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Trillium Bridge ehealth Forum 2014 Athens
1. Update on the Trillium Bridge Project
Catherine Chronaki
euoffice@HL7.org
www.trilliumbridge.eu
Funded under
FP7-610756
2. 2
eHealth market is demanding!
HL7 CDA is a powerful tool for incremental
interoperability
Endorsed and adopted by several governments
Constrained with Templates and Implementation Guides
Developed independently… a cost to interoperability
eHealth market calls for agile processes and tools
Interoperability to lower costs
plug-n-play interoperability assets
Intelligent user interfaces
Can SDO’s do better?
What can you do to help?
3. 3
EU/US MoU Roadmap:
expected outcomes
Development of use cases/user stories
Perform Vocabulary Analysis
Perform Infrastructure Alignment
Perform Healthcare provider Mediated
Exchange analysis
Semantic and syntactic mapping of scenario
related health data
Pilots
A global standard or IG
for patient summaries?
4. 4
Why Trillium Bridge?
A builder perspective…
What can we do to lower the cost of transatlantic business
engagement in eHealth?
Reduce barriers for transatlantic coordination, health care, trade
Decrease standards development and implementation costs
Accelerate convergence towards global standards
Support right of citizens to their health data and safety
Well, perhaps we could try building..
…a Transantlantic Bridge for EHR summaries!
5. 5
Trillium Bridge Project
What:
Pragmatic Feasibility study on the exchange of Patient Summaries
across the Atlantic
How:
Comparing, analyzing, and mapping patient summaries starting with
Meaningful Use 2 C-CDA/CCD and EU patient summaries (epSOS)
When:
From: July 2013 to February 2015
Who:
A stellar consortium comprising EU member state ministries,
provider networks, industry, associations, SDOs
7. 7
Objectives of Trillium Bridge
Building the Transatlantic bridge for patient
summaries
Use cases gap analysis identify barriers /easy
winsdeployment
Interoperability assets Implementations Validation
Policy alignment, future standardization, and sustainability
Feasibility study to set the tone and pace for
interoperability in the global eHealth ecosystem.
Attain the vision of EU-US eHealth MoU and
roadmap!
8. 8
Milestones to success
Selecting
Grounds:
• Pilot Use Cases
• Business
Architecture
• Gap Analysis
Building the
Bridge:
• Aligning Structure
& Terminology
• Trust Agreements
• Interoperability
assets
Testing the
Bridge:
• Testing Tools
• Data Sets
• Validation
Reports
Policy Alignment:
•Organizational, Legal,
Regulatory Interoperability
• Feasibility Analysis
• Cross-vendor integration
• Incentives
• Standardization
• Innovative Business models
• eIdentification,
• Security and privacy
• Education
• Clinical Research
We are
here
9. 9
Trillium Bridge Use Cases
One Value proposition:
When patient needs unplanned care overseas, a EHR summary fit for the
purpose of safe and efficient health care is available.
After the health care encounter, patient receives encounter report in a
format and language that can be understood back home.
Two use cases:
Provider mediated (citizen controlled, provider initiated)
Patient mediated (citizen initiated, citizen controlled)
Blazing the transatlantic path – constraints and assumptions
Translation of narrative unstructured content (not in scope)
Incorporate patient summary elements in EHR or PHR (not in scope)
Preconditions: citizen empowerment
EU Citizens have access to their EU Patient Summary (e.g. epSOS PAC, HECR)
US Citizens have access to their Clinical Summary in
C-CDA/ CCD
10. 10 10
Imagine the Barriers to International Care
International visitors to US each year 66,600,000
US people travel abroad each year 58,496,587
Average stay (days) when travelling 4
Total Person-Days in Foreign Country 500,386,348
Total Person-Years in Foreign Country 1,370,922
US ED Visits/year 129,800,000
US Population 309,300,000
ED Visits/1000 US Citizens 420
Expected ED visits by travelers to/from US 575,317
Why Trillium Bridge?
Source: Larry Garber, Atrius Health
11. 11
Provider Mediated Case:
Technical Architecture Overview
National
Contact Point
(Italy)
National
Contact Point
(Spain)
National
Contact Point
(Portugal)
Trillium
Bridge
Gateway
(based on the
epSOS Open
NCP)
IHE XCA
IHE XCPD
IHE ATNA
(epSOS)
Local Connector &
eHealth Exchange
Gateway
Transformer
CTS-2
IHE XCA
IHE XCPD
IHE ATNA
(eHealth Exchange)
National
Contact Points
other
interested MS
Lux, Finland, Greece, Slovenia..
MU2
C-CDA/ CCDEU Patient
Summary
epSOS pivot
document (EN)
Terminology Services
• EU epSOS master values (MVC/MTC)
• US core value sets (NLM)
12. 12
Patient Mediated Use Case:
Technical Architecture Overview
Portuguese
Portal
(epSOS Patient
Access)
TrilliumBridge
Transformer
Tethered Personal
Health Record or
Health App or
BlueButton+
CTS-2
Terminology Services
• EU epSOS master values (MVC/MTC)
• US core value sets (NLM)
Italian
(Lombardy)
Portal (epSOS
Patient Access)
Doctor Displays PS
In local language prepares
encounter report
Get EU patient
summary
Request
transform..
Martha gets
her CCD
Via BlueButton
Get clinical summary
Paolo has
encounter report
in CCDA/CCD
Request
transform..
Spanish Portal
(epSOS Patient
Access Service)
EU MS
National Portal
(epSOS Patient
Access)
OpenNCP
Portal
1 2 3 4 56
7
Paolo has his EU
Patient Summary
epSOS pivot (EN)
1
2
Request
transform..
3 4
13. 13
Trillium Bridge: achievements/work ahead
Completed Gap analysis
In collaboration with S&I WG EHR Interoperability work stream
Released Deliverable D2.2: Comparing Patient Summaries in the
EU and US: Gap Analysis and Pilot Use Case Definition
Identified interoperability Assets
Established the basis for a terminology service to offer
interoperability assets
Plan to provide prototype CTS-2 service
Inform and support standardization efforts
Refine assets, complete the puzzle
15. 15
EU/US MoU Roadmap:
expected outcomes & Trillum Bridge
Development of use cases/user stories
Perform Vocabulary Analysis
Perform Infrastructure Alignment
Perform Healthcare provider Mediated Exchange
analysis
Semantic and syntactic mapping of scenario
related health data
Pilots
A global standard or IG
for patient summaries?
16. 16
Check out the Trillium Demo..
I hope you had the opportunity to see
the demo of Martha and Paolo crossing
the Trillium Bridge with their patient
summary.
If not, you still have time to stop at the
interoperability pavilion during the
break.
Otherwise, stay tuned… for Boston.
www.ehealth2014.eu
ROMANI
A
TURKE
Y
CROATI
A
CZECH
REPUBL
IC
BOSNIA &
HERZEGOVI
NA
European HL7
affiliate
membership 957
orgs (2011)
email: Euoffice@HL7.org
List: Europe@HL7.org
Web site: www.HL7.eu
17. 17
Parting Thoughts…
eHealth standards are the safety net that strengthens the fabric
of the global eHealth infrastructure.
Interoperability at affordable cost
Built once used anytime and anywhere
Working across cultures and borders
Health IT is enabling safe informed health care
Key to new market opportunities
Milestone in the path to a healthier world
Culture of collaboration, creativity, and understanding for the eHealth
ecosystem.
Deploy or Die!
Joi Ito, Head MIT Media Lab
Notas del editor
Good afternoon, Mr chairman, distinguished guests,
It is a unique privilege and honor to be here, in the eHealth Forum, in Megaron, in Athens, in my homeland, a week before the European elections to give you an update on the exchanging patient summaries across the Atlantic.
The Trillium Bridge project.
It was last year, at the 3rd EU/US Marketplace and EU/US MoU Assembly in Dublin that I was invited to present the Trillium Bridge as a proposed initiative. The truth is that our transatlantic team in close collaboration with the ONC S&I WS EHR Interoperability has been busy.
We have accomplished a lot as you will see, but Trillium Bridge is an ambitious project, and we are not really happy,
We feel that we could or we should have accomplished more.
Anyway, you will be the judge of that.
What, I would like to share with you today three things: (a) we have pieced together parts of the puzzle of the transatlantic exchange of patient summaries; (b) In doing so we have helped advanced awareness of interoperability issues in Europe.
Before, I go into Trillium Bridge specifics,
I would lie to share with you my thoughts on the HL7 CDA standards, interoperbailtiy and the eHealth market
We have done well, but you can do better.
Recently, I attended a course on Behaviour economics where the keynote shared with us, that the information society can help us invest our energy into meaningful work.
Why?
Reduce barriers for transatlantic coordination, health care, trade
Decrease standards development and implementation costs
Accelerate convergence towards global standards
Support fundamental right of citizens to their health data, ensuring their safety when receiving health care overseas.
That is the vision of the EU-US eHealth cooperation MoU and roadmap!
Build a bridge for EU/US patient summaries to be exchnaged across the Atlantic
Identify use cases of transatlantic exchange of patient summaries
Compile gap analysis to identify barriers and easy wins
Assemble Interoperability assets to support implementation effort
Validate exchange of patient summaries and bestow an award
Develop feasibility study to guide future developments
Facilitate policy alignment, future standardization, and sustainability
Why?
Lower costs/barriers for transatlantic business engagement
Reduce implementation/configuration costs
Decrease standards development costs
Accelerate convergence towards global standards
Support the fundamental right of citizens to their health information
First steps towards realizing the vision of the MoU
Consider This:
What does it take for a provider of a health information system that has been certified under MU-2 to configure it for the EU market?
Have you any thoughts on the amount of this effort today?
What should Trillium Bridge do to reduce it?
So how are we going to build this transatlantic bridge for EHRs?
Well, first we will Select the grounds, identify the most promising areas/the low hanging fruits, by comparing patient summary specifications for gap analysis and by selecting key use cases.
Then, we will Build the bridge: assemble interoperability assets, mappings of terminology data sets, translations, etc.
Next we will Test the bridge: configure testing tools and validate patient summary exchange
But for our efforts to persist and be result oriented, we will also contribute to policy alignment, standardization, sustainability of resources.
We will address seven key areas: education, cross-vendor integration, incentives, standardization, innovation, research, security & privacy,
Policy briefs will be developed by thought leaders at the two ends of the Atlantic and our findings and lessons learned and recommendations will be reported
In our feasibility study to guide future calls for proposals to inspire and drive investment in new initiatives and products.
Our feasibility study will be based on validation reports by leading providers in the EU and US. These include in the US Kaiser Permanente and Atrius Health (a gp network in Ma) and member states (Prt, Spain, It) that have committed to implementing the epSOS patient access service.
the Master Value
Sets Catalogue (MVC), which applies across all Member States, and the Master
Translation/Transcoding Catalogue (MTC).