1. FACTORIES Orchestration
Legal & Organizational
Specifications
Semantic
Technical
Testing
Operations
Implement planned components
Plan developments under Project specific branches
Stork 2.0
Trillium Bridge
… e.SENS
Make branches re-converge after validation, integration, testing, into formal main releases
Relation with EC DG-CONNECT, DG-SANCO (DG-HELTH), DG-DIGIT

2. OpenNCP
OpenNCP

3. open : engaging : evolving : credible
OpenNCP Community
open : engaging : evolving : credible

4. OpenNCP Community
implementation story
OpenNCP

5.
ENABLE
Healthcare
cross border services

6. epSOS - Cross Border Health Services
OpenNCP Community
epSOS - Cross Border Health Services
Patient Summary (PS)
ePrescription / eDispensation (eP/eD)
Patient Access (PAC)
Health Care Encounter Report (HCER)
Medication Related Overview (MRO)

7. epSOS project Original Idea Recognized outcome Actions taken
OpenNCP Community
epSOS project
Original Idea
Limit project results to specifications
Leave implementation to PNs
Recognized outcome
Feasibility of achieving interoperability between PNs was very low
PNs commitment with specs was low
Actions taken
In 2010, it was decided to engage a consortium to develop a reference implementation

8. Reference Implementations
OpenNCP Community
Reference Implementations
1st implementation - epSOS induced
Based on Proprietary software (Fraunhofer, Elga and Tiani)
2nd implementation – country independent initiative
epSOS open common components (SRDC, from Turkey)
3rd implementation (OpenNCP) - epSOS induced
Full set of open source components ready to reuse
As a bundle or as components
With a supporting open community
FET was an epSOS induced development for epSOS,
while the SRDC development is an independent commercial development primarily for one country,
while the OpenNCP is an epSOS induced development for epSOS and beyond.
Yes, they can all be considered reference implementation, but there is more to it.

9. OSS Reference Implementation
OpenNCP Community
OSS Reference Implementation
Open Source Software (OSS)
source code made available, providing the rights:
to use
to study
to change
to distribute
very often developed in a public, collaborative manner

10. OpenNCP Community
community
OpenNCP

11. OpenNCP Community
OpenNCP

12. OpenNCP Community
OpenNCP Vision
...design and develop a set of Open Source Components (OpenNCP) that can be adopted by Participating Nation, to build their local implementation of the epSOS NCP.

13. OpenNCP Community
NCP Common Component
Architecture

14. Motivation and Culture
OpenNCP Community
Motivation and Culture
Skills and Expertise
Willing People
Common needs
Community

15. OpenNCP Community
OpenNCP Community
Open group of people orchestrated by an agile software development methodology conducting effort on designing, coding, testing and delivering OpenNCP technology

16. Adopted by 14 of epSOS Countries
OpenNCP Community
Since 2012
~ meetings (tconf or f2f)
200
Software Components 21
Validated by IHE: 3 PAT & 4 PPTs 7
epSOS I & II services available
epSOS I/II
Adopted by 14 of epSOS Countries

17. Usage and Contribution
OpenNCP Community
Usage and Contribution
USAGE
14 MS
CONTRIB.
3 MS
Malta
AT, CH,
PT, EE,
FI, GR,
HU, IT, 
SP, SE,
SI, LU, HR, MT
GE, DK, TR
17 – Contributing Countries // 14 USING contries
27 - Contributors (developers, consultants, adopters)
3 - Spanned timezones
24- Source repositories

18. Contributions Nature Quality Assurance: CI Actors and Relations
OpenNCP Community
Contributions Nature
DEVELOPERS
CODE
CONTINUOUS
INTEGRATION
LOCAL
DEPLOY / DEVELOP.
Quality Assurance: CI Actors and Relations
ARTIFACTS
ADOPTERS

19. OpenNCP Community Collaborative Design Technology Engineering
OpenNCP Community
Collaborative Design
Technology Engineering
Support & Maintenance
Knowledge Sharing
open : engaging : evolving : credible

20. OpenNCP Community
architecture
OpenNCP

21. Part 1: Technical architecture
Part 1: Technical architecture

22. What services are supported?
epSOS 1
Patient Summary (PS) – fetch a summary of person’s vaccinations, allergies, adverse reactions, immunizations, past illnesses, medical devices, medication summary, etc. etc.
Electronic Prescription (eP) – fetch electronic prescriptions, dispense them, send dispensation information back to patient’s home country
epSOS 2
Healthcare Encounter Report (HCER) – after a healthcare encounter, submit new information to patient’s home country
Medication Related Overview (MRO) – fetch history of medication use (subset of a patient summary)
Patient Access (PAC) – show Patient Summary data to the patient in a chosen language
Something new
Trillium Bridge: Support of some use cases, demoed here in Athens.
Export translated patient summary from the PAC view.
Load a document into the portal and translate it into a chosen language.

23. What IHE profiles are supported?
Communication between NCPs:
XCPD Cross-Community Patient Discovery
Patient identification
XCA Cross-Community Access
Fetch a list of available documents
Retrieve a certain document
XDR Cross-enterprise Document Reliable Interchange
Submit a document to the patient’s home country
Security and logging:
ATNA Audit Trail and Node Authentication
Write audit logs about every transaction.
A web interface for access to logs is included
XUA++ Cross-Enterprise User Assertion, with extensions
Send healthcare professional authentication information and treatment relationship confirmation to patient’s home country, along with requests for data
Two different assertions, something not commonly supported
In documents and server infrastructure other profiles may be also supported (e.g. BPPC, CT). However, for OpenNCP they are “transparent”.

24. OpenNCP: overall architecture
NCP Country B role
NCP Country A role
XCPD client
XCPD server
epSOS server APIs
Patient
search
National interfaces or APIs
National patient ID infrastructure
epSOS client connector
Portal B
or another client
XCA client
XCA server
PS, eP search
National PS infrastructure
eD, Consent, HCER submit
XDR client
XDR server
National eP/eD infrastructure
National HCP ID infrastructure
Patient authentication infastructure (for PAC service)
Security manager
Security manager
Consent manager
Audit record repository
National consent infrastructure
Audit manager
Audit manager
Audit record repository
eADC
eADC
Transformation modules
Transformation modules TM
TSAM
LTR TM
TSAM
LTR
Configuration and maintenance
Configuration and maintenance
Terminology sync mgr
Config mgr
Config mgr
Terminology sync mgr
epSOS central services
Core component
Config server
TM = transformation manager
TSAM = Transformation Service Access Manager
LTR = Local Terminology Repository
eADC = epSOS Automatic Data Collector
Terminology server
National component

25. Example: Request a document and send it from A to B
Country B
Country A
TRC-STS
Assertion validator
HCP data, patient ID
TRC
assertion
OK or
error description
Assertion
XCA Retrieve request with
HCP ID and TRC assertions
fetchDoc()
fetchDoc()
Portal B
epSOS XCA protocol terminator (client)
epSOS XCA protocol terminator (server)
National Connector
HCP authenticator
Friendly
Friendly
Pivot
Audit log
Audit log
Pivot
Friendly
Friendly
Pivot
Audit log
Audit log writer
Audit log writer
Transformation manager
Transformation manager
* Some components missing from the figure: eADC, consent manager, config manager
Friendly
Document in language A or B
HCP = Healthcare professional
TRC = Treatment Relationship Confirmation
STS = Secure Token Service
Pivot
Document in English

26. OpenNCP: a library or an out-of-the-box product?
Both
Offers a ready-to-deploy NCP solution, with clear installation instructions
Offers a set of components which can be used separately
A blueprint for the use of certain external OSS components

27. Support of IHE profiles
Implementation of IHE profiles is complete for the epSOS use cases
For other use cases certain modifications or additions may be required.
Clear trade-off: Jack of all trades vs. Master of own profession. OpenNCP is more for the latter.
National connectors may affect compatibility, and they often do
Attributes in metadata originating from the National Infrastructures are not always IHE-compatible.
Responsibility is with epSOS PNs.
OpenNCP is quick and adaptive
Compatibility is a moving target. Requirements keep changing, and profiles/bindings do change with them. Minor changes may be crucial.
IHE validators keep getting updated, and generally do a very good job.
Countries which used OpenNCP could easily modify the implementation themselves, and received constant support from the OpenNCP community.

28. What a PN must do, except installing OpenNCP
Develop a national connector (examples supplied)
Communication with the national infrastructure
Generation of epSOS friendly documents, processing incoming documents
Develop a consent management service and a policy manager
Implement a consent and policy manager, to replace the default (supplied) one
Develop a service for citizens, to give/revoke consents
Extend the portal (epsos-web or OpenNCP portal)
Develop an HCP authentication module, to replace the default one
Patient authentication for the PAC service
May involve communication with other national services (e.g. in Finland, the national pharmacy register and the national professional rights register)
Setting OpenNCP is perhaps the easiest part
An estimate for Finland: 25 % of epSOS work international, 75 % national, despite (or maybe due to) a well-established and stable national infrastructure
Easy to do a demo or a small pilot, hard to make a solution to cover a full nation. The same 25/75 % rule is an optimistic guesstimate.
All challenges/obstacles are known only after all of them have been cleared.

29. Part 2: Use of OpenNCP in a real pilot
Part 2: Use of OpenNCP in a real pilot

30. Experiences from the use in a real pilot environment
Stable
“Shoot and forget” – months of uptime both in PPT and in production
Survived changes in the NI without restarts.
Survived changes in background database management systems without restarts.
Somewhat fragmented
SOA has had a clear impact on the architecture. Good for design and stability, but not always easy for setting up the infrastructure.
Firewalls are abundant in National eHealth systems. “Have we opened all what is required, but not more?”
Secure?
OpenNCP itself (+epsos-web) has been security tested successfully
National extensions can make a big difference
Network infrastructure and maintenance processes can make a big difference
Check your national logging requirements

31. What have you learned? OpenNCP is an IHE-compliant software pack
Implements a number of IHE profiles + document transformations
Implementations often epSOS-specific, but may be extended/modified (open source!)
Can be used for communication between nations, but also for other needs
OpenNCP is stable and quick to set up
The core is rather compact and easy to study and understand
All PNs that use OpenNCP could develop national connectors within reasonable time, with only little support from the OpenNCP community
Has been running in production since summer 2013, and in pre-pilot testing since summer 2012
Users need more than only OpenNCP
Many components have too much national flavor, out of the scope of OpenNCP
Setting up software is straightforward, changing organizational processes, laws or people’s minds much more difficult
P.S. With OpenNCP, we succeeded, hope this means something.

32. OpenNCP Community
tooling
OpenNCP

33. Team Organization INDUSTRY Others TEAM TCONFS
Team Organization
Others
INDUSTRY
TEAM
TCONFS
AWESOME TECHNICAL DEBATES
Epic
DEVELOPMENT ITERATIONS
STRONG SENSE OF COOPERATION
Ultra-fast
SUPPORT
This is how we able to work as Community!
PN RESOURCES
Others

34. Methodologies We are Agile! SCRUM BASED DEVELOPMENT KANBAN SUPPORT
Methodologies
We are Agile!
DEVELOPMENT
SCRUM BASED
Development iterations organized in SPRINTS
Required features represented in BACKLOG items
WORK-ITEMS produced after each iteration
TODO, IN PROGRESS, QUALITY CONTROL and DONE are the tasks / issue available statuses
SUPPORT
KANBAN
BASED
Representation of pending issues in a easy-to-check board perspective;
Each issue has a card assigned;
Each card navigates across multiple swimlanes, representing the current status;
Each card also contain information about how long they are present in the board;
Multiple levels of priority are available for each issue;
Issue solving is not confined to sprint duration (vs SCRUM);
Set in place since the very beginning of OpenNCP!

35. Development and Support Management Continuous Integration
Used Tools
Development and Support Management
Knowledge Sharing
Code Management
Continuous Integration
Atlassian supports actively OPEN-SOURCE initiatives by providing free-of-charge tools at on-demand platform;
All the stored information is OPEN for everyone to access;
We are now migrating code repositories from Google Code to Bitbucket;
OpenNCP also uses Jenkins for Continuous Integration and delivery;

36. Development Management
Development Management
Landing Page
Assigned issues
Graphical statistics
Updates stream
JIRA customized landing page with useful information about projects and development progress;
The OpenNCP contributor can easily check the assigned issues and the latest updates;

37. Labeling makes easy to understand
Planning Development
Development Board I
Sprints planning
Grouping by epics
Labeling makes easy to understand
This is how we plan the development work
Product owners, scrum masters and developers plan the development sprints, including ahead ones;
Grouping by epics makes it easier to focus on goals;

38. Resumed task information
Tracking Development
Development Board II
Status swimlanes
Quick filters
Resumed task information
...and how we track the performed work
Scrum board, where developers can check their assigned tasks;
Configured Quick filters makes it easier to focus on targets;
This board handles only one sprint at the time;

39. Indication about issue time
Tracking Support
Support Board
Status swimlanes
Indication about issue time
Priority grouping
JIRA Kanban view of support incidences;
The developers and reporters are able to track the progress of the issues;
The issues stay on the board until they are solved;

40. Knowledge Sharing Past events Quick access to relevant topics
Knowledge Sharing
Landing Page
Past events
Quick access to relevant topics
Activity Stream
Quick access to releases and component specifications
Landing page of Knowledge Sharing platform;
Tries to concentrate different kinds of pointers to information stored on sub-pages;
Entry point for OpenNCP Documentation;

41. Knowledge Sharing Diagrams Code Snippets Usage information
Knowledge Sharing
Specification Page
Diagrams
Code Snippets
Usage information
Specification pages contain details about the implementation of the components;
Provide information on how to integrate and use the components;
Keep track of the component versions;

42. Knowledge Sharing Please jump in and explore it! Meeting Minutes
Knowledge Sharing
Meeting Minutes
Installation Manuals
Development Topics
Event Pages
Please jump in and explore it!

43. Code Management Git repositories Commit history
Code Management
Git repositories
Commit history
First selected code hosting solution was Google Code, as it was free and open;
It fulfills all the requirements needed until this moment;
Additional requirements in the present pushed the migration to a more capable platform;

44. Code Management Git repositories Commit history Code Reviewing
Code Management
Git repositories
Commit history
Code Reviewing
The Bitbucket solution provides all the previous functionality;
It also allows code reviewing mechanisms, with pull requests;
All the JIRA and Confluence users are also integrated, and other information as well;

45.
Coding Culture
GIT FLOW Model is used for branching, versioning and development management
Semantic Versioning is used as version scheme
We always try to document our work, by relating the tasks with the performed work. And that includes additional explanations, if necessary.
Maven – main reasons: ease of code distribution, ease of inter-component version management and ease of build, test and release/publication processes.
Git - facilitate the distributed and non-sequential nature of development, ensure that all contributions would have equal footing in the repository, the de-centralized and distributed version control system git
Semantic Versioning has a well-defined set of rules describing which types of code changes warrants which types of version number changes.
Cont. Int server furthermore ensure the publication of development snapshots, such that new developers are always able to work on the newest versions of the code.

46. Continuous Integration w/ execution information
Quality Assurance
Continuous Integration
Continuous Delivery
List of Jobs
w/ execution information
Code Quality
Integration Testing
Continuous Delivery

47. Collaborative platform created by the European Commission
Tools
Publishing Framework
Collaborative platform created by the European Commission
Support open source development work done by government agencies in Europe
Tool
JoinUp
Location

48. Other Used Technologies Web-Service Framework
Other Used Technologies
Programming Language
Web-Service Framework
Build Framework
Versioning Scheme
Maven – main reasons: ease of code distribution, ease of inter-component version management and ease of build, test and release/publication processes.
Git - facilitate the distributed and non-sequential nature of development, ensure that all contributions would have equal footing in the repository, the de-centralized and distributed version control system git
Semantic Versioning has a well-defined set of rules describing which types of code changes warrants which types of version number changes.
Cont. Int server furthermore ensure the publication of development snapshots, such that new developers are always able to work on the newest versions of the code.
Licensing Scheme

49. Integration and Testing Arrangements
epSOS Industry Team and OpenNCP Community Workshop
Integration and Testing Arrangements

50. Quality Assurance: Unit Tests
Integration and Testing
Quality Assurance: Unit Tests
Unit Testing is also used in several components in the OpenNCP (e.g. Audit Manager, Transformation Manager);
The unit tests coverage is expected to increase, as new developments are performed and the usage of OpenNCP components is more widespread;
Test Definitionat Knowledge Base

51. Integration and Testing Continuous Integration Actors and Relations
Integration and Testing
Code Repository
Pull
Source-code
Pull/Push Source-code
Contribution
Local development Environment
Continuous Integration Environment
Integration Testing
Environment
Pull dependency binaries
Pull dependency binaries
Adoption
Artifacts
Repository
Push dependency binaries
Continuous Integration Actors and Relations

52. Integration Testing Scheme
Integration and Testing
Test Classes
Artifact To Test
Mocked Information
NCP-A
Test Client
(Simulates NCP-B)
NCP-A
Mocked National Connector
Clients simulate both Portal and NCP-A, with hard-coded messages, according to each test.
Mocked information is used to perform the tests.
NCP-B
Test Client
(Simulates Portal)
NCP-B
All this orchestration is made possible with:
NCP-B Artifact is tested using the previously produced NCP-A Artifact.
Integration Testing Scheme

53. Integration and Testing
Integration and Testing
OpenNCP Integration Testing
Assertions
HL7v3
IHE Remote Validation Services are used during integration testing, within Jenkins pipelines.
Audit Messages
Assertions
Assertions
XD*
CDA
PDF
Remote Validation Service Invocation
IHE Validation Services
This is the output we see on our CI environment
This features can also be used by PNs, on their national environments.
Integration Testing: IHE Remote Validation Services

54. OpenNCP Community
Lessons Learnt
OpenNCP

55. Lessons Learnt The future of the OpenNCP
OpenNCP Community
Lessons Learnt
The future of the OpenNCP
depends on the community sustainability
Testing, Validation and Adoption
lead to technology maturity assurance
PNs MUST acknowledge
Willingness and Commitment to participate and autonomy to maintain local services
We envision our work as FOUNDATIONAL
and may empower future eHealth initiatives