It should be simple. A physician in any European country should be able to obtain summary data on a patient from another via a single interface. That way they can treat the patient accordingly, no matter where they happen to be. Yet creating and sharing such patient summaries has proved to be time-consuming, presenting technical and legal challenges and requiring resources.
In Estonia, TEHIK, the Health and Welfare Information Systems Centre, is responsible for making Estonian patient summary data interoperable with other countries’ systems. The ongoing effort is part of a European initiative seeking to harmonise e-Prescription services.
The work is now starting to deliver, with Estonian patient summary information available to Portuguese physicians, and vice versa as of this summer. Doctors in Luxembourg and France can also access Estonian patient data, and reciprocal data sharing is being implemented in Estonia where possible. Altogether, 25 European countries are working to integrate patient summary and e-Prescription services across the region by 2025. The project kicked off in 2017 and e-Prescriptions have already been available between Estonia and Finland since 2019 and 2020.
Continuous testing and trialling
But it’s not easy, and it takes time. But, according to Liisa Lvova, TEHIK’s crossborder data exchange manager, Estonia was well positioned to deliver on its end of the European patient summaries project, as it has maintained electronic health records for years. “Creating the patient summaries in the desired format is not that difficult, though it is rather time-consuming,” Lvova said.
A concurrent challenge has been the legal aspects associated with data sharing across borders. Lvova said TEHIK has had to engage the Estonian government to create a data protection impact assessment for the effort, for example.
One aspect that is a drain on resources is the continuous testing and trialling of the patient summary data sharing systems so that they meet European specifications and can go live. In particular, such testing requirements have added time to the implementation process, she said.
“When Estonia wishes to go live with the patient summary service with another member state, we have to perform production environment tests, then comes the evaluation by the European Commission, and in case there are any errors we’ll have to fix those and in some cases perform the test again,” said Lvova. “This is another time-consuming process and might take months.”
Rather than sharing between platforms, Estonian patient summaries are formatted to meet guidelines and made available to a single European data access point, from which doctors can recall them in other countries in a standard format and in their own languages. Doctors can then use the information to complement their efforts to determine a course of treatment.
Keeping the sensitive data secured
The shared patient summaries may include information on allergies and unwanted reactions, previous health issues, prescribed medications, any surgeries or procedures, and vital statistics. Information about medical appliances, such as bone screws or heart stimulators, alcohol or tobacco use, immunisations, and pregnancies will also be made available in the patient summary.
One aspect of the project that Lvova particularly stressed is data security. She underscored that doctors could access patient summary data, not a patient’s entire electronic health records. The European Commission also audits all cross-border data exchange services to ensure security. The services are also compliant with the General Data Protection Regulation, and any complaints can be addressed to the national data protection inspectorate, she said.
Inês Antunes, an analyst and project manager in the Portuguese Ministry of Health’s Information Systems Department, echoed Lvova’s observations when asked about the challenges in implementing crossborder patient summaries and e-Prescription services. She noted that external factors, such as the priority given to the COVID-19 pandemic, had created issues for her team.
In the case of e-Prescriptions, she noted that the Portuguese team had to liaise with the different software providers that support the country’s nearly 3,000 pharmacies. Portugal has a population of 10 million.
“However, both the Portugal and Estonia cross-borders teams worked together to overcome these obstacles and to successfully complete the testing phases required to comply with the European Commission guidelines,” Antunes noted.
Even with the first waves of the pandemic behind us, it’s still unclear if the 25 European countries taking part in the cross-border data exchanges will be able to share patient summaries and e-Prescriptions by the 2025 deadline as originally desired, Lvova admitted. However, Estonia is ready to work with partners once they are ready to implement and test their services.
“This is the initial plan of the project, but nothing can be guaranteed,” said Lvova. “TEHIK has finished the developments on the Estonian side, and we are planning and doing the production tests with possible partners and proceeding with additional countries to go live,” she said.