Status and perspective of personal health informatics in Denmark

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					   Status and perspective of
 personal health informatics in
             Denmark




Mads Ronald Dahl
PhD, Assistant Professor
Institute of Public Health
Section for Health Informatics
University of Aarhus
Denmark
MD@HI.AU.DK
WWW.HI.AU.DK
                                 1
                 Agenda

•   Introduction
•   History and status
•   Example on our research
•   IEEE workshop input




                              2
3
Denmark (2006)
14 counties
270 local governments
5.430.000 people
43.560 km2
No. 7




                        4
         Danish EHR History
• 1967      System: Control data 3300
  – “in a few years there will be no paper
    journals…..the data will be digital and
    assembled in a fraction of a second”
• First national strategy 1996-2000
  – 13 regional projects and 1 EHR observatory
  – Denmark wants a EHR
     • A lot of technical, system, bits and byte talk
     • Politics
                                                        5
        Danish EHR History
• Second national strategy 2000-2002
  – Focus of EHR in the hospital sector
  – Focus on data standard


• What did we see and hear then?




                                          6
www.epj.dk Crete, October 11,72002
www.epj.dk Crete, October 11,82002
   How did we communicate and evaluate?
 Concepts /                                          B-EHR
                                                                Initiatives of the strategy
                          Integration                                                                                NQR
terminology                                         systems
                            Platform
    (20)                                              (1,2)
                               (8)                                                                        QI Pilot

                                              B-EHR pilots                                         DGMA
                                                 (3-6)                                                                        IQR
        Classifications                                                   NHCR                                                (17)
           (22,23)                                                         (14)

                                                          Pilot NHCR                   NPI (15)
                                                              (14)                                                       Legal-
                                                                                ”New-DRG”                                safety
Basic EHR                                                                                                             clarification
standard                                                        Convertion                                                 (7)
                                        XML-EPJ
                                                              New -> Old (14)                      HealthCare-
                                        messages
                                                                                                     portal
                                          (25)                                         Old-DRG        (18)
                                                                                      accounting
                                               Medication-
                                                messages                                                                      SDN on
                                               in XML (4)                                                                     internet
                                                                                                                                (26)
                    Primary EHR
                        (21)
                                                                                                                              PKI for
                GP-                            Medicatio-                                             User-                   Health
              systems                          profile (16)                                        management              professionals
                                                                                                                                9
                                                                                                                               (24)
        Danish EHR History
• Third national strategy 2003-2007
  – Focus on EHR in the primary health sector
  – and continuous and interconnected
    healthcare system



         •“.. seamless data exchange among parties in
         the health care service is of vital importance”.


                                                            10
           Strategy 2003-2007 vision
    • “The pivotal point is the patient’s influence
      on his own treatment and his involvement
      in self-care. “

    “.. citizen must be able to receive and to give
       relevant and personally customized
       information.”


                                                                 11
http://www.sst.dk/publ/Publ2004/National_IT_strategy.pdf pp 17
                                                   Initiatives of the
                                                        strategy
 Concepts /                                          B-EHR
                          Integration                                                                                NQR
terminology                                         systems
                            Platform
    (20)                                              (1,2)
                               (8)                                                                        QI Pilot

                                              B-EHR pilots                                         DGMA
                                                 (3-6)                                                                        IQR
        Classifications                                                   NHCR                                                (17)
           (22,23)                                                         (14)

                                                          Pilot NHCR                   NPI (15)
                                                              (14)                                                       Legal-
                                                                                ”New-DRG”                                safety
Basic EHR                                                                                                             clarification
standard                                                        Convertion                                                 (7)
                                        XML-EPJ
                                                              New -> Old (14)                      HealthCare-
                                        messages
                                                                                                     portal
                                          (25)                                         Old-DRG        (18)
                                                                                      accounting
                                               Medication-
                                                messages                                                                      SDN on
                                               in XML (4)                                                                     internet
                                                                                                                                (26)
                    Primary EHR
                        (21)
                                                                                                                              PKI for
                GP-                            Medicatio-                                             User-                   Health
              systems                          profile (16)                                        management              professionals
                                                                                                                               12
                                                                                                                               (24)
13
                  Political vision
• Relevant and personally customized information.

• All Danes have an E-box
• Digital signature
  – 720.000 issued since 2003
     •   Valid 2 years
     •   I have 3
     •   20% of Danes (maybe only 5 – 10 %)
     •   Maybe 1-2% use for HI


                                               14
       Danish EHR 2005-2006
• More than 28% of ”Hospital beds”
• 50 % of the hospitals has a EHR system
  – (EHR evaluation report 2005)
• 99 % of general practitioner use IT

    Structured EHR            Extended Green system
    Structured EHR with SUP   Mulitsectional EHR
    Structured EHR with LHR   Cross-sectional EHR
    GEPJ                      Multisectional with health codes
    GEPJ compatible           EHR with SUP
    GEPJ-light                EHR with instructions
    GEPJ-ultra....?           EHR with ......


                                                                 15
   The regional reform in Denmark
   1.1.2007
   From 14 counties to 5 regions


   From 270 to 98 local governments




                                      16
http://www.kl.dk/372656/
                 Full stop
• The Danish health minister (Lars Løkke
  Rasmussen) make a full stop.
  – He wants a central control of the EHR
    implementation
  – One EHR solution for the healthcare sector
  – High ambitions
  – Bad result
  – Who is to blame?

                                                 17
                 Danish focus
• Diabetes patients
• Dermatology
    – Wound healing topics
•   E-mail consultation with general practitioner
•   Medicine profile (sundhed.dk)
•   Pharmacists
•   Donor register
•   One EHR solution

                                                    18
          IEEE 2407 vision
• Healthcare Information for all by 2015
• Provide a standard of
  – Consumer tools to stay healthy
  – Consumer tools to improve health
• Improve healthcare information in
  developing countries



                                           19
        Scientific questions
• What do we mean by “All”?
• How do we stay healthy?
• What improves our health?

• How do we communicate with potential
  consumers of health informatics?



                                         20
Who do we mean by “All”?
             • Above 60 years old
             • Vast population
                   – ~1.2 mill (21%). 1
             • Heterogeneous
               – Income, health, social,
                 mobility. 2
             • Gets ill
                   – 42% of all admissions. 3




             1: Population statistics January 2006
             2: Audun-Olsen, 2001:47
                                                           21
             3: Danish statistics, SYG1A and UD1 2004-2006
             Our research
The study
• cross-sectional survey
• 2000 Danes over 60 years of age
• Postal questionnaire made for the
  purpose.

• 54% responded


                                      22
      Do the elderly use the internet for
   information about health and disease?
• ~45% used the internet
• ~20% searched for health information
• ~3% searched for health information before
  consultation with a doctor
• Age is a factor
• Gender is not a factor
• Attitude towards technology is a factor
• Economy?
• Education level?
• State of health?                             23
ICT in developing country's




                              24
Informatics to the test


   No smoking
   3 days
   12 hours
   27 minutes




                          25
                       Literacy level
Who can we give tools of health informatics?
Example: information on diabetes (thought experiment)

                        Percentage of the population




      info. from Dr.




          Info. from
         general www




          Info. From
            PubMed



                       0%     20%      40%     60%      80%   100%   26
      IEEE 2407 working group
• Should discuss and define:
  – Potential and relevant consumers
  – Level of information complexity
  – Personalized informatics
     • Right information
     • to the right person
     • at the right time
  – Usability of distribution technology
  – Enactment theory

                                           27
     Professor Balthazar




System (code)   Communication (language)
                                           28
   Status and perspective of
personal health informatics in
            Denmark


Mads Ronald Dahl
M.Sc, PhD, Assistant Professor
Institute of Public Health
Section for Health Informatics
University of Aarhus
Denmark

MD@HI.AU.DK
WWW.HI.AU.DK
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