|Implemented in this survey?|
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.
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
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:
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)
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.
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.
Hospitals (run by the counties), hospital personnel, general practitioners, primary sector, pharmacies etc. wíth whom the hospitals are in contact.
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
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.
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".
|Implemented in this survey?|
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.
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.
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.
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.
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.
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
The process has been described at a 20/80% process- 20% IT and 80% organizational development.
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.
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.
|Quality of Health Care Services||marginal||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.
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).
Terkel Christiansen, Mette Birk-Olsen