The value of interoperability in healthcare Healthcare services are typically organised on a national level, yet there are cases where patients require care while abroad. Cross-border eHealth interoperability will help ensure clinicians have the data they need to manage such patients safely, yet it is also important to establish a rigorous business case if these services are to be sustained, as Professor Dipak Kalra explains The individual Member States of the EU run their own national health services in their own ways, yet the European Commission (EC) does play a role in supporting the provision of cross-border care. The EC is presently establishing a European technical infrastructure and services to enable the secure communication of patient medical summaries and electronic prescriptions between European countries in authorised healthcare situations. However, while there are often cases where people require healthcare outside their own country, the numbers are dwarfed by national citizens using their own domestic healthcare services. “It is not sustainable to set up specific business models or develop special systems and services that only support this small patient number,” points out Professor Dipak Kalra, the Principal Investigator of the VALUeHEALTH project. An initiative funded under the Horizon 2020 programme, VALUeHEALTH, was set up with a clear remit. “We have investigated and now produced a business model and business plan for the sustainability of cross-border eHealth services,” says Professor Kalra. “That is, cross-border exchange of information between Member States, in relation to supporting the health of citizens who either cross borders and then need healthcare, or are deliberately referred to go across a national border to receive healthcare.”
eHealth services This means exchanging patient-related data and supporting healthcare professionals to maintain some degree of continuity of care, in potentially multiple locations, which is a challenging task given Europe’s cultural and linguistic diversity. The initial cross-border services mainly support emergency care situations, which impact on relatively small patient numbers. It can be difficult for Member
30
VALUeHEALTH work plan Interoperability (EIF)
Roadmap of prioritised use cases
Legal
Adoption strategies & incentives
Organisational
Business modelling
Semantic
Business Model
Technical
Business Plan
Service implementation & deployment
Stakeholder engagement & endorsement Management
States to justify their contributions to the costs involved in cross-border eHealth services in comparison to their ICT spending on within border services, which encouraged Professor Kalra and his colleagues to look for mutually beneficial scenarios. “The starting philosophy of the project was to look for win-win scenarios in which an investment by countries in cross-border services would actually also support them with their own withinborder healthcare communications,” he outlines. The project partners worked with a wide range of European experts to identify situations in health and social care in which interoperability is most needed. “We developed a portfolio of business use cases, scenarios of health information exchange, which would be plausible and useful both within and across borders,” explains Professor Kalra. A set of prioritisation criteria were developed to assess these use cases, and eventually two were prioritised, one of which was safe prescribing. When a medical professional is assessing a patient, it is clearly important to have the relevant background information about their medical history before issuing a new prescription. “The interoperability case to share information is to allow somebody
who is treating a patient to safely issue a new prescription - to ensure they have enough information about the patient that could inform a safe prescribing decision,” says Professor Kalra. The second use case was to go beyond the content of the current European emergency care summary, to make it efficient and useful to support continuity of care for patients with common, long-term conditions, such as diabetes. “The aim is to prioritise the information that would support somebody caring for a patient with a long term condition such as diabetes, to provide reasonably sound continuity of care for a patient,” explains Professor Kalra. “So in both situations we are dealing with an unfamiliar patient-clinician interaction.” The clinician may have no local records on the patient’s medical history, which will affect the quality of care they can provide. Professor Kalra describes a hypothetical example of a patient with diabetes who has experienced a hypoglycaemic attack while abroad. “Their blood sugar has dropped suddenly and unexpectedly – they’ve felt very dizzy and fallen on the floor in a shopping centre in a tourist town, and then been taken to hospital by ambulance,” he outlines. The clinician can restore the blood sugar back to normal levels fairly
EU Research
