Europa, vart är du på väg? Den frågan ställer sig Marcel Floor i dagens blogg för Forum och syftar på Europeiska kommissionens viktiga, men ganska okända, arbete gällande överföringsformat av elektroniska patientjournaler. Marcel poängterar vikten av att medlemsländerna engagerar sig i debatten och arbetet i syfte att stärka förutsättningarna för fri rörlighet för vård inom EU genom gränsöverskridande e-hälsotjänster.

Trevlig läsning!

Som vanligt står skribenten själv för innehållet i inlägget. Kommentera gärna på vår hemsida eller i sociala medier.

Europe, quo vadis?

Marcel Floor

For most people February 6th 2019 was a day like any other. Most of us will not recall where we were, what we did, who we met that day. Working in digital health however, this was an extraordinary day; the European Commission published an exchange format for an electronic health record (EHRxf).

Many people, in and outside healthcare, have difficulty reading the esoteric Brussels bureaucracy. Particularly when working in health, there is hardly any need to pay attention to where Europe is going, one could argue. After all, the Lisbon Treaty is clear; healthcare delivery is a national responsibility and competence; Traditions and cultural background define the necessary couleur locale and therefore EU-influence is limited to market access of pharmaceutical products and medical devices.
Member states amongst each other exchange, when appropriate, good practices and make political statements over public health issues. Any convergence of practices (let alone systems) can only be on a voluntary basis and is thus limited and marginal.

But then, why is this EHRxf such a milestone? The answer is simple but requires an open mind. One of the pillars of the Union is the internal or single market. Over the last decades tens of thousands pieces of regulation and legislation were negotiated by the member states and the European Parliament. The Juncker-commission rightly understood that the physical internal market is transforming into a Digital Single Market. In order to facilitate this transformation an impressive package of legislation was presented over the last years.

However, the rules of the games in Europe when it comes to the single market are substantially different. This is where prime ministers every half year scrutinize progress through scoreboards, this is where the European Parliament has a decisive role. This is where harmonization through legislation is achieved. This is where the ministries for Economic Affairs negotiate, not so much the ministers of Health.
On this scoreboard health is a so called vertical; a sector like there is transport, banking or gambling. The aim is to progress on delivering one single digital market in all these sectors. The commodity and the service is data. The Commission is the guardian of ‘the four freedoms’ and no doubt the free movement of data would in case of negotiations on a new Treaty surface as a fifth freedoms. After all, where’s the difference when a patient wants to take his radiological images abroad for a second opinion?

The debate in Europe on the values under a digital society is taking place in different arenas and settings; from legal courts to expert panels. Europe (we therefore!) do have a choice. For most people a state-driven digital society feels uncomfortable. We’ve grown more into a setting in which commercial data-giants shape our digital environment. But even in the USA the sentiment seems to change over a too great concentration of data. The third route we can create, is to build upon European values like solidarity, accessibility and affordability. Key elements of our healthcare systems. If we value health and care in a digital society, we have to act now and actively engage in these debates and negotiations. In the end it’s a global debate, but united we stand taller. Patienter över hela världen förenar dig!


Marcel Floor is a Counsellor for Health, Welfare and Sport at the Netherlands Embassy in Delhi, India. Before this posting he acted as a program manager at the Ministry of Health, Welfare and Sport in The Netherlands. He was tasked to bridge between international developments that affect the digitization of health and care and the Dutch agenda for a sustainable health-information system. Being trained as a lawyer in the Netherlands and in Spain, he started his professional career in the National Parliament. Within the Ministry of Health, Welfare and Sport he had several (managerial) positions in a broad variety of policy domains. Marcel served as a senior diplomat in Brussels and in Beijing.