INTEGRATING THE HEALTHCARE ENTERPISE (IHE) Orientation Workshop International HL7 Interoperability Conference-10 Carlos Guilherme Costa, Product Manager, Alert, IHE US & Eu Connectathon participant Julio Carau, Director, Hospital de Clinicas "Dr. Manuel Quintela", Montevideo, Uruguay

Agenda This Morning: Part 1: THE IHE STANDARDS ADOPTION PROCESS: achieving practical interoperability This Afternoon: Part 2: USERS AND VENDORS WORKING TOGETHER: how can I contribute & benefit from IHE HOW TO USE IHE RESOURCES: hands on experience

Agenda Part 1: THE IHE STANDARDS ADOPTION PROCESS: achieving practical interoperability 3 3

IHE: A Framework for Interoperability A common framework for harmonizing and implementing multiple standards Application-to-application System-to-system Setting-to-setting Enables seamless health information movement within and between enterprises, regions, nations Promotes unbiased selection and coordinated use of established healthcare and IT standards to address specific clinical needs What 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

Standards: Necessary…Not Sufficient Standards are Foundational - to interoperability and communications Broad - varying interpretations and implementations Narrow - may not consider relationships between standards domains Plentiful - often redundant or disjointed Focused - standards implementation guides focus only on a single standard IHE provides a standard process for implementing multiple standards

IHE: Connecting Standards to Care Healthcare professionals work with industry Coordinate implementation of standards to meet clinical and administrative needs Clinicians and HIT professionals identify the key interoperability problems they face Providers and industry work together to develop and make available standards-based solutions Implementers follow common guidelines in purchasing and integrating effective systems IHE: A forum for agreeing on how to implement standards and processes for making it happen

Standards Adoption Process Testing at Connectathons IHE Demonstrations Develop technical specifications Products with IHE Identify available standards (e.g. HL7, DICOM, IETF, OASIS) Timely access to information Easy to integrate products Document Use Case Requirements

Stakeholder Benefits Healthcare providers and support staff Vendors Improved workflows Information whenever and wherever needed Fewer opportunities for errors Fewer tedious tasks/repeated work Improved report turnaround time Vendors Align product interoperability with industry consensus Decreased cost and complexity of interface installation and management Focus competition on functionality/service space not information transport space SDOs Rapid feedback to adjust standards to real-world Establishment of critical mass and widespread adoption

IHE Implementation Strategy Leverage established standards to allow rapid deployment and plan for future Pragmatic, Ease of Evolution Enable architectural freedom (patient vs. provider centric, centralized vs. decentralized, scalable (from office to enterprise to IDN to Regional and National Networks) Configuration flexibility Support breakthrough use cases: variety of care settings, care coordination, public health, PHR, EHR Interoperability for broad constituencies IHE 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

12 Years of Steady Growth 1998 – 2010 The IHE Development Domains 12 Years of Steady Growth 1998 – 2010 Pathology since 2006 Radiation Oncology since 2004 Radiology since 1998 Cardiology since 2004 Patient Care Devices since 2005 Patient Care Coordination since 2004 Eye Care since 2006 Quality Research & Public Health since 2006 Laboratory since 2004 Pharmacy NEW 2009 (Healthcare) IT Infrastructure since 2003

International Growth of IHE Switzerland Local Deployment, National Extensions Promotional & Live Demonstration Events Over 300 Organizational Members (all stakeholders) Malaysia Turkey China Australia Austria Spain Netherlands Taiwan Canada UK Japan Italy Germany France USA 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Pragmatic global standards harmonization + best practices sharing 11 11 11

IHE Integration Profiles - Model Actors in precisely defined roles Abstracts a specific function of information system …Executing precisely defined transactions Using existing standards ……To solve real world interoperability problems Specifying Integration Profiles

Key IHE Concepts Generalized Systems -> Actors Interactions between Actors -> Transactions Problem/Solution Scenarios -> Integration Profiles For 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.

Product XYZ from Vendor T The Product World….. Product XYZ from Vendor T

The IHE World…. IHE Transaction IHE Transaction IHE Actor IHE Actor

Mapping IHE to Products Product XYZ from Vendor T Actor Actor IHE Transaction IHE Transaction IHE Actor Actor IHE Actor IHE Transaction

Organization of Technical Frameworks Volume 1: Integration and content Profiles Describes clinical need and use cases Identifies : the actors and transactions or, content modules Volume 2+ of Technical Framework Provides implementation specification for transactions or content modules

IHE and Service Oriented Architectures SOA is a powerful business driven design methodology SOA “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 & content Key messages Meeting the requirements of the healthcare professionals when exchanging patient clinical information is critical: trust in the information and ease of access is paramount.

Standards Adoption Process Testing at Connectathons IHE Demonstrations Products with IHE Timely access to information Easy to integrate products Develop technical specifications Identify available standards (e.g. HL7, DICOM, IETF, OASIS) Document Use Case Requirements

IHE Connectathon Open invitation to vendor and other implementors community Advanced testing tools (GAZELLE) Testing organized and supervised by project management team Thousands of cross-vendor tests performed Results recorded and published

IHE Connectathons Massive yearly events : 70-80 vendors 250-300 engineers 100-120 systems ….integrated in 5 days Vendors do not pass… until an IHE Project Manager attest it ! Last Connectathon: Chicago, USA, January 11-15, 2010 Bordeaux, France, April 12-16, 2010

http://www.ihe.net/Connectathon/index.cfm

Leveraging IHE Integration Statements Vendors Claim IHE Compliance in an explicit way Can rely on an objective and thorough specification (IHE Technical Framework) Willing to accept contractual commitments Willing to correct “implementation errors” Buyers Can compare product integration capabilities Simplify and strengthen their RFPs Can leverage a public and objective commitment Decreased cost and complexity of interface deployment and management

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. 24 24

HIMSS Interoperability Showcase

Example: 2010 HIMSS Interoperability Showcase

Implementation Tools (1) Open source implementations are available for XDS, XCA, XCPD, PIX, PDQ, ATNA, CT, and more: Microsoft under codeplex http://ihe.codeplex.com/ NIST under Source Forge http://sourceforge.net/projects/iheos/ HIE-OS under Source Forge http://sourceforge.net/projects/hieos/ FHA CONNECT http://www.connectopensource.org More on the next page….. 27

Implementation Tools (2) Open source implementations are available for XDS, XCA, XCPD, PIX, PDQ, ATNA, CT, and more, from Open Health Tools: http://www.projects.openhealthtools.org OHT – IHE Profiles (Charter) https://iheprofiles.projects.openhealthtools.org OHT – Open Exchange (Forge) https://openexchange.projects.openhealthtools.org OHT – Model Driven Health Tools (Charter) https://mdht.projects.openhealthtools.org September, 2005

Working Together to Deliver Interoperable Health Information Systems Providers and Vendors Working Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings http://www.ihe.net

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 status When 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 record Key messages Meeting the requirements of the healthcare professionals when exchanging patient clinical information is critical: trust in the information and ease of access is paramount.

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 authenticated Each user shall be authenticated on the edge system All traffic trough the infrastructure is encrypted Patient consent needs multiple choices or levels Unless opt-in, no data about a specific patient may be shared Several data sharing policies offered to the patient consent Each 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.

Categories of Healthcare Communication Services HIEs and Shared EHRs Patient and Provider ID Mgt Hospitals e.g. access to last 6 months historical labs and encounter summaries e.g. get a current list of allergies or med list from a source e.g. order a lab test, track status and receive results Security Document Sharing Dynamic Information Access Workflow Management Source-persisted and attested health records Specific info snapshot provided on demand 2 or more entities synchronize a task 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.

Categories of Healthcare Communication Services HIEs and Shared EHRs Patient and Provider ID Mgt Hospitals Medical Summary (XDS-MS) e.g. access to last 6 months historical labs and encounter summaries e.g. get a current list of allergies or med list from a source e.g. order a lab test, track status and receive results Security Cross-Enterprise Document Sharing (XDS) Document Sharing Dynamic Information Access Workflow Management Source-persisted and attested health records Specific info snapshot provided on demand 2 or more entities synchronize a task Patient 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.

IHE Profiles Specifications Go to: www.ihe.net/Technical_framework For XDS:Under IT Infrastructure E.g. IT Infrastructure Technical Framework (XDS.b) For PIX:Under IT Infrastructure E.g. IT Infrastructure Technical Framework (PIX, HL7V2) Or PIXV3 supplement (PIX HL7 V3). For XDS-MS: Under Patient Care Coordination E.g. PCC Technical framework (XDS-MS)

The IHE Global Standards Adoption Process First Step: Propose a Use case for Interoperability 35 35

Patient Identifier Cross-referencing for MPI Services 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 mapping across other systems’ identifiers for their patients Optionally, notify domain systems when other systems update identifiers mapping for their patients

Patient Identifier Cross-referencing for MPI Value Proposition Maintain and linked 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

The IHE Global Standards Adoption Process Second Step: Propose a design and select standards for such an IHE Profile 38 38

Patient Identifier Cross-referencing for MPI Transaction Diagram

Patient Identifier Cross-referencing for MPI Process Flow Showing ID Domains & Transactions

Patient Identifier Cross-referencing for MPI Identity Patient Cross References B:X456 C: ? B:X456 C: 2RT

Patient Identifier Cross-referencing for MPI Actors Patient Identity Source Definition Assigns patient identities within its own domain Notifies 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) Profile Transaction Supported - Required Patient Identity Feed [ITI-8] (as sender)

Patient Identifier Cross-referencing for MPI Actors Patient Identifier Cross-reference Consumer Definition Requires information about patient identifiers in other domains Requests patient identifier information from Patient Identifier Cross-reference Manager Transaction Supported - Required PIX Query [ITI-9] (as sender) Transaction Supported - Optional PIX Update Notification [ITI-10] (as receiver)

Patient Identifier Cross-referencing for MPI Actors Patient Identifier Cross-reference Manager Definition Serves a well-defined set of Patient Identifier Domains Receives patient identifier information from Patient Identity Source Actors Manages cross-referencing of identifiers across domains Transactions Supported - Required Patient Identity Feed [ITI-8] (as receiver) PIX Query [ITI-9] (as receiver) PIX Update Notification [ITI-10] (as sender)

Patient Identifier Cross-referencing for MPI Standards Used: 2 Profiles PIX: HL7 Version 2.5 ADT Registration and Update Trigger Events (HL7 2.3.1) 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) PIX V3: HL7 V3 Leverage Web Services (harmonized WS by IHE Appendix V)

The IHE Global Standards Adoption Process Third Step: Engage implementers for Testing Trial Implementation profile at Connectathons Fourth 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 2 46 46

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 profiles Complete list on: www.ihe.net/technical_framework 47 47

Registering Health Records:IHE-XDS Clinic Record Community Specialist Record Hospital Record Health Info Exchange Repository of Documents 1-Reference to records Repository of Documents Index of patients records Clinical Encounter Clinical IT System Then 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).

4-Patient data presented to Physician Access to Shared Records : IHE-XDS Clinic Record Community Specialist Record Hospital Record HIE Repository of Documents 3-Records Returned Repository of Documents Aggregate Patient Info 4-Patient data presented to Physician Index of patients records Clinical Encounter Clinical IT System Then 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-Reference to Records for Inquiry

Health Information Exchanges Interoperability: Cross-enterprise Document Sharing Cross-Enterprise Document Sharing simplifies clinical data management by defining interoperable infrastructure. Transparency = Ease of Evolution Patients have guaranteed portability and providers may share information without concerns of aggregation errors. Digital Documents = Patients and providers empowerment Supports both centralized and decentralized repository architectures. Ease of federation nationally. Flexible privacy, Flexibility of configurations Addresses 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.

Cross-Enterprise Document Sharing (XDS) Standards Used Healthcare Content Standards HL7 CDA header extract HL7 data types Electronic Business Standards ebXML Registry, SOAP, Web Services … Internet Standards HTTP, 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.

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

Combining IHE Profiles Document Content & Modes of Document Exchange Doc Content Profiles (Semantics content) Scanned Doc XDS-SD Consent BPPC Emergency EDR Pre- Surgery PPHP Functional Status Assesment FSA Imaging XDS-I Laboratory XD*-Lab Discharge & Referrals XDS-MS PHR Exchange XPHR Document Exchange Integration Profiles Document Sharing XDS / XCA Reliable Pt-Pt Interchange XDR Media Interchange XDM IHE 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

Patient Longitudinal Record Typically, a patient goes through a sequence of encounters in different Care Settings Long Term Care Acute Care (Hospital) Other Specialized Care (incl. Diagnostics Services) GPs and Clinics (Ambulatory) Continuity of Care: Patient Longitudinal Record

Building and accessing Documents Documents Registry Longitudinal Record as used across-encounters Document Repository Long Term Care Acute Care (Inpatient) Other Specialized Care or Diagnostics Services Care Record systems supporting care delivery PCPs and Clinics (Ambulatory) Submission of Document References Retrieve of selected Documents

Cross-Enterprise Document Sharing (XDS.b) Actor/Transaction Diagram

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.

XDS - Value Proposition Distributed: Each Care delivery organization “publishes” clinical information for others. Actual documents may remain in the source EHR Cross-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.

How real is XDS ? Stable specification IHE Technical Framework Published XDS.b Supplement that offers: Use most recent Web Services stds (MTOM/XOP) Allow Retrieve sets of Documents in one transaction Same services First 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-wide 4 open source toolkits available, numerous product implementations in EMRs and Infrastructure offerings.

IHE, Global Standards-Based Profiles Adopted in National & Regional Projects (sample) Lower Austria NETHERLANDS Friesland Natn’l Mamography Italy Conto Corrente Venetto - Friuli France DMP VITL-Vermont Austria Suisse St Gallen Lausane Quebec, Toronto, Alberta, British Columbia Canada Infoway Wales Imaging France Imaging IDF Boston Medical Center - MA For more complete list see: tinyurl.com/wwXDS Philadelphia HIE Belgium Flemish-Leuven KeyHIE Pennsylvania South Shore Hospital, NY Boston Medical Center, MA Vermont Information Technology Leaders, VT KeyHIE/Geisinger Health System, PA Lower Austria Region (near Vienna) Friesland Cardiology Network North Carolina Healthcare Information and Communications Alliance,NC CareSpark, TN Azienda Sanitaria Locale n. 4 Chiavarese USA - NHIN Austria-ELGA France-DMP Providence Health System, OR South-Africa-Gauteng Montreal McGill - Quebec Toronto East Network - Ontario British Columbia Alberta Project Doge Italy Friuli Region Ireland - National PACS Japan-Nagoya Shanghai Kobe-Stroke Mgt Cardiology Network Groningen Amsterdam Radiology Network Rotterdam HIE Flemish Hospital Network Dutch Mammo Screening Mayo Clinic, MN New York Presbyterian, NY Italy-Health Optimum IHE North American Connectathon, USA CareSpark – TN & VA SHARP CA South Africa THINC- New York NCHICA – N. Carolina Providence Health System - OR CHINA-Shanghai Imaging Info Sharing CHINA-MoH Lab results sharing JAPAN-Nagoya Imaging Info Sharing, Nationwide PDI guideline 6060 60 60

IHE-XDS is part of a family of profiles Regional, national, local or disease centric networks need a consistent set of Integration Profiles Fifthteen Integration Profiles completed and tested, plus five ready to implement = Standards-based interoperability building blocks for Rich Document Content for end-to-end application interoperability. Patient identification management Security and privacy Notification and data capture XDS 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

IHE Integration Profiles for Health Info Nets What is available and in trial implementation Security & Privacy Clinical and PHR Content Patient ID Mgmt Emergency Referrals Format of the Document Content and associated coded vocabulary PHR Extracts/Updates ObGyn Documents Lab Results Document Content Scanned Documents Format of the Document Content Imaging Information Medical Summary (Meds, Allergies, Pbs) and associated coded vocabulary 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 Assertion Provides Trusted Identity Patient Demographics Query Patient Identifier Cross-referencing Map patient identifiers across independent identification domains Document Subscription and Notification Request Form for Data Capture External form with custom import/export scripting Health Data Exchange Other 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 Final Text Approved Trial Implementation-2009– Final Txt 2010

XDS-MS Medical Summary or PHR Extract Exchange Profile based on HL7 CDA Rel 2 and HL7 CCD IG Structured and Coded Header Level 1 Patient, A uthor, Authenticator, Institution, Header always structured and coded Time of Service, etc. S S t t r r u u c c t t u u r r e e d d C C o o n n t t e e n n t t w w i i t t h h c c o o d d e e d d s s e e c c t t i i o o n n s s : : Level 2 · Title - coded sections with non - structured Reason for Referral nor coded content (text, lists, tables). · · Vital Signs  Simple Viewing (XML Style sheet) · · M M e e d d i i c c a a t t i i o o n n Text Structure Entry Med, Problems and Allergies as highly structured text. Text easy to import/parse Level 3 Med Problems a nd Allergies have a fine-grain structure with optional coding. Coding Scheme explicitly identified. Coded Section Entry Level 3 · Studies · · A A l l l l e e r r g g i i e e s s One 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 History · · P P r r o o b b l l e e m m s s XDS-MS and XPHR enable both semantic interoperability & simple viewing ! · Care Plan

Use of a shared XDS infrastructure to access Radiology Reports and Images (XDS-I) Between Radiology and : Imaging specialists Non-imaging clinicians Hospital PACS Y Radiology -to- Radiology Radiology -to- Physicians PACS Z Imaging Center The 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 Practice Same XDS Infrastructure (Registry and Repositories) for medical summaries and imaging information !

in the Enterprise Interoperable Health Information Systems Providers and Vendors Working Together to Deliver Interoperable Health Information Systems And Across Care Settings  Intra Hospital Workflows and Information Access in the Enterprise http://www.ihe.net

IHE Solutions within the Enterprise EMR - HIS eMPI User Auth Enterprise IT Infrastructure Radiology RIS PACS Img Acq Laboratory LIS Auto Mgr Analyzer Cardiology CIS Cath ECG Eye Care Pathology Home Hub Therapy Plan Nursing Station Established Feb 2009 Img Acq Treatment Devices Devices Devices Radiation Therapy Pharmacy Intensive Care Unit

IHE Solutions within the Enterprise Example: Cardiology EMR - HIS eMPI User Auth Enterprise IT Infrastructure Radiology RIS PACS Img Acq Laboratory LIS Auto Mgr Analyzer Cardiology CIS Cath ECG Eye Care Pathology Cardiology Integration Profiles Cardiac Catheterization Lab Workflow Echocardiography Lab Workflow Retrieve ECG for Display Displayable Reports Cath and Echo Evidence Documents Home Hub Therapy Plan Nursing Station Established Feb 2009 Img Acq Treatment Devices Devices Devices Radiation Therapy Pharmacy Intensive Care Unit 67 67

IHE Solutions within the Enterprise Example: IT Infrastructure EMR - HIS eMPI User Auth Enterprise IT Infrastructure Radiology RIS PACS Img Acq Laboratory LIS Auto Mgr Analyzer Cardiology CIS Cath ECG IT Infrastructure Integration Profiles Patient Administration Management Patient Demographics Query Patient Identifier Cross-referencing Retrieve Information for Display Enterprise User Authentication Consistent Time Patient Synchronized Applications Audit Trail and Node Authentication Personnel White Pages Shared Value Sets Eye Care Pathology Home Hub Therapy Plan Nursing Station Established Feb 2009 Img Acq Treatment Devices Devices Devices Radiation Therapy Pharmacy Intensive Care Unit 68 68

IHE Solutions within the Enterprise Example: Radiology EMR - HIS eMPI User Auth Enterprise IT Infrastructure Radiology RIS PACS Img Acq Radiology Integration Profiles Radiology Scheduled Workflow Patient Information Reconciliation Access to Radiology Information Portable Data for Imaging Consistent Presentation of Images Key Image Note Presentation of Grouped Procedures Evidence Documents Audit trail and Node Authentication (Rad option) Teaching Files and Clinical Trials Export Post-processing Workflow Reporting Workflow Charge Posting Simple Image and Numeric Reports Laboratory LIS Auto Mgr Analyzer Cardiology CIS Cath ECG Eye Care Pathology Home Hub Therapy Plan Nursing Station Established Feb 2009 Img Acq Treatment Devices Devices Devices Radiation Therapy Pharmacy Intensive Care Unit 69 69

IHE Solutions within the Enterprise Example: Laboratory EMR - HIS eMPI User Auth Enterprise IT Infrastructure Radiology RIS PACS Img Acq Laboratory LIS Auto Mgr Analyzer Cardiology CIS Cath ECG Eye Care Pathology Laboratory Integration Profiles Laboratory Testing Workflow Laboratory Information Reconciliation Laboratory Point Of Care Testing Laboratory Device Automation Laboratory Code Set Distribution Laboratory BarCode Home Hub Therapy Plan Nursing Station Established Feb 2009 Img Acq Treatment Devices Devices Devices Radiation Therapy Pharmacy Intensive Care Unit 70 70

Laboratory Testing Workflow (LTW) & Laboratory Device Automation (LDA) Placer order Order Placer Order Filler Filler order Work order Results Results Automation Manager Order Result Tracker Work Order Steps Query & download modes Tests results Pre/post processor Analyzer LTW LDA Profiles based on HL7 V2.5.1 Solid implementation experience

IHE Solutions within the Enterprise Example: Patient Care Devices EMR - HIS eMPI User Auth Enterprise IT Infrastructure Radiology RIS PACS Img Acq Laboratory LIS Auto Mgr Analyzer Cardiology CIS Cath ECG Patient Care Devices Profiles Device Enterprise Communication (DEC) Alarm Communication Mgt (ACM) Subscribe to Patient Data (SPD) Patient Identity Binding (PIB) Rosetta Terminology Mapping (RTM) Eye Care Pathology Home Hub Therapy Plan Nursing Station Established Feb 2009 Img Acq Treatment Devices Devices Personal Devices Radiation Therapy Pharmacy Intensive Care Unit 72 72

Working Together to Deliver Interoperable Health Information Systems Providers and Vendors Working Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings http://www.ihe.net

Agenda Part 1: THE IHE STANDARDS ADOPTION PROCESS: achieving practical interoperability This Afternoon: Part 2: USERS AND VENDORS WORKING TOGETHER: how can I contribute & benefit from IHE HOW TO USE IHE RESOURCES: hands on experience 74 74

See you for Part 2, this afternoon