eHealth-INTEROP Report in response to EU Mandate/403-2007

Implementers (archive)
1

Dear all,

Today the final draft of the eHealth-INTEROP Report in response to EU Mandate/403-2007 was published. The report can be downloaded from: http://www.ehealth-interop.nen.nl/
Comments and suggestions to this document can be made to NEN untill october 22th.

Scope:

The European Commission has issued in 2007 a mandate to the European Standardization Organizations (ESOs), CEN, CENELEC, and ETSI, to develop a coordinated work programme for standardization in health informatics (Mandate M/403).
A Coordination Group of the three ESOs has been established to collaborate on the preparation of the 10 work programme in consultation with other activities as appropriate; the detailed process is contained in the technical proposal for the work, at Annex A.
The above-mentioned work programme will be provided in the form of an overview report analysing existing work and requirements and contain a list of proposed work items for possible standards action.
The resulting report will be submitted to the European Commission as required by the mandate for 15 approval and subsequent execution by the three ESOs as phase 2 of the mandate.
Objective
The objective […] is to carry out phase one of the European Commission (EC) Mandate M/403 by providing an analysis and planning of existing relevant standards, specifications and technical reports (with short descriptions), including work under way, and the creation of a proposed coordinated work 20 programme for standardization in health informatics (eHealth) to be carried out by CEN, CENELEC and ETSI. This programme will cover tasks needed to achieve the goals with priorities to be identified for those deliverables that require an earlier adoption…

Priority 1:
resolve the inconsistencies, or at least facilitate co-existence, between standards based on fundamentally different principles (e.g. Electronic Records exchange formats using either CEN

13606 or HL7 RIM based documents);

Since, in my opinion, this document will become the roadmap for e-health interoperability in Europe, it’s important to understand it’s implications and if these aren’t defined well enough to provide input/ comments in order to make it better.

So please read it carefully and if you have any comments and/or suggestions please send them either directly to NEN (shirin.golyardi@nen.nl) or through me. If you do, please send a CC to this list, so everybody can follow this discussion.

Cheers,

Stef

2

Thanks Stef! Very Important document. I will bring it to our national
standards committee. I'd like to have Brazil aligned with Europe in this
initiative. We are at the moment defining several interoperability
standards and there is a confusion between 13606 - RIM - CCR....
All the best,
Beatriz

Stef Verlinden wrote:

3

Dear all,

The results of a quick browse through.

-1-
Is it correct that they do not mention:

  • Contsys 13940 System of Concepts for Continuity of Care
  • HISA EN12967 Health Information Services Architecture

-2-
Is it correct that ‘Profiles’ (IHE-profiles) are mentioned frequently?
193 times and several paragrapghs/chapters devoted to it?

-3-
Is it correct that Archetypes and Templates are mentioned a few times and never defined?

-4-
What to think of the text starting on page 13?

By using the very generic logical model in Figure 2.1 we are electing not to use the more specific models
described in, for example, ISO TR20514 "Health informatics — Electronic health record — Definition,
scope, and context"xxii, the ISO TS18308 "Health informatics — Requirements for an electronic health
record architecture"xxiii or the HL7 "Electronic health record functional requirements"xxiv. To do so at this
point might be interpreted as indicating a preferred EHR model – which is not a message it would be
appropriate to convey at this stage in response to the mandate, even if the writers of the Report held such
a preference.

-5-
Do they think that ISO 18308 (Requirements for an EHR-Architecture) is of no value any longer?

-6-
Am I correct to observe that HL7 v2 and HL7v3 are mentioned but never EHR-Extracts?

-7-
Am I correct to observe that the PHR-system is mentioned a few times, only?

-8-
Am I correct that European standards dealing with Privacy and Access Control are not mentioned at all?
E.g. the Patient mandate in EN13606-part 4.

-9-
Am I correct to observe that coding systems like ICPC, ICD and many others are not elaborated upon.

-10-
Am I correct to observe that no attention is paid to other types of standardisation organisations?
Organisations that publish using Internet techniques because their product needs to be flexibly published and is unfit for publication using classical methods like printing and PDF/Word files?

-11-
I’m I correct to notice that the only focus is on:

interoperability between proprietary EHR-systems, using messages and message profiles?
And not on standards that deal with EHR-systems (and their enterprise information bus), including exchangeable objects like EHR-extracts?

Gerard Freriks

Electronic Record Company B.V.

Distributor of Ocean Informatics

for Europe and the Middle East

Leidsevaart 594-596
NL-2014HT Haarlem
PO Box: 376, NL-2300AJ Leiden

the Netherlands

M: +31 620347088
E: g.freriks@e-RecordCompany.EU

4

Gerard,

I just sent Shirin a response on this

there are some interesting statements in this report. It occurred to me that some newer resources and developments may be useful to you.

  • the online Clinical Knowledge Service. http://www.openEHR.org/knowledge
    this is currently in beta-testing and is intended to implement many of the governance and quality ideas in e.g. Q-REC. openEHR is not seeking to define these rules - it just supplies a system which can implement them. You can login if you like - you will see review groups, teams, all kinds of things. With Eurorec, various government e-health programmes and maybe the Commission, we hope to get some funding to enable this to become a primary place for archetypes, terminology subsets and templates to be developed and managed by online collaborative groups.
  • in terms of the necessary structure of standards, some of the slides in http://www.openehr.org/shared-resources/getting_started/government_orgs.html may be useful to you; I am sure you will like slide 10.
  • in terms of multi-lingual translations of archetypes, these are beginning to appear; there are 50 in german already, and the dutch RMIMs will be archetypes soon I understand. Of course these needs managing and QA, but now the tooling environment can support this; what is needed is institutional buy-in to set the quality standards and ensure consistency etc.
  • the openEHR template data schema (TDS) mechanism is a way of making archetypes / templates semantics (including Snomed bindings) directly available and usable by vendors at minimum cost. It is not published yet, but we can provide examples if you like. Has been demonstrated to UK and Aus governments. It also allows machine-generated message definitions to be made directly from archetypes and templates.
    So in summary - there is some more technology than there was before. Now it needs some coordinated government support…

Gerard Freriks wrote:

(attachments)

OceanCsmall.png

5

FYI - regarding e-health interoperability in Europe, I came across this news
article today:
"Europe launches its healthcare data exchange pilot"
http://healthcareitnews.eu/content/view/1227/40/

6

Thanks.

“The Swedish health ministry has been fundamental in setting up the epSOS pilot, he noted.”

Since the Swedish chose 13606 as a standard for their national EHR, does this also mean that the 13606 standard will be incorporated in this epSOS pilot?

Cheers,

Stef

7

Hi!

I asked Daniel Forslund (Head of Section – eHealth) at the Ministry of
Health and Social Affairs and he swiftly responded that the standards
mandate M/403 and the CEN EN13606 standard will be considered in the
project. They are already included in the epSOS work description. This
is of course no guarantee that 13606 will be included in the project
work or results, but the Swedish coordinators have a clear ambition to
include 13606 where suitable.

Best regards,
Erik Sundvall
erisu@imt.liu.se http://www.imt.liu.se/~erisu/ Tel: +46-13-227579

"The Swedish health ministry has been fundamental in setting up the epSOS
pilot, he noted."
Since the Swedish chose 13606 as a standard for their national EHR, does
this also mean that the 13606 standard will be incorporated in this epSOS
pilot?

...

8

That's good news. If 13606 will indeed be incorporated in the epSOS
program it will help tremendously in the acceptance and distribution
of 13606 based systems.

Cheers,

Stef