The Nexus of Forces in Action – Use-Case 13: E-Medical Data Access and Exchange



A person on vacation needs emergency medical care while in a foreign country. The medical care provider needs access to the medical history of the person needing medical care.

Primary Industry Sectors


Business Value

Malpractice risk mitigation, QoS

Key Business Functions

Medical history discovery, medical history access, medical history interoperability, medical history update, medical claim to insurer

Primary Actors

Medical provider in foreign country, primary care physician in home country

Secondary Actors

Patient's medical insurer

Machine Actors

Messaging, integration, cloud (private, hybrid, public, community), medical data analytics, monitoring, mobile alerts, social networks (awareness)

Key Technologies

Big data, mobility

Main Scenario

A person on vacation suffers a stroke while in a foreign country. The stroke prevents the person from speaking. The medical provider in the foreign country needs access to the person's medical history to determine the proper treatment. Some medical history is maintained by the person's primary care physician in the person's home country. Some medical history is located in a variety of other systems. Once medical treatment is completed, the medical history data needs to be updated by the medical provider. The medical provider will need to submit a claim to the patient's medical insurer.

Some of the patient's medical history is available electronically using one standard, whereas the medical provider in the foreign country uses a different standard. Other medical history data is located in multiple medical provider locations.

Secure access to the medical history data and then data integration are the key challenges.

Key Data

Master Data

Patient record (controlled access)

Current Observations Data

Patient temperature, blood pressure, pulse rate, etc. (obtained from sensors, open access)

Historical Data

Information about patient history (controlled access)

Query Data

Data sought by attending healthcare provider to make best decision regarding proper treatment (controlled access).

Action Taken Data

Information about treatment given to patient (controlled access once added to historical data).

Real Business Examples

US Department of Health and Human Services

The US Department of Health and Human Services Office of the National Coordinator for Health Information Technology (ONC) is encouraging international health IT standards, and is engaged in a number of efforts to promote them. Some of those efforts include:

  • Defining an international vocabulary for health terms and products
  • Standardizing healthcare summary documents
  • Increasing patient access to their health information internationally
  • A consistent health IT standards framework to build upon
  • An increasing demand for international health IT professionals
  • Roadmap for international health IT collaboration

See Dr. Doug Fridsma’s article: International Health IT Standards: A Closer Look at ONC Efforts in HealthITBuzz.

European Health Insurance Card

The European Health Insurance Card (EHIC) lets people who are ordinarily resident in a European Economic Area (EEA) country get state healthcare at a reduced cost or sometimes for free in other EEA countries that they visit. It will cover a person for treatment that is needed to allow them to continue their stay until their planned return. It also covers them for treatment of pre-existing medical conditions and for routine maternity care, as long as they are not going abroad to give birth. (See the EHIC website.)

International Federation of Health Information Management

The International Federation of Health Information Management (IFHIMA) assists national associations and health record professionals to implement and improve health records and the systems that support them. IFHIMA was established in 1968 as a forum to bring together national organizations committed to improvement in the use of health records in their countries. The founding organizations recognized the need for an international organization to serve as a forum for the exchange of information relating to health records, health information management, and IT. (See the IFHIMA website.)

Additional Considerations

Existing Interoperability Standards

SNOMED, the World Health Organization International Classification of Diseases (ICD) current revision (ICD 10) and next revision (ICD 11), Health Level Seven International (HL7), US health IT initiatives like the Direct Project, Blue Button, Consolidated Clinical Document Architecture (CCDA), and many others.

Comments on Context

Inter-country agreements between patient care records and insurance coverage will need policy agreement and coordination.