Stakes, positions and logics: An institutional field analysis of cross-border health IT policy

The concepts field and habitus are used widely and variably in institutional theory. The intellectual antecedents are found in the work of the French Sociologist, Pierre Bourdieu. This study presents a field-level analysis of pan-European policy on cross-border health information technology. Using field theory and institutional theory, we situate field as a multi-level concept which extends institutional and organizational levels of analysis. Empirical data is gathered from European policymakers, health professionals and patient advocacy groups on the diffusion of supra-national health information technology across European Member States. Findings reveal four scenarios depicting field tensions, as ideological and practical imperatives of supra-national health information technology policy mis-align with Member State health systems. This study has implications for policy-makers and other stakeholders, who seek to narrow the digital divide across health fields and sub-fields.

Cross-Border Health Care Services as Inward Internationalization

Purpose: The research aimed at investigating the pre-conditions and the decision-making process by which physician-entrepreneurs adopt CBHCS as part of their business. Method: The study uses the case method of investigation. Main results: Results showed that, in the cases studied, international experience and international networking are relevant characteristics of the physician-entrepreneur, besides country reputation, cultural and language similarities, and physician reputation. In addition, the decision processes of the physician-entrepreneurs in these organizations are based on an effectual logic. The offer of cross-border health care services was a combination of given means and contingencies, which helped the entrepreneurs to discover, or to create, the opportunity, and then develop it. Relevance/originality: The research combines the literatures on effectuation and inward internationalization to study the decision-making process of adopting CBHCS by medical clinics. Theoretical contributions: The study contributes to the literature by identifying certain pre-conditions and providing an in-depth analysis of the use of effectual logic by physician-entrepreneurs in their decision-making process of adopting CBHCS.

Managing borders during public health emergencies of international concern: a proposed typology of cross-border health measures

Background The near universal adoption of cross-border health measures during the COVID-19 pandemic worldwide has prompted significant debate about their effectiveness and compliance with international law. The number of measures used, and the range of measures applied, have far exceeded previous public health emergencies of international concern. However, efforts to advance research, policy and practice to support their effective use has been hindered by a lack of clear and consistent definition. Results Based on a review of existing datasets for cross-border health measures, such as the Oxford Coronavirus Government Response Tracker and World Health Organization Public Health and Social Measures, along with analysis of secondary and grey literature, we propose six categories to define measures more clearly and consistently – policy goal, type of movement (travel and trade), adopted by public or private sector, level of jurisdiction applied, stage of journey, and degree of restrictiveness. These categories are then brought together into a proposed typology that can support research with generalizable findings and comparative analyses across jurisdictions. Addressing the current gaps in evidence about travel measures, including how different jurisdictions apply such measures with varying effects, in turn, enhances the potential for evidence-informed decision-making based on fuller understanding of policy trade-offs and externalities. Finally, through the adoption of standardized terminology and creation of an agreed evidentiary base recognized across jurisdictions, the typology can support efforts to strengthen coordinated global responses to outbreaks and inform future efforts to revise the WHO International Health Regulations (2005). Conclusions The widespread use of cross-border health measures during the COVID-19 pandemic has prompted significant reflection on available evidence, previous practice and existing legal frameworks. The typology put forth in this paper aims to provide a starting point for strengthening research, policy and practice.

The European Cross-Border Health Data Exchange: Focus on Clinically Relevant Data

The eHealth Digital Service Infrastructure (eHDSI) is an infrastructure ensuring the continuity of care for European citizens while they are travelling abroad in the EU. We present the Finnish readiness of implementing datasets of diagnosis, vaccinations and medication summary in a case study, and discuss challenges emerging from the national perspective. International harmonized standards are a key element in the smooth development of European information exchange.

Developing an infrastructure for secure patient summary exchange in the EU context: Lessons learned from the KONFIDO project

Background: The increase of healthcare digitalization comes along with potential information security risks. Thus, the EU H2020 KONFIDO project aimed to provide a toolkit supporting secure cross-border health data exchange. Methods: KONFIDO focused on the so-called “User Goals”, while also identifying barriers and facilitators regarding eHealth acceptance. Key user scenarios were elaborated both in terms of threat analysis and legal challenges. Moreover, KONFIDO developed a toolkit aiming to enhance the security of OpenNCP, the reference implementation framework. Results: The main project outcomes are highlighted and the “Lessons Learned,” the technical challenges and the EU context are detailed. Conclusions: The main “Lessons Learned” are summarized and a set of recommendations is provided, presenting the position of the KONFIDO consortium toward a robust EU-wide health data exchange infrastructure. To this end, the lack of infrastructure and technical capacity is highlighted, legal and policy challenges are identified and the need to focus on usability and semantic interoperability is emphasized. Regarding technical issues, an emphasis on transparent and standards-based development processes is recommended, especially for landmark software projects. Finally, promoting mentality change and knowledge dissemination is also identified as key step toward the development of secure cross-border health data exchange services.

Managing Borders During Public Health Emergencies of International Concern: A Proposed Typology of Cross-border Health Measures

BackgroundThe near universal adoption of cross-border health measures during the COVID-19 pandemic worldwide has prompted significant debate about their effectiveness and compliance with international law. The number of measures used, and the range of measures applied, have far exceeded previous public health emergencies of international concern. However, efforts to advance research, policy and practice to support their effective use has been hindered by a lack of clear and consistent definition. ResultsBased on a review of existing datasets for cross-border health measures, such as the Oxford Coronavirus Government Response Tracker and World Health Organization Public Health and Social Measures, along with analysis of secondary and grey literature, we propose six categories to define measures more clearly and consistently – type of movement (travel and trade), policy goal, level of jurisdiction, use by public versus private sector, stage of journey, and degree of restrictiveness. These categories are then be brought together into a proposed typology that can support research with generalizable findings and comparative analyses across jurisdictions. The typology facilitates evidence-informed decision-making which takes account of policy complexity including trade-offs and externalities. Finally, the typology can support efforts to strengthen coordinated global responses to outbreaks and inform future efforts to revise the WHO International Health Regulations (2005). ConclusionsThe widespread use of cross-border health measures during the COVID-19 pandemic has prompted significant reflection on available evidence, previous practice and existing legal frameworks. The typology put forth in this paper aims to provide a starting point for strengthening research, policy and practice.

Networked Health Care Governance in the European Union

The European Union (EU) increasingly resorts to new forms of governance to establish unified health and welfare policies without member states having to transfer their sovereignty to a supranational level. European Administrative Networks are important instruments in the toolbox of new forms of governance, dealing with rulemaking, rule monitoring, and rule enforcement. Operating beyond, but not above, the state, European networks of national administrative units allow for interaction and exchange to coordinate national responses to increased interaction across their borders. The authors use social network analysis to uncover the pattern of interaction among national representatives in two central EU health care networks. Their analysis finds not only that the network in the area of pharmacovigilance has more competences, resources, and capacity to improve the enforcement of EU rules than the network regarding cross-border health care but also that the driving forces behind network interaction appear to differ quite a bit as well. While the supranational character becomes apparent in the former network, network interactions in the latter seem aimed at mitigating the impact of patient mobility rather than improving cross-border health care take up.