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 4, 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. New Webinar Information • We have switched over to GoToMeetings that allows participants to stream audio directly from their electronic device (VoIP), which provides a more cost-effective telephone/audio service. • Participants have the option to join using EITHER VoIP or Telephone but NOT both. • Participants will need to register for every meeting. Visit our Wiki homepage for the latest webinar information: http://wiki.siframework.org/EU-US+eHealth+Cooperation+Initiative. • After you “Register,” you will immediately be prompted to “Run” the “Citrix Online Launcher.exe.” By double-clicking this it will automatically “Install” GoToWebinar. If your electronic device does not detect the automatic download, please check your e-mail for a link for manual download instructions. • System Requirements: • PC-based attendees require Windows® 8, 7, Vista, XP or 2003 Server • Mac®-based attendees require Mac OS® X 10.6 or newer • Mobile attendees require iPhone®, iPad®, Android™ phone or Android tablet

5. Agenda

6. 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 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. Visit the EU-US eHealth/Health ITCooperation Initiative Wikipage • For the latest meetings announcements, meeting details and initiative contacts visit our homepage at http://wiki.siframework.org/EU-US+eHealth+Cooperation+Initiative.

9. Locating the Interoperability Work Group Wikipage • http://wiki.siframework.org/Interoperability+of+EHR+Work+Group

10. 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.

11. Real World Scenarios Working Session

12. Real World Scenarios • Scenario 1:Moving From Region to Region & 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 chaperone and chaperone needs to obtain medical records for treatment • Scenario 6: Ran out/forgot of 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)

13. Scenario 1 Scenario 1: Moving from Region to Region & Immunizations • User Story: A family with three children move to a new region within the same 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. (maybe do a 1a and a 1B – country and country and region to region)- patient mediated might be the one facilitated the exchange – language barriers (cross border) to think about reference terminologies • Country to Country (where there are language barriers) • Within a country (may have language considerations) • Are there consents that need to go back and forth • Language • Privacy (which includes consent) • Legal • Type of exchange • Actors: • Patient Dependents • Previous Primary Care Physician (PCP) • New Selected Primary Care Physician (PCP) • Immunization Provider (don’t replace one with other use both)

14. Scenario 2 Scenario 2: Broken Eyeglasses • User Story: A patient accidentally breaks their glasses 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 glasses without having to have their eyes examined again by a new doctor. (prescription time limit) – small limited set of Data Elements – Provider that fills prescription may not have computers – maybe retrieving from PHR (rather then provider) • Themes – Patient mediated exchange vs. Query response – Start to create a framework around this • Do we want to include insurance information • we would need to do one around claims – make this a candidate (maybe make this modular) • Authenticating credentials • Actors • Patient • Provider that originated the eyeglass prescription • Provider that fills the eyeglass prescription

15. 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 breast cancer 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 oncologist in Europe. • User Story 2: An elderly, but not yet retired, man lives 6 months in the U.S. and 6 months in Europe to care for his elderly mother.He was recently diagnosed with prostate cancer and had radiation treatment.He also has advanced degenerative disease and several other health conditions. He needs regular PSA monitoring, bone scans etc. • This is a very complex set of user stories - maybe diabetes or blood pressure monitoring – or making it a very explicit cancer user story • Actors: • One Patient • Previous Primary Care Physician (PCP) or Oncologist • New Selected Primary Care Physician (PCP) or Oncologist

16. 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. • 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. • Actors: • Patient • Hospital Emergency Department • Hospital Inpatient Services • PCP in home country

17. Scenario 5 Scenario 5: Group of students traveling with chaperone and chaperone needs to obtain medical records for treatment • User Story: • Actors: • One Patient • Previous Primary Care Physician (PCP) • New Selected Primary Care Physician (PCP)

18. 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

19. 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

20. Additional Scenarios to Consider • 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

21. 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 Wikipageregularly for updates: http://wiki.siframework.org/Interoperability+of+EHR+Work+Group • Don’t forget we have a new web meeting tool and you will have to REGISTER for each meeting before being supplied the link to access the meeting

22. 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

23. Questions

24. 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