February 12, 2013

EU-US eHealth Scenarios

You may have come across the US EU Memorandum of Understanding on exchange of health care data. It is an approach to improve eHealth collaboration across the Atlantic and is run by the European Commission (responsible body being DG CNECT) and US Department of Health and Human Services 's (responsible body being the Office of the National Coordinator for Health Information Technology).

The most recent related publicized event was the 2012 Boston meetings aiming to define an actionable roadmap to support the Memorandum. Flying back to Europe I was trying to identify actionable scenarios to support actual exchange of patient related health data across the Atlantic. I aimed at somehow combining the two different (if not opposing) conceptual approaches – namely the pursuit for patient mediated exchange in the US and for provider mediated exchange in the EU. My starting point was to acknowledge in an equal fashion the different existing policies and work already performed on both sides, as well as to maximise the use of existing infrastructure, while maintaining the security-, identification-, data ownership- specificities of each region. The result are a couple of early stage brainstorming scenarios. It is very likely they might include show-stoppers (legal, organisational, though not semantic). And there are probably a number of other alternative scenarios.
When trying to identify existing services on both sides that could be used as proxies to feed data into these new cross-Atlantic scenarios we obviously look for a number of characteristics: significant content overlap, significant semantic overlap (or at least existing structured data on both sides that could be cross-mapped), and possibly being in production or late pilot stage with real patients. You don't have to be a Nobel laureate to think of Blue Button and epSOS.

The Blue Button initiative is a joint venture between the US Department of Veterans Affairs (VA), HHS, and US Department of Defense, in which these three agencies have collectively undertaken the simple but powerful action of allowing veterans, Medicare beneficiaries, and members of the military to freely and easily download electronic copies of their own personal health information or claims (by simply hitting a newly installed “Blue Button” on the VA, Medicare, and military’s patient/beneficiary websites).  Deployed in October 2010, it is now expanding into Blue Button +. Implementation example: Veterans Affairs

epSOS is a Large Scale Pilot co-funded by the European Commission and most EU Member States collaborate in it. It develops a practical eHealth framework and ICT infrastructure to enables secure access to patient health information among different European healthcare systems. The two scenarios being implemented within epSOS are ePrescription and Patient Summary.

Now, how could we put these two together at minimum cost and efforts? As source data are coming from two different systems, the scenarios would probably be different depending on the direction of transfer.Now let us look at the scenarios - 1 and 2 are US to EU, and 3 is EU to US.

Scenario 1 (for US citizens travelling to EU): while downloading Blue Button patient summary, US residents can also choose to upload this data into epSOS - possibly stored in 'US virtual NCP'. This would be an additional functionality of Blue Button. This data would be available for access by the EU physician at the time of contact.

Scenario 2 (for US citizens travelling to EU): Alternatively to Scenario 1, the data in epSOS can be generated at time of contact of US patient with the EU care provider - based on patient request and accessed by the epSOS capable care provider at the point of care in EU, using the 'US virtual National Contact Point' - NCP - at the moment of providing care (patient summary can be stored at 'US virtual NCP' for future use). This would be an additional functionality of Blue Button for the US patient (the epSOS country B portal would only need to add a new country of origin).
Both scenarios would likely require setting up some kind of a 'virtual NCP' for the US, into which Blue Button data can be imported.

Scenario 3 (for EU citizens travelling to US): EU residents travelling to the US can download epSOS patient summary into a Blue Button type format&medium. The download can take place either before the encounter or at the time of encounter. The data can then be imported to any US system supporting Blue Button import. Export from epSOS system would be an additional functionality within epSOS end-user portal aimed to EU citizens. No ‘virtual NCP’ for US would be required as compared to Scenarios 1 and 2.

Of course a number of issues (ownership, data recency/reliability, identification, data manipulation, reduced trust) arise with each of the scenarios and would need to be addressed. What's your take on them - do you find them feasible? I plan to update this post based on your feedback.


Antonio Atalaia said...

Hi. Excellent post. The sharing you describe will potentially benefit individuals. However, data sharing is mainly about big data analysis and this will mean a new vision over traditional values, like data ownership and individual privacy. That is what makes sharing data so problematic, I think.

Antonio Atalaia

Matic Meglic, MD PhD MBA said...

Antonio, thanks. What you're pointing out is very important and it's something we're partly covering in another EC funded initiative called patientregistries.eu, helping patient registries become more interoperable and share data.