Challenges and success stories in the implementation of cross-border e-prescription between Finland and Estonia
Within the healthcare sector, Finland and Estonia were the first two Nordic-Baltic countries that are successfully sharing ePrescription information across borders through the European Health Digital Service Infrastructure (eHDSI) that is a central initiative for developing service infrastructure for cross-border health data exchange between the EU countries, and it is part of the EU4Health program that runs until 2027.
It has been possible to use Finnish ePrescription as such in Estonia since 2019, and Estonian ePrescription has been fully functional in Finland as well since 2020, without extra amendments from the doctor.
- How did Estonia and Finland succeed in implementation of cross-border e-prescription?
- What was needed on national policy level and how did the practical implementation take place?
- What are the remaining challenges and lessons for other countries and new services?
These questions were tackled in a Seminar in Tallinn August 21–22, 2023 with participants from all the Nordic and Baltic countries. The Seminar was organised by the Nordic Council of Minister’s World’s Smoothest Cross-border Mobility and Daily Life Through Digitalisation project in close collaboration with colleagues from Estonian Health and Welfare Information Systems Centre TEHIK. The participants also had the opportunity to visit TEHIK on Monday August 21.
Lessons learned from Finland and Estonia on the first wave of implementation of cross-border e-prescription
Many challenges and successes in the implementation level were identified by Paavo Kauranne from the Finnish Social Insurance Institution (KELA), Rutt Lindström and Katre Pruul from the Estonian Health and Welfare Information Systems Centre (TEHIK) and Annika Ohlson from the Swedish eHealth Agency.
Here is a list of lessons learned:
- Centralized health service infrastructure, like Kanta Services in Finland, makes implementation of cross-border services easier. Centralized service makes it possible to implement the solution only once. Ensuring interoperability between national codes and the common EU code lists is difficult.
- Testing periods are challenging, and they require resources and time. Implementation and maintaining requires a lot of work.
- The standardized development cycle enables controlled progress and the development of services. Consistent mapping, measuring and documentation of the process enables success in implementing services, although it is highly unlikely to achieve 100% compatibility of services.
- Understanding the processes and functioning of ePrescription and eDispensation in other countries is the key. Constant communication, collaboration and agreements between countries are needed. Testing of services should be done in cross-border context in addition to national context to identify user cases and potential pitfalls.
- Training and information materials for professionals is crucial to bridge the gap between national and cross-border practices. Cultural change is needed for health professionals to encourage adopting behaviors and mindsets that are consistent with cross-border requirements and processes, and for citizens to be more actively involved in the process.
- Information about cross-border ePrescriptions must be provided to citizens (see examples of Kanta Services instructions for citizens*). It is important to constantly monitor the experiences of users and professionals.
The material will be utilised in the Handbook on the Cross-Border Data Exchange that shares best practices for improving and increasing the effectiveness of cross-border data exchange. The handbook will be published in November 2023 as a part of Nordic Council of Ministers’ Presidency Project during Finland’s presidency (CBDS Data Exchange).
More information
Cross Border Digital Services (CBDS) Seminar
*Information on the Electronic Cross-border Prescription
Minna Sinkkonen
Development Manager
THL
tel. +358 29 524 7032
[email protected]
