The document outlines the concept of cross-border interoperability in healthcare, emphasizing the ability to exchange health information across countries while addressing various challenges, including legal, semantic, and technical interoperability. It highlights the roles of initiatives like IHE and HL7 in promoting standards for better information exchange and patient care, as well as providing examples of workflows and use cases for effective implementation. Additionally, it discusses the integration of systems, services, and different actors to enhance healthcare cooperation and improve patient outcomes.

1. Cross-border
Interoperability

2. “Interoperability is the ability of making systems and
organizations to work together (inter-operate).”

3. “Cross-border Interoperability aims to provide tools and
common ways to exchange (health) information between
countries”

4. Challenges
Legal
Interoperability
Semantic
Interoperability
Organisational
Interoperability
Technical
Interoperability

5. ! Implementation of legal common grounds for
information exchange;
! Establishment of circles of trust;
! Legal recognition of involved parties, such as HCPs
(including their roles), patients and others;
! Set in place common authentication mechanisms
(e.g. European e-Identification projects);
! Others;
LegalandOrganizational
Interoperability

6. ! Represent as much as possible the information using
clinical code-systems;
! If necessary, define common and agreed value sets
for information exchange;
! Establish formal mappings of existent information to
the agreed value sets;
! Include also the translations to allow multi-language
capabilities (cross-country scenarios);
Semantic
Interoperability

7. ! Implement common interfaces for services;
! Establish agreed format for information exchange;
! If possible, prove and certify the compliance level of
the involved systems;
! Define roadmaps for information integration;
! And others;
Technical
Interoperability

8. Citizens and patients
! Receive health care abroad (almost) seamlessly;
! Receive medication in a foreign country on existing
prescription;
! Access to his own information in multiple languages
and recognized formats;
Health care providers
! Get quick and easy access to key patient data;
! Improve health care cooperation across borders;
Health care quality
! Reduce medication errors by exchanging data;
! Facilitate the occasional care of foreign patients
Benefits

9. “So... How can we give response to some of this issues?”

10. IHE
What is?
IHE is an initiative by healthcare
professionals and industry
Aims to improve the way computer
systems in healthcare share information.
Promotes the coordinated use of
established standards such as DICOM and
HL7 to address specific clinical needs in
support of optimal patient care.
Systems developed in accordance with
IHE communicate with one another
better, are easier to implement, and
enable care providers to use information
more effectively.
Vision
Enable seamless and secure
access to health information
whenever and wherever needed.
Mission
IHE improves healthcare by
providing specifications, tools and
services for interoperability.
IHE engages clinicians, health
authorities, industry, and users to
develop, test, and implement
standards-based solutions to vital
health information needs.

11. ! Anatomic Pathology
! Eye Care
! IT Infrastructure
! Laboratory
! Patient Care Coordination
! Patient Care Devices
! Quality, Research and Public Health
! Radiation Oncology
! Radiology
IHEDomains

12. IHEEcosystem

13. IHETechnical
Frameworks
Integration Profiles
Actors
Transactions
Transaction Details

14. HL7
What is?
Founded in 1987, Health Level Seven
International (HL7) is a not-for-profit,
ANSI-accredited standards developing
organization.
Its dedicated to providing a
comprehensive framework and related
standards for the exchange, integration,
sharing, and retrieval of electronic health
information
This information that supports clinical
practice and the management, delivery
and evaluation of health services.
Vision
To create the best and most
widely used standards in
healthcare.
Mission
HL7 provides standards for
interoperability that improve care
delivery, optimize workflow,
reduce ambiguity and enhance
knowledge transfer among all of
our stakeholders.
All processes include high
scientific rigor and technical
expertise.
“The 1000 kg Gorilla of
Healthcare Standards”

15. HL7v2
Common Messaging Standard
Positive Negative
! Simple syntax
! Easy to understand
! Widely adopted, with great
experience;
! Backwards compatibility;
! Old technology
! Poor format
! Very limited scope
! Very limited on expansion;
MSH|^~&|GHH LAB|ELAB-3|GHH
OE|BLDG4|200202150930||ORU^R01|CNTRL-3456|P|2.4<cr>PID|||555-44-
4444||EVERYWOMAN^EVE^E^^^^L|JONES|19620320|F|||153 FERNWOODDR.^
^STATESVILLE^OH^35292||(206)3345232|(206)752-121||||AC555444444||67-A4335^OH^20030520<cr>OBR|1|845439^GHH OE|1045813^GHH LAB|155

16. HL7v3
Quality Methodology to supercede version 2
Positive Negative
! Rigorous and Thorough
Definitions
! Computable Base
! Based on XML & UML
! Deep Knowledge Required
! Complex Syntax
! Very expensive
! Common Semantics != Common
Engineering
<PRPA_IN201305UV02 ITSVersion="XML_1.0" xmlns="urn:hl7-org:v3">
<id extension="3660db44-40ab-4e9b-947e-a3ea3a4e80cc"root="67488c74-84f6-42c5-a9db-4a848fa49941"/><creationTime value="20140407"/><versionCode code="V3PR1"/>
(...)

17. HL7FHIR Fast Health Interoperable Resources
! Small building blocks for health records;
! XML / JSON representation;
! Tailored for REST but useable in other ways;
! Standard Data, Narrative and Extensions
! Best ideas from HL7, DICOM and IHE
! Based on industry best practices, with a focus on
simplicity and implementability;

18. EuropeanReference
Projects epSOS STORK
Trillium Antillope

19. eHealth Integration
Platform

20. Topics
1. Description
2. Key-functionalities
3. Business services provided
4. General architecture
5. Application scenarios
6. Demonstration workflows
7. Other supported use-cases

21. ! Provides Technical and Semantic interoperability;
! Was firstly designed with EU Interoperability
Framework as blueprint;
! Boosts the exchange of health-related information
among departments, organisations or geographical
apart clinicians and patients ;
! Was built using well known and cutting edge
eHealth standards, allowing many integration
possibilities;
Description

22. Keyfunctionalities
Interoperability
Connectors
uIN core components
that enable information
exchange
Authentication &
Authorization
user authentication and
credentials assertion
Audit Trail
a storage and
consultation service
to audit events
performed by users
Notifications
send and receive several
kind of messages via
email, SMS or inApp
Monitoring
continuous assessment
of availability in the ICT
ecosystem
Templating
Repository
document schemes for
consultation and usage

23. Businessservices
provided Master Patient Index
maintain consistent, accurate and
current demographic and essential
medical data on the patients,
across one or several organizations
Patient Summary
standardized set of basic
medical data that includes
important clinical facts required
to ensure
safe and secure healthcare
Terminology Services
record clinical information in
ways that enable meaning-based
retrieval, providing effective access
to information for decision support
Quality Conformance
quality evaluation of health
records made, such as checking
if the data of a given form is
properly and fully completed

24. Usedstandardsand
IHEprofiles
HL7 FHIR
Most promising and recent HL7 draft standard.
Oriented towards a lightweight REST approach, compatible with
HL7 v2 and v3.
Foresees easier integration with new paradigms (e.g. mobile, web)
IHE XDS.b
Well known IHE Profile to handle storage, query and retrieval of
documents. Can be complemented for a more community-
oriented use-case with the XCA profile.
IHE PIX/PDQ
Well known IHE profiles for handling the interfaces with Master
Patient Index. Allowing the execution of demographic queries
and patient identifiers cross-referencing.
Can be complemented for a more community-oriented use-case
with the XCPD profile.
CTS2
Common Terminology services interface. CTS2 is a model and
specification for discovering, accessing, distributing and updated
terminological resources on the internet.
DICOM
Well known standard for clinical images and reports exchange
and representation, regarding the format, service, etc.

25. *
GeneralArchitecture
Integration
Layer
Services
Layer
Persistence
Layer
Additional
Services
IHE PIX/PDQ
XCPD
IHE XDS.b
XCA
CTS2 HL7 FHIR Others
Master
Patient
Index
Document
Registry
Repository
Terminology
Service
Others
No-SQL
Database
SQL
Relational
Database
Audit
Trail
Notifications
PACS
DICOM
Viewer
Report
Templates
Others

26. ApplicationScenarios Legacy
System
✓ Compliant Services
→ IHE, HL7 FHIR, etc
✓ Extended Interfaces
✓ Added Functionalities
Region A
Region B
BridgingNetworksEnabling
Systems
eHealth
Services
Challenge
us!
Master Patient
Index
Documents
Terminologies
Others

27. Master
Patient Index
*
Workflow:Patient
Summary
Appointment, emergency episode, etc
Document
Repository
✓ Patient Search
✓ Document Search
✓ Document Retrieve
✓ Semantic Transformation
✓ Auditing
Country | Region | Hospital ACountry | Region | Hospital B
1. A patient goes to an appointment on a different hospital, region
or country;
2. The doctor asks for the patient’s home location and performs a
search for the patient identifiers match;
3. The doctor asks about privacy concerns, then searches for Patient
Summary;
4. A Patient Summary list is presented to the doctor;
5. The selected document is retrieved from the Patient’s home
location;
6. If necessary, the document is translated or transcoded;
7. All the operations are audited;

28. Master
Patient Index
*
Workflow:PSwith
noConsent
Appointment, emergency episode, etc
Document
Repository
✓ Patient Search
✓ Document Search
✓ Document Retrieve
✓ Semantic Transformation
✓ Auditing
Country | Region | Hospital ACountry | Region | Hospital B
1. A patient goes to an appointment on a different hospital, region
or country;
2. The doctor asks for the patient’s home location and performs a
search for the patient identifiers match;
3. The doctor then searches for Patient Summary;
4. A missing consent warning is presented to the doctor, instead of
a document list;

29. Master
Patient Index
*
Pharmacy
Prescription
Repository✓ Patient Search
✓ e-Prescription Search
✓ e-Prescription Retrieve
✓ Semantic Transformation
✓ Report Dispensation
✓ Auditing
Country | Region | Location ACountry | Region | Location B
1. A patient goes to a pharmacy on a different location, such as a
region or country;
2. The pharmacist asks for the patient’s home location and performs
a search for the patient identifiers match;
3. The pharmacist searches for available e-Prescriptions;
4. A prescription list is presented to the pharmacist;
5. If necessary, the selected document is translated and/or
transcoded;
6. The pharmacist dispenses one or more drugs, reporting back the
dispensation, being all the operations are audited;
Workflow:
ePrescription

30. Othersupporteduse-
cases Health-Care Encounter
Report
As a support for the Patient
Summary use-case, the main goal
for this use case is to report back
to the Patient’s origin location the
information about the outcome of
an encounter
Patient Access
The main purpose for this use-case
is to provide access to the Patient to
its own clinical information in
different languages, for example.
Medication Related
Overview
As a support for the ePrescription,
this use-case tries to provide
additional information for the
Pharmacist and also for the
Patient, regarding the
administration of the drugs (and
others).
eIdentification
Recent developments allow the
integration of uIN existent portal
system with strong authentication
mechanisms, (e.g. smart-cards,
mobile access tokens)
This feature is aligned with the
European project STORK, that
promotes eIdentification.

31. Thank you!
contact@iuz.pt
+351 234 247 381
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3810-074 Aveiro, Portugal
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