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

Standards-based electronic health records
In a discussion paper that was the basis for the 1999 health sector IT strategy, the Ministry of the
Interior and Health, in co-operation with Danish Counties and the Copenhagen Hospital Corporation,
presented a picture showing that, despite the efforts of the 1990s, the majority of processing of patient
data in hospitals was still being done manually using paper-based health records. From an ICT
perspective there was great variety in the information management technologies being used in
hospital; additionally, their development was not occurring quickly enough.
From an operational/process perspective, all hospitals had a patient administration system
handling essential administrative and operational tasks. The functionality and user-friendliness of
these systems varied widely. The quality of data in these systems was generally regarded as being a
significant problem. From a management perspective, hospitals’ ICT systems were not providing
sufficient basis for management decision making, planning or quality control. The paradox was that
the required data was being manually registered in patient records – the problem was not a lack of
data, but inadequate data management.
This analysis resulted in further recommendations with regard to EHRs that became part of the
1999 and 2003 national health sector IT strategies.
One of these strategies’ goals has been to enable the sharing of data between the disparate ICT
solutions that exist in the sector through the use of EHRs based on common standards. Plans were to
introduce these EHRs in all hospitals before the end of 2005. However, due to problems with the
implementation of the national EHR standard, and the impact of the Structural Reform, in 2004 this
goal was changed to be more open-ended. Under the broad oversight of the Ministry of Interior and
Health, work in this area has been moved forward by the National Health IT Strategy Group (with
members from all levels of government) and a mix of working and steering groups working on
specific initiatives. Two particularly important initiatives in this context are the BEHR (Basic structure
for Electronic Health Records) project and the work of the steering group dealing with the
implementation of the national standard for EHRs.
The national BEHR project will create the basis for co-ordinated development of EHR concepts,
tying health sector ICT to a common architecture with all the associated organisational and
performance advantages such an approach allows. The resulting EHRs will be based on common
standards for clinical definitions, administrative processes and technology, ensuring that
interoperability between different systems can be achieved. The Board of Health has the role of setting
standards.
The EHR work is focused on introduction of EHRs into the health service delivery environment
in a way that ensures interoperability across the health sector. Achieving this requires a number of
initiatives and/or changes to be undertaken at both the whole-of-sector and individual organisation
levels, including a reference implementation of BEHR, establishment of a common data model,
development of XML schemas for communication of health data based on the reference
implementation of BEHR, and education of health sector personnel.
In the background, as a result of the Structural Reform reducing the number of hospital
administrations, there has been a policy question regarding the best way to achieve integrated data
management at the regional level. The National Board of Health has identified two possible
approaches to this issue: 1) develop a single system for all of Denmark; or 2) make the existing
systems interoperable. The weight of opinion is in favour of the interoperability approach, as it both
reduces the operational risks relating to implementation of Structural Reform and fits with the wider
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