Morten Elbaek Petersen, CEO, sundhed.dk

Title: Transforming public healthcare -The
Danish National
e-Health Portal
Speaker Info: Morten Elbaek Petersen,
CEO, sundhed.dk
Agenda
• The goals of the portal sundhed.dk
• A guided tour of sundhed.dk
• The Danish Health Care System – and
sundhed.dk
• Information for cancer patients
• Evaluation and challenges
The goals of the portal are:
• To bring together future electronic communication between
patients and the health care service
• To function as a communication tool for the stakeholders of
the health care service.
• To give citizens and/or patients an overview of the
organization of the health care service and information related
to the use of the healthcare service; and support the patient in
attending to his own health situation.
• To put expert information at the disposal of health care
professionals.
• To facilitate inter-patient communication on how to cope with
chronic diseases; ”online patient networks”
Features:
Citizens/Patients
Directory of names and addresses
•
Contact information
•
E-services (booking, prescription renewal, consultation) (log on)
•
E-commerce (pharmacies) (log on)
•
Comparison of prices, quality and accessibilty
Information about prevention and treatment
•
Medical information (eg. information about treatments)
•
Waiting list information from hospitals
•
Patient satisfaction mesaures on every hospital dep.
•
Smileys for every hospital
•
Preventive medicine
•
Health laws and regulations
•
Patient to patient dialogue – connecting patients coping with similar issues
Access to own health data (log on)
•
Cross-sectorial personal electronic medicine profile
•
Patients’ medical history (since 1977)
•
Electronic Health Record (from hospital records)
•
Online Donor Registration and access to own data
Features: Health
professionals
Information for GP (log on)
• Web access to laboratory data
• ICPC search of diagnoses from GP’s electronic healthcare program
(Linkportal)
• Online access to Medical Handbook (open for all users, but aimed at GP’s)
All Health care professionals (log on)
• eMedicine records
• Electronic patient records etc (almost total coverage of the 5 regions)
• Waiting list information from hospitals
• Cochrane library
Regional and national information
• Contact information (authorities, departments, health personnel)
• Information on referral principles to hospitals/regions
• Preventive medicine
• Health laws and regulations
• Laboratories and consultants
The Danish Health Care System
- and sundhed.dk
The Danish Health Care
System
• Public health care (85 % of costs are financed through taxes)
• Free access to most health services for all Danish citizens
• A homogenous health care system
3 levels:
NATIONAL: Parliament, Government / Ministry of Health; makes
the laws for the two acting levels
REGIONAL: 5 Regions; Hospitals (about 80), Psychiatry, Primary
health care, e.g.
LOCAL: 98 Municipalities, Child nursing, Home nursing,
Preventive treatment and health promotion eg.
The ”Nearest-level” principle in
Denmark - the General Practitioner is
the gatekeeper
Physiotherapist
General
Practitioner
Hospital
Casualty
Department
Pharmacy
Patient
Chiropractor
Practising
Specialists
Practising dentists
Organization of
sundhed.dk
Owners/Board (Politicians)
Project Management group
Reference Group
15 members (Health Professionals)
IT arcitecture group
CEO
Secretariat
Computer Contractors
800 editors from Health Authorities
Information for cancer patients
How can cancer patients benefit
from sundhed.dk?
• Access the same information as health professionals
– Medical information in general
– Cancer pathway information for every region
– Patient satisfaction information from every hospital
– Access to the patient’s own medical record etc.
– Patient-to-patient dialogue
– Living Will-possibility
National cancer pathways
•
In October 2007: agreement between the Danish Government and the Danish
Regions on acute action and accurate information for all cancer patients. The core of
this > develop integrated cancer pathways as organizational and clinical standards for
the diagnostics and treatment for all cancer types.
•
Cancer pathways focus on “the journey of the patient through the health care
system”. The aim is to reduce processing-times, in particular to reduce referral time,
obtain faster diagnosing and quick onset of treatment.
•
Furthermore it is the objective to ensure that all cancer patients are treated according
to national clinical guidelines.
•
14 working groups supervised by the National Board of Health were established and
developed cancer pathways for the diagnostics and treatment of 34 cancer types.
•
A national solution for monitoring the cancer pathways is developed focusing on timestandards.
Evaluation and challenges
How to measure the success?
Due to the time and proces of establishment, the Danish
eHealth Portal never had a business case on which to
evaluate the impact and the resources spent to
document any such impact!!!
•
•
•
•
International and peer recognition
The owners’ willingness to invest further
Acceptance from clinical staff
Acceptance from the public
International and peer
recognition
•
•
•
•
•
•
EU-award 2004: e-health, along with MedCom
Top of the web 2005 by The Danish Ministry of Science, Technology and
Innovation and The National IT and Tele Agency
E-commerce award 2006 by The Danish eBusiness Association and The
Danish IT Industry Association
The digitalization award 2006: by among others The Digital Taskforce,
The Ministry of Science, Technology and Innovation and The Danish IT
Industry Association
The Computerworld Honours Program 2007 – the committee was
searching for organizations and institutions that are creating the global best
practice in leading the worlds ongoing IT revolution.
Health Consumer Powerhouse rating 2008:
“We have recommended other countries to take a look at the Danish
internet portal sundhed.dk, because in our opinion it is the state of the
art”
Health Consumer Powerhouse
rating 2008
Willingness to reinvest and
broaden the portal
• Since the launch in 2003 the scope of the portal
has broadened
• In 2007 some of the owners’ signaled that the
current scenario is the least ambitious out of
three – the others making sundhed.dk a provider
of services to other portals or making it an
integral part of the IT infrastructure.
• Financing further development is still an issue.
Clinical acceptance
• General agreements have helped enable GP’s
and others in the primary care sector to acquire
a Digital Signature and publish information in a
national directory/”Yellow Pages”.
• Criticism of response time
• Hospital employees need frequent and fast log
on procedures and are in less need of ”outside”
information > less use of sundhed.dk
Public acceptance: Total unique
visitors 2003 -2009
Unique visitors, month by month
350000
300000
250000
200000
Serie1
150000
100000
50000
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au 4
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au 5
g05
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au 6
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au 7
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au 8
g08
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9
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Some facts that document the
effects of the portal:
•
One third of the information seekers are reassured by the information on sundhed.dk,
and choose to delay or avoid a visit to the GP. Fewer information seekers become
worried and arrange to see a doctor. The net saving is app. 900.000 consultations
and 4 to 10 million kilometers in transport.
•
Enough consultations were handled via e-mail in 2008 to result in a further saving of
½ to 1 kilometer of transport for every dane.
•
Every third user of the price check for dentist treatments end op saving money as a
result.
•
Every third user of the waiting list time check for hospital treatment discover, that they
can save more than 1 month of waiting by choosing another hospital.
Some facts that illustrate the effect
of current use
•
50,000 Danes are currently in AC therapy. The Center for Selfmanaged Oral
Anticoagulant Therapy is working on a pilot project with a group of these patients who
make measurements themselves and enter the results on sundhed.dk. Algorithms
then calculate whether the patient’s medication dosage has to be adjusted. Normally,
patients having AC therapy must go to the local hospital at regular intervals – but with
the web-based decision support, patients can now avoid the frequent visits.
•
More than 90% of the diabetes patients indicate that by means of the DiaLog solution
they are better able to follow the development in their diabetes, intervene and
exercise self-care. 70-80% of the health care professionals say that direct patient
access means more problem-oriented interviews, increased co-responsibility,
improved self-care and higher patient satisfaction.
•
The Medicine Profile on sundhed.dk automatically registers all purchases of
prescribed medication in Denmark as individual, personal medicine profiles for every
citizen to help improve the quality of drug therapy. In the annual report 2003-2004
from the Danish Pharmaceutical Association, reference is made to Danish and
international studies, which show that 6-14% of all cases of hospitalization in medical
wards is due to problems related to medicinal products. Obviously, even a small
reduction in medication errors has great impact on both economy and quality of life.
Specific results from EHR’s
• In January 2007 GP’s and citizens gained access to
electronic health records from the hospitals in the first
area in Denmark.
• Evaluation >>> EHR’s
– Add value at the GP’s
– Offers the patients reassurance – especially patients with
chronic conditions.
– Are generally accepted and considered safe: The
protection measures behind the patient access online is
considered safe by 91 per cent.
Specific results from patient-topatient dialogue
•
•
Since late 2007 hospital wards and patient organizations have
cooperated to create on-line dialogue where patients with similar
chronic diseases can share experiences.
Evaluation >>> patient networks:
–
–
–
–
many readers (anonymous users) that return frequently
fewer ”bloggers”/contributors (10 %).
Real interaction and exchange of advice and contact
Many patients respond that they find new information and knowledge of
how other patients experience their condition.
– Most find that the information puts them at easy while a minority
becomes more anxious.
– not 100 % clear if patients find that their lives have improved due to the
patient networks online.
Challenges in the adaption
• Diffusion of Digital Signature
• Shared ownership sometimes means that
you are nobody’s pet project/darling
• Sundhed.dk is a supplement to local,
regional initiatives and sometimes
compete with these initiatives for the same
ressources (time and money)
Factors contributing to the
succes of sundhed.dk
•
In Denmark the internet has surpassed all other media and sources
regarding the citizens’ search for health information. 60 percent of
the population has used the internet for this purpose.
• It has been possible to establish a national system of unique and
secure identification of citizens (and health professionals such as
GP’s) – the identification leads to the display of relevant health data
without violation of legislation or the citizens’ rights to privacy.
• General agreements between regions and GP’s, dentists and others
have secured diffusion of services and online service declarations
• Denmark (and other Scandinavian countries) is characterized by
citizens with a high level of trust towards public administration and
protection of personal information