The Connecting Europe Facility (CEF) eDelivery Building Block and its AS4-based message exchange solution, promoted by the European Commission, have seen significant and increasing interest and adoption from users. The eDelivery AS4 profile provides a state-of-the-art, standards-based solution for the secure and reliable exchange of documents and data. It is already being used for cross-border and cross-domain exchanges in various domains.
The Health domain realises the benefits of adopting AS4. “E-Health infrastructures need performance, especially in a sector where every minute of a doctor’s work should not be spent in IT document processing. AS4 will help e-Health projects in establishing such large-scale infrastructures by providing a reliable message exchange definition. Healthcare stakeholders in the need of building a document exchange platform (e.g., sharing documents across hospitals and regions) should consider AS4 as a way to achieve interoperability”, says Massimiliano Masi, IT Security Architect at Tiani Spirit, an Austrian company that develops standard-based software solutions for secure data exchange in the health sector.
As eDelivery is a domain-independent solution, it requires refinements and additional specifications for deployment in specific domains. Such specifications provide more details on how eDelivery specifications are used in conjunction with existing standards in the domain.
Healthcare has a long history of developing and deploying solutions for electronic exchange of patient care data. There are multiple established open standards, covering the many different aspects of data exchange in the health domain, each with their own mature governance bodies and processes. Integrating the Healthcare Enterprise (IHE) is an organisation dedicated to coordinating and harmonising the use of standards in healthcare data exchange and addresses the challenge of having to use standards from multiple bodies, and doing so in a consistent and interoperable way.
As Charles Parisot of IHE Europe, explains, “IHE is an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information. IHE is not itself a standards body, but an organisation that specifies and promotes the coordinated use of established standards to address specific clinical needs in support of optimal patient care.”
IHE is divided in domains, encompassing all areas of healthcare such as cardiology, pharmacy, research, etc. A technical framework supports each domain; a collection of so-called integration profiles. Each profile aims at assisting implementations of critical clinical use cases for information sharing. New profiles are incorporated into the technical framework using a well-defined development process: a profile is proposed, evaluated, and made available for public comment. After this phase, the work item is termed a Supplement for Trial Implementation. Though not final and to be incorporated in the technical framework, it is ready to be used in projects.
This process was also followed for AS4, which in August 2018 resulted in publication of an IHE Supplement that defines an Asynchronous AS4 Option, which can be used in conjunction with selected IHE profiles. The AS4 Option is based on existing AS4 conformance profiles, and enables use of the AS4 features such as security, reliable messaging, message exchange patterns and processing modes. The Asynchronous AS4 Option strikes a balance between innovation and continuity. For example, the innovative AS4 Pull feature helps address network connectivity constraints (firewalls policies) on incoming connections. This is a known problem of the current IHE Technical Framework faced by earlier e-Health projects that looked into using asynchronous exchanges. In other areas, such as packaging and naming conventions for message headers, the Asynchronous AS4 Option follows existing IHE design choices. This reduces the implementation effort for vendors offering IHE based solutions that want to add support for AS4.
As Charles Parisot explains, “after Trial Implementation Supplements have been sufficiently implemented and tested and any necessary changes made, Supplements are published as Final Text. Final Text Supplements are made available as separate documents and then merged into the domain Technical Framework document with the next yearly release.”
Throughout the year, IHE organises multiple testing events called Connectathons, at which participants validate that their implementations are conformant and interoperate with other implementations. Participants have the opportunity to fix any problems live, if needed. Reflecting the international membership of the IHE, these Connectathons take place in Asia, the US and Europe. To progress to Final State, a Trial Implementation Supplement needs to be tested successfully, with proven interoperability, between at least three vendors at two Connectathons.
The next European Connectathon will take place in 8 to 12 of April 2019 in Rennes, France. The Asynchronous AS4 Option for Profiles such as XCA (Cross-community Access) and XCPD (Cross-community Patient Discovery) is on the testing agenda. Several participants are registered to test their implementations.
“Tiani Spirit started implementing the AS4 Technical Framework Supplement using off-the shelf components and using existing implementations as test references. This solution gives the company the flexibility to use AS4 in different settings, even in deployments with less computing power. Participating in the Connectathon allows us to spot and fix bugs in implementations that would cost effort and money when running projects in production afterwards. Testing AS4 with partners allows us to validate the first integration in the Tiani SpiritEHR and to share experiences with the other developers”, said Massimiliano Masi.
The Directorate-General for Health of the European Commission (DG SANTE) with the assistance of the Directorate-General for Informatics (DIGIT) are currently implementing a proof of concept to demonstrate the use of the IHE Asynchronous AS4 Option to perform the data exchange operations foreseen in the eHealth Digital Service Infrastructure (eHDSI). In this context, they will participate in the Rennes event and welcome more companies to join them in the Connectathon.
The Innovation & Networks Executive Agency (INEA) is currently organising the CEF eDelivery 2019 Call for €1 million in grant funding supporting the adoption of CEF eDelivery and AS4. The call is open from 14 February until 14 May 2019.
In case you are interested to apply to the CEF Telecom 2019-1 call, you can register to the Virtual Info Day, organised by the Innovation & Networks Executive Agency, here to be held on 7 March 2019.