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Document LifeCycle ManagementINTEGRATED CARE GEOGRAPHIC SCOPEInternational eHealth initiativeshave been promoted over the years by the EuropeanCommission to ensure the free and safe flow of workersand tourists. However, beyond a standard European HealthInsurance Card for patient identification and access to A&Eservices, EU member states have achieved little in terms ofcross-border information sharing so far.National eHealth strategies,which include building integrated patient records, havebeen launched in countries such as the U.K., France andSaudi Arabia. These initiatives, however, still face challengesthat need to be addressed, such as change managementrequirements.Region-wide integrated healthand eHealth programshave been the prevalent model in countries like Germany,Spain, Italy and the Nordics. In large regions with manypatients and hospitals, the governance challenges arestill big, but more manageable than at the national level.Decisions regarding data standards, procurement andprogram implementation can be managed through pilots andescalation mechanisms, built to reconcile points of view atthe regional level, where the overall budget is held.Community healthcare providersrevolve around one or a small group of hospitals that act asa small ecosystem. This is also the geographic scope of mostpatients’ mobility. The majority of patient interaction withhealthcare providers takes place in the area where they live.The challenges thatnational programsencounter in supportingintegrated care andintegrated patient recordsindicates that a purely topdownnational approachis not viable. As a result,policy-makers are breakingdown national programsinto community-level pilotsand regional-level projectsthat are more sustainablein the long-term.19