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EU-US eHealth/Health IT Cooperation InitiativeInteroperability of EHR

Work Group

August 14, 2013

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All Panelists

Agenda

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1. Welcome and Introductions2. Initiative Overview3. Scope Statements4. Goals/Objectives5. Work Plan6. Next Steps

Interoperability Support Leads

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• US Point of Contacts– Mera Choi, Mera.Choi@hhs.gov– Jamie Parker, jamie.parker@esacinc.com– Gayathri Jayawardena, gayathri.jayawardena@esacinc.com– Amanda Merrill, amanda.merrill@accenturefederal.com– Emily Mitchell, emily.d.mitchell@accenturefederal.com

• EU Point of Contacts – Benoit Abeloos, Benoit.ABELOOS@ec.europa.eu – Frank Cunningham, frank.cunningham@ec.europa.eu– Catherine Chronaki, chronaki@gmail.com

• UK Point of Contacts

Overall EU-US eHealth Cooperation - Vision

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• To support an innovative collaborative community of public- and private-sector entities, including suppliers of eHealth solutions, working toward the shared objective of developing, deploying, and using eHealth science and technology to empower individuals, support care, improve clinical outcomes, enhance patient safety and improve the health of populations.

EU-US eHealth Cooperation

Executive Summary…

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• Health related information and communication technology (most usually referenced as “eHealth” in Europe and “health IT” in the US) is an important and growing sector in the United States and the European Union. It is a rapidly developing and highly innovative area. It has considerable potential to promote individual and community health while fostering innovation and economic growth.

• Both the United States and the European Union are currently working to encourage more effective use of ICT and ICT in general, in delivery of health services, including disease prevention and health promotion. The Transatlantic Economic Council has therefore decided to make a critical contribution to this development by promoting interoperability of health related information and communication technology (eHealth/health IT) products and services, gaining improved mobility and consistent proficiency recognition for a professional workforce, and by helping to prevent unnecessary regulatory divergences.

EU-US eHealth Cooperation

Executive Summary Continued

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• We have decided to implement specific cooperative action plans for the following high-priority areas: Advancing eHealth/health IT Interoperability – we will

collaborate to accelerate progress towards the widespread deployment and routine use of internationally recognized standards that would support transnational interoperability of electronic health information and communication technology;

eHealth/health IT Workforce Development – we will work together to identify approaches to achieving our common goals for achieving a robust supply of highly proficient eHealth/health IT professionals and assuring health care, public health, and allied professional workforces have the eSkills needed to make optimum use of their available eHealth/health information technology. Equally, we will identify and address any competency and knowledge deficiencies among all staff in healthcare delivery, management, administration and support to ensure universal application of ICT solutions in health services.

EU-US eHealth Cooperation

Executive Summary Continued

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• The cooperative action plans anticipate robust participation by relevant experts and stakeholders, across the public, private and academic sectors. The public sector participants expect to confer with academic stakeholders, and to convene, catalyze and support creative collaborations among capable and willing private and academic sector participants, while offering guidance consistent with their policymaking responsibilities. All participants, and particularly the private-sector participants, in specific projects and initiatives under the action plans will identify solutions consistent with best practices in relevant fields (such as information science and workforce development).

• Over time, we expect to update the priority action plans to reflect progress made and new opportunities identified in the course of their implementation. We also recognize that, as work progresses and circumstances evolve, we may later want to develop cooperative action plans for additional areas and potentially involving additional participating public- and private-sector entities and/or different roles for entities also participating in the eHealth/health IT Interoperability and Workforce Development cooperative action plans.

EU-US eHealth Cooperation

Challenge

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• To promote individual and community health in a global environment, and enable a robust and innovative ecosystem of eHealth/health IT that supports the electronic exchange of human- and machine-readable health, clinical, medical and management information to advance the health of individuals and communities, we must maintain and enhance inter-governmental cooperation and also collaboration between governments and the private sector.

• The Memorandum of Understanding between The United States Department of Health and Human Services and The European Commission on Cooperation Surrounding Health Related Information and Communication Technologies (MOU) was signed in December, 2010, to demonstrate our shared dedication to cooperation addressing these challenges. Exploration of specific potential activities and approaches to implementing transatlantic interoperability, consistent with the principles and vision described in HHS-EC MOU require careful and inclusive analysis. This action plan articulates early, concrete steps toward the transatlantic interoperability and health IT workforce goals.

International Interoperability of EHRScope Statement

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• Working to accelerate and advance the progress of eHealth/health IT interoperability standards and interoperability implementation specifications for electronic health record systems that meet high standards for security and privacy protection for the international community.

International Interoperability of EHR

Goals/Objectives…

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• To have international interoperability of electronic health records information to include:• semantic interoperability; • syntactic interoperability; and• patient mediated data exchange (including

privacy and security issues surrounding exchange of health data).

International Interoperability of EHR

Goals/Objectives Continued

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• Three key goals of the technical work stream:

• Identify a subset of commonly used vocabularies and terminologies that can serve as the basis of an internationally recognized subset to support semantic interoperability (shared meaning). Multiple coding systems are in place in both the US

and EU, and analysis of administrative, clinical, laboratory and medication coding systems.

• Harmonize the formats (or structures) for how information is structured to support syntactic interoperability Multiple similar formats are used in the EU member

states, the epSOS project, and the US. • Identify a working group (complete) and to begin

defining pilot projects.

International Interoperability of EHR

US Initiatives…

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• Structured Data Capture (SDC) • The SDC Initiative will provide an infrastructure to standardize the

capture and expanded use of patient-level data collected within an EHR. The infrastructure will consist of 4 new standards:

• A standard for the CDEs that will be used to fill the specified forms or templates

• A standard for the structure or design of the form or template (container)

• A standard for how EHRs interact with the form or template; and

• A standard to enable these forms or templates to auto-populate with data extracted from the existing EHR

• Blue Button Plus (BB+) • The Blue Button+ initiative advanced the implementation standards,

tools, and services associated with the Blue Button to provide consumers with automated updates to their health information in a human readable and machine readable format

• Current Status:• ABBI launched the new Blue Button Plus website (

http://bluebuttonplus.org) with Push Implementation

International Interoperability of EHR

US Initiatives Continued

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• Transitions of Care (ToC)• The ToC initiative defines the electronic communication and data

elements necessary for clinical information exchange to support transfers of care between providers and to inform patients.

• Data Segmentation for Privacy (DS4P)• The DS4P initiative addresses the information interchange and

system functional requirements that will enable the enforcement of Federal, State, local, and organizational policies as well as Patient Consent Directives regarding the sharing of protected health information.

International Interoperability of EHR

EU Initiatives

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• TRILLIUM BRIDGE • Support action that will carry out a feasibility study on the transatlantic exchange

of patient summaries with participation of major stakeholders in the EU and US• CAMEI

• Support action that addresses digital skills for the healthcare workforce• epSOS (www.epsos.eu)

• Large scale pilot that developed specifications and cross-border pilots for ePrescription and patient-summaries across the EU. Its interoperability framework will serve as the basis for the specification of EU-wide patient summaries and the EU/US roadmap

• eHealth Governance Initiative (www.ehgi.org)• A joint action and a thematic network comprising member states and various

stakeholders that aims to establish a governance structure for eHealth• Semantic HealthNet (http://www.semantichealthnet.eu/)

• A network of excellence composed of academia, SDOs and other stakeholders to define a governance structure for semantic interoperability in Europe

• Antilope• A thematic network supporting the adoption and testing of existing eHealth

standards and specifications throughout Europe.• Convergence workshop Initiative (http

://www.eurorec.org/convergence2013/register.cfm#invitation)• An initiative to align efforts across EC projects, jointly hosted by EuroRec and the

European Commission DG Connect, to share best practices and results in semantic interoperability, privacy and security, quality metrics and business models.

• Other EU semantic interoperability projects

International Interoperability of EHR

EU: epSOS Use Cases

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• Patient Summary (PS):• While abroad, a patient seeks unexpected care. The Health Professional,

after heaving identified and checked the consent confirmation, requests the PS from the Country of Affiliation. The PS is shown mapped in the epSOS pivot format, with coded data translated in Country of Treatment language

• Health Care Encounter Report (HCER):• While abroad, a patient seeks unexpected care. The Health Professional,

after heaving received the PS, generates a CDA L3 document as Encounter Report. The document is transferred, mapped and translated to the Country of Affiliation

• Medication Related Overview (MRO):• A pharmacist, who cannot access the PS, requests the medication

summary and list of allergies (frequently derived from the PS)• Patient Access:

• A patient while in the Country of Affiliation, may request his PS mapped and translated in one of the epSOS languages:• This is the basis for Trillium Bridge Patient Mediated Interoperability

International Interoperability of EHRepSOS Patient Access (PAC) to Trillium Bridge Services

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• Some epSOS Countries plans to provide their citizens with epSOS Patient Access Service: The citizen may request his PS, in epSOS format, translated into any epSOS language

• Trillium will extend the service by Providing the export in the selected format to allow:• Patient mediated access:

• English document handed/showed to the US physician

• Structured document provided through secure media/mail/clouds

• Provider mediated access:• The US physician requests the document to the EU

healthcare institution (more difficult to implement)• Providing ways of importing in the EU citizen PHR /

EHR PS generated in US• Providing services to EU physician to read/access to

US citizen PS

International Interoperability of EHR

UK

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• Introduction• Sub-workstream participation

Next Steps

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• Discussion….• Interoperability Work Group will continue to meet every

Wednesday from 10:00am - 11:00am (ET)/4:00pm - 5:00 pm (CEST) starting August 21, 2013.– Webinar Details:

• Dial In: +1-650-479-3208 • Access code: 665 238 131 • WebEx URL: https://

siframework2.webex.com/siframework2/onstage/g.php?t=a&d=665238131

Join the EU-US eHealth/Health ITCooperation Initiative

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• We encourage all members to “sign up” for the initiative. By joining this ensures you stay up-to-date with the work being done, communications and any initiative activities.

• Simply complete the EU-US MOU Project Signup Form on the Wiki Page: http://wiki.siframework.org/EU-US+MOU+Roadmap+Project+Sign+Up

Interoperability Support Leads

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• US Point of Contacts– Mera Choi, Mera.Choi@hhs.gov– Jamie Parker, jamie.parker@esacinc.com– Gayathri Jayawardena, gayathri.jayawardena@esacinc.com– Amanda Merrill, amanda.merrill@accenturefederal.com– Emily Mitchell, emily.d.mitchell@accenturefederal.com

• EU Point of Contacts – Benoit Abeloos, Benoit.ABELOOS@ec.europa.eu – Frank Cunningham, frank.cunningham@ec.europa.eu– Catherine Chronaki, chronaki@gmail.com

• UK Point of Contacts

Questions

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Resources • EU US Wiki Homepage

– http://wiki.siframework.org/EU-US+eHealth+Cooperation+Initiative

• Join the Initiative– http://

wiki.siframework.org/EU-US+MOU+Roadmap+Project+Sign+Up

• Reference Materials– http://wiki.siframework.org/EU-US+MOU+Roadmap+Project+R

eference+Materials