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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
26/10/2019 2
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
26/10/2019IHIC 2019: The International Patient Summary 4
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
IHIC 2019: The International Patient Summary
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
IHIC 2019: The International Patient Summary
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…
26/10/2019 IHIC 2019: The International Patient Summary 10
It comes from a long history ..
26/10/201911
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
IHIC 2019: The International Patient Summary
26/10/2019 IHIC 2019: The International Patient Summary 12
.. it has not been built on a green field…
International Patient Summary
.. but on solid foundations …
26/10/201913
epSOS eHN PS eHDSI
IHIC 2019: The International Patient Summary
.. 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…
26/10/2019 15IHIC 2019: The International Patient Summary
…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)
26/10/2019 17IHIC 2019: The International Patient Summary
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 ?
26/10/2019 18IHIC 2019: The International Patient Summary
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
IHIC 2019: The International Patient Summary
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
IHIC 2019: The International Patient Summary
R
e
s
o
l
u
t
i
o
n
Scale
IPS Progressive Approach
26/10/201921
LOW
HIGH
HIGH
IPS
IHIC 2019: The International Patient Summary
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
IPS Progressive Approach
26/10/201922
LOW
HIGH
HIGH
IPS
IHIC 2019: The International Patient Summary
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
…..
26/10/2019IHIC 2019: The International Patient Summary 23
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 …
26/10/2019IHIC 2019: The International Patient Summary 24
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
26/10/2019IHIC 2019: The International Patient Summary 27
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.
26/10/2019IHIC 2019: The International Patient Summary 30
THE IPS STANDARDS
26/10/2019IHIC 2019: The International Patient Summary 31
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
26/10/2019IHIC 2019: The International Patient Summary 32
CEN EN 17269:2019
26/10/2019IHIC 2019: The International Patient Summary 33
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
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
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 product and by-products
The «IPS»
document
The IPS data blocks
library
26/10/2019IHIC 2019: The International Patient Summary 39
The IPS “library”
26/10/2019 40IHIC 2019: The International Patient Summary
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..
26/10/2019IHIC 2019: The International Patient Summary 42
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
26/10/2019IHIC 2019: The International Patient Summary 43
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
26/10/2019IHIC 2019: The International Patient Summary 44
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
26/10/2019IHIC 2019: The International Patient Summary 46
The IPS product and by-products
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
The IPS product and by-products
48® 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
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
The IPS product and by-products
49® 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
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
26/10/2019 50IHIC 2019: The International Patient Summary
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 !
51IHIC 2019: The International Patient Summary 26/10/2019
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.
52IHIC 2019: The International Patient Summary 26/10/2019
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,..).
53IHIC 2019: The International Patient Summary 26/10/2019
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…
26/10/201954
IHIC 2019: The International Patient Summary
26/10/201955
International Patient Summary