1. Towards a European ecosystem for health care data
eStandards as infrastructure for innovation
Catherine Chronaki
Secretary General
HL7 Foundation, Brussels, Belgium
Contact: euoffice@HL7.org
Funded under
H2020-643889

2. 2
HL7 Foundation:
who we are..
HL7 the best and most widely-used
eHealth standards since 1986
HL7 v2, Clinical Document Architecture, HL7 FHIR
19 National Affiliates in Europe (~38 wordwide)
European HL7 foundation established in 2010
European Funded Research Projects
eHGI, Antilope, Semantic Healthnet,
Trillium Bridge, Expand, Trillium-II
PHC34: ASSESS CT, OpenMedicine, eStandards
Annual HL7 in Europe Newsletter
Website: www.HL7.eu
eHealth policy & Research
eHealth stakeholders group; mHealth Guidelines;
ENISA expert group
EFMI council (2012-): eHealth Week
EFMI Board (2016)
HIMSS Europe
SDO Joint Initiative Council
HL7 Vision: A world in which everyone can securely access and use the right health data when and where they need it.
Digital Enlightment Forum: Towards a European Ecosystem for Health Care

3. Forces facing health systems: technology
•Rapid progress in analytics and digitization
•Innovation in medicine

4. Digital Single Market –
digital health priorities and challenges
Pillars of digital transformation in health and social care
 Give citizens better access to their health data everywhere in the EU
 Connect and share health data for research, faster diagnosis, and better health
outcomes
 Use digital services for citizen empowerment and person-centered care.
Challenges
 Risks of privacy breaches (65.89%)
 Heterogeneity of electronic health records (58.24%)
 Cybersecurity risks (54.42%)
 Lack of technical interoperability (48.46%)
 Data quality and reliability (45.32%)
 Lack of infrastructure (44.02%)
Digital Enlightment Forum: Towards a European Ecosystem for Health Care

5. 5
eStandards can unlock data
for trust & flow
Today: Massive health data accumulated in silo EHR systems for documentation
Need to move from passive documentation to active use of information and knowledge creation:
activation!
Patient summaries defined at the macro level for cross-border exchange for emergency or unplanned care
at a national level.
Need to address communities and individuals!
Standards and profiles address a predefined exchange of information.
Need flexible use of available content and structure, recognizing national, regional or local jurisdictions:
trust & flow!
Digital Enlightment Forum: Towards a European Ecosystem for Health Care

6. 6
eStandards Project Highlights
Problem: Standards roadmap to support large-scale eHealth
deployment
Ambition: Re-establish SDOs as the authority and
shepherd of high quality widely-adopted standards
that advance cost effective sustainable interoperability.
Key outcomes:
Co-creation,
Governance,
Alignment Framework
eStandards lifecycle model
Best practices today in health data exchange
Next steps:
eStandards workshop as part of the
JIC meeting in London, Nov 2017
Engage stakeholders eHealth Stakeholder Group
Digital Enent Forum: Towards a European Ecosystem for Health Care

7. 7
eStandards project vision is that of a global eHealth ecosystem
Where:
 people have navigation tools for safe and
informed health care
 interoperability assets fuel creativity,
entrepreneurship, and innovation
eStandards:
 nurture digital health innovation
 strengthen Europe’s voice & impact
 enable co-creation and trusted
provider-user relationships
www.estandards-project.eu
Roadmap available at:
Digital Enlightment Forum: Towards a European Ecosystem for Health Care
Source: eStandards D3.1

8. 8
Making Digital Work for health
with Trust and Flow
Co-create
to make it real using
standards
Governance
to make it scale for
large-scale deployment
Alignment
to make it flourish in a
sustainable way
Digital Enlightment Forum: Towards a European Ecosystem for Health Care
http://www.hl7.org/fhir

9. 9
Patient summary as Health data navigator
Think of the Patient summary as a window to a person’s health or dashboard:
Medications, allergies, vaccinations, problems and procedures,
labs, diagnostic imaging, recent or planned encounters, implantable devices
advance directives
“Bring the Power of Platforms to Health Care” using data to drive:
administrative automation, networked knowledge, and resource orchestration [Bush & Fox,
HBR November 2016]
eStandards need to
help build trust
unlock the power of health data
facilitate decision support
navigate the health system
Digital Enlightment Forum: Towards a European Ecosystem for Health Care

10. 10
International Patient Summary
(IPS) Implementation Guide: Purpose & Scope
Goal: identify the required clinical data, vocabulary and
value sets for an international patient summary.
Scope: “The IPS specification shall focus on a minimal
and non-exhaustive Patient Summary, which is specialty-
agnostic and condition-independent, but still clinically
relevant.”
The primary use case is to provide support for cross-border
or cross-juridictional emergency and unplanned care:
Cross-jurisdictional patient summaries (through
adaptation/extension for multi-language and realm scenarios,
including translation).
Emergency and unplanned care in any country, regardless of
language.
Value sets based on international vocabularies
that are usable and understandable in any country.
Data and metadata for document-level provenance.
Digital Enlightment Forum: Towards a European Ecosystem for Health Care

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What is FHIR?
Based on a set of modular components - “Resources”
Resources refer to each other using URLs
Small discrete units of exchange with defined behaviour and meaning
Have known identity and behaviour
Extensions permit adding data not part of core
Resources are combined into “Profiles” to solve clinical & admin problems
Parties exchanging data define the specifics of using resources
and their relations using Profiles.
Profiles are the framework for defining services.
Test data and servers are available
Exchange resources between systems
Using a RESTful API (e.g. web approach)
As a Bundle of resources (messages, documents)
Positives
Service driven - composition
Modify components with changing need
Portability of components by moving code with the data
Digital Enlightment Forum: Towards a European Ecosystem for Health Care
Modified from: Ed Hammond
2016
Let’s have a look: https://www.hl7.org/fhir/

12. 12
Patient History: Resource explorer
Click on instance to see details
Source from David Hay
Digital Enlightment Forum: Towards a European Ecosystem for Health Care
Implementation
Global
Free

13. 13
Emergency department as decision environment
High decision density
Decision fatigue
Throughput pressure
Wide range of illnesses
Diagnostic Uncertaintly
Narrow time windows
Interruptions and distractions
Shift work/sleep disruption
Shift changes
cognitive decline at the end of a shift
30%
Diagnostic Error in ED
Radiology 5%
Missed injuries 12%
Cardiovascular 19%
Respiratory 30%
Overall ~16%
Digital Enlightment Forum: Towards a European Ecosystem for Health Care
Source: Dr. Pat Croskerry, Emergency London; https://www.youtube.com/watch?v=GFE6D5460oE
It’s not about what we know,
it’s about how we think!

14. 14
Emergency data sets
Digital Enlightment Forum: Towards a European Ecosystem for Health Care
http://aktin.art-decor.org
source: Kai Heitmann
https://tinyurl.com/y7assld4

15. • Quality assurance
• Health goals
• Early warnings
Can we use patient summaries to unlock patient data?

16. 16
Can Patient summaries leverage HL7 FHIR
to unlock the power of data and drive our digital future?
YES, HL7 FHIR is part of the solution
It opens a window, but It takes a village…
Digital Enlightment Forum: Towards a European Ecosystem for Health Care

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What do we need to make it happen
with standards and interoperability?
Co-create
make it real by standards
Governance
scale for
large-scale deployment
Alignment
flourish in sustainable ways
Digital Enlightment Forum: Towards a European Ecosystem for Health Care

18. mhm@medcom.dk
euoffice@HL7.org
www.trilliumbridge.eu
Digital Enlightment Forum: Towards a European Ecosystem for Health Care
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