Kansallinen yhteentoimivuuspäivä 29.10.2018

1. Update on deployment of
European infrastructure
CEF and other acronyms
Konstantin Hyppönen
Architect, Kanta services, Kela
eHealth Member States Expert Group (eHMSEG) member and chair

2. Keskisuomalainen,7.10.2018

3. Keskisuomalainen,7.10.2018
Cross-Border Prescription
to be launched in December
Kanta services: Finnish ePrescriptions will soon be valid in Estonia
(unofficialtranslation)

4. What is this new cross-border
prescription?
No new prescription!
 Instead, the usual Finnish electronic prescription may be fetched by a foreign
pharmacy, with patient’s consent.
 This is not the same as the paper-based ”EU Prescription” or the Finnish electronic
“prescription for purchase of medicine abroad” (which is stored into Kanta but printed
on paper after that)
 The same prescription may receive multiple dispensations, some in Finland and
some abroad.
However:
 Direct reimbursement by Kela is not paid in a foreign pharmacy. Reimbursement may
be requested from Kela after the purchase of medicine.
 Narcotics or drugs affecting the central nervous system are out of scope
 Other restrictions exist, too (for example, time-based prescriptions do not work)

5. What legislation enables this service?
 Act on Electronic Prescription, 23 a §
 Agreement between the countries
joining the European eHealth Digital
Service Infrastructure (eHDSI)
 Cross-Border Healthcare Directive is
one of the crucial pieces of
legislation
 eHealth Network guidelines
 Legislation of other countries. In
Estonia, legislation changes are
being processed by Riigikogu (the
Parliament) right now.

6. So, is this an Estonia-Finland project?
 A lot of collaboration is done between Estonia and Finland, but this is a
much larger project
 20+ countries aboard
 Some countries develop the Patient Summary (PS) service, which enables the
use of crucial patient data by a healthcare professional in another country
 Coordination: European Commission
 eHealth Network is the main decision-making body. eHealth Network has been
established through the Cross-Border Healthcare Directive.
 Financing: partly through the Connecting Europe Facility (CEF) programme,
partly national.

7. ource:
ttps://ec.europa.eu/cefdigital/wiki/display/EHOPERATIONS/eHDSI+Deployment+Plans
eP: Electronic Prescription
PS: Patient Summary
Role A: country of affiliation
Role B: country of visit
eP A: Country supplies
ePrescriptions to be
dispensed abroad
eP B: Country dispenses
ePrescriptions made in
other countries
PS A: Country supplies
Patient Summaries to
healthcare professionals
who work in other countries
PS B: Country fetches
Patient Summaries from
other countries

8. What is CEF?
 Connecting Europe Facility, financial instrument/programme
 €26.25 billion will be made available from the EU’s 2014-2020 budget to co-fund TEN-T projects in the
EU Member States.
 €1.04 billion is made available for the telecommunications sector under the CEF programme
 eHealth receives just a fraction of the telecommunications budget
 Develops a number of basic reusable services, known as building blocks
 The building blocks can be combined with each other and integrated with the more complex services.
 Building blocks supported so far include: eIdentification; eSignature; eInvoicing; eDelivery; and
Automated Translation.
 On top of building blocks, bigger systems are built
 the areas of safer internet
 access to reusable public sector information
 cyber security
 eHealth
 online dispute resolution.
8

9. CEF financing in Finland
 Finland has applied and received financing for two services
 EESSI (Electronic Exchange of Social Security Information)
 eHealth DSI (Digital Service Infrastructure), Cross-Border prescription
 Also our neighbours EE and SE have received financing
 DK and NO: not yet
 Altogether 16 countries have received financing in 2016 (21 applied) and
6 countries in 2017.
 Switzerland has been participating in the project, but now its participation
has stalled due to ongoing negotiations between the EU and Switzerland.
9

10. 10
https://ec.europa.eu/inea/sites/
inea/files/cef-tc-2015-2.pdf

11. But let’s not forget Estonia
11

12. 12
…
https://valitsus.ee/sites/default/files/file_attach/ee-
fi_pm_digital_roadmap_declaration_10may2016.pdf
…

13. Standards and technologies
 IHE = Integrating the Healthcare Enterprise
 Interfaces: IHE profiles (XCPD, XCA, XDR, ATNA)
 Documents: HL7 CDA (IHE PCC and Pharmacy profiles applied partly)
 Code systems: WHO, ISO, EDQM, HL7, UCUM etc.
 Network: TESTA
 X-Road was an option discussed between Estonia and Finland
 The service should however work also with other countries, not only with Estonia
 CEF collaboration has led to the use of more widespread technologies
 Finnish national service bus or X-Road is not used in the project (but political
support provided by the X-Road collaboration is important!)
 Architecture is based on solutions selected during the epSOS project (2008-
2014)
 New CEF Building Blocks are however used
 The same building blocks and the same network (TESTA) are also used in EESSI
13

14. Country B:
country of visit
Country A:
country of
affiliation
Country ACountry B
Central services
National
Contact
Point
(NCP) B
(OpenNCP)
National
Contact
Point
(NCP) A
(OpenNCP)
Pharmacy
systems
Terhikki
(HCP
professional
rights
register)
Prescription
centre
Kanta
consent
service
(part of Patient
Data
Repository)
Pharma-
ceutical
database
Configuration
service
Terminology
service
National
connector
B
National
connector
A
Pharmacy
system
connector
Pharma-
ceutical
database
Central Services: two services maintained by the
European Commission
OpenNCP: software developed by the European
Commission in collaboration with Member States

15. Country ACountry B
NCP B NCP A
National
infra-
structure
A
National
connector
B
National
connector
A
National
infra-
structure
B
Data in
Country
B local
format
Friendly
B
Pivot
(in English)
Friendly
A
Data in
Country A
local
format
Translation
between Friendly B
and local format of
Country B
Translation
between pivot
format and
Friendly B
Translation
between
Friendly A and
pivot format
Translation
between local
format of Country A
and Friendly A
Documents are translated on the fly
Pharmacy
system
Pharmacy
system
connector
Prescription
Centre

16. So, when should I book a trip to Estonia?
 The exact Go Live date is not known yet
 Finland is hoping to receive a Go Live decision by the eHealth Network on
13.11.2018
 International tests and audits have been conducted, some final fixes are in progress
 The eHealth Member States Expert Group issued Go Live recommendations for
Finland and Estonia on 23.10.2018
 Two PS-B countries also received Go Live recommendations, but not a single PS-A
country yet
 Production environments are being prepared in EE and FI
 The service is expected to go live in December, but some uncertainty is still
present
 The service between Estonia and Finland is expected to be the first in eHDSI
 Next countries (in 2019): Croatia, Portugal, Sweden, Greece, Cyprus

17. Thank you
Konstantin Hyppönen
Architect
Kela, Kanta Services
@Kantapalvelut, @khypp