New book: Resistance, power struggles, and regional divides drove digital revolution in Danish healthcare

A new book tells the inside story of how Denmark developed and implemented a national Electronic Medical Record (EMR) system—told by the very people who made it happen. Through interviews with politicians, doctors, civil servants, and IT experts, the book reveals the internal battles within organisations and the cultural divides. It also highlights the determination that took a regional pilot project from the former Aarhus County to hospitals across the western half of Denmark.

The book, “Healthy trust – and sick systems”, is an honest and engaging account of how a complex, but highly functional, EMR system for the Danish healthcare sector was created. Bringing together a group of visionary political leaders, public officials, and clinicians and software developers, the project was driven by professionalism, collaboration, and accountability. The project was not without fierce resistance, including political power struggles and stark regional differences. 

In candid interviews with journalist Kurt Henriksen, key stakeholders share their perspectives on both the triumphs and the setbacks. At the time, a digital healthcare transformation of this scale had never been attempted in Denmark. Building the system from scratch meant taking risks, enduring setbacks—including a demotion of the project. What made the project a success was the willingness of a few committed individuals to take responsibility, stand by difficult decisions, and keep going until the system worked.

Featured voices in the book include: 

Johannes Flensted-Jensen, former County Mayor of Aarhus County (now part of Central Denmark Region), who prioritised the project politically and ensured momentum from day one. 

Jørgen Schøler Kristensen, DMSc and Medical Director at Aarhus University Hospital, who led the development of the system’s medication module. 

Mogens Engsig-Karup, then Head of Informatics and overall responsible for the EMR project in Aarhus County. 

Børge Jensen, former Chief Physician at Skejby Hospital (today part of Aarhus University Hospital) and head of the steering committee. 

Michael Holm, founder and owner of Danish software company Systematic, which developed the EMR system known as Columna Clinical Information System. 

Jutland versus Copenhagen

One of the central themes in the book is the divide between Jutland (mainland Denmark) and Zealand (the island that includes the capital, Copenhagen). From the outset, Aarhus County tried to engage Copenhagen County in the development collaboration, but faced both organisational and cultural resistance. 

“We tried in many ways. I think it’s fair to say that the political sentiment in Copenhagen County Council was simply that nothing useful could possibly come from Jutland that they couldn’t do better themselves,” says Johannes Flensted-Jensen in the book. 

Today, the EMR system developed by Systematic is used in all three regions west of the Great Belt Strait (which separates Zealand from mainland Denmark). In contrast, the Capital Region and Region Zealand chose the Health Platform developed by U.S.-based Epic Systems. That decision later sparked national debate and criticism due to reported challenges with usability and patient safety. 

The book reflects deeper contrasts in political mindsets, organisational culture, and approaches to healthcare technology. 

Lessons for the future

Healthy trust – and sick systems is not just about the past. It also looks to the future, offering ten broad recommendations from researchers and IT experts on how public sector IT projects can succeed. The book delivers sharp —but nuanced— criticism of the consultancy industry and makes the case for empowering public sector organisations to lead projects themselves. 

The message is clear: success depends not just on technology, but on trust, leadership, and accountability. The book also acknowledges that some things that worked 25 years ago might not be acceptable by today’s standards. 

The book will be published on Friday, 13 June 2025, by Blue Sail Media, and can be ordered here: 
https://cicerowebshopdk.myshopify.com/products/bog  
Price: DKK 100 + shipping