Quality and Efficiency of the Implementation – Deployment of Generic Cross Border eHealth in Cyprus

Maturity of the proposed Action

Cyprus will do everything in its power to continue complying with eHealth Network guidelines and decisions:

Overarching principles are defined by Directive 2011/24/EU
Guideline on an Organisational Framework for eHealth National Contact Point
Governance model for the eHealth Digital Service Infrastructure during the CEF funding
On minimum/non-exhaustive patient summary dataset for electronic exchange
On ePrescriptions dataset for electronic exchange

and aims to be compliant with:

Multilateral legal agreement (as soon as there is a formal endorsement by the eHN).

Cyprus decided to apply for CEF funding the deployment of eHealth generic services on the basis of high level of maturity of National eHealth systems, namely the national ePrescription/eDispensation and Patient Summary solutions.

Cyprus is committed to deploy and provide a cross border eHealth service under the CEF 2015 eHealth time frame (2017 to 2020).

Cyprus participated and gained significant experience in scrutiny and peer-to-peer tests, scoping cross border Patient Summary, supervised by IHE at the Connectathon in Luxemburg in April 2015, Expanadathon in Lisbon in December 2015, and will also participate in the Connectathon in Bochum in April in 2016. The Cyprus team (the University of Cyprus in collaboration with the Ministry of Health) participated testing their open source software libraries for epSOS and EHR.

More specifically, in order to address the need for open source software, linked with recent ICT technological trends, the FIWARE project [http://www.fiware.org/] “Open APIs for Open Minds” was funded under the EU “Future Internet Public-Private Partnership – Internet Enabled Innovation in Europe” program (FI-PPP) [http://www.fi-ppp.eu/]. This is an open initiative aiming to create a sustainable ecosystem to grasp the opportunities that will emerge with the new wave of digitalization caused by the integration of recent internet technologies. FIWARE is divided in several pillars where each one of them is focused on a specific scientific area. One of the main pillars is the “Future Internet Social and Technological Alignment Research” (FI-STAR) project dedicated to the development of a cloud based platform with open source libraries that can be exploited for eHealth applications [https://www.fi-star.eu/fi-star.html].

Targeting towards the enrichment of the FI-STAR framework for use in the health care domain, the EHR-EN software library that was the area covered by the Cyprus award addressed the following two objectives. Firstly, to build (i) the Electronic Health Record specific enabler (EHR-SE), (ii) the patient summary specific enabler based on the “European Patients Smart Open Services” (epSOS) project (epSOS-SE), and (iii) the Picture Archiving and Communications System (PACS) specific enabler based on the dcm4che open source software [http://www.dcm4che.org/] (PACS-SE). The above three FI-STAR platform enablers facilitate the deployment of innovative applications and value added services in the health care sector. The second objective is to validate and evaluate the EHR-SE, epSOS-SE, and PACS-SE FI-STAR specific enablers by developing proof of concept collaboration scenarios, which will finally prove and demonstrate the usability, applicability and adaptability of the proposed enablers in agreement with the EU “eHealth Action Plan 2012-2020 Innovative healthcare for the 21^st century”.

The patient summary epSOS SE architecture is shown in Fig. 2.1.1. It is based on the following components. (i) Management/Administration component: This component is responsible for the configuration and monitoring of the epSOS SE. (ii) Rest Interface: Responsible to establish communication with third parties. (iii) Storage component: Responsible to communicate with the Storage GE for storing and retrieving the collected data. (iv) OpenNCP client connector component: Responsible to communicate with the openNCP client connector. (v) Timing Service component: Responsible to communicate with the Timing Service SE for having a common time stamp. (vi) The security component is responsible for authorization and authentication of the requested access to the epSOS SE. (vii) Event Management: Responsible to communicate with the Event Management SE. The epSOS SE BACK-END API covers the connection to the OpenNCP. More specifically, the epSOS SE includes a repository in which data are stored and retrieved using specific APIs. Furthermore, the epSOS SE offers the functionality to develop the client site and the client connector to a local NCP portal as it is defined by the epSOS large scale project and following the recommendations and guidelines offered by the OpenNCP platform (see also Fig. 2.2.2). The connector provides methods that use the aforementioned APIs for retrieving the documents requested by the OpenNCP platform. More details and the link for downloading epSOS SE can be found at the FI-STAR project catalogue [http://catalogue.fi-star.eu/enablers/]. Figure 2.1.2 presents a pilot FI-STAR based eHealth application using the EHR SE, the epSOS SE and the PACS SE.

Fig. 2.1.1 FI-STAR epSOS SE architecture (that can be for downloading from the FI-STAR project catalogue [http://catalogue.fi-star.eu/enablers/]).

Fig. 2.1.2 Integrated interoperable eHealth services based on the IHE profiles. A FI-STAR eHealth solution is demonstrated showing its connection with Hospital Information Systems (HIS) legacy systems, and the exchange of patient summaries using the OpenNCP server.

The FI-STAR eHealth application is exchanging patient info with: (i) other legacy systems via the national infrastructure hub, and/or (ii) patient summaries via the national infrastructure hub and its connection to the OpenNCP server. The supported IHE profiles are also documented below.

The EHR SE (that is also a component of EHR SE) was certified for selected profiles at the IHE European Connectathon in April 2015. Specifically, the EHR-SE implemented the PDQv3 and XDS.b IHE profiles. The PDQv3 supports a consumer profile and lets applications query a central patient information server and retrieve a patient’s demographic and visit information. The XDS.b Profile (Cross-Enterprise Document Sharing) is focused on providing a standards-based specification for managing the sharing of documents between any healthcare enterprises. For this profile, two actors were implemented, the first is the consumer, and the second actor is the source as documented above. The implemented profiles were tested with registries and repositories implemented by other companies participating in the five day connectivity and interoperability marathon. In total, 10 different companies took part in the performed tests with the EHR-SE and 20 tests were performed which were all successful.

The epSOS SE (that is also a component of EHR SE) was certified for selected profiles at the IHE European Expandathon in December 2015. Specifically, the epSOS-SE implemented and passed successfully the following IHE profiles and actors: (i) epSOS Security ARR, (ii) e-SENS-NREE NCP-A, (iii) epSOS ePS Document CONTENT_CREATOR (for both NCP-A and NCP-B), and (iv) epSOS ePS Document CONTENT_CONSUMER (for both NCP-A and NCP-B). In total 10 different organisations participated (9 countries and EU DG Sante) in the three day connectivity and interoperability marathon.

In the IHE European Connectathon in Bochum in April 2016 the following IHE profiles will be tested: (i) epSOS-Authentication – epSOS-Authentication (NCP-A – National Contact Point Country A & NCP-B – National Contact Point Country B; (ii) epSOS ePS Document – epSOS Patient Summary Document (A & B), CONTENT_CONSUMER – Content Consumer, CONTENT_CREATOR – Content Creator; (iii) epSOS Identification Service (A & B); (iv) epSOS Patient Service (A & B); (v) epSOS Security (A & B), SN – Secure Node, ARR – Audit Record Repository; (vi) e-SENS-NREE – Non Repudiation Evidence Emitter (A & B).

Cyprus will strictly comply and follow the principles defined by Directive 2011/24/EU (namely article 11th and 14th) and will follow the “Guidelines on an Organisational Framework for eHealth National Contact Point”. See section 2.2 Management Structure for more details.

Cyprus will be able to deploy a technical gateway (Pre-Production and Operation environments) based on the NCPeH specifications.

The Cyprus NCPeH technical gateway needs further implementation developments and testing and this activity will be finalised with the award of this proposal. This relates to the National Infrastructure concerning the Patient Summary and the ePrescription/eDispensation.

Cyprus is planning to perform testing activities, namely with the involvement of health professionals, citizens and with the participation on Connect-a-thons/Project-a-thons.

Cyprus will be able to perform scrutiny and peer-to-peer test, namely through the participation at IHE Connect-a-thons in 2016 and 2017 with Patient Summary and 2018 with ePrescription.

All the readiness criteria related to the following entities will be strictly followed (see also section 2.2): Legal, Organizational, Semantic, Technical, Testing, Dissemination and Training, Operations, and Evaluation.