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How Denmark Tackled Healthcare Interoperability — And What Germany Can Learn From It

  • Writer: Julia van Holt
    Julia van Holt
  • Jul 17
  • 5 min read

Updated: Jul 18

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The interoperability crisis in European healthcare is real. Across Europe, healthcare systems struggle with fragmented patient data, leading to inefficiencies, safety risks, and poor user experiences for both clinicians and patients. But one country stands out as an exception: Denmark 🇩🇰


With a national eHealth strategy, early adoption of HL7 FHIR, and tight coordination between public and private sectors, Denmark has built one of the most advanced digital health infrastructures in the world. In contrast, Germany's digital health transformation is still mired in fragmented systems, inconsistent implementations, and isolated pilot projects.


Denmark’s Digital Health Strategy: Built on Open Standards and Strong Governance


A National Push for Healthcare Data Integration

Denmark launched its national digital health strategy in 2014 to unify health data across hospitals, municipalities, and general practitioners. The strategy focused on enabling real-time data exchange, improving care coordination, and boosting patient safety.


HL7 FHIR: The Backbone of Denmark’s Health Data Exchange

To make interoperability work at scale, Denmark embraced FHIR (Fast Healthcare Interoperability Resources) — a modern, API-based standard for healthcare data. Built on RESTful APIs, JSON, and modular resource structures, FHIR enabled the country to connect legacy systems to modern applications without a full overhaul. This flexible approach allowed Denmark to avoid expensive “rip-and-replace” migrations, develop new digital services incrementally, and ensure nationwide interoperability.


Public Leadership, Private Support

The digital transformation was led by public institutions with players such as MedCom (Denmark’s national coordination body for healthcare data exchange and interoperability, responsible for defining message standards and managing cross-sector communication), the Danish Health Data Authority (that oversees infrastructure, governance, and strategy execution), and Danish tech companies — including Trifork — who supported individual implementations, but the governance, standards, and architecture were publicly led. The result is a coherent, secure, and scalable ecosystem.


Denmark’s Interoperability in Action: Real-Time, Nationwide Data Access

FHIR now powers core elements of Denmark’s digital health infrastructure:


  • Shared Medication Record

  • e-prescription

  • National Vaccination Register

  • Electronic Referrals

  • Electronic Patient Journals

  • Care communication across municipalities and regions


A special highlight is the national health information portal "sundhed.dk", which serves as the central interface for all digital health applications. Every Dane receives an identification number at birth, which allows them to log into the health portal and view their complete medical history: every diagnosis, treatment, medication, surgery, lab result, etc., is stored there.


With the patient’s consent, doctors can access complete patient histories within seconds, communicate across sectors – all while fully complying with GDPR regulations. It’s no surprise, then, that according to a study by the Bertelsmann Foundation, 89% of Danish citizens trust their medical institutions.


Germany’s Status Quo: Fragmented Systems and Missed Opportunities


A different picture emerges in Germany, where, according to a survey by Ärzte Zeitung, only 64% of citizens are satisfied with their medical care. 71% of Germans want faster progress in the digitalization of the healthcare system. At the same time, many hospitals and medical practices in Germany still operate with closed, non-interoperable IT environments.


Patient data is spread across various systems - often without interoperability:

  • HIS for admissions and clinical documentation

  • LIS for lab results

  • RIS and PACS for radiology


A physician seeking a full clinical picture of a patient may need to access several systems, a time-consuming and error-prone process that detracts from patient care. The ones who are most frustrated about missing interoperability are physicians, patients, and scientists who have to deal with the consequences every day.


ISiK: First Steps Toward Interoperability


gematik is Germany’s central organization for healthcare digitization, responsible for building, operating, and standardizing the Telematics Infrastructure (TI) and defining mandatory technical specifications for digital health applications. The organization introduced ISiK (Informationstechnische Systeme in Krankenhäusern) that mandates the adoption of FHIR-based interfaces in hospitals. The goals: Standardized APIs for key functions such as patient lookup, medication, vitals, appointments, documents, and more. Vendor compliance with ISiK specs is obligatory in order to achieve national alignment toward interoperability. Yet (probably also because of a lack of any consequences), implementation remains very slow and inconsistent: Not all vendors have delivered ISiK-compliant systems. Some charge high fees for using “interoperability features” - quite the opposite of what is tried to be achieved by its introduction. Many hospitals remain overwhelmed by the complexity and costs.


Denmark vs. Germany: A Comparison


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The graphic compares Germany and Denmark across four dimensions of digital health maturity: Digital Health Index, Policy Activity, Digital Health Readiness, and Actual Data Usage. Denmark significantly outperforms Germany in all categories, scoring above 70% in most areas, while Germany remains below 45%, with particularly low values in actual data usage (15.8%). These results highlight Denmark’s advanced digital infrastructure and effective implementation, in contrast to Germany’s slower progress and fragmented digital health landscape.

Category

Denmark

Germany

National Strategy

Yes, since 2014

Fragmented across initiatives

Core Standard

HL7 FHIR (fully adopted)

HL7 FHIR (in early rollout, e.g. via ISiK)

Governance

Public institutions (MedCom, SDa)

Mixed — federal and state agencies

Real-Time Data Exchange

Yes, nationwide

Limited to pilot implementations

Public-Private Alignment

Strong coordination

Patchy and inconsistent

GDPR Compliance

Built-in from the start

Still evolving

What Germany Can Learn from Denmark


  1. Strategic Alignment is Key Denmark succeeded not because of technology alone, but because of policy, governance, and institutional alignment. Germany needs a similarly coherent national digital health strategy, not just funding programs.

  2. Interoperability Is Not a Feature — It’s the Foundation Interoperability must be treated as core infrastructure — not a premium add-on from vendors. The government must enforce fair access and pricing for FHIR APIs across all certified providers in order to finally break vendor lock-in.

  3. Privacy and Interoperability Can Coexist Denmark’s system is GDPR-compliant by design. Security and privacy don’t require sacrificing interoperability — they can reinforce each other.


The Path Forward for Germany’s Digital Health Transformation


Develop Reference Architectures: Modular FHIR-based blueprints tailored to different care settings, specialties, and regions.

Expand Public-Private Collaboration: Align vendors, hospitals, researchers, and regulators around agile, outcome-driven implementation. Firemetrics, a spin-off from the University Hospital Essen, demonstrates how private companies can support public research institutions in the area of interoperability.


Launch a Unified National Strategy: Consolidate pilot projects into a long-term roadmap that guides interoperability across all sectors. Denmark’s digital health system wasn’t built overnight. But its steady, standards-driven approach shows that nationwide interoperability is possible — without compromising care quality, data privacy, or clinical workflows. For Germany, the question is no longer whether interoperability can be achieved. It’s how fast we can make it a reality.


Citations & Further Reading


HL7 FHIR Overview – HL7 International: https://www.hl7.org/fhir/overview.html


MedCom Denmark: https://www.medcom.dk/


Danish Health Data Authority: https://sundhedsdatastyrelsen.dk/english


German Federal Ministry of Health – Digitalgesetz: https://www.bundesgesundheitsministerium.de/digitalgesetz


gematik – FHIR in Telematikinfrastruktur: https://www.gematik.de/anwendungen/fhir




 
 
 

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