Because Italy beats France and Germany on the electronic health record
The in-depth study by Enrico Martial
With Covid, electronic health records (FSE, in English EHR, Electronic Health Record) have become an urgency. The availability and accessibility of patient data not only allow economic savings in taking care, but reduce the time for assessing health conditions, with direct effects in the management of the pandemic. Italy seems to be ahead: at the end of March 2021 it already had 47.3 million files activated, while Germany only started in January and France expects to reach 40 million files in 2022 alone.
After sixteen years of preparation, many doubts and resistance on data security, Germany has decided to start its own electronic health record (elektronische Patientenakte – ePA) from 1 January 2021, as an overcoming of the fragmented systems in progress and with the objective of gradually covering the population enrolled in one of the 105 compulsory health insurances.
Born as a project in 2011, the German ESF ran aground due to the complications due both to the protection of sensitive data and to the mutualistic articulation of the system. On the impulse of Covid, after a bill in July, on 14 October 2020 the Bundestag adopted the law for the regulation of personal data, therefore the operation of the German ESF and its automatic creation. As in other countries, the citizen is the owner of the data, has the right to know them and to verify who accesses them. Implementation will take some time: from mid-2021 German family doctors should be able to connect, only from 2022 will they include reports, x-rays, or pediatric information, as well as historical vaccination data.
Although internal criticism is not lacking, Italy was further ahead and in May 2020 it had activated 13.7 million files, albeit with strong differences for Regions. At a conference in Venice, seven years earlier, on October 14, 2013, Simone Paolucci of Lombardia Informatica already counted 6 million citizens enrolled in their regional ESF. The turning point was made by Covid: the government adopted, with the Relaunch decree of 19 May 2020, the automatic feeding of data unless the patient opposes it. With the Ristori decree of 28 October it is foreseen the availability of the results of the antigen tests on the ESF, implemented from 11 December 2020.
At the end of March 2021, Italy had activated 47.3 million electronic health records, also at the instigation of the Agency for Digital Italy (AGID). On four late Regions the replacement intervention (of vertical subsidiarity) of the State was exercised: Abruzzo, Campania, Calabria and Sicily. To date, the activations are completed or close to completion in almost all regions (the latest is Abruzzo). The use is establishing itself in recent weeks: the FSEs are consulted by doctors and health companies, who are starting to feed them. Regional disparities are still strong, but an assessment will only be possible in a few months, if the progress and timing are similar to those of the activations. In the first quarter of 2021, health authorities in seven regions and doctors in eight regions consulted ESFs at a rate of over 90% and in three fed it at 100%, while in three regions doctors began feeding them, with rates from 20 % to 80%.
The exchange of data between the Regions (which also allows patient mobility) has been strengthened by the "National Infrastructure for Interoperability" (INI) provided for by the 2017 budget law (n.232 / 2016), and by the sharing of database standard (in acronym HL7 DCA ie “Health Level 7 / Clinical Document Architecture”). The Guidelines with the HL7 Standard date back to March 31, 2014 and the choice at the time facilitated many subsequent steps.
In France the situation is better than Germany, but it lags behind Italy. In July 2020 there were 9.3 million files, the government goal is to reach 40 million health files in 2022. The law of 24 July 2019 (Ma Santé) gave rise to a reorganization plan, with greater territorial controls and a digitization program. A government program following a consultation "Ségur de la Santé" ( which Startmag.it spoke about ) assigned 2 billion euros to digitization: dematerialized recipe, contents and terms of telemedicine, creation of a state Health Data Hub, launched on November 29, 2019.
However, some problems remained open: for example, the French interoperability standard (CI-SIS) of 2012, while also referring to the HL7 standard, was orientative and not prescriptive. The Isaac-Sibille report to the National Assembly only on 22 July 2020 called for the prescriptive adoption in France of the HL7 standard, also promoted by the European Union. The automatic creation of the French ESF, foreseen by the law of 2019, will therefore come into operation from 1 July 2021. It takes time both for the transition from the different software currently used – which will cease to be compatible – and for the implementation in a system of articulated health management and also in this case mutual, not universal as the Italian one.
The comparison of the three great founding countries may change in the coming months, the ranking may reverse, but it should be remembered that other member states have made important progress on the health record. Denmark (MedCom), Estonia (which is considered a true European champion) or Sweden (INERA-NPÖ) have set up or are completing their own ESFs. There are also developments at the regional level: for example, Andalusia – with the Diraya system – already in 2008 with its own ESF covered 90% of the population, managed electronic prescriptions for 3335 pharmacies for 4900 doctors, as well as reservations or the management of specialist care.
On the other hand, it should be remembered that the Electronic Health Record has a European dimension, which focuses on interoperability with a Commission Recommendation of 6 February 2019, with funds from the Connecting Europe Facility, and with a first exchange between about twenty Countries.
This is a machine translation from Italian language of a post published on Start Magazine at the URL https://www.startmag.it/sanita/perche-litalia-batte-francia-e-germania-sul-fascicolo-sanitario-elettronico/ on Sat, 10 Apr 2021 05:45:19 +0000.