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Denmark

Denmark

Over half of the world’s hearing aids are made by 3 Danish companies (UBS 2019). In 1950, Denmark became the first country in the world to provide free hearing aids to its citizens (Hindhede 2013). The country combines a comprehensive and generous government welfare system with an innovative and entrepreneurial private sector.

Country’s healthcare system in a nutshell

Denmark’s healthcare system is built on four pillars (Sternberg, 2022):

  • Universal coverage

  • Financed by general taxes

  • Free and equal access

  • High degree of decentralisation

The system has fully embraced digitalisation. Each region is responsible for storing electronic health record (EHR) data in the region’s data repository. EHR coverage is comprehensive, with healthcare providers legally required to report to these regional repositories. The two EHR systems in use (EPIC and Systematic) operate independently without direct data exchange. The national E-Journal shows healthcare professionals information from the EHRs of other regions (Fragidis & Chatzoglou, 2018; Jensen & Thorseng, 2017; Tikkanen et al., 2020).

Health insurance covers the entire population of Denmark: both members of health insurance schemes and those with free access to state-provided healthcare services (Our World in Data, 2011).

Public vs private

Health care spending by country in 2021.svg
Source: The World Bank.
The pink column refers to the public expenditure as a % of the country’s total healthcare expenditure. The blue dot is the country’s expenditure on health per capita, expressed in international dollars at purchasing power parity.

The national PHR

History

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

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.

PKB_Book Cover and Slides_20250210.png
Timeline of main events (Jensen and Thorseng 2017 Fig 13.1)

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

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).

PKB_Book Cover and Slides_20250210 (1).png

 Features

Sundhed.dk has a federated architecture. It draws from 120 local systems without storing or duplicating.

PKB_Book Cover and Slides_20250210 (3).png
PKB_Book Cover and Slides_20250210 (3).png

Patients can log in after identity verification. Their medical records include data from general practitioners (GPs), hospital electronic health record (EHR) systems (Petersen, 2019), and certain private health professionals (Hartlev, 2014). Features include (Sundhed.dk, 2023):

  • Accessing their health journal, with medical records from healthcare providers. Records include imaging reports, test results, referrals, discharge letters, medications and vaccinations.

  • Seeing past appointments with GPs, specialists, and public hospitals.

  • Requesting repeat prescriptions.

  • Registering or deregistering as an organ donor, creating a treatment will, checking the status of screening procedures, and granting relatives power of attorney to view their health data.

  • Marking certain information as private to hide from healthcare professionals using Sundhed.dk. A hospital’s employees can still see the data in their hospital’s local EHR.

Healthcare professionals can access their patients' health data through Sundhed.dk. It also provides clinical information and guidelines that may not be available in their local EHR. For example, GPs can access hospital EHRs, waiting lists, and contact details for other healthcare professionals (Petersen, 2019).

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.

  • The inability of 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.

Statistics

Usage

 

Annual visits to sundhed.png

Most used services

  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.

(The Norwegian Directorate of eHealth, 2022)

Nordics NPS and knowledge

Net Promoter Score (NPS) is a tool to measure customer likelihood of recommending 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

Denmark:

  • Net Promoter Score: 21 (2021)

  • 96% have heard of sundhed.dk (2021)

In comparison to other Northern European countries for context:

Finland:

  • Net Promoter Score*: 52 (2020)

  • Second most respected website (2020)

Norway:

  • Net Promoter Score*: 48 (2021)

  • 97% have heard of Helsenorge (2021)

Sweden:

  • Net Promoter Score*: 45 (2021)

  • 99% have heard of 1177 (2020)

(The Norwegian Directorate of eHealth, 2022)

Screenshots

Homepage of Sundhed.dk
screencapture-sundhed-dk-borger-min-side-2024-11-15-16_52_26 (1).png
This screenshot shows what patients see after selecting "Access your health data" on Sundhed. The original Danish translation contains some inaccuracies. Here's the revised version: The "Access your health data" section allows patients to log in with MitID to view health data that the healthcare sector has recorded about them. The "Health journal" provides access to hospital records, test results, referrals, the patient's medication card, and a summary of past visits to general practitioners, specialists, dentists, and physiotherapists. "Laboratory answers" should be corrected to "Laboratory results," and "Practicing physician" should be revised to "General practitioner." The "Declaration of Consent" requires patients to give consent for their personal health data to be displayed on Sundhed.dk. In the "Registrations" section, the phrase "status of screening procedures" should be changed to "Status of screening process." Additionally, "Onion" should be corrected to "Log," where patients can view and track inquiries made by systems regarding their medical treatment and transitions between healthcare providers over the past two years. This log also shows inquiries made by individuals who have been granted power of attorney, and patients can view their children's logs until they turn 15, as well as those of individuals for whom they hold power of attorney.

Bibliography

 

 

 

 

 

 

 

 

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