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eHealth systems putting the patient at the centre
01 December 2009

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Interoperability and building trust in the privacy and security of eHealth systems is the route to patient-centric healthcare

The introduction of computer systems into healthcare – eHealth – has to take into account what the medical staff and other specialists who use these systems need if they are to deliver integrated healthcare.

But to consider eHealth solely from the perspective of those who provide care and manage healthcare facilities is to overlook the perspective of the patient – the most critical element in structuring any eHealth system. For the full benefits to be realised, patients must be put at the centre and eHealth systems must suit their needs.

“This is not to say that system design only focuses on patients,” says Octavian Purcarea, Microsoft’s Industry Solutions Manager for Public Sector Health. “While I’m a believer in the importance of being patient-centric, healthcare systems must also be multi-centric, suiting the needs of all users.”

The keys to finessing this balance are first, to ensure that standards are in place to permit hardware and software from different vendors to interoperate, allowing data to flow freely, and be accessed and manipulated by any specialist. Second, concerns about the security and privacy of electronic health records must be addressed.

Microsoft is investing on its own behalf to address the issues of interoperability, data security and privacy. At the same time the company is collaborating with partners across Europe, in particular on two joint projects that form part of the EU’s Competitiveness and Innovation programme.

Smart thinking

The first, European Patients Smart Open Services (epSOS –, is taking steps to help doctors deal with the complications of treating people who need medical care when outside their own country. This can range from dispensing essential medication that has been lost or left behind, to trying to diagnose and treat someone who has fallen ill, without having access to previous medical history – and often in the face of a language barrier.

Several EU countries have implemented patient summaries and electronic prescriptions (see box below) as elements of national eHealth systems.

The €23 million epSOS project aims to get these systems to communicate via a central system, so that health professionals can access records held in another country, in their own language.

In the case of ePrescriptions it will be possible to check a patient’s record and ensure the correct drugs are dispensed.

This is a potent illustration of the value of patient-centric eHealth systems. Rather than the time-consuming need to get permission from the national health authority that controls the record, the idea is that individual patients give permission for their record to be accessed.

epSOS began work in July 2008 by surveying the Patient Summary and ePrescription systems that are currently in use, studying the legal data protection requirements of each partner country and developing technical specifications. The second phase of the project will test the specification in live pilots involving doctors, hospitals and pharmacies.

Better safety

epSOS is impressive in scale, bringing together 35 companies with 24 public healthcare bodies and research institutions in 12 countries. The end result should be to improve patient safety and increase efficiency and cost-effectiveness in cross-border care. All the specifications, protocols and software tools generated in the project will be made available free of charge, enabling the widespread application of the epSOS platform.

But as Purcarea notes, all these outputs will be of little value unless would-be users have trust in the system. “Protecting healthcare records and complying with all EU and national data protection legislation is critical. Whatever the advantages for doctors and patients of getting eHealth systems in different countries to communicate, it won’t happen unless there is confidence on the part of patients that data will remain private, Doctors must also be confident that they are getting access to the correct records. And patients must be eligible to receive treatment.”

"It won’t happen unless there is confidence on the part of patients that data will remain private."
- Octavian Purcarea, Microsoft’s Industry Solutions Manager for Public Sector Health

A second content integration project should help to address these security, privacy and identification issues, and build the trust that is required. STORK (Secure idenTity acrOss boRders linKed, is working to make national electronic identification (eID) systems for guaranteeing a person’s identify online, interoperate.

Electronic government

The STORK project comes at this from the perspective of the growing number of services – from filing tax returns, to setting up companies and paying vehicle tax – that fall under the umbrella of electronic government (eGov). The aim is that EU citizens will be able to present their national eID to access these services in other countries. The Stork platform will act as a central interchange, passing on requests from an eID system in one country, to verify and guarantee the identity of an individual on the eID system of another country.

Citizens will thus be able to establish their bona fides and access services in any country that is part of the scheme, by presenting their national eID. “It’s self-evident that having one eID to get access to services – including healthcare – when abroad is the ideal vision,” said Purcarea.

The strength of the STORK approach is that the user controls who gets access to their data, which remain in the respective national system.

The issue of identification is central to accessing both government services and healthcare while abroad. STORK and epSOS have a joint programme looking at how developments in eID in STORK can be used to address the issue of patient identification in epSOS. “The e-identity management concepts, processes and tools developed in STORK for use in electronic government should of course be applicable to eHealth,” says Purcarea.

He points out that some national programmes are pointing the way to having a single electronic identity for accessing all public services. “Austria, for example, is developing a single electronic identity system in which one smart card gives access to all government services.”

There is much lip service paid to the ideal of patient-centric healthcare. Yet in Europe there remains much resistance to one of the key requirements of making this a reality – that is, giving patients formal control of their medical records.

As STORK and epSOS aim to illustrate, giving patients the right – and the means – to allow a doctor to access their records if they are taken ill when abroad will undoubtedly lead to improvements in healthcare. This should provide a powerful demonstration of the benefits of truly patient-centric ehealth.

What is a Patient Summary?

A Patient Summary is a concise, standardised clinical record that makes a pre-defined patient health data set available both for booked consultations with specialists and for emergency medical treatment. The Summary gives healthcare providers the essential information needed to provide continuity of care in case of the unexpected, such being taken ill when abroad, or when the patient consults a provider other than the general practitioner with whom he/she is registered.

What is an ePrescription?

An ePrescription provides data including the drug name, strength, form, dosage and/or the condition for which it is prescribed, in electronic format.

More information,

Author: Nuala Moran