Danish Province Blazes Trail on EPR

Most healthcare systems in the industrialised world are struggling to develop or implement different models of electronic patient records, with the UK together with Australia, Canada, New Zeeland and the Netherlands often cited as being world leaders.

But one of the most advanced and widespread EPR programmes in use is in the Danish province of Vijborg. Henning Bruun-Schmidt, CEO of Health and Hospital Services for the County Council of Vijborg told E-Health Media about the programme.

Work on EPRs began in Vijborg, a province with a population on 250,000 in North West Jutland, in 1992. "In Denmark we have a national plan for national EPR coverage within two years," explained Bruun-Schmidt.

Vijborg plans to beat these national targets. "We have 65% EPR coverage now and plan to have it fully in use by next year," said Bruun-Schmidt. The Vijborg EPR programme covers the entire local health community covering, primary community, social and secondary care.

Under the national plan each of Denmark’s 14 strong, local regional authorities are developing their own local EPR strategy.

Under this national/local approach, while each region develops its own EPR system it does so within a framework of national interoperability and data standards. Once local EPR systems are in place the aim is to integrate them to produce a national Electronic Health Record (EHR).

According to Bruun-Schmidt this devolved approach has led to "too many different approaches", but has ensured that the development of EPRs has been based on the needs of local health communities and fully involved clinicians.

“You can’t just go to a shop and buy and EPR, you must develop one based on your specific needs by working with your doctors and responsible clinicians,” said Bruun-Schmidt. "If you tried to buy a finished system you would miss that bottom-up process which is very important."

He added that it is also vital to work closely with clinicians to ensure that the right data is collected and workflows are properly developed. "Otherwise we still collect too much garbage information and the workflows will still be flawed."

Asked about the investment required to develop the programme, Bruun-Schmidt stressed that EPR simply can’t be seen as an optional extra, but as important a part of a hospital’s infrastructure as electricity or water, but acknowledges the dilemmas politicians face on in setting priorities for healthcare investments.

"If you have a politician that is asked to make a priority between IT and a hip replacement, it’s very difficult to ask for IT as a priority," he explained.

The solution Bruun-Schmidt came up with as head of Health and Hospital Services at Vijborg County Council was to take IT of the list of priorities and make it a must do. "We have taken it away from the list of priorities and said it is like heating or electricity".

Denmark’s EPR programme has also benefited from the availability of a national register of patients established in 1966, which provides the unique patient identifier all EPR systems rely on.

Early developments have included the move to digitised radiology, first introduced in 1991; a fully fledged electronic prescribing system; order communications; and electronic reporting of test results.

Bruun-Schmidt added that not investing in IT to deliver more efficient, cost-effective healthcare is simply not an option: "We cannot meet the growing demand for health services without technology".

While the Vijborg EPR system currently operates over an intranet and focuses on the acute hospital sector the next stage is to move to a web-based system and further develop the exchange of information between primary and secondary care.