Why you should care

Countries in Europe are beginning to exchange e-prescriptions and medical records of patients. But what about data safety? 

Imagine traipsing around a charming medieval castle on your honeymoon when a crippling skin condition resurfaces — or being on a business trip in a neighboring country when struck with recurring joint pain. You take your prescription to the nearest pharmacy, but the folks in lab jackets can’t help you because they don’t have the specific drug your doctor prescribed. This is a very real concern for the 170 million — one in every three — European citizens who travel to another EU country at least once a year. Luckily, a cure may be available soon.

A new transnational effort promises to ease access to medicines and health care across Europe through the exchange of digital prescriptions among member states. These prescriptions will categorize medicines by their active ingredients — not by brand names — to ensure that pharmacies can give patients the correct medications under their local names.

By the end of this year, 10 EU countries are expected to have joined the initiative, with another 12 slated to do so by the end of 2021. And it’s not just about e-prescriptions. This cross-border exchange is part of a broader ambition to fully digitize and trade patient data across the entire continent, starting with patient summaries that can help doctors quickly understand the medical history of someone from, say, Germany, who falls sick in Italy.

It doesn’t help if you don’t have this exchange of prescriptions across borders.

Tapani Piha, former European Commission official

First off the block were Finland and Estonia, which began exchanging digital prescriptions in late January, followed shortly after by the Czech Republic and Luxembourg, which have signed up to trade patient summaries. Later this year, Croatia, Portugal, Malta, Cyprus, Greece and Belgium will follow suit. While it’s too early to track the success of the exchanges already in operation, early evidence points to the popularity and utility of the initiative: In just the two and a half months since they started, some 1,600 Finland-issued digital prescriptions have been picked up in Estonia.

These efforts to exchange patient data seek to build on a growing momentum toward e-prescriptions within the borders of individual European nations. Denmark, Estonia — where nearly all prescriptions are digital — and Sweden have led the way, and other countries such as Spain, the U.K., France and Italy have also embraced the practice. For those who travel across European borders though, it’s the latest initiative that could prove decisive.

“It doesn’t help if you don’t have this exchange of prescriptions across borders,” says Tapani Piha, the former head of cross-border health care and the eHealth unit at the European Commission.

The process is relatively simple: After a patient’s personal physician issues a digital prescription, it’s sent to the home country’s eHealth portal, which transfers it directly to a second country’s electronic database. After a period of review, it’s issued to a pharmacy in that country, then picked up by the traveling patient.

Still, the exchange of digital prescriptions is a novel concept — especially since most countries are still trying to navigate electronic prescriptions on a national level. Outside of Europe, Canadian system PrescribeIT was launched last year and operates in several provinces, with the ambition of becoming the country’s nationwide e-prescription service. Australia’s national digital health strategy, meanwhile, forecasts the ability for physicians to provide paper-free versions for all prescriptions by 2022. Once countries beyond Europe embrace e-prescriptions, their exchange across continents might soon also become a reality: Someone from France visiting the U.S. could benefit, for instance.

The European initiative is rooted in a 2011 directive from Brussels aimed at ensuring more widespread care for all Europeans. The end result, EU officials hope, is a system — part of the bloc’s Digital Single Market — in which complete electronic health records, not just e-prescriptions, can move freely among member states. “Both developments offer significant opportunity for improving safety, quality and efficiency in the delivery of patient care,” experts from the European Association of Hospital Pharmacists wrote in a recent report.

If these cross-border efforts increase pressure on more European governments to adopt e-prescriptions within their countries, that’ll help patients too, proponents of the initiative argue. For one, e-prescriptions eliminate the chance of pharmacies misreading a doctor’s handwriting, avoiding potentially dangerous, if accidental, mistreatment. They also boost transparency by categorizing medications strictly by the active ingredient, says Jelena Malinina, a digital health policy officer at the European Consumer Organization, and not by the pharmaceutical manufacturer. That eliminates the risks of doctors pushing more expensive brands of medicines.

And when it comes to exchanging digital prescriptions, there’s the obvious benefit of greater accessibility. “To me as a consumer, it would mean that I’m more satisfied with the system where I can have the freedom” not to worry about the availability of medication while traveling, Malinina says. That, in turn, could even help burnish trust in the EU’s sprawling and often unwieldy bureaucracy at a time when it’s under political threat from populist forces.

But with big data also comes the potential for big problems. Just as the world’s leading tech firms have been hobbled by serious concerns over data privacy, digital prescriptions also aren’t immune to potential hacks. And that raises an even more fundamental question: A successful continental effort depends on each individual country’s capacity to manage its own digital infrastructure. “It basically requires a good strategy at the national level first,” says Malinina. Shoddy national systems, which can sometimes hamstring, rather than expedite, the prescription process could seriously derail Brussels’ plan.

What’s more, the EU’s cross-border ambitions faced a recent setback following the release of a European Court of Auditors report that gave the bloc’s eHealth initiatives a lukewarm assessment, at best. It reminded officials that the data-sharing plan was far behind, considering that a dozen member states had earlier been expected to already be exchanging information on a regular basis by last year.

But proponents remain hopeful about the system’s positive effects — now that it’s finally taking off. Piha, the former eHealth chief, acknowledges that even one scandal concerning data privacy, for example, could significantly hamper the project. But he also believes people will be more inclined to trust the system if they’re exposed to it in a meaningful way. “The more you understand,” Piha says, “the more trust there is.”

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