Response to interpellation 2024/25:570 on Nordic e-prescription
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
The debate concerns the introduction of a Nordic e-prescription. KD argues that the government should not establish its own Nordic solution because it would mean time-consuming and resource-intensive double work against the upcoming EU solution EHDS 1. KD emphasizes that Sweden lacks the necessary digital infrastructure and standards to be able to dock into other systems 2 3. KD considers it the only reasonable line to work with EHDS and that work is ongoing in Sweden 3 4. KD argues that it is not a good model to do something that only applies to the Nordic countries 4. S wants the Nordic countries to take the lead and create a solution now 5 6. S believes there is frustration over waiting for the EU 5 6 7.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! Eva Lindh has asked me if I intend to act to enable Nordic citizens to collect e-prescriptions within the Nordic region.
The expedited processing of e-prescriptions between countries has previously been addressed within the framework of the Inquiry E-prescriptions within the EEA, which Eva Lindh also raises in her question. The inquiry submitted proposals that could enable the exchange of e-prescriptions within the EEA. The inquiry recommends, among other things, a number of changes to acts and ordinances for that purpose.
However, much has happened at the EU level since the investigation's final report. The Regulation on the European Health Data Space, often abbreviated EHDS, entered into force on March 26 this year. The regulation, among other things, requires Member States to enable the exchange of e-prescriptions among themselves through the cross-border infrastructure MyHealth–EU, which differs from today's voluntary cooperation between Member States.
In January 2024, the Government appointed Mats Nilsson to assist the Ministry of Health and Social Affairs in enabling a national digital infrastructure for health data. The assignment includes, among other things, adapting Swedish law to the regulation on the European Health Data Space. The instructions to the investigation include considering the proposals submitted in, among others, the reports E-recept within the EEA (SOU 2021:102) and Patient Summaries within the EEA and Sweden (SOU 2023:13) regarding the exchange of e-prescriptions and patient summaries.
Parallel to this, intensive preparatory work is underway at the E-health Authority to enable the exchange of, among other things, e-prescriptions across national borders in accordance with the requirements set out in the EHDS.
Since the work with the implementation of EHDS is in full swing, the focus moving forward should lie on the union-wide solution and thus not on a separate Nordic solution alongside the new EU system. Establishing temporary bilateral or regional solutions should be seen as a potentially time-consuming and resource-intensive duplication of work against the background of the new order expected to enter into force as the EHDS regulations begin to be implemented. A specific Nordic solution would thus risk leading to us establishing parallel systems, which in turn risks delaying the work with EHDS because it is the same personnel resources that are needed for e-prescriptions within the EU as within the Nordic region.
With that said, I and the Minister for Social Affairs, who is responsible for digital issues, will continue to follow the matter in the future as well.
Eva Lindh (S)
Mr. Speaker! Thank you very much, Minister, for the answer!
We Social Democrats have pushed the issue of e-prescriptions for many years. The reason is that we see that this is not working. Let me start by explaining what e-prescriptions are, in case anyone is wondering about it.
Previously, we had to keep track of that yellow slip with the prescription that we were issued at the doctor's. Now, one can go with their identification and get their medicine. This means that I do not need to take the yellow slips between Stockholm and Linköping, which I often travel between, or anywhere else.
But when it comes to traveling between our Nordic countries, it is a stop. In that case, it is not possible to do it in that way. We Nordic countries have a vision that the Nordic region should be the most integrated region, that is to say, the area where we can travel most easily and easily live in one country and work and operate in another. But this creates problems, as one of my party colleagues clearly experienced when he had forgotten his prescription at home. It can have very large consequences.
During the years that we have pursued the issue, we have had a political dialogue, and we have held conversations many times. Every time we get the answer that we should wait for the EU. At the same time, we see that Finland, for example, has made this possible. One can travel from Finland to the Baltic countries and get out your medicine. Between those countries it works; an agreement has been made.
When some of us, members of the welfare committee in the Nordic Council, were in the EU and met the top executives in the field, they said: Do not wait for us, but go ahead! Then we can follow the system that exists and that is being developed so that it can actually be made possible. So do not wait, go ahead!
Even though we now, just as the Minister has so profitably accounted for, have all the work that has been ongoing and is ongoing, we do not have the solution on the table today because the Nordic Council of Ministers says: Wait for the EU! And the EU says: Please go ahead! In the Nordic Council, among us parliamentarians, there is a common frustration that nothing is happening.
When it comes to border barrier issues, that is, when there are barriers to traveling, living, residing and working in our various Nordic countries, there are a whole number of issues in the area of health and medical care. This is a very clear and concrete such issue.
Therefore, the question is: Who is right? Should we not be able to go ahead and follow the countries that have already made this possible and which also belong to the EU? Then we can make it possible here much faster than if we are to wait for something to happen in our common European work.
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker and Member! I know that the Member has a long-standing and solid commitment to Nordic issues. Why previous Social Democratic governments have not pushed in this part, I cannot answer. But I believe – and now I am taking a risk – that we have the same view today as one, i.e., previous governments, had then: Since EHDS is on the way, it is wrong to have double systems.
I believe those may have been the reasons why previous Social Democratic governments in the Nordic Council did not take the initiatives that the member perhaps would have wished. I believe it was a proper measure.
Let me also be a bit frank and say that I do not believe that the EU has answered our Nordic countries that we should go first, because that is not how the work with EHDS looks. In that case, I would like to know who in the EU has answered for the EU that we should go first.
This is based on us setting standards that are common in the EU and that we implement them in Sweden. It is not that it is one country's standards that the rest will follow – unfortunately, for that might have been desirable. But it would not have been Sweden's standards, because we have lagged far behind when it comes to digital health information. We have not had the national standards that would have made it possible for us to dock with Finland or the Baltics. That is what we have lacked in the system.
Now it is underway. The responsible minister is the Minister for Social Affairs. The roadmap was presented in the summer of 2023, and work is ongoing in all its parts. But we ourselves needed to do work at home to be able to dock into all other systems, regardless of whether it had been a Nordic system or the European system that is now underway.
In the current situation, as I have said, I cannot really answer what has been said in previous discussions. Nowhere in the decisions that have been made here in the chamber or from previous Social Democratic governments have I noted that it has been chosen to wait on EHDS and instead prefer a Nordic solution. That one has a Nordic interest in this, however, I fully understand.
When I last met my colleagues in the Nordic Council, two weeks ago, several issues were raised that were not exactly this one, but which were nevertheless adjacent. We were then very careful to say that we do not want separate solutions. We want common, large-scale solutions. Not least, we want to ensure that the Nordic countries that are not in the EU shall have the opportunity to dock in and obtain the standards and be able to become part of the system through agreements. But a common European system with standards is the way forward, no separate solution anywhere else.
It is precisely the residents in the border area who need our changes in their everyday lives. They often need to be able to use and enjoy both our countries in parallel, quite simply. It has become considerably more difficult since the pandemic.
We visited Torneå during our council of ministers meeting. It is a prime example of where people previously did not look at where the border was but lived naturally between the countries. Then came the pandemic, which put up obstacles, physical ones. Today, people are trying to find their way back to each other, but it is difficult. It will take a long time, I believe, before we get this real integration. It is, therefore, a lot of work that needs to be done.
Of course, it is individual people who travel, such as the member and myself, who would benefit from this. But I am primarily thinking of all residents in border areas who need functioning solutions.
When we work with EHDS going forward, it is therefore important that we bring our Nordic colleagues along, so that we do this jointly. But there should not be any separate solution in the Nordics parallel to EHDS – that is the government's view today.
Eva Lindh (S)
Mr. Speaker! I shall give the Minister some answers.
Who said what? Yes, we met the executives – the management – who are responsible for these issues in the EU. They said: There is no problem with the Nordic Council or the Nordics themselves, the Nordic countries, going first. So do it!
We have no interest in doing something instead of something else, but this is precisely about taking the lead. We think that it would actually be possible to do this and to resolve this sooner.
My question to the Minister is: When does the Minister believe this will become a concrete reality? It is about the people who live in these areas, just as the Minister mentions. The greatest benefit is for people who, as I said earlier, live and reside in a Nordic country and work or operate in another Nordic country. There are many who travel between countries. This would facilitate things very much for them.
When would this be clear and have a concrete effect, which becomes a reality for those people?
Then it concerns this matter of who has done what. I can only state that all parties in the Nordic Council are completely in agreement that this is a priority issue. Members from all parties in the Nordic countries will ask the same question to their ministers. We think, in fact, that we have waited long enough.
Since we submitted this membership proposal in the Nordic Council, six years have passed. Regardless of who has sat in government in Sweden, Norway, Finland, Iceland, or Denmark, it has not become a reality. I am not interested in debating who has done what or not. No one has done enough for this to become a reality.
Now we will jointly pose questions to our governments in our Nordic countries. I am pleased about that. One shares the assessment of the need but also wonders: What are the practical obstacles? Specify those obstacles – practical, technical, or legal – that remain today! That is the joint question that we will pose.
My question is: When will this become a reality, if we now wait for the EU?
This is more of an information to everyone listening: There is no dividing line between the parties in the Nordic Council. We think that this is an important issue. The question that is asked to all ministers who have responsibility for these issues in our Nordic countries is: What are the obstacles today when it comes to actually taking the lead and making this possible between our Nordic countries already now?
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! Thank you, the member, for the supplementary submission and comments!
The obstacle is that we lack digital infrastructure for healthcare in Sweden. That is what we have lacked. We have not had the standards that are required. The work is currently underway. However, we cannot dock with anyone else until we have it in place ourselves.
As appears from my answer, it is also what prevents us from not having done the homework. It is not the case that we are waiting for the EU. We are doing our own work in order to be able to dock into all the systems that will come. I referred to the investigator Mats Nilsson, who is working intensively with this. There are more investigations, shall I say, but the member may well take that up with the responsible minister.
We must do many things now in order to be able to dock into the system. But as I understand it, the member demands that we simultaneously proceed with our own Nordic system. We will not do that. We will work with EHDS and enable the rest of the Nordics to also be part of the same system. Doing two parallel systems does not work. It is about creating the standards required to be able to dock into EHDS, ensuring that they become open in an appropriate way, and reaching agreements between states when it comes to the other Nordic countries.
It is the line that we have from the government's side and which I think is the only reasonable one.
I am fully aware that the parties' views in the Nordic Council differ from the parties' views in governments, that is to say, the Council of Ministers.
As I said: I cannot know for sure what previous governments have thought. But as I perceive it, we have the same opinion today. EHDS is what we are to do jointly. Then we will dock in the rest of the Nordics when we have it in place. If it can be done simultaneously is rather a question for investigators who are working on precisely these issues. They will surely return with answers on this – what is possible and what is not.
Eva Lindh (S)
Mr. Speaker! My question was: When does the Minister believe this will become visible in reality for the people who live and work in these areas? When will this become a reality? I am thinking, for example, of those who live in Sweden and who work in Norway. One of the longest borders between two countries is between Sweden and Norway, and there are many there who have an everyday life in the two countries.
When does the Minister judge that this would become a reality – if our Nordic countries do not move forward with a solution? That is the question.
We can ask further about what the Social Democratic government did. But all Nordic governments and representatives have said: We are waiting for the EU. There has been no distinguishing answer from any of the Nordic countries. It is perhaps there somewhere that the frustration lies, that we in six years have waited for something to happen in the EU. We could have gone ahead together.
There is absolutely a frustration, and it has increased because the answer only becomes: We are waiting for the EU. That is why we are jointly taking an action, in order to together get an answer from all the responsible ministers in the Nordic countries. We need to take the lead and resolve the obstacles that exist when it comes to living and working in the different Nordic countries because we have so much cooperation and exchange. Even if not everything is the same, our Nordic countries are more similar than Sweden and other countries outside of the Nordics.
When does the Minister judge that this can become a reality?
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! When? The member may ask the responsible minister – if there is any specific date. But we know when EHDS begins to apply. The decision has been made, and all countries that belong to the EU stand behind it.
Regarding what the member is asking about, I shall be very straightforward. Work is currently underway in Sweden. We are not waiting for anyone. Many investigations are ongoing so that we can dock into EHDS. The same applies to the rest of the countries in the Nordic region that are members of the EU. Everyone is working on getting their country into EHDS.
The members of the committee request that we simultaneously do something that only applies to the Nordic countries. No, we are probably quite in agreement that it is not a good model. EHDS is the track we have. Then everyone needs to work at home to ensure that they have the digital healthcare infrastructure required. Then one ensures that standards allow for interoperability. As I said, it is also about enabling other countries, which are not part of the EU but with whom we have a close partnership, to be part of EHDS in an appropriate way. This can concern primary use of healthcare data but also secondary use, which is also extremely interesting for research and development.
Those are the questions we carry with us in the work ahead. But it is the responsible minister, Minister for Social Affairs Jakob Forssmed, who can give more specific answers.
We will not build up any parallel systems, but that is what we do together. We would like to see the entire Nordic region involved in that work.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.