Thierry Dart & Stéphane Spahni provide theories and examples of the Swiss and French Projectathons in this second IHE-Europe webinar session.
We can start um so we have three speakers today the first one will be Stefan spanny who is a n architect at the Geneva Geneva University Hospital and also um IH Europe Deputy co-chair he will be presenting what is a project Aton and more specifically the Swiss uh project
Aton and then we will have uh tiar so director of medical Affair and labeling department at vs which is the national French agency and his colleague M prior that’s project manager at the ins also I will leave the floor to Stefan to start and you should be able now Stefan
Perfect thank you thank you thank you Sophia good afternoon everybody so I will present first a bit the project Aton and then move to what we do in Switzerland in this regard uh if you look at some key steps when you are making a project uh the key ones more related to
Ig you have to select the the standards you define the use cases and out of that you can start your implementation and then you need to validate your implementation so there you will have connect Aton you will have project Aton and you have pre-production tests so we’ll focus on
The two low uh boxes which are part of what we call the IG testing Continuum testing Continuum is here for as the name says testing the implementations and you have different parts different uh building blocks for doing the testing you have enablers you can start by participating for example to
Fire hl7 fire connect Aton to plug Aton other hack Aton or other connect Aton then we have the central part is the the key tools parts of the testing Continuum the connect Aton and project Aton but you also have other tools like the Shone uh more for testing uh in
Relation with imaging you also have the IG Conformity assessments which will will not speak of it uh today which is more Conformity assessment of a product both connect Aton project Aton you have results that are published or uh published under the the project uh the Conformity assessment makes a product leling so
Goal of the connect Aton which are similar to those of the project Aton is really to promote the interoperability through the adoption of the common standards the IG profiles to validate the Conformity or the the good implementation of the profiles like with uh Standalone test you will test for
Example if you produce a document you will validate that the structure of the document is correct that the content is correct so that’s what we call Standalone test you can also do some tests against simulators when you implement an exchange between two parties you generally Implement one of
The two parties and you test again the simulator of the other party and then during the most the the most important phase during the connect at tone is testing against other implementation because we know that if you if we test only uh uh with with our own
Implementation in a closed box we will not takeover many many mistakes many problems so it’s very important to test against other implementations of the same profiles other peers project Aton is exactly the same simply while the connect Aton is more generic testing you test the the IG
Profiles like there are in a project Aton you will test in a a specific context like we will see after the Swiss context or the French context but so there are small differences between the two governance governance of a connecton is under the I Regional National deployment uh committee governments I Europe for
Europe I North America for the North America i Japan for Japan uh while the project atone is under the project governance like the the ins in France heal Swiss in switzland the criterias for success for having a successful uh testing session it’s for the the IG test methods and the the
Criterias developed uh in relation with each I profile for the collect Aton in a project Aton you may have some specific rules linked to the projects to which you are participating or some specific uh extensions linked to the project and results the IG connect Aton results are
Published in uh on an official site of IG publication of results of a project Aton it depends on the project it’s a project that has the lead for publishing or not publishing the result of the project at on there are certain number of project Aton
Now uh there is the one in uh South America Canada Health inway wh uh European commission through the My Health at AU is also doing project Aton and the ins project Aton in France the epr project Aton in Switzerland and the list will certainly grow over the
Years and but as I I show there are small differences between the two but if we look at concrete realization you have pictures here from the last two connect atom the one in mro the one in Ren but in both cases you have in the the left
Tables in montra where for the Swiss epr project Aton the the room which is just on the right of the the top image is this one which uh where there was was the ANS the French project Aton so it’s basically the same kind of events you have the different uh developers the different
Systems that are coming and which will do a certain number of tests together against one against the other and using the the same kind of tools so going more specific to the the Swiss CPR projecton as I mentioned it’s related to a specific Project Specific environment and for us in Switzerland the the
Project or the the environment is the electronic patient record uh federal law which was uh published in 18 and in force from April 2020 uh the context is a bit different from the one for example in France uh we have National regulations but we have Regional implementations and Regional responsibility of the
Implementations uh which lead in Switzerland to several electronic patient records communities which are XDS Affinity domains so separate implementation separate systems separate environments but that have to be interconnected that have to be linked together because a user should never know that there are different communities over the country a patient
In Geneva going for care in Zurich do not have to know that it’s not the same community that the professional is not in the same platform as him it’s a whole and it has to be transparent for the users both the patients and the healthcare professionals so we have now eight of
These different communities eight uh that’s Regional communities each one is implementing its own set of services its own implement it has its own implementation of the epr services of the management of a community of the onboarding of patients on boarding of Physicians everything is DC multipli multiplicated by by eight
And but all these have to work together and from the outside be seen as one big epr platform epr Community the or every Community is based on IG profiles that’s part of the law there are a certain number of mandatory profiles quite a quite a lot of different profiles there are also National
Extensions about the the the access log uh about the the management of um the index of healthcare professionals uh the management of the the access rules the policies and some Central Services for managing the national uh patient identifier so part let’s say standard according to the international IG profiles and some
Specializations what we called uh volume four for the IG profiles or specific Swiss profiles every Community every technical platform has to be certified the processes the implementation of the standards the implementation of national extensions and of course the interoperability between the different implementations all that has to be certified by a certified
Auditor uh primary systems making deep integration also have to go through uh a bit limited but still uh a certification technical implementation of the interface faces with the with the community the processes the administrative processes are certified and this audit is performed at least every two or three
Years by a certified auditor and in between by the community the primary system is Affiliated to so then there’s a question how can you how can we support the implementers and the certifiers because they have to certify that a platform that also uh the technical implementation is uh corresponding to
The the specifications so the IG profiles and the national extensions so there is the generic testing where the software providers can do the the generic testing of the implementation of the EDG profiles through the connect Tunes but we also have the Swiss project Aton where we do the EP related testing
So same model as the connect Aton but the test plans are tuned are designed according to the epr use cases and the national uh complements and the national profiles project Aton may be run parallel with the the connect Aton to same same time same location like in mot
In uh last year or independently like this year uh as the connect Aton was in uh in Ren we have uh we had a connect Aton in Bur in both cases we are using the IG gazel platform the IG testing tool platform for the apri related testing so we have a
Selection of the mandatory profiles correspond to the implemented domains we do not test in the project at on profiles that are outside of the scope of the the original project uh there are also some restrictions in the transactions we will test for example for the the patient uh
Identity uh or the patient demographic query we are using the one the specifications based on hl7 V V3 not V2 so we will test only P V3 PDQ V3 transactions and not the others and that’s also valid for other uh profiles National extensions and so we have a
Cent set of profiles and transactions for the project Aton which really Maps the needs of the project and in order to do this test in the the best uh with the best environment uh possible we have a reference implementation which is made out of the testing tools the IG gazel testing tools
But tuned configured with the the Swiss profile so proposing only the epr used transactions and based on the national extensions National specifications also have a set of samples based again on the national specifications the project Aton itself is organized every year since 2017 one week like the theconnect Aton it’s
Inot and the key use cases we are testing is the patient management document management and heare professional directory management uh the participants are a few primary systems DPR platforms implementers and Central Services we are trying to get more and more primary systems so that they can validate also their
Implementation uh we had uh collaboration in 18 19 and 22 with the connect Aton so like I showed the the picture for MRA where we do in the same room so we share the the same technical infrastructure and we can have also uh which is very very interesting for every
Participant synergies with the it connect Aton participants so each one can have a look can know what the others are doing and some companies are participating in both the connect Aton and the project Aton we have also started uh in 21 uh we had an medication project at on in spring
Because we were just starting the edication testing now it’s uh part of the national EP project Aton every year uh so it’s uh one uh aspect of the EP project Aton for the edication uh the Swiss projecton is organized as a it’s a partnership between el Swiss and IG Swiss and it’s
Uh implemented by IG Europe IG Catalyst for the the technical platform eal Swiss is more the main organizer the sponsor and IH Swiss uh has the technical project management and olders support related to ig we also have some additional testing events uh that’s linked to the the structure of the law where the
Communities are responsible for allowing primary systems to connect to the platform so they are uh validating the technical interconnection of the primary systems with the the the DPR Community with the DPR technical platform and we do not follow for that uh onee cycle because primary assistance may be ready at any
Time so for example for the the French speaking uh Community which is called Cara from which I am member uh we organize periodic what we call caraton which is again it’s a small project Aton uh with only one primary system and the community and we test all the the profiles implemented by the
Primary system they may have a partial deep integration so we test every transactions they are uh implementing and we do not have the monitors like for project at own but it’s the car technical team which is doing the the validation and for that we are that’s
Why also I mentioned that we have uh developed a special toolkit uh we are testing a primary system against the the technical platform the technical instances of the epr platform and the identity providers and Cara has developed uh a proxy uh which is called a integration kit which is in between
The the technical platform and the primary systems with uh two goals one is to intercept every request and response and validate it with the gazel tools so every message uh query and response are validated with the IG gazel tools and you have uh through a web page you have
A report with a link on the gazel uh test instance and it has also another functionality which is to to help the in the early phases the primary systems Implement uh implementers by providing a certain number of functionality especially linked to the the IDP uh where they can simulate the uh
Users authentication and all the the burden of the the certificates the the SSL certificates they can be managed at the a integration kit level for the initial development phase of course when we do the testing the par the Parise system has to implement all that and
It’s just used as a proxy for uh linking with the testing tools but it’s very useful for that and that’s it for the the Swiss project at and I will leave the floor to my French colleagues and we’ll take the questions after thank you Stefan uh maybe I will share share my
Screen for you TI and M you are all able to see it yes yes thank you good morning everyone um I will explain uh how we organize a French project at why and how I will be with my PR uh next slide first we are we are the French heal
Agency French heal agency is a national government agency we have a free Mission and U in the mission of to regulate we have um two framework one for interoperability and one for security um we also member of F and F level S at the international and National level next
Slide um in term of interoperative we are profiling and most of work uh we are writing a national extension of the profile we are also Distributing terminology we are testing and by testing we have a national platform for testing and we are organizing each year
A project Aton and we are also have a certification process next slide um in France um at the national level the law establish a French Health identity number called ens identif National under practition directory we have also what we call a d do medical DM is a national XDS repository
Of CDA document it’s in production since since 201 and we use CDA profiling most are only PDF uh CDA we level one I mean PDF but some I level three and we use biological report in level three humanization report and a Child Health Report on a copy also of prescription and
Dispensation we have also at the national level um a secure email system for practitioner uh for practitioner uh called messery security Sante and we have a third system mon Sante for patient uh with a passion calendar based on fire we have also a viewer CDA documents so patient could
See the document in the dosier medical part and you have a small component also of patient health record next slide um in France regulation is National implementation of this free system uh is at a National level and we have a national interoperative framework where Bas most of our job is
To do profiling most are I National profile extension of of international profile we also have some profile based on fire implmentation guide we have this National inity from work since 2009 we have a national uh project annual and National project we have also an N platform and we have also a
Terminology server and we have a certification process for uh since 20 2021 next slide I will not go in detail but here you have the main component the main interface under name of the profile we use most are from E uh so we have at the center the DMP is
A CDA repository of documents using XDS repository connected with professional software on the right and also with patient software on the left we have also uh um a patient has space mon Sante with a fire registry free for Vital sign and for calendar next slide we are we have been organizing
Project Aton since 20 it’s a national project at on it’s on most your case are based on DMP mon Sante we are also organ we are also organizing testing for for project for testing um for example uh directories sharing image also on the testing tool is based on gazel we are organizing a
Project at by yourself and also connected with yashi Europe connect at only two times and uh the last time it was this year in September with the same new case and the ID idea is to create Synergy with AI Community during this uh during the the European connect next
Slide what are the benefit for vendors of a project for the for vendors is to test the compliance of this system um is also to report to us any correction or EV or evolution in know specification and that’s very important for us to have a feedback uh from the
Vendors from the for from the developers um for the vendors benefits are also to meet and to test their software to meet uh or team and uh this is a free event there also other benefit for us to is to improve the maturity of of for specification and to respond directly to
To the vendors there are also interest for the monitors these interest is to improve their their level of expertise and to meet vendors and monitors next slide so we organize the first franch project ton in Ren uh a few years ago we have we testing only two profile and we
Have only eight vendors and the last uh last project at we in R September um we are we have been texting 36 profile and we have 45 vendors so quite huge project at on uh for for this year next slide this this last the last French projected
On 45 vendors more than 20 people you can see a small screenshot of the French project at inen uh three 370 test many message uh exchange on the coordination tool we also organized 10 uh Workshop about interop and of course we other satisfaction survey next slide what is the what is very important
In a project at only the organization and by the organization it’s quite very long and complicated I mean we have a we organize each year project at on and organizing a project that only is four or six months of preparation or project at is virtual and
Also face tof face event so we have we need a tool to coordinate virtual and face tof face Event Event uh there are 20 uh sorry there are many monitors and there are also monitors from Regional organization in France so we have many monitors in the French pro project at
Home why um the idea behind that is to help the vendors I think project at also is is Al is also um a way for us to OB the vendors using the tool we have a a national platform testing tool based on gazelle and we have also two
Coordination Tool uh slack on the teams and as you see for testing 30 six profile we have also many more than 20 200 uh testing models so the organization is quite huge and complicated do not forget you have to organize it’s it’s long next slide in parallel we have also a
Certification process I will not go in detail called seante This is a short view of the main domain of the seure stage one so the first stage of the of the certification process as you see many things are based on ER profile next slide uh the is to connect testing
Projected on testing for certification as you see this is the number of tests uh done in our inter testing platform in gazel as you see uh you can see the increasing of monthly uh number of tests during the certification stage one and during the certification stage two the
Certification stage two are not is not is not is it’s it’s only a preparation uh testing uh stage actually next slide and if what are the B effect of the project at on the certification process is a number of CDA docment in the DMP in mon Sante
As you see we have an increasing on the number of document um in this in this National CDA repository next slide of course this work is is done by a team this is a all team at is next slide well thank you uh for all thank
You for thank you sopia and thank you for for your attention and if you are you if you have question of course do not visitate Terry there is a question and I think you might be uh the one uh who can reply to is how are the project Aton positions in respect to
Your mandatory certification what is the interdependency well um what are the position is um well the position of projector actually is to help the vendors I mean we do not publish the result of the test we publish only the participants of V participant for testing and um during the project Aton
The vendors are testing their software uh and during the certification they will pass a certification it’s a it’s a for us uh project at is to help is a tool to help the vendors to pass the certification process it’s a training but um a a training really towards the uh certification right
Yes Yan I will dis yeah your your microphone is uh enabled so you can speak up another question that we have in the chat do you have requirements to have tested an i profile before it can come into your project thaton no for for the fres project at
All no the idea uh the idea is to help the vendor so we have no requirement um the idea is to have the the fre fre days with the developers of the for fre days to help the the developers and the vendors to implement the sorry the specification there is no there is
No there is no requirement I the same situation in Switzerland this is Yan can I can I ask now or because I was I’ve managed to be double muted uh I I would like to to to ask um first first of all I was um saying thank you both for for both
Presentations and uh my question would be like one step lower uh than being a country that is already able to to organize a project Aton what would be the requirements should there first be a boot camp where people would at least understand what is gazelle how to connect to it
Uh or or it’s it’s okay to go straight into into project Aton what I mean is uh if you’re in the stage of thinking about implementing something and at the same time saying look we will be starting to implement this and in two years time we will be testing it and
There will be a project Aton start to prepare for it start to prepare for it now what would be the the best steps for that well for for Switzerland we did not have any boot camps we more or less assume that if a software provider is implementing something based on the
IG profiles for for the project that they already know that they already did an initial step of look looking at gazel and how to test uh through the the gazl tools it may be it may be however useful interesting if you have a depending on the the level of knowledge you have in
The country uh I can make a parallel with the hdsi the uh the crossb ealth infrastructure the first the first last year we we did a boot camp to train because there was only a few person that was aware of the installation of a national contact Point how to to
Validate a few things and then uh there was the the the project Aton but then the the knowledge or there was enough people knowing how to participate how to do the testing and then it’s uh mutual help between the participants so it’s not it’s not a prerequisite to make a boot
Camp uh it depends on on how many people you have who may help the each other well um for side I think we would do not have a boot camp also I think one of the well go on organize of we organize your first project at home and
We only maybe one or two profile uh for us for the first time five years ago it was only two profile eight vendors so it’s why it it was very small uh organize it don’t forget you have four or six month of preparation uh during this preparation you have
To uh communicate to the vendors um we are organizing typical um three or four webinar uh three or four webinar for to recruit uh vendors also to explain how to use gazelle so it’s very important I think the best way is to organize a small project at home one or two profile
On T you”ve expressed already a couple of times that it is a lot of work a project Aton right but it it is of course in the uh in the lifeline of a project right um but do you consider the efforts worthwhile the outcome well no I consider it’s actually
I consider it’s mandatory to organizer project item why because it’s also for us a way not only to test the vendors but also to help them but also to improve or specification it’s a good way for us to have um exchange with the developers it’s a good way
To understand um how the implementation is done by the vendors so it’s for us very important uh to organize each year project at for example for this year we have published uh two um two two correction two correction of uh profile uh this uh this uh this month um
So it’s very very important to exchange to see uh all the developers are are using a profile so for us a project at is a part of a project and also is a part of the specification and towards the implementations yes Nationwide right it’s a key event if you
When you build such a such an infrastructure to to have this first for for testing validating that the for enabling the vendors the providers to to validate their thing also to make the community of implementers around your project so it say a very high value also aside the it’s not only the testing
Itself it’s also creating this community of because these vendors the these software implementers will have will exchange information with with others and you may have problems some sometime so it’s good to have this this community and if I may uh complement the answer to to Yan’s
Question uh two two things uh I was in contact with a software developer who had to develop software for the Cara community and Cara said well you have to use IG profiles Etc and uh we had a few discussions together they they asked me how is I how
Is it structed how do we participate to a project Aton Etc and eight months later they were participating at the project Aton without any problem the other thing I can say uh the the AIC toolkit we have developed is helping a lot new commers in the in the I world
Because they they configure they they Implement of course they they configure their uh their endpoints and then they play the application and the AIC proxy will do all the stuff uh linked to gazelle and you have one page where you see one line per transaction you have sent and you
Can click on the transaction you have sent and you have immediately the the result of the corresponding gazel tools so it’s also one way to simplify the the use of the gazel tools because you have already all the test is already performed with the correct validator and you just have to click to
Have the result and that’s also very useful for helping them those who do not know how to use GLE tools thank you there is a question from avert and I think it was towards TI is the national contact Point part of the reference environment and a you refer to the
National contact point in the uh crossborder exchange right that’s correct but uh Stefan mentioned also their National contact points and believe it was part of the reference environment it’s part of the law of the federal law okay it’s not part of the reference environment because Switzerland has been excluded by
The from the cross border a few years ago until politics uh and um agreements between the European commission and Switzerland are pre-established so it’s it’s foreen but it’s not yet part of the refence implementation okay and in France of course we have a national contact point to exchange a CDA document with other
European countries and uh other European countries can access to the DMP the CD the CDA repository for two use case for prescription and for um um patient sumary yes patient sumary sorry okay so there was another poll uh on what topic could a project Aton be useful we see here cross border
Um I I wonder San uh in a crossb exchange countries without having a projecton experience do you think it’s feasible to uh have uh European project tons on this well the the European commission is organizing every year uh cross border hdsi project atum where all national contact points have to
Participate because there’s a yearly update upgrade of the software infrastructure and it’s uh from what I know it’s mandatory for every country in operation to participate to the yearly upgrade project Aton but it’s yeah it’s a project Aton between the national contact points you may then have a pro a
National project Aton that will include the link between the national NCP and the national infrastructure thank you I think indeed that would be uh very useful do we know the use cases that are test uh during the test the the projector on of the national contact
Points and all the use cases of d ncps uh currently EP elect um e prescription e dispense patient summary and I think normally access to original clinical documents and of course all what relates to the patient identification patient consent or all all transactions being used between two national contact points so it’s really
The the national contact points trust Zone it’s uh it’s excluding the the interfaces with the the national uh country but it includes the the the content that will uh be consumed by the national contact point and sent forward to the other NCP that’s included but not the interface between
The national contact point and the national um infrastructure we have launched another poll here um what would be the main type of support you would need you cannot um check multiple uh options one one final question uh from anyone please speak up while we wait for that I have a
Question can project Aton completely could project Aton completely um um replace the connecton Stan it’s not the same goal in in a well if you have an international company in the project Aton you will test only the specific aspects and the national specifications you may have differences
So I would say that in this case you will be interested also in first doing the connect Aton validating your generic implementation of the profiles and there you will be able to during one week validate all the profiles you are using and then you complete the Gap with
The national project in the project Aton where you do the specific the the part specific to to the country where you will not test everything you have implemented you will test the transactions required by the the country or the project the the use cases of the project the the
Specific the specifics from the from the project so for me it’s complimentary for I think it’s it’s probably a bit different for a company that is active only in one country in one specific aspect well probably the project at us yes I think it’s also complementary especially for international or european
Vendors as you said for National Vendors National Vendors for example in France we have also National Vendors who are who only pass the project at home I mean also it could be twostep a project the project or testing step step um is some step are more complicated also where in
The project at on and of course it’s also based on the use case for defining INF frence so we have use case for uh for ex for example for biological report for immunization content so we have a special F focus on on some e profile you have a ground competence with the
Connect Aton ground knowledge of the profiles and then with the project Aton you add some specifics related to the project may I ask a Charles a question a little bit different um I have heard a little bit but not too much Clarity on what you foresee the role of the
Projectan to be uh on a on a sustained uh basis so not to introduce a new use case a new profile new implementation and deploy them as effectively as possible but let’s assume something is deployed it has been running for five years is there still a role for the project for the project
Toan and if so uh what is it and what do you foresee uh for those uh deployed things the role of the connector th to be both both to Swiss and French Switzerland first yeah okay um first I hope that the specifications of the project of the the
The platform will evolve over five years adding new use cases that will be not Frozen for five years no my question is with the with the same use case yeah yeah well for for the same use case we see that some vendors are not coming again and again every year if there
There are no new use case I I think it’s a Pity because connect Aton and project Aton you are creating this community of implementers of community of interest in this uh in this profiles in this implementation and even if you have nothing new uh it’s always interesting to have
The contact with the others and building and maintaining this community of interest but don’t vendors have new version of their product and how do they make sure they still work in uh in your in your project well yeah that’s their responsibility of course um it’s not a certification formally the the project
Aton it’s a validation of their their implementation so if they change their implementation they should come again to the project Aton of course I think the community aspect is is very important what about friend yeah uh in France uh well we have each year we have
New vendors and we have also of um over we have also the old vendors we have the same and the new vendors it depends um for example if a company vendor have a new version they they they can pass the pro the project at on and also they also come
Vendors come also to exchange between other vendors to exchange with us it’s not only a testing event it’s also a it’s also an event to meet your the meet to meet community and it’s quite important um to have a community of of people so we have many vendors are coming each year
Okay thank you you are muted Ken thank you all thank you TI San gal thank you for being here for your questions the recording is available and before you go uh please rate the webinar we hope to see you uh in uh one month and enjoy the uh end of the year