Danish GPs enjoy the best IT systems, says study

Denmark is the most advanced country in the world for clinical information technology systems in primary care, health informatics luminary Professor Denis Protti has stated.

Danish GPs are used to sending one another clinical information over their secure network; over 90% of clinical communications are exchanged in this way. The study estimated only 41 GPs in the whole country were not connected to the network.

"The Danes are paid to go out and spend time with other GPs to learn about technology," explained Professor Protti.

Benefits are enjoyed by patients as well as clinicians in the country. For instance, a national online health portal, set up in 2005, provides information to patients about waiting list information and allows them to schedule GP appointments, renew prescriptions and access their own health records – including an audit of who has viewed them.

Patients in Denmark can also contact their GPs by e-mail for medical advice. GPs are paid twice the amount for e-mail consultations as they are for phone, which Protti argued greatly increased adoption rates.

The study, which was presented by Professor Protti at his inaugural lecture at City University, London, was originally commissioned by Canada Health InfoWay, the federal government agency set up to foster adoption of electronic health records across Canada. It aimed to find out the causes behind widescale IT adoption in general practice and what benefits can accrue from its use.

Ten countries – Australia, Austria, Denmark, England, Germany, the Netherlands, New Zealand, Norway, Scotland and Sweden – were analysed. Although the countries were not ranked for their level of clinical IT adoption, Professor Protti said that Denmark was probably the best out of all of them, with New Zealand closely behind.

Primary care IT in England was singled out for its work on its pay for performance scheme, the Quality and Outcomes Framework. Protti argued that QOF had done a great deal to prioritise entry of clinical data into computer systems as opposed to handwritten notes.

Scottish GPs were named along Danish and New Zealanders as being most capable of receiving and processing laboratory reports.

There was no one single thread that indicated widespread adoption of IT in primary care, the study concluded, although Protti noted that smaller countries tended to be more successful than larger ones.

"In North America our physicians are significantly behind most of the rest of the world in the use of technology," Protti commented at the beginning of his lecture, adding that a recent study that concluded 22% of GPs in the continent frequently used clinical IT systems was considered "generous".

A large variety of organisation types, both public and private sector, were responsible for seeing through healthcare IT reform across the world, said Protti: "Denmark has a non-profit organisation, at arms-length from government." New Zealand, on the other hand, operated its healthcare IT project through a wholly private company. What mattered was that a unifying organisation was responsible, as well as some kind of government impetus.

However, Protti stressed that GPs were crucial for the successful implementation of healthcare IT in general. "What seems clear in all ten countries is the recognition that significant progress towards an Electronic Health Record, with all its potential to improve clinical outcomes, is impossible without the full participation of general practitioners."

The quality and availability of data was "tremendously variable" from country to country, ranging from small sample sizes and anecdotes to comprehensive feedback. Further research was needed in many cases, he said.

Professor Protti is holding the position of chair of health informatics at City University between 1 September and 30 November, and is to be visiting professor in 2008.