the international patient summary: a cross-sdos...

IHIC 2019

October 22nd, Warsaw

The International Patient

Summary: a cross-SDOs

initiative

Giorgio Cangioli

HL7 IPS project co-facilitator

CEN IPS project team member

(IHE IPS profile team member and ISO

IPS NWIP team member)

International Patient Summary (IPS) Standard

IHIC 2019: The International Patient Summary

What is it ?

The IPS : an X-SDOs initiative

What’s next

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Not a new concept…

▪ What a Patient Summary is and what it does ?

▪ Everyone seems to have their own idea about what it is and what it should do

▪ The PS is simple in concept …but the PS come with its own baggage

26/10/2019IHIC 2019: The International Patient Summary 3

What the IPS is ?

▪ Patient

▪ Summary

It emphasizes the need to provide generic

solutions for global application beyond a

particular region or country.

Health record extract comprising a standardized

collection of clinical and contextual information

(retrospective, concurrent, prospective) that

provides a snapshot in time of a subject of

care’s health information and healthcare

SOURCE: ISO/TR 12773-1:2009 (en) Business requirements for health summary

records — Part 1: Requirements]

◼ International


The IPS: a focused PS

26/10/20195

Provide a healthcare summary for a citizen at the point of care

It is a minimal and non-exhaustive

It is specialty-agnostic and condition-independent……but still clinically relevant


The IPS: a focused PS

26/10/20196

Designed to be simple

Usable any time, in any place; by any one

Multi-beneficiaries: Individuals, Healthcare Providers, Society


The IPS is not an EHR !

26/10/2019 IHIC 2019: The International Patient Summary 8

WHERE IT ALL BEGAN…

26/10/2019 9IHIC 2019: The International Patient Summary

The IPS….is not a flower in a desert…


It comes from a long history ..

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The epSOS projects, cross-border

pilot for PS and eP Exchange, 2009-

2014... and several others ..to the

eHDSI

2010 EU US EU/US MoU: ONC

Standards and Interoperability

Framework (ONC S&I) EU/US eHealth

Cooperation Initiative; EU Trillium

Project; 2013 The INTERPAS Project,

HL7

2015 Transatlantic eHealth/health IT

Cooperation Roadmap: enforcement

of the IPS concept.eHealth

Network

Guidelines

2013-2016



.. it has not been built on a green field…

International Patient Summary

.. but on solid foundations …

26/10/201913

epSOS eHN PS eHDSI


.. But not limited to them..

class Products Overview

FUTURE (goal)

eHN EU PS Guidelines

eHDSI PS IGHL7 IPS CDA IGHL7 IPS FHIR IG

CEN/EN 17269 IPS

CEN/TS 17288 IPS

European PS IG

C-CDA CCD IHE PCC

It Has Multiple Versions

HL7 Pharma CDA Templates

C-CDA on FHIR

CommonCEN/EN 17269CEN/TS 17288CDA IPSFHIR IPSCDAFHIR

Legend

Trillium II FHIR profiles

Trillium II FHIR profiles (final)

IGs for other EU eHealth Services

Name: Products OverviewAuthor: Giorgio Cangiol iVers ion: 1.0Created: 21/11/2016 00:00:00Updated: 21/05/2018 18:13:14

Argonaut (US)

Argonaut (US; future)

«use»

isTheEvolutionOf

refer

useAsInput

provideImplemenationGuidanceFor

useAsInput

isProgressivelyHarmonizedWith

useAsInput

isProgressivelyHarmonizedWith

refine

«use»

implement

isTheEvolutionOf

implement

isCompliantWith

refer

useAsInput

useAsInput

refer

useAsInput

useAsInput

isTheEvolutionOf

14IHIC 2019: The International Patient Summary

THE IPS: A STORY OF SDO COLLOBORATION…


…the journey began three year ago ...

26/10/2019IHIC 2019: The International Patient Summary

16

The IPS Project: the HL7 Int. CEN/TC 251 agreement (April, 2017)


Vision

• “In order to further the care for citizens across the globe, we agree to collaborate on a single, common International Patient Summary (IPS) specification that is readily usable by all clinicians for the (cross-border) unscheduled care of a patient.”

Scope

• “The IPS specification shall focus on a minimal and non-exhaustive Patient Summary, which is specialty-agnostic and condition-independent, but still clinically relevant.”

Implementable

Applicable for global use

Extensible and open

Sustainable

IPS

Prin

cip

les

What was the first iteration of IPS ?


The focus of use for IPS is unscheduled (cross-border) care..the data model for the IPS has been constructed to serve this case…

…but it provides a base-line usable also within other scheduled or planned care cases.

What was the first iteration of IPS ?

eHN EU PS

Guidelines

CEN/EN 17269

IPS

CEN/TS 17288

IPS

HL7 IPS CDA

IG

HL7 IPS FHIR

IG

refer

implementProvide guidance for EU

refine


refer

26/10/2019 19

R

e

s

o

l

u

t

i

o

n

Scale

IPS Progressive Approach

26/10/201920

LOW

HIGH

HIGH

…refining constraints,

consider local and scheduled care

..tight focus: Cross-border,

Unscheduled care…

…SoC assumed to be

adult, on Business/for

pleasure…

IPS


R

e

s

o

l

u

t

i

o

n

Scale


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LOW

HIGH

HIGH

IPS


The IPS Dataset matures…

..increasing detail as required

by stakeholder community…

… and recognising

different capacities and

potential gain/pain!

IPS

R

e

s

o

l

u

t

i

o

n

Scale


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LOW

HIGH

HIGH

IPS


IPS

…impacting data description and use of IPS

Acceptance & adoption

Education and skills

Subjects of Care

concerns are

amplified …

IPS

The goal: an «IPS ecosystem» of standards

Deployers

SDOs

Clinicians

Patients

Clinical

Guidelines

Vendors

Policy

Makers

Acto

rs

Pro

du

cts

Terminologies

Validators

APIsSystem

Functional

Models

Computable

Logical ModelsEducational

Material

…..


The IPS as

▪ The HL7 and CEN collaboration on IPS has worked superbly well

with 4 specifications near completion in few years !

▪ The Global Patient Set (including the «IPS SNOMED CT Free

Set») by SNOMED International has been published

▪ ISO and IHE joined the game

▪ ..hopefully, to be further extended …


The IPS family has grown…

25IHIC 2019: The International Patient Summary 26/10/2019

A new entry…

26IHIC 2019: The International Patient Summary

Patient Care Coordination

Just approved a new IPS

profile work item!

26/10/2019

The current IPS landscape

eHN EU PS

Guidelines

CEN

EN 17269

CEN

TS 17288

HL7

IPS CDA IG

HL7

IPS FHIR IG

implement

provide guidance for EU

refine

refer

implement

SNOMED

IPS Free Set useuse

EN 17269: implementation independent content of the IPS

TS 17288: guidelines for establishing a EU IPS service

IPS FHIR IG: how to implement the IPS using HL7 FHIR

IPS CDA IG : how to implement the IPS using HL7 CDA

ISO IPS NWIP

IHE IPS

Proifle

u

s

e

globalize


Status

CEN/TC251

▪ EN 17269

- Expected publication November

2019

▪ TS 17288

- Ready for publication.

- New ballot on going

HL7 Int.

▪ HL7 CDA IPS IG (STU)

- Published (STU Oct 2018)

▪ HL7 FHIR IPS IG (STU)

- Ballot Sept 2019 passed

- STU published by the end of the

year

28 26/10/2019IHIC 2019: The International Patient Summary

Status

SNOMED Int.

◼ IPS SNOMED CT Free Set

▪ Announced by HL7 Int. and

SNOMED Int. at the last HIMSS

2019

▪ Published on September 2019

within the SNOMED International

Global Patient Set

ISO/TC 215

◼ IPS dataset

▪ The EN17269 (IPS data set) has

been moved to ISO.

▪ Approved at the last ISO meeting in

Goteborg April 2019

▪ Proposed development track of 18-

months as International Standard

(skip the committee draft (CD)

stage ).

29 26/10/2019IHIC 2019: The International Patient Summary

Status

IHE IPS

▪ Project approved under IHE Patient

Care Coordination domain

▪ Intent to contribute to the IPS

efforts towards Connectathon

testing, Conformity Assessment,

and demonstration opportunities.


THE IPS STANDARDS


CEN IPS EN 17269

...formalises the dataset required to share information about the

medical background and history of a patient ….

.. It uses the European guidelines (version 2, November 2016) as

an official source for the requirements….

The dataset is minimal and non-exhaustive <…> specialty-

agnostic, condition-independent and usable by all clinicians for the

unscheduled care of a person…

…usable as a valuable subset of data items for scheduled care…

It is implementation independent.

This international standard does not cover workflow processes of

data entry, data collection, the summarisation act nor subsequent

data presentation. ..

The International Patient Summary


CEN EN 17269:2019


CEN IPS TS 17288

The International Patient Summary: Guideline for European Implementation

…. provides European implementation guidance for the

International Patient Summary (prEN 17269).

… it is also intended to be usable for more localised

deployment, <…> as an additional benefit, its components may

be reused to improve the interoperability of EHRs through

common exchange formats.

..it addresses: Jurisdictional requirements;

Governance, Privacy and data protection and Conformance.

..it includes examples of transport formats…

Out of Scope: recommend a particular delivery

platform/service/template.26/10/2019IHIC 2019: The International Patient Summary 34

HL7 IPS CDA Implementation Guide

http://www.hl7.org/implement/standards/

product_brief.cfm?product_id=48326/10/2019IHIC 2019: The International Patient Summary 35

http://www.hl7.org/implement/standards/product_brief.cfm?product_id=483

The FHIR IPS IG (STU)

36

https://build.fhir.org/ig/HL7/fhir-ips/

Based on FHIR R4

It describes the “IPS document” and the data blocks (FHIR profiles) used to build it

26/10/2019IHIC 2019: The International Patient Summary

https://build.fhir.org/ig/HL7/fhir-ips/

Subject

Author

Attester

Custodian

MedicationSummary

Allergies andIntolerances

Problem List

Immunizations

History of Procedures

Medical Devices

Diagnostic Results

Vital Signs

Past History of Illness

Pregnancystatus + history summary

Social History

Functional Status Autonomy/ Invalidity

Plan of Care

Advance Directives

„Header“ Required Recommended Optional

IPS Sections

The IPS product and by-products

It is a document !

…composed by a set of reusable data blocks !26/10/2019IHIC 2019: The International Patient Summary 38

The IPS


The «IPS»

document

The IPS data blocks

library


The IPS “library”


Library of reusable..(fragments; resources; building blocks;…)

Common “core” set of data

With minimal common terminologies

Extensibleextensions

The IPS “library”

IPSs and Mobile Field Hospital

Encounter Reports were build on

(HL7 FHIR) IPS resources

EU ModEX, Bucharest, 2018 Oct 15-17

WHAT’S NEXT..


Artefacts (Info Models – as is)

CEN

EN 17269

HL7

IPS CDA IG

HL7

IPS FHIR IG

CEN

TS 17288

EN 17269

EN 17288

IPS PROFILES

IPS Template

Imp

lem

en

t

CDA IG

FHIR IG

CDA IG


Implementation

Specific

Implementation

Independent

..a better linkage among IPS artefacts…

EN 17269

IPS Template

HL7 IPS LM

The computable

«glue»EN 17269

Logical Model

IPS PROFILES


Facilitating the mappings among models

EN 17269

IPS Template

EN 17269

Logical Model

Others

HCIM/ZIB

HL7 IPS-EN 17269

Concept Map

IPS PROFILES

HL7 IPS LMFHIR -HL7 IPS LM

Concept Map



47® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

IPS Document

AllergyIntoleranceProfile

MedicationStatementProfile

<..> Profile

AllergyIntolerance

Profile

MedicationStatement

Profile

US-Core

“defines the minimum conformance

requirements for accessing patient

data”

IPS specifically aimed at supporting the use case scenario for ‘unplanned, cross border care’ <..>.IPS dataset is minimal and non-exhaustive; specialty-agnostic

and condition-independent; but still clinically relevant.

Its tight focus on unplanned care is not a limitation, but, on the

contrary, enables the IPS profiles to be used as common minimal

‘core’ set beyond its initial scope.<..>

Profile

US Core

Requestor

US Core

Responder



IPS Document



<..> Profile

AllergyIntolerance

ProfileMedicationStatement

Profile

<..>

Profile

US Core

Requestor

US Core

Responder

IPS Base

AllergyIntolerance

Profile

IPS Base

MedicationStatement

Profile

<..>

Profile

specialize

IPS Base

Requestor

IPS Base

Responder



IPS Document



<..> Profile

AllergyIntolerance

XYZ Core ProfileMedicationStatement

XYZ Core Profile

<..>

XYZ Core

Profile

IPS Base

AllergyIntolerance

Profile

IPS Base

MedicationStatement

Profile

<..>

Profile

specialize

XYZ PS

Documentspecialize

International Patient Access


IPA and IPS are doing different -but related things.

Intent : describing how an application acting on behalf of a patient can access information about the patient from an clinical records system using a FHIR based API.

Make the IPS real !


The IPS community of practice

▪ https://chat.fhir.org/#narrow/stream/207835-

IPS aims to facilitate the growth of a global IPS

(International Patient Summary) community of

practice by sharing, exploring, and

developing ideas around the IPS.


https://chat.fhir.org/#narrow/stream/207835-IPS

The IPS community of practice

▪ It is not limited to the FHIR IG

▪ It is intended to be open to any discussion and idea about

the IPS ecosystems, including:

1. the IPS CDA implementers, the CEN EN 17269 standard (the

reference IPS dataset), the future ISO IPS standard and the IHE IPS

profile;

2. the implementation of the IPS and associated services

3. the relationship with other related initiatives (e.g. US Core,..).


Some initiatives

▪ Argentina has recently started a national service based on FHIR using the HL7 FHIR IPS as the first shared document.

▪ Norway and New Zealand are looking at the IPS FHIR profiles

▪ The new balloted Italian Patient Summary refers explicitly the prEN 17269

▪ Interest in Canada (Ontario), UK on both the CEN IPS and the HL7 FHIR IPS.

▪ The new Austrian Patient Summary will be based on IPS.

▪ On going discussions about eHDSI and IPS. The first step will be the adoption of EN 17269 (IPS dataset)

▪ Idea of creating an Asian Patient Summary IG based on IPS

▪ ..and more are coming…

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International Patient Summary