The electronic Personal Health Record (e-PHR) was developed in 2016 to establish a more comprehensive approach to foster health provision for migrants arriving in Europe, and to facilitate follow-up and continuity of care. The product was requested by the European Commission - General Directorate for Health and Food Safety (EC-DG SANTE), in the context of large numbers of new arrivals to the region, challenging domestic health systems and demonstrating the need to expedite implementation of EU directives regarding cross-border care and data sharing. The e-PHR is a resource for Health Professionals aiding health assessments and medical follow ups for new migrants.

The e-PHR is currently under further upgrade to meet the new technological developments and needs e.g. a new section specific to Covid-19.

Large numbers of migrants arriving into Europe posed challenges around health provision. There was a growing need for a harmonized tool for health assessments within and across EU Member States which would allow to record and retrace the medical history, examinations, medications and vaccinations of newly arrived migrants within and across countries, facilitate the transit to destination countries and foster the integration in national health systems.

The e-PHR presents an example of best practice in enhancing health monitoring and health information systems as well as ensuring continuity of care for refugees and migrants. The e-PHR contributes to the Sustainable Development Goals towards well-managed migration (SDG Target 10.7) and Universal Health Coverage (SDG Target 3.8), and Member State commitments to “leave no one behind”. It also relevant to the attainment of Goals 8 and 17.

The e-PHR helps to construct/reconstruct the medical history, examinations and medication and vaccination for arriving migrants, thereby establishing and recording a migrants’ health status and medical needs. It provides an opportunity to record subsequent provision of treatment, including vaccinations, and to offer counselling and health education services and overall fosters appropriate health care provision for migrants, including continuity of care. The tool also supports Health Professionals in getting a comprehensive view of the person’s health status and needs during clinical encounters and/or treatment. For authorized users, records are retrievable from multiple locations within the member states and across borders. The e-PHR is accompanied by a Handbook to be used by Health Professionals, which provides guidance on the use of the e-PHR and, in more general terms, the health assessment process for migrants and refugees. In addition, Member States are supported in building the capacity of health mediators, selected also among the migrant/refugee population and to provide training on health mediation and on the electronic platform usage.

Co-funded under the amended EU Third Health Programme (2014-2020) of the European Commission’s Directorate General for Health and Food Safety (DG SANTE), the e-PHR has been implemented with support by IOM in Bulgaria, Croatia, Cyprus, Greece, Italy, Slovenia, and Serbia. The action also benefitted from the partnership with the European Center for Disease Control, WHO, UNFPA, UNAIDS, and ICRC.

The e-PHR has been developed, piloted and implemented within broader initiatives led by IOM: the Re-Health and Re-Health2 programmes. These programmes aimed at assisting EU Member States under migratory pressure to address the health-related migrants’ issues, while taking into consideration possible communicable diseases and cross-border health events.

The initiative consisted of three main components: i. establishment of an electronic health database and the electronic PHR, ii. exploratory phase, and iii. piloting of the PHR/e-PHR in the field in different countries across Europe.

After a pilot phase in Croatia, Greece, Italy and Slovenia, IOM (in coordination with Member States) implemented and consolidated the use of the e-PHR as a single tool for health assessments in EU countries and developed a revised version of the tool and its related electronic platform, expanding its usage to Bulgaria, Cyprus and Serbia while scaling up in Croatia, Greece, Italy and Slovenia

After an initial piloting phase of the PHR/e-PHR in the field in different countries across Europe and its consolidation as a single tool for health assessments under the Re-Health and Re-Health2 programmes respectively, the electronic tool has been additionally implemented within other programmes as well as being recognized as one of the SDG good practices, success stories and lessons learned between 2018/2019.
The e-PHR is currently being implemented under the ATES programme: Technical Assistance and support to the Local Health Authority of Syracuse, in Italy, where IOM is assisting the regional health authorities in fully integrating the platform within the regional system. In addition, the platform is also being used within IOM activities in Greece, where the tool will also contribute to the integration of third-country nationals at regional and local level.
Furthermore, under a new action, the e-PHR system is currently upgraded in order to enable interested States and other key stakeholders to acquire skills, knowledge and expertise to collect, analyze, share and disseminate quality, timely, disaggregated and comparable migration health data. This upgrade will take into account the latest technology available and update of variables (e.g. COVID-19) as well as adapt the platform for a better interface with national systems.

The e-PHR is a user-friendly and secure patient record management platform that can be used by domestic and international actors. As per January 31 2019, over 24,000 health assessment have been done using the e-PHR.

The e-PHR has also increased and improved the presence of health professionals in the designated sites (and the quality of their assessments and care), and the presence of qualified and trained health mediators able to ensure that not only interpretation took place (in systems where often this professional figure is not yet recognized). In addition, health promotion and wellbeing were fostered among the beneficiaries, and trainings on migration health for Law Enforcement Officers, HPs and Social Workers was carried out. Using this standardized tool as well as improving awareness and resources through this action ensured that migrants were properly followed up, attendance at emergency departments for minor illnesses decreased, and overall communities benefitted from it. The e-PHR can generate tailored reports, which highlight the main disease trends and needs across the migrant population, and this aggregate information is important public health information for decision makers.

As a result of the initial implementation of this tool, over 24,000 health assessment were done using the e-PHR until January 2019. The e-PHR has contributed to the facilitation of follow-up and continuity of care to migrants arriving to selected EU Member States, facilitating a comprehensive approach at EU level to foster health provision to migrants.

The e-PHR has also increased and improved the presence of health professionals in the designated sites (and the quality of their assessments and care), and the presence of qualified and trained health mediators able to ensure that not only interpretation took place (in systems where often this professional figure is not yet recognized). In addition, health promotion and wellbeing were fostered among the beneficiaries, and trainings on migration health for Law Enforcement Officers, HPs and Social Workers was carried out.

The e-PHR has been successful because it leveraged IOM’s extensive international experience with health assessments and medical data management. This was coupled with financing and support received from EU DG SANTE, Member States and other partners.

There is now a need to further develop and disseminate the e-PHR implementation module of governance across Europe ensuring that health checks are offered and provided to ensure access to health care for all migrants requiring health protection.

With the current pandemic the e-PHR is even more needed for what concerns cross-border care and data sharing.

IOM is coordinating with Member States and relevant partners to ensure sustainability and further scale up of the implementation and use of the e-PHR. There is interest from Member States and other players on further implementation of the tool. For example, e-PHR is currently supported by a local grant in Italy. Sustainability is also facilitated through in-person and virtual training sessions on the PHR database and e-platform, performed in coordination with national health authorities and IOM country offices. The e-PHR can be replicated and used in different settings, different from the European one and is easy to interface and adapt becoming either a more agile or elaborated tool in line with an IOM need assessment.

The e-PHR system is currently upgraded in order to enable interested States and other key stakeholders to acquire skills, knowledge and expertise to collect, analyse, share and disseminate quality, timely, disaggregated and comparable migration health data. This upgrade will take into account the latest technology available and update of variables (e.g. COVID-19) as well as adapt the platform for a better interface with national systems.

The e-PHR has contributed to the facilitation of follow-up and continuity of care to migrants arriving to selected EU Member States, contributing to a comprehensive approach at EU level to foster health provision to migrants. A resource for health professionals on health assessments for new migrants in the EU was also developed as a supplement to the e-PHR, contributing to its sustainability and transferability.

Personal Health Record: https://ec.europa.eu/health/sites/health/files/migrants/docs/handbook_healthprofessionals_en.pdf

Poster on e-PHR: https://www.re-health.eea.iom.int/sites/default/files/images/pages/PHR-poster_Re-Health2.jpg

Handbook for Health Professionals: https://ec.europa.eu/health/sites/health/files/migrants/docs/handbook_healthprofessionals_en.pdf