In Denmark's Electronic Health Records Program, a Lesson for the U.S.

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The Frederiksberg University Hospital in Copenhagen looks like any other hospital in the developed world, except for one notable absence: there are no clipboards. Instead, doctors and nurses carry wireless handheld computers to call up the medical records of each patient, including their prescription history and drug allergies. If a doctor prescribes a medication that may cause complications, the computer's alarm goes off. In the hospital's department of acute medicine — where patients often arrive unconscious or disorientated — department head Klaus Phanareth's PDA prevents him from prescribing dangerous medications "on a weekly basis," he says. "There's no doubt that it saves lives."

In the effort to reform American healthcare, electronic health records (EHR) are a double victory: they both save money (by reducing the duplication of tests and labor associated with manual filing systems) and improve outcomes (by reducing medical errors). President Obama recently pledged $19 billion to computerize America's medical records by 2014. But while health economists and campaigners in America debate what such a brave new paperless world will look like, the small Scandinavian country of Denmark has already made the transition, and is happy to tell the world about it. (Read "The Year in Medicine 2008: From A to Z.")

Denmark has a centralized computer database to which 98% of primary care physicians, all hospital physicians and all pharmacists now have access. Danish residents can gain access to their own records through a secure website. The website alerts the patient by email if a doctor, pharmacist or nurse views their records, and allows patients to make appointments, set end-of-life wishes, and even email their doctor for advice on illnesses that do not require an office visit. While basic records go back to 1977, a detailed history is available of all "patient contacts" since 2000.

These systems and others in Denmark are attracting attention from healthcare reform advocates in the United States. A recent study by the nonprofit Commonwealth Fund rated the country's healthcare IT systems as the most efficient in the world, with computerized record keeping saving Danish physicians an average 50 minutes a day of administrative work. "That's essential for our doctors," says Jeff Harris of the American College of Physicians, who points out that U.S. family physicians have the highest administration costs in the developed world and "are already under strain from all the paperwork required to run an office."

Denmark has several inherent advantages that have aided in the early adoption of electronic health records, according to Kenneth Ahrensberg of SDSD, the Danish government body responsible for the development of electronic health records. It is a small country (population: 5 million) with an IT-savvy citizenry. Trust in the federal government is high. Most helpfully, the country's healthcare is run by the public sector. When the country's health service established a National Patient Registry in 1977 — a system that required doctors to file patient visit details to the government health service in order to be reimbursed for their work — the country unknowingly laid the groundwork for electronic health records by putting in place centralized record keeping. "We are happy to be seen as a test bed for new technology," Ahrensberg says. "But we also recognize that every country is different and we had several advantages over larger countries like Britain, Canada or America." (See the top 10 medical breakthroughs of 2008.)

And advanced though it may be, Denmark's transition to digital records has not been seamless. After the government decided to move away from paper records in 1999, a team of officials came up with a new coding system that required doctors to insert all information and notes in alpha-numerical form. The system was never implemented and eventually abandoned in 2006 after many physicians and nurses complained. Now, instead of one over-arching system, record keeping utilizes various compatible systems, linking networks established by regional health agencies. "What we found is that EHR adoption must be done by evolution rather than revolution," says Jens Andersen of, the state healthcare web portal. "You have to work with the systems already in place."

When TIME visited Copenhagen in March, the EHR evolution was evidently still in progress, with the latest phase focusing on the roll out of telemedicine programs. In the past year, Denmark has piloted two home monitoring programs for patients with diabetes and patients on blood thinning medication — groups that are at high risk of expensive emergency hospitalization. For diabetics, specially trained nurses make home visits to patients with diabetic foot ulcers — which often become infected and lead to amputations. Over a secure video link, the doctor and nurse discuss the ulcers and decide a course of treatment. For patients on blood thinners, who are at high risk of stroke, doctors can remotely monitor the blood work of patients and alert them if they are at risk of hemorrhaging or clots. The excitement over such programs is palpable.

At Frederiksburg Hospital, Dr Phanareth and his PHD student Anders Kjaer are running the first randomized study ever made to show that patients with exacerbation of Chronic Obstructive Pulmonary Disease (COPD) — the group responsible for 10% of all hospital admissions in the country — can be treated at home using telemedicine technology. In a bare office in the hospital, Dr Phanareth monitors patients via a pulse oximeter device and a spirometer device (for lung function) that are blue-tooth enabled and linked through a secure web connection to the hospital. Using videoconference technology, he can guide the patients on whether to administer oxygen, nebulizer therapy and other treatments. "Usually when a doctor wants to do a study like this he comes across red tape and funding difficulties. But because the political wind is blowing our way in Denmark, it's extremely easy for us to get permission for this sort of work," Phanareth says. "Sometimes, a lack of resistance is all you need for change to happen."

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