Security Improvements for Safer Cross-Border E-Health Services in Europe

Introduction

The use of electronic prescription and patient summary services (eP/ PS) has been recognized as an important strategic policy to improve health care across Europe and to support access to safe and high-quality, cross-border healthcare (Tinholt et al., 2013). Electronic prescribing has already proved that can help patients by providing easier prescription and medication pick-up procedures, fewer difficulties over prescription insurance coverage and an increase in patient safety (e.g. by checking legible prescriptions for harmful interactions) (Hollingworth et al., 2007; Wang et al., 2009). Key benefits of electronic prescription (eP) have been identified as improving the quality of health care services, increasing the efficiency and effectiveness of prescribing and dispensing medications, reducing medication errors, and health care cost savings (Pangalos et al., 2013). Failure to implement properly eP systems can result in new types of errors that can reduce workflow efficiency, increase medication cost, and threaten patient safety (Zadeh & Tremblay, 2016).

The Directive on cross-border healthcare (European Parliament, 2011) regulates patients’ rights to cross-border care and makes provision for the continuity of their care through a shared patient summary (PS) and the deployment of eP. It also creates the initial legal framework for cross-border care in the EU. It also establishes the need of a digital infrastructure for the cross-border exchange of health data. The deployment of electronic health (eHealth) solutions for eP/ PS is expected to increase safety and quality of care throughout the European Union and associated countries (EU) by ensuring continuity of care across borders and by providing immediate clinical information needed for unplanned care. What is envisioned is fewer concerns about possible adverse interactions with current treatment and health conditions (allergies, drug interaction, etc.) and the provision of safer healthcare, in cases of emergency or on occasional basis abroad. Other benefits foreseen include lower cost and improved efficiency, through the mutual exploitation of some technological assets with other domains, in order to enable sustainability of eHealth cross-border services through maintenance cost reduction.

Despite favorable attitudes towards both cross-border eP/ PS, multiple perceived barriers impede their incorporation and integration in clinical practice. Until very recently, infrastructures were not in place in all EU countries to support the system and stakeholders in some jurisdictions were reluctant to embrace eHealth due to the high cost and the lack of security of the systems (Kierkegaard, 2013). Patient identification and consent processes were laborious and somewhat time consuming, and member states have varying degrees of health care policy, privacy enforcement and laws concerning data protection (Milieu Ltd & time.lex, 2014). In most of the cases integration with national, health information technology (IT) systems was, and still in some cases is, missing. A lot of progress has been made during the past few years (Staffa et al., 2018; Nalin et al. 2019) and digital exchange of eP & PS is already supported and some health records of patients are already exchanged in the EU.