Our project is focusing on the two legs of that triangle:
The communication between the municipality and the hospital, and between the municipality and the general practitioner,
explains Kirsten Skovrup, project manager of the Exchange of Information within the Health Care Sector project who is also head of department in the IT section of the Department of Care for the Elderly and Disabled of the Municipality of Aalborg.
In handling the exchange of so much information there is always the risk of information reaching the wrong recipient and misunderstandings, - and that the information is too slow on its way. This is why the project group behind the "Exchange of Information within the Health Care Sector" project has set the goal of finding a method for the interchange of information that is both fast and secure and simple to use for alle parties.
Together with the Municipality of Aalborg, the General Practicing Doctors of Svenstrup, The Medical Clinic in Sulsted, the General Practicing Doctors of Gug, the Health Clinic in Vejgaard and the Medical Department of the Hospital of Aalborg are participating in the project.

Several Routes of Information
To understand the origin of problems, let us follow a – fictitious – senior citizen of Aalborg for the occasion:
Ragnhild is 82 years old and lives in her own flat. She is walking-impaired, she is usings a walking aid, and every morning the nurse of the home care calls around to help her get her compression stocking on. She gets meals on wheels, and every other week the municipal cleaners call around. Adding to this the district nurse calls around once a week to attend her leg sore and make an account of the medicine to be administered – Among other things Ragnhild suffers from hypertension.
One day Ragnhild has an indisposition and falls in her home. She is admitted to hospital, and the home care, the meals-on-wheels catering, the district nurse and the cleaners must now be notified that Ragnhild is not going to need their assistance for a while. On the other hand, the hospital needs to know what medicine is administered to Ragnhild – and what help she is used to receive from the care of the elderly and the district nurse of the Aalborg municipality.
Once Ragnhild is discharged from hospital, the homecare needs to be notified – and maybe Ragnhild needs extra aids and facilities and extra home care during the first time. Her doctor needs to be notified that his patient has been admitted to hospital – and that she may need medical prescriptions.
If only a few elements of this information are late or are lost, Ragnhild might risk not to receive the help she needs.

A Coherent Patient Procedure
- We have three goals with the project: To improve quality, to enhance efficiency, and to improve service. It all boils down to creating unity – to create coherent patient procedures, agree Kirsten Skovrup, Ove Grann general practicioner of the Health Clinic in Vejgaard, and Bente Dam, head nurse of the Medical Dept. of the Aalborg Hospital.
- It falls natural to electronically transfer such information. However, one must make sure that only relevant information is transferred, and that it gets to the appropriate recipient. A major problem is the municipality and the hospital running different IT sytems, and again the general practicioners are using several different systems. We need to establish standards for the communication between our systems, Bente Dam explains:

At the hospital most of these procedures are still handled manually. The county of North Jutland has just deployed an electronic case record system in a few selected departments of the county. The Medical Dept. of the Aalborg Hospital was not among those selected, and it is still not known when the Department will have an electronic case record system implemented.
The development of the data interchange format is in the hands of the Danish MedCom health datanet who has already come a far way in the development of standards for the heath care field. The standards are independent of the IT system used - this is called an edifact standard. The project group has agreed on what information to interchange. Now the major hurdle to take is getting this information implemented in the IT systems of the doctors, the hospital and the municipality.

Pilot Project this Autumn
MedCom has already made a lot of progress with the part of the project covering the interchange of information between the municipality and the general practicioners.
- This autumn it will be launched in a pilot or test run between the district nurses of the municipality and the doctors attached to the project. As things look now, information will be held in three tables: Reordering of medicine prescriptions from the district nurse to the doctor, short messages – for example the doctor asking the district nurse to check the patient's blood pressure every second week – and a status on the patient in the home care system. Here the doctors will have access to some of the information that is otherwise hard to make available in a timely fashion. This could be information on the type of aid and help received by the citizen, or who is reponsible that this patient gets her medicine, explains Ove Grann.

For the Benefit of All
Once MedCom has completed test runs late this autumn, the system will be made available – not only to doctors and nurses in the entire County of North Jutland but in principle nationwide.
And this is also going to happen with the remaining elements of the project: First a test is run locally. Next everybody should be able to benefit from the project results.
The pilot test for the interchange of information between the hospital and the municipality will be launched in early 2002 between a selected ward of the Medical Dept and the municipality of Aalborg. Once it is up and running, other wards of the Medical Dept. will start establishing this communication. Next step is enabling the remaining hospitals of the county to connect to the system. Citizens of Aalborg are often admitted to other hospitals of the county than that of Aalborg.
The entire project is expected to be completed by the end of 2003.