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EU-US eHealth/Health IT Cooperation Initiative

Interoperability of EHR Work Group

January 29, 2014

Meeting Etiquette• Participants automatically enter the webinar in “listen

only” mode. The organizer will then unmute all participants. We ask if you are not speaking to manually mute yourself

• NOTE: VoIP participants have the ability to “Mute” themselves by clicking on the green microphone. However, if you would like to speak, only you can unmute yourself.

• If you are dialing in using a telephone and NOT using the VoIP you MUST dial the audio pin in order for the organizer to unmute you – if you do not use the audio pin and just push # when prompted the Organizer cannot unmute you

Meeting Etiquette CONTINUED

• If you are calling from a telephone, please do not put your phone on hold. If you need to take a call, hang up and dial in again when you have completed your other call

• This meeting is being recorded• Another reason to keep your phone or

your VoIP on mute when not speaking

• Use the “Chat” or “Question” feature for questions, comments and items you would like the moderator or other panelists to know.

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Agenda

Topic Time Allotted

General Announcements 5 minutes

Recap: Mapping Sub-Work Group 10 minutes

Presentation: Gerard Freriks (Netherlands) 25 minutes

C-CDA CCD to epSoS PS Mapping Update 10 minutes

HL7 WGM Update 5 minutes

Next Steps/Questions 5 minutes

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Meeting Times

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Washington, DC

10:00am (ET)London

3:00pm/15:00 (GMT)Germany

4:00pm/16:00 (CET)Athens

5:00pm/ 17:00 (EET)

Interoperability of EHR Work Group meets

everyWednesday

General Announcements• To join our weekly webinars, visit the EU-US eHealth

Collaboration Wiki Homepage for the latest meeting information: http://wiki.siframework.org/EU-US+eHealth+Cooperation+Initiative

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• To subscribe to our mailing list, simply complete the EU-US MOU Project Signup Form: http://wiki.siframework.org/EU-US+MOU+Roadmap+Project+Sign+Up

• To submit a brief biography of yourself (150 words or less), review the criteria listed at http://wiki.siframework.org/Interoperability+of+EHR+Work+Group#Work Group Members and e-mail your bio and photo (optional) to Gayathri Jayawardena at gayathri.jayawardena@esacinc.com• To access current and archived meeting

materials, visit the Project Meeting Artifacts section: http://wiki.siframework.org/Project+Meeting+Artifacts

Mapping Sub-Work Group

Purpose• Mapping Sub-Work Group was launched

yesterday (Tuesday, January 28) and will continue for 8 consecutive weeks

• This work group will continue our current epSOS-CCDA mapping efforts for the EU-US Interoperability Informative Guide

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Washington, DC

9:00am (ET)London

2:00pm/14:00 (GMT)Germany

3:00pm/15:00 (CET)Athens

4:00pm/ 16:00 (EET)

Mapping Sub-Work Group

Meeting Time

Every Tuesday

for 8 Consecutive Weeks

(Next meeting: February 4, 2014)

Mapping Sub-Work Group

Artifacts

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• To access archived meeting materials (e.g. presentation and video), visit the Project Meeting Artifacts section: http://wiki.siframework.org/Project+Meeting+Artifacts

• Please review the epSOS/C-CDA Header Data Element Spreadsheet and submit comments through the online comment form located here: https://docs.google.com/spreadsheet/ccc?key=0AiAfdYPeAnM-dG1mczY3dXN4WEl5eEpYVE5fV0pFWUE&usp=drive_web#gid=11

CEN/ISO 13606EHR-Communication

Gerard Freriks

25-01-2014

EU-USA

© CEN/ISO 13606 Association

13606 Developments

– ISO standard since 2008 - 2010

– 20 year developments in EU projects, Good European/Electronic Health Record

– ISO Renewal process is underway

– Designed using ISO 18308 Requirements for an EHR System Architecture

– 2 precursor trial standards

– Harmonised with ContSys, HISA

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© CEN/ISO 13606 Association

13606 History

– CDA is subset

– CIMI RM is subset

– Selected by EU as one of the Base Standards in Europe

– Used by: England, Sweden, Spain, Andalusia, Ireland

• Kind of used by: CIMI, Australia, Slovenia, Slowakia, Australia,

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© CEN/ISO 13606 Association

CEN/ISO 13606

Scope: EHR-Communication– This part of ISO 13606 specifies the communication of part or all of the

electronic health record (EHR) of a single identified subject of care between EHR systems, or between EHR systems and a centralized EHR data repository.

– This part of the multipart series, ISO13606, is an information viewpoint specification as defined in ISO/IEC 10746-1[13]. This part of ISO 13606 is not intended to specify the internal architecture or database design of EHR systems.

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© CEN/ISO 13606 Association

CEN/ISO 13606

New Scope:– From EHR-Communication to

– Information Viewpoint for Interfaces

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© CEN/ISO 13606 Association

CEN/ISO 13606

13606 5 part standard:

– Part 1: Reference Model

– Part 2: Archetype interchange specification (Archetype Object Model)

– Part 3: Reference archetypes and Term Lists

– (Part 4: Patient Mandate (PMAC))

– Part 5: Interface specification

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© CEN/ISO 13606 Association

CEN/ISO 13606

Paradigms

– Message paradigm:Implementation guide, IHE profile and testing is necessary

– Two Level Model Paradigm (Reference Model, AOM -> ArchetypesSupports model driven approachNo need for Implementation guide and no need for IHE Profile and testing

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© CEN/ISO 13606 Association

CEN/ISO 13606

Reference Model

– Represents the global characteristics of health record components,

– how they are aggregated, and the context information required to meet ethical, legal and provenance requirements.

– This model defines the set of classes that form the generic building blocks of the EHR.

– It reflects the stable characteristics of an electronic health record,

– and would be embedded in a distributed (federated) EHR environment as specific messages or interfaces (as specified in Part 5).

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© CEN/ISO 13606 Association 18

CEN/ISO 13606

© CEN/ISO 13606 Association 19

CEN/ISO 13606

© CEN/ISO 13606 Association 20

CEN/ISO 13606

© CEN/ISO 13606 Association 21

CEN/ISO 13606

© CEN/ISO 13606 Association

CEN/ISO 13606

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Archetype

– the formal definition of prescribed combinations of the building-block classes defined in the Reference Model for particular clinical domains or organizations.

– An archetype is a formal expression of a distinct, domain-level concept, expressed in the form of constraints on data whose instances conform to the reference model.

– For an EHR_Extract, as defined in this part of ISO 13606, an archetype instance specifies (and effectively constrains) a particular hierarchy of RECORD_COMPONENT sub-classes, defining or constraining their names and other relevant attribute values, optionality and multiplicity at any point in the hierarchy, the data types and value ranges that ELEMENT data values may take, and other constraints.

© CEN/ISO 13606 Association

Archetype EditorepSOS PS Template

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© CEN/ISO 13606 Association

Archetype EditorepSOS PS Template

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© CEN/ISO 13606 Association 25

© CEN/ISO 13606 Association 26

© CEN/ISO 13606 Association 27

© CEN/ISO 13606 Association

Archetype Editor

Characteristics• Reference Model independent (incl CDA)

• Output formats:• Various Tree views• HTML Mock-up screen• MindMap• HTML table view• Excel• Schematron• Generated XML data instantiations

• Can be integrated with Terminology server• Mapping:

• Creation of mappings from and to other (proprietary) formats• Execution of those mappings

• Integration with Artefact library manager

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Phases of Harmonization

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<clinicalDocument>(Clinical Summary Form)

<header> (document ID, author, patient ID…)

<component> [Body]

<section> [Procedures]

<entry> (Colonoscopy)<procedureCode><procedureDate><…>

<entry> [Gastroscopy]<entry> [CABG]…

<section> [Current Medications]

<section>…

<entry> [ASA]<entry> [Warfarin]<entry> [CABG]

<entry>

Phase 1

• Section level mapping between epSOS and CCD

Phase 2

• Header’ Data Element mapping

Phase 3

• Sections’ Data Element mapping

Phase 4

• Value Set mapping

Completed

Remaining

Dat

a G

ranu

larit

y an

d Co

mpl

exity

Mapping Review/Validation:Resources and Process• All harmonization/mapping work is done on Google spreadsheet:

– Link: https://docs.google.com/spreadsheet/ccc?key=0AiAfdYPeAnM-dG1mczY3dXN4WEl5eEpYVE5fV0pFWUE&usp=drive_web#gid=11

– Access: anyone with link– Privileges:

• “View and Comment” – everyone with link (the one above)• “Edit” – selected

– EU: one designated XML/epSoS PS subject matter expert– US: Mark Roche (for now)

» Above may be reviewed/updated as project continues• Review Process:

– Review/validate mapping outcomes after each phase with community– Review points:

• Mapping completeness• Mapping accuracy• Mapping gaps

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Mapping Sub-Workgroup

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• Goal: The mapping SWG will continue our current epSOS-CCDA mapping efforts for the EU-US Interoperability Informative Guide

• Kick-off meeting took place on January 28th • Overview of Meeting:

• Reviewed Section Level Mapping• Introduced Data Element Header Mapping

• Homework: Review Header Data Element Mapping• Note: Header Mapping will be posted to the google doc by COB

Friday 1/31• Next meeting: February 4th, 2014• Meeting Time: Tuesdays 9 AM – 10 AM EST / 2 PM – 3 PM GMT (UTC)

Note: As mapping sections are completed, they will be presented to the full workgroup for review and comment

Homework: Review Phase 2, Header’ Data Element Mapping

1. Are template names and OIDs correct?2. Are all Header Data Elements (DE) listed?3. Are DE names correct?4. Are X-Path Statements correct?5. Are requirements (R,R2,O) correct?6. Are Data Types correct?6. Is mapping complete (within header)?7. Is mapping accurate (correct)?8. Are there mapping gaps (Exists in epSoS PS but not in C-CDA CCD

and vice versa)?9. Is mapping clear and unambiguous?10. What is missing?

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Homework: Review Phase 2, Header’ Data Element Mapping

• Review google doc• Demonstrate how to comment

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Updates from HL7

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• EU PSS: • Presented to Structured Documents WG and US Realm Task Force

• Balloting:• Balloting timelines are currently being updated; confirming standards

strategy with leadership• SDO’s to consider engaging: HL7, ISO, JIC, CEN

• Deliverables:• Mapping IG (Transformation guide)

• Renamed to “Informative Guide: Analysis for Harmonized EU US Patient Summary Exchange”

• Comparative analysis between C-CDA CCD and epSOS• Value Set Mapping

• Longer term objective:• Harmonized template for Patient Summary

• Trillium Bridge Alignment:• Continue collaboration with Trillium Bridge

Preparing for Next Meeting

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• Next meeting will be on Wednesday, February 5, 2014 at 10:00 am (ET)/5:00 pm (EET)

• Please attend the next Mapping Sub-Work Group on Tuesday, February 4, 2014.

Interoperability of EHR Project Support Team

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• US Point of Contacts– Mera Choi, Mera.Choi@hhs.gov– Jamie Parker, jamie.parker@esacinc.com– Gayathri Jayawardena, gayathri.jayawardena@esacinc.com– Amanda Merrill, amanda.merrill@accenturefederal.com– Mark Roche, mrochemd@gmail.com – Virginia Riehl, virginia.riehl@verizon.net

• EU Point of Contacts – Benoit Abeloos, Benoit.ABELOOS@ec.europa.eu – Frank Cunningham, frank.cunningham@ec.europa.eu– Catherine Chronaki, chronaki@gmail.com

Questions

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Initiative Resources • EU-US Wiki Homepage

– http://wiki.siframework.org/EU-US+eHealth+Cooperation+Initiative

• Join the Initiative– http://

wiki.siframework.org/EU-US+MOU+Roadmap+Project+Sign+Up

• EU-US Initiative Reference Materials– http://

wiki.siframework.org/EU-US+MOU+Roadmap+Project+Reference+Materials

• Interoperability of EHR Homepage– http://wiki.siframework.org/Interoperability+of+EHR+Wo

rk+Group

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