What Can We Learn From Denmark?

With so much of our focus on health IT developments in the United States, I think it is sometimes valuable to take a step back and look at how other countries are approaching the topic. That’s what consulting firm Accenture has done with a valuable new report called “Connected Health: The Drive to Integrated Healthcare Delivery.”

Accenture defines connected health as “an approach to healthcare delivery that leverages the systematic application of healthcare information technology to facilitate the accessing and sharing of information, as well as to allow subsequent analysis of health data across healthcare systems.” It also encourages communication and collaboration among all of the various stakeholders involved in a patient’s health.

The report studied the development of health IT infrastructure in eight countries: Australia, Canada, England, France, Germany, Singapore, Spain and the United States. Despite great variations in types of insurance and levels of health IT experience, all of the countries are under financial pressure to integrate healthcare. Just as we are seeing a wide variation in architectures of state-level HIEs here in the U.S., globally there are many approaches being taken to connected health, ranging from centralized approaches that seek to execute high levels of control over the development of nationwide solutions (Singapore and England) to countries in which development is “locally led” and connectivity is achieved from the bottom up (United States and Spain), Accenture notes. In between is a “middle-out” approach, where the central government provides an overarching strategic direction but the solutions are developed locally (Canada, Germany, Australia and France). (I would argue that the United States might fall more into this third group, since the federal government does seem to be setting a strategic direction now.)

I was most intrigued by a case study in the report’s appendix detailing progress in Denmark. It paints a picture of an already existing infrastructure that our policymakers are envisioning beyond Stage 3 of the meaningful use regime.  

After many years of work on HIE, Denmark’s healthcare IT infrastructure features a national IT hub, the health data net, which allows information exchange among different parts of health services. Ninety-eight percent of Denmark’s 3,600 general practitioners and all pharmacies and hospitals use the health data net, as do 74 percent of specialists and 44 percent of local authorities. The health data net allows for referrals, discharge summaries, exchange of clinical data, e-prescriptions, teleradiology services and much more, Accenture found.

Denmark’s EHR centers on what it calls the “e-Journal.” The e-Journal project began in 2009 and is now available to all hospitals and all general practitioners across the country. “The e-Journal makes extracts of registered patient data available via the MedCom HIE secure network, and it ensures that hospital doctors and GPs have access to patient data no matter where the patient has been hospitalized previously.  All Danish citizens can access their own e-Journal via the national e-health portal,” the report notes.

Part of the health data net, the national e-health portal—Sundhed.dk—acts as a single access point to healthcare services for both citizens and professionals, Accenture reports. The portal offers directory services, general and disease-specific health information, access to national guidelines and more. Citizens can use services such as booking GP appointments and renewing prescriptions.

One of the things that makes this all possible is that more than 1 million Danes now have a digital signature—”NEM-ID”—which allows them to access information from their e-Journal through Sundhed.dk, and to see who has accessed their data. The use of a universal ID number has been a major enabler of change, according to Accenture. National registers have been in use for decades, largely made possible through unique identifiers for all residents in Denmark—introduced in 1966. This has been a real stumbling block in the United States. Members of Congress are afraid to even introduce the topic because many people are paranoid about Big Brother and national identifiers.

So what can we learn from Denmark? Accenture notes that in Denmark patients have been at the center of the change program with portals and mobile health solutions designed to enable people to take more responsibility for their own health. The national government also has put a focus on boosting the health IT sector and promoting the healthcare business. Inspired by a “Green Growth” program to boost the energy sector, it focuses on testing new innovative technologies and public-private innovations.

I think ONC and CMS are to be applauded for trying both to put more emphasis on patient-centered solutions and promoting health IT startups and innovation. But a few of the benefits that Denmark has are difficult for us to replicate: a much smaller population and health system, as well as decades of experimentation with different approaches to connected health. We can try to “go to school” on other countries’ experiences, but in the end we will have to work through our own particular issues, which are bound to be more difficult because of our health sector’s size and complexity. But at least the journey has begun. And it’s nice to be reminded occasionally that so many other countries are on it with us.