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 hearing aids for free 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):

1. Universal coverage

2. Financed by general taxes

3. Free and equal access

4. 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 show healthcare professionals information from the EHRs of other regions (Fragidis & Chatzoglou, 2018; Jensen & Thorseng, 2017; Tikkanen et al., 2020).

Health insurance covered 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

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 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.

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 competition. 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).

Features

Sundhed.dk operates on a federated architecture. It draws from 120 local systems without storing or duplication.

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, 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, medications and vaccinations.

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

• Requesting repeat prescriptions

• Registering or deregistering 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.

• Marking certain information as private, so that these are hidden from healthcare professionals. However, health information would still be accessible by healthcare professionals in the hospital's electronic patient record system where the patient is treated.

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 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.

Statistics

Usage

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

8. Warrent

9. Find a health offer

10. Dentist prices

Source: The Norwegian Directorate of eHealth, 2022.

Nordics NPS and knowledge

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

Source: 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://www.emerald.com/insight/content/doi/10.1108/IJHCQA-09-2016-0136/full/html (accessed 3 November 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).

• Hindhede, A and Larsen, K, 2019. The rise and fall of audiology in Denmark, 1950-2010. Available at https://praktiskegrunde.dk/2013/praktiskegrunde(2013-1+2f)hindhede-larsen.pdf (accessed 2 November 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://www.ncbi.nlm.nih.gov/books/NBK543679/ (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://ebooks.iospress.nl/doi/10.3233/SHTI210644 (accessed 3 November 2024).

• Our World in Data, 2011. Percentage of population covered by health insurance. Available at: https://ourworldindata.org/grapher/health-protection-coverage (Accessed 2 November 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).

• Towart, L. and Meyer, S.R., 2019. Longer term investments: medical devices. UBS. Available at:https://www.ubs.com/content/dam/WealthManagementAmericas/cio-impact/Medical Devices.pdf (accessed 2 November 2024).

Back: Authors / Next: England