International mobility not only opens many opportunities for individuals but also places new demands in cross-border health care and in health information exchange practices. As cross-border mobility has increased significantly in the Nordic and Baltic countries over the last 10 years, and as it has become more common to study, work or live in a neighbouring Nordic or Baltic country, digital health care services and data transfers, such as electronic prescriptions and patient records, have the potential to offer increased safety, freedom of travel and ensure the overall continuity of care for citizens across borders. (See also https://www.nordicstatistics.org/who-goes-where-in-the-nordic-region/.)
The work package on health services
The health services work package is steered by the Finnish Institute for Health and Welfare. The work package supports the CBDS Programme, which aims to strengthen Nordic-Baltic cooperation in cross-border digital services to contribute to regional integration and mobility and thus to fulfil the Nordic cooperation’s vision of becoming the most integrated region in the world. The work package also supports a key objective of the Finnish Presidency of the Nordic Council of Ministers, which aims to ensure the seamless flow of health-related data in the context of the smoothest everyday life and mobility between countries through digitalisation. The project will create Nordic added value in particular by contributing to the European eHealth Digital Service Infrastructure (eHDSI) process for supporting and promoting eHealth services in the Nordic context.
The work package will not start its work from scratch. It will continue the work first carried out by epSOS (Smart Open Services for European Patients), a European large-scale pilot testing for the cross-border exchange of certain health data: a summary of a patient's most important health data in case of unplanned care (the Patient Summary) and the electronic prescription (ePrescription). The epSOS project ran for six years (2008-2014) and developed, piloted, and evaluated cross-border eHealth services and formulated recommendations for future work. The focus was on safe, secure, and high-quality services for exchange of patient summary data and ePrescriptions between European countries.
The project and the health services work package is part of the programme for Finland's Presidency of the Nordic Council of Ministers in 2021. For more info, see also https://stm.fi/en/nordic-cooperation/finnish-presidency-2021.
The baseline studies part on the health work package (workpackage no. 2) presents an overview of the current capabilities of the Nordic and Baltic countries when it comes to exchange of health care data, different structures, ongoing development actions in the field, and plans concerning ePrescriptions and Patient Summaries. Varying structures and a number of actors working with health data issues were identified in different countries. Moreover, there are many technical and semantic interoperability challenges related to current exchange practices of ePrescriptions and Patient Summaries. In general, the countries are using different systems and databases for different purposes, such as ePrescriptions, vaccinations, health records and social welfare. Moreover, the content of the Patient Summary data sets significantly varies between the countries, but standardised fields or a minimum data set are usually found. In general, the compilation of the Patient Summary data set is handled manually, and the amount and quality of data depends heavily on the health care providers and how they update the fields. This may affect the general quality of the data in the systems.
The baseline study also includes an identification of the factors that are slowing down, preventing, or constraining data access and exchange of health data. To establish semantic interoperability among ePrescriptions and Patient Summaries, smooth cross-border health data exchange requires both national and international cooperation. In addition, resources and financial issues were identified as significant organisational barriers to cross-border development. The key legal barriers slowing down, preventing, and constraining data access and exchange of ePrescriptions and Patient Summaries are data privacy and information security-related challenges. Also, the fact that many countries do not have a national legislation that supports cross-border health data exchange is a central legal barrier. Overall, benchmarking, knowledge sharing, and common prioritisation between countries are seen as important aspects in further development. The eHealth Digital Services Infrastructure (eHDSI) especially seems to be a key initiative for the cross-border exchange of ePrescriptions and Patient Summaries. Besides the semantics, patient-accessible electronical health records (PAEHR) and eIdentification (eID) are also important themes that need to be taken into account in future development work.