Dimitrios Katehakis, Researcher, Foundation for Research and Technology – Hellas, Greece

1. A Framework for eHealth Interoperability
Management in Greece
Dimitrios G. KATEHAKIS, Head of Center for eHealth Applications and Services
Foundation for Research and Technology – Hellas, Greece
July 3rd 2019, Samos, GreeceSAMOS 2019 SUMMIT on ICT-enabled Governance

2. A Framework for eHealth Interoperability Management in Greece
July 3rd, 2019 2SAMOS 2019 SUMMIT on ICT-enabled Governance Samos, Greece
Portfolios of Greek public eServices:
focus on eHealth
Source: http://www.moh.gov.gr/ [27-04-2019] Source: http://www.idika.gr/ [27-04-2019]Source: http://www.eopyy.gov.gr/ [27-04-2019]
Introduction

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July 3rd, 2019 3SAMOS 2019 SUMMIT on ICT-enabled Governance Samos, Greece
Other eHealth services
• Hospitals (Public and Private)
• Primary Health Care
• Telematic Applications
• Regional Health Information
Networks
• Research projects (non-clinical
applications, e.g. for clinical trials)
• Regional Health Systems Initiatives
• …
Introduction

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Steps towards an integrated EHR
4
Refined eHealth European Interoperability Framework
http://ec.europa.eu/health/ehealth/docs/ev_20151123_co03_en.pdf
Introduction
Ref: D. G. Katehakis, A. Kouroubali, I.Fundulaki: Towards the Development of a National eHealth Interoperability
Framework to Address Public Health Challenges in Greece. Proceedings of the First International Workshop on
Semantic Web Technologies for Health Data Management (SWH 2018), Monterey, California, USA, October 9, 2018.

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EU framework of cooperation
• Digital Agenda 2020
• eHealth Action Plan 2012-2020: Innovative healthcare for the 21st century
• Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of
patients’ rights in cross-border healthcare (the cross border healthcare directive)
• Regulation (EU) N°910/2014 on electronic identification and trust services for electronic transactions in the
internal market (eIDAS Regulation)
• Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection
of natural persons with regard to the processing of personal data and on the free movement of such data,
and repealing Directive 95/46/EC (General Data Protection Regulation)
• Directive (EU) 2016/1148 of the European Parliament and of the Council of 6 July 2016 concerning measures
for a high common level of security of network and information systems across the Union (Directive on
security of network and information systems - NIS Directive)
• COMMISSION RECOMMENDATION of 6.2.2019 on a European Electronic Health Record exchange format
• eHealth Network and eHAction: decisions, recommendations, exchange of experience and best practices
• CEF and eHDSI: Building Blocks
EU Framework of Cooperation

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First draft of the eHealth EIF model
Refined eHealth European Interoperability Framework
http://ec.europa.eu/health/ehealth/docs/ev_20151123_co03_en.pdf
Medication
Radiology
Laboratory
Patient Summary
Referral-and Discharge reporting
Participatory healthcare
Telemonitoring
Multidisciplinary Consultation
Public Health
Healthcare Analytics
Reimbursement of delivered care
EU Framework of Cooperation

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Some examples
• Belgium (KMEHR, https://www.ehealth.fgov.be/)
• Switzerland (Swiss EPR, https://www.e-health-suisse.ch/)
• Finland (Kanta, https://www.kanta.fi/)
• Austria (ELGA, https://www.gesundheit.gv.at/)
• France (Interop'Santé, http://www.interopsante.org/)
…
• United States (eHealth Exchange, https://sequoiaproject.org/ehealth-exchange/)
• Australia (Australian Digital Health Agency, https://www.digitalhealth.gov.au/)
…
• European Commission (CEF eHDSI,
https://ec.europa.eu/cefdigital/wiki/display/EHOPERATIONS/eHealth+DSI+Operat
ions+Home)
Examples & Best Practices

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Some relevant initiatives
• epSOS (2008-2014, www.epsos.eu)
• Trillium Bridge (2013-2015, www.trilliumbridge.eu)
• ANTILOPE (2013-2015, www.antilope-project.eu)
• EXPAND (2014-2015, www.expandproject.eu)
• e-SENS (2013-2017, https://www.esens.eu/)
• CEF programme (https://ec.europa.eu/inea/en/connecting-europe-facility)
• eHealth Network (http://ec.europa.eu/health/ehealth/policy/network/index_en.htm)
• JAseHN (2015-2018, http://jasehn.eu/)
• eStandards (2015-2017, http://www.estandards-project.eu/)
• VALUeHEALTH (2015-2017, http://www.valuehealth.eu/)
• EuroCAS (2016-2018, https://www.euro-cas.eu)
• ISA² programme (2016-2020, https://ec.europa.eu/isa2/isa2_en)
Examples & Best Practices

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Use case driven approach
Key Challenges and User Needs
1 Describe User needs for today and
tomorrow
2 Deduce Interoperability Use cases
3 Analyze your current infrastructure
Select Use Cases
1 Define your criteria selection
2 Define your eHealth roadmap
3 Select your use cases
Define your implementation
1 Define your governance (distribution of
responsibilities between technical and
organizational level
2 Describe your interoperability realization
scenarios
3 Select profiles and standards (IOP
Framework)
4 Develop corresponding detailed
Interoperability Specifications
Define your testing strategy
1 Define your testing environment
2 Select your test tools
Develop your tender
1 Prepare your budget
2 Write your tender based on your
interoperability specifications
3 Validate your tender following
EU/National rules
2
3
4
5
1
Examples & Best Practices

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Potential use case sources
• Antilope project
• https://www.antilope-
project.eu/resources/
• eHealth Exchange Use Cases
• https://sequoiaproject.org/wp-
content/uploads/2017/01/eHealth-
Exchange-Use-Case-Webinar-2017Jan13-
Finalv2.pdf
• HIMSS Interoperability Use Cases
• https://www.himss.org/library/interoper
ability-standards/adoption-
implementation/use-cases
• IHE Use Case Repository
• https://usecase-repository.ihe-
europe.net/
10
Examples & Best Practices

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EHRxF Recommendation
Sets out a framework for the development of a European electronic health
record exchange format in order to achieve secure, interoperable, cross-
border access to, and exchange of, electronic health data in the Union.
 Set of principles that should govern access to and exchange of electronic health
records across borders in the Union
 Set of common technical specifications for the cross-border exchange of data in
certain health information domains, which should constitute the baseline for a
European electronic health record exchange format
 Process to take forward the further elaboration of a European electronic health
record exchange format.
[Ref: EUROPEAN COMMISSION C(2019) 800 final – COMMISSION RECOMMENDATION of
6.2.2019 on a European Electronic Health Record exchange format (Text with EEA relevance)]
Examples & Best Practices

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Vision of the implementation
of the eHealth EIF
Examples & Best Practices

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Commission Decision (EU) 2015/1302 of 28 July 2015 on the identification
of ‘Integrating the Healthcare Enterprise’ profiles for referencing in public
procurement
Source: http://eur-lex.europa.eu/legal-content/EL/TXT/HTML/?uri=CELEX:32015D1302&from=EN
XCPD
XDR
CT
PDQ
XCF
XDM
ATNA
PAM
SVS
DIS
XD LAB
XDS-I.b
XUA
XPHR
SWF
SWF.b
XCA
XDS.b
PIX
BPPC
PRE
MS
PIR
LTW
LCSD LAW XD-SD
Examples & Best Practices

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Some challenges …
• to facilitate the assimilation and ensure wider acceptance
• to create a roadmap for the development and coordinated maintenance of
national specifications/ catalogues
• to effectively adopt international standards and specifications
• to create a national set of open data and interoperability specifications for
the healthcare domain, in compliance with ReEIF and the new EIF
• to develop national (technical and semantic) interoperability specifications
compatible with the corresponding European ones
• to create a mechanism for compliance control and certification
• to establish and sustain effective governance
Conclusions

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Conclusions
• the introduction of apps and tools, as public services to support integrated
EHR services, is expected to have a significant impact on the quality of life
and overall cost to individuals and the society
• standardization paves the way for increasing the quality of the produced
solutions
• Requiring a coordinated governance framework and governmental persistence
• lack of wider acceptance and fragmentation in efforts remain obstacles
for wider adoption and consequently all the expected benefits are yet to
be experienced
• there is no solution that “fits all”
• Adaptability and personalization are key to successful deployment
Conclusions

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Ευχαριστώ! Thank You!
Dimitrios G. KATEHAKIS, Head of Center for eHealth Applications and Services
Foundation for Research and Technology – Hellas, Greece
Conclusions
For more info:
• http://www.ics.forth.gr/
• http://www.moh.gov.gr/articles/ehealth
• https://ec.europa.eu/health/ehealth/overview_en
• https://ec.europa.eu/digital-single-market/en/european-policy-ehealth
• https://ec.europa.eu/isa2/eif_en