Ellen Kirstine Riegels Østergård

A brief summary of the project

The Danish healthcare system is facing some of the largest investments in technology in recent history. The healthcare reform agreed in November 2024 allocates DKK 27.5 billion to modern hospitals, medical equipment, IT and healthcare services. This includes a DKK 22 billion health fund for hospital modernisation between 2026 and 2035, a DKK 2 billion investment framework for the rollout of digital solutions, and DKK 3.5 billion for local healthcare initiatives between 2027 and 2031. The reform also establishes Digital Health Denmark as a new national organisation for digital health, with a preparatory organisation established on 1 January 2026 and formal establishment scheduled for 2027. The technologies now being procured span digital platforms, medical equipment, welfare technologies and hybrid solutions. They will shape Danish healthcare over the next two decades.

Yet for a substantial proportion of patients, particularly those with temporary or permanent impairments, often combined with multimorbidity and frailty, these technologies do not work as intended. A recent Danish study (Andersen et al., 2025) found that 43% of an unselected sample of acutely admitted patients in the Emergency Department at Nordsjællands Hospital had low digital literacy, creating barriers to using the digital platforms increasingly needed for coordinated care. Patient screens procured in compliance with all formal requirements are, in practice, unusable for many of the patients they were intended to help. Hospital beds and welfare technologies pass through procurement processes yet still create barriers for the very patients they are meant to support. The costs are poorer clinical outcomes, higher healthcare system costs and a loss of dignity.

This is a problem of system design. The technologies themselves are too often poorly matched to the populations they are intended to serve, but the deeper failure lies in the evaluation and procurement system that allows such technologies to pass. There is currently no operational evidence base capturing the variation in abilities within a given patient population. Procurement decisions are therefore made against usability requirements that systematically overlook this variation. This is a practical gap that can be addressed.

This PhD project will develop, validate and implement a method for characterising the capability profiles of patient populations and use these profiles as the basis for evidence-based technology assessment in healthcare procurement. The method will apply across the digital, medical, welfare and hybrid technologies in which the healthcare reform will invest. Universal Design (UD) provides the conceptual framework: systems should be designed for the actual distribution of human capabilities within a population, rather than for a standardised user who does not exist. The Emergency Department at Nordsjællands Hospital, where patient diversity is greatest and exclusion has been empirically documented, will serve as the project’s proof-of-concept setting.

If successful, the project will provide Danish healthcare procurement with what evidence-based medicine brought to clinical practice: a structured way to ground decisions in knowledge about the people for whom those decisions are made. The project will contribute new knowledge to the field of Universal Design in Denmark by extending UD methods from the design phase to procurement decisions, where systems become fixed for many years. It will also operationalise Article 4(1)(f) of the UN Convention on the Rights of Persons with Disabilities within the Danish healthcare sector.