Crossing the Trillium Bridge at HIMSS2015

www.trilliumbridge.eu

Crossing the Trillium Bridge: Transatlantic Exchange of Electronic Health Record SummariesFor the Trillium Bridge Consortium:

Catherine Chronaki (HL7 Foundation, Be), Henrique Martins (SPMS, MoH Portugal, Pt), Arturo Romero (MoH Spain, ES), Harold Solbrig (Mayo Clinic, US), Alexander Berler (Gnomon Informatics, GR)

DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

Trillium Bridge Project: a feasibility study and builder perspective…

The problem The Solution

• What can we do to lower the cost of transatlantic business engagement in eHealth?

– Reduce barriers for transatlantic coordination, health care, trade

– Decrease standards development and implementation costs

– Accelerate convergence towards global standards

– Support right of citizens to their health data and safety

• Well, perhaps we could try building.. …a Transatlantic Bridge for EHR summaries!

• Pragmatic Feasibility study on the exchange of Patient Summaries across the Atlantic

• Compare, analyze, and map EU/US EHR patient summaries starting with Meaningful Use 2 C-CDA/CCD and EU patient summaries (epSOS)

• July 2013 to June 2015

• Stellar consortium of EU member state provider networks, associations, SDOs

Trillium Bridge: where are we?

Trillium Bridge: methodology

Building the Transatlantic bridge for EHR patient summaries

• Complete Gap analysis

• User stories, use cases, business architecture, D2.2

• Identify interoperability Assets

– Established STS terminologyservice associating EU/US terms, D3.1

– proof of concept transformer of EHR structures and semantics, D3.2

• Inform and support standardization efforts

– ground work of an Intl EHR patient summary

– Aligning infrastructure, D4.1

• Refine assets, work on the puzzle through validation

– Test with EU countries and US providers, D4.2

– Set the tone and pace for interoperability

in the global eHealth ecosystem, D5.1, 5.2

Selecting Grounds

Building the Bridge

Testing the Bridge

Policy Alignment

We are

here

CTS-2

Trillium

transformer

Trillium Bridge: where are we?

Attain the vision and aims of EU-US of the eHealth MoU and roadmap!

Under the Hood

CCD

CCD

EPSOSEPSOS

Structure

Transformation

Code

Mapping

Language

Translation

CTS-2

Transformer Components

Under the hood

Transformer Gateway Open Source Software

Patient Summaries in Spain

– In Spain, most Communities (regions) produce PS

• HCDSNS Project communicates individual community PS

• Requirements of PS consolidation are being studied

• > 15 million citizens have PS available (April 2015)

• Source EHR coverage very high at Primary & Family Care

• Source EHR coverage is less advanced in hospitals

– Trillium Bridge acts as a conceptual prototype for:

• Standards adoption

• Functional design (clinician-oriented & safety-aware)

• Technical implementation (messaging-oriented & integrity)

• Actual communications still not feasible

09/06/14 2

Citizen

Sections

Postal

Document: Bilingual

Organization

Items

1 2

3 4 5 6

Patient Summaries in Spain

Future Prospects:

– Agreement levels: EU-USA, bilateral, patient led

– All-bilingual approach

– Multilingual terminologies go mainstream

– “Convincing” industry about business added value of PS will require proof of feasibility and large-scale adoption

– Population coverage measuring will be essential

– Trillium Bridge documents may guide and teach

– Testing and validating requirements

– Automated generation for all citizens

– Stimulus for standards adoption

– Solving practical legal issues

– Complete semantic units approach

– Opportunities to innovate

Trillium Bridge fits eHealth Strategy:

THE PORTUGUESE BRIDGE...

The last American Census (2000) estimated a total of 1.173.691

Portuguese and luso-americans residing in USA

There are 95 Portuguese citizens/luso-americans in active political activity,

and more than 385 portuguese collectivities (cultural, recreational,

religious)*

* - Portuguese presidency website data

Portugal is fashionable in 1º Semester of 2014, American tourism in

Portugal was of about 227 million Euros, 47,8MEuros more than in 2013

(26,7% increase in 1 year). 156100 in 6 months individuals, which is

about 3548000 hotel nights (21,8% increase) tourists in Portugal *

Number of residents perhaps more than 5000?;

http://www.americansinportugal.org/

*- national institute of statistics/bank of portugal

Portugal (about 3,5/9 Million Patient Summaries ready for exchange)

~ 10 million citizen

~ 50 Public Hospitals

~ 400 Primary Care Centres

~ 90% running SPMS ICT solutions (ADT and EHR)

~ 60 ICT Solutions (SPMS portfolio)

PT Ministry of Health

DGS

Clinical Guidance

ACSS

Financialand ruler

SPMS

Technical Implementation

09/06/14 11

• International Projects

• Represent the fastest and secure way to learn from experience and lessons learnt. Belonging and actively participating in EU projects allow our teams to learn from example and improve our technical & semantic implementation skills.

• Trillium Bridge

• Represents the opportunity for explore possible solutions towards cross Atlantic health information exchange, namely what concerns PS structures and terminologies used. It also represents the right opportunity to push forward unfulfilled gaps left by epSOS in what concerns to PAC service (e.g. export and import, transformation EU-US)

• Piloted Uses Cases• Provider Mediated

• Patient Mediated

Luxembourg

• Some facts

ca. 550.000 Inhabitants

Largest foreign national community in EU (45%)

ca. 155.000 Commuters(FR/BE/GE)

Three official languages

Luxembourgish

French

German

Questions and Answers…

• How does Trillium Bridge fit with the eHealth strategy of your country?

– By definition the eHealth Strategy of Luxembourg is cross border enabled

– 45% of residents are expatriates

– Luxembourg hosts many EU institutions

• How do Patient Summaries and Trillium Bridge work in your country?

– Patient Summaries are part of the national strategy

– The size of Luxembourg make it a perfect reference implementation and Large scale pilot

– Trillium provides guidance on solving legal and organizational issues

• What are the prospects you see for the future?

– Patient mobility will increase

– Patient engagement is part of EU and US strategies

– Trillium Bridge will enforce the patient role in his care both planned or unplanned

Giving value to Trillium scenarios

• Healthcare Provider Mediated Scenario

– Trillium Gateway is reference implementation that proves that healthcare information exchange based on Standards is possible

– Patient summary is a valid start especially for unplanned care

– Trillium Bridge has worked on creating an international patient summary dataset that can be populated by globally accepted encounter reports.

• Patient Mediated Scenario

– Involving the patient is the first step to establish the Gateway

– Trillium Gateway would enable a “Blue Button enabled” strategy for US expatriates to Europe and beyond

– Legal and organizational issues can be bypassed by the direct consent of the patient.

Is there a Market?

Snapshots from EU-US market

US is ranked 3rd as potential medical tourism destination

• source: Economist Intelligence Unit

US is already a treatment destination

>150.000 Patients travel NOW to the US for expert care

– Copyright © 2010 Treatment Abroad

33% of European Healthcare Travelers are coming to North America

– Copyright © 2009 Grail Research, LLC

6.32 million Americans (excluding military) live in 160-plus countries of which 1,6 Million in Europe

– source AARO

4,817,437 European citizen living in the US

– source 2000 US census

Snapshots from a small nation: Greece

• 30m€/yr spent now for non resident episodes of care

• 2bn€/yr in 10 yrs (ranked 11th as a potential medical tourism country)

• 21M tourists in 2014 and growing

• 300.000 EU expatriates in Greece

• 100.000 US citizen lived in Greece the last 10 yrs

• 50.000 Greek students in the US

• >2.500 Greek Cancer Patient travel to the US, spending >12M€

Source: Medical Tourism study, Min of Tourism

Having a global vision for citizens on the move

• Accommodate new business models

– Create an interoperable “healthcare e-passport” service

– Establish a global encounter report format compliant to standard based patient summaries

– Patient outsourcing

– Patient mobility –

• break the m-health information silos

– Focus on prevention

and information flow

• Technology is not a barrier

(i.e. Trillium Bridge)

Medical Tourism

Second Opinion

Disease Management

Expatriate Care

Chronic CareM-Health

Clinical Trial Management

Trillium Gateway

Enabled by

What’s next?

Check out our Demo:South Building, Hall A, Booth 2084

Transformer(CTS2)

IHE XCPDIHE XCA

IHE ATNA(epSOS)

IHE XCPDIHE XCA

IHE ATNA(eHealth)

Trillium Bridge Gateway(epSOS Open NCP)

National Contact Point

Thank you to an incredible team and journey

HL7 Europe:

Catherine Chronaki

Giorgio Cangioli

IHE Europe:

Karima Bourquad

Charles Parisot

Eric Poiseau

Kaiser Permanente:

Jamie Ferguson

Kevin Isbell

Virginia John

Zachary Gillen

Mayo Clinc:

Harold Solbrig

Christopher Chute

Kevin Peterson

Gnomon:

Kostis Kaggelides

Alexander Berler

Kostas Karkaletsis

Spain:

Arturo Romero

Juan Pablo Martinez

Iciar Abad

Portugal:

Henrique Martins

Arlete Monteiro

Alexandra Cabral

Alexandre Santos

Licinio Kustra Mano

Rui Alves

Luxembourg:

Heiko Zimmerman

Herve Barge

Italy:

Marcello Melgara

Phast:

Nicolas Canu

Ana Estelrich

Franck Gener

Lantana:

Liora Alschuler

Russ Hamm

Sarah Gaunt

Zabrina Gonzaga

Eurorec:

Dipak Kalra

Smart EHR:

Elaine Blechman

Stephen Kay

Larry Garber