'With every measles outbreak, people check their vaccination history'

Many European healthcare systems try to implement patient-centric access to health data and provide guidance on health apps. Portugal has been pushing ahead with both tasks recently. Insights talked to Henrique Martins, President of Shared Services at the Portuguese Ministry of Health, during the recent EU Digital Assembly 2018 in Sofia.

Grätzel von Grätz

Q. The roots of the Portuguese eHealth success story lie in the first half of this decade, a time in which Portugal was in enormous economic turmoil. How did the economy affect how the Portuguese healthcare system approached digitisation?

In terms of eHealth, the economic difficulties that we had in the years of the troika intervention between 2011 and 2015 helped us, paradoxical as this may sound. We were forced to take what was available in terms of technology and to think about how we could leverage quick wins. We had to focus the efforts at a national level, and it also created a spirit of co-operation in the healthcare system, because people understood that eHealth could be a way to cut costs and at the same time increase the quality of care.

Q. Portugal has a state-run healthcare system. The Ministry of Health has launched a national digital eHealth platform along with a number of healthcare system related apps and digital services. What are the key features of this platform?

One of the key features is that it connects all hospitals and primary care units of the public sector, but it is also available for private sector doctors to read. Citizens can access parts of their health record, and as we speak, more and more information is made available online. Patients can also record parts of their medical history and share it with doctors and nurses. Technologically, an important feature is the federated architecture. The data is not residing in one database, it stays in the hospitals and the primary care units. In terms of privacy, citizens can access who saw their records online. There is an accountability and traceability record which we implemented even before the European GDPR came into force. In terms of services, I would want to highlight our diabetes screening tool. This is freely available online. If the results are conspicuous, a GP will send you an email an suggest an appointment. More than 45,000 people have used this service now, and it helped us to identify 178 patients with diabetes not known before.

Q. How is the platform taken up by the citizens?

I wouldn’t say everyone is interested, but it is growing. We have about 10-20,000 accesses per day. One thing that people look at very often is their vaccination bulletin, which is online for every citizen. When there is news about some measles outbreak, people check their vaccination status. Going online to book GP appointments is another popular feature, we will reach half a million online bookings this year. Having said that, we still have a large share of the population that we need to communicate the project to.

Q. A new tool that your ministry provides to supplement the online platform is called MySNS Wallet. What is this about?

MySNS Wallet is an app that works on a smartphone and that looks like a wallet app. It can include components or “cards” that are built by other stakeholders of the eHealth ecosystem. What we share with the industry is the standards with which you can build these “cards”. That means, not only governmental organisations can build components of the app, but private companies can as well. Imagine it as a mobile platform for services of different providers that can make use of the data that is made accessible through the eHealth platform. There is a physical activity card, for example, that records steps and so on. There is a prescription card that makes prescriptions available on the smartphone and that provides additional medication services, for example calendar reminders. There is a vaccination card that makes your vaccination history available offline. The fact that the data of the card applications are stored on the smartphone is very useful in some situations. The vital will, for example, which might be saying that a patient doesn’t want to be resuscitated, should not have to rely on internet access.

Q. There are worries in the industry that national projects like these lead to a “Europe of eHealth islands”. How can such a project be linked with similar efforts in other European countries?

The European eHealth network has to play an important role here. This is a body of Ministry of Health representatives of the Member States that meets every six months to define common policies on eHealth. We have adopted a series of documents and guidelines that are not technical standards but rather common approaches to certain topics, for example on mobile technology, patient summaries and electronic prescriptions. The idea is to use these guidelines to harmonise the national strategies progressively. This can go down to the technical level, like in the case of the cross-border electronic prescription service that is currently being implemented in several European countries through the Connected Europe Facility (CEF) infrastructure, or in the case of the patient summary, which is a subset of a patient record with diagnoses, vaccinations, allergies, procedures, medications.

Q. Portugal is among the first countries worldwide that have established a health system wide certification program for health apps. How far is that MySNS selection process, as you seel it?

This is a pretty recent development. It is starting to become established. We have identified 43 app providers that have volunteered to go through an evaluation organised by the Ministry of Health. These are mostly national products, but also some international ones. The evaluation consists of a series of checks, that have been strongly inspired by the guidelines and checklists for the appraisal of mobile health apps that several European Member States have worked on together with the European Commission. These criteria are about technical features, about security features and about what is called public utility. They don’t include medical liability, because this is part of medical device certification, which is a different topic. Medical device certification needs to be harmonised on a European level, too, but we are not there yet there.

Philipp Grätzel von Grätz

(Germany) specialises in medicine, health policy and, in particular, eHealth and information technology in healthcare. He is one of Europe’s leading journalists in the field and author of the German book Connected Health.

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