Status report on A Nordic reference architecture for Personal Connected Health and Care at the major Swedish ehealth conference.

1. A Nordic reference architecture
for Personal Connected Health
and Care

2. Agenda
∙ Why a Nordic collaboration?
∙ Nordic reference model for Personal connected health
architectures
∙ Applied architectures of the Nordic countries
– Norway
– Sweden
– Denmark
∙ Q&A

3. At the home of the
Citizen
Health Care
Home Care
Home care tele
health solution
Diabetes tele
health solution
Geriatric tele
health solution
The reality without standards – citizen perspective

4. At the home of the
Citizen
Health Care
Home Care
Home care tele
health solution
Diabetes tele
health solution
Geriatric tele
health solution
A shared set of standards simplifies consolidation in the home setting

5. Health or home
Care
Electronic health
record
KOL tele care
solution
At the home of the
Citizen
The reality without standards - healthcare professional perspective

6. Health or home
Care
Electronic health
record
KOL tele care
solution
At Home of the
Citizen
A shared set of standards reduces the amount of double registration

7. At the home of the
Citizen
Health or home
Care
Electronic health
record system
vendor
Diabetes tele
care solution
€
€€
€
A vendor has to invest in
integrations specific to
each customer - 4
customers means 4 times
the cost. And we all know
who pays the bill!
The reality without standards - market/vendor perspective

8. At the home of the
Citizen
Health or home
Care
Electronic health
record system
vendor
Diabetes tele care
cloud solution
€
Using standards, One
integration fits all
customers - 4 customers
shares the cost of 1
integration.
Shared standards reduce cost for actors on the Nordic e-health market

9. At the home of the
Citizen
With a Nordic collaboration, a vendor is more likely to invest in a
standard and customers/buyers will spend less on integrations
Coordinated
standards
selections
Vendor 1Vendor 2
Vendor 3
Vendor 4

10. The collaboration
Jonan Eltes
Thor Schliemann
Lars Kristian Roland
Jari Porrasmaa

11. ?
Towards a Common Nordic Language for Telemedicine Architecture

12. Norwegian architecture principles:
● Standards based (Continua, FHIR and SCAIP) + nordic cooperation
● Separate storage and display applications (allow for multi-vendor solutions)
● Data that is important to be shared, is planned stored in national repository (FHIR-based), but
in mean-time municipalities will implement local FHIR-based systems according to national
specifications
● Not all data is relevant to share… some is kept locally.
● Citizen must be able to see all data about themselves.
● Currently draft recommendations
Norwegian reference architecture for personal connected health

13. Swedish architecture principles:
- The architecture is vendor- and topology agnostic (open market)
- Is actually an application of the generic reference architecture. All principles of the general national HIE reference
architecture apply, to secure that all information can be accessed for any legally supported purpose
- Standards-based information exchange - today Continua and HL7 Green CDA WS. HL7 FHIR PoC in the planning (future
Nordic alignment).
Swedish reference architecture for personal connected health

14. Sweden - applied reference architecture
Case 1 - “Integrated telemedicine solution”

15. Sweden - applied reference architecture
Case 2 - “Personal Monitoring as a Service”

16. Danish architecture principles:
● Separate storage and display applications (multi-vendor solutions)
● Data collected within the principles of Continuas framework
● HL7 CDA PHMR (Personal Health Monitoring Record)
Danish reference architecture for collecting health data from the citizens

17. Danish reference architecture for sharing documents and images
Danish Cross Sharing Architecture:
● Clinical Data available as documents HL7 CDA
● Using IHE XDS infrastructure services

18. Danish architecture principles
Clear accountability
∙ The collection of health data is done in cooperation between the parties
– accurate agreements about who is responsible for equipment, support, etc.
The collected Health Data made available to all relevant health professionals
∙ Data are at the level as other data produced at hospitals etc.
The use of International standards - ensures broad market support
∙ Using standards to reduce uncertainty by investing in solutions and ensure
∙ enables re-use, reduced cost and comlexity
Common metadata for forward search of relevant clinical information about patients
∙ to find relevant information across domains and IT solutions
∙ increasing semantic interoperability

19. Telecare North (TCN)
In Region of North Jutland, Denmark a large scale project for COPD patients,
Telecare North (TCN), have shown that there are benefits to be gained for both
patients and society.
The research has given a nuanced view of telemedicine. It shows that there is an
economic benefit to the society, but only if telemedicine offered for the right
groups, for example people with severe COPD.
∙ They had a strong focus on empowering citizens in telemedicine offers.
∙ The project hit the target for usability with 88 percent of participants in Telecare
North finding their telemedicine equipment user-friendly.
∙ The positive impact that telemedicine has the citizen's quality of life.
– 61 percent of participants feel that they are better able to control their
disease, and
– 71 percent feel safer in everyday life with telemedicine.

20. Tele health information
system
EHR information
access
Health care information
system
Welfare data capture
application
Exchange of EHR
documents
Form-based patient
questionnaires
Welfare technology
device
Observation uploadDevice connectivity
A B C
Welfare technology
device data
subscription
Norway: PCD-01 (hData)
+ FHIR (REST)
Norway: Continua Norway: FHIR???
(still undefined)
Norway: Not defined Norway: FHIR/REST Norway: XDS m/FHIR-
innhold
SE now: IHE PCD-01,
next: FHIR
SE now: Continua
next: Continua
SE NOW: SE-specific, next
FHIR
SE NOW: vendor-specific,
next: ?
SE NOW: Green CDA WS,
next: FHIR
SE NOW: Green CDA WS,
next: FHIR
DK: Now Propr. JSON
Recommended: to be
done
DK: Continua
recommended
DK: HL7-CDA QFD/QRD
(Continua)
DK:Not defined DK: To be done DK: IHE-XDS w/PHMR
and QFD/QRD
FI;: FHIR for wellbeing
apps to connect to
national PHR
FI;: Evaluating continua
Vendor specific solutions
Bluetooth, USB, etc.
FI;: FHIR questioinaire
and FHIR questioinaire
response, some CDA as
well
FI;: Not defined (looking
into FHIR subsc.
mechanism)
Mainly vendor specific
for telecare
FI;: FHIR / REST + Web
GUI professionals
PatientData: CDA R2+
DICOM + PDF
FI;: HL7 V3, XDS-I + XCA,
DICOM
SE
NO
DK
FI

21. Questions?
Meet us at the Inera booth!