Czech healthcare prepares for building affinity domains
The building blocks of electronic health care, or eHealth, include the creation of electronic health records and documents and their subsequent sharing. Documents can be shared in a variety of ways.
Affinity Domains
One option, based on international standards and recommendations, is so-called affinity domains. Recently, the creators of the Czech national eHealth are finally leaning towards this option, especially under pressure from the professional community and based on the experience of neighbouring countries such as Austria, Switzerland and recently, for example, Poland.
Affinity domain is a concept introduced by the recommending technical profiles of the international organisation IHE. It can be imagined as an agreement of a group of health care institutions whose members follow common rules for sharing electronic medical records as well as a common way of communicating with the outside world and other surrounding domains.
Document Registry
The main element of such a domain is a document registry in which all shared documents and medical records of patients receiving care within the domain are registered. The actual storage of these documents and records may then be in a single shared repository or in multiple repositories, including hospital information systems in healthcare facilities that are part of the affinity domain. Another unifying element of the domain is a uniform way of identifying documents and patients.
There is currently a fairly intense debate among health informatics experts about what mode to set up such domains and what role the government should play in this. One of the extreme solutions is the existence of a single national domain.
This option will allow state control over all data sharing, but will be very rigid in principle with very limited options and slow development. The opposite extreme would be to let affinity domains emerge without any rules.
Unless we want to go the extreme route in the Czech Republic or try completely new ways, we need to find a balanced compromise where the state sets the rules and boundaries and provides adequate financial support to the founders and members of such domains to build and operate them. The optimal size of a domain appears from experience to be one or more regions. At the same time, the existence of central services, such as the forthcoming tribal registries or the national catalogue of eHealth services, is highly appropriate.
