Barriers and facilitators to implementation of the interoperable Survivorship Passport (SurPass) v2.0 in 6 European countries: a PanCareSurPass online survey study

PURPOSE

Long-term follow-up (LTFU) care for childhood cancer survivors (CCSs) is essential to improve and maintain their quality of life. The Survivorship Passport (SurPass) is a digital tool which can aid in the delivery of adequate LTFU care. During the European PanCareSurPass (PCSP) project, the SurPass v2.0 will be implemented and evaluated at six LTFU care clinics in Austria, Belgium, Germany, Italy, Lithuania and Spain. We aimed to identify barriers and facilitators to the implementation of the SurPass v2.0 with regard to the care process as well as ethical, legal, social and economical aspects.

METHODS

An online, semi-structured survey was distributed to 75 stakeholders (LTFU care providers, LTFU care program managers and CCSs) affiliated with one of the six centres. Barriers and facilitators identified in four centres or more were defined as main contextual factors influencing implementation of SurPass v2.0.

RESULTS

Fifty-four barriers and 50 facilitators were identified. Among the main barriers were a lack of time and (financial) resources, gaps in knowledge concerning ethical and legal issues and a potential increase in health-related anxiety in CCSs upon receiving a SurPass. Main facilitators included institutions' access to electronic medical records, as well as previous experience with SurPass or similar tools.

CONCLUSIONS

We provided an overview of contextual factors that may influence SurPass implementation. Solutions should be found to overcome barriers and ensure effective implementation of SurPass v2.0 into routine clinical care.

IMPLICATIONS FOR CANCER SURVIVORS

These findings will be used to inform on an implementation strategy tailored for the six centres.

IT-Related Barriers and Facilitators to the Implementation of a New European eHealth Solution, the Digital Survivorship Passport (SurPass Version 2.0): Semistructured Digital Survey

BACKGROUND

To overcome knowledge gaps and optimize long-term follow-up (LTFU) care for childhood cancer survivors, the concept of the Survivorship Passport (SurPass) has been invented. Within the European PanCareSurPass project, the semiautomated and interoperable SurPass (version 2.0) will be optimized, implemented, and evaluated at 6 LTFU care centers representing 6 European countries and 3 distinct health system scenarios: (1) national electronic health information systems (EHISs) in Austria and Lithuania, (2) regional or local EHISs in Italy and Spain, and (3) cancer registries or hospital-based EHISs in Belgium and Germany.

OBJECTIVE

We aimed to identify and describe barriers and facilitators for SurPass (version 2.0) implementation concerning semiautomation of data input, interoperability, data protection, privacy, and cybersecurity.

METHODS

IT specialists from the 6 LTFU care centers participated in a semistructured digital survey focusing on IT-related barriers and facilitators to SurPass (version 2.0) implementation. We used the fit-viability model to assess the compatibility and feasibility of integrating SurPass into existing EHISs.

RESULTS

In total, 13/20 (65%) invited IT specialists participated. The main barriers and facilitators in all 3 health system scenarios related to semiautomated data input and interoperability included unaligned EHIS infrastructure and the use of interoperability frameworks and international coding systems. The main barriers and facilitators related to data protection or privacy and cybersecurity included pseudonymization of personal health data and data retention. According to the fit-viability model, the first health system scenario provides the best fit for SurPass implementation, followed by the second and third scenarios.

CONCLUSIONS

This study provides essential insights into the information and IT-related influencing factors that need to be considered when implementing the SurPass (version 2.0) in clinical practice. We recommend the adoption of Health Level Seven Fast Healthcare Interoperability Resources and data security measures such as encryption, pseudonymization, and multifactor authentication to protect personal health data where applicable. In sum, this study offers practical insights into integrating digital health solutions into existing EHISs.

Scaling up and implementing the digital Survivorship Passport tool in routine clinical care - The European multidisciplinary PanCareSurPass project

BACKGROUND

Childhood cancer survivors (CCS), of whom there are about 500,000 living in Europe, are at an increased risk of developing health problems [1-6] and require lifelong Survivorship Care. There are information and knowledge gaps among CCS and healthcare providers (HCPs) about requirements for Survivorship Care [7-9] that can be addressed by the Survivorship Passport (SurPass), a digital tool providing CCS and HCPs with a comprehensive summary of past treatment and tailored recommendations for Survivorship Care. The potential of the SurPass to improve person-centred Survivorship Care has been demonstrated previously [10,11].

METHODS

The EU-funded PanCareSurPass project will develop an updated version (v2.0) of the SurPass allowing for semi-automated data entry and implement it in six European countries (Austria, Belgium, Germany, Italy, Lithuania and Spain), representative of three infrastructure healthcare scenarios typically found in Europe. The implementation study will investigate the impact on person-centred care, as well as costs and processes of scaling up the SurPass. Interoperability between electronic health record systems and SurPass v2.0 will be addressed using the Health Level Seven (HL7) International interoperability standards.

RESULTS

PanCareSurPass will deliver an interoperable digital SurPass with comprehensive evidence on person-centred outcomes, technical feasibility and health economics impacts. An Implementation Toolkit will be developed and freely shared to promote and support the future implementation of SurPass across Europe.

CONCLUSIONS

PanCareSurPass is a novel European collaboration that will improve person-centred Survivorship Care for CCS across Europe through a robust assessment of the implementation of SurPass v2.0 in different healthcare settings.

The Role of HL7 FHIR in the European Project GATEKEEPER

The European Project GATEKEEPER aims to develop a platform and marketplace to ensure a healthier independent life for the aging population. In this platform the role of HL7 FHIR is to provide a shared logical data model to collect data in heterogeneous living, which can be used by AI Service and the Gatekeeper HL7 FHIR Implementation Guide was created for this purpose. Independent pilots used this IG and illustrate the impact of the approach, benefit, value, and scalability.

Design and Adoption of a FHIR IG to Support a Telemonitoring Environment in Gatekeeper Project

Telemedicine can provide benefits in patient affected by chronic diseases or elderly citizens as part of standard routine care supported by digital health. The GATEKEEPER (GK) Project was financed to create a vendor independent platform to be adopted in medical practice and to demonstrate its effect, benefit value, and scalability in 8 connected medical use cases with some independent pilots. This paper, after a description of the GK platform architecture, is focused on the creation of a FHIR (Fast Healthcare Interoperability Resource) IG (Implementation Guide) and its adoption in specific use cases. The final aim is to combine conventional data, collected in the hospital, with unconventional data, coming from wearable devices, to exploit artificial intelligence (AI) models designed to evaluate the effectiveness of a new parsimonious risk prediction model for Type 2 diabetes (T2D).

Experience from the Development of HL7 FHIR IG for Gatekeeper Project

The GATEKEEPER (GK) Project was financed by the European Commission to develop a platform and marketplace to share and match ideas, technologies, user needs and processes to ensure a healthier independent life for the aging population connecting all the actors involved in the care circle. In this paper, the GK platform architecture is presented focusing on the role of HL7 FHIR to provide a shared logical data model to be explored in heterogeneous daily living environments. GK pilots are used to illustrate the impact of the approach, benefit value, and scalability, suggesting ways to further accelerate progress.

G-Lens: Using HL7 FHIR International Patient Summary to Highlight Key Information in Medication Leaflets

Medication therapy adherence remains an important problem in health care, and information about medicines from electronic product information is large and untapped resource. The Gravitate-Health project is a large European Union Public Private Partnership that aims to elicit value for electronic product information, starting with information in a patients International Patient Summary.

FAIRness for FHIR: Towards Making Health Datasets FAIR Using HL7 FHIR

Medical data science aims to facilitate knowledge discovery assisting in data, algorithms, and results analysis. The FAIR principles aim to guide scientific data management and stewardship, and are relevant to all digital health ecosystem stakeholders. The FAIR4Health project aims to facilitate and encourage the health research community to reuse datasets derived from publicly funded research initiatives using the FAIR principles. The 'FAIRness for FHIR' project aims to provide guidance on how HL7 FHIR could be utilized as a common data model to support the health datasets FAIRification process. This first expected result is an HL7 FHIR Implementation Guide (IG) called FHIR4FAIR, covering how FHIR can be used to cover FAIRification in different scenarios. This IG aims to provide practical underpinnings for the FAIR4Health FAIRification workflow as a domain-specific extension of the GoFAIR process, while simplifying curation, advancing interoperability, and providing insights into a roadmap for health datasets FAIR certification.

FAIR4Health: Findable, Accessible, Interoperable and Reusable data to foster Health Research

Due to the nature of health data, its sharing and reuse for research are limited by ethical, legal and technical barriers. The FAIR4Health project facilitated and promoted the application of FAIR principles in health research data, derived from the publicly funded health research initiatives to make them Findable, Accessible, Interoperable, and Reusable (FAIR). To confirm the feasibility of the FAIR4Health solution, we performed two pathfinder case studies to carry out federated machine learning algorithms on FAIRified datasets from five health research organizations. The case studies demonstrated the potential impact of the developed FAIR4Health solution on health outcomes and social care research. Finally, we promoted the FAIRified data to share and reuse in the European Union Health Research community, defining an effective EU-wide strategy for the use of FAIR principles in health research and preparing the ground for a roadmap for health research institutions. This scientific report presents a general overview of the FAIR4Health solution: from the FAIRification workflow design to translate raw data/metadata to FAIR data/metadata in the health research domain to the FAIR4Health demonstrators' performance.

An Agile Approach to Accelerate Development and Adoption of Electronic Product Information Standards

The Medical Product Information found in most medication boxes offer a wealth of information, including terms of active ingredients, excipients, indications, dosage, route of administration, risks, and safety information. Digital health services that help patients, their care givers, and health professionals to manage medication, can be improved with tailored information based on user profile, the patient's Electronic Health Record (EHR) summary, and Medicinal Product Information. The electronic Product information (ePI) comprises the summary of product characteristics, package leaflet, and product label. The European Medicines Agency released in 2021 the first version of the EU proof-of-concept ePI standard based on HL7 FHIR. The Gravitate-Health project uses this common standard as a springboard to implement a federated open-source platform and services that helps advance access, understanding, and adherence by providing trusted medicinal information in an interoperable and scalable way. In this paper, we present the agile technical approach and co-creation process to design, test, and progressively mature interoperability working with the HL7 Vulcan Accelerator and FHIR connectathons.

Factors Influencing Implementation of the Survivorship Passport: The IT Perspective

Compared to the general population, childhood cancer survivors represent a vulnerable population as they are at increased risk of developing health problems, known as late effects, resulting in excess morbidity and mortality. The Survivorship Passport aims to capture key health data about the survivors and their treatment, as well as personalized recommendations and a care plan with the aim to support long-term survivorship care. The PanCareSurPass (PCSP) project building on the experience gained in an earlier implementation in Giannina Gaslini Institute, Italy, will implement and rigorously assess an integrated, HL7 FHIR based, implementation of the Survivorship Passport. The six implementation countries, namely Austria, Belgium, Germany, Italy, Lithuania, and Spain, are supported by different national or regional digital health infrastructures and Electronic Medical Record (EMR) systems. Semi structured interviews were carried out to explore potential factors affecting implementation, identify use cases, and coded data that can be semi-automatically transferred from the EMR to SurPass. This paper reflects on findings of these interviews and confirms the need for a multidisciplinary and multi-professional approach towards a sustainable and integrated large-scale implementation of the Survivorship Passport across Europe.

EFMI Inside - the Official Newsletter of the European Federation for Medical Informatics - 2021-1

This is the second volume of the official magazine of the European Federation for MedicalInformatics (EFMI) named as “EFMI Inside”, which was established as Newspaper in Lyon in August 2019, during “MEDINFO 2019” Conference and EFMI Council meeting. Idea for founding EFMI Inside was born by Catherine Chronaki, current President of EFMI and Izet Masic, Honorary Fellow of EFMI and Editor-in-Chief of the official journal of EFMI Acta Informatica Medica. EFMI Council members discussed and concluded to start with magazine in which we can record important and prompt facts and information about past of EFMI, with current and future activities of European Federation for Medical Informatics). After the first issue published in 2020 a lot of medical informaticians expressed their positive comments about usufull and informative magazine within medical informatics field worldwide. This publication became an important and useful resource of EFMI activities for everybody who wants to be familiar with Medical informatics development and achievements in all areas of this academic and scientific discipline in European countries, but also, worldwide. The second issue covered facts about 31st MIE 2021 Conference organized in Athens in May 2021, but also contains important facta about other EFMI activities and intreview with a pinoneer of Medica informatics, academician Gjuro Dezelic from Croatia, and finaly, obituaries of the three influential Medical informatics experts: Francis Roger France, Ragnar Nordberg and Peter Pharow. Some of chairs of Working Groups contributed with their reports in the past year who were actively involved in the development of Medical informatics in their countries, but also worldwide.

EFMI Inside - the Official Newsletter of the European Federation for Medical Informatics - 2022-1

This is the issue of third volume of EFMI Inside - the official magazine of the European Federation for Medical Informatics (EFMI), founded in Lyon, France in August 2019, during “MEDINFO 2019” Conference and EFMI Council meeting. In this issue readers can find important information about events organized during 2022 by EFMI Working Groups and national Medical informatics associations, including the most influential Conference - 32nd MIE 2022 Conference held in Nice, France in May 2022, and EFMI STC held in Cardiff in September 22. This EFMI Inside issue contains important facts about other EFMI activities which needed to be recorded for people who couln’t be active participants at the evenings organized by EFMI and members of EFMI associatins.. Very important part of the issue is official report of the EFMI Council Secretary, Professor Alfred Winter about EFMI Council meetings during years 2020, 2021 and 2022 with included all important facts about EFMI activities during past, especialy during the mandate of Alfred Winter as Secretary from 2014 until 2022. It was the first time that all important facts about EFMI were completed at the one place and we decided to published it as some kind of historical bachground of EFMI for people who will continue managing EFMI Council and EFMI Board activities in the future.In this issue we also involved information about new elected Honorry Fellows during last three years and also obituaries about members who passed away, but their names need to be mentioned regarding its important contributions in the development of Medical informatics globaly and in its national organizatios, Some of chairs of Working Groups contributed with their reports in the past year who were actively involved in the development of Medical informatics in their countries, but also worldwide.

One Digital Health: A Unified Framework for Future Health Ecosystems

One Digital Health is a proposed unified structure. The conceptual framework of the One Digital Health Steering Wheel is built around two keys (ie, One Health and digital health), three perspectives (ie, individual health and well-being, population and society, and ecosystem), and five dimensions (ie, citizens’ engagement, education, environment, human and veterinary health care, and Healthcare Industry 4.0). One Digital Health aims to digitally transform future health ecosystems, by implementing a systemic health and life sciences approach that takes into account broad digital technology perspectives on human health, animal health, and the management of the surrounding environment. This approach allows for the examination of how future generations of health informaticians can address the intrinsic complexity of novel health and care scenarios in digitally transformed health ecosystems. In the emerging hybrid landscape, citizens and their health data have been called to play a central role in the management of individual-level and population-level perspective data. The main challenges of One Digital Health include facilitating and improving interactions between One Health and digital health communities, to allow for efficient interactions and the delivery of near–real-time, data-driven contributions in systems medicine and systems ecology. However, digital health literacy; the capacity to understand and engage in health prevention activities; self-management; and collaboration in the prevention, control, and alleviation of potential problems are necessary in systemic, ecosystem-driven public health and data science research. Therefore, people in a healthy One Digital Health ecosystem must use an active and forceful approach to prevent and manage health crises and disasters, such as the COVID-19 pandemic.

New Scopes for Practice - Interdisciplinary Webinars for Emergency Medicine and Biomedical Informatics - Health Informatics

This paper presents the early outcomes of the educational cooperation between two European academic associations, namely the European Federation of Medical Informatics (EFMI) and European Society of Emergency Medicine (EUSEM). Two webinars were organized in December 2019 and June 2020 to explore areas where mutual education would be beneficial for interdisciplinary cooperation to advance the digitization of emergency departments for the benefit of patients, health professionals and the health system as a whole. Preliminary findings from the analysis of these two webinars are presented and the steps for further cooperation are outlined.

From Raw Data to FAIR Data: The FAIRification Workflow for Health Research

Background FAIR (findability, accessibility, interoperability, and reusability) guiding principles seek the reuse of data and other digital research input, output, and objects (algorithms, tools, and workflows that led to that data) making them findable, accessible, interoperable, and reusable. GO FAIR - a bottom-up, stakeholder driven and self-governed initiative - defined a seven-step FAIRification process focusing on data, but also indicating the required work for metadata. This FAIRification process aims at addressing the translation of raw datasets into FAIR datasets in a general way, without considering specific requirements and challenges that may arise when dealing with some particular types of data.

Objectives This scientific contribution addresses the architecture design of an open technological solution built upon the FAIRification process proposed by “GO FAIR” which addresses the identified gaps that such process has when dealing with health datasets.

Methods A common FAIRification workflow was developed by applying restrictions on existing steps and introducing new steps for specific requirements of health data. These requirements have been elicited after analyzing the FAIRification workflow from different perspectives: technical barriers, ethical implications, and legal framework. This analysis identified gaps when applying the FAIRification process proposed by GO FAIR to health research data management in terms of data curation, validation, deidentification, versioning, and indexing.

Results A technological architecture based on the use of Health Level Seven International (HL7) FHIR (fast health care interoperability resources) resources is proposed to support the revised FAIRification workflow.

Discussion Research funding agencies all over the world increasingly demand the application of the FAIR guiding principles to health research output. Existing tools do not fully address the identified needs for health data management. Therefore, researchers may benefit in the coming years from a common framework that supports the proposed FAIRification workflow applied to health datasets.

Conclusion Routine health care datasets or data resulting from health research can be FAIRified, shared and reused within the health research community following the proposed FAIRification workflow and implementing technical architecture.

Education in Biomedical and Health Informatics: A European Perspective

In higher education, programs in specialization in Health Informatics, Medical Informatics, Health Engineering are continuously growing. In this research, almost 1800 universities and colleges were checked in order to find related educational programs at all academic levels. Approximately 1000 academic leading degree programs in those domains have already been identified. The detailed records of the related educational programs will help to understand the current educational needs and priorities. Although, the growth of the related educational programs is not the same in each country.

Children's Immunisation in Europe - A Vision of Using the HL7 International Patient Summary to Transform Local Data into Child-Specific Information and Population Health Knowledge

Immunisation is a key preventive health measure for children. E-health applications have been used for over 50 years, yet still there is no harmonization or standardization, while uncoordinated policy initiatives proliferate. Two EU research projects (Trillium II and MOCHA) have come together with experts and stakeholders, and used EU-wide situation analysis research to seek to stimulate development of data and process standards as a harmonizing force in a supporting policy environment, putting the child as the central data collation unit.

A Privacy Management Analysis (PMA) of Exchanging International Patient Summary

This paper provides a summary of the Privacy Management Analysis method followed for the analysis of the International Patient Summary exchange use cases of Trillium II Project. The objective is to recommend the required security and privacy measures by providing traceability from Regulations/Principles/Preferences to the recommended Security & Privacy Measures that needs to be implemented in pilots.

IPS Governance Framework: Current Practices in Specification Use and Updates

The eStandards methodology stressed the importance of trust and flow for health data as a key characteristic of well-functioning health systems. A digital health compass, leveraging perspectives of health systems, digital health markets, citizens, and workforce, drives a process of co-creation, governance and alignment in eStandards. A repository of best practices and common components further advances interoperability, as new projects add their experience. This paper proposes a governance framework for requirements management, intelligence gathering, specification use, and updates to promote sustainable governance for International Patient Summaries. It is based on interviews of 14 patient summary projects and initiatives in Europe and the United States.

Interoperability Assets for Patient Summary Components: A Gap Analysis

The International Patient Summary (IPS) standards aim to define the specifications for a minimal and non-exhaustive Patient Summary, which is specialty-agnostic and condition-independent, but still clinically relevant. Meanwhile, health systems are developing and implementing their own variation of a patient summary while, the eHealth Digital Services Infrastructure (eHDSI) initiative is deploying patient summary services across countries in the Europe. In the spirit of co-creation, flexible governance, and continuous alignment advocated by eStandards, the Trillum-II initiative promotes adoption of the patient summary by engaging standards organizations, and interoperability practitioners in a community of practice for digital health to share best practices, tools, data, specifications, and experiences. This paper compares operational aspects of patient summaries in 14 case studies in Europe, the United States, and across the world, focusing on how patient summary components are used in practice, to promote alignment and joint understanding that will improve quality of standards and lower costs of interoperability.

In Search of a Digital Health Compass to Navigate the Health System

Healthcare systems increasingly rely on digital technologies to sustain costs and improve access to quality care. Data drive a wave of automation aspiring to improve productivity by forging connections between health and wellness, medical research, and clinical decision support. Mobile apps and patient-generated data combined with provider recordings pave the way towards personalized care pathways and just-in time access to health services. Navigating the health ecosystem becomes challenging as roles and relationships change. This paper reflects on the digital health compass to navigate the health system using one's own data. Health information technology standards are at the core of the compass, to tap the potential of shared aggregate data and sustain trust. The notion of the patient summary as a window to one's health is used as an example to drive our call for action for health informatics to develop methods to calibrate the digital health compass and feed on 'my data', respecting 'my decision', to fuel 'our ePower'.

Designing Reliable Cohorts of Cardiac Patients across MIMIC and eICU

The design of the patient cohort is an essential and fundamental part of any clinical patient study. Knowledge of the Electronic Health Records, underlying Database Management System, and the relevant clinical workflows are central to an effective cohort design. However, with technical, semantic, and organizational interoperability limitations, the database queries associated with a patient cohort may need to be reconfigured in every participating site. i2b2 and SHRINE advance the notion of patient cohorts as first class objects to be shared, aggregated, and recruited for research purposes across clinical sites. This paper reports on initial efforts to assess the integration of Medical Information Mart for Intensive Care (MIMIC) and Philips eICU, two large-scale anonymized intensive care unit (ICU) databases, using standard terminologies, i.e. LOINC, ICD9-CM and SNOMED-CT. Focus of this work is lab and microbiology observations and key demographics for patients with a primary cardiovascular ICD9-CM diagnosis. Results and discussion reflecting on reference core terminology standards, offer insights on efforts to combine detailed intensive care data from multiple ICUs worldwide.

European Patient Summary Guideline: Focus on Greece

The European Patient Summary (PS) guideline specifies a minimal dataset of essential and important information for unplanned or emergency care initially defined in the epSOS project with aim to improve patients' safety and quality of Care. The eHealth Network of European Union (EU) Member State (MS) representatives established under Article 14 of the EU directive 2011/24 on patient rights to cross-border healthcare adopted PS guideline in November 2013 and since then the guideline has been part of MS strategic eHealth implementation plans, standardization efforts, and concrete regional, national, European and international projects. This paper reviews implementation efforts for the implementation of an operational patient summary service in Greece drawing on challenges and lessons learned for sustainable standards-based large scale eHealth deployment in Europe and abroad, as well as the reuse of best practices from international standards and integration profiles.

Towards mHealth Assessment Guidelines for interoperability: HL7 FHIR

The number of health-related mobile apps (mHealth apps) has increased dramatically over the last three years. Health professionals have started recommending apps to their patients, while healthcare systems, advocacy groups, and professional societies review or commission apps of relevance to their members. Still the issues surrounding mHealth apps are strongly debated as policy makers and legislators seek to strike the right balance between a voluntary code of conduct and regulation that can offer eHealth consumers the guidance and support they need. This paper reviews the EU policy landscape surrounding mobile health focusing on issues identified in the Green paper and follow-up activities. Then, it moves on to discuss HL7 FHIR, the mHealth WG, and relevant standardization projects and reflect on the implications for large scale eHealth deployment in Europe.

Large Scale eHealth Deployment in Europe: Insights from Concurrent Use of Standards

Large-scale eHealth deployment projects face a major challenge when called to select the right set of standards and tools to achieve sustainable interoperability in an ecosystem including both legacy systems and new systems reflecting technological trends and progress. There is not a single standard that would cover all needs of an eHealth project, and there is a multitude of overlapping and perhaps competing standards that can be employed to define document formats, terminology, communication protocols mirroring alternative technical approaches and schools of thought. eHealth projects need to respond to the important question of how alternative or inconsistently implemented standards and specifications can be used to ensure practical interoperability and long-term sustainability in large scale eHealth deployment. In the eStandards project, 19 European case studies reporting from R&D and large-scale eHealth deployment and policy projects were analyzed. Although this study is not exhaustive, reflecting on the concepts, standards, and tools for concurrent use and the successes, failures, and lessons learned, this paper offers practical insights on how eHealth deployment projects can make the most of the available eHealth standards and tools and how standards and profile developing organizations can serve the users embracing sustainability and technical innovation.

Interoperability standards enabling cross-border patient summary exchange

In an increasingly mobile world, many citizens and professionals are frequent travellers. Access during unplanned care to their patient summary, their most essential health information in a form physicians in another country can understand can impact not only their safety, but also the quality and effectiveness of care. International health information technology (HIT) standards such as HL7 CDA have been developed to advance interoperability. Implementation guides (IG) and IHE profiles constrain standards and make them fit for the purpose of specific use cases. A joint effort between HL7, IHE, and HealthStory created Consolidated CDA (C-CDA), a set of harmonized CDA IGs for the US that is cited in the Meaning Use II (MU-II) regulation. In the EU, the Patient Summary (PS) Guideline recently adopted, cites the epSOS IG also based on HL7 CDA, to support cross-border care in the EU and inform national eHealth programs. Trillium Bridge project supports international standards development by extending the EU PS Guideline and MU-II in the transatlantic setting. This paper presents preliminary findings from comparing patient summaries in the EU and US and reflects on the challenge of implementing interoperable eHealth systems in the cross-border or transatlantic setting.

HL7 CDA in the national ePrescription efforts of Finland & Greece: a comparison

This paper presents an overview and comparison of national efforts on ePrescribing in Finland and Greece focusing on aspects of interoperability and standards. Building on experience of HL7 affiliates in Finland and Greece, the role of HL7 Clinical Document Architecture (CDA) in assuring interoperability within the national and cross-border framework for ePrescription is addressed underlining current use of standards and interoperability challenges for large scale adoption.

eMeasures: a standard format for health quality measures

Health quality measures can be used to improve the effective use of Electronic Health Record systems (EHRs) in health care delivery. The Health Quality Measures Format (HQMF) is a standard for representing a health quality measure as an electronic document. This presentation will present the standard, review the development process of quality measures for EHR system using HL7 CDA R2, and reflect on the outlook for eMeasures implementation and adoption.

Online communication between doctors and patients in Europe: status and perspectives

Background

Use of the Internet for health purposes is steadily increasing in Europe, while the eHealth market is still a niche. Online communication between doctor and patient is one aspect of eHealth with potentially great impact on the use of health systems, patient-doctor roles and relations and individuals’ health. Monitoring and understanding practices, trends, and expectations in this area is important, as it may bring invaluable knowledge to all stakeholders, in the Health 2.0 era.

Objective

Our two main goals were: (1) to investigate use of the Internet and changes in expectations about future use for particular aspects of communication with a known doctor (obtaining a prescription, scheduling an appointment, or asking a particular health question), and (2) to investigate how important the provision of email and Web services to communicate with the physician is when choosing a new doctor for a first time face-to-face appointment. The data come from the second survey of the eHealth Trends study, which addressed trends and perspectives of health-related Internet use in Europe. This study builds on previous work that established levels of generic use of the Internet for self-help activities, ordering medicine or other health products, interacting with a Web doctor/unknown health professional, and communicating with a family doctor or other known health professional.

Methods

A representative sample of citizens from seven European countries was surveyed (n = 7022) in April and May of 2007 through computer-assisted telephone interviews (CATI). Respondents were questioned about their use of the Internet to obtain a prescription, schedule an appointment, or ask a health professional about a particular health question. They were also asked what their expectations were regarding future use of the Internet for health-related matters. In a more pragmatic approach to the subject, they were asked about the perceived importance when choosing a new doctor of the possibility of using email and the Web to communicate with that physician. Logistic regression analysis was used to draw the profiles of users of related eHealth services in Europe among the population in general and in the subgroup of those who use the Internet for health-related matters. Changes from 2005 to 2007 were computed using data from the first eHealth Trends survey (October and November 2005, n = 7934).

Results

In 2007, an estimated 1.8% (95% confidence interval [CI], 1.5 - 2.1) of the population in these countries had used the Internet to request or renew a prescription; 3.2% (95% CI 2.8 - 3.6) had used the Internet to schedule an appointment; and 2.5% (95% CI 2.2 - 2.9) had used the Internet to ask a particular health question. This represents estimated increases of 0.9% (95% CI 0.5 - 1.3), 1.7% (95% CI 1.2 - 2.2), and 1.4% (95% CI 0.9 - 1.8). An estimated 18.0% (95% CI 17.1 - 18.9) of the populations of these countries expected that in the near future they would have consultations with health professionals online, and 25.4% (95% CI 24.4 - 26.3) expected that in the near future they would be able to schedule an appointment online. Among those using the Internet for health-related purposes, on average more than 4 in 10 people considered the provision of these eHealth services to be important when choosing a new doctor.

Conclusions

Use of the Internet to communicate with a known health professional is still rare in Europe. Legal context, health policy issues, and technical conditions prevailing in different countries might be playing a major role in the situation. Interest in associated eHealth services is high among citizens and likely to increase.

HL7's comprehensive standards set and its international collaboration for enabling semantically interoperable eHealth and pHealth solutions

The workshop is organized by HL7 and its affiliates to present and to discuss HL7's activities for providing international standards and specifications to enable advanced semantically interoperable eHealth and pHealth solutions, adaptable to national health systems through localization. The workshop especially focuses on the multi-disciplinary structure of HL7 and its liaisons with international and national standards developing organizations as well as important health informatics initiatives. Demonstrating existing and emerging solutions and strategies within HL7's broad scope and spectrum, the international scope of HL7 standards is highlighted.

Collaboration--a new IT-service in the next generation of regional health care networks

During the past 10-15 years, Regional Health Care Networks (RHCN) have been established in many regions throughout the world. RHCN build on well-known techniques, methodologies and appropriate standards. Most of the European Countries today have set up IT strategic plans that focus on the establishment of RHCN. The benefits of having access to all relevant information are tremendous and contribute to cost-effective and coherent health services. By the rapid spread and use of Internet, technology has made it possible to interconnect all kinds of applications. In 2000, the most experienced regions in Europe joined PICNIC, a European project to develop the Next Generation Regional Health Care Networks and to support their new ways of providing health and social care. The previous generation of Regional Health Care Networks supported the interconnection of applications by transfer of messages. Messaging is an effective means of integration for isolated high-specialised systems that only need to exchange data. This service will continue to be one of the most important services in the future health care networks. However, tighter coupling may be desirable in some instances to avoid replicating the same functionality in several applications. In other words, certain services can be common and used by a number of applications instead of building that service inside each application. These common services are called middleware services. In PICNIC (http://www.medcom.dk/picnic), a new middleware Collaboration IT service has been identified and developed. This service allows the end users to perform real-time clinical collaboration, with exchange of text, structured data, voice and images across the limits of a single region. A clinical collaboration is associated with the shared clinical context to provide a record of relevant clinical information and facilitates synchronous as well as asynchronous collaboration. This new IT service builds on the increasing popularity of instance messaging and presence systems that facilitate smooth transition between synchronous and asynchronous interaction. The new Collaboration IT service is expected to have a strong impact on the practice of health care in the next generation of Regional Health Care Networks.

Collaboration--a new IT-service in the next generation of regional health care networks

During the past 10-15 years, Regional Health Care Networks have been established in many regions throughout the world. Regional Health Care Networks build on well-known techniques, methodologies and appropriate standards. Most of the European Countries have today set up IT strategic plans, with focus on establishment of Regional Health Care Networks. The benefits of having access to all relevant information are tremendous and provide a more cost-effective and coherent health service. By the rapid spread and use of Internet the technology have made it possible to interconnect all kinds of applications. The most experienced regions in Europe have joined a European project PICNIC to develop the Next Generation Regional Health Care Networks to support their new ways of providing health and social care. The previous generation of Regional Health Care Networks, developed in the past 10-15 years, supported the interconnection of applications by transfer of messages. This service will also continue to be one of the most important services in the future health care networks. Messaging is an effective means of integration of isolated high-specialised systems that only needs to exchange data. Tighter coupling may be desirable in some instances to avoid replicating the same functionality in several applications. In other words, certain services can be common and used by a number of applications instead of building that service inside each application. These common services are called middleware services. In PICNIC a new middleware Collaboration IT-service has been identified. This service allows the end users to perform real time clinical Collaboration, with exchange of text, structured data, voice and images.

Virtual workspaces in I2Cnet

The objective of I2Cnet (Image Indexing by Content network) is to provide network-transparent content-based access to medical image archives as an Internet/intranet value-added service. Through a typical web browser, healthcare professionals interact with image collections, browse images similar to a query image, compare these images to images from other collections, and contribute their own images or comments. Specific I2Cnet services available on the World Wide Web (WWW) include image processing and feature extraction, content- and annotation-based search for images and image-related information, and authoring of annotations and image descriptions. Virtual workspaces provide the necessary mechanisms to support user sessions in I2Cnet, providing for service interoperability, persistence, and user interaction. In the course of a user session, which begins with a workspace log-in and ends explicitly with a workspace log-out or implicitly by exiting the browser, virtual workspaces maintain the common context.

The I2Cnet service architecture paradigm

The main objective of the Image Indexing by Content network (I2Cnet) is to provide network-transparent content-based access to medical image archives based on a collection of interoperable Internet/intranet added-value services. This paper discusses I2Cnet, focusing on its service architecture paradigm. I2Cnet services such as image annotation, processing, description, and content-based retrieval, as well as the on-line collaboration service are presented. Exemplary user sessions are used to illustrate how virtual workspaces facilitate the interoperation of I2Cnet services, following the "network computer" approach to information management.

I2C: a system for the indexing, storage, and retrieval of medical images by content

Image indexing, storage, and retrieval based on pictorial content is a feature of image database systems which is becoming of increasing importance in many application domains. Medical image database systems, which support the retrieval of images generated by different modalities based on their pictorial content, will provide added value to future generation picture archiving and communication systems (PACS), and can be used as a diagnostic decision support tools and as a tool for medical research and training. We present the architecture and features of I2C, a system for the indexing, storage, and retrieval of medical images by content. A unique design feature of this architecture is that it also serves as a platform for the implementation and performance evaluation of image description methods and retrieval strategies. I2C is a modular and extensible system, which has been developed based on object-oriented principles. It consists of a set of cooperating modules which facilitate the addition of new graphical tools, image description and matching algorithms. These can be incorporated into the system at the application level. The core concept of I2C is an image class hierarchy. Image classes encapsulate different segmentation and image content description algorithms. Medical images are assigned to image classes based on a set of user-defined attributes such as imaging modality, type of study, anatomical characteristics, etc. This class-based treatment of images in the I2C system achieves increased accuracy and efficiency of content-based retrievals, by limiting the search space and allowing specific algorithms to be fine-tuned for images acquired by different modalities or representing different parts of the anatomy.