1. February 7, 2005IHE EU-Conference & Workshop IHE IT Infrastructure Established Integration Profiles Charles Parisot, GE Healthcare IHE IT Infrastructure co-chair Integrating the Healthcare Enterprise

2. February 7, 2005IHE EU-Conference & Workshop www.IHE-europe.org W W W. I H E. N E T Providers and Vendors Coming Together to Deliver Interoperable Health Information Systems Within and Between Enterprises and Settings

3. February 7, 2005IHE EU-Conference & Workshop Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Consistent Time Coordinate time across networked systems Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains IHE IT Infrastructure 2003-2004 IHE IT Infrastructure 2004-2005 Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. New Patient Demographics Query New Personnel White Page Access to workforce contact information New Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record New Consistent Time Coordinate time across networked systems Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains IHE IT Infrastructure 2003-2004

4. February 7, 2005IHE EU-Conference & Workshop IHE IT Infrastructure 2004-2005 Patient Identity Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications Patient Demographics Query New

5. February 7, 2005IHE EU-Conference & Workshop IHE IT Infrastructure 2004-2005 Security Enterprise User Authentication Provide users a single name and centralized authentication process across all systems 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. New Personnel White Page Access to workforce contact information New

6. February 7, 2005IHE EU-Conference & Workshop IHE IT Infrastructure 2004-2005 Access to Patient Records Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record New

7. February 7, 2005IHE EU-Conference & Workshop IHE IT Infrastructure Established Integration Profiles Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications Consistent Time Coordinate time across networked systems

8. February 7, 2005IHE EU-Conference & Workshop IHE IT Infrastructure Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications Consistent Time Coordinate time across networked systems Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains

9. February 7, 2005IHE EU-Conference & Workshop Patient Identifier Cross-referencing for MPI Abstract / Scope Allow all enterprise participants to register the identifiers they use for patients in their domain Participants retain control over their own domain’s patient index(es) Support domain systems’ queries for other systems’ identifiers for their patients Optionally, notify domain systems when other systems update identifiers for their patients

10. February 7, 2005IHE EU-Conference & Workshop Patient Identifier Cross-referencing for MPI Value Proposition Maintain all systems’ identifiers for a patient in a single location Use any algorithms (encapsulated) to find matching patients across disparate identifier domains Lower cost for synchronizing data across systems  No need to force identifier and format changes onto existing systems Leverages standards and transactions already used within IHE

11. February 7, 2005IHE EU-Conference & Workshop Patient Identifier Cross-referencing for MPI Transaction Diagram

12. February 7, 2005IHE EU-Conference & Workshop Patient Identifier Cross-referencing for MPI Process Flow Showing ID Domains & Transactions

13. February 7, 2005IHE EU-Conference & Workshop Patient Identifier Cross-referencing for MPI B:X456 C: 2RT Identity Patient Cross References B:X456 C: ?

14. February 7, 2005IHE EU-Conference & Workshop Patient Identifier Cross-referencing for MPI Standards Used HL7 Version 2.5  ADT Registration and Update Trigger Events A01: inpatient admission A04: outpatient registration A05: pre-admission A08: patient update A40: merge patient  Queries for Corresponding Identifiers (ADT^Q23/K23)  Notification of Identifiers Lists Updates (ADT^A31)

15. February 7, 2005IHE EU-Conference & Workshop PIX Integration Profile & MPI The typical view Patient Identification Domain C Patient Identity Cross- reference Manager Patient Identification Domain A (Master Domain) Patient Identification Domain B Master (A) Patient Identity Source Master Patient Index

16. February 7, 2005IHE EU-Conference & Workshop PIX Integration Profile & MPI The Equivalent IHE Model Patient Identification Domain C Patient Identity Cross- reference Manager Patient Identification Domain A (Master Domain) Patient Identification Domain B Master (A) Patient Identity Source Master Patient Index

17. February 7, 2005IHE EU-Conference & Workshop IHE IT Infrastructure Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications Consistent Time Coordinate time across networked systems Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user

18. February 7, 2005IHE EU-Conference & Workshop Simple and rapid access to patient information Access to existing persistent documents in well-known presentation formats: CDA, PDF, JPEG. Access to specific key patient-centric information for presentation to a clinician : allergies, current medications, summary of reports, etc.. Links with other IHE profiles - Enterprise User Authentication, Patient Identifier Cross-referencing and Cross Enterprise Document Sharing Retrieve Information for Display Abstract / Scope

19. February 7, 2005IHE EU-Conference & Workshop User Convenience:  Healthcare providers can "see" the information. A significant integration step.  Workflows from within the users’ on-screen workspace or application.  Complements multiple simultaneous apps workflow of Patient Synchronized Apps Broad Enterprise-Wide access to information:  Web technology for simple clients  Clinical data handling fully assumed by the information source that holds clinical data. Retrieve Information for Display Value Proposition

20. February 7, 2005IHE EU-Conference & Workshop Standards Used:  Web Services (WSDL for HTTP Get).  General purpose IT Presentation Formats: XHTML, PDF, JPEG, CDA L1 (HL7)  Client may be off-the-shelf browser or display application. Two services :  Retrieve of Specific Information: Patient centric: patient ID Type of Request (see next slide) Date, Time, nMostRecent  Retrieve a Document Object Unique Instance Identifier (OID) Type of Request Content Type Expected Retrieve Information for Display Key Technical Properties

21. February 7, 2005IHE EU-Conference & Workshop Transaction Diagram Retrieve Information for Display Display Information Source Retrieve Specific Info for Display [11] Summary of All Reports Summary of Laboratory Reports Summary of Radiology Reports Summary of Cardiology Reports Summary of Surgery Reports Summary of Intensive Care Reports Summary of Emergency Reports Summary of Discharge Reports List of Allergies List of Medications Retrieve Document for Display [12] Persistent Document Types of Requests

22. February 7, 2005IHE EU-Conference & Workshop Query Keys – Transaction [11] Retrieve Specific Information for Display Parameter Name Request Type patientID lowerDate Time upperDate Time MostRecen tResults REQ R R O O R Description requestType specifies what type of information shall be retrieved. This parameter shall always be valued. This attribute identifies the subject of the results being queried for. Its value shall include identification of assigning authority. Used to constrain the earliest date/time of creation of information. Used to constrain the latest date/time of creation of information. The numeric value that indicates the number of most recent results to be included into the response, i.e., 1 indicates to provide the latest result.

23. February 7, 2005IHE EU-Conference & Workshop Query Keys – Transaction [12] Retrieve Document for Display Parameter Name Request Type Document UID Description This parameter is required to have a value of “DOCUMENT”. Identifies document’s UID as known to both actors. REQ R R PreferredC ontentType This parameter is required to identify the preferred format: JPEG. PDF, CDA L1 that the document is to be provided (as MIME content type). R

24. February 7, 2005IHE EU-Conference & Workshop IHE IT Infrastructure 2004-2005 Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications Consistent Time Coordinate time across networked systems Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications

25. February 7, 2005IHE EU-Conference & Workshop Abstract / Scope Patient Synchronization of Multiple Disparate Applications Single Patient Selection When combined with PIX Profile, allows patient synchronization across patient identifier domains When combined with EUA Profile, provides user Single Sign-on (SSO) Patient Synchronized Applications

26. February 7, 2005IHE EU-Conference & Workshop Value Proposition User Convenience:  Eliminates the repetitive task of selecting the patient in each application  Permits the user to select the patient in the application for which they are most familiar and / or appropriate to the clinical workflow Patient Safety:  Ensures all data being viewed across applications is for the same patient Leverage Single Development Effort:  Allows vendors to leverage single CCOW enablement effort to support multiple actors: Patient Context Participant (PSA) User Context Participant (EUA) Patient Synchronized Applications

27. February 7, 2005IHE EU-Conference & Workshop Patient Synchronized Applications Actors Context Manager Actor The IHE Context Manager Actor may encompass more than a CCOW context manager function. It may include a number of other components such as the context management registry and patient mapping agent. Patient Context Participant Actor The Patient Context Participant Actor shall respond to all patient context changes. This actor shall set the patient context provided the application has patient selection capability.

28. February 7, 2005IHE EU-Conference & Workshop Transactions Diagram Patient Synchronized Applications These transactions are required for both Actors for compliance

29. February 7, 2005IHE EU-Conference & Workshop Key Technical Properties Standards Used:  HL7 Context Management “CCOW” Standard, Version 1.4  Support for both Windows and Web Technology  Support of “Patient Subject” IHE Constraints:  Specifies use of Patient.Id.IdList item Ensures maximum interoperability with PIX Profile Protects against future deprecation of patient identifier items (HL7 2.3.1, 2.4, 2.5, CCOW). Patient Synchronized Applications

30. February 7, 2005IHE EU-Conference & Workshop IHE IT Infrastructure 2004-2005 Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Consistent Time Coordinate time across networked systems

31. February 7, 2005IHE EU-Conference & Workshop Enterprise User Authentication Scope Support a single enterprise governed by a single set of security policies and having a common network domain. Establish one name per user to be used for all IT applications and devices. Facilitate centralized user authentication management. Provide users with single sign-on.

32. February 7, 2005IHE EU-Conference & Workshop Enterprise User Authentication Value Proposition Meet a basic security requirement  User authentication is necessary for most applications and data access operations. Achieve cost savings/containment  Centralize user authentication management  Simplify multi-vendor implementations Provide workflow improvement for users  Increase user acceptance through simplicity  Decrease user task-switching time. More effective security protection  Consistency and simplicity yields greater assurance.

33. February 7, 2005IHE EU-Conference & Workshop Consistent Time Scope and Value Proposition Meet a basic security requirement  System clocks and time stamps of the many computers in a network must be synchronized.  Lack of consistent time creates a “security hole” for attackers.  Synchronization ±1 second is generally sufficient. Achieve cost savings/containment  Use the Network Time Protocol (NTP) standard defined in RFC 1305.  Leverage exisisting Internet NTP services, a set-up option for mainstream operating systems.

34. February 7, 2005IHE EU-Conference & Workshop EUA and CT Key Technical Properties Standards Used  Kerberos v5 (RFC 1510) Stable since 1993, Widely implemented on current operating system platforms Successfully withstood attacks in its 10-year history Fully interoperable among all platforms  HL7 CCOW, user subject  Network Time Protocol (RFC 1305) Minimal Application Changes  Eliminate application-specific, non-interoperable authentication  Replace less secure proprietary security techniques  Leverage NTP interfaces built-into operating systems

35. February 7, 2005IHE EU-Conference & Workshop Enterprise User Authentication Kerberos Authentication Kerberos Server “kinit” Cache Request TGT Response (contains TGT) application TGT Request Service ticket Response with Service Ticket Application server Protocol specific communication, using Service Ticket as authenticator Communication Initiated Initial username, password Single System Environment

36. February 7, 2005IHE EU-Conference & Workshop Enterprise User Authentication Key Attributes Limited network overhead  Kerberos is network-efficient, developed at a time when high-speed networks were rare.  CCOW is similarly network-efficient Kerberos and CCOW work with any user authentication technology  Tokens, biometric technologies, smart cards, …  Specific implementations require some proprietary components, e.g., biometric devices.  Once user authentication is complete, network transactions are the same for all technologies.

37. February 7, 2005IHE EU-Conference & Workshop Enterprise User Authentication Transaction Diagram with CCOW Option

38. February 7, 2005IHE EU-Conference & Workshop Consistent Time Transaction Diagram Maintain Time [ITI-1] ↑ Time Server Time Client

39. February 7, 2005IHE EU-Conference & Workshop IHE IT Infrastructure Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications Consistent Time Coordinate time across networked systems

40. February 7, 2005IHE EU-Conference & Workshop Synergy between IHE IT Int. Profiles RID with EUA/CT & PIX Display Client Authentication Agent Time Client Information Source Kerberos Authentication Server Time Server Patient Identity Consumer Patient Identity X-ref Manager Example of support of multiple actors/profiles 40

41. February 7, 2005IHE EU-Conference & Workshop Synergy between IHE IT Int. Profiles Apps with PSA, EUA & PIX Application A Client Authentication Agent Time ClientKerberos Authentication Server Time Server Patient Identity Consumer Patient Identity X-ref Manager Context Manager Application B Context participant Example of support of multiple actors/profiles 41

42. February 7, 2005IHE EU-Conference & Workshop A Pause for Questions ? www.IHE-europe.org W W W. I H E. N E T Integrating the Healthcare Enterprise

43. February 7, 2005IHE EU-Conference & Workshop Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Consistent Time Coordinate time across networked systems Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains IHE IT Infrastructure 2003-2004 IHE IT Infrastructure 2004-2005 Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. New Patient Demographics Query New Personnel White Page Access to workforce contact information New Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record New Consistent Time Coordinate time across networked systems Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains IHE IT Infrastructure 2003-2004

44. February 7, 2005IHE EU-Conference & Workshop IHE IT Infrastructure 2004-2005 Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Map patient identifiers across independent identification domains Patient Identifier Cross-referencing for MPI Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications 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. New Patient Demographics Query New Personnel White Page Access to workforce contact information New Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a distributed patient electronic health record New

45. February 7, 2005IHE EU-Conference & Workshop Introduction: EHR Cross-Enterprise Document Sharing First step towards the longitudinal dimension of the EHR Focus: Support document sharing between EHRs in different care settings and organizations

46. February 7, 2005IHE EU-Conference & Workshop Acute Care (Inpatient) GPs and Clinics (Ambulatory) Long Term Care Other Specialized Care (incl. Diagnostics Services) Continuity of Care : Patient Longitudinal Record Typically, a patient goes through a sequence of encounters in different Care Settings

47. February 7, 2005IHE EU-Conference & Workshop community Clinical Encounter Clinical IT System RecordsSent Laboratory Results Specialist Record Hospital Record Finding the records of a patient-Manual & tedious The challenge: Finding and accessing easily documents from other care providers In the community.

48. February 7, 2005IHE EU-Conference & Workshop community Clinical Encounter Clinical IT System Index of patients records (Document-level) 1-Patient Authorized Inquiry Temporary Aggregate Patient History 4-Patient data presented to Physician Sharing System 3-RecordsReturned Reference to records Laboratory Results Specialist Record Hospital Record 2-Reference to Records for Inquiry Sharing records that have been published

49. February 7, 2005IHE EU-Conference & Workshop Acute Care (Inpatient) PCPs and Clinics (Ambulatory) Long Term Care Other Specialized Care or Diagnostics Services Building and accessing Documents EHR-CR: Care Record systems supporting care delivery Documents Registry Document Repository EHR-LR: Longitudinal Record as used across-encounters Submission of Document References Retrieve of selected Documents

50. February 7, 2005IHE EU-Conference & Workshop 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.

51. February 7, 2005IHE EU-Conference & Workshop XDS - Value Proposition Distributed: Each Care delivery organization “publishes” clinical information for others. Actual documents may remain in the source EHR-CR. Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain (e.g. an LHII). Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (HL7-CDA, ASTM-CCR, 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.

52. February 7, 2005IHE EU-Conference & Workshop Integration Model 1: EHR-CR with Repository at Source An EHR-CR completes a phase of care for a patient where it:  Has these documents available as Repository Actor.  Registers documents with a Registry actor. Any other EHR-CR may query the Registry actor, and chose to retrieve some of these documents from any Document Repository Actor.

53. February 7, 2005IHE EU-Conference & Workshop Integration Model 2: EHR-LR with Third Party Repository An EHR-CR completes a phase of care for a patient where it:  Provides the documents to a Repository Actor of its choice.  Documents are Registered with a Registry Actor. Any other EHR-CR may query the Registry actor, and chose to retrieve some of these documents from any Document Repository Actor.

54. February 7, 2005IHE EU-Conference & Workshop Integration Model 3: EHR-CR feed a EHR-CR/EHR-LR hub An EHR-CR completes a phase of care for a patient where it:  Provides and Registers a set of documents to a Document Repository in an EHR-CR. The EHR-CR Consumer Actor has the documents and may respond to queries and provide them to other document consumers.

55. February 7, 2005IHE EU-Conference & Workshop Patient Access also possible A patient accesses own record:  Query and Retrieve a set of documents using for example a portal application that offers the ability to display documents’ content. This is a particular case of an EHR-CR, where the patient is interested her/his own care. Patient may also register and provide documents.

56. February 7, 2005IHE EU-Conference & Workshop Conclusion: IHE Cross-Enterprise Document Sharing IHE XDS is a critical element to enable sharing of health information between EHR Systems. Access Control and Doc Content Profiles are on the IHE Roadmap for 2005. collaboration contributing to a more cost-effective and rapid deployment In collaboration with well established standards bodies (HL7, ASTM, CEN, OASIS, IETF, DICOM, etc.) and other EHR related initiatives world-wide (EuroREC, etc.), IHE is contributing to a more cost-effective and rapid deployment of community, regional and national health IT infrastructures.

57. February 7, 2005IHE EU-Conference & Workshop How real is XDS ? Specification work since Nov 2003 Public Comments June-July 2004  600 constructive comments received.  Validity of XDS approach confirmed around the world. Stable specification IHE Technical Framework Published Aug 15 th, 2004 (TI Supplement) IHE Connectathon - January 2005 (USA)-17 vendors HIMSS Feb 2005 - show-wide demonstration IHE Connectathon - April 2005 (Europe)-27 vendors Several Implementation Projects by health authorities in 2005

58. February 7, 2005IHE EU-Conference & Workshop Exposition d’interopérabilité HIMSS 2005 Organisée par HIMSS, un des sponsors IHE aux USA. Intégrant les milieux hospitaliers et ambulatoires :  partage inter-entreprise de l’information de santé entre les milieux de soins hospitaliers et ambulatoires. Intégrant les dossier patient électroniques sur les stands des fournisseurs:  milieu hautement interactif, basé sur les normes, visant à démontrer l’interopérabilité pratique entre les entreprises de soins.

59. February 7, 2005IHE EU-Conference & Workshop Exposition d’interopérabilité HIMSS 2005 Visiteurs géreront leur dossier de soin électronique au sein du « réseau régional HIMSS ». Environnement communiquant s’appuyant sur le profil IHE Cross-enterprise Document Sharing:  Bati autour d’un « XDS document registry » central.  Des « XDS ocument repositories » distribués.  17 DES qui publient/partagent divers documents (Résumé Patient-CCR, HL7-CDA, HL7-lab, PDF).

60. February 7, 2005IHE EU-Conference & Workshop Exposition d’interopérabilité HIMSS 2005 Partage d’information inter-entreprise en milieu hospitalier, 20 fournisseurs: CedaraGusrada/Care Science NIST DictaphoneIDX Novell Eastman KodakInterSystems Open Text EclipsysInfinitt Sentillion EmageonKryptiq Siemens Epic MedCommons Univ. Of Washington GE Healthcare Mortara Instruments Fournisseurs testés au connectathon présentant un produit: Partage d’Information en milieu ambulatoire, 13 fournisseurs: AllscriptsGE HealthcareMidMark CapMed/SanDiskIDX NextGen CernerKrytiq WebMD EclipsysMedcomSoft ETIAMMediNotes

61. February 7, 2005IHE EU-Conference & Workshop HIMSS 2005 – Show-Wide Interoperability Vendor System Ambulatory Showcase Booth Home PCP Multispecialty Clinic Diag Center Cross-enterprise Showcase Booth Cardiology Radiology IT Infrastructure In-Patient/Out-patient Vendor Booth Allscripts CapMed Cerner Eclipsys GE Healthcare IDX Infinitt InterSystems Krytiq MedCommons MediNotes NextGen OpenText Siemens WebMD HIMSS “RHIO” with Cross-enterprise doc sharing

62. February 7, 2005IHE EU-Conference & Workshop Secured Node Document Consumer Retrieve Document Query Documents Patient Identity Source Patient Identity Feed Document Source Document Registry Document Repository Provide&Register Document Se t Register Document Set Secured Node ATNA crée un domaine sécurisé sur internet: User Accountability (Audit trail) Node-to-Node Access Control Node-level user authentication Les Contrôles d’accès utilisateurs sont prévus pour 2005. Sécurité pour XDS Sécurité pour XDS Se base sur le Profil IHE Audit Trail & Node Authentication

63. February 7, 2005IHE EU-Conference & Workshop IHE IT Infrastructure 2004-2005 Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications 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. New Personnel White Page Access to workforce contact information New Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record New Patient Demographics Query New Retrieval of a patient list including patient names, identifiers, contacts, and visit information

64. February 7, 2005IHE EU-Conference & Workshop Patient Demographics Query Abstract/Scope Allow quick retrieval of a patient list including common patient names, identifiers, contacts, and visit information Enable selection of correct patient when full identification data may not be available Limits access to only a subset of demographic and visit information

65. February 7, 2005IHE EU-Conference & Workshop Patient Demographics Query Value Proposition Enables access on demand to diverse systems and devices  Participants that do not need continual synchronization of patient registration information  Devices that cannot participate in monitoring of ADT feeds, e.g.: Small-footprint devices Low-memory devices

66. February 7, 2005IHE EU-Conference & Workshop Patient Demographics Query Value Proposition (cont’d) Allow search on full or partial data Retrieve information from any domain to which the client has query access Allows use of matching algorithm (e.g., soundex) to find near matches

67. February 7, 2005IHE EU-Conference & Workshop IHE IT Infrastructure 2004-2005 Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications Consistent Time Coordinate time across networked systems Patient Demographics Query New Personnel White Page Access to workforce contact information New Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record New Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. New

68. February 7, 2005IHE EU-Conference & Workshop IHE and Security User Identity  PWP, EUA User Authentication  EUA Node Authentication  ATNA Security Audit Trails  ATNA Data Integrity Controls  CT, ATNA TLS option Data Confidentiality  ATNA TLS option Access Controls  Future item in IHE roadmap

69. February 7, 2005IHE EU-Conference & WorkshopScope Defines basic security features for an individual system for use as part of the security and privacy environment for a healthcare enterprise. Extends the IHE radiology oriented Basic Security profile (defined in 2002) to be applicable to other healthcare uses. Supports two categories of network environments First of a family of profiles with different kinds of authentication.

70. February 7, 2005IHE EU-Conference & Workshop IHE makes cross-node security management easy:  Only a simple manual certificate installation is needed.  Separate the authentication, authorization, and accountability functions to accommodate the needs of different approaches.  Enforcement driven by ‘a posteriori audits’ and real-time visibility. IHE Goal with ATNA

71. February 7, 2005IHE EU-Conference & Workshop Integrating trusted nodes System A System B Secured System Secure network Strong authentication of remote node (digital certificates) network traffic encryption is not required, it is optional Secured System Local access control (authentication of user) Audit trail with: Real-time access Time synchronization Central Audit Trail Repository

72. February 7, 2005IHE EU-Conference & Workshop IHE IT Infrastructure 2004-2005 Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications 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. New Patient Demographics Query New Personnel White Page Access to workforce contact information New Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record New

73. February 7, 2005IHE EU-Conference & Workshop Personnel White Pages (PWP) – Abstract/Scope Provide access to basic information about the human workforce members  Does not include Patients Defines method for finding the PWP Defines query/access method Defines attributes of interest

74. February 7, 2005IHE EU-Conference & Workshop Personnel White Pages (PWP) – Value Proposition Single Authoritative Knowledge Base  Reduce duplicate and unconnected user info database  Single place to update Name Changes New Phone Number Additional Addresses Enhance Workflow and Communications  Providing information necessary to make connections Phone Number Email Address Postal Address

75. February 7, 2005IHE EU-Conference & Workshop Personnel White Pages (PWP) – Value Proposition Enhance User Interactions  Provide user friendly identities and lists List of members Displayable name of a user Initials query Contributes to Identity Management  Additional methods of identity cross verification Name, address, phone number, email Cross reference with Enterprise User Authentication identity  Future expansion likely will contain certificates

76. February 7, 2005IHE EU-Conference & Workshop PWP - Transactions Personnel White Pages Consumer Query for Healthcare Workforce Member Info Provide access to healthcare staff information to systems in a standard manner. Personnel White Pages Directory DNS Server Find Personnel White Pages

77. February 7, 2005IHE EU-Conference & Workshop Thank You Questions ? W W W. I H E. N E T Integrating the Healthcare Enterprise