E-health in Denmark Conference, Slovakia, Oct 17, 2007

IBM Healthcare and Life SciencesAgenda• Healthcare in Denmark• E-health in Denmark- Elements- Sample solutions:• Medcom• Electronic Patient Records - overview• National EHR in Denmark: eJournal• ePrescription & Personal Electronic Medicine Profile• DiaLog – Diabetes Shared Care• Danish National eHealth Portal© 2006 IBM Corporation

IBM Healthcare and Life SciencesThe Danish healthcare systemMinistry of Interiorand HealthDanish MedicinesAgencyNational Boardof HealthDanish RegionsDanishMunicipalities• All healthcare in Denmark is publicly funded• Tasks and responsibilities are split betweenState, Counties and Municipalities• GP’s are private enterprises, paid py tbe state(but administered through the Counties.• 5,7 mill. Citizens in Denmark• Healthcare expenditure approx. 8% of GDP• 67 hospitals – down from 92 in 1998© 2006 IBM Corporation

IBM Healthcare and Life SciencesThe average use of healthcare services in Denmark increasesignificantly with the age of the populationAverage use of public health expenditurecompared to citizen age, 2001© 2006 IBM Corporation

IBM Healthcare and Life SciencesDuring 2002 – 2007 a reform of Danish healthcare has been planned© 2006 IBM Corporation

IBM Healthcare and Life SciencesThe number of municipalities is reduced from 271 to 98 – aiming for asize of +30.000 inhabitants, and averaging 55.000© 2006 IBM Corporation

IBM Healthcare and Life SciencesAt the same time the 15 counties are merged into 15 healthcare regions© 2006 IBM Corporation

IBM Healthcare and Life SciencesAfter the reform, the new Health Regions will be funded by the state –and from the MunicipalitiesComposition of the Revenue of the Regions within Health Care• Health Regions cannot any longer issue localtax – or increase tax• 75% of income is fixed from the State• 5% of income is activity dependent – fromthe State• 10% of income is fixed – from theMunicipalities• 10% of income is activity dependent – fromthe Municipalities• 85% of Regions financing is fixed – 15% isvariable© 2006 IBM Corporation

IBM Healthcare and Life SciencesAgenda• Healthcare in Denmark• E-health in Denmark- Elements- Sample solutions:• Medcom• Electronic Patient Records - overview• National EHR in Denmark: eJournal• ePrescription & Personal Electronic Medicine Profile• DiaLog – Diabetes Shared Care• Danish National eHealth Portal© 2006 IBM Corporation

IBM Healthcare and Life SciencesE-health status in DenmarkE-health elements:• Unique patient identifier: Since 1977• National patient registry: dating back to 1977• Secure infrastructure – data security and privacy: PKI/digital signature – national +hospitals• Healthcare information network: Project established 1994. Now 97% coverage• General e-health portal: Project established 2003. Now in phase 4• Country wide sharing of data: Medicine and EPR overview established• Disease management – targeting chronic patients: Multiple projects.• Wellness management – targeting general population health: Part of e-health portal• Pervasive Healthcare: Eldertech project – diagnostics and wireless infrastructureE-health is supplemented by:• Electronic Patient Record at hospitals: 30%-50% coverage• Country HIS database (patient statistics): National projects• Clinical databases: National projects• Accreditation and quality improvement programs: Accreditation strategy and qualityimprovement agency© 2006 IBM Corporation

IBM Healthcare and Life SciencesGetting the organisation and motivation of the stakeholders right was abig contributor to the succesMinistry of Interiorand HealthDanish MedicinesAgencyNational Boardof HealthDanish RegionsDanishMunicipalitiesMedComSundhed.dk© 2006 IBM Corporation

IBM Healthcare and Life SciencesClinical information must be linked to a classification, which provide a clear and commonterminology. SNOMED CT is chosen by HL/7.SNOMED CT countries© 2006 IBM Corporation

IBM Healthcare and Life SciencesAgenda• Healthcare in Denmark• E-health in Denmark- Elements- Sample solutions:• Medcom• Electronic Patient Records - overview• National EHR in Denmark: eJournal• ePrescription & Personal Electronic Medicine Profile• DiaLog – Diabetes Shared Care• Danish National eHealth Portal© 2006 IBM Corporation

IBM Healthcare and Life SciencesE-health in Denmark: MedCom and Sundhed.dkSundhed.dkHealth Portal2003 -MedComHealth Net1994 -Who is behind?Ministry of Health, National Association of County Councils, Ministry of Social Affairs, National Association of LocalAuthorities, National Board of Health, Copenhagen Hospital Corporation, Danish Pharmaceutical Association© 2006 IBM Corporation

IBM Healthcare and Life Sciences1993: The six flowsEU Concerted Action on Primary CarePrimaryhealthSo simple!So much!So similar!© 2006 IBM Corporation

IBM Healthcare and Life SciencesStatus & Benefits• 1995 Primary Clinics - 92%• 490 Specialists - 62%• 332 Pharmacies - 100%• 63 Hospitals - 100%• 50 Municipalities• 2,5 mill. each month• 60 – 70 % of all communication• 30 hours saved per week in typical GP practice• Telephone calls to hospitals reduced with 66%• Cumulative benefits: 872 million €According to 2006 study from Empirica Market Research© 2006 IBM Corporation

IBM Healthcare and Life SciencesAgenda• Healthcare in Denmark• E-health in Denmark- Elements- Sample solutions:• Medcom• Electronic Patient Records - overview• National EHR in Denmark: eJournal• ePrescription & Personal Electronic Medicine Profile• DiaLog – Diabetes Shared Care• Danish National eHealth Portal© 2006 IBM Corporation

IBM Healthcare and Life SciencesApplication Architecture for EPR in DenmarkMedicationClinicalnotesBookingRequest &answerMISQualityRecord- Care path templates and classification models- Platform for user modules- Interface to integration and data storage- Services for security, printing etc.Integration and data storage layer© 2006 IBM Corporation

IBM Healthcare and Life SciencesEPR example: Medicine Module – stand-alone part of EPR• Security- Patient identification by bar code ID with every drugadministration- Drug identification by bar code• Alarms- Interactions- Double prescriptions- Prescriptions with known drug allergy optional onATC level 3 or 5- Drugs identified by bar code has known dosage, incase of lack of specific strength a similar drug has aproposed calculated number of tablets- Comments are obligatory when there is dispensedless of a drug than prescribed- Dispensing more than prescribed is not allowed© 2006 IBM Corporation

IBM Healthcare and Life SciencesAgenda• Healthcare in Denmark• E-health in Denmark- Elements- Sample solutions:• Medcom• EPR: Medicine Module & Clinical Notes• National EHR in Denmark: eJournal• ePrescription & Personal Electronic Medicine Profile• DiaLog – Diabetes Shared Care• Danish National eHealth Portal© 2006 IBM Corporation

IBM Healthcare and Life SciencesNational EHR in Denmark: eJournal• The project was established in 1999 by 2 Danish counties• eJournal purpose is to:- solve the problem of data exchange between multiple Electronic Patient Record(EPR) systems within the same organisational entity (County or Region)- create a meta model which represents the data common for EPR’s on the market- define a XML standard to contain the meta model data and define extract algoritmsand programs for extract from the biggest EPR’s on the market- develop a database for storing EPR data from different EPR’s (in SUP format)- develop a HTML, XML schema oriented presentation system to present EPR datain read-only format – but with consistent patient information across different EPR’s- run a proof-of-concept for eJournal, proving all of the above• In 2002, after proof-of-concept, eJournal was included in the National Danish ITstrategy© 2006 IBM Corporation

IBM Healthcare and Life SciencesThe actual implementation of eJournal is flexible and scalableData merged from different hospitalsScheduled daily extractsOn demand extracts (urgent)Web Services (SOAP)EPR system ..EPR system 3EPR system 2EPR system 1Extracted XML filesSUP DatabaseSystemWeb interface (HTML)Key data from: PAS, PACS, EPJ, HIS, RIS, etcData for statistical useNow extracting from: IBM Patient Record System, OPUS (CSC Scandihealth), EPJ (WM-data) & FPAS (Fyns Amt)© 2006 IBM Corporation

IBM Healthcare and Life ScienceseJouranl – clinical pathway overview© 2006 IBM Corporation

IBM Healthcare and Life SciencesAn activities overview is presented in the SUP web‘Contacts’‘Diagnosis’‘Ordination’‘Medical ordination’‘Request/booking’‘Procedure’‘Drug Dispensing’‘Anamnese’‘Observation’‘Test results’‘Clinical Notes’‘Adminstrativeinformation’© 2006 IBM Corporation

IBM Healthcare and Life SciencesAgenda• Healthcare in Denmark• E-health in Denmark- Elements- Sample solutions:• Medcom• EPR: Medicine Module & Clinical Notes• National EHR in Denmark: eJournal• ePrescription & Personal Electronic Medicine Profile• DiaLog – Diabetes Shared Care• Danish National eHealth Portal© 2006 IBM Corporation

IBM Healthcare and Life SciencesPrescription Server and Medicine Profile• Improved communication between physicians, patients and home care staff• Better and more correct medication• More precise overview of medicine use – also over time• Knowledge collection in one place• Information follows the patient• Better monitoring and follow-up• And a very positive business case:- Prescription server savings of minimum 80.000 Euro per 100.000 prescriptions- Home care savings of 20 mEuro in Denmark• Definitions- Prescription Server• Improved communication between physicians, pharmacies, home care staff andpatients- Medicine Profile• Decision support with both intention of prescription and follow up on consumption© 2006 IBM Corporation

IBM Healthcare and Life SciencesZooming in on a prescriptionComplianceSubstitutionPrescriptionswithin the sameATC group© 2006 IBM Corporation

IBM Healthcare and Life SciencesCompliance for the selected prescriptionCalculateddrug reserve© 2006 IBM Corporation

IBM Healthcare and Life SciencesChecking for interactionsLevel ofinteraction© 2006 IBM Corporation

IBM Healthcare and Life SciencessubsutionaldrugsUnit price© 2006 IBM Corporation

IBM Healthcare and Life SciencesAgenda• Healthcare in Denmark• E-health in Denmark- Elements- Sample solutions:• Medcom• EPR: Medicine Module & Clinical Notes• National EHR in Denmark: eJournal• ePrescription & Personal Electronic Medicine Profile• DiaLog – Diabetes Shared Care• Danish National eHealth Portal© 2006 IBM Corporation

IBM Healthcare and Life SciencesDisease management can target the 80% of medical expense from 20%of patients with chronic illnessesTypical diseases: Diabetes Heart related diseases Respiratory diseases DepressionTargeting chronically ill patients with IT-technology in order to: Improve planning and treatment Follow the patient everywhere – in hospital, in their home, at GP Involve and motivate the patient Let the patient take more responsibility and participate more actively Strenghten GP knowledge of hospital treatments and procedures- with the objective to create a better quality of life for the patient, improve clinicaltreatment, save hospitalresources and strengthen cooperation in healthcare.© 2006 IBM Corporation

IBM Healthcare and Life SciencesFind patientCreate patientStatisticsProfile Help Log offDiaLog Shared CareDiabetes medicineGraphsHistory Print status Basic dataAgeContactsmorecreatemorecreateEye statuscreatemorecreatemoremoremoremoremoreFoot statuscreateMeasurescreatemoremoremoremoreOther treatmentmorecreatemoremoremoremoremoremoreLab resultscreateSelf carecreateAcute complicationscreatemoremoremoremoremoremoremoremorePatient notescreatemoremoremoreOther complicationsmorecreatemoremoremoremore

IBM Healthcare and Life SciencesAgenda• Healthcare in Denmark• E-health in Denmark- Elements- Sample solutions:• Medcom• EPR: Medicine Module & Clinical Notes• National EHR in Denmark: eJournal• ePrescription & Personal Electronic Medicine Profile• DiaLog – Diabetes Shared Care• Danish National eHealth Portal© 2006 IBM Corporation

IBM Healthcare and Life SciencesA demo of the sundhed.dk health portal is available on IBMswebsite:http://www-05.ibm.com/services/dk/gbs/healthcare/eng/© 2006 IBM Corporation

IBM Healthcare and Life SciencesIntegration via the e-health portal (sundhed.dk)© 2006 IBM Corporation

IBM Healthcare and Life SciencesThe ehealth approachHospitalPatientShared careGPGovernmentPharmacySecurity, privacy and confidentialityCo-operation- eReferrals- eDischarges- Access to HR- Work on same HROptimize work routinesThe healthcare challenge- eBooking- eConsultation- Healthcare Yellow pages- Support choice of healthcare organization- eRenewal of medicine prescription- Update own informationUse the patients capacity- Shared Care- Track own medical history- Track own medicine use- Treatment informationMore patientsFewer physiciansHigher healthcare costsPrevent illness- Disease Information- Medicine informationThe right treatment- Decision support- Medical history- Adverse drug reaction- CAVE Registration- Access lab resultsTake action in time- Track medicine use- Test yourself© 2006 IBM Corporation

IBM Healthcare and Life SciencesTotal unique visitors Dec. 2003 – Dec. 2006Total 3 mio. unique visitors hits in December 2006250000200000150000100000500000dec-03mar-04jun-04sep-04dec-04mar-05jun-05sep-05dec-05mar-06jun-06sep-06dec-06© 2006 IBM Corporation

IBM Healthcare and Life SciencesExamples of benefitsElectronic donor registration• 2/3 of all registrations are now carried out electronic on sundhed.dk• There has been a 40 % increase in the registrationE-mail-consultation with the general practitioner• An increase of 144 % for e-mail-consultations in the period January-November 2006 (compared to theyear before) to a total of 410.968.• A tripling of e-mail-consultations in a year = a total of 194.675 in 2005 compared to 2004• The number of GP’s with e-services is almost four times bigger compared to December 2003 – resultingin a 48 % coverage in December 2006• 87 % has a digital signatur (December 2006)• 61 % of the Danish population wishes to communicate electronic with their GP’s (Survey on awareness2006)The citizens access to own medical history• More than 4.000.000 page views since the launch in September 2005• A tripling of registered users in a month (digital signature users)• 25.000 orders of the digital signature in little over a month© 2006 IBM Corporation

IBM Healthcare and Life SciencesAwards• EU-award 2004: e-health, along with MedCom• Top of the web 2005 by The Ministry of Science, Technology and Innovation andThe National IT and Tele Agency• E-commerce award 2006 by The Danish eBusiness Association and The DanishIT Industry Association• The digitalization award 2006: by among others The Digital Taskforce, TheMinistry of Science, Technology and Innovation and The Danish IT IndustryAssociation• Computerworld Honors in US 2007© 2006 IBM Corporation