MedCom’s Anna Seeberg Hansen and Janne Rasmussen present an overview of MedCom’s role in the Danish healthcare system and its priorities in the area of digital health.
The demographic changes most countries are facing make healthcare a topic with extraordinarily high priority these years. At the same time, advances in, for example, medicine and technology provide new opportunities but also complexity to the present and future health and wellness domain. One aspect, which is currently prevailing in Denmark, is enhanced continuity of care, especially considering a growing elderly population, a specialisation of hospital services and increased area of responsibility for other healthcare providers such as general practitioners and homecare.
Many initiatives at national and local level have been started to develop and implement solutions for this situation, and a common agreement is that an even stronger patient-centred focus and better cross-sectorial collaboration and communication are of the essence. In this context, information and data sharing between relevant actors in a pre-agreed, structured and technically supported way plays a fundamental role.
This piece will provide an overview of MedCom as a national bridge-builder between the public and private actors in the Danish e-health context. For 25 years, MedCom has worked to establish electronic communication and data sharing as a natural process in relevant daily operations concerning patient care, whether the patient is in the GP office, in hospital etc.
The role of MedCom
MedCom was established in 1994 as a public-funded, non-profit organisation and is financed and owned by the Ministry of Health, Danish regions and Local Government Denmark. Our purpose is to facilitate the co-operation between authorities, organisations and private firms linked to the Danish healthcare sector and to ensure development, testing, dissemination and quality assurance of standards for electronic communication and information sharing in the healthcare sector to support excellent continuity of care.
We have together with our collaborating partners succeeded in securing an extensive use of standardised electronic messages so that important patient information is shared at the right time between primarily hospitals, homecare and general practitioners but also other health providers such as physiotherapists, dentists, pharmacies, specialist practitioners etc.
We achieve this through adherence to our core values:
- User focus
- Pragmatic approach
We believe that dialogue and collaboration create reliability, that a user focus leads to solutions that work, that a pragmatic approach, where we listen and actively discuss with our collaborating partners, is key to efficient results, and, finally, that we are open to new knowledge, ideas and diversity.
The Danish healthcare system
To understand MedCom’s role and activities better, the context in which we operate and the national goals we contribute our part to, is explained in this section, where a brief overview of the overall Danish healthcare system and the digital health strategy are provided.
The Danish healthcare system is universal and based on the principles of free and equal access to healthcare for all citizens. The healthcare system offers services to all residents in Denmark, of which the majority are financed by general taxes. The healthcare system operates across three political and administrative levels (national, regional and local levels): the state, the five regions and the 98 municipalities.
- The state sets the national targets and laws, provides the central funding and administers data on all citizens in Denmark
- The regions’ main role is to administer the 54 public hospitals, but they also manage most of the psychiatric services and oversee the private practice sector services, e.g. general practitioners, through contracts
- The municipalities are responsible for a wide range of health services like home care, nursing home, rehabilitation and physiotherapy, social psychiatry, local and specialised dental care.
In addition, the sector overall encompasses approximately 2,000 general and 1,200 specialist practices, 400+ pharmacies and 100+ IT systems from approximately 60 vendors.
Digital health as a national priority
To support the ability for each part to be able to communicate electronically with each other, infrastructure, standards and a collaborative approach have generated much progress over the years. Now more than six million messages are exchanged every month.
It is also the result of a longstanding strategic effort. Since the late 1990s, Denmark has had a national strategy in first health telematics, which then became e-health and now is mostly referred to as digital health.
This has enabled Denmark to take a position as one of the leading countries in the world when it comes to digital health. The current strategy, ‘A Coherent and Trustworthy Health Network for All -Digital Health Strategy 2018–2022’, states that Denmark will continue to develop a health system that acts as a unified, close and coherent healthcare network.
The strategy includes five focus areas:
- The patient as an active partner invites patients to be a part of their pathway through better insight into their illness, including data, and flexible interaction with the health system, including from home
- Knowledge on time focuses on providing the healthcare employees with easy, timely and secure access to relevant knowledge
- Prevention is the prevention of illness in the first place. The health system has to be able to meet patients earlier, in a more targeted way and where they are
- Trustworthy and secure data is crucial so that patients trust the health system to keep their health data secure
- Progress and common building blocks refer to new technology, including testing new ways to roll out common solutions and developing a common digital infrastructure that links IT systems together.
Ensuring digitally supported data sharing in Denmark
MedCom’s work cuts across several of these strategies as it is more to be part of the foundation on which to build progress in all the digital health priorities. What we do can be divided into three overall categories that all contribute to ensuring timely and secure exchange of structured and relevant information between healthcare parties.
Firstly, system management for the operation of common Danish IT infrastructures within the healthcare sector. MedCom administers three systems for public authorities. One of the systems is the Danish Health Data Network (DHDN), which is a secured network for data communications in the Danish healthcare sector. DHDN links secure local networks together in a shared infrastructure. Furthermore, the system management also works on creating virtual conference rooms and is a cross-sectorial video infrastructure that can be used by all parts in the healthcare sector.
Secondly, we create Danish standards by profiling international standards for the Danish context in collaboration with the healthcare providers and IT vendors. MedCom has developed more than 150 standards, profiles and web services, which are all being used increasingly. At the same time, new standards are being developed on a regular basis. All of them are implemented with IT vendors within the healthcare sector. MedCom’s standards ensure that the various IT systems and organisations can reuse the data which is exchanged.
To also ensure that the communication is efficient and with as few errors as possible, vendors and organisations go through a standardised, uniform and ISO:9001 2015-certified test procedure at MedCom’s test centre. Successfully tested systems are certified by MedCom.
Lastly, we make sure that the standards are put to proper use and generate value for healthcare professionals and patients. Implementation projects, which secure the use of the standards in daily practice, take up a large part of MedCom’s activities. The projects cover a wide range of health and social care services.
An example is the programme for ‘Digital General Practice’. In 2018, MedCom launched it with the aim to strengthen the connection and quality in the treatment in general practice and the digital co-operation between the sectors in the health service. This also includes a more intelligent IT solution in the clinics and more self-service for patients.
In the Danish health system, the general practitioner (GP) is the citizen’s gateway to most other parts of the health sector. The GP, therefore, has an essential role in the overall system itself and for the citizens directly. However, general practice is characterised by an insufficient capacity of GPs and geographical areas in which general practices are disappearing.
This combined with a higher life expectancy, increase in prevalence of lifestyle diseases, reduction of beds in hospitals and faster discharge from hospital puts the core of the primary health sector under great pressure. There is, consequently, a need to streamline work processes to ensure more time for patient consultations, and one way to support this is to digitalise.
Digital General Practice includes:
- Fast patient overview
- Better preparation for consultations
- Intelligent inbox
- Improvement of discharge summary
- Communication with local nursing
- Citizen-oriented app (My Doctor).
In addition, we have new projects on widespread use of video consultations and artificial intelligence. All in their own way contribute to establishing a better use of time and resources in general practices, but jointly they also characterise a sustainable and future-oriented general practice sector, in which the patient and GP relationship is still at the core of the business.
The topic of healthcare provision is perhaps more pertinent than ever in Denmark, as health services are challenged due to a growing elderly population, increased medical costs, more specialised hospital services and increased area of responsibility. Therefore, an even stronger patient-centred focus and better cross-sectorial collaboration and communication are of the upmost importance. MedCom has worked as a national bridge-builder between the public and private actors in the Danish digital health context for many years and will together with its partners continue to optimise the use of data sharing.
Anna Seeberg Hansen
Please note, this article will appear in issue 9 of Health Europa Quarterly, which will be available to read in April 2019.