Update on the Trillium Bridge Project

Catherine Chronaki

euoffice@HL7.org

www.trilliumbridge.eu

Funded under FP7-610756

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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?

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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?

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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!

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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

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Innovative Entrepreneur

s

US Health Care

Providers

European Standardization

epSOS National Bodies

with Patient Access pilot

Trillium Bridge: transatlantic community of Knowledge and Action

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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!

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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

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Trillium Bridge Use CasesOne 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 assumptionsTranslation of narrative unstructured content (not in scope)

Incorporate patient summary elements in EHR or PHR (not in scope)

Preconditions: citizen empowermentEU 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

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Imagine the Barriers to International CareInternational 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 129,800,000US 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

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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 XCAIHE XCPDIHE ATNA (epSOS) Local Connector

& eHealth Exchange Gateway

Transformer

CTS-2

IHE XCAIHE XCPDIHE ATNA(eHealth Exchange)

National Contact

Points otherinterested

MSLux, Finland, Greece, Slovenia..

MU2 C-CDA/ CCD

EU Patient Summary epSOS pivot document (EN)

Terminology Services• EU epSOS master values

(MVC/MTC)• US core value sets (NLM)

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Patient Mediated Use Case: Technical Architecture Overview

Portuguese Portal

(epSOS Patient Access)

Trilliu

m

Brid

ge

Tra

nsfo

rmer

Tethered Personal Health

Record orHealth App orBlueButton+

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 patientsummary

Request transform..

Martha getsher CCDVia 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)

OpenNCPPortal

1 2 3 4 56

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Paolo has his EU Patient Summary epSOS pivot (EN)

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Request transform..

3 4

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Trillium Bridge: achievements/work ahead

Completed Gap analysisIn 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

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Interoperability assets online

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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?

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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

ROMANIA

TURKEY

CROATIA

CZECH REPUBLIC

BOSNIA & HERZEGOVINA

European HL7 affiliate membership 957 orgs (2011)

email: Euoffice@HL7.orgList: Europe@HL7.orgWeb site: www.HL7.eu

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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 careKey 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