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a new era in legal and policy framework for EU Cooperation on eHealth
• Proposal for a European Directive on patients’ rights in cross-border healthcare
• Commission Recommendation on cross-border interoperability of electronic health record systems
• Communication on telemedicine for the benefit of patients, healthcare systems and society
• eHealth Standardisation Mandate 403• 2009, the European eHealth Governance Initiative,
through a Joint Action Initiative was launched
2008 a new Era22.10.2010 Page 3
AustriaCzech RepublicDenmarkFranceGermanyGreeceItaly – LombardyThe NetherlandsSlovakiaSpainSpain – AndalusiaSpain – Castilla la ManchaSpain – CataloniaSwedenUnited Kingdom –EnglandUnited Kingdom –Scotland
12 epSOS Countries22.10.2010 Page 4
The Project Team consists of 29 beneficiaries from 12 member states: AT, CZ, DE, DK, EL, ES, FR, IT, NL, SK, SE and the UK
• ATNA, ANDA, CAHTA, CATA, CLM, CNRS, DENA, DKNA, ELGA, EMPIRICA, ESNA, FRAUNHOFER, FRNA, GEMATIK, GIPDMP, IHE, IZIP, LOMBARDY, LISPA, MEDCOM, NHS, NHIC, NICTIZ, NLNA, PHARMAXIS, SALAR, SENA, THESS, ZI
• Competence Centers Including/working with local organizations with thousands of Contributors
• IHE-Europe representing ICT industry team
The epSOS Project Team22.10.2010 Page 5
1. Accenture
2. Engineering Ingegneria Informatica S.p.A
3. Oracle
4. Agfa Healthcare
5. ETIAM
6. Posam
7. Apollo
8. GE Healthcare
9. RISE
10. BT
11. Gemalto
12. Sineura S.p.A
13. Carecom
14. Gnomon
15. Steria Mummert Consulting AG
16. Cisco
17. ICW
18. Tiani-Spirit
19. CMP Medica
20. Indra
21. TrebleM
22. CompuGROUP
23. Mawell
24. Insiel
25. T-Systems
26. dbMotion
27. Intel Corporation S.A.
28. X-tention
29. Dedalus
30. Microsoft
31. 3M
32. Electronic Record Company
33. Netsmart
The epSOS Industry Team
From Strategies to Services
Provide concrete cross border services that ensure safe, secure and efficient medical treatment for citizens when travelling across Europe
• Focus on services close to the patient:– Patient Summary for EU Citizens
• Occasional Visit• Regular Visit
– ePrescribing for EU Citizens• Medication ePrescription• Medication eDispensation
• Build on existing National eHealth Projects and use experiences and knowledge from all Member States
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46Code Title Leader Start End Start EndWP1.1 Analysis and comparison of national plans/solutionsNLNA M1 M6 M1 M11 x x x x x x x x x x xWP1.2 Overall evaluation of the projectFRNA M1 M36 M1 M44 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x xWP1.3 Dissemination ATNA M1 M36 M1 M42 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x xWP2.1 Analysis and comparison of legal and regulatory issuesTHESS M1 M36 M1 M42 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x xWP3.1 Definition of ePrescription ServicesESNA M7 M12 M7 M15 x x x x x x x x xWP3.2 Definition of Patient Summary ServicesESNA M7 M12 M7 M15 x x x x x x x x xWP3.3 System Architecture FRNA M13 M18 M10 M21 x x x x x x x x x x x xWP3.4 Common Components Specif icationFHGISST M13 M18 M10 M17 x x x x x x x xWP3.5 Semantic Services FRNA M10 M18 M10 M18 x x x x x x x x xWP3.6 Identity Management ELGA M10 M15 M10 M18 x x x x x x x x xWP3.7 Security Services LOMBARDY M10 M15 M10 M18 x x x x x x x x xWP3.8 Integration and customisationMEDCOM M13 M18 M13 M22 x x x x x x x x x xWP3.9 Development of proof of concept system for pilot phaseLOMBARDY M16 M24 M13 M23 x x x x x x x x x x xWP3.10 Proof of concept testing LOMBARDY M22 M30 M21 M32 x x x x x x x x x xWP4.1 Specif ication of test scenarios including site choiceCATA M7 M12 M8 M16 x x x x x x x x xWP4.2A Preconditions and EU level preparationGEMATIK M13 M15 M19 M21 x x xWP4.2B Preconditions and site level preparationIZIP M13 M21 M19 M27 x x x x x x x x xWP4.3 Pilot implementation (EU, national, local)IZIP M19 M27 M25 M34 x x x x x x x x x xWP4.4 Operation I IZIP M25 M27 M31 M33 x x xWP4.5 Operation II IZIP M28 M36 M34 M42 x x x x x x x x xWP5.1 Coordination SENA M1 M36 M1 M42 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x xWP5.2 Technical management GEMATIK M1 M36 M1 M42 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x xWP5.3 Administrative management EMPIRICA M1 M36 M1 M42 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x
2010 2011
Original update2008 2009
Analysis & Requirements
Technical
Specification
Integration &
Testing
Operation
Analysis & Evaluation
& Recommendation
Project Plan22.10.2010 Page 8
EU memberstate(not participating)
Non EU country
Single (national)patient identifier
Multiple (regional)
patient identifiers
Availability of Patient Identifier 201022.10.2010 Page 9
Nationally-led
Regionally-led
Not available / unknown
EU memberstate(not participating)
Non EU country
Fully available
Partly available
Fully available
Partly available
HCP Identifier suitable for Auth & Digital Signature 2010
22.10.2010 Page 10
Nationally available & operational
Regionally available
& operational
Not available / unknown
EU memberstate(not participating)
Non EU country
>25%
<25%
>25%
<25%
Availability of ePrescription 201022.10.2010 Page 11
Nationally available & operational
Regionally available
& operational
Not available / unknown
EU memberstate(not participating)
Non EU country
>25%
<25%
>25%
<25%
Availability of Dispensation info 201022.10.2010 Page 12
Federating national HCOs
Federating countries
A country becomes a member of the epSOS trusted domain.....
If a health care provider organisation (HCPO) demonstrates conformance to epSOSrequirements then it may offer the epSOS services
The HCPO is accountable to the NCP
The NCP is accountable to the epSOS community
epSOS Trusted Domain22.10.2010 Page 13
• Three different blocks in each dataset
– Patient Identification
– HCP identification
– Medicine: prescription and dispensed medicine data
Prescription Item ID
Original or copy of the prescription in Country A
Country B Single concept
—Active ingredient (Country B)
—Strength of the medicinal product (Country B)
—Medicinal product package (in Country A)
—Pharmaceutical dose form (in Country B)
Brand name of the medicinal product prescribed in Country A
Number of packages
Posology
Date of issue of the prescription
eP Dataset22.10.2010 Page 14
Need for information in FranceNeed for information in France
• Maria Schmidt, a 25 year old Austrian Austrian student enrolled in the Erasmus program, shows up at the Emergency departement at the CHU Dijon (Hospital in Dijon). The chief complaint is abdominal pains following 3 to 4 hours after a meal.
• An abdominal x-rays show signs of intestinal occlusion. The overall clinical presentation is inconclusive, with a diffuse abdominal pain and not needing surgical intervention.
• The physician considers keeping the patient under observation only, or performing an exploratory lapartomy (Ex-Lap).
Hospital in Dijon
(CHU Dijon)??
Request to the French NCPRequest to the French NCP
• As the physican knows that epSOS can provide more information, he searches for the patient. The search is directed towards the French National Contact Point (NCP) which in turn will provide the location of the student’s Patient Summary.
CHU de Dijon
Request for information
French NCP
Request from NCP France to NCP AustriaRequest from NCP France to NCP Austria
• The French NCP performs, based on protocols which are out of scope for the semantic presentation, a request for information to the Austrian NCP.
Request for information
French NCPAustrian
NCP
Austrian Patient Summary Austrian Patient Summary –– 11
1. The Austrian Patient Summary belonging to this patient is located.
2. The document is syntaxically transformed into the epSOS CDA format, according to the specifications.
National Connector and National Transformer
Transformation
original xml - epSOS CDA
Austrian Patient Summary Austrian Patient Summary –– 22
National Connector and National Transformer
epSOS CDA original pdf with the same CDA header
1. The original document is transformed into an epSOS CDA document as shown
2. The original document is also transformed into a pdf
3. The pdf has the same CDA header as the epSOS CDA document (in order to provide the link and the traceability between the two documents)
CDA+ pdf
Austrian Patient Summary Austrian Patient Summary –– 33
National Contact Point
Value Set # 1
Value Set # 2
Value Set # 3
epSOS Local Terminology Repository
The document epSOS CDA uses the Terminology Services interface of the Terminology Services Access Manager (TSAM) . These
services use a data base containing the epSOS Local (National) Terminology Repository
TSAM
epSOS Local Terminology RepositoryepSOS Local Terminology Repository
• The content is orginally in English, the terms are based on criterias defined by the use-cases identified by the Member States (epSOS Master Value Sets Catalogue - MVC).
• The Member States have translated the terms in their language and transcoded into them in their national coding system leveraging the epSOS Ontology. This results in the epSOS Master Translation/Transcoding Catalogue – MTC
• The Local Terminology Repository is a subset the epSOS Central Reference Terminology Server.
• If an update is made to the epSOS Central Reference Terminology Server, the Local Terminology Repositories are notified and updated.
epSOS MTC epSOS MTC –– Translation and TranscodingTranslation and Transcoding
• Simplified view of the MTC applying to this use case
Terms from different code systems are transcoded using Terms from different code systems are transcoded using the epSOS Reference Terminology present in the the epSOS Reference Terminology present in the
epSOS MVCepSOS MVC
Information return from Austrian NCP to French Information return from Austrian NCP to French NCPNCP
• The Austrian NCP sends two documents to the French NCP:
• the transformed document (the pivot CDA document)
• the original document in a pdfpdf format to the French NCP in a CDA wrapper
French NCP Austrian NCPInformation returned
Results available for the French Results available for the French physicianphysician
• The French physician receives the original document as pdf in German as well as the transformed document in the epSOS format.
CHU de Dijon
French NCP
Information returned
epSOS CDAoriginal pdf with the same CDA header
Austrian Patient Summary understandable by the Austrian Patient Summary understandable by the French physicianFrench physician
Use case Use case -- conclusionconclusion
• The French physician sees the following helpful information in the Austrian Patient Summary obtained via epSOS services:– 3 years ago: emergency cholecystectomy
– 1 year ago repeated sub-occlusive episodes.
• Based on these useful information an abdominal scan is done showing a peritoneal bridle occlusion.
• A laparotomy is performed.
epSOS has helped the attending physician in epSOS has helped the attending physician in providing better care for the patient!providing better care for the patient!
17 /18
• Scenario 1: acting as Country B (receiver of patient information)
• Scenario 2: acting as Country A (sender of patient information)
epSOS Pilot Site Candidates22.10.2010 Page 31
• Scenario 3: acting as Country A (sender of
prescription information)
• Scenario 4: acting as Country B (receiver of
prescription information)
epSOS Pilot Site Candidates22.10.2010 Page 32
INFRASTRUCTURES INVOLVED PS/eP
HCPO 3.445
• Hospitals 183
• Farmacies 2.149
• PoC 1.113
HUMAN RESOURCES INVOLVED
HCP 30.157
Total numbers
epSOS Pilot Site Candidates22.10.2010 Page 33
Pilot Site Candidates: Austria
• Involved regions: five cities -Innsbruck, Grieskirchen, St. Pölten, Vienna and Wels
• Coverage: Patient Summary (acting as Country A & B) in Innsbruck, St. Pölten and Vienna. eDispensation (acting as Country A) in Grieskirchen and Wels
• Acting as Country A:Estimated annual outwards patient flow: approx. 7,200
• Acting as Country B: 4 hospitals, 136 GPs and specialists
epSOS Pilot Site Candidates22.10.2010 Page 34
Pilot Site Candidates: Czech Republic
• Involved regions: the whole country
• Coverage: Patient Summary, acting as Country A & B
• Acting as Country A: over one million patients with an electronic health record. Estimated annual outwards patient flow to epSOS countries: 7,300
• Acting as Country B: 10,000 HCPs within 6,000 HCOs, of which 50 are hospitals (see map), scattered all over the country
epSOS Pilot Site Candidates22.10.2010 Page 35
Pilot Site Candidates: Denmark
• Involved regions: the whole country, and in particular Copenhagen
• Coverage: Patient Summary (acting as Country A), ePrescription (acting as Country A & B) and eDispensation (acting as Country A & B)
• Acting as Country A: eP for the entire country. Estimated outwards patient flow: approx. 8,000
• Acting as Country B: 3,100 GPs and specialists, 60 hospitals, eDispensation at 2 pharmacies in Copenhagen
epSOS Pilot Site Candidates22.10.2010 Page 36
Pilot Site Candidates: France
• Involved regions: four cities - Dijon, Lille, Paris and Poitiers
• Coverage: Patient Summary (acting as Country A & B) for incoming and outgoing Erasmus students at the universities of Dijon, Lille, Poitiers and Paris-X.
• Acting as Country A: 600 French students from the 4 universities participated in the Erasmus programme 2006/07 (outgoing)
• Acting as Country B: the four universities received more than 400 incoming Erasmus students in 2006/07
epSOS Pilot Site Candidates22.10.2010 Page 37
Pilot Site Candidates: Germany
• Involved regions: Baden-Württemberg, Bavaria, Rhineland-Palatinate
• Coverage: Patient Summary, acting as Country A
epSOS Pilot Site Candidates22.10.2010 Page 38
Pilot Site Candidates: Greece
• Involved regions: two cities –Athens and Thessaloniki
• Coverage: Patient Summary and ePrescription/eDispensation, acting as Country B
• Acting as Country B: estimated HCOs/HCPs involved: 15pharmacies, 2 hospitals, 20 HCPs. Total annual tourist flow (inwards): over 6 million visitors
epSOS Pilot Site Candidates22.10.2010 Page 39
Pilot Site Candidates: Italy
• Involved regions: Lombardy, in particular the provinces of Pavia and Brescia
• Coverage: Patient Summary (acting as Country A & B) and ePrescription/ eDispensation (acting as Country A)
• Acting as Country A: Acting as sender of PS in the provinces of Pavia and Brescia. The whole region Lombardy acting as sender of eP information and receiver of dispensed medicine information
• Acting as Country B: Acting as receiver of PS in the Garda Lake area (Brescia)
epSOS Pilot Site Candidates22.10.2010 Page 40
Pilot Site Candidates: Slovakia
• Involved regions: Martin and Dolny Kubin
• Coverage: Patient Summary and ePrescription/Dispensation, acting as Country A & B
• Acting as Country A: PS and eP for 10,000 citizens
• Acting as Country B: eP at 8 pharmacies in Martin and Dolny Kubin. PS at 2 hospitals and 15 outpatient care units
epSOS Pilot Site Candidates22.10.2010 Page 41
Pilot Site Candidates: Spain• Involved regions: Andalusia,
Balearic Islands, Castile - La Mancha, Catalonia, Valencia
• Coverage: Patient Summary and ePrescription/Dispensation, acting as Country A & B
• Acting as Country A: PS for the entire population of all five regions. eP for the entire population of all regions except CLM.
• Acting as Country B: PS and eP/eD in the whole regions of Valencia and the Balearic Islands, and in selected cities/provinces in Andalusia, Catalonia and CLM
epSOS Pilot Site Candidates22.10.2010 Page 42
• Involved regions: the whole country, and in particular Östergötland, Scania, Stockholm and Norrbotten
• Coverage: Patient Summary and ePrescription/Dispensation, acting as Country A & B
• Acting as Country A: eP for the entire country. Acting as sender of PS in Östergötland and Norrbotten
• Acting as Country B: acting as receiver of PS in Östergötland and Norrbotten. eP/eD at selected pharmacies in Stockholm, Scania and Norrbotten
epSOS Pilot Site Candidates
Pilot Site Candidates: Sweden
Have joined CALLIOPE WG 7 or is in proposal for epSOS II
1. Belgium
2. Bulgaria3. Croatia4. Estonia
5. Finland
6. Hungary
7. Iceland8. Luxembourg9. Malta
10. Norway
11. Poland
12. Portugal
13. Slovenia
14. Switzerland
15. Turkey
Collaboration with WG722.10.2010 Page 44
base from Mikael Erlandsson
Oh so you are also implementing
eHealth?
Cooperation is Key22.10.2010 Page 45