What is the eHDSI?

I had the pleasure of personally participating from its very first days in the implementation of the so-called eHealth Digital Service Infrastructure (eHDSI). Member states conceived eHDSI as an open interoperability architecture across borders that would allow the safe, stable, and trusted data information exchange. During the early epSOS project times, European experts analysed and defined several use cases and specifications. In the end, two of them, Patient summary exchange and electronic medicinal prescription are now in their deployment phase. eHDSI deployment under the CEF (Connected Europe Facility) funds started in 2015, bringing all of us now closer than ever to the expected result. The first two countries, Estonia and Finland that launched cross border ePrescription, have announced operational services this January, having already served more than 1,000 patients. Others are expected to follow until the end of 2019 with an end milestone of having all involved member states serving patient summaries and ePrescriptions in routine operation by the end of 2022.

Patient summaries in Europe

Robert Stegwee has already well defined the role of the patient summary and the international patient summary standards underway. The patient summary is a key document that has an appropriate use in emergency or unplanned care, while the Trillium II project proved that Patient Summaries could be adapted for use in many more use cases. Since 2007 when the European cross border adventure started, the European Commission underwent a massive effort to educate member states to collaborate across borders. This resulted in the guidelines for patient summary implementation across Europe that has been dramatically enlarged and stabilised later on, by the Trillium II project, the HL7 IPS project and the CEN IPS project. It also resulted into the eHDSI specifications and the openNCP framework, an open source platform that is now technically supported by the so-called eHDSI application provider, orchestrated by DG Santé: openNCP specifications are the combination of European digital services specifications of widely accepted standards orchestrated under specific IHE integration profiles.

Is eHDSI perfect?

eHDSI has been created on solid grounds both on the technical level (i.e., stable specifications, well-established test tools) and at the organisational level, allowing member states to decide freely on deployment timelines, national priorities, and goals. As it is set up now, however, it is a closed network of government to government (G2G) services, available only to public bodies responsible for national healthcare services, taking into account the political and technical complexities across borders. While this architecture has some definite benefits, it also has introduced significant barriers. Let’s explore those briefly. First of all, this is a provider to provider service, which means that the patient has to provide all the legal and administrative support for the data processing and consent of his sensitive medical data so that they can be conveyed through this gateway-based information highway.

Furthermore, it seems that eID issues and trust between member states still do not fully allow seamless data flow across borders. Finally, semantics and terminology interoperability barriers are hard to overcome, since each new use case semantics have to go through a thorough decision making and auditing process. As a consequence, eHDSI does not engage or empower the patient, and this is a significant drawback to broad eHDSI adoption.

A vision of tomorrow…

So what is the solution?  Do we throw ten years and more of European investments down the drain? Certainly not! The answer is to open the eHDSI to the market and allow new and innovative companies to invest and deploy new services by reusing and incorporating the eHDSI specifications. If so, it will enable recognising the European citizens as the key end users and beneficiaries of eHDSI and will simplify the eID, data protection, and consent issues significantly. It will also allow the adoption of the specifications deployed under eHealth CEF. The market is already capable, specifications are well known, and new developments such as the international patient summary standard and the Trillium II technical effort have proven the value of new standards such as HL7 FHIR in this new era to come.

In short, please open eHDSI to new opportunities. To name a few: allow the creation and validation of private owned openNCP based contact points, promote the collaboration of the private and public sectors on top of the eHDSI (several Pre-commercial Procurement projects in H2020 have already paved the way), put the patient in the driver’s seat, examine real cross border needs such as chronic patient mobility, rare disease patients, medical tourism and others. Europe can win this innovation battle of the health IT infrastructure of tomorrow, let the private sector innovate, we can still make a difference.

Alexander Berler is a director for consulting services at Gnomon Informatics SA. Healthcare IT News is a HIMSS Media publication.

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