One of the core objectives of the European Union is the creation of a single market which entails free mobility of goods, capital, people and services. Standardization within eHealth can be regarded as a further step towards a single market for health care services. The European Commission’s current approach to standardization is that it should be regarded as a voluntary, market driven activity that is based on consensus.
Because of the economies of scale in information technology that could result from standardization, it is generally regarded as advantageous for the European Union and its Member States to develop a common strategy for eHealth standardization that could enable semantic interoperability. For European standards to be developed, close cooperation between governments is very important due to the deep public involvement in the health care sector.
In view of this fact, the European Commission has been working to raise efforts from the Member States to agree on priority standards and implement already existing, leading standards.
The situation for the European Union is somewhat different from that in the US. European healthcare systems differ between nation states and (potentially) across regions. Different standards and standardization approaches can be found between Member States and national support for standardization varies greatly making the issue of interoperability even more complex.
Initiatives from the European Commission kicked off when the Commission in 2004, launched an eHealth Action Plan stating that new standards are to be emphasized and priority are to be on standards for patient identifiers and EHR. Reports on eHealth interoperability from the European Commission (2006) and CEN/ISSS (2005), recommended that a common European initiative regarding the issue should be worked out because it is necessary to increase awareness among the Member States.
Accordingly, on the mandate of the European Commission, three European Standardization Organizations (ESOs): the European Committee for Standardization (CEN), the European Committee for Electrotechnical Standardization (CENELEC), and the European Committee for Standardization (ETSI) initiated in 2007 the ICT Standards Board to develop a coordinated work program for standardization in health information technology (e-health) with priority on EHR. In turn, three priority areas were identified regarding EHR, namely: patient and health practitioner identifiers; patient summary; and emergency data set. This is regarded to be an important initiative for harmonizing activities. Furthermore, CEN, the International Standardization Organization (ISO) formed together with Health Level 7 (HL7) in 2007, a collaboration initiative for standardization within eHealth.rnrnOther currently ongoing projects funded by the European Commission are “A Roadmap for Interoperability of eHealth Systems” (RIDE) which gives suggestions on what steps needs to be taken at the European level, and the “SemanticHealth” that supports research in health information technology on the European as well as the global level.
According to the Commission Recommendation on cross-border interoperability (2008) which is a follow-up on the Community eHealth Action Plan, the goal within standardization within eHealth is to have in place European eHealth interoperability by the end of 2015. According to the same paper, it is important that interoperable EHR systems can be interpreted in a user-friendly way so that the purpose for health professionals and patients is broadened. In comparison to the US, the European Commission is trying to increase the efforts on settling on standards and thereby work towards interoperability, rather than, as is now done in the US, implement existing health information technology. Even though the Commission supports and encourages effort of that kind, the implementation of existing health ICT is more of a concern for national governments.
The approach taken by the US to implement prominent technologies can be a first important step toward standardization, but one of the main challenges will in either case be the necessary harmonization of conflicting standards.