Bridget A. Moorman, CCE Technical Manager, The Continua Alliance, Europe Overview of System Architectures and Technologies-United4Health Pilot Telehealth Sites 11/15/2018

Sample U4H System Architecture-COPD Patient’s home Hospital or Primary Care PATIENT BRIEFCASE SERVER GATEWAY RESPIRATORY SPECIALIST NURSE OR CLINICIAN GENERAL PRACTITIONER PULMONOLOGITS AT HOSPITAL OR LOCAL HEALTH DISTRICT OTHER INVOLVED HEALTHCARE PROFESSIONALS DATA TRANSMISSION DATA ACCESS TELECONSULTATION (VIDEO OR TELEPHONE) OPTIONAL CONTACT 1 2 3 22 October 2015

Device types and standards used at interfaces 1 2 3 Telecommunications standard Manual Entry (7 sites), RS232 (1 sites), USB (3 sites, BlueTooth (10 sites) POTS, ADLS, GPRS, GSM); Internet and TCP/IP (12 sites); Web portals and dedicated applications (all sites) Internet – mix of public, private, VPN and use of mobile Data/Messaging standard Continua Compliant (IEEE 11073 PHD and HL7) (2 sites), proprietary (all others) Continua Compliant (IEEE 11073 PHD and HL7) (2 sites), proprietary all others HL7 – most sites 22 October 2015

Highlights Czech Republic – platform being used can be modified to support many different clinical workflows; database drives sensor and telecommunication functions Scotland – enforced same interface broker for diabetic glucometer input across region – immediately scaled once was implemented Galicia, Spain – adding telehealth ‘prescription’ into discharge formulary which triggers installation into patient home of kit Slovenia and Norway wrestled with security issues; Slovenia required that vendor servers be installed and managed within hospital infrastructure; Norway built VPN and locked down product which ensures data security at rest, in transit and in storage Finland is using PHR portal as part of overall EMR offerings to patients within region; supporting “bring your own device” and web based application delivery for gathering patient generated data and integrating it into healthcare eHealth service offerings Most of the sites will be providing the service after the project is over; has become a standard of care 22 October 2015

HIMSS Interoperability Levels Foundational– all sites used the basic physical standards for interoperability Structural – a few of the sites had integration into their EMRs and used messaging standards Semantic – None of the sites used data standards; three of the sites will be using Continua compliant devices in future Additional Interoperability category Clinical Workflow – is this workflow and system going to be a standard of care after the project and does technology enable the care? Most sites will be using the U4H system or an evolved system to provide chronic condition management after project is over Some sites will be using platform to support other care workflows Some sites have electronically integrated the data into their EMRs 22 October 2015

Questions? Thank you. Czech and Welsh Demos follow Bridget.moorman@continuaalliance.org Questions? Thank you. Czech and Welsh Demos follow 11/15/2018