1. EU-US eHealth/Health IT Cooperation Initiative Interoperability of EHR Work Group August 21, 2013 0

2. Meeting Etiquette Remember: If you are not speaking, please keep your phone on mute 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 participants 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. Agenda TopicTime Allotted General Announcements5 minutes Review Interoperability Goals15 Minutes Discuss Process to achieve milestones/timeline15 minutes Real World Scenarios (keep it simple)15 minutes Next Steps/Questions10 Minutes 2

4. General Announcements 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 3 Note: Please check the meeting schedule weekly to get the most up-to-date meeting information

5. Join the EU-US eHealth/Health IT Cooperation Initiative 4 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

6. Today’s Goals 5 GoalsComplete Review and agree upon the Interoperability Workgroup Scope and Goals Review Real World Scenarios (keep it simple)

7. International Interoperability of EHR Scope Statement 6 Working to accelerate and advance the progress of eHealth/health IT interoperability standards and interoperability implementation specifications for electronic health record systems that meet high standards for security and privacy protection for the international community.

8. International Interoperability of EHR Goals/Objectives… 7 To have international interoperability of electronic health records information to include: semantic interoperability; syntactic interoperability; and patient mediated data exchange (including privacy and security issues surrounding exchange of health data).

9. International Interoperability of EHR Goals/Objectives Continued 8 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).  Multiple coding systems are in place in both the US and EU, and analysis of administrative, clinical, laboratory and medication coding systems. Harmonize the formats (or structures) for how information is structured to support syntactic interoperability  Multiple similar formats are used in the EU member states, the epSOS project, and the US. Identify a working group (complete) and to begin defining pilot projects.

10. Today’s Goals 9 GoalsComplete Review and agree upon the Interoperability Workgroup Scope and Goals Begin Discussion on Real World Scenarios

11. 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 10

12. 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) 11

13. Transitions Of Care (TOC) Example An initial step in Use Case development is to identify the Scenario and User Story we want to address As an example, here is one scenario from the S&I Framework’s Transitions of Care initiative Scenario 1: The Exchange of Clinical Summaries from Provider to Provider – User Story 1: The Exchange of Information to Support the Transfer of Patient Information from One Provider to Another Setting 1: Hospital or Emergency Department from where patient is discharged (sends discharge summary to PCP or Care Team). Setting 2: Patient's PCP or Care Team (receives discharge summary from Hospital or ED clinical system). – User Story 2: Closed Loop Referral Setting 1: PCP's office (sends consultation request clinical summary to specialist). Setting 2: Specialist's office (receives referral request clinical summary from PCP; send consultation summary to PCP). Return to Setting 1: PCP’s office – User Story 3: Complex Series of Care Transactions Setting: Emergency Department Setting: Hospital 12

14. Real World Scenarios Moving From Country to Country Broken Eyeglasses Ran out 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 issue while in a different country) Blue Button Immunizations (tetanus) Querying population for outbreak – Query for recalled prescription 13

15. Today’s Goals 14 Goals Complete Review and agree upon the Interoperability Workgroup Scope and Goals Begin Discussion on Real World Scenarios (Keep It Simple)

16. Next Steps 15 Discussion…. Interoperability Work Group will continue to meet every Wednesday from 10:00am - 11:00am (ET)/4:00pm - 5:00 pm (CEST) starting August 28, 2013. – Webinar Details: Dial In: +1-650-479-3208 Access code: 665 238 131 WebEx URL: https://siframework2.webex.com/siframework2/onstage/g.php?t=a&d=665238131 https://siframework2.webex.com/siframework2/onstage/g.php?t=a&d=665238131 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

17. Join the EU-US eHealth/Health IT Cooperation Initiative 16 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

18. Visit the EU-US eHealth/Health IT Cooperation Initiative Wiki Page 17 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

19. Meeting Materials 18 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

20. Interoperability Support Leads 19 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

21. Questions 20

22. 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 21