Presentation Transcript

1. Trillium Bridge: WP2Scenarios and Use CasesMarcello Melgara – LombardiaInformatica

   04/12/2013 <-> 12/04/2013
2. Foreward Thispresentationsummarizes the scenarios and the data exchange Use Cases agreedduring the Kick-Off Meeting on September 20th-21st, Cambridge (MA) Thisshall be usedasbasis for the identification of issues and for the definition of detailed use cases Trillium Bridge: Bridging Patient Summaries across the Atlantic.
3. What Information can be exchanged and why… ScenArioS Trillium Bridge: Bridging Patient Summaries across the Atlantic.
4. Scenarios A patient travelling from and to Europe and US is requested to have an official document that justifies the medicines that brings with him/her during the travel. Note: The epSOS PS includes the list of current medications. The epSOS PAC service can be used for translating in English the medications’ information. This scenario is covered mainly by a paper-based patient mediated exchange; data might be displayed using a mobile. Trillium Bridge: Bridging Patient Summaries across the Atlantic. Kick Off Meeting
5. User Stories / Scenarios Collected 18 Real World User Stories, from: S&I Framework, US Trillium Brigdekik off meeting, EU - US epSOS, EU DipakKalra, EuroRec, EU EleineBlechman, Prosocial, US Larry Garber, Atreus Health, US Analised for feasibility with available clinical information From them derived Use Case, taking into consideration also epSOS and Meaningful Use 2 Use Cases Trillium Bridge: Bridging Patient Summaries across the Atlantic. Kick Off Meeting
6. Scenarios US patientasks GP for an eHealthsummary (Adverse reactions to drugs, medication, allergies, list of problems), paper or electronicbeforetravel to one or more EU countries. EU patient with medicationallergies and implant is admitted to US hospital on the nationwideexchangenetwork, provider queries for epSOS PS Trillium Bridge: Bridging Patient Summaries across the Atlantic. Kick Off Meeting
7. Information to be exchanged Independently on the way information will be exchanged, this is the information we expect to share: List of active medications (for custom control). eHealthsummaryfor unplanned care: information about adverse reactions to drugs, medication, allergies, list of problems are made available to foreign Health Professionals in case of unplanned care. Information about implants. Trillium Bridge: Bridging Patient Summaries across the Atlantic.
8. How Information can be exchanged… Use cases Trillium Bridge: Bridging Patient Summaries across the Atlantic.
9. Translate US Transform EU Translate US Transform EU Trillium Bridge: Bridging Patient Summaries across the Atlantic.
10. US EU Transform (Translate) US EU Transform (Translate) Trillium Bridge: Bridging Patient Summaries across the Atlantic.
11. Use Cases During the Kick off meeting it was agreed that : the project deals with test data NOT with real patient data Basing on this principle the provider query could be realized using a test epSOS NCP (Europe) and a XCA based test environment (USA). To be evaluated if the Node on US-side will be based on the OpenNCP implementation Both patient and provider mediated exchange are considered Several support can be used for the exchange (USB/remote drive (cloud)/email) The document transformation may be needed The document translation is needed Also the transformation of the original document in pdf should be considered Trillium Bridge: Bridging Patient Summaries across the Atlantic.
12. Use Cases Seven different«categories» of use caseshavebeenidentified. (seenextslides for details) The identified use caseshavebeenordered by complexity The first five to be analyzed for the Pilot The last two for future evolutions All of themshall be furtheranalyzed in order to: Specializetheminto more detailed use cases , includingpossiblespecialization for EU to US and US to Eu communications Identifypossibletechnical, legal, semantic, implementationissues Trillium Bridge: Bridging Patient Summaries across the Atlantic.
13. Use Cases First fivecategorieshavebeengroupeddepending on: If the documenttranslation/transformationneeds to be preparedin advanceby the patient or when the care isprovided (ad hoc) Ifitis a patient or providedmediatedprocess Trillium Bridge: Bridging Patient Summaries across the Atlantic.
14. Use Cases For each use casesisdescribed : The use case identifier Name and Description The nameassignedduring the kick-off meeting (originalname) If the documentisprepared in advance or ad hoc Trillium Bridge: Bridging Patient Summaries across the Atlantic.
15. Use Cases For each use case : Itisdescribedif a syntacticaltrasformation from the epSOS and/or C-CDA ToC format isneeded Are nottaken in account the trasformation from the local formats to the epSOS and/or C-CDA ToCone. Itis assume that the translationisalwaysrequired (unless special casesas UK or MT) Trillium Bridge: Bridging Patient Summaries across the Atlantic.
16. Use Case #1 UC #1 The patientprepares and brings a printable format. The Patient prepares the document before crossing the border and brings with him his patient summary (paper/pdf) OriginalName: Patient-mediated translation Document prepared in advance Trillium Bridge: Bridging Patient Summaries across the Atlantic.
17. Use Case #1 No Syntacticaltrasformations epSOS-CDA/ C-CDA required The documentisprinted in the target language EU: thisisdoneusing the epSOS PAC service, thattransformsoriginalinto epSOS CDA / English US: isthisdoneusing a «Trillium» Trasformation Service ? Trillium Bridge: Bridging Patient Summaries across the Atlantic.
18. Use Case #2 UC #2 The Patient shows a prepared PS using his device The patient obtains access to document from abroad and shows provider on own device. There is the possibility to print document and/or use as pdf. Original Name: Patient-mediated transformation/translation using patient device Document prepared in advance Trillium Bridge: Bridging Patient Summaries across the Atlantic.
19. Use Case #2 No SyntacticaltrasformationsepSOS-CDA/ C-CDA required The documentisgenerated in the target language EU: thisisdoneusing the epSOS PAC service, thattransformsoriginalinto epSOS CDA / English US: isthisdoneusing a «Trillium» Trasformation Service ? Trillium Bridge: Bridging Patient Summaries across the Atlantic.
20. Use Case #3 UC #3 The patientprovides the access to the PS for being visualized with the provider device Patient retrieves document from cloud, while abroad, and grants access to provider; provider visualizes transformed/translated document using provider device. OriginalName: Patient-mediated transformation/translation using provider device Document prepared in advance Trillium Bridge: Bridging Patient Summaries across the Atlantic.
21. Use Case #4 UC #4The Patient shows the PS using his device Patient obtains access to document from abroad without having prepared it in advance and shows provider on own device. There is the possibility to print document and/or use as pdf. OriginalName: Patient-mediated transformation/translation using patient device Document prepared ad hoc Note: this can be merged with UC#2 - it has not yet been decided. The difference is related to when the doc is prepared (in advance – ad hoc) Trillium Bridge: Bridging Patient Summaries across the Atlantic.
22. Use Case #4 Do wereallyneed to distiguish UC #2 and #4 ? No Syntacticaltrasformations epSOS-CDA / C-CDA required The documentisprovided in the target language EU: thisisdoneusing the epSOS PAC service US: isthisdoneusing a «Trillium» Trasformation Service ? Trillium Bridge: Bridging Patient Summaries across the Atlantic.
23. Use Case #5 UC #5The provider gets and visualizes the PS using his device While receiving unplanned care, the provider accesses the Patient Summary via own EHR-S and visualizes the document OriginalName: Patient-mediated transformation/translation using provider device Document prepared ad hoc Trillium Bridge: Bridging Patient Summaries across the Atlantic.
24. Use Case #5 Evaluateif the realization of this scenario can be based-on existing epSOS NCP implementation. In this case the node to nodeexchangeddocumentwould be an English epSOS PS The C-CDA trasformationwould be performed in the «National Connector» Component : willthisperformed by a «Trillium» Trasformation Service ? Trillium Bridge: Bridging Patient Summaries across the Atlantic.
25. Use Case #6 UC #6 The trasformed/translated PS generatedabroad, isintegrated (imported) within the Patientapplication The document(s) obtained by patient or provider by any of the above means (UC#1 to UC#5) are integrated in the patient's application. OriginalName: Patient-mediated obtained document integration KickOff Meeting : to be considered only for future extensions Trillium Bridge: Bridging Patient Summaries across the Atlantic.
26. Use Case #7 UC #7 The trasformed/translated PS isintegrated (imported) within the provider application The document(s) obtained by patient or provider by any of the above means (UC#1 to UC#5) are integrated in the provider's system OriginalName: Provider-mediatedobtaineddocumentintegration KickOff Meeting : to be considered only for future extensions Trillium Bridge: Bridging Patient Summaries across the Atlantic.
27. How to ? Trillium Bridge: Bridging Patient Summaries across the Atlantic.
28. epSOS PAC (Transform to CDA, English) epSOS CDA Text EU Language Codes English EU US Trillium Bridge: Bridging Patient Summaries across the Atlantic.
29. epSOS PAC (Transform to CDA, English) EU Transform US epSOS CDA Text EU Language Codes English C-CDA ToC Text EU Language Codes English Trillium Bridge: Bridging Patient Summaries across the Atlantic.
30. epSOS PAC (Transform to CDA, English) epSOS CDA Text EU Language Codes English EU US C-CDA ToC Text EU Language Codes English Transform Trillium Bridge: Bridging Patient Summaries across the Atlantic.
31. C-CDA ToC Text English Codes EU Language US EU Transform C-CDA ToC Text English Codes English Translate Trillium Bridge: Bridging Patient Summaries across the Atlantic.
32. C-CDA ToC Text English Codes EU Language C-CDA ToC Text English Codes English US Transform EU Translate Trillium Bridge: Bridging Patient Summaries across the Atlantic.
33. epSOS CDA Text English Codes EU Language C-CDA ToC Text English Codes English US Translate & Transform EU Trillium Bridge: Bridging Patient Summaries across the Atlantic.
34. epSOS CDA Text English Codes EU Language C-CDA ToC Text English Codes English US Transform EU Translate & Transform Trillium Bridge: Bridging Patient Summaries across the Atlantic.
35. HIGH levelmappingbetweenEPSOS CDA – Meaningful Use c-cda Trillium Bridge: Bridging Patient Summaries across the Atlantic.
36. Trillium Bridge: Bridging Patient Summaries across the Atlantic.
37. Trillium Bridge: Bridging Patient Summaries across the Atlantic.
38. AREAS OF INTERSECTIONS Trillium Bridge: Bridging Patient Summaries across the Atlantic.
39. High level Value set mapping Trillium Bridge: Bridging Patient Summaries across the Atlantic.
40. Goodcoverage of «feasible» Use Cases Severalpoints of contactbetween epSOS CDA and MoU C-CDA Data Sets and ValueSets / adoptedCoding Systems Planning for a first Proof of Concept in May 2014 atAthens eHealth week CONCLUSIONS Trillium Bridge: Bridging Patient Summaries across the Atlantic.
41. MAPPING WITH INITIAL USE CASES Trillium Bridge: Bridging Patient Summaries across the Atlantic.
42. The followingslidesdescribeshow the initiallyidentified Use Cases mapinto the new ones. Trillium Bridge: Bridging Patient Summaries across the Atlantic.
43. Use Case #1 This use case maps with the previously identified use cases The patient shows a translated, paper printed representation of his/her Patient Summary The patient shows a translatedversion of his/her Patient Summary as PDF using his/her (mobile) device The Patient Summary is loaded on the device and shown The patient loads his/her Patient Summary as PDF on a removable device. The device is provided to the physician. Trillium Bridge: Bridging Patient Summaries across the Atlantic. Kick Off Meeting
44. Use Case #1 This use case maps with the previously identified “Italian Citizen visiting US” descriptive use cases 1.EU Marcello accesses the epSOS Patient Access Service, gets his epSOS Patient Summary in English and prints it. When abroad, he hands the paper to the US physician 2.EU Marcello accesses the epSOS Patient Access Service, gets his epSOS Patient Summary in English, download the structured document and PDF on his mobile device. When abroad, he hands his device to the US physician. The US physician visualizes the PDF document content on the Marcello's mobile. Trillium Bridge: Bridging Patient Summaries across the Atlantic. Kick Off Meeting
45. Use Case #1 This use case maps with the previously identified “US Citizen visiting Italy” descriptive use cases 1.US John gets a printed copy of his Patient Summary. When abroad, he hands the paper to the Italian physician (able to understand English) i) John accesses his PHR-S, gets his Patient Summary and prints it. ii) John asks his GP to have a printed copy of his Patient Summary. 2.US John accesses his PHR-S, gets his Patient Summary, download the structured document and PDF on his mobile device. When abroad, he hands his device to the Italian physician. The Italian physician visualizes the document content (PDF) on the John's mobile. Trillium Bridge: Bridging Patient Summaries across the Atlantic. Kick Off Meeting
46. Use Case #2 This use case maps with the previously identified use cases The patient shows a translatedPDF version of his/her Patient Summary using his/her (mobile) device The Patient Summary is shown accessing his/her PHR-S portal The Patient Summary is loaded on the device and shown This use case maps with the previously identified “Italian Citizen visiting US” descriptive use cases 2.1.EU When abroad, Marcello accesses the epSOS Patient Access Service, and displays on his mobile/tablet/laptop his epSOS Patient Summary translated in English. He hands his device to the US physician. The US physician visualizes the document content on the Marcello's mobile This use case maps with the previously identified “US Citizen visiting Italy” descriptive use cases 2.1.US When abroad, John accesses remotely his PHR-S and displays on his mobile/tablet/laptop its content. He hands his device to the Italian physician. The Italian physician visualizes the document content on the John's mobile. Trillium Bridge: Bridging Patient Summaries across the Atlantic. Kick Off Meeting
47. Use Case #3 This use case maps with the previously identified use cases The patient loads his/her Patient Summary on a remote drive (cloud). The patient provides the foreign physician with the credentials needed for getting this document. The physician visualizes the translatedPatient Summaryusinghis/her EHR-S and/or a “standard” display tool This use case maps with the previously identified “Italian Citizen visiting US” descriptive use cases 4.2.EU Marcello accesses the epSOS Patient Access Service so he gets his epSOS Patient Summary in English. The structured document - optionally together with a printable representation of the original content - is exported into a remote drive (cloud). The physician is enabled to get the epSOS Patient Summary stored in the drive and visualizes it using his/her EHR-S or a “standard” display tool . Trillium Bridge: Bridging Patient Summaries across the Atlantic. Kick Off Meeting
48. Use Case #4 This use case maps with the previously identified use cases The patient shows a translatedPDF version of his/her Patient Summary using his/her (mobile) device The Patient Summary is shown accessing his/her PHR-S portal The Patient Summary is loaded on the device and shown This use case maps with the previously identified “Italian Citizen visiting US” descriptive use cases 2.1.EU When abroad, Marcello accesses the epSOS Patient Access Service, and displays on his mobile/tablet/laptop his epSOS Patient Summary translated in English. He hands his device to the US physician. The US physician visualizes the document content on the Marcello's mobile This use case maps with the previously identified “US Citizen visiting Italy” descriptive use cases 2.1.US When abroad, John accesses remotely his PHR-S and displays on his mobile/tablet/laptop its content. He hands his device to the Italian physician. The Italian physician visualizes the document content on the John's mobile. Trillium Bridge: Bridging Patient Summaries across the Atlantic. Kick Off Meeting
49. Use Case #5 This use case maps with the previously identified use cases The foreign provider, after having identified the patient, requests to the patient's Country of Affiliation a Patient Summary of that patient. The remote country verifies if is entitled to fulfill such a request (correct patient identification, consent provided when applicable,....). If it is, the summary is retrieved and returned in a "suitable format". This use case maps with the previously identified “Italian Citizen visiting US” descriptive use cases I.II.EU The US physician, after having identified Marcello, requests to the Lombardy Health Care System his Patient Summary. After having verified that such a request can be fulfilled (correct patient identification, consent provided when applicable,....) , the Patient Summary of Marcello is retrieved, converted in a "suitable format“ and returned to the US physician. The US physician visualizes the returned summary using his/her EHR-S or a “standard” display tool Trillium Bridge: Bridging Patient Summaries across the Atlantic. Kick Off Meeting
50. Use Case #5 This use case maps with the previously identified “US Citizen visiting Italy” descriptive use cases I.I.US The Italian physician, after having identified John, requests to the US health provider the John’s Patient Summary. After having verified that such a request can be fulfilled (correct patient identification, consent provided when applicable,....) , the Patient SummaryofJohn is retrieved converted in a "suitable format“ and returned to the Italian physician. The Italian physician then visualizes the returned summary using a using his/her EHR-S (e.g. the epSOS PS display tool) ii) the summary is displayed in Italian Trillium Bridge: Bridging Patient Summaries across the Atlantic. Kick Off Meeting

51. Trillium Bridge: Bridging Patient Summaries across the Atlantic

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