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A European Patient Summary Infrastructure

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  • 1. A European Patient Summary InfrastructureA. Carenini (CEFRIEL) Reto Krummenacher (STI Innsbruck)Elena Simperl (STI Innsbruck) Douglas Foxvog (DERI Galway)
  • 2. The eHealth Scenario in TripCom The European Patient Summary (EPS) Hospitals, p , An infrastructure for sharing patient clinics Laboratories summary at European level • 5.000 health authorities • More than 1 million users (clinicians and administrative staff) • 500 millions citizen summaries Home care Specialists Citizens services General Practitioners Administration, Assurance companiesCurrent national eHealth systems cannot be adopted as-is at an EU-wide level: All of them force the adoption of a particular standard All of them assume to operate with the same laws and privacy regulations Regulations in a country prevents its eHealth system to operate as-is in another country Sixth Framework Programme Priority 2 © TripCom 2 Information Society Technologies (IST) Specific Targeted Research Project
  • 3. The EPS Scenario Requirements for the EPS Infrastructure Scalability 500.000.000 patient summaries 5.000 Local health authorities Multilateral Solution M ltil t l S l ti Virtual common infrastructure distributed among parties Coordinate multidisciplinary actors in access data asynchronously and from different locations diff tl ti Privacy and Data Ownership National and Local policies to authorize caregivers to access citizen data Each healthcare party owns the summaries of the cared citizens Data heterogeneity Intensive use of knowledge: structured data and terminologies g g Messages and vocabularies are expressed using different standards Sixth Framework Programme Priority 2© TripCom 3 Information Society Technologies (IST) Specific Targeted Research Project
  • 4. The EPS Scenario Triple Space Capabilities Decentralized, Distributed and Shared Space Each healthcare party p p y provides resources to the whole space p Persistent Publication Actors persistently publish and update data in their own space, enforcing d t ownership f i data hi Other actors can retrieve the published data Security Mechanisms Global and local policies to access data Coordination Support pp Interactions decoupled in time, location and reference Information are organized in a virtual tree-like structure of spaces Spaces are managed by so-called TripCom kernels Sixth Framework Programme Priority 2© TripCom 4 Information Society Technologies (IST) Specific Targeted Research Project
  • 5. EPS Architecture Data model(s) Ontologies are used to model data inside the EPS Message ontologies: based upon the most adopted standards for exchanging patient data, such as HL7 CDA and ASTM CCR Vocabulary ontologies: model of existing coding systems to re- y g g g y use clinical terminologies, such as: ICD10, ICD9, LOINC, MESH, MTH, NCI, RXNORM, UMLS PS ontology t l Head Registry data (name, date of birth, residence) Administrative data (IDs, insurance info) Body B d Problems, alerts, medications, immunizations, encounters Procedures, Procedures Advance Directives Plan Of Care Directives, Sixth Framework Programme Priority 2© TripCom 5 Information Society Technologies (IST) Specific Targeted Research Project
  • 6. EPS Architecture Subspaces, Roles and Policies The subspaces of a single PS space Head: For administrative accesses Body: For clinical accesses Private: To restrict access to some data Each space has a corresponding access control policy Security attributes provided by the user allow mapping the user onto a role Permissions are given to roles wrt wrt. operations on the space (read, write, delete) The Th policy of a space also regulates li f l l t the evaluation order of the policies of its subspaces Sixth Framework Programme Priority 2© TripCom 6 Information Society Technologies (IST) Specific Targeted Research Project
  • 7. eHealth national systems: state of the art UK: NHS Spine Demographics of all the patients are centrally stored in the Personal Demographic Services repository Medical data can be either stored in the National Care Record or in local systems Access with smart cards containing digital certificates (PKI) and individual PINs. Role based Role-based access control with SAML assertions Message exchange through a g g g custom version of HL7 v.3 Sixth Framework Programme Priority 2© TripCom 7 Information Society Technologies (IST) Specific Targeted Research Project
  • 8. eHealth national systems: state of the art The Netherlands: AORTA Distributed architecture with a central Hub Clients ask the Hub for data The Hub locates data, fetches and returns it to the client No central repository of clinical data → data belongs to the source organization Data exchange through custom HL7 v.3 messages Unique Healthcare Practitioner ID (UZI) card and pincode Identification and authentication of healthcare practitioner Role of health practitioner Relies on PKI Sixth Framework Programme Priority 2© TripCom 8 Information Society Technologies (IST) Specific Targeted Research Project
  • 9. Integrating the EPS with NHS Spine Data: HL7 v.3 messages can be automatically lifted to their RDF representation Security: SAML security assertions can be natively used when interacting with the TS User-restricted User restricted data: Sealed envelopes correspond to the Private subspace of a Patient Summary PS spaces structures: p Demographics centrally stored → on a single kernel Clinical data can be centralized or distributed Centralized data in the main Body/Private PS subspace and managed by a single kernel Distributed data inside subspaces of Body/Private spaces and managed by remote kernels Sixth Framework Programme Priority 2© TripCom 9 Information Society Technologies (IST) Specific Targeted Research Project
  • 10. Integrating the EPS with NHS Spine (2) (2 Sixth Framework Programme Priority 2© TripCom 10 Information Society Technologies (IST) Specific Targeted Research Project
  • 11. Integrating the EPS with AORTA Data: HL7 v.3 messages can be automatically lifted to their RDF representation Data for building patient summaries MUST be held in a space owned by the originating Health Authority Sixth Framework Programme Priority 2© TripCom 11 Information Society Technologies (IST) Specific Targeted Research Project
  • 12. Integrating AORTA and NHS Spine with the EPS EPS spaces must be configured in order to be used as a central repository by NHS Spine and as a registry by AORTA Nation-wide spaces ensure uniqueness of the PS spaces identifiers Policies of the top-level spaces just specify very basic rules Recursive read and policy evaluation is massively used Inside a PS PS policies must allow evaluated starting from the leaf spaces A PS is still divided into 3 main areas Each “contributing nation” manages a subspace inside each of the 3 areas The spaces of the “contributing nation” are hosted on the contributing nation kernels managed by the “contributing nation” Sixth Framework Programme Priority 2© TripCom 12 Information Society Technologies (IST) Specific Targeted Research Project
  • 13. Integrating AORTA and NHS Spine with the EPS (2) Sixth Framework Programme Priority 2© TripCom 13 Information Society Technologies (IST) Specific Targeted Research Project
  • 14. Thank you for your attention http://www.tripcom.org Sixth Framework Programme Priority 2© TripCom Information Society Technologies (IST) Specific Targeted Research Project

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