Secretaria Regional de Saúde e Proteção Civil, is the Regional Health authority in Madeira, one of the adoption sites where the xShare Yellow button will be adopted using the European Electronic Health Record Exchange Format (EEHRxF), thus the Electronic Health Record (EHR) sharing will be consolidated in this region through the development of networks and ecosystems that will contribute to the robustness of the European Health Data Space (EHDS). Madeira presents a population of approximately 250,000 inhabitants, supported by 3 public hospitals along with 47 health centres, providing community, primary and secondary care, emergency services, and inpatient mental health care. Each patient is assigned a unique EHR that consolidates all medical and socio-clinical information. To date, the Regional Health Service has recorded over 599,804 EHRs and more than 57.4 million clinical care episodes.
Madeira’s aim in this project is to bring healthcare professionals and citizens closer, equipping health institutions with innovative, interoperable, and intelligent solutions that enhance the delivery of care.
By integrating the xShare Yellow button, patients will gain seamless access to their health information, while interoperability between healthcare providers is assured, fostering a single, secure, and standardized digital health market across Europe.
This approach promotes patient empowerment, active participation in healthcare management, and creates synergies for a truly integrated, high-quality, and sustainable healthcare system.
(2,3 and 4 to be assessed upon the development of the International Patient Summary category)
Considering the reference architecture, in the case of this adoption site, the following blocks are considered:
| Security, Privacy & Authentication | The MADEIRA Health Service implements robust security, privacy, and authentication measures to ensure the protection of sensitive health data and compliance with national and EU regulations, including GDPR. Citizens can access the patient portal and App through user/password authentication that requires a 2-point authentication according to data register upon the Regional Health System registration. |
| Data Management | The MADEIRA Health Service has developed its own HIS, in which each patient has a unique EHR, featuring all medical records and social clinical data within the public health sector in which health data is structured. The ATRIUM to FHIR IPS Translation Server is the core component that handles communication between ATRIUM database and other services. This component manages data creation and transformations, returning only the necessary information to the patient portal. The patient has the possibility to download the health information in machine format and PDF. |
| Consent repository | The HIS in MADEIRA has a consent repository where the informed consents of each patient are stored. |
| Consent Management | The HIS in MADEIRA manages patient information in accordance with the informed consents provided by users. Patients have control over who can access their data, aligning with GDPR principles. All access and modifications to health records are logged and audited for compliance and security. |
| MyHealth@EU Connector | N/A |
| Smart Links | N/A |
| Data repository | The HIS comprises both primary and secondary healthcare services across the region. Patient records and health data are centralized in a structured data centre for health information in Madeira. Access to specific health data is restricted to authorized medical professionals and patients, ensuring secure login for healthcare professionals using multiple verification methods, where patients and professionals authenticate via national health cards or digital identity systems. |
| Audit repository | The MADEIRA health system manages internal audits to maintain and improve healthcare standards in its in-house developed HIS. |
As an implementation scenario, the next figure shows how the different blocks are implemented and interconnected in the specific case of this adoption site.
Next steps will strengthen the FHIR-based output for the International Patient Summary and its associated resources through the xShare yellow button demonstrations. In the Madeira adoption site, export and sharing functionalities will be expanded, allowing appSESARAM users to generate their Patient Summary in the FHIR format, ensuring compliance with the latest standards and interoperability between Madeira health institutions.
Additionally, an upcoming priority will be to deepen collaboration between the Madeira and Catalunya Regions by integrating the xShare button within medical tourism testing initiatives and demonstration in both Regions.
Following, the next step will actively extend the scope to include additional health data shared via the xShare button, with a future focus on imaging reports, laboratory results, and discharge reports.
andreia.pimenta@madeira.gov.pt
