). TeleCare Nord estimates that the potential economic gains from this particular group amount to 7.000 DKK annually for each patient in municipalities and region. The cost reduction is primarily driven by fewer hospitalizations.
- Here you see an open tele simulated consultation
- OpenTeleHealth is a universal cloud-based remote health measurement platform. Citizens can measure health data at home using an app and a wide range of medical measurement devices. Doctors and nurses can access patient data from a web portal.