epsos 201000930 term - termkonferenstermkonferens.se/2010/frli.pdf · french national contact point...

22.10.2010

From strategies to services

– eHealth as the enabler for cross-border healthcare

22.10.2010

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

AustriaCzech RepublicDenmarkFranceGermanyGreeceItaly – LombardyThe NetherlandsSlovakiaSpainSpain – AndalusiaSpain – Castilla la ManchaSpain – CataloniaSwedenUnited Kingdom –EnglandUnited Kingdom –Scotland

12 epSOS Countries22.10.2010

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

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

EU memberstate(not participating)

Non EU country

Single (national)patient identifier

Multiple (regional)

patient identifiers

Availability of Patient Identifier 201022.10.2010

Nationally-led

Regionally-led

Not available / unknown


Non EU country

Fully available

Partly available

Fully available

Partly available

HCP Identifier suitable for Auth & Digital Signature 2010

22.10.2010

Nationally available & operational

Regionally available

& operational



Non EU country

>25%

<25%

>25%

<25%

Availability of ePrescription 201022.10.2010

Nationally available & operational

Regionally available

& operational



Non EU country

>25%

<25%

>25%

<25%

Availability of Dispensation info 201022.10.2010

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

• 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

Example of translation work (Sweden)22.10.2010

epSOSepSOSSemantic InteroperabilitySemantic Interoperability

General Flow of Information22.10.2010

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


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


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

Translation/TranscodingTranslation/Transcoding

epSOS Local Terminology Repository

epSOS terms

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

• Scenario 3: acting as Country A (sender of

prescription information)

• Scenario 4: acting as Country B (receiver of

prescription information)


INFRASTRUCTURES INVOLVED PS/eP

HCPO 3.445

• Hospitals 183

• Farmacies 2.149

• PoC 1.113

HUMAN RESOURCES INVOLVED

HCP 30.157

Total numbers


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


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


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


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


Pilot Site Candidates: Germany

• Involved regions: Baden-Württemberg, Bavaria, Rhineland-Palatinate

• Coverage: Patient Summary, acting as Country A


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


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)


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


Pilot Site Candidates: Spain• Involved regions: Andalusia,

Balearic Islands, Castile - La Mancha, Catalonia, Valencia


• 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


• Involved regions: the whole country, and in particular Östergötland, Scania, Stockholm and Norrbotten


• 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

base from Mikael Erlandsson

Oh so you are also implementing

eHealth?

Cooperation is Key22.10.2010

46epSOS – Smart Open Services for European Patients

Thank you for your attention!

[email protected]

epsos 201000930 term - termkonferenstermkonferens.se/2010/frli.pdf · french national contact point...

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