# International patient data exchange through the patient > How hospitals in different countries can share a patient's record through the patient: a portable FHIR R4 record, an International Patient Summary, consent per clinic, and what it does not replace. Source: https://developers.anpheros.com/guides/international-patient-data-exchange **When a patient moves between countries, the clinic that needs their history usually cannot reach the system that holds it.** On Anpheros the record is held by the patient, in standard HL7 FHIR R4 form, and a clinic anywhere can read the part the patient allows, for as long as they allow it. The patient is the bridge between systems that do not talk to each other. ## The problem Hospital systems in different countries use different products, different languages and different legal frameworks. A direct connection between two hospitals needs agreements, security reviews and integration work that rarely happen for a single patient. The patient, however, is present at both ends and has a legal right to their own data in most jurisdictions. ## How it works on Anpheros 1. **The record is portable.** It is stored as FHIR R4 resources with codes from standard terminologies, such as LOINC for laboratory results, ICD-10 for conditions and ATC for medications, and it can be exported as an International Patient Summary (`Patient/$summary`), a document validated with the official HL7 validator. See [International Patient Summary (IPS) in FHIR](https://developers.anpheros.com/guides/international-patient-summary-fhir). 2. **The patient allows a clinic.** The clinic sends a request, and the patient approves it from their phone wherever they are, for 30, 90 or 365 days. See [how a clinic requests access](https://developers.anpheros.com/guides/clinic-access-request). 3. **The clinic reads, in its own language and system.** Terminology is standard, so a laboratory value or an allergy means the same thing in each country. Free text stays in the language it was written in. 4. **The clinic adds its own results,** with the patient's consent, labelled with who wrote them, and the patient keeps them. 5. **The patient can withdraw access** at any time and see every read in the access log. ## What it covers, and what it does not - It works **through the patient**. It does not connect national health systems to each other, and it does not replace them. Where a national system exists, such as a country's patient summary service, the patient-held record is an additional route, not a substitute. See the [European Health Data Space for developers](https://developers.anpheros.com/guides/ehds-for-developers) for how the wider European framework relates. - It carries **structured data** well: conditions, medications, allergies, laboratory results, vaccinations, measurements. Documents, such as discharge letters, travel as files with their checksum. - **Language** is not translated automatically. Codes and structured values are interpreted the same way everywhere; narrative text is not. - **Data location:** the data stays in the EU region by default, whichever country the reading clinic is in. A US data region is available on request for US production customers under a business associate agreement; production for US patient data starts only after it is signed. ## For a hospital that wants to receive patients from abroad - Accept a patient's **International Patient Summary** or a request through the platform instead of asking for paper copies. - Map your system's patient, condition, medication and observation records to FHIR once; the same mapping works for every patient who arrives through the platform. The [integration guide](https://developers.anpheros.com/guides/integrate-clinic-systems-fhir) shows the steps. - Use the sandbox first, with synthetic patients, to test the integration before any real record is involved. ## Frequently asked questions ### Can a hospital in one country read a patient's record from another country? Yes, with the patient's approval. The clinic requests access, the patient allows it for a stated period, and the clinic reads the allowed scope as FHIR R4 data. Neither hospital needs to connect to the other's systems. ### Is this the same as a national health data exchange? No. National and European exchanges connect institutions. This route runs through the patient and complements them; it is useful when no institutional connection exists between two providers. ### Which language is the record in? Structured data uses international codes, so it can be read in any language. Text written by a clinician stays in its original language; it is not translated automatically. ### Where is the data stored when a clinic abroad reads it? In the European Union. A clinic outside the EU reads it through the API; the data is not copied to another region by default; a US region is available on request for US patients. ### What does the patient control? Who can read, which resource types, for how long, and whether to withdraw. The patient also sees every read of their record. ## Related - [A patient data platform for clinics and hospitals](https://developers.anpheros.com/guides/clinics-and-hospitals) - [How a clinic requests access to a patient's record](https://developers.anpheros.com/guides/clinic-access-request) - [International Patient Summary (IPS) in FHIR](https://developers.anpheros.com/guides/international-patient-summary-fhir) - [European Health Data Space (EHDS) for developers](https://developers.anpheros.com/guides/ehds-for-developers) - [Healthcare data interoperability](https://developers.anpheros.com/guides/interoperability)