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

1. EU-US eHealth/Health IT Cooperation InitiativeInteroperability of EHR Work Group September 18, 2013

2. Using the Web Meeting Tool • 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. Using the Web Meeting Tool • 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. General Announcements • The Interoperability of EHR Work Group meets every Wednesday from 10:00am – 11:00am ET or 4:00pm-5:00pm CEST • To participate please see the “Weekly Meetings” Section of the EU-US eHealth Collaboration Wiki Homepage: http://wiki.siframework.org/EU-US+eHealth+Cooperation+Initiative • We will be presenting our work at the EU-US eHealth Conference in Boston, MA Oct 21-23, 2013 http://b2match.eu/eu-us-ehealth-marketplace-boston2013 Note: Please check the meeting schedule weekly to get the most up-to-date meeting information

6. 3rd EU-US eHealth Marketplace and Conference • http://b2match.eu/eu-us-ehealth-marketplace-boston2013/pages/home • Two-day program that will bring together international leaders, healthcare professionals, technology providers, academia, patient groups, innovators, entrepreneurs and policymakers to discuss current trends and business opportunities in healthcare information technology. Program also includes panel and keynote remarks from leading health innovators; a unique and successful brokerage networking program; exhibitions; informal networking and more. • The EU-US eHealth Cooperation project will be providing updates on our work. • Interoperability and Workforce Development Work Groups will host face-to-face working sessions on Tuesday, October 22, 2013. • Registration is required for this event.

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. Meeting Materials • For all meeting minutes, presentations, reference materials and recordings please visit the Materials tab and select “Past Meetings” from the drop down menu http://wiki.siframework.org/Project+Meeting+Artifacts.

9. Review of Upcoming Meetings

10. Real World Scenarios Working session

11. Comments: • Thank you for your support and facilitation of the webinar meetings. I wanted to point you to the following before today’s session: • (i)             Clinical trial scenario introduced by myself/King’s College London: we have looked at this further and it appears the scenario needs more elaboration. There are several data standards developed that can support clinical trial data harmonisation and exchange. I wanted to go back to our academics and produce a more nuanced version of it. I can talk about this during the call as well. • One European initiative – ECRIN (in addition to CDISC )– will come back with a more nuanced scenario – how we could bring this forward for consideration • Send sources to Jamie.parker@esacinc.com for posting and distribution • (ii)            It would be excellent to circulate short bios of people on the call, so that we know of the background and expertise of participants and be able to collaborate better during the call. At the moment this creates some uncertainty – the positive being that I find myself needed to speak plainly and concisely to be understood by all, irrespective of expertise. Some information on participants would help, however. • Please send bio to jamie – jamie.parker@esacinc.com • (iii)           There was mention of radiology reports being fed through in the scenarios 1-7. We need to bear in mind that these are text files and they often transmitted through the XML  protocol. Radiology images is a whole different exercise, with guidelines in place determining acceptable levels of image resolution, device configuration etc.

12. Scenario Matrix

13. Criteria for Selecting Scenarios • This is just a start – we want to realize success so we need to pick a scenario that is: • Addresses a realistic and common health care event • Data Exchange • Target group scenarios will cover • Send additional wording to jamie.parker@esacinc.com • Scope can be accomplished in a short timeframe • Within 1 year – 16 months • Can leverage existing health care interoperability standards • Balance domains and standards that are applicable • Semantic Interoperability • Privacy and Security considerations • Broad application • Likely to be adopted by EU and US • High probability of stakeholder engagement • Springboard for extension to other areas

14. Real World Scenarios • Scenario 1:Moving From Country to Country & Immunizations • Scenario 2: Broken Eyeglasses • Scenario 3:Planned Care • Scenario 4:Patient has a heart attack and ends up in the ER (or patient is hit by a car) • Scenario 5:Group of students traveling with someone acting on behalf of, or in the place of, a parent, legal guardian, patient, or subject who needs to obtain medical records for treatment • Scenario 6: Ran out of/forgot prescription medication while on vacation and need it refilled (for example blood pressure medication) • Scenario 7: Ambulatory (patient has pre-existing condition such as diabetes that has been out of control and needs to fix the

15. Scenario 1 Scenario 1A: Moving from Country to Country & Immunizations (Provider to Provider) • User Story 1: A family with three children moves to a new country. In order for the children to be admitted to their new schools they must provide a complete list of immunizations and obtain any additional immunizations needed. The family has identified a provider in the new region. The new provider needs to request the immunization records for the children to be sent to her from the previous provider. • Actors: • Patient Dependents • Previous Primary Care Physician (PCP) • New Selected Primary Care Physician (PCP) • Immunization Provider • Data types: • Consent and privacy • Immunization records Scenario 1B: Moving from Country to Country & Immunizations (Patient Mediated) • User Story 1: A family with three children moves to a new country. In order for the children to be admitted to their new schools they must provide a complete list of immunizations and obtain any additional immunizations needed. The family has identified a provider in the new region. The patient accesses their PHR and sends the immunization records to the new provider. • Actors: • Patient Dependents • Previous Primary Care Physician (PCP) • New Selected Primary Care Physician (PCP) • Immunization Provider • Data types: • Immunization records

16. Scenario 2 Scenario 2A: Broken eyeglasses (Provider to Provider) • User Story: A patient accidentally breaks their eyeglass while travelling abroad. They need their home provider to send their eyeglass prescription to their new optometrist. The optometrist requests the patient’s prescription from their home provider. • Actors • Patient • Provider that originated the eyeglass prescription • Provider that fills the eyeglass prescription • Data types • Prescription including date prescription was written • Consent and privacy Scenario 2B: Broken eyeglasses(Patient Facilitated) • User Story: A patient accidentally breaks their eyeglasses while travelling abroad. They need their home provider to send their eyeglass prescription to them. The patient needs to retrieve their prescription and take the prescription to a prescription eyewear store in Europe to purchase new eyeglasses without having to have their eyes examined again by a new doctor. • Actors • Patient • Provider that originated the eyeglass prescription • Provider that fills the eyeglass prescription • Data types • Prescription including data prescription was written • Evidence that this is a legitimate prescription Comments/Feedback: • Real example involving lost eyeglasses on trip to UK • Consider replacing broken eyeglasses with broken pacemaker

17. Scenario 3 Scenario 3: Planned Care • User Story 1: A couple from France moved to the United States in September 2010. Their baby was born shortly after in the U.S. in January 2011. The maternal grandparents travel to the U.S. each year for 6 months to baby-sit. The maternal grandmother had diabetes that has been treated in Europe but needs monitoring in the U.S.while she is living there. The grandmother has healthcare insurance in the U.S. but she needs her U.S. physician to interact with her provider in Europe. • Actors: • One Patient • Previous Primary Care Physician (PCP) or Oncologist • New Selected Primary Care Physician (PCP) or Oncologist • Data Types: • Medications • Lab results • Problem list • COPD

18. Scenario 4 Scenario 4: Emergency and Inpatient Care • User Story 1: Patient has a heart attack and is taken to the ER. When returning home information from the ER must be transferred to their PCP (Patient Mediated Exchange) • Patient has information in PHR (i-phone ) OR the patient may only have their insurance card in their wallet – which may be how EHR provider gets PCP information • User Story 2: A student is studying abroad in Italy and they are hit by a car towards the end of their stay. They are taken to a nearby hospital for treatment for head trauma. The patient is admitted and treated for approximately two weeks before they are discharged. The patient is cleared for travel back to the U.S., however, they will need to check in with their PCP back home for any side effects from the medication or additional treatments or radiology scans needed as a precaution. As per new policy at the Italian hospital they must send a summary of the hospitalization stay including treatment plans to the PCP identified by the patient. (what if no PCP – student does not have one on return – maybe college student) • Actors: • Patient • Hospital Emergency Department • Hospital Inpatient Services • PCP in home country • Data Types: Comments/Feedback: • Similar to epSOS Patient Summary Use Case (see slide 17) • Consider combining with scenario 1 • Consider re-wording the User Story to reflect a “break the glass” scenario • We need a scenario that has some inpatient component • This should be a 2 way communication (both of these scenarios have inpatient stay) • Data set would include summary of care

19. Scenario 5 Scenario 5: Group of students traveling with someone acting on behalf of, or in the place of, a parent, legal guardian, patient, or subject and that person needs to obtain medical records for treatment User Story: • Actors: • Person acting on behalf of, or in the place of, a parent, legal guardian, patient, or subject • One Patient • Previous Primary Care Physician (PCP) • New Selected Primary Care Physician (PCP) • Data types: Comments/Feedback: • Consider combining with scenario 4 • Maybe include a planned care scenario for a student studying abroad such as Asthma – medical records go to the school or university clinic (health records already there)

20. Scenario 6 Scenario 6: Patient runs out of/forgets prescription medication while on vacation and needs a refill (for example blood pressure medication) • User Story: A patient is travelling through Europe and left their prescription blood pressure medication at their previous hotel in Germany. They are unable to get in touch with the hotel staff in Germany to have their prescription mailed to them. Therefore, they visit a pharmacy in Spain to see if they can request the medication from the patient’s cardiac specialist back home who wrote the prescription for the medication. The pharmacy has the medication that the patient has been prescribed. The pharmacist in Spain needs to validate the prescription with the patient’s cardiac specialist before they can dispense it. • Actors • Patient • Physician who wrote the prescription • Pharmacy seeking to fill the prescription • Data types: Comments/Feedback: • Similar to epSOSePrescription Use Case (see slide 17)

21. Scenario 7 Scenario 7: Ambulatory • User Story: A patient who has a history of poorly managing their diabetes is traveling in a different country. After hiking the Swiss Alps the patient experiences numbness and tingling in their feet. The patient disregards these symptoms attributing them to the recent hike and exhaustion from the trip. Five days later the patient steps on a nail, however, does not realize this until someone informs him that his right foot is bleeding. The patient goes to an urgent care center to treat his injury and to see a diabetic counselor to determine how best to manage his fluctuating diabetes condition. The urgent care center needs to obtain a copy of the patient’s medical history from the past five years including any medications the patient has been taking to manage their diabetes. • Actors: • One Patient • Physician Treating Patient’s Diabetes • Urgent Care Center Physician in Switzerland • Data types: Comments/Feedback: • Consider combining with scenario 1 and 4 • Similar to epSOS Patient Summary Use Case (see slide 17)

22. epSOS Use Cases • Scenarios 4 & 7 (Emergency & Inpatient Care and Ambulatory) are similar to the Patient Summary Use Cases: • Use Case 1: an occasional visitor in country B, for example someone on holiday or attending a business meeting. The distinguishing characteristic is that this type of visit is irregular, infrequent, and may not be repeated. This is a type of incidental encounter where the Health Care professional may have no previous record of the person seeking care. • Use Case 2: the person is a regular visitor to country B, for example someone who lives in one country but works in another country. The distinguishing characteristic is that this type of visit is regular, frequent, and the person seeking care may be accustomed to using services in the country where he or she works as a matter of personal convenience. This is a type of occasional situation where the Health Care professional may have some information available from previous encounters, therefore the patient could have a medical record locally stored in country B, and maybe a PS in country B plus in country A. If this is the case, both PSs should be available for the HCP to be consulted. • Scenario 6 (Prescriptions) is similar to the ePrescription Use Case: • Use Case 1: Common scenario in interoperability between ePrescription services, where the patient has been already prescribed in his home country.

23. Additional Scenarios to Consider • Billings, claims • Quarantine situation and public health entity that this is happening • Blue Button • Portal being able to access by both patient and provider • Cell phone to hold the records • Immunizations (tetanus)- if someone is in a different country - how can they or their provider that is treating them access their immunization records to date? • A real world scenario of interest to us at King’s College London is where EU & US universities collaborate in health research studies and clinical trials: it would be excellent to have the semantic and syntactic means to reduce or eliminate the extra work to harmonize data sets. • Querying population for outbreak - Public Health scenario. Rather than being patient specific this scenario is more of a public health option. Querying the population regarding an outbreak or querying for recalling a prescription. • Query for recalled prescription

24. Next Steps • Interoperability of EHR Work Group will continue to meet every Wednesday from 10:00am - 11:00am (ET)/4:00pm - 5:00 pm (CEST) • Check the Interoperability of EHR Work Group Wikipage regularly for updates: http://wiki.siframework.org/Interoperability+of+EHR+Work+Group

25. Upcoming Meetings

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

27. Questions

28. 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