Transcript Scenario 4

EU-US eHealth/Health IT
Cooperation Initiative
Interoperability of EHR
Work Group
September 25, 2013
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Agenda
Topic
Time Allotted
General Announcements
5 minutes
Scenario Matrix
10 minutes
Review of proposed scenarios
40 minutes
Next Steps/Questions
5 minutes
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General Announcements
• The Interoperability of EHR Work Group 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
• We will be presenting our work at the EU-US eHealth Conference in
Boston, MA Oct 21-23, 2013 http://b2match.eu/eu-us-ehealthmarketplace-boston2013
Note: Please check the meeting schedule weekly
to get the most up-to-date meeting information
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3rd EU-US eHealth Marketplace and
Conference
•
http://b2match.eu/eu-us-ehealth-marketplace-boston2013/pages/home
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Two-day program that will bring together international leaders, healthcare
professionals, technology providers, academia, patient groups, innovators,
entrepreneurs and policymakers to discuss current trends and business
opportunities in healthcare information technology. Program also includes panel
and keynote remarks from leading health innovators; a unique and successful
brokerage networking program; exhibitions; informal networking and more.
•
The EU-US eHealth Cooperation project will be providing updates on our work
•
Interoperability workgroup will have a Face-to-face working session will be held
for the Interoperability of EHR Work Group (afternoon of Tuesday October 22,
2013).
•
Registration is required for this event.
Submit Your Bio
• The EU-US eHealth/Health IT Initiative will begin creating a
repository of bios to post onto its Wikipage and need your
help!
• Please submit a brief biography of yourself (150 words or
less) that outlines your:
– current professional responsibilities;
– most recent projects in relation to the EU-US work stream
and/or interest to work with the EU-US initiative;
– areas of interest and/or expertise;
– any relevant credentials and/or professional
appointments; and
– a photo (optional).
• Please e-mail your bio and photo (optional) to Gayathri
Jayawardena at [email protected]
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Join the EU-US eHealth/Health IT
Cooperation Initiative
• 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/EUUS+MOU+Roadmap+Project+Sign+U
p
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Meeting Materials
• 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.
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Review of Upcoming Meetings
Date
Meeting Topics
Sept. 18th, 2013
• Final Discussion on Proposed Scenarios
• Discussion on Selection Criteria
Sept. 25th , 2013
• Selection of Scenario(s)
• Identifying Assumptions
• Identifying “In Scope” and “Out of Scope” items
Oct. 2nd, 2013
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Oct 9th, 2013
• Continuation of discussion on Transactions
• Functional Requirements
Oct 16th, 2013
• Finalizing Assumptions, In Scope, Out of Scope, Actors, Roles,
Transactions, Functional requirements in preparation for Boston
Meeting
Oct 23rd, 2013
• Face to Face Working Session at the Boston EU-US eHealth
Conference to finalize Use Case
Identifying Assumptions
Identifying “In Scope” and “Out of Scope” items
Identify Actors and Roles
Identify Transactions of the Actors
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Real World Scenarios
Working session
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Scenario Matrix
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Criteria for Selecting Scenarios
• This is just a start – we want to realize success so we need
to pick a scenario that is:
• realistic and common health care event
• Scope can be accomplished in a short timeframe
– Within 1 year – 16 months
• Can leverage existing health care interoperability standards
– Balance domains and standards that are applicable
• Semantic Interoperability
• Privacy and Security considerations
• Broad application
– Likely to be adopted by EU and US
– High probability of stakeholder engagement
– Springboard for extension to other areas
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Real World Scenarios
Scenario 1: Moving From Country to Country & Immunizations
Scenario 2: Broken Eyeglasses
Scenario 3: Planned Care
Scenario 4: Patient has a heart attack and ends up in the ER (or patient is
hit by a car)
• Scenario 5: Group of students traveling with someone acting on behalf of,
or in the place of, a parent, legal guardian, patient, or subject who needs
to obtain medical records for treatment
• Scenario 6: Ran out of/forgot prescription medication while on vacation
and need it refilled (for example blood pressure medication)
• Scenario 7: Ambulatory (patient has pre-existing condition such as
diabetes that has been out of control and needs to fix the
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Scenario 1
Scenario 1A: Moving from Country to Country & Immunizations (Provider to Provider)
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User Story 1: A family with three children moves to a new country. In order for the children to be admitted to their new
schools they must provide a complete list of immunizations and obtain any additional immunizations needed. The family
has identified a provider in the new region. The new provider needs to request the immunization records for the children
to be sent to her from the previous provider.
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Actors:
– Patient Dependents
– Previous Primary Care Physician (PCP)
– New Selected Primary Care Physician (PCP)
– Immunization Provider
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Data types:
– Consent and privacy
– Immunization records
Scenario 1B: Moving from Country to Country & Immunizations (Patient Mediated)
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User Story 1: A family with three children moves to a new country. In order for the children to be admitted to their new
schools they must provide a complete list of immunizations and obtain any additional immunizations needed. The family
has identified a provider in the new region. The patient accesses their PHR and sends the immunization records to the new
provider.
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Actors:
– Patient Dependents
– Previous Primary Care Physician (PCP)
– New Selected Primary Care Physician (PCP)
– Immunization Provider
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Data types:
– Immunization records
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Scenario 2
Scenario 2A: Broken eyeglasses (Provider to Provider)
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User Story: A patient accidentally breaks their eyeglass while travelling abroad. They need their home provider to send
their eyeglass prescription to their new optometrist. The optometrist requests the patient’s prescription from their
home provider.
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Actors
– Patient
– Provider that originated the eyeglass prescription
– Provider that fills the eyeglass prescription
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Data types
– Prescription including date prescription was written
– Consent and privacy
Scenario 2B: Broken eyeglasses (Patient Facilitated)
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User Story: A patient accidentally breaks their eyeglasses while travelling abroad. They need their home provider to
send their eyeglass prescription to them. The patient needs to retrieve their prescription and take the prescription to a
prescription eyewear store in Europe to purchase new eyeglasses without having to have their eyes examined again by a
new doctor.
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Actors
– Patient
– Provider that originated the eyeglass prescription
– Provider that fills the eyeglass prescription
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Data types
– Prescription including data prescription was written
– Evidence that this is a legitimate prescription
Comments/Feedback:
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Real example involving lost eyeglasses on trip to UK
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•
Consider replacing broken eyeglasses with broken pacemaker
Scenario 3
Scenario 3: Planned Care
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User Story 1: A couple from France moved to the United States in September 2010. Their
baby was born shortly after in the U.S. in January 2011. The maternal grandparents travel
to the U.S. each year for 6 months to baby-sit. The maternal grandmother had diabetes
that has been treated in Europe but needs monitoring in the U.S. while she is living there.
The grandmother has healthcare insurance in the U.S. but she needs her U.S. physician to
interact with her provider in Europe.
Actors:
– One Patient
– Previous Primary Care Physician (PCP) or Oncologist
– New Selected Primary Care Physician (PCP) or Oncologist
Data Types:
– Medications
– Lab results
– Problem list
– COPD
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Scenario 4
Scenario 4: Emergency and Inpatient Care
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User Story 1: Patient has a heart attack and is taken to the ER. When returning home information from the ER must be
transferred to their PCP (Patient Mediated Exchange)
– Patient has information in PHR (i-phone ) OR the patient may only have their insurance card in their wallet – which
may be how EHR provider gets PCP information
User Story 2: A student is studying abroad in Italy and they are hit by a car towards the end of their stay. They are taken to
a nearby hospital for treatment for head trauma. The patient is admitted and treated for approximately two weeks before
they are discharged. The patient is cleared for travel back to the U.S., however, they will need to check in with their PCP
back home for any side effects from the medication or additional treatments or radiology scans needed as a precaution. As
per new policy at the Italian hospital they must send a summary of the hospitalization stay including treatment plans to the
PCP identified by the patient.
Actors:
– Patient
– Hospital Emergency Department
– Hospital Inpatient Services
– PCP in home country
Data Types:
Comments/Feedback:
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Similar to epSOS Patient Summary Use Case (see slide 17)
Consider combining with scenario 1
Consider re-wording the User Story to reflect a “break the glass” scenario
We need a scenario that has some inpatient component
This should be a 2 way communication (both of these scenarios have inpatient stay)
Data set would include summary of care
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Scenario 5
Scenario 5: Group of students traveling with someone acting on behalf of, or in the
place of, a parent, legal guardian, patient, or subject and that person needs to obtain
medical records for treatment
User Story:
• Actors:
– Person acting on behalf of, or in the place of, a parent, legal guardian, patient, or
subject
– One Patient
– Previous Primary Care Physician (PCP)
– New Selected Primary Care Physician (PCP)
• Data types:
Comments/Feedback:
• Consider combining with scenario 4
• Maybe include a planned care scenario for a student studying abroad such as Asthma
– medical records go to the school or university clinic (health records already there)
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Scenario 6
Scenario 6: Patient runs out of/forgets prescription medication while on vacation
and needs a refill (for example blood pressure medication)
User Story: A patient is travelling through Europe and left their prescription blood
pressure medication at their previous hotel in Germany. They are unable to get in touch
with the hotel staff in Germany to have their prescription mailed to them. Therefore, they
visit a pharmacy in Spain to see if they can request the medication from the patient’s
cardiac specialist back home who wrote the prescription for the medication. The pharmacy
has the medication that the patient has been prescribed. The pharmacist in Spain needs to
validate the prescription with the patient’s cardiac specialist before they can dispense it.
• Actors
– Patient
– Physician who wrote the prescription
– Pharmacy seeking to fill the prescription
• Data types:
Comments/Feedback:
• Similar to epSOS ePrescription Use Case (see slide 17)
•
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Scenario 7
Scenario 7: Ambulatory
User Story: A patient who has a history of poorly managing their diabetes is traveling in a
different country. After hiking the Swiss Alps the patient experiences numbness and tingling in
their feet. The patient disregards these symptoms attributing them to the recent hike and
exhaustion from the trip. Five days later the patient steps on a nail, however, does not realize
this until someone informs him that his right foot is bleeding. The patient goes to an urgent care
center to treat his injury and to see a diabetic counselor to determine how best to manage his
fluctuating diabetes condition. The urgent care center needs to obtain a copy of the patient’s
medical history from the past five years including any medications the patient has been taking to
manage their diabetes.
• Actors:
– One Patient
– Physician Treating Patient’s Diabetes
– Urgent Care Center Physician in Switzerland
• Data types:
Comments/Feedback:
• Consider combining with scenario 1 and 4
• Similar to epSOS Patient Summary Use Case (see slide 17)
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epSOS Use Cases
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Scenarios 4 & 7 (Emergency & Inpatient Care and Ambulatory) are similar to
the Patient Summary Use Cases:
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Use Case 1: An occasional visitor in country B, for example someone on holiday or attending a
business meeting. The distinguishing characteristic is that this type of visit is irregular, infrequent,
and may not be repeated. This is a type of incidental encounter where the Health Care professional
may have no previous record of the person seeking care.
Use Case 2: The person is a regular visitor to country B, for example someone who lives in one
country but works in another country. The distinguishing characteristic is that this type of visit is
regular, frequent, and the person seeking care may be accustomed to using services in the country
where he or she works as a matter of personal convenience. This is a type of occasional situation
where the Health Care professional may have some information available from previous encounters,
therefore the patient could have a medical record locally stored in country B, and maybe a PS in
country B plus in country A. If this is the case, both PSs should be available for the HCP to be
consulted.
Scenario 6 (Prescriptions) is similar to the ePrescription Use Case:
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Use Case 1: Common scenario in interoperability between ePrescription services, where the patient
has been already prescribed in his home country.
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Additional Scenarios
to Consider
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Billings, claims
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
Immunizations (tetanus)- if someone is in a different country - how can
they or their provider that is treating them access their immunization
records to date?
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 - Public Health scenario. Rather than
being patient specific this scenario is more of a public health option.
Querying the population regarding an outbreak or querying for recalling a
prescription.
– Query for recalled prescription
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Next Steps
• Interoperability of EHR Work Group will continue to meet
every Wednesday from 10:00am - 11:00am (ET)/4:00pm 5:00 pm (CEST)
• Send Bios
• Check the Interoperability of EHR Work Group Wikipage
regularly for updates:
http://wiki.siframework.org/Interoperability+of+EHR+Work+
Group
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Upcoming Meetings
Date
Meeting Topics
Sept. 18th, 2013
• Final Discussion on Proposed Scenarios
• Discussion on Selection Criteria
Sept. 25th , 2013
• Selection of Scenario(s)
• Identifying Assumptions
• Identifying “In Scope” and “Out of Scope” items
Oct. 2nd, 2013
•
•
•
•
Oct 9th, 2013
• Continuation of discussion on Transactions
• Functional Requirements
Oct 16th, 2013
• Finalizing Assumptions, In Scope, Out of Scope, Actors, Roles,
Transactions, Functional requirements in preparation for Boston
Meeting
Oct 23rd, 2013
• Face to Face Working Session at the Boston EU-US eHealth
Conference to finalize Use Case
Identifying Assumptions
Identifying “In Scope” and “Out of Scope” items
Identify Actors and Roles
Identify Transactions of the Actors
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Interoperability Support Leads
• US Point of Contacts
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Mera Choi: [email protected]
Jamie Parker: [email protected]
Gayathri Jayawardena, [email protected]
Amanda Merrill, [email protected]
Emily Mitchell, [email protected]
Mark Roche, [email protected]
Virginia Riehl, [email protected]
• EU Point of Contacts
– Benoit Abeloos, [email protected]
– Frank Cunningham, [email protected]
– Catherine Chronaki, [email protected]
• UK Point of Contacts
– Pending
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Questions
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Resources
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•
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EU US Wiki Homepage
– http://wiki.siframework.org/EU-US+eHealth+Cooperation+Initiative
Join the Initiative
– http://wiki.siframework.org/EU-US+MOU+Roadmap+Project+Sign+Up
Reference Materials
– http://wiki.siframework.org/EUUS+MOU+Roadmap+Project+Reference+Materials
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