Seamless European e-health web

Europeans are becoming more mobile and healthcare systems have to keep up. A research consortium is seeking to chart a road map for e-health interoperability that would eventually hook up the health information systems of Member States in a seamless web.

Europeans are more mobile than ever before, moving not only around their own countries, but also across a largely borderless EU, in pursuit of leisure, education, career advancement or cultural enrichment. In addition, healthcare has changed significantly, with fewer people sticking to the same doctor, more patients visiting different specialists, health workers moving around more, as well as the emergence of e-health technologies which allow remote treatment and consultations.

This enhanced mobility has brought with it challenges. What happens if a person falls sick away from home or moves to another part of the country or another country altogether? Although European health services have introduced sophisticated electronic information management systems, these are often designed to work on a local level and are often not interoperable.

The International Standards Organisation defines interoperability as 'the ability of two or more systems to interact with one another and to exchange information according to a prescribed method in order to achieve predictable results.'

A useful analogy would be to think back to the early days of the personal computer when software developers produced programmes in isolation. This meant that data could not even be shared between the same type of software (for example, a spreadsheet) produced by different manufacturers, different types of software (word processor and database), or different platforms (IBM and Apple).

Today, interoperability in the PC market has become so highly evolved that data can be shared between different brands of the same software, different types of software and different platforms.

However, this is not yet the case with healthcare information systems. To tackle this challenge, Member States and the EU have mounted concerted efforts to create national and Union-wide interoperability.

'The establishment of e-health interoperability at the European level will create a win-win situation for various kinds of stakeholders that are involved in any phase of health delivery process,' explains Asuman Dogac, a professor at the Department of Computer Engineering of the Middle East Technical University in Ankara, Turkey.

According to Dogac, in the future, Europeans will ideally be able to go anywhere and not sense any difference in the quality of healthcare they receive, doctors and health bodies will be able to access information on foreign patients just as easily as they do for local ones, and patient records will be accessible at any time from anywhere not only for professionals with the necessary access right but also for the patients themselves.

Making this dream a reality requires sophisticated interoperability solutions to link up regional and national health information systems into a seamless European web. With EU funding, RIDE seeks to chart a route for Member States to enable their national e-health networks to talk to and understand one another.

The project's nine partners in seven countries have already drawn up two draft versions of its e-health interoperability road map and work is in progress on the final version. This document complements the objectives of the Commission's eHealth action plan, particularly with regard to semantic interoperability.

'Two crucial principles have been identified by the RIDE project,' Dogac told ICT Results ahead of a presentation at the eChallenges conference on 24 October 2007. 'The first is the central leadership of the European Commission in coordinating Member State activities and the second is the need for an incremental deployment process in which growing (in physical coverage) and evolving (increasing functionality) pilots are being developed across Member States.'

To achieve this, RIDE has benchmarked good practice and promoted the exchange of experience. It has also formulated 'visionary' scenarios, mapped out the gap between the current situation and the desired future one and documented the limitations of current policies and strategies.

One of the good practice cases identified by RIDE was Medcom, the Danish healthcare network. It provides national standards for communication flows relating to referrals, discharge letters, laboratory results, X-rays, prescriptions and billing between hospitals, pharmacies, laboratories and other related institutes. It is used almost universally in Denmark, with 97% of general practitioners, 74% of full-time specialists, all pharmacies and hospitals utilising the system.

In order to achieve interoperability at European level, it is necessary that this kind of widely used national network is established in all EU Member States. Then, the interoperability of these networks can be realised through well-defined interfaces.