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

Danish approach of flexible decentralised development of e-government based on a common
architecture and standards.
Observations
The two standards-based initiatives described above present a contrast in terms of the pace of
achievement of strategic goals that have been set for the health sector. While Denmark is
acknowledged as having made impressive progress with the overall development of e-government in
its health sector, the development of its common health data network has occurred more steadily and
quickly than its implementation of EHRs.
There are a number of reasons for this situation. First, electronic transmission of health data is a
more straightforward and non-controversial activity than the design and implementation of EHRs.
Transmission of electronic messages between different health organisations is clearly much more a
technological challenge than the business of defining and implementing standards relating to the
structure and content of such messages. Second, defining standards for EHRs is very complex for two
reasons – the sheer variety of potential EHR standards that need to be taken into account (especially in
the pan-European context), and the fact that an EHR must meet the sometimes very different
requirements of clinicians and hospital administrators.
A third factor that has slowed nation-wide implementation of EHRs is the impact that the
Structural Reform is having on the health sector, imposing a major reorganisation of hospitals, and a
reallocation of service delivery responsibilities that sees municipalities playing a larger role in the
health sector in the future. While some commentators feel that the Structural Reform presents a
strategic opportunity to make significant progress towards the goal of a fully standardised and
interoperable health ICT environment, the weight of opinion is that the organisational changes already
imposed by the Reform are of such magnitude that adding a further drive towards health ICT goals to
these changes would risk successful implementation of the Reform as currently proposed, and also
threaten the continuity and quality of service provision through the reform period.
A fourth factor behind the slower pace of EHR development is the major investments that health
sector organisations (especially hospitals) have each made in their current clinical and administrative
systems and surrounding business processes. Each organisation has taken its own approach to systems
and processes, meaning that as well as being faced with significant costs of change they also face a
very complicated environment for achieving interoperability. These costs and complexities are not
evenly spread among all actors, meaning that each has differing incentives and challenges to face in
arriving at some satisfactory sector-wide and collaborative outcome. Discussions about this with
representatives of a number of Danish regions highlighted the existence of strong and divergent vested
interests acting as obstacles to finding the most optimal way forward with the implementation of
EHRs.
Conclusion
Health care is one of the most complex areas for e-government implementation in OECD
countries. It is an area where significant outcomes hinge upon the way that information is used, both in
service delivery and back-office administration. There is a very high requirement to ensure the privacy
and security of health information, and high costs associated with the development and operation of
health ICT systems and applications. There is also often a significant difference between the goals,
incentives, views, knowledge and skills, and informational requirements of hospital administrators,
clinicians and vendors of health sector ICT products and services.
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