October 2010IHE Orientation-Cyprus 1 INTEGRATING THE HEALTHCARE ENTERPISE (IHE) Orientation Workshop TurkMIA Conference-10 Charles Parisot, IHE-Europe.
Presentation on theme: "INTEGRATING THE HEALTHCARE ENTERPISE (IHE) Orientation Workshop"— Presentation transcript:
1 INTEGRATING THE HEALTHCARE ENTERPISE (IHE) Orientation Workshop International HL7 Interoperability Conference-10Carlos Guilherme Costa, Product Manager, Alert, IHE US & Eu Connectathon participantJulio Carau, Director, Hospital de Clinicas "Dr. Manuel Quintela", Montevideo, Uruguay
2 AgendaThis Morning:Part 1: THE IHE STANDARDS ADOPTION PROCESS: achieving practical interoperabilityThis Afternoon:Part 2:USERS AND VENDORS WORKING TOGETHER: how can I contribute & benefit from IHEHOW TO USE IHE RESOURCES: hands on experience
3 AgendaPart 1: THE IHE STANDARDS ADOPTION PROCESS: achieving practical interoperability33
4 IHE: A Framework for Interoperability A common framework for harmonizing and implementing multiple standardsApplication-to-applicationSystem-to-systemSetting-to-settingEnables seamless health information movement within and between enterprises, regions, nationsPromotes unbiased selection and coordinated use of established healthcare and IT standards to address specific clinical needsWhat is IHE?Optimal patient care requires efficient access to comprehensive electronic health records (EHRs). The Integrating the Healthcare Enterprise (IHE) initiative accelerates the adoption of the information standards needed to support EHRs. More than 100 vendors have implemented and tested products based on IHE.IHE improves patient care by harmonizing healthcare information exchange. IHE provides a common standards-based framework for seamlessly passing health information among care providers, enabling local, regional and national health information networks.4
5 Standards: Necessary…Not Sufficient Standards areFoundational - to interoperability and communicationsBroad - varying interpretations and implementationsNarrow - may not consider relationships between standards domainsPlentiful - often redundant or disjointedFocused - standards implementation guides focus only on a single standardIHE provides a standard process for implementing multiple standards
6 IHE: Connecting Standards to Care Healthcare professionals work with industryCoordinate implementation of standards to meet clinical and administrative needsClinicians and HIT professionals identify the key interoperability problems they faceProviders and industry work together to develop and make available standards-based solutionsImplementers follow common guidelines in purchasing and integrating effective systemsIHE: A forum for agreeing on how to implement standards and processes for making it happen
7 Standards Adoption Process Testing at ConnectathonsIHE DemonstrationsDevelop technical specificationsProducts with IHEIdentify available standards (e.g. HL7, DICOM, IETF, OASIS)Timely access to informationEasy to integrate productsDocument Use Case Requirements
8 Stakeholder Benefits Healthcare providers and support staff Vendors Improved workflowsInformation whenever and wherever neededFewer opportunities for errorsFewer tedious tasks/repeated workImproved report turnaround timeVendorsAlign product interoperability with industry consensusDecreased cost and complexity of interface installation and managementFocus competition on functionality/service space not information transport spaceSDOsRapid feedback to adjust standards to real-worldEstablishment of critical mass and widespread adoption
9 IHE Implementation Strategy Leverage established standards to allow rapid deployment and plan for future Pragmatic, Ease of EvolutionEnable architectural freedom (patient vs. provider centric, centralized vs. decentralized, scalable (from office to enterprise to IDN to Regional and National Networks) Configuration flexibilitySupport breakthrough use cases: variety of care settings, care coordination, public health, PHR, EHR Interoperability for broad constituenciesIHE and the Electronic Health Record (EHR)IHE has defined a common framework to deliver the basic interoperability needed for local and regional health information networks. It has developed a foundational set of standards-based information exchange Integration Profiles with three interrelated efforts:Cross-Enterprise Document Sharing (XDS) support for document content interoperability. This supports a standards-based EHR across clinical encounters and care settings.A security framework for protecting the confidentiality, authenticity and integrity of patient care data.Cross-domain patient identification management to ensure consistent patient information and effective searches for EHRs.IHE: Offers consistent, standards-based record sharing for EHRs and other information systems
10 12 Years of Steady Growth 1998 – 2010 The IHE Development Domains12 Years of Steady Growth 1998 – 2010Pathology since 2006Radiation Oncology since 2004Radiology since 1998Cardiology since 2004Patient Care Devices since 2005Patient Care Coordination since 2004Eye Care since 2006Quality Research & Public Health since 2006Laboratory since 2004Pharmacy NEW 2009(Healthcare) IT Infrastructure since 2003
11 International Growth of IHE SwitzerlandLocal Deployment, National ExtensionsPromotional & Live Demonstration EventsOver 300 Organizational Members (all stakeholders)MalaysiaTurkeyChinaAustraliaAustriaSpainNetherlandsTaiwanCanadaUKJapanItalyGermanyFranceUSA199920002001200220032004200520062007200820092010Pragmatic global standards harmonization + best practices sharing111111
12 IHE Integration Profiles - Model Actors in precisely defined rolesAbstracts a specific function of information system…Executing precisely defined transactionsUsing existing standards……To solve real world interoperability problemsSpecifying Integration Profiles
13 Key IHE ConceptsGeneralized Systems -> ActorsInteractions between Actors -> TransactionsProblem/Solution Scenarios -> Integration ProfilesFor each Integration Profile:the context is described (which real-world problem)the actors are defined (what systems are involved)the transactions are defined (what must they do)Generalized the systems because there are many ways vendors can bundle products.Some PACS may include a Report Creator, others may not.Some Modalities may include a Print Composer, others may not.
14 Product XYZ from Vendor T The Product World…..Product XYZ from Vendor T
15 The IHE World…. IHE Transaction IHE Transaction IHE Actor IHE Actor
16 Mapping IHE to Products Product XYZ from Vendor TActorActorIHE TransactionIHE TransactionIHE ActorActorIHE ActorIHE Transaction
17 Organization of Technical Frameworks Volume 1: Integration and content ProfilesDescribes clinical need and use casesIdentifies :the actors and transactions or,content modulesVolume 2+ of Technical FrameworkProvides implementation specification for transactions or content modules
18 IHE and Service Oriented Architectures SOA is a powerful business driven design methodologySOA “wraps” interoperability in “services”, but does not solve interoperability:E.g. Web Services may or may not be used in SOA. IHE Profiles are largely (not always) based on Web Services.Standardizing Services “offered” along with the “protocols” is 20 years old (Open System Interconnect). Good, but a Service definition does not result in compatibility “on the wire”.IHE Integration profiles are supportive of Service Oriented Architecture, but do not “require” use of SOA. IHE is Service Aware !Bits have to be compatible on the wire: No way to avoid specifying transaction & contentKey messagesMeeting the requirements of the healthcare professionals when exchanging patient clinical information is critical: trust in the information and ease of access is paramount.
19 Standards Adoption Process Testing at ConnectathonsIHE DemonstrationsProducts with IHETimely access to informationEasy to integrate productsDevelop technical specificationsIdentify available standards (e.g. HL7, DICOM, IETF, OASIS)Document Use Case Requirements
20 IHE ConnectathonOpen invitation to vendor and other implementors communityAdvanced testing tools (GAZELLE)Testing organized and supervised by project management teamThousands of cross-vendor tests performedResults recorded and published
21 IHE Connectathons Massive yearly events : 70-80 vendors engineerssystems….integrated in 5 daysVendors do not pass…until an IHE Project Manager attest it !Last Connectathon:Chicago, USA, January 11-15, 2010Bordeaux, France, April 12-16, 2010
23 Leveraging IHE Integration Statements VendorsClaim IHE Compliance in an explicit wayCan rely on an objective and thorough specification (IHE Technical Framework)Willing to accept contractual commitmentsWilling to correct “implementation errors”BuyersCan compare product integration capabilitiesSimplify and strengthen their RFPsCan leverage a public and objective commitmentDecreased cost and complexity of interface deployment and management
24 IHE Demonstrations: NOT an IHE Connectathon IHE Connectathon is about qualifying “real-world implementations”. Strict process and controlled technical testing activity. It is the stick !IHE demonstration is about education and promotion about what some “connectathon tested implementations” can achieve. It is the carrot !Implementations participating to an IHE Demonstration are required to have passed an IHE Connectahon. Not all vendors and products are demonstrated.2424
27 Implementation Tools (1) Open source implementations are available for XDS, XCA, XCPD, PIX, PDQ, ATNA, CT, and more:Microsoft under codeplexNIST under Source ForgeHIE-OS under Source ForgeFHA CONNECTMore on the next page…..27
28 Implementation Tools (2) Open source implementations are available for XDS, XCA, XCPD, PIX, PDQ, ATNA, CT, and more, from Open Health Tools:OHT – IHE Profiles (Charter) https://iheprofiles.projects.openhealthtools.orgOHT – Open Exchange (Forge)https://openexchange.projects.openhealthtools.orgOHT – Model Driven Health Tools (Charter) https://mdht.projects.openhealthtools.orgSeptember, 2005
29 Working Together to Deliver Interoperable Health Information Systems Providers and VendorsWorking Together to DeliverInteroperable Health Information Systemsin the Enterprise andAcross Care Settings
30 Requirements for an open HIE/EHR Bring trust and ease of use for healthcare professionals:Care delivery organizations choose information to share:Based on patient health statusWhen they see fit (discharge, end of encounter, etc.)What information to share (pick relevant documents, and content elements).Care delivery organizations access patient info through:Their own local EMR (if they have one)Through a shared portal/service otherwise.When accessing patient info:Find quickly if relevant information is available or not (single query)May select among relevant records (may be done in background)Among them chose to import whole or part in local patient recordKey messagesMeeting the requirements of the healthcare professionals when exchanging patient clinical information is critical: trust in the information and ease of access is paramount.
31 Requirements for an open HIE/EHR(2) Bring trust and privacy to patients:Only authorized organizations and authenticated healthcare providers may transact in the HIE:Each node or IT system interfaced is strongly authenticatedEach user shall be authenticated on the edge systemAll traffic trough the infrastructure is encryptedPatient consent needs multiple choices or levelsUnless opt-in, no data about a specific patient may be sharedSeveral data sharing policies offered to the patient consentEach shared record/document is assigned to specific policies (or not shared) at encounter time.Healthcare providers may only access records/documents compatible with their role.Meeting the requirements of the patient when exchanging its information is critical: trust in the information and protecting the privacy and confidentiality for the consumer is paramount.
32 Categories of Healthcare Communication Services HIEs and Shared EHRsPatient and Provider ID MgtHospitalse.g. access to last 6 months historical labs and encounter summariese.g. get a current list of allergies or med list from a sourcee.g. order a lab test, track status and receive resultsSecurityDocumentSharingDynamicInformationAccessWorkflowManagementSource-persisted and attested health recordsSpecific info snapshotprovided on demand2 or more entitiessynchronizea taskThe different services performing health information exchange fall in three categories. Hospitals have traditionally use primarily Workflow Mgt type and Dynamic Query services. Document Sharing, little used in hospitals, is however one of the primary mode of information exchange is the sharing of persisted and attested health records among independent organizations. We will focus on Document sharing in the next few slides.
33 Categories of Healthcare Communication Services HIEs and Shared EHRsPatient and Provider ID MgtHospitalsMedical Summary (XDS-MS)e.g. access to last 6 months historical labs and encounter summariese.g. get a current list of allergies or med list from a sourcee.g. order a lab test, track status and receive resultsSecurityCross-Enterprise Document Sharing (XDS)DocumentSharingDynamicInformationAccessWorkflowManagementSource-persisted and attested health recordsSpecific info snapshotprovided on demand2 or more entitiessynchronizea taskPatient Id Cross-Referencing (PIX)The different services performing health information exchange fall in three categories. Hospitals have traditionally use primarily Workflow Mgt type and Dynamic Query services. Document Sharing, little used in hospitals, is however one of the primary mode of information exchange is the sharing of persisted and attested health records among independent organizations. We will focus on Document sharing in the next few slides.
34 IHE Profiles Specifications Go to:For XDS:Under IT InfrastructureE.g. IT Infrastructure Technical Framework (XDS.b)For PIX:Under IT InfrastructureE.g. IT Infrastructure Technical Framework (PIX, HL7V2)Or PIXV3 supplement (PIX HL7 V3).For XDS-MS: Under Patient Care CoordinationE.g. PCC Technical framework (XDS-MS)
35 The IHE Global Standards Adoption Process First Step: Propose a Use case for Interoperability3535
36 Patient Identifier Cross-referencing for MPI Services Allow all enterprise participants to register the identifiers they use for patients in their domainParticipants retain control over their own domain’s patient index(es)Support domain systems’ queries for mapping across other systems’ identifiers for their patientsOptionally, notify domain systems when other systems update identifiers mapping for their patients
37 Patient Identifier Cross-referencing for MPI Value Proposition Maintain and linked all systems’ identifiers for a patient in a single locationUse any algorithms (encapsulated) to find matching patients across disparate identifier domainsLower cost for synchronizing data across systemsNo need to force identifier and format changes onto existing systemsLeverages standards and transactions already used within IHE
38 The IHE Global Standards Adoption Process Second Step: Propose a design and select standards for such an IHE Profile3838
39 Patient Identifier Cross-referencing for MPI Transaction Diagram
40 Patient Identifier Cross-referencing for MPI Process Flow Showing ID Domains & Transactions
42 Patient Identifier Cross-referencing for MPI Actors Patient Identity SourceDefinitionAssigns patient identities within its own domainNotifies Patient Identifier Cross-reference Manager of all events related to patient identification (creation, merge, etc.)Example: Registration (ADT) Actor in IHE Radiology Scheduled Workflow (SWF) ProfileTransaction Supported - RequiredPatient Identity Feed [ITI-8] (as sender)
43 Patient Identifier Cross-referencing for MPI Actors Patient Identifier Cross-reference ConsumerDefinitionRequires information about patient identifiers in other domainsRequests patient identifier information from Patient Identifier Cross-reference ManagerTransaction Supported - RequiredPIX Query [ITI-9] (as sender)Transaction Supported - OptionalPIX Update Notification [ITI-10] (as receiver)
44 Patient Identifier Cross-referencing for MPI Actors Patient Identifier Cross-reference ManagerDefinitionServes a well-defined set of Patient Identifier DomainsReceives patient identifier information from Patient Identity Source ActorsManages cross-referencing of identifiers across domainsTransactions Supported - RequiredPatient Identity Feed [ITI-8] (as receiver)PIX Query [ITI-9] (as receiver)PIX Update Notification [ITI-10] (as sender)
45 Patient Identifier Cross-referencing for MPI Standards Used: 2 Profiles PIX: HL7 Version 2.5ADT Registration and Update Trigger Events (HL )A01: inpatient admissionA04: outpatient registrationA05: pre-admissionA08: patient updateA40: merge patientQueries for Corresponding Identifiers (ADT^Q23/K23)Notification of Identifiers Lists Updates (ADT^A31)PIX V3: HL7 V3Leverage Web Services (harmonized WS by IHE Appendix V)
46 The IHE Global Standards Adoption Process Third Step: Engage implementers for Testing Trial Implementation profile at ConnectathonsFourth Step: Based on lessons learned from Connectathons implementers, correct/clarify Profile and Publish as “Final Text” in Domain Technical Framework. Will be presented in part 24646
47 IHE offers a broad collection of Profiles Use Cases addressed are specified in a series of Domain Technical Frameworks (Volume 1)Two broad classes of profiles: Integration (how to move the data) and Content (what the data conveys).A few example of “cross-enterprise” integration and content profilesComplete list on:4747
48 Registering Health Records:IHE-XDS Clinic RecordCommunitySpecialist RecordHospital RecordHealth Info ExchangeRepository of Documents1-Referenceto recordsRepository of DocumentsIndex ofpatients recordsClinical EncounterClinical IT SystemThen any edge systems, such as this clinical systems, may query the document registry (Step 2), and then retrieve documents of interest through their pointer provided by the registry (Srep 3). Finaly, the resulting information is presented to the resuesting physician in our example (Step 4).
49 4-Patient data presented to Physician Access to Shared Records : IHE-XDSClinic RecordCommunitySpecialist RecordHospital RecordHIERepository of Documents3-RecordsReturnedRepository of DocumentsAggregate Patient Info4-Patient data presented to PhysicianIndex ofpatients recordsClinical EncounterClinical IT SystemThen any edge systems, such as this clinical systems, may query the document registry (Step 2), and then retrieve documents of interest through their pointer provided by the registry (Srep 3). Finaly, the resulting information is presented to the resuesting physician in our example (Step 4).2-Referenceto Records for Inquiry
50 Health Information Exchanges Interoperability: Cross-enterprise Document Sharing Cross-Enterprise Document Sharing simplifies clinical data management by defining interoperable infrastructure. Transparency = Ease of EvolutionPatients have guaranteed portability and providers may share information without concerns of aggregation errors. Digital Documents = Patients and providers empowermentSupports both centralized and decentralized repository architectures. Ease of federation nationally. Flexible privacy, Flexibility of configurationsAddresses the need for a longitudinal healthcare data (health records). Complements to interactive workflow or dynamic access to data.Behind XDS, there are rather fundamental principles that ensure a cost-effective and flexible infrastructure that supports a broad range of centralized and decentralized configurations.
51 Cross-Enterprise Document Sharing (XDS) Standards Used Healthcare Content StandardsHL7 CDA header extractHL7 data typesElectronic Business StandardsebXML Registry, SOAP,Web Services …Internet StandardsHTTP, IETF, W3C, …Implemented world-wide by over 150 vendors/open source.Adopted in several national & regional projects: Italy, Austria, Canada, USA, Japan, South Africa, France, Netherlands, etc.)XDS relies on an array of solid and world-wide adopted standards. Since its initial definition, XDS has been widely implemented and now reached full maturity. Adoption by national and regional projects, is now significant and continues to expand.
52 Why is IHE-XDS a breakthrough ? It based on an International Standards; ebXML registry: OASIS and ISO standard, Web Service/Soap/XML.Sharing of digital documents as “attested by the source”, meets the most urgent needs. A proven healthcare community data-sharing paradigm (Feeding a central web server is view only and hinders use of EHRs).Efficient to support all types of Health IT Systems (IDNs, Hospitals, Ambulatory, Pharmacy, Diagnostics Centers, etc.) and all types of information (summaries, meds, images, lab reports, ECGs, etc.), structured and unstructured.Meets both the needs of push communication by info sources and on-demand pull in a variety of centralized or distributed architectures.Offer a consistent, standards-based and functional record sharing for EHRs, PHRs & other IT Systems
53 Combining IHE Profiles Document Content & Modes of Document Exchange Doc Content Profiles (Semantics content)Scanned DocXDS-SDConsentBPPCEmergencyEDRPre- SurgeryPPHPFunctional Status AssesmentFSAImagingXDS-ILaboratoryXD*-LabDischarge & ReferralsXDS-MSPHR ExchangeXPHRDocument Exchange Integration ProfilesDocumentSharing XDS / XCAReliable Pt-Pt InterchangeXDRMedia InterchangeXDMIHE Integration Profiles offer flexibility in that they can be mixed and matched to meet a broad range need.This slide illustrates that not only XDS may be used to exchange documents, by interchange media such as USB keys and CDs are specified by the XDM Integration Profile. Likewise a varity of content
54 Patient Longitudinal Record Typically, a patient goes through a sequence of encounters in different Care SettingsLong Term CareAcute Care (Hospital)Other Specialized Care (incl. Diagnostics Services)GPs and Clinics (Ambulatory)Continuity of Care:Patient Longitudinal Record
55 Building and accessing Documents Documents RegistryLongitudinal Record as used across-encountersDocument RepositoryLong Term CareAcute Care (Inpatient)Other Specialized Care or Diagnostics ServicesCare Record systems supporting care deliveryPCPs and Clinics (Ambulatory)Submission of Document ReferencesRetrieve of selected Documents
57 XDS – Value Proposition Foundation for Health IT Infrastructures: Shared Electronic Health Record, in a community, region, etc.Effective means to contribute and access clinical documents across health enterprises.Scalable sharing of documents between private physicians, clinics, long term care, pharmacy, acute care with different clinical IT systems.Easy access: Care providers are offered means to query and retrieve clinical documents of interest.
58 XDS - Value Proposition Distributed: Each Care delivery organization “publishes” clinical information for others. Actual documents may remain in the source EHRCross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain (e.g. a region).Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (HL7-CDA, PDF, DICOM, etc.)Document Content Neutral: Document content is processed only by source and consumer IT systems.Standardized Registry Attributes: Queries based on meaningful attributes ensure deterministic document searches.
59 How real is XDS ?Stable specification IHE Technical Framework PublishedXDS.b Supplement that offers:Use most recent Web Services stds (MTOM/XOP)Allow Retrieve sets of Documents in one transactionSame servicesFirst implementation in clinical use in region of Genoa - Italy) since early 2006.Several since: Lower Austria region, State of Vermont, Nagoya city, South Africa region, Dutch regions, etc.Adopted by several national programs world-wide4 open source toolkits available, numerous product implementations in EMRs and Infrastructure offerings.
60 IHE, Global Standards-Based Profiles Adopted in National & Regional Projects (sample) LowerAustriaNETHERLANDSFrieslandNatn’l MamographyItaly Conto CorrenteVenetto - FriuliFrance DMPVITL-VermontAustriaSuisse St GallenLausaneQuebec, Toronto, Alberta, British Columbia Canada InfowayWalesImagingFrance Imaging IDFBoston Medical Center - MAFor more complete list see: tinyurl.com/wwXDSPhiladelphia HIEBelgiumFlemish-LeuvenKeyHIE PennsylvaniaSouth Shore Hospital, NYBoston Medical Center, MAVermont Information Technology Leaders, VTKeyHIE/Geisinger Health System, PALower Austria Region (near Vienna)Friesland Cardiology NetworkNorth Carolina Healthcare Information and Communications Alliance,NCCareSpark, TNAzienda Sanitaria Locale n. 4 ChiavareseUSA - NHINAustria-ELGAFrance-DMPProvidence Health System, ORSouth-Africa-GautengMontreal McGill - QuebecToronto East Network - OntarioBritish ColumbiaAlbertaProject DogeItaly Friuli RegionIreland - National PACSJapan-NagoyaShanghaiKobe-Stroke MgtCardiology Network GroningenAmsterdam Radiology NetworkRotterdam HIEFlemish Hospital NetworkDutch Mammo ScreeningMayo Clinic, MNNew York Presbyterian, NYItaly-Health OptimumIHE North American Connectathon, USACareSpark – TN & VASHARP CASouth AfricaTHINC- New YorkNCHICA – N. CarolinaProvidence Health System - ORCHINA-ShanghaiImaging Info SharingCHINA-MoHLab results sharingJAPAN-NagoyaImaging Info Sharing,Nationwide PDI guideline60606060
61 IHE-XDS is part of a family of profiles Regional, national, local or disease centric networks need a consistent set of Integration ProfilesFifthteen Integration Profiles completed and tested, plus five ready to implement = Standards-based interoperability building blocks forRich Document Content for end-to-end application interoperability.Patient identification managementSecurity and privacyNotification and data captureXDS is one integration profile among a consistent and growing family of profiles. When used together these profiles provide a solid basis for building a health information exchange.IHE-XDS + related IHE Integration profiles provide a complete interoperability solution
62 IHE Integration Profiles for Health Info Nets What is available and in trial implementation Security & PrivacyClinical and PHR ContentPatient ID MgmtEmergency ReferralsFormat of the Document Content and associated coded vocabularyPHR Extracts/UpdatesObGyn DocumentsLab Results Document ContentScanned DocumentsFormat of the Document ContentImaging InformationMedical Summary(Meds, Allergies, Pbs)and associated coded vocabularyConsistent TimeCoordinate time across networked systemsAudit Trail & Node AuthenticationCentralized privacy audit trail and node to node authentication to create a secured domain.Basic Patients Privacy ConsentsEstablish Consents & Enable Access ControlDocument Digital SignatureAttesting “true-copy and originCross-Enterprise User AssertionProvides Trusted IdentityPatient Demographics QueryPatient Identifier Cross-referencingMap patient identifiers across independent identification domainsDocument Subscription and NotificationRequest Form for Data CaptureExternal form with custom import/export scriptingHealth Data ExchangeOtherCross-Enterprise Document SharingRegistration, distribution and access across health enterprises of clinical documents forming a longitudinal recordCross-Enterprise Document Pt-Pt Reliable InterchangeCross-Enterprise Document Media InterchangeCross-Community AccessFinal Text ApprovedTrial Implementation-2009– Final Txt 2010
63 XDS-MS Medical Summary or PHR Extract Exchange Profile based on HL7 CDA Rel 2 and HL7 CCD IG Structured and Coded HeaderLevel 1Patient, Author, Authenticator, Institution,Header always structured and codedTime of Service, etc.SSttrruuccttuurreeddCCoonntteennttwwiitthhccooddeeddsseeccttiioonnss::Level 2Title-coded sections with non-structuredReason for Referralnor coded content (text, lists, tables).Vital Signs Simple Viewing (XML Style sheet)MMeeddiiccaattiioonnText StructureEntryMed, Problems and Allergiesas highly structured text.Text easy to import/parseLevel 3Med Problems andAllergies have afine-grain structure withoptional coding. CodingScheme explicitly identified.Coded SectionEntryLevel 3StudiesAAlllleerrggiieessOne of the most common information exchange neeed is to create an summary of a patient chart and share for other care provider to import. In this type of document, it is clear that the information content is not only textual information, but highly structured information for the most important information, medication, allergies, diagnosis, and patient demographics informations. This IHE medical summary, XDS-MS is based on the HL7 CDA release 2 standard, just like the PHR extract, XPHR, which is aligned on the ASTM/HL7 CCD implementation guide.Social HistoryPPrroobblleemmssXDS-MS and XPHR enable both semantic interoperability & simple viewing !Care Plan
64 Use of a shared XDS infrastructure to access Radiology Reports and Images (XDS-I) Between Radiology and :Imaging specialistsNon-imaging cliniciansHospitalPACS YRadiology -to- RadiologyRadiology -to- PhysiciansPACS ZImaging CenterThe very same IHE XDS infrastructure used to share medical summaries, may alos be used to share diagnosis images and imaging reports. This is specified by the XDS-I integration proifile.Physician PracticeSame XDS Infrastructure (Registry and Repositories) for medical summaries and imaging information !
65 in the Enterprise Interoperable Health Information Systems Providers and VendorsWorking Together to DeliverInteroperable Health Information SystemsAnd Across Care Settings Intra Hospital Workflows and Information Accessin the Enterprise
66 IHE Solutions within the Enterprise EMR - HISeMPIUser AuthEnterprise IT InfrastructureRadiologyRISPACSImg AcqLaboratoryLISAuto MgrAnalyzerCardiologyCISCathECGEye CarePathologyHome HubTherapy PlanNursing StationEstablished Feb 2009Img AcqTreatmentDevicesDevicesDevicesRadiation TherapyPharmacyIntensive Care Unit
67 IHE Solutions within the Enterprise Example: Cardiology EMR - HISeMPIUser AuthEnterprise IT InfrastructureRadiologyRISPACSImg AcqLaboratoryLISAuto MgrAnalyzerCardiologyCISCathECGEye CarePathologyCardiology Integration ProfilesCardiac Catheterization Lab WorkflowEchocardiography Lab WorkflowRetrieve ECG for DisplayDisplayable ReportsCath and Echo Evidence DocumentsHome HubTherapy PlanNursing StationEstablished Feb 2009Img AcqTreatmentDevicesDevicesDevicesRadiation TherapyPharmacyIntensive Care Unit6767
68 IHE Solutions within the Enterprise Example: IT Infrastructure EMR - HISeMPIUser AuthEnterprise IT InfrastructureRadiologyRISPACSImg AcqLaboratoryLISAuto MgrAnalyzerCardiologyCISCathECGIT Infrastructure Integration ProfilesPatient Administration ManagementPatient Demographics QueryPatient Identifier Cross-referencingRetrieve Information for DisplayEnterprise User AuthenticationConsistent TimePatient Synchronized ApplicationsAudit Trail and Node AuthenticationPersonnel White PagesShared Value SetsEye CarePathologyHome HubTherapy PlanNursing StationEstablished Feb 2009Img AcqTreatmentDevicesDevicesDevicesRadiation TherapyPharmacyIntensive Care Unit6868
69 IHE Solutions within the Enterprise Example: Radiology EMR - HISeMPIUser AuthEnterprise IT InfrastructureRadiologyRISPACSImg AcqRadiology Integration ProfilesRadiology Scheduled WorkflowPatient Information ReconciliationAccess to Radiology InformationPortable Data for ImagingConsistent Presentation of ImagesKey Image NotePresentation of Grouped ProceduresEvidence DocumentsAudit trail and Node Authentication (Rad option)Teaching Files and Clinical Trials ExportPost-processing WorkflowReporting WorkflowCharge PostingSimple Image and Numeric ReportsLaboratoryLISAuto MgrAnalyzerCardiologyCISCathECGEye CarePathologyHome HubTherapy PlanNursing StationEstablished Feb 2009Img AcqTreatmentDevicesDevicesDevicesRadiation TherapyPharmacyIntensive Care Unit6969
70 IHE Solutions within the Enterprise Example: Laboratory EMR - HISeMPIUser AuthEnterprise IT InfrastructureRadiologyRISPACSImg AcqLaboratoryLISAuto MgrAnalyzerCardiologyCISCathECGEye CarePathologyLaboratory Integration ProfilesLaboratory Testing WorkflowLaboratory Information ReconciliationLaboratory Point Of Care TestingLaboratory Device AutomationLaboratory Code Set DistributionLaboratory BarCodeHome HubTherapy PlanNursing StationEstablished Feb 2009Img AcqTreatmentDevicesDevicesDevicesRadiation TherapyPharmacyIntensive Care Unit7070
71 Laboratory Testing Workflow (LTW) & Laboratory Device Automation (LDA) Placer orderOrder PlacerOrder FillerFiller orderWork orderResultsResultsAutomation ManagerOrder Result TrackerWork Order StepsQuery & download modesTests resultsPre/post processorAnalyzerLTWLDAProfiles based on HL7 V2.5.1Solid implementation experience
72 IHE Solutions within the Enterprise Example: Patient Care Devices EMR - HISeMPIUser AuthEnterprise IT InfrastructureRadiologyRISPACSImg AcqLaboratoryLISAuto MgrAnalyzerCardiologyCISCathECGPatient Care Devices ProfilesDevice Enterprise Communication (DEC)Alarm Communication Mgt (ACM)Subscribe to Patient Data (SPD)Patient Identity Binding (PIB)Rosetta Terminology Mapping (RTM)Eye CarePathologyHome HubTherapy PlanNursing StationEstablished Feb 2009Img AcqTreatmentDevicesDevicesPersonal DevicesRadiation TherapyPharmacyIntensive Care Unit7272
73 Working Together to Deliver Interoperable Health Information Systems Providers and VendorsWorking Together to DeliverInteroperable Health Information Systemsin the Enterpriseand Across Care Settings
74 AgendaPart 1: THE IHE STANDARDS ADOPTION PROCESS: achieving practical interoperabilityThis Afternoon:Part 2:USERS AND VENDORS WORKING TOGETHER: how can I contribute & benefit from IHEHOW TO USE IHE RESOURCES: hands on experience7474