EHTEL Telemed eHealth IOP Satellite – Heidelberg, 12 June 2008
Continuity of Care Record (CCR) in Germany ? –
PROREC activities on the way to EHR interoperability
Sebastian Claudius Semler
- Vice Chair PROREC-DE –
ªfounded in Dec. 2002
ªGerman association (e.V.)
ªprivate and institutional memberships
ªnational EUROREC centre (member of EUROREC) ªPROREC intentions:
ªfoster implementation and pervasiveness of EHR / EPR ªcontribute to standardisation of EHR / EPR
ªdissemination of EHR / EPR benefits ªChairmen PROREC-DE:
ªHorst Strüter (2002-2005) ªBernd Blobel (2005-2007) ªRolf Engelbrecht (2007- ) ªParticipant in EU project QREC
ª2002 association with VHitG; 2006 first new industrial members ªworkshop acitivites; 2007/08: CCR workshops
EuroRec - Institute
«European Institute for Health Records»
ª non-profit organisation ª established 16 April 2003
ª goal: promotion of applications and systems based on
Electronic Health Record systems (EHRs) in Europe
ª Support of national ProRec centres in Europe ª EUROREC repository & tools
EU Funding periods
ª PROREC (1996-99) – WIDENET (2001-03) – Q-REC (2006-08)
Participation in EU projects
Zentren Belgium Bulgaria Danmark Germany France Ireland Italy Rumania Serbia Slovakia Slovenia Spain Antragsteller Greece Great-Britain Netherlands Norway Poland Portugal Sweden Turkey Hungaria Cyprus
“ Differences in Language, Culture und Health Care System ”
European Quality Labelling and Certification of Electronic Health Record systems (EHRs)
Duration: 2006 - 2008
Contract No: IST-27370-SSA
Coordinator: Prof. Georges De Moor http://www.eurorec.org/
National policies for EHR implementation in the European area: social and organizational issues
Duration: 2007 - 2010
Contract No: IST-27370-SSA Coordinator: Dr. Laurence Esterle
A Roadmap for Interoperability of eHealth Systems in Support of COM 356 with Special Emphasis on Semantic Interoperability
Duration: 2006 - 2007 Contract No: IST-027065
Coordinator: Prof. Asuman Dogac
ªMethods and Processes for “Quality labelling and
Certification” of EHR systems in Europe
ªEstablishing of a central EUROREC repository for quality
and certification criteria, suitable for testing, benchmarking etc.
ªHarmonisation via national PROREC centres
ª12 Partner and 2 “subcontractors”
ªEuroRec Institute = coordinating partner ª30 months (01-01-2006 – 30-06-2008)
Continuity of Care Record (CCR)
ªdeveloped 2003 – 2006 by ASTM
(American Society for Testing and Material)
ªASTM E 2369-05
Standard Specification for the Continuity of Care Record (CCR)
ªASTM Committee E31 on Healthcare Informatics –
SUBCOMMITTEE E31.28 on ELECTRONIC HEALTH RECORDS / CCR Initiative (c/o Claudia Tessier)
ªsupported by > 12 clinical associations and institutions (US),
representing 500.000 MDs – e.g. American Academy of Family Physicians (AAFP), American Academy of Pediatrics
ªCCR = core data set as (patient) summary
of all the key current and historical data
that defines that patient’s current clinical status
Technical Design of the CCR
(Source: ASTM – CCR)
Comprehensive Security, Confidentiality, and Privacy
ª Support for compete dis-identification of data from patient and provider(s).
ª Support for static encryption and encryption in transport (IETF/W3C Compliant). ª Support for blinded patient, provider, and data identifiers.
ª IETF/W3C Compliant - all content tagged, all formatting supported through
ª Maximized for parsing efficiency and system scalability.
ª Language (tag and content) independence. ª Human readability.
ª Ease of implementation. Data Model
ª XML-based object-relational data model.
ª De-normalized for processing (processor) efficiency. ª UML object data model representation.
ª Designed to map seamlessly with PHR and EHR architectures. ª Support for 100% open-source implementation if desired.
ª Implemented using widely supported machine-readable (XML) and display/print output (PDF/H) formats.
Continuity of Care Record (CCR) Structure
XML-based, flexible data representation, scalable
ªCCR Header ªCCR Identification ªPatient Identification ªCCR Body ªPayers ªAdvance Directives
ªFunctional Status, Problems (incl. Diagnoses) ªFamily & Social History, Alerts
ªVital Signs, Results (incl. Lab)
ªProcedures, Plan of Care, Addresses ª…
Continuity of Care Record (CCR) Problems
ªto identify & extract the key clinical data needed
from the patient and the medical record to make clinical decisions
ªneed to have interoperable data models
ªneed to have data access (export & import) to EHR systems ªcomplementary to HL7 CDA
ªexchange of “data sets” vs. “electronic documents” ª“de-normalized” vs. “redundant”
ª“flexible” vs. “not binding / not mandatory” ªno (obligate) controlled terminology
ªexisting model convenient to US MDs, not fully compatible
Continuity of Care Record (CCR) in Germany ?
ªEHR situation in Germany:
ªno central mission and national institution
to push nation-wide EHRs (no “masterplan”) ªGematik ?
ªwill § 291a EPR ever come ?
ªsecondary use scenarios restricted by law
ªTechnical, organizational and financial resources are bound
to implementation project of the health card and the gematik telematics infrastructure.
ªlocal and regional approaches and projects
ªwith different business models ªwith different standards
ªfrustration and declination of IT / EPR projects by the
Continuity of Care Record (CCR) in Germany ?
ª3rd Workshop: “CCR-DE – a medical data set
supporting continuity of care”
ªMunich, 27 – 29 April 2008 Topics: ªBasis ªExperiences from CCR-implementations in US (ASTM CCR) ªEHR-COM international standard (EN 13606) ªGoals
ªDevelopment of a concept for CCR-DE ªImplementation considerations
Continuity of Care Record (CCR) in Germany ? PROREC Project Idea
ªEvaluation of CCR data set with German MDs
(is CCR suitable for the German routine ?)
ªEvaluation of CCR data sets concerning usability for clinical /
epidemiological research, public health
ªGerman translation of CCR specification and field definitions ªconceptual integration of archetypes (EN 13606 – openEHR) ªconceptual integration of well-defined nomenclature
elements (controlled terminology)
ªconceptual integration of gematik security architecture ªpilot implementation with German practitioners – using
medication export data sets for gematik ePrescription
ªShowcase: … bringing back benefits of structured data
exchange to the German MDs ! (no CCR vs. CDA project!) Support: Bavaria Min. Health, Baymatik / Go-In (eGK-Testregion),
Thank you for your attention !
Contact data + more information: