Launching of the EU-US eHealth Cooperation Initiative 20 June 2013 Dr. Douglas Fridsma Office of the National Coordinator for Health IT, DHHS Peteris Zilgalvis Head of Health and Well-Being Unit DG CONNECT, European Commission Benoit Abeloos & Frank Cunningham Health and Well-Being Unit DG CONNECT, European Commission

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Agenda 1. Welcome Dr. Douglas Fridsma, Office of the National Coordinator for Health IT, DHHS Frank Cunningham, Health and Well-Being Unit DG CONNECT, European Commission Benoit Abeloos, Health and Well-Being Unit DG CONNECT, European Commission Peteris Zilgalvis, Health and Well-Being Unit DG CONNECT, European Commission 2. Introduction: Peteris Zilgalvis 3. Project Overview – Doug Fridsma Vision and motivation for the initiative 4 Project Plan - Benoit Abeloos – Frank Cunningham Discussion of charter, milestones 5. Process – Frank Cunningham Process for gathering input, reporting progress and communication 6. Next Steps - Frank Cunningham 7. Questions and Comments 3

EU-US cooperation on eHealth The EU and the US recognise the importance of health- related ICTs Wish to strengthen their relationship and support global cooperation in this area A MoU (signed in Dec 2010 by EC VP N. Kroes and US Secretary of Health K. Sebelius) aims to foster a mutual understanding of the common challenges

Context The Trans-Atlantic Economic Council (TEC) of Nov reinforced commitment to the MoU Preliminary discussions by the US DHSS and DG CONNECT on the development of a global conceptual framework Articulation of how Health-related ICTs support improved health and address economic benefit and promote innovation. EU-US eHealth MoU

Initial Areas of Cooperation Two issues identified of having immediate importance: Development of internationally recognised and utilised interoperability standards for EHRs Strategies for development of skilled health IT workforces Further areas of cooperation such as research, innovation and policy co-ordination will be discussed in the coming months EU-US eHealth MoU

Roadmap Activities – EU Support Actions Two EU support actions (resulting FP7 ICT Call 10) will be launched in the coming months: TRILLIUM BRIDGE focuses on international interoperability of EHRs CAMEI addresses digital skills for the healthcare workforce These actions have partners from both sides of the Atlantic EU-US eHealth MoU

Other EU initiatives supporting the EU-US process The epSOS project, which has developed an interoperability framework which will serve as a basis for the EU-US roadmap The eHealth Governance initiative, which is composed of member states and various stakeholders in order to establish a governance structure for eHealth within Europe SemanticHealthNet, which is a network of excellence composed of academia, SDOs and other stakeholders to define a governance structure for semantic interoperability in Europe Antilope, a thematic network supporting the adoption and testing of existing eHealth standards and specifications Other EU semantic interoperability projects

Potential Initiatives Supporting the MOU Roadmap… Structured Data Capture: The SDC Initiative will provide an infrastructure to standardize the capture and expanded use of patient-level data collected within an EHR. The infrastructure will consist of 4 new standards: A standard for the CDEs that will be used to fill the specified forms or templates A standard for the structure or design of the form or template (container) A standard for how EHRs interact with the form or template; and A standard to enable these forms or templates to auto-populate with data extracted from the existing EHR Blue Button The Blue Button+ initiative advanced the implementation standards, tools, and services associated with the Blue Button to provide consumers with automated updates to their health information in a human readable and machine readable format Current Status: ABBI launched the new Blue Button Plus website ( with Push Implementationhttp://bluebuttonplus.org ABBI successfully demonstrated

Project Overview EU-US eHealth Cooperation Initiative - Goals Support an innovative and collaborative community of public- and private-sector entities, working toward the shared objective of developing, deploying, and using eHealth science and technology to : empower individuals support patient care improve clinical outcomes enhance patient safety improve the health of populations

Project Overview EU-US eHealth Cooperation Initiative -Current Status October 25, 2012: the HHS and EU convened a meeting of transatlantic stakeholders to discuss ways to implement the principles and vision described in the MOU May 15, 2013: a subsequent meeting was held during the eHealth Summit in Dublin Ireland. Several work areas have been identified; semantic interoperability, syntactic interoperability, patient mediated exchange and workforce development. Short term and long term goals were established to make progress. Champions/thought leaders still need to be identified for each work area to drive the projects and promote accountability. A widely available source for information and participation in the Roadmap initiatives has been made available. US+MOU+Roadmap+Project+Homepage US+MOU+Roadmap+Project+Homepage

Project Overview EU-US eHealth Cooperation Initiative Goals Recruit active participation by relevant experts and stakeholders across the public, private and academic sectors to identify solutions consistent with best practices in relevant fields. Three different work streams have been identified to help achieve the initiative goals: 1.International Interoperability Standards Accelerate progress toward the widespread deployment and routine use of internationally recognized standards that will support transnational interoperability of electronic health information and communication technology. 2.Patient Empowerment Empower patients through the use of standardized access to their own health care information 3.Workforce Development Identification of approaches for achieving a pool of highly proficient eHealth/health IT professionals by ensuring relevant training and by identifying competency and knowledge gaps among staff in healthcare delivery and management.

Project Overview EU-US eHealth Cooperation Initiative- International Interoperability Standards Three key goals of the technical workstream: 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 structure to support syntactic interoperability Multiple similar formats are used in the EU member states, the epSOS project, and the US. A working group in this area has been established. Pilot projects are getting started but more need to be defined.

Project Overview EU-US eHealth Cooperation Initiative -Workforce Development A pool of highly proficient eHealth/health IT professionals is needed. Many health IT jobs are vacant due to lack of skilled professionals. Two groups within this field who need skills enhancement are health informaticians and clinicians or managers. An audit of the professional workforce needs to be done to determine what kind of skills exist. A profile of competencies that are needed by employers should be completed. Experts who can support integration of HIT into clinical environments and understand the importance of change management within these environments will be essential.

Project Plan EU-US eHealth Cooperation Initiative - Project Charter To promote individual and community health in a global environment, and enable a robust and innovative ecosystem of eHealth/health IT that supports the electronic exchange of human- and machine-readable health, clinical, medical and management information to advance the health of individuals and communities. To maintain and enhance inter-governmental cooperation in this area. To maintain and enhance collaboration between governments and the private sector in this area. To explore specific potential activities and approaches to implementing transatlantic interoperability and international workforce development. 15

Project Plan EU-US eHealth Cooperation Initiative - Scope Statement This initiative focuses on activities to advance goals for cooperation around health related information and communication technology, with a specific emphasis on two areas:  international interoperability of Electronic Health Records information, to include semantic interoperability, syntactic interoperability, patient and healthcare provider mediated data exchange (including identification, privacy and security issues surrounding exchange of health data)  cooperation around the shared challenges related to eHealth/health IT workforce and eHealth/health IT proficiencies

Project Plan EU-US eHealth Cooperation Initiative - Outcomes A set of international interoperability standards that can be used by all health care providers to easily exchange information around the world. A set of standards for definition of eHealth/health IT professionals, accreditation and training.

Project Plan EU-US eHealth Cooperation Initiative - Deliverables for Interoperable Health Records Create initial set of use cases, based on community and stakeholder input: Patient mediated exchange Healthcare provider mediated exchange Compare existing US and EU vocabularies, terminologies and clinical models to identify areas of overlap and commonality Identify available resources and opportunities for aligning them (technology and standards to support ongoing collaboration with vocabularies, modeling, and interoperability) Agree on specifications, standards and architecture for the pilot projects Compare the data/document structures used in the US and EU by comparing the consolidated CDA (C-CDA) and the exchange standards used in epSOS

Project Plan EU-US eHealth Cooperation Initiative -Interoperability Milestones Compare existing US and EU vocabularies, terminologies and clinical models to identify areas of overlap and commonality Identify available resources and opportunities for aligning them (technology and standards to support ongoing collaboration with vocabularies, modeling, and interoperability) Agree on specifications, standards and architecture for the pilot Compare the data/document structures used in the US and EU by comparing the consolidated CDA (C-CDA) and the exchange standards used in epSOS

Project Plan EU-US eHealth Cooperation Initiative Workforce Milestones Complete analysis of role based competencies. Identify or create curricula based on competency analysis. Definition and agreement on common standards of competence and professionalism that identify “fitness to practice” health informatics and accreditation of professionals

Process EU-US eHealth Cooperation Initiative - Logistics We will be meeting as a community through conference calls and web meetings. All Announcements, Meeting Schedules, Agendas, Minutes, Reference Materials, Use Case, Project Charter and General information will be posted on the EU-US eHealth Cooperation Initiative Wiki page. US+MOU+Roadmap+Project+Homepagehttp://wiki.siframework.org/EU- US+MOU+Roadmap+Project+Homepage Join us for our next meeting.

Process EU-US eHealth Cooperation Initiative

The EU-US eHealth Cooperation Initiative is open for anyone to join. This community will meet frequently by webinar and teleconference We use Wiki pages to facilitate discussions. Information on how to join the Community can be found on the Wiki: EU-US eHealth Cooperation Initiative US+MOU+Roadmap+Project+Sign+Up US+MOU+Roadmap+Project+Sign+Up In order to ensure the success of our initiative we encourage broad and diverse participation from the community. This is your chance to have an impact on the creation and implementation of a pilot program in this important area of health IT development. Please feel to comment on the Proposed Project Charter US+MOU+Roadmap+Project+Charter+and+Members US+MOU+Roadmap+Project+Charter+and+Members 23 Next Steps cont.…

Keep an eye on the EU-US eHealth Cooperation Initiative Wiki to find out when you can join us for our next meeting The time and meeting information will be available on: US+MOU+Roadmap+Project+Homepage US+MOU+Roadmap+Project+Homepage

Resources and Questions For additional information please consult the EU-US MOU Roadmap wiki pages Homepage: ( – for Announcements, Meeting Detailshttp://wiki.siframework.org/EU-US+MOU+Roadmap+Project+Sign+Up Interoperability Work Group: ( +International+interoperability+of+health+records) – for updates, meeting schedules and materials for this work grouphttp://wiki.siframework.org/Working+Group+- +International+interoperability+of+health+records Work Force Development Work Group: ( +eHealth+health+IT+workforce) for updates, meeting schedules and materials for this work grouphttp://wiki.siframework.org/Working+Group+- +eHealth+health+IT+workforce Join: ( – to sign up and see fellow participantshttp://wiki.siframework.org/EU-US+MOU+Roadmap+Project+Sign+Up Reference Materials: ( US+MOU+Roadmap+Project+Reference+Materials) – for materials pertinent to this initiativehttp://wiki.siframework.org/EU- US+MOU+Roadmap+Project+Reference+Materials 25

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