September, 2005What IHE Delivers 1 INTEGRATING THE HEALTHCARE ENTERPISE (IHE) Orientation Workshop International HL7 Interoperability Conference-08 Charles Parisot, IHE Europe, GE Healthcare, Buc, France Eric Poiseau, IHE Europe Technical Project Manager, INRIA Rennes

2 Agenda 08:30-10:30 THE IHE STANDARDS ADOPTION PROCESS: achieving practical interoperability - Charles Parisot Coffee Break 11:00-12:30 USERS AND VENDORS WORKING TOGETHER: how can I contribute & benefit from IHE – Charles Parisot Lunch Break 13:30-15:00 HOW TO USE IHE RESOURCES: hands on experience – Eric Poiseau

3 Agenda 08:30-10:30 THE IHE STANDARDS ADOPTION PROCESS: achieving practical interoperability Coffee Break 11:00-12:30 USERS AND VENDORS WORKING TOGETHER: how can I contribute & benefit from IHE – Charles Parisot Lunch Break 13:30-15:00 HOW TO USE IHE RESOURCES: hands on experience – Eric Poiseau

44 IHE: A Framework for Interoperability A common framework for harmonizing and implementing multiple standards Application-to-application Application-to-application System-to-system System-to-system Setting-to-setting 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

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

6 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 Clinicians and HIT professionals identify the key interoperability problems they face Providers and industry work together to develop and make available standards-based solutions Providers and industry work together to develop and make available standards-based solutions Implementers follow common guidelines in purchasing and integrating effective systems 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

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

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

9 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 RHIO) Configuration flexibility Support breakthrough use cases: variety of care settings, care coordination, public health, PHR, EHR Interoperability for broad constituencies IHE: Offers consistent, standards-based record sharing for EHRs and other information systems

10 Growth in IHE Domains Radiology (18 profiles) IT Infrastructure for Healthcare (20 profiles) Cardiology (7 profiles) Laboratory (6 profiles) Radiation Oncology (3 profiles) Patient Care Coord. (5 profiles) Patient Care Devices (3 profiles) Pathology Eye Care (4 profiles) 1999 Over 200 vendors involved world-wideOver 200 vendors involved world-wide 8 Technical Frameworks8 Technical Frameworks 64 Integration Profiles64 Integration Profiles Testing at Connectathons world-wideTesting at Connectathons world-wide Demonstrations at major conferences world-wideDemonstrations at major conferences world-wide Veterinary Endoscopy Pharmacy Public Health, Quality and Research

1111 International Growth of IHE France Local Deployment National Extensions Promotional & Live Demonstration Events Funding USAGermanyItalyJapanUKCanadaKoreaTaiwanNorway Netherlands Spain ChinaAustria Pragmatic global standards harmonization + best practices sharing Australia

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

13 IHE Technical Frameworks Implementation Guide for each Integration Profile An Integration Profile : A Set of Actors A Set of Actors Exchanging Transactions Exchanging Transactions Use cases Process Flows For each transaction: Std referenced Std referenced Options specified Options specified Mapping required Mapping required ActorsTransactions

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

15 Key IHE Concepts Generalized Systems -> ActorsGeneralized Systems -> Actors Interactions between Actors -> TransactionsInteractions between Actors -> Transactions Problem/Solution Scenarios-> Integration ProfilesProblem/Solution Scenarios-> Integration Profiles For each Integration Profile:For each Integration Profile: the context is described (which real-world problem)the context is described (which real-world problem) the actors are defined (what systems are involved)the actors are defined (what systems are involved) the transactions are defined (what must they do)the transactions are defined (what must they do)

16 1 st key concept: Actor Represents a set of application roles and responsibilities performed by a system Always supported by a real-world system A real-world system may support several IHE Actors Examples: Order Placer Order Placer Order Filler Order Filler Patient Admission, Discharge and Transfer (ADT) Patient Admission, Discharge and Transfer (ADT) Laboratory Automation Manager Laboratory Automation Manager Point Of Care Analyzer Point Of Care Analyzer IHE leaves the definition of products to users and vendors

17 2 nd key concept: Transaction A set of interactions or messages defined between two Actors for a specific task. Defines unambiguously how the Actors must cooperate to achieve this task. Using existing standards such as HL7, DICOM, NCCLS etc. Order Placer Order Filler New order Order accepted Battery replaced Acknowledgement Status change Acknowledgement Example: Transaction LAB-1 « Placer order management » Order Placer Order Filler Placer order management [LAB-1] IHE defines transactions at a user-level workflow

18 3 rd key concept: Integration Profile Examples: Enterprise User Authentication Retrieve Information for Display Laboratory Scheduled Workflow Echo Laboratory Workflow Cross-Enterprise Document Sharing Referenced standard (e.g. HL7) Detailed messaging info Roles Integration Profile Actor … Transaction ……… Solves an Integration Problem: A collection of real world information exchange capabilities supported by a set of specific Actors using Standards-based Transactions

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

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

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

22 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. 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 precise Service definition does not result in compatibility on the wire. Standardizing Services offered along with the protocols is 20 years old (Open System Interconnect). Good, but a precise Service definition does not result in compatibility on the wire. IHE Integration profiles are supportive of Service Oriented Architecture, but do not require them. Service Aware ! Bits have to be compatible on the wire: No way to avoid specifying transaction & content Bits have to be compatible on the wire: No way to avoid specifying transaction & content

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

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

25 Massive yearly events : vendors engineers systems ….integrated in 5 days IHE Connectathons Vendors do not pass… until an IHE Project Manager attest it ! Next Connectathon: Wien, Austria, April 20-24, 2008

26

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

28 Example: 2008 HIMSS Interoperability Showcase Next Demonstration at WoHIT, Copenhagen, Nov 4-6, 2008

29 Feb 2008 HIMSS Interoperability Showcase Next Demonstration at WoHIT, Copenhagen, Nov 4-6, 2008

30 Featured this year in the HIMSS Showcase… 76 connected applications, 32 IHE profiles Secured Health Information Exchange with broad content Clinical Scenarios, focusing on clinician and patient access and information sharing across the continuum of care Population Health, Quality and Research Privacy and Security HITSP Interoperability Specifications Vendors Connected 51 Supporters22 Total73 Health information exchange with patient care devices Personal health record solutions Financial and administrative systems for billing and claims attachments (CAQH/CORE) Expanded distributed demonstration in an HIE format showing connectivity with vendor booths The 2008 Cast:

31 Providers and Vendors Working Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings Health Information Exchange (HIE) or shared EHR Health Information Exchange (HIE) or shared EHR

32 Requirements for an open HIE/EHR Bring trust and ease of use for healthcare professionals: Care delivery organizations choose information to share: Care delivery organizations choose information to share: Based on patient health status Based on patient health status When they see fit (discharge, end of encounter, etc.) When they see fit (discharge, end of encounter, etc.) What information to share (pick relevant types of documents, and content elements). What information to share (pick relevant types of documents, and content elements). Care delivery organizations access patient information through: Care delivery organizations access patient information through: their own local EMR (if they have one), or their own local EMR (if they have one), or through a shared portal/service otherwise. through a shared portal/service otherwise. When accessing patient info: When accessing patient info: Find quickly if relevant information is available or not (single query). Find quickly if relevant information is available or not (single query). May select among relevant records, which ones to see (may be done in background) May select among relevant records, which ones to see (may be done in background) Among those of interest, chose to import in whole or part in its own EMR patient record (responsibility). Among those of interest, chose to import in whole or part in its own EMR patient record (responsibility).

33 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: Only authorized organizations and authenticated healthcare providers may transact in the HIE: Each node or IT system interfaced is strongly authenticated Each node or IT system interfaced is strongly authenticated Each user shall be authenticated on the edge system (where context is best known) Each user shall be authenticated on the edge system (where context is best known) All traffic trough the infrastructure is encrypted All traffic trough the infrastructure is encrypted Patient consent needs multiple choices or levels Patient consent needs multiple choices or levels Unless opt-in, no data about a specific patient may be shared Unless opt-in, no data about a specific patient may be shared Several data sharing policies offered to the patient consent Several data sharing policies offered to the patient consent Each shared record/document is assigned to specific policies (or not shared) at encounter time. 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. Healthcare providers may only access records/documents compatible with their role.

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

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

36 IHE Profiles Specifications Go to: For XDS:Under IT Infrastructure IT Infrastructure Technical Framework 5.0 (XDS.b) IT Infrastructure Technical Framework 5.0 (XDS.b) Until 5.0 published: use XDS.b+XDS Stored Query supplements. Until 5.0 published: use XDS.b+XDS Stored Query supplements. For PIX:Under IT Infrastructure IT Infrastructure Technical Framework 4.0 or 5.0 (PIX, HL7V2) IT Infrastructure Technical Framework 4.0 or 5.0 (PIX, HL7V2) Or PIXV3 supplement (PIX HL7 V3). Or PIXV3 supplement (PIX HL7 V3). For XDS -MS: Under Patient Care Coordination PCC Technical framework 3.0 PCC Technical framework 3.0

37 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 domains 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

38 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 No need to force identifier and format changes onto existing systems Leverages standards and transactions already used within IHE

39 Patient Identifier Cross-referencing for MPI Transaction Diagram

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

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

42 Patient Identifier Cross-referencing for MPI Actors Patient Identity Source Definition Definition Assigns patient identities within its own domain Assigns patient identities within its own domain Notifies Patient Identifier Cross-reference Manager of all events related to patient identification (creation, merge, etc.) 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 Example: Registration (ADT) Actor in IHE Radiology Scheduled Workflow (SWF) Profile Transaction Supported - Required Transaction Supported - Required Patient Identity Feed [ITI-8] (as sender) Patient Identity Feed [ITI-8] (as sender)

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

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

45 Patient Identifier Cross-referencing for MPI Standards Used: 2 Profiles PIX: HL7 Version 2.5 ADT Registration and Update Trigger Events ADT Registration and Update Trigger Events A01: inpatient admission A01: inpatient admission A04: outpatient registration A04: outpatient registration A05: pre-admission A05: pre-admission A08: patient update A08: patient update A40: merge patient A40: merge patient Queries for Corresponding Identifiers (ADT^Q23/K23) Queries for Corresponding Identifiers (ADT^Q23/K23) Notification of Identifiers Lists Updates (ADT^A31) Notification of Identifiers Lists Updates (ADT^A31) PIX V3: HL7 V3 Leverage Web Services (harmonized WS by IHE Appendix V) Leverage Web Services (harmonized WS by IHE Appendix V)

46 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 PIX Server acting as MPI

47 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 Linking PIX Server

48 Community or sub-network Clinical Encounter Clinical IT System Aggregate Patient Info 4-Patient data presented to Physician Sharing System Clinic Record Specialist Record Hospital Record 2-Reference to Records for Inquiry Introduced at HIMSS in 2005 : IHE-XDS 3-RecordsReturned 1-Reference to records Repository of Documents Index of patients records

49 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.

50 Cross-Enterprise Document Sharing (XDS) Standards Used Healthcare Content Standards HL7 CDA header extract Internet Standards HTML, HTTP, ISO, IETF … Electronic Business Standards ebXML Registry, SOAP, Web Services … Implemented world-wide by close to 100 vendors/open source. Adopted in several national & regional projects: Italy, Austria, Canada, USA, Japan, South Africa, France, etc.)

51 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 ( Message feeding a central web server 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

52 Combining IHE Profiles Document Content & Modes of Document Exchange Document Exchange Integration Profiles Document Sharing XDS Sharing XDS Media Interchange XDM Reliable Pt-Pt Interchange XDR Doc Content Profiles (Semantics content) Scanned Doc XDS-SD LaboratoryXD*-Lab PHR Exchange XPHR Discharge & Referrals XDS-MS ImagingXDS-I ConsentBPPCEmergencyEDR Pre- Surgery PPHP Functional Status Assesment FSA

53 Acute Care (Hospital) 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

54 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

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

56 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.

57 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.

58 XDS Document XDS Submission Set XDS Folder Key Concepts IHE XDS Integration Profile: Key Concepts

59 Document Repository and Registry Example of Submission Request Document Repositories Document Registry Submission Request Document Document Entry Submission Set 1 Folder A

60 XDS Document A set of attested clinical information (structured or not) which form an element of a patient record to be shared. It may already exist within the source IT system. XDS Submission Set A set of documents related to a patient that a (team of) clinician(s) in the same source system have decided to make available at one point in time to potential consumers. XDS Folder A means to group documents for a number of other reasons: Team work across several physicians, Episode of care, Emergency information for a patient, etc. XDS leaves open the use of folders to affinity domain clinicians. Key Concepts IHE XDS Integration Profile: Key Concepts

61 How real is XDS ? Stable specification IHE Technical Framework Published Aug 15 th, 2004 (TI Supplement) XDS.b Supplement that offers: Use most recent Web Services stds (MTOM/XOP) Use most recent Web Services stds (MTOM/XOP) Allow Retrieve sets of Documents in one transaction Allow Retrieve sets of Documents in one transaction Same services Same services First implementation in clinical use in region of Genoa - Italy) since early Several since: Lower Austria region, State of Vermont, Nagoya city, South Africa region, 2 Dutch regions, etc. Adopted by several national programs world-wide 4 open source toolkits available, numerous product implementations in EHRs and Infrastructure offerings.

62 IHE, global standards-based profiles adopted by several national & regional projects Quebec, Toronto, Alberta, British Columbia Canada Infoway Denmark (Funen) Italy (Veneto) Spain (Aragon) THINC- New York NCHICA – N. Carolina Italy (Conto Corrente Salute) Boston Medical Center - MA France DMP UK CfH (Radiology WF) Philadelphia HIE CHINA-MoH Lab results sharing CPHIC – Pennsylvania CHINA-Shanghai Imaging Info Sharing JAPAN-Nagaya Imaging Info Sharing South Africa Malaysia VITL-Vermont CareSpark – TN & VA Netherland Amsterdam Lower Austria

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

64 IHE Integration Profiles for Health Info Nets What is available and has been added in 2007 Emergency Referrals Format of the Document Content and associated coded vocabulary PHR Extracts/Updates Format of the Document Content and associated coded vocabulary ECG Report Document Format of the Document Content and associated coded vocabulary Lab Results Document Content Format of the Document Content and associated coded vocabulary Scanned Documents Format of the Document Content Imaging Information Format of the Document Content and associated coded vocabulary Medical Summary ( Meds, Allergies, Pbs) Format of the Document Content and associated coded vocabulary Clinical and PHR Content Health Data Exchange Patient Demographics Query Patient Identifier Cross-referencing Map patient identifiers across independent identification domains Notification of Document Availability Notification of a remote provider/ health enterprise Request Form for Data Capture External form with custom import/export scripting Patient ID Mgmt Other Final Text Approved Final Txt 2008 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 Security & Privacy 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

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

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

67 Community Clinic Lab Info. System PACS Teaching Hospital PACS ED Application EHR System Physician Office EHR System XDS Scenario + use of ATNA & CT PMS Retrieve Document Register Document Query Document XDS Document Registry ATNA Audit record repository CT Time server Record Audit Event MaintainTime MaintainTime Event Maintain Time Provide & Register Docs Record Audit Event XDS Document Repository Secured Messaging

68 Community Clinic Lab Info. System PACS Teaching Hospital PACS ED Application EHR System Physician Office EHR System XDS Scenario + use of PIX & PDQ A87631 PACS L-716 Affinity Domain Patient Identity Source M Retrieve Document Provide & Register Docs Register (using Pt ID)Query Document (using Pt Id) Patient Identity Feed Document Registry M L-716 A87631 Patient Identity Feed PIX Query PIX Query Patient Identity Feed Patient Identity XRef Mgr Patient Identity Feed PDQ Query to Acquire Affinity Domain Patient ID M A87631 L-716 M XDS Document Repository XDS Document Repository ATNA Audit record repository CT Time server

69 Providers and Vendors Working Together to Deliver Interoperable Health Information Systems in the Enterprise And Across Care Settings Intra Hospital Workflows and Information Access Intra Hospital Workflows and Information Access

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

71 IHE Solutions within the Enterprise Example: Cardiology Radiology CardiologyLaboratory Enterprise IT Infrastructure Enterprise IT Infrastructure EMR - HIS RIS PACS Img Acq CIS CathECG LIS Auto Mgr Analyzer -Radiation Therapy -Patient Care Devices -Patient Care Devices -Pathology -Pathology -Eye Care -Eye Care Cardiology Integration Profiles Cardiac Catheterization Lab Workflow Echocardiography Lab Workflow Retrieve ECG for Display Displayable Reports Cath and Echo Evidence Documents eMPI User Auth

72 IHE Solutions within the Enterprise IT Infrastructure (Enterprise) Radiology CardiologyLaboratory RIS PACS Img Acq CIS CathECG LIS Auto Mgr Analyzer -Radiation Therapy -Patient Care Devices -Patient Care Devices -Pathology -Pathology -Eye Care -Eye CareeMPI User Auth EMR - HIS 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 Enterprise IT Infrastructure Enterprise IT Infrastructure

73 IHE Solutions within the Enterprise Radiology Radiology CardiologyLaboratory Enterprise IT Infrastructure Enterprise IT Infrastructure EMR - HIS RIS PACS Img Acq CIS CathECG LIS Auto Mgr Analyzer -Radiation Therapy -Patient Care Devices -Patient Care Devices -Pathology -Pathology -Eye Care -Eye CareeMPI User Auth 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 How to use IHE ? IHE Radiology IHE RadiologyHandbook

74 IHE Solutions within the Enterprise Example: Laboratory Radiology CardiologyLaboratory Enterprise IT Infrastructure Enterprise IT Infrastructure EMR - HIS RIS PACS Img Acq CIS CathECG LIS Auto Mgr Analyzer -Radiation Therapy -Patient Care Devices -Patient Care Devices -Pathology -Pathology -Eye Care -Eye Care Laboratory Integration Profiles Laboratory Testing Workflow Laboratory Information Reconciliation Laboratory Point Of Care Testing Laboratory Device Automation Laboratory Code Set Distribution Laboratory BarCode eMPI User Auth

75 General scope of LAB TF Ordering, placing, scheduling and performing clinical laboratory tests on in vitro specimen, within acute care settings Tests in lab as well as at the point of care. Chemistry and Microbiology included with thorough examples Sharing laboratory reports within a wide community of care providers Anatomic pathology addressed by a separate domain in IHE

76 Organization of LAB Technical Framework rel 2.1 Volume 1: Use Cases, Profiles, actors, dependencies Volume 2: Description of message-based transactions Volume 3: Document-based transaction (lab report) Volume 4: Common subset of LOINC test codes Openly available at:

77 Lab TF Rel 2: Integration Profiles Workflow Content Laboratory Testing Workflow (LTW) Laboratory Device Automation (LDA) Laboratory Point Of Care Testing (LPOCT) Laboratory Code Sets Distribution (LCSD) Laboratory Barcode Labeling (LBL) Sharing Laboratory Reports (XD-LAB) V3:CDA V2.5 HL7 Subset of LOINC test codes

78 Dependencies toward IHE IT Infrastructure

79 Lab TF Rel 2: Integration Profiles Workflow Content Laboratory Testing Workflow (LTW) Laboratory Device Automation (LDA) Laboratory Point Of Care Testing (LPOCT) Laboratory Code Sets Distribution (LCSD) Laboratory Barcode Labeling (LBL) Sharing Laboratory Reports (XD-LAB) V3:CDA V2.5 HL7 Subset of LOINC test codes

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

81 IHE Profiles Specifications Go to: For LTW:Under Laboratory Laboratory Technical Framework 2.1 (LTW, LDA) Laboratory Technical Framework 2.1 (LTW, LDA)

82 Providers and Vendors Working Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings

September, 2005What IHE Delivers 83 Coffee Break

84 Agenda 08:30-10:30 THE IHE STANDARDS ADOPTION PROCESS: achieving practical interoperability - Charles Parisot Coffee Break 11:00-12:30 USERS AND VENDORS WORKING TOGETHER: how can I contribute & benefit from IHE – Charles Parisot Lunch Break 13:30-15:00 HOW TO USE IHE RESOURCES: hands on experience – Eric Poiseau

85 Understanding the IHE Initiative IHE has a clear focus IHE is a healthcare domain-based initiative IHE creates synergies for interoperability testing across domains IHE addresses the standards adoption process IHE is both regional and multi-national IHE is both user lead and vendor driven

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

8787 IHE Organizational Structure Contributing & Participating Vendors Regional Deployment IHE Europe IHE North America France USA Canada IHE Asia-Oceania Japan KoreaTaiwan Netherlands Spain Sweden UK Italy Germany Norway China Austria ACC ACCE ACEP JAHIS JIRA JRS METI-MLHW MEDIS-DC JAMI RSNA SFR SFIL SIRM BIR EuroRec COCIR EAR-ECR DRG ESC Professional Societies / Sponsors ACP GMSI HIMSS Global Development Radiology Cardiology IT Infrastructure Patient Care Coordination Patient Care Devices Laboratory Pathology Eye CareRadiation Oncology Public Health, Quality and Research IHE International Board

8888 IHE Sponsors Professional societies (stakeholder representation) Healthcare Information Management Systems Society (HIMSS) Healthcare Information Management Systems Society (HIMSS) Radiological Society of North America (RSNA) Radiological Society of North America (RSNA) British Institute of Radiology (BIR), British Computer Society (BCS British Institute of Radiology (BIR), British Computer Society (BCS German Radiology Society (DRG) German Radiology Society (DRG) GMSIH (IT France), SFIL (laboratory), French National Project (DMP) GMSIH (IT France), SFIL (laboratory), French National Project (DMP) European Society of Cardiology European Society of Cardiology ……Many other European Societies ……Many other European Societies American College of Physicians (ACP), American College of Emergency Physicians (ACEP) American College of Physicians (ACP), American College of Emergency Physicians (ACEP) …Many other American healthcare societies (ACCE), (AAO), (ASTRO), etc. …Many other American healthcare societies (ACCE), (AAO), (ASTRO), etc. JAHIS (IT Japan), and many other Japanese Societies JAHIS (IT Japan), and many other Japanese Societies And many more…. And many more….

89 IHE Participants and Relationships Participants include: Users - Clinicians, Staff, Administrators, CIOs, Governments Users - Clinicians, Staff, Administrators, CIOs, Governments Vendors of Information Systems and Equipment Vendors of Information Systems and Equipment Consultants Consultants Relationship with Standards Development Organizations (SDOs): HL7, DICOM, ISO, CDISC, ASTM, W3C, IEEE, IETF, and many others HL7, DICOM, ISO, CDISC, ASTM, W3C, IEEE, IETF, and many others Approved via ISO/TC 215 allowing for IHE profiles to be published as ISO deliverables Approved via ISO/TC 215 allowing for IHE profiles to be published as ISO deliverables National Adoption of Healthcare IT Standards and IHE Profiles DMP(France), ELGA(Austria), HITSP (USA), Infoway (Canada), many others worldwide….. DMP(France), ELGA(Austria), HITSP (USA), Infoway (Canada), many others worldwide…..

9090 IHE Organizational Structure Contributing & Participating Vendors Regional Deployment IHE Europe IHE North America France USA Canada IHE Asia-Oceania Japan KoreaTaiwan Netherlands Spain Sweden UK Italy Germany Norway China Austria ACC ACCE ACEP JAHIS JIRA JRS METI-MLHW MEDIS-DC JAMI RSNA SFR SFIL SIRM BIR EuroRec COCIR EAR-ECR DRG ESC Professional Societies / Sponsors ACP GMSI HIMSS Global Development Radiology Cardiology IT Infrastructure Patient Care Coordination Patient Care Devices Laboratory Pathology Eye CareRadiation Oncology Public Health, Quality and Research IHE International Board

91 IHE International Governance - Membership Membership: Members are Organizations–Sign Governance & IP once. Members are Organizations–Sign Governance & IP once. Three Organizational Categories: User, Developer, General Interest Three Organizational Categories: User, Developer, General Interest Member designates a primary/alternate representatives to one of more Committees (Domains, Test& Tools, MarCom). Member designates a primary/alternate representatives to one of more Committees (Domains, Test& Tools, MarCom). Voting rights lost after three missed meetings, regained at second meeting Voting rights lost after three missed meetings, regained at second meeting Elect Committee (or sub-Committee) co-chairs. One User & one vendor recommended for Planning Committees Elect Committee (or sub-Committee) co-chairs. One User & one vendor recommended for Planning Committees Regional and National IHE Committee members required to become members of IHE International. Regional and National IHE Committee members required to become members of IHE International.

92 IHE International Governance – Others Committees IHE Regional or National Deployment Committees are independent entities with their own governance but close collaborative relationship with IHE International. IHE International Board empowers Regional and National Committee. 3 year commitment, renewable. Oversees Testing and Tools Committee Coordinates the various Regional and National Committees. Coordinates the various Regional and National Committees. Oversees Marketing & Communication Committee Consistency of communication among Domains within IHE International and various Regional and National Committees. Consistency of communication among Domains within IHE International and various Regional and National Committees.

93 As a Provider or Vendor Contributor Offer Clinical Use Case Input to Drive IHE Profile Development Become a member of relevant domains Planning or Technical Committees Become a member of relevant Regional/National Committees Help to shape IHEs future direction As a Vendor Participant Respond to Public Comments of Domain Supplements Attend the June Educational Workshop Participate in Connect-a-thons and Demonstrations As a Provider/Consultant Participant Respond to Public Comments of Domain Supplements Attend the June Educational Workshop Attend Demonstrations and include IHE Integration Profiles in your RFPs and Integration Projects. How can I participate?

94 What can you do? Learn about IHE, Insist on relevant IHE profiles compliance in your RFPs and contract documents: Select Integration Profiles, and Appropriate Actor(s) Select Integration Profiles, and Appropriate Actor(s) Ask vendors for their products IHE Integration Statements. Ask vendors for their products IHE Integration Statements. Need more interoperability ? Contribute to IHE Committees Contribute to IHE Committees

95 IHE Web site: Frequently Asked Questions Integration Profiles in Technical Frameworks: See Volume 1 of each TF for Use cases Cardiology Cardiology Eye Care Eye Care IT Infrastructure IT Infrastructure Laboratory Laboratory Patient Care Coordination Patient Care Coordination Patient Care Devices Patient Care Devices Pathology Pathology Quality Quality Radiation Oncology Radiation Oncology Radiology Radiology Connectathon Result: Vendor Products Integration Statements

96 How to Participate As a User or Vendor Committee Member Become a member of relevant Domains Planning or Technical Committees As a User, Consultant or Vendor Interested Observer Provide Public Comments on Technical Framework Supplements Attend Demonstrations, Educational Events and Workshops

97 More Resources Frequently Asked Questions Integration Profiles in Technical Frameworks: Cardiology Cardiology IT Infrastructure IT Infrastructure Laboratory Laboratory Patient Care Coordination Patient Care Coordination Patient Care Devices Patient Care Devices Radiation Oncology Radiation Oncology Radiology Radiology Connectathon Results Vendor Products Integration Statements Participation in Committees and Connectathons

September, 2005What IHE Delivers 98