Electronic Patient Records in the Danish HC Sector

• Abstract
• Characteristics of this policy
• Purpose and process analysis
• Expected outcome
• References

Abstract

Purpose: Development and implementation of Electronic Patient Records in the whole health care sector by the end of 2005. Coordination and corporation between national authorities, regional authorities and clinical practice of the testing and further development of EPRs through common standards.

Recent developments

Degree of Innovation	traditional		innovative
Degree of Controversy	consensual		highly controversial
Structural or Systemic Impact	marginal		fundamental
Public Visibility	very low		very high
Transferability	strongly system-dependent		system-neutral
current    previous

The changes in the administrative structure of Denmark will support the further development of a national standard for EPR.

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Initiators of idea/main actors

• Government

• Providers

Stakeholder positions

The yearly economic agreement between the government and the counties was made in June 2004, and further initiative hase been taken to fulfill that year's agreement that all hospitals should have introduced EPR based on common standards by the end of  2005. A steering committee consisting for EPR is established with representatives from the Ministry of the Interior and Health, National Board of Health and Danish Regions. The aim of the steering committee is to ensure a coordinated enterprise between the different EPR-projects in the counties of Denmark and ensure the development of the national standard for an EPR - named G-EPR (Basic Structure for Patient Records). The steering committee will at the end of year 2004 make an adjusted plan for the further working processes.

In April 2004 a new version of G-EPR was released. This is a model to automatically report data to central databases like the Database of Patients in Denmark (Landspatientregisteret) and on how to obtain the data for the calculation of DRG (Diagnose Related Groups). One part of G-EPR is the GEPKA-project (Basic Structure for Patient Records and Clinical Testing) which is a testing of some or all parts of the G-EPR model within a clinical context. One Hospital in the project  tested the model for three months and the evaluation - which will be done in October 2004 - is part of the continuing development of a standard for the EPR.

Since July 2004 citizens and GPs can access PEM (the Personal and Electronic Medicine Profile) on the web-site www.sundhed.dk. PEM gives every GP an overview of the prescription drugs of his patients and the citizen can see a list of the medicine products. PEM will at first be based on the data which pharmacies report to the Danish Medicines Agency about patients' purchase of prescription-only medicinal products (Lægemiddelstyrelsen 2003).

The Budget Review 2004 concludes that the introduction of mobile, digital assistance for outward fieldwork like home care potentially involves benefits such as improved quality of data, better services for the user, a better work environment and greater employee satisfaction (Finansministeriet 2004:270). Projects like CareMobil will document benefits and barriers of implementing mobile technology in home care. A standard for the CareMobil-system has been developed and will be tested from August 2004 (Nyhedsmagasinet Danske Kommuner 2003).

Groups Affected

1. Hospitals (run by the counties). 
2. Hospital personnel. 
3. General practitioners, primary sector, pharmacies etc. wíth whom the hospitals are in contact.

Type of Incentives (financial, non-financial)

It is a part of the budget agreement between the government and the association of counties (who are responsible for the day-to-day running of the health care sector) that EPRs shall be implemented. The budget agreement includes ceilings on the local taxation by the counties and the size of a government lump sum grant to each county.

Actors and positions

Government
Ministry of Interior and Health	very supportive		strongly opposed
Providers
Association of Counties	very supportive		strongly opposed
National Board of Health	very supportive		strongly opposed
Association of Municipalities	very supportive		strongly opposed
current    previous

Influences in policy making and legislation

EPR will be a part of the changes in the administrative structure of Denmark that abolishes the 14 Counties of Denmark and making five Health Regions which will have the responsibility of the Hospitals and Health Care. The financial responsibility will mostly remain with the Government.

The new generation of EPR systems is in process. National authorities want  regional authorities and clinical practitioners to cooperate in the development of common standards of an EPR system.

One of the arguments of the Commission on Administrative Structure for removing one administrative level is that it naturally requires political and administrative willingness to acknowledge benefits of e.g. development of one national EPR instead of a number of different systems (The Ministry of the Interior and Health 2004).

Legislative outcome

Enactment

Actors and influence

Government
Ministry of Interior and Health	very strong		none
Providers
Association of Counties	very strong		none
National Board of Health	very strong		none
Association of Municipalities	very strong		none
current    previous

Positions and Influences at a glance

Adoption and implementation

Administrative personnel in the counties, IT suppliers, hospital management and hospital personnel are included in the adoption and implementation of EPRs.

New releases of G-EPR (Basic Structure for Patient Records) have been developed and will be tested in selected clinical practises. These testing of the model will be a part of the further development. New versions of the G-EPR model is in progress and is described in details on the web-site: http://medinfo.dk/epj/gepj/.

Hospitals or hospital departments have introduced different EPR systems locally, and as a consequence there is a need for a common standard for a basic structure of the EPR systems.

Pilot projects for developing and validating standards for EPR systems at a national level (G-EPR by the National Board of Health). While PRs are still being further developed and refinded, it is the goal to implement these no later than by 2005. 

Monitoring and evaluation

The introduction of EPRs is monitored and evaluated every year by the EPR Observatory (Danish: "EPJ Observatoriet") and the Ministry of Interior and Health. The next status report will be published end of October 2004.

Dimensions of evaluation: structure, process.

Expected outcome

It is expected that all hospitals will be able to exchange information electronically across county borders and others with whom they collaborate, such as the primary care sector, by the end of 2005.

Impact of this policy

Quality of Health Care Services	marginal		fundamental
Cost Efficiency	very low		very high
current    previous

The changes in the administrative structure of Denmark will support the further development of a national standard for EPR.

References

Sources of Information

www.sundhed.dk

Finansministeriet 2004. Budgetredegørelse 2004. Udgifter og effektivitet i den offentlige sektor.

Finansministeriet 2004. Aftaler om den kommunale økonomi for 2005.

Lægemiddelstyrelsen 2003. Indikation. Nyhedsbrev fra Lægemiddelstyrelsen. 22 August 2003.

The Ministry of the Interior and Health 2004. Recommendation of the Commission on Administrative Structure. No. 1434.

Nyhedsmagasinet Danske Kommuner. Højteknologi ind i ældreplejen. 27. November 2003.

Regeringen 2004. Det nye Danmark - en enkel offentlig sektor tæt på borgeren

Author/s and/or contributors to this survey

Mette Birk-Olsen

Suggested citation for this online article

Mette Birk-Olsen. "Electronic Patient Records in the Danish HC Sector". Health Policy Monitor, 9 October 2004. Available at http://www.hpm.org/survey/dk/a4/4