Cross-border Interoperability

“Interoperability is the ability of making systems and

organizations to work together (inter-operate).”

“Cross-border Interoperability aims to provide tools and

common ways to exchange (health) information between

countries”

Cha

lleng

es

Legal Interoperability

Semantic Interoperability

Organisational Interoperability

Technical Interoperability

! Implementation of legal common grounds for

information exchange;

! Establishment of circles of trust;

! Legal recognition of involved parties, such as HCPs

(including their roles), patients and others;

! Set in place common authentication mechanisms

(e.g. European e-Identification projects);

! Others;

Lega

l and

Org

aniz

atio

nal

Inte

rope

rabi

lity

! Represent as much as possible the information using

clinical code-systems;

! If necessary, define common and agreed value sets

for information exchange;

! Establish formal mappings of existent information to

the agreed value sets;

! Include also the translations to allow multi-language

capabilities (cross-country scenarios);

Sem

anti

c In

tero

per

abili

ty

! Implement common interfaces for services;

! Establish agreed format for information exchange;

! If possible, prove and certify the compliance level of

the involved systems;

! Define roadmaps for information integration;

! And others;

Tech

nica

l In

tero

per

abili

ty

Citizens and patients

! Receive health care abroad (almost) seamlessly;

! Receive medication in a foreign country on existing

prescription;

! Access to his own information in multiple languages

and recognized formats;

Health care providers

! Get quick and easy access to key patient data;

! Improve health care cooperation across borders;

Health care quality

! Reduce medication errors by exchanging data;

! Facilitate the occasional care of foreign patients

Ben

efit

s

“So... How can we give response to some of this issues?”

IHE

What is?

IHE is an initiative by healthcare professionals and industry

Aims to improve the way computer systems in healthcare share information.

Promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical needs in support of optimal patient care.

Systems developed in accordance with IHE communicate with one another better, are easier to implement, and enable care providers to use information more effectively.

Vision

Enable seamless and secure access to health information whenever and wherever needed.

Mission

IHE improves healthcare by providing specifications, tools and services for interoperability.

IHE engages clinicians, health authorities, industry, and users to develop, test, and implement standards-based solutions to vital health information needs.

! Anatomic Pathology

! Eye Care

! IT Infrastructure

! Laboratory

! Patient Care Coordination

! Patient Care Devices

! Quality, Research and Public Health

! Radiation Oncology

! Radiology

IHE

Do

mai

ns

IHE

Eco

syst

em

IHE

Tech

nica

l Fr

amew

ork

sIntegration Profiles

Actors

Transactions

Transaction Details

HL7

What is?

Founded in 1987, Health Level Seven International (HL7) is a not-for-profit, ANSI-accredited standards developing organization.

Its dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information

This information that supports clinical practice and the management, delivery and evaluation of health services.

Vision

To create the best and most widely used standards in healthcare.

Mission

HL7 provides standards for interoperability that improve care delivery, optimize workflow, reduce ambiguity and enhance knowledge transfer among all of our stakeholders.

All processes include high scientific rigor and technical expertise.

“The 1000 kg Gorilla of

Healthcare Standards”

HL7

v2

Common Messaging Standard

Positive Negative

! Simple syntax

! Easy to understand

! Widely adopted, with great

experience;

! Backwards compatibility;

! Old technology

! Poor format

! Very limited scope

! Very limited on expansion;

MSH|^~\&|GHH LAB|ELAB-3|GHH OE|BLDG4|200202150930||ORU^R01|CNTRL-3456|P|2.4<cr> PID|||555-44-4444||EVERYWOMAN^EVE^E^^^^L|JONES|19620320|F|||153 FERNWOOD DR.^ ^STATESVILLE^OH^35292||(206)3345232|(206)752-121||||AC555444444||67-A4335^OH^20030520<cr> OBR|1|845439^GHH OE|1045813^GHH LAB|155

HL7

v3

Quality Methodology to supercede version 2

Positive Negative

! Rigorous and Thorough

Definitions

! Computable Base

! Based on XML & UML

! Deep Knowledge Required

! Complex Syntax

! Very expensive

! Common Semantics != Common

Engineering

<PRPA_IN201305UV02 ITSVersion="XML_1.0" xmlns="urn:hl7-org:v3"> <id extension="3660db44-40ab-4e9b-947e-a3ea3a4e80cc" root="67488c74-84f6-42c5-a9db-4a848fa49941"/><creationTime value="20140407"/><versionCode code="V3PR1"/>

(...)

HL7

FH

IR

Fast Health Interoperable Resources

! Small building blocks for health records;

! XML / JSON representation;

! Tailored for REST but useable in other ways;

! Standard Data, Narrative and Extensions

! Best ideas from HL7, DICOM and IHE

! Based on industry best practices, with a focus on

simplicity and implementability;

Euro

pea

n R

efer

ence

P

roje

cts epSOS STORK

Trillium Antillope

eHealth Integration Platform

Top

ics 1. Description

2. Key-functionalities

3. Business services provided

4. General architecture

5. Application scenarios

6. Demonstration workflows

7. Other supported use-cases

! Provides Technical and Semantic interoperability;

! Was firstly designed with EU Interoperability

Framework as blueprint;

! Boosts the exchange of health-related information

among departments, organisations or geographical

apart clinicians and patients ;

! Was built using well known and cutting edge

eHealth standards, allowing many integration

possibilities;

Des

crip

tio

n

Key

fun

ctio

nalit

ies Interoperability

Connectors

uIN core components that enable information exchange

Authentication & Authorization

user authentication and credentials assertion

Audit Trail

a storage and consultation service to audit events performed by users

Notifications

send and receive several kind of messages via email, SMS or inApp

Monitoring

continuous assessment of availability in the ICT ecosystem

Templating Repository

document schemes for consultation and usage

Bus

ines

s se

rvic

es

pro

vid

edMaster Patient Index

maintain consistent, accurate and current demographic and essential medical data on the patients, across one or several organizations

Patient Summary

standardized set of basic medical data that includes important clinical facts required to ensure safe and secure healthcare

Terminology Services

record clinical information in ways that enable meaning-based retrieval, providing effective access to information for decision support

Quality Conformance

quality evaluation of health records made, such as checking if the data of a given form is properly and fully completed

Use

d s

tand

ard

s an

d

IHE

pro

file

sHL7 FHIR

Most promising and recent HL7 draft standard. Oriented towards a lightweight REST approach, compatible with HL7 v2 and v3.Foresees easier integration with new paradigms (e.g. mobile, web)

IHE XDS.bWell known IHE Profile to handle storage, query and retrieval of documents. Can be complemented for a more community-oriented use-case with the XCA profile.

IHE PIX/PDQ

Well known IHE profiles for handling the interfaces with Master Patient Index. Allowing the execution of demographic queries and patient identifiers cross-referencing.Can be complemented for a more community-oriented use-case with the XCPD profile.

CTS2Common Terminology services interface. CTS2 is a model and specification for discovering, accessing, distributing and updated terminological resources on the internet.

DICOMWell known standard for clinical images and reports exchange and representation, regarding the format, service, etc.

*

Gen

eral

Arc

hite

ctur

eIntegration

Layer

Services Layer

Persistence Layer

Additional Services

IHE PIX/PDQXCPD

IHE XDS.bXCA CTS2 HL7 FHIR Others

Master Patient Index

Document Registry

Repository

Terminology Service Others

No-SQL Database

SQL Relational Database

Audit Trail Notifications

PACSDICOM Viewer

Report Templates Others

Ap

plic

atio

n Sc

enar

ios

Legacy System

✓ Compliant Services→ IHE, HL7 FHIR, etc✓ Extended Interfaces✓ Added Functionalities

Region A

Region B

Brid

ging

Net

wor

ksEn

ablin

g Sy

stem

seH

ealt

h Se

rvic

es

Challenge

us!

Master Patient Index

Documents

Terminologies

Others

Master Patient Index

*

Wo

rkfl

ow

: Pat

ient

Su

mm

ary

Appointment, emergency episode, etc

Document Repository✓ Patient Search

✓ Document Search✓ Document Retrieve✓ Semantic Transformation✓ Auditing

Country | Region | Hospital ACountry | Region | Hospital B

1. A patient goes to an appointment on a different hospital, region

or country;

2. The doctor asks for the patient’s home location and performs a

search for the patient identifiers match;

3. The doctor asks about privacy concerns, then searches for Patient

Summary;

4. A Patient Summary list is presented to the doctor;

5. The selected document is retrieved from the Patient’s home

location;

6. If necessary, the document is translated or transcoded;

7. All the operations are audited;

Master Patient Index

*

Wo

rkfl

ow

: PS

wit

h no

Co

nsen

t

Appointment, emergency episode, etc

Document Repository✓ Patient Search

✓ Document Search✓ Document Retrieve✓ Semantic Transformation✓ Auditing

Country | Region | Hospital ACountry | Region | Hospital B

1. A patient goes to an appointment on a different hospital, region

or country;

2. The doctor asks for the patient’s home location and performs a

search for the patient identifiers match;

3. The doctor then searches for Patient Summary;

4. A missing consent warning is presented to the doctor, instead of

a document list;

Master Patient Index

*

Pharmacy

Prescription Repository✓ Patient Search

✓ e-Prescription Search✓ e-Prescription Retrieve✓ Semantic Transformation✓ Report Dispensation✓ Auditing

Country | Region | Location ACountry | Region | Location B

1. A patient goes to a pharmacy on a different location, such as a

region or country;

2. The pharmacist asks for the patient’s home location and performs

a search for the patient identifiers match;

3. The pharmacist searches for available e-Prescriptions;

4. A prescription list is presented to the pharmacist;

5. If necessary, the selected document is translated and/or

transcoded;

6. The pharmacist dispenses one or more drugs, reporting back the

dispensation, being all the operations are audited;

Wo

rkfl

ow

: eP

resc

rip

tio

n

Oth

er s

upp

ort

ed u

se-

case

s Health-Care Encounter Report

As a support for the Patient Summary use-case, the main goal for this use case is to report back to the Patient’s origin location the information about the outcome of an encounter

Patient Access

The main purpose for this use-case is to provide access to the Patient to its own clinical information in different languages, for example.

Medication Related Overview

As a support for the ePrescription, this use-case tries to provide additional information for the Pharmacist and also for the Patient, regarding the administration of the drugs (and others).

eIdentification

Recent developments allow the integration of uIN existent portal system with strong authentication mechanisms, (e.g. smart-cards, mobile access tokens)This feature is aligned with the European project STORK, that promotes eIdentification.

Thank you!

contact@iuz.pt

+351 234 247 381

Rua Calouste Gulbenkian, n. 13810-074 Aveiro, Portugal

iuz.pt

iuz-technologies