EU-US eHealth/Health IT
Cooperation Initiative
Interoperability of EHR
Work Group
March 26, 2014
0
Meeting Etiquette
• Participants automatically enter the webinar in “listen only”
mode. The organizer will then unmute all participants. We ask if
you are not speaking to manually mute yourself
• NOTE: VoIP participants have the ability to “Mute”
themselves by clicking on the green microphone. However, if
you would like to speak, only you can unmute yourself.
• If you are dialing in using a telephone and NOT using the VoIP
you MUST dial the audio pin in order for the organizer to unmute
you – if you do not use the audio pin and just push # when
prompted the Organizer cannot unmute you
Meeting Etiquette
CONTINUED
• If you are calling from a telephone, please
do not put your phone on hold. If you
need to take a call, hang up and dial in
again when you have completed your
other call
• This meeting is being recorded
• Another reason to keep your phone or your VoIP
on mute when not speaking
• Use the “Chat” or “Question” feature for
questions, comments and items you would
like the moderator or other panelists to
know.
2
Agenda
Topic
Time Allotted
General Announcements
5 minutes
Final Report Out from Mapping Sub-Workgroup
35 minutes
Drafting the White Paper
15 minutes
Next Steps and Logistics
5 minutes
3
Meeting Times –CHANGE TO SCHEDULE
Washington, DC
10:00 am (EDT)
Eastern Daylight Time
London
15:00 (BST)
British Summer Time
Germany
16:00 (CEST)
Central European Summer Time
Athens
17:00 (EEST)
Eastern European Summer Time
Interoperability Work
Group will meet every
other Wednesday
(through mid-May)
Next meeting April 9th,
2014
We will be back on our regular
time schedule (1 hour later for
EU team). These times are
posted to the left.
4
General Announcements
To join our weekly webinars, visit the EU-US eHealth
Collaboration Wiki Homepage for the latest meeting information:
•
http://wiki.siframework.org/EU-US+eHealth+Cooperation+Initiative
•
•
To subscribe to our mailing list, simply complete the EU-US MOU
Project Signup Form: http://wiki.siframework.org/EUUS+MOU+Roadmap+Project+Sign+Up
•
To submit a brief biography of yourself (150 words or less), review
the criteria listed at
http://wiki.siframework.org/Interoperability+of+EHR+Work+Group
#Work Group Members and e-mail your bio and photo (optional) to
Gayathri Jayawardena at gayathri.jayawardena@esacinc.com
To access current and archived meeting materials,
visit the Project Meeting Artifacts section:
http://wiki.siframework.org/Project+Meeting+Artifac
ts
5
Phases of Harmonization
Data Granularity and Complexity
Completed
• Section level mapping
between epSOS and CCD
Phase 1
<clinicalDocument>
(Clinical Summary Form)
<header>
(document ID, author, patient ID…)
<component> [Body]
<section> [Procedures]
• Header’ Data Element
mapping
Phase 2
• Sections’ Data Element
mapping
Phase 3
<entry> (Colonoscopy)
<procedureCode>
<procedureDate>
<…>
<entry> [Gastroscopy]
<entry> [CABG]
…
<section> [Current Medications]
Phase 4
• Value Set (VS) mapping
<entry> [ASA]
<entry> [Warfarin]
<entry> [CABG]
<section>…
<entry>
6
Comparative Analysis – in numbers
Analysis/Map
ping Type
CCDA
epSoS
Status
Gaps
Header Data
Elements (DEs)
~100 DEs
~100 DEs
Review complete.
All but several epSoS
DEs are mappable to
CCDA. Mapping and gap
details documented in
excel (for now)
CCDA provides a lot more DEs and
attributes than epSoS. epSoS contains
some DEs (such as primary health care
provider for EU citizen traveling to
another EU country) not in CCDA.
Section Level
18 sections
16 sections
All sections mapped.
epSoS Active Problems and Hx of Past
illnesses map to Problem Section in
CCDA. CCDA sections such as Advance
Directive, Encounters, Family History
and Payers are not in epSoS.
Section Data
Elements (DEs)
Significantly
more DEs (~2x
or more)
~70 DEs
First Pass completed.
Second pass completed.
CCDA CCD has significantly more Data
Elements than epSoS. There are about
10 epSoS DEs not in CCDA CCD.
IG guides on both ends do not specify all
information that CDA schema allows.
Value Sets
74 Value Sets
(not used by
CCD)
45 Value Sets
(not all used
by PS form)
Review completed.
Scope: overlapping VSs.
Some for HL7 VS. Many for clinical
vocabularies.
DE Mapping Review – few highlights
• Procedures (g):
– @code
– @displayName
– OriginalText
• Vitals (m/g):
– epSoS: syst/dias BP (2 codes)
– CCDA CCD: syst/dias BP, HR, weight, height…etc (12
codes)
• Results (m/g):
– epSOS: Blood Group
– CCDA CCD: ANY Result
8
Value Set mapping - highlights
• Value Sets mapping completed in last week:
– INDRoleClass
– documentCode
– VitalSigns
– Clinical VS:
• ATC-RxNorm
• Diseases/Problems: ICD10-SNOMED CT
9
Value Set mapping – highlights…cont
• Common types of issues:
– Code system same but different code subsets
used (typical for SNOMED CT and HL7 codes)
– Code system different AND codes have different
granularity (1 to M maps). E.g:
• epSoSIllnessesandDisorders (ICD10) – CCDA Problem VS
(SNOMED CT)
• epSoSActiveIngredient (ATC) – RxNorm
• epSoSVaccines - CVX
10
Diseases/Problems VS
•
•
EU VS: 9,529 codes (ICD10CM)
US VS: 16,443 codes (SCT)
– epSoS -> SNOMED CT
Map rule: relaxed vs. strict
1
2
3
4-9
10-19
20-49
50-99
~100-350
No maps
Mapped SNOMED CT
codes
1
2
3
4-9
10-19
20-49
50-99
>100
No maps
Relaxed
More spec. ICD10
Less spec. ICD10
Code “Bandwidth”
7%
6%
5%
15%
7%
3%
1%
1%
55%
epSoS ICD10
codes
11%
7%
5%
14%
3%
1%
1%
<0.05%
58%
Mapped SNOMED
CT codes
Map rule
epSoS ICD10
codes
Strict
Case: relaxed -> strict (one code)
Relaxed
Strict
360 ->
250 ->
3
180
1 2 3
# SCT codes
100 101,…
11
One-to-many
Relaxed (#360)
Strict (#3)
12
Next Steps:
• White Paper/Technical Report
– Summarize analysis/mapping outcomes
– Provide Mapping:
•
•
•
•
Sections
Overlapping Des
Overlapping Value Sets
Value Set codes
– Publish within HL7 and S&I
– Guidance for new International Template for Patient Summary
• INT Template Development and Value Set development
• IG development
– Ballot through HL7 and ISO
13
Next Steps (cont.)
1.
Identification of most common subsets from the common, international
vocabularies — LOINC, ICD10, SNOMED, and ATC/RXNORM (others?).
1.
2.
2.
Creation/Harmonization of an internationally recognized, balloted standard for
transitions of care.
1.
2.
3.
3.
“shrinks the change” and makes it easier for us to do value-set mappings between attributes
that use ICD10 in the US and SNOMED in another country.
It provides the tools to the industry so that they can internalize these standards, be certified
to these standards, and create their own internal mapping constructs/tools based on these
subsets.
This can start at the intersection of the attributes between US and EU, and expand to include
both US and EU attributes.
The goal is to ballot internationally recognized standard for transitions of care in HL7 and
then in ISO, and for it to be more constrained version of the CCDA CCD.
This would mean we can certify EHR products to these specifications, and we should be able
to exchange documents on international level.
Create policy goals across member states that allows a patient to get an
electronic copy of their transition of care document.
1.
This empowers patients, makes the infrastructure easier, and avoids many obstacles that
exist within existing governments about sharing patient information.
New International Patient Summary
INT template (HL7/ISO)
3 View INT Patient Summary
1 Log on
within EHR
EU Patient
US Physician
PHR
2
EHR
Retrieve INT version on
Patient Summary
INT Patient Summary
Header
document ID, author, patient ID…etc.
DE vocabulary constraints
Constrained, HIGH FREQUENCY Value Set
Problem code SHOULD be SNOMED CT
Value Set or ICD-10-CM Value Set
Top SNOMED CT codes OR
Top ICD10 codes (based on SCT to ICD10 cross-maps)
MAY have 0..*
<translations> (local codes)
Body
Problems/Diagnosis
Problem Code & Name
Problem Start Date
Problem End Date
EHR
….
Example
Example HTML
17890003 (Hepatic infarction)
123XYZ (Leberinfarkt)
Corresponding XML
<code code=“17890003 ” codeDisplayName=“Hepatic infarction” codeSystem=“SNOMED CT”
<translation code=“123XYZ ”, codeDisplayName=“Leberinfarkt”>
</code>
Medications, Vital Signs…etc.
K76.3 (Infarction of liver)
<entry> [ASA]
<entry> [Warfarin]
<entry> [CABG]
239-2 (Infarkt jetre)
<code code=“K76.3” codeDisplayName=“Infarction of liver” codeSystem=“ICD-10-CM”
<translation code=“239-2”, codeDisplayName=“Infarkt jetre”>
</code>
15
New Value Set
Maintenance (e.g. IHTSDO)
•
•
•
•
Today, SNOMED CT is available in US English, UK English, Spanish, Danish and Swedish.
Translations into French, Lithuanian, and several other languages are currently taking place!
Current SNOMED CT: 400,000 codes
High frequency VS: Top 5,000 codes -> focuses translation efforts AND utilization
17890003 (Hepatic infarction)
Adopt (eng.)/ Deposit (hr.)
Adopt (sp.)/ Deposit (gn.)
Adopt (eng.)/ Deposit (np.)
Adopt (eng.)
Adopt (eng.)
Adopt (fr.)/ Complete (fr.)
16
Mar- Apr 4
May- Jun ‘14
Jul- Aug ‘14
Sept- Oct ’14
Nov- Dec ‘14
EU-US Timeline for 2014
EU-US
White Paper Report
INT template design
Value Set development
IG development/Review
HL7 Ballot Package Development
HL7 Project Scope Statement (May 18)
HL7
HL7 Notification of Intent to Ballot (June 29)
Ballot Preview Period
HL7 Ballot (Aug 8- Sept 8)
HL7 WG Meeting (Sept. 14-19)
Milestones
HL7 Ballot Reconciliation
Paper published (May)
INT template IG (Jul 5)
HL7 Initial Content Due (Jul 13)
HL7 Final Content Due (Aug 3)
17
White Paper Discussion
• We are going to work be working on a white
paper in addition to the harmonized template
• The white paper will provide an overview of the
outcomes of the mapping exercise and
incorporate the detailed mapping spreadsheets
as well as discuss the differences between epSOS
to CCD sections
• We will be working on the white paper in the
Interoperability WG sessions
• We will NOT meet next week
• Meetings will resume on Wednesday, April 9th
18
Next Meeting
• Next meeting will be on Wednesday, March April
9th, 2014 at 10:00 am (ET)/16:00 pm (EET)
• Now through mid May we will be meeting every
other week
– During the off weeks we will be drafting the white paper
• Community Calls will be a review and input of the drafted white
paper
• Community will also be provided updates on the Templates work
resulting from the mapping activities
19
Project Support Team
• US Point of Contacts
–
–
–
–
–
–
Mera Choi, Mera.Choi@hhs.gov
Jamie Parker, jamie.parker@esacinc.com
Gayathri Jayawardena, gayathri.jayawardena@esacinc.com
Amanda Merrill, amanda.merrill@accenturefederal.com
Mark Roche, mrochemd@gmail.com
Virginia Riehl, virginia.riehl@verizon.net
• EU Point of Contacts
– Benoit Abeloos, Benoit.ABELOOS@ec.europa.eu
– Frank Cunningham, frank.cunningham@ec.europa.eu
– Catherine Chronaki, chronaki@gmail.com
20
Initiative Resources
• EU-US Wiki Homepage
– http://wiki.siframework.org/EUUS+eHealth+Cooperation+Initiative
• Join the Initiative
– http://wiki.siframework.org/EUUS+MOU+Roadmap+Project+Sign+Up
• EU-US Initiative Reference Materials
– http://wiki.siframework.org/EUUS+MOU+Roadmap+Project+Reference+Materials
• Interoperability of EHR Homepage
– http://wiki.siframework.org/Interoperability+of+EHR+Work+Gr
oup
21