Cases

The following are the existing OOP cases that were identified through the case analyis  in Deliverable 1.2:

 

Scenario:

To provide you a brief introduction to the future OOP scenario in healthcare domain, we kindly ask you to watch the following video. Alternatively you may click through the subsequent slideshow, which contains subtitles to explain the scenario interactions. Moreover, the textual description and posters could be found under the  interactive slideshow.

Video:

Health Scenario from SCOOP4C on Vimeo.

 

Slideshow:

Description:

Karl, a resident from country A goes to the hospital in his home country to be examined by a doctor (1). The doctor discovers that Karl suffers from an illness and now needs continuous medication. Consequently, the doctor updates Karl’s medical record in the Health Information System (2) using his national digital ID for authentication. At the same time, the doctor issues an ePrescription and stores it in the ePrescription Information System again using his national digital ID (3). The prescription does not include a specific name of a medication; however, it consists of a list of the needed medicine. Karl has access to his medical records and the issued ePrescriptions via the patient portal (4).

When Karl moves to country B for a temporary job (5), he goes to a pharmacy to get his medicine (6). When visiting the pharmacy, he gives consent to the pharmacy in country B to retrieve the particular ePrescription (6.1). As soon as Karl’s identification is validated via his national digital ID, the pharmacist triggers the request for the ePrescription from country A through the pharmacy portal (7). The pharmacist has to authenticate himself with his national digital ID to access the pharmacy portal. According to the request from country B, the ePrescription Information System provides the approved prescription to the pharmacy via the pharmacy portal (7.1).

The pharmacist searches for available medication according to the list of ingredients listed in the received ePrescription. In the case of different suitable medicines with the same ingredients, Karl is asked to decide which drug suits him most on the base of the pharmacist’s consultation. The pharmacist dispenses the medical products (8) to Karl. Afterward, the pharmacist generates an eDispensation document, which will be automatically transferred to the ePrescription Information System in country A (8.1).

The secure transport protocol facilitates safe and secure cross-border transmission of the medical data. In addition, the secure data exchange infrastructure connects different systems in the medical environment on national level. Common vocabulary and cross-border standards are used to map the medical data (e.g. ingredients of drugs) between the Member States.
 

Health Domain Poster

Gap list Health

Nr. Area of Gap Scenario Domain Name of Gap Brief Description of Gap Related Barrier identified in WP1
H.3 Political Commitment Health H.3

Political commitments at both national and European levels would outline the importance of the OOP implementation in the health domain. However, the absence of commitment at ministerial level could threat the accurate implementation of the OOP in this scenario.

 D 1.1, p 6. Political commitment D 1.2, p 23. Estonian Central Health Information System and Patient Portal
H.11 Legal Interoperability Health H.11

There are differing proficiency requirements for pharmacists in different Member States. Additionally, some national legislation limited the access to citizen's medical data to particular professional groups. Consequently, pharmacists with different proficiency levels would have different rights for accessing patients' data, threatening the implementation of this scenario.

 D 1.1, p 6. Legal interoperability
H.2 Legal Interoperability Health H.2

There is a variety of regulations on European and national levels to support the OOP implementation in this domain. Nevertheless, the absence of implementation guidelines and agreements by European and national legislation cloud threat the concrete implementation of the OOP in this scenario.

 D 1.1, p 6. Legal interoperability
H.9 Legal Interoperability Health H.9

Though existing agreements between Member States could support the EU-wide implementation of the OOP, probable conflict between these bilateral agreements could hinder the OOP implementation on EU level. These agreements should be harmonised or replaced by EU level agreements and regulations.

 D 1.1, p 6. Legal interoperability
H.10 Legal Interoperability Health H.10

Different insurance regulations in the Member States could prevent dispense of medicine in foreign countries.

 D 1.1, p 6. Legal interoperability
H.7 Technical Interoperability Health H.7

Infrastructures such as national portals and information systems provide essential base for the cross-border implementation of the OOP in different domains. Lack of these infrastructures (e.g. pharmacy portals in this scenario) have been identified as existing gap.

 D 1.1, p 7-8. Technical interoperability /Technical enablers such as secure networks and infrastructure
H.8 Technical Interoperability Health H.8

Absence of the EU level, eDelivery building block prevents direct connection between independent government organizations (and businesses).

 D 1.1, p 7-8. Technical interoperability /Technical enablers such as secure networks and infrastructure
H.12 Technical Interoperability Health H.12

In general, technical stability is essential for smooth implementation of all scenarios. Particularly in medical services it is very crucial to have stable technical infrastructure.

 D 1.1, p 7-8. Technical interoperability /Technical enablers such as secure networks and infrastructure
H.1 Interoperability Governance Health H.1

Participating bodies often exchange information basis on the bilateral agreements. It would be better to standardise these contracts and open the services on basis of multilateral SLA.

 D 1.1, p 8. Interoperability governance / Governance mechanisms
H.13 Interoperability Governance Health H.13

Legal, semantic, organisational, and technical interoperability enablers are needed for seamless interoperability between different entities. Moreover, all these interoperability enablers should match each other's. (Lack of harmony between different interoperability enablers could threat smooth interoperability)

 D 1.1, p 8. Interoperability governance / Governance mechanisms
H.5 Trust and Transparency Health H.5

Data subjects' consent is essential requirement for data sharing on both domestic and EU level. This is not facilitated by current infrastructures. In this scenario, patient should be able to provide consent for data sharing to the specific pharmacy in the foreign country.

D 1.1, p 8. Trust and transparency
H.6 Trust and Transparency Health H.6

Patients should be able to see their up-to-date medical data as well as to check whom, when, and why access their personal and medical data. This is currently facilitated for Estonian patient; though, it should be implemented in all other Member States as well.

D 1.1, p 8. Trust and transparency
H.14 Trust and Transparency Health H.14

In Emergency situations, when patient cannot provide data sharing consent to the pharmacy. They should be able to access to the patient's ePrescription to provide emergency services.

 D 1.1, p 8. Trust and transparency
H.4 Data protection and privacy Health H.4

The patients should be able to forbid doctors and other data consumers in this scenario to access their health information. In Estonia, patients may do this on patient portal

 D 1.1, p 8. Data protection and privacy

Roadmap Action List (Health)

Roadmap Area Nr. Scenario Domain Gap Reference Nr. Roadmap Action Description of Action Measures Expected Results Responsible Actors Roadmap
Data quality DQA.3 Education, Social Protection, Taxation, Moving, Health Ensure quality of new data Provide training courses, video tutorials and detailed how to deal with data-to-data recorders e.g. front-desk employees. Development of multilingual vocational training for data recorders Enhanced quality of new data, i.e. every piece of data is correctly recorded from the start. National policy makers, Public officials and employees, VET practitioners
Citizen-centred design CCA.3 Social Protection, Health, Taxation, Moving, Education Develop OOP scenarios based on collected information on needs to create citizen centred solutions Regularly perform analysis of state of play in different OOP domains in order to be able to develop relevant citizen cantered OOP scenarios. Research on citizen's needs in OOP services, Design of future OOP scenarios, Implementation of enablers Elaborated scenarios in different OOP domains and applicable for different procedures. Higher level of acceptance by citizens, citizen centric aspects is more in focus. EU implementers, National implementers, Academia
Interoperability Governance IGA.4 Education, Health, Moving, Social Protection E.1, E.15, E.17, E.18, H.13, M.5, SP.5 Improve interoperability governance by legal EU acts The improvement should be achieved through the development of legal acts and corresponding guidelines according for clear organisational, legal, semantic, and technical decisions and solutions. Implementation of regulations Accurate legal EU acts will increase sufficient competencies and finances for realising governance processes according to EIF and EIRA. EU legislators
Interoperability Governance IGA.3 Education, Social Protection, Health, Moving, Taxation E.14, E.16, SP.8, H.8, M.10, T.8, T.9 Implement all components of eIDAS The eIDAS regulation covers various components including the eID for individuals, a digital seal for organisations, issuance of certificates, security tokens, digital signatures, timestamping, validation of certificates, and trust service list. However, s Implementation of regulations National implementers are responsible to make sure that all components of the eIDAS regulation are achieved. This will improve security and facilitate the cross-border authentication of individuals and the validation of communications and data exchange. National implementers
Interoperability Governance IGA.2 Education, Moving, Social Protection, Health, Taxation E.4, E.11, M.4, SP.13, H.7, H.8, T.2, T.3 Establish an eDelivery building block in specified domains in all Member States Seamless implementation of the eDelivery node at the identified domains on the national level according to the evaluated deficiency. Implementation of regulations Implementation of the eDelivery building blocks in all Member States will ease the implementation and execution of the cross-border OOP services. National implementers
Interoperability Governance IGA.1 Education, Moving, Social Protection, Health, Taxation E.4, E.11, M.4, SP.13, H.7, H.8, T.2, T.3 Investigate domains with lack of sufficient eDelivery nodes in all Member States An eDelivery node should be in place in each domain and all Member States in order to facilitate cross-border and cross-domain electronic data and document exchange. This action aims to investigate and point out any area where the eDelivery node is missin Research on successful diffusion of enablers Academia and EU policy makers should come together to investigate and specify all policy domains in the Member States, where the eDelivery is needed. The results will benefit to the implementation and interaction between Member States. Academia, EU policy makers
Data protection and privacy DPA.5 Education, Moving, Health, Social Protection, Taxation Harmonized implementation of GDPR GDPR is already in place, but rules are not harmonised and there is no clear understanding what has to be implemented in terms of data protection. Implementation of regulations Clear rules on data protection in the EU and all member states. EU policy makers, National policy makers
Data protection and privacy DPA.4 Education, Health, Taxation, Social Protection, Moving Control of the use of data by an independent institution An independent agency, like EU data protection officer should overlook the use of data for cross-border digital public services in order to avoid misuse of data Implementation of regulations More trust and transparency, control over the misuse of data EU policy makers, National policy makers
Data protection and privacy DPA.3 Health, Education, Taxation, Moving, Social Protection H.4 Right to withdraw consent for data sharing any time Citizens should have right to withdraw their consent for data sharing any time easily and transparently if they feel a misuse of data. This also means they need to have a transparent overview of the use of their data and to whom at which time they have gi Policy Recommendation, Implementation of regulations More control and transparency of the use of data for citizens. Consequently, more trust of citizens in the state and the use of data. EU policy makers, National policy makers, Service providers
Data protection and privacy DPA.2 Education, Social Protection, Health, Taxation, Moving Implement mandatory technical modules for citizens’ consent for data sharing Service providers should implement mandatory technical modules for any OOP service so that citizens can give or withdraw their consent for any OOP service according to Policy maker laws Implementation of enablers During the application for a cross-border service, citizens can choose if their data should be automatically exchanged between different member states or not EU policy makers, National policy makers, Service providers
Data protection and privacy DPA.1 Education, Social Protection, Taxation, Moving, Health Agree on and implement common data protection standards Making agreement on and implementation of the common data protection standards for cross-border data exchange Implementation of regulations, Agree on common technical solutions Data protection standards paves the way for coherent cross-border data exchange EU implementers, National implementers, EU policy makers, EU policy makers, Service providers
Motivators MA.6 Education, Health, Moving, Social Protection E.11, H.5, H.14, M.12, SP.2 Implement a comprehensive solution for sharing consent once Develop a comprehensive solution for requesting subject's data sharing consent in order to avoid redundancy in iterative steps of sharing consent. i.e. subject can share her/his consent once for different OOP services Implementation of enablers Increased motivation of citizens to use more accessible and unsophisticated services EU implementers, National implementers
Motivators MA.5 Social Protection, Health, Taxation, Moving, Education Develop a standardized business process in cross-border OOP services with equivalent purposes/functionalities EU-wide. Implementation of standard business processes to guarantee intuitiveness and user friendliness in OOP in equivalent/adjacent services offered cross-border, so that both service providers and end users could intuitively understand the purposes and logic of Design processes User-friendliness and acquaintance of solution, which leads to higher citizens' motivation to use the service. EU implementers, National implementers
Motivators MA.4 Social Protection, Health, Taxation, Moving, Education Educate citizens about benefits and positive impacts of the (cross-border) OOP by conducting workshops and distributing materials. Organization of educational events/workshops for citizens, as well as development and distribution of electronic or paper based brochures/booklets about the advantages of cross-border OOP. Active citizens engagement, Awareness raising to citizens Increased level of citizen's interest on services. High level of awareness of benefits and constructive impacts of the OOP solutions. Higher level of citizens' engagement. Service providers
Motivators MA.3 Social Protection, Health, Taxation, Moving, Social Protection Communicate knowledge about benefits and positive impacts of the (cross-border) OOP implementation to citizens through PR campaigns Conduct PR campaign through major communication channels such as social media, TV, newspaper, etc., in order to reach different citizen groups. Awareness raising to citizens Increased level of citizen's interest on services. High level of awareness of benefits and constructive impacts of the OOP solutions. EU policy makers, National policy makers, Service providers
Motivators MA.2 Social Protection, Health, Taxation, Moving, Education Inform citizens about benefits and positive impacts of the (cross-border) OOP implementation Making citizens aware of the benefits such as administrative burden reduction, cost and time saving etc. as well as the positive impacts on society and economy, which come by the (cross-border) OOP implementation Awareness raising to citizens Increased level of citizen's interest on services, higher level of awareness of benefits and constructive impacts of the OOP solutions will lead to more motivation among citizens. EU government, National government, Academia, NGOs
Motivators MA.1 Social Protection, Health SP.3, SP.4 Expand existing OOP future scenarios to develop more comprehensive OOP solutions in different procedures. Extension of the OOP scenarios with the aim of including extra procedures (including more public services in specific domain). Ensure the coverage of different services in order to raise the motivation aspect. Design of future OOP scenarios As the extended scenarios are covering a wider range of services in each domain, citizens’ participation and motivation to use OOP solutions will increase. EU implementers, National implementers, Service providers
Trust and Transparency TTA.6 Health, Social Protection, Education, Moving, Taxation H.6, SP.7, E.8, M.7, M.8, T.10 Provide rights to withdraw data sharing consent as well as to modify their personal data Citizens should have the right to withdraw their consent for data sharing as well as to, to correct and even delete (if not necessary) their personal data at any time Policy Recommendation More control on the correctness and use of personal data leads to higher level of trust EU policy makers, National policy makers, EU legislators, National legislators
Trust and Transparency TTA.5 Health, Social Protection, Education, Moving, Taxation H.6, SP.7, E.8, M.7, M.8, T.10 Develop EU-wide transparency regulation Development of regulation on EU level, in order to grant transparency on the use of personal data that applies to all the EU-Members (in order to grant cross-border services). Implementation of regulations An EU wide transparency regulation is implemented and citizens are aware of it. Transparent use of personal data is guaranteed by government. EU government, National government, National legislators, EU legislators
Trust and Transparency TTA.4 Health, Social Protection, Education, Moving, Taxation H.6, SP.7, E.8, M.7, M.8, T.10 Inform citizens about transparent implementation of the OOP Active distribution of educative and promotional materials on transparency aspects of OOP services among the citizens by government. Awareness raising to citizens Public awareness about transparent OOP implementation. Higher level of citizens' of trust. Willingness of citizens to cooperate in terms of use of personal data and data sharing consent. National government