Now, however, he can go to the doctor without leaving home, using some simple medical devices and a notebook computer with a Web camera. He takes his own weekly medical readings, which are sent to his doctor via a Bluetooth connection and automatically logged into an electronic record.
“You see how easy it is for me?” Mr. Danstrup said, sitting at his desk while video chatting with his nurse at Frederiksberg University Hospital, a mile away. “Instead of wasting the day at the hospital?”
He clipped an electronic pulse reader to his finger. It logged his reading and sent it to his doctor. Mr. Danstrup can also look up his personal health record online. His prescriptions are paperless — his doctors enters them electronically, and any pharmacy in the country can pull them up. Any time he wants to get in touch with his primary care doctor, he sends an e-mail message.
All of this is possible because Mr. Danstrup lives in Denmark, a country that began embracing electronic health records and other health care information technology a decade ago. Today, virtually all primary care physicians and nearly half of the hospitals use electronic records, and officials are trying to encourage more “telemedicine” projects like the one started at Frederiksberg by Dr. Klaus Phanareth, a physician there.
Several studies, including one to be published later this month by the Commonwealth Fund, conclude that the Danish information system is the most efficient in the world, saving doctors an average of 50 minutes a day in administrative work. And a 2008 report from the Healthcare Information and Management Systems Society estimated that electronic record keeping saved Denmark’s health system as much as $120 million a year.
Now policy makers in the United States are studying Denmark’s system to see whether its successes can be replicated as part of the overhaul of the health system making its way through Congress. Dr. David Blumenthal, a professor of health care policy at Harvard Medical School who was named by President Obama as national coordinator of health information technology, has said the United States is “well behind” Denmark and its Scandinavian neighbors, Sweden and Norway, in the use of electronic health records.
Denmark’s success has much to do with the its small size, its homogeneous population and its regulated health care system — on all counts, very different from the United States. As in much of Europe, health care in Denmark is financed by taxes, and most services are free.
“It was a natural progression for us,” said Otto Larsen, director of the agency that regulates the system. “We believe in taking care of our people, and we had believed this was the right way to go.”
He and others acknowledged that the system is hardly perfect. It faces budget constraints , and the country is still refining common standards for electronic health records.
“We’re trying to streamline now,” Mr. Larsen said. “There are too many systems out there.”
And he is pushing to use still more information technology and to encourage more initiatives like the telemedicine project at Fredriksberg Hospital.
At Thy-Mors Hospital in the rural region of North Jutland, doctors are using I.B.M. software that pulls data from a patient’s electronic health record and superimposes it on a three-dimensional image of a human body, allowing doctors to quickly get an overview of the person’s medical history. The doctor can rotate the image, zoom in and click on ailments to get more information.
The ambulances have access to electronic medical records, so medical technicians can update them for the doctors even as patients are on their way to the emergency room.
Kurt Nielsen, the hospital’s director, says that while the doctors are not particularly adept at information technology, they have gradually embraced it. And it helps that the staff was involved in developing the innovations.
“My staff at the hospital is very, very satisfied,” he said. “We build these systems in an incremental way, and seek their input throughout.”
It remains an open question what lessons from Denmark, a nation of six million people, can be transferred to the United States.
“Denmark is probably the most advanced country in the world that I have seen,” said Denis J. Protti, a professor of health information technology at the University of Victoria in British Columbia and an author of the Commonwealth Fund study. “Of course, it’s the same size as some of your states.”
Culturally, Danes are also different. Mr. Larsen, of Denmark’s health information agency, says his countrymen have few objections to the national patient registry — perhaps because they have different priorities from Americans when it comes to medical privacy.
“As long you are a healthy man, you fear for your privacy,” he said. “It is when you are sick that you wish people knew what your problem was.”
Still, Dr. Protti and other experts say the Danish experience shows that using electronic health records is efficient, cost-effective — and doable, with a little work.
Dr. John D. Halamka, another adviser to the Obama administration on electronic health records, says Denmark offers the United States a peek into the future, with some logistical variations.
Dr. Halamka, the chief information officer at Harvard Medical School, doubts that the United States will ever have a national patient registry, but he thinks that electronic medical records can succeed as long as patients have control over their own records.
Beth Israel Deaconess Hospital in Boston, where Dr. Halamka is a practicing emergency room physician, was one of the first hospitals in the nation to adopt electronic health records, a decade ago. It remains in a minority — about 10 percent of American hospitals and about 17 percent of American doctors use electronic records, according to studies published in The New England Journal of Medicine.
Two of the nation’s most robust users of electronic health records are the Department of Veterans’ Affairs and the Kaiser Permanente health system. Last week, the two jointly announced that with patient authorization, electronic health records can now be shared between the systems.
At Beth Israel, patients can choose to store their electronic health records using several kinds of programs — Google Health, Microsoft Healthvault or the hospital’s own software — and they control access to their records. In the veterans’ system and at Kaiser Permanente, patients have access to their own health records.
Another challenge is the United States’ sheer size, with 50 state governments and a multiplicity of privacy laws.
Dr. Halamka is vice chairman of a federal advisory panel that has established national standards for electronic health records, meant to help states, hospitals, doctors and patients using various types of software to store their records to share information.
“The standards have been set for parties to communicate,” he said. “There’s hope, and we’re on the right trajectory.”
In Denmark, meanwhile, advocates of information technology are eager to share advice — and enthusiasm.
Mr. Nielsen, of Thy-Mors Hospital, said the transition must be gradual.
“It was done throughout some years,” he said. “It is important to know that it did not happen instantly.”
Back at the 150-year-old Frederiksberg University Hospital in Copenhagen, a nurse, Steffen Hogg Christensen, was preparing medical information kits like the one Mr. Danstrup uses.
Health information technology is no easy task, Mr. Christensen said. Training colleagues and elderly patients can be daunting and time-consuming.
“But isn’t it amazing, how innovative we can be?” he said, smiling broadly. “And all in these old walls.”
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Autor(en)/Author(s): Sindya N. Bhanoo
Quelle/Source: The New York Times, 11.01.2010
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