Catalonia
The TIC Salut Social Foundation (FTSS) is a public agency under the Catalan Ministry of Health and the Ministry of Social Rights and Inclusion. It fosters innovation in health and social care through the strategic use of ICT. FTSS supports the integration of digital solutions across the Catalan Health and Social Care System (SISCAT), which encompasses more than 2,600 healthcare and social care resources. These include around 68 hospitals, 434 primary care centres, 40 mental health institutions, and 102 residential and long-term care facilities. In this context, resources refer not only to entire centres but also to specific units or services within them, such as community mental health teams, day hospitals or local consulting rooms. Together, these resources ensure universal public access to care for Catalonia’s eight million inhabitants.
The Catalan Public Healthcare System offers the secure Yellow Button tool within the La Meva Salut (LMS) platform, allowing citizens to download their clinical data—including the International Patient Summary (IPS) in XML format—for cross-border healthcare use. The IPS contains key health information like diagnoses, medications, and immunizations.
During the project, FTSS aims to enhance the tool’s reliability in the IPS content and implement the solution in the private sector to enable seamless data exchange between public and private providers. Additional developments include a mobile application IPS viewer for citizens that can visualize one single IPS or more than one in a combined view (it is in a testing stage).
Personas - use cases
Priority categories
International Patient Summary (IPS)
Yellow Button basic functionalities
Download
Architecture
Considering the reference architecture, in the case of this adoption site, the following blocks are considered:
| Public | Private | |
| Security, Privacy & Authentication | Access via La Meva Salut (LMS) using ID (ID-Cat Mobil) and two-factor-authentication (2FA). Registration requires in-person verification. | Access with application user/password + token. Only works inside the organization’s intranet. No patient data is stored. |
| Data Management by Custom Connectors | Data from EHR, transformed into CDA/FHIR using IHE guides. | Data from organization DB is transformed into FHIR resources using Mith Connect integrations engine. Using this resources, the CDA R2 L3 or FHIR Bundle formats can be generated. |
| Consent Management | Not included. Patient handles all actions. | Not included. IPS is downloaded by the patient. |
| MyHealth@EU Connector | Not included, under consideration. | Not included, evaluating its usefulness. |
| Smart Links | Not included, under consideration. | Not included, evaluating its usefulness. |
| Data repository | MHD profile being implemented to receive patient CDA. | No patient data is stored. Internal DB holds mappings, controlled vocabularies, audit log, etc. |
| Audit repository | Sends ATNA data export message to an IHE certified Audit Record Repository. Implementation and certification of IHE ATNA profile ARR and SA actors at Trieste 2024. | Includes FHIR-based auditlog management. |
| Consent repository | Not included. Patient handles all actions. | Not included. IPS is downloaded by the patient. |
As an implementation scenario, the next figure shows how the different blocks are implemented and interconnected in the specific case of private sector in this adoption site.
Timeline
| Month Range | Public Sector | Private Sector |
| M0–M3 | Kick-off: "Botó Blau" launched in "La Meva Salut" for CDA IPS download by the citizen | Kick-off: Needs assessment and situational analysis in private centers |
| M4–M6 | BUC definition - Confirm format and compliance of IPS download in CDA (diagnoses, medication, allergies, etc.) and eP/eD (visible by citizen in PDF) | BUC definition - Develop "BB software" for CDA R2 L3 + implementation guide |
| M7–M9 | BUC definition - Continue IPS format validation and compliance | BUC definition - Begin development of IPS Viewer App (CDA format); prep PoC sites |
| M10–M12 | Personas/User stories/Requirements definition - Finalize IPS quality enhancements | Personas definition - Run PoCs in 2 centers + finalize Viewer App (CDA R2 L3) |
| M13–M15 | Personas/User stories/Requirements definition - Prep for FHIR generation; technical groundwork | Personas/User stories/Requirements definition - Add FHIR generation capabilities ( as additional web service) |
| M16–M18 | Personas/User stories/Requirements definition - Implement FHIR output (CDA to FHIR mapping) | Personas/User stories/Requirements definition - Include FHIR web service for IPS generation and Adapt Viewer App to read FHIR-formatted IPS and multiple FHIR documents merging |
| M19–M21 | Prep LMS for upload interface (via eConsulta or secure channel, non-integrated) | Validation of Viewer and prepare piloting session and inclusion of more centers |
| M22–M24 | Enable IPS upload in LMS (manual via eConsulta or other secure channel) | Situational analysis in new centers |
| M25–M27 | Refinements on the FHIR output and IG adaptations | Refinements on the FHIR output and IG adaptations |
| M28–M30 | Final refinements, consolidation of demonstration results and identification of priorities for continued development beyond xShare | Final refinements, consolidation of demonstration results and identification of priorities for continued development beyond xShare |
December 2023: Leverage of the tool to download Clinical Data for sharing purposes with other healthcare providers named Blue Button adopted in la Meva Salut.
December - May 2024: Confirmation of the possibility of the Button to download the Medical information in the IPS format in CDA (diagnoses, medication, immunizations, surgical procedures, allergies and discharge reports) and ePrescription in PDF
May - November 2024: Focus on improvements of the generated IPS (medication summary section, EEHRxF compliance, etc.)
May 2025: Implementation of FHIR output
June 2025: Enable IPS upload in LMS in pre- environment (no direct EHR integration at this stage)
November 2024: Launch of a web-based IPS viewer in the LMS
November 2024: Incorporation of SmartLink and QR code support for secure access
Demonstrations / interviews
Challenges and Remarks
Public Sector: The main challenge was to introduce changes within La Meva Salut, an established and widely used application deeply integrated into the Catalan public healthcare system. Beyond improving the generated IPS documents and aligning them with updated specifications and implementation guides, this required substantial adaptation to the platform’s existing workflows, operational requirements and development priorities. The aim was to introduce useful improvements for patients while maintaining the reliability and usability of a service already embedded in their everyday access to healthcare information.
Future work outside xShare will continue to improve document upload and sharing, making these processes as practical and intuitive as possible for users. Extending the work to other priority categories remains a longer-term objective beyond xShare. Further developments will take account of evolving EEHRxF specifications and relevant EHDS implementing acts. In parallel, the team will explore opportunities to connect with MyHealth@EU to support cross-border sharing and examine how health data could be reused for research or public health.
Private Sector:
The main challenge was to adapt the solution to the diverse contexts of private healthcare providers, whose technical capabilities, resources and data availability vary considerably. Demonstration activities therefore focused on one centre, allowing the implementation to be developed in depth within its operational environment. Beyond alignment with interoperability standards and implementation guides, the content and completeness of the generated IPS depended on the clinical information collected, structured and accessible within the centre’s existing systems.
Future work will continue to improve the IPS and extend implementation to additional document types through i2X and other European collaborations, supporting alignment with evolving European objectives and specifications. Collaboration with further healthcare centres will continue beyond xShare, building on the experience gained and adapting the solution to each centre’s needs and capabilities.