Transcript Dias nummer 1

Road map to Denmark's healthy future
Strategy for digitalization 2013-2017
Nanna Skovgaard - Head of Division, Ministry of Health
Flemming Christiansen - Director, National Board of eHealth
Agenda
1. The Danish healthcare sector at a glance
2. Government goals for health and digitalization
3. Facts and priorities for a new digitalization strategy 2013-2017
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Every day-use and benefit realization
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Connected care and better use of data
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Citizen involvement and telemedicine
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Governance, standards and mobility
4. Choices and dilemmas to be handled in coming years
1. THE DANISH HEALTHCARE SYSTEM – MAIN
CHARACTERISTICS
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Free and equal access to public healthcare (5,5 mio. people)
Universal coverage (same system for everyone)
Tax financed (84 pct.) – 4.348 USD pr. capita
Private co-payment in certain areas (16 pct.)
Fully public financed healthcare
Private co-payment
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GP’s and specialist (with
reference from GP)
All hospital stay and
treatment
All medicines and aides
received in hospital
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Out-of hospital medicines
and aides
Dentists
Regional responsibilities
• Hospital and psychiatric treatment
• Primary health care / public health
care scheme
• General Practitioners (family
doctors)
• Private practicing specialists
• Adults dental services
• Physiotherapy
Municipal responsibilities
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Preventive care and health promotion
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Rehabilitation outside hospital
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Treatment of alcohol and drug abuse
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Co-financing regional health care
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Child nursing
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Child dental services and special dental
care
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School health care
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Home nursing
Responsibilities at national level
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Basic decisions regarding structure of healthcare sector
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Agreements on finance, quality, service targets etc.
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Clinical guidelines and clinical path ways
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Collect and present data on quality of treatment, activity and cost
etc.
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Provide regulation and common standards, fx ICT
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Provide it-infrastructure
Prerequisites for ehealth in Denmark
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An IT-ready population: Broadband penetration is the among the highest in
Europe - 95% of the population have internet access.
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A unique personal identifier is issued to all Danish citizens at birth and a
digital signature is widely used
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National Health Databases maintained for more than 30 years
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Law revisions in recent years have established a broader access to
personal health data for medical staff – liberal use of data – BIG DATA
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eGovernment-strategy 2011-15: Digital Letterbox & text messages
Basic challenge and ambition:
* When we want to do more with data, we face more mutual dependencies
* Commitment on information, tasks, competences, flows - end to end
* Systematic reliability and systematic semantic
3. New Digitalization Strategy 2013-2017
HIS is key to efficient, coordinated, reliable and equal health services:
1. Focus on use of HIS - benefit realisation - ”no paper journals”
2. Connected care: Cross sector cooperation and better use of data
3. Patient empowerment - treatment at home and patient-centred data
4. Transparency on progress/commitment
- Business case-driven strategy - pragmatic case by case
How does ICT look inside of hospitals?
Number of regional EHR landscapes
• Legacy of many systems - different levels of maturity
• No ”one system-strategy” – interoperability is key
25
20
15
10
5
0
2007
Region Hovedstaden
2010
Region Sjælland
2011
September 2012
Region Syddanmark
Ultimo 2012
Region Midtjylland
Ultimo 2013
Region Nordjylland
Single Sign-on in place
14
12
10
8
6
4
2
0
Nord
Hovedstaden
Antal hospitaler i alt
Syd
Midt
Antal hospitaler med implementeret ESA
Sjælland
EMR –registrations done within 24h?
2 hospitaler med højest andel
Gennemsnit af regionens hospitaler
2 hospitaler med lavest andel
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Nord
Hovedstaden
Syd
Midt
Sjælland
Electronic registration boards for emergency care in
all hospitals
3.1. Focus on the use of HIS - benefit realisation
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Mobile and easy access to full patient summaries and CBI
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No-paper hospitals: Get rid of paper based work processes
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Close (old) competing it-solutions
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Making solutions work to support clinicians in every day work
eCommunication between sectors
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Electronic messages have to a large extent replaced handwritten
messages between GPs and hospitals:
Type of message
% digital
Referrals from GPs to specialized treatment
81 pct.
Discharge letters from hospitals to GPs
99 pct.
Lab test orders and resultats between GPs and labs
99 pct.
Communication between local municipalities and
hospitals (MedCom-messages)
Messages sent to municipalitites
Nord
Hovedstaden
Syd
Midt
Messages sent from municipalities
Sjælland
Nord
250
250
200
200
150
150
100
100
50
50
0
0
Hovedstaden
Syd
Midt
Sjælland
eCommunication between hospitals and
municipalities – by Q1 2013 exp. 90 pct. green
No. of received messages, , pr. 1000
inhabitants
No. of sent messages, pr. 1000 inhabitants
0-50
0
50-100
1-15
100-150
15-30
Bornholm
150-
Bornholm
30-45
Hjørring
Hjørring
45-
Frederikshavn
Læsø
Frederikshavn
Brønderslev
Læsø
Brønderslev
Jammerbugt
Hørsholm
Jammerbugt
Thisted
Hørsholm
Allerød
Aalborg
Rudersdal
Thisted
Allerød
Aalborg
Rudersdal
Rebild
Morsø
Lyngby-Taarbæk
Furesø
Vesthimmerland
Gentofte
Rebild
Morsø
Ballerup
Lyngby-Taarbæk
Furesø
Vesthimmerland
Gladsaxe
Mariagerfjord
Gentofte
Herlev
Gladsaxe
Mariagerfjord
Skive
Glostrup
Skive
Frederiksberg
Rødovre
Albertslund
Glostrup
København
Brøndby
Norddjurs
København
Hvidovre
Vallensbæk
Viborg
Frederiksberg
Rødovre
Albertslund
Høje-Taastrup
Randers
Lemvig
Struer
Herlev
Ballerup
Høje-Taastrup
Randers
Lemvig
Ishøj
Tårnby
Brøndby
Norddjurs
Struer
Dragør
Hvidovre
Vallensbæk
Viborg
Syddjurs
Ishøj
Tårnby
Greve
Holstebro
Syddjurs
Favrskov
Greve
Holstebro
Favrskov
Herning
Silkeborg
Århus
Herning
Silkeborg
Helsingør
Gribskov
Skanderborg
Århus
Ikast-Brande
Hillerød
Fredensborg
Odder
Ringkøbing-Skjern
Halsnæs
Ikast-Brande
Hillerød
Samsø
Horsens
Frederikssund
Odsherred
Samsø
Egedal
Vejle
Frederikssund
Odsherred
Egedal
Hedensted
Kalundborg
Varde
Billund
Holbæk
Vejle
Lejre Roskilde
Kalundborg
Varde
Fredericia
Solrød
Nordfyns
Vejen
Kolding
Fanø
Odense
Vejen
Kolding
Stevns
Slagelse
Næstved
Lejre Roskilde
Solrød
Nordfyns
Ringsted
Kerteminde
Fanø
Køge
Sorø
Middelfart
Odense
Esbjerg
Ringsted
Kerteminde
Stevns
Slagelse
Faxe
Næstved
Nyborg
Assens
Holbæk
Fredericia
Køge
Sorø
Middelfart
Esbjerg
Faxe
Nyborg
Assens
Haderslev
Haderslev
Faaborg-Midtfyn
Faaborg-Midtfyn
Svendborg
Vordingborg
Tønder
Svendborg
Vordingborg
Tønder
Aabenraa
Fredensborg
Odder
Horsens
Hedensted
Billund
Helsingør
Gribskov
Skanderborg
Ringkøbing-Skjern
Halsnæs
Aabenraa
Sønderborg
Ærø
Sønderborg
Langeland
Ærø
Lolland
Guldborgsund
Langeland
Lolland
Guldborgsund
Dragør
Shared Medication Record
19
Shared Medication Record – implementation, status
Hospitals
GPs
Specialists
Doctors on
calll
Municipaliti
es
PCT.
Region
Hovedstaden *
Region Sjælland
0,0
43,4
28,3
100,0
100,0
37,1
29,9
100,0
20,0
30,3
42,2
100,0
Region Midtjylland
100,0
21,4
38,0
100,0
Region Nordjylland
100,0
34,6
43,9
100,0
Region Syddanmark
0
0
0
0
0
Digital infrastructure - National Serviceplatform
3.2. Connected care and patient flows – liquid data
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By 2017 - Full digital communication between sectors – more
stability and systematic related to tasks and communication
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Continued work on national infrastructure and shared patient
information and data cross sectors
3.3. Treatment at home and patient empowerment
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Large potential in involving patients and relatives in own treatment,
care, rehabilitation and prevention.
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Collecting and use of data at home
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Building national infra structure for data – up take of new solutions
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Logistics and ownership related to devices and data
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Presentation and sharing of data end-to-end
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New ways of organising tasks and responsabilities –> how?
3.3 Goals regarding treatment at home and patient
empowerment
2017 – connected care on personal data
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Cross sector booking and view of calendar on “health”.dk
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Basic data accessible
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Patients diary
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Presentation and transmission of biometric data from own ”wearables”
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Diary notes
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Mobile access
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Telemedical initiatives where sound business cases
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Strong commitment on common standards and infrastructure
Communicating with Citizens
”Sundhed.dk” - the official Danish
eHealth Portal for public healthcare
services.
Citizens have access to personal health
data such as:
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Info on prescription medicine
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Selected information from
Electronic Health Records
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Organ Donor Registration
Citizens can participate:
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Building “My dairy” with data and
stories – shared national platform
Public acceptance health.dk
HealthTech Counsil
Telemedicine
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National Action Plan for Telemedicine 2012
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Based on positive experiences in a series of municipalities and regions
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Agreement between government, Danish Regions and Local
municipalities to large scale initiatives and pilots:
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On ulcers – nation wide
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On COPD – all patients in one region
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Building infrastructure (Continua HA)
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Testing tele-psychiatry
The goal is better treatment, better
economy and better jobs.
Reference architecture for collecting health data from
citizens
Vision
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Data coming from the citizen can be used on equal terms with data
coming from within the health care system.
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Health data coming from the citizen can become available for all
relevant health professionals across organisational borders and IT
systems.
Reference architecture for collecting health data from
citizens
Purpose
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Reach consensus and act as a guideline on how to collect, communicate and store
health data from the citizen, making data available in a simple and transparent way.
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Establish a framework for Danish profiled standards for:
• collection, communication and storage of data from equipment used for
monitoring and collecting data in the patient’s home
• communication of data to the health IT systems processing and collecting
data
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Establish ownership and data responsibility
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Establish technical and security standards for measuring and collection equipment,
lines of communication and storage of the data collected.
Reference architecture for collecting health data from
citizens
Process
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Working group established September 2012
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Presentation to the advisory committee January 2013
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Public hearing planned at the beginning of 2013.
4. Transparency & commitment between parties
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Transparency on shared goals and progress – shared plans for
projects and implementation both local and national
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Mechanisms for daily management and payment of shared
infrastructure
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Direction, closer coordination and follow-up in the National Board
on Health-it
4. Some real choices – and dilemmas
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We have a history of collecting and sharing data on patients and
treatment that are second to none internationally. In a new are of
“intelligent health” – what does it take to keep that position?
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We base our infrastructure on international standards
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We want to make full use of data between sectors – this puts high
demands on shared definitions and standards both when it comes
to local systems , local work processes, competences etc.
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We want to cooperate internationally. We are too small to do it our
selves – we need broad mandate, speed to compete – and a pull
also from industry
Thank You!
For more info:
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sum.dk
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nsi.dk