EHRxF –a short overview

Relation with CEN IPS

Vincent van Pelt, MD

Senior advisor, Nictiz

CEN IPS Final meeting, 19-03-2019

February 2019: Recommendation EHRxF

EHREXCHANGE

FORMAT

WORKSHOPEHREXCHANGE

FORMAT

WORKSHOP

WELCOME TO

EHREXCHANGE

FORMAT

WORKSHOP

BRUSSELS

BERLAYMONT BUILDING

5TH

DEC. 2018

Workshops

1st workshop Lisbon, 9th and 10th July 2018

2nd Brussels, 25th September 2018

3rd Brussels, 5th December 2018

EHREXCHANGE

FORMAT

WORKSHOPEHREXCHANGE

FORMAT

WORKSHOP

EHRxF Representatives

05th Dec. 2018 – Brussels 3rd EHRxF WorkShop 4

• Cyprus Florentia Zeitouni

• Czech Republic Hynek Kruzik

• Estonia Katre Pruul

• Finland Heikki Virkkunen

• Germany Andreas Grode

• Greece Dimitrios G. Katehakis

• Lithuania Linas Kavolius

• Netherlands Conchita Hofstede

Vincent van Pelt

• Norway Georg Fredrik Ranhoff

• Malta Clinton Farrugia

• Portugal João Gonçalves

• Romania Simona Coroi and

Andreea Gărăiacu

• Serbia Vedran Martinovic

• Slovakia Pavol Rieger

• Spain Arturo Romero

• Sweden Omid Mavadati

• Switzerland Stéphane Spahni

• United Kingdom Jeremy Thorp

EHREXCHANGE

FORMAT

WORKSHOPEHREXCHANGE

FORMAT

WORKSHOP

MS participating in the discussion

05th Dec. 2018 – Brussels 3rd EHRxF WorkShop 5

EHRxF

Comments on Non-Paper Doc.

# Country Date

1 Bulgaria 29 Nov. 2018

2 Cyprus 03 Dec. 2018

3 Greece 03 Dec. 2018

4 Norway 03 Dec. 2018

5 Poland 03 Dec. 2018

6 Spain 03 Dec. 2018

7 Sweden 03 Dec. 2018

8 Portugal 03 Dec. 2018

8 Netherlands 03 Dec. 2018

9 Czech Republic 03 Dec. 2018

10 Denmark 03 Dec. 2018

11 Lithuania 03 Dec. 2018

12 Germany 03 Dec. 2018

13 Ireland 04 Dec. 2018

14 Estonia 04 Dec. 2018

3rd WS on EHRxF Representatives

# Country Name F2F/Tcon

1 Czech Republic Hynek Kruzik F2F

2 Norway George Ranhoff F2F

3 Slovenia Mate Beštek F2F

4 Greece Dimitrios Katehakis F2F

5 Poland Pawel Masiarz F2F

6 PortugalHenrique Martins F2F

Diogo Martins F2F

7 Italy Stefano Van der Byl F2F

8 GermanyAndreas Grode F2F

Beatrice Streit F2F

9 Netherlands Vincent Van Pelt F2F

10 Estonia Priit Tohver Video

FRAMEWORK FOR CROSS-BORDER EXCHANGE OF ELECTRONIC

HEALTH RECORDS

Framework for the development of a European electronic health record

exchange format in order to achieve secure, interoperable, cross-border

access to, and exchange of, electronic health data in the Union.

The framework includes:

• a set of principles that should govern access to and exchange of electronic

health records across borders in the Union;

• baseline for a European electronic health record exchange format;

• Iterative process to take forward the further elaboration of a European

electronic health record exchange format.

EHRxF Objectives

Principles for access to and cross-border exchange of electronic health records

• Patients: secure access and sharing of electronic health data across borders

• Citizen centric by design• Comprehensiveness and machine-readability• Security

• Identification and authentication• Auditability• Consent or other lawful basis• Data protection and confidentiality

• Continuity of service

ELECTRONIC HEALTH RECORD SYSTEMS IN MEMBER STATES Ensuring secure access to electronic health record systems• protection of health data

Tools and incentives• ReEIF• IHE profiles• …

National digital health networks• Representation of eHealth and healthcare stakeholders to work out strategies

EHRxF - Principles

Baseline for a European electronic health record exchange format

• Patient Summary;

• ePrescription/eDispensation;

• Laboratory results;

• Medical imaging and reports;

• Hospital discharge reports.

Further elaboration of a European electronic health record exchange format

• Organise National Digital Health Networks per country (organisation networks);

• Share knowledge between national competence centres;

• Build up a joint coordination process;

• Collaborate on the specification of semantic and technical specifications for cross-border exchange of health data;

• Build on existing initiatives such as the Common Semantic Strategy task force;

• Establish practical implementation guidelines, share good practice and promote awareness actions for citizens and

healthcare providers;

• Some MS may adopt electronic health record interoperability at a faster speed.

EHRxF - Baseline

FRAMEWORK FOR CROSS-BORDER EXCHANGE OF ELECTRONIC HEALTH RECORDS (3/3)

Monitor progress towards interoperability

• Annual reports, shared roadmap

Future work

• identify and review emerging technological and methodological innovation

Assessment of the effects of the Recommendation

• Report on the progress and foster cooperation

EHRxF - Process

Patient Summary – participating countries

Land PS-A PS-B 2018 (1) 2019 (2) 2020 (3) 2021 (4)

Austria 3 3

Belgium 3 2

Croatia 2 1

Cyprus 2 2

Czech Republic 1 1

Estonia 3 3

France 3 3

Germany 3 3

Greece 3 2

Hungary 3 3

Ireland 3 --

Italy 3 3

Luxembourg 2 1

Malta 1 1

Netherlands -- 4

Portugal 1 1

Slovenia 4 4

Spain 3 3

PS-B (import)

PS-A (export)

Technical format

Adoption

ASTM E2369-12 not used

C-CDA USA, Meaningful Use 2

C-CDA, FHIR USA

CDA Not used in EU

CDA → eHDSI

CDA NCPeH/OpenNCP

(CDA, FHIR) European Norm -2019

CDA, FHIR HCIMs

History of Patient Summary initiatives

CCR (Continuity of Care Record)

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

CCD (Continuity of Care Document) = CCR + HL7 CDA

Blue Button

XDS-MS (Cross-Enterprise Sharing of Medical Summaries)

epSOS

eHealth DSI (eHN)

CEN IPS

BgZ

The ‘BgZ’ has been based upon these projects and is 99% compatible with the eHDSI Guidelines and the CEN IPS European Norm

= USA = Europa = Netherlands

Sections epSOS eHN/eHDSI CEN IPS BgZ

Allergies and intolerances ✓ ✓ ✓ ✓

Diagnostic studies ✓ ✓ ✓ ✓

Functional status - - ✓ ✓

Immunizations ✓ ✓ ✓ ✓

Medical devices ✓ ✓ ✓ ✓

Medication ✓ ✓ ✓ ✓

Plan of care ✓ ✓ ✓ ✓

Pregnancy information ✓ ✓ ✓ ✓

Problems ✓ ✓ ✓ ✓

Alerts ✓ ✓ - ✓

Functional status - - ✓ ✓

Advance directives - - ✓ ✓

Procedures ✓ ✓ ✓ ✓

Social history ✓ ✓ ✓ ✓

Vital signs ✓ ✓ - ✓

PS initiatives -comparison at the section level

• NOTE: Alerts are currently recorded in Problems and in Allergies. Vital signs are under Diagnostic studies.• BgZ: Dutch Patient Summary• Extensions and additions are foreseen in updated versions of the IPS.

More information

• CEN IPS: http://www.ehealth-standards.eu/en/projects/

• CEN IPS European Norm 17269: http://www.ehealth-standards.eu/draft-european-standard-

17269-the-patient-summary-for-unplanned-cross-border-care-approved/

• CEN IPS Technical Specification 17288: http://www.ehealth-standards.eu/draft-european-

technical-specification-17288-the-international-patient-summary-guidance-for-european-

implementation-approved/

• eHDSI: https://ec.europa.eu/cefdigital/wiki/display/EHOPERATIONS/eHealth+DSI+Operations+Home

• (List of use cases): https://usecase-repository.ihe-europe.net/

eStandards

Refined eHealth European Interoperability Framework

Care Process

Policy

IT Infrastructure

Legal and regulatory

Information

Applications

Alignment of care processes

Agreements between organisations

Integration, communication formats, UI

Communication protocols, network, databases

Compatible legislation and regulations

Datasets, coding, terminologies

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Location A Location B

Legal and regulatory

Shared workflowProcess Process

Aligned policiesPolicy Policy

Compatible infrastructureIT Infrastructure IT Infrastructure

Legal and regulatory

Common data modelInformation Information

Communication formatsApplications Applications

Compatible legislation

Interoperability between organizations

ReEIF - Interoperability between stakeholders

Process

Policy

IT Infrastructure

Legal and regulatory

Information

Applications

Policy makers, CMIOs

Information analysts, terminologists

Software engineers

Healthcare-Managers

System architects

Regulators and advisors

System engineers

Business- and information architects

Healthcare directors

Healthcare professionals

Patients

Strategic Tactical Operational

System managers

Lawyers

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