Lone Høiberg, MedCom, lho@medcom.dk
Mie Borch Dahl Kristensen, MedCom, mbk@medcom.dk
Christian Nøhr, University of Southern Denmark, cn@mmmi.sdu.dk
Updated mapping of
telemedicine projects in Denmark
ITCH 2019 16-02-2019
How to find Denmark
Denmark
Some comparisons
Denmark
• Populations 5.8 mill. Citizens
• Area 42.924 km²
• Population density 135 citizens/km²
• Life expectancy 80.4 years (2018)
Canada
• Populations 36.7 mill. Citizens
• Area 9.985.000 km²
• Population density 4 citizens/km²
• Life expectancy 82.3 years (2016)
The Danish Healthcare Sector
Organisation
In Denmark there are:
▪ 4 EHR systems public hospitals
▪ 4 Municipality IT systems
• 8 GP IT systems
None of the systems are integrated with each other.
In order to communicate between sectors, electronic communication in standards is sent via the Danish Health Data Network.
MedCom is the system manager for the Danish Health Data Network (SDN).
Denmark has been working strategically with telemedicine for years and several telemedicine projects are carried out across the Danish healthcare sector.
Denmark has nether high mountains or large distances, but like many other
countries, Denmark has an aging population and an increasing number of chronic patients.
One way to meet this challenge is the use of telemedicine solutions. The
telemedicine map can help identify initiatives with potential for dissemination.
The Danish Healthcare Sector
MedCom in brief
MedCom in brief
History: Established in 1994 in Odense. Today: 39 employees.
Purpose: Standardise and digitise the most common used means of communication between GPs, hospitals and municipalities.
Constellation: Jointly owned by Danish Ministry of Health, Danish Regions and Local Government Denmark
Format: Project organisation running in two-four-year project periods.
Currently: MedCom 11.
Approach: User involvement across the whole spectrum, incl.
vendors; Dynamic organization that is adaptable to societal, political and technological changes.
MedCom in brief
Standards, test and
dissemination
Cross-sectoral dissemination
System management
International activities
You can find more information about MedCom here https://www.medcom.dk/medcom-in-english/about-medcom.
Mapping telemedicine activities
Background and purpose
August 2012: National action plan for rolling out telemedicine in DK
MedCom should collect and publish an overview of the diffusion of telemedicine in the Danish health care sector as a step to systemise the wealth of telemedicine experience.
Few large- scale projects
Lack of overview
Lack of knowledge sharing
Overview – how?
Overview of the diffusion of telemedicine
Local knowledge
Working group
Database
https://telemedicinsk-landkort.dk/?locale=en
Categories of data
• Type of initiative
• Master data
• Participants
• Used by
• Health areas
• Used for
• Technologies
• Editors
Strategy for collecting data
… if you want to?
… maybe you need a reminder ;-)
Strategy for collecting data
Yearly, until 2016:
+ Decentralisation - Extensive and time consuming procedure
Manuel reminder
Are your initiative(s) updated?
Any new initiatives?
Strategy for collecting data
+ Directly targeted, outdated contact info discovered + Easy access to editor site through direct links
+ More precise and less time-consuming data collection Yearly, since 2017:
Automatic reminder
Reminders and support info Direct links
The package of autogenerated emails
”You are registered as a contact person of ……”
o Is this correct?
o Do you agree on what is registered?
”Your initiative is reaching its finishing date….”
o Is this correct?
o What is going to happen to the initiative?
Other efforts to increase data quality?
1. Additional mandatory fields to be filled
2. Yearly cleaning-up task (duplicates, initiatives with missing information)
Results – updated mapping 2018
289
345
402
430
347
0 50 100 150 200 250 300 350 400 450 500
2013 2014 2016 2017 2018
Registered initiatives
Results – updated mapping 2018
0%
10%
20%
30%
40%
50%
60%
2013 2014 2016 2017 2018
Procent of all initiatives
Registered initiatives
During dissemination or in operation Projects
Different purposes of use
Health care professionals/practitioners –knowledge sharing and corporation
Is there any experience about using telemedicine in this setting, that I can learn from?
Evaluations?
Contact information?
Decision makers/officials/researchers/ - statistics and decision support
How many?
Which characteristics? (status, technology, volume etc.) Trends
Lessons learned
Inclusion criteria
Telemedicine, defined by WHO:
The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities.
Incompleteness of data
The telemedicine map does not contain a complete set of data for all telemedicine initiatives in the Danish health service. Updating of the telemedicine map is voluntary:
• There may be initiatives in regions, municipalities and GP, which is not registered due to a lack of knowledge of the telemedicine map.
• There may be initiatives not been updated at the relevant point in time.
• Several users register the same project unaware that it has already been recorded.
• Knowledge of the telemedicine map is currently greatest in municipalities and hospitals.
General practices have started late in the WG and have fewest initiatives recorded.
Data validity
• Data is not validated or reviewed before publication
• Incorrect recording of data is not necessarily discovered or corrected
Implemented qualitative improvements
• Optimised strategy for collecting data (Autogenerated emails)
• Yearly clean up initiatives from 2017
• More mandatory fields
• Focus on the data model, and relevant parameters
• Information flyers
• Subscribe opportunities
• WG includes GP’s representatives
• More advanced search functions
How much is the database used?
Recording of data Use of data
Data must be valid, reliable and updated to be used, and data must be used to motivate people to deliver valid, reliable and updated data
How much is the database used?
0 100 200 300 400 500 600
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39
Antal
Per week (2018)
Unique page views
0 20 40 60 80 100 120 140 160
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 Per week (2018)
Sessions
70 visits/week 168 page views/week
How much is the database used?
• Continued dissemination of knowledge of the telemedicine map is important.
• Greater focus on how to use the telemedicine map. What’s in it for the a clinician, a project manager and so on.
• Continued focus on correct registration of initiatives. We have the WG for discussion and reflection on recording behaviour.
Focus areas
Potentials
Potentials
Can the database/the map be used overcome pilotitis?
National: study characteristics and trends
+ pick out initiatives for testing in larger scale + guide an even deployment across regions Local: Bring projects and people together → less pilotitis
Objective: Knowledge sharing and guidance
https://telemedicinsk-landkort.dk/?locale=en
• Type of initiative (project, during dissemination, in operation)
• Master data (title, purpose, start + end date, volume, contact person(s), links)
• Participants (regions, hospitals, municipalities, general practice)
• Used by (patient, GP, nurse …)
• Health areas (mental, respiration, cardio-vascular …)
• Used for (diagnostics, monitoring, conference … )
• Technologies (hardware, software, integrations)
• Editors
Strategy for collection data
22%
39% 39%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
2013 2017 2018
Latest update
1. Which sector?
2. Which health conditions?
3. Which activities?
4. Which technology?
190 (62%) 114 (38%)
8 (10%)
Municipality
GP
Hospital
N=305, options are not mutually exclusive
Mono-sectorial 244 (80%)
Cross-sectorial 33 (11%)
Unknown 28 (9%)
2 (6%) 27 (82%)
1 (3%)
Municipality
GP
Hospital
3 (9%)
N=33 cross sectional initiatives
Cardio-vascular 44 (14%)
Mental 57 (19%)
General/unspecified 59 (19%)
Respiration 50 (16%)
Muscular and skeletal systems 31 (10%)
Endocrine/metabolic/nutritional 26 (9%)
Nervous system 21 (7%)
N=305, options are not mutually exclusive
Professional teleconference 113 (37%)
Patient/health care professional conference 116 (38%)
Home-monitoring 91 (30%)
N=305, options are not mutually exclusive
Home-monitoring devices 45 (15%)
Vide-conference equipment 120 (39%)
PC
113 (37%)
Tablet 85 (28%) Smartphones
49 (16%)
N=305, options are not mutually exclusive
Interaction Monosectoriel telemedicine
Cross-sectoriel telemedicine
Often used technology
Active citizen
Solutions, where the citizen and the clinician each have a role.
APP, Smartphone, Equipment for home monitoring and
videoconferencing, PC, Tablet, Web-portal
With
participating citizen
Solutions, where the citizen participates with a therapist in collaboration with another therapist.
Wound Care, Video Interpreting, Video conferencing.
Without citizen
Solutions where minimum two therapists are in dialogue.
Video conference for expert evaluation.
Secondary opinion.
Denmark and eHealth
https://ec.europa.eu/digital-single-market/en/news/european-hospital-survey-benchmarking-deployment-ehealth-services-2012-2013
http://ehealth-indicators.eu/fileadmin/indeh/documents/indeh_final_report.pdf