1. April, 2010What IHE Delivers 1 An Introduction to Integrating the Health Enterprise Dr Vincent McCauley Chair, IHE Australia

2. 22 IHE Organizational Structure Contributing & Participating Vendors IHE North America USA Canada IHE Asia Japan KoreaTaiwan China ACC ACCE ACEP HISA JAHIS JIRA JRS METI-MLHW MEDIS-DC JAMI RSNA SFR SFIL MSIA SIRM BIR EuroRec RACS COCIR EAR-ECR DRG RANZCR ESC Professional Societies / Sponsors ACP GMSIHIM SS HL7 AUS IHE International Board Global Development Radiology Cardiology IT Infrastructure Patient Care Coordination Patient Care Devices Laboratory Pathology Eye CareRadiation Oncology Public Health, Quality and Research IHE Asia-Pacific New ZealandAustraliaMalaysia IHE Europe FranceNetherlands Spain Sweden UK Italy Germany Norway Austria Regional Deployment

3. 3 IHE Australia Organisational Structure IHE Australia Sponsors - Health Informatics Society of Australia (HISA) - Health Informatics Society of Australia (HISA) - Health Level Seven (HL7) Australia - Health Level Seven (HL7) Australia - Medical Software Industry Association (MSIA) - Medical Software Industry Association (MSIA) - Royal Australasian College of Radiologists (RANZCR) - Royal Australasian College of Radiologists (RANZCR) Some Australian Supporting IHE members - Health Information Management Association of Australia (HIMAA) - Health Information Management Association of Australia (HIMAA) - Royal Australian College of Surgeons (RACS) - Royal Australian College of Surgeons (RACS) - Australian Diagnostic Imaging Association (ADIA) - Australian Diagnostic Imaging Association (ADIA)

4. 4 IHE Domains RadiologyCardiology Radiation Oncology IT Infrastructure Patient Care Coordination Patient Care devices Laboratory, Pathology, Eye Care. Pharmacy Quality Research and Public Health

5. IHE Value Proposition IHE Solutions are Driven by Strategic Healthcare Lead Users that collaborate with Healthcare VendorsIHE Solutions are Driven by Strategic Healthcare Lead Users that collaborate with Healthcare Vendors IHE Solutions are Generic, Reusable and Interoperable based on Healthcare Standards: DICOM, HL7, RFCIHE Solutions are Generic, Reusable and Interoperable based on Healthcare Standards: DICOM, HL7, RFC IHE Solutions Optimize the Clinical WorkflowsIHE Solutions Optimize the Clinical Workflows IHE Deployment process – Connectathon, Integration Statements and Users Success Stories information helps to refine the product “Business Case”IHE Deployment process – Connectathon, Integration Statements and Users Success Stories information helps to refine the product “Business Case” IHE Technical Framework specification describes the Global IHE solutions at a High Level for Planning & Marketing and in details for products Architects and Engineering developmentIHE Technical Framework specification describes the Global IHE solutions at a High Level for Planning & Marketing and in details for products Architects and Engineering development

6. IHE Benefits Clinical UsersClinical Users Greater access to consistent informationGreater access to consistent information Fewer errors, fewer tedious tasksFewer errors, fewer tedious tasks AdministratorsAdministrators Increased throughput - Better schedulingIncreased throughput - Better scheduling Reduce CostReduce Cost BuyersBuyers Specify/purchase RFP’s integration capabilities easily and Freedom to acquire “Best of Breed” systemsSpecify/purchase RFP’s integration capabilities easily and Freedom to acquire “Best of Breed” systems IT ProfessionalsIT Professionals Faster, more predictable integration projectsFaster, more predictable integration projects Facilitate cooperation of competing vendorsFacilitate cooperation of competing vendors

7. 7 IHE Profile Examples (XDS/XDS-I) Cross-Enterprise Document Sharing for Imaging  Shares clinical documents, images, diagnostic reports and related information between healthcare enterprises (PIX) Patient ID Cross-referencing  Cross-index patient IDs across multiple sites (PDQ) Patient Demographics Query  Query and retrieve a patient’s demographic and visit information (ATNA) Audit Trail and Node Authentication  Systems Authentication  Audit events management (BPPC) Basic Patient Privacy and Consent  Patient privacy consents & enforcement

8. 8 IHE Problem Solution Process User driven, Vendor led – A standardised process ISO TR28380 Working with vendors, care providers and standards organizations, IHE:  Distills a clear description of the problem (Users)  Determines the right way to solve it using standards (Vendors) (IHE Profile)  Documents the solution in an implementation guide (IHE Technical Framework)  Coordinates cross-vendor testing of the solution (IHE Connectathon)  Demonstrates vendor implementations (IHE Showcase) Go see the rest of the profiles

9. 9 IHE Testing Process Users Sponsors: Project ManagementTeam Vendors Sponsors:Exhibits Develop Testing Tools Implement Profile Actors In-HouseTesting Connectathon Demonstration DeploySystems Testing Results Approves Test Logs IHE Technical Framework (IHE Profile Specifications) Product + Integration Statement

10. 10 What is a Connectathon? Cross-vendor, live, supervised, structured tests All participating vendors’ products tested together in the same place/time Experts from each vendor available for immediate problem resolution… fixes are done in minutes, not months!! Each vendor tests with multiple trading partners (actual product to actual product) Testing of real-world clinical scenarios using IHE Integration Profiles

11. 11 Media Creator Printer [Media Reader] Image Display [Media Reader] PACS [Media Importer] CD John Doe DICOM Data Web Data (Optional) DICOM PC Browser Web Data Required to cleanup Patient ID, Acc#, etc. A “simple” IHE Profile - Portable Data for Imaging

12. 12 IHE Integration Profiles for Health Info Nets Emergency Referrals Format of the Document Content and associated coded vocabulary PHR Extracts/Updates Format of the Document Content and associated coded vocabulary ECG Report Document Format of the Document Content and associated coded vocabulary Lab Results Document Content Format of the Document Content and associated coded vocabulary Scanned Documents Format of the Document Content Imaging Information Format of the Document Content and associated coded vocabulary Medical Summary ( Meds, Allergies, Pbs) Format of the Document Content and associated coded vocabulary Clinical and PHR Content Health Data Exchange Patient Demographics Query Patient Identifier Cross-referencing Map patient identifiers across independent identification domains Notification of Document Availability Notification of a remote provider/ health enterprise Request Form for Data Capture External form with custom import/export scripting Patient ID Mgmt Other Final Text Approved Trial Implementation-2007 – Final Txt 2008 Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a longitudinal record Cross-Enterprise Document Pt-Pt Reliable Interchange Cross-Enterprise Document Media Interchange Cross-Community Access Security & Privacy Consistent Time Coordinate time across networked systems Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. Basic Patients Privacy Consents Establish Consents & Enable Access Control Document Digital Signature Attesting “true-copy and origin Cross-Enterprise User Attestation User Attributes fro Access Control

13. 13 IHE, global standards-based profiles adopted by several national & regional projects Quebec, Toronto, Alberta, British Columbia Canada Infoway Denmark (Funen) Italy (Veneto) Spain (Aragon) NCHICA – N. Carolina Italy (Conto Corrente Salute) Boston Medical Center - MA France DMP UK CfH (Radiology WF) Philadelphia HIE CHINA-MoH Lab results sharing KeyHIE – Pennsylvania CHINA-Shanghai Imaging Info Sharing JAPAN-Nagoya Imaging Info Sharing South Africa Malaysia Singapore VITL-Vermont CareSpark – TN & VA Netherland Amsterdam Lower Austria

14. 14 IHE Problem Solution Process

15. 15 From Standards to Solving a Use Case NeHTA PIP WG Standards Australia Interoperability Specifications + Constructs Standards Adoption/Profiling Technical Use Case Driven Base Standards Foundations IHE HL7, OMG, X12, DICOM, ISO, W3C etc… Business Use Case

16. 16 IHE Australia Conformance Testing IHE Conformance Testing supervised by NATA accredited Testing Laboratory (AHML) Certification Interoperability Specifications + Constructs Standards Adoption/Profiling Technical Use Case Driven Base Standards Foundations

17. 17 IHE Chicago Connectathon 2010

18. 18 IHE Chicago Connectathon 2010

19. 19 IHE Chicago Connectathon 2010 104 vendors 150 applications 498 engineers Approx. $2 million in employee costs over 5 days 77 IHE Profiles

20. 20 Australian Secure Messaging Specification development process DoHA PIP GP eHealth initiative January 2009 Initial NeHTA Secure Message Delivery (SMD) specification Joint Vendor (MSIA) / NEHTA working group refined specification - 25 Vendors, 6 meetings, 9 days - 25 Vendors, 6 meetings, 9 days - Technical sub-committee – 6 vendors, 4 meetings 8 days - Technical sub-committee – 6 vendors, 4 meetings 8 days

21. 21 Australian Secure Messaging Specification development process Output of PIP Working Group submitted to Standards Australia Nov 2009 - 3 Technical Specifications + 1 technical report - 3 Technical Specifications + 1 technical report Standards Task force Rapid public comment and publication => Four publications January 2010 ATS-5822:2010 – Secure messaging delivery

22. 22 Australian Secure Messaging Specification development process Continuing work by Conformance/Compliance subcommitee NEHTA alpha code available March 2010

23. 23 Secure Messaging Connectathon Funded by DoHA, contribution by vendors Testing single standard – Secure Message Delivery ATS-5822:2010 Standardised content available as IHE Australia profiles for eResults (ATS 5201:2010) and eReferral Master Class and testing streams

24. 24 Secure Messaging Connectathon Tooling o Test management using Gazelle (IHE International) o Java alpha code (NEHTA) o Pre-connectathon remote capability testing (AHML) o Connectathon Functional Test harness and process (AHML)

26. Useful Links 26 www.ihe.net www.ihe.net.au http://ihe-australia.wikispaces.com http://wiki.ihe.net http://motorcycleguy.blogspot.com/2010/01/where -in-world-is-xds.html http://motorcycleguy.blogspot.com/2010/01/where -in-world-is-xds.html

27. 27 Italy (Genoa Region)

28. 28 Italy (Genoa Region) In service since January 2006. 4 Hospitals and 500 physician offices. EMRs import and export documents from their local records. All vendor products required to pass IHE-Europe connectathon in April 2005. Patients chose to join through one of their care provider Infrastructure includes:  XDS Registry  XDS Repository shared at the regional level  PIX for patient Id linking  Doc content is CDA with PDF content. Plan in place to move to CDA rel 2 with structured data. IHE (XD*-Lab) CDA Lab primary candidate.

29. 29 Austria (Lower Austria and National) Lower Austria Region (around Vienna) Deployed in 2007 - Operational. 1.5 Million patients on-line. 11 hospitals connected. Use IHE profiles: XDS, PIX, XDS-SD, ATNA, XUA, BPPC. National project launched in 2007 (ELGA). Given the success to deploy the first region is about one year. Roll-out includes:  Ministry backing of IHE conformance (IHE-Eu Connectathon)  Extending to Ambulatory Physicians in 2008  Step-wise introduction of structured and coded content with HL7 CDA based IHE Content Profiles. Lower Austria

30. 30 USA (Philapdelphia Region) Philadelphia Health Info Exchange in service since 2005. Focused on images and reports sharing. 5 Hospitals + Imaging Center + Public Health  The Hospital of the University of Pennsylvania  Thomas Jefferson University Hospital  Children’s Hospital of Philadelphia  Presbyterian Medical Center  Pennsylvania Hospital  UPHS Community Radiology  Philadelphia Department of Public Health Migration to XDS, ATNA, PIX and XDS-I completed in 2007. Demonstrated live at RSNA-Chicago Nov 2007

31. 31 USA (Other) HITSP (HHS sponsored) accepted 8 IHE Integration profiles for: Lab results distribution and sharing, Registration and Medication History for Consumers, Biosurveillance. 2 NHIN-1 Pilots (CSC and IBM) leveraged IHE profiles (Med Summaries and Lab). South Shore, MA: Operational (Inpatient and Emergency Dept) NHIN-2 Trial Implementations (NCHICA, Virginia & CareSpark HIEs) Several HIEs projects are actively planning the use of IHE  Vermont State  KeyHIE (PA)  eHealthConnecticut  Boston Medical Center and affiliated clinics