title: Interoperability after deployment: persistent challenges and regional strategies in Denmark.
abstract: OBJECTIVE
  The European Union has identified Denmark as one of the countries who have the potential to provide leadership and inspiration for other countries in eHealth implementation and adoption. However, Denmark has historically struggled to facilitate data exchange between their public hospitals' electronic health records (EHRs). Furthermore, state-led projects failed to adequately address the challenges of interoperability after deployment.
  
  
  METHODS
  Changes in the organizational setup and division of responsibilities concerning the future of eHealth implementations in hospitals took place, which granted the Danish regions the full responsibility for all hospital systems, specifically the consolidation of EHRs to one system per region.
  
  
  METHODS
  The regions reduced the number of different EHRs to six systems by 2014. Additionally, the first version of the National Health Record was launched to provide health care practitioners with an overview of a patient's data stored in all EHRs across the regions and within the various health sectors.
  
  
  RESULTS
  The governance of national eHealth implementation plays a crucial role in the development and diffusion of interoperable technologies. Changes in the organizational setup and redistribution of responsibilities between the Danish regions and the state play a pivotal role in producing viable and coherent solutions in a timely manner.
  
  
  CONCLUSIONS
  Interoperability initiatives are best managed on a regional level or by the authorities responsible for the provision of local health care services. Cross-regional communication is essential during the initial phases of planning in order to set a common goal for countrywide harmonization, coherence and collaboration.
authors.affiliation: Department of Computer Science, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Patrick
authors.initials: P
authors.lastname: Kierkegaard
mesh_terms: D003718:Denmark; D057286:Electronic Health Records / Q000458:organization & administration / Q000592:standards; D066275:Health Information Exchange / Q000592:standards; D006751:Hospital Information Systems / Q000458:organization & administration / Q000592:standards; D006801:Humans; D012041:Regional Medical Programs / Q000458:organization & administration; D017216:Telemedicine / Q000458:organization & administration / Q000592:standards
keywords: electronic health records; health information exchange; hospital care; implementation governance; interoperability