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Interoperability and connectivity
EU [2008]   European Commission Recommendation of 2 July 2008 on cross-border interoperability of electronic health record systems

"Electronic health record systems have the potential to achieve greater quality and security in health information than the traditional forms of health records. Interoperability of electronic health record systems should make access easier, and enhance the quality and safety of patient care throughout the Community by providing patients and health professionals with relevant and upto- date information while ensuring the highest standards of protection of personal data and confidentiality. Enhancing cross-border cooperation in the domain of eHealth requires cooperation between providers, purchasers and regulators of healthcare services in different Member States."


"The Commission responded to the report ‘Creating an Innovative Europe’ of the independent expert group with the Communication "A Lead Market Initiative for Europe" that aims at the creation and marketing of innovative products and services in lead industrial and social areas, including eHealth. One of the main targets of the proposed initiatives to boost the interoperability of electronic health record systems, since the health information and communication systems and standards currently used in Member States are often incompatible and thus present a barrier to the emergence of cost-effective and innovative information technology solutions for healthcare."


"Achieving and maintaining cross-border interoperability of electronic health record systems implies managing a continuous process of change and the adaptation of a multitude of elements and issues within and across electronic infrastructures in Member States. These electronic infrastructures are necessary to exchange information, interact cooperate in order to ensure the highest possible levels of quality and safety in healthcare provision to patients. Implementing interoperability of electronic health record systems will require a complex set of framework conditions, organisational structures and implementation procedures involving all relevant stakeholders."

"To achieve this, Member States are invited to undertake actions at five levels, namely the overall political, the organisational, the technical, the semantic and the level of education and awareness raising."



 bullet  European Commission Recommendation of 2 July 2008 on cross-border interoperability of electronic health record systems  bullet  ICT for better Healthcare in Europe []
EU [2006]   Connected Health: Quality and Safety for European Citizens. Unit ICT for Health in collaboration with the i2010 sub-group on eHealth and the eHealth stakeholders’ group. Commission of the European Communities, Information Society & Media DG.

"This paper outlines priority issues which must be pursued vigorously in order to reach all of these health systems goals - improve patient safety, encourage well-informed citizens and patients on health matters, and create high-quality health systems and services - and, at the same time, face international competition in the eHealth sector."

"The main reasons for accelerating the introduction of interoperable eHealth solutions in a collaborative and coordinated way in Europe are the increasing mobility of European citizens, the aging population and the empowerment of citizens, the continuity of care and the creation of a bigger, European-wide market for many health applications and technologies."

"The result of this process [supporting the Lisbon Strategy, March 2000] will be a set of guidelines on eHealth interoperability, as well as an agreed process to implement these guidelines in the various Member States and at the Union level."

Specific topics discussed in the report include the patient summary, patient and professional identifiers, the emergency data set, ePrescribing.

 bullet  Complete report  bullet  EU eHealth interoperability  bullet  Information on the report on  bullet  The European Interoperability Programme
USA [2005]   Commission on Systemic Interoperability. Ending the Document Game: Connecting and Transforming Your Healthcare Through Information Technology, NLM/NIH/HHS 2005

"This report describes what can be gained and what is required to achieve an interoperable system of electronic healthcare information. This goal can be reached, and its benefits are worth the effort that will be required."

"The evidence cited in this report compels action to achieve an interoperable health information technology system in the United States."


"Americans need a connected system of electronic healthcare information available to all doctors and patients whenever and wherever necessary.

In 2000, the Institute of Medicine (IoM) estimated that between 44,000 and 98,000 Americans die each year from preventable medical errors. Subsequent studies have estimated that the number may be twice as high. Medical errors are killing more people per year, in America, than breast cancer, AIDS, or motor vehicle accidents. This pain and suffering is compounded by the knowledge that many of these errors could have been avoided.

"The lack of immediate access to patient healthcare information is the source of one-fifth of these errors.

"One of every seven primary care visits is affected by missing medical information. In a recent study, 80 percent of errors were initiated by miscommunication, including missed communication between physicians, misinformation in medical records, mishandling of patient requests and messages, inaccessible records, mislabeled specimens, misfiled or missing charts, and inadequate reminder systems.6 Under the current paper-based system, patients and their doctors lack instant, constant access to medical information. As a result, when a patient sees more than one doctor, no doctor knows exactly what another doctor is doing, or even that another doctor is involved. The consequences range from inconvenient to critical or even fatal. Each time an individual encounters a new healthcare provider, that patient must retell his or her medical history. Not only is this redundant, it can introduce error and imprecision, ensuring that no two copies of a personal medical record will be exactly alike. In an emergency, delay and a lack of information can be deadly.

"In the age of the Internet, this shortcoming is unacceptable. Many other problems stem from the lack of connectivity. Since doctors often work independently, the lack of shared knowledge can cause duplicate tests to be ordered, resulting in unnecessary expense and, occasionally, risk, and pain. The same problem exists for prescriptions, which can conflict with one another to create life-threatening drug interactions.

"Security and confidentiality are limited by the difficulty of tracking access to paper-based records. The paper-based system necessitates consultations via telephone calls, faxes, and e-mails without the benefit of complete medical records. Patients who want follow-up information on their conditions must schedule time with doctors, nurses, or staff, or conduct research independently—there is no networked access to supporting information.

"Handwritten records—most notoriously, prescriptions—are easily misread, causing potentially life-threatening mistakes. Similarly, analysis of large numbers of paper records is impossible, denying the public the benefits of early warnings of dangerous trends in disease or bioterrorism, and other research-driven efforts."


 bullet  Complete report  bullet  endingthedocument
 bullet  Press release: 25 October 2005
EU [2005]   eHealth Standardization Focus Group 2005-03-04. Current and future standardization issues in the e-Health domain: Achieving interoperability.

CEN/ISSS has on the request of the European Commission started a new investigation of standards requirements in the area of "eHealth", in connection with the eEurope 2005 action line and in support of the eHealth Policies of the member states. An open CEN/ISSS Focus Group was created to prepare a report and recommendations on these issues.


 bullet  eHealth Standardization Focus Group and links to report
USA [2004]   Achieving Electronic Connectivity In Healthcare. A Preliminary Roadmap from the Nation's Public and Private-Sector Healthcare Leaders. Connecting for Health, July 2004.
This report forms part of an incremental Roadmap intended to lay out near-term actions necessary to achieving electronic connectivity in healthcare systems.

Recommendations In Brief

  1. "Creating a Technical Framework for Connectivity: The creation of a non-proprietary “network of networks” to support the rapid acceleration of electronic connectivity that will enable the flow of information to support patient care. The network should be based on a “Common Framework” of agreements among participants. The network should use a decentralized, federated architecture that is based on standards, safeguards patient privacy and is built incrementally, without the use of a National Health ID or a centralized database of records.
  2. "Addressing Financial Barriers: The development of financial and other incentives and related processes, such as standards certification, to promote improvements in healthcare quality through the adoption of clinical applications and information exchange based on standards.
  3. "Engaging the American Public: Reaching out to the public with a consistent set of messages to be used by government, healthcare, and consumer leaders to promote the benefits of electronic connectivity and to encourage patients and consumers to access their own health information. "

"Connecting for Health is a public-private collaborative designed to address the barriers to development of an interconnected health information infrastructure. ... Connecting for Health was established by the Markle Foundation and receives additional funding and support from the Robert Wood Johnson Foundation."  [CFH].

 bullet  Report  bullet  Executive Summary  bullet  Summary of Recommendations (Technical Panel)  bullet  Connecting for Health

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