patient summaries and the european ehealth digital service...
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Patient Summaries and the European eHealth Digital
Service Infrastructure Christof Gessner - gematik, Germany
19th International HL7 Interoperability Conference
22nd – 24th October 2019
Warsaw, Poland
Agenda:
• Cross-border service infrastructure for eHealth• Connecting Europe Facility - CEF
• eHealth Digital Service Infrastructure – eHDSI
• eHealth DSI Member States Expert Group - eHMSEG
• Using PS across borders
• Current developments and challenges
What is CEF
TRANSPORT€ 26.25 bn
ENERGY€ 5.85 bn
TELECOM
Broadband€ 170 m
Digital Service
Infrastructures€ 970 m *
CEF Regulation (REGULATION (EU) No 1316/2013)
The Connecting Europe Facility (CEF) is a regulation that defines how the Commission can finance support for the establishment of trans-European networks to reinforce an interconnected Europe.
* - 100 m Juncker Package
CEF Telecom GuidelinesThe CEF Telecom guidelines cover the specific objectives and priorities as well as eligibility criteria for funding of broadband networks and Digital Service Infrastructures (DSIs).
CEF Work ProgrammeTranslates the CEF Telecom Guidelines in general objectives and actions planned on a yearly basis.
HOW IS IT REGULATED?
CEF Telecom – what does it finance
D igital Service Infrastructures (DSIs)
EUROPEAN COMMISSION MEMBER STATES
CORE SERVICE PLATFORM(Services offered by the European
Commission)
GENERIC SERVICES(Grants for projects in the
Member States)
https://ec.europa.eu/cefdigital/wiki/x/QAFfAQ https://ec.europa.eu/inea/connecting-europe-facility/cef-telecom
eHealth DSI Deploying Countries
CEF eHealth DSI (eHDSI)
PS eP
Austria
Croatia
Cyprus
Czech Republic
Estonia
Finland
France
Germany
Greece
Hungary
Ireland
Italy
Luxembourg
Malta
Portugal
Sweden
Netherlands
Spain
What is the eHealth DSI?
• Services and Infrastructure using ICTs that enable cross border Healthcare services.
• Use Cases:
• Patient Summary, provides access to health professional to verified key health data of a patient during an unplanned care encounter while abroad
• ePrescription, enables patients to receive equivalent medication treatment while abroad to what they would receive in their home country
DISTRIBUTED SERVICES
eHDSI System Architecture
Central Services
• 1 EU wide instance
• Configuration
NCPeH – National contact Point for eHealth
• 1 per Country
• Run-time
NCPeHCountry x
NCPeHCountry y
NCPeHCountry z
NCPeHCountry …
RU
N-T
IM
EC
ON
FIG
UR
ATIO
N
CENTRAL SERVICES
Configuration services Terminology services
National Infrastructure
Netw
ork
ing
The interoperability challenge
Health Portal
Clinical Data Repository
Applications
TESTA-NG
National Infrastructure
Country B (Country of Treatment) Country A (Country of Affiliation)
Messagin
g a
nd
Tra
nsport
- Patient Summary
- ePrescription
NCPeH NCPeH
Connector
REQUESTER PROVIDER
Connector
CORE Services: TERMINOLOGY services (Architecture)
CTS SERVER
API
Central Terminology Services
NCPeH
TSAM-Sync
Third Party Terminology Services
LTR
Application Portal
National Terminology Services
Admin Portal
National Portal
Terminology Repository
20172016 2018 20202019
eHDSI Timescales: Core Services
MS GO LIVE
CEF eHealth DSIPatient Summary and ePrescription
PLANNED IN PROGRESS COMPLETED
Communication & Collaboration
Requirements and Specifications
Configuration services
Terminology services
Test and Audit services
NCPeH Reference Implementation
Operations Orchestration
Dec Mar Jun
MarMar
Mar Mar
Mar Mar
Mar Mar
Mar
Mar
Feb
Mar
Mar
Feb Feb
Mar
Mar
Sep SepSep
Jan
Jan
Jan
Jul
Jul
Dec
Mar
MarJan
Jan Nov
POLICY GOVERNANCE
Policy Owner eHealth Network
Policy Secretariat DG SANTE (B3)
MS Policy SupportJoint actions
(such as JAseHN WP5)
IT GOVERNANCE
DSI Owner (and DSI Co-Owner)
SANTE (Directorate B) (and CNECT Directorate H)
Operational Management Board (eHOMB)
DG SANTE (B3, A4),CNECT (H3), DIGIT
Chair and co-chairs of eHMSEG
Member States Expert Group (eHMSEG)
eHealth NCP
Managers
DSI Solution Provider SANTE (A4), DIGIT (A3, B4)
MS Operational SupporteHealth NCP Experts
(through eHDSI Communities)
eHDSI Governance organisation
Source: eHDSI Governance Modelhttps://ec.europa.eu/cefdigital/wiki/x/z0QZAg
eHDSI Communities
OPERATIONS
Audit Framework TF
Test Framework TF
SEMANTIC
Coordination WG
Organisation WG
Architecture WG
Semantics WG
TECHNICAL
STEERING COMMITTEE
TECHNICAL COMMITTEE
SMP/SML TF
Non-Repudiation
DEVELOPERS
eHDSI Communities
Legend:TF: Task ForceWG: Work Group
eHDSI Service Offering
USERS perspectiveSOLUTION PROVIDER perspective
Online version: https://ec.europa.eu/cefdigital/wiki/x/3EQZAg
eHDSI Service Offering - Solution Provider perspective
EPRESCRIPTION & PATIENT SUMMARY
EUROPEAN REFERENCE NETWORKS (ERN)
PATIENT REGISTRIES
GENERIC SERVICES GENERIC SERVICESGENERIC SERVICES
CORE SERVICES
NCPeH
Reference
Implementation
Clinical communication
and Patient management
Advanced Clinical
communication Platform
Services SPECIFICATIONS
CONFIGURATION services
TERMINOLOGY services
TEST and AUDIT services
MONITORING services
Services REQUIR. & RECOMMEND.
COMMUNICATION Platform
SERVICE DESK Platform
COLLABORATION Toolkit Knowledge Sharing Work Orchestration Teleconferencing
EC – eHDSISolution Provider
each Member State
Patient Summaries and the eHDSI
• How does it fit together?
• eHDSI PS• CDA IG in ART-DECOR
• Test framework, using IHE Gazelle
• Annual release cycle
• based on eHN guidelines (functional requirements)
• CEN IPS project – funded by EU commission
• HL7 IPS project – CDA IG, FHIR IG
Main "semantic" challenges of PS in eHDSI
• Structured information can not be communicated• Allow multiple code systems
• English translation my be sufficient
• increase concept granularity
• revise and update specific code systems (Allergies, Vaccines, Implants..)
• allow some information as free text (posology)
• Structured and coded information is not available• member states must provide a roadmap for alignment
• Different processes to assemble PS• raise awareness, make process visible to participants
Role of CEN/HL7 PS for eHDSI
• eHN decided to investigate options to move to IPS• use CEN IPS as functional base specification
• gap analysis (in progress)
• analyze possible future migration scenarios• iterative changes?
• use HL7 CDA PS IG as alternative new specification?
• use HL7 FHIR PS IG as alternative new specification?
• uptake of additional eHDSI use cases might add more options
Thank you!
Christof Gessner - gematik, Germany
eHDSI Semantic Task Force, Architecture WG Leader
Chairman HL7 Germany
Use Cases: Patient Summary and ePrescription