100 Percent of Primary Care Doctors in Denmark Use Electronic Medical Records

New Commonwealth Fund Profile Points to Lessons for the U.S. and Health Care Reform

March 11, 2010, New York, New York— All primary care doctors in Denmark use electronic medical records and 98 percent have the ability to electronically manage patient care—including ordering prescriptions, drafting notes about patient visits, and sending appointment reminders. In addition, almost all medical communication between primary care doctors, specialists, and hospitals is electronic, according to a new Commonwealth Fund profile of the Danish health care system.

Ramping up the use of health information technology (HIT) tools like electronic medical records (EMRs) in the United States, where currently only 46 percent of physicians use EMRs, is an important part of the recent stimulus bill and the health care reform currently being debated on Capitol Hill. According to Denis Protti and Ib Johansen, authors of the report, Widespread Adoption of Information Technology in Primary Care Physician Offices In Denmark: A Case Study, much could be learned from the Danish system, where HIT use among primary care doctors soared from 15 percent in the early 1990s to more than 90 percent by the year 2000. Data for the report were gathered through visits and interviews with Danish officials and general practitioner (GPs) over the past five years, as well as through a review of the scientific literature.

Danish patients have the ability to electronically access all of their medical information including, medical records, tests results, and hospital discharge instructions. They can also electronically schedule appointments and renew prescriptions, and have access to after hours care when they need it. As a result, Denmark residents have well coordinated, efficient health care and report the highest satisfaction in the European Union with their health care system.

"Denmark continues to work vigorously toward an efficient, patient-centered health care system and has strategically employed health information technology to help achieve that goal," said Commonwealth Fund President Karen Davis. "The Commonwealth Fund's international health care surveys have consistently shown us that the United States lags behind when it comes to health information technology. However, the promotion of health information technology in the recent stimulus bill and current health reform bills are an encouraging sign. These efforts, combined with some of the best ideas from Denmark's success –a coherent national policy, financial incentives to adopt technologies, and technical support for providers—could go a long way toward moving this country to a high performance health care system."

The Commonwealth Fund profile details several successful strategies used in Denmark including:

  • A coherent national policy: The Danish policy supported the development of a national health information technology infrastructure and objectives that linked health information technology enhancements to the quality, efficiency and patient-centeredness of the health care system.
  • Mandatory adoption of EMRs: Beginning in 2004, adoption of EMRs became mandatory under the primary care physician contract and, in 2009, a requirement to use email technology to communicate with patients was instituted.
  • Technical support: The provision of technical support, with data consultants regularly visiting practices to train physicians and staff, helps practices improve data quality and implement standards, and encourage use of the full functionality of EMRs.
  • Incentives: The use of financial incentives to physicians, including faster reimbursement and additional fees for patient-doctor email consultations helped with the spread and acceptance of HIT.

Overall, Danish physicians have been satisfied with using technology as part of their regular practice—they report increased efficiency, quicker access to patient data, better coordination with hospitals and emergency departments, and saving approximately one hour of staff time every day offsetting the cost of investing in the technology.

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