Cross-Border Activities in eHealth

 The Directive on the application of patients’ rights in cross-border healthcare enables EU citizens
a cross-border access to healthcare services in the European Union member states.
 The implementation of the directive has required the change of national laws. Thus, the national
authorities have created guidelines for the citizens.
 Safe health information transfer is a basic principle of the cross-border healthcare.
 The Smart Open Services for European Patients (epSOS) pilot (2008–2014) attempts to achieve
cross-border interoperability between electronic health record systems in Europe.
 The aim of this pilot is to enable seamless patient health information exchange and improve the
quality and safety of healthcare when people move between European countries.
 Totally 23 countries have participated on the pilot and are developing together a practical
eHealth framework and infrastructure that makes possible to transfer patient health
information between different healthcare systems in Europe.
 In the first phase, the pilot focuses on two areas: access to important medical data for patient
treatment (patient summary) and cross-border use of electronic prescriptions (e-Prescription).
Patient summary includes the most important clinical date required to ensure safe and secure
healthcare. It is mainly intended to be used in emergency situations, but also in the scheduled
healthcare situations it is useful. e-Prescription includes medication prescription and dispensing.
 Medication is prescribed in the patient’s home country with patient’s consent. When travelling
abroad, a patient has possibility to retrieve the prescribed medication.
 At the moment, information transfer in both cases is in use only in certain epSOS countries. The
project extension started in 2011 and it analyzes and tests the following services: the patient
access to their data, the Medication-Related Overview, the Healthcare Encounter Report, the
integration of the 112 emergency services, and the integration of the European Health
Insurance Card.

eHealth Applications

 In 2008, the Finnish National Institute for Health and Welfare (previously referred to as STAKES)
in cooperation with the eHealth ERA project evaluated the implementation of eHealth policies
and the deployment of eHealth applications in the European Union.
 According to the report, the main eHealth applications are EHRs, patient identifiers, health
portals for informing patients and professionals on health issues and disease prevention, citizen
card activities, and telemedicine.
 The Monitoring National eHealth Strategies study provided an update on the progress of
eHealth activities in Europe.
 Country Reports are available at http://www.ehealth-strategies.eu/database/ database.html.
The analysis of progress published in 2008 combined with the total number of reported
activities in 2010 is presented in Table 52.2.
 The table presents an overview of the situation, but is not conclusive due to differences in the
features and functions of eHealth applications in different countries, and deployment can be
present only in primary or secondary care.
 In addition, deployment can be partly national, regional, or local. The 2008 report shows that
Finland was the only country to report activities in all 14 areas. Additionally, 11 countries
(Austria, Belgium, Denmark, Germany, Greece, Hungary, Italy, Poland, Slovakia, Sweden, and
the United Kingdom) have reported activities in more than 10 areas.
 All countries have reported activities on the EHR, but it is unknown whether these
developments concern primary care, secondary, or both.
 More specific activities regarding the development of the EHR in 2008 are not conducted often:
patient summary (n = 10), data definition/coding (n = 15), standards (n = 20), semantic
interoperability (n = 14).
 In 2010, patient summary and EHR-like projects were in the routine use in 7 European
countries. In two countries piloting of the system was going and 5 countries were at
implementation phase. Surprisingly 20 European countries were at the planning stage.
 EHR deployment in the European Union has mainly progressed well, but there are interesting
differences in the deployment status of other eHealth applications.
 In 2010, e-prescription activities (eCapture, eTransfer, eDispensation) were reported in 22
countries (21 countries in 2008), but eCapture was in use in 15 countries, eTransfer in 9
countries, and eDispensation in only 7 countries.
 In 2010, the citizen health card is used in almost all countries (n = 25), but activities regarding
professional cards are reported by a smaller number of countries (n = 18). However, in 2008
only 7 countries reported professional card activities, so the progress has been good.
 Different functions are included in citizens’ health cards in different countries; the most
common were patient ID and national health insurance coverage. In many countries, health
cards and identification issues are closely related to each other.
 Almost all countries (n = 26) reported patient ID activities in 2010, while 22 countries reported
professional ID activities. The type of identification method differs between countries. In
general, there are two methods: healthcare-specific identifiers and national identification
numbers. Based on the 2008 report, health portals for citizens (23 countries) are introduced
more often than health portals for professionals (16 countries).
 Typically, citizens’ health portals include information about general health and service systems.
In accordance with the European Union’s strategic goals, telemedicine applications are reported
in all countries. The most common types of applications were teleconsultation and
teleradiology including picture archiving communication systems).
 Improvements in patient safety and quality of care are identified as a major benefit of eHealth,
and the European Union has included them in the eHealth Action Plan as part of the i2010
strategic framework. In addition, the European Commission introduced in 2006 the eHealth for
Safety study which aimed to identify key issues, topics, and challenges where ICT applications
might improve patient safety and recommendation for future research topics.
 These activities indicate the importance of patient safety issues in Europe, but surprisingly only
7 countries (Belgium, the Czech Republic, Finland, Greece, Slovakia, Sweden, and the United
Kingdom) reported some activities in this field. Germany and Latvia reported no activities, and
the data for the remaining 18 countries were missing.
 European Union has adopted patient safety as a key goal in the development of nursing
informatics applications and healthcare systems. At present, the EU-funded European Network
for Patient Safety (EUNetPaS) project is coordinating national efforts.
 Also WHO has launched programs on a global scale that include the inventories of ongoing
researches. Many European countries have executed studies to assess the magnitude of
adverse events in their respective countries, mostly based on detailed audits of medical records
or primarily involved in a running adverse event reporting programs.
 A new EU-funded joint project concerning eHealth applications and activities was begun in the
beginning of 2014. ENS4Care is a Thematic Network involving 24 partners coordinated by
European Federation of Nurses Associations (EFN).
 During two-year period ENS4Care network aims to develop evidence-based ICT guidelines for
the implementation of eHealth services in nursing and social care.
 The guidelines are based on best practices which have achieved major benefits in cost-
effectiveness and better self-management of care.
 The project is targeted on the following key areas of care: healthy lifestyle and prevention, early
intervention and clinical practice in integrated care, skills development for advanced roles, and
nurse e-Prescribing.
 The ENS4Care will collect existing guidelines and good practices from participating organizations
and their networks. Patient safety is one of the key drivers of the project and the project
creates more understanding how ICT tools might improve safety in healthcare.