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Electronic Patient Records in hospitals

Country: 
Denmark
Partner Institute: 
University of Southern Denmark, Odense
Survey no: 
(3)2004
Author(s): 
Terkel Christiansen, Mette Birk-Olsen
Health Policy Issues: 
New Technology, Quality Improvement
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no no
Featured in half-yearly report: Health Policy Developments Issue 3

Abstract

Development and implementation of EPR in the whole health care sector by the end of 2005. EPR can be seen as a part of an IT strategy for the whole health care sector allowing access to information about health care and a better exchange among health care professionals involved in the treatment of a patient. It is the vision that patients will get access to their own patient record.

Purpose of health policy or idea

It is the aim to develop and implement the use of Electronic Patient Records (EPR) in the whole health care sector. The document "National IT strategy for the health care sector 2003-2007" by the Ministry of Interior and Health (2003) includes a description of initiatives to strengthen the coordination of IT initiatives at the central level and to promote an optimal application by the providers of health care. The strategy is a continuation of the former IT strategy for the hospitals 2000-2002. These initiatives should ensure the fulfilment of the agreement of 2003 between the government and the counties - as a part of the yearly economic agreement between these two parties - that all hospitals have introduced EPR based on common standards by the end of  2005. The users of EPRs must by then have acquired the necessary qualifications to use the records, and  relevant organisational changes must be made in order to secure the best possible application of EPRs.

The introduction of  EPR can be seen as a part of an overall IT strategy for the health care sector which gives the citizens better access to information in general about health and health care, and to ease the exchange of information about patients between health care providers. Thus, the overall vision of the IT strategy is:

  1. to contribute to a better  interplay between the citizens and the health care providers and - more generally - to support the citizens´ ability to take care of  own health and treatment,
  2. to promote a continuous patient course although the patient may be in contact with a number of different providers. Exchange of patient data between providers must be easy, and it gives the citizen a possibility to influence own treatment,
  3. a tool to register and find information which is relevant for the health care providers for planning and medical decision-making as well as a tool for easing the communication internally and between institutions and sectors. Better communication is expected to lead to better quality of care,
  4. from a societal point of view IT should assist in a better use of resources that are available in the health care sector. It is expected to influence work processes across sectors and professional boundaries and to lead to increased quality of care and a better control and organisation of health care activities.

While EPR have been used extensively by GPs during the last 10 years, the introduction of EPR in hospitals have lagged behind. Various initiatives have been  taken  in the counties without necessary coordination. Still, each county is developing their own system, but in cooperation, benefiting for each other's experience. The EPRs also vary between specialties as each specialty has specific needs for information.  A national standard for an EPR has been developed, named G-EPJ.

A precondition for the IT strategy is that each person in Denmark has an identification number  which information about date of birth (DD/MM/YY) followed by four digits.

In the municipalities, care for elderly is supported by care journals. At the present moment 80-85% of the clients are covered by an electronic journal. A CareMobile project aims at using small portable PC when visiting and caring for elderly in their homes. It is the aim that information about client can easily be exchanged, for example in case of hospitalization (Source: Kommunernes Landsforening Nov. 27, 2003)

Main points

Main objectives

Increased efficiency in use of health care resources, increased  quality of care. Better coordination of the health care process. Centrally controlled coordination of  the implementation and use of  IT.

Type of incentives

 It was 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 should 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.

Groups affected

Hospitals (run by the counties), hospital personnel, general practitioners, primary sector, pharmacies etc. wíth whom the hospitals are in contact.

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Characteristics of this policy

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

IT in the health care sector is not new. In 2002, 87% of all general practitioners used an electronic journal, and a number of IT systems existed in the sector, including the patient administrative system (PAS), booking systems, laboratory systems. In general there are no resistance towards using IT as long as it can support and ease working routines. But different hospitals and hospital departments have different working routines and norms which risk being changed in order to obtain the best possible utilization of EPRs. Consequently, EPRs can create resistance to changes within a hospital, department, or between professionals.

Political and economic background

The budget agreement between the government and counties for the year 2003 included an agreement on "a common goal that the hospitals in the country have introduced electronic patient records by the end of 2005" (Ministry of Finance - Finansministeriet 2002). This has been followed up in the National IT-strategy for the health care sector 2003-2007 by the Ministry of Interior and Health (Indenrigs-og Sundhedsministeriet 2003) where a number of goals have been set up with respect to citizens, health professionals and society as a whole. The strategy can be seen as a further development of the "National IT Strategy for hospitals 2000-2002".

Change based on an overall national health policy statement

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no no

Origins of health policy idea

The main part of the EPRs that exists is based on local initiatives (by hospitals, departments or wards). Each system has been developed through a cooperation between different IT suppliers, resulting in different IT solutions. This has created isolated "IT islands" where different EPR systems is not able to communicate with each other. Until now, it has been difficult to obtain acceptance of a common national standard for the EPR system, in particular because many counties  have gone a long way in  implementing their own local or regional EPR system. At the present moment, a new generation of EPR systems is in process of being developed which makes it possible for hospital departments both within and outside a given county to communicate electronically in spite of different EPR systems. Such systems require common standards and flexibility, that is, systems build on modules.

The primary actor in the development of standards has been the work by the National Board of Health to validate the national G-EPR (Basic Structure for Patient Records) which has created the basis for common standards and definitions of concepts.

Approach of idea

The approach of the idea is described as:
renewed: Development started in the beginning of the 1990s. In 1996 The ministry of health gave economic support to local development of IT solutions. Many initiatives started in 1996-97.

Innovation or pilot project

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

Stakeholder positions

The implementation of EPRs vary considerably by county. Some have just started and are at the planning stadium while others have used EPRs in a number of departments, or even at a whole hospital. There is an equally great variation with respect to a politically approved  IT strategy for the health care sector according to EPJ-Observatory (2003).

In many countries the EPRs started as initiatives at hospital departments, often by especially interested persons as the local driving force, and gradually is spread to the whole organisation.

The latest development with a national focus on hospital EPRs have creates a certain competition among counties which have already gone a long way in developing EPRs and acquired experience. Consequently, they want to influence the development of standards.

Influences in policy making and legislation

Some counties and hospital directors have criticised the the budget agreement between the government and counties for the year 2003 when the agreement was negotiated in spring 2003, and again in the fall of 2003 when the ERP Observatory published its status report (EPJ-Observatoriet 2003). The reason was that some counties were of the view that the goal of 100% coverage of EPR in hospitals could  not be reached by the end of 2005. Other counties were more positive towards a central control of the development.

Legislative outcome

success

Adoption and implementation

Administrative personnel in the counties, IT suppliers, hospital management and hospital personnel are included in the adoption and implementation of EPRs. It consists of  a number of tasks, including

  1. development of  IT competences of personnel,
  2. organizational changes, including changed work routines.

The process has been described at a 20/80% process- 20% IT and 80% organizational development.

Monitoring and evaluation

The introduction of EPRs is currently being monitored and evaluated by the EPR Observatory (Danish: "EPJ Observatoriet") and the Ministry of Interior and Health. The EPR Observatory was founded in 1998 by the then Ministry of Health with the purpose to follow and evaluate 13 selected EPR projects. Since 2001 the Observatory follows and describes the EPR development in the Danish health care sector through current collection of information and publication of a yearly status report. The report informs about, e.g., the IT budget by the counties, as compared to the total budget, number of beds covered by EPRs, and benefits of using EPRs (evaluation of benefits and barriers to the introduction of EPRs).

The Ministry of Interior and Health undertakes a current follow-up of the national IT strategy, including ongoing initiatives. In addition, each single county and hospitals make evaluations, especially of the IT capabilities of the users, use of time, access ability and work routines.

Dimensions of evaluation

Structure, Process

Results of evaluation


 

Expected outcome

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

Impact of this policy

Quality of Health Care Services marginal rather fundamental fundamental

Use of EPRs is one of several effective means to support and document a systematic quality assurance of the services by the health care sector, including increased professional quality, improved coordination and organization of work routines.

The development and implementation of EPRs is expensive in terms of software, hardware, establishment of IT work stations and education of personnel. The running costs will also demand resources for securing support and continuous development. In the long run, a number of effects in terms of increased productivity, efficiency and documentation can be expected.

 

References

Sources of Information

EPJ-Observatoriet 2003. Statusrapport 2003.
Finansministeriet 2002. Aftaler om finansloven 2003.
Indenrigs- og Sundhedsministeriet 2003. National IT-strategi for sundhedsvæsenet 2003-2007.
Nyhedsmagasinet Danske Kommuner. Højteknologi ind i ældreplejen. 27. Nov. 2003 (www.dk.kl.dk/default.asp?id=19808)

The website www.sundhed.dk, established in December 2003, collects information about health and health care and is a tool for exchange of (confidential) information about patients within the healthy care sector. It is a vision that citizens can get access to their own patient records. The website includes information about diseases, prevention, treatment, pharmaceuticals, law,  facts and statistics about health and health care activities  in the health care sector (including surveillance of the health of the population, health statistics and health care statistics).

Author/s and/or contributors to this survey

Terkel Christiansen, Mette Birk-Olsen

Suggested citation for this online article

Terkel Christiansen, Mette Birk-Olsen. "Electronic Patient Records in hospitals". Health Policy Monitor, 04/04. Available at http://www.hpm.org/survey/dk/a3/2