JAseHN Joint Stakeholders Workshop on Cross-Border Guidelines

29 June 2016

The programme was arranged into 3 sections modelling the new guidelines structure comprising a core generic part, and two annexes focused upon e-Prescriptions & Patient Summary guidelines.  Attendance was by invitation and numbered over 40 people, representing different stakeholders from multiple countries.  The workshop had 3 objectives:

1) to develop understanding of the eHealth network, JAseHN and action plans;

2) to understand direction of travel respect to the guidelines and

3) to allow people to contribute to the revision and updating of the guidelines.

The current e-Prescriptions guidelines were agreed in 2014. One proposal was the request to consider the dispensing use case in addition to the prescribing use case.  There were many questions raised; too many that could not be answered prior to the CEF funded implementation phase from 2017 onwards.  However it was an expectation or hope that the implementation schedule as part of the eHealth Digital Service Infrastructure (eHDSI) will resolve these questions as it works with real data between now and 2020. It was recognised that the e-Prescriptions guidelines could not be too prescriptive, but needed to permit flexible solutions.

It was noted that 21 Member States applied for the CEF funds to go ‘live’. In this context, CEF funding is for the core services, the governance model and the detailed specification of the National Contact Points (NCP).  The fact that so many Member States wish to take part changes the idea of “non-binding” guidelines (to be used on a voluntary basis by the Member States); they are now effectively binding given that the CEF Guideline funding requires the Member States to meet the requirements (for cross-border) within the guidelines.

The organisational consideration is captured by the organisational framework (OFW).  NCP in the cross-border directive means a broad communication channel. An NCP for eHealth is more precisely tied to the domain, and should comply to the requirements of the guidelines.  The OFW is related to the NCP for eHealth. It was agreed that better naming would remove some of the confusion. Currently, the generic part of the OFW includes a wide range of topics from enablers for implementation, education & training, and quality standards and validation.

It was strongly recommended that the refined eHealth interoperability framework be used to help the descriptions of things to be considered for the guidelines.

The annexes are structured into 3 parts: introductory material (including general provisions, legal and organisational considerations), the  formal guidelines (semantic and technology requirements), and support material (e.g. different approaches being put in place by MS). At present there are just two annexes, but it is expected that other annexes will be added in the future, e.g. patient registers, rare diseases.

The first version of the guidelines for the Patient Summary (PS) were initiated in 2013. The current scope is ‘emergency/ unscheduled’ care. This is usable and useful as a minimum, but can also help in part broader scenarios, it will never be sufficient for these broader concerns.  It is the most current snapshot.  What is the potential, wider scope,  e.g. planned care, chronic conditions, rare diseases?  Is there Evidence of use and clinical requirement? The criteria to apply is compact, focused and easy to use. Perhaps consider the PS as a single page, a front page of a book; an index to more specific detail in later pages within the book. One area to be considered is the country specific requirements and differences, and how the guideline can be kept flexible.

Opportunity and responsibility to influence direction of travel — now, one year, five years?  The idea of ensuring that incremental, building blocks might be the way to go to allow flexibility, and to cater for different capacities and needs from different Member States. There was a question as to whether or not the building block would be attestable; this will differ between countries depending on jurisdiction and make interchange more complex.  This was not resolved, but there were some for, and some against. Optionality, however, will definitely be necessary across Europe and globally.

Principles as to what is optional or mandatory would be helpful; perhaps the principle of what is static versus dynamic characteristics of the patient might be one example of such a principle.  A specific example, a PS might not need blood pressure readings, but the aggregate health issue, high blood pressure. The guidelines should be flexible, at the principle level, not be too prescriptive so as to avoid continual updating. Also, the query whether there should be any distinction between cross-border and national PS, should be addressed, where some experts thought there was no difference between the two.

The revised guidelines plus both annexes are due to be adopted by the eHealth network meeting on the 21st November this year.

+31(0)15 2 690 313