Trillium II /Focus workshop at Informatics for Health2017: Manchester, April 24-27, 2017 Frailty is an age-related state of vulnerability to the risk of adverse health out-comes after a stressor event. The condition predisposes individuals to progressive decline in different functional domains, leading to falls and fractures, disability and dependency on others, hospitalization, institutional placement and ultimately death. We discuss drivers, challenges and opportunities for healthcare information standards related to frailty in old age in an effort to launch a call for coordinated action across research, policy, and academia. Key issues are selected as the back-drop for this discussion: EHR, patient summaries and frailty in a context of coor-dinated care enabled by health IT standards. Presentation 5 of 5: Catherine Chronaki, HL7 Foundation

1. Reinforcing the Bridges and Scaling up
EU/USCooperation on Patient Summary
Trillium II

2. Dissemination and Networking:
Development and Evaluation:
• LANTANA CONSULTING GROUP, LLC, US
• SmartPHR PROSOCIAL APPLICATIONS INC, US
• Sequoia, Healtheway, Inc. DBAThe Sequoia Project, US
Standards Organizations:
Health Systems and Associated Competence centers:
• MedCom (Administrative Coordinator) DK
• LISPA - LOMBARDIA INFORMATICA, IT
• THL -TERVEYDEN JA HYVINVOINNIN LAITOS, FI
• eSANTE - AGENCE eSANTE, LU
• TicSalut – Catalunia, ES
• SPMS, PT
• Reliant, Reliant Medical Group, Inc., US
• HSCP Healthcare Services Platform Consortium, US
• KAISER FOUNDATION HOSPITALS, US

3. Where are we now?
Connected Europe Facility/eHealth Digital
Services Infrastructure (eHDSI)?
eHDSI funded Member States
PS eP
Austria
Croatia
Cyprus
Czech Republic
Estonia
Finland
France
Germany
Greece
Hungary
Ireland
Italy
Luxembourg
Malta
Portugal
Sweden
Switzerland
• Tools and services using ICTs that can
improve cross border Healthcare
services.
• Use Cases:
– Patient Summary, provides access
for health professionals to verified
key health data of a patient during
an unplanned care encounter while
abroad
– ePrescription, enables patients to
receive equivalent medication
treatment while abroad to what they
would receive in their home country

4. Advancing Standards and Profiles
Today:
• Massive health data accumulated in silo EHR systems serving documentation.
• We need to move from passive documentation to active use of information and knowledge creation:
activation!
• Patient summaries defined at the macro level: cross-border exchange for emergency or unplanned
care at government level.
• Move to meso and micro level to address communities and individuals.
Shaping the future: Focus on the top level: systems of innovation.
25 April 2017 Informatics for Health 2017 4

5. Scaling-up the use of patient summaries
Emergency
• Emergency response teams
Manchster April 25, 2017 Informatics for Health 2017
Trillium-II’s ambition touches the individual by their mobile – their personal communication hub and
the community through an aggregating dashboard making the most of our data-driven economy.

6. vaccinations
medications
encounters
Identification allergies
Implantable
devicesProblems
Health team
Security
preferences
Health team
Security
preferences
problems
Social history

7. Manchster April 25, 2017 Informatics for Health 2017

9. List of current
problems /
diagnoses
Problem/
Diagnosis
Description
Problems / diagnoses that fit under these conditions:
1) may have a chronic or relapsing course (e.g.
irritable bowel syndrome, otitis media),
2) the patient receives repeat medications (e.g.
diabetes mellitus, hypertension)
3) persistent and serious contraindications for classes
of medication (e.g. dyspepsia, migraine, asthma)
Problem Id (code) Normalized identifier
Onset time Date of problem onset

10. Medical
Devices and
implants
Device and
Implant
description
Describes the patient's implanted and external
medical devices and equipment that their health
status depends on.
Includes devices as cardiac pacemakers,
implantable fibrillator, prosthesis, ferromagnetic
bone implants, etc. that are important to be known
by the HP
Device Id code Normalized identifier
Implant date Date when procedure was performed

11. Major Surgical Procedures
in the past six months
Procedure
Description
Describes the type of procedure
Procedure Id
(code)
Normalized identifier
Procedure date Date when procedure was performed
Treatment
Recommendations
Recommendations
Description
Therapeutic recommendations that do not include
drugs (diet, physical exercise constraints, etc)
Recommendation
ID (code)
Normalized identifier

12. Description Need of the patient to be continuously assessed by third parties,
invalidity status may influence decisions about how to administer
treatments
Invalidity Id code Normalized invalidity identifier (if any, otherwise free text)

13. List of current medicines Active ingredient
Exemption: brand name
Substance that alone or in combination with one or more other
ingredients produces the intended activity of a medicinal product
Brand name if a biological medicinal product or when justified by
the health professional (ref. Commission Directive 2012/52/EU)
Active ingredient id code Code that identifies the active ingredient
(All prescribed
medicines whose period
of time indicated
Strength the content of the active ingredient expressed quantifiably per
dosage unit, per unit of volume or per unit of weight, according to
the pharmaceutical dose form. Example 500 mg per tablet
treatment has not yet
expired whether it has
been dispensed or not)
Pharmaceutical dose form the form in which a pharmaceutical product is presented in the
medicinal product package (e.g. tablet, syrup)
Number of units per intake the number of units per intake that the patient is taking, e.g. 1 tablet
Frequency of intakes Frequency of intakes per hour/day/week/monthe e.g. each 24 hours
Duration of treatment Example: 14 days
Date of onset of treatment Date when patient needs to start taking the medicine prescribed

14. Social History
Observations
Social History
Observations related to
smoking, alcohol, diet
Health related “life-style factors" or "life style
observations"
Example: cigarette smoker, alcohol consumption
Reference date range Example: from 1974 thru 2004
Physical findings Vital Signs
Observations
Blood pressure One value of blood pressure which
includes: systolic blood pressure and
diastolic blood pressure
Date when
blood pressure
was measured
Date when blood pressure was
measured

16. John Smith
A TALE IN SEVERAL ACTS
How is responsibility managed among all care professionals (doctors, nurses, social
workers, informal caregivers, care managers etc.)
What information about the patient health status would be required to ensure efficient
professional help along the entire pathway?
What information about the patient is necessary to assure a smooth transfer among different
health care entities?
What kind of data should the patient summary provide to optimize care in planned and every
day settings?
What kind of data on frailty status is necessary if any?

19. mhm@medcom.dk
euoffice@HL7.org
EvaluateBridge
HarmonizeGuide
Manchster April 25, 2017 Informatics for Health 2017