1. eHealth Standards and Profiles in Action for Europe and Beyond
Vincent van Pelt
Senior Advisor, Nictiz (NL)
eHealth Forum
October 26, 2016
eHealth Stakeholders Group 1

2. eStandards
The ambition of eStandards is to strengthen Europe’s global voice and local impact
Reinforcing the bridges across the Atlantic, and between member states
Addressing the challenges around interoperability in a practical way.
Expected results - more alignment and convergence
Experiences from different countries
New use cases (after Antilope)
Guideline addressing how to work with:
Competing or overlapping standards
Clinical content in profiles for large-scale eHealth deployments

3. Interoperability – agreements on different levels
Legal and regulatory
Compatible legislation and regulations
Policy
Agreements between organisations
Care Process
Alignment of care processes
Standards and Profiles, Certification
Security, Privacy, Governance
Information
Datasets, coding, terminologies
Applications
Integration, formatting of information, UI
IT Infrastructure
Communication protocols, network, databases
Antilope

4. Interoperability – cooperation of different stakeholders
Strategic
Tactical
Operational
Legal and regulatory
Legislators, advisors
CEOs
Lawyers
Policy
Policy
makers
Care
Managers
Healthcare
professionals
Patients
Care Process
Information- analysts, terminologists
Standards and Profiles, Certification
Security, Privacy, Governance
Business- and
information architects
Information
Software developers
Applications
System- architects
System maintanance
System engineers
IT Infrastructure
Antilope

5. Use Cases and Realization Scenarios
Use case - describes a process and its requirements a functional description of what needs to be done
Realization scenario – provides a possible solution for the use case a technical solution for the use case (one use case can have multiple realization scenarios)
Examples: medication, discharge letters, referrals, radiological studies, patient summary, involvement of the patient, telemonitoring, …
#1: Increase the relevance of standards sets to professionals and patients, by linking the use cases for standards sets explicitly to professional clinical guidelines and having representatives of patient and professional organisations review these use cases.
#2: Encourage the incorporation of mature and shared clinical information models in health guidelines and digital health applications, detached from the particular use case and formalism used.
#3: Support and enable the flow and mixed use of health data across jurisdictions, health record systems, and personal devices (“break down the silos”) to promote safe and effective health management and secondary use of health data.
#4: Provide clarity and guidance on the regulatory framework relating to information from personal health and wellness or Active and Assisted Living (AAL) services, when shared with (a team of) healthcare professionals.

6. Combining standards and profiles
Care Processes
Can be described as use cases that consist of process steps
In these process steps, information has to be exchanged
Information
Information elements have to be defined..
..and linked to terminologies
Applications
Information must be ‘packaged’ into communication standards
Preferably using reusable information building blocks
Profiles use MIBBs and only have to define cardinality and conformance
IT Infrastructure
And sent between ICT systems, networks and databases
eStandards

7. eStandards – some key messages
Look at all the interoperability levels, and work together in implementation projects.
Start small, from clearly defined use cases.
Use standardized templates for describing use cases and realization scenarios
Do not reinvent the wheel, look for use cases that already have been worked out (Antilope, eStandards).
Selection of standards and profiles depends on the use case (and on the domain)
From one use case you can create different realization scenarios (using different standards and profiles) – then find out which scenario works best (using a template for comparing realization scenarios).
Care Process
#1: Increase the relevance of standards sets to professionals and patients, by linking the use cases for standards sets explicitly to professional clinical guidelines and having representatives of patient and professional organisations review these use cases.
#2: Encourage the incorporation of mature and shared clinical information models in health guidelines and digital health applications, detached from the particular use case and formalism used.
#3: Support and enable the flow and mixed use of health data across jurisdictions, health record systems, and personal devices (“break down the silos”) to promote safe and effective health management and secondary use of health data.
#4: Provide clarity and guidance on the regulatory framework relating to information from personal health and wellness or Active and Assisted Living (AAL) services, when shared with (a team of) healthcare professionals.

8. eStandards – some key messages
Information
Use tools for the data definition, such as ART-DECOR. Once again, the wheel has already been invented – reuse work from others, literally or as inspiration.
Make sure vendors can implement the standards by defining implementation guidelines
Use what has already been done in the field
Look for standards for push and pull traffic
As international as possible
Applications
#1: Increase the relevance of standards sets to professionals and patients, by linking the use cases for standards sets explicitly to professional clinical guidelines and having representatives of patient and professional organisations review these use cases.
#2: Encourage the incorporation of mature and shared clinical information models in health guidelines and digital health applications, detached from the particular use case and formalism used.
#3: Support and enable the flow and mixed use of health data across jurisdictions, health record systems, and personal devices (“break down the silos”) to promote safe and effective health management and secondary use of health data.
#4: Provide clarity and guidance on the regulatory framework relating to information from personal health and wellness or Active and Assisted Living (AAL) services, when shared with (a team of) healthcare professionals.
IT Infrastructure

9. eStandards – some key messages
Identify use cases from an end-user perspective, including glossary, scenario, actors, privacy requirements and variations.
Select profiles and standards (e.g. IHE and Continua profiles) that support the use case.
Refine data content, including document templates, metadata, master files, terminology.
Write interoperability specifications (implementation guides) that describe the standards/profiles selected, the refined data content, and other project specific local needs. This specification enables implementation of the use case across the various IT systems and devices.
Organise testing by preparing test cases and a test environment for implementers to demonstrate component interoperability and by organising cross-implementer connectivity testing.
Educate end-users on interoperability: Develop communications materials to familiarise end-users on the benefits and impact of Interoperability.
#1: Increase the relevance of standards sets to professionals and patients, by linking the use cases for standards sets explicitly to professional clinical guidelines and having representatives of patient and professional organisations review these use cases.
#2: Encourage the incorporation of mature and shared clinical information models in health guidelines and digital health applications, detached from the particular use case and formalism used.
#3: Support and enable the flow and mixed use of health data across jurisdictions, health record systems, and personal devices (“break down the silos”) to promote safe and effective health management and secondary use of health data.
#4: Provide clarity and guidance on the regulatory framework relating to information from personal health and wellness or Active and Assisted Living (AAL) services, when shared with (a team of) healthcare professionals.

10. Templates for Use Case and Realization Scenario
Title
Purpose
Relevance
Domain
Scale
Context
Information
Participants
Functional process steps
Title
Related Use Case
Scenario context
Actors
Transactions
Technical process steps
Associated Profiles
Possible issues
Implementation examples
#1: Increase the relevance of standards sets to professionals and patients, by linking the use cases for standards sets explicitly to professional clinical guidelines and having representatives of patient and professional organisations review these use cases.
#2: Encourage the incorporation of mature and shared clinical information models in health guidelines and digital health applications, detached from the particular use case and formalism used.
#3: Support and enable the flow and mixed use of health data across jurisdictions, health record systems, and personal devices (“break down the silos”) to promote safe and effective health management and secondary use of health data.
#4: Provide clarity and guidance on the regulatory framework relating to information from personal health and wellness or Active and Assisted Living (AAL) services, when shared with (a team of) healthcare professionals.

11. ART-DECOR Dutch ‘clinical building blocks’ International projects
#1: Increase the relevance of standards sets to professionals and patients, by linking the use cases for standards sets explicitly to professional clinical guidelines and having representatives of patient and professional organisations review these use cases.
#2: Encourage the incorporation of mature and shared clinical information models in health guidelines and digital health applications, detached from the particular use case and formalism used.
#3: Support and enable the flow and mixed use of health data across jurisdictions, health record systems, and personal devices (“break down the silos”) to promote safe and effective health management and secondary use of health data.
#4: Provide clarity and guidance on the regulatory framework relating to information from personal health and wellness or Active and Assisted Living (AAL) services, when shared with (a team of) healthcare professionals.

12. Use Case Repository Realization Scenario
#1: Increase the relevance of standards sets to professionals and patients, by linking the use cases for standards sets explicitly to professional clinical guidelines and having representatives of patient and professional organisations review these use cases.
#2: Encourage the incorporation of mature and shared clinical information models in health guidelines and digital health applications, detached from the particular use case and formalism used.
#3: Support and enable the flow and mixed use of health data across jurisdictions, health record systems, and personal devices (“break down the silos”) to promote safe and effective health management and secondary use of health data.
#4: Provide clarity and guidance on the regulatory framework relating to information from personal health and wellness or Active and Assisted Living (AAL) services, when shared with (a team of) healthcare professionals.

13. Useful links eStandards Antilope ART-DECOR eHealth Network (eHN)
International
Dutch
eHealth Network (eHN)
Assets
Guide to interoperability between XDS Affinity Domains
Use Case Repository
ART-DECOR
SNOMED-CT
LOINC
HL7
FHIR
IHE
#1: Increase the relevance of standards sets to professionals and patients, by linking the use cases for standards sets explicitly to professional clinical guidelines and having representatives of patient and professional organisations review these use cases.
#2: Encourage the incorporation of mature and shared clinical information models in health guidelines and digital health applications, detached from the particular use case and formalism used.
#3: Support and enable the flow and mixed use of health data across jurisdictions, health record systems, and personal devices (“break down the silos”) to promote safe and effective health management and secondary use of health data.
#4: Provide clarity and guidance on the regulatory framework relating to information from personal health and wellness or Active and Assisted Living (AAL) services, when shared with (a team of) healthcare professionals.