IT-Related Barriers and Facilitators to the Implementation of a New European eHealth Solution, the Digital Survivorship Passport (SurPass Version 2.0): Semistructured Digital Survey
Authors: de Beijer Ismay A E , van den Oever Selina R , Charalambous Eliana , Cangioli Giorgio , Balaguer Julia , Bardi Edit , Alfes Marie , Cañete Nieto Adela , Correcher Marisa , Pinto da Costa Tiago , Degelsegger-Márquez Alexander , Düster Vanessa , Filbert Anna-Liesa , Grabow Desiree , Gredinger Gerald , Gsell Hannah , Haupt Riccardo , van Helvoirt Maria , Ladenstein Ruth , Langer Thorsten , Laschkolnig Anja , Muraca Monica , Pluijm Saskia M F , Rascon Jelena , Schreier Günter , Tomášikova Zuzana , Trauner Florian , Trinkūnas Justas , Trunner Kathrin , Uyttebroeck Anne , Kremer Leontien C M , van der Pal Helena J H , Chronaki Catherine ,   PanCareSurPass Consortium
Published: May 2024

Background
To overcome knowledge gaps and optimize long-term follow-up (LTFU) care for childhood cancer survivors, the concept of the Survivorship Passport (SurPass) has been invented. Within the European PanCareSurPass project, the semiautomated and interoperable SurPass (version 2.0) will be optimized, implemented, and evaluated at 6 LTFU care centers representing 6 European countries and 3 distinct health system scenarios: (1) national electronic health information systems (EHISs) in Austria and Lithuania, (2) regional or local EHISs in Italy and Spain, and (3) cancer registries or hospital-based EHISs in Belgium and Germany.

Objective
We aimed to identify and describe barriers and facilitators for SurPass (version 2.0) implementation concerning semiautomation of data input, interoperability, data protection, privacy, and cybersecurity.

Methods
IT specialists from the 6 LTFU care centers participated in a semistructured digital survey focusing on IT-related barriers and facilitators to SurPass (version 2.0) implementation. We used the fit-viability model to assess the compatibility and feasibility of integrating SurPass into existing EHISs.

Results
In total, 13/20 (65%) invited IT specialists participated. The main barriers and facilitators in all 3 health system scenarios related to semiautomated data input and interoperability included unaligned EHIS infrastructure and the use of interoperability frameworks and international coding systems. The main barriers and facilitators related to data protection or privacy and cybersecurity included pseudonymization of personal health data and data retention. According to the fit-viability model, the first health system scenario provides the best fit for SurPass implementation, followed by the second and third scenarios.

Conclusions
This study provides essential insights into the information and IT-related influencing factors that need to be considered when implementing the SurPass (version 2.0) in clinical practice. We recommend the adoption of Health Level Seven Fast Healthcare Interoperability Resources and data security measures such as encryption, pseudonymization, and multifactor authentication to protect personal health data where applicable. In sum, this study offers practical insights into integrating digital health solutions into existing EHISs.