This activity includes the planning and monitoring of design activities, the definition of the architecture and functionalities of cross-border services, the creation of the software platform and its integration with the national interoperability infrastructure, testing in a pre-production environment. It also includes the preparation of the organizational and legal procedures necessary for the operational management of cross-border eHealth services. In the testing phase of the NCPeH infrastructure, in addition to checking the functionality, the procedures for carrying out the Audits and the actions aimed at obtaining authorization from the eHealth Network to activate the NCPeH, are also taken care of.

Cross-border eHealth services are divided into:

• Services for Italian citizens abroad (in this case Italy acts as Country of Affiliation, or Country A),
• Services for foreign citizens in Italy (in this case Italy acts as a Country of Treatment, or Country B)

In the event that Italy operates as a Country A, the NCPeH receives from abroad the request for a Patient Summary (PS) and/or an electronic prescription (ePrescription or eP) for an Italian citizen requesting healthcare at a foreign point of care. The EHR national architecture is used to verify the citizen’s personal information and consent, to send clinical data abroad, to interconnect the National Contact Point for eHealth (NCPeH) to the regional systems and finally to retrieve clinical documents (PS and eP).

When Italy operates as Country B, health professionals or pharmacists connect through a dedicated portal to the NCPeH, which sends the request for PS and/or eP to the NCPeH of the country of affiliation of the foreign citizen being treated; it receives the documents and provides them to healthcare professional or pharmacist, with the tools to view it.

The peculiarity of the eHealth services is that PS and eP are shown to the physician or pharmacist in his language. The original documents provided by Country A are transformed, transcoded and translated. The semantic components of the NCPeH have the purpose of carrying out the transformations on the documents to be sent and the translations of the documents received, safeguarding the semantic content and the medico-legal validity.

A specific component of the NCPeH called National Connector transforms the Italian PS into a version syntactically compatible with the European specifications. Similarly, it transforms the Italian electronic prescription (the dematerialised prescription) into an electronic prescription (EP), consistent with European specifications.

Cross-border interoperability is made possible thanks to the mutual recognition of the health systems and procedures of the different Member States. Mutual "trust" is based on the application of the European Directives and Regulations issued on the subject, in particular for the security aspects, compliance with the rules for the privacy protection and the definition and implementation of pre-established organizational procedures.

These procedures are verified through an Audit process carried out by the European Commission, with the support of experts appointed by the other Member States participating in the CEF eHDSI Project.

The results of the audit and tests, together with the demonstration of having complied with all legal and organizational requirements, constitute the objective elements on the basis of which eHealth Network will give a positive opinion on the activation of the NCPeH.

After this approval, the platform will be transferred to production together with all the technical, semantic, organizational components necessary for the implementation of cross-border eHealth services.

After this approval, the platform will be transferred to the production environment together with all the technical, semantic, organizational components necessary for the implementation of cross-border eHealth services and subjected to non-regression tests, to ensure the functionality of the active components before implementation. The test will be repeated after the adoption of new releases or the implementation of new services.