12 European Countries Launch Initiative for E-Health System Compatibility

A large scale European project, bringing together 12 member states and supported by the European Commission, will take the lead in ensuring national e-health systems work together (interoperability) so that Europeans can benefit from the latest health technology advances wherever they travel in the European Union (EU).

In July 2008, an important development in healthcare information technology (IT) was made with the launch of the European patient Smart Open Services (epSOS) ‘large scale pilot' on interoperability of national e-health systems, involving 12 EU countries and scheduled to run for three years. Every member state has its own system of storing healthcare information, yet these systems often cannot ‘talk' to each other. Any citizen who falls ill in a member state that is not their own should be able to have a local physician from any EU state access their vital information quickly and accurately, the European Commission (Brussels, Belgium) and epSOS team reported, as quite often, lives are at stake.

Fabio Colasanti, European Commission director general in charge of information society and media, including information and communications technology for e-health, said, "The challenge of the increasing mobility of European citizens in the context of healthcare has been addressed by the European Commission. Together with the launch of its proposal for a ‘directive on the application of patients' rights in cross-border healthcare,' the issue of its July [2008] recommendation on the cross-border interoperability of electronic health record systems and the start of the epSOS pilot, the European Commission is laying the groundwork for improved healthcare options for traveling EU citizens. Interoperability is obviously a key factor in this, and some countries struggle with interoperability within their own state, let alone beyond their borders. With the epSOS large scale pilot, we are trying to identify, then test, the relevant tools to make things happen.”

The Swedish Health Ministry has been fundamental in setting up the epSOS pilot. Information and Communication Technology (ICT) of sorts has existed in this country for about 30 years. The goal of the epSOS large-scale pilot, according to Daniel Forslund, head of the section on e-health in Sweden's Ministry of Health and Social Affairs, is "to improve patient safety. Citizens should be able to trust any healthcare system in any country they visit or work in.”

Twelve countries have already signed-up for the three-year epSOS project: Austria, the Czech Republic, Denmark, France, Germany, Greece, Italy, the Netherlands, Slovakia, Spain, Sweden, and the United Kingdom. Flora Giorgio, of the European Commission's ICT for Health at the Information Society and media directorate-general and the EU's project manager, reported that this early take-up means that it is "already a major success. Before this, yes, we had a declaration of intent. But now, this has gone further with 12 member states and the Commission putting money and resources on the table. It's a big step forward. The scheme aims to connect what already exists. The countries will look at all their systems for, say, electronic health records, and see what can be shared. These countries can already see the value in working together. They are all committed to making sure that all EU citizens benefit from e-health, even when they travel to another EU country. This is also a great opportunity for the rest of the EU who will hopefully see this as a nudge in the right direction.”

The Commission is funding half of the costs. The project is divided into work packages covering different issues: analysis of the current situation in the participating countries; exploration of legal questions; development of technical specifications covering the basic components needed to use personalized health data securely; and setting up a test environment to evaluate the findings in a realistic situation.

Back in Sweden, Fredrik Linden, the project coordinator of epSOS, is managing the project with the primary task of mediating between all the parties on the crucial legal implications (e.g., patient privacy, the implications for healthcare providers when writing journal entries) and technical practicalities of e-health interoperability, among other issues.

In spite of what may seem to be a mammoth task, given the project's mere 36-month running period, Mr. Linden is upbeat. "Three years is certainly long enough to achieve much--despite the inevitability of there being so many different opinions to take into account,” he stated. "Getting started is a big step as it is, and I'm confident that we'll make good headway within the timeframe. After three years, we'll be able to give good recommendations on EU-wide legalities and achieve practical results on the very real issues of interoperability.”

The cooperation of industry is, of course, vital to effective interoperability. There had been some reluctance in the past to work together among companies that had invested huge sums of money in researching and developing their own particular products but that is changing. Indeed, there is now an alliance of companies telling the Commission that they understand that their products need to work with each others. The joint aim is to make e-health less fragmented and industry is currently working to come up with guidelines. A few years ago, this would have been unthinkable.

Peter Künecke, of the IHE (Integrating the Healthcare Enterprise) Europe group that represents the ‘gateway' to industry, remarked, "We have a network of more than 30 companies including big and smaller players from a range of countries. One of the most important factors here is that this is probably the first time that member states have happily accepted industry involvement in this field. "It's fair to say that, in the long term, industry can only survive with standardization. Interfacing and interoperability are necessary so, therefore, companies are now investing their time and expertise. Of course, we will never have 100% interoperability, but let's go as far as we can.”

As for what can practically be achieved in just three years, Mr. Künecke said, "It's a tough limit and, of course, there is a longer game that will be played out. But, within the timeframe, we will look at what technology can be re-used, prototypes, functionality, and so on. This is certainly a big phase. But there will also be a lot of work after the three years is over.”

There is optimism for the future: while just 12 countries are currently participating in the epSOS large scale pilot, Daniel Forslund commented, "At the end of the three years we will, of course, be very keen to disseminate the information to other member states.”

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