Title:

Electronic health records

Several states already implemented electronic health records as tools to support eHealth (see also the results of Hämäläinen et al. (2007)). Concepts as ‘electronic health record’, ‘electronic patient file’, ‘patient health file’, ‘electronic medical records’ (Netherlands), ‘electronic locum record for GPs’ (Netherlands), ‘electronic case record’ (Germany), ‘electronic medical file’ (Belgium), ‘virtual patient record’ (Italy), ‘citizen-managed personal electronic health record’ (Germany, under preparation), ‘central electronic health record’ (Germany), ‘summarised electronic health record’ (Belgium), ‘NHS care record’ (UK), … all refer to the electronic health or medical records. A lot of initatives are still in the implementation stage (see also Stroetmann (2007, 29), Wilson and Lessens (2006, 19) and Nouwt (2007, 161)). In Germany a ‘citizen-managed personal electronic health record’ is currently under preparation. In the Netherlands the ‘electronic medication file’ (EMD) and ‘observation file generalist’ (WDH) are in test phase in pilot regions. In Switzerland, the electronic patient record will be used only from 2015.

A lot of countries report great differentiation in health records (system specific use of systems depending on the needs of the level of health care, the type of organizations and the region of deployment). The Health Information Network Europe survey confirms this differentiation in the levels of sophistication between European countries as well.  

As a result of the highly diverse standards and types of records, integration between health records is currently not that common (for example Switzerland, Germany). Regions/countries try or plan to enhance interoperability and communication between the Health Records (the Dutch AORTA, Swedish harmonisation efforts, the example of the German region Rhine-Westphalia, the Belgian BeHealth platform and decentralised FLOW, the Spanish Plan Avanza). The UK Map of Medicine is another example of a decentralized way of merging information from health records. Some countries explicitly mention the efforts to create (national or regional) standardization in the use and development of health records (for example the Swiss national health strategy, Swedish Carelink project, Hungarian Standardization Committee; Spanish plan Avanza, the Communicating for health program in the UK). According to CEN (The European Standards Committee) this does not mean that European states have to make all electronic health records uniform in every detail.

The operational advantages of health record systems in health care are mentioned as important purposes by our partners. According to the answers of the partners, the intended use of electronic health records must mainly be seen in relation to the enhancement of communication between healthcare professionals and between healthcare professionals and patients. Electronic health records are used make an overview of the the medical history of patients within particular health care settings (Norway, Netherlands, Spain, Italy, UK…). Electronic health records are also assumed to enhance quality and continuity in the delivery of health care to a specific patient inside a specific context (hospitals or ‘locum GPs’ (see Netherlands)). The Belgian answer also stresses the symbolic function of electronic records (General Practitioners are put at the centre of first line care). Next to the benefits for the communication and efficiency, electronic records are assumed to be useful for administrative purposes (e.g. billing). Switzerland and Hungary explicitly refer to the role of insurance funds in the development of centralised patient information from the electronic record. In Hungary the EHR system is used to deal with the problem of defaulters to pay their insurance membership. The use of health records for epidemiological reasons has been mentioned as well. The Belgian, Spanish and Italian (Jhospital system) answers point out to the use of health record data on the aggregated level to investigate and optimize the delivery, quality and organization of health care. The emergence of clinical pathways and health trajectories has become an important field of research.

Electronic health cards

In general, we received little information on the state of the art on electronic health cards in the selected countries. Several countries report that no electronic health cards exist (Norway, Netherlands and Sweden). However, the European health insurance card, introduced by a decision of the European Council of Barcelona 2002, has been implemented in the European Economic Community since 2004 - 2005. Next to the European health insurance card, some countries mention other electronic health (insurance) cards. Belgium has a SIS (social identity) card for all citizens and a SAM (secure access module) card for healthcare professionals. In Spain, each community/region has its own eHealth card. In Italy (Lombardy), the CRS (carta regionale del servizi) for citizens and the SISS (Health Care Information System) card for healthcare professionals are perceived as corner stones of a ‘Healthcare extranet’ that links professionals, social services, organizations and citizens and enables tracking of all the events in the context of patient treatment and the provision of value added services.

The minimization of administrative efforts for insured citizens is mentioned as an important purpose by Switzerland, Italy and Belgium. E.g. the Belgium SIS card is used for authentication of the insured in health care. In the Basque Country (País Vasco), e.g. ‘the card allows for a number of procedures through the Internet, offering an advanced security level, utilising the electronic card exactly as it happens with the doctor, in the case for example of requesting a second medical opinion, clinical records, clinical episodes and data of medical leave.’ (European Commission, annex Spain, 2007). Sometimes the card is used to update data (e.g. the health card of Galicia, Spain).