Rights In Cross-border Healthcare Research Articles

Connecting the Electronic Medical Records in the European Union – Where Do We Stand and Where Does It Go?

The editorial discusses the integration of eHealth systems in the European Union (EU) through the eHealth Digital Service Infrastructure (eHDSI) project. The EU's unique approach to integration involves overcoming language and system differences among its 27 member states. The European Directive 2011/24/EU emphasizes patients' rights in cross-border healthcare, pushing for interoperability in national eHealth systems. The eHDSI project aims to facilitate emergency cross-border healthcare. It involves National Contact Points for eHealth (NCPeH) in each country, connecting through standardized interfaces. The project covers Patient Summary (PS) exchange, electronic prescription (eP), dispensation (eD), and Original Clinical Documents (OrCD) exchange. Despite its progress, the eHDSI faces challenges, including language diversity and differences in national healthcare systems. Key performance indicators (KPIs) reveal operational details, with 11 NCPeHs established by 2023. While eP/eD services are more developed, PS exchange and OrCD usage remain limited. Although eHDSI seems to be a viable project, its real-world usage is currently low. This can be attributed to technical complexities and incomplete implementation. Broader use should be pursued instead of expanding the system's capabilities. The complexity of the eHDSI and its implementation could pose additional challenges, and widespread use may not be achieved before 2030.

ERN CRANIO patient coverage of craniosynostosis in Europe

BackgroundAgainst the backdrop of the European Directive on patients’ rights in cross-border healthcare, 24 European Reference Networks (ERNs) were launched in 2017. ERNs are networks of specialised hospitals working together to support patients with rare and/or complex diseases. ERN CRANIO is the ERN for craniofacial anomalies and ear, nose and throat disorders. The aim of this study was to explore ERN CRANIO’s patient coverage of craniosynostosis.MethodsERN CRANIO members and applicants were asked to retrospectively report the number of ‘new craniosynostosis patients’ (isolated and syndromic) seen in 2017. The number of live births per country in 2017 was retrieved from EUROSTAT, the EU’s statistical office. The number of new patients reported per country and the number of live births were used to generate country-specific prevalence figures per 10,000 live births. These figures were compared to expected prevalence ranges for craniosynostosis, and syndromic craniosynostosis specifically, defined by recent European studies. The percentage of syndromic craniosynostosis cases per country was also compared to the expected percentage range.ResultsBased on previous studies, the expected prevalence ranges for craniosynostosis and syndromic craniosynostosis specifically were respectively defined as 4.4–7.2 and 0.9–1.6 patients/10,000 live births. For craniosynostosis (‘total’; isolated + syndromic), 'new patient' data from the UK and Finland generated prevalence figures within the expected range, and those in France, Spain, Italy, Portugal and Germany are lower than expected. However, when including applicant data, the prevalence figures for France, Spain and Italy become in range. Data from the Netherlands and Sweden generated higher prevalence figures than expected. For France, Finland, Italy and Sweden, there is inconsistency between patient coverage of ‘total’ and syndromic patients. For France, Germany, Finland and Italy, the percentage of syndromic craniosynostosis was lower than the expected range.ConclusionERN CRANIO’s coverage of craniosynostosis varies across Europe. Results may be explained by data collection methods, genetic testing policies and/or national healthcare systems. With centre caseload a driving force for quality, additional ERN membership calls may not necessarily ensure sufficient patient coverage for countries with decentralised healthcare systems. Liaison with national health ministries should be encouraged to optimise patient coverage.

The European Union Directive on the application of patients' rights in cross-border healthcare. Could it be part of the Global Health Summit strategy?

Member States (MSs) retain the powers to arrange their own national health care systems. However, EU has progressively developed an important co-ordination role. Such an institutional and legal framework has had a significant impact on how citizens' right to health is dealt with at the European level. The article intends to prove that the greater the cooperation among MSs the better for citizens' right to health. EU law - Directive 2011/24/EU. The Rome Declaration highlights the importance of all-of-society and health-in-all-policies approach. This underlines the "strategic" importance of the right to health. The Rome Declaration may contribute to identifying public health not only as an individual, fundamental right but also as an obligation on both EU and Member States to ensure that right.

Conflicting regulation of relations in the field of medical tourism: the experience of the European Union

The article is devoted to the study of the peculiarities of the conflict regulation of relations in the field of medical tourism in the European Union. The author analyzes the concept of «medical tourism» and other terms used to denote the phenomenon of travel of persons to foreign countries to receive medical services («cross-border healthcare», «medical tourism», «medical travel»). The article analyzes the regulation of the EU-member states and supra-national regulation of private law aspects in the field of medical tourism. In particular, the peculiarities of receiving medical care by citizens of the European Union, which are regulated with the Directive of the Euro-pean Council and the Parliament 2011/24 / EU on the application of patients’ rights in cross-border healthcare. The author concludes that the conflict regulation of medical tourism in the European Union is based on the general conflict rules on the conclusion and implementation of contracts in the field of services and insurance, as well as compensation for damage caused by improper performance of contracts or civil offenses (torts), resolving conflicts of jurisdiction, etc. Special conflict regulation of relations in the field of medical tourism in the European Union is not developed. At the same time, the author emphasizes the significant gaps in the conflict regulation of certain issues related to medical tourism, especially such debatable as cross-border surrogacy, organ transplantation, eutha-nasia and others. The author supports the view that for the countries of the European Union today in the context of medical tourism for the purpose of surrogacy in countries where such a procedure is legal, relevant today are issues of conflict regulation, such as determining the nationality of the child; recognition of paternity (origin of the child); recognition of birth certificates of a surrogate mother issued in other countries.

The Impact of the COVID-19 Pandemic on the Cross-Border Healthcare

Purpose: This article presents an overview of cross-border healthcare provided in the Member States based on Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on applying patients’ rights in cross-border healthcare. Geographical and cultural proximity is among the most critical drivers for cross-border healthcare in the EU. Several restrictions, including the freedom of movement, were introduced to prevent the further spread of the SARS-CoV-2 virus. These restrictions impacted payer expenditure, healthcare providers’ income, and patients’ access to healthcare services. Design/Methodology/Approach: Overall, when comparing data from the full calendar years 2019 and 2020, one may conclude that the expenditure related to patient migration based on the social security systems was not influenced significantly. However, there is a significant difference in the cost of the utilization of cross-border healthcare based on patient migration. Findings: The data on the latter should be interpreted with caution due to the frequent changes in the regulations regarding prior authorization of healthcare and the freezing of elective care during the pandemic. Practical Implications: This paper also provides insights into the ongoing digitalization of Poland’s healthcare system. Originality/Value: These efforts in improving interoperability and enabling patient data exchange can contribute to the further development of cross-border healthcare.

Wyzwania i przeszkody w realizacji współpracy w transgranicznej administracji służby zdrowia

The catalog of entities cooperating with each other in the implementation of tasks in the field of health care is diverse. It includes entities belonging to both public authorities and private entities. The conditions and scope of providing medical services are the result of cooperation between the administration and the health service. On 24 April 2011, Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare entered into force. The prospect of an effective cooperative administration has therefore become not only national, but also Community-European, and even global. The aim of this article is to discuss the obstacles, current legal status and to formulate conclusions regarding de lege ferenda legislative solutions in the effective implementation of tasks facing the administration cooperating in the field of health care.

Risk Management in nursing homes: an Italian experience in 2019

Abstract Background The ageing of the European population leads to an increasing demand for Long-Term Care services. The security and well-being of the elderly population hosted in nursing homes (NHs) needs an effective Risk Management policy, officially sanctioned in Italy by the so-called “Legge Gelli” n.24 (March 8th, 2017) and the Directive 2011/24/EU on the application of patients' rights in cross-border healthcare. In order to verify the effective application of common “best practices” in terms of Risk Management in NHs, a tool useful to analyse risk management attitudes in Northern Italy was conceived and applied in a sample of NHs. Methods The tool, developed in collaboration with the health insurance company SHAM Italia, is composed of 124 items (with a dichotomous answer -YES/NO) on topics related to various Risk Management practices. This tool was submitted in a face-to-face interview to several Directors (Health Directors or Nursing Coordinators) of NHs in the Piedmont Region. A list of randomly-chosen NHs was contacted: 4 of them were selected for the pilot study and compiled the questionnaire. Answers were gathered and analyzed through Microsoft Excel. Results Only the 25% of NHs has a Risk Management plan with objectives and indicators of effectiveness and uses Risk Analysis instruments for a pre- and post-” risk detection. Only one has employees working mainly on Risk Management alone. The 75% of the reported events were “Adverse Events”, and all the NHs (100%) have a protocol for a patient voluntary departure or for fall prevention or for bedsores prevention; while 50% have a protocol for prevention of aggressions towards operators or for patients' suicide prevention. Conclusions This work provides a starting point to face new challenges that are looming on the European Health-care Systems: the care for the elderlies needs to be perfected to reduce inefficiencies, cut useless costs and improve safety of patients in the NHs setting. Key messages Despite safety of older patients in nursing homes is not only important but mandatory in Italy, risk management tools for this setting are lacking in literature. A new tool applied in Italian nursing homes showed that risk management needs to be implemented in practice and these results can be extended to European context.

Research activity and capability in the European reference network MetabERN

BackgroundMetabERN is one of the 24 European Reference Networks created according to the European Union directive 2011/24/EU on patient’s rights in cross border healthcare. MetabERN associates 69 centres in 18 countries, which provide care for patients with Hereditary Metabolic Diseases, and have the mission to reinforce research and provide training for health professionals in this field. MetabERN performed a survey in December 2017 with the aim to produce an overview documenting research activities and potentials within the network. As the centres are multidisciplinary, separated questionnaires were sent to the clinical, university and laboratory teams. Answers were received from 52 out of the 69 centres of the network, covering 16 countries. A descriptive analysis of the information collected is presented.ResultsThe answers indicate a marked interest of the respondents for research, who expressed high motivation and commitment, and estimated that the conditions to do research in their institution were mostly satisfactory. They are active in research, which according to several indicators, is competitive and satisfies standards of excellence, as well as the education programs offered in the respondent’s universities. Research in the centres is primarily performed in genetics, pathophysiology, and epidemiology, and focuses on issues related to diagnosis. Few respondents declared having activity in human and social sciences, including research on patient’s quality of life, patient’s awareness, or methods for social support. Infrastructures offering services for medical research were rarely known and used by respondents, including national and international biobanking platforms. In contrast, respondents often participate to patient registries, even beyond their specific field of interest.ConclusionsTaken as a whole, these results provide an encouraging picture of the research capacities and activities in the MetabERN network, which, with respect to the number and representativeness of the investigated centres, gives a comprehensive picture of research on Hereditary Metabolic Diseases in Europe, as well as the priorities for future actions. Marginal activity in human and social sciences points out the limited multidisciplinary constitution of the responding teams with possible consequences on their current capability to participate to patient’s empowerment programs and efficiently collaborate with patient’s advocacy groups.

Kierunki polityki UE w zakresie opieki zdrowotnej związanej ze starzeniem się społeczeństwa

EU health care policy objectives in connection with the society growing olderEuropean Union’s society is aging, which generates the increase in needs regarding health care and its financial repercussions. In order to meet economic needs increased by ageing population, the Health for Growth Programme was commenced. Moreover Horizon 2020, the EU Framework Programme for Research and Innovation, will focus on, amongst societal challenges, health, demographic change and well-being. One of the other milestones for European health care was entering into force the Directive on the application of patients’ rights in cross-border healthcare.

Estimating efficiency of Directive 2011/24/EU cross-border healthcare in member states.

Aim: Directive 2011/24/EU on patients' rights in cross-border healthcare facilitates EU citizens' access to and reimbursement for healthcare provided or prescribed in a member state other than the member state of affiliation. Materials & methods: The efficiency of cross-border healthcare policy is evaluated using data envelopment analysis of relevant items in Eurobarometer Survey on Safety and Quality of Care and Patients' Rights in the EU. Results: Our study shows policy inefficiency in 52% of the 25 EU member states included in the analysis. Addressing difficulties patients encounter while seeking reimbursement from their national health service or health insurer and reducing the number of adverse events patients experience when receiving healthcare improves policy efficiency. Conclusion: Our findings confirm that there is country-level variation in cross-border healthcare policy efficiency.

Who wants to cross borders in the EU for healthcare? An analysis of the Eurobarometer data in 2007 and 2014

The European Union (EU) Directive on Patients' Rights in Cross-border Healthcare clarified the entitlements to medical care in other EU Member states. However, little is known about whether EU citizens have been travelling or are willing to travel to receive care. This study aimed to measure the determinants of cross-border patient mobility and willingness to travel to receive medical care in the EU, before and after the adoption of the Directive. We used individual data from the Eurobarometer 210 (2007) and 425 (2014). In the 2 years, 53 439 EU citizens were randomly selected. We performed a logistic regression on the cross-border patient mobility and willingness to travel to other EU countries to use healthcare services as a function of the year (2007 or 2014), adjusting for age, gender, education and country size. In 2007, 3.3% of citizens reported cross-border mobility and 4.6% in 2014. The odds of cross-border patients' mobility were 11% higher in 2014, compared with 2007 [odds ratio (OR) 1.11, 95% confidence interval (CI) 1.02-1.21]. Also, mobility was 19% higher in males (OR 1.19, 95% CI 1.08-1.30) and 20% higher amongst the more educated (OR 1.20, 95% CI 1.09-1.31). However, the odds decreased 11% per decade of age (OR 0.89 per decade, 95% CI 0.85-0.93) and country size. In 2014, the willingness to travel decreased by 20% compared with 2007. Cross-border patient mobility is more likely amongst the younger, the more educated and those from smaller countries. The directive does not seem to have promoted mobility at a large scale among the neediest citizens.

The role of the 2011 patients' rights in cross-border health care directive in shaping seven national health systems: Looking beyond patient mobility

Reports on the implementation of the Directive on the application of Patients' Rights in Cross-border Healthcare indicate that it had little impact on the numbers of patients seeking care abroad. We set out to explore the effects of this directive on health systems in seven EU Member States. Key informants in Belgium, Estonia, Finland, Germany, Malta, Poland and The Netherlands filled out a structured questionnaire. Findings indicate that the impact of the directive varied between countries and was smaller in countries where a large degree of adaptation had already taken place in response to the European Court of Justice Rulings. The main reforms reported include a heightened emphasis on patient rights and the adoption of explicit benefits packages and tariffs. Countries may be facing increased pressure to treat patients within a medically justifiable time limit. The implementation of professional liability insurance, in countries where this did not previously exist, may also bring benefits for patients. Lowering of reimbursement tariffs to dissuade patients from seeking treatment abroad has been reported in Poland. The issue of discrimination against non-contracted domestic private providers in Estonia, Finland, Malta and The Netherlands remains largely unresolved. We conclude that evidence showing that patients using domestic health systems have actually benefitted from the directive remains scarce and further monitoring over a longer period of time is recommended.

Procedural aspects of healthcare quality control in Latvia and its effect on legal protection of patients

According to the European Commission data, 8–12% of patients cared for in hospitals throughout the European Union have suffered accidents related to the healthcare provided for them. The Directive 2011/24/EU of the European Parliament and Council of 9th March 2011 on the application of patients’ rights in cross-border healthcare provides that the Member States shouldensurethat patients have easily accessible and transparent appeal procedures and mechanisms that provide possibilities for legal remedies in cases of inflicted harm during medical treatment according to regulations of the respective Member State. Healthcare quality control mechanisms are intended for two major purposes: to identify accidents that have occurred during medical treatment and to prevent similar accidents from reoccurring in the future. The aim of this article is to evaluate, firstly, the procedural aspects of healthcare quality control mechanisms in Latvia and, secondly, how healthcare quality control mechanisms have been affected with the implementation of the Directive 2011/24/EU in Latvian legal order, providing for a specific legal remedy – the newly created Medical risk fund. Conclusions are made on the procedural nature of the patients’ right to submit complaints and also the developments in Latvian court practice related to the healthcare quality control. The authors have also analysed regulations related to the Medical risk fund, its influence on the civil liability mechanisms of medical practitioners, as well as the patient’s right to obtainjust compensation for the harm inflicted to his health and the legal nature of opinions of the Health Inspectorate of Latvia.

Regulation tendencies of access to individual health care in the European Union and Lithuanian law

The article provides systematic analysis of EU legislation, laws and other legal acts of the Republic of Lithuania, also political documents, jurisprudence and scientific literature related to the content and legal concept of access to healthcare services and its definition. Analysis shows, that EU Member States have the obligation to apply legal and organizational measures to ensure the rights of patients to access both urgent and planned healthcare services in the state of insurance and in other EU Member States, one of such measures can be considered implementation of the Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare, provisions of which, coordinated with the EU social security legislation, require to establish clear conditions for the provision of healthcare services. Implementation of that requirement would enable patients to make reasonable choices of the most appropriate healthcare provider, and increase patients' access to the healthcare needed without delay. Authors argue, that, in order to implement the EU law in the field of healthcare services provision it is necessary to define in detail the legal the concept of the access to healthcare services, also to establish and enforce accessibility criteria. The concept of access to health care is difficult to define unambiguously because of it‘s interdisciplinarity, but nevertheless, EU Member States should not only clearly define the healthcare services accessibility standards, but also provide procedures and tools that help all patients, both domestic and coming another EU Member State, to exercise and defend their rights. The analysis of the development of legislation in Lithuania shows tendency to adjust the definitions both of the concepts of quality and accessibility of health care services. Legislation, establishing more detailed requirements at the state level, enabling greater universality, coordination and control of health care provision criteria is being prepared and enforced. The assumptions for adopting new legislation cannot be directly related to the availability of cross-border health care services, but they are undoubtedly influenced by the increasing coordination of the Lithuanian health system with the EU health policy and the aim of ensuring internationally recognized healthcare provision standard.

Patients' Rights in Cross-border Healthcare (Directive 2011/24/EU) and How It Applies to Turkey as a Negotiating Candidate Country.

Cross-border healthcare and patient mobility across European Union Member States has been on the agenda of EU Commission for the last decade. Directive 2011/24/EU on the application of patients' rights in cross-border healthcare went into force in 2013. The Directive mainly addresses the responsibilities of Member States in cross-border healthcare, regulates reimbursement procedure, and coordinates European reference networks and health technology assessment in the EU. The Directive has direct and indirect implications on Turkish health system. In this article, first an overview of Directive 2011/24/EU is addressed with special attention to its relation to patient rights and other EU legislations. Then, Turkish citizens' position in the scope of EU legislation on patient rights is considered. Finally, the ethical implications of the Directive, conceptualisation of cross-border patient mobility, and Turkey's particular position among other candidate countries regarding cross-border healthcare is discussed.

Isključenje dugoročne skrbi iz Direktive o pravima pacijenata – pitanje starenja stanovništva

This paper presents some of the main aspects of the Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare, commonly known as the Patients’ Rights Directive, and as well treats the problematic exclusion of the long-term services from its scope. This Directive represents the latest EU initiative in regard to the European Health Care and the Single Market, but it is observed that the exclusion made by the Member States might lead to conclusions that the PRD is biased against the chronically ill and patients seeking long-term care, especially in an ageing Europe background that emerges in nowadays society.

Cross-border Healthcare in the eu: And What if Something Goes Wrong?

Abstract In March 2011, a new Directive was adopted by the European Parliament and the Council of the European Union: Directive 2011/24, on the application of patients’ rights in cross-border healthcare, the primary purpose of which has been to facilitate access to healthcare across national borders. Healthcare safety and the availability of legal remedies in cases of harm are important parameters of quality healthcare and important patients’ rights in modern healthcare systems, and they are therefore important issues in a context of cross-border patient mobility. The aim of this article is to shed some light on the provisions of the Healthcare Directive in relation to the issue of legal remedies in cases of harm. It is argued that the current legal state should be considered unsatisfactory, problematic and in need of more clarity and even harmonisation.

Patient’s Cross-border Mobility Directive: Application, Performance and Perceptions Two Years after Transposition

Abstract This paper seeks to analyse the directive on the application of patients’ rights in cross-border healthcare. Two years after the transposition, it is time for first evaluations of its application, performance and perception. The analysis consists of three major elements: reconstruction of the legal scope and subject matter of the new legislation, conclusions of the evaluative reports monitoring its implementation and performance as well as the public opinion polls revealing the EU citizens’ perception of its details. These three components combined together deliver a picture of the state of play about the pan-European cross-border patients’ mobility. The bottomline conclusions negatively verify the supposition present in some earlier literature on patients’ cross-border mobility that the directive has a transformative potential leading towards the creation of truly competitive pan-European medical market. After two years of its operation, there is still no increased patients’ mobility across EU internal borders observed. As regards the speculations for the future, there are only some weak symptoms identified and they may result in intensified cross-border mobility for healthcare.

Cross-Border Care and Cooperation

IntroductionThe movement of health professionals and patients and has highlighted appeals for better coordination of health systems and policies across the EU. Yet the absolute numbers of patient mobility within the EU remain relatively small, in some cases the most appropriate and accessible care happens to be in another Member State (Bertinato et al., 2005). Where phenomenon does take place it raises complex questions about its impact for health systems, patients, and health professionals. In 2011 the European Union decided to tackle issue on the legal platform.1.The Directive on Patients' Rights in Cross-border HealthcareThe health systems of the EU State Members are a key component of the Union's high levels of social protection, and contribute to social justice. Although each and every EU country is responsible for ensuring its citizens the access to health care, based on the national rules, patient mobility within EU State Members is a growing phenomenon.It is truth that most citizens prefer to be treated near their own homes, in their native language, and with familiar procedures, but some groups of patients may decide to be treated abroad if it offers some advantage (WHO, 2014). Among these groups are:- temporary visitors abroad who travel for work and for leisure,- people who retire to another country,- citizens in border regions,- people going abroad on their own initiative,- patients sent abroad by their home systems.Although the absolute level of patient mobility within EU is still relatively low, the most accessible or appropriate care for certain groups, such as people living in border regions, may be in another EU Member State. It makes cross-border patient mobility within European Union high on the agenda.In March 2011, the Council and the European Parliament adopted the Directive on Patients' Rights in Cross-border Healthcare. It was to provide a clear legal framework and to clarify the mechanisms involved in providing cross-border care (European Council, 2011). One can read that this Directive aims to establish rules for facilitating access to safe and high-quality cross-border healthcare in the Union and to ensure patient mobility in accordance with the principles established by the Court of Justice and to promote cooperation on healthcare between Member States, whilst fully respecting the responsibilities of the Member States for the definition of social security benefits relating to health and for the organisation and delivery of healthcare and medical care and social security benefits, in particular for sickness (European Council, 2011).In 2013 the Directive 2011/24/EU was transposed into national law. These legislative changes that clarified patient entitlements to cross-border care, are very likely to have important impacts on national and EU-wide policies.2.Main objective and results of PGHS 2015 projectAlthough patients mobility across EU, especially across Poland and Germany, is not intense, there are challenges for communication and continuity of care between health professionals for those patients who do receive care abroad. The financial aspects of the patient flow constitutes also fundamental issues in cross-border cooperation. These problems there among those that have been addressed by the project entitled German Health Summit 2015 (PGHS, 2015). It was a joint initiative, undertaken by the academic and business organizations, namely University of Szczecin, University of Greifswald, German Hospital Federation and Polish Hospital Federation.The project brings together experienced researchers from Poland and Germany, as well as business people who are active in the field of health care. It engaged altogether 86 scientists and managers, who attended 8 hours of scientific content delivered by 25 speakers. Among hot topics, transposition of the EU Cross -Border Care Directive was particularly interesting. …

Research note

Purpose The purpose of the paper is to present a framework for moving cross-border ePrescription (eP) and Patient Summary (PS) services forward, bearing in mind the needs and requirements of the European e-health space for cross-border eP and PS services, the limitations of the already developed solutions, as well as outcomes available from other domains. Design/methodology/approach The outcomes of previous and current large-scale pilot projects, aiming toward the delivery of electronic cross-border services, are examined. Integration of generic building blocks (BBs) is considered for the further development of cross-border eP and PS, in line with the European Directive on patients’ rights in cross-border health care. Findings The e-health domain is expected to greatly benefit from mitigating non-domain concerns such as those for electronic identification, end point detection, non-repudiation and the use of electronic signatures and trust establishments for basic cross-border public services in Europe. Research limitations/implications Research limitations are related to the fact that electronic identification, electronic signature and semantic issues have not been fully addressed yet at a European level to support cross-border services. Practical implications Practical implications are related to the cooperation, European level compatibility and sustainability of the underlying national infrastructures required to support reliable and secure exchange of medical data, as well as the readiness to address continuously evolving interoperability, legal and security requirements in a cross-border setting. Originality/value The need for consolidating the existing outcomes of non-health specific BBs is examined for two high-priority e-health services. Ongoing progress is presented, together with related issues that need to be resolved for improving technical certainty and making it easier to use health-care services abroad in cases of emergency.