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--- ivci:bordeaux_2025 [2025/05/29 20:03] – [The EUVABECO EVC Project] nbunker
+++ ivci:bordeaux_2025 [2025/05/30 08:47] (current) – fkaag
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 === Shaping the Future of Global Vaccine Interoperability ===
-The International Summit on Vaccine Coding & Standards was held May 9, 2025 in Bordeaux. There vaccine code experts, immunization registry leaders, and public health professionals gathered to tackle one of the most critical challenges in immunization today—ensuring that vaccine data is accurate, interoperable, and useful across borders.
+The first in-person meeting of the International Vaccine Code (IVC) Initiative was held in Bordeaux, bringing together experts from across Europe and Americas to explore the technical, clinical, and operational challenges of vaccine coding. With over 35 participants attending both in person and online, the event marked a major milestone in building a collaborative global community focused on improving how vaccinations are digitally recorded and shared.
+The meeting opened with a review of IVC's goals and accomplishments so far, including monthly calls, the launch of the IVC website, interviews with countries and organizations, and work on mapping and metrics. Participants shared their backgrounds and expectations through an interactive poll, revealing a wide range of experience levels and strong interest in improving global harmonization, tracking vaccine histories, and understanding the role of NUVA—a terminology developed by SYADEM—as a pivot code system for vaccines.
+The core of the meeting focused on in-depth presentations about NUVA and its integration into systems like SNOMED CT, WHO Drug, national registries, and EU projects such as ePIL and the European Vaccination Card (EVC). Real-world use cases from Luxembourg, Canada, the U.S., and Qatar demonstrated the challenges of managing and reconciling vaccine data across fragmented systems. NUVA’s conceptual framework of valences emerged as a unifying method for linking diverse codes and improving clinical decision support.
+Toward the end of the meeting, discussions shifted to sustainability and future governance. Participants debated the pros and cons of forming a formal organization versus aligning with existing structures like SNOMED or HL7. While no final decision was made, there was strong consensus that IVC fills a unique gap and that its work should be nurtured through partnerships and “matchmaking” with larger efforts already underway.
+The energy and feedback from participants confirmed that this work is both needed and technically on the right track. Moving forward, the IVC Initiative will focus on expanding its community, deepening partnerships, and continuing to serve as a bridge between technical solutions and public health realities in the field of immunization.
-This one-day summit was a unique opportunity to collaborate, share insights, and help shape the future of vaccine coding and interoperability.
 ====== Bordeaux 2025 Meeting Summary ======
-**Date:** May 9, 2025
+**Date:** May 9, 2025  \\
-**Location:** Radisson Blu Hotel, Bordeaux, France
+**Location:** Radisson Blu Hotel, Bordeaux, France  \\
-**Event:** International Summit on Vaccine Coding & Standards
+**Event:** International Summit on Vaccine Coding & Standards  \\
 **Hosted by:** International Vaccine Codes Initiative (IVCI)
@@ Line 36: / Line 43: @@
 ===== Session Summaries =====
-=== Foundations & Global Perspectives ===
+  FOUNDATIONS AND GLOBAL PERSPECTIVES
 ==== NUVA: What It Is and Why It Matters ====
@@ Line 45: / Line 52: @@
-=== Key Takeaways ===
+=== Key Points ===
 **Origins and Evolution**
@@ Line 87: / Line 94: @@
 A demonstration of the NUVA mapping platform was shared:
-[https://nuva.syadem.com/mapping](https://nuva.syadem.com/mapping)
+[[https://nuva.syadem.com/mapping]]
 === Additional Notes ===
@@ Line 93: / Line 100: @@
 ==== How NUVA Uses Valences to Standardize Vaccine Codes ====
-//Speaker: Jean-Louis Koeck//
+//Speaker: Jean-Louis Koeck (Syadem)//
 This presentation provided critical clinical context for understanding the valence model at the heart of NUVA.
-== Key Takeaways ==
+=== Key Points ===
   * **Core Definitions**: Jean-Louis began by clearly defining "Vaccine" and "Antigen"—foundational concepts in immunology shared globally. While basic, these helped establish common ground for a diverse audience.
@@ Line 110: / Line 117: @@
     - Vaccine prescription using valence labels rather than commercial product names
-== In Summary ==
+=== In Summary ===
 Valences offer a **common clinical language** to assess protection, regardless of which product or national code system is used. This session made clear that valences are the **core bridge** between vaccination data and actionable immunization guidance.
 ==== The NUVA Extension to SNOMED CT ====
-*Speakers: Suzy Roy & Peter Williams (SNOMED International)*
+//Speakers: Suzy Roy & Peter Williams (SNOMED International)//
 This presentation explained how NUVA is being integrated into the SNOMED CT ecosystem to support broader adoption and interoperability.
@@ Line 147: / Line 154: @@
-=== Real-World Use Cases – Global & European Union ===
+  REAL-WORD USE CASES - GLOBAL AND EUROPEAN UNION
 ==== EU Strategy for Cross-Border Vaccination Records ====
-*Speaker: Georgios Margetidis*
+//Speaker: Georgios Margetidis, Health and Digital European Agency (HaDEA)//
-*Notes to be added*
+=== Key points ===
+Georgios presented the frame for the European Commission (EC) actions in the field of digital health.
+According to the European treaties, health is a national competence of Member States. Apart from specific cases regarding cross-border continuity of care, the EC actions can only be incentives. This has been achieved so far through studies, recommendations, joint actions and voluntary groups.
+The European Health Data Space (EHDS) regulation, published in March 2025, creates a new context for digital health, with the obligation for Member States to progressively build up interoperability across electronic health records both for primary and secondary use of data.
+An harmonized approach for recording administered vaccines would be a significant contribution to this objective. Patient summaries, including vaccination history, should be exchangeable across all Member States by March 2029.
+=== In summary ===
+The EHDS regulation allows the EC to become prescriptive on interoperability.
 ==== View from the Industry (ePIL & NUVA Integration) ====
@@ Line 209: / Line 226: @@
-=== Real-World Use Cases – Countries ===
+  REAL-WORK USE CASES - COUNTRIES
 ==== Luxembourg Experience ====
-//Speaker: Maud Delporte* (Agence eSanté Luxembourg)//
+//Speaker: Maud Delporte (Agence eSanté Luxembourg)//
 Maud Delporte shared the ongoing efforts in Luxembourg to digitize and centralize vaccine histories through the **Carnet de Vaccination Électronique (CVE)**—a national immunization registry built with NUVA at its core.
@@ Line 279: / Line 296: @@
 ==== North American Experiences ====
-*Speaker: Shannon Coleman*
+//Speaker: Shannon Coleman (STCHealth)//
-*Notes to be added*
+Shannon Coleman provided a comprehensive overview of vaccine coding practices and challenges in North America, drawing from her experience at STCHealth—a software vendor and integrator supporting immunization data exchange across various sectors.
+=== Key Points ===
+  * **STCHealth’s Role**:     STCHealth operates across the U.S. healthcare ecosystem—from public health agencies to payers, providers, and employers. They support **Immunization Information Systems (IIS)** and health data exchange nationally and internationally.
+  * **Vaccine Code Systems in the U.S.**: Shannon outlined several coding systems commonly used in the U.S. Each plays a role in recording, billing, and reporting—but integrating them smoothly remains a challenge:
+    - **CVX** (Vaccines Administered)
+    - **MVX** (Manufacturer Codes)
+    - **NDC** (National Drug Codes)
+    - **CPT** (Current Procedural Terminology)
+  * **The Code Creation Pipeline**: A key highlight was how **complex** the process is to establish and disseminate a new vaccine code:
+    - One diagram showed the **approval and creation pipeline** for CVX/NDC codes.
+    - Another diagram illustrated the **adoption process**, revealing multiple layers of system updates, testing, and communication that are often underestimated.
+  * **IIS Code Management Realities**: Shannon explained that even after a code is published, it needs to be manually entered or synchronized into various parts of an IIS. STCHealth sees three main update models:
+    - **Manual** – Fully dependent on staff entry.
+    - **Hybrid** – Partially automated with staff validation.
+    - **Service-Based** – Centralized services update local systems.
+  * **IZ Gateway**: The **IZ Gateway** initiative is helping improve interoperability among U.S. state IISs. However, it still faces limitations, especially in handling non-U.S. vaccine codes in global contexts.
+  * **International Use Case: Qatar**: Shannon shared STCHealth’s experience in **Qatar**, where their system had to be adapted to support **non-U.S. vaccines**. This highlighted the U.S.-centric design of many current tools and underscored the need for more **globally adaptable code frameworks**.
+  * **Looking Ahead**:  Key recommendations and areas of focus:
+    - Improve internal coordination and tooling for managing vaccine codes.
+    - Enhance **national release mechanisms** for vaccine codes from CDC.
+    - Create guidance documents and dictionaries to define key terms and concepts for more consistent implementations.
+=== In Summary ===
+This session demonstrated the **technical complexity and operational reality** of managing vaccine codes in the U.S. It also showed how experiences from international deployments (like Qatar) reveal the need for globally harmonized coding systems—something initiatives like NUVA can help support.
 ==== Canadian Experience ====
-*Speaker: Myriam Talantikit*
+//Speaker: Myriam Talantikit (Canada Health Infoway)//
-*Notes to be added*
-=== Implementing NUVA for Interoperability ===
+This presentation provided an overview of how vaccine data is standardized, coded, and shared across Canada, with emphasis on the current systems in place, recent progress, and remaining challenges.
+=== Key Points ===
+  * **Canada Health Infoway (CHI)**: CHI is a national, independent, not-for-profit organization established in 2001. It leads **digital health innovation** in Canada and supports the **Canadian Standards Release Centre (CSRC)**, which maintains SNOMED CT CA and other terminologies.
+  * **Decentralized Immunization Registries**
+    - Canada does **not have a national immunization registry**.
+    - Each **Province and Territory (P/T)** maintains its own system, with exceptions in places like **Nunavut** (no registry) and **Northwest Territories** (uses EMRs).
+    - These registries are confidential and population-based.
+  * **National Vaccine Catalogue (NVC)**
+    - Serves as the central repository of vaccine information in Canada.
+    - Leverages **SNOMED CT CA** and integrates with other terminologies like DIN, lot numbers, and expiry dates.
+    - Supported by a **national terminology server** that offers consistent terminology access.
+  * **National Terminology Service (NTS)**
+    - Provides access to a wide range of terminologies including SNOMED CT CA, LOINC, pCLOCD, UCUM, and others.
+    - Benefits include:
+      - **Centralized access**, frequent updates, and FHIR compatibility.
+      - Improved **semantic interoperability** across systems.
+      - Tools for **concept mapping, validation, and expansion**.
+  * **Pan-Canadian Health Data Content Framework (pCHDCF)**
+    - Developed by CIHI to **standardize person-centric data** across care settings.
+    - Focuses on data modeling, semantic consistency, and aligning national priorities.
+    - Serves as the foundation for national interoperability efforts.
+  * **Pan-Canadian Patient Summary (PS-CA)**
+    - A localized implementation of the **International Patient Summary (IPS)**.
+    - Built using HL7 FHIR profiles, it enables portable and shareable patient summaries across Canadian jurisdictions.
+    - Actively developed in collaboration with provincial stakeholders.
+  * **Successes:**
+      - Rapid support and adoption for COVID-19 vaccine codes.
+      - National RFC (Request For Change) process in place.
+      - Strong alignment between NVC and CHI terminologies.
+  * **Challenges:**
+      - **Outdated and local terminologies** persist in some jurisdictions.
+      - High barrier to **SNOMED adoption** for smaller organizations.
+      - Complexity in managing thousands of terminology copies.
+      - Some legacy tools like patient picklists are underutilized or outdated.
+  * **Discussion on Canadian Vaccine Catalogue (CVC)**
+    - During Q&A, participants asked about the now-discontinued **CVC** previously managed by CanImmunize.
+    - While the CVC was previously compared with NUVA, it is no longer in use and considered **outdated** in current Canadian practice.
+=== In Summary ===
+Canada’s vaccine coding landscape is evolving, with strong national leadership in terminology and standards through CHI. Despite the **decentralized registry model**, shared tools like the NVC, national terminology server, and PS-CA are improving **interoperability and standardization**—laying a foundation for long-term digital immunization strategies.
+  IMPLEMENTING NUVA FOR INTEROPERABILITY
 ==== Mapping Across Code Systems ====
-*Speaker: Timothée Doulut*
+//Speaker: Timothée Doulut (SYADEM)//
-*Notes to be added*
+Timothée Doulut demonstrated how the NUVA system supports cross-mapping between various vaccine coding systems, using valences as the unifying conceptual anchor.
+=== Key Points ===
+  * **From Valences to Vaccines**:  Timothée walked through the process of mapping a vaccine code by **first identifying its valences**—the smallest functional units that describe immune response.
+    Once valences are known, the NUVA system can identify the corresponding vaccine codes.
+  * **Mapping Tools at nuva.syadem.com**: A **web-based mapping tool** was showcased, where users can input existing codes (e.g., CVX, ATC, CIP, CNK, CTI) and retrieve:
+    - NUVA vaccine codes
+    - Associated valences
+    - Brand or abstract vaccine concepts
+  * The system supports both:
+    - **Direct mapping** (e.g., a specific product like PRIORIX)
+    - **Indirect mapping** via shared valences (e.g., DTaP/Hib combinations)
+  * **Handling Missing or New Concepts**: If an external code has no match in NUVA:
+    - It is assessed by reviewing disease coverage, product name, dose, and formulation.
+    - If new valences are needed, they are created.
+    - If the vaccine is already covered by existing valences, a **new vaccine concept** is added using those valences.
+  * **Decision-Making Process**:  Mapping a new code into NUVA involves multiple steps:
+    - Determine if the code is **abstract or concrete**.
+    - Identify associated **diseases** and **valences**.
+    - Evaluate whether to **reuse** or **create** a concept.
+  * The goal is always to preserve semantic precision while supporting practical interoperability.
+  * **Terminology Sensitivities: "Generic" Vaccines** :  One key discussion point came from the use of the term **"generic vaccine"** in the slides.
+    - Intended meaning: a **generalized vaccine concept** not tied to a specific product.
+    - However, participants from the **vaccine manufacturing sector** noted that “generic” implies **non-branded biosimilar drugs**, which do not yet exist for vaccines.
+    - Outcome: The group agreed to **avoid using "generic"** in future presentations to prevent confusion and respect established pharmaceutical terminology.
+=== In Summary ===
+This session highlighted how **NUVA’s valence-driven approach** supports efficient and scalable mapping across multiple vaccine coding systems. The demonstration of the mapping tool and discussion around concept management illustrated how NUVA is built to **bridge gaps** between fragmented code systems, while adapting respectfully to stakeholder language and expectations.
 ==== Metrics on Code Systems ====
-*Speaker: François Kaag*
+//Speaker: François Kaag (IVCI/SYADEM)//
-*Notes to be added*
+François Kaag introduced a method for using NUVA to generate metrics that evaluate the completeness, precision, and redundancy of other vaccine coding systems. These metrics can help developers understand the strengths and limitations of their systems and support better cross-system alignment.
+=== Key Points ===
+  * **Abstract vs. Concrete Vaccines**: François clarified the terminology around **abstract vaccines**—concepts that describe the vaccine type or valence structure without referring to a branded product. Examples:
+    - "Polio" is a higher-level abstract concept.
+    - "IPV" and "OPV" are more specific abstract vaccines.
+    - Branded vaccines like "Infanrix" or "Gardasil" are **concrete** vaccines.
+  * He introduced the **"abstraction cone"**, a visual tool showing how vaccine concepts range from general to highly specific. This supports reasoning about what kinds of vaccine data a coding system can capture.
+  * **Completeness and Precision Metrics**: NUVA can be used to compare how well other coding systems:
+    - **Completeness**: Cover the full range of vaccine concepts in NUVA.
+    - **Precision**: Distinguish between similar concepts without ambiguity.
+  * Example findings:
+    - **CVX** covers 88% of NUVA concepts with 82% precision.
+    - **ATC** covers 83%, but precision is only 71%.
+    - **CVC** is lower on both measures.
+    - **CNK** has very low completeness and high ambiguity (precision not calculated).
+  * **Redundancy**
+    Redundancy measures how many codes in an external system map to the same NUVA concept. This isn’t necessarily a flaw—it often reflects the external system's inclusion of other dimensions (e.g., packaging, administration form).
+  * Example:
+    - CVX-120 and CVX-170 both map to the same NUVA concept (DTaP/IPV/HIB vaccine), differing only by geographic usage.
+    - CNK codes include both flask and syringe presentations for the same vaccine.
+  * **Tooling and Results**: A Python script (`NUVA_Eval.py`) was introduced to calculate these metrics.
+    - Input: a CSV mapping file.
+    - Output: metrics for **completeness**, **precision**, and **redundancy**.
+    - Reference materials and code are available at: https://ivci.org/nuva
+  * **Interpreting the Metrics**: These metrics are **not absolute quality scores**—they must be interpreted based on the **intended purpose** of the code system:
+    - A code system may be highly **complete** but imprecise (e.g., a generic “Any Vaccine” code).
+    - Conversely, pharmaceutical databases may be **highly precise** but unable to represent historical or abstract vaccination records.
+=== In Summary ===
+NUVA provides a structured way to **evaluate and compare vaccine coding systems**. By analyzing how abstract and concrete vaccine concepts are covered and differentiated, François offered a **valuable toolset for improving the interoperability and quality of vaccine terminology** across countries and organizations.
 ===== Next Steps and Closing Discussion =====
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 **Closing Remarks:**
-Despite a few early departures, the day ended with energy and optimism. Feedback was positive, and the technical direction of NUVA was affirmed. The key challenge ahead is ensuring long-term viability—through partnerships, funding, or a hosting structure that ensures continuity. As Suzy from SNOMED put it, IVC now needs a “matchmaker” to connect the right people and opportunities.
+Despite a few early departures, the day ended with energy and optimism. Feedback was positive, and the technical direction of NUVA was affirmed. The key challenge ahead is ensuring long-term viability—through partnerships, funding, or a hosting structure that ensures continuity. As one participant put it, IVC now needs a “matchmaker” to connect the right people and opportunities.
 ===== Next Meeting Planning =====
@@ Line 324: / Line 493: @@
 The consensus: IVC should position itself as a collaborative infrastructure partner—bridging multiple organizations working toward better vaccine interoperability.
-===== To Be Added =====
-Each section above contains placeholders. Please return and fill in:
-  * Technical and clinical details of each presentation.
-  * Examples or screenshots shown (if any).
-  * Audience questions and feedback from each session.
-  * Any significant quotes or memorable moments from speakers.
@@ Line 336: / Line 499: @@
-==== Slide decks ====
+===== Slide decks =====
 ^ Slides  ^ Presenter  ^ Organization  ^
 | **TRAINING SESSION**  | | |