May 2011Value of IHE 1 INTEGRATING THE HEALTHCARE ENTERPISE Value of IHE Profiles and testing for cross- institutional health services FINteroperability in Health 2011 Charles Parisot, IHE International Board & IHE-Europe Steering Committee, GE healthcare

Interoperability: From a problem to a solution 2 Profile Development eHealth Projects 2 Project Specific Extensions IHTSDO IETF Profiling Organizations are well established Base Standards

IHE Europe & IHE National IHE Europe & IHE National IHE International 3 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

4 13 Years of Steady Evolution 1998 – 2011 The IHE Development Domains Pharmacy Since 2009 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 (Healthcare) IT Infrastructure since 2003 since 2008

5 International Growth of IHE France  Local Deployment, National Extensions  Promotional & Live Demonstration Events  Over 400 Organizational Members (see USA Germany Italy Japan UK Canada Taiwan Netherlands Spain Austria Pragmatic global standards harmonization + best practices sharing 2008 Australia 2010 China Turkey Malaysia Switzerland

What is IHE, how much adopted ? ISO Health Informatics: TR28380 Global Standards Adoption – IHE Process and Profiles Home Health: CONTINUA and IHE work together. Partners in EU Project Smart Personal Health Widespread adoption of IHE Profiles by National and Regional Projects around the world: USA, Europe, Asia   US National Health Information Network (NwHIN) leverages IHE profiles (XCA, XDR, XCPD, BPPC, ATNA)   12 Country European epSOS Project: IHE-Europe hosting Industry Team, support project interoperability conformance testing (XCA, XCPD, ATNA, XUA, BPPC, CDA Content Modules from PCC).   In use in several national and regional projects (Austria, France, South Africa, Italy, Netherlands, USA, Japan, Switzerland, Canada)   EU Commission eHealth Interop Mandate 403 leverages IHE process   European HITCH project to roadmap conformance testing and certification leverages the IHE testing experience 6

eHealth and Interoperability: What’s new in IHE Profiles ? Patient Care Devices Patient Care Coordination Radiology IT Infrastructure And more: Pharmacy, Eye Care, Endoscopy, Dentistry Domains 7

eHealth and Interoperability: What’s new in IHE Profiles ? Patient Care Devices Patient Care Coordination, Radiology IT Infrastructure Testing, Tools and Connectathons And more: Pharmacy, Eye Care, Endoscopy, Dentistry Domains 8

9 Courtesy: Continua Alliance General Device - Communication Architecture

10 Single data interface architecture: all Continua Personal Health Devices, all IHE-PCD Medical Devices, and all IHE EMRs!

11 DEC Profile: PCD-01 Transaction It profiles HL7 V2.6 + IEEE Device Data Terminology IHE DEC Profile: PCD-01 transaction  Two transport: TCP/IP+MLLP or WS (ITI TF App V)  One profiled message format (HL7 V2.6): compact, common  One simple data model for all devices (data levels, values, units, etc.) IHE RTM Profile: Rosetta Terminology Mapping For each specific home and care device (over 300):  Consistent ‘containment hierarchy’ and value sets for coded data  Consistent use of units-of-measure for enumerated values A revolution: a consistent approach to importing device data in a medical record

eHealth and Interoperability: What’s new in IHE Profiles ? Patient Care Devices Patient Care Coordination Radiology IT Infrastructure Testing, Tools and Connectathons And more: Pharmacy, Eye Care, Endoscopy, Dentistry Domains 12

13 Patient Care Coordination Strategy to define library of “practical” reusable “data modules” ( or template, molecules, archetypes, data element models ) for CDA Rel 2 now reaching maturity :  Initiated by IHE PCC moved to HL7 with CCD Implementation Guide  PCC TF includes now over 300 “modules” aligned with CCD  All IHE domains defining CDA R2 based Document Content profiles (PCC, Lab, Pharmacy, QRPH, ITI) reuse same module library.  Consistency across IHE Doc Content Profiles and HL7 implementation Guides under review under auspices of US ONC. Minor discrepancies consolidated and place under OHT-Model Driven Health Tools. A consistent approach to standardized modular definition of clinical content

14 Road to semantic interoperability: a huge step A revolution: a consistent approach to standardized modular definition of clinical content Terminology Value Sets: Snomed ICD LOINC IEEE Etc.TemplatesModules Data Elements Archetypes CDA Rel2 Header Section A Section B Section L Section K Result in a Flexible but Consistent set of Document Types

15 Patient Care Coordination Maternal and Baby Care now supported with a complete set of CDA documents:   Antepartum Education (APE)   Antepartum Laboratory (APL)   Antepartum History and Physical (APHP)   Antepartum Summary (APS)   Labor and Delivery History and Physical (LDHP)   Labor and Delivery Summary (LDS)   Maternal Discharge Summary (MDS)  Newborn Discharge Summary (NDS)  Postpartum Visit Summary (PPVS) All relying on the standardized modular definition of clinical content

eHealth and Interoperability: What’s new in IHE Profiles ? Patient Care Devices Patient Care Coordination Radiology IT Infrastructure Testing, Tools and Connectathons And more: Pharmacy, Eye Care, Endoscopy, Dentistry Domains 16

17 Radiology XDS-I continues to receive much attention   Multi-Community Clarifications with XCA-I   Implementation is now widespread and feedback is positive Radiation Exposure Monitoring ready for prime time   Most new modality products support REM to track actual exposure   Imaging Departments: PACS, RIS, dedicated applications emerging   Some national dose registries in pilot   Regulations made explicit in many countries

eHealth and Interoperability: What’s new in IHE Profiles ? Patient Care Devices Patient Care Coordination Radiology IT Infrastructure Testing, Tools and Connectathons And more: Pharmacy, Eye Care, Endoscopy, Dentistry Domains 18

19 IT Infrastructure Growing understanding of the strength and breadth of the “XD*” family of profiles   XDM on for ubiquitous pt-to-pt send or CD/USB for media   XDR on SOAP/WS for point-to-point exchange   XDS for registry-centric exchange in a “community”*   XCA for peer to peer federation of “communities”* To be combined with different patient identification strategies:   PDQ Shared stable source of Identities*   PIX for “MPI” centric patient Id linkage   XCPD for discovery & ID linkage across communities   XCPD for location discovery with a shared source of identities* * Most likely suited for Finland

20 IT Infrastructure XDS and related Profiles extend deployment:   Off-the shelf sharing of records/documents (Finns invention !)   Robust service: submission sets, replace/amend, etc.   Open source and support by well over 100 products (infrastructure & EPRs).   Projects range from communities (a few hospitals/clinics) to regions and nations. A few registries/repositories with more than 1 million patients.   Implementation feedback is positive: moving beyond interfacing to user experience.

21 IHE, Global Standards-Based Profiles Adopted in National & Regional Projects (sample) Quebec, Toronto, Alberta, British Columbia Canada Infoway THINC- New York NCHICA – N. Carolina Italy Conto Corrente Venetto - Friuli Boston Medical Center - MA Philadelphia HIE CHINA-MoH Lab results sharing CHINA-Shanghai Imaging Info Sharing JAPAN-Nagoya Imaging Info Sharing, Nationwide PDI guideline South Africa VITL-Vermont CareSpark – TN & VA NETHERLANDS Friesland Natn’l Mamography Lower Austria France DMP Wales Imaging Belgium Flemish-Leuven Suisse St Gallen Lausane Providence Health System - OR KeyHIE Pennsylvania SHARP CA France Imaging IDF 21 For more complete list see: tinyurl.com/wwXDS

22 IT Infrastructure Completed the regional & national infrastructure needs:   Terminology Value Set distribution/updates with extended SVS profile: Retrieve value Sets by unique identifier Queries to search and access value set descriptions   Healthcare Provider Directory (HPD) Based on LDAP Support Provider Persons or Provider Organizations or both (with optional relationships)   Security and Privacy increasingly better understood: Encryption and Audit Trail (ATNA) Basic Patient Privacy Consent (BPPC) User Assertion (XUA) now enriched with explicit attributes

XDW - Necessity Many different worldwide projects have as goals to paperless/digitizing of clinical processes. At the bases of all these projects there is the management of workflows across multiple organizations:  For example various eReferral, chronic care workflows  Flexible nature and processes for these workflows  Clinical, economic, social and organizational impact value

XDW – Key Elements Focuses on the Cross-Enterprise Workflow for Document Sharing in support of workflow document and status management. Key elements: Managing multi-organizational workflows Workflow associated information in referenced documents Tracking the past steps of the workflow related to specific clinical event that triggered it Flexibility: any entities to join in workflow Generic workflow infrastructure: workflow specifics are known only in point of care systems (Workflow federation)

Creation of eReferral Document Creation of Clinical Report A Use Case Example of XDW (1) 25 Workflow Document (1) Workflow Document (2) Workflow Document (3) Workflow Document (4)

A Use Case Example of XDW (3) 26 Workflow Document Structure

XDW Standards XDW: a new content profile for a workflow management document No new transaction are introduced. Leverages existing ITI IHE Profiles:  XDS.b, DSUB, BPPC, ATNA, No XDS Metadata extension expected, but specific rules about Metadata content and update rules for the workflow Document Public Comment opens late May 2011 (one month) Trial implementation available in August 2011.

eHealth and Interoperability: What’s new in IHE Profiles ? Patient Care Devices Patient Care Coordination Radiology IT Infrastructure Testing, Tools and Connectathons And more: Pharmacy, Eye Care, Endoscopy, Dentistry Domains 28

Implementation Tools Open source implementations are available for XDS, XCA, XCPD, PIX, PDQ, ATNA, CT, and more:   HIE-OS under Source Forge   Microsoft under codeplex   NIST under Source Forge / /   OHT – IHE Profiles Charter   OHT – Model Driven Health Tools-Charter

30 Interoperability Testing Needs an Ecosystem 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

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

32 IHE Connectathons 2011 Connectathon: Chicago, USA, January 17-21, 2011 Pisa, ITALY, April 11-15, 2011 Australia, July 2011 Japan, October 2011 Massive yearly events : vendors engineers systems ….integrated in 5 days

Profile Development & Testing Base Standards eHealth Projects Interoperability Specifications 33 Interoperability: From a problem to a policy IETF Countries/Regions with such a process: Austria (ELGA, Regions) France (ASIP) USA (NwHIN) Italy (Venetto, etc.) China (MoH) Switzerland (ehealth suisse) Canada (Infoway) Simple and Effective Profile Recognition Process & Policy Leverage Synergies of Global Standards and Profiles Recognized: Profile A Profile B Profile C …..

IHE- Roles of Different levels Regional Profile Deployment IHE Europe FranceNetherlands Spain Turkey UK Italy Germany Switzerland Austria Radiology Cardiology IT Infrastructure Patient Care Coordination Patient Care Devices Laboratory Pathology Eye CareRadiation Oncology Public Health, Quality and Research Pharmacy IHE Finland National Engagement Projects European Coordination Testing & Education International Use Cases & Profiles International Governance IHE International Board Global Profile Development 34 Open to to all all Stakeholders Stakeholders

IHE based “Interoperability” experience has demonstrated significant benefits to national and regional programs:  Reduce specification consensus time  Simplify implementation efforts  Reuse of testing tools and processes  Shared implementation experience 35

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

May 2011Value of IHE 37