Lars Hulbæk is the Deputy Manager of MedCom, which aims to develop electronic communication and information sharing in the Danish health sector. MedCom has financed the development of a national infrastructure for home monitoring that allows data from home monitoring systems to be integrated into healthcare records. This involves establishing national standards, a database to store home monitoring data, and interfaces for sharing data with electronic patient records and health portals. Currently over 700 patients are using the system and over 67,000 home monitoring results have been stored in the national database. The next steps involve further testing and integrating the system with additional home monitoring solution providers.

1. Lars Hulbæk
Lars Hulbæk
Deputy Manager
LHF@medcom.dk
”From the home and the body
- to the nurse and the GP”
The vision:
• Simple and easy connectivity between home monitoring systems
and the national eHealth infrastructure - and existing EPR systems
in all parts of the Danish health care sector
• Support of a multi-supplier strategy and the market of home
monitoring systems
1. National action plan for Telemedicine
2. National infrastructure and standards for home monitorering
3. The long and winding road to national dissemination

2. Lars Hulbæk
What is MedCom?
MedCom is a partnership of authorities, organisations and private enterprise associated
with the Danish health sector. In the 1999 financial agreement between the counties and
the government, it was decided to make MedCom permanent, with the following aims:
“MedCom shall contribute to the development, testing, dissemination and quality
assurance of electronic communication and information in the health sector with a view to
supporting good practice in patient care.”
MedCom is financed by:
The Ministry of Health
The Danish Regions
Local Government Denmark
Lars Hulbæk, LHF@medcom.dk

3. Lars Hulbæk
Lars Hulbæk, LHF@medcom.dk
2001
Small scale pilots
Focus on hospitals
Radiology, pathology
Today
Focus on large scale implementation of mature telemedicine concepts
Cooperation between hospital and district nurses
Video conference
Home monitorering
Telemedicine in Denmark - 12 years after…

4. Lars Hulbæk
National action plan for dissemination
of telemedicine (August 2012)
A common plan for the Public Health Sector
• Danish Government
• Danish Regions
• Local Government Denmark
Dissemination of mature telemedicine concepts
80 million DKK (10.7 million Euros) from the Danish Government
and a significant contribution from regions and municipalities
A part of the eGovernment Strategy 2011-2015
and the National eHealth Strategy 2013-2017
Lars Hulbæk, LHF@medcom.dk

5. Lars Hulbæk
Lars Hulbæk, LHF@medcom.dk
Moving from pilot projects within telemedicine to
national scale implementation
What is a mature telemedicine solution?
1) Well functioning technical solution and infrastructure
2) Good user experiences or even clinical evidence
3) Positive businesscase
• Good Danish tradition for IT supported cross sector cooperation
• Lack of national IT standards and IT infrastructure to the patients’
home
• Lack of large scale experience and strong documentation
• Lack of knowlegde about how to share the costs and benefits between
the hospitals, municipalities , and GPs
• Lack of national tariffs for cross sector telemedicine

6. Lars Hulbæk
Lars Hulbæk, LHF@medcom.dk
National action plan for dissemination
of telemedicine (August 2012)

7. Clinical Integrated Home monitoring
• Large scale demonstration
• 2012-2014 (4,5 million euros)
• Large scale demonstration of home monitoring
• 5 clinical trials/patient groups, 1000 patients
• 2 regions and 5 municipalities
Technical part:
• National database for data from patients home
• National standards/profiles for integration to EPR and the national
eHealth portal
• Developed in cooperation with the ”Tele Care Nord” project
Lars Hulbæk, LHF@medcom.dk

8. IT-infrastructure and homemonitoring
Lars Hulbæk, LHF@medcom.dk
National eHealth Infrastructure & standards

9. Laboratory Report from ”the home and the body”…
Lars Hulbæk, LHF@medcom.dk
• Version 1.0: 18 typical home monitorering parameters (”KIH and Telecare Nord”)
• Generic interface – easy to extend with further parameters
• Based on international NPU codes for laboratory medicine
• Documented in OIO-XML and translated to HL7/PHMR (MedCom HL7 profile)

10. Technical status on Clinical Integrated Home monitoring
Lars Hulbæk, LHF@medcom.dk
National database version 1.0 in use
Placed in Region Nord, accessible from the National Health Net
Interface for data collection from different home monitoring systems
Interface for data sharing with EPR / health portal
Interfaces based on OIO-XML (Laboratory Report)
Interfaces based HL7/PHMR standards (Personal Health Monitoring Report)
Solution prepared for adoption in the National Service Platform
Solution prepared for XDS (national/regional patient index)
Access to data for patients at the national eHealth Portal sundhed.dk
Status January 31, 2014
• 734 uniqe patients in the national database
• 67.233 specific home monitoring results in the national database
Primary focus in 2014:
Support to the 5 clinical pilot-projects in ”Clinical Integrated Home
monitorering” and ”Telecare Nord”: Clinical usefullness and Business Case
validation
Secondary focus in 2014:
Test and integration with different suppliers of home monitoring solutions
Reuse in any other Danish home monitorering projects / activities

11. Three steps to cross sector dissemination
- The MedCom way…
1) National consensus
• Standards and infrastructure: To ensure a multi-supplier strategy
• National business case and project plan: To ensure the marked for
eCollaboration
2) Pilot projects
• ”First pilots”: Testing in daily use
--------- National infrastructure for Home Monitoring, February 2014 ---------
• ”Secondary pilots: Implementation in all relevant IT systems
3) National dissemination - all relevant users
• Patient groups
• Hospitals
• Municipalities
• GPs
Lars Hulbæk, LHF@medcom.dk

12. Challenges and Requirements
- Cross sector large scale dissemination
Implies huge investments
• Healthcare organisations
• IT vendors
Requires strong leadership
• Courage: Selecting priority areas within telemedicine
• Persistence: Ongoing support - all the way
• Patience: The long and winding road to full dissemination…
1993 2013
MedCom eMessages
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Lars Hulbæk
Deputy Manager
LHF@medcom.dk
Thank you for your
attention!