Country profile: Denmark

    Denmark has 5.5 million inhabitants and is administratively divided in five regions. The country has a predominantly public health provision with 60 public and a few small private hospitals. Furthermore, there are 3.000 primary care physicians (GPs), 1.000 practicing specialists and 330 pharmacies, as well as dentists, physiotherapists etc. Home care, nursing homes, rehabilitation etc. are municipal tasks that should, to a large extent, be integrated into the healthcare system. The more this is the case, the sooner patients can be discharged from hospital. The buzz-word in Denmark for IT support for frail people being cared for at their homes is “welfare technology”. 

ICT use and eHealth strategy

The use of ICT is extremely widespread among Danish GPs, with almost all Danish GP practices using a computer with Internet access (91 percent with broadband access; broadband connectivity thereby being among the highest in Europe). Local storage of patient data is extremely commonplace, as is the use of computers in consultations. It is, in fact, exceedingly rare to find a GP practice that doesn’t use computers in patient care. The storage of patient data is also very common and not limited to administrative data: nearly all radiology results are stored electronically. The transfer of electronic health data is also commonplace, with almost all laboratory results being transferred electronically. The transfer of data among health care providers is also a routine ocurrence, as is the use of ePrescription (which has all but replaced non-electronic prescriptions). Also, for over 40 years, all Danish citizens have received a unique personal identifier at birth. No chip card for citizens’ access to health or health insurance has been issued.

The Danish eHealth strategy dates back to 1996, the same date at which the implementation of an EHR system was decided on. Since then, several cycles of public eHealth strategies and implementation have been on-going. Today, they comprise four elements:

1. MedCom, www.medcom.dk  manages a secure health data net and intersectoral communication of more than 40 standardised message types (e-prescriptions, lab orders and answers, referrals, discharge letters etc.).  All patient management systems for hospitals GPs and pharmacies have incorporated the messaging system used on the secure net after certification by MedCom.  Four million messages including 80% of all prescriptions are exchanged per month.  ID management and data security are handled via a 3 tier agreement system, a software based PKI infrastructure and logging of all entries.
2. The Health Portal www.sundhed.dk can be accessed with digital signature, by  citizens as well as professionals - under the ruling of Danish data protection authorities. While citizens only gain access to general and personal information, professionals have access to a number of services including reading of electronic records etc. 
3. About 15 different electronic patient record systems are interoperable in the GP sector, but EPR’s are still a challenge for many hospitals. Denmark hosts the new SNOMED CT organisation, and, at preset, central authorities focus at  on advanced IT medication support and the patient summary.
4. Telemedicine has an increasing focus on tele-homecare.  Formalized consulting across the borders of the country is rare.

One of the main challenges of Danish eHealth policy is the great number of individuals involved in its implementation, which has lead to problems implementing systems such as EHR in hospitals. In response, the organisation of electronic health care has been reformed drastically in 2007 under the label of Coherent Digital Health in Denmark.

Legal framework

The globalization of medicine as a consequence of eHealth makes the clash of principles between free EU market and the national autonomy of health provision evident. Denmark generally relies on bilateral transborder agreements with concrete partners in eHealth matters.

Denmark also explicitly tries to avoid regulating eHealth specifically, given that electronic health care is seen and implemented as a natural extension of health care in general. While several provisions regarding electronic health care exist in broad regulatory efforts such as the Health Act of 2008, there is comparatively little legislation concerning eHealth specifically, especially considering the role eHealthcare plays in the Danish healthcare field.

However, the latest eHealth strategy points towards the fact that regulating data security and patient privacy in eHealth scenarios specifically is a necessity, which may lead to more targeted regulation in the future. Generally, the Danish legislation has been very flexible with regard to healthcare reforms whenever legal provisions were perceived as an impediment to technological progress.

Denmark respects the patients’ and citizens’ rights as recommended by the Council of Europe and ratified EU directives such as 95/46, 97/66 and others, but in practice many health professionals do find the rules cumbersome, and they complain.

Danish groups participate in many EU, DG. INFSO and InterReg projects  steadily leading to an exploration of transsectoral, transregional and transnational interoperability and integration of services.  This has been in line with documents and recommendations like ”Towards Interoperable eHealth for Europe”, 2005 by ESA, ITU and WHO, the “i2010” plan and the “Connected Health” document of  DG INFSO. These projects have shown that integration does not depend solely on the technical framework for interoperability, but solutions must also respect the semantic, conceptual, political, legal, cultural and organizational differences.

All these aspects as well as remuneration, liability, insurance fraud and other issues are to be mastered before healthcare can be provided across Europe irrespective of national borders. This will clearly be demonstrated by the tendered Large Scale Pilot on European interoperability for the Patient Summary and the Medication Record.