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Discover →A clinical summary across borders
When a European citizen receives care in a country other than the one of residence — for tourism, work, study or emergency — the local physician usually needs the minimum clinical information to act safely: current medications, allergies, active problems, vaccinations, recent vital signs. Historically this information was inaccessible across borders; the patient had to provide it from memory or carry paper documents, often in a language different from the physician’s.
The European response to this problem is called Patient Summary, and rests on two pillars:
- International Patient Summary (IPS) — the content standard that defines what an interoperable patient summary must contain
- MyHealth@EU (formerly eHDSI, eHealth Digital Service Infrastructure) — the federated infrastructure enabling exchange of patient summary and electronic prescriptions across Member States
International Patient Summary
IPS is a content standard developed jointly by CEN (European Committee for Standardization), ISO and HL7 from the mid-2010s, on request of the European Commission. It answers the need for a minimum, clinically robust and jurisdiction-adaptable specification of a patient health summary.
Formal publications:
- CEN EN 17269:2019 — “Health informatics — The International Patient Summary”, European standard
- ISO/HL7 27269:2021 — international ISO equivalent, published after the joint ISO/HL7 ballot process
- HL7 IPS Implementation Guide — HL7 official IG published as FHIR R4, translating IPS into the resource model
The minimum content defined by IPS covers eight mandatory or conditionally mandatory sections:
- Current medications — active therapies with dosage, schedule, route of administration
- Allergies and intolerances — drug, food and environmental allergies, with reaction and severity
- Active problems / problem list — current diagnoses and conditions
- Immunizations — documented vaccination history
- Significant recent procedures
- Implanted or in-use medical devices
- Recent laboratory results and vital signs
- Current pregnancy (if applicable)
Optional sections add: advance directives, past medical history, social history, care plan.
IPS in CDA and IPS in FHIR
IPS is agnostic to exchange format. The content standard is implementable in:
- CDA R2 (IPS CDA Implementation Guide) — the first implementation, used in eHDSI services since 2019
- FHIR R4 (HL7 IPS IG) — modern implementation, used both in next-generation eHDSI services and in patient apps and national programmes
The FHIR IPS IG defines:
Composition— IPS document with LOINC-coded sections- Profiles for
Patient,AllergyIntolerance,MedicationStatement,Condition,Immunization,Procedure,Observation,Device,DeviceUseStatement Bundleof type document as container- Code Systems and Value Sets with required terminologies (SNOMED CT, LOINC, ATC, ICD-10, UCUM)
IPS FHIR is deliberately designed as a base Implementation Guide from which national IGs can be derived — each country can further constrain it based on its specifics (e.g. use of the Italian fiscal code, national OIDs, local value sets).
eHDSI → MyHealth@EU
The European frame of cross-border exchange rests on Directive 2011/24/EU on cross-border healthcare and on the work of the eHealth Network — the coordination body among Member States in digital health.
eHDSI (eHealth Digital Service Infrastructure) was designed from 2015, with first services live in 2019. In 2022-2023 the European Commission renamed the service to MyHealth@EU to unify branding and reflect the expansion of services delivered.
Services currently active on MyHealth@EU:
- Patient Summary (PS) — exchange of a patient’s summary towards a physician in the host country
- ePrescription / eDispensation (eP) — a prescription issued in the country of residence is recognised and dispensed in the host country
Services on the roadmap:
- Laboratory Results
- Medical Imaging Reports
- Hospital Discharge Reports
As of February 2024 the network has over ten Member States active in at least one of the two base services — Austria, Croatia, Czech Republic, Estonia, Finland, Greece, Hungary, Ireland, Luxembourg, Malta, Portugal, Spain, Slovenia, with gradual extension to other countries.
National Contact Points
The MyHealth@EU architecture is federated. Each Member State builds and operates its National Contact Point for eHealth (NCPeH): a national gateway that:
- Exposes the country’s eHealth services abroad (the Austrian patient receives his Italian PS through the Italian NCPeH, which queries the FSE)
- Exposes foreign countries’ services to its own health system (the Italian physician consults the PS of an Austrian patient through the Italian NCPeH, which talks to the Austrian NCPeH)
- Manages authentication, consent, semantic and syntactic matching between national variants of the same standard
Between two NCPeHs flows a SOAP/REST request with a SAML Assertion attesting the requester’s identity, country and legal basis. The destination NCPeH consults its national infrastructure (in Italy the Sogei FSE Gateway), produces the conformant IPS document (in CDA or FHIR), and returns it — possibly with automatic translation of narratives into the requesting physician’s language.
OpenNCP
NCP development is facilitated by an open source initiative supported by the European Commission: OpenNCP — a reference implementation of the NCPeH, published as open source software under the EUPL licence. OpenNCP provides:
- Web portal for the host country’s healthcare professional
- Orchestration engine for request/response flows
- Automatic translation components
- Integration with federated identity infrastructures (STORK, eIDAS)
- Audit and logging modules
Several Member States have built their NCPeHs on top of OpenNCP, adapting it to the national regulatory frame. The project is supported by the Commission through evolution and maintenance contracts.
Italy in MyHealth@EU
Italy’s path to MyHealth@EU formally began in 2019 and proceeds in phases. The Italian NCPeH is implemented by the Ministry of Health with technical support from Sogei. Patient Summary and ePrescription/eDispensation services are in progressive activation, with conformance testing with the European Commission and gradual rollout across Regions joining first.
The link between the Italian NCPeH and the Electronic Health Record is the operational junction: the Italian PS is produced from the regional FSE data (through Sogei’s national FSE Gateway) and exposed in the required IPS format. The FSE 2.0 transition towards Italian FHIR profiles under PNRR Mission 6 will facilitate native IPS FHIR exposure, benefiting both MyHealth@EU and the internal ecosystem.
IPS outside MyHealth@EU
IPS does not live only inside the European network: it is increasingly the de facto exchange format for patient summary in heterogeneous contexts. Relevant use cases:
- Personal patient apps — IPS FHIR is the typical export format of patient summaries towards PHRs and patient-managed health wallets
- Humanitarian organisations — where the patient summary must be portable across operators from different countries
- Multi-centre clinical trials — as a starting format for collecting baseline clinical demographics
- International private healthcare — for cross-border health insurance and corporate programmes
The existence of IPS as a CEN/ISO/HL7 standard guarantees content interoperability even outside the MyHealth@EU perimeter.
Relationship with EHDS
The next chapter is the European Health Data Space (EHDS). The regulation proposal, presented by the Commission in May 2022 and in trilogue over recent months, reached a provisional political agreement between Council and European Parliament in March 2024. Once formally adopted, the regulation will make MyHealth@EU the reference infrastructure for primary use of health data at European level, expanding the service set and imposing structured obligations on Member States in terms of contents, formats and interoperability.
IPS will remain the core of the European patient summary, with expected evolution towards exclusive FHIR use in next-generation services.
References: CEN EN 17269:2019 — Health informatics, The International Patient Summary. ISO/HL7 27269:2021. HL7 IPS Implementation Guide (FHIR R4). Directive 2011/24/EU (cross-border healthcare). MyHealth@EU (formerly eHDSI), European Commission. OpenNCP (EUPL licence).