The Danish ehealh Portal sundhed.dk. A presentation of danish ehealth and the Sundhed.dk International Foundation

Transcription

1 The Danish ehealh Portal sundhed.dk A presentation of danish ehealth and the Sundhed.dk International Foundation

2 Why? International interest in sundhed.dk and Danish ehealth Purpose: Consultancy: many years of experience Fast, cheap solutions Reliable and public-private-network Mature ehealth projects / Trade promotion Contact: Jakob Uffelmann, CEO, the Sundhed.dk International Foundation jau@sundhed.dk

3 A public-private foundation which aims to commercialize the best of Danish Healthcare & ehealth Sundhed.dk International Foundation is an open construction with participation of public and private organizations and companies Was founded summer 2017 and functions according to set of articles The overall aim is to commercialize Danish experiences and products within Healthcare and ehealth The idea originated from the international interest in sundhed.dk, the National Danish ehealth portal

4 What can the foundation bring to the table? The idea is to bring an ecosystem and experience from both sides of the table to solve the task With access to proven commercial products and the end users the foundation can set the right team to solve the challenge Focus on the service, user journey and/or challenge to bring the right components into the equation rather than selling just one product, research rapport or similar Solid experience with large scale implementations of ehealth solutions

5 Types of service Consultancy Analytics & roadmaps Technical infrastructure ehealth implementation Healthcare concepts Technological assessments & advisory Large scale implementation advisory Delivery Software solutions (Medico, EHR, eprescription, custom applications) ehealth portals Healthcare concepts Research collaboration Project & program management Infrastructure components

6 The Danish ehealth landscape Overview of the danish ehealth The main stakeholders Regions, Municipalities, state The national suppliers Board of Healthdata, sundhed.dk, Medcom The major solutions Elektronisk patientjournal, Medicinkort, sundhed.dk portalen, Landspatientregisteret, E-journal, Laboratorie databanken, Vaccinationsregisteret

7 The state the first of a 3 layered health system

8 Strategy Ét sikkert og sammenhængende sundhedsnetværk for alle The strategy focus on The citizen as an active partner The right information at the right time Preventive care Safety and trust Common building blocks

9 Area of responsibility Turning health politics into initiatives National programs Sets goals for the regions and municipalities Plays an active role in several health IT projects and initiatives Some funding of projects (minor) Overall governance of some national initiatives

10 Regions the main supplier of healthcare

11 Regional strategies Each region got their own strategi and one common De facto the majority of the regions ehealth endeavor is the development and maintainance of the EPJ systems. Not alot of room for innovative projects and improvements The common strategy is about how to create digital solutions to help patients experience coherent treatment across sectors This has not been fulfilled strategy period is

12 Regional assignments Operate hospitals and outpatient clinics Run university hospitals Clinical research Agreement with general practitioners Operate the electronic patient record and clinical databases

13 Municipalities Prevention, rehabilitation and some support of chronic patients and telemedicine

14 98 municipalities Common tender on telemedicine but otherwise little coorperation The national strategy on digitalization is their main common strategic document It s more a vision than a strategy with specific initiatives Focus is on welfare technology and telemedicine Very little ehealth

15 The major national ehealth organizations

16 Organization made in 2003 to run the national Danish ehealth portal Grown from a content only portal in 2003 to an advanced platform and infrastructure component Integrated to more than 120 different data sources Ownership 80 % regions 14 % state 6 % municipalities Semi independans of state governance with its own political board

17 Medcom came around in 1994 and is a cornerstone in Danish ehealth Tasked with supplying standards for communication Based on mutual agreement and had no mandate to force standards on anyone Also works with certifying various systems for general practitioners Operates the Danish healthdatanet Ownership 33 % state 33 % regions 33 % municipalities Governed by a board of civil servants

18 Estabilished in 2015 after various attempts to make different ehealth organizations in the stats Governed by the ministry of health Works with making reference architechtures in the field of integration, datamodels and security Operates Medicinkortet, National Service Platform and the common security model for the health professionals

19 The solutions Sundhed.dk portalen Electronical patient records Medicinkort Landspatientregisteret E-journal Laboratorie databanken Vaccinationsregisteret Content and more

20 Sundhed.dk

21 Sundhed.dk Established in December 2003 First personalized services in april 2004 using digital signature for citizens and health professionals Medicine fra 2004 EHR notes in 2005 Laboritory results from 2006 Consolidated overview for clinicians in 2013 Sundhedsjournalen integrated with all EHR systems in the hospitals and all GPs systems. Next step is municipalities

22 Some statistics. Population 5,8 million people 3,3 million know sundhed.dk 1,7 million unique users every month ~50 employees at sundhed.dk + ~10 consultants Yearly budget is around 9 million More than 120 different integration points on the portal A mix of information for patients and doctors and interactive services

23 The number of users increases Unique visitors, month by month from 2003 to Copenhagen 1st August 2018

24 Users of sundhed.dk Resourceful fathers Chronic patients Urban women Citizens educated Copenhagen 1st August 2018 Female relatives

25 Sundhed.dk Safe Harbor for personal clinical data In general people are concerned about others having access to their personal data People find that sundhed.dk s handles their data in a secure and trustworthy way

26 My health Overview Copenhagen 1st August 2018

27 E-journal A read-only version of all EPJ notes, national database.

28 Elektroniske patient journaler Denmark got 4 different systems Capital Region and Region Sealand Joined forces and bought Epic Region South has Cosmic from Cambio But just had a tender and selected Columna from Systematic Region Midt got Columna Region North got Clinical Suite from DXC but just decided to enter the Region South tender and get Columna

29 Connectivity? Epic covers 2 regions and is one system thats operated in conjunction. The platform is called Sundhedsplatformen and is subject to alot of controversy. We ll get back to that! The 3 other regions will end up with the same system but it will be 3 different instances of the EPJ and not one system. Data is instead exchanged though sundhed.dk instead of trying to obtain direct interoperability and for very good reasons.

30 DXC/Clinical suite

31 Systematic/Columna

32 Epic/Sundhedsplatformen

33 Sundhedsplatformen The ambition was extramely high but there are a multitute of problems Implementation was hurried Medication is not a module but part of the flow. This can t integrate to Medicinkortet yet Problem with getting correct data out of the system. The datamodel is a secret The system is extremely hard to use and often requires 30+ clicks to complete a task or flow A large part of the clinical staff is more or less in open war with the leadership of the region. The doctors felt stigmatized at one point. Savings was calculated in budgets in advance but the activity has dropped signifiacant making it double trouble

34 Medicinkortet - FMK Most popular application on sundhed.dk Is used extensively by all health professionals in Denmark The app is extremely popular with the citizens Its an important patient tool for empowerment and to navigate when a patient is send between various specialists Based on eprescriotion and build out with medication from the clinic and elderly homes

35 Some statistics. Population 5,8 million people Pageviews by citizens January views The app: views Health professionals traffic on Sundhedsjournalen which include the medicine card January 2018 GPs Hospitals sessions sessions Add to this the use of the medicine modules that integrates directly into the medicine card. This handles most of the daily use.

36 It started here:

37 Medicine card anno 2018

38 The app downloaded ~ times

39 Laboratoriedatabanken

40

41 Landspatientregisteret Contains all patient contacts with the healthcare system Repositoty of DRG Dates back to 1977 Access for citizens thought sundhed.dk

42 Vaccinationsregisteret

43 Patientdata overview Strong and patientcentric alternative to colonoscopy

44 Patients handbook.

45 Doctors handbook. #1 with GPs

46 Colon cancer screening using camera pill Strong and patientcentric alternative to colonoscopy Can add capacity and expand uptake to screening programs Higher sentivity compared to traditional coloscopy (article out soon) Minimal invasive Research and development of machine assisted reading of films is in progress

47 Chemotherapy to Central Hospital in Denmark

48 Infertility is the most common disease for people between 20 and 40 years of age Long waiting lists and lots of uncertaincy for the involved parties. Huge demand for valid information and certaincy

49 Mobil tool for health professionals Diagnose and operation codes Organizational information Doctors handbook Medication with recommendations, ATC, dose suggestion and more

50 Blended care for alcohol addiction Sundhed.dk, Region Syddanmark, municipalities

51 Strategic ambition for Digital security and reliability of data More data on sundhed.dk A more user friendly portal More users to sundhed.dk New strategic period will likely focus on mobility and interactive services

52 The Danish Model - for connected ehealth Build components and eco systems rather than large systems Grow organic through mutual agreements Standardize only on demand and let the business needs dictate the standard, not the technical side Decentralize governance and let the system boundaries follow the organizational boundaries Don t fall into the governance trap when you consolidate we did!

53 Perspectives Digital security and reliability of data Overview and coherent experience for patients in treatment National entry point for cross sectorial access to data Citizens own data from wearables and questionieres Better tools for empowerment of chronic patients Better tools for prevention and early diagnosis

54 Does it make a difference? Giving access and sharing of data does make a difference Quality measurements Increased quality in the dialogue between patients and healthprofessionals Empowerment of relatives Activity measurements across sectors Transparancy for patients and policy makers

55 Patient satisfaction

56 Thank you!