Denmark
- Federica Andreoni
- Mohammad Al-Ubaydli
Country’s healthcare system in a nutshell
Denmark has a tax-based universal healthcare, all citizens have access to healthcare providing full coverage of the population. Its healthcare system is based on four pillars:
Universal coverage
Financed by general taxes
Free and equal access
High degree of decentralisation
The healthcare system in Denmark has embraced full digitalization. Each region is tasked with storing electronic health record (EHR) data in their respective data repositories. The EHR coverage is comprehensive, with healthcare providers mandated by law to report to these regional data 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 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 login to see their medical record, and every professional can also access it to see their patients records.
The history of Sundhed.dk traces back to 2001, when a broad political governing body was established to support the start of the development of the national e-health portal. This included The Association of County Councils, The Ministry of the Interior and Health, The Greater Capital’s Hospital Association, and Copenhagen and Frederiksberg Municipalities.
One of the initial duties for the board of directors was to set up a tender process. Given the size and intricacy of creating the shared infrastructure, they opted to conduct the tender as a competition, starting in spring 2002. The Maersk Data Consortium, made up of LEC, ACURE, PLS/Ramboll, and Bysted, emerged as the victor of the competition. A contract was signed with them by the central office of sundhed.dk in early 2003. However, it was not until 2009 that patients were given access to their data: in April 2009, sundhed.dk was launched on a new technical platform, and a development department started to do most development of services in-house, while external consultants were approached only to develop standalone services (the opposite than it used to happen before). One of the first initiatives at that time was to make medical records from public hospitals available so that patients would be able to see parts of their medical record such as treatments, diagnoses, and notes made by the healthcare personnel. (Jensen and Thorseng, 2017; Sundhed.dk, 2023)
Jensen, T. B., & Thorseng, A. A. (2017). Building national healthcare infrastructure: the case of the Danish e-health portal. Information Infrastructures within European Health Care: Working with the Installed Base, 209-224.
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 and access their medical records on the platform after verification. These records include data from their general practitioners (GPs), from the electronic health record (EHR) systems of hospitals (Petersen, 2019), and some private health professionals (Hartlev, 2014).
Healthcare professionals can also use the platform, to access the health data of their patients. Thanks to sundhed, they also have access to clinical information, guidelines, and patient data that may not be available in their own systems. For instance, GPs can access hospital EHRs, waiting lists, and contact information from other healthcare professionals (Petersen, 2019).
On the platform, patients can:
access their health journal: here they can see health data from healthcare providers, such as their medical record from their public hospital, descriptions of X-ray examinations and scans carried out at public hospitals, test results, referrals, discharge letters, medications list (this includes the ability for patients to request repeat prescriptions), a list of past medical appointments with Gp/specialists/public hospital.
register and deregister as an organ donor, create a treatment will, see the status of screening procedures, give relatives power of attorney to view their health data or hide some data from the record.
Patients can see entries made in systems by their doctor and by authorised carers (but cannot see entries made in local journal systems at private practitioners' offices and at public hospitals)
see a list of their vaccinations (Sundhed.dk, 2023).
Challenges and areas for improvement
inability of patients to connect their devices to the record to automatically get their data such as from, for example, the glucometer.
lack of integrations with data sources such as EPIC, which has been introduced by some regions (Jensen, 2016)
Patients cannot add their own data to the record
Published outcomes - statistics
Sundhed.dk most used services in 2021:
Laboratory results (corona test results included)
Patient journal
Medicine card
Patient & Doctors handbook
Image descriptions
Appointments
Find a practitioner
Warrent
Find a health offer
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: (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: (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: (Accessed 25 July 2024).