Exchanging Information Across Borders: A Systematic Review of European Health Information Transfer

Structured Abstract Background: The United States’ health care system is usually accused of being both expensive and wasteful. The inadequacy of structures to coordinate care is often considered one of the causes of these high-cost/poor quality results. Other countries such as the UK, Canada, and Japan have made electronic health records a high priority intervention for better coordination of care. However, little is known about the breadth of medical information exchange methods and their associated levels of success. The European Union Border Regions is a good area to study, as it has a long history of patient travel across borders and a wide breadth of services offered from medically simple (e.g. vaccines) to medically complicated (e.g. oncological treatment). Purpose: Determine methods of health information exchange to coordinate care in the European border regions for patients undergoing micro-movement into non-native countries to receive care. Data Sources: EMBASE and PubMed, any study type, and grey literature cited within other relevant publications. Study Selection: I chose English language studies and reports to answer the primary question. Studies chosen had to include information on case studies or surveys of areas with known medical care between borders. No future study proposals, judicial reviews, or terminology papers were included. Papers had to report on patients undergoing cross-country medical services. Travel for purchase of medications was not included. Patients had to be residents in the border regions of Europe. Any methods of medical information exchange between providers were included. Control/comparison groups of methods of information exchange and outcomes (success/failure indications) were preferred but not necessary. Data Synthesis: I included 7 cases (3 papers and 4 case studies from grey literature). The majority of the studies I included (6/7) gave general themes without quantifying how frequently these appeared. The literature showed that many approaches to medical information exchange (e.g. direct access to electronic health records, written record exchange, and telemedicine) exist within border regions and between providers caring for patients within them. I didn’t use any pre-defined cutoff for success or failure of a project. Rather it was accepted that a project/case was successful or failed if it was defined/reported as such by the authors of the paper presenting it. No one method or group of methods gave a clear, coherent and easily observed pattern of success or failure. Model: Given no singularly necessary and consistently successful method of medical information exchange, I created a separate categorization of various information transfer methods/combinations along two variables: technological investment and human capital investment. There were too few data points to create a reliable model. However, the limited model suggests that there is no one method or list of methods that consistently and reliably results in successful health information exchange. Rather, specific combinations of attributes with specific ratios of human capital investment to technological investment are needed. Limitations: I could not identify any studies that explicitly answered the primary question of the paper. Six of seven cases could give only themes of methods without frequencies of their associated successes/failures. As a result, rather than being able to address the issue of success/failure as a probability, I had to create an overall crude dichotomous grade for outcomes. All of the studies had either sampling or measurement limitations. A full analysis of the value of different information exchange options is made difficult by the paucity of reported information on methodology used. Conclusions: Among many methods of cross-border medical record exchange, no one stood out as a particular success. The paucity of publications and other sources of information may limit conclusions about what works in transmitting patient information across state boundaries, and further research, especially on how the interaction of technology and human capital may smooth the flow of information, may contribute to the development of evidence-based policy.Master of Public Healt