Country’s healthcare system in a nutshell

Denmark has a tax-based universal healthcare system that provides full coverage for all citizens. Its healthcare framework is built on four key pillars:

• Universal coverage.

• Financed by general taxes.

• Free and equal access.

• High degree of decentralisation.

(Sternberg, 2022)

Denmark's healthcare system has fully embraced digitalisation. Each region is responsible for storing electronic health record (EHR) data in their respective data repositories. EHR coverage is comprehensive, with healthcare providers legally required to report to these regional repositories. While there are two distinct EHR systems in use throughout the country (EPIC and Systematic), they operate independently without direct data exchange. Nonetheless, healthcare professionals can access their patients’ EHRs through the E-Journal, which includes information from other regions (Fragidis & Chatzoglou, 2018; Jensen & Thorseng, 2017; Tikkanen et al., 2020).

According to the most recent data from 2011, health insurance covered the entire population of Denmark. This coverage encompasses both those who are members of health insurance schemes and those who have free access to state-provided healthcare services (Our World in Data, n.p.)

Public vs private

The national PHR

History

Sundhed.dk is a public, internet-based portal where every citizen can log in to view their medical records, and healthcare professionals can access it to see their patients' records.

The history of Sundhed.dk dates back to 2001, when a broad political governing body was formed to support the development of a national e-health portal. This body included the Association of County Councils, the Ministry of the Interior and Health, the Greater Capital’s Hospital Association, and the municipalities of Copenhagen and Frederiksberg.

One of the board of directors' first tasks was to initiate a tender process. Given the scale and complexity of building the shared infrastructure, they chose to conduct the tender as a competition, beginning in the spring of 2002. The Maersk Data Consortium—comprising LEC, ACURE, PLS/Ramboll, and Bysted—won the competition. The central office of Sundhed.dk signed a contract with the consortium in early 2003.

However, patients did not gain access to their data until 2009. In April 2009, Sundhed.dk was relaunched on a new technical platform, and an internal development department took over most of the service development, while external consultants were brought in only for standalone services—reversing the previous approach. One of the first initiatives at that time was to make medical records from public hospitals accessible to patients, allowing them to view parts of their records, such as treatments, diagnoses, and notes made by healthcare personnel (Jensen and Thorseng, 2017; Sundhed.dk, 2023).

Features

In its technical design, sundhed.dk operates on a federated IT architecture, integrating with local systems. This means sundhed.dk can draw data from over 120 different sources without storing or duplicating it.

Every Danish citizen can log in to the platform after verification and access their medical records, which include data from general practitioners (GPs), hospital electronic health record (EHR) systems (Petersen, 2019), and certain private health professionals (Hartlev, 2014).

Healthcare professionals can also use the platform to access their patients' health data. In addition to patient data, Sundhed.dk provides access to clinical information and guidelines that may not be available in their own systems. For example, GPs can access hospital EHRs, waiting lists, and contact details for other healthcare professionals (Petersen, 2019).

On the platform, patients can:

• Access their health journal, which includes medical data from healthcare providers. This data encompasses medical records from public hospitals, descriptions of X-ray examinations and scans, test results, referrals, discharge letters, and a list of medications. Patients can also request repeat prescriptions and view a record of past appointments with GPs, specialists, and public hospitals.

• Register or deregister as an organ donor, create a treatment will, check the status of screening procedures, and grant relatives power of attorney to view their health data. They also have the option to hide certain information from their health record.

• View entries made by their doctor and authorised carers in the system. However, they cannot access entries made in local journal systems used by private practitioners and public hospitals.

• Access a list of their vaccinations.

(Sundhed.dk, 2023).

Challenges and areas for improvement

Despite its many strengths, there are still areas where the system could improve to further enhance patient engagement and functionality.

• One key limitation of the current system is the inability for patients to connect personal health devices, such as home monitoring devices, to their records.

• Patients cannot currently add their own health data to their medical records

Published outcomes - statistics

Sundhed.dk most used services in 2021:

1. Laboratory results (corona test results included)

2. Patient journal

3. Medicine card

4. Patient & Doctors handbook

5. Image descriptions

6. Appointments

7. Find a practitioner

8. Warrent

9. Find a health offer

10. Dentist prices

(The Norwegian Directorate of eHealth, 2022)

How well-known are the portals?

Denmark:

• Net Promoter Score*: 21 (2021)

• 96% has heard of sundhed.dk (2021)

In comparison to other Northern European countries for context:

Finland:

• Net Promoter Score*: 52 (2020)

• Second most respected web site (2020)

Norway:

• Net Promoter Score*: 48 (2021)

• 97% has heard of Helsenorge (2021)

Sweden:

• Net Promoter Score*: 45 (2021)

• 99% has heard of 1177 (2020)

*Net Promoter Score (NPS) is a tool to measure customer likelihood to recommend a company, a product or a service to a friend or colleague.

• -100-0: Bad

• 0-30: Good

• 30-70: Very good

• 70-100: Excellent

(The Norwegian Directorate of eHealth, 2022)

Screenshots

Bibliography:

Fragidis, L.L. and Chatzoglou, P.D., 2018. Implementation of a nationwide electronic health record (EHR): The international experience in 13 countries. International Journal of Health Care Quality Assurance, 31(2), pp.116-130. Available at: https://pubmed.ncbi.nlm.nih.gov/29504871/ (Accessed 25 July 2024).

Hartlev, M., 2014. Overview of the national laws on electronic health records in the EU Member States: National Report for Denmark. Available at: https://health.ec.europa.eu/document/download/adaaa3b6-b336-4e65-8897-2b05a689f193_en (Accessed 21 August 2024).

Jensen, T.B. and Thorseng, A.A., 2017. Building national healthcare infrastructure: the case of the Danish e-health portal. In Information Infrastructures within European Health Care: Working with the Installed Base, pp.209-224. Available at: https://pubmed.ncbi.nlm.nih.gov/31314325/ (Accessed 25 July 2024).

Nielsen, N.B., Sekkal, C.K. and Yoganathan, S., 2021. Online Investigations on Optimizing the Danish Health Portal Sundhed.dk. In Context Sensitive Health Informatics: The Role of Informatics in Global Pandemics, pp.89-93. IOS Press. Available at: https://pubmed.ncbi.nlm.nih.gov/34755696/ (Accessed 25 July 2024).

Petersen, M.E., 2019. Achieving better health and well-being via the Danish e-Health portal sundhed.dk. Eurohealth, 25(2), pp.20-23. Available at: https://iris.who.int/bitstream/handle/10665/332595/Eurohealth-25-2-20-23-eng.pdf (Accessed 25 July 2024).

Sternberg, J., 2022. Denmark: the leading digital health nation. Digital Switzerland. Available at: https://digitalswitzerland.com/denmark-the-leading-digital-health-nation-a-magical-country/ (Accessed 25 July 2024).

Sundhed.dk, 2023. Background. Available at: https://www.sundhed.dk/borger/service/om-sundheddk/om-organisationen/ehealth-in-denmark/background/ (Accessed 25 July 2024).

TEHDAS Towards European Health Data Space, n.d. TEHDAS country visits. Available at: https://tehdas.eu/tehdas1/packages/package-4-outreach-engagement-and-sustainability/tehdas-country-visits/ (Accessed 25 July 2024).

The Norwegian Directorate of eHealth, 2022. Comparative analysis 2022: National Health Portals in the Nordics. Available at: https://assets.ctfassets.net/e03pgm1m5c6m/32Ntg6PRQXKIKjuCHpGKBU/cb0a883fb7b0bd651f71b9ef68da1cd9/2022_Nordic_National_Health_Portals_report_v1.1__1_.pdf (Accessed 25 July 2024).

Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A. and Wharton, G.A., 2020. International Health Care System Profiles - Denmark. The Commonwealth Fund. Available at: https://www.commonwealthfund.org/international-health-policy-center/countries/denmark (Accessed 25 July 2024).