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Standards as Infrastructure for Innovation

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Digital Enlightment Forum: Towards a European ecosystem for health care data
Presentation of eStandards/Trillium II at the workshop of the Digital Enlightment Forum

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Standards as Infrastructure for Innovation

  1. 1. Towards a European ecosystem for health care data eStandards as infrastructure for innovation Catherine Chronaki Secretary General HL7 Foundation, Brussels, Belgium Contact: euoffice@HL7.org Funded under H2020-643889
  2. 2. 2 HL7 Foundation: who we are.. HL7 the best and most widely-used eHealth standards since 1986 HL7 v2, Clinical Document Architecture, HL7 FHIR 19 National Affiliates in Europe (~38 wordwide) European HL7 foundation established in 2010 European Funded Research Projects eHGI, Antilope, Semantic Healthnet, Trillium Bridge, Expand, Trillium-II PHC34: ASSESS CT, OpenMedicine, eStandards Annual HL7 in Europe Newsletter Website: www.HL7.eu eHealth policy & Research eHealth stakeholders group; mHealth Guidelines; ENISA expert group EFMI council (2012-): eHealth Week EFMI Board (2016) HIMSS Europe SDO Joint Initiative Council HL7 Vision: A world in which everyone can securely access and use the right health data when and where they need it. Digital Enlightment Forum: Towards a European Ecosystem for Health Care
  3. 3. Forces facing health systems: technology •Rapid progress in analytics and digitization •Innovation in medicine
  4. 4. Digital Single Market – digital health priorities and challenges Pillars of digital transformation in health and social care  Give citizens better access to their health data everywhere in the EU  Connect and share health data for research, faster diagnosis, and better health outcomes  Use digital services for citizen empowerment and person-centered care. Challenges  Risks of privacy breaches (65.89%)  Heterogeneity of electronic health records (58.24%)  Cybersecurity risks (54.42%)  Lack of technical interoperability (48.46%)  Data quality and reliability (45.32%)  Lack of infrastructure (44.02%) Digital Enlightment Forum: Towards a European Ecosystem for Health Care
  5. 5. 5 eStandards can unlock data for trust & flow Today: Massive health data accumulated in silo EHR systems for documentation Need to move from passive documentation to active use of information and knowledge creation: activation! Patient summaries defined at the macro level for cross-border exchange for emergency or unplanned care at a national level. Need to address communities and individuals! Standards and profiles address a predefined exchange of information. Need flexible use of available content and structure, recognizing national, regional or local jurisdictions: trust & flow! Digital Enlightment Forum: Towards a European Ecosystem for Health Care
  6. 6. 6 eStandards Project Highlights Problem: Standards roadmap to support large-scale eHealth deployment Ambition: Re-establish SDOs as the authority and shepherd of high quality widely-adopted standards that advance cost effective sustainable interoperability. Key outcomes: Co-creation, Governance, Alignment Framework eStandards lifecycle model Best practices today in health data exchange Next steps: eStandards workshop as part of the JIC meeting in London, Nov 2017 Engage stakeholders eHealth Stakeholder Group Digital Enent Forum: Towards a European Ecosystem for Health Care
  7. 7. 7 eStandards project vision is that of a global eHealth ecosystem Where:  people have navigation tools for safe and informed health care  interoperability assets fuel creativity, entrepreneurship, and innovation eStandards:  nurture digital health innovation  strengthen Europe’s voice & impact  enable co-creation and trusted provider-user relationships www.estandards-project.eu Roadmap available at: Digital Enlightment Forum: Towards a European Ecosystem for Health Care Source: eStandards D3.1
  8. 8. 8 Making Digital Work for health with Trust and Flow Co-create to make it real using standards Governance to make it scale for large-scale deployment Alignment to make it flourish in a sustainable way Digital Enlightment Forum: Towards a European Ecosystem for Health Care http://www.hl7.org/fhir
  9. 9. 9 Patient summary as Health data navigator Think of the Patient summary as a window to a person’s health or dashboard: Medications, allergies, vaccinations, problems and procedures, labs, diagnostic imaging, recent or planned encounters, implantable devices advance directives “Bring the Power of Platforms to Health Care” using data to drive: administrative automation, networked knowledge, and resource orchestration [Bush & Fox, HBR November 2016] eStandards need to help build trust unlock the power of health data facilitate decision support navigate the health system Digital Enlightment Forum: Towards a European Ecosystem for Health Care
  10. 10. 10 International Patient Summary (IPS) Implementation Guide: Purpose & Scope Goal: identify the required clinical data, vocabulary and value sets for an international patient summary. Scope: “The IPS specification shall focus on a minimal and non-exhaustive Patient Summary, which is specialty- agnostic and condition-independent, but still clinically relevant.” The primary use case is to provide support for cross-border or cross-juridictional emergency and unplanned care: Cross-jurisdictional patient summaries (through adaptation/extension for multi-language and realm scenarios, including translation). Emergency and unplanned care in any country, regardless of language. Value sets based on international vocabularies that are usable and understandable in any country. Data and metadata for document-level provenance. Digital Enlightment Forum: Towards a European Ecosystem for Health Care
  11. 11. 11 What is FHIR? Based on a set of modular components - “Resources” Resources refer to each other using URLs Small discrete units of exchange with defined behaviour and meaning Have known identity and behaviour Extensions permit adding data not part of core Resources are combined into “Profiles” to solve clinical & admin problems Parties exchanging data define the specifics of using resources and their relations using Profiles. Profiles are the framework for defining services. Test data and servers are available Exchange resources between systems Using a RESTful API (e.g. web approach) As a Bundle of resources (messages, documents) Positives Service driven - composition Modify components with changing need Portability of components by moving code with the data Digital Enlightment Forum: Towards a European Ecosystem for Health Care Modified from: Ed Hammond 2016 Let’s have a look: https://www.hl7.org/fhir/
  12. 12. 12 Patient History: Resource explorer Click on instance to see details Source from David Hay Digital Enlightment Forum: Towards a European Ecosystem for Health Care Implementation Global Free
  13. 13. 13 Emergency department as decision environment High decision density Decision fatigue Throughput pressure Wide range of illnesses Diagnostic Uncertaintly Narrow time windows Interruptions and distractions Shift work/sleep disruption Shift changes cognitive decline at the end of a shift 30% Diagnostic Error in ED Radiology 5% Missed injuries 12% Cardiovascular 19% Respiratory 30% Overall ~16% Digital Enlightment Forum: Towards a European Ecosystem for Health Care Source: Dr. Pat Croskerry, Emergency London; https://www.youtube.com/watch?v=GFE6D5460oE It’s not about what we know, it’s about how we think!
  14. 14. 14 Emergency data sets Digital Enlightment Forum: Towards a European Ecosystem for Health Care http://aktin.art-decor.org source: Kai Heitmann https://tinyurl.com/y7assld4
  15. 15. • Quality assurance • Health goals • Early warnings Can we use patient summaries to unlock patient data?
  16. 16. 16 Can Patient summaries leverage HL7 FHIR to unlock the power of data and drive our digital future? YES, HL7 FHIR is part of the solution It opens a window, but It takes a village… Digital Enlightment Forum: Towards a European Ecosystem for Health Care
  17. 17. 17 What do we need to make it happen with standards and interoperability? Co-create make it real by standards Governance scale for large-scale deployment Alignment flourish in sustainable ways Digital Enlightment Forum: Towards a European Ecosystem for Health Care
  18. 18. mhm@medcom.dk euoffice@HL7.org www.trilliumbridge.eu Digital Enlightment Forum: Towards a European Ecosystem for Health Care EvaluateBridge HarmonizeGuide

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