DECIPHER architecture approach. Co-funded by the European Union

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1 DECIPHER architecture approach

2 Overall objective Using Personal Health Records (PHR) to support cross-border health PHR EHR Decipher Application PHR =Personal Health Record EHR =Electronic Health Record

3 PHR EHR comparison Personal Health Record (PHR) Electronic Health Record (EHR) Purpose Record manager Cross-border health issues Personal health and wellness data repository maintained to support the individual in health management An individual citizen Inherently a cross-border solution: data travels along with the individual Medical records maintained for the purposes of healthcare delivery A healthcare service provider EHR s are national, regional and local systems (crossborder access targeted by epsos)

4 Overall architecture Patient-physician interaction options: patient shows data on phone display patient prints data data is exchanged on USB memory PHR-S =Personal Health Record System EHR-S =Electronic Health Record System File operations (storage,retrieval send, print) File interface DECIPHER App EHR-S EHR-S PHR-S PHR interface Country of treatment (B) Country of affiliation (A) Patient Access Service epsos / PAC PAC interface Language translation based on epsos semantic services

5 Main components The PHR system containing personal health data and/or providing access to the medical records (EHR) of the patient Media for exchanging personal health data Easy-to-use mobile application for information access and health management EHR system (documentation of care episodes) The EHR system (containing patient s medical records) Automatic translation service for PHR contents

6 Existing EHR / PHR solutions Personal Health Channel (PHC) Access to FSET by EHIC smartcard HealthVault platform (local/regional pilots) Taltioni PHR platform HC3 (Catalonia EHR system) FSET (Toscana EHR system) Summary care record + N3 network KanTa (National EHR archive)

7 Interfaces Interface Need in Decipher Standards / specifications 1. PHR-Decipher App Transfer information between Decipher App and PHR 2. Storage media Store/retrieve PHR information to/from storage media 3. Translation Obtaining automatic translation of PHR content 4. PHR-PAC Transfer of clinical information to patient s PHR Web Services + HL7 CCD (Continuity of Care Document) IHE/XDM + HL7 CCD Translation service based on epsos or other service Web Services + HL7 CCD (Continuity of Care Document)

8 PHR data structures Identified data structures and contents: HL7/CCD HITSP C32 Blue Button Epsos IHE/XPHR Structures are similar with minor deviations. HL7 CCD (Continuity of Care document) is proposed to be used HL7/CCD contents Advance directives Allergies Encounters Family history Functional status Healthcare provider info Immunizations Medical equipment Medications Patient contacts Payers Person information Plan of care Problem Procedures Results Social history Vital signs

9 Authentication options Method Usage Examples of standards / defacto standards / products Service specific username and password Federated webauthentication based on username and password Challenge question / respone One-time passwords Smartcard PKI authentication Mobile (SIM-card) PKI authentication Biometric authentication Device authentication Widely used in global internet services. Widely used in global internet services, especially in social media services. Used as an additional security measure typically in the context of username/password authentication. Widely used in online services with high security demand e.g. in network banking. Widely used in national services. Some implementations exist (e.g. Finland) Biometric authentication is used in some personal devices (phones, tablets, laptops) Hardware or software based solutions can be used for authenticating the user platform. Basic or form-based authentication (over HTTPS), Digest authentication. Google (OpenID), Microsoft account, Facebook Advantages Simple implementation. Simple implementation. User-friendly (same password for many services). Disadvantages Password difficult to remember. Not a strong authentication method. Not a strong authentication method. - Simple implementation. Provides additional security to other methods, but is not secure enough as the sole method. Mostly national (e.g. TUPAS in Finland) and proprietary (e.g. SecurID). PKCS #11, X.509 ETSI-MSS, X.509 ISO/IEC (biometric information protection) Intel Identity Protection Technology. SecureKey. Misuse of password is difficult as it is constantly changing. Strong authentication method. Attractive for mobile apps with high security demands. User-friendly approach, since the authentication identifier is always present (e.g. fingerprint) User friendly approach bringing additional security. More elaborate to use compared to username/password Efforts needed for acquiring the smart card and smart card reader. Not yet widely in use. Not a secure enough used as the sole method. Identifiers are not anonymous and can not be revoked. Hardware based solutions are not available in all platforms. Currently the best option Possible options when widely available Or develop new ones

10 Relevant clinical coding systems Code system Description Languages ICD-10 Classification of diseases and health problems Translated to 42 languages (incl. English, Spanish and Italian) ICPC-2 Classification of diseases and health problems for primary care Translated to 19 languages (incl. English, Spanish and Italian) ATC Classification of drugs Several (including English, Spanish and Italian) LOINC Identification of laboratory and clinical observations Translated to 6 languages (incl. English, Spanish and Italian) Rationale for using codes: semantic interoperability automatic language translation

11 Test environment Decipher UI Decipher Core Services Web Service request Test PHR platform (WP5) Features: Test user accounts Simple data query functions Response content: CCD Web Service response + CCD Emulate PHR interface

12 Thank you for your attention!

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