Interoperability of Cross-Border EHR Exchanges in Europe

By Anett Molnar, Senior Manager, Public Policy and Engagement, HIMSS International

Anett Molnar

EHR exchanges are becoming operational in the European Union (EU), starting with ePrescriptions between Estonia and Finland, followed by patient summaries between Luxembourg and the Czech Republic, and eventually Croatia.

The EU’s reported state of uptake shows that over 16,000 electronic health documents have been exchanged using the eHealth Digital Service Infrastructure since the service became operational in January 2019, with Portugal and Malta now having received the green light to join this pioneering group of countries later this year. By the end of 2021, both services will gradually be implemented in 22 EU countries on a voluntary basis. Work has begun to extend the scope to include laboratory requests and results, medical imaging and hospital discharge reports, as well as to create a European health data space based on harmonized semantic databases to open the door for further research and innovation.

Continuity of Care for Citizens While Travelling Abroad in the EU

Years and years of planning went into laying the ground for such a complex exercise from agreeing on technical specifications to design the governance structure on top of financing the pan-European eHealth Digital Service Infrastructure. One must not forget that in the EU, Member States have primary responsibility over organising and delivering health services and medical care, and European Union policies and actions are restricted to complementing national efforts by supporting the modernisation of the health infrastructure and improve efficiency of the health system as a whole.

The key consideration behind the electronic cross-border health service is putting the patients in control and supporting their healthcare. This is done by ensuring continuity of care for European citizens while they travel abroad in the EU and facilitating planned movement for healthcare so that European citizens can get the benefit of expertise not available in their home countries. By giving EU countries the possibility of sharing health data in a secure, efficient and interoperable way through an EHR exchange, their citizens will ultimately benefit from better care when they are in need of medical attention in another country where they might not speak the local language.

Interoperability is About Governance

When I started working for HIMSS several years ago, I remember interoperability as a very technical topic, understood only by a few and discussed mainly in the Global Health Conference exhibition floor by IT specialists.

Things have changed and interoperability is now in mainstream discussions within a much broader context. For instance, the European Interoperability Framework calls for integrated public service governance models where technical, semantic, organizational and legal interoperability complement each other—and this is exactly what is reflected in the European Commission’s Recommendation on a European Electronic Health Record Exchange Format.

In addition to recommending standards like HL7 CDA, IHE profiles and DICOM to use in cross-border EHR exchanges, it suggests HL7 FHIR and application programming interfaces for future consideration. It also puts in place a multi-stakeholder approach called Joint Coordination Process involving the Member States, the European Commission and engages all relevant stakeholders, including healthcare professional organisations, national competence centres, industry actors and patient groups.

We Have the Necessary Technologies, Adoption Needs to Be Accelerated

Unfortunately, EHR exchanges only benefits a few of us at the moment. Connecting health systems allowing semantic interoperability even at local level is a big challenge in most countries. Wide spread and easily accessible cross-border care is still more of a fiction rather than reality – but it can’t be stressed enough that we have the necessary technologies, adoption needs to be accelerated.

Members of the HIMSS Communities in Europe, especially the Dutch and the Nordics are in the forefront of championing interoperability both at national and international level and challenging their own ecosystems to join forces and unlock the flow of health data across borders. To mention a couple of the most recent initiatives.

The Netherlands Ministry of Health, Welfare and Sport and HIMSS announced their joint commitment to support and advance digital health and interoperability on a global scale with the ultimate goal of improving health and healthcare outcomes.

Following the goal set by the Nordic Council of Ministers to make the Nordic region the most sustainable and integrated region in the world by 2030, key stakeholders of the HIMSS Nordic Community launched the Nordic Interoperability Project to demonstrate the value of open, seamless, cross-border healthcare ecosystem from the patients’ point of view.

The Nordic Interoperability Project shares why interoperability is so important.

By continuing to support community-led initiatives that leverage the vast capabilities of interoperability and unleash the power of data, we can positively impact the health of every human, everywhere.


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