August 31, 2004IHE European Cardiology 1 Integrating the Healthcare Enterprise IHE, beyond cardiology and radiology An interoperability strategy for the enterprise Charles Parisot, GE Healthcare IHE IT Infrastructure Co-chair

August 31, 2004IHE European Cardiology 2 Goals of IHE Speed up the rate and quality of integration in healthcare environments Foster communication among vendors Prove that integration is attainable based on standards Improve the efficiency and effectiveness of clinical practice

August 31, 2004IHE European Cardiology 3 IHE drives healthcare standards based-integration

August 31, 2004IHE European Cardiology 4 A Proven Standards Adoption Process IHE Integration Profiles B IHE Integration Profile A Easy to Integrate Products IHE Connect-a-thon Product With IHE IHE Demonstration User Site RFP Standards IHE Technical Framework Product IHE Integration Statement IHE Connect-a-thon Results IHE Integration Profiles at the heart of IHE :  Detailed selection of standards and options each solving a specific integration problem  A growing set of effective provider/vendor agreed solutions  Vendors can implement with ROI  Providers can deploy with stability

August 31, 2004IHE European Cardiology 5 IHE 2004 achievements and expanding scope Over 80 vendors involved world-wide, 4 Technical Frameworks 31 Integration Profiles, Testing at yearly Connectathons, Demonstrations at major exhibitions world-wide Provider-Vendor cooperation to accelerate standards adoption

August 31, 2004IHE European Cardiology 6 IHE Deliverables 1.Venues for discussion between users and vendors 2.Common vocabulary/ view of the world based on:  Standard information models (HL7, DICOM, etc.)  Coded information and their meaning 3.Technical Framework = An Implementation Guide  ACTORS in roles performing TRANSACTIONS to accomplish Specific Processes  Together they form INTEGRATION PROFILES 4.Connectathon: Cross-vendor testing opportunity. 5.Public Demonstrations / Education/ Publications 6.Marketing Tools for compliant products: Connectathon results published Products claim conformance with Integration Statement

August 31, 2004IHE European Cardiology 7 What IHE is NOT! A standards development organization  Uses established standards (HL7, DICOM, others) to address specific clinical needs  Activity complementary to SDOs, formal relationship with HL7 and DICOM Simply a demonstration project  Demos only one means to the end—adoption  Backed up by documentation, tools, testing, and publication of information

August 31, 2004IHE European Cardiology 8 IHE: A stepwise approach Cardiology Labora- tory Pharmacy,….. Radiology Patient Identifier Linkage, Registries, Security Electronic Health Record Enterprise Scheduling Patient Management Order Management

August 31, 2004IHE European Cardiology 9 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)

August 31, 2004IHE European Cardiology 10 IHE Radiology Integration profiles - Patient Information Reconciliation Access to Radiology Information Consistent Presentation of Images Basic Security Evidence Documents Key Image Notes Simple Image and Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled Workflow

August 31, 2004IHE European Cardiology 11 IHE Penetration in Radiology Now entering Year 6 !! 50+ vendors worldwide 100+ systems in annual Connectathons Geographic spread  U.S., France, Germany, Japan, Italy, Korea, Taiwan, U.K, Norway, Netherlands, Spain, etc. Well over 100 commercial products available

August 31, 2004IHE European Cardiology 12 IHE IT Infrastructure Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications 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. New Patient Demographics Query New Personnel White Page Access to workforce contact information New Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record New

August 31, 2004IHE European Cardiology 13 IHE Penetration in IT Infrastructure and Laboratory Has just completed Year 1 !! About 20 vendors worldwide 40+ systems in annual Connectathons Geographic spread  U.S., France, Italy, Japan, Germany, etc. Commercial products appearing

August 31, 2004IHE European Cardiology 14 IHE Laboratory Integration Profiles Laboratory Scheduled Workflow (LSWF) done in 2003 Tests performed by a laboratory for an identified inpatient or outpatient Laboratory Patient Information Reconciliation (LPIR) year 2004 Tests performed on an unidentified or misidentified patient Laboratory Code Set Distribution (LCSD) year 2004 Sharing the batteries and tests code sets throughout the enterprise Laboratory Device Automation (LDA) year 2004 Pre-analytic process, analysis and post-analytical treatment Laboratory Point Of Care Testing (LPOCT) year 2004 Tests performed on point of care or patient’s bedside

August 31, 2004IHE European Cardiology 15 IHE 2004 achievements and expanding scope Over 80 vendors involved world-wide, 4 Technical Frameworks 31 Integration Profiles, Testing at yearly Connectathons, Demonstrations at major exhibitions world-wide Provider-Vendor cooperation to accelerate standards adoption

August 31, 2004IHE European Cardiology 16 An Example of IHE IT Infrastructure Integration Profile

August 31, 2004IHE European Cardiology 17 Introduction: EHR Cross-Enterprise Document Sharing First step towards the longitudinal dimension of the EHR Focus: Support document sharing between EHRs in different care settings and organizations

August 31, 2004IHE European Cardiology 18 Acute Care (Inpatient) 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

August 31, 2004IHE European Cardiology 19 community Clinical Encounter Clinical IT System RecordsSent Laboratory Results Specialist Record Hospital Record Finding the records of a patient-Manual & tedious The challenge: Finding and accessing easily documents from other care providers In the community.

August 31, 2004IHE European Cardiology 20 community Clinical Encounter Clinical IT System Index of patients records (Document-level) 1-Patient Authorized Inquiry Temporary Aggregate Patient History 4-Patient data presented to Physician Sharing System 3-RecordsReturned Reference to records Laboratory Results Specialist Record Hospital Record 2-Reference to Records for Inquiry Sharing records that have been published

August 31, 2004IHE European Cardiology 21 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

August 31, 2004IHE European Cardiology 22 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.

August 31, 2004IHE European Cardiology 23 XDS - Value Proposition Distributed: Each Care delivery organization “publishes” clinical information for others. Actual documents may remain in the source EHR-CR. Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain (e.g. an LHII). Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (HL7-CDA, ASTM-CCR, PDF, DICOM, etc.). Document Content Neutral: Document content is processed only by source and consumer IT systems. Standardized Registry Attributes: to ensure deterministic document searches.

August 31, 2004IHE European Cardiology 24 XDS – Conclusion Foundation for EHR & Health IT Infrastructures Effective contribution and access to shared documents across all types of health enterprises Scalable, Flexible and Easy access XDS to be one of the major highlights of 2005 Annual HIMSS Conference & Exhibition. Dallas, Tex., Feb : used as a foundation for an on-site demonstration of interoperability in support of a National Health Information Networks. Attendees at the conference will be able to create and share their own health records across vendor booths as well as in the ambulatory and acute care settings on the conference exhibit floor.

August 31, 2004IHE European Cardiology 25 How real is XDS ? Specification work since Nov 2003 Under Public Comments June-July 2004  600 constructive comments received, Stable specification IHE TF Aug 15 th, 2004 IHE Connectathon January 2005 (USA) HIMSS Feb 2005 show-wide demonstration IHE Connectathon April 2005 (Europe)

August 31, 2004IHE European Cardiology 26 IHE, The practical solutions to the effective use of information exchange standards in healthcare

August 31, 2004IHE European Cardiology 27 IHE Thank You !

August 31, 2004IHE European Cardiology 28 More information…. IHE Web sites: Technical Frameworks: ITI V1.0, RAD V5.5, LAB V1.0, CARD V1.0 Technical Framework Supplements - Trial Implementation May 2004: Radiology August 2004: Cardiology, IT Infrastructure December 2004: Laboratory Non-Technical Brochures : IHE Fact Sheet and FAQ IHE Integration Profiles: Guidelines for Buyers IHE Connect-a-thon Results Vendor Products Integration Statements