In order to ensure that Europe’s citizens can benefit from their right to live, work and visit other European countries knowing that their health needs will be met safely and affordably, the eHealth elements of Member States’ national health systems must be interoperable. Currently, much remains to be done to achieve this interoperability. The TMA-Bridge project formulated a strategic plan on how to move forward towards successful eHealth for the citizen and by first building a basis of controlled implementation and interoperability.

The responsible person for the project on the EC side was Octavian Purcarea, while his counterpart on the project side was Dr Didier Schmitt of ESA, Dr Kass playing a leading role on the team. The TM Alliance website provides more detailed information on the activities of the alliance.

Layers technology

The Telemedicine Alliance (TMA), comprising of the European Space Agency (ESA), the World Health Organization (WHO) and the International Telecommunication Union (ITU), in its first phase of work, formulated a Vision for citizen-centred eHealth services by 2010. A key outcome of this study was that a major obstacle to the implementation of eHealth was the issue of interoperability. In its second phase of work, the TMA presented a Strategic Plan for trans-national eHealth interoperability with creative, citizen-centred, action-oriented strategic actionable recommendations. This aims to empower (promote and foster) stakeholders at all levels - political, organisational and social, and technical - to take action in order to achieve actual and sustainable interoperability.

The recommended action plan embraces two types of recommendations: the first includes conditions that must be met for the successful implementation of the strategy, while the second includes detailed recommendations for actions that support the achievement of the strategy. Local, national, and international stakeholders need to act to ensure an enthusiastic uptake of trans-national eHealth services that promote access to, quality and equity in health systems. They need to collect evidence on the benefits derived from actual eHealth services, ensure the digital health divide† does not lead to e-exclusion by creating a gap between those who have access to internet-based health care and those who do not, and perform continuous evaluation and monitoring of progress towards meeting the needs of citizens as proposed in the TM Alliance Vision for 2010.

The list of publications for this and the earlier project are provided in the list of publications under the publications category ICT & Healthcare (Telemedicine, eHealth, Data Privacy).

A summary of this project is provided in the downloadable brochure:

Summary of Recommendations:

Political Perspective

1 Take Legal and Regulatory Action

1.1 Develop a legal framework (common guidelines) for health data transfer. This will enable the bi-directional transfer of data between electronic healthcare systems in different Member States

1.2 Bring Member State’s confidentiality and privacy laws into harmony to ensure health data is protected and access is authorised according to European Data Privacy Legislation

1.3 Develop a clear statement on the legal liability for treatment both to cover bilateral and European wide agreements. These must specify which country’s liability laws are applicable in each health service scenario

2 Create and implement a framework for monitoring and evaluation to measure progress towards meeting trans-national citizen’s needs including basic statistics, benchmarking and indicators, for the number of mobile patients, the quality of care provided, the cost of care provided…etc.

Organizational and Social Perspective

3 Develop a workflow model that will incorporate organisational and social models into trans-national systems so that clear and unambiguous guidelines can be developed for all aspects of trans-national eHealth and communicated to those involved, including, but not limited to, administrators, providers of healthcare, citizens and insurers. These procedures should also include actions to mitigate the impacts of the digital divide to ensure that over time all providers can have access to electronic health information. Special attention needs to be paid to the treatment of vulnerable populations (e.g. migrant workers, people living in remote areas, disabled persons, elderly persons, (ICT) illiterate persons, etc.)

4 Create an environment for sharing knowledge of proven (good) practice and build the knowledge and capability of health professionals

5 Create the facilities and the content to ensure that eligibility to receive treatment can be known at the point and time of care. This should also include knowledge of reimbursement regulations for the patient and the provider and a mutual recognition of the availability of health services provided by both Member States and those to which the patient is eligible.

6 Ensure that relevant data in electronic form is available to the treating healthcare professional and citizen. This means that transfer between electronic health information systems or allowed access from one system to another must be implemented.

7 Ensure that language and cultural differences are incorporated into the system and available at the point and time of care. This should include a European Union wide agreement on minimum basic data sets (including, but not limited to, an emergency data set), language and terminology translation and a recognition of cultural sensitivities

Technical Perspective

8 Create a European telecommunications infrastructure as part of the eEurope initiative, which will provide the technical support for the transmission of data in a manner conforming to the data protection legislation in place, and which meets the needs of eHealth.

9 Incorporate a set of value added applications into the infrastructure, by identifying and implementing a set of achievable key applications.

10 Develop a central access point for health information standards, by establishing one access point for health information standards for the semantic content, coding classification and ontologies. 11 Increase awareness of the importance of existing interoperability-related standards for eHealth, by ensuring that data-interchange standards are known, understood and implemented in both supplying and procuring organizations.