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Digital Health: Trends, standards and practices at Heart and-vessels2017

  1. Catherine CHRONAKI HL7 Foundation Ψηφιακή υγεία: τάσεις, πρότυπα και πρακτικές Digital Health: Trends, standards and practices
  2. 2 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,
  3. 3 Digital Health Trends
  4. 4 Digital Health Trends: user experience Athens, January 27, 2016, Source: medical futurist 2016
  5. 5 Workforce: Health Professional Perspectives (US) on digital health Athens, January 27, 2016, 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
  6. 6 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 26 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, Ref: Zelmer J, et al. International health IT benchmarking: learning from cross-country comparisons. J Am Med Inform Assoc 2016;0:1–8
  7. 7 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,
  8. 8 Source: HIMSS Insights 2015 Athens, January 27, 2016,
  9. 9 It's time to get doctors out of EHR data entry Athens, January 27, 2016,
  10. 10 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,
  11. 11 Ed Hammond’s patient summary of the 90’s: what has changed? Athens, January 27, 2016, HL7 v3 Reference Information Model
  12. 12 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 Athens, January 27, 2016, Base Standards Use Case based Standards Sets Assurance and Testing Live Deployment Feedback and Maintenance Tooling and Education Forums and Monitoring
  13. 13 Disruptive innovation in eHealth Standards Complex  simple Costly  free Specialized  generic Comprehensive  simple and tools-driven Athens, January 27, 2016, F– Fast (design & implement) H – Healthcare I – Interoperable R – Resources (Building blocks)
  14. 14 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, Modified from: Ed Hammond 2016 Let’s have a look:
  15. 15 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, clinFHIR Patient and Data Profiles Conformance Terminology Modified from David Hay
  16. 16 Patient History: Resource explorer Click on instance to see details Source from David Hay Athens, January 27, 2016,
  17. 17 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,
  18. 18 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: Developed Transformer of Patient summaries: 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.”
  19. 19 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, 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.
  20. 20 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,
  21. 21 eStandards Roadmap: A digital health compass for cooperative standards development in large scale eHealth deployment Athens, January 27, 2016, 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

Notas del editor

  1. Good afternoon, I am delighted to be here and share with you some of the latest development in European mHealth policy focusing on the guidelines for mobile health apps, and the issue of interoperability and HL7 FHIR; Fast Healthcare interoperability resources, the recent celebrity, in standards which reflects three things: Just in time standards, we want to share data now, low cost standards Desegration of eHealth, since FHIR uses web standards, JASON, restful approach, etc. Incremental approach that nurtures large scale eHealth deployment. We will review the draft guidelines, then move to the mHealth WG of HL7 and some standardization projects related to FHIR in mobile health apps, and eventually to what this means for standards development in this area. This work was done jointly with Frnak Ploeg enterprise architect at the university of Groningen and representative of HL7 at the working group of the European commission on quality guidelines for mobile apps.
  2. Digital Health Compass Multiple dimensions that need attention, - opportunities, divides or rifts, Collaboration – co-creation – activation – preference for participation, and engagement Digital native / Digital immigrant / Digital ignorant / Digital refugees / Digital outcast / Digital refuges
  3. What is the extend to which healthcare professionals use electronic systems to store ad manage patient health information and data, as well as functionalities to support health care delivery What types of clinical and other activities are supported by electronic means
  5. Trillium Bridge concluded a gap analysis comparing the implementation guides for epSOS and CCD-CCD and managed to identify the shared clinical elements: problems, medications, allergies. It also triggered the creation of interoperability assets: terminology prototype, transformer, and also an account of differences in the IHE profiles in EU and US on patient identity and document query retrieve. Several validation activities where carried out in EU/US Marketplace, HIMSS, IHE Europe, eHealth Week. Finally it led to a key transversal recommendation, and 20 thematic ones. The key recommendation is advance an international patient summary standard to enable people to access and share their health information for emergency or unplanned care anywhere and as needed. At a minimum the IPS should include innumication, allergies, medications, clinical problems, past operations and implants.
  6. Objective: how do I better understand the perspectives of my stakeholders? How do I better facilitate the collaboration between the stakeholders - understand the multiplicity of relationships How do I better collaborate with other SDOs - the 3.4 guide good citizenship of SDOs to make best use of the understanding of perspective of stakeholders to drive good content of standards. Health System – government and regulators Rules to abide by for sustaining and innovating the health system Public health reporting and analysis Communication and coordination across health systems Workforce Communication and coordination of care Dissemination and availability of knowledge (CDSS) Citizens Active involvement in health maintenance and decisions Navigating the health system (or systems) they are involved in eHealth Market Creating opportunities for new health and IT services