InteropEHRate started in 2019 and has now released the final version of the open specification (including usage scenarios, user requirements, overall architecture and protocol specifications, FHIR profiles, S-EHR conformance levels) and a reference governance model to manage it.
D2D protocol supports HRs exchange by means of Bluetooth on Android and iOS. It allows the use of ID-Cards or qualified digital certificates to identify citizens. R2D Access protocol offers different modalities of data import, including asynchronous one, and exploits eIDAS infrastructure to identify citizens. R2D Backup protocol supports the backup of encrypted health and may be used to restore the saved health data on another mobile device, while the cloud service provider has access only to the encrypted version of the health data, to preserve the privacy. If activated by the citizen, the R2D Emergency protocol allows trusted HCPs to access and enrich health data they stored on the cloud, during an emergency. RDS protocol allows EU citizens to participate in a research network and contribute to multicentric research studies, by sharing specific anonymised health data directly with the research centres involved in the studies they contribute to, without involving third parties. Different kinds of anonymization are supported. Final versions of the R2D specification leverage the WADO-RS standard to support the download of DICOM images, similar support is added to the RDS protocol too.
The security conformance levels specification includes new evaluation criteria and a specific assessment process defined for determining the level of conformance of a S-EHR app or a S-EHR Cloud service. This methodology was applied and tested to classify the level of conformance of the prototypes developed by InteropEHRate. The specification includes a step-by-step guide to evaluate activities object of privacy policies.
The InteropEHRate FHIR profiles were published as two InteropEHRate FHIR Implementation Guides, for Cross-Border Data Exchange (CBDE) and for Research Data Sharing, covering both the representation of health data required by the InteropEHRate scenarios and the representation of metadata for representing the provenance of data and for supporting identification, consents, translation and encryption. The released final version of InteropEHRate framework includes: a reference implementation of the five protocols; prototypes of S-EHR app and HCP App (example of application for the HCPs), prototype of R2D Access service, of EHR Index (optional components supporting one of the variants of the R2D Emergency protocol), of S-EHR Cloud service; prototypes of service nodes to operate a research network based on the RDS protocol.
The final implementation of the D2D, R2D, and RDS protocols, and related security mechanisms, were released as reusable software libraries for Android and Windows, and were exploited to implement the final prototype of S-EHR and HCP App, co-designed by focus groups of patients and HCPs. The reusable libraries were used to implement supporting services like S-EHR Cloud, R2D Access Service, RDS nodes. The InteropEHRate framework also includes a new version of tools and services for data conversion, translation and information extraction.
These results can be used singularly or in combination with the others. All reference implementation libraries, and most of the prototype applications and services, were released as open source software and actually deployed and validated by final users (patients, HCPs, researchers) during the pilots. The evaluation data was released as a public report, available with other InteropEHRate documentation, for future exploitation and evolutions of the project results.
