Heikka Ahava
email: heikki.ahava@gmail.com

The Standardization of Mobile Systems from NMT to Mobile Internet

The paper presents how the 1G, 2G and 3G mobile system standards were created. The focus is on the strong contribution of different Nordic players: administrations, operators and manufacturers. It covers the years from 1970 to the end of the millennium. .

Introduction

This paper will tell the story how early mobile phone services with bulky vehicle mounted speech-only terminals have developed to the modern mobile Internet services, which are available practically everywhere with sleek smart phone devices. The focus is on how the standardization and global regulatory processes made this possible. The Nordic countries played a key role in this, and their early experiences later served as a model in European and international fora.

The time span is from the early NMT (Nordic Mobile Telephone) to 3G services, i.e. from 1970s to the end of the millennium. During these years major technical hardware developments (birth of microprocessors, digital signal processing etc.) were achieved, and without them the mobile Internet would still be a dream. These more hardware-oriented topics are not included in this paper.

The Cellular Systems from the First Generation (1G) to 3G

Before the 1G cellular systems 2-way mobile radios were used in e.g. military, maritime, aviation, and freight haulage services. All these equipments were of very different types and none of them could be described as mass market goods. One of the limiting factors for the mass markets is the availability of the frequencies. Frequencies are a natural resource like the farming land area which can be e x p a n d e d only to a point. Higher and higher frequency bands were taken into use as new radio technologies evolved, but due to the physical laws of the radio propagation these bands could not be used to wide area mobile services.

To overcome the capacity problem engineers in Bell Laboratories in late 1940s got the idea that radio towers can be arranged in a hexagonal pattern and this could support a telephone network. In these hexagonal cells the same frequency bands can be reused, depending on the cell radius and transmit power. By reducing the cell size and power levels and reusing the frequencies the network capacity can be increased considerably. But it took more than 30 years until cellular systems could be deployed commercially.

The 1G systems like NMT offered only speech services and some supplementary services not yet available in fixed networks. During 1970s data communication was used only very limited i.e. there was not yet any need for data services. Microprocessors were already available, and they were needed in the implementation of the 1G car phones which operated on the 450 MHz band.

At the same time (1981-82), when the NMT services were opened, Nordic administrations and the Netherlands proposed a 2G system which later became known as GSM. It was a digital system and in its specification data services were already recognized. The first GSM networks were officially opened in 1991, but due to technical implementation challenges the real commercial activities started a bit later. Originally GSM offered circuit switched 9.6 kbit/s data rate. Later during its evolution phase higher rate packet mode services were also made available. In this period users started to access their emails over GSM, but web surfing was not yet very common due to the high usage costs. One of the most interesting new services of GSM was Short Message Services (SMS). During its specification phase nobody could foresee its huge success and the sort of a revenue generator it became for the operators and service providers.

In 1988 the European Union started a technology research program called RACE (Research and Development in Advanced Communications Technologies). One of its work packages was called UMTS (Universal Mobile Telecommunication Services). Its work was continued in several fora. Later this was better recognized as 3G. The first networks were opened in 2001 but again the real business was slightly delayed. This system opened the doors to the explosive growth of mobile data services and to the mobile access to Internet. It is interesting to note that the evolution steps from 1G, 2G to 3G each took about 10 years.

The evolution did not stop here. Afterwards 3.5G and 4G have materialized and today we see headlines of 5G. However, the generation gaps are not so big because the development nowadays is based more on gradual evolutionary steps.

The Standardization of NMT (Nordisk Mobiltelefon)

Early Steps

During the Midsummer 1969 the Nordic Telecommunications Conference was held in Kabelvåg on Lofoten, Norway. There were representatives from all 5 national Nordic telecom agencies. As in all meetings the last agenda item was "Any other business". Normally at this point meeting delegates pack their bags and quickly leave for refreshments and then go home. This time they did not do that, because the Swedish delegation had a proposal to start a long-term project to develop a new mobile telephone system. They argued that a similar service could be developed for all Nordic countries, and by sharing the development work and its results major economic benefits could be achieved. The meeting decided to set up a working group to study the issue.

Regulatory Hurdles

Before new mobile phone services could be opened several regulatory changes were needed. To own and use a radio transmitter a special license was required, because radio transmitters were considered as security risks. Although e.g. in Finland the same State Authority PTT issued the licenses and operated the telecom networks this question was difficult to resolve, because two different offices were involved. It might take weeks or even months until the operating permit could be issued and the customer should wait this period until he could begin to use the service.

The NMT working group set as a goal that the user could use the same terminals in all Nordic countries. This was another revolutionary idea, because importing a radio transmitter to another country had been very complicated. The assumption was that only spies could even think of doing it.

The Director Generals of the Nordic PTT's found a solution in 1976. Its principles facilitated international roaming with mobile telephones in a way that in those days was revolutionary:

• The user's national administration issues a license allowing the user to operate the terminal in all Nordic countries • The fixed subscription fees must be paid to the national operator • The call charges are paid to the country where the roaming user is making the calls. One more terminal related topic was their ownership. In those days the end user equipment connected to a public network was in many countries owned by the operators and not by the user. This time the administrations decided that the subscribers could buy their terminals from the open market. This decision created a new competitive market which strongly helped to boost the sales. To do this a rigid type approval system had to be created. The practical verification tests were done with a system simulator developed by a small Finnish company Insinööritoimisto Hakala. This method ensured that all the type approved terminals operated in an identical manner with the system simulator and later with real networks as well.

The availability of a new frequency band is always a major regulatory challenge in mobile telecommunication, because in practice all usable bands were already used by some service, and this time a common band had to be found in all Nordic countries. The adoption of 450 MHz band was decided. In Sweden this created a problem because that band was reserved for military purposes and Sweden had invested a lot for these equipment. After long negotiations a compromise was found: NMT service can use the 450 band in peace time, but if mobilization is required then military can grab half of the band for their purposes.

Later, when the 450 band became too congested due to traffic demand m u c h higher than expected, NMT service was opened also on 900 MHz. During this transition the system specifications were also slightly changed. One of the most important changes was that at this time hand-portable mobile phones were allowed and their availability speeded up the growth of mobile telephony.

Standardization Topics

As mentioned earlier a working group started to explore the system principles. In January 1971 Mr Håkan Bokstam, the chairman of the working group, was able to write down 14 requirements for the system. These became better known as "14 commandments". This document became fundamentally important for the future of the mobile telecommunication. When comparing the requirements to modern days' systems they are all still valid although they were formulated more than 40 years ago. Some of the commandments included the words "if technically and economically feasible" because the group was unsure about the speed of the technology evolution. The "if" sentences could have been deleted, because the requirements could be and were implemented as proposed by the group.

The secretary of the group was Thomas Haug, originally Norwegian but working in Televerket, Sweden. He became later the chairman of the NMT group following the accidental death of Mr Bokstam. Mr Haug is undoubtedly one of the greatest names in the standardization of mobile telecoms, and after finishing in NMT he was nominated as the chairman for the GSM group. He served in this position for several years and was a key person in guiding the GSM standardization in a very challenging technical and political environment. He was well known to interrupt the meetings for coffee breaks when no progress was made and ask the key figures to find a solution before the problem could be discussed again in the meeting. Dr.

Thomas Haug received in 2013 the US National Academy of Engineering the Charles Stark Draper Prize.

Traditionally the Telecom administrations had developed the standards behind the closed doors sharing the results only with e.g. the local industries. NMT was different. The group shared its results as much as possible with industrial players. By opening the precompetitive process it was possible to base the forthcoming technical standards on the results of the world wide knowledge.

The normal practice was that the radio systems were delivered as a whole by a single vendor. The NMT group also wanted to create competition in radio subsystems, so they specified the interface between the base stations and switching system. Now even smaller manufacturers were able to offer base stations. This approach created a very competitive base station market but e.g. in the US it took tens of years until the Base Station competition was opened. In NMT e.g. Nokia entered the mobile network business with base stations only.

As highlighted above the NMT group made superb results but in one aspect they failed badly: market estimates. Luckily the estimates were far too conservative. The assumption was that e.g. in Sweden there would be 45000 NMT subscribers in 10 years. After the service was opened it took less than two years to reach that number. The biggest challenge for the operators all the time was to cope with this phenomenal growth.

The Creation of the GSM standard (2G)

Early Steps

The basic goal was to create a new Pan-European system. This need was well understood because with the exception of NMT in Nordic countries, Holland and Switzerland all other European countries had their own national systems and there was no mutual interworking. International roaming in Central Europe was both technically and administratively impossible.

The work for a new system was started in 1982 in CEPT which is an organization of 26 mainly Western European PTT Administrations. Before that the World Administrative Radio Conference in 1979 had allocated a band on 900 MHz in Europe to a land mobile communications system.

A working group was established under the chairmanship of Thomas Haug to study the question. The group was called Groupe Spécial Mobile (GSM) and the same acronym was used as the name of the new system . Later the system was renamed to Global System for Mobile communications. As in NMT the charter of this group was left very open because the meeting had not a clear understanding what could be achieved.

Although the working environment was now far more challenging due to the conflicting national industrial politics, the experiences from the earlier NMT work were utilized. Now the 14 Commandments of NMT were rewritten as 12 Basic Requirements for GSM. The new ingredients were: the need for hand-portables, data services, interworking with data networks and voice security.

Political Challenges

The inner circle included the leaders of the French, German, Italian and UK delegations, but still the Nordic operators were carefully being listened to because the success of NMT was well recognized. It is worth noting that in the early stages no industry participants were allowed to attend the meetings. However, all the administrations informed unofficially their manufacturers.

As a European wide activity was going to be started the European Commission became active and wanted to fund the operation. This initiative was not welcomed because the CEPT thought that they had the talent and funds. However, when the EEC created the Frequency Directive for the 900 MHz band, it was recognized positively, because after that no other new system could use the 900 band. The non EEC countries of CEPT also followed the Directive. A representative of the Commission was allowed to attend the GSM meetings.

GSM Standardization Starts

CEPT delegates understood that at some point in time they had to publicize the work more but they wanted to make a few key decisions within this core group. One of the hot topics was the radio access method. To find the best solution a competition was arranged where the industry and research labs could also participate. A narrow band Time Division Multiplex Access (TDMA) system won the tests. This system was proposed by several Nordic industrial and research groups. The problem afterwards was that a Franco-German proposal based on a wide band solution had been agreed on highest political level in both countries. So, only an interim decision could be achieved, but after a few months the political objection was removed and the earlier decision could be ratified.

European Telecommunication Standards Institute (ETSI) is Created 1987

After the access method and a few other key issues were decided the standardization work moved to ETSI, where all interested parties could join with equal rights. The doors were opened also to non-European members. The birth of the GSM also made a big change in the operator business. Before the PTT's had operational monopolies which allowed them to e.g. invest in wide research activities like NMT. But when the GSM networks were opened telecommunication markets were also liberalized in Europe, and the old monopolies suddenly had competitors in their home markets. In the competitive markets the incumbent operators now focused their activities on network operations and not on the new business creation.

Gradually the manufacturers took a leading role in ETSI GSM. Both Ericsson and Nokia had also been active earlier behind the curtains but now they got a more visible role. As both companies achieved a great market success with their GSM network and terminal products their opinions were carefully listened to, and in many cases the operator customers also supported their suppliers. However, the two companies did not dominate alone because there were strong competitors like Motorola, Siemens and Alcatel, who also had competent and innovative engineers in their teams. All these leading companies invested heavily in the standardization because they wanted to create as many essential patents as possible. These patent portfolios have later proved to be strategically very important. Companies like Apple and Google, who originally did not participate in the standardization of cellular systems, have had serious problems with incumbent patent owners when they issued iPhone and Android products. It has been said that the only reason for Google to buy Motorola was to grab its essential cellular patent portfolio.

Phased Approach

The original goal was that all the standards s h o u l d b e ready when the services were planned to open in July 1991. However, it was soon understood that this w o u l d not be possible and it was decided that the services should start with Phase 1 standards, and Phase 2 standards would be finished later. It turned out to be delayed to 1995. After that 3G would be the next step. However, based on several reasons Nokia made a proposal in 1993 that there was a lot of potential in the GSM platform which could be further developed. There was some opposition to the proposal but finally it was adopted. Major improvements were done in GSM such as enhanced speech codecs, high speed data, packet radio service.

The standardization of GSM was finished in 1997 after 15 years of intense work. But it paid well because GSM was a real success story in the history of telecommunications. From start pan-European service was the goal, but it finally ended as a global system with only a few white spots on the world map.

Other 2G Systems

Although the standardization culture is very different in the USA a similar beauty contest of the access method was arranged. Ericsson's TDMA was the winner there. But after the Qualcomm introduced their Code Division Multiplex Access CDMA system there was not a single system as in Europe but two competing systems. The TDMA , known as DAMPS (Digital Advanced Mobile Phone Service), standard had to be rewritten several times until it was ready in 1993. Nokia contributed actively in the terminal related parts of the standard.

Japan also created their own 2G standard. Ericsson was again very active and the Japanese adopted their TDMA technology called JDC (later PDC). The Japanese were not able to export it outside their country. After this experience they decided that when the 3G was done they would partner with someone else in order not to repeat the limited success of PDC.

Later, in mid 90s, a new frequency band for Personal Communication Services (PCS) was made available in the USA. This opened the door for GSM in the USA. The standard had to be modified to the new environment and especially Nokia and Ericsson were very active in this process. After PCS services were opened there were three different network technologies based on GSM, DAMPS and CDMA.

The Focus moves to Mobile Data, 3G Systems are born

The Targets

In the late 1990s the ambition level was again raised in Europe: now we wanted to standardize a truly global system. It had to be based on the GSM evolution because the operators did not want to invest in a totally new system. The trick was how to tempt Koreans, Japanese and the US CDMA camp to work with us. The World Administrative Council had allocated a new global frequency band for this in 1982. So the corner stone was already laid down.

In 1990s Internet had already made its revolution and the new system had to provide similar user Internet experience as the users had in wireline networks.

As the goal was set higher so were the challenges. In this presentation only key parts of the history can be covered. Books have been written and a lot of academic research has been done about the creation of the 3G. The focus of this paper is again on what Scandinavians did and how important their role was.

Preparing for the "3G Beauty Contest"

As mentioned in s e c t i o n 2 the CEC funded several technology research programs. The projects attracted all main players. In a way we were killing the time, because nobody wanted to start the 3G standardization at this stage while there was still a lot of work to do with GSM. However, this gave the opportunity to operators, manufacturers and research labs to study new technologies and the possibility to create relevant patents. The CEC hoped that a consensus about the new 3G technology could be found in this process but it did not happen.

Japan had moved ahead with 3G faster than Europe, and their decisions had impact on us. Americans had already done their heavy lobbying in Japan and for a moment it looked like Japan would go their way towards Qualcomm's CDMA 2000. However, Ericsson learnt about this and was able to turn Japan to Wideband CDMA technology which had far better chances to become a global system.

At this point Ericsson was alone with WCDMA in Europe and understood that alone they had no chances. So they contacted Nokia although at that time Nokia was favouring another technology, Wideband TDMA. Internal discussions started in Nokia and after a while they concluded that WCDMA would be a better choice for the global coverage and decided to support it. This technology was not new to Nokia, because it had earlier done related projects with the Oulu University of Technology.

It is worth pointing out that the manufacturers now were in the driver's seat and operators had the bystanders' role but, of course, in the final voting they had a lot to say. Nearly all subsidiaries of the Japanese industry in Europe supported WCDMA but all the other major manufacturers were against. They were supporting TD-CDMA (Time-Division CDMA), the system which was originally proposed by Siemens.

The management of Nokia, Ericsson and Siemens had several meetings where we tried to find a common solution. No real solution was found in these discussions. When the battle between the two competing groups intensified, the Commission became worried and tried to help but again without any success. The CEC was worried that the mobile market could be split in Europe, which would have been a major setback compared to the pan-European success with GSM.

In the agreement with Japan Nokia and Ericsson had set one major condition for their support: the protocols of the 3G core network must be based on GSM evolution ie. GSM Mobile Application Protocol. This was very difficult for the Japanese to accept because they had worked actively in the International Telecommunications Union (ITU) to develop another Broadband ISDN based solution. Finally when the Japanese understood how critical the situation was they gave up. There was some drama in this process. We had a trilateral meeting which at one point split into two groups: top management and technical experts. In the expert group Japanese members continued to promote their choice, but in the management meeting we were told that the precondition set by Nokia and Ericsson was accepted. Before the final vote this decision was made perfectly clear to everybody and it helped us very much.

We were surprised that Qualcomm and Lucent did not propose their CDMA 2000 for the vote. Those two companies stayed very quiet during the ETSI system selection process, although in the USA and in ITU they were promoting their choice aggressively.

UMTS Radio Access Decision in Paris, January 1998

In the final vote there were two main competitors WCDMA (Ericsson, Nokia) and TD CDMA (Siemens). The first one was widely supported by operators and administrations and the second one by manufacturers. The last discussions were centered mostly around IPR (Intellectual Property Rights) issues and industrial politics (Europe vs Japan). This plenary meeting was the largest ETSI meeting ever, 1523 weighted votes given by 198 members in the indicative voting. Nobody abstained. WCDMA got the majority with 61,1% but this was too little because more than 71% was required. Now it was clear that a solution could not be found by voting.

The key supporters of WCDMA and TD CDMA convened in their own closed meetings. During the night Ericsson and Nokia drafted a compromise proposal and this was accepted by Siemens and its allies. Next morning the main meeting continued with the final official vote. Actual voting was done so that the chairman noted that nobody opposed the compromise and nobody wanted to abstain i.e. he concluded that the meeting made a unanimous decision. This way all the participants were bound to accept the compromise solution. An option was made available for TD CDMA but it was never implemented. So in real life only WCDMA networks were made commercially available and all the WCDMA supporters got what they wanted.

Towards the Global Standard

The ETSI decision was a crucial step to create a global standard and now the actual standards drafting should start. It was evident that we needed all the other regional standards bodies to work together. One could not expect that Japanese, Chinese, Koreans and Americans could accept a standard written in Europe. ITU was not an option because manufacturers have no voting rights there and it was also considered too political.

In ETSI we decided to establish 3G Partnership Project (3GPP) to draft the standard. The group was made open to all global players. Once the standard text was approved in 3GPP it was afterwards sent to the regional standards bodies for the decision i.e. to be rubberstamped. 3GPP became a great success. Since the WCDMA services were opened we had a system available in all countries, where there are cellular services and global roaming with a single terminal is possible. This has been a benefit not only t o the global travelers but to the ordinary users as well. The global mass markets lowered the network equipment and user terminal prices reducing considerably the end users' telecommunication costs.

A high level political problem popped up when the EU was preparing a UMTS Decision. The US State Secretary, Ms Albright reacted in a letter to Commissioner Bangemann claiming that the Decision draft is anti-competitive. After some armtwisting a compromise was found. It did not have any commercial meaning and the WCDMA became practically the only 3G standard which was deployed in European networks.

Final Remarks

The evolution of the mobile networks did not stop at WCDMA but it was followed with e.g. HSPA, LTE. There has been a real need for huge capacity increases due to the explosive growth of the traffic generated by the smartphones. According to the statistics of the Global Mobile Suppliers Association (GSA), at the end of year 2013 there were almost 2 billion mobile broadband subscriptions, and the forecast for 2018 is about 5,6 billion subscriptions. According to Ericsson the growth of the data traffic was about 70% in 2013 while the voice traffic had hardly any growth.

When we were planning for 3G WCDMA we knew that 3G networks would provide a whole load of new services but nobody was able to forecast what we all experience today with our smartphone devices. "The 14 Commandments" written down 41 years ago guided the mobile systems standards creation to the birth of 3G WCDMA, but later the evolution of Internet technologies took over. At the same time the leadership has also moved from Europe to the USA and Asia although Ericsson and Nokia are still the two leading network suppliers.

This presentation is based mainly on my experiences from working in Nokia Corporation during years 1973 to 2007 and on the related books listed below.


Mogens Ritsholm
email: aritsholm@post.tdcadsl.dk

Public Data Networks in the Nordic Countries

Public data networks were introduced in many countries app. 1980. Norway, Finland, Sweden and Denmark evolved common networks in the Nordic countries. The project was named NPDN (Nordic Public Data Network). It was a circuit switched network based on the X.21 recommendation from CCITT. NPDN is described and placed as an element in the ongoing development of data transmission via the public telecommunications networks -from analogue modems to fiber and IP.

Data Transmission via Public Telecommunications Networks

Data transmission via the telecommunications network using modems evolved from the mid 1960s. The modems were standardized by CCITT ( Commité Consultatif International Télégraphique et Téléphonique) under ITU (International Telecommunication Union).

In those days standardization of the telecommunication industry was performed mostly through ITU with telecommunication operators as the driving force. Any success in the market for new products relied on adoption of standards by ITU, where CCITT produced recommendations for the fixed network.

Modems for data transmission used leased analogue lines (300-3400 Hz) or similar dial-up connections via the public telephone network. For speeds at 48 kbit/s and more the so-called group connections were used. A group was 48 kHz bandwidth in the core network, which was normally used by 12 telephone channels in the FDM (Frequency Division Multiplex) hierarchy in the backbone analogue network. From a telecom station to the customer baseband transmission technology was used (biphase, AMI etc.) at higher speeds -similar to the technique later used in ISDN.

Modem technology and interfaces were standardized by CCITT in the V-series 1 . Today the interface specification in V.24 and V.28 are the best known, while the modulation standards for different speeds now are history with today's fully digital telecom networks.

Most modems at higher speeds were expensive. I recall that a 9.6 kbit/s modem in 1979 was priced at 30-40.000 Dkr. That was similar to an engineer's salary for 5-6 months. In addition the leased lines were expensive, and by 1979 Denmark therefore had only approximately 10.000 such lines and less than a handful connections of more than 48 kbit/s.

2

The Birth of Public Data Networks

In 1968 CCITT established a new study group (no. 7) in order to evolve standards for public data networks in the X-series of recommendations. Two types of public data networks were defined in the 1970s, namely circuit switched public data networks with X.21 as the basic synchronous interface standard and packet switched public data networks with X.25 as the basic interface.

Both types of networks were influenced by the philosophy known from the telephone network. They offered connection oriented services, where connections are established by a call request/call procedure. This allowed the network to manage resources and guarantee resources for established connections, while requests for new connections could be rejected during overload situations -exactly as the main philosophy of the telephone network.

In X.21 the network offered direct transparent circuit connections at 600, 2400, 4800 and 9600 bit/s in full duplex mode. In X.25 the network offered logical connections of packet forwarding based on HDLC framing of the packets. A X.25 subscriber could therefore establish several logical connections at the same time, and the packet mode allowed transformation to other types of terminals such as teletype 2 terminals in a packet assembly/ disassembly function as standardized in X.3/X.28/X.29.

X.21 and X.25 recommendations were stabilized by 1980 together with almost 100 supporting X-series recommendations for network to network interfaces, service elements, numbering etc.

1 In CCITT each study group evolved recommendations with a specific letter. X was used by study group 7 and V by study group 16 2 A teletype terminal is a terminal, where each character is transmitted and received asynchronous framed by a start and a stop element. Such terminals was originally electromechanical

3

The NPDN (Nordic Public Data Networks)

The telecom administrations of Norway, Sweden, Finland and Denmark decided in 1975 to establish national circuit switched public data networks in a common process. Ericsson was chosen as the main system contractor with a system based on AXE3 in the switches. But Nokia, EB (Elektrisk Bureau) of Norway and Søren T. Lyngsø A/S from Denmark also participated in the development and production of equipment to the network.

The networks opened commercially in 1982 under the name Datex in the Nordic countries. But the networks were individual national networks with no common operation except interconnection according to X.71 and X.61 (based on common channel signaling as a user part of SS74 ). In fact X.61 was the first international usage of SS7, which now is the most common signaling system for telephone and mobile networks.

The networks offered circuit switching with X.21, X.21bis (V.24 interface) or X.20bis (asynchronous) at 600, 2400, 4800 and 9600 bit/s.

In Denmark two exchanges (Århus and Copenhagen) were established. Nationwide coverage was ensured from the start with a range of decentralized equipment using analogue (FDM) or digital (PCM) connections. But most customers were connected via cheap base band modems to a multiplexer or concentrator at the local exchange. A connection could be established in 200-500 msek dependent on the speed chosen by customer . This was considerably faster than the later ISDN, where call setup time was 3-6 seconds. By 1987 Datex had 10.000 subscribers in Denmark and app. 50.000 in the Nordic countries.

Similar public networks were established in Germany and Austria (called Datex-L), but most other countries opened only X.25 networks during the 1980s. X.25 networks were also opened in the Nordic countries, but there was no common Nordic effort to develop these networks, and different vendors were chosen.

X.21 was primarily used for national communication, while X.25 was used primarily for international communication as the only switched data transmission service with global coverage (except telex). The IP-based internet was not available for commercial companies as a service in the 1980s.

With its high stability due to redundancy in the design Datex was used for critical applications established in the banking sector and other sectors in the 1980s. For the first time many of these applications in regional offices were fully dependent on data communications with centralized IT applications. One of the systems in Den-mark was SDC (Sparekassernes datacenter) connected to app. 2000 sites via Datex. Another application was the Dankort-system with online money transactions. It was established with dial-up telephone connections and modems to the local exchange and further transmission through Datex to the central book-keeping system.

The Dream of Public Data Networks

Public data networks offered digital connectivity globally and nationwide in a period, where the public telecom networks were undergoing transformation from analogue to digital transmission. In Denmark digitalization started commercially with rural connections in 1974, and digitalization of the backbone began in 1978, while the first digital telephone exchanges were put into service in 1982. The full digitalization of exchanges and connections was completed in 1998. Public data networks offered nationwide and international direct connectivity of reliable "data paths" between customers during the transformation. Public data networks were also based on the idea, that direct connectivity among customers would be as important to data communication as the similar connectivity known from the telephone service.

But until today the need for full connectivity at the transmission level has not been the most important requirement for the market. Connectivity is typically achieved by centralized services and not by direct connections between end customers. Just think of services such as e-mail, centralized IT applications of companies etc.

Therefore public data networks were gradually overtaken by services without full connectivity (and therefore cheaper) such as frame relay and later typically VPN on the internet etc.

Teletex was an attempt to use public data networks to transport documents (like telex) based on the end-to-end direct transmission through public data networks, X.21 or X.25. But Teletex never really caught on. In reality public data networks were used mainly to replace fixed connections as a cheaper, unified and more stable alternative.

In Denmark Datex was mostly used as transmission solution from thousands of terminals nationwide to one or a few data centers. The most used facilities were direct calls, where the customer always establishes connection to a specific number and closed user group5 , where transmission can be limited to a group of numbers.

The End of NPDN

During the last 10 years all X.21 networks in NPDN have been closed. In Denmark Datex was closed in 2012, thirty years after the opening of the service. The last major application was the Dankort system, which now fully relies on internet access at the point of sale. It is astonishing, that this application of Datex existed more or less unchanged for nearly 30 years.

Also most X.25 networks are now closed or overtaken by specialized international providers with few customers.

X.21 and X.25 still exists

Although the public data networks are no longer widely used, the interface specifications are still often used. X.21 physical interface is used for synchronous direct connection of equipment. X.25 in its DTE-DTE version is similarly often used as a layer 3 protocol to connect equipment directly. X.25 is also used in specialized networks, for example in packet radio and as backbone capacity for specialized applications such as teller machines. Public data networks played a role for the internet and further development in telecommunications. For example HDLC was shaped to practical standards (LAPB 6 ) through X.25, which is also often still considered the mother of all layer 3 protocols, even if IP is a simpler connectionless protocol.

The Development of Switching Technologies

During the 30 years period since the introduction of NPDN nearly all data transmission has moved to packet based transmission and switching. The underlying reason is that cost of transmission has declined less than processor costs. It is therefore beneficial to optimize use of transmission by organizing data in packets, where several communications can share the same transmission resource on a statistical basis.

To illustrate the technological status in 1980 a common European packet switched network, Euronet, opened in 1980 with a node in Copenhagen. The total capacity of a node in that network proved to be only 50 packets/second. With the further development of processor capacity and dedicated hardware this changed dramatically during the 80s with typical capacities of a packet switching node growing to several thousand packets/second.

ATM was an attempt to raise the capacity of switching in a way very similar to circuit switching. In circuit switching the basic element is an envelope with 6 or 8 bits of data and 2 overhead bits (status and alignment). In ATM the basic element is a cell with a fixed length of 53 bytes. As in circuit switching the switching in ATM can be performed in a switching block with little use of processing power. ATM also contains resource management through connection oriented mode of operation. Unlike connectionless mode as in IP overbooking cannot happen.

But even ATM did not expand as a public service, and IP with variable length packets is now the dominant mode for transmission and switching of data.

With fiber connections all the way to the end users and future optical switching some form of new switching technology may be needed. The balance between processor power and transmission capability may be changed. But it is perhaps too early to even talk about it. So I will abstain from that subject.

Benefits from Nordic Cooperation

NPDN was one of many concrete common projects born in the spirit of Nordic cooperation formally based on groups established under Nordisk Ministerråd. There was intense Nordic cooperation in international bodies such as ITU, CEPT, ETSI, ISO, Cenelec etc. Sometimes with common positions, sometimes without. But always with collection and sharing of information. Other areas were cooperation in satellite communications and mobile communication ( NMT -Nordic Mobile Telephone).

Nordic telecommunication operators and Nordic industry benefitted both practically and through the evolving of competence in many specialized areas of the telecom sector. In the 1990s it was even considered to merge Nordic operators to form a stronger international player, but only Telia and Sonera merged in practice. Today the standardization is fully in the hands of key industrial players. Hopefully the spirit of Nordic cooperation still exists. Telecommunications is still a complex and fast evolving sector for the individual small Nordic countries.

AXE was the product name of Ericson's digital telephone exchange, where all telephone circuits are switched as 64 kbit/s streams.

SS7 (Signaling System no. 7) was the first signaling system, where signaling protocols used specific data channels instead of the traffic channels. Also called out of band signaling.

Closed user group is a security facility in X.21 and X.25. Only members of a group can connect with each other and call attempts from others are rejected by the network.


Svenolof Karlsson¹
email: karlsson@storkamp.com

Anders Lugn²
email: anders@baralugn.se

How Was Present-Day Ericsson born?

Keywords: History of telecommunications, Nordic countries, NMT, mobile communication technology standards, Ericsson, Nokia

Present-day mobile telephony was created by the Nordic public telecommunications companies. Its foundation was laid in genuine Nordic cooperation in the development of the NMT standard, "mother" of modern mobile telephony, in 1969-1981. Absolutely crucial for success, the NMT group designed a solid and reliable system architecture for mobile calls and boldly took the step to opt for intelligent terminals. Other decisive elements included roaming and handover and the principle of handing the technology over to the rest of the world, free of charge.

Later, this attitude led Ericsson and Nokia to victory in the "world wars" that were later fought over the technology standards for 2G, 3G and 4G. In our view, the core in the Nordic view on technology, society and man can be summed up in terms like transparency, nerdy attitude, result-orientation and team power. Culture will beat strategy, every time, and these characteristics explain the Nordic countries' dominance in telecommunications development.

1

The Land of Naive Nerds -Some Historic Roots

One cannot talk about the history of information technology without talking about nerds. For a start let us dwell a moment on the subject. Towards the end, we will comment why the topic of nerds is relevant also when trying to understand Ericsson.

The first nerd was Anders Chydenius (1729-1803), the primary advocator of the principle of transparency. He is a strong candidate for the post. Son of a clergyman, and later priest himself, he spent his childhood in the Kemi-Lapland wilderness, the northernmost pastorate in Finland.

Anders Chydenius wrote his Master's thesis about Canadian birchbark canoes -the ones that we now call Native American canoes -and built them himself and tried to interest his parishioners in building ones, too. He developed a first-class nerdship in the art of argumentation and eloquence -no-one could beat him on that point. For instance, in the pamphlet Den nationnale winsten (The National Gain), published in 1765, he presented roughly the same theoretical framework as Adam Smitheleven years before Smith's The Wealth of Nations.

In 1765, Anders Chydenius was elected as one of the 57 ecclesiastic members of the Swedish Riksdag of the Estates, an unknown chaplain from a little parish from the back of beyond, with the lowest status in the company of high-ranging parsons and bishops. But before the Riksdag of the Estates was over, he was a much feared politician and had changed the Swedish constitution for good.

To put it briefly, he pushed through the world's first decree on the freedom of the press and introduced the principle of transparency in Sweden, as the first country in the world. Since then it has been one of the foundation pillars in the Swedish-Finnish nation: the decision-making process should be transparent and everyone should have access to any information.

The second nerd was Abraham Niclas Edelcrantz (1754-1821), who introduced the digital principle in communication. Maybe Abraham Niclas Clewberg, born in 1754 in Åbo (Turku), docent in physics and the history of literature at Åbo Akademi University, at the age of 19. Later he was promoted the head librarian at the university, but as often was the case with gifted people, he soon moved to Stockholm.

He became King Gustav III's private secretary, first director of the Royal Theatre, superintendent of the Royal Museum, chairman of the Board of General Fire Insurance Institution and member of the Swedish Academy and all the other contemporary academies in Sweden.

In 1789, he was knighted and adopted the name Edelcrantz. But first and foremost, he developed the first signalling system along the lines of the digital principle, in other words, information based on the digits zero and one. Inspired by the ideas of Frenchman Claude Chappe, Edelcrantz developed an optical telegraph line that was inaugurated in 1794 and connected Sweden and Finland. Figure 1 is a photo of a replica installed in Furusund.

Juha Heinänen was the first to use the Internet in Finland. In 1983, he introduced the first e-mail connection from the University of Tampere to Sweden, in 1986 he got the permission to administer Finnish Internet addresses and in 1988 he established the first fixed line Internet connection to Finland. Jarkko Oikarinen, who in his summer job at the IT Centre of the University of Oulu in 1988 developed the first chat network over the Internet, IRC, Internet Relay Chat -which is still alive and well. At present, he is working for Google in Stockholm.

Another example is a group of students, viz. Teemu Rantanen, Kari Sydänmaanlakka, Kim Nyberg and Kati Suominen, who developed the first graphical web browser, called Erwise (figure 2). Erwise was developed in 1991 to 1992 as a Master's project at the Helsinki University of Technology, with Tim Berners-Lee as the instigator.

The web browser allowed one to open a new website by clicking the mouse on a marked hypertext link. One could search text on the website and download multiple sites simultaneously. It even had a function that was to lay the foundation for Google later on: If the word you were searching for was not found on the website, the browser started looking for the word on other websites.

Unfortunately, the economy was in deep recession in Finland in 1992. Tim Berners-Lee chose Viola web browser and there was no-one to develop Erwise. Instead, the Erwise gang gave part of its code to Mosaic, later Netscape.

Two more Finnish pioneers are Linus Torvalds -needs no further presentation, we presume -and Michael Widenius -called Monty, from Helsinki. He is the main author of the code for the original MySQL, a database system based on open source, a parallel to Linux. MySQL was bought by Sun Microsystems in 2008, for a billion dollars.

In conclusion: Finland and Sweden, like the rest of the Scandinavian countries, have one special success factor that is seen over and over again: the attitude of the naive nerd. An attitude that may sometimes seem conceited, in the belief that one is capable of solving all the problems by oneself, but it also has an aspect of generosity: one shares with others.

The best results are achieved when everyone is pooling their know-how and sharing their ideas. Preferably, the solutions should be so functional and inexpensive that everyone can use them. Paying for exclusiveness is not first and foremost in the list of priorities.

In our book on Ericsson, Changing the World, we identify this view as the winning formula also in the case of telephony. The first example is a list of the cities with the highest proportion of telephones in the world in 1885: The other example shows the highest proportion of mobile telephones exactly one hundred years later in eight European countries, see figure 3. The Englishman Alfred Rosling Bennett, who was the leading authority on telephones in Europe in the 1890's, concluded that the benefits of telephones would be the greatest if they were made available as easy and inexpensive as possible, as was done in the Nordic countries. In 1895, this is what he wrote in his book The Telephone Systems of the Continent of Europe: "There would seem to be something in the Scandinavian blood, which renders the possession of many telephones as essential to their owners' happiness. Wherever two or three Swedes, or Norwegians, or Danes, or Finns of Scandinavian descent, are gathered together, they almost infallibly proceed to immediately establish a church, a school, and a telephone exchange. Whatever else in life that is worth having generally comes after."

2

The Birth of Mobile Telephony -the Death of LME 1969 was a year of liberation and trust in the future. Friday, 27th June 1969, the day before Midsummer Eve, gave many examples of this.

In New York, police raided Stonewall Inn Gay Bar -which resulted in three days of riots against the police. This incident marks the beginning of Pride parades all over the world. The same day the song Je t'Aime Moi Non Plus with Serge Gainsbourg & Jane Birkin was released in France. You are sure to remember it. Also in Great Britain, it was a memorable day with the first launch of Black Arrow, the carrier rocket that later placed the first British satellite into Earth orbit.

Soon after this, Neil Armstrong stepped on the surface of the moon. A little later that summer, it was time for Woodstock Music & Art Fair.

But the most important event on 27th June, 1969, took place in Kabelvåg on Lofoten Islands in Norway, and witnessed the foundation of modern mobile telephone, at Vågans community college. It took place at the venue for the 34th Nordic telecommunications conference. No participants from LM Ericsson were attending, and none from Nokia either, because at this time they didn't give a thought to mobile telephony. All the delegates represented the Nordic PTTs.

When they got to the last item on the conference agenda -"Any other business" -Carl-Gösta Åsdal asked to speak. He was the chief radio engineer at the Swedish PTT and he proposed that the Nordic PTTs should consider joint mobile telephone solutions.

And that was what the conference decided to do. Twelve years later, we see the launching of NMT (Nordisk Mobil Telefon, Nordic Mobile Telephony), the mother of all consequent mobile telephony. Here just a couple of brief comments:

• NMT represents the Nordic mindset A Nordic conference such as this one proves that such a thing still exists. In fact, Nordism reached its climax officially around 1970 in a treaty called Nordek that proposed Nordic economic cooperation, as an alternative to the European Economic Community, EEC.

But only days before the treaty would be officially ratified, it lapsed because of power politics. But the mindset was established: The Nordic countries formed an entity, and their cooperation was taken for granted.

• NMT was an engineering dream-come-true NMT was such a success because -and so say all of those who were involved in itof the fact that the engineers were allowed to work by themselves and politicians never interfered or meddled with their work.

It was simply because the politicians did not understand the potential of mobile telephony. In other areas, they tried to control issues in great detail -as in the case of data cooperation and TV satellites -but without any great success.

One example on how the NMT group made a conscious effort to keep "off the radar" is their task description. From the very beginning, the young radio technicians were planning a joint Nordic mobile telephone system".

The first draft was written by the NMT Chairman Håkan Bokstam. After some modifications the central sentence said (in Swedish), that the purpose was to create "compatible Nordic public mobile telephone systems, possibly a joint system".

It can be difficult today to fully understand how bold the NMT project was. For instance, a system crossing national borders would have been unthinkable in any other part of the world. At this time, people were not even allowed to take a radio transmitter with them across the border without a special permit -a legacy after the war: one was viewed as a potential spy.

• NMT expressed a complete concept This is the absolutely most important document in the NMT process, see figure 5: It is the list of the fourteen operational requirements for NMT. They were put down by Håkan Bokstam in his hotel room in Oslo the day before the NMT meeting on 20th January, 1971. These requirements came to be called "the fourteen commandments" that every solution in the mobile telephone system had to comply with. One of the commandments was formulated like this: "automatic searching of mobile subscriber […] registrates under which base station the subscriber is located" … meaning roaming. Another commandment was formulated like this: "automatic transfer of ongoing call from one base station to the next base station" … meaning handover.

• Everything was transparent, know-how was shared

The NMT group had over one hundred meetings. Everyone contributed for the common good, there was no national rivalry. The participants spoke Scandinavian -a mixture of Swedish, Norwegian and Danish. Despite occasional protests from the Finns, the majority refused to switch to English.

There was never a question of applying for patents for the NMT inventions. On the contrary, they were offered free of charge to the rest of the world. It turned out to be a problem later on when Motorola, Qualcomm and others claimed patents on inventions that the NMT group had already developed years before. The NMT group had to dig deep in their archives to prove that they had, in fact, been first to the mill.

• The subscribers should own the equipment

The NMT group stood behind this principle from the very beginning, mobile telephones should not be owned by the PTTs, as was the case in landline phones.

Therefore, the group invited manufactures, such as LM Ericsson and Nokia, to develop devices and equipment, based on the NMT specifications. It was more due to practical than ideological reasons, the PTTs would never have invested the kind of money that was needed in product development.

The NMT system was launched in the Nordic countries between October 1981 and March 1982, and it was an immediate success. It aroused a lot of interest internationally, and in June 1982 eight prominent figures of the NMT group were invited as guests of honour by British Telecom and France Telecom. These two telecom operators had just before published their plan of a joint British-French NMT service.

NMT was later adopted in about 50 countries. But, as we well know, NMT-plans in France and England did not materialize. Europe recognized that the NMT system was superior to all of the other contemporary mobile telephone systems. But because of envy and competition, they started to develop rival analogue mobile systems. None of them were any match for NMT.

The Northeners' next success was the GSM standard (originally Groupe Spécial Mobile, a working group within Conférence européenne des administrations des postes et télécommunications, CEPT, the European Post and Telecommunications Conference). The GSM standard can be described as a digital version of NMT, added with a SIM card. Thomas Haug, a Norwegian working for the Swedish PTT, played a very important role, first as the chairman of the NMT group and later, for an entire decade, from 1982 till 1992, in charge of the GSM process, leading to its enormous success. Today, Thomas Haug is 87 years old and lives in Sollentuna, to the north of Stockholm.

What about LM Ericsson's role in all this? In short: they were struggling against it. Mobile telephony was seen as something strange and uninteresting business-wise. The relationship towards PTTs was overbearing.

Just one example: AXE, this fantastic exchange that Televerket and LM Ericsson had developed together. The NMT people wanted to use AXE for their mobile telephone system -they needed to maximize the intelligence of the exchange to keep down the complexity of the base stations. But LM Ericsson, the only supplier, refused -in their view, AXE was over-dimensioned for such a marginal thing as mobile telephony.

LM Ericsson had to be heavy-handedly forced down the aisle. It was done by Televerket's new director-general, Tony Hagström. In a meeting where no minutes were kept, the directors-general of the Nordic PPTs decided to place their procurement contracts with Nordic suppliers.

The Finnish PTT had already placed an order for its exchange with the Japanese NEC. The Finns managed to worm their way out of the contract by adding a new cost item to the economic calculation, "hallinnolliset sovituskustannukset" -"administrative adjustment costs". It made NEC more expensive than LM Ericsson. LM Ericsson's attitude had fatal consequences. By the turn of the Millennium, the income generated by landline telephony had dropped to a fraction of former figures. To put it bluntly, mobile telephony was the reason for LM Ericsson's death.

The New Ericsson -King of the Standards Game

Ericsson as a company is still alive and well, despite everything. The explanation spells SRA and its employees who were long described as amateurish cowboys. SRA, Svenska Radioaktiebolaget, was founded in 1919 with LM Ericsson as one of its many shareholders. Its purpose was to develop radio communications in Sweden, first and foremost because of military reasons. In order to acquire the required competence, Marconi was invited as a major shareholder.

In the early 1980s, there were only two shareholders left: Marconi and LM Ericsson. At that time, the Swedish Army was SRA's biggest customer, and SRA had developed a special competence in radars and putting together radio telephony solutions.

The present-day Ericsson emerged within SRA. One figure gives a perfect illustration of this fact: in 1980 SRA's billing was 400 million Swedish crowns, in 2000 Ericsson billed 200 billion crowns for mobile telephone (and 73 billion crowns for other business).

It is 500 times bigger than in 1980 and corresponds to a 40 per cent increase in twenty consecutive years. No Swedish company has, before or since, been able to present such growth figures.

During the cause of these events, Marconi's shares had been acquired by Ericsson, and mobile telephone had become the overwhelmingly dominant business in Ericsson that had undergone a total change.

What is the explanation? In part, Åke Lundqvist, CEO at SRA from 1977 till 1987, in many ways a rebel who was driving crazy the managers working for the big brother, LM Ericsson. In our opinion, he can be described as the founder of the present-day Ericsson. These are some of the decisive issues that he pushed through:

-to sell complete mobile telephone systems to the customers, instead of forcing the customers to put together the systems themselves -to enter new markets, first and foremost the USA -against the express wishes of the Group management SRA learnt all about the American standard AMPS in a short time and conquered 30 per cent of the market share. -to find devoted nerds who worked all hours of the day with technology development: this was how Ericsson, through SRA, stepped in the GSM technology (and, it must be said, by ignoring turf boundaries and cooperating with the nerds at Televerket) -to develop small hand-held telephones, first for NMT in 1987, and later for GSM in 1992. It is fascinating that it happened at the exact same time as Nokia launched its corresponding telephones. -to learn how to sell telephones.

Simultaneously with all this, through its presence all over the world -in 180 countries -the SRA people gained solid experience of a very essential skill: how to play the standards game, meaning the technical standards that any future solutions will be based on. Naturally, everyone wants to have solutions based on the technology where one feels strong.

In our book Changing the World we describe the development of mobile telephony as a play around standards, in four acts, where 1G turns into 2G which turns into 3G and the present-day 4G.

They could be called four "wars" where the Nordic countries have each time beaten the USA. In the battles on 2G, 3G and 4G, Ericsson has been the dominant warlord. In the 2G and 3G wars, Ericsson was accompanied by its faithful partner Nokia, but in the 4G war Nokia chose to take its own path. We wonder if it turned out to be one of the reasons for Nokia's sad fate in the mobile telephone business.

NMT clearly demonstrates the importance of a joint technology standard. As we mentioned earlier, the Nordic countries agreed on the fourteen commandments on how to build up their system architecture. Thanks to this understanding and shared values, the Scandinavians created an arena where everything worked in the system and where the actors could compete with cards on the table.

Ericsson and Nokia found each other in this: the NMT commandments tallied with their genes and by acting in unison, they could control the play around the standards. This was especially obvious in the case of the 3G standard UMTS, where in the autumn 1997 Ericsson and Nokia went as far as to seek support from the operators in a joint roadshow (where they handed out pens as shown in figure 4).

In January 1998 they raised their champagne glasses for a toast in both the companies after ETSI, the European Telecommunications Standards Institute, had decided to adopt UMTS -whose radio access technology WCDMA is a direct descendant of the GSM track.

All this resulted in Bill Gates's visit in Kista a couple of weeks later, in February 1998. He wanted to cooperate in an operating system for mobile phones. But he came one day too late -Ericsson, Nokia and a couple of others had signed an agreement on Symbian the day before.

Less than ten years later, in November 2007, the 4G standard was clear, when the American operator Verizon decided after three years of secret discussions with Ericsson, to abandon the CDMA and Wimax tracks and, instead, go for LTE.

For some reason, which we are not familiar with, Nokia had at this stage decided to follow another road.

One example of the two companies' different choice of roads relates to touch screens. Ericsson wanted, early on, to go for touch screens -you are sure to remember the old Ericsson mobile phones that one could use with a pin. Ericsson's problem was that it was much too little a player for global launching in the case of mobile phones. Such a move had to be taken together with another actor -Nokia, of course, a very familiar company for the Ericsson people.

Nokia had developed its own technology for touch screens but, for some reason, did not believe in it and rejected Ericsson's invitation. Jan Uddenfeldt, Ericsson's former technology manager has talked about the profound disappointment this meant for Ericsson: "It's an awful shame that Nokia never realized what they had missed. They stubbornly and repeatedly said no to touch phones. Had they accompanied us on that road, later events could have been different. When Apple launched their Iphone in 2007, it was too late."

In that case, was Nokia's fall a result of their breaking away from their roots? Did they not understand or acknowledge the strength of the Nordic genes?

Did they want, because of resentment, to draw away from Ericsson? It is wellknown that Nokia's management got a trauma to struggle with when the company was in 1991 offered for sale to Ericsson, and Ericsson did not want to buy Nokia.

Had Nokia and Ericsson been able to develop a smartphone by 2007 that would have made Iphone unnecessary?

In our opinion, Steve Jobs managed to accomplish something that is actually a Nordic speciality: to develop easy and user-friendly devices.

Today, Ericsson and Nokia have sold their mobile telephone businesses to Sony and Microsoft, respectively. So in the present situation, Ericsson and Nokia are, in a way, in the same situation. To conclude with, here are some of Ericsson's success factors:

Fig

  Fig. 4. The p operators wor

Table 1 .

 1 Inhabitants and telephone subscriptions in 1885

		Population	Subscribers	Percent
	Stockholm	215,000	4,832	2.25
	Helsinki	46,000	575	1.25
	Kristiania	144,300	1,629	1.13
	Copenhagen	214,000	1,336	0.49
	Berlin	1,280,000	4,248	0.33
	Paris	2,800,000	4,054	0.14
	London	4,765,000	4,193	0.09


Thomas Skousen
email: thomasskousen@gmail.com

Herbert Jessen
email: herbert@lichinger.dk

The Journey towards a National Healthcare Data Network in Denmark

For a start this paper contains a short historical overview showing important steps in the ICT development in Danish healthcare with emphasis on the data network and communications. In 1988 the development of a national healthcare data network began. It was initiated with experiments with an EDI message for prescriptions, exchanged between GPs and pharmacies. Later more parties, i.e. hospitals, laboratories, municipalities etc. were connected to the network. In the year of 2000 a great part of the paper based messages exchanged between the parties were developed as EDI messages, standardized and in daily use by all parties. The paper ends by describing the development since year 2000, when the strategy was supplemented with new methods, where the exchange mechanism was changed from sending data between parties to sharing data through central national repositories. The role of legislation in the field is discussed.

.

Introduction

As a patient being treated by a healthcare system you meet a number of parties (such as your own general practitioner (GP), hospital departments, specialists, laboratories, municipal social services, etc.) who need to cooperate in order to offer you a proper treatment. In this paper the various parties are named actors.

This cooperation calls for effective and secure ways of exchanging patient data, such as illustrated in fig. 1. The interaction between the actors, and the use of ICT to facilitate and improve the exchange of information is the main topic addressed in this paper.

Historical Overview

Fig. 1. The

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The Start of a National Health Care Data Network

One of the problems considering the patients' situation as shown in figure 1 is securing effective communication between the involved parties of patient data. This was/is, unfortunately, often missing.

The development of data communication networks and services made it natural in the late 1980s to see digital exchange of data as a possible solution of the emerging data exchange problems in the healthcare sector. The advantages are a.o. that actors receive selected and relevant patient data from other actors without undue delays, that failures in transfer of data between actors could be minimized and that workflows could be made more effective.

The Amager experiment

In 1988 the first step towards this data network was taken. A pharmacist on the island of Amager near Copenhagen realized he had an employee sitting in a telephone boot for many hours per day, receiving telephone-prescriptions from the GPs in the area. On the other hand, the GPs found that the telephone number of the pharmacy was often occupied. The pharmacist was convinced that a better solution would be digital exchange of prescription-data. In 1989 he persuaded The Pharmaceutical Association to take an initiative to assemble the interested parties: The Danish Health and Medicines Authority, The Danish Medical Association, the regional authorities and different suppliers of it-systems and data-communication services. The so-called Amager Experiment was created with the purpose of testing the technical possibilities and evaluating the consequences of the electronic data-interchange of prescriptions.

It turned out to be a complicated project due to the following: • many involved parties with different agendas, • 4 different GP-systems should communicate with 2 different pharmacy systems which resulted in 8 different interfaces,

• communication standards had to be agreed on and developed, • data security issues had to be considered and last but not least • the parties who invested most were not the parties who gained most.

The project started behind schedule in January 1990 but ran quickly into problems. It turned out that the data communication was difficult to realize in practice. The parties could not agree on how to handle failures, and the technical solutions were not interacting as prearranged. To solve the problems an independent consultant was hired as technical project manager.

A considerable number of problems had to be solved. A standard prescription EDI (Electronic Data Interchange) message was created and agreed on, a reliable technical solution was outlined, and systematic testing of interactions between the GP systems and the pharmacy systems was undertaken. It also turned out that there was a need for a new message: an EDI receipt message returned to the GP system in order to secure that the prescription was correctly received in the pharmacy.

The prime success-criteria were that the involved parties could acknowledge the perspective in electronic data interchange and that the security issues could be solved.

After solving many problems the experiment was running almost smoothly by the end of 1990. The results were considered very promising, and it was decided to continue and extend the communication to involve more GPs and pharmacies.

In September 1990 a project evaluation report was presented. It had a number of recommendations specially directed to The Danish Health and Medicines Authority, who had to give the official permission to continue the dissemination of electronic data interchange in the sector. The authority should

• approve data communication of prescriptions between GP systems and pharmacy systems, • decide on minimum requirements for GP and pharmacy systems before they could be authorized for data communication,

• implement an authorization procedure for systems,

• reexamine the content of the EDI prescription message on the background of the experience gained from the Amager experiment and • invite to new and more elaborated projects in the area.

Even at this early stage the perspective was emphasized. The Amager Experiment showed the use of open standard EDI-messages as a mean for paperless interchange of medical data between the parties in the healthcare sector and you could catch a glimpse of the vision: A National Health Care Data Network.

The data network experiment in Odder

Based on the results in Amager, where the interchange of prescription data became everyday routine, the county of Århus in 1991 decided to launch a larger project with more actors and more messages involved.

In the town of Odder the project was organized with the following actors, as shown in figure 3: GPs, Hospital departments, the county, the municipality, and the pharmacies.

This was an interesting project because it dealt with a substantial part of the messages in the healthcare sector. In comparison with the connections seen in fig. 1, we already covered a major part of the channels. However it must be noticed that the messages shown with dotted lines were only tested sporadically during the project.

The establishment of the secure communication network also made it possible to exchange text-based secure e-mails between all the parties who participated. On the one hand this made the communication very effective and on the other hand e-mail was used for messages in the interim period where the standard EDI message was not yet finalized and authorized.

What were the benefits for the citizen? This is a natural political question, and in the evaluation report from the project a short story from the daily operation was told as an illustration of the perspective:

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	• Semant tic point-to-poi int connections s based on bila ateral agreemen nts The basic c new concepts s of SMR are: • Expens sive point-to-po oint integration ns between man ny ICT-system ms • Shared Medication Re ecord (SMR) c contains a patie
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	lume in message e exchanges s you need a ce pensate for this To comp which enab jects sites w trolled mann However system with between act les immediate where project ner is very obv r, as previousl h a centralized tors, but was in on-line access members can entral coordina s to updated in share docume ating ICT syste nformation. Th ents and inform em with servic he parallel to p mation in a c ces, • Provide es to healthcare e professionals s a quick actual pro-• All pres scriptions and changes in me edication are sto on-ter data abase. vious. y mentioned, d on-line datab nitiated as an e the first step t base did not o effect of nation towards a nati ccur as a resu nal legislation i ional coordina ult of cooperat in 1999. All m • Provide es overview for r the patient ated • Prescrip ptions are hand dled by pharma acies through t tion med-• All acc ess to SMR fro om the actors i s done through
	ata instead o of Sending D eives public su escription rece icine on pre ubsidy, i.e. the e patient only pays part of al syste em needs to be accessed) Data price of the e medicine. Th e new legislati ion demanded that the subsid dy percentage During th he last 10 year rs the demand for collaborativ	the in-
	n exchange-pat s exchange dat ttern, where in ta with design ndependent IC nated partners, h the total acc creases with cumulated cons sumption of th he patient. As cially in situ uations where many professi ionals (from d delivery of medicine coul d take place at t any of the 30 00 independent T systems on is well suited the purchase a and re-t pharmacies, t this currently pa articipate in th he treatment of f a patient. Te d in legislation i inevitably calle ed for a centra al on-line datab base (with all c citizen's accum mu-examples of f new care patt terns demandin ng new ICT sol
	al communicati other beforeh patient care wi tor needs actu ves insufficient and file exchan er be a comple any integratio ver know wher n fig. 5 below. ion is needed o and (just like ithout prior no ual and up-to-d or few actors a exchanging e-m otification and date patient rec are involved, a mails). But if d instruction fr cord informati and ase of medicine lated purcha e). This tren nd indicates the e urgency of sh haring healthca ac-This legi slation paved t the road for a n number of sha ared services w within the medi ica-tient and a c constantly chan nging number o of healthcare p rom tion area: Or it is a an acknowledg gement of the fact that health ion, • The Me edicine profile containing all citizens purch hase of prescrip ption medicine. . tient and is s only shared d with profess sionals if appr t. nge between a ete solution. M ons between m re the most ac . actors will to Mainly because many ICT syst ctual and newe a certain deg you will need tems ("spaghe est information Figure 6 below illustrat tes the SMR co oncept: n is es, phar rmacists, and th he citizens. etti-• The sha ared medicine r record (SMR), , which is a nat tional service f for doctors, nur rs-d to enablin ng pharmacies t to deliver and p price medicine e correctly gree • E-presc cription server as a national o on-line service containing all prescriptions a and healthcare r records thus wi ill never becom me an asset of t

Experiences and Knowledge

Looking back on the development of a healthcare data network in Denmark the experiences can be resumed in the following important points:

• Shared infrastructures and services require cooperation and commitment from all parties -it is not necessarily the parties who invest most who get the most outcome! • EDI messages were well suited for the start: the e-prescription, referrals and lab requests turned out to be great successes! • EDI messages were well suited where one party sends a message to a known other party and expects an answer, i.e. a dialogue! • The EDI development was lacking of a common agreed concept model, which could give a unique definition of the elements, agreed by all parties! • EDI messages are not a solution when many parties need to be informedand you don't know which party will use which information and when! • The EDI development and deployment has taken 20 years -based on voluntary participation!


Thomas Skousen
email: thomasskousen@gmail.com

Herbert Jessen
email: herbert@lichinger.dk

The First Attempt to a National Strategy -why it failed and how it developed into today's situation

This paper begins with a short historical overview showing important steps in the ICT development in Danish healthcare with emphasis on the Electronic Healthcare Record (EHR), the most discussed application in the Danish healthcare sector. In 1996 the Ministry of Health, based on a Danish governmentally launched ICT-program, created a vision and a strategy for the development of the EHR. The process resulting in this strategy is described, and the main lines of the strategy are outlined. Unfortunately, the following activities were characterized by uncoordinated development governed by local political or technical strategies in the different counties leading to lack of standardization. The last part of the paper describes how the technology development calls for a new way of thinking collaborative systems and it shows the impact of the development of central national repositories and discusses the current implementation problems.

Introduction

From an ICT point of view the development of ICT-support in the healthcare sector has followed two lines:

• Infrastructure and shared services being offered to all parties (GPs, hospitals, laboratories, pharmacies etc.) and • Local ICT-applications targeting local departmental needs and local hospital needs.

The development of the infrastructure, i.e. a national healthcare data network, is covered in another conference paper: The journey towards a national healthcare data network in Denmark.

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A National Action Plan

In the early 90s some hospitals had initiated experiments with EHR-systems in selected departments. The challenge was to create an efficient tool that supported the clinical processes which, by the way, also implied comprehensive changes in organization and work flows. A few of the experiments can be mentioned.

In 1994 a modified Swedish system had been sold by IBM to the hospital in the city of Vejle. The aim was to show the benefits from an EHR-system and to spread the system to all hospitals in the County of Vejle (and from IBM's point of view, to other counties as well).

In the hospital of Rudkøbing a doctor headed a project where a GP-system was modified and implemented at the Hospital. Later the hospitals of southern Funen formed an EHR-project based on the experiences from this first project.

In other hospitals different departments also conducted experiments.

The experiences from the different projects pointed in many directions. In march1996 the Danish government launched an ICT-political program. One of the areas addressed was the healthcare sector where ICT was seen as having the potential to contribute to a better healthcare. In the program especially development and implementation of EHR-systems were seen as an important step to better health services with swift treatments. The expectations were great.

However, one of the problems was the strong disagreement on how to define an EHR-system, but everyone agreed that the situation could be described as seen in figure 3 where 5 blind men are examining an elephant and getting different results of this examination. An EHR-system was perceived differently by all professions and from every medical group of specialty (surgery, medicine, X-ray, psychiatry, etc.).

Based on the national ICT-program a consulting team in co-operation with the Danish Institute for Health (DSI1 ) proposed to The Ministry of Health to establish an initiative to create a national strategy and action plan for the establishment of EHR in Denmark.

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Current experience

Despite delimitation of the 5 pilot projects and the fact that there were relatively few clinical employees involved, some forward-pointing experiences were found. Focus was on central work processes pointed out by the project participants as good examples for the use of EHR-systems. A few examples can be mentioned.

Most projects mentioned the ward rounds, i.e. the daily visit to all patients where doctors, nurses and secretary together see and evaluate the healthcare status of the patient (in Danish Stuegang).

Here all necessary information is present, all actors are assembled with the patient, and immediate decisions on treatment for each patient can be taken. The participants in the pilot projects doubted whether the system should support this process. The ward rounds are highly relevant, when all documentation is available on paper, because this will be the only moment where all relevant information is available. Having an EHR-system where everyone has direct access to all information all the time, means that there is no need for seeing the patients on a specific time of the day. This is one of many examples of changes in old established routines caused by EHR. It indicates that the implementation of EHR demands a huge organizational development effort.

Improved communication was also emphasized as an essential EHR characteristic. One can, for example, request clinical investigations, treatment and other services directly through the system. We know from experience that fewer errors occur when using an ICT-system, while data transfer from one paper medium to another paper medium (and this is done a great number of times in a hospital) easily results in errors.

All pilot projects showed that the EHR-systems affect the daily work greatly. It is impossible to continue with the existing routines, if you want to get benefits from the EHR investment. Another finding from the pilot projects was the lack of clarity about the future roles of the professional groups. For example, which role the secretary will have in the future when the doctors themselves write the medical record -a factor which, incidentally, was considered very controversial.

The pilot projects found the organizational implementation of EHR very resource consuming. And last but not least, strong management support during the whole project is essential.

Future user needs

It was decided to map the future needs and wishes from 9 different user groups (medicine, surgery, X-ray specialists, psychiatrists, department management, etc.). Every group was invited to a one-day workshop, where the needs were mapped as specifications and the benefits of the future EHR-system facilities were discussed and given priority. As shown in figure 4 the technology offered a number of facilities. These facilities could lead to potential benefits for the different groups in a hospital. On the other hand, you could argue that a desired gain from the EHR implementation dictates the technical features needed to achieve the goal.

The figure shows a generalized picture which all could agree on. In the workshops the picture was made operational by discussing the specific benefit for every user group and a prioritized list was prepared.

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Vision and Strategy

Based on the described analyses the strategy was expressed along the following lines:

• Together with the owners of hospitals (í.e. the counties) The Ministry of Health forms a forum for planning, implementing and coordinating the EHR-development • The HEP-project must, as much as possible, involve the regional and local parties in the development • The HEP-project must contribute to the financing (i.e. most central national funding) of the initiatives and projects which are the results of the strategy • The HEP-project shall call for project proposals in selected areas • The HEP-project shall evaluate the initiatives of this action plan and disseminate results.

The contents of the HEP-project were described as 7 targeted themes:

1. Testing of EHR implementation methodology 2. Testing of EHR technology 3. EHR information activities 4. EHR standardization activities 5. Security issues 6. EHR and organizational development 7. Coordination of related areas (like statistical production, clinical databases and a number of specific current activities)

Each theme was concretized in a number of initiatives which could form the basis for local projects and experiments.

Coordinated National Initiatives -or the Lack of It

The purpose of HEP was to launch national coordinated initiatives to promote EHR development. The third step of HEP needed the direct involvements of the hospitals.

The hospitals were encouraged to launch projects and the motivation was there. The Ministry of Health called for projects, and the hospitals were expected to send terms of reference, i.e. documents which contain all the information that defines the project.

Many proposals were presented, and a reasonable financial support would amount to about 50 mio. Danish kroner.

The Ministry, however, had only about 5 mio. Danish kroner -so the motivation vanished.

The result was that only a few projects were started, and the projects were mostly targeting the local needs.

Every county supported their preferred vendor, and the transversal standardizing activities were lacking.

As one important result of HEP: the EHR-development came on the list of issues in all counties, and most counties developed own strategies and began own development in the area.

Generally, in the following years three different roads were used by the counties:

• The county acquired (and modified) an existing EHR-system on the market, securing a product which also had other customers and was based on proven technology • The county developed an EHR as an addition to the systems they had already implemented (i.e. a patient registration system) • The county selected new technology and went into a risky EHRdevelopment project.

One of the outcomes of HEP was also the invention of the so-called EHRobservatory, a body which each year monitors and reports progress and penetration of EHR systems in Denmark, presented and discussed at a yearly conference. This contributed to knowledge sharing and some degree of coordination.

Subsequent Central Initiatives

In the years after HEP the National Health Authority (Sundhedsstyrelsen) started a development-project on standardization of EHR-terminology and -datastructure. The idea was to develop a framework which could be used by all counties and ensure seamless exchange of data between involved systems from different parties. The framework was called G-EPJ, a generalized EHR. The framework comprised a standardization of semantics and syntax for the terminology as well as a certain standardization of clinical processes around EHR. This initiative did not materialize. Other initiatives such as the Danish translation of the SNOMED Clinical Terms (a systematically organized computer processable collection of medical terms providing codes, terms, synonyms, and definitions used in clinical documentation and reporting) also did not materialize in EHR systems.

The main reason was resistance from the counties (later from the regions). The resistance was partly NIH (Not Invented Here) based and partly 'it is too difficult to implement' based.

The 12 Counties become 5 Regions

A local authority reform resulted in 2007 in the creation of 5 regions instead of 12 counties, and the prime responsibilities of the regions became the public hospitals and healthcare. But at the same time the new 98 municipalities had to take over more healthcare related tasks, i.e. post hospital treatment, home care, elderly care, and general public health initiatives. The regions were to become more specialized with focus on specialist hospitals.

One of the effects of this organizational change in the EHR development was an improved focus on EHR standardization within each region, causing the number of different EHR products on the market to be reduced from 10+ to 5. But at the same time each region again chose very different products.

The need for standardization and interchange standards (like HL7, DICOM, MedCom EDIFACT and XML) increased. It was a fact that not only data needed to be exchanged between hospitals in a secure way (within regions and between regions). Secure communication and data exchange with GPs and the IT-systems at the municipalities (Electronic Healthcare Systems) were also demanded as a consequence of the sectorial division of public healthcare between regions, municipalities and GPs.

There is still a need for all actors to be able to share EHR data among sectors.

To address this need, the regions established an EHR repository solution where extracts from the hospital EHR were copied at regular intervals and made available to other hospitals at the admission of patients. This information was also at the disposal of the GPs and other healthcare professionals. However, the information reflected what was available from the hospital EHR and did not properly target the needs of GPs and the municipals.

Another initiative is the Shared Medication Record (SMR), an on-line repository where all parties through legislation are obliged to retrieve and store actual and structured medication information of all patients. The SMR is integrated in all GP systems and in all EHR systems at hospitals, and in 2014 the SMR will be integrated to all municipal healthcare systems.

Two Routes and Strategies to follow

The first route is the repository strategy where the patient owns the EHR data in the repository. This is an obvious route to follow when more data need to be shared by the professionals. This has the consequence that you add costs when integrating the repository to local solutions.

Another route to take is to mandate all publicly funded actors (hospitals, GPs, municipalities) to use the same common EHR platform, forcing them to operate on the same databases.

This route is demonstrated and made technically possible by the co-operation of two of the regions (Capital Region and the Region of Zealand) to join force to acquire a fully SNOMED compatible EHR platform with capabilities to supporting also GPs and homecare tasks.

Both the of the above models and strategies demand a political legislative mandate where the sovereignty of the regions, the GPs and the municipalities to choose their own ICT solution (also mandated through EU tender regulations) is reduced significantly. Moreover, it will certainly require a national governance body to co-ordinate the program.

Unfortunately, due to the present political realities a decision in this direction seems unrealistic.

Experiences and Knowledge

Looking back on the development and implementation of the EHR in Denmark the experiences can be resumed in the following important points:

The EHR implementation was trigged by the technology possibilities -but it showed to be a huge political, organizational and cultural project. As a result EHR was 20 year under development!

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DSI was an independent institution dealing with research, analysis and advice on the Danish healthcare.

The counties/regions/municipalities have local autonomy. A consequencenational initiatives can only be driven by central legislation and heavy central funding From experience we know many actors -coming from different organizations and professions -have various terminology. This leads to the understanding that a common language is necessary in order to understand each other, which requires standardization The development until now have had focus on the needs of healthcare workers -the patients' needs for coordinated information have not been met. In the future a new balance between the two points of view has to be found.