1. EU-US eHealth/Health IT Cooperation Initiative Interoperability of EHR Work Group August 28, 2013 0

2. Meeting Etiquette Remember: If you are not speaking, please keep your phone on mute 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 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 finished with your other call Hold = Elevator Music = frustrated speakers and participants This meeting is being recorded Another reason to keep your phone on mute when not speaking Use the “Chat” feature for questions, comments and items you would like the moderator or other panelists to know. Send comments to All Panelists so they can be addressed publically in the chat, or discussed in the meeting (as appropriate). From S&I Framework to Participants: Hi everyone: remember to keep your phone on mute All Panelists

3. New Webinar Information We have switched over to GoToMeetings New features of this services include: – VoIP Allowing participants to stream audio directly from their electronic device, which provides a more cost-effective telephone/audio service. Participants will need to register for every meeting. Visit our Wiki homepage for the latest webinar information: http://wiki.siframework.org/EU- US+eHealth+Cooperation+Initiative.http://wiki.siframework.org/EU- US+eHealth+Cooperation+Initiative After you “Register,” you will immediately be prompted to “Run” the “Citrix Online Launcher.exe.” By double-clicking this it will automatically “Install” GoToWebinar. If your electronic device does not detect the automatic download, please check your e-mail for a link for manual download instructions. System Requirements: – PC-based attendees require Windows® 8, 7, Vista, XP or 2003 Server – Mac®-based attendees require Mac OS® X 10.6 or newer – Mobile attendees require iPhone®, iPad®, Android™ phone or Android tablet Additionally you have the option to use EITHER VoIP or Telephone but NOT both 2

4. Agenda TopicTime Allotted General Announcements5 minutes Review Interoperability Goals15 Minutes Review potential Real World Scenarios (keep it simple) 15 minutes Continue Brainstorm Discussion on Real World Scenarios 15 minutes Next Steps/Questions10 Minutes 3

5. General Announcements We have obtained new dial in numbers to make it easier for those calling in from other Countries – GotoMeeting – uses Voice Over IP (VoIP) The Interoperability Workgroup meets every Wednesday from 10:00am – 11:00am ET or 4:00pm-5:00pm CEST – To participate please see the “Weekly Meetings” Section of the EU-US eHealth Collaboration Wiki Homepage: http://wiki.siframework.org/EU-US+eHealth+Cooperation+Initiative http://wiki.siframework.org/EU-US+eHealth+Cooperation+Initiative 4 Note: Please check the meeting schedule weekly to get the most up-to-date meeting information

6. Join the EU-US eHealth/Health IT Cooperation Initiative 5 We encourage all members to “sign up” for the initiative. By joining this ensures you stay up-to-date with the work being done, communications and any initiative activities. Simply complete the EU-US MOU Project Signup Form on the Wiki Page: http://wiki.siframework.org/EU- US+MOU+Roadmap+Project+Sign+U p http://wiki.siframework.org/EU- US+MOU+Roadmap+Project+Sign+U p

7. Today’s Goals 6 GoalsComplete Review and agree upon the Interoperability Workgroup Scope and Goals Review Real World Scenarios (keep it simple)

8. International Interoperability of EHR Scope Statement 7 Working to accelerate and advance the progress of eHealth/health IT interoperability standards and interoperability implementation specifications for electronic health record systems for the unambiguous semantic interpretation of clinical data that meet high standards for security and privacy protection and fidelity (faithful to the source) for the international community and for the enhanced care quality and safety of the patient. Working toward shared objective…. To support an innovative collaborative community of public- and private-sector entities, including suppliers of eHealth solutions, working toward the shared objective of developing, deploying, and using eHealth science and technology to empower individuals, support care, improve clinical outcomes, enhance patient safety and improve the health of populations.

9. International Interoperability of EHR Goals/Objectives… 8 To have international interoperability of electronic health records information to include: semantic interoperability; Including “levels” of achievement syntactic interoperability; and patient mediated data exchange (including privacy and security issues surrounding exchange of health data).

10. International Interoperability of EHR Goals/Objectives Continued 9 Three key goals of the technical work stream: Identify a subset of commonly used vocabularies and terminologies that can serve as the basis of an internationally recognized subset to support semantic interoperability (shared meaning). Harmonize the formats (or structures) for how information is structured to support syntactic interoperability Support the use of Patient Mediated Data Identify a working group (complete) and to begin defining pilot projects.

11. Today’s Goals 10 GoalsComplete Review and agree upon the Interoperability Workgroup Scope and Goals Begin Discussion on Real World Scenarios

12. Real World Scenarios as a Path to our First Goal Goal: Identify a subset of commonly used vocabularies and terminologies that can serve as the basis of an internationally recognized subset to support semantic interoperability (shared meaning). Creating Scenarios helps determine which problem to address first Further along in the Workgroup process we will discuss which vocabularies are relevant to that Real World Scenarios – Rather then bringing every vocabulary and terminology and standard to the table start with the ones that support the user story and expand from there 11

13. Real World Scenarios Criteria It is simple and achievable (we want to declare success) It is feasible and broadly realistic It is patient centric (to start) 12

14. Real World Scenarios… Moving From Country to Country – Regional issues – maybe not even country to country?? Can we constrain this or should we constrain this? Or even provider to provider Broken Eyeglasses Ran out/forgot of prescription medication while on vacation and need it refilled (for example blood pressure medication) Ambulatory (patient has pre-existing condition such as diabetes that has been out of control and needs to fix the Patient has a heart attack and ends up in the ER (or patient is hit by a car) – Foreign speaking hospital – When returning home information is able to follow them home (push – to go back home) Group of students traveling with chaperon and chaperon needs to get medical records for treatment Are we covering Military??? (pure military or quasi deployment) – sudden outbreak/natural disaster - NO 13

15. Real World Scenarios cont. Quarantine situation and public health entity that this is happening Blue Button – Portal being able to access by both patient and provider – Cell phone to hold the records Planned Care – New USA citizens have a baby and they get their European parents to come and baby-sit 6 months at a time each (mother, then mother-in-law). The mother has breast cancer that has been treated in Europe but need monitoring etc. Healthcare insurance is provided by the family, she needs her USA physician to interact with her oncologist in Europe. (patient and provider-mediated access). – An elderly, but not yet retired, man lives 6 months in USA and 6 months in Europe to care for his elderly mother. He was recently diagnosed with prostate cancer and had radiation treatment. He also has advanced degenerative disease and several other health conditions. He needs regular PSA monitoring, bone scans etc. Immunizations (tetanus) A real world scenario of interest to us at King’s College London is where EU & US universities collaborate in health research studies and clinical trials: it would be excellent to have the semantic and syntactic means to reduce or eliminate the extra work to harmonize data sets. Querying population for outbreak – Query for recalled prescription 14

16. Today’s Goals 15 Goals Complete Review and agree upon the Interoperability Workgroup Scope and Goals Begin Discussion on Real World Scenarios (Keep It Simple)

17. Next Steps 16 Discussion…. Interoperability Work Group will continue to meet every Wednesday from 10:00am - 11:00am (ET)/4:00pm - 5:00 pm (CEST) – Webinar Details: – https://www3.gotomeeting.com/register/552324134 https://www3.gotomeeting.com/register/552324134 Register for the meeting Select the link supplied after registration (this will also appear in your email if you accidentally close the page before joining) Check the Interoperability wiki regularly for updates: h ttp://wiki.siframework.org/Working+Group+-+International+interoperability+of+health+records h ttp://wiki.siframework.org/Working+Group+-+International+interoperability+of+health+records

18. Join the EU-US eHealth/Health IT Cooperation Initiative 17 We encourage all members to “sign up” for the initiative. By joining this ensures you stay up-to-date with the work being done, communications and any initiative activities. Simply complete the EU-US MOU Project Signup Form on the Wiki Page: http://wiki.siframework.org/EU- US+MOU+Roadmap+Project+Sign+U p http://wiki.siframework.org/EU- US+MOU+Roadmap+Project+Sign+U p

19. Visit the EU-US eHealth/Health IT Cooperation Initiative Wiki Page 18 For the latest meetings announcements, meeting details and initiative contacts visit our homepage at http://wiki.siframework.org/EU- US+eHealth+Cooperation+Initiative.http://wiki.siframework.org/EU- US+eHealth+Cooperation+Initiative

20. Meeting Materials 19 For all meeting minutes, presentations, reference materials and recordings please visit the Materials tab and select “Past Meetings” from the drop down menu http://wiki.siframework.org/Project+Meeting+Artifacts. http://wiki.siframework.org/Project+Meeting+Artifacts

21. Interoperability Support Leads 20 US Point of Contacts – Mera Choi, Mera.Choi@hhs.govMera.Choi@hhs.gov – Jamie Parker, jamie.parker@esacinc.comjamie.parker@esacinc.com – Gayathri Jayawardena, gayathri.jayawardena@esacinc.comgayathri.jayawardena@esacinc.com – Amanda Merrill, amanda.merrill@accenturefederal.comamanda.merrill@accenturefederal.com – Emily Mitchell, emily.d.mitchell@accenturefederal.comemily.d.mitchell@accenturefederal.com EU Point of Contacts – Benoit Abeloos, Benoit.ABELOOS@ec.europa.eu Benoit.ABELOOS@ec.europa.eu – Frank Cunningham, frank.cunningham@ec.europa.eufrank.cunningham@ec.europa.eu – Catherine Chronaki, chronaki@gmail.comchronaki@gmail.com UK Point of Contacts

22. Questions 21

23. Resources EU US Wiki Homepage – http://wiki.siframework.org/EU-US+eHealth+Cooperation+Initiative http://wiki.siframework.org/EU-US+eHealth+Cooperation+Initiative Join the Initiative – http://wiki.siframework.org/EU-US+MOU+Roadmap+Project+Sign+Up http://wiki.siframework.org/EU-US+MOU+Roadmap+Project+Sign+Up Reference Materials – http://wiki.siframework.org/EU- US+MOU+Roadmap+Project+Reference+Materials http://wiki.siframework.org/EU- US+MOU+Roadmap+Project+Reference+Materials 22