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					Information exchange and
  patient - centered care

       Ib Johansen, MI
       www.medcom.dk
Danish Health Sector
5.4 mill inhabitants
95 % citizens access to Internet
5,8 mill Mobilephones

63 (38)Public hospitals – 21,000 Beds
>10 private hospitals-     < 250 Beds

3,450 GPs      (2,000 clinics)
 811 Private specialists, 205 P/T
 322 Pharmacies
2,700 Dentists (1,650 clinics)
1,829 Physiotherapist (580 clinics)
 224 Chiropractors
 726 Psychologists

  5 Regions
 98 Municipalities
  1 Private Health Insurance
MedCom - Who are behind ?
• Danish Ministry of Health
• Danish National Board of Health
• Ass. of Danish Regions
• Ministry of Social Affairs
• Ass. of Municipalities
• Danish Doctors Association
• Danish Pharmacy Association


• Budget 2 mill €/year = 40 cents / citizen
   – 55 % staff, running cost
   – 45 % specific projects
         What is MedCom ?
                                                                                              MedCom


• Project-ideas                                                                                       Amter




                                                                                                              V.Sjæ
                                                                       Ringk




                                                                                                                                     Fborg



                                                                                                                                                    KøbA
                                                                                              Sø Jy




                                                                                                                      SStrø




                                                                                                                                                                  KPLL
                           12. feb 2000




                                                                                                                              Rosk
                                                                                      Vejle




                                                                                                                                                           Born
                                                                               Ribe
                                                    NJyl



                                                                 Årh




                                                                                                       Fyn




                                                                                                                                             H:S




                                                                                                                                                                         SSI
                                                           Vib




                                                                                                                                                                               ML
                        3 udskrivningsbreve         85     80    75    1       0      75      90       85     50      70      68             50     1      50
                        4 amb. notater              30     80    75    1       0      75      90       85     0       70      0      0       0      0      0
                        5 skadebreve                85     80    75    1       0      75      90       92     70      70      68     1       0             50




• Project management
                        6 røntgensvar               85     0     5     0       0      75      90       62     40      70      68     0              0      50
                        16 lægevagtnotat                   80    75    60      70     75      90       85     75      65      68     50      50     50     0
                        43 Speciallægeepikriser     20     20    20    20      20     20      20       20     20      20      20     20      20     20     20
                        50 Fysioterapeutepikriser   0      0     0     0       0      0       0         1     0       0       0      0       1      0      0
                        49 Bookingsvar              0            0     0       0      0       1        15     0       0       0      0       0      0      0




• Consensus-standards
                        1 indlæg.henvis             10           1     0       0      10               15     0       1       4      0              0      0
                        2 ambhenvis.                10           1     0       0      10               15     0       1       4      0              0      0
                        7 røntgenhenvis.            10     0     10    0       0      10      5        15     0       1       4      0       0      0      0
                        44 Speciallægehenvis.       1      0     1     1       1      1       1         1     1       1       1      1       0      0      0




• Technical advise
                        9 kemisvar                  85     80    75    60      65     75      90       85     40      65      74     50      50     50     75     60           1
                        11patologisvar                     80    0     0       0      30      90       85     60      65      5      65
                        13 mikrobio.svar                   80          0       0      75      75       85     60      65      50     0       50     0      60            50
                        yy klin imm. svar           0      1     0             0      0       0        80     0       0              0       0      0      0



                        8 kemirekvirering           0      0     0     0       0      0       0         0     0       0       0      0       0      0      0      0            0



• Marketing
                        10 patologirekv.            0      0     0     0       0      10      0        16     0       0       0      10      0      0      0
                        12 mikrobio. rekv.          0      0           0       0      0       0         0     0       0       0      0       0      0      0             0



                        14 ruclæger                 20     10    10    10      50     50      35       10     20      20      17     50      25     25     0
                        15 rucapoteker              0      0     0     0       0      0       0         0     0       0       0      5       0      0      0




• Pilots-tests
                        48 ructandlæger             0      10    0     5       0      5       15        0     0       0       15     50      0      15     0
                        47 ruclægevagt              100 100      0     100 100 100 100 100 100 100 100 100                                   0     100     0
                        ff rucfysioterapeut         0      0     0     0       0      0       0         0     0       0       0      0       0      0      0
                        rr ruclaborartorier                                                                                                                       0            30




• Openness
                        25 recept læger             59     55    47    35      39     50      55       50     40      40      35     30      15     20     65
                        17 recept lægevagt          90     90    90    90      90     90      90       90     90      90      100 100        90     90     0


                                                    90 Meddelelsen er igang                   0       Meddelelsen ikke igang                       startet i 2000
MedCom


Center for
        -
Sundheds-telematik




                                national MedCom
                     All using VANS
                         EDI / XML-standards

                     r

                     1      
                             
                         1† 
               MedCom -The Danish Health Data Network
                                           Messages/Month
1500000                                                                                             Prescriptions
                                                                                                    1389023 84%
                                                                                                    1039105 = 73%
1400000        GP´s with EDI :             2120 = 100 %
1300000        Specialists with EDI:        765 = 94 %

1200000        Hospitals with EDI :         63 = 100%

1100000        Pharmacies with EDI:        322 = 100 %
                                                                                                    Disch. Letters
               Doctors on Call:                 5 = 100 %                                           1131750 94 %
                                                                                                    682923 ==85 %
1000000
               Health Insurance:                5 = 100 %
 900000
                          /min
               102 messages                                                                         Lab. reports
 800000
                                                                                                    988151 99
                                                                                                    543040 = 82 %
 700000
 600000
 500000                                                                                             Lab Requests
 400000                                                                                             349840 = 85 %

 300000
                                                                                                    Referrals
 200000                                                                                             177525 = 65 %
 100000
                                                                                                    Reimbursement
      0   92    93   94   95     96   97   98     99   20   O1   O2   O3   O4   O5   O6   O7   O8   21049 = 99 %
MedCom

                                      Communication – patients
Danish Centre for
Health Telematics                     Based on national MedCom standards
                      • Results ready when patients need them
                      • GPs advice to patients updated and
                        relevant
                      • Acces to relevant patient information
                      • Higher quality – fewer mistakes
                      • No paper handling



                       Amter
                    med i MedCom
                       1 til 1 (15)
MedCom
                                            Denmark –
Danish Centre for
Health Telematics
                                       European frontrunner
                           Benchmarking ICT use among GP in Europe
                                      (2007) - 29 countries
                    • 100 % GPs are using EMR ( invested by own money)
                    • 100 % GPs are using MedCom e-communication
                    • 91 % broadband connection




                        Amter
                     med i MedCom
                        1 til 1 (15)
         GP visits / EDI penetration

  120

  110

  100                                          Consultation (x 1000)

   90                                          GPs % (100 year
   80                                          2001)
                                               GP-EDI %
   70

   60

   50
          2001     2002   2003   2004   2005


Source: MedCom, 2005
MedCom and Sundhed.dk

Sundhed.dk
Health Portal
2000 -

MedCom
Health Net
1994 -
Security Management
   Medication profile
Central database 2 years
PEM - Personal e-Medication
 WEB – E.LPR
Hospital cases
    Waiting times




X
    Waiting times




X
    Waiting times




X
    Waiting times




X
    Waiting times




X
WebEHR - Consent
View – All Episodes of Care
View – All Episodes of Care
View – All Episodes of Care
bv
        Lab results
All labs / results <5 years
MedCom
                                 Central servers,
Center for
                                 e-Referral Hotel
        -
Sundheds-telematik



                                       VANS




                                       e-Referral
                                         Hotel




                     r

                     1      
                             
                         1† 
MedCom


Center for
Sundheds-telematik
        -
                                    Status - Patients
                     • Reduced waiting times
                     • Information about waiting times
                     • Info about treatments – number of
                       cases
                     • Patients access to own data
                                 – Cronical diseases = selftreatment
                     • Medication costs – “reduced”
                     r

                     1      
                             
                         1† 
MedCom


Center for
Sundheds-telematik
        -
                                          Status DK 2008
                     • Transfer of messages between different
                       systems and different Health Care
                       providers
                     • Patients access to own data, selftreatment
                     • Actual Health Care Provider have access to
                       relevant data
                     • Informed patients = better selfcare
                     • Strategy:
                                  –   obligatory use of EMR,
                                  –   e-mail consultation
                                  –   Digital certificate for all public services
                      r

                      1   1† 
                             
                              
                                  –   Service Oriented Architecture (SOA)
MedCom


Center for
        -
Sundheds-telematik




                                       Ib Johansen, MI
                                              MedCom
                                 Rugaardsvej 15, 2.sal, 5000 Odense C
                                              Denmark

                                         www.medcom.dk
                                          ijo@medcom.dk

                     r

                     1      
                             
                         1† 

				
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