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EU-US eHealth/Health IT Cooperation Initiative

Interoperability of EHR Work Group

December 4th, 2013

Meeting Etiquette• Participants automatically enter the webinar in “listen

only” mode. The organizer will then unmute all participants. We ask if you are not speaking to manually mute yourself

• NOTE: VoIP participants have the ability to “Mute” themselves by clicking on the green microphone. However, if you would like to speak, only you can unmute yourself.

• If you are dialing in using a telephone and NOT using the VoIP you MUST dial the audio pin in order for the organizer to unmute you – if you do not use the audio pin and just push # when prompted the Organizer cannot unmute you

Meeting Etiquette CONTINUED

• If you are calling from a telephone, please do not put your phone on hold. If you need to take a call, hang up and dial in again when you have completed your other call

• This meeting is being recorded• Another reason to keep your phone or

your VoIP on mute when not speaking

• Use the “Chat” or “Question” feature for questions, comments and items you would like the moderator or other panelists to know.

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Agenda

Topic Time Allotted

General Announcements 5 minutes

Review Data Elements 15 minutes

Discuss National Contact Point Questions, Generalized Diagrams, & Sequence Diagrams

25 minutes

Review Use Case Table of Contents 10 minutes

Next Steps/Questions 5 minutes

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Meeting Times

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Washington, DC

10:00am (ET)London

3:00pm/15:00 (GMT)Germany

4:00pm/16:00 (CET)Athens

5:00pm/17:00 (EET)

Interoperability of EHR Work Group

meets everyWednesday

General Announcements

• To participate in our weekly webinars, please visit the EU-US eHealth Collaboration Wiki Homepage: http://wiki.siframework.org/EU-US+eHealth+Cooperation+Initiative

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Note: Please check the meeting schedule weekly to get the most up-to-date meeting information

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

Submit Your Bio• Submitted biographies are now posted on the

Wikipage http://wiki.siframework.org/Interoperability+of+EHR+Work+Group#Work Group Members

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Archived Meeting Materials

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• Visit the “Materials” tab and select “Past Meetings” from the drop down menu to access all archived meeting materials http://wiki.siframework.org/Project+Meeting+Artifacts.

Preparing for Meetings

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• Given our timeline and the amount of material to cover please ensure you are up-to-date with all of the activities of the interoperability work group– Visit the “Past Meetings” section of the wikipage for the

latest interoperability meeting materials and recordings http://wiki.siframework.org/Project+Meeting+Artifacts.

– If you have questions, need help or want a quick update please feel free to reach out to any member of the support team

– We will have little or no time to review what was covered the week prior in order to make our deadlines and deliverables

• FIRST MILESTONE: Completed Use Case by December 4th (with consensus completed by December 18th)

Use Case Development Timeline

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Date Inputs Discussion Outputs11/13/1

3Updated scope based on comments Comments that need further discussion 

Finalize ScopeDiscuss Assumptions, Actors, and Roles

Assumptions, Actors, and Roles to be posted for commentsData exchange diagrams and tables and pre and post conditions to be posted for comments

11/20/13

Updated Assumptions, Actors, and Roles based on commentsUpdated data exchange diagrams/tables and pre and post conditionsComments that need further discussion

Review and update Data exchange diagrams Data exchange tables Pre and Post Conditions

Data exchange diagrams, data exchange tables, pre and post-conditions to be posted for comments

11/25/13

Updated data exchange diagrams, data exchange tables, pre and post-conditions based on commentsComments that need further discussionDraft data element tables

Review and finalize Data exchange diagrams Data exchange tables Pre and Post ConditionsBegin review of draft data element tables

Finalized Data exchange diagrams Data exchange tables Pre and Post ConditionsDraft data element tables to be posted for comments

12/04/13

Updated data exchange diagrams, data exchange tables, pre and post conditions and data element tables based on commentsComments that need further discussion 

Review and finalize Data exchange diagrams Data exchange tables Pre and Post Conditions Data element tables

Finalized Data exchange diagrams Data exchange tables Pre and Post Conditions Data element tables

12/11/13

Draft use case with all sections completed

End to end review of draft use case Updated use case based on end to end comments and ready for consensus posting

12/18/13

Consensus comments mapped into the use case

Review consensus comments and finalize use case

Approved use case

Use Case Discussion

• Today’s discussion:– Data Elements Section Categories

• Are all of these categories needed?

– National Contact Point Questions, Generalized Diagrams, and Sequence Diagrams

– Use Case Table of Contents

epSOS to C-CDA CCD Mapping

In support of Use Case

Vision – Objective - Goals

• Vision:– Ability to electronically transmit and use Clinical Summary

(=Patient Summary) documents between US and EU:• syntactic and semantic interoperability

• Objective:– Develop 1-to-1 mapping with core (=limited=constrained)

information required to be included in Clinical Summary:• Data Elements + Vocabularies(=values).

• Goals (divided in phases):– Phase 1: Map Header and Sections information– Phase 2: Map Data Element within each section– Phase 3: Map Vocabularies associated with data elements

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Candidate for comparative analysis: Clinical Summary Form

• Health Level Seven Consolidated Clinical Document Architecture Release 1.1 (July 2012)– CDA R2 C-CDA R1.1– http

://www.hl7.org/implement/standards/product_brief.cfm?product_id=258

• Focus:– CCD template (within C-

CDA)

• epSoS (Patient Summary Form)– CDA R2 NE (May 2005)– HL7 IG: CDA R2-CCD

(April 1, 2007)– http://www.epsos.eu/

• Focus:– Appendix II

epsos_revised_data-set_25april2013.pdf

US EU

Use Case Mapping

• Use case mapping will be at the section/category level and NOT at the detailed data element level

• Detailed data element mapping will be done in the harmonization phase

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Phase 1: Map header and sections

• Header– Header of the Patient Summary information contains general

data about the document such as author of document, patient information, confidentiality settings…etc.)

• Sections (body)– Body of Patient Summary contains patient-specific

information organized in sections such as Medication section, Problems/Diagnosis/section, Allergy sections…etc.

• Note:– Information (individual data elements) may be organized

(grouped) in a different way in EU and US!

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Phase 1: EU Sections (epSoS)

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Section Name

Information (data elements) within section

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Phase 1: USA Sections (C-CDA CCD)

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EU: epSoS

USA: C-CDA CCD

Mapping - process

• Mapping maintained in Google Spreadsheet– Document updated in real time– Document publicly available– Document is machine processable! = can be imported

into database for quick analysis.

• Production– After mapping is completed, information from

spreadsheet will be transferred (packaged) in agreed upon format such as Word document, PDF document…etc.

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Data Element Sections

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National Contact Point Questions

• Currently, if an EU country does not have a NCP, can it receive patient data from other EU countries? If so, who is responsible for assuring authorization, code mapping, data mapping, and translation in this case?

• Will all NCPs provide all of the following services: code mapping, data mapping, code translation, text translation and authorization services?

• What would be the requirement of EU countries for a US recipient of EU citizen patient data if there is no US National Contact Point?

• Are there any examples in the US of organizations that provide services that are equivalent to the EU National Contact Points, i.e., code mapping, data mapping, code translation, text translation and authorization services ?– David: Several regional or state-level HIEs probably perform many of these

services through a combination of products from HIE vendors and/or self-developed software. Examples can be found at http://www.interopwg.org/membership.html

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Use Case Table of Contents

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1. Preface and Introduction 2. Initiative Overview

1. Initiative challenge statement 3. Use case scope

• Background• In scope• Out of scope• Communities of interest

4. Value statement5. Use case assumptions6. Pre-conditions7. Post-conditions8. Actors and Roles9. Use Case Diagram10. Scenario

• User Story• Activity Diagram

i. Base flowii. Alternative flow

• Functional requirementsi. Information interchange requirementsii. System requirements

• Sequence Diagram 11. Risks, Issues and Obstacles12. Dataset RequirementsAppendices

Use Case Development Timeline

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Date Inputs Discussion Outputs11/13/1

3Updated scope based on comments Comments that need further discussion 

Finalize ScopeDiscuss Assumptions, Actors, and Roles

Assumptions, Actors, and Roles to be posted for commentsData exchange diagrams and tables and pre and post conditions to be posted for comments

11/20/13

Updated Assumptions, Actors, and Roles based on commentsUpdated data exchange diagrams/tables and pre and post conditionsComments that need further discussion

Review and update Data exchange diagrams Data exchange tables Pre and Post Conditions

Data exchange diagrams, data exchange tables, pre and post-conditions to be posted for comments

11/25/13

Updated data exchange diagrams, data exchange tables, pre and post-conditions based on commentsComments that need further discussionDraft data element tables

Review and finalize Data exchange diagrams Data exchange tables Pre and Post ConditionsBegin review of draft data element tables

Finalized Data exchange diagrams Data exchange tables Pre and Post ConditionsDraft data element tables to be posted for comments

12/04/13

Updated data exchange diagrams, data exchange tables, pre and post conditions and data element tables based on commentsComments that need further discussion 

Review and finalize Data exchange diagrams Data exchange tables Pre and Post Conditions Data element tables

Finalized Data exchange diagrams Data exchange tables Pre and Post Conditions Data element tables

12/11/13

Draft use case with all sections completed

End to end review of draft use case Updated use case based on end to end comments and ready for consensus posting

12/18/13

Consensus comments mapped into the use case

Review consensus comments and finalize use case

Approved use case

Next Steps

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• Prepare for our next meeting• Continue submitting your bios• Attend the next Interoperability of EHR Work

Group meeting Wednesday December 11th from 10:00am - 11:00am (ET)/4:00pm - 5:00 pm (CEST)

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– Mark Roche, mrochemd@gmail.com – Virginia Riehl, virginia.riehl@verizon.net

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

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+Reference+Materials

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