@khypp

Cross-border transfer of

patient’s records

With a focus on prescription services

Konstantin Hyppönen

Chair of eHealth Member States Expert Group

Chief Architect for Kanta Services, Kela (Social Insurance Institution, Finland)

eHealth DSI

Infrastructure currently

designed for Patient

Summary and Electronic

Prescription services

Partly in production,

deployment in progress

More countries expected to

join the process in 2020

New services are in the

discussion phase

PS

eP

PS+eP

Sourc

e:

https://e

c.e

uro

pa

.eu

/cefd

igital/w

iki/dis

pla

y/E

HO

PE

RA

TIO

NS

/eH

DS

I+D

ep

loym

en

t+P

lan

s

eP: Electronic Prescription

PS: Patient Summary

Country A: country of origin

Country B: country of visit

eP A: country sends

prescriptions and receives

dispensations

eP B: country dispenses

medicinal products on

foreign prescriptions

PS A: country sends patient

summary documents to

foreign healthcare

professionals

PS B: country fetches

patient summaries from

other countries

= in production

= very soon in

production

How does a country go live in eHDSI?

Preparation phase

Implement + fix bugs

Test – Preparatory, Formal, Re-Testing

Audit + Follow-Up Audit and any extra fixes

Decision phase

eHMSEG issues a recommendation

eHealth Network makes the final decision

If the decision is conditional, any remaining findings need to be closed

Go live – And this also takes about 2 months

It takes

2+ years

May 2016

Helsinki

After that we entered

eHDSI

…

Source:

https://valitsus.ee/sites/default/files/file_attach/ee-

fi_pm_digital_roadmap_declaration_10may2016.pdf

…

Cross-border prescription: how it all

started

epSOS pilot implemented during 2010-2014, with a number of

countries entering production for a few months

Finland piloted the service with Sweden, number of dispensations was

low because of the short duration of the pilot

Also other countries piloted the service (FR, AT, GR, EE, IT to name

some)

A small period of “waiting time” during 2014-2016

eHealth DSI deployment launched in 2017 – now at full speed!

Electronic prescription in Europe – a Finnish patient purchasing medication in a pharmacy abroad

This is reality right now

0

100

200

300

400

500

600

1 2 3 4 5 6 7 8 9 10 11 12

Dispensations of Finnish prescriptions

abroad, 2019

Why prescriptions are difficult?

Even if the concept of a prescription is similar in different countries,

the devil is in the details.

10

General experiences so far

The number of events has stabilized after about two months, and is

at approximately 17-18 dispensations per day on the average

Some small growth is still visible

The service has been running rather smoothly with no major

technical problems discovered

The service is being used, and helps people

11

What could have been done better?

The known limitations of the service have emerged more often than expected.

The biggest problem is with time-based prescriptions (“medication for 1 year of use” instead of “4x100 tablets”)

We have received a lot of feedback from customers.

A couple of yet unclear cases have been reported

A prolonged-release tablet dispensed instead of a standard one

In one case a prescription was declared fully dispensed, even if it should have perhaps stayed as partially dispensed.

It's also unclear whether driver's licenses or similar documents should be accepted.

We went for official travel documents, was this an incorrect decision? Legislation is unclear on this part.

12

What has surprised us

The number of events was a bit bigger than what we expected

News coverage was truly excellent, dozens of articles published,

and interest generated also in eHealth circles. The service was

mentioned even in a Finnish comedy TV show!

According to the questions received so far the service is often used

by Finns living in (not only visiting) Estonia.

People ask about possibility to act on someone's behalf, this is a

needed feature.

13

14

15 Noin viikon studio, 15.2.2019

What’s next in eHDSI?

More countries to join the services, and more services/roles for the

current countries

Discussion about unplanned vs. planned care

Discussion about new use cases (imaging results, referrals, etc)

Maybe also new ways to receive the services, such as mobile access or

online consultations

Integration with eID (HEALTHeID)

ISO IDMP (2023-2024)

16

Percentage of people who sought health-

related information on line, 2008 and 2017

The increase is almost 2x,

in some countries almost

5xǂ

7169

65 64 64 63

59 59 58 58 57 5755 54 54 53 52 51 51 51 50

4745 44 43

3734 33 33

64 63

56

52

45 44 43

0

10

20

30

40

50

60

70

80

2008 2017

ǂ Source: Eurostat Database, based on the

European ICT survey of individuals aged 16-74.

http://dx.doi.org/10.1787/888933836789

Source: Eurobarometer,

Attitudes towards the

impact of digitisation

and automation on

daily life

https://ec.europa.eu/digital-

single-market/en/news/attitudes-

towards-impact-digitisation-and-

automation-daily-life

Summary

eHDSI is liveAnd there is

more to come!”Tremendous

but feasible”

Let’s do this

together!

Thank you!

Konstantin Hyppönen

Chair of eHealth Member States Expert Group

Chief Architect for Kanta Services, Kela (Social Insurance Institution, Finland)

@khypp