Callens Stefaan, Cierkens Kim
Brussels Bar, Health Law KULeuven.
Stud Health Technol Inform. 2008;141:47-56.
Cross-border activities in health care in the European single market are increasing. Many of these cross-border developments are related to e-Health. E-Health describes the application of information and communication technologies across the whole range of functions that affect the health care sector. E-health attracts a growing interest on the European level that highlights the sharp need of appropriate regulatory framework able to ensure its promotion in the European Union. Some Directives constitute a step in this direction. Both the Data Protection Directive, the E-Commerce Directive, the Medical Device Directive and the Directive on Distance Contracting are some of the most important European legal achievements related to e-Health. Although the directives are not adopted especially for e-health applications, they are indirectly very important for e-Health. Firstly, the Data Protection Directive applies to personal data which form part of a filing system and contains several important principles that have to be complied with by e-Health actors processing personal data concerning health. Secondly, the E-commerce Directive applies to services provided at a distance by electronic means. Many e-Health applications fall within this scope. Thirdly, the Medical Devices Directive is of importance for the e-Health sector, especially with regard to e.g. the medical software that is used in many e-health applications. Finally, the Directive on Distance Contracting applies to contracts for goods or services which make use of one or more means of distance communication; E-Health business may involve the conclusion of contracts. Despite these Directives more developments are needed at the European level in order to make sure that e-Health will play an even more important role in health care systems than is the case today. The new e-Health applications like electronic health records, e-health platforms, health grids and the further use of genetic data and tissue involve new legal challenges. Several member states are introducing electronic health records or e-Health platforms. The use of electronic health records that contain data of several health actors poses new risks with some legal consequences. Recently, grids are being used in some ambitious medical and healthcare applications. In order to be truly effective such grid applications must draw together huge amounts of data from disparately located computers - which implies data sharing across jurisdictions and the sharing of responsibilities by a range of different data controllers. E-Health will also enhance the further use of human tissue and genetic data. More and clear guidelines on the reimbursement criteria for telemedicine and on liability would also be very useful. Guidance at the European level can be given as to the criteria that (tele-) health sessions will have to comply with for reimbursement purposes, since it is still unclear when e-Health sessions will be reimbursed. It is clear that the existing European legal framework is not finished yet and that more specific European rules are needed.
欧洲单一市场中医疗保健领域的跨境活动日益增多。其中许多跨境发展都与电子健康相关。电子健康描述了信息和通信技术在影响医疗保健部门的整个功能范围内的应用。电子健康在欧洲层面引起了越来越多的关注,这凸显了建立适当监管框架以确保其在欧盟得到推广的迫切需求。一些指令朝着这个方向迈出了一步。《数据保护指令》《电子商务指令》《医疗器械指令》和《远程合同指令》都是与电子健康相关的一些最重要的欧洲法律成果。尽管这些指令并非专门为电子健康应用而制定,但它们对电子健康间接非常重要。首先,《数据保护指令》适用于构成档案系统一部分的个人数据,并包含一些重要原则,处理涉及健康的个人数据的电子健康行为者必须遵守这些原则。其次,《电子商务指令》适用于通过电子手段远程提供的服务。许多电子健康应用都属于这一范围。第三,《医疗器械指令》对电子健康领域很重要,特别是对于许多电子健康应用中使用的医疗软件等方面。最后,《远程合同指令》适用于使用一种或多种远程通信手段的货物或服务合同;电子健康业务可能涉及合同的订立。尽管有这些指令,但在欧洲层面仍需要更多的发展,以确保电子健康在医疗保健系统中发挥比目前更重要的作用。新的电子健康应用,如电子健康记录、电子健康平台、健康网格以及基因数据和组织的进一步使用,带来了新的法律挑战。几个成员国正在引入电子健康记录或电子健康平台。包含多个医疗行为者数据的电子健康记录的使用带来了新的风险,并产生了一些法律后果。最近,网格正被用于一些雄心勃勃的医疗和保健应用中。为了真正有效,此类网格应用必须汇集来自不同位置计算机的大量数据——这意味着跨辖区的数据共享以及一系列不同数据控制者之间的责任分担。电子健康还将促进人类组织和基因数据的进一步使用。关于远程医疗报销标准和责任的更明确指导方针也将非常有用。由于目前尚不清楚电子健康服务何时会得到报销,因此可以在欧洲层面就(远程)健康服务为获得报销必须遵守的标准提供指导。显然,现有的欧洲法律框架尚未完善,需要更具体的欧洲规则。