SIGCIS 2012 Workshop, Parallel Session III: Three ICT Innovations that transformed the Danish Society – The Nordic Way
Name: Stig Kjær Andersen
Institutional Affiliation: Department of Health Science and Technology, Aalborg University, Denmark
E-mail address: ska@hst.aau.dk
Paper Type: Traditional
Paper Title: The Danish Electronic Health Record (EHR) – from Visions to Reality – a Nearly Two Decades Long Journey under Changing Conditions
Paper Abstract: Stig Kjær Andersen has been head of research projects, and is still heavily involved in the efforts to make the Electronic Health Record a true breakthrough – also from the view of a ‘practitioner’. His key point in the proposed paper is to show that this effort is in some respects still ‘work in progress’ and an area, where much is to be learned. The the doctors and nurses – and even the patients – were brought in and heard, but often at the wrong places in
Name: Stig Kjær Andersen
Institutional Affiliation: Department of Health Science and Technology, Aalborg University, Denmark
E-mail address: ska@hst.aau.dk
Paper Type: Traditional
Paper Title: The Danish Electronic Health Record (EHR) – from Visions to Reality – a Nearly Two Decades Long Journey under Changing Conditions
Paper Abstract: Introducing complex systems as EHR nationwide is a long and complex process, and has a history with many important angles. We have chosen to focus on the context and conditions that the EHR planning, development and implementation had to exist in. .
Realizing the volatility and the importance of conditions are important knowledge elements in the understanding of why the history is as it is.
The Danish General Practitioner’s EHR took off from “no one had it” to full implementation at all GPs over a short span of years. The context and conditions for the accomplishment in this period are characterized by a stable conservative IT infrastructure, a stable standardization organisation operating in political neutral waters (MEDCOM), systems with a few clear well defined goals, and clear monetary incentives. The Municipal EHR system has had a similar history.
In the timespan it has taken to get from start to a functioning EHR at hospitals, the general conditions have been uneven and quite different from the GP’s EHR history and we are, despite all the years, not yet at the end of the pathway.
The vision of a hospital EHR system is persistent over the years: It has to be always available, always updated and carrying all information, the user only has to enter specific information once, and it will be available for all sorts of secondary purposes imaginable.
On the contrary, the common understanding on what really constitutes a hospital EHR system has been a moving target, not on a theoretical level but simply on a practical and political level.
Several dedicated cross-organizational organisations did see the light of the day. They served as organizer, policy maker, governmental standard proposer in the cross field between ministry, national board of health, regions, and hospitals. They all have some decision power and expertise, but were more or less lacking resources to implement solutions.
The dilemma between having structured data or free text as the basis for the clinical content of an EHR is an EHR architectural issue and was also a major discussion point. The dilemma had a major influence on the design, development, implementation, and reuse policy of data from the systems at the hospital level. Is has been like a swinging pendulum between a depth structuring of the underlying complex data models vs. simple free text information. Two major “schools” did emerge in the beginning of the century: G-EPJ, the basic EHR structure; a detailed complex overall data model supporting a deductive diagnostic process, and SUP, Standardized patient information; a scheme for structured “wrapping” of all types of clinical information, special for exchange purpose. G-EPJ was developed over a couple of years but failed in the synchronisation of development, clinical verification and test, and commercial development. SUP acted as a temporary data exchange platform between commercial systems and was the basis of the e-journal, whish later became a successful national initiative.
The EHR upstart period has survived three national strategic plans, all characterized by having:
- a political offset,
- goals related to the time period they were created in,
- a platform for political resource negotiation,
- and lack of proper post evaluation.
They did serve their purpose in a changing political environment.
A hundred year old tradition for documentation and knowledge sharing has been transformed by EHR systems, and we see them as an increasingly important part of the professional healthcare system in Denmark. It has been a road not only paved with successes, but also failures.
the development, and maybe under wrong pretexts.
