Description (EN): The service shall examine how digital health solutions and policies in stakeholders’ territories foster the development of data-driven healthcare and digital health services, identify existing and potential opportunities and challenges to cross-border movement of health data and prescriptions and propose policy recommendations. In particular, the objective of this activity is to examine how eHealth solutions can be developed and promoted in the evolving landscapes of technology, territorial governance and cross-border cooperation in the stakeholders’ territories. The targeted analysis should identify best practices as well as legal, public policy and other challenges and opportunities to digitalization in health sector. Results will also be used by stakeholders as input to implementing their ongoing and planned eHealth policy developments and reforms.
Read more Achievements (EN): Estonia and Finland are among the leading countries in digital healthcare, although they followed two different approaches regarding eHealth services. Estonia launched its health information system in 2008, becoming the first country in the world to fully implement such a system nationwide. Finland began the development of its national EHR as early as 2002, with the launch in 2007.
Today these countries boast some of the highest eHealth adoption statistics in Europe.
Estonia:
According to our ESPON project eHealth, while healthcare in Estonia, in general, has been almost completely decentralised since the passing of the Health Services Organization Act (2002), the introduction of digital healthcare has been handled centrally. At the present, the services landscape is dominated by the solutions developed centrally by the state and relying on the national health information system
eHealth forms a part of a broader framework of public e-services under the concept of e-Estonia, which, in addition to eHealth, includes other services like e-taxes, e-school, e-commercial registries, and e-elections. The Government CIO Office at the Ministry of Economic Affairs and Communications (MoEAC) is at the top of the e-Estonia horizontal governance. It is in charge of shaping the broad information society policy framework, taking care of the central infrastructure (X-road and ID card) and technology standards, and co-ordinating ICT and e-services development across the public sector.
The Estonian approach translates that by 2018 100% of billing in healthcare and prescriptions, 97% of hospital discharge letters, 60% of ambulatory case summaries, 60% of dental care summaries and 50% referrals are digital. 1.6 million people have documents in the health information system and 34 million different documents are stored here: 21 million summaries of visits or treatments and discharge letters; 1.7 million referrals; 7.5 million diagnostic study reports and procedures. Every month doctors make 1.9 million queries in the health information system and there are 244,369 unique visitors to the patient portal (15% of the population).
Finland:
For the Finnish healthcare system, eHealth project found that it is highly decentralised, comprised of a three-level publicly funded healthcare system as well as a considerably smaller private sector. Regional outreach and impact are achieved by the means of regional level planning and prioritisation, which is ultimately carried out via the allocation of project funding and further monetary means. Regional or local authorities are ultimately responsible for the provision of healthcare to their respective residents. Within this system, the National Electronic Health Record KanTa collects data from various healthcare providers.
By 2018 digitalisation has reached a level of coverage of 100% for Finnish healthcare systems, where its counterpart dealing with social affairs is expected to soon follow suit. A 100% use of electronic patient records by primary health centres and secondary care hospital districts, as well as 100% coverage of EHR in the public, and 80% coverage of EHR in the private sector all help to illustrate Finland’s achievements.
Cross-border digital healthcare:
Nordic countries stand out among EU Member States due to their willingness to engage in cross-border cooperation for digital healthcare. Examples of Nordic cooperation include the Nordic eHealth Research Centre (NeRN) of the Nordic Council of Ministers, that was established in 2012. The NeRN’s core aspiration is to establish a governance system for the collection of data and formulation and monitoring of eHealth strategies, thereby manifesting a currently absent coherent policy document for the Nordics.
The potential scope of this collaboration, however, expands beyond the geographic scope of the Nordics, as demonstrated by the gradually intensified collaboration with the WHO over the past years in several projects, such as the prospective, but not yet completed, development of an eHealth maturity index. In addition, the internationally operating database “NOWBASE” within the Nordics stands out as one of the most noteworthy recent advancements.
NOWBASE is a shared interface for the Nordic Medico-Statistical Committee (NOMESCO) and the Nordic Social Statistical Committee (NOSOSCO), who collaboratively seek to ensure that health and social statistics in the Nordic countries are comparable across borders, gathering statistics in associated fields is feasible and facilitated, and presenting, processing and managing gathered data is promoted and encouraged.
However, while the Nordic countries have enjoyed similar legal systems which would result in achieving cohesion faster, Finnish and Estonian legal systems are notable for their difference, Estonia having a more permissive approach to legislation and a centralised approach towards digitisation while Finland is characterised by its decentralised digital healthcare.
Despite the differences in legal systems, Finland and Estonia have signed an agreement for joint cross-border cooperation to allow healthcare providers access to healthcare databases. This allows access to digital prescriptions and to full patient medical history. The opportunity to use ePrescriptions abroad benefits citizens by making the management of medications treatment easier, while pharmacies benefit from the improved data quality for their activities because digital prescriptions issued in another country becomes available in a standardized form and in the local language. The mutual commitment is represented by the launch of the Nordic Institute of Interoperability Standards (NIIS) in Tallinn.
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Expected Results (EN): The service shall examine how digital health solutions and policies in stakeholders’ territories foster the development of data-driven healthcare and digital health services, identify existing and potential opportunities and challenges to cross-border movement of health data and prescriptions and propose policy recommendations. In particular, the objective of this activity is to examine how eHealth solutions can be developed and promoted in the evolving landscapes of technology, territorial governance and cross-border cooperation in the stakeholders’ territories. The targeted analysis should identify best practices as well as legal, public policy and other challenges and opportunities to digitalization in health sector. Results will also be used by stakeholders as input to implementing their ongoing and planned eHealth policy developments and reforms. More concretely, the objective of this activity is to satisfy the stakeholders’ knowledge needs as defined below:- How are digital healthcare solutions implemented in stakeholder’s territories? What kind of policies have been put in place in order to facilitate and implement digital health solutions?- What are the key driving forces and potentials, challenges and obstacles for data driven future healthcare in stakeholder’s territories? What is the situation with cross-border data governance, data models, legislative, political, cultural, economic, technological and other relevant aspects contributing to digital service development in the healthcare sector?- How do the legislative, political, cultural, economic, technological and other obstacles apply also to digitalisation in sectors beyond eHealth (potential transferability of research findings to other sectors than eHealth, e.g. education, urban planning, any other public service sector)?- What evidence can be found on the impact of digitalising services in health sector in stakeholder’s territories in terms of economic and social benefits?- How could the radio frequency regulations in the European and national levels promote future digital health services by making use of the available spectrum more efficiently and intelligently, including different spectrum sharing techniques?- What are the good practices in delivering digital healthcare solutions that can be transferred to other EU territories for policy development or for helping to design future digital and data-driven health solutions? How to promote and support future digital health developments, foster new technologies and cross-border movement of health services and data in EU in terms of legislation and policies?The main outcome of the service should be:- Comparative territorial evidence and analysis of digital health solutions implemented and public policies in place in stakeholder territories.- Identification of key driving forces and potentials, challenges and obstacles for data driven future healthcare, including state-of-art cross-border data governance and human-centered data models crucial for trusted cross-border personal data usage (e.g online profiling tools, mobile follow-ups of treatment, smart symptom check, targeted follow-up visits, and trusted patient information flow across choice of healthcare provider/region/country). Identification shall cover legislative, political, cultural, economic, technological and other relevant aspects contributing to EU General Data Protection Regulation (GDPR) on digital service development in healthcare sector.- Evidence on how legislative, political, cultural, economic, technological and other obstacles apply also to digitalisation in sectors beyond eHealth (potential transferability of research findings to other sectors than eHealth, e.g. education, urban planning, any other public service sector).- Evidence on the economic and social impacts of digitalising services in health sector.- Roadmap of steps and portfolio of good practices that can be transferred to other EU territories for policy development or for helping design future digital and data-driven health solutions.- Recommendations for radio frequency regulations in the European and national level for enabling future digital health services with more efficient and intelligent use of available spectrum including different spectrum sharing techniques.- Policy proposals at EU level to support future digital health developments and cross-border integration of data-driven solutions (e.g de-regulation and policy assessment).The stakeholder territories include Estonia, Slovenia, and cities of Oulu in Finland and Sofia in Bulgaria. The study area includes territories with different healthcare management systems. For example, responsibilities for healthcare are shared by private sector, municipalities and state (Estonia), or by municipalities and state (Bulgaria, Slovenia). Finland is undergoing radical social and healthcare reform where the responsibility will be shifted from municipalities to regions.Stakeholders are undergoing reforms in health sector due to demographic trends and public financing challenges. In addition, eHealth initiatives are important building blocks for making health sector more efficient.Important territorial aspect in Estonia and Finland is increasing cross-border movement of patients that creates the necessity to analyse in-depth the opportunities and challenges for cross-border movement of health data and cross-border service delivery.Development of innovative ICT solutions and eHealth services opens pathways to multi-level and public-private cooperation. It will also provide for place-based and more inclusive solutions for key public service delivery for citizens as well as enabling new business models and startups.For each of the four territories, a thorough analysis is expected on the concrete challenges the city, region or country is confronted with, in terms of policies, practices and legal framework in delivering eHealth services. The study should tackle the policy questions related to stakeholder territories at local, regional, national, cross-border and European scales. This case study type of work should include a preliminary stage of mapping; followed by in-depth reviews of key trends affecting the stakeholder territories; interviews with policymakers and other stakeholders (to be agreed upon with the steering committee – see below) to understand the key objectives, policy and legal context as well as ongoing practices, as well as notable obstacles to implementation; strategies used to navigate data movement and other cross border cooperation related challenges in each case; analysis of the provision of eHealth services and their effectiveness; and potential to transfer knowledge and policy learning. The analysis of existing policies and legal framework should include relations upwards (for example, in relation to European and national governments); downwards (in relation to sub-regional and local delivery bodies); and horizontal (in relation to organisations at the same level, e.g. adjacent municipalities, public and private healthcare providers).
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