A Nordic reference architecture for Personal Connected Health

and Care

Agenda

∙ Why a Nordic collaboration? ∙ Nordic reference model for Personal connected health

architectures ∙ Applied architectures of the Nordic countries

– Norway– Sweden– Denmark

∙ Q&A

At the home of the Citizen

Health Care

Home Care

Home care tele health solution

Diabetes tele health solution

Geriatric tele health solution

The reality without standards – citizen perspective

At the home of the Citizen

Health Care

Home Care

Home care tele health solution

Diabetes tele health solution

Geriatric tele health solution

A shared set of standards simplifies consolidation in the home setting

Health or home Care

Electronic health record

KOL tele care solution

At the home of the Citizen

The reality without standards - healthcare professional perspective

Health or home Care

Electronic health record

KOL tele care solution

At Home of the Citizen

A shared set of standards reduces the amount of double registration

At the home of the Citizen

Health or home Care

Electronic health record system vendor

Diabetes tele care solution

€

€€€

A vendor has to invest in integrations specific to each customer - 4 customers means 4 times the cost. And we all know who pays the bill!

The reality without standards - market/vendor perspective

At the home of the Citizen

Health or home Care

Electronic health record system vendor

Diabetes tele care cloud solution

€

Using standards, One integration fits all customers - 4 customers shares the cost of 1 integration.

Shared standards reduce cost for actors on the Nordic e-health market

At the home of the Citizen

With a Nordic collaboration, a vendor is more likely to invest in a standard and customers/buyers will spend less on integrations

Coordinated standards selections

Vendor 1Vendor 2Vendor 3

Vendor 4

The collaboration

Jonan Eltes

Thor Schliemann

Lars Kristian Roland

Jari Porrasmaa

?

Towards a Common Nordic Language for Telemedicine Architecture

Norwegian architecture principles:● Standards based (Continua, FHIR and SCAIP) + nordic cooperation● Separate storage and display applications (allow for multi-vendor solutions)● Data that is important to be shared, is planned stored in national repository (FHIR-based), but

in mean-time municipalities will implement local FHIR-based systems according to national specifications

● Not all data is relevant to share… some is kept locally. ● Citizen must be able to see all data about themselves. ● Currently draft recommendations

Norwegian reference architecture for personal connected health

Swedish architecture principles:- The architecture is vendor- and topology agnostic (open market)- Is actually an application of the generic reference architecture. All principles of the general national HIE reference

architecture apply, to secure that all information can be accessed for any legally supported purpose- Standards-based information exchange - today Continua and HL7 Green CDA WS. HL7 FHIR PoC in the planning (future

Nordic alignment).

Swedish reference architecture for personal connected health

Sweden - applied reference architectureCase 1 - “Integrated telemedicine solution”

Sweden - applied reference architecture Case 2 - “Personal Monitoring as a Service”

Danish architecture principles:● Separate storage and display applications (multi-vendor solutions)● Data collected within the principles of Continuas framework● HL7 CDA PHMR (Personal Health Monitoring Record)

Danish reference architecture for collecting health data from the citizens

Danish reference architecture for sharing documents and images

Danish Cross Sharing Architecture:● Clinical Data available as documents HL7 CDA● Using IHE XDS infrastructure services

Danish architecture principles

Clear accountability∙ The collection of health data is done in cooperation between the parties

– accurate agreements about who is responsible for equipment, support, etc.

The collected Health Data made available to all relevant health professionals∙ Data are at the level as other data produced at hospitals etc.

The use of International standards - ensures broad market support∙ Using standards to reduce uncertainty by investing in solutions and ensure∙ enables re-use, reduced cost and comlexity

Common metadata for forward search of relevant clinical information about patients∙ to find relevant information across domains and IT solutions∙ increasing semantic interoperability

Telecare North (TCN)

In Region of North Jutland, Denmark a large scale project for COPD patients, Telecare North (TCN), have shown that there are benefits to be gained for both patients and society.

The research has given a nuanced view of telemedicine. It shows that there is an economic benefit to the society, but only if telemedicine offered for the right groups, for example people with severe COPD.

∙ They had a strong focus on empowering citizens in telemedicine offers.∙ The project hit the target for usability with 88 percent of participants in Telecare

North finding their telemedicine equipment user-friendly.∙ The positive impact that telemedicine has the citizen's quality of life.

– 61 percent of participants feel that they are better able to control their disease, and

– 71 percent feel safer in everyday life with telemedicine.

Tele health information system

EHR information access

Health care information system

Welfare data capture application

Exchange of EHR documents

Form-based patient questionnaires

Welfare technology device

Observation uploadDevice connectivity

A B C

Welfare technology device data

subscription

Norway: PCD-01 (hData) + FHIR (REST)

Norway: Continua Norway: FHIR???(still undefined)

Norway: Not defined Norway: FHIR/REST Norway: XDS m/FHIR-innhold

SE now: IHE PCD-01, next: FHIR

SE now: Continuanext: Continua

SE NOW: SE-specific, next FHIR

SE NOW: vendor-specific, next: ?

SE NOW: Green CDA WS, next: FHIR

SE NOW: Green CDA WS, next: FHIR

DK: Now Propr. JSONRecommended: to be done

DK: Continua recommended

DK: HL7-CDA QFD/QRD (Continua)

DK:Not defined DK: To be done DK: IHE-XDS w/PHMR and QFD/QRD

FI;: FHIR for wellbeing apps to connect to national PHR

FI;: Evaluating continuaVendor specific solutionsBluetooth, USB, etc.

FI;: FHIR questioinaire and FHIR questioinaire response, some CDA as well

FI;: Not defined (looking into FHIR subsc. mechanism)Mainly vendor specific for telecare

FI;: FHIR / REST + Web GUI professionalsPatientData: CDA R2+ DICOM + PDF

FI;: HL7 V3, XDS-I + XCA, DICOM

SE

NO

DK

FI

Questions?

Meet us at the Inera booth!