1. September, 2005Cardio - June 2007 IHE for Regional Health Information Networks Cardiology Uses

2. 2 Cardio - June 2007 Acute Care (Inpatient) PCPs and Clinics (Ambulatory) Long Term Care Other Specialized Care or Diagnostics Services Regional Health Information Organization (RHIO) Document Registry Cross-Enterprise Document Sharing

3. 3 Cardio - June 2007 RHIOs – an emerging trend 95% of healthcare encounters in local home area Regional markets often limited to 2-5 major IDNs, facilitating agreement among all players Social factors favor regional business agreements Regional markets may be assisted by state initiatives Regional Health Information Organizations (RHIOs) recognized as the preferred model for EHR data sharing by US Dept. of Health and Human Services

4. 4 Cardio - June 2007 IHE’s approach for RHIOs Interoperability technical specification for local, regional, disease-specific, or national health information exchange Enable document search and document exchange between EHR systems, ancillary IT systems (lab, pharmacy, payers), and personal health record systems Incrementally build on (do not replace) existing healthcare business models, including models of “data custodianship” Avoid the pitfalls of “rampant featurism” – keep it simple IHE Cross-Enterprise Document Sharing (XDS) introduced in 2005

5. 5 Cardio - June 2007 Community or regional network Clinical Encounter Clinical IT System Index of patients records (Document-level) Aggregate Patient Info 4-Patient data presented to Physician Sharing System Clinic Record Specialist Record Hospital Record 2-Reference to Records for Inquiry 3-RecordsReturned 1-Reference to records Repository of Documents XDS – How it works

6. 6 Cardio - June 2007 Cross-Enterprise Document Sharing benefits Sharing of Documents minimizes clinical data management by the infrastructure. Transparency = Ease of Evolution Supports both centralized and decentralized repository architectures; ease of federation and evolution. Flexibility of configurations = Supports multiple business models Avoids replication/aggregation of data in sharing infrastructure. No false assertion of consolidated “truth” about patient Patients have guaranteed portability of data among RHIO- participating providers. Digital Documents = Patient and providers empowerment

7. 7 Cardio - June 2007 Cross-Enterprise Document Sharing (XDS) Standards Used Two “categories” of standards used XDS Infrastructure (Document sources, consumers, registries, repositories) ebXML Electronic Business Standards XDS Doc Content Medical Summaries (HL7 CDA/CRS+V3) Imaging (DICOM) ECG Reports (PDF+) …

8. 8 Cardio - June 2007 Why is IHE-XDS a breakthrough ? Based on an International Standard - 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 data-sharing paradigm aligned with existing models of data custodianship. 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 the needs of both point-to-point push communication 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

9. 9 Cardio - June 2007 IHE-XDS family of profiles Security and privacy Patient identification management Notification of document availability Rich Document Content for end-to-end application interoperability  Structured medical summary (incl. meds, allergies, problems)  Imaging information (incl. images and reports)  More in development IHE-XDS + related IHE Integration profiles provide a complete interoperability solution

10. 10 Cardio - June 2007 Cross-Enterprise Sharing of Medical Summaries (XDS-MS) Discharge or Referral Document Created Report Repository Referred Physician Patient Examination or Discharge Notification The Cross-Enterprise Sharing of Medical Summaries Integration Profile solves the problem of transferring summary patient information between providers in different clinical settings. EMR Medical Summary Document Registry Review of Medical Summary

11. 11 Cardio - June 2007 Structured Content with Coded Entries  Reason for Referral     Vital Signs     Studies  Social History  Care Plan XDS-MS Medical Summary Structured and Coded Header Patient, Author, Authenticator, Institution, Time of Service, etc. Header always structured and coded Title-coded sections with non-structured non-coded content (text, lists, tables).  Simple Viewing (XML Style sheet) Level 1 Level 2 Text Structure Entry Text Structure Entry Meds, Problems and Allergies required as highly structured text.  Text easy to import/parse Text Structure Entry Level 3 Meds, Problems and Allergies have a required fine-grain structure with optional coding. Coding Scheme not standardized, but explicitly identified. Coded Section Entry Coded Section Entry Coded Section Entry Level 3 XDS-MS enables both semantic interoperability and simple viewing ! Medications  Allergies  Problems

12. 12 Cardio - June 2007 Use of XDS infrastructure to access Imaging Reports and Images (XDS-I) Hospital Imaging Center Physician Practice Between Hospital and : Between Hospital and : Imaging specialistsImaging specialists Non-imaging cliniciansNon-imaging clinicians PACS Y PACS Z PACS -to- PACS PACS -to- Office Same XDS Infrastructure (Registry and Repositories) for medical summaries and imaging information !

13. 13 Cardio - June 2007 IHE-XDS Status Technical Framework final text published August 2005. Implemented world-wide by more than 30 vendors / open source. Adopted in several national & regional projects (Italy, France, Canada, Austria, USA, etc.) IHE XDS: 15800 “Google” references (Jan ‘06)

14. 14 Cardio - June 2007