OECD Peer Review of E-Government in Denmark - ePractice.eu

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standards for quality application of ICT in health services, with a particular emphasis on ensuring quick implementation of EHRs. E-government in the health sector Denmark has taken a strong interest in the use of ICT in its health sector since the 1960s. In 1995, the Government established a Hospital Commission to investigate whether hospitals could be organised in a better way. The Commission’s report had a special focus on how ICT could be used to increase the efficiency and quality of health services. Two particularly relevant initiatives were in the background: 1. The Government’s 1995 IT Action Plan, which stated that the use of IT offered extensive opportunities for improved health services, and identified EHRs and health data networks as essential in this context. 2. A 1994 action plan for EHRs, which funded development of eight to ten EHR solutions by counties. The National Board of Health evaluated these proposals and, in 1999, made some suggestions regarding standards for EHR concepts, technology and information security. The Commission’s report identified the need for common EHR data standards to support communication between EHR systems, and for a minimum of content and substance in those EHRs. The report also highlighted the need for changes in the legislation relating to patient registration, to enable smooth communication of relevant information between health sector organisations. It also noted that, in many hospitals, there was a need for investment in the physical ICT infrastructure (networks, etc.), and adjustments in organisation and business processes to allow for introduction of EHRs. The opportunities and challenges pointed out in the Commission’s report were all issues covered in national health sector IT strategies from 1999 onwards. Standards-based health sector ICT Today, Denmark provides two clear and contrasting examples of the development and use of standards-based ICT and data management in the health sector. These are: 1) MedCom, a co-operative national programme between public and private organisations that enables electronic communication between all parties in the health sector – both administrative and clinical; and 2) the ongoing process of developing EHRs. MedCom – the Danish health care data network Development of the Danish healthcare data network started in the late 1980s, when interest in electronic communication in the health sector led to the launch of local projects by the Association of County Councils. These projects highlighted the need for cross-sector communication in health care. A trial electronic data interchange (EDI) project took place between 10 pharmacies and 11 medical practices in 1990. The first regional EDI projects began in 1992. In 1992, as a reaction to these projects, Funen County proposed a national EDI initiative bringing together State and county government, private companies and health care organisations under the name “MedCom – The Danish Healthcare Data Network”. The objective was to develop national standards for the most common communication flows between medical practices, hospitals and 151
pharmacies (e.g. referrals and discharge letters, laboratory results, X-ray letters, prescriptions and hospital billing, etc.) This first project (MedCom I) ran from 1994 to 1996. Slow dissemination and adoption of MedCom I standards led to a second project (MedCom II), undertaken during 1997-1999. The primary purpose of MedCom II was to ensure rapid and widespread adoption of MedCom I standards. In addition, the scope of the project was broadened to include local authorities, physiotherapists, dentists and telemedicine initiatives. Internet technology was also starting to be used widely in Danish government, and so was incorporated into the design of the MedCom standards. MedCom II resulted in EDI-based communication in the health sector between hospitals, medical practices, and pharmacies becoming more common, with around 1.3 million “messages” exchanged each month (representing 30-50% of the total number of messages exchanged in the sector at that time). By the end of 1999, more than 2000 medical practices, pharmacies, hospitals, and laboratories were connected to the MedCom healthcare data network. In a 1999 financial agreement between counties and the State government, MedCom was made a permanent fixture, with the goal that it would contribute to the development, testing, dissemination and quality assurance of electronic communications in support of good patient progression thorough the health system. It became clear that large-scale usage of EDI was creating quality assurance problems, mainly due to EDI service providers implementing the MedCom standards differently. This led to establishment of the MedCom III project, which focused on this issue, during 2000/01. Since 2002, work has been ongoing on MedCom IV which, to a large extent, builds upon MedCom III. MedCom IV consists of four sub-projects: 3. An Internet strategy aimed at fully developing the national, Internet-based health care data network. 4. Municipal projects aimed at achieving large-scale use of MedCom standards for communication between hospitals and municipal health services. 5. The XML-EHR communication project, aimed at achieving nation-wide use of all relevant MedCom standards for communication within and between hospitals. 6. The SUP project aims at achieving Internet access to EHRs, both within a county and across county boundaries. Today, standards-based EDI has overtaken paper-based communication in the Danish health sector. EDI is used by 88% of general practitioners, 57% of specialists, 100% of pharmacies and hospitals and 26% of local authorities. Examples of the benefits include time savings of around 50 minutes per day for medical practitioners, and a 66% reduction in follow-up telephone calls for hospitals. One of the most significant and public outcomes of MedCom so far has been the development of Denmark’s health sector portal, www.sundhed.dk (Health Denmark), based on MedCom standards. The portal is the main Internet access point to Danish health authorities, facilitating communication and services between health professionals and citizens and allowing users to book appointments with GPs, receive e-mail consultations, and renew prescriptions. 152
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OECD PEER REVIEW OF E-GOVERNMENT IN
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TABLE OF CONTENTS SUMMARY ASSESSMEN
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ANNEX A: OVERVIEW OF POLITICAL AND
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OECD PEER REVIEW OF E-GOVERNMENT IN
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While it is vital that the Governme
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Finance and the MVTU following thes
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this challenge was frequently menti
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Alongside the problem of the reliab
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In terms of its impact on organisat
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and businesses. While it is not cer
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considerable strategic importance t
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government organisations are aware
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8. Monitoring and evaluation Denmar
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Abstract There is a favourable envi
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E-government context Government pol
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The Structural Reform Between 2005
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administrative procedures. The find
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Figure 1.2 E-government structure a
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II. THE CASE FOR E-GOVERNMENT Denma
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• Creation of a competitive marke
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Abstract Government organisations c
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Source: OECD E-Government Survey: D
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Figure 3.2 Legislative and regulato
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modernisation process, especially i
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and the generally high level of tru
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fund it has created providing a tot
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outright barriers. The clearest evi
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Figure 3.5 Use of public digital se
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• Employment status: students and
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APPENDIX TO CHAPTER 3: INFORMATION
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Figure 3.A.4 ICT usage among Danish
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Figure 3.A.8 Internet access among
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IV. PLANNING AND LEADERSHIP The e-g
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The strategy notes that Denmark is
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exchanged electronically. This is e
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with even lower rankings for driver
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involvement in e-government therefo
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In addition to support for the Join
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Figure 4.5 Responsibility for desig
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V. ORGANISATIONAL CHANGE This chapt
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Structural Reform and e-government
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The Task Force has initiated a proj
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Figure 5.2 Share of documents recei
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Box 5.1 Improving middle management
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Abstract Collaboration is relativel
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Co-ordination of e-government polic
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Box 6.1 Key e-government co-ordinat
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The CRS encompasses a number of reg
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Digital signatures are now being wi
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Denmark - something that could be a
Page 101 and 102: Staffed by employees from the Digit
Page 103 and 104: The additional workload is connecte
Page 105 and 106: such a framework be designed; and 3
Page 107 and 108: schemas used in different areas of
Page 109 and 110: • Changing conditions in the publ
Page 111 and 112: municipalities, which might otherwi
Page 113 and 114: The current situation has evolved o
Page 115 and 116: Figure 6.6 Impacts of partnerships
Page 117 and 118: Source: OECD E-government Survey: D
Page 119 and 120: Abstract The Danish vision for e-go
Page 121 and 122: Figure 7.1 Drivers of e-government
Page 123 and 124: • To ensure internal knowledge of
Page 125 and 126: • The lack of information and the
Page 127 and 128: Figure 7.2 Source and type of e-gov
Page 129 and 130: Figure 7.4 Constraints on demand fo
Page 131 and 132: When asked about the level of impor
Page 133 and 134: eing for one group or another (e.g.
Page 135 and 136: Figure 7.8 Use of electronic delive
Page 137 and 138: The national portal www.denmark.dk
Page 139 and 140: identification of the relationship
Page 141 and 142: Abstract At the all-of-government l
Page 143 and 144: • At least 60 percent of all publ
Page 145 and 146: External audit Another important el
Page 147 and 148: can have impacts: 1) “service cha
Page 149 and 150: Figure 8.4 Responsibilities for mon
Page 151: CASE STUDY 1: STANDARDS-BASED E-GOV
Page 155 and 156: Danish approach of flexible decentr
Page 157 and 158: CASE STUDY 2: ACHIEVING E-GOVERNMEN
Page 159 and 160: Estimation of benefits for both eDa
Page 161 and 162: ANNEX A: OVERVIEW OF POLITICAL AND
Page 163 and 164: ANNEX B: INSTITUTIONAL CONTEXT AND
Page 165 and 166: Administrative environment Organisa
Page 167 and 168: Other State government responsibili
Page 169 and 170: − Models to support inter-organis
Page 171 and 172: ICT usage As discussed in Chapter 3
Page 173 and 174: Promotion of IT Research and Educat
Page 175 and 176: other reforms. The plan identified
Page 177 and 178: Overall, these action plans were su
Page 179 and 180: E-mail addresses for everyone Anoth
Page 181 and 182: had developed extensive practical k
Page 183 and 184: ANNEX E: METHODOLOGY Definition of
Page 185 and 186: The survey asked State and local go
Page 187 and 188: ANNEX F: GLOSSARY This glossary was
Page 189 and 190: BIBLIOGRAPHY Agency for Governmenta
Page 191 and 192: Ministry of Science, Technology and
Page 193: Statistics Denmark (2004b), Nyt fra
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