EU-US eHealth/Health IT Cooperation Initiative Interoperability of EHR Work Group

1. EU-US eHealth/Health IT Cooperation InitiativeInteroperability of EHR Work Group December 4th, 2013

2. 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

3. 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.

4. Agenda

5. Meeting Times Washington, DC 10:00am (ET) London 3:00pm/15:00 (GMT) Interoperability of EHR Work Group meets everyWednesday Germany 4:00pm/16:00 (CET) Athens 5:00pm/17:00 (EET)

6. General Announcements • To participate in our weekly webinars, please visit the EU-US eHealth Collaboration Wiki Homepage: http://wiki.siframework.org/EU-US+eHealth+Cooperation+Initiative Note: Please check the meeting schedule weekly to get the most up-to-date meeting information

7. Join the EU-US eHealth/Health ITCooperation Initiative • We encourage all members to “sign up” for the initiative. By joining, this ensures you stay up-to-date with the work being done, communications and any initiative activities • Simply complete the EU-US MOU Project Signup Form on the Wiki Page: http://wiki.siframework.org/EU-US+MOU+Roadmap+Project+Sign+Up

8. Submit Your Bio • Submitted biographies are now posted on the Wikipagehttp://wiki.siframework.org/Interoperability+of+EHR+Work+Group#Work Group Members

9. Archived Meeting Materials • Visit the “Materials” tab and select “Past Meetings” from the drop down menu to access all archived meeting materials http://wiki.siframework.org/Project+Meeting+Artifacts.

10. Preparing for Meetings • Given our timeline and the amount of material to cover please ensure you are up-to-date with all of the activities of the interoperability work group • Visit the “Past Meetings” section of the wikipage for the latest interoperability meeting materials and recordings http://wiki.siframework.org/Project+Meeting+Artifacts. • If you have questions, need help or want a quick update please feel free to reach out to any member of the support team • We will have little or no time to review what was covered the week prior in order to make our deadlines and deliverables • FIRST MILESTONE: Completed Use Case by December 4th (with consensus completed by December 18th)

11. Use Case Development Timeline

12. Use Case Discussion • Today’s discussion: • Data Elements Section Categories • Are all of these categories needed? • National Contact Point Questions, Generalized Diagrams, and Sequence Diagrams • Use Case Table of Contents

13. epSOS to C-CDA CCD Mapping In support of Use Case

14. Vision – Objective - Goals • Vision: • Ability to electronically transmit and use Clinical Summary (=Patient Summary) documents between US and EU: • syntactic and semantic interoperability • Objective: • Develop 1-to-1 mapping with core (=limited=constrained)information required to be included in Clinical Summary: • Data Elements + Vocabularies(=values). • Goals (divided in phases): • Phase 1: Map Header and Sections information • Phase 2: Map Data Element within each section • Phase 3: Map Vocabularies associated with data elements

15. Candidate for comparative analysis: Clinical Summary Form • Health Level Seven Consolidated Clinical Document Architecture Release 1.1 (July 2012) • CDA R2 C-CDA R1.1 • http://www.hl7.org/implement/standards/product_brief.cfm?product_id=258 • Focus: • CCD template (within C-CDA) US EU • epSoS(Patient Summary Form) • CDA R2 NE (May 2005) • HL7 IG: CDA R2-CCD (April 1, 2007) • http://www.epsos.eu/ • Focus: • Appendix II epsos_revised_data-set_25april2013.pdf

16. Use Case Mapping • Use case mapping will be at the section/category level and NOT at the detailed data element level • Detailed data element mapping will be done in the harmonization phase

17. Phase 1: Map headerand sections • Header • Header of the Patient Summary information contains general data about the document such as author of document, patient information, confidentiality settings…etc.) • Sections (body) • Body of Patient Summary contains patient-specific information organized in sections such as Medication section, Problems/Diagnosis/section, Allergy sections…etc. • Note: • Information (individual data elements) may be organized (grouped) in a different way in EU and US!

18. Phase 1: EU Sections (epSoS) Section Name Information (data elements) within section

19. Phase 1: USA Sections (C-CDA CCD)

20. EU: epSoS USA: C-CDA CCD

21. Mapping - process • Mapping maintained in Google Spreadsheet • Document updated in real time • Document publicly available • Document is machine processable! = can be imported into database for quick analysis. • Production • After mapping is completed, information from spreadsheet will be transferred (packaged) in agreed upon format such as Word document, PDF document…etc.

22. Data Element Sections

23. National Contact Point Questions • Currently, if an EU country does not have a NCP, can it receive patient data from other EU countries? If so, who is responsible for assuring authorization, code mapping, data mapping, and translation in this case? • Will all NCPs provide all of the following services:  code mapping, data mapping, code translation, text translation and authorization services? • What would be the requirement of EU countries for a US recipient of EU citizen patient data if there is no US National Contact Point? • Are there any examples in the US of organizations that provide services that are equivalent to the EU National Contact Points, i.e., code mapping, data mapping, code translation, text translation and authorization services  ? • David: Several regional or state-level HIEs probably perform many of these services through a combination of products from HIE vendors and/or self-developed software. Examples can be found at http://www.interopwg.org/membership.html

24. Use Case Table of Contents • Preface and Introduction • Initiative Overview • Initiative challenge statement • Use case scope • Background • In scope • Out of scope • Communities of interest • Value statement • Use case assumptions • Pre-conditions • Post-conditions • Actors and Roles • Use Case Diagram • Scenario • User Story • Activity Diagram • Base flow • Alternative flow • Functional requirements • Information interchange requirements • System requirements • Sequence Diagram • Risks, Issues and Obstacles • Dataset Requirements • Appendices

25. Use Case Development Timeline

26. Next Steps • Prepare for our next meeting • Continue submitting your bios • Attend the next Interoperability of EHR Work Group meeting Wednesday December 11thfrom 10:00am - 11:00am (ET)/4:00pm - 5:00 pm (CEST)

27. Interoperability Support Leads • 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 • Emily Mitchell, emily.d.mitchell@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

28. Questions

29. 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 • Reference Materials • http://wiki.siframework.org/EU-US+MOU+Roadmap+Project+Reference+Materials