2. IHE in North America Chris Carr Director of Informatics/Staff Liaison to IHE Radiological Society of North America

3. 2009-04-05HIMSS 20092 IHE North America What?/Who?What?/Who? OrganizationOrganization TestingTesting ImplementationImplementation Learn more/Get involvedLearn more/Get involved

4. 2009-04-05HIMSS 20093 Regional Deployment Committee Multinational association assembled to oversee testing and implementation activitiesMultinational association assembled to oversee testing and implementation activities Two national deployment committees:Two national deployment committees: –IHE Canada –IHE USA

5. 2009-04-05HIMSS 20094 IHE Canada – Established 2007 Part of Standards Collaborative

6. 2009-04-05HIMSS 20095 IHE USA – Established 2008 Initial sponsors and supporters:Initial sponsors and supporters: –HIMSS –RSNA –American Academy of Ophthalmology (AAO) –American College of Cardiology (ACC) –American College of Physicians (ACP) –American College of Clinical Engineering (ACCE) –American College of Emergency Physicians (ACEP) –American Society for Therapeutic Radiation Oncology (ASTRO) Preparing for incorporation in Q2 2009

7. 2009-04-05HIMSS 20096 Deployment Committee Responsibilities Sponsor and oversee testingSponsor and oversee testing Support development of test toolsSupport development of test tools Conduct demonstrations and education eventsConduct demonstrations and education events Establish relationships with national HIT agencies, EHR initiatives, etc.Establish relationships with national HIT agencies, EHR initiatives, etc. Develop any national extensions to IHE Technical FrameworksDevelop any national extensions to IHE Technical Frameworks

8. 2009-04-05HIMSS 20097 Connectathon History: 1999-2009 Continuous, steady expansion in scope and participation in Connectathon:Continuous, steady expansion in scope and participation in Connectathon: –1999: 15 companies, 24 systems –2009: 77 companies, 126 systems

9. 2009-04-05HIMSS 20098 Connectathon History 1999: First IHE Connectathon1999: First IHE Connectathon 1999 - present: Continual expansion of scope and participation1999 - present: Continual expansion of scope and participation 2001: First IHE-Europe Connectathon2001: First IHE-Europe Connectathon 2002: First IHE-Japan Connectathon2002: First IHE-Japan Connectathon 2005: First multi-domain North American Connectathon: Cardio, IT, Radiology2005: First multi-domain North American Connectathon: Cardio, IT, Radiology 2008: Testing Coordinated with HITSP2008: Testing Coordinated with HITSP

10. 2009-04-05HIMSS 20099 What is a Connectathon? Face-to-face interoperability testing eventFace-to-face interoperability testing event Tests implementation of Integration Profiles: integration capabilities defined in IHE Technical FrameworksTests implementation of Integration Profiles: integration capabilities defined in IHE Technical Frameworks Testing structured and supervised by Technical Project Management TeamTesting structured and supervised by Technical Project Management Team Successful results recorded and published by event sponsorsSuccessful results recorded and published by event sponsors Used as preparation for IHE demonstrations eventsUsed as preparation for IHE demonstrations events Primary purpose: foster adoption of standards-based solutions in productsPrimary purpose: foster adoption of standards-based solutions in products

11. 2009-04-05HIMSS 200910 Connectathon

12. 2009-04-05HIMSS 200911 Connectathon Results Tool contains Connectathon results from 2001 to present Part of the testing management tool Development underway to build a new PRODUCT REGISTRY including specific vendors product implementations of Integration Profiles

13. 2009-04-05HIMSS 200912 Integration Statements

14. 2009-04-05HIMSS 200913 Integration Statements on www.ihe.net www.ihe.net

15. 2009-04-05HIMSS 200914 Product Registry – coming soon! http://product-registry.ihe.net/

16. 2009-04-05HIMSS 200915 IHE and Canada Health Infoway CHI has worked on development of IHE profiles, eg, XDS and XDS-I CHI contractors have provided testing oversight at Connectathons CHI contributed to development of testing tools CHI has specified IHE profiles as “Pan- Canadian Standards” Numerous implementation projects using IHE profiles

17. 2009-04-05HIMSS 200916 Canada Health Infoway: Standards Used in Diagnostic Imaging No single standard addresses DI Requirements Internet Standards XML, PDF, JPEG, JPIP, MIME, HTTP, FTP, UTF-8, … Electronic Business Standards ebXML, Web Services Healthcare Content, Messaging, Terminology HL7/CDA, DICOM SNOMED CT, LOINC, ICD-10CA, CCI EHRS Blueprint v2 Privacy & Security Privacy Legislation IHE Integration Profiles Rad: XDS-I, SWF, PIR, CPI, PGP, KIN, PDI IS: XDS, PIX, PDQ, ATNA, EUA, XUA, BPPC, CT

18. 2009-04-05HIMSS 200917 DI Data Sharing in the EHR Environment HL7DICOM XDSTransactions: INFOSTRUCTURE POS Registries Data & Services EHR Data & Services Business Rules EHR Index Message Structures Terminology Services Security Mgmt Data Privacy DataTerminology Longitudinal Record Services HIAL Client Registry Provider Registry Location Registry Communication Bus Common Services Shared Health Record DI Repository EHR Viewer Physician/ Provider RISPACSEMR/CPOE CTUS DI ClinicsHospitals RISPACS HIS CTMRIUS PACS DI Studies Presentation states Measurements RIS Orders Reports Imaging Modalities DI Studies Presentation states XDS Doc Registry XDS Document Repository DI Repository XDS Document Registry Registry entries Metadata XDS Document / DI Repository Manifests Document Sets Images Reports Relevant images Presentation states Measurements Other evidence docs

19. 2009-04-05HIMSS 200918 VA IHE Success Story All VA DICOM image acquisition uses IHE Radiology Transactions to interface modalities to PACS: –#5 - Modality Worklist Provided - download patient and study –#8 - Modality Images Stored - send images to the PACS 200 different models of radiology instruments interfaced Exactly the same IHE DICOM interface to Consults for ophthalmology (eye care), dentistry, endoscopy, pathology, and cardiology. The VA will not purchase a new modality unless it supports both of these capabilities.

20. 2009-04-05HIMSS 200919 IHE: Supporting HHS/ONC Goals Healthcare Information Technology Standards Panel (HITSP) Nationwide Health Information Network Architecture Projects (NHIN) Health Information Security and Privacy Collaboration (HISPC) Certification Commission for Healthcare Information Technology (CCHIT) American Health Information Community  National eHealth Collaborative Standards harmonization and adoption Interoperability testing Security and privacy standards Specifications for standards- based EHR functionality to support RHIOs

21. 2009-04-05HIMSS 200920 HITSP Recommended Standards BiosurveillanceBiosurveillance –ICD-9CM – International Classification of Diseases v. 9 Clinical Modifications –ICD-10 CM – Diagnoses and Procedures –IHE-XDS – Integrating the Healthcare Enterprise (IHE) Cross- Enterprise Document Sharing –IHE-XDS Lab – IHE Laboratory Report Document Sharing –IHE-RFD – IHE Retrieve Form for Data Capture –IHE-PIX – IHE Patient Identification Cross-Referencing –IHE-RAD – XDS-I – IHE Cross-Enterprise Sharing of Images –IHE-NAV – IHE Notification of Document Availability –IHE-XDS-MS – IHE Medical Summary Document Sharing –ISO/TC215 -DTS 25237 - Health Informatics Pseudonymisation –LOINC – Logical Observation Identifiers Names and Codes –NCCLS – National Committee for Clinical Laboratory Standards –RxNorm – National Library of Medicine RxNorm

22. 2009-04-05HIMSS 200921 HITSP Recommended Standards Consumer EmpowermentConsumer Empowerment –IHE-XDS – Integrating the Healthcare Enterprise (IHE) Cross-Enterprise Document Sharing –IHE-PIX – IHE Patient Identification Cross-Referencing –IHE-PDQ – IHE Patient Demographics Query –Health Level Seven (HL7) CDA R2 – HL7 Clinical Document Architecture Release 2 –HL7 CCD – HL7 Continuity of Care Document with mappings from ASTM E 2369-05 Continuity of Care Record (CCR), X12 N 270/271 and NCPDP Script 8.1. –HL7 EHR Systems Functional Model Draft Standard for Trial Use (DSTU) –Logical Observation Identifiers Names and Codes (LOINC)

23. 2009-04-05HIMSS 200922 Electronic Health Record ExchangeElectronic Health Record Exchange –IHE-XDS Lab – IHE Laboratory Report Document Sharing –IHE-PIX – IHE Patient Identification Cross-Referencing –IHE-PDQ – IHE Patient Demographics Query –Health Level Seven (HL7) CDA R2 – HL7 Clinical Document Architecture Release 2 –HL7 v. 2.5 –Clinical Laboratory Improvement Amendments (CLIA) –Logical Observation Identifiers Names and Codes (LOINC) –Health Insurance Portability and Accountability Act (HIPAA) –Systematized Nomenclature of Medicine – Clinical Terms (SNOMED – CT) –Unified Code for Units of Measure (UCUM) HITSP Recommended Standards IHE contributes to HITSP’s success

24. 2009-04-05HIMSS 200923 HITSP and Federal Procurement Former HHS Secretary Leavitt “recognized” the work product of HITSP, meaning that it will be used in for federal purchasing specifications for all affected health IT systems as of Jan. 1, 2009.

25. 2009-04-05HIMSS 200924 Testing – HITSP, CCHIT and NHIN HITSP interoperability pilot testing performed at IHE ConnectathonHITSP interoperability pilot testing performed at IHE Connectathon CCHIT, NIST and IHE have agreement to collaborate on testing toolsCCHIT, NIST and IHE have agreement to collaborate on testing tools NIST and IHE collaborated to provide testing services for first NHIN testing event in August 2008NIST and IHE collaborated to provide testing services for first NHIN testing event in August 2008

26. 2009-04-05HIMSS 200925 IHE Testing Tools 11 years experience automating HIT interoperability testing11 years experience automating HIT interoperability testing Test management tool evolving to support remote testingTest management tool evolving to support remote testing Close partnership with National Institute of Standards and TechnologyClose partnership with National Institute of Standards and Technology

27. 2009-04-05HIMSS 200926 IHE Testing Tools: Project Gazelle Proxy System Under Test Network Gazelle Test Engine Control Configuration Info Feedback External Validation Services Tests Scenario Actor Simulators Gazelle Control System External Validation Services External Validation Services External Validation Services Actor Simulators System Under Test Database 22/05/08Projet IHE-Dev Inria Rennes Demographic Service

28. 2009-04-05HIMSS 200927 More Resources - More Resources - www.ihe.netwww.ihe.net Integration Profiles/Technical FrameworksIntegration Profiles/Technical Frameworks Connectathon ResultsConnectathon Results Product Registry – coming soon!Product Registry – coming soon! Webinar and presentation materialsWebinar and presentation materials Committee/domain activitiesCommittee/domain activities Governance and Membership MaterialsGovernance and Membership Materials

29. 2009-04-05HIMSS 200928 Providers and Vendors Working Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings http://www.ihe.net