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EU eHealth in focus


In Europe, the eHealth Network established under article 14 of the cross-border directive endorsed in November 2013, the guideline for a minimum health data set to be used in emergency or unplanned care cross-border situations.

During a live demonstration in Boston (US), experts from the Trillium Bridge project proved that it is technically feasible to exchange Electronic Health Record (EHR) data between the European Union and the United States. This means that in theory it is possible for a local treating physician, provided the patient has given his or her consent, to request and access an EHR patient summary from the patient’s provider across the Atlantic. 

Following the success of this demonstration, the EC published an official post where the event is pointed out as an important step towards Digital Agenda for Europe.

Feel free to share your thoughts about this, below in the comments.

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Marisa Branco


Transatlantic exchange of Patient summaries:

Live demonstration from Trillium Bridget Project.

Last month, October 22, at the State House of Massachusetts in Boston, during the 5th EU-US eHealth Marketplace and Conference, the Trillium Bridge, presented a live demonstration of provider-mediated exchange of patient summaries between EU and US, proving the technical feasibility of the exchange.

Gnomon Informatics SA supported by iUZ and the OpenNCP community worked with the Kaiser Permanent (KP) eHealth Exchange team (the major provider of healthcare services in the United States and the main partner in that country) to create a proof of concept reference implementation of the Trillium Bridge gateway as part of their eHealthPassTM project that is able to exchange clinical patient summaries with the eHealthWay.


Trillium Bridge Project

The Trillium Bridge project, co-funded by the European Commission, is a transatlantic clinical data exchange mission to establish the foundations of an interoperability bridge for the meaningful exchange of patient summary and electronic health records between the European Union (EU) and United Sates (US).


 According with Trillium organisation the project “support action extends the European Patient Summaries (epSOS) and Meaningful Use II, Transitions of Care in the United States to establish an interoperability bridge that will benefit EU and US citizens alike, advancing eHealth innovation and contributing to the triple win: quality care, sustainability and economic growth.”


The Trillium Bridge gateway, an adapted version of the national contact points in EU Member States for the epSOS large scale pilot, was used to search and retrieve in real time, the patient summary in CCD (Continuity of Care Document) of a United States citizen, enrolled in a Kaiser Permanente health plan. The demonstration involved:


  • a patient (Martha): who is from San Diego and had an accident during a trip to Italy where she was taken to the hospital

  • a fictional Italian doctor (played by Giorgio Cangioli Trillium Bridge project manager): Giorgio, deep in his role of the Italian physician, accessed the patient summary in Italian and wrote a note for patient’s physician back in the States.

  • Zachary Gillen (interoperability director at Kaiser Permanente) reviewed the information together with Martha once she was back home.



  • a patient (Paolo Cerutti): a European Citizen visiting the US, who suffers from chronic hypertension and lost his new medication while traveling to San Francisco and could not explain the symptoms he was experiencing

  • Zachary (as a KP Physician) showed that the same functionality can be available for Paolo Cerutti. In Boston, Zachary, successfully retrieved in CCD the patient summary of Paolo and identified his medication.


The demonstration proved that with effective transatlantic collaboration, the EU and the US can set the pace and tone for global standards development and eHealth innovation.

The experience gained and lessons learned will inform the work of IHE profiles XCPD (Cross-Comunity Patient discovery) and XCA (Cross-Comunity Access) and will be continued in pursuit of end-end integration for HIMSS 2015 in Chicago on April 2015.It is also expected to inform the efforts underway toward an international patient summary specification under the auspices of HL7 (Health Level 7), ISO (International Organization for Standardization) , and CEN.

We’ll give you the inroads of this project. Tell us what you think, bellow in the comments. 

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Ana Castilho

Interoperability Infographic | iUZ Blog

(Check our new infographic below)


We have been talking a lot about health interoperability lately, but what this mean exactly?

Well, have you watch Marcelo Fonseca iUZ.Talk back in July?


Back then, Marcelo explained iUZ point-of-view in the health interoperability field, and has referred important related aspects during his pitch. We have recorded it and you can still view it in our Youtube Channel.



Health Interoperability definition


According with HIMSS – Health Information and Management System Society, health interoperability is:

(…) the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged.

Data exchange schema and standards should permit data to be shared across clinicians, lab, hospital, pharmacy, and patient regardless of the application or application vendor. Health interoperability means the ability of information systems to work together within and across organisational boundaries in order to advance the effective delivery of healthcare for individuals and communities.

There are three levels of health information technology interoperability:

  1. Foundational (allows data exchange from one information technology system to be received by another)
  2. Structural (an intermediate level that defines the structure or format of data exchange)
  3. Semantic (provides interoperability at the highest level, which is the ability of two or more systems or elements to exchange information and to use the information that has been exchanged. Takes advantage of both the structuring of the data exchange and the codification of the data including vocabulary so that the receiving information technology systems can interpret the data)

(Source: HIMSS – Definition of Interoperability)



Cross-Border Interoperability and Challenges in the Interoperability field


At iUZ we have committed a lot of our time to cross-border interoperability in the healthcare field (check our epSOS case study (new) page), as cross-border interoperability “aiming to provide tools and common ways to exchange information between countries” (Source: Slideshare). According with epSOS, cross-border interoperability also means interoperability between neighbouring and non-neighbouring epSOS Member States and their entire territories.
In Marcelo pitch, he spoke about a few challenges in the interoperability field, being:

Legal and organisational interoperability challenges, such as:

  • Implementation of legal common grounds for information exchange
  • Establishment of circles of trust
  • Legal recognition of involved parties, such as HCPs (including their roles), patients and others
  • Set in place common authentication mechanisms (e.g. European e-Identification projects)
  • Etc.

interoperability challenges, such as:

  • Represent as much as possible the information using clinical code-systems
  • Define common and agreed value sets for information exchange (e.g. health sets of terminologies)
  • Establish formal mappings of existent information to the agreed value sets
  • Include the translations to allow multi-language capabilities (for cross-country scenarios)
  • Etc.

interoperability challenges, such as:

  • Implement common interfaces for services
  • Establish agreed format for information exchange
  • Prove and certify the compliance level of the involved systems
  • Define roadmaps for information integration
  • Etc.



Interoperability Benefits


Regarding the benefits for having information systems connected through cross-border health interoperability, are:

  • For citizens and patients:
    • Receive health care abroad (almost) seamlessly;
    • Receive medication in a foreign country on existing prescription;
    • Access to his own information in multiple languages and recognised formats;
  • For Health care providers:
    • Get quick and easy access to key patient data;
    • Improve health care cooperation across borders;
  • Health care quality:
    • Reduce medication errors by exchanging data;
    • Facilitate the occasional care of foreign patients


The answers to these issues are in these organisms:

  • IHE – Integrating the Healthcare Enterprise
  • HL7 – Health Level Seven International
  • DICOM – Digital Imaging and Communications in Medicine





We’ve already written about IHE, when we joined IHE international as a member organization and when we went to Connectathon 2014 in Vienna (Austria). IHE – Integrating Healthcare Enterprise, is an initiative by healthcare professionals and industry leaders that aims to improve the way computer systems in healthcare share information.

According with IHE, they intend to promote the coordinated use of established standards such as DICOM and HL7 to address specific clinical needs in support of optimal patient care. Systems developed in accordance with IHE communicate with one another better, are easier to implement, and enable care providers to use information more effectively. (Source: IHE)



Health Level Seven International (HL7) is a not-for-profit, ANSI-accredited standards developing organization. HL7 provides standards for interoperability that improve care delivery, optimize workflow, reduce ambiguity and enhance knowledge transfer among all stakeholders.

HL7 is dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information.



Digital Imaging and Communications in Medicine (DICOM) “is a standard for handling, storing, printing, and transmitting information in medical imaging.” (Source: Wikipedia)



See our new brand infographic about “What is Health Interoperability?”:


Click in the image to view full-size or see it on Slideshare. Don´t forget to share it.




There are much more to say about health interoperability. Share with us your thoughts, below in the comments.

Opening the Future of Healthcare.
Contact iUZ today at +351 234 247 381 or visit iuz.pt

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Ana Castilho

Interoperability - Joining IHE International


Interoperability in Healthcare.  Integrating the Healthcare Enterprise (IHE International)

epSOS European Patient – Smart Open Services project was a massive and a key interoperability project for iUZ, as we explained in our business case study. Through this project and some others, we’ve achieved knowledge and experience in the IHE Profiles field.

As we referred, through the epSOS we’ve started to use some IHE Profiles, and we’ve already been to three IHE Connectathons in Europe (Bern – 2012, Istanbul – 2013 and Vienna – 2014), as we explained in this post.

This type of actions gave us the needed experience and background in IHE profiles field, and for that we consider that was time to become an institutional member of IHE International.


We’ve been accepted as a IHE Member Organisation, in the middle of August

But, for those who do not know, what is IHE International?

IHE International – Integrating the Healthcare Enterprise is a U.S. organisation that intends to promote the Health Industry connected to interoperability. IHE aims to improve sharing communication between information systems linked through the creation and development of interoperability standards.

Our membership allows us to contribute in a pro-bono basis, with more than 200 organisations in IHE International. We have associated to the IT Infrastructure Domain, regarding the Technical Committee, where Ivo Pinheiro and Marcelo Fonseca are representing iUZ.
According with IHE, IT Infrastructure (ITI) Domain:

“… addresses the implementation of standards-based interoperability solutions to improve information sharing, workflow and patient care.

This domain, begun in 2003, was originally launched by sponsor Health Information Management Systems Society (HIMSS). In 2008, GIP-DMP (Groupement d’Intérêt Public pour le Dossier Médical Personnel) joined HIMSS to help sponsor this domain adding additional user representation in Europe.

Together they are responsible for development and publication of the IHE IT Infrastructure Technical Framework.“ (Source: IHE – ITI Domain)

Throughout the ITI Committee association, selected by us among a range of 22 other committees, we can have a voice participating in meetings regarding the creation and revise of IHE profiles concerning the domain.


epSOS and OpenNCP- Open National Contact Point using IHE Profiles

Our work in Interoperability in Healthcare and in IHE Profiles was mainly during epSOS implementation, and subsequently OpenNCP. We have applied the usage of the following profiles:

  • XCPD (Cross-Community Patient Discovery): The Cross-Community Patient Discovery (XCPD) profile supports the means to locate communities which hold Patient relevant health data and the translation of Patient identifiers across communities holding the same Patient’s data. A community can contain EHRs, PHRs and other systems. More info at: http://bit.ly/IHE-XCPD
  • XCA (Cross-Community Access): The Cross-Community Access profile supports the means to query and retrieve Patient relevant medical data held by other communities. A community can contain EHRs, PHRs and other systems and healthcare applications. More info at: http://bit.ly/IHE-XCA
  • XDR (Cross-Enterprise Document Reliable Interchange): Cross-Enterprise Document Reliable Interchange (XDR) provides document interchange using a reliable messaging system. This permits direct document interchange between EHRs, PHRs, and other healthcare IT systems. More info at: http://bit.ly/IHE-XDR
  • XUA (Cross-Enterprise User Assertion): The Cross-Enterprise User Assertion Profile (XUA) provides a means to communicate claims about the identity of an authenticated principal (user, application, system, etc) in transactions that cross enterprise boundaries. The XUA Profile supports enterprises with different authentication mechanisms. More info at: http://bit.ly/IHE-XUA
  • BPPC (Basic Patient Privacy Consents): This profile provides a mechanism to record the Patient privacy consent(s) and a method for Content Consumers to use to enforce the privacy consent appropriate to the use. More info at: http://bit.ly/IHEBPPC

Tell us your thoughts, below in the comments.

(image: Chris Potter)



Opening the Future of Healthcare.
Contact iUZ today at +351 234 247 381 or visit iuz.pt


Ana Castilho

Bridge - Expand-Project


Have you heard about Expand Project?

If not, the Expand Project - Expanding Health Data Interoperability Services is being funded by the European Commission Competitiveness and Innovation Programme (CIP) within the ICT Policy Support Programme, and is being led by the Portuguese Health Ministry, Shared Services – SPMS.

In a few words, Expand is bridging a selected number of eHealth Projects, like epSOS – Smart Open Services for European Patients to CEF – Connecting Europe Facility (anchored to the Europe 2020 Strategy), in order to deploy large-scale cross-border projects.

The main purpose of the Expand Project intends to support and promote EU Member States in “delivering their local eHealth plans and improving cross-border care” (Source: Expand Project).

As well as epSOS, SemantinHealthNet (SHN), CALLIOPE, eHR4CR, PARENT, e-SENS, and other projects, are being guided by the decisions taken in the eHealth Network (eHN), not forgetting, the Trillium Bridge project and the eHealth Governance Initiative (eHGI).

If you want to know more about Expand Project go to: expandproject.eu

Expand Project

Have you heard about this initiative?
Share your thoughts with us, below in the comments.


(image by Nicolas Raymond)


Opening the Future of Healthcare.
Contact iUZ today at +351 234 247 381 or visit iuz.pt

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Ana Castilho

IHE-Europe Interoperability

Last Friday, 11th July our CEO Isabel Cruz and Ivo Pinheiro were at the First Meeting in Portugal for “Technical Interoperability in Information Systems for Health”, associated with the IHE-Europe. The event was organised by SPMS and took place in Faculdade de Engenharia do Porto.

During the event was referred the IHE role and several national framework case studies. IHE (Integrating the Healthcare Enterprise) through their specifications connects clinical institutions, IT industries and users in order to raise healthcare interoperability, among organizations.

Interoperability Director at IHE-Europe, Karima Bourquard spooked about IHE-Europe, such as, IHE Profiles; Case Studies; How to create an IHE National Chapter and the Connectathon events as we’ve write to you in this post.

Have you been to this event?

By the way, check this video to know a bit further about IHE-Europe:

Please, share your thoughts, below in the comments.


(image: IHE-Europe)

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Ana Castilho

epSOS Industry Team

(Source: Flickr – Heather Cast a Line)


Have you heard about epSOS Project?

For those who didn’t, epSOS is a European eHealth Project started in 2008, where Portugal was involved through SPMS and iUZ as its technical partner. This initiative is a cross-border interoperability platform, which allows access to the patient health records and the use of electronic prescriptions (or ePrescriptions) in European countries, while a citizen is in a foreign country.

During this project the opportunity to become part of epSOS Industry Team pop up, and since early April we are proud to be part of it, and to share it with you.


But, what is the “epSOS Industry Team”?

The Industry Team (IT) is a pro bono consortium represented by IHE-Europe. IT is a segment of epSOS project, which presently connects a group of 30 eHealth companies – SME’s and multinationals – that work together with their knowledge for a common good – epSOS (source: epsos.eu).

Any company in the eHealth field can participate with their knowledge and expertise. In iUZ case, we are supporting with the knowledge acquired during the implementation of epSOS Project in Portugal, such as, providing semantic and technical interoperability knowledge and expertise and, assisting with the developments of OpenNCP (Open National Contact Point) building blocks.

With this association iUZ pretends to help leverage eHealth in Europe, creating also new business opportunities and expanding our network.

If you want to know more about iUZ participation in epSOS project, please go to our case study. Also find more information about the Industry Team in epSOS website.


Have you heard about epSOS Project? Are you part of one of the companies from the Industry Team?

Let us know in the comments.

Opening the Future of Healthcare.
Contact iUZ today at +351 234 247 381 or visit iuz.pt

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