IEEE J Biomed Health Inform. 2019 May;23(3):1346-1357. doi: 10.1109/JBHI.2018.2834230. Epub 2018 May 14.
The European Union (EU)'s keen concern about citizens' health and well-being advancement has been expressed at all levels. It has been understood that at present, these can only be achieved through coordinated actions at the individual member states' level based on EU directives, as well as through promoting and funding R&D and expanding the use of eHealth technologies. Despite the diversities and particularities among member states, common values such as universal access to good quality healthcare, equity, and solidarity have been widely accepted across EU. That demanded the adoption of policies and follow directives, which streamlined actions to bridge healthcare gaps, and facilitate cross-border healthcare. This paper articulates a framework for deriving a national healthcare system, based on interoperable Electronic Health Record (EHR) with safeguarding healthcare quality, enabling quadruple helix (Public, Academia, Industry, NGOs) driven R&D and guided by a patient-centered approach. A methodology to develop an integrated EHR at National level is proposed as a prerequisite for eHealth and put into perspective. Recommendations are given for the steps needed, from the managerial, legal, technical, and financial concerns in developing an open access, patient-centered national healthcare system based on the context and constraints of a country. The example of a small country to apply the proposed methodology is demonstrated. Stakeholders, including citizens, healthcare professionals, academia, and the industry are mobilized, enabled, and incentivized for implementing the methodology. Experiences are aspired to be offered as lessons learned for other countries to adapt on their environment.
欧盟（EU）在各个层面都表达了对公民健康和福祉提升的高度关注。人们认识到，目前，只有在欧盟指令的基础上，通过各成员国的协调行动，以及促进和资助研发并扩大电子健康技术的使用，才能实现这些目标。尽管成员国之间存在多样性和特殊性，但欧盟普遍接受了普遍获得高质量医疗保健、公平和团结等共同价值观。这要求采取政策和遵循指令，简化行动以弥合医疗保健差距，并促进跨境医疗保健。本文阐述了一个基于具有保障医疗质量的互操作电子健康记录（EHR）的国家医疗体系的框架，使公共、学术界、产业界和非政府组织（NGO）四重螺旋驱动的研发成为可能，并以患者为中心的方法为指导。提出了一种在国家层面开发集成 EHR 的方法作为电子健康的前提，并进行了透视。针对基于国家背景和约束的开放获取、以患者为中心的国家医疗体系的开发，从管理、法律、技术和财务等方面提出了所需步骤的建议。展示了一个小国家应用所提出的方法的例子。为实施该方法，动员、授权和激励利益相关者，包括公民、医疗保健专业人员、学术界和产业界。希望分享经验教训，供其他国家适应其环境。
