September, 2005What IHE Delivers 1 Didi Davis, Director of IHE, HIMSS National Committee on Vital and Health Statistics (NCVHS) July 27, 2006 IHE Testimony

2 Connecting standards to healthcare delivery Care providers work with vendors to coordinate the implementation of standards to meet their needs  Care providers identify the key interoperability problems they face  Drive industry to develop and make available standards-based solutions  Implementers follow common guidelines in purchasing and integrating systems that deliver these solutions IHE, effective way to establish those “standards” for how to implement standards

3 What is Integrating the Healthcare Enterprise? IHE provides a common framework for passing health information seamlessly:  within the healthcare enterprise  across multiple healthcare enterprises  for local, regional & national health information networks IHE is sponsored by healthcare professional associations: HIMSS, RSNA, ACC, ACP, ACCE, ESC, SFR, BIR, GMSIH, etc. IHE drives standards adoption to address specific clinical or administrative needs

4 IHE Organizational Structure Multi-Domain & Multi-National IHE Organizational Structure Multi-Domain & Multi-National Participants contribute Global Development: Radiology, IT Infrastructure, Cardiology, Lab, etc. Delegates IHE Europe IHE North America IHE Asia/Oceania Regional & National Deployment supervises reports IHE (International) Strategic Development Committee Sponsor Co-Chairs Global Interoperability IHE Domain-related Planning and Technical Committees

5 Proven 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

6 IHE 2006 – Nine Active Domains Close to 200 vendors involved world-wide, 5 Technical Frameworks 51 Integration Profiles, Testing at Connectathons Demonstrations at major conferences world-wide

7 NCVHS Discussion Template of NHIN Draft – NCVHS Confidentiality and Security Electronic health records E-prescribing systems Public health systems Immunization Registries Personal health records Other edge systems Other edge systems Policy Edge System Examples: Confidentiality & Security Network Functional Requirements Examples: Patient Data/Record Location Transport Security (e.g., Audit Trails, Authentication) Confidentiality & Security Policy

8 Requirement 1: Allow “edge” systems to retain functionality and autonomy

9 Requirement 2: Allow Flexibility to support multiple architectures A broad range of architectures are supported (centralized, distributed, federated).

10 Requirement 3: Provide Incremental Phases Phase 1: Share Care Status Information Phase 2: Diagnostic Results and Therapeutic Information Phase 3: Clinical Decision Support and Advanced Access Control Phase 4: Active Quality Reporting and Health Surveillance available 6 mos to 1 yr 2YRs +

11 Some of the Benefits Recognize simple hard costs savings: paper, fax, admin labor Improve information access: (  duplicate procedures,  safety,  collaboration) Data-driven Clinical Decision Making HealthcareInformationTransparency available 6 mos to 1 yr 2YRs +

12 Community or sub-network Clinical Encounter Clinical IT System Index of patients records (Document-level) Aggregate Patient Info 4-Patient data presented to Physician Sharing System Clinic Record Specialist Record Hospital Record 2-Reference to Records for Inquiry Introduced at HIMSS in 2006 : IHE-XDS 3-RecordsReturned Reference to records Repository of Documents

Interoperability Showcase More than 3,000 attendees visited the Showcase 37 vendors demonstrated 48 health information technology (IT) systems in a RHIO format 700 attendees created and tracked their own electronic health record (EHR) 63 educational sessions presented 5 international delegations visited the Showcase Three HIMSS 2006 keynote speakers toured the Showcase 16 clinical scenarios - EHR and personal health record (PHR) systems, and multiple care delivery settings

14 General Impressions “I was impressed with the progress I saw in the Interoperability Showcase over the past year. I am encouraged by the vendor industry’s demonstration of the real potential for interoperability. This type of collaboration is required for us to realize the potential for information technology in healthcare.” “I was impressed with the progress I saw in the Interoperability Showcase over the past year. I am encouraged by the vendor industry’s demonstration of the real potential for interoperability. This type of collaboration is required for us to realize the potential for information technology in healthcare.”  Dr. David Brailer, Vice Chairman, American Health Information Community and former National Coordinator, Health Information Technology

15 HIE Requirements ConsideredTiming Security/AuditingY Phase I - Foundational Patient Identity Y Phase I - Foundational Definition of what is shared Y Ongoing thru all Phases Data location; local or centralized? Y Phase 1 - Foundational Workflow Considerations Y Phases 1, 2, 3 Public Health Needs Y Phase 2 Patient’s role Y Phase 3, 4 Adaptability to future changes Y Phase 3, 4 What’s Missing or Needs Clarity?

Nation-Wide coordination of policies, resources and priorities – ONC Initiatives and Contracts for unifying regions The AHIC Community serves as hub for identifying breakthrough opportunitiesThe AHIC Community serves as hub for identifying breakthrough opportunities CCHIT focuses on developing a mechanism for certification of health care IT productsCCHIT focuses on developing a mechanism for certification of health care IT products HITSP bringing together all relevant stakeholders to identify appropriate IT standardsHITSP bringing together all relevant stakeholders to identify appropriate IT standards HISPC is a partnership focused on addressing variations in business policy and state law that affect privacy and securityHISPC is a partnership focused on addressing variations in business policy and state law that affect privacy and security NHIN focuses on interoperability pilots starting in 2006NHIN focuses on interoperability pilots starting in 2006 Health Information Technology Standards Panel (HITSP) Nation-Wide Health Information Network Architecture Projects (NHIN) The Health Information Security and Privacy Collaboration (HISPC) The Certification Commission for Health Information Technology (CCHIT) American Health Information Community Chaired by HHS Secretary Leavitt Seven federal agency representatives Six health industry members One IT industry member (Intel) One employer (Pepsi) One state health department member (IN) The National Health IT Effort

17 HITSP Harmonization Process HITSP Harmonization Process II Requirements Analysis III Standards Identification V Standards Selection VII Inspection Test VIII Interoperability Specification Dissemination IX Harmonization Process Management Begin Support Receive Request IV Gaps/ Overlaps Resolution VI Interoperability Specification Construction I Harmonization Request

18 The Role of IHE The Role of IHE Models for Harmonization  Mapping of standards which have different levels of granularity  Preferred standards and evolution over time  Unification Building Blocks Implementation Guides/Interoperability Specifications Architecture and Context Process Expertise  Standard v. Implementation Guide  Testing Pilots such as those in Massachusetts

19 More information…. IHE Web site: Technical Frameworks Technical Framework Supplements – Trial Implementation Non-Technical Brochures :  Calls for Participation  IHE Fact Sheet and FAQ  IHE Integration Profiles: Guidelines for Buyers  IHE Connect-a-thon Results  Vendor Products Integration Statements Questions?

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