1. EU-US eHealth/Health IT Cooperation Initiative Interoperability of EHR Work Group January 8, 2014 0

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. 2

4. Agenda TopicTime Allotted General Announcements5 minutes Where Are We Now?10 minutes C-CDA CCD to epSoS PS Mapping Overview from Mark Roche, MD 40 minutes Harmonization, Next Steps and Questions5 minutes 3

5. Meeting Times 4 Washington, DC 10:00am (ET) Washington, DC 10:00am (ET) London 3:00pm/15:00 (GMT) London 3:00pm/15:00 (GMT) Germany 4:00pm/16:00 (CET) Germany 4:00pm/16:00 (CET) Athens 5:00pm/ 17:00 (EET) Athens 5:00pm/ 17:00 (EET) Interoperability of EHR Work Group meets every Wednesday

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 http://wiki.siframework.org/EU-US+eHealth+Cooperation+Initiative 5 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+Uphttp://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 Members and e-mail your bio and photo (optional) to Gayathri Jayawardena at gayathri.jayawardena@esacinc.com http://wiki.siframework.org/Interoperability+of+EHR+Work+Group #Work Group Membersgayathri.jayawardena@esacinc.com To access current and archived meeting materials, visit the Project Meeting Artifacts section: http://wiki.siframework.org/Project+Meeting+Artifacts http://wiki.siframework.org/Project+Meeting+Artifacts

7. Where Are We Now? 6  USE CASE ACCEPTANCE As discussed on our last call, we have updated the Accepted Use Case with editorial comments and have changed the “patient summary” wording to “clinical summary”.  4 additional affirmative votes and comments Please see the updated use case on the wiki for review of the changes.  LAUNCH OF HARMONIZATION PHASE Use Case Development Harmonization Implementation Guide Pilot & Testing

8. Continuity of Care Document (CCD) – CDA R2 NE (May 2005) – HL7 IG: CDA R2 C-CDA R1.1 (July 2012) CCD template epSoS Patient Summary (PS) Form – CDA R2 NE (May 2005) – HL7 IG: CDA R2-CCD (April 1, 2007) – epSoS IG: Appendix II epsos_revised_data- set_25april2013.pdf USEU In Scope: – Semantic Interoperability – Syntactic Interoperability Standards for: Clinical Summary Document Standards and Harmonization Out of Scope: – Transport – Privacy & Security Sources: US http://www.hl7.org/implement/standards/product_brief.cfm?product_id=258 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=258 EU http://www.epsos.eu/http://www.epsos.eu/

9. Phases of Harmonization 8 (Clinical Summary Form) (Clinical Summary Form) (document ID, author, patient ID…) (document ID, author, patient ID…) [Body] [Procedures] (Colonoscopy) [Gastroscopy] [CABG] … (Colonoscopy) [Gastroscopy] [CABG] … [Current Medications] … [ASA] [Warfarin] [CABG] [ASA] [Warfarin] [CABG] Phase 1 Section level mapping between epSOS and CCD Phase 2 Header’ Data Element mapping Phase 3 Sections’ Data Element mapping Phase 4 Value Set mapping Completed Remaining Data Granularity and Complexity

10. Mapping Review/Validation: Resources and Process All harmonization/mapping work is done on Google spreadsheet: – Link: https://docs.google.com/spreadsheet/ccc?key=0AiAfdYPeAnM- dG1mczY3dXN4WEl5eEpYVE5fV0pFWUE&usp=drive_web#gid=11https://docs.google.com/spreadsheet/ccc?key=0AiAfdYPeAnM- dG1mczY3dXN4WEl5eEpYVE5fV0pFWUE&usp=drive_web#gid=11 – Access: anyone with link – Privileges: “View and Comment” – everyone with link (the one above) “Edit” – selected – EU: one designated XML/epSoS PS subject matter expert – US: Mark Roche (for now) » Above may be reviewed/updated as project continues Review Process: – Review/validate mapping outcomes after each phase with community – Review points: Mapping completeness Mapping accuracy Mapping gaps 9

11. Review Resources 10 Implementation Guides (IG) Examples: –PDF –XML

12. Review: Phase 1, Section-level mapping –> Available on Google Spreadsheet 11 1.Are all Sections listed? 2.Are section names correct? 3.Are section LOINCs and OIDs correct? 4.Are requirements (R,R2,O) correct? 5.Is mapping complete (section-level)? 6.Is mapping accurate (correct)? 7.Are there mapping gaps? 8.Is mapping clear and unambiguous? 9.What is missing?

13. Review: Phase 2, Header’ Data Element mapping –> In process of being transferred to Google Spreadsheet. Availability will be announced. 12 1.Are template names and OIDs correct? 2.Are all Header Data Elements (DE) listed? 3.Are DE names correct? 4.Are X-Path Statements correct? 5.Are requirements (R,R2,O) correct? 6.Are Data Types correct? 6.Is mapping complete (within header)? 7.Is mapping accurate (correct)? 8.Are there mapping gaps (sth. Exists in epSoS PS but not in C- CDA CCD and vice verse)? 9.Is mapping clear and unambiguous? 10.What is missing?

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15. Google Spreadsheet Demo All harmonization/mapping work is done on Google spreadsheet: –Link: https://docs.google.com/spreadsheet/ccc?key=0AiAfdYPeAnM- dG1mczY3dXN4WEl5eEpYVE5fV0pFWUE&usp=drive_web#gid =11 https://docs.google.com/spreadsheet/ccc?key=0AiAfdYPeAnM- dG1mczY3dXN4WEl5eEpYVE5fV0pFWUE&usp=drive_web#gid =11 14

16. EMERGE Demo What is EMERGE? –EMERGE is a web based application that provides synthetic (dummy) clinical data for ~700 patients –Clinical Data is available in HTML format (human-readable) –Clinical Data is also available in XML format (machine-readable) XML format is compliant with C-CDA R1.1 CCD standard Why was EMERGE developed? –To provide EHR vendors in US with examples that will help them more easily understand C-CDA CCD Implementation Guide (IG) and thus configure EHR to comply with provisions of Meaningful Use Stage 2. 15

17. Standards and Harmonization Continue Semantic and Syntactic Harmonization Work Work towards having demo for Athens conference in May 2014 16

18. Preparing for our Next Meeting 17 We will be meeting next week Wednedsay Jan 15 th, 10:00 am ET, 5:00 pm EET Review materials posted onto Wikipage and e-mail the Use Case Development team with any questions http://wiki.siframework.org/Interoperability+of+EHR+Work+Group

19. Interoperability of EHR Project Support Team 18 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 – Mark Roche, mrochemd@gmail.commrochemd@gmail.com – Virginia Riehl, virginia.riehl@verizon.netvirginia.riehl@verizon.net 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

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21. Initiative 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 EU-US Initiative Reference Materials – http://wiki.siframework.org/EU- US+MOU+Roadmap+Project+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+Gr oup http://wiki.siframework.org/Interoperability+of+EHR+Work+Gr oup 20