National Audit Office of Denmark

Report on the problems connected with the development and implementation of the digitally based Shared Medication Record Read full summary in English

2014 report 24/2013

The purpose of the examination was to assess whether the department of the Danish Ministry of Health, the Danish National eHealth Authority (NHA) and the five regions that are responsible for the hospitals have made an adequate effort to develop and implement the Shared Medication Record (SMR). With the SMR, data on the citizens’ medication can be shared across hospitals, general practitioners, etc. and relevant health staff and the patients have direct digital access to updated medical data round the clock. The report answers the following questions: 1) Has the Ministry of Health and the NHA provided a sufficient framework for carrying through the SMR programme? 2) Has the Ministry of Health and the NHA directed the SMR programme towards delivering within the agreed costs, time and quality parameters, and has the effort made by the ministry and the NHA in this respect been adequately underpinned by the regions? 3) Have the regions ensured implementation of the SMR by the end of 2013, and has the NHA ensured an adequate level of IT security? 4) Has the Ministry of Health informed the Finance Committee of the Danish Folketing (parliament) correctly on the development and implementation of the SMR system?

In the report: part paragraphs: 2, 6-7 of Main Conclusion (page 2-3)

- Several independent public and private parties are involved in the SMR programme, which increases the need for effective programme management.

- When the framework of the project was defined, however, neither the Ministry of Health nor the NSH adhered to the principles for good practice concerning anchoring of the programme in the top management.

- significant weaknesses in the programme management performed by the Ministry of Health and the NSH, including inadequate follow up on programme risks, on the development in total costs, on the realization of benefits and on delays

- without additional clarification by the Ministry of Health it reimains uncertain how the SMR programme can achieve the target set in the original business case, which calls for linking all parts of the healthcare sector to the SMR and full usage thereof

- the benefits and costs related to the programme have not been clarified and it has not been sufficiently clear what the parties were required to deliver and when

In the report: part Paragraph 2 Point 1 of Chapter 1, Paragraphs: 3-4 of Main Conclusions (page 2-3)

- NSH had neither mapped the work processes that the SMR was designed to underpin.

- nor tested the usability or the quality of the data sufficiently, before it was attempted to put local SMR integration into full operation at hospitals and GPs in 2011 and 2012

- the pilot that had been carried out had failed to demonstrate that the SMR would work for daily operation for all relevant groups of health professionals

- the steering committee had decided to maintain development and implementation of the system nationwide without carrying out further pilots

The risk cases visible on this page are collected and described by the e-Government Subgroup of the EUROSAI IT Working Group in contact with author Supreme Audit Institutions (SAI). In the same way, analytical assumptions and headings are chosen by the Subgroup. We encourage you to read the original texts by SAIs - to be found in the linked files.