Denmark, an eHealth nation - What can we learn?

Sundhed.dk is the official portal for the public Danish Healthcare Services and enables patients and healthcare professionals to find information and communicate. IHE Netherlands talks to Thomas Krogsgaard Holme, IT Architect, involved with the development of this portal and speaker on the Dutch conference on Architecture in Health IT, organised by HL7 Netherlands, IHE Netherlands and Nictiz on the 20th of June in het NBC at Nieuwegein, the Netherlands.

The site www.sundhed.dk is a public, internet-based portal that collects and distributes health care information among citizens and health care professionals. It is unique in bringing the entire Danish health care sector together on the internet and providing an accessible setting for citizens and health care professionals to meet and efficiently exchange information.

Developments

The initiative to establish The Danish eHealth Portal was taken by the Association of County Councils in Denmark, the Ministry of Interior and Health and others back. The backend portal was developed as the result of a project competition (EU open procedure). The nine-month development phase was launched in December 2003. In 2009 the eHealth portal was upgraded and relaunched on a new technical platform.

About the period of developing Thomas Krogsgaard Holme tells us following, in a more detailed way: “Before 2003 there was very simple eHealth portal based mainly on CMS content and without integration to healthcare data. At a certain point in time the Danish government decided to have a portal with the name ‘sundhed.dk’ (healthcare). This all took place around 2001. In 2002 we started with building the portal with IBM tools. Some time later the decision was made to switch from IBM Websphere to our own program. This all was still before my employment. The issue was, we wanted to be able to have more suppliers than just IBM for writing the code. It improved not to be possible. And, some of the costs were regarded as pretty high at IBM. So, we decided to let the code to be written by NNIT. Shortly after the new portal was launched, sundhed.dk decided to insource development and maintenance. From that time on I was involved. First of all we had to change our CMS-system (Content Management System), Team Site. We implemented our own frontend and kept the backend the same as developed by NNIT. But, there still were some issues. So we decided also to change the backend and selected a new CMS-system. We ended up with Sitecore. It was important to us that we kept developing the frontend ourselves. At approximately the same time we changed the implementation of the frontend website and moved to the MVC-technology by Microsoft. We remade all asp server side pages. It was also necessary to change all kinds of details which were very cumbersome. By then, we had changed the entire portal frontend, amongst others the complete url-structure.”

Developments go on. “The most recent major change is that the doctor’s handbook – about 8000 pages written by healthcare professionals – is implemented, and also a patient section, which describes the same content in non-technical terms”, tells Thomas Krogsgaard Holme.

What are the plans for the future? Holme is proud to announce that they started to integrate the portal with the social media such as Facebook and LinkedIn. “The major purpose is to promote the regular website in the Google search engine.”

IHE-XDS

Thomas Holme

Thomas Holme

Were there difficulties to encounter during the total development? Holme: “We were supposed to integrate with a national IHE XDS index. The index is a metadata library, in which you can lookup what kinds of medical data is available and where. However, the project was stopped due to difficulties with the data sources. They proved unable to provide the metadata for the index, and with no metadata consuming the index became futile.”

Copy or not?

Since the portal was launched in 2003 traffic have grown from approximately 100.000 unique visitors per month to 900.000 in February 2013. In 2006 we had around 400.000 page views per month, in February 2013 we passed 1.500.000. So we dare to say that the portal is rather successful. Can other countries copy the Danish system? Holme laughs as says: “No, you can’t copy a system. Sometimes you are able to copy a bit. Some of the elements will be common to all systems. Everybody needs for example a CMS. But, what makes it difficult to copy, is that all systems are based on the medical system in the specific countries.”

It is generally assumed, according to the people of sundhed.dk, that their experiences are particularly relevant to countries with a homogenous health care system. Also countries that have one source of financing for healthcare, free choice of healthcare provider within a cooperating sector and agreed standards of data exchange between operators and authorities. And, last but not least, countries must have a high level of trust regarding the public sector and the access to personal information.

At the conference of the 20th of June in the Netherlands Holme will start telling about how the Danish healthcare system is built up. “But my focus will be on the technical aspects of architecture”, he let us know.

 

More information: www.sundhed.dk/service/english/

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Characteristics of the Danish healthcare

Homecare, nursing homes, rehabilitation etc. are municipal tasks that integrate with the healthcare system, meaning patients can be discharged early from the hospital.

Broadband penetration is the highest in Europe and more than 95% of the population has access to the Internet.

All healthcare institutions and GPs have access to both the open and the secured Danish Health Data Network. All GPs have an electronic patient record system and use electronic communication and transactions extensively.

About 15 different electronic patient record systems are interoperable in the GP sector and four different homecare records are used in the municipalities. Through a consensus process with vendors of almost 100 systems, all patient management systems for hospitals, GPs, homecare and pharmacies have incorporated the messaging system after special certification.

A unique personal identifier is issued to all Danish citizens at birth, and a secure web-ID (called NemID) is issued free of charge. The web-ID is used to access netbanking and to access public sites with eServices.

eHealth including telemedicine is implemented in municipal, regional and national collaboration’.

Source: www.sundhed.dk

 

The purpose of the Danish Ehealth portal

- Bring together relevant information from all parts of the health service

- Offer a shared platform of communication

- Empower patients by offering maximum insight and transparency in the health care  sector

- Offer health care providers easy access to clinical information about their patients’  medical history.

 Source: www.sundhed.dk