Danish health care – overview and template

The Danish Health care sector - overview

The counties run most hospitals. There is a tendency towards both greater competition and cooperation among hospitals and counties and e.g. in the Copenhagen region seven hospitals have joined up in one organization. There are also state-owned and municipal hospitals plus a few private hospitals. The counties are also responsible for a number of institutions eg for the disables and the municipalities are responsible for e.g. care of the elderly and home-care of patients. GP’s, specialist clinics and pharmacies are private.

The National Board of Health is responsible for development and application of the Healthcare Sector’s Classification System, healthcare sector terminology and definitions, electronic case file standards, EDIFACT standards and healthcare data network and databases on clinical quality. The work today includes a very ambitious plan to work with new concepts of processes and cooperation and the development of a set-up for sharing data in patient-files.

MedCom – The Danish Centre for Health Telematics - is a joint public agency coordinating the development of standards for messages. Medcom carries millions of messages and helps to ensure quality and efficiency in the treatment of patients.

In Denmark the authorities have launched an ambitious plan to create a public health portal in two years. The vision is to embrace all electronic communication between patients and the health care sector and to be a communication tool for the health care professionals. Furthermore the portal will provide information to the health care professionals and information for the patiens/citizens enabling greater responsibility for wellness, healthcare and self-care.

EDIFACT is widely used in Denmark within the hospital sector. There is now a general tendency to mode towards the use of XML especially in order to facilitate new patterns of data interchange among a wider health community including municipalities (responsible for home-care of the disabled, the elderlyetc.), GP’s, pharmacies.

The are a number of projects going on in Denmark with different aims and scope, but which have in common the use of XML and which enforce the need for coordiation. At the moment the major players are working towards a Health Domain XML Committee to coordinate work within the health sector and with other sectors via liaisons with the national XML-Committee.

Data network messages

The most common types of messages in the Danish Healthcare Data Network are:

Referrals
Discharge summaries
Laboratory requests
Laboratory results
Pathology requests
Pathology results
X-ray requests
X-ray results
Prescriptions

Types of services in the health sector

Clinical services and telematics
1 / Clinical messages
2 / Clinical e-mail
3 / Clinical booking
4 / Shared records
5 / Care protocols
6 / Mobile and emergency
7 / Home care monitoring
8 / Telemedicine
Health information services
9 / Surveillance information
10 / Yellow pages
11 / Professional guidelines
12 / Disease Quality management
13 / Public health information
14 / Continuing professional development
Administrative services and e-commerce
15 / Reimbursements
16 / Electronic commerce
17 / Patient-ID
18 / Ressourcemanagement

This list has been worked out by the joint European PICNIC project of which MEDCOM is the coordinator.

Servicetemplate - Health

Note: This is a fictional case bases on real premises.

Service

Patients complaints about healthcare, treatment, hospitals and hospitals personal

Service interaction

Citizen complaint sent to authorities – complaint office – with pre-filled form.

Citizen interact with citizens authority file/database for identification (Danish CPR – a general database for unique identification of citizens. Similar - but more advanced - to health security number in other countries).

Citizen interact with complaint office.

Citizen interact with digital signature system.

Complaint office interact with ERM-systems at different hospitals and doctors.

Complaint office reply to the citizen via e-mail

Subjects (actors)

Patient

Complainer – can be a lawyer, the patient or anybody else

Complaint office

ERM-system

CPR database

Locations

Internet access for citizens

CPR database as web-service

ERM-system at hospitals or at docters as web-service

Complaint office ERM system or database

Identifiers

CPR number – person identification number. Mandatory

Unique identification number for event at hospitals or doctors ERM-system – not mandatory

Evidence

Use of digital signature. Use of intermediary enterprise that stores e-mails, logs on computersystems.

Outcome

Contributes to an open democratic society where the citizens can easily claim their rights

Rules

There is Danish legislation for this kind of complaints.