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Trillium Bridge II - Reinforcing the Bridges and Scaling up EU/US Cooperation on Patient Summary

Periodic Reporting for period 2 - Trillium II (Trillium Bridge II - Reinforcing the Bridges and Scaling up EU/US Cooperation on Patient Summary)

Reporting period: 2018-01-01 to 2019-06-30

Trillium II advances global Electronic Health Record interoperability with support, alignment and promotion of International Patient Summary (IPS) standards and by implementing the recommendations of Trillium Bridge, operational arm of the EU/US MoU on eHealth (2013-15).

The purpose of Trillium II is to bridge, harmonize, and evaluate patient summary initiatives guiding towards aligned IPS standards in a community of practice fostering digital health innovation with concete objectives:
• Highlight social value of IPS standards in events & workshops
• Bridge IPS initiatives with validated interoperability assets, sharing lessons learned
• Contribute to IPS Standards governance with the Joint Initiative Council
• Develop, collect and assess IPS learning resources for disaster readiness exercises
• Engage mobile Health companies and app developers with IPS standards in competitions
• Foster innovation & inform health policy sharing IPS assets and building synergies

Trillium II collaborates proactively with eHealth policy and deployment projects, organizes competitions for mobile health innovators and takes part in disaster exercises to advance global IPS adoption.
The work of the Trillium II project, as a coordination and support action depended heavily on the speed and direction of other activities and in particular: (a) EU-US MoU and roadmap on cooperation on eHealth standards (b) eHealth Digital Services Infrastructure (eHDSI) progress with implementation, deployment of patient summary use case, change management of the specification, and roadmap of new use cases; (c) CEN/IPS project progress of standardization; (d) national/regional initiatives on EHR interoperability and national/EU/private funding for digital health; (e) patient advocacy, health professional, industry, and government driven initiatives. Some of the initiatives mentioned above did not exist when the project concept was established in 2016, or started in January 2017, as for example the EC communication on the transformation of health and care or the EC recommendation on the EHRxF. While delays in the schedules of activities was anticipated, the influence of GDPR, the mission on cancer, and impact of the data economy and AI were not. As an example, a proposal for the free SNOMED set of terms was discussed and turned down by the SNOMED board in January 2018. One year later, an agreement was signed between HL7 and SNOMED at HIMSS2019 for a free set of terms to be used in the IPS..
The Project Executive Committee, with support from members of the Advisory Board, has exercised remarkable agility, witnessed by its many achievements.

Work of Trillium was carried out in this dynamic environment and within the limited resources of the project, emphasis was placed on frequent communication with stakeholders sharing views and developing a culture change, that welcomes health data anchored on the individual patient or citizen, are trusted and enable safe informed care as needed. Patient summaries as a citizen right is slowly being accepted and the question of how to productively make use of it is still processed by stakeholders. Governance of the associated specification, and the idea of virtual circle of providing feedback to standards bodies is still worked out.
Maximizing the impact of resources, while the program included participation in one disaster exercise, Trillium participated in two - Bucharest and Estonia. Trillium II identified fertile ground for the use of health data in disaster medicine and we trust other projects will follow. The workplan included two pilot cases, and the project signed agreements with 5 initiatives, and 4 of them C3Cloud, MOCHA, EUMFH, Frailsafe resulted in concrete pilot studies. A number of activities or collaborations like SurPass, hypertension/wellness, European vaccination card, rare disease passport, genomics, EHRxF are left to follow-up initiatives.
Achievements beyond state-of-the-art:
Trillium II was able to carry out a very ambitious program of supporting standardization and aligned development of IPS standards. This acceleration was in part due to the availability of tools and examples, and two servers. Achieving the publication of the standard has been recognized as quite an achievement.

Trillium II also brought the following innovations:
- Configuration canvas for the patient summary component libraries has been identified by the innovation radar (see D2.2 Configuration Canvas for patient summary component libraries ).
- Open source tools, example and servers to test against has been very useful for developers of mHealth apps of smartphone apps to see them.

Next steps:
The future impact of Trillium II will come from the open engagement process we have conducted in Europe, the US and beyond, which has laid the foundation for the establishment of a worldwide community on IPS. The Global IPS Community of Practice is the culmination of 2.5 years work of supporting standardization, liaising with potential users of the IPS, developing training material to accelerate implementation of IPS standards, and providing feedback from users.
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