Portal Panacea

In a first-of-its-kind project, health care data is made available to Denmark's 5.3 million residents.

Denmark, like most countries, faced a serious health-related quandary: how to deliver efficient, effective and affordable care at a time of escalating costs and increased demand for services.

But unlike many others, Denmark harnessed IT to create a national health portal to help drive improvements in its health care system. This portal, called Sundhed.dk (sundhed means health), has increased communication among doctors and between doctors and patients, increased collaboration among health care providers, boosted efficiencies and even improved the quality of care.

The Danish National e-Health Portal is attracting attention from around the globe, thanks to its innovation and success. Its also the 2007 winner in the health care category in Computerworlds annual Honors Program.


sundhed.dk There are very few regions or countries of the world that have done anything like what Denmark has done. Theyre all talking about it, how nice it would be to have something like this, says Jonathan Edwards, a London-based analyst at Gartner Inc.

The idea of a portal isnt unique to Danish health officials. Businesses and other institutions were already using them while Sundhed.dk was still in its infancy in the early 2000s.

In fact, Dr. Finn Klamer, who championed the idea of Sundhed.dk from the start, says he saw early on that commercial portals were successfully reaching health care consumers. And based on his own experience of using technology to automate parts of his general practice, he also saw how IT could create efficiencies in health care.

But Klamer says he didnt want to mimic the commercial sites that promoted specific products; he saw the need for something broader and much more interactive.

We needed a concept that would give us better coordination, better quality and a better patient flow, as seen by the professionals and the patients also. And it was important that the portal could also be a link between the professional partners, exchanging ideas about the patients, he explains.

Many people shared those goals and came together to build Sundhed.dk, says Morten Elbaek Petersen, CEO of the Danish National e-Health Portal. The key players in the countrys health care system including regional government officials, the pharmacists association, general practitioners, hospitals and their CIOs created the Danish National e-Health Portal and in May 2002 hired Petersen to run it.

There was room to do something completely different, room to use the Internet in a new way that brought everybody together, says Morten Godiksen, public relations manager at Sundhed.dk.

The new agency received €7.5 million from those partners to create and implement Sundhed.dk. Petersen says the agency in 2003 awarded the contract to build the portal to Acure, part of IBM Denmark A/S in Copenhagen, because the company understood the need for integration and a platform that could easily be built upon.

The portal is a J2EE environment built on Java and Enterprise JavaBeans, explains Torben Hagen Britze, the ongoing lead IT development person from Acure. Other technology choices include IBM products such as Tivoli Access Manager, WebSphere Portal Server, WebSphere Application Server and Database II, and Interwoven Inc.s TeamSite for content management.

The first of the projects three phases went live December 2003, when Sundhed.dk launched as an information portal. The next two phases, delivered in 2004, first supported collaboration and then full communication along with the ability to monitor and share patients online health records.

The Danish National e-Health Portal extended its contract with Acure to develop and improve the site.

Denmark had some advantages when officials first started work on Sundhed.dk. Some 85% of the countrys health care services are publicly financed, making for a very homogeneous system, Petersen says. And every Danish citizen already had a personal identification number thats used for various public functions, such as paying taxes, checking out library books and labeling health care records.

Moreover, many of the IT building blocks needed to make Sundhed.dk work were already in place at the various medical practices and institutions that serve patients. Godiksen points out that many in the health care sector already had Web sites, medical databases and electronic patient records; the only thing lacking was the coordination to put them all together.

The Danish portal is really only possible because they had implemented those other things, Edwards says.

Pockets of Resistance

Thats not to suggest that the Danes didnt encounter obstacles.

Britze says the need to build up information in the months before the portals debut put a strain on contributing institutions. However, an enhancement in the content management system that allowed editors to preview content helped ease that pressure.

And, Britze says, the standard software available in 2003 couldnt support the portals requirements for high availability as well as some of its specific functions a challenge met by working with software vendors to develop the needed functionalities.

Moreover, some general practitioners, who provide most of the health care services in Denmark, didnt want to be part of the project, Petersen says. Others didnt have the supporting technology they needed in their practices and they resisted getting it.

When you get IT, it takes time to learn it. And [doctors are] there to help patients, not for learning IT, he says.

Citizens have also been slow to obtain digital signatures, which work with the national ID numbers to allow secure access to personal information. Im not sure if everyone has felt the motivation or understands the benefits of it, Godiksen says.

Good public relations helped solve those problems. It was due to good stories that we turned around that struggle, Petersen says, adding that backing from the general practitioners union helped win support as well.

Today, Sundhed.dk logs about 250,000 unique visitors per month, Godiksen says. Visitors can access not only general health information, but also patient-specific material, such as details about their prescriptions, doctors instructions and upcoming appointments.

Godiksen says he sees a future that allows for more online interaction perhaps chat rooms where doctors can answer questions in real time.

But Godiksen says the more immediate goal is to simply increase the portals use. He says there are about 5 million people in Denmark, including 150,000 health care professionals, and its clear that more people use the health care system than are using the portal to help manage their care.

Sundhed.dk is the interface to every health care organization in Denmark, Britze says, and the potential is huge.

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Pratt is a Computerworld contributing writer in Waltham, Mass. Contact her at marykpratt@verizon.net.

Copyright © 2007 IDG Communications, Inc.

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