Catherine CHRONAKI
HL7 Foundation
euoffice@HL7.org
Ψηφιακή υγεία: τάσεις, πρότυπα και πρακτικές
Digital Health: Trends, standards and practices

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A digital health compass to navigate the (digital) health system
Base Standards
Use Case based
Standards Sets
Assurance and
Testing
Live
Deployment
Feedback and
Maintenance
Tooling and
Education
Forums and
Monitoring
Athens, January 27, 2016, euoffice@HL7.org

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Digital Health Trends

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Digital Health Trends:
user experience
Athens, January 27, 2016, euoffice@HL7.org
Source: medical futurist 2016

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Workforce: Health Professional Perspectives (US) on digital health
Athens, January 27, 2016, euoffice@HL7.org
Meaningful use
Financial incentive programs for use of certified EHR technology
EHR usability – user experience
Adoption and continued productive use
Connected health
Telemedicine and mobile health
maximize health care resources
increased flexible opportunities for patient to engage with
clinicians
Patients better self-manage their care
Health information exchanges
Sharing of information among physicians and hospitals to
improve health care in communities

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0%
20%
40%
60%
80%
100%
primary care facilities manage patients online
Radiology images exchange in acute care
Synchronous telehealth capability in acute care
access to test results online by patients
e-appointment booking by patinets
e-request perscription renewal refill
secure messaging with patients
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10
7
0
3
3
0
5
12
8
0
2
2
4
2
9
15
31
26
26
27
Maturity of eHealth solution in 30 European Countries (OECD, EU)
>75% 50-75% <50%
Athens, January 27, 2016, euoffice@HL7.org
Ref: Zelmer J, et al. International health IT benchmarking: learning
from cross-country comparisons. J Am Med Inform Assoc 2016;0:1–8

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Concerns with wide adoption of EHRs
Unintended clinical consequences of broad EHR adoption:
reduced time for patient-clinician interaction
new and burdensome data entry tasks to front-line clinicians
More patients, lengthened workdays
Interoperability among EHR systems has languished – steep learning curve.
These frustrations contribute to decreased satisfaction with professional work
life. [JAMIA2016]
Athens, January 27, 2016, euoffice@HL7.org

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Source: HIMSS Insights 2015
Athens, January 27, 2016, euoffice@HL7.org

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It's time to get doctors out of EHR data entry
Athens, January 27, 2016, euoffice@HL7.org

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Patient summaries in the health ecosystem
Patient summary is a window to a person’s health, a personal dashboard with a lens allowing
to look more closely:
problems and procedures
Medications and implantable devices
vaccinations
allergies
labs
images
Encounters
Can HL7 FHIR help in Unlocking data, facilitate decision support, navigate the system?
Bring the Power of Platforms to Health Care [Bush & Fox, HBR November 2016]
administrative automation
networked knowledge
resource orchestration
Uber Health: 2015: one-day pilot to deliver 2,000 flu shots over four hours in 35 cities.
Athens, January 27, 2016, euoffice@HL7.org

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Ed Hammond’s patient summary of the 90’s:
what has changed?
Athens, January 27, 2016, euoffice@HL7.org
HL7 v3 Reference Information Model

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What do we mean by eStandards?
Perspective – intermediate goals - guidance
“Formal” standards: A set of standards
and/or specifications that are agreed upon
through an open consensus based
process &
can be referenced by contracting parties
and/or regulatory bodies
Need eStandards to really support and
promote eHealth deployment:
Standard sets need to be constructed fit
for purpose for specific use cases
Tooling need to support the use of
standards in large scale eHealth
deployment
www.estandards-project.eu
Athens, January 27, 2016, euoffice@HL7.org
Base Standards
Use Case based
Standards Sets
Assurance and
Testing
Live
Deployment
Feedback and
Maintenance
Tooling and
Education
Forums and
Monitoring

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Disruptive innovation in eHealth Standards
Complex  simple
Costly  free
Specialized  generic
Comprehensive  simple and tools-driven
Athens, January 27, 2016, euoffice@HL7.org
F– Fast (design & implement)
H – Healthcare
I – Interoperable
R – Resources (Building blocks)

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What is FHIR?
Based on a set of modular components - “Resources”
Resources refer to each other using URLs
Small discrete units of exchange with defined behaviour and
meaning
Have known identity and behaviour
Extensions permit adding data not part of core
Resources are combined into “Profiles” to solve clinical and
administrative problems
Parties exchanging data define the specifics of using resources
and their relations using Profiles.
Profiles are the framework for defining services.
Test data and servers are available
Exchange resources between systems
Using a RESTful API (e.g. web approach)
As a Bundle of resources (messages, documents)
Positives
Service driven - composition
Modify components with changing need
Portability of components by moving code with the data
Athens, January 27, 2016, euoffice@HL7.org
Modified from: Ed Hammond
2016
Let’s have a look: https://www.hl7.org/fhir/

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ClinFHIR: clinicials on FHIR
web based training and development:
View resources for a patient
Create resource instance from profile
Can be a base type or a profiled type (some limitations)
Create simple profiles
Specific server roles (according to clinFHIR)
Data/patient – patient related (clinical) and ‘reference’ (Practitioner, Organization)
Conformance – profile, extensionDefinition (both StructureDefinition)
Terminology – ValueSet & Terminology operations
Important to be STU consistent!
Hapi STU-3 for Data, Grahame for Conformance, Terminology
Athens, January 27, 2016, euoffice@HL7.org
http://clinfhir.com/
clinFHIR
Patient
and Data
Profiles
Conformance
Terminology
Modified from David Hay

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Patient History: Resource explorer
Click on instance to see details
Source from David Hay
Athens, January 27, 2016, euoffice@HL7.org

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Is HL7 FHIR enough for Patient Summaries
eStandards identified a number of gaps:
Professional guidelines
Clinical information models
Reliable mix of patient and provider generated data
Regulatory clarity
Terminology initiatives
Localization and adaptation
Open access and open data tools for deployment of standards
Standards sets in procurement
Governance and maintenance process for standards sets
Athens, January 27, 2016, euoffice@HL7.org

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Achievements of Trillium Bridge
Gap analysis
Compared patient summary specifications in EU/US
Shared clinical elements: problems, medications, allergies
Interoperability Assets
Established a terminology prototype CTS-2 service: http://extension.phast.fr/STS_UI
Developed Transformer of Patient summaries: http://informatics.mayo.edu/trillium-bridge
Mediated Differences in EU/US IHE XCPD/XCA profiles for Patient Identity and Document Query/Retrieve
Validation activities: 4 EU countries/ Kaiser Permanente
EU/US Marketplace; HIMSS 2015; IHE Europe Connectathon 2015, eHealthWeek 2014,15
Feasibility study:
Reflected upon standards, cross-vendor integration, incentives, clinical research,
security and privacy, innovative business models, education
Recommendation:
“Advance an International Patient Summary (IPS) standard
to enable people to access and share their health information
for emergency or unplanned care anywhere and as needed.
At minimum the IPS should include immunizations, allergies,
medications, clinical problems, past operations and implants.”

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Ambition for International Patient Summary
In case of Emergency, the patient
summary is there in our mobile
phone and can be understood
anywhere in the world
Emergency response teams can
use the patient summaries to
capture accurately the aggregate
and individual needs of a
community hampered by disaster.
Athens, January 27, 2016, euoffice@HL7.org
The ambition of Trillium II touches the person
(through it mobile home – the hub) and the
community (making the post of our data-driven
economy.

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Can Patient summaries leverage HL7 FHIR
to unlock the power of data and drive digital health innovation?
YES, HL7 FHIR is part of the solution
It opens a window, but It takes a village…
Athens, January 27, 2016, euoffice@HL7.org

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eStandards Roadmap: A digital health compass
for cooperative standards development in large scale eHealth deployment
Athens, January 27, 2016, euoffice@HL7.org
eHealth Consumers
e.g. Patients/citizens/travellers/..
Workforce
Healthcare Professionals/ pharmacists/ hospitals / …
Healthcare Systems
e.g. Procurers
eHealth Market
e.g. Vendors
eHealth DSI
EU-US MoU