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MAPPING THE HEALTHCARE DATA LANDSCAPE IN DENMARK Report Authors Vinay Venkatraman Priya Mani August Ussing August 2015 About this report This report is prepared by Leapcraft Aps on request by Copenhagen Healthtech Cluster, Copenhagen Capacity in May 2015. The premise of research has mainly been intensive desk research done over 8 weeks and a combination of Leapcraft’s experiences on working with big data solutions for the Danish market. We have tried to ensure that the list of medical databases referred to and listed in this report are still active and that the list itself is exhaustive. However it is not a comprehensive or complete list by any means. Wherever possible and relevant, statements about institutions and organisations have been borrowed from their own website to ensure the correct interpretation of their role and activities. DISCLAIMER : All material presented in the report is meant to be indicative and to inform Copenhagen Healthtech Cluster’s research needs. This report is not for public use or research purpose. MAPPING THE IN IN DENMARK MAPPING THEHEALTHCARE HEALTHCAREDATA DATALANDSCAPE LANDSCAPE DENMARK CONTENTS CONTENTS Pg. 04 05 05 06 1. Introduction 1.1 Background 1.2 Identity as a National Infrastructure 2. The Landscape of Danish healthcare 2.1 The State 2.1.1 Danish Regions 2.1.2 Municipalities 08 2.2 Data Infrastructure 2.3 Data Administrators 2.3.1 Documentation- General Practitioners (GP) 10 2.3.2 Who generates what type of data? 2.3.3 Types of documentation 2.3.4 Registration Practices 14 15 2.3.5 Double Registrations and Inconsistencies 2.3.6 The role of Medcom 2.4 The Data Documentation Initiative 2.4.1 Platforms, Integration and connectivity 16 2.5 Data for citizen access 2.5.1 Sundhed.dk 2.5.2 e-Journal 17 3. Sources of information 3.1 National registries 19 20 22 3.1.1 Clinical databases 3.1.2 Cohort Studies 3.1.3 Genome Data in Denmark 3.1.4 Biobanks 23 3.1.5 A note on Economic and Social Data 4. Accessing the health data 4.1 Legislation 24 4.2 The Danish Data Protection Agency : Datatilsynet 4.3 The Danish Data Archive: Dansk Data Arkiv 4.4 Danish Research Ethical Council: Den Nationale Videnskabsetiske Komité 4.5 The Danish Council of Ethics Etiskråd 4.6 Challenges in intersectoral research 25 28 5. Society as a Cohort 30 6. Mapping the Databases 32 7. Contextual extrapolation of Healthcare Data 36 8. Conclusion 38 9. The Next Steps 5.1 Demographic focus : Women, Children, Elderly & Veterans Appendix List of National Registers : Data quality, period of collection and contact. List of Clinical Databases : Data quality, period of collection and contact. List of Cohort Studies : Data quality, period of collection and contact. List of Centers of Genome Research : Data quality, period of collection and contact. 3 MAPPING THE HEALTHCARE DATA LANDSCAPE IN DENMARK 1.Introduction This report aims to understand the known sources of healthcare data in Denmark and see how this data is connected and can be corelated to each other and other social data to make it meaningful to more stakeholders in the healthcare sector, the healthcare industry of diagnostics, medical devices, private healthcare and insurance and ofcourse, to citizens themselves. The report also outlines the legislative and ethical guidelines around usage of healthdata in Denmark through scenarios of use to highlight challenges in information exchange at intra- and inter-sectoral levels. Beginning with a comprehensive layout of the Danish social welfare system which is the primary link between the citizen and state and thus a robust database, the report in chapter 2 introduces all the public sector players who collect, collate and use health data. Points of contact and interaction in the system that generate this data have been discussed in detail along with possibilities for citizen access to both personal and public data. A short overview of the procedures around retrieval and use of data for research access as well as commercial use (including research for commercial pursuits) is presented. While the registrations are intensive and often exhaustive, the formats themselves are not aligned and hence this chapter delves deeper into the issues of data integration and discusses in further detail the registration practices, even at the most basic patient - doctor level, that essentially generates this data. This analysis helps outline the barriers and challenges in the healthdata landscape as it is now, and can help in improving the framework for future databases. Chapter 3 discusses in further detail the various categories under which this healthcare data is collected describing the periods of time and population breadth covered in these, thus reflecting on the quality of the available data. The various registers are classified in detail here covering clinical data registers, quality indicator registers and tissues and bio materials sample databases. Privacy around personal data is given great importance in Denmark, giving great credibility to health data generated here. Chapter 4 lists the various agencies that work towards keeping this system secure in good detail giving one an overview of the legal framework for potential cross sectoral research projects and further data mining. The challenges to accessing information stored in specific registers at both intra- and inter sectoral levels has been outlined. Chapter 5 looks at possibilities to synthesise the various data sources and make new sense from it. After mapping existing efforts, the report looks at potential new lenses to see the same data like demography, general wellbeing and chronic illnesses. An attempt has been made to see the entire landscape of data sources mapped on a lifetime. As we see this historical data collection activity as a mass of data on specific factors, it reveals evolution of lifestyle syndromes, focus of the healthcare sector and policy making, gender based tendencies etc. Analysis can take take a predictive turn as the map can be interpreted across many indicators. Using the body as a spatial metaphor in chapter 6, the various registers are mapped giving one an overview of areas of keen research interest, funding and of value to population studies. All kinds of registers are notably mapped here, stressing the volume of data that exist for a particular area of study. A detailed contextual extrapolation of data use is explained in chapter 7 citing potential use case scenarios and the way forward to realise these mentioning the different stakeholders and a possible road map. The report concludes with a road map for use of this healthcare data combined with other rich socioeconomic data collected in Denmark for welfare projects and private sector projects. 5 1.1 Background 1.2 Identity as a National Infrastructure The Nordic countries have been front runners in the collection of data on births, deaths, disease and its control. Data on education and employment, immigration and emigration have also been duly collected as it was and is the backbone of the welfare state model. Growing population, tax collection and disbursement of complex welfare funds pushed the state’s early foray into digitisation of data. Thus very high quality data of the whole society is available for varying, yet long periods of time. Using a unique personal identification number assigned to all persons with a permanent residence in Denmark (CPR-number)5, it is possible to link data from one or more registers or from other sources with registerbased information at an individual level 6. It was established in 1968 and contains the name, address, personal identification number, date and place of birth, citizenship and other information about the country’s citizens and residents. For example, information on causes of death has been collected since 1875 in Denmark1, information on compulsory schooling and continuing education are available for cohorts born after 19452, information on twins are available for cohorts born after 1870 3, and cancer incidence has been registered for the whole country since 1943 4 . Additionally, each Danish firm has a unique identification number, the CVR Number 7, which makes the link between a firm and employees possible 8 . Thus, the access to information on important exposures, confounders such as education, income, and ethnicity and various health-related outcomes offers immense opportunities for doing epidemiological research on, for example, the association between occupational exposures, disease incidence, mortality, social issues, clinical indicators, and rehabilitation. Additionally, all data pertaining to real estate properties in Denmark are maintained in the BBR 9 which includes detailed historical data on property evaluation, condition, renovation, ownership and pollution levels of constructions. This indepth recording reflects socio-economic data that can be related to population transition , lifestyle and well being. 1 Helweg-Larsen K. The Danish Register of Causes of Death. Scand J Public Health 2011;39(Suppl7):26–9. 2 Jensen V, Rasmussen A. Danish education registers. Scand J Public Health 2011;39(Suppl 7):91–4 3 Skytthe A, Christensen K, Kyvik K, Holm N. The Danish Twin Registry. Scand J Public Health 2011;39(Suppl 7):75–8. 4 Gjerstorff M. The Danish Cancer Registry. Scand J Public Health 2011;39(Suppl 7):42–5. 5 CPR- Det Centrale Personregister https://cpr.dk/ 6 Pedersen CB. The Danish Civil Registration System. Scand J Public Health 2011;39(Suppl 7):22–5. 7 CVR- Det Centrale Virksomhedesregister http://datacvr.virk. dk/data/ 8 Petersson F, Baadsgaard M, Thygesen LC. Danish registers on personal labour market affiliation. Scand J Public Health 2011;39(Suppl 7):95–8. 9 BBR - Bygnings og Boligregisteret - The Building and Housing Register. www.bbr.dk. MAPPING THE HEALTHCARE DATA LANDSCAPE IN DENMARK 2. The Landscape of Danish Healthcare The layout of the Danish healthcare system and the Danish political system forms an important basis for the work on eHealth in Denmark. Health care in Denmark is based on two main principles: Free and equal access to public health care. This includes general and specialised practitioner services and services at all public hospitals. Dentists and outof-hospital medicines and some therapies are provided under private or co-payment models on a case basis. Universal coverage. All residents in Denmark are entitled to public health care benefits in kind. The public health care system is organised in two main sectors: primary health care and the hospital sector. The primary health care sector deals with general health problems and care and consists primarily of general practitioners, practising specialists, practising dentists, physiotherapists and home nursing. Primary health care also includes preventive health schemes, public health care and dental care for children. The hospital sector deals with medical conditions that require specialised treatment, equipment and intensive care. A general practitioner (GP) must refer the patient to a hospital for examination and treatment unless it is a question of an accident or acute illness. Usually it is necessary to be referred by a GP for treatment by a specialist. Since 1993, patients have had the right to choose between all public somatic hospitals for treatment. An extended free choice, since 2002, has given patients the right to choose a state financed treatment at a private hospital if waiting times at the recorded in the BBR are nationwide registers pertaining to all citizens and residents of Denmark and established protocols means the extrapolation of all this data with a single identification number is possible, but not explicitly done today. The data is informative and forms the basis of nearly all register based researches in the country. The data is gathered and accessible nation wide and a large part of this (except the CPR number itself) is available for research and commercial use and further, the anonymisation of data, partly or wholly is possible. Aggregated data and statistics from these registers is made public. 2.1.1 Danish Regions The Danish Regions coordinates the common interests of the 5 regions at the national level and negotiate the annual financial framework for the regions with the government as well as enter into agreements with the private practising sector including GPs and dentists.10 Public hospitals and contracts with all GPs are the undertaking of Danish Regions (Danske Regioner)11. The data collected is currently from the primary healthcare and the hospital sector which use different platforms and registration protocols. Yet, the data collected is almost entirely digitised thus generating an intense, deep pool of e- health records pertaining to every individual’s healthcare history. While the data can be transferred across systems, the format is still text documents. The Regional eHealth Organisation (Regionernes SundhedsIT organisation – RSI, est. 2010)12 accelerates and coordinates the implementation of eHealth across the five regions. All projects, collection of data and maintenance of databases are carried out with one of the regions as the main principal. 2.1.2 Municipalities public hospitals are too long. The administrative break up of the between: 1. The State 2. Danish Regions (Danske Regioner) 3. Municipalities (Kommune) The Sundhedsdatastyrelsen, part of the Sundheds- og Ældreministeriet is the agency for the National Sundhed IT (NSI) that until August 2015 was part of the Statens Serum Institute. 2.1 The State The CPR and CVR registers along with property data The regions are divided into 98 municipalities (Kommuner) and are responsible for a wide range of health services like local and specialised dental care and rehabilitation preventive treatment, homecare, nursing homes, rehabilitation (not hospital), treatment of alcohol and drug abuse, social psychiatry and physiotherapy.13 Thus the municipalities collect data on various socio-economic indicators giving deep insights into every individual where therapy and chronic care at the municipality level can thus be linked to various other municipality activities such as education, work place conditions, tax collection, welfare schemes. 7 Illustration 1: The Landscape of Danish Health Care - Infrastructure & Access The nation wide infrastructure is continuously recording personal data at the state (geo-bio data), region (e-health records) and municipality levels (e-care records). The data, specifically, healthcare data is recorded in national registers, tissues and samples are collected in bio banks and data of specific health conditions is actively recorded in clinical databases, by active participation and inactively by course of treatment in hospitals. Access to the data is made available both for personal use (one’s own data) and is systematically anonymised at various resolutions for research purposes. This infrastructural landscape is well integrated ensuring every instance of interaction between the state and the resident is documented both qualitatively and quantitatively. Hospitals ECR EPR Lab, Imaging sytems chronic care Electronic Care Record Electronic Patient Record BBR Building & Housing Register Municipal Infrastructure Regional Infrastructure National Shared Infrastructure State / Intra Governmental E Medical Records, with education,housing, employment records Secure Data National IT, Architecture, Standards, CPR & Civil Registration System INFRASTRUCTURE CVR Central Virksomhed Register National Clinical Clinical Registers & Databases Databases Services Biobanks Research DOCUMENTATION Registeries, tissue samples, databases Secure Data Danskerne Sundhed Denmarks Statistics ESundhed Healthcare Professional ACCESS Research Doctors Citizen Aggregated / Inter register Research Open Data Sundhed.dk Citizen Doctors Personal health records, hospital journals, reports Secure Data INTERACTION 5 regions http://www.medcom.dk/dwn5350 www.regioner.dk 12 http://www.regioner.dk/sundhed/sundheds-it/rsi 13 http://www.ikas.dk/IKAS/English/The-Danish-healthcaresystem.aspx 10 11 96 Municipalities 3500 GPs Commercial MAPPING THE HEALTHCARE DATA LANDSCAPE IN DENMARK 2.2 Data Infrastructure 2.3. Data Administrators All the health databases are administered by a data manager who works within the Regions Competence Center. Data entry for some databases is directly done into the nationwide register, while some others are maintained in regional registers which in turn plug into the nation wide register. There is double documentation of some variables in this case. The Regions’ Clinical Quality Development Programme (Regionernes kliniske Kvalitetsudvikling Program, RKKP)20 represents infrastructure supported nation wide clinical databases, Danish multidisciplinary Cancer Groups (DMCG) and centers of epidemiology, biostatistics, health informatics and clinical quality. The program’s primary objective is to ensure continued improved utilisation of the nationwide clinical databases It was formed in Sept. 2010 and has since focused on ensuring the framework for prioritisation and management of databases; better use of existing data / reduction of data entry tasks; standardisation of inputs and outputs in relation to databases; product development and proper method development. The RKKP is located in Århus. The five regions have their own competence centers for clinical epidemiology and they work together with the Joint Secretariat (the RKKP). Competence centers have been established in all the 5 regions and they oversee the IT requirements of each database, identify relevant clinical content, workflows, IT advice and offer data analysis validated by statistical epidemiological principles. There are 3 competence centers for register based Epidemiology Studies while the other 2 are focussed on data quality and indicators. Kompetencecentre for Epidemiologi & Biostatistik (KCEB) KCEB-Nord – Located in Aarhus/Aalborg14 KCEB-Syd –Located in Odense Universitetshospital15 KCEB-Øst – Located in Glostrup as a part of the Forskningscenter for Forebyggelse og Sundhed (Research center for Prevention and health)16 Kompetencecentre for Klinisk Kvalitet & Sundhedsinformatik (KCKS) KCKS-Vest – Located in i Århus, along with RKKP17 KCKS-Øst – located in København Ø, as part of IT, Medico og Telefoni, Region Hovedstaden The Danish Healthcare Quality Programme ( Den Danske Kvalitetsmodel, DDKM)18 is a national accreditation system for quality development across the entire healthcare sector along with methods to measure and control this quality. The programme serves as a method to produce continuous and persistent quality development across the entire healthcare sector. The DDKM aims to generate and combine data which is already being collected in the Danish healthcare sector. This data includes, among other things, the national quality databases, data on adverse events, national patient satisfaction surveys. DDKM is public and multisectorial. The Danish Institute for Quality and Accreditation in Healthcare (Institut for Kvalitet og Akkreditering i Sundhedsvæsenet) IKAS19 develops, plans and manages the DDKM. 2.3.1 Documentation- General Practitioners (GP) In Denmark around 98% of the population (health insurance group 1) are assigned to a specific general practitioner through a list system. The GP acts as a gate-keeper with regard to referrals to specialists and hospitals, and services are free of charge. The remaining 2% of the population (health insurance group 2) have chosen the right to consult any GP or practising specialist at any time, in return for paying a substantial part of the doctor’s fee. 21 Services to both groups are registered in the National Health Service Register (NHSR). The data in the register is generated through the GP’s invoices to the Regional Health Administration. All practices are computerised and they send an electronic fee request containing information about the citizens, the provider, and the type of service to 14 http://www.kea.au.dk/klinisk%20kvalitet/kompetencecenternord/kompetencecenter.html 15 http://www.ouh.dk/wm220632 16 https://www.regionh.dk/kliniskedatabaser/Sider/default.aspx 17 www.kcks-vest.dk 18 http://www.ikas.dk/DDKM.aspx 19 www.ikas.dk 20 http://www.rkkp.dk/om-rkkp/ 21 John Sahl Andersen, Niels De Fine Olivarius, and Allan Krasnik. The Danish National Health Service Register. Scand J Public Health July 2011 39: 34-37, doi:10.1177/1403494810394718 9 Illustration 2: The Danish Healthcare Landscape: What data is collected? Who has health data? Who can access it? Examples of databases CLINICAL State / Intra Governmental Biological data & samples related EMR Pato Bank Dansk transfusionsdatabase PKU Registret National BioBank Cause of Death Register ADHD databasen Dansk Føtalmedicinsk Database Organdonationsdatabasen etc. Citizen Research TREATMENTS Citizen Research Specific Procedures/ Conditions related EMR Dansk almenmedicinsk database IVF Register Rehabilitation Register National Patient Register Cancer register Akut Kirurgi Databasen Blærecance Dansk Anæstesi Databaser Dansk apopleksiregister Dansk børnecancer register Dansk Brystkræft Database etc. TREATMENTS access CLINICAL NON-CLINICAL NON-CLINICAL Research Citizen Information connecting to CPR Donorregistret Livstestamentregister Autorisationsregisteret Fællesmedicinkort venteinfo.dk Administration af udleveringstilladelser Mobilt Akut System Databasen (MAS) Ventetid på danske apoteker DEMOGRAPHIC www.regioner.dk Data from all hospitals DEMOGRAPHIC Doctors Research Person related data CPR (Det centrale personregister) Fødselsregisteret Dødsårsagsregisteret *Also includes other reflecting databases like eductaion, employment, welfare benefits etc. AGENCIES Doctors PLATFORM Here, it can be seen that the state itself is actively involved in cross sectoral data analysis that it presents through various platforms both at the individual level (Statens Institut for Folkesundhed) and nation wide level (Danmarks Statistics). The data collected and managed by various agencies reflects their focus and in turn the various kinds of research projects the data feeds into. The data owners work under larger universities (for domain knowledge), as national infrastructure (regions, municipalities) and independently (Statens Serum Institute, National Biobank). Data is accessible at various resolutions depending on the need for access ( fundamental research, industry assisited research, self health monitoring, nation-wide health and wellness trend monitoring etc.) However it appears, that a holistic overview of all of a person’s personal data is perhaps visible only to the State through the CPR number. While the linking all the various data silos is technically possible, there are no platforms that offer this linked socio-economic-health view to the individual. ACCESS Citizen Doctors Research Commercial State / Intra Governmental At a higher demographic level, population data will need to be parsed quite extensively to collect similar parameters for comparitive studies across specific population studies. The nature of data, both raw and collated that is readily available for commercial research remains however unclear. MAPPING THE HEALTHCARE DATA LANDSCAPE IN DENMARK the Regional Health Administration every week which passes the information on to the National Board of Health (Sundhedsstyrelsen). The list of variables is comprehensive. 22 The GPs occupy a central position in the Danish health care system as the patients’ primary point of entry to health services. The GP ensures that the patient is given the right to treatment and right treatment and is referred to the right professionals in the health service. The GP is thus the coordinator and the person with professional responsibility for referring patients to hospitals, specialists and other healthcare professionals. Table 1 : Who generates what type of data? 2.3.2 Who generates what type of data? Every point of contact with the health care system generates information and data about a patient. This can be both quantitative and qualitative and registers are maintained to that. Some of this data is of primary nature ( raw data) and the rest is secondary data that is derived from the registers or reflecting registers. In the Danish context, most of the healthcare is managed by the public healthcare system, and yet a small fraction is supplemented by the private healthcare who are still obliged to maintain the personal heath records of the patient during the period of treatment at a private center. Examples of data generated are provided in the table below. For further reading refer Sec.3 on Pg 13 Raw data generated at every touch point contributes to the bigger data pool. Here are some examples of qualitative and quantitative fields that are populated through the data gathering process. Secondary data is generated by numerous sources that service the larger healthcare industry. The list here is only indicative. EXAMPLES OF QUALITATIVE CONTENT EXAMPLES OF QUANTITATIVE CONTENT General Practice records Observations symptoms diagnosis medical history prescriptions requisition of tests Vital statistics test results Frequency of visits Total time per case GPs Pharmacy records Prescription Compliance Drug Interactions Allergies Waiting time Frequency of order Population health Pharmacies, Hospitals Electronic Care Records Summary of point of care Patient Satisfaction Record of Incomplete care Use of resources personnel, time, infrastructure etc. Treatments Tests if any Electronic Health Records diagnoses, treatment, imaging, Pathology, lab results, outcomes, Treatments Tests if any Health Insurance records treatment, outcomes Private or Public health insurance Biological samples - Bio banks, Hospitals PRIMARY DATA SECONDARY DATA Health registers EXAMPLES OF QUALITATIVE CONTENT EXAMPLES OF QUANTITATIVE CONTENT Costs, resources Patient communites (e.g Diabetes, Cancer, psoraisis, alcohol rehab etc. John Sahl Andersen, Niels De Fine Olivarius, and Allan Krasnik. The Danish National Health Service Register, Scand J Public Health July 2011 39: 34-37, doi:10.1177/1403494810394718 22 RESPONSIBILITY Hospitals RESPONSIBILITY Individual register owners 11 2.3.3Types of Documentation 2.3.4 Registration Practices All data generated and collected can be broadly classified under the following types. While some of them are qualitative, some others are quantitative and the format can be both text (.xml) and numerical values. Typically, entering data to the central registers is handled by secretaries who report the interaction between the doctor and the patient. The reporting of data from hospitals to the central records is ongoing in the patient administration systems (PAS) systems. Patient behaviour Health issue, compliance with treatment, outcomes, personal choices or preferences Health outcomes Medical records, hospital statistics, insurance data, observational indicators Longitudinal Patient records Pathology, drug and product information, social and environmental factors, medical history consisting of diagnosis codes, doctor’s notes, lab reports and diagnostic images - wounds, xrays etc.) Resource Use Each contact with the health care system (time waited, spent and quality), treatments, costs etc. Population Health All clinical data generated under controlled randomised trials, other structured content like lab tests, images or unstructured content like notes, medical history etc. Montoring devices At home monitoring devices, personal devices, apps that quantify the body or physiological data generated from bed side monitors at hosiptals and other sensors. Sales & Marketing Data from pharmacies, sales, marketing and product data, insurance claims etc. Other reflecting data Environmental data like weather, pollution, atmospheric allergents, diease outbreaks etc. 23 http://www.sum.dk/Aktuelt/Publikationer/Analyse-afkvalitetsoplysninger-i-Danmark-juni-2010/Kapitel%204.aspx 24 ibid. For further reading refer Sec.4.7 on Pg 24. The decision on who is responsible for registering the quality databases is taken at the branch level. This means that it varies from department to department, on whether the registrations are made by a clinician, a nurse or a secretary. However, in most cases, doctors or nurses in charge of the case inputs to quality databases. 23 The input of data to the central registers typically happens as follows: 1) The doctor collects information as part of a conversation with the patient, or an operative procedure and writes notes, fills out forms or dictates notes to the secretaries. 2) The information is thus transferred to the secretaries who in turn input the information in the patient administrative system and edit or debug the entries. Input of data to the clinical quality databases are 1) The doctor inputs the information - but rarely as the collection of information happens (i.e not during a patient visit or procedure) 2) The nurse inputs the data 3) The doctor fills out a form which is then input by the secretary. The most common is of course the first two options and a conservative estimate is that 2/3rd of all information input happens this way. 24 Recording practices in clinical quality databases can be generally categorised into three main groups. 1) The recording is directly done into the other central registers (LPR, pathology register, etc.) and thus there are no independent records in the database. 2) The recording reports directly to their own database. The same information is reported in varying degrees to both the central registers and database causing double registrations. 3) Combination of shared recording with central, and separate reports. Continued on Pg. 14 MAPPING THE HEALTHCARE DATA LANDSCAPE IN DENMARK Illustration.3 Platforms, Flow of Messages and Quality of Data between the various stakeholders. All messages between the different stakholders and sectors (primary & secondary) are marked in this flow chart of electronic messages. The administrators (municipality) and online interfaces (sundhed.dk) are also marked here as a source of generating and receiving messages. The digitalisation strategy in the public sector of Denmark has intended to reduce person based interactions (enquiry, reporting etc.) and paper work (intimations, collection, imposing of fines etc.) to a bare minimum by creating a single online interface for this. Here, one sees only the health sector, but a similar messaging protocol exists in other public sectors as well. The nature of the messages are both qualitative (text, like surveys, journals, notifications, reports) and quantitative (numerical, like pathology reports, biological profiles etc.). Numerous databases on quality of healthcare are maintained reflecting resource utilisation, costs and patient satisfaction. This flow chart is loosely based on a representation of flow of electronic messages in the health sector in the Report “IT brings Danish Health sector together” Pg.6, published on the public portal sundhed.dk. Information from medcom.dk, IKAS and quality indicators of databases has been added to this to include every data point in the system, reflecting whether they are clinical, non clinical, and if the data reflects a economic value or not. The stakeholders often use multile platforms which cause some discrepancies in data formats and sharing and this number is indicated on the chart as well. In 2014, EPIC, an American solutions provider has been chosen to overcome the many challenges posed by non synchronous platforms and data formats. In the years to come, EPIC is expected to create unanimity between the messgaing systems and architecture, reducing lag and irrelevance. 2100 clinics 60 hospitals 96 Kommunes in 5 Regions 16 15 1 PRACTITIONERS 3500 in PLATFORMS GP Hospital 1 12 sundhed,dk stakeholders Citizen GP Hospital Public Health Insurance Online booking of appointments. Online consultations In-person visit. Prescription renewal. Communication to the citizen. Transfer of patient records Referral Bookings Call for participation in surveys, change of doctor etc. Change of address Request for Prescription Renewal. Communication & Information from all Danish healthcare services. Access & update journal Requis Lab Re Booking report. Discharge letters Transfer of patient records Billing and Reimbursement Billing and Reimbursement Requis Lab Re Billing and Reimbursement Billing a Reimb Lab Re Sundhed.dk Data type Clinical Non clinical economic non economic 13 250 726 550 in 250 clinics 3 5 10 9 11 ed,dk ation & from all thcare date 5 Telemedicine 12 245 Requisitions Requisitions Lab Reports Lab Reports Requisitions X Ray Referrals Lab Reports Lab Reports Billing and Reimbursement Billing and Billing and Billing and Billing and Billing and Billing and Reimbursement Reimbursement Reimbursement Reimbursement Reimbursement Reimbursement Lab Reports Prescriptions Referrals Referrals Referrals Discharge letter Discharge letter Discharge letter Referrals Discharge letter Prescriptions Billing and Reimbursement etc. ETC. MAPPING THE HEALTHCARE DATA LANDSCAPE IN DENMARK The registration and any duplicate entries in the clinical databases depends on how each database is constructed. Since there are no overarching guidelines for building databases input fields, the area is characterised by different solutions. Also, irrespective of the database, typically the same variables especially from the LPR is what is double registered. These are about basic demographic information, administrative healthcare information and clinical information about diagnoses, procedures, examinations and medical history. 2.3.5 Double Registrations & Inconsistencies a clinical quality database. Over the spring of 2010, the Sundhedsstyrelsen mapped and analysed double registrations across the system. 32 nationwide clinical databases, equivalent to 90 per cent. of all registered patients in quality databases were mapped. The focus was the extent to which health staff use unnecessary time on record in quality databases, Documentation and exchange of data in the Danish Healthcare Data Landscape is clearly seen in the illustration hereunder. Illus 4. Det danske Sundhedsvæsenen Although the data is computerised, much of the data is manually entered and the nature of the administrative distribution causes the same data to be entered a multiple times. When this happens across different platforms used in the practice, it results in different formats of documentation, minor variations caused by human entry and thus it can be challenging to achieve a unified longitudinal data set without setting aside preparatory time for parsing the data. Part of the problem of inconsistency stems from Denmark’s own digitalisation history. An early foray into digitising health records while providing long periods of data, often comes with data recorded across platforms that do not integrate very well or possibly support the same fields of data entry. Technically speaking, since Denmark was a frontrunner in digitalisation of its medical records, the data pool is inundated by a huge challenge of legacy systems and outdated platforms. Within the GPs alone, 16 different platforms are in use. The hospitals use 15 different platforms which are not the same as the ones used by GPs. Transfer of patient data is mainly textual (.xml) based between the systems except for when numerical data is used, for e.g. pathology reports. Another instance is the restructuring of the municipalities in 2007 when 276 municipalities were reduced to just 98, resulting in codes that don’t match. Different collection periods, changed or altered variables all mean that there could be issues of inconsistent longitudinal datasets. A double registration in this context can be defined as data with mandatory inputs into the LPR or other central registers but is also simulatnoeusly collected in Primary Health Care Practitioners Pharmacies Home Care Nursing Homes Visiting nurse All Rehab work XMLformat text based Messaging System Secondary Health Care Hospitals because the database variables are also reported to a central repository. The variable was categorised as a double registration only if all outcomes for the given variable is registered in a central register. The survey shows that annually, almost 30 million. double registrations were made between clinical databases and central health records. Between clinical databases and LPR / CPR alone, there were 25 million. double registrations annually, equivalent to about 85 per cent. of the total number of double registrations. About 75% of annual double registration takes place in five of the clinical databases. Double registrations could be avoided by increasing integration with data from the central health records. 25 The Center for Register-based Research lists some interesting challenges in the existing Danish healthcare data. Examples of inconsistencies include, 1) The Danish Civil Registration System (CPR) contains http://www.sum.dk/Aktuelt/Publikationer/Analyse-afkvalitetsoplysninger-i-Danmark-juni-2010/Kapitel%204.aspx 25 15 information on permanent residence including emigrations, immigrations and disappearances. This is recorded in 9 different data sources with (although minor) missing and inconsistent information, where persons may be registered to reside at a specific address in Denmark while also being registered as living abroad. 26 2) The municipal reform in 2007 reduced the number of municipalities from 276 to 96 causing a difference in codes assigned to these municipalities. 27 3) The National Patient Register (NPR) contains an administrative database containing patient-level information, a database describing diagnoses given at somatic in- and outpatient departments, and procedures performed at somatic in- and outpatients departments. This information is contained in one database per year, so far yielding 35 administrative databases, 35 diagnostic databases, and 35+ databases on procedures performed. In addition, there are some changes in what types of information are included, as well as inconsistencies due to varying variable lengths between years. 28 Ref, Illustration. 4 Platforms, Flow of Messages and Quality of Data between the various stakeholders. on Pg. 12. 2.3.6 The role of Medcom MedCom is a public, non profit organisation that facilitates cooperation between healthcare stakeholders. It contributes to the development, testing, deployment and quality assurance of electronic communication and information in the health sector. It is jointly financed by the Ministry of Health, Danish Regions and Local Government Association. Medcom sets the digitisation standards across the industry, providing authorisation and approvals for platforms and data exchange formats used by professionals across the healthcare sector. municipalities, pharmacies and private laboratories. Messaging systems between the primary and secondary healthcare sector are crucial and currently Medcom oversees the approval of platforms and formats for this service. 2.4 The Data Documentation Initiative The Data Documentation Initiative (DDI) is an international cooperation for setting metadata documentation standards for describing data from the social, behavioral, and economic sciences. Data is unanimously expressed in .Xml and the DDI has a specification on how metadata must be stored. It now supports the entire research data life cycle. DDI metadata accompanies and enables data conceptualization, collection, processing, distribution, discovery, analysis, repurposing, and archiving. 29 2.4.1 Platforms, Integration and connectivity- The Danish case While the registers and databases have an impressive record of quality of treatments, outcomes of care and improvement initiatives and numerous guidelines at local, regional and national levels written over a long period of time, a rather obvious problem of integrating all these initiatives has surfaced. About 3500 practitioners across 2100 clinics in 98 municipalities use 16 different platforms to make a data entry of Primary health care. While mostly they accept and send the same data fields, there are differences which eventually affects the completeness of the data. The case is similar with the hospitals. 60 public hospitals use 15 different platforms to record and exchange data. The chance to leapfrog into a futuristic data repository seems a bit challenging - both from a technological aspect and behavioural resistance from the large administrative work force. Medcom ensures relevance and a strong IT infrastructure needed for secure and coherent access to healthcare data across the regions, municipalities and all practitioners. They set the standards for software platforms used by the practitioners to ensure that a comparable depth of data is collected nation wide. CIRRAU Advantages . www.cirrau.au.dk ibid. 28 ibid. 29 http://www.ddialliance.org/what 26 Working in alignment with the national strategy for healthcare digitalisation, Medcom has come to cover telemedicine infrastructure, public health insurance, 27 MAPPING THE HEALTHCARE DATA LANDSCAPE IN DENMARK 2.5 Data for citizen access Anyone with a CPR number can access their health data. The portal sundhed.dk, gives access to journals and entries made at every contact point with a healthcare professional. This gives the individual a good amount of personal data for basic understanding. To get overviews on societal health data and statistics, aggregated data is also made available for citizen use. To understand a particular health condition, citizens can access the portal esundhed.dk, which gives access to aggregated data from specific, nation wide registers with a possibility to select variables for viewing. Danmarks Statistics offers a rich repository of annually published, aggregated and analysed data. Danskernessundhed30 publishes its findings from nationwide surveys to offer a big picture view of the nations state of heath and healthcare. The Interaktiondatabase 31 describes drug interactions and citizens are given the possibility to check this online. Sundhed.dk also offers a huge repository of common illnesses and treatment, therapy and medication options for them. 2.5.1 Sundhed.dk Sundhed.dk is an online portal that was established in 2003 to provide a common digital entry to reliable information about an individual’s health and the Danish health system and at the same time create an opportunity to provide health care professionals with access to improved ways of communicating digitally between each other and with patients. The partners behind sundhed.dk are Danish Regions, the Ministry of Health and municipalities through Local Government Denmark (LGDK). 32 As a citizen, one can log in with their CPR number and access their health records generated at the GP, reports from the hospitals and any associated pathological tests or any other contact points with other healthcare professionals. While most records are real time, pathological reports are still deferred by a few weeks. of the Danish population. Clinicians at hospitals have access to e-Journalen directly through the hospital’s eHR system, while GPs can access the system through sundhed.dk. Furthermore, patients can also gain access to their own data via sundhed.dk. 2.6 Data for research access All large institutions concerned in the collection of data provide an interface to apply for access to data. Researchers are requested to furnish details of their study for access. This procedure also applies to other socio-economic data sources which opens up possibilities for intersectoral research. Some databases are more parsed and better tagged than others depending on how the data was gathered. As a case, consider the National Biobank that has a repository of over 16 million biological samples. The samples accessed by robots can be retrieved based on multiple variables - For example, it is possible to retrieve blood spots from diabetics of Danish origin, between a particular age and income window, having had a case of a broken arm, and with three children. 2.7 Data for commercial access Commercial entities can apply for use of personal data across sectors. Their permission of use and application is governed by the Danish Research Ethical Council which is the approval body for all register based research. 2.5.2 e-Journal The e-Journalen (“e-record”) system gives patients and healthcare professionals digital access to information on diagnoses, treatments and notes from eHR systems in all public hospitals. 30–40 per cent of the hospitals also provide access to information on medicine and sample results from laboratories. By the end of 2011, the system contained health data on more than 85 per cent www.danskernessundhed.dk http://www.interaktionsdatabasen.dk 32 www.kl.dk 30 21 17 3.Sources of information Mainly, three types of data are used by public and private entities to steer or design healthcare products, services and for policy making : 1. Health survey data, 2. Information about general consumption patterns 3. Administrative data generated by the healthcare delivery system. Data based on clinical care come from electronic health records, clinic-based administrative datasets, and government reimbursement datasets. Large-scale registries are generated and maintained by the Regions, state health authorities, professional societies, pharmaceutical and device companies, and the government. Clinical trials, whether publicly or privately funded, can function as rich sources of observational data, useful for exploring questions that go beyond their original hypothesis. Common features of all these types of data include an electronic format, predefined fields, and for most, large numbers that enable robust analysis. Data collected through these various registers, clinical studies, pathology tests etc, can be broadly classified as clinical and nonclinical data. Clinical data usually refers to a real time database that can be a data collective as any of the under: Electronic health records - This is the most basic, yet vital data collected at the point of interaction between the healthcare provider and the citizen. It includes demographic information, diagnoses, treatments, prescriptions and medicines, pathology tests, hospitalisation, insurance, cost reimbursements etc. Administrative data provides statistics and information on hospital inpatient and emergency department utilisation. Health insurance data includes data on all touch points that provide a service reimbursable by the public health insurance and details of subsidies provided on certain treatment offers. Disease registries contain data within a very specific range of fields relevant to the disease type. These would include registries for diabetes, cancer, heart disease, asthma etc. Health surveys could be regional or national and contain data specifically collected for research purposes pertaining to behaviour, diets and lifestyle, quality and experience of healthcare etc. Clinical trials data is registries of controlled and randomised studies conducted by hospitals, research centers and private companies. Non clinical data includes psychological, behavioral and sociodemographic factors in addition to information about a patient's relationships, neighborhoods and communities. Healthcare data collected through the system reflect economic data - data that indicate infrastructural expenditures, medicine, treatment or therapy costs. Information on the nationwide registers and clinical quality databases we found, are distributed across multiple sources, not one giving a detailed overview of the landscape. While the National Board of Health (Sundhedsstyrelsen) lists a majority of the national databases, details of administrators, quality indicators and data variables, period of data collection and access is distributed across many websites. Hereunder is a list of sources of information we have used to compile the list of national health registers and clinical databases. Refer to Table 2 for list of websites with information on ehealth records 3.1 National registries From 1 March 2012, all data on the state of public health and data concerning health service activity, economics and quality has been consolidated at, and analysed by, Statens Serum Institut (SSI). The data is utilised for national and local authority tasks and made available for research and analysis purposes in the field of health. The registries comprise data on the nation’s health, morbidity and mortality, together with data on healthcare sector organisation and economics. The national registries publish statistics on a regular basis, and offer access to data extraction. In addition, extracts from the registries are provided for activities such as analysis, research and planning. Examples of National registries include, the Register for causes of death which has information on death and relating causes based on death certificates issued from 1875, or the National Patient Register MAPPING THE HEALTHCARE DATA LANDSCAPE IN DENMARK Table 2 : Health agencies with information on clinical databases. INSTITUTION INFORMATION ON DATABASE Statens Serum Institute www.ssi.dk e-Sundhed eSundhed.dk National Biobank www.biobankdenmark.dk Explains the biobanks in Denmark and how data from various registers can be combined. Gives researchers online access to combined data from all the biobanks participating in the Danish National Biobank initiative. Datal Protection Agency Datatilsynet All legal requirements required to start, maintain and access registers and databases pertaining to personal data and how they may be processed. Kompetencecenter for Klinisk Kvalitet og Biostatistik, Nord www.kea.au.dk Kompetencecenter for Klinisk Kvalitet & Sundhedsinformatik Competence Center for National Clinical Databases, East Region H Region Hovedstaden www.regionh.dk List of nation wide clinical databases with format of the database explained along with purpose, indicators, data collection, annual reports, organisational contacts, current status and funding. Competence Center for National Clinical Databases, South Center for Clinical Epidemiology Center for Kliniske Epidemiologi Odense Univery Hospital www.ouh.dk Very brief information on only national databases that are populated and maintained by the center with details of those incharge and relevant weblinks. Center for Register-based Research Center for Register Forskning nccr.au.dk A rich repository of all nationwide registers (non-health included). Very brief information on each, but contains contact details and organisational structure of the database. Regionernes Kliniske Kvalitetsudviklingsprogram (RKKP) www.rkkp.dk Links to clinical databses, annual reports, their own websites (in case of important ones like diabetes or cancer) Center for Integrated Register-based Research Excellent overview on application & approval procedures for inter-register research, especially useful for interdisciplinary predictive analysis. Some regional databases within the Capital Region are also listed. 19 (NPR) which collects information on diagnoses and operations performed in hospitals since 1977, or the National Health Service Register (NHSR) which since 1990, collects information from primary health care contractors about quality of treatment and services, or the Pathology Register which from 1997 holds data on all pathological studies conducted by the country’s pathology departments etc. 3.1.1 Clinical databases A clinical quality database is a registry containing selected measurable indicators which, based on individual disease courses, serves to shed light on either parts of or the overall performance standards within the health service and outcomes for a limited category of patients. These databases are all restricted to a diagnostic group, a medical speciality or procedure. This means that separate databases are maintained for patients with conditions such as COPD, breast cancer, cardiac insufficiency etc. Illustration 5: Clinical Databases - Construct & Workflow This depicts the administrative construct of clinical databases in Denmark. Each stakeholder contributes to the data quality both by intrinsic domain knowledge, and computation infrastructure. The representation of Danish Regions in the maintainence of a database ensures nationwide outreach for data collection. The establishment of the database itself is overseen by Datatilsynet where anyone wishing to setup a database applies for permissions and further clearance from the the Danish Research Ethical Council. Formats for setting up the database are established by the Datatilsynet. Regions Steering Comittee RKKP Oversees resource & experience utilisation between competence centers and ensures consistent workload. Clinical Database Professional support to ensure coverage, professional consensus on indicators and necessary acceptance of Database performance Regional Competence Center MAPPING THE HEALTHCARE DATA LANDSCAPE IN DENMARK The data are used for monitoring the quality of treatment in order to assess any underperformance and potentials for improving quality of care. There are currently approximately 60 national clinical quality databases, which in combination cover approximately 60 categories of medical conditions. Examples of clinical quality databases could be the Colorectal Cancer Database which contains diagnostic, treatment and follow up on all colorectal cancer patients from 2001, or the Hysterectomy Database that since 2004 contains diagnostic, treatment and follow up information on all women who undergo hysterectomy, the Cytogenetic Register which since 1968 contains information on persons who have undergone prenatal chromosomal diagnostic procedures. The clinical databases are organised under a public authority (for e.g, the Regions) for reasons of administrative ownership and data security and based within a scientific institution to ensure professional support, consensus on indicators and peer acceptance. The databases are attached to one of three Centers for Competence for epidemiology and Biostatistics who provide IT and workflow advice and bring expertise on data analysis. 3.1.2 Cohort Studies Over the last 50 years numerous cohort studies have been conducted providing ample opportunity for researchers to revisit contextual data with new research probes. Cohort studies are often established with a specific focus (for e.g. to study the establishment, development or progress of a particular condition). Yet in a context like Denmark, where personal data has been meticulously documented and digitised for decades, cohorts assume a new dimension. The same data can be reassembled and also combined with other socio-economic data pertaining to the same person to derive new findings. An example of a broad spectrum cohort is the Danish National Birth Cohort where children are followed continuously through their childhood (pre-teenage year) via qualitative questionnaires and quantitative recordings of vital statistics at regular intervals. This data can be understood with data on their sensorial and lanuguage development at kindergartens, education records at primary school, data on other members of the family, parents income, residence etc. which have broader implications if considered for future socio-welfare frameworks and governmental policies. Another such study is the Diet, Cancer and Health cohort which in its very nature is broad, recording lifestyle and its effect on overall onset, treatment and therapy of cancer. Such studies could generate data points that are relevant to other sectors such as the agriculture and food industry, manufacturing industry at large or feed into fundamental genome research. The data will further reflect on the economy of persons and their families and thus data is very valuable in the welfare model as every instance of welfare payout ( unemployment, rehabilitation, support etc.) is only adding burden to the system. While these are very large scale cohorts, smaller cohorts can be very valuable too. The Gerda Frentz Cohort for example is not just another cancer register. The true incidence of non melanoma cancers is a very vital information in the nordic populations due to their predisposition to skin cancers co-affected by their environment (sun and UV radiation), diet and subsequent absorption of food and importantly lifestyle factors like sun based activities which prolongs exposure and risk. 21 Here are some of the largest cohorts conducted in Denmark: The Danish National Cohort Study (DANCOS) is a nationally representative public health survey based on linkage of information in the repeated Danish Health Interview surveys, 1986–2005 Diet, Cancer and Health is a Danish prospective cohort study aimed at investigating the associations between dietary habits, lifestyle, and cancer development. The participants were recruited during 1993—1997. The Danish National Birth Cohort (DNBC)33 aims to study the period from conception to early childhood and examine how this period influences health conditions at later stages in life. Determinants for reproductive failures, identifying pre- and perinatal determinants for important health problems in childhood and improving the infrastructure for future studies of health and disease using a life-course perspective are key. 101,042 pregnant women were recruited in first trimester at first antenatal visit at the GP’s during a massive enrolment plan between 1996-2002 and 96,986 children resulting from the pregnancies are being followed through. 34 The Danish HIV Cohort Study(DHCS)35 collects data to study temporal changes in the demographic composition of the HIV population. The effects of the antiretroviral therapy is recorded alongside mortality, any new AIDS-defining events etc. All clinics treating HIV infected patients in Denmark participate in DHCS. As treatment is restricted to eight departments of infectious diseases and medicines are delivered free of charge, medicines cannot be purchased from pharmacies in Denmark. The Soon-Pregnant Cohort Study 36 is a web based study investigating risk factors for delayed fecundability and miscarriage. Women are between 18-40 years old, trying to become pregnant and not using contraceptives or fertility treatments. Feasibility of web based cohorts is also being explored in this study. The Danish Newborn Screening Biobank (NBS-Biobank)37 from 1976, collects blood spots of all newborns to screen for Phenylketonuria, congenital hypothyroidism and toxoplasmosis in order to improve screening, statistics and eventually diagnostics later in infancy. The Gerda Frentz Cohort (GFC)38 studies the profile and true incidence of non-melanoma skin cancer and was initiated as the registration of cancers was incomplete in the Danish Cancer Registry. The DANVIR Cohort39 records prevalence and mortality with chronic viral hepatitis (Hep B, Hep C) and its comorbidities with cancer and cirrhosis. 33 Data collection began in 1996, and was nationwide by 1999. Danish Epidemiology Science Centre, Statens Serum Institut. 34 http://www.cls.ioe.ac.ukpage.27aspx?&sitesectionid =342&sitesectiontitle=Danish+National+Birth+Cohort 35 Data collected from 1995 onwards. Department of Infectious Diseases, Copenhagen University Hospital. 36 Snart Gravid-The Danish Web based Pregnancy Planning study. Mikkelsen, Ellen M et al. “Cohort Profile: The Danish WebBased Pregnancy Planning Study—‘Snart-Gravid.’” International Journal of Epidemiology 38.4 (2009): 938–943. PMC. Web. 24 June 2015. 37 Data with dried blood spots collected from 1982 onwards. Department of Clinical Biochemistry, Statens Serum Institute 38 Data collected from 1995. Department of Clinical Epidemiology. Århus University Hospital. 39 Data has been collected once from January 1 1995 to end 2006. Updates are planned at intervals of three years. MAPPING THE HEALTHCARE DATA LANDSCAPE IN DENMARK 3.1.3 Genome Data in Denmark It appears that genetic research in Denmark is not specifically funded by private firms, scientific educational institutes or government institutions alone. Rather, funding and support seem to be co-established and funding is mostly to large research initiatives, genomic efforts being a prominent path. Genome research has benefitted with numerous public private partnerships and efforts initiated by Danish private companies like Novo Nordisk A/S, Carlsberg Laboratory, Statens Serum Institute, Christian Hansen’s Lab, Danisco, Leo Pharma, Lundbeck Pharma, Neurosearch, Nordic BioScience Diagnostics A/S etc. The Danish Parliament in 1991, recognising the need for channelising research, funding and intellect in fundamental research setup The National Research Foundation 40 (Danmarks Grundforsikningsfond) as an independent organisation. Funding is effected through Centers of Excellence (CoE), but various programs and initiatives towards the internationalisation of Danish research is supported. The Danish Reference Genome Project44 is a database of 30 (of an expected 150) individual, fully mapped genomes from the Danish population. It allows detailed analysis of the individual genetic differences between the individuals and is seen as a starting point for individualised treatments in the future. The database is small, thus providing a benchmark on who is a normal Dane and a perceived deviation from this normal, thus a cause of illness. The database is administered by Genome Denmark. Danish Platform for Large-scale Sequencing and Bioinformatics is a collaboration between the University of Copenhagen, the Technical University of Denmark (DTU), Aarhus University and Aalborg University and will co-operate with Bavarian Nordic A/S, Beijing Genomics Institute Europe A/S and Genomic Expression ApS. This platform brings Beijing Genome Institute (BGI) Europe to establish what will be the world’s largest and most elite genome research lab in the world. 3.1.4 Biobanks Danmarks Nationale Biobank See Appendix for List of CoE for healthcare in Denmark Genome Denmark41 is a national platform for sequencing and bioinformatics involving universities, hospitals and private companies and one of their strongest research agendas is to use genomic research for improved efficiency of personalised treatment and healthcare delivery in the future. The Danish health system has routinely collected biological material from a large number of individuals and this is documented and physically stored at the National Biobank. 45 The main purpose of the Danish National Biobank is to give scientists from Denmark and abroad overview and access to more than 16 million biological samples in both existing and future collections. The Center for Genomic Epidemiology42, located within the Danish Technical University, works to set up a central database which will provide internet based solutions with a simplification of the total genome sequence information and comparison. This activity is being expanded to include microorganisms (vira and parasites, metagenomic samples) which can be path breaking for epidemiology studies. The Danish Biobank Register gives researchers online access to combined data from all the biobanks participating in the Danish National Biobank initiative. Through national collaboration large biobanks, based at hospitals, universities and other research institutions in Denmark, regularly submit data to the Danish Biobank Register. Data from the biobanks are linked to disease codes and demographic information from national The Center for Biological Sequence Analysis 43 conducts basic research in the field of bioinformatics and systems biology. The group has a highly multi-disciplinary profile including molecular biologists, biochemists, medical doctors, physicists and computer scientists. CBS represents one of the largest bioinformatics groups in academia in Europe. www.dg.dk www.genomedenmark.dk 42 http://www.genomicepidemiology.org/index.html 43 www.cbs.dtu.dk 44 http://www.genomedenmark.dk/english/about/ referencegenome/ 45 www.biobankdenmark.dk 40 41 23 administrative registries on an individual level. 4. Accessing the health data Anonymous data sets are made available to researchers around the world through a web-based search system. So far, information from the following biobanks are available through the Danish Biobank Registry: While healthcare data in Denmark looks apparently well documented and retrieval of huge volumes of data pose no doubt, there are still technical and administrative frameworks that regulate the access of data and its resolution. Procedurally, some registers can be accessed at the research institution administering the data with due permissions while some data is on an individual level needs approval of multiple agencies for access and analysis. A typical approval process might involve the Datatilsynet (Danish Data Protection Agency), Statens Serum Institute and Statistics Denmark. Agencies like CIRRAU facilitate in organising research within the premise of necessary paperwork. This could take anywhere between 12-18 months. 1. The Danish Patobank (approx. 12 million tissue samples from national hospitals) 2. The Danish Cancer Society’s project biobank “Kost, kræft og helbred” (samples from 57,000 cohort participants) 3. The new DNB biobank at Rigshospitalet (50,000 samples collected annually) For further reading refer Sec.4.6 4. The Cancer biobanks (de Kliniske Kræftbiobanker) Samples from the Danish National Birth Cohort (300,000 samples) 5. Blood spots from all newborn Danes since 1976 (1,9 million samples) 3.1.5 A note on social and economic data Economic and social data is collected with as much breadth and depth as healthcare data in Denmark, making data analysis rich and addressing multi party needs. The Danish Data Protection Agency and the Danish Data Archive are still responsible for the overall authorisation and archival of this data but the collection is distributed at the municipality, regional and national levels. Aggregated analysis of this data can be found with Denmark’s Statistics and to some extent on Danskernessundhed.dk and eSundhed.dk 4.1 Legislation Data entry, access and retrieval in Denmark is governed by the Act on Processing of Personal Data (Persondataloven)46 The Act on Processing of Personal Data (Act No. 429 of 31 May 2000) entered into force on 1 July 2000. The regulations of the Act on Processing of Personal Data apply to the processing of personal data if the processing is conducted for scientific or statistical purposes. Personal data is understood as data about a person that directly or indirectly can be identified. Processing is understood as all forms of handling of data, i.e. collection, registration, storage, application, etc. 47 However, the act does not apply to data already made anonymous. Anonymous data is defined as any data that cannot be traced back to an individual. 4.2 The Danish Data Protection Agency Datatilsynet Read the Act here: http://www.datatilsynet.dk/ english/the-act-on-processing-of-personal-data/ read-the-act-on-processing-of-personal-data/ compiled-version-of-the-act-on-processing-of-personal-data/ 47 http://www.datatilsynet.dk/ As retrieved on 18th July 2015 48 www.datatilsynet.dk 46 The Data Protection Agency48 is the state authority that oversees the Act on Processing of Personal Data. The agency consists of a Data Council (DataRåd) - and a secretariat. The agency maintains an inventory of all databases maintained in the country under the category “Fortegnelsen”. However this is not offered for public use as a handbook or directory of databases yet. MAPPING THE HEALTHCARE DATA LANDSCAPE IN DENMARK 4.3 The Danish Data Archive Dansk Data Arkiv The Danish Data Archive (DDA) is Denmark’s national social science data archive acquiring, preserving and disseminating data generated from social science, health science and history. Through an agreement with the Danish Data Protection Agency the DDA preserves data materials containing personal identifiers. The data and personal identifiers are stored separately and a special permit is required for the access to the data. The DDA adheres to metadata documentation guidelines set by the DDI. 49 4.4 Danish Research Ethical Council Den Nationale Videnskabsetiske Komité Under the Committee Act, it is the responsibility of the committee system on health research ethics to ensure that from a research ethic point of view, health research projects are carried out in a responsible manner, and that the rights, safety and wellbeing of trial subjects participating in such biomedical research projects are protected, while at the same time possibilities are being created for the development of new, valuable knowledge. 50 They are the single authorising body for all register based research for both research and commercial purposes. 4.5 The Danish Council of Ethics Etiskråd The Council was established in 1987 as a result of a directive from the Parliament to advise the Parliament and other Government agencies on new bio and gene technologies, while creating discussions and debates around this area. Members of the council are honorary and elected for their experience in this field. The Council advises and creates debate on biotechnology, which affect human life, our nature, the environment, and food. The Council also works with ethical issues related to the healthcare sector. 51 4.6 Challenges of intersectoral data access Data transfer between sectors in many cases needs approval from the patients. This means that while data coverage is complete at the organisational level, extracted databases may not reflect the true incidence of cases. For example, an incidence of hospitalisation will be reported to the GP only on approval from the patient. Or a case of psychiatric treatment at a hospital can be kept out of the patient’s journal if the patient so wishes, and only reflected in the hospital’s own case file. This choice of disclosure is a vital part of the trust framework that data collection in Denmark builds on. The role of the Act on Processing of Personal Data and the Danish Research Ethical Council are nuanced in that the transfer of personal data between registers (for example, between the hospital’s register and a Cancer Register, or the case of information on hospitalisation being intimated to the GP ) is governed by the Act itself while the extrapolation of data from any of the registers is under the purview of the Danish Research Ethical Council and prior approval is mandatory. However, some agencies are helping bridge this gap by facilitaing help with paper work and legislative issues. For example, the following agencies are useful references : Center for Register based Research (NCCR) is a national institution, established in 2000, and embedded in the Faculty of Social Sciences in Aarhus in 2005, contributes to the integration of health sciences and and social register based research to strengthen the social scientific use of register data. The center, apart from advice, helps in the practical participation in researches of this kind. 52 Center for Integrated Register-based research (CIRRAU)53 located at Århus University facilitates interdisciplinary research in the academic areas of Social Sciences, health sciences and elements from Natural Sciences based on databases and biobanks within a framework of translational population studies. Five categories of data constitute the CIRRAU data resource: 1. The Family Relations Database 2. Economic, Social and Contextual Data 3. Prescription Data 4. Geocodes 5. Data Contributions from Participnts http://samfund.dda.dk/dda/default-en.asp http://www.cvk.sum.dk/ 51 http://www.etiskraad.dk/ 52 http://ncrr.au.dk/om-centret/ 53 http://cirrau.au.dk/ 49 50 25 5. Society as a Cohort The data from various national registries and conditionspecific clinical databases are linkable with varying degrees of effort and parsing to an individual’s level. The challenge if any, is of data completeness. The Danish National Health Service Register for Primary Care (Sygesikringsregisteret, NHSR)54 contains information about the activities of health professionals contracted with the tax-funded public healthcare system. These are general practitioners (GPs), practicing medical specialists, physiotherapists, dentists, psychologists, chiropractors, and chiropodists. The purpose of the register, which is within the remit of the National Board of Health (Sundhedsstyrelsen), is to document activities in primary health care for administrative use and to contribute to research in public health. Since this register is concerned with reimbursements, it is considered fairly complete. In this context, every person with a CPR number, i.e anyone legally residing in Denmark leaves a trackable and comprehensible trail of data on quality of life and consumption of resources. Presented here are three different scenarios of viewing a person’s health data along his lifetime, which represented aptly, presents itself as a cohort and represented collectively, is a cohort conducted on an entire society. Illustration 6 : Society as a Cohort -A scenario view on how data is populated and could be accessed over a lifetime. A sample of a healthy person’s health data gathered through a lifetime. Numerous screening efforts for a spectrum of conditions results in population data that is rich with health indicators that help determine population health trends, genetic predispositions and lifestyle corelated to life stages. This scenario view gives us an idea of how meticulously our lives are documented, even in the case of a largely healthy life with few interactions with the healthcare system. WELL BEING BIRTH REGISTER DIAGNOSIS HOSPITAL Patobank Radiologiske ydelser DRG (diagnoserelaterede grupper) Danes treated at foreign hospitals (DUSAS) Database for Geriatri Dansk Anæstesi Database Demensdatabasen Landspatientregisteret Akut mave-tarm kirurgi databasen Fælles akutdatabasen Akut Kirurgi Databasen MEDICATION Lægemiddelstatistikregisteret Danske medicinpriser THERAPY Tværsektoriel Rehabiliteringsdatabase Genoptræningsregisteret http://www.ssi.dk/Sundhedsdataogit/Registre%20og%20 kliniske%20databaser/De%20nationale%20sundhedsregistre/ Sundhedsokonomi%20finansiering/Sygesikringsregister.aspx 54 GERIATRIC Dansk Palliativ Database Landsdækkende DEATH REGISTER Dødsårsagsregisteret MAPPING THE HEALTHCARE DATA LANDSCAPE IN DENMARK Furthermore, the Danish population is considered as being largely homogenous and non-transient which is ideal for long term population (also gene-pool) studies . With a wide range of register based studies, cohorts can be easily assembled to observe developments across a group for specific factors. An example is the Borberg cohort of patients with neurofibromatosis that was established in 1940 55 and was reinvestigated in a follow-up study 46 years later. Sørensen et al 56 revisited this established cohort and linked to data from the DCR to follow patients for the development of malignant neoplasms after diagnosis of neurofibromatosis 1. The registry-based approach was also used in the same study to investigate risk factors and survival. 57 Illustration 7 : Society as a Cohort - Scenario of accident and physical & mental rehabilitation cases From such a scenario view, it is easier to understand and infer the treatment quality in hospitals and post trauma care. It is very relevant to varied sectors from transportation and traffic ( for e.g response time), disbursement of welfare funds (for e.g unemployment in case of long rehab or disability) etc. if the data can be parsed and visualised in interesting ways. The various registers that would /could be populated by a single incident are shown here under. When seen in conjunction from birth and various other registeries that are populated as part of the healthcare, it is interesting to analyse the incidence of accidents, quality of treatment and thus healthcare. An accident which involves admittance in a hospital is treated as a case of secondary care. All documentation pertaining to this episode is maintained only at the hopital, including medications given and any tests conducted. Should the patient have any degree of rehabilitation provided, this is also kept within the hospital records. All this data is shared with the GP only after prior consent from the patient on discharge. If the patient so wishes, the entire data or a part of it can be kept unreported, exclusively within hospital records. This is very interesting when considering the true breadth of all the registries. WELL BEING BIRTH REGISTER HOSPITAL ACCIDENT Ulykkeregisteret Mobilt Akut System Databasen (MAS) Dansk Intensiv Database Dansk transfusionsdatabase Landspatientregisteret Danes treated at foreign hospitals (DUSAS) Dansk Anæstesi Database Akut mave-tarm kirurgi databasen Fælles akutdatabasen Akut Kirurgi Databasen Organdonationsdatabasen INCIDENT Alkoholbehandlingsregisteret Stofmisbrugere i Behandling Dansk Depressiondatabase Dansk apopleksiregister Clinical and genetic investigations into tuberous sclerosis and Recklinghausen’s neurofibromatosis; contribution to elucidation of interrelationship and eugenics of the syndromes. Borberg A. Acta Psychiatr Neurol Scand Suppl. 1951; 71():1-239. 56 Long-term follow-up of von Recklinghausen neurofibromatosis. Survival and malignant neoplasms. Sørensen SA, Mulvihill JJ, Nielsen A. N Engl J Med. 1986 Apr 17; 314(16):1010-5. 57 Nguyen-Nielsen M, Svensson E, Vogel I, Ehrenstein V, Sunde L. Existing data sources for clinical epidemiology: Danish registries for studies of medical genetic diseases. Clinical Epidemiology. 2013;5:249-262. doi:10.2147/CLEP.S45228. 55 REHAB Tværsektoriel Rehabiliteringsdatabase Genoptræningsregisteret DEATH REGISTER Dødsårsagsregisteret PSYCHIATRY Klinisk database for børne- og ungdomspsykiatri Psychiatric Research Register Coercive Psychiatry Register Database over børns dødsfald efter ulykker 27 Illustration 8 : Society as a Cohort - Scenario of screening, treatment and care in chronic ailments In this wellness journey of a person, some instances of chronic care have been mapped. Specific registers have been instituted for these illnesses. Viewing the registers as different scenarios allows one to see the relevance of the registers . This scenario makrs the registers that reflect the life-long use of resources in a chronic condition, treatment, efficacy and outcomes. Much can be learnt about demographic tendencies in developing chronic illnesses and the state’s role in prevention and cure. Some reflecting databases are also mentioned here, as the earliest screening factors or diagnosis has happened through other procedures. Read in tandem, regsiters across these stages could provide vital insights into early screening, genetic predisposition and lifestyle. WELL BEING BIRTH REGISTER DIAGNOSIS Patobank Radiologiske ydelser DRG (diagnoserelaterede grupper) Chronic genetic HÆMOPHILIA Rehabilitation Register CEREBRAL PALSY Opfølgningsprogram for Cerebral Parese Dansk Føtalmedicinsk Database Chronic Lifestyle DIABETES Dansk Voksen Diabetes Database Dansk Register for børne- og ungdomsdiabetes Den landsdækkende klinisk kvalitetsdatabase for screening af diabetisk retinopati og maculopati Det Nationale Diabetesregisteret Dansk Diabetes Database CANCER DEATH REGISTER Dødsårsagsregisteret MAPPING THE HEALTHCARE DATA LANDSCAPE IN DENMARK 5.1 Demographic focus : Women, Children, Elderly & Veterans Several registers have been established to study specific demographic groups, as clinical databases, registers and cohort studies. The health of women has been a particular area of focus with cervical cancer, mammography screening, breast cancer, gynaecological cancers being important. Reproductive health of women is important especially seen with other population indicators and thus quality of birthing, IVF, abortion, pregnancy screening, early pregnancy related abortions, birth & complications are all registered. Cohorts have been established to study pre-pregnancy, pregnancy and eventually birth and development of a child in close relationship to its mother thus giving researchers a chance to develop population prognosis especially with health indicators for genetically and nurture induced predisposed conditions. Children, with some registers concerning birthing share register data with women, but on their own have several health registers especially for conditions like childhood diabetes & cancer. Together with health records maintained at schools, this can be extrapolated with family data and education data to analyses data for welfare schemes, future job markets, diet & nutrition studies, mental health etc. Geriatric care is a huge component of social welfare & healthcare, which gives no surprise to detailed information maintained Nationwide database of Geriatrics, the Danish Palliative Care database and the Danish Dementia Database. Apart from these there are other socio-economic databases maintained by the different kommunes on spending for the elderly in home care, institutional nursing, food delivery, transport etc. The Armed forces maintain the Sessions Register, but we have been unable to find further information on this and related registers in the scope of this study. 29 Illustration 9: Women and Children: Unique and symbiotic datasets for future population studies A specific case of registers pertaining to women and children is considered here. While most of these registers concern demographic specific data, some are about reproductive health, birth and early infancy. These registers are closely linked by their very nature and have been shown as such in the illustration. While some of these registers are popluated based on true incidents, many are populated by surveys and more recently entire cohorts are being tested with an exclusive online platform with only online engagement with participants. The Soon to be Pregnant study is one such cohort being conducted only through online participation. Diabetes Børnedatabasen (Børns helbred) - Indskoling og Udskoling (BMI, højde & vægt) Børnedatabasen (Børns helbred) - First living year Klinisk database for børne- og ungdomspsykiatri Database over børns dødsfald efter ulykker Opfølgningsprogram for Cerebral Parese Dansk børnecancer register Cancer General Child Danish National Birth Cohort Reproduction Education women Employment Birth health records at School Body Cancer Familie database Dansk Bræstkraft Database Dansk Gynækologisk Cancer Database DDD-Dansk Register for børne- og ungdomsdiabetes The larger Danish cohort studies on Soon to be pregnant women, and child development could be read with smaller nation wide registers on pregnancy screening, complications, birthing and post natal care. They are insightful on various levels- from life style to life stage - a clear insight can be reached upon on co-related demographic shifts, patterns in income groups and this could have huge inputs in pharmaceutical research and go-to market strategy for such companies. The State benefits from this understanding for a better structuring of its welfare funds and infrastructure. MAPPING THE HEALTHCARE DATA LANDSCAPE IN DENMARK 6. Mapping the Databases With a plethora of registers, databases, clinical studies and cohorts, it was imperative to see them mapped on the body - the body being the metaphor for areas of study. The obvious inferences were the areas where a lot of research is done, but it also revealed the many areas of concern where there is a lack of systematic data collection. The many registers that have been enlisted in the report are essentially specific health condition data drawn from the National Patient Register (NPR) and categorised into a specific register. So the individual registers do not provide any extra breadth of information than the NPR. Yet, the depth of clinical data specifically logged into specific registers makes cross sectoral research rich and diverse. Individual factors can be measured against other socio-economic factors to project new connections and value for other stakeholders. The body view of the registers also allows one to see the different research strategies adopted to study a particular area - For example, female reproductive sciences in the Danish population is now studied with smaller registers collecting nation wide data on gynaecological cancer, cervical cancer, birthing and abortion. There are specific registers recording IVF treatment and abortion in early pregnancy. Further there are cohort studies that are recording the months leading upto conceiving (pre-pregnancy environment and factors ) and birth and child rearing. This way, a part of the selected population has a deeply documented wellness journey which could be very valuable for other stakeholders. Pharmaceutical research stakeholders who also invest heavily into health research delve into huge volumes of anonymised data for research on new drug delivery or their future strategies. Illustration 10 : A body based view on health registers, cohorts and clinical studies Studies and registers pertaining to men and women are presented in this illustration. The numbers correspond to the List of Registers presented in the Appendix to this report. This allows us to see the health areas where we have the largest amounts of data which is reflective of population health and governmental priority. The diabetes and cancer registers are extrapolated separately, the numebr of registers reflecting the dimension of the illness. However the registers for the children and elderly have to be viewed with other socio-economic registers as these are intesive on time and healthcare personnels in a welfare system. Please refer to the appendix for The List of Registers. (109) (149) (4,7,8,12,28,34, 49,63) (88,99,115,126, 143, 147, 151) (163) (100) neck (13) (108) (18,31, 40,41, 42, 43,55 ) (30,33, 52) (125) (122,138,141,142 ) (22, 25) (10) (29,37,38,39, 48) (123) (15) (30,33) (11, 26) (148) (24,91) (14,16,17,19,80) (92,119, 162) (118) (65, 113) (27, 35, 50) (6, 21,62,64,111) (114,144) (150) (58, 59,60) Screening database (32,44,45,46,47, 70) National Register Cohort Studies Nationwide Clinical Study (119, 96,163) (17,23,80,92) (15,22,24,25) (165,166) (148) Demographic Data (59,60,150, 58,64) DIABETES (40) (37,38,48,112) (39) (11,143,149) (23, 37,96,117) (14,) (153,168) (117,38) (98,102,103,104,124,132,133,134) CANCER (116) (53,126) MEN WOMEN (83,84,85,114,115,144,148) (6,9,13,21,26,28,29,30,40,50,56,58,60,62,64,108,111) (22,24,25 ) (160) (9,10,16,150) MAPPING THE IN IN DENMARK MAPPING THEHEALTHCARE HEALTHCAREDATA DATALANDSCAPE LANDSCAPE DENMARK CONTEXTUAL EXTRAPOLATION OF HEALTHCARE DATA Data for Calculation and verification of business cases. Demographics, Segments and Costs The Danish health care data landscape is fragmented but very rich. When this dataset is combined with demographic from Denmark Statistics and budget allocations from various regions, it will provide an in-depth view into the segment of healthcare and how the spending patterns are organised. This is a vital piece of market analytics that help existing companies but also point to new areas that startup and foreign investors could take deep interest. We foresee new service possibilities, optimisations and novel products to fill the any gaps that are emerging from the landscape. Data to quantify non-economic effects of new solutions. Support Innovation Decisions Interestingly the data available in the Danish healthcare system is a mix of qualitative and quantitative data. A large pool of journal entries and text logs could actually be mined to extract a semantic model that can inform and support decision making on levels like quality of service, quality of counselling and support etc. There are numerous extrapolations that might support non economic indicators that would make the overall system better for the end user or patient support. MAPPING THE HEALTHCARE DATA LANDSCAPE IN DENMARK Data for basis of new solutions, collaborations Data is the new currency of the digital age. The Danish health data is not just a goldmine waiting to be tapped but also could form the basis for totally new types of solutions – esp new collaborative ones. Traditionally the diagnosis to care to prognosis pathway has been a fragmented journey both in terms of data and patient care. Modern data technologies will create a more unified opportunities for stakeholders to engage in a more seamless data landscape. This cementing of data process will also enable new business cases to emerge from this confluence. This collaborative culture around health care innovation fuelled by data would be a strong growth market and enormous potential – esp for non traditional players. Data for pattern analysis at large scale for planning and research. The Danish healthcare system is quite intensive (excellent raw material) but is yet to see the emergence of large scale pattern recognition models. The cause – effect relationship and spotting of trends have happened in relative isolation based on disease areas (e.g diabetes) or demographic basis (e.g elderly). This is mostly due to the professional specialisation and administrative legacy of many of these initiatives. This is going to change rapidly with the introduction of many big data technologies which will enable the cross finding and correlation mapping of various data sets at very large scale. There are numerous opportunities to be exploited in terms of large scale epidemiological studies, market analysis and better optimisation strategies based on macro-economic view of the health care system. This though would need extensive cross organisational collaboration and reduction of administrative silos. There are indications of such an approach already being used in research – esp genetic and phenotype. This approach is yet to be systematically done on administrative and economic aspect of the healthcare system MAPPING THE HEALTHCARE DATA LANDSCAPE IN DENMARK CONCLUSION The Danish health care data is perhaps the earliest of its kind and thus, is a fantastic opportunity as well as a challenge at the same time. The richness and depth of data combined with a unique person identification number is a gold mine of data driven opportunities for new types of services and products to evolve. On the other hand the legacy of the old systems means, many of these datasets are fragmented and reside in numerous organisational and technological silos. In this study, we realised the extent to which new possibilities could emerge in tandem with new technological trends. Some of the new technological trends that will highly influence the data landscape of the Danish healthcare systems are : 1. Big data analytics - the rise of cloud enabled solutions for identifying and analysing new treatments. ‘ 2. Quantified self - Patients being empowered with data collation tools and devices at home. 3. Genetic modelling driven Machine learning and pattern recognition at large scale, typically driving new pharmaceuticals. 4. IOT in hospitals - sensor enabled data collection of both therapy as well as patient status. 5. Software as a service - new forms of services that are entirely enabled by software tools 6. Service robotics - the automatisation and augmentation of many basic services esp. in convalescence and elderly care. 7. Personalised Medicine - tailor made therapy based on genetic as well as physiological data. 8. Telemedicine - remote care enabled by new communication technologies 9. Tertiary care - the emergence of new types of services that are more focused on overall wellbeing rather than diseases. These trends are global and some of them will be pioneered in Denmark and many in other parts of the world but the foundation for the fostering of these new innovations are deeply engrained in the Danish Society. This is due to 5 major factors that are unique to the Danish system : 1. Very rich data sets from many decades - the basis of many types of new data enabled services 2. Good governance and regulation on data privacy - balanced by an open data approach to non sensitive data 3. Data Policy and politics - a well debated but progressive policy environment that works in the favour of citizens and end users. 4. Pharma and health tech cluster in greater Copenhagen area and neighbouring southern Sweden. 5. Pervasive internet and data connectivity across the entire country. We can foresee the rise of a new type of health care economy that is driven by entrepreneurship, public private partnerships and university based research. These are clear trends and the signals to support them are visible though there is a long way for these to flourish into a rich ecosystem with the right business models. The coming decade will be the rise of the data driven economy for the Danish health tech cluster. MAPPING THE IN DENMARK MAPPING THEHEALTHCARE HEALTHCAREDATA DATALANDSCAPE LANDSCAPE IN DENMARK THE NEXT STEPS The Danish Healthcare system is abundant with opportunities. Denmark has had a long tradition in providing advanced healthcare with universal access to all its citizens. The quality of healthcare depended for long on good clinical practice supported by purchasing modern technology to support it. At this point in time, the confluence of good medicine and management alone is not enough. The new paradigm of healthcare is clearly moving towards a system that is based on collaboration, data driven and precision-tailor made medicine. This combined with change in social structures influenced by media and internet technologies, shift in demographic etc will make it necessary for the Danish healthcare system to evolve itself and the logical next steps as a recommendation could be as below: 1. The use of data driven methods to drive public procurement The public sector is the largest buyer of healthcare in Denmark, its a clear value addition to have a more accurate, evidence based tendering process. There are huge efficiency gains to be made and the public-private partnership initiatives already point to the right directions. Still the purchasing of healthcare services and products will have to be smarter for both cost-benefit of the system itself but also to nurture pioneering systems and innovation. Luckily the Øresund region has a huge health-tech industry that should be an excellent collaborator in the process. 2. Using connected technology with a more collaborative clinical practice The interaction between the patient and caregiver will undergo major shifts driven by the quantified self, web technologies and communication technologies. This will question the current way in which both primary and secondary healthcare sector is organised. Its a natural progression to build new systems to support this paradigm in the participatory traditions of the welfare model. 3. A data driven approach to preventive healthcare Following advances in genomics, bio-informatics, predictive analytics, sensor driven data gathering etc is a clear global tendency that will change citizen expectation very fast in Denmark, considering how fast and early on the social media trend is adopted in Denmark. Having the policies and governance in place to embrace this trend would be crucial link to growth for this sector. 4. The myth of the rich data set in Denmark Paradoxically the Danish healthcare system is a gold mine of data to drive the above three paradigms due the excellent data quality and density available. Though the data is trapped in organisational silos and data architecture is not designed for collaborative use at scale. There is an urgent need to build unified data interchange protocols and allow faster turnaround for data mashups to happen. These above paradigm shifts are also ripe with opportunity for delivering better healthcare to citizens but also nurturing entrepreneurship and growth for companies.The following are some clear pointers that could pave the road to support healthy growth. 1. Digital Marketplace Copenhagen Healthtech Cluster could enable a digital market place that brings together research, clinical practice and commercial partners in tandem with public agencies and hospitals. This marketplace would need to be very governed and regulated for it to be a trustworthy exchange of value. It has to be imagined as an online platfrom where insights and ideas blend in a very practical context. 2. Sandbox development environment To support the Digital Marketplace it’s highly recommended to create a virtual sandbox that has a wide selection of anonymised sample data from the various databases identified in this report. This will have to be wrapped in a modern API (Application programming interface) and due care should be given to data availability, quality and privacy. The participants in the sandbox should be able to logically scale the solution they prototype by allowing a pre-screened and easy connectivity at the right terms. This would be vital to make this a long lasting system. This sort of facility would make it much easier for companies and startups to prototype solutions faster in collaboration with clinical and regulatory settings. 3. Smart Procurement The biggest and most obvious beneficiary of a digital marketplace would public purchasers who can both seed specific problems and needs into the system. If there is a critical mass of participants it would create healthy competition letting the most innovative as well as cost effective solutions to foster. Kategori (Reg / CDb / Coh.) DBCG Danish Stroke Register Danish Childrens Cancer Register Danish Breast Cancer Operative Group Danish Depression database Danish esophagus, Gastroesophageal transitional DECV cancer and Stomach-cancer group Danish Ultrasound scannings during pregnancy database Landsdækkende kliniske databaser / Dansk apopleksiregister National Clinical Database Landsdækkende kliniske databaser / Dansk børnecancer register National Clinical Database Landsdækkende kliniske databaser / Dansk Brystkræft Database National Clinical Database Landsdækkende kliniske databaser / Dansk database for fedmekirurgi National Clinical Database Dansk Føtalmedicinsk Database Landsdækkende kliniske databaser / (ultralydskanninger i graviditeten) ?= Is National Clinical Database this the FØTO-databasen Cancer, Child Women Condition, Obesity kliniske databaser / Dansk Depressiondatabase Condition, mind Landsdækkende National Clinical Database Landsdækkende kliniske databaser / Dansk Esofagus-, Cardia- og National Clinical Database Ventrikelkarcinom database Condition, Cardio, Brain Condition, cancer Women, Child Condition, Landsdækkende kliniske databaser / Dansk Galdedatabase Abdomen, Gall National Clinical Database 8 9 10 11 12 13 14 15 Women, reproduction DBCR Danish Anaesthesia database Landsdækkende kliniske databaser / Dansk Anæstesi Database National Clinical Database Specific Procedure, Brain 7 16 UOFDanish Bladder Cancer Committee DABLAC A kliniske databaser / Blærecancer Cancer, urinary Landsdækkende National Clinical Database 6 Landsdækkende kliniske databaser / Dansk Gynækologisk Cancer Database National Clinical Database Quality of Treatment Clinical quality Clinical quality Clinical quality Clinical quality Clinical quality Clinical quality Clinical quality Region H - KCKS West Danish Regions, KCKS, vest DGCD 2005-> Clinical quality RegionH Danish Regions Danish Gynaecological Cancer Database 2011-> http://www.kcks-vest.dk/kliniskekvalitetsdatabaser/apopleksi/ https://www.regionh.dk/kliniskedatabas er/nationale-databaser/Sider/DanskAnaestesi-Database-DAD.aspx http://www.uofdatabase.dk/ KCKS, vest: Kvalitetskonsulent Annette Odby Claus Høgdall, Rigshospitalet, Tlf. 3545 4248 claus.hogdall@regionh. dk https://www.regionh.dk/kliniskedatabas er/nationale-databaser/Sider/DanskGynaekologisk-Cancer-DatabaseDGCD.aspx http://www.dfms.dk/ http://www.kcks-vest.dk/kliniskekvalitetsdatabaser/decv/ http://www.kcks-vest.dk/kliniskekvalitetsdatabaser/danskdepressionsdatabase/ Kvalitetskonsulent Susanne Stenkær Ravnkilde http://www.dapho.dk/ Susanne.Stenkaer@sta b.rm.dk, Maj-Britt Jensen, E.mail Århus Tlf. 3866 www.dbcg.dk Universitetshospital [email protected], 0662 Kompetencecenter Data Manager : Lasse for Klinisk Kvalitet og Pirk, KCKS,West Biostatistik, Nord RegionH Anne Nakano KCKSWest, [email protected]. dk Kristian Antonsen, vicedirektør, Bispebjerg Hospital, kristian.antonsen.01@r egionh.dk, Tlf. 3531 2941 http://www.kcks-vest.dk/kliniskekvalitetsdatabaser/akutkirurgidatabasen/ Kompetencecenter for Klinisk Kvalitet og Biostatistik, Nord Danish Regions http://www.kcks-vest.dk/kliniskekvalitetsdatabaser/adhd-databasen/ Danish National Biobank http://www.biobankdenmark.dk/Danish Tel: 3268 5199 / 3268 %20Biobank%20Register/Biobanks%2 9163, [email protected] 0in%20the%20register.aspx k http://www.organdonation.dk/organdon ationsdatabasen/ http://www.organdonor.dk/ Link Competence Center for Clinical Quality and Information Technology West (KCKS-West) Biobank Scientific Research Danish Registry 30 92 23 28, [email protected] Contact person KCKS, vest: Kvalitetskonsulent Lea Haller [email protected] Statistics / data manager: Heidi Larsson 2003->, Danish Regions, (KCEB-north) Data expanded after Clinical quality KCEB North, KCKS Manager Poul Erik 2007 West Schødt Schlosser (KCKS-west) : [email protected] Styregruppeformand Olav Bjørn Pedersen, Email: [email protected], Århus Tlf. 4033 1158 2008-> Scientific Research Universitetshospital Camilla Bernt Wulff, Tlf: 3545 3722 Camilla.Bernt.Wulff@re gionh.dk Sep 2010-> , 2015-> includes related plastic surgery Administration Administration Region H Kompetencecenter Øst FØTO DDD DFR 1976-> 2003- > 2003 - > 2005-> 2003- > 2011- > 1990-> Data owner Danish gall database Danish database for bariatric surgery - DAD Emergency Surgery Database Acute kliniske databaser / Akut Kirurgi Databasen diseases,Ulcer, Landsdækkende National Clinical Database Hospital Attention Deficit Hyperactivity Disorder Database - 5 Landsdækkende kliniske databaser / ADHD databasen National Clinical Database The Danish Pathology Bank Condition Patobank - - Abreviat Data collected Purpose ion 4 Kliniske støtteregistre Donor Register Statement of Will Register Donorregistret Data source (English) Livstestamentregister Data source (Danish) Diagnosis Specific Kliniske Støtteregistre Procedure, Patientinformati Kliniske Støtteregistre on TAG 3 2 1 CODE List of National Registers and Clinical Databases APPENDIX https://www.regionh.dk/Sundhed/P olitikker-PlanerStrategier/Documents/Rapport_fra _arbejdsgruppen_vedr_klinisk_kval itet_final.pdf https://www.regionh.dk/kliniskedata baser/nationaledatabaser/Sider/FoetalmedicinskDatabase.aspx http://webcache.googleusercontent .com/search?q=cache:http://www.r kkp.dk/om-rkkp/de-kliniskekvalitetsdatabaser/ https://www.regionh.dk/Sundhed/P olitikker-PlanerStrategier/Documents/Rapport_fra _arbejdsgruppen_vedr_klinisk_kval itet_final.pdf http://webcache.googleusercontent .com/search?q=cache:http://www.r kkp.dk/om-rkkp/de-kliniskekvalitetsdatabaser/ http://webcache.googleusercontent .com/search?q=cache:http://www.r kkp.dk/om-rkkp/de-kliniskekvalitetsdatabaser/ https://www.regionh.dk/Sundhed/P olitikker-PlanerStrategier/Documents/Rapport_fra _arbejdsgruppen_vedr_klinisk_kval itet_final.pdf http://webcache.googleusercontent .com/search?q=cache:http://www.r kkp.dk/om-rkkp/de-kliniskekvalitetsdatabaser/ http://webcache.googleusercontent .com/search?q=cache:http://www.r kkp.dk/om-rkkp/de-kliniskekvalitetsdatabaser/ http://webcache.googleusercontent .com/search?q=cache:http://www.r kkp.dk/om-rkkp/de-kliniskekvalitetsdatabaser/ Referenced from DID KRC / DCCG Danish intensive database Danish Colorectal Cancer Database Danish quality database for breast cancer screening Danish Quality Database of Birth Danish quality database for cervix screening Danish Quality Database for Mammography Screening Danish Liver and Biliary Cancer Database Danish Nephrology Society Land Register Danish neuro-oncology register Dansk Pancreas Cancer Database DPCD Danish Sarcoma Database Landsdækkende kliniske databaser / Dansk Intensiv database National Clinical Database Landsdækkende kliniske databaser / Dansk Kolorektal Cancer Database National Clinical Database Landsdækkende kliniske databaser / Dansk Kvalitetsdatabase for National Clinical Database brystkræftscreening Landsdækkende kliniske databaser / Dansk Kvalitetsdatabase for Fødsler National Clinical Database Landsdækkende kliniske databaser / Dansk Kvalitetsdatabase for National Clinical Database livmoderhalskræftscanning Landsdækkende kliniske databaser / Dansk kvalitetsdatabase for National Clinical Database mammografiscreening Landsdækkende kliniske databaser / Dansk Lever- og Galdevejscancer National Clinical Database Databasen Landsdækkende kliniske databaser / Dansk Nefrologisk Selskabs National Clinical Database Landsregister Landsdækkende kliniske databaser / Dansk neuroonkogisk register National Clinical Database Landsdækkende kliniske databaser / Dansk Pancreas Cancer Database National Clinical Database Landsdækkende kliniske databaser / Dansk Sarkom Database National Clinical Database Cancer Cancer, Women Birth, Child,women Cancer, Women Cancer, Women Cancer Nephrology Cancer Cancer Cancer Specific Landsdækkende kliniske databaser / Dansk transfusionsdatabase Procedure, National Clinical Database Blood, Hospital 20 21 22 23 24 25 26 27 28 29 30 31 Landsdækkende kliniske databaser / Database for behandling af National Clinical Database reumatologiske patienter Condition, Orthopaedic 33 Database for treatment of rheumatologic patients Landsdækkende kliniske databaser / Dansk Tværfagligt register for Hoftenære Danish Interdisciplinary Register for National Clinical Database Lårbensbrud Femoral Thigh Break Acute Diseases 32 Danish transfusion database 2008-> 2008-> Sep 2010-> 2001-> 2008-> Oct 2003-> 2000-> 1998-> 2003-> 1997, 2007-> 2009-> 2011-> 1990-> But contains data back to 1964 DANBIO 2006-> DTDB DSD DNOR DNSL DLGCD 2011-> DKMS DKLS DKF DHHD Specific Procedure, hospital Danish Hysterectomy and Hysteroscopy Database Landsdækkende kliniske databaser / Dansk Hysterektomi og Hysteroskopi National Clinical Database Database Specific Procedure, reproduction 19 DHR Danish Heart Register Landsdækkende kliniske databaser / Dansk Hjerteregister National Clinical Database Cardio 18 Danish Hernia Database 17 Landsdækkende kliniske databaser / Dansk Herniedatabase (ingvinalhernier National Clinical Database og ventralhernier) Condition, reproduction Clinical quality Clinical quality Investigative Clinical quality Clinical quality Clinical quality Region H Kompetencecenter Øst Danish Regions Region H Kompetencecenter Nord Danish Regions Danish Regions Region H Kompetencecenter Syd Danish Society of Nephrology (DNS) Data Manager:Michael Due Larsen Therapy efficacy,Treatment quality Clinical quality Danish Regions Region H Kompetencecenter Nord Region H Kompetencecenter Nord Clinical quality Clinical quality Treatment quality Clinical quality Analysis Hans Ulrik FriisAndersen, [email protected]. dk Thor Schmidt , [email protected] k Ann-Dorthe Zwisler, [email protected] Monika Madsen, monika.madsen.01@re gionh.dk Annette Settnes, Hillerød Hospital, Annette.Settnes@regio nh.dk, Tlf: 4829 6237 Sofia Kyndesen, sofia.mi.jin.spaabaek.m oeller.kyndesen@regio nh.dk,Tlf. 2992 0248 https://www.regionh.dk/kliniskedatabas er/nationale-databaser/Sider/DanskHysterektomi-og-HysteroskopiDatabase-DHHD.aspx karbase.dk www.herniedatabasen.dk https://www.regionh.dk/Sundhed/P olitikker-PlanerStrategier/Documents/Rapport_fra _arbejdsgruppen_vedr_klinisk_kval itet_final.pdf https://www.regionh.dk/Sundhed/P olitikker-PlanerStrategier/Documents/Rapport_fra _arbejdsgruppen_vedr_klinisk_kval itet_final.pdf https://www.regionh.dk/kliniskedata baser/nationaledatabaser/Sider/DanskHjerteregister-DHR.aspx https://www.regionh.dk/kliniskedata baser/nationaledatabaser/Sider/DanskHerniedatabase.aspx www.gicancer.dk www.nephrology.dk http://webcache.googleusercontent .com/search?q=cache:http://www.r kkp.dk/om-rkkp/de-kliniskekvalitetsdatabaser/ KCKS West: Quality http://www.kcks-vest.dk/kliniskeConsultant :Annette http://www.dnog.dk/database kvalitetsdatabaser/dansk-neuroIngeman onkologisk-register/ http://webcache.googleusercontent At KCKS West, Data http://dpcg.gicancer.dk/Default.aspx?pI .com/search?q=cache:http://www.r Manager: Jan Nielsen D=10 kkp.dk/om-rkkp/de-kliniskekvalitetsdatabaser/ http://webcache.googleusercontent Dansk Sarcome Gruppe http://www.ortopaedi.dk/index.php?id= .com/search?q=cache:http://www.r Tlf: 23 67 90 47, 24 kkp.dk/om-rkkp/[email protected] kvalitetsdatabaser/ https://www.regionh.dk/Sundhed/P olitikker-PlanerTlf.: +45 8942 4800 · http://www.dtdb.dk/ Strategier/Documents/Rapport_fra [email protected] _arbejdsgruppen_vedr_klinisk_kval itet_final.pdf Hos KCKS-vest: http://webcache.googleusercontent http://www.kcks-vest.dk/kliniskeKvalitetskonsulent .com/search?q=cache:http://www.r kvalitetsdatabaser/hoftenaereAnnette Ingeman kkp.dk/om-rkkp/de-kliniskelaerbensbrud/ [email protected] kvalitetsdatabaser/ https://www.regionh.dk/Sundhed/P tlf: 38633103 mail: olitikker-Planerhttps://danbio-online.dk/ databasen@danbioStrategier/Documents/Rapport_fra online.dk _arbejdsgruppen_vedr_klinisk_kval itet_final.pdf Peter Nørgård Larsen, Rigshospitalet https://www.regionh.dk/Sundhed/P olitikker-PlanerStrategier/Documents/Rapport_fra _arbejdsgruppen_vedr_klinisk_kval itet_final.pdf http://webcache.googleusercontent http://www.kcks-vest.dk/kliniskeData Manager Pia .com/search?q=cache:http://www.r Andersen, KCKS, West kvalitetsdatabaser/livmoderhalskraefts kkp.dk/om-rkkp/de-kliniskecreening/ kvalitetsdatabaser/ KCKS, west: Quality Consultant Lea http://www.kcks-vest.dk/kliniskekvalitetsdatabaser/livmoderhalskraefts Grey Haller : creening/ [email protected] Competence Centre for Epidemiology and Biostatistics, North & Competence Data Manager: Lasse Pirk Centre for Clinical Quality and Health Informatics, West. Peter Ingeholm, Tlf: +45 38 68 14 03 Email: peter.ingeholm.01@regi https://www.regionh.dk/kliniskedatabas RegionH onh.dk er/nationale-databaser/Sider/DanskKontaktperson i KCKS- Kolorektal-Cancer-Database.aspx Øst: Mette Roed Eriksen, specialkonsulent Scientific Research RegionH Scientific Research Statens Institut for Folkesundhed Scientific Research Regionshospitalet Horsens DDDDVDD DDD? Diabase LYFO LYFO DDD-Danish Adult Diabetes Database DDD-Diabase - The nationwide clinical database for screening of diabetic retinopathy and maculopathy The Hematologic Common Database - Acute leukemia The Hematologic Common Database - Chronic myeloid disorders The national schizophrenia database Danish Kidney Cancer Committee Landsdækkende kliniske databaser / DDD-Dansk Voksen Diabetes Database National Clinical Database DDD-Den landsdækkende klinisk Landsdækkende kliniske databaser / kvalitetsdatabase for screening af National Clinical Database diabetisk retinopati og maculopati Landsdækkende kliniske databaser / Den Hæmatologiske Fællesdatabase National Clinical Database Lymfom Landsdækkende kliniske databaser / Den Hæmatologiske Fællesdatabase National Clinical Database Myelomatose Condition, Diabetes Blood, Cancer, Landsdækkende kliniske databaser / Den Hæmatologiske Fællesdatabase Condition National Clinical Database Akut leukæmi Landsdækkende kliniske databaser / Den Hæmatologiske Fællesdatabase National Clinical Database Kroniske myeloide sygdomme Condition, Diabetes Blood, Condition Blood, Condition Blood, Condition Orthopaedic Orthopaedic Orthopaedic Orthopaedic Diabetes Condition, Mind Landsdækkende kliniske databaser / Det nationale skizofrenidatabase National Clinical Database Landsdækkende kliniske databaser / Kidneycancer Cancer, nephro National Clinical Database 38 39 40 41 42 43 44 45 46 47 48 49 50 DOF DOF NDR Landsdækkende kliniske databaser / Den ortopædiske fællesdatabase - Dansk The united orthopedics database National Clinical Database korsbåndsregister Danish cruciate ligament register The united orthopedics database Landsdækkende kliniske databaser / Den ortopædiske fællesdatabase - Dansk Danish shoulder arthroplasty National Clinical Database skulderalloplastik register Register Landsdækkende kliniske databaser / Det Nationale Diabetesregisteret National Clinical Database UOFDAREN CA DOF Landsdækkende kliniske databaser / Den ortopædiske fællesdatabase - Dansk The united orthopedics database National Clinical Database knæalloplastik Register Danish knee arthroplasty Register Diabetes register DOF LYFO Landsdækkende kliniske databaser / Den ortopædiske fællesdatabase - Dansk The united orthopedics database National Clinical Database hoftealloplastik Register Danish hip arthroplasty Register The Hematologic Common Database - Multiple myeloma LYFO DDD- Danish Register of Child and DSBD Adolescent Diabetes. Landsdækkende kliniske databaser / DDD-Dansk Register for børne- og Child, Diabetes National Clinical Database ungdomsdiabetes 37 The Hematologic Common Database - Lymphoma The database for Asthma in Denmark Landsdækkende kliniske databaser / Databasen for Astma i Danmark National Clinical Database Condition, Respiration 36 1996-> 2005-> 2005-> 2005-> 2005-> 2005-> 2005-> 2005-> 2005-> 1999-> 1996-> 2015-> 1990-> Database for chronical kidney failure Landsdækkende kliniske databaser / Database for kronisk nyresvigt National Clinical Database Condition, Nephrology ? 35 DIPSY Data for clinical quality in psychiatric treatment Landsdækkende kliniske databaser / Database for klinisk kvalitet i psykiatrisk National Clinical Database behandling Psychiatry 34 Region H Region H Region H Region H RegionH RegionH RegionH RegionH Danish Regions Danish Regions Danish Regions Region H Kompetencecenter Syd Clinical quality Clinical quality Danish Regions Region H , KCKS Vest Statens Serum Scientific Research Institut Clinical quality Clinical quality Clinical quality Clinical quality Clinical quality Clinical quality Clinical quality Clinical quality Monitor, treatment quality Monitor, treatment quality Clinical quality Monitor, treatment quality Clinical quality Region H https://www.regionh.dk/kliniskedatabas er/nationale-databaser/Sider/DenHaematologiske-Faellesdatabase.aspx https://www.regionh.dk/kliniskedatabas er/nationale-databaser/Sider/DenHaematologiske-Faellesdatabase.aspx https://www.regionh.dk/kliniskedatabas er/nationale-databaser/Sider/DenHaematologiske-Faellesdatabase.aspx https://www.regionh.dk/kliniskedatabas er/nationale-databaser/Sider/DenHaematologiske-Faellesdatabase.aspx http://www.kcks-vest.dk/kliniskekvalitetsdatabaser/diabase/ http://www.kcks-vest.dk/kliniskekvalitetsdatabaser/skulderalloplastikregister/ http://www.kcks-vest.dk/kliniskekvalitetsdatabaser/korsbaendsregister/ http://www.kcks-vest.dk/kliniskekvalitetsdatabaser/knaealloplastikregister/ http://www.ssi.dk/Sundhedsdataogit/Re Mette Kramer Pedersen gistre%20og%20kliniske%20databaser http://www.laeger.dk/portal/pls/port , Tlf.: 3268 5142 , /De%20nationale%20sundhedsregistre al/!PORTAL.wwpob_page.show?_ [email protected] /Sygdomme%20leagemidler%20behan docname=10765412.PDF dlinger/Diabetesregisteret.aspx https://www.regionh.dk/Sundhed/P KCKS, vest: olitikker-PlanerKvalitetskonsulent Lene http://www.kcks-vest.dk/kliniskeStrategier/Documents/Rapport_fra Korshøj kvalitetsdatabaser/skizofreni/ _arbejdsgruppen_vedr_klinisk_kval [email protected] itet_final.pdf Anne Nakano KCKShttp://webcache.googleusercontent West, .com/search?q=cache:http://www.r [email protected]. http://www.uofdatabase.dk/ kkp.dk/om-rkkp/de-kliniskedk kvalitetsdatabaser/ Anne Hjelm, KCKS West. E-mail: [email protected] k , tel 7841 3987 Anne Hjelm, KCKS West. E-mail: [email protected] k , tel 7841 3988 Anne Hjelm, KCKS West. E-mail: [email protected] k , tel 7841 3989 https://www.regionh.dk/Sundhed/P olitikker-PlanerStrategier/Documents/Rapport_fra _arbejdsgruppen_vedr_klinisk_kval itet_final.pdf http://webcache.googleusercontent https://www.regionh.dk/kliniskedatabas .com/search?q=cache:http://www.r er/nationale-databaser/Sider/Danskkkp.dk/om-rkkp/de-kliniskeDiabetes-Database.aspx kvalitetsdatabaser/ Anne Hjelm, KCKS http://www.kcks-vest.dk/kliniskeWest. E-mail: [email protected] kvalitetsdatabaser/hoftealloplastikregister/ k , tel 7841 3986 Peter de Nully Brown, [email protected] h.dk Tel: +45 3545-1128 Sofia Kyndesen sofia.mi.jin.spaabaek.m oeller.kyndesen@regio nh.dk "Peter de Nully Brown, [email protected] h.dk,Tel: +45 35451128 Sofia Kyndesen, sofia.mi.jin.spaabaek.m oeller.kyndesen@regio nh.dk" Peter de Nully Brown, [email protected] h.dk,Tel: +45 35451128 Sofia Kyndesen, sofia.mi.jin.spaabaek.m oeller.kyndesen@regio nh.dk Peter de Nully Brown, [email protected] h.dk Tel: +45 3545-1128 Sofia Kyndesen sofia.mi.jin.spaabaek.m oeller.kyndesen@regio nh.dk KCKS-Vest:Katrine Abildtrup Nielsen [email protected] KCKS-Vest:Katrine Abildtrup Nielsen [email protected] KCKS-Vest:Katrine Abildtrup Nielsen [email protected] Selskabsecretary@nep http://www.nephrology.dk/ hrology.dk https://www.regionh.dk/Sundhed/P olitikker-PlanerStrategier/Documents/Rapport_fra _arbejdsgruppen_vedr_klinisk_kval itet_final.pdf https://www.regionh.dk/Sundhed/P olitikker-PlanerStrategier/Documents/Rapport_fra _arbejdsgruppen_vedr_klinisk_kval itet_final.pdf Nationwide database of Geriatrics Nationwide Clinical Database of Contact Allergy The Danish Vascular Registry Landsdækkende kliniske databaser / Landsdækkende database for Geriatri National Clinical Database Landsdækkende kliniske databaser / Landsdækkende Klinisk Database for National Clinical Database Kontaktallergi Landsdækkende kliniske databaser / Landsregisteret Karbase / Karbase National Clinical Database Landsregister Specific Procedure, Elderly Condition Cardio 53 54 55 The schlerosis treatment register Danish Cancer of the testis Committee Landsdækkende kliniske databaser / Register uro-onkologisk fællesdatabase National Clinical Database Landsdækkende kliniske databaser / Sclerosebehandlingsregistret National Clinical Database Landsdækkende kliniske databaser / Testiscancer National Clinical Database Biobank Cancer Condition, Schlerosis Cancer, Men Condition 60 61 62 63 64 65 Orthopaedic 70 71 Sagsbehandling Admin/ Case Registration, Hospital 69 Statistik Statistik Sagsbehandling 68 Patientinformati Patientinformation on Admin/ Case Registration, Sagsbehandling Hospital National Indikator Project NIP Biobank Admin/ Case Registration, Hospital 67 66 UOFDanish Prostate Cancer Committee DAPRO CA Landsdækkende kliniske databaser / Cancer, Prostatacancer Prostrate, Men National Clinical Database 59 Danmarks Statistics Bevægelsesregisteret Ordinationer af kopipligtige lægemidler Autorisationsregisteret Administration af udleveringstilladelser Ventetider venteinfo.dk Akut mave-tarm kirurgi databasen Vævsanvendelsesregisteret Denmarks Statistics Movement Register Authorization Register Waiting Time Danish Urological Cancer Group The Tissue Register Danish Penis Cancer Committee AUT NIP UOFDATECA DMSG UoF VAR Danish benign Prostatic Hyperplasia Database Prostrate, Men Landsdækkende kliniske databaser / Prosbase National Clinical Database 58 Landsdækkende kliniske databaser / Peniscancer National Clinical Database Cancer,Men 57 Organ Donation Database Cancer Specific Procedure, UOFDAPEC A GER ? 2004-> April 2010 - > 1993-> 2004-> KOL / DRKOL ? 56 Monitroing of pathways for cancer Chronic obstructive pulmonary disease Landsdækkende kliniske databaser / Kronisk obstruktiv lungesygdom National Clinical Database Condition, Respiratory 52 Landsdækkende kliniske databaser / Monitorering af pakkeforløb for kræft National Clinical Database Landsdækkende kliniske databaser / Organdonationsdatabasen National Clinical Database Clinical vein database Landsdækkende kliniske databaser / Klinisk vene database National Clinical Database Blood 51 RegionH Region H - Det nationale Indikatorprojekt Danish Regions Danish Regions RegionH Administrative Administrative Treatment quality Clinical quality Clinical quality Clinical quality Statens Serum Institut Region H - Det nationale Indikatorprojekt Danish Regions Region H Kompetencecenter Nord Danish Regions Statens Serum Scientific Research Institut Clinical quality Clinical quality Quality Assessment Clinical quality Scientific Research RegionH Clinical quality Clinical quality Region H Kompetencecenter Øst https://www.regionh.dk/kliniskedatabas er/nationaledatabaser/Sider/LandsregistretKarbase.aspx https://www.regionh.dk/kliniskedatabas er/nationale-databaser/Sider/Kliniskdatabase-for-Kontaktallergi.aspx https://www.regionh.dk/kliniskedatabas er/nationaledatabaser/Sider/Landsdaekkendedatabase-for-Geriatri.aspx http://www.kcks-vest.dk/kliniskekvalitetsdatabaser/sclerose/ http://webcache.googleusercontent .com/search?q=cache:http://www.r kkp.dk/om-rkkp/de-kliniskekvalitetsdatabaser/ https://www.regionh.dk/Sundhed/P olitikker-PlanerStrategier/Documents/Rapport_fra _arbejdsgruppen_vedr_klinisk_kval itet_final.pdf http://webcache.googleusercontent .com/search?q=cache:http://www.r kkp.dk/om-rkkp/de-kliniskekvalitetsdatabaser/ https://www.regionh.dk/Sundhed/P olitikker-PlanerStrategier/Documents/Rapport_fra _arbejdsgruppen_vedr_klinisk_kval itet_final.pdf ssi.dk http://webcache.googleusercontent .com/search?q=cache:http://www.r kkp.dk/om-rkkp/de-kliniskekvalitetsdatabaser/ http://webcache.googleusercontent .com/search?q=cache:http://www.r kkp.dk/om-rkkp/de-kliniskekvalitetsdatabaser/ http://www.laeger.dk/portal/pls/port al/!PORTAL.wwpob_page.show?_ docname=10765412.PDF http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser /De%20nationale%20sundhedsregistre http://www.laeger.dk/portal/pls/port Hanna Joensen, Tlf.: /Personoplysninger%20sundhedsfaglig al/!PORTAL.wwpob_page.show?_ 3268 5133, [email protected] %20beskeaftigelse/Autorisationsregist docname=10765412.PDF eret.aspx, http://sundhedsstyrelsen.dk/da/ds/opsl agautreg Anne Nakano KCKSWest, http://www.uofdatabase.dk/ [email protected]. dk dk Anne Nakano KCKSWest, [email protected]. http://www.uofdatabase.dk/ dk http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser Linda Saabye Kongerslev, Tlf.: 3268 /De%20nationale%20sundhedsregistre /Dodsaarsager%20biologisk%20materi 5138, [email protected] ale/Vaevsanvendelsesregisteret.aspx Anne Nakano KCKSWest, http://www.uofdatabase.dk/ [email protected]. Tlf: 78 45 09 50, E-mail: [email protected] Anne Nakano KCKSWest, [email protected]. http://www.uofdatabase.dk/ dk Kirsten Vinding, Kirsten.Laila.Vinding@r syd.dk Thor Schmidt, [email protected] k Jeanne Duus Johansen, [email protected] Monika Madsen, monika.madsen.01@re gionh.dk Nikolaj Eldrup MD Ph.D., Tlf. 3092 2346, [email protected] Katrine Roos Prechtkatrine.roos.prec [email protected] http://www.kcks-vest.dk/kliniskeKatrine Abildtrup Nielsen [email protected] kvalitetsdatabaser/kol/ https://www.regionh.dk/Sundhed/P olitikker-PlanerStrategier/Documents/Rapport_fra _arbejdsgruppen_vedr_klinisk_kval itet_final.pdf https://www.regionh.dk/Sundhed/P olitikker-PlanerStrategier/Documents/Rapport_fra _arbejdsgruppen_vedr_klinisk_kval itet_final.pdf Admin, hospital Admin,Hospital Statistik Admin,Hospital Statistik Admin,Hospital Statistik Women 76 77 78 79 80 Cancer Cancer 84 85 Treatment quality Psychiatry 87 88 86 Cancer 83 82 Reflecting Registers Reflecting Registers Hospital 75 81 Hospital 74 Sundhedsovervågning Sundhedsovervågning Sundhedsovervågning Sundhedsovervågning Sundhedsovervågning Sundhedsovervågning Sundhedsovervågning Sundhedsovervågning Statistik Statistik Statistik Hospital 73 Statistik Hospital 72 National Patient Register Radiological services GP Register (doctors, dentists, fysiotherapists etc.) DUSAS (Danes treated at foreign hospitals) Landspatientregisteret - Radiologiske ydelser Yderregisteret (doctors, dentists, fysiotherapists etc.) Register over danskere behandlet på udenlandske sygehuse og aktivitet i speciallægepraksis. Danish Patient Safety Database The Central Psychiatric treatments register Det Psykiatriske Centrale Behandlingsregister Waiting time in Danish pharmacies 1943-> Cancer register - New occurences of cancer 1943-> 1973-1994 & 2006-> 1943-> DPSD ABR DUSAS 2002-> 1995-> 1976-> 1976-> 1976-> 1976-> Cancer register - Cancer survival Cancer register - Other neoplasias Register for Work Hazards Abortion Register Dansk Patient Sikkerheds Database Ventetid på danske apoteker Cancerregisteret - Nye kræfttilfælde Cancerregisteret - Kræftoverlevelse Cancerregisteret - Andre neoplasier Bivikrningsovervågning Arbejdssskaderegister Abortregisteret Statistikbanken REGR31, Regionernes regnskaber efter område, funktion, dranst Regional Accounts & finances og art Sundhedsstyrelsens elektroniske stillings Electronic position and vacancy og vakancetælling counting* LPR National Patient Register Operations Landspatientregisteret - Operationer LPR LPR National Patient Register - Activity on diagnosis level Landspatientregisteret - Aktivitet på diagnoseniveau LPR National Patient Register - Activity on diagnosis group Landspatientregisteret - Aktivitet på diagnosegruppe Statens Serum Institut Statens Serum Institut Statens Serum Institut Statens Serum Institut Statens Serum Institut Statens Serum Institut Statens Serum Institut Statens Serum Scientific Research Institut Danmark Scientific Research Apotekerforening Scientific Research Statens Serum Institut Scientific Research Statens Serum Institut Scientific Research Statens Serum Institut Administrative Administrative Administrative Administrative Administrative Administrative Administrative http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser /De%20nationale%20sundhedsregistre /Sygdomme%20leagemidler%20behan dlinger/Landspatientregisteret.aspx http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser /De%20nationale%20sundhedsregistre /Sygdomme%20leagemidler%20behan dlinger/Landspatientregisteret.aspx, http://www.esundhed.dk/sundhedsregi stre/LPR/Sider/LPR01_Tabel.aspx http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser /De%20nationale%20sundhedsregistre /Sygdomme%20leagemidler%20behan dlinger/Landspatientregisteret.aspx http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser /De%20nationale%20sundhedsregistre /Sygdomme%20leagemidler%20behan dlinger/Landspatientregisteret.aspx http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser /De%20nationale%20sundhedsregistre /Personoplysninger%20sundhedsfaglig %20beskeaftigelse/Yderregisteret.aspx http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser /De%20nationale%20sundhedsregistre /Sundhedsokonomi%20finansiering/DU SAS.aspx http://www.laeger.dk/portal/pls/port al/!PORTAL.wwpob_page.show?_ docname=10765412.PDF http://www.laeger.dk/portal/pls/port al/!PORTAL.wwpob_page.show?_ docname=10765412.PDF http://www.laeger.dk/portal/pls/port al/!PORTAL.wwpob_page.show?_ docname=10765412.PDF https://data.digitaliser.dk/alle?svco mr=20.00.00.00 http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser http://www.laeger.dk/portal/pls/port /De%20nationale%20sundhedsregistre al/!PORTAL.wwpob_page.show?_ /Sygdomme%20leagemidler%20behan docname=10765412.PDF dlinger/Cancerregisteret.aspx http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser /De%20nationale%20sundhedsregistre /Sygdomme%20leagemidler%20behan dlinger/Cancerregisteret.aspx http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser /De%20nationale%20sundhedsregistre /Sygdomme%20leagemidler%20behan dlinger/Cancerregisteret.aspx Patientombuddet [email protected] / http://www.dpsd.dk/ lekontor@patientombudd et.dk Milan Fajber, Tlf:3268 5143, [email protected] Margit Rasted, Tlf: 3268 5153, [email protected] Maya Christel Milter, Tlf: 3268 5141, [email protected] Helle Rejnhold Sørensen, Tlf.: 3268 5210, [email protected] Milan Fajber, Tlf:3268 5143, [email protected] Margit Rasted, Tlf: 3268 5153, [email protected] Maya Christel Milter, Tlf: 3268 5141, [email protected] Helle Rejnhold Sørensen, Tlf.: 3268 5210, [email protected] Milan Fajber , Tlf:3268 5143, [email protected] Margit Rasted, Tlf: 3268 5153, [email protected] Maya Christel Milter, Tlf: 3268 5141, [email protected] Helle Rejnhold Sørensen, Tlf.: 3268 5210, [email protected] http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser http://www.laeger.dk/portal/pls/port Christian Theodor Ulrich, Tlf.: 3268 9065, /De%20nationale%20sundhedsregistre al/!PORTAL.wwpob_page.show?_ /Graviditet%20fodsler%20born/Abortre docname=10765412.PDF [email protected] gisteret.aspx Kristian Nielsen, Tlf.: 3268 5135, [email protected] Christian Theodor Ulrich, Tlf.: 3268 9065, [email protected] Kristian Nielsen, Tel:3268 5135, [email protected] Erik Villadsen , Tel.: 3268 5131, [email protected] Kristian Nielsen, Tel:3268 5135, [email protected] Erik Villadsen , Tel.: 3268 5131, [email protected] Kristian Nielsen, Tel:3268 5135, [email protected] Erik Villadsen , Tel.: 3268 5131, [email protected] Kristian Nielsen, Tel:3268 5135, [email protected] Erik Villadsen , Tel.: 3268 5131, [email protected] Ulykkeregisteret Medicinsk fødselsregister/Fødselsregisteret Sundhedsovervågning Treatment, Apotek Diagnosis Accident Birth, Child, Women 93 94 95 96 Psychiatry 99 Cancer Danish Head and Neck Cancer Group Cancer database DAHANCA (Danish Head and Neck Cancer Group) 106 Cancerdatabase 108 Admin 105 The Child Database (Children's health) - Early and late primary school (BMI, height & weight) Børnedatabasen (Børns helbred) Indskoling og Udskoling (BMI, højde & vægt) DAGS (Danish Ambulant Grouping system) Cancer 104 The Child Database (Children's health) - First living year Børnedatabasen (Børns helbred) - First living year DAGS (Dansk Ambulant Grupperingssystem) Child 103 Blood spots from all newborn Danes since 1976 Blood spots from all newborn Danes since 1976 107 Child 102 Alcohol treatment register Alkoholbehandlingsregisteret The Health Agency's Central Dental SCOR Register Sundhedsstyrelsens Centrale Odontologiske Register (SCOR), CPR (The central person register) Birth, child 101 Sundhedsovervågning Administrative Statens Serum Institut Serum Scientific Research Statens Institut 2009-> 2009-> 1976-> 2005-> 1999-> 1970-> Statens Serum Institut Statens Serum Institut Clinical quality Administrative Administrative Administrative Administrative Scientific Research Danish Regions Statens Serum Institut Region H Kompetencecenter Nord Statens Serum Institut Statens Serum Institut Danish Biobank Registry Statens Serum Scientific Research Institut Scientific Research Administrative Statens Serum Institut Center for Scientific Research Ulykkesforskning 1973-1995. After 1995 through Administrative landspatientregi steret 1990-> 1970->, but not covering the Statens Serum whole country Scientific Research Institut until 1997-> 1994-> 1994-2005 manual register. Scientific Research Statens Serum 2005-> digitally Institut registered 1970-> DAHAN 2002-> CA CPR DECV NAB SEI Coercive Psychiatry Register Register over anvendelse af Tvang i psykiatri PKU MFR LRP LSR IVF Cause of Death Register - Stillborn DAR The Neonatal Screening Biobank Medical Birth Register The Accident Register Pathology register Medicines Register IVF-register (fertility) DAR Register for dødefødte PKU Registret Landsdækkende register for Patologi Lægemiddelstatistikregisteret IVF-registeret (fertilitet) Pregnancy Screening Register Cause of Death Register - Table CPR (Det centrale personregister) Therapy , Addiction 100 Sundhedsovervågning Death, child 98 Sundhedsovervågning Sundhedsovervågning 97 Sundhedsovervågning Sundhedsovervågning Sundhedsovervågning Women 92 Gravid Screeningsregistret Epidemiologisk overvågning Sundhedsovervågning Dødsårsagsregisteret Sundhedsovervågning Sundhedsovervågning 91 Death 90 89 http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser /De%20nationale%20sundhedsregistre /Graviditet%20fodsler%20born/IVFregisteret.aspx http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser /De%20nationale%20sundhedsregistre /Sygdomme%20leagemidler%20behan dlinger/Laegemiddelstatistikregisteret.a spx http://www.laeger.dk/portal/pls/port al/!PORTAL.wwpob_page.show?_ docname=10765412.PDF http://www.laeger.dk/portal/pls/port al/!PORTAL.wwpob_page.show?_ docname=10765412.PDF http://www.laeger.dk/portal/pls/port al/!PORTAL.wwpob_page.show?_ docname=10765412.PDF Thomas Tjørnelund Nielsen, Tlf.: 3268 5162, [email protected] http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser /De%20nationale%20sundhedsregistre /Graviditet%20fodsler%20born/Borned atabasen.aspx http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser Thomas Tjørnelund /De%20nationale%20sundhedsregistre ssi.dk Nielsen, Tlf.: 3268 /Graviditet%20fodsler%20born/Borned 5162, [email protected] atabasen.aspx https://www.regionh.dk/Sundhed/P olitikker-PlanerStrategier/Documents/Rapport_fra _arbejdsgruppen_vedr_klinisk_kval itet_final.pdf http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser http://www.laeger.dk/portal/pls/port Maya Christel Milter, /De%20nationale%20sundhedsregistre al/!PORTAL.wwpob_page.show?_ Tlf: 3268 9082, /Personoplysninger%20sundhedsfaglig docname=10765412.PDF [email protected] %20beskeaftigelse/CPRregisteret.aspx http://www.laeger.dk/portal/pls/port al/!PORTAL.wwpob_page.show?_ docname=10765412.PDF http://webcache.googleusercontent Dahanca Secretariat, .com/search?q=cache:http://www.r +45 7846 https://www.dahanca.oncology.dk/ kkp.dk/om-rkkp/de-kliniske2620,DAHANCA@onco kvalitetsdatabaser/ logy.dk k http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser http://www.laeger.dk/portal/pls/port Claudia Ranneries, Tlf.: /De%20nationale%20sundhedsregistre al/!PORTAL.wwpob_page.show?_ 32685128, [email protected] /Sygdomme%20leagemidler%20behan docname=10765412.PDF dlinger/Alkoholbehandlingsregister.asp x Danish National Biobank Tel: 3268 5199 / 3268 http://www.biobankdenmark.dk/Danish %20Biobank%20Register/Biobanks%2 9163, [email protected] 0in%20the%20register.aspx http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser Claudia Ranneries, Tlf.: /De%20nationale%20sundhedsregistre 32685128, [email protected] /Dodsaarsager%20biologisk%20materi ale/Dodsaarsagsregisteret.aspx http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser http://www.laeger.dk/portal/pls/port Emil Nygaard /De%20nationale%20sundhedsregistre al/!PORTAL.wwpob_page.show?_ Jørgensen, [email protected], Tlf.: 2230 /Sygdomme%20leagemidler%20behan docname=10765412.PDF dlinger/Tvang%20i%20psykiatrien.asp 7904 x Bjarne Laursen or Hanne Møller, 65507777, http://www.sifolkesundhed.dk/Forskning/Sygdomme %20og%20tilskadekomst/Ulykker/Ulyk kesregisteret.aspx http://www.ssi.dk/Sundhedsdataogit/Re Christian Theodor gistre%20og%20kliniske%20databaser http://www.laeger.dk/portal/pls/port Ulrich, Tlf.: 3268 9065, /De%20nationale%20sundhedsregistre al/!PORTAL.wwpob_page.show?_ [email protected] /Graviditet%20fodsler%20born/Fodsels docname=10765412.PDF register.aspx Milan Fajber, Tlf.: 3268 5143, [email protected] Tlf.: 3268 5125, [email protected] Maya Christel Milter, Tlf: 3268 9082, [email protected] http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser http://www.laeger.dk/portal/pls/port Claudia Ranneries, Tlf.: 32685128, [email protected] /De%20nationale%20sundhedsregistre al/!PORTAL.wwpob_page.show?_ /Dodsaarsager%20biologisk%20materi docname=10765412.PDF ale/Dodsaarsagsregisteret.aspx Elderly Child, Diabetes Cancer Women Apotek Admin Heart Condition Death, Child Respiratory Elderly 116 117 118 119 120 121 122 123 124 125 126 Demensdatabasen Databasen for Astma (under etablering) Fælles Medicinkort United Medicine card Joint Emergency Databasen DRG (diagnosis related groups) The dementia database Children's death by accident register Database over børns dødsfald efter ulykker Database for atrial fibriliation Database for Atrieflimren (under etablering) Database for chronic hepatitis B & C Health status of Danes (Numbers fra the National Health Profile) Danskernes sundhed (Tal fra den nationale sundhedsprofil) Database for kronisk hepatitis B og C Danish medicin prices Danske medicinpriser Dansk urogynækologisk database FMK - DANHE P Danish Regions Scientific Research RegionH Scientific Research RegionH Scientific Research RegionH Scientific Research RegionH Clinical quality Scientific Research RegionH Region H Kompetencecenter Øst Statistik, Reimbursement, Danish Regions Quality of treatment 2013-> 1975-2009 Region H Kompetencecenter Syd Danish Regions Statens Institut for Folkesundhed Region H Kompetencecenter Øst Danish Regions Statens Institut for Folkesundhed Administrative Clinical quality Administrative Danish Regions Scientific Research RegionH Clinical quality Scientific Research Clinical quality Scientific research Danmark Scientific Research Apotekerforening Clinical quality Currently being Scientific Research RegionH established 1996-> 2010-> 1985-> DUGAB Danish urogynaecological databse ase 2006-> DTS Danish Bowel Cancer Screening Database Dansk Tarmkræftscreening Database DRBU Danish register for child and youth diabetes Dansk Register for Børne- og Ungdomsdiabetes DPD DMD DDD DAMD Danish Palliative Database Cross-sectoral Rehabilitation Database Danish Melanoma Database Danish Diabetes database Danish bladder cancer register The Danish General Medicine Database Dansk Palliativ Database Tværsektoriel Rehabiliteringsdatabase Admin Therapy 115 Dansk Melanom Database 129 Cancer, Skin 114 Dansk kvalitetsdatabase for biologisk behandling af kroniske inflammatoriske tarmsygdomme (under etablering) Fælles akutdatabasen Condition 113 Dansk Diabetes Database Emergency Diabetes 112 Dansk blærecancer Register 128 Cancer, Urinary 111 Dansk almenmedicinsk database Danish Cytogenetic Register DRG (diagnoserelaterede grupper) GP 110 Screening 127 Gene 109 Peter Johannsen, Tlf 3545 6702 [email protected] gionh.dk Birgitte Rühmann,birgitte.ruhma [email protected] https://www.regionh.dk/Sundhed/P olitikker-PlanerStrategier/Documents/Rapport_fra _arbejdsgruppen_vedr_klinisk_kval itet_final.pdf http://webcache.googleusercontent .com/search?q=cache:http://www.r kkp.dk/om-rkkp/de-kliniskekvalitetsdatabaser/ http://webcache.googleusercontent .com/search?q=cache:http://www.r kkp.dk/om-rkkp/de-kliniskekvalitetsdatabaser/ https://www.regionh.dk/Sundhed/P olitikker-PlanerStrategier/Documents/Rapport_fra _arbejdsgruppen_vedr_klinisk_kval itet_final.pdf http://www.sundhedsprofil2010.dk/ http://www.kcks-vest.dk/kliniskekvalitetsdatabaser/falles-akutdatabasen/ https://www.regionh.dk/kliniskedatabas er/regionhdatabaser/Sider/DemensDatabasen.as px http://www.kcks-vest.dk/kliniskekvalitetsdatabaser/databasen-forastma-i-danmark/ http://www.laeger.dk/portal/pls/port al/!PORTAL.wwpob_page.show?_ docname=10765412.PDF http://webcache.googleusercontent .com/search?q=cache:http://www.r kkp.dk/om-rkkp/de-kliniskekvalitetsdatabaser/ http://webcache.googleusercontent .com/search?q=cache:http://www.r kkp.dk/om-rkkp/de-kliniskekvalitetsdatabaser/ http://webcache.googleusercontent .com/search?q=cache:http://www.r kkp.dk/om-rkkp/de-kliniskekvalitetsdatabaser/ https://www.regionh.dk/Sundhed/P olitikker-PlanerStrategier/Documents/Rapport_fra _arbejdsgruppen_vedr_klinisk_kval itet_final.pdf http://www.apotekerforeningen.dk/anal http://dst.dk/da/Statistik/emner/sun yser-ogdhed# fakta/analyser/medicinpriser.aspx http://dugabase.dk/ https://www.regionh.dk/kliniskedatabas er/nationale-databaser/Sider/KliniskVene-Database.aspx www.DSBD.dk https://www.regionh.dk/kliniskedatabas er/nationale-databaser/Sider/DanskPalliativ-Database.aspx https://www.regionh.dk/kliniskedatabas er/nationale-databaser/Sider/DanskGalde-Database-DGD.aspx https://www.regionh.dk/kliniskedatabas er/nationale-databaser/Sider/DanskMelanom-Database.aspx http://www.siBjarne Laursen, bla@si- folkesundhed.dk/Forskning/Sygdomme folkesundhed.dk %20og%20tilskadekomst/Ulykker/B%C 3%B8rned%C3%B8dsdatabase.aspx Lene Korshøj Tel +45 78 41 39 89 [email protected] Mette Roed Eriksen, Region H Lisbet Rosenkrantz Hölmich, Klinisk forskningslektor KCKS-Øst, Sofia Kyndesen sofia.mi.jin.spaabaek.m oeller.kyndesen@regio nh.dk Monika Madsen, monika.madsen.01@re gionh.dk Mogens Grønvold, Bispebjerg Hospital [email protected], Tlf: 3531 3524 Maiken Bang Hansen, [email protected] h.dk Tlf 3531 2082 Jannet Svensson,JSVE0041@ heh.regionh.dk Voksen, Susanne https://www.regionh.dk/kliniskedatabas Stenkær, er/nationale-databaser/Sider/DanskSusanne.Stenkaer@sta Diabetes-Database.aspx b.rm.dk Dansk Almenmedicinsk http://www.dak-e.dk/ KvalitetsEnhed, Tlf. 6550 3054 Birth, child Therapy Therapy 134 135 136 137 Rehabilitation Register - Services on hospital Femoral fractures Interaction Database Genoptræningsregisteret - Ydelser på sygehus Hjerteinsufficiens Hoftenære frakturer Interaktionsdatabasen (brug af lægemidler, naturlægemidler, stærke vitaminer, mineraler og grapefrugtjuice) Therapy Condition, Cardio Accidents Pharmacology Cardio 138 139 140 141 142 Region H - Det nationale Indikatorprojekt Region H - Det nationale Indikatorprojekt Statens Serum Institut Scientific Research RegionH Rapid Response System Database (RSS database) National database for Søvnapnø Nyrecancer Emergency Condition Nephrology, cancer 146 147 148 Mobilt Akut System Databasen (MAS) Scientific Research Sundhedsstyrelsen Medicine combination Medicinkombination (samtidig brug af lægemidler, naturlægemidler, stærke vitaminer, mineraler og grapefrugtjuice) Pharmacology 145 Kidney Cancer DAREN CA National database for Sleep Apnea NDOSA 2010-> Clinical quality Clinical quality Clinical quality Clinical database for non melanoma skin cancer Klinisk database for Non-melanom hudkræft Cancer 144 NMSCC Clinical database for child & youth psychiatry Klinisk database for børne- og ungdomspsykiatri Child, Psychiatry 143 Danish Regions RegionH Danish Regions Region H Kompetencecenter Syd Danish Regions Clinical quality Kardiologisk fællesdatabase - Dansk hjertesvigtdatabase Danish Regions Sundhedsstyrelsen, [email protected], Tlf.nr 44 88 97 57 Inger Gillesberg, Tlf. 38682482 E-mail Inger.Gillesberg@Regio nh.dk Birgitte Rühmann , birgitte.ruhmann@regio nh.dk Poul Jørgen Jennum,poul.joergen.je [email protected] Thor Schmidt, [email protected] k,Tlf: 4044 7480 Sundhedsstyrelsen, [email protected], Tlf.nr 44 88 97 57 Thomas Tjørnelund Nielsen, Tlf.: 3268 5162, [email protected] Thomas Tjørnelund Nielsen, Tlf.: 3268 5162, [email protected] Statens Serum Institut Scientific Research Sundhedsstyrelsen Administrative Administrative Cardio 2007-> 2007-> Clinical quality BupBase GES GES Thomas Tjørnelund Nielsen, Tlf.: 3268 5162, [email protected] Statens Serum Institut Region H - Det nationale Indikatorprojekt Region H - Det nationale Indikatorprojekt Region H - Det nationale Indikatorprojekt Kardiologisk fællesdatabase - Dansk hjerterehabiliteringsdatabase Heart insufficiency Rehabilitation Register - Plans Administrative 2007-> Rehabilitation Register - All services GES Administrative Administrative Administrative Scientific Research Births register - New born Genoptræningsregisteret - Planer Genoptræningsregisteret - Alle ydelser Fødselsregisteret - Fødte Births register - Births and complications Birth,child 133 Fødselsregisteret - Fødsler og komplikationer Birth, child 132 Family database Births register - Births Familiedatabasen ? 131 Fødselsregisteret - Fødsler Familieambulatoriet 130 https://www.regionh.dk/kliniskedatabas er/nationale-databaser/Sider/Nationaldatabase-for-SoevnapnoeNDOSA.aspx https://www.regionh.dk/kliniskedatabas er/regionh-databaser/Sider/Mobilt-akutsystem-databasen-i-RegionHovedstaden.aspx http://www.medicinkombination.dk/ http://webcache.googleusercontent .com/search?q=cache:http://www.r kkp.dk/om-rkkp/de-kliniskekvalitetsdatabaser/ http://webcache.googleusercontent http://www.kcks-vest.dk/kliniske.com/search?q=cache:http://www.r kvalitetsdatabaser/hjerterehabilitering/ kkp.dk/om-rkkp/de-kliniskekvalitetsdatabaser/ http://webcache.googleusercontent http://www.kcks-vest.dk/kliniske.com/search?q=cache:http://www.r kvalitetsdatabaser/hjertesvigt/ kkp.dk/om-rkkp/de-kliniskekvalitetsdatabaser/ https://www.regionh.dk/Sundhed/P olitikker-PlanerStrategier/Documents/Rapport_fra _arbejdsgruppen_vedr_klinisk_kval itet_final.pdf http://webcache.googleusercontent .com/search?q=cache:http://www.r kkp.dk/om-rkkp/de-kliniskekvalitetsdatabaser/ http://www.interaktionsdatabasen.dk/ http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser /De%20nationale%20sundhedsregistre /Sygdomme%20leagemidler%20behan dlinger/Genoptraening.aspx http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser http://www.laeger.dk/portal/pls/port /De%20nationale%20sundhedsregistre al/!PORTAL.wwpob_page.show?_ /Sygdomme%20leagemidler%20behan docname=10765412.PDF dlinger/Genoptraening.aspx http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser /De%20nationale%20sundhedsregistre /Sygdomme%20leagemidler%20behan dlinger/Genoptraening.aspx https://www.regionh.dk/Sundhed/P olitikker-PlanerStrategier/Documents/Rapport_fra _arbejdsgruppen_vedr_klinisk_kval itet_final.pdf https://www.regionh.dk/Sundhed/P olitikker-PlanerStrategier/Documents/Rapport_fra _arbejdsgruppen_vedr_klinisk_kval itet_final.pdf http://www.kcks-vest.dk/kliniskekvalitetsdatabaser/foedsler/ http://www.kcks-vest.dk/kliniskekvalitetsdatabaser/foedsler/ http://www.kcks-vest.dk/kliniskekvalitetsdatabaser/foedsler/ http://www.laeger.dk/portal/pls/port al/!PORTAL.wwpob_page.show?_ docname=10765412.PDF https://www.regionh.dk/Sundhed/P olitikker-PlanerStrategier/Documents/Rapport_fra _arbejdsgruppen_vedr_klinisk_kval itet_final.pdf Cancer, Men Psychiatry Treatment Birth, child Army Admin 150 151 152 153 154 155 Women 162 Early Pregnancy and Abortion Quality Database Tidlig Graviditet og Abort Kvalitetsdatabase Online eye-sight Eye Oncology Group The new DNB biobank at Rigshospitalet The new DNB biobank at Rigshospitalet The Danish Cancer Society’s project biobank “Kost, kræft og helbred” The Danish Cancer Society’s project biobank “Kost, kræft og helbred” Websyn Biobank 161 Eyes Cancer 160 The Cancer biobanks (de Kliniske Kræftbiobanker) The Cancer biobanks (de Kliniske Kræftbiobanker) 164 Cancer 159 Health Insurance Register Sygesikringsregisteret Tumorer i øjne Admin 158 SER RAB CPOP DOOG Ti-Gr-ab Drug addicts in treatment Register SIB Statistics over treatment with blood pressure devices Statistik over behandling med blodtryksmidler Stofmisbrugere i Behandling Family tree & data Slægt og data The Army Register Samples from the Danish National Birth Cohort Samples from the Danish National Birth Cohort Sessionsregister Registered Alternative Therapist Psychiatric Research Register The prosdatabase Registreret Alternativ Behandler Psykiatriske Forskningsregister Prosdatabasen Program for Cerebral Opfølgningsprogram for Cerebral Parese Follow-up Palsy 163 Therapy, Addiction 157 156 Cerebral Palsy, child 149 Multiple databases, earliest from 1946. 1990-> 1996-> 2005-> 2010-> Sundhedsstyrelsen og Sundhedsministeriet http://www.rab-behandlere.dk/cm1/ https://www.regionh.dk/Sundhed/P olitikker-PlanerStrategier/Documents/Rapport_fra _arbejdsgruppen_vedr_klinisk_kval itet_final.pdf http://www.laeger.dk/portal/pls/port al/!PORTAL.wwpob_page.show?_ docname=10765412.PDF https://www.regionh.dk/kliniskedata baser/nationaledatabaser/Sider/Opf%C3%B8lgnin gsprogram-for-Cerebral-Parese(CPOP).aspx Danish National Biobank http://www.biobankdenmark.dk/Danish Danish Biobank Tel: 3268 5199 / 3268 Scientific Research Registry %20Biobank%20Register/Biobanks%2 9163, 0in%20the%20register.aspx [email protected] k http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser http://www.laeger.dk/portal/pls/port Statens Serum /De%20nationale%20sundhedsregistre al/!PORTAL.wwpob_page.show?_ Scientific Research Institut Tlf.: 2230 7904 /Personoplysninger%20sundhedsfaglig docname=10765412.PDF %20beskeaftigelse/Sessionsregisteret. aspx DIS-Danmark | Rylevej DIS-Danmark 8, Bro | 5464 Brenderup https://www.slaegtogdata.dk/kilder (private) | Danmark https://digitaliser.dk/resource/3941 Lægemiddelstyrelse Scientific Research n ? 62 http://www.ssi.dk/Sundhedsdataogit/Re gistre%20og%20kliniske%20databaser http://www.laeger.dk/portal/pls/port Statens Serum Claudia Ranneries, Tlf.: /De%20nationale%20sundhedsregistre al/!PORTAL.wwpob_page.show?_ Administrative Institut 32685128, [email protected] /Sygdomme%20leagemidler%20behan docname=10765412.PDF dlinger/Stofmisbrugere%20i%20behan dling.aspx http://www.ssi.dk/Sundhedsdataogit/Re Christian Theodor gistre%20og%20kliniske%20databaser http://www.laeger.dk/portal/pls/port Statens Serum Administrative Ulrich, Tlf.: 3268 9065, /De%20nationale%20sundhedsregistre al/!PORTAL.wwpob_page.show?_ Institut [email protected] /Sundhedsokonomi%20finansiering/Sy docname=10765412.PDF gesikringsregister.aspx Danish National Biobank Biobank Tel: 3268 5199 / 3268 http://www.biobankdenmark.dk/Danish Scientific Research Danish %20Biobank%20Register/Biobanks%2 Registry 9163, [email protected] 0in%20the%20register.aspx k Danish National Biobank Biobank Tel: 3268 5199 / 3268 http://www.biobankdenmark.dk/Danish Scientific Research Danish %20Biobank%20Register/Biobanks%2 Registry 9163, [email protected] 0in%20the%20register.aspx k Danish National Biobank Biobank Tel: 3268 5199 / 3268 http://www.biobankdenmark.dk/Danish Scientific Research Danish %20Biobank%20Register/Biobanks%2 Registry 9163, 0in%20the%20register.aspx [email protected] k Oejvind Lidegaard, https://www.regionh.dk/kliniskedata [email protected] baser/nationaleScientific Research RegionH http://www.tigrab.dk/ k,Tlf.: 3545 0950 databaser/Sider/Tidlig-graviditetKatrine Roos Precht og-abort-kvalitetsdatabase.aspx http://webcache.googleusercontent Jens Overgaard Tel: .com/search?q=cache:http://www.r http://doog.dk/ Clinical quality Danish Regions 89492629, kkp.dk/om-rkkp/[email protected] kvalitetsdatabaser/ Erik Kann, [email protected] https://www.regionh.dk/kliniskedatabas Scientific Research RegionH Birgitte Rühmann, er/nationalebirgitte.ruhmann@regio databaser/Sider/Websyn.aspx nh.dk Scientific Research Region H Kompetencecenter Nord Scientific Research RegionH Niels Wisbech Pedersen, Niels.W.Pedersen@rsy d.dk Helle Mätzke Rasmussen, www.cpop.dk [email protected] Sofia Kyndesen sofia.mi.jin.spaabaek.m oeller.kyndesen@regio nh.dk TAG Sygehusbenyttelse - Befolkningen efter diagnosegruppe, nøgletal, alder og køn Indlæggelser efter område, diagnose (99 gruppering), alder og køn Indlæggelser efter område, diagnose (23 gruppering), alder og køn Indlæggelser, sengedage og indlagte patienter efter område, alder og køn Indlæggelser, sengedage og indlagte patienter efter område, diagnose (99), alder og køn Indlæggelser, sengedage og indlagte patienter efter område, antal sengedage, alder og kø IND05 Indlagte patienter efter område, dominderende diagnose(99 gruppering) alder og køn Indlagte patienter efter område, diagnose (99 gruppering), alder og køn Indeks for indlæggelser efter familietype, alder og køn Indeks for indlæggelser af voksne efter indekstype, socioøkonomisk status, alder og køn Indeks for indlæggelser af voksne efter uddannelse, alder og køn Indeks for indlæggelser af børn efter familiens uddannelse, alder og køn Indeks for indlæggelser efter område, alder og køn Indeks for indlæggelser efter herkomst, alder og køn Indeks for indlæggelser efter boligtype, alder og køn Hospital usage - Population - diagnosis group, key figures, age and gender Hospitalizations after area, diagnosis (99 grouping), age and gender Hospitalizations after area, diagnosis (23 grouping), age and gender Hospitalizations, bed days, patients after area, age and gender Hospitalizations, bed days, patients after area, diagnosis(99), age and gender Hospitalizations, bed days, patients after area, number of bed days, age and gender Hospitalized patients after area, dominant diagnosis (99), age and gender Hospitalized patients after area, diagnosis (99), age and gender Index for hospitalizations after family type, age and gender Index for hospitalizations of adults after index type, socio-economical status, age and gender Index for hospitalizations of adults after education, age and gender Index for hospitalizations of children after the family's education, age and gender Index for hospitalizations after area, age and gender Index for hospitalizations after origin, age and gender Index for hospitalizations after housing type, age and gender INDAMP01 AMB01 Ambulante behandlinger efter område, diagnose (99 gruppering), alder og køn Ambulante behandlinger efter område, diagnose (23 gruppering), alder og køn Ambulante behandlinger og ambulante patienter efter område, alder og køn Ambulante behandlinger og ambulante patienter efter område, diagnose (99), alder og køn AMB04 Ambulante behandlinger og ambulante patienter efter område, antal behandlinger, alder og AMB05 Ambulante patienter efter område, dominerende diagnose (99 gruppering), alder og køn Ambulante patienter efter område, diagnose (99 gruppering), alder og køn Indeks for ambulante behandlinger efter familietype, alder og køn Ambulant treatments after area, diagnosis (99 grouping), age and gender Ambulant treatments after area, diagnosis (23 grouping), age and gender Ambulant treatments and ambulant patients after area, age and gender Ambulant treatments and ambulant patients after area, diagnosis (99), age and gender Ambulant treatments and ambulant patients after area, number of treatments, age and gender Ambulant patients after area, dominant diagnosis (99 grouping), age and gender Ambulant patients after area, diagnosis (99 grouping), age and gender Index for ambulant treatments after family type, age and gender Open/Closed Scientific Research Open Indeks for ambulante behandlinger af voksne efter uddannelse, alder og køn Indeks for ambulante behandlinger af børn efter familiens uddannelse, alder og køn Index for ambulant treatments of adults after education, age and gender Index for ambulant treatments of children after the family's education, age and gender AMBP06 Scientific Research Open Scientific Research Open Index for ambulant treatments of adults after index type, socio-economical status, age and gend Indeks for ambulante behandlinger af voksne efter indekstype, socioøkonomisk status, ald AMBP04 AMBP05 Scientific Research Open Scientific Research Open Scientific Research Open Scientific Research Open Scientific Research Open Scientific Research Open Scientific Research Open Scientific Research Open Scientific Research Open Scientific Research Open Scientific Research Open Scientific Research Open Scientific Research Open Scientific Research Open Scientific Research Open Scientific Research Open Scientific Research Open Scientific Research Open Scientific Research Open Scientific Research Open Scientific Research Open Scientific Research Open Scientific Research Open Scientific Research Open Scientific Research Open Scientific Research Open Purpose AMBP03 AMBP02 AMBP01 AMB03 AMB02 INDP10 Index for hospitalizations of children after index type, socio-economical status, age and gender Indeks for indlæggelser af børn efter indekstype, socioøkonomisk status, alder og køn INDP09 INDP08 INDP07 INDP06 INDP05 INDP04 INDP03 INDP02 INDP01 IND04 IND03 IND02 IND01 INDAMP03 INDAMP02 Sygehusbenyttelse - Befolkningen efter område, persongruppe, nøgletal, alder og køn Sygehusbenyttelse - Befolkningen efter område, diagnosegruppe, nøgletal, alder og køn Hospital usage - Population after person group, area, key figures, age and gender Abreviation Data source (Danish) Hospital usage - Population after diagnosis group, area, key figures, age and gender Data source (English) Examples of aggregated healthcare data from Statistics Denmark Data collected Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Danmarks Stati 2006-2013 Data owner http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 http://www.statistikbanken.dk/statbank5a/default.asp?w=1920 Link CEBI WJC Center for Experimental Bio Informatics Center for GeoGenetics Centre for Gene Regulation and Plasticity of Neuro-endocrine Network Wilhelm Johannsen Centre for Functional Genome Research 2001 http://www.wjc.ku.dk/ http://www.ku.dk/ geogenetics.ku.dk/ mrnp.au.dk PlaCe Center for Molecular Plant Physiology DTU Instituional support Eske Willerslev Matthias Mann Birger Lindberg Møller Henriette Giese Ole Lund Person Torben Heick Jensen Kristian Helin University of Copenhagen Aarhus University Niels Tommerup, [email protected] University of Copenhagen The Royal Veterinary and A Lars-Inge Larsson http://www.natlab.dtu.dk RISØ National Laboratory / The Royal Veterinary and http://www.ku.dk/ Agricultural University. University of Southern www.cebi.sdu.dk/ Denmark http://www.cbs.dtu.dk/ Centre for mRNP Biogenesis and Metaolism CPMS Center for Plant-Microbe Symbiosis 1993 Website epigenetics.ku.dk CBS Center for Biological Sequence Analysis Formed Centre for Epigenetics Abbreviation Institute List of Genome Research Centers Report prepared by Leapcraft ApS Contact Vinay Venkatraman CEO, Leapcraft Strandgade 54 1401 Copenhagen K www.leapcraft.dk / [email protected]