From Concept to Implementation: A Policy and Standards Roadmap for a Global Medical Record System for Travelers with Chronic Disease.

Abstract

International travel by people with multimorbidity and polypharmacy is increasing, and clinicians who treat these patients abroad seldom have access to accurate and current information about them. Mechanisms for cross-border exchange do exist: the International Patient Summary (IPS), European cross-border health services, and national patient portals all move summary clinical data between jurisdictions. What none of them yet provides is automated abstraction of decades of longitudinal records into a short summary, and reliable determination of which diagnoses are active and which medications are current. They also do not provide consistent deployment across jurisdictions that record and code data differently. Sørensen (2022) established the clinical case for a Global Medical Record System (GMRS) and outlined its core data elements. We argue that four recent developments provide a window of policy opportunity: COVID-19 vaccination credentials, which showed that portable health data can be deployed at population scale; formalization of the HL7 IPS as an ISO standard with an implementation guide (FHIR IG); regulatory mandates for health data interoperability in the United States and the European Union; and an ongoing transatlantic collaboration aimed at mapping a GMRS algorithm onto those standards. Herein we make a policy case for coordinated international action, describe the standards pathway of mapping the GMRS to the FHIR IPS and United States Core Data for Interoperability (USCDI), and propose a structured maturation pathway for research and validation via a Denmark-United States collaboration. The GMRS would add to the IPS an abstraction layer that decides which of a patient's accumulated entries belong in the summary. We present this as a proposed roadmap and policy argument as the GMRS algorithm has not yet undergone formal validation which would be required before actual deployment.