COPENHAGEN, Denmark — The host country for the World of Health IT (WHIT) congress, Denmark was formally declared the most advanced e-health system in Europe by the European Commission (EC).

Considering the depth and breadth of the Danish program, it might also claim to be the most fully functional e-health system in the world with patient records for nearly all of its 5.5 million citizens, shared access to medical and administrative records for registered care givers, and a 95% penetration for its e-prescription system.

Last year the Danish e-health agency MedCom pioneered the Baltic Health Network connecting six neighboring nations on a common telemedicine platform for providing care to remote rural and island-based citizens of all the countries.

Some of Denmark's islands and remote regions are closer to Swedish or Norwegian hospitals than Danish centers and the system facilitates the exchange of patient summaries, medication records and administrative data.

Next year, building on this same shared system, Denmark plans to open R-Bay, the first on-line brokering system for medical services where countries with a surplus of radiologists, such as Latvia or Estonia, can bid for contracts from hospitals in countries with shortages of this expertise, such as Sweden and Denmark.

Inspired by the E-Bay model, the infrastructure provider, Carestream North Europe Region (Helsingborg, Sweden), will hold the first discussions with American hospitals at the Radiological Society of North America meeting in Chicago at the end of this month to bring not only their specialized consultations into the network but also their bids for everyday second opinions.

These Danish achievements were highlighted during the WHIT congress by European Commissioner Viviane Reding, who after designating Denmark the lead country for e-health in the European Union, later paid a visit to the Danish Village set up in the exhibition hall to demonstrate different parts of the system.

Like the Vikings of old, the Danes are seeking international engagements and find themselves on the leading edge of the EC's ambition to export European expertise in e-health.

"We have been working on this e-health system for 15 years," said Christina Wanscher, who leads the international development group within MedCom.

"When another country comes to visit and tells us they want to set up a similar program, we tell them to expect that it will also take them 15 years," she said.

In the emerging medical field of e-health, success stories tend to be local, such as for the Lombardy region of Italy or for Kaiser Permanente (Oakland, California) in the U.S., but rarely do projects benefit an entire national population.

Yet all these benchmark programs share a fundamental quality, which is a single payer for health services.

Germany, for example, has a state statutory health fund but it is managed by over 300 competing health insurance companies, and there is a diverse mix of ownership for hospitals, including private chains that are approaching a one-third market share. And Germany is clearly struggling to develop its much needed e-health system.

In Denmark there is a single payer, which is the Danish government.

General practitioners (GPs) are independent, for example, but 95% of their revenue comes from the state-run health program.

The 60 hospitals in Denmark are owned and operated by the five regional governments, but they receive all of their revenue from a single source, the Danish health program.

This gives Denmark strong tools for the heavy lifting needed to develop and deploy an e-health program.

The Danes prefer to call it building consensus.

The success in Denmark comes from having both an open market structure for industry providers and a government mechanism to build agreement, or consensus, on frameworks and platforms, according to Claus Pedersen of the international business development team at MedCom.

"The market ethic brings good solutions at the right prices but it is the government that creates this market opportunity," he said.

Where the U.S. is the champion of leaving free markets to determine success for vendors, Pedersen said that in the field of e-health, "there is not really even a functional market for American vendors, because there is no interoperability established for systems."

"A given U.S. healthcare system cannot replace its current information technology by choosing among other IT products without incurring a heavy switching cost to re-install and convert over to the new system," he said.

In Denmark there are more than 100 different health IT providers whose products are able to communicate and interoperate, to mix-and-match, he said, thanks to the consensus on standards and frameworks developed by MedCom over 15 years.

"When you look at what a Danish GP pays for health IT, it is extremely cheap compared to the United Kingdom or Germany, even if our market is smaller in comparison," Pedersen said.

As an extreme example of the openness of the MedCom platform, Wanscher said one doctor asked his son to build a customized IT system, which subsequently was certified as compliant by MedCom and is in use at the private practice.

"He has received offers to sell the design but refuses," Pedersen said.

Yet the powerful leverage of the Danish government that built the celebrated e-health program could prove its undoing as well, he said.

In 2007 Denmark launched a structural reform to tighten and consolidate its gains in infrastructure. A new framework for the computerization of the healthcare sector was created, the Sammenhaergende Digital Sundhed Danmark, to give healthcare professionals wider access to all patient health data using a Shared Medical Card.

Currently the redrawn organizations are being put in place and a consolidation of the system will follow. "One of the risks we are facing is if we do not maintain the market structure while we are consolidating, we will get a de facto monopoly with fewer buyers and only five places to sell," Pedersen said.