EU-US eHealth/Health IT Cooperation Initiative Interoperability of EHR Work Group

1. EU-US eHealth/Health IT Cooperation InitiativeInteroperability of EHR Work Group March 26, 2014

2. 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

3. 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.

4. Agenda

5. Meeting Times –CHANGE TO SCHEDULE 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. 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

6. 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/EU-US+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 Membersand e-mail your bio and photo (optional) to GayathriJayawardena at gayathri.jayawardena@esacinc.com • To access current and archived meeting materials, visit the Project Meeting Artifacts section: http://wiki.siframework.org/Project+Meeting+Artifacts

7. Phases of Harmonization <clinicalDocument> (Clinical Summary Form) Completed <header> (document ID, author, patient ID…) Data Granularity and Complexity <component> [Body] <section> [Procedures] <entry> (Colonoscopy) <procedureCode> <procedureDate> <…> <entry> [Gastroscopy] <entry> [CABG] … <section> [CurrentMedications] <entry> [ASA] <entry> [Warfarin] <entry> [CABG] <section>… <entry>

8. Comparative Analysis – in numbers

9. DE Mapping Review – few highlights • Procedures (g): • @code • @displayName • OriginalText • Vitals (m/g): • epSoS: syst/dias BP (2 codes) • CCDA CCD: syst/diasBP, HR, weight, height…etc (12 codes) • Results (m/g): • epSOS: Blood Group • CCDA CCD: ANYResult

10. Value Set mapping - highlights • Value Sets mapping completed in last week: • INDRoleClass • documentCode • VitalSigns • Clinical VS: • ATC-RxNorm • Diseases/Problems: ICD10-SNOMED CT

11. Value Set mapping – highlights…cont • Common types of issues: • Code system samebut different code subsets used (typical for SNOMED CT and HL7 codes) • Code system differentAND codes have different granularity (1 to M maps). E.g: • epSoSIllnessesandDisorders (ICD10) – CCDA Problem VS (SNOMED CT) • epSoSActiveIngredient (ATC) – RxNorm • epSoSVaccines - CVX

12. Diseases/Problems VS • EU VS: 9,529 codes (ICD10CM) • US VS: 16,443 codes (SCT) • epSoS -> SNOMED CT Map rule: relaxed vs. strict Relaxed More spec. ICD10 Map rule Code “Bandwidth” Less spec. ICD10 Strict Case: relaxed -> strict (one code) 1 2 3 100 101,… # SCT codes

13. One-to-many Relaxed (#360) Strict (#3)

14. 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

15. Next Steps (cont.) • Identification of most common subsets from the common, international vocabularies — LOINC, ICD10, SNOMED, and ATC/RXNORM (others?). • “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. • Creation/Harmonization of an internationally recognized, balloted standard for transitions of care. • 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. • This empowers patients, makes the infrastructure easier, and avoids many obstacles that exist within existing governments about sharing patient information.

16. NewInternational Patient SummaryINT template (HL7/ISO) 1 2 3 Retrieve INT version on Patient Summary Log on View INT Patient Summary within EHR DE vocabulary constraints Constrained, HIGH FREQUENCY Value Set INT Patient Summary 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) PHR Header document ID, author, patient ID…etc. MAY have 0..* <translations> (local codes) Body Example EHR EHR Problems/Diagnosis Example HTML Corresponding XML 17890003 (Hepatic infarction) Problem Code & Name Problem Start Date Problem End Date …. <code code=“17890003 ” codeDisplayName=“Hepatic infarction” codeSystem=“SNOMED CT” <translation code=“123XYZ ”, codeDisplayName=“Leberinfarkt”> </code> 123XYZ (Leberinfarkt) US Physician EU Patient Medications, Vital Signs…etc. K76.3 (Infarction of liver) <entry> [ASA] <entry> [Warfarin] <entry> [CABG] <code code=“K76.3” codeDisplayName=“Infarction of liver” codeSystem=“ICD-10-CM” <translation code=“239-2”, codeDisplayName=“Infarkt jetre”> </code> 239-2 (Infarkt jetre)

17. NewValue SetMaintenance (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.)

18. EU-US Timeline for 2014 White Paper Report INT template design EU-US Value Set development IG development/Review HL7 Ballot Package Development HL7 Project Scope Statement (May 18) HL7 Notification of Intent to Ballot (June 29) Ballot Preview Period HL7 HL7 Ballot (Aug 8- Sept 8) HL7 WG Meeting (Sept. 14-19) HL7 Ballot Reconciliation Paper published (May) INT template IG(Jul 5) Milestones HL7 Initial Content Due (Jul 13) HL7 Final Content Due (Aug 3)

19. 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

20. 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

21. 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

22. Initiative Resources • EU-US Wiki Homepage • http://wiki.siframework.org/EU-US+eHealth+Cooperation+Initiative • Join the Initiative • http://wiki.siframework.org/EU-US+MOU+Roadmap+Project+Sign+Up • EU-US Initiative Reference Materials • http://wiki.siframework.org/EU-US+MOU+Roadmap+Project+Reference+Materials • Interoperability of EHR Homepage • http://wiki.siframework.org/Interoperability+of+EHR+Work+Group