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EHRxF –a short overview
Relation with CEN IPS
Vincent van Pelt, MD
Senior advisor, Nictiz
CEN IPS Final meeting, 19-03-2019
February 2019: Recommendation EHRxF
EHREXCHANGE
FORMAT
WORKSHOPEHREXCHANGE
FORMAT
WORKSHOP
WELCOME TO
EHREXCHANGE
FORMAT
WORKSHOP
BRUSSELS
BERLAYMONT BUILDING
5TH
DEC. 2018
Workshops
1st workshop Lisbon, 9th and 10th July 2018
2nd Brussels, 25th September 2018
3rd Brussels, 5th December 2018
EHREXCHANGE
FORMAT
WORKSHOPEHREXCHANGE
FORMAT
WORKSHOP
EHRxF Representatives
05th Dec. 2018 – Brussels 3rd EHRxF WorkShop 4
• Cyprus Florentia Zeitouni
• Czech Republic Hynek Kruzik
• Estonia Katre Pruul
• Finland Heikki Virkkunen
• Germany Andreas Grode
• Greece Dimitrios G. Katehakis
• Lithuania Linas Kavolius
• Netherlands Conchita Hofstede
Vincent van Pelt
• Norway Georg Fredrik Ranhoff
• Malta Clinton Farrugia
• Portugal João Gonçalves
• Romania Simona Coroi and
Andreea Gărăiacu
• Serbia Vedran Martinovic
• Slovakia Pavol Rieger
• Spain Arturo Romero
• Sweden Omid Mavadati
• Switzerland Stéphane Spahni
• United Kingdom Jeremy Thorp
EHREXCHANGE
FORMAT
WORKSHOPEHREXCHANGE
FORMAT
WORKSHOP
MS participating in the discussion
05th Dec. 2018 – Brussels 3rd EHRxF WorkShop 5
EHRxF
Comments on Non-Paper Doc.
# Country Date
1 Bulgaria 29 Nov. 2018
2 Cyprus 03 Dec. 2018
3 Greece 03 Dec. 2018
4 Norway 03 Dec. 2018
5 Poland 03 Dec. 2018
6 Spain 03 Dec. 2018
7 Sweden 03 Dec. 2018
8 Portugal 03 Dec. 2018
8 Netherlands 03 Dec. 2018
9 Czech Republic 03 Dec. 2018
10 Denmark 03 Dec. 2018
11 Lithuania 03 Dec. 2018
12 Germany 03 Dec. 2018
13 Ireland 04 Dec. 2018
14 Estonia 04 Dec. 2018
3rd WS on EHRxF Representatives
# Country Name F2F/Tcon
1 Czech Republic Hynek Kruzik F2F
2 Norway George Ranhoff F2F
3 Slovenia Mate Beštek F2F
4 Greece Dimitrios Katehakis F2F
5 Poland Pawel Masiarz F2F
6 PortugalHenrique Martins F2F
Diogo Martins F2F
7 Italy Stefano Van der Byl F2F
8 GermanyAndreas Grode F2F
Beatrice Streit F2F
9 Netherlands Vincent Van Pelt F2F
10 Estonia Priit Tohver Video
FRAMEWORK FOR CROSS-BORDER EXCHANGE OF ELECTRONIC
HEALTH RECORDS
Framework for the development of a European electronic health record
exchange format in order to achieve secure, interoperable, cross-border
access to, and exchange of, electronic health data in the Union.
The framework includes:
• a set of principles that should govern access to and exchange of electronic
health records across borders in the Union;
• baseline for a European electronic health record exchange format;
• Iterative process to take forward the further elaboration of a European
electronic health record exchange format.
EHRxF Objectives
Principles for access to and cross-border exchange of electronic health records
• Patients: secure access and sharing of electronic health data across borders
• Citizen centric by design• Comprehensiveness and machine-readability• Security
• Identification and authentication• Auditability• Consent or other lawful basis• Data protection and confidentiality
• Continuity of service
ELECTRONIC HEALTH RECORD SYSTEMS IN MEMBER STATES Ensuring secure access to electronic health record systems• protection of health data
Tools and incentives• ReEIF• IHE profiles• …
National digital health networks• Representation of eHealth and healthcare stakeholders to work out strategies
EHRxF - Principles
Baseline for a European electronic health record exchange format
• Patient Summary;
• ePrescription/eDispensation;
• Laboratory results;
• Medical imaging and reports;
• Hospital discharge reports.
Further elaboration of a European electronic health record exchange format
• Organise National Digital Health Networks per country (organisation networks);
• Share knowledge between national competence centres;
• Build up a joint coordination process;
• Collaborate on the specification of semantic and technical specifications for cross-border exchange of health data;
• Build on existing initiatives such as the Common Semantic Strategy task force;
• Establish practical implementation guidelines, share good practice and promote awareness actions for citizens and
healthcare providers;
• Some MS may adopt electronic health record interoperability at a faster speed.
EHRxF - Baseline
FRAMEWORK FOR CROSS-BORDER EXCHANGE OF ELECTRONIC HEALTH RECORDS (3/3)
Monitor progress towards interoperability
• Annual reports, shared roadmap
Future work
• identify and review emerging technological and methodological innovation
Assessment of the effects of the Recommendation
• Report on the progress and foster cooperation
EHRxF - Process
Patient Summary – participating countries
Land PS-A PS-B 2018 (1) 2019 (2) 2020 (3) 2021 (4)
Austria 3 3
Belgium 3 2
Croatia 2 1
Cyprus 2 2
Czech Republic 1 1
Estonia 3 3
France 3 3
Germany 3 3
Greece 3 2
Hungary 3 3
Ireland 3 --
Italy 3 3
Luxembourg 2 1
Malta 1 1
Netherlands -- 4
Portugal 1 1
Slovenia 4 4
Spain 3 3
PS-B (import)
PS-A (export)
Technical format
Adoption
ASTM E2369-12 not used
C-CDA USA, Meaningful Use 2
C-CDA, FHIR USA
CDA Not used in EU
CDA → eHDSI
CDA NCPeH/OpenNCP
(CDA, FHIR) European Norm -2019
CDA, FHIR HCIMs
History of Patient Summary initiatives
CCR (Continuity of Care Record)
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
CCD (Continuity of Care Document) = CCR + HL7 CDA
Blue Button
XDS-MS (Cross-Enterprise Sharing of Medical Summaries)
epSOS
eHealth DSI (eHN)
CEN IPS
BgZ
The ‘BgZ’ has been based upon these projects and is 99% compatible with the eHDSI Guidelines and the CEN IPS European Norm
= USA = Europa = Netherlands
Sections epSOS eHN/eHDSI CEN IPS BgZ
Allergies and intolerances ✓ ✓ ✓ ✓
Diagnostic studies ✓ ✓ ✓ ✓
Functional status - - ✓ ✓
Immunizations ✓ ✓ ✓ ✓
Medical devices ✓ ✓ ✓ ✓
Medication ✓ ✓ ✓ ✓
Plan of care ✓ ✓ ✓ ✓
Pregnancy information ✓ ✓ ✓ ✓
Problems ✓ ✓ ✓ ✓
Alerts ✓ ✓ - ✓
Functional status - - ✓ ✓
Advance directives - - ✓ ✓
Procedures ✓ ✓ ✓ ✓
Social history ✓ ✓ ✓ ✓
Vital signs ✓ ✓ - ✓
PS initiatives -comparison at the section level
• NOTE: Alerts are currently recorded in Problems and in Allergies. Vital signs are under Diagnostic studies.• BgZ: Dutch Patient Summary• Extensions and additions are foreseen in updated versions of the IPS.
More information
• CEN IPS: http://www.ehealth-standards.eu/en/projects/
• CEN IPS European Norm 17269: http://www.ehealth-standards.eu/draft-european-standard-
17269-the-patient-summary-for-unplanned-cross-border-care-approved/
• CEN IPS Technical Specification 17288: http://www.ehealth-standards.eu/draft-european-
technical-specification-17288-the-international-patient-summary-guidance-for-european-
implementation-approved/
• eHDSI: https://ec.europa.eu/cefdigital/wiki/display/EHOPERATIONS/eHealth+DSI+Operations+Home
• (List of use cases): https://usecase-repository.ihe-europe.net/
eStandards
Refined eHealth European Interoperability Framework
Care Process
Policy
IT Infrastructure
Legal and regulatory
Information
Applications
Alignment of care processes
Agreements between organisations
Integration, communication formats, UI
Communication protocols, network, databases
Compatible legislation and regulations
Datasets, coding, terminologies
Secu
rity
, Pri
vacy
, Go
vern
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Stan
dar
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an
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rofi
les,
Qu
alif
icat
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Location A Location B
Legal and regulatory
Shared workflowProcess Process
Aligned policiesPolicy Policy
Compatible infrastructureIT Infrastructure IT Infrastructure
Legal and regulatory
Common data modelInformation Information
Communication formatsApplications Applications
Compatible legislation
Interoperability between organizations
ReEIF - Interoperability between stakeholders
Process
Policy
IT Infrastructure
Legal and regulatory
Information
Applications
Policy makers, CMIOs
Information analysts, terminologists
Software engineers
Healthcare-Managers
System architects
Regulators and advisors
System engineers
Business- and information architects
Healthcare directors
Healthcare professionals
Patients
Strategic Tactical Operational
System managers
Lawyers
Secu
rity
, Pri
vacy
, Go
vern
ance
Stan
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dP
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Ce
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