Global healthcare is at a crossroads. There is an urgent need to break down industry silos and increase collaboration to drive progress towards a patient-centric and cost-effective model. Denmark has been at the forefront of many IT initiatives within health services. The majority of these initiatives are based on a common infrastructure, which has helped put Denmark in pole position. The Danish National eHealth Portal, known as sundhed.dk ("sundhed" means "health") helps to promote the optimisation of the Danish healthcare sector. Sundhed.dk is a public, Internet-based portal that collects and distributes healthcare information among citizens and healthcare professionals.
Policy Context
Sundhed.dk is a result of a joint national and regional effort to support healthcare professionals and citizens’ interaction through IT. A comparatively modest investment in infrastructure and a shared system has actually resulted in the development of services that are used across municipalities and regions all over Denmark – and have thus helped regional and local parts of the health service avoid massive investments in solutions that could only be used regionally and locally instead of being compatible. The idea behind Sundhed.dk was to create a single point of access to the Danish health service for citizens and health care professionals by gathering existing as well as future information and communication within the healthcare sector. Behind the user friendly interface of the portal lies a complex infrastructure of connected networks and databases from many parties in the health sector. This infrastructure across sectors and technologies has been created with very few means by using existing data as the foundation, connecting the databases and at the same time supporting an efficient and structured exchange of data among relevant parties in the health sector. In January 2007, a reform was implemented in Denmark. 15 counties were merged into five regions, and 271 municipalities were consolidated to 98. Sundhed.dk supported the reform by tying the former counties together and allowing them to communicate as one region from Day 1. The Danish healthcare authorities provided a vision and strategic direction for a national, interoperable health care system, but they relied on the private sector to provide a competitive technology industry, privately operated support services, and shared investments in health IT adoption.
Description of target users and groups
All Danish citizens have access to Sundhed.dk, enabling patients to communicate, and patients and their families to get an overview of correct and updated healthcare information, making the services appear close-by, open and familiar. Every citizen has his own personal page (available upon identification), which reflects the specific situation of this particular person.
Description of the way to implement the initiative
Sundhed.dk is a partnership established between all public health authorities in Denmark. The overall critical factor in bringing Sundhed.dk to reality has been the organizational and political aspects. The successful implementation first of all needed a powerful management with the participation of the most important stakeholders. The project had to make fast results, focusing on the stakeholders’ benefits. Communication standards were needed – and of course a well-planned IT project. The project was broken down into three main phases. The first phase of the implementation was concluded with the launch of sundhed.dk as an information portal on December 10th, 2003. Efficient communication and distribution of guidelines were among the national benefits of this version. The next version supported collaboration based on functionality such as a reduction of double tests and entering of information only once. In 2004, the final phase of the portal was implemented, now turning Sundhed.dk into a full portal offering full communication and the ability to monitor and optimize treatment by sharing the same EHRs.
Technology solution
Based on MedCom’s (Denmark’s coordinating organization for healthcare IT) existing infrastructure, Sundhed.dk has transformed the Danish health service from consisting of information islands of independent, individual solutions and databases, each with its own limited group of users, into a structure that is based on the joint use of standard solutions and sharing of data. In helping every user who logs on to the portal via the personal identification, the portal has been built in such a way that it adapts the presentation to its user’s needs – it is in fact several channels in one. Presentation management is supported by a role-based and personalized, customizable portal environment. The portal must provide information to a large range of user groups: physicians; GPs; pharmacists; dentists: chronically sick, frequent users; occasional users; etc. Every user group has its own special requirements with regard to the information it needs and how it is presented. To handle all these user groups’ special and sometimes personal requirements combined with almost 100 different applications, adding new applications to the portal every three months, it is crucial to have technology handling presentation management.
Main results, benefits and impacts
Sundhed.dk is a peaceful revolution of communication and collaboration within the Danish healthcare sector. While most public-sector websites are about to adjust to current requirements and expectations, Sundhed.dk was developed from the outset with just this type of service and dialog in mind to enable all parties within the Danish health sector - including the patient - to communicate and collaborate via a single, shared web interface by means of a shared infrastructure, reducing total costs – exactly the opposite of the general trend within health care. Every Danish citizen has his own personal page (available upon identification), which reflects the specific situation of this particular patient. Here, the citizen can find accurate and updated health care information, e.g. view treatments and diagnoses from his own hospital patient record, book appointments with his general practitioner (GP) and send secure e-mails to health care authorities, order medication from pharmacies, monitor own drug compliance and get access to local disease management systems in out-patient clinics. Patients can also renew prescription drugs, survey shortest waiting lists for operations and quality ratings of hospitals, and register as organ donor, and register whether or not they wish to continue to receive treatment if they are critically ill and unable to communicate, and the proposed treatment cannot cure them. By giving access to own health information and supporting a pathway approach, the patient now is encouraged to participate actively in own treatment – realizing the vision of shared care. For example, Sundhed.dk allows diabetes patients and health care professionals in one region to access the diabetes management solution, which is integrated into existing Lab Systems, Hospital Information Systems and Electronic Health Records (EHR). The portal provides the 150,000 Danish healthcare professionals with a better foundation for decision-making. By giving healthcare professionals easy access to the latest patient information from most hospitals and laboratories in the country via the secure portal they get the opportunity to make quick and well-founded decisions in specific situations during treatment. In this way, the patient will experience interaction with the healthcare services as a much more coherent pathway.
Return on investment
Return on investment: Not applicable / Not availableTrack record of sharing
The portal’s range of information and services has proved that it is possible to work across sector borders and specialist fields to present the user with a single point of entry that provides a general view and guides the user to the relevant information and the relevant services. Thus, Sundhed.dk integrates systems that are specific to the Danish health service – but other regional or national health services, or completely different sectors or industries, will be able to obtain similar benefits by making use of the experience gained from sundhed.dk of building transparency and sharing information and systems. Other organizations and communities can also benefit from Sundhed.dk’s approach of establishing agreement on a shared basis and platform so that new services/solutions developed for one region or one purpose are made in such a way that they can also be used elsewhere as organizations and workflows are adjusted to the new electronic possibilities. Recent initiatives that are in part inspired by Sundhed.dk are being planned and/or developed in Sweden, Singapore, Canada and Germany.
Lessons learnt
Lesson 1 - The challenges of the project were to provide a patient-centric and cross-sector health care infrastructure with the capability of collaboration and sharing of highly sensitive information. It was to enable a broad general access for citizens, health care professionals and IT systems. The infrastructure had to support high availability combined with the capability of deploying new functionality and access to new information at low cost and with a minimum time to market. Lesson 2 - These challenges were met by providing an abstraction layer on top of existing platforms and applications. Through an Internet-based, service-oriented portal environment supported by a range of standard integration packages, the project has built a national common infrastructure. Lesson 3 - To optimize the actual value of Sundhed.dk now and in the future, the focus will continue to be not only on the technology itself, but also on the prerequisites for leveraging its potential – thus making it imperative to carefully align incentives, maintain and elaborate a culture of collaboration, and maintain a correct balance between central and local leadership. Lesson 4 - The biggest objection faced by the Sundhed.dk project was of an organizational nature. It was a major challenge to embed local and regional websites in a new, national brand that people could not identify with right away.
Scope: National