Security Improvements for Safer Cross-Border E-Health Services in Europe

Security Improvements for Safer Cross-Border E-Health Services in Europe

Dimitrios G. Katehakis (Foundation for Research and Technology – Hellas, Greece), George Pangalos (Aristotle University of Thessaloniki, Greece) and Andriana Prentza (University of Piraeus, Greece)
Copyright: © 2020 |Pages: 25
DOI: 10.4018/978-1-7998-2390-2.ch010

Abstract

Preserving patient safety, patient rights, and safeguarding trust are crucial components for the provision of high-quality medical treatments across borders. This chapter focuses on required technological improvements to address quality challenges through the adoption of generic building blocks (BBs) towards enabling seamless care between European healthcare systems. The authors present important considerations that are relevant to incremental, cross-sectorial advancements for the enhancement of the technology used for the implementation of the directive on the application of patients' rights in cross-border healthcare. These include cross-domain technical BBs to support non-repudiation, capability lookup, dynamic service location, and electronic identification. The authors use cross-border electronic prescription and patient summary, as a case to discuss the use of related international interoperability standards, together with recommendations for future work relevant to the introduction of better quality, trustworthy, cross-border, electronic health services in Europe.
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Introduction

The use of electronic prescription and patient summary services (eP/ PS) has been recognized as an important strategic policy to improve health care across Europe and to support access to safe and high-quality, cross-border healthcare (Tinholt et al., 2013). Electronic prescribing has already proved that can help patients by providing easier prescription and medication pick-up procedures, fewer difficulties over prescription insurance coverage and an increase in patient safety (e.g. by checking legible prescriptions for harmful interactions) (Hollingworth et al., 2007; Wang et al., 2009). Key benefits of electronic prescription (eP) have been identified as improving the quality of health care services, increasing the efficiency and effectiveness of prescribing and dispensing medications, reducing medication errors, and health care cost savings (Pangalos et al., 2013). Failure to implement properly eP systems can result in new types of errors that can reduce workflow efficiency, increase medication cost, and threaten patient safety (Zadeh & Tremblay, 2016).

The Directive on cross-border healthcare (European Parliament, 2011) regulates patients’ rights to cross-border care and makes provision for the continuity of their care through a shared patient summary (PS) and the deployment of eP. It also creates the initial legal framework for cross-border care in the EU. It also establishes the need of a digital infrastructure for the cross-border exchange of health data. The deployment of electronic health (eHealth) solutions for eP/ PS is expected to increase safety and quality of care throughout the European Union and associated countries (EU) by ensuring continuity of care across borders and by providing immediate clinical information needed for unplanned care. What is envisioned is fewer concerns about possible adverse interactions with current treatment and health conditions (allergies, drug interaction, etc.) and the provision of safer healthcare, in cases of emergency or on occasional basis abroad. Other benefits foreseen include lower cost and improved efficiency, through the mutual exploitation of some technological assets with other domains, in order to enable sustainability of eHealth cross-border services through maintenance cost reduction.

Despite favorable attitudes towards both cross-border eP/ PS, multiple perceived barriers impede their incorporation and integration in clinical practice. Until very recently, infrastructures were not in place in all EU countries to support the system and stakeholders in some jurisdictions were reluctant to embrace eHealth due to the high cost and the lack of security of the systems (Kierkegaard, 2013). Patient identification and consent processes were laborious and somewhat time consuming, and member states have varying degrees of health care policy, privacy enforcement and laws concerning data protection (Milieu Ltd & time.lex, 2014). In most of the cases integration with national, health information technology (IT) systems was, and still in some cases is, missing. A lot of progress has been made during the past few years (Staffa et al., 2018; Nalin et al. 2019) and digital exchange of eP & PS is already supported and some health records of patients are already exchanged in the EU.

Key Terms in this Chapter

Service Metadata Publisher/Capability Lookup: Enables the participants of an eDelivery Messaging Infrastructure to dynamically discover each other's capabilities (legal, organisational, and technical). For this to happen, each participant must publish its capabilities and settings in an SMP.

Service Metadata Locator/Dynamic Service Location: The key component that enables dynamic discovery of participants in message exchange networks. As a result, these networks can scale up without being affected by the management of an increasing number of participants. Instead of having participants managed by a central node, address resolution becomes fully distributed and consequently much more scalable.

Electronic Prescription: A medicinal prescription issued and transmitted electronically. The ePrescription service is made up of electronic prescribing and electronic dispensing: ePrescribing is defined as prescribing of medicines in software by a health care professional legally authorized to do so, for dispensing once it has been electronically transmitted, at the pharmacy. eDispensing is defined as the act of electronically retrieving a prescription and giving out the medicine to the patient as indicated in the corresponding ePrescription.

Non-Repudiation: The security service by which the entities involved in a communication cannot deny having participated. Specifically the sending entity cannot deny having sent a message (non-repudiation with proof of origin) and the receiving entity cannot deny having received a message (non-repudiation with proof of delivery).

Connecting Europe Facility: A European Union fund for pan-European infrastructure investment in transport, energy and digital projects, which aim at a greater connectivity between European Union member states. It operates through grants, financial guarantees, and project bonds.

Patient Summary: An identifiable dataset of essential and understandable health information that is made available at the point of care to deliver safe patient care during unscheduled care [and planned care] with its maximal impact in the unscheduled care.

Interoperability: Interoperability, within the context of European public service delivery, is the ability of disparate and diverse organisations to interact towards mutually beneficial and agreed common goals, involving the sharing of information and knowledge between the organisations, through the business processes they support, by means of the exchange of data between their respective ICT systems.

eHealth DSI: The initial deployment and operation of services for cross-border health data exchange under the Connecting Europe Facility (CEF).

National Contact Point for eHealth: National Contact Point for eHealth, which may act as an organisational and technical gateway for the provision of eHealth Cross-Border Information Services.

Electronic Identification: The process of using person identification data in electronic form uniquely representing either a natural or legal person, or a natural person representing a legal person.

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