Nov 30, 2004IT International Update 1 Integrating the Healthcare Enterprise IHE Update Charles Parisot, GE Healthcare IHE IT Infrastructure Technical Committee Co-chair

Nov 30, 2004IT International Update 2 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

Nov 30, 2004IT International Update 3 Acute Care (Inpatient) PCPs and Clinics (Ambulatory) Long Term Care Other Specialized Care or Diagnostics Services Sharing 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

Nov 30, 2004IT International Update 4 Standards selection for IHE XDS No single standard can address Cross-enterprise Document Sharing Marriage of healthcare standards facilitates implementation and leverages complementary technologies (e.g. security & privacy). Healthcare Content Standards HL7 CDA, CEN EHRcom ASTM CCR DICOM, etc. Internet Standards HTML, HTTP, ISO, PDF, JPEG, etc. Electronic Business Standards ebXML Registry, SOAP, etc.

Nov 30, 2004IT International Update 5 HIMSS 2005 Interoperability Showcases HIMSS leverages its sponsorship of IHE to demonstrate practical interoperability in two large Showcase Exhibits: cross-enterprise sharing of health information in the acute care (18 vendors) and ambulatory (14 vendors). HIMSS Showcase exhibits linked with vendor booths (10 vendors) show-wide. Show-wide interactive environment demonstrating attendees “patient” record in a “HIMSS RHIO”. Uses IHE Cross-enterprise Document Sharing:  Around a central document registry  Distributed document repositories  17 EHR that publish/share documents (CCR, CDA, HL7-lab, PDF)

Nov 30, 2004IT International Update 6 HIMSS 2005 Interoperability Showcases cross-enterprise sharing of health information in the acute care, 18 vendors: CedaraGE HealthcareMortara Instruments DictaphoneIDXNIST Eastman KodakInterSystemsNovell EclipsysInfinitt TechnologyOpen Text EmageonKryptiqSentillion EPICMedCommonsSiemens ambulatory sharing of health information, 14 vendors: AllscriptsGE HealthcareMidMark CapMed/SanDiskHealthrampMisys CernerIDXNextGen EclipsysKrytiqWebMD ETIAMMediNotes HIMSS sponsors the testing and demonstration of IHE interoperability in two large Showcase Exhibits:

Nov 30, 2004IT International Update 7 HIMSS 2005 – Show-Wide Interoperability Vendor System Ambulatory Showcase Booth Home PCP Multispecialty Clinic Diag Center Cross-enterprise Showcase Booth Cardiology Radiology IT Infrastructure & Lab In-Patient/Out-patient Vendor Booth Allscripts Eclipsys GE Healthcare Healthramp IDX Infinitt InterSystems MedCommons Novell OpenText Siemens HIMSS “RHIO” with Cross-enterprise doc sharing

Nov 30, 2004IT International Update 8 Imaging Information Content Format of the Document Content and associated coded vocabulary Simple Document Content Format of the Document Content and associated coded vocabulary For Display Document Content Format of the Document Content Lab Results Document Content Format of the Document Content and associated coded vocabulary IHE Profiles for a “Regional Health Info Organization” What are the gaps to be filled in 2005 ? Patient Identifier Cross-referencing Map patient identifiers across independent identification domains 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. Patient Demographics Query Personnel White Page Access to workforce contact information Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record User Identity, Authentication and Permissions Enable Basic Access Control Cross-Enterprise Notification Notification of a remote provider/ health enterprise Continuity of Care Document Content Format of the Document Content and associated coded vocabulary

Nov 30, 2004IT International Update 9 Infrastructure and Interoperability Cross-Enterprise Document Sharing (XDS) minimizes clinical data management by the infrastructure. Transparency = Ease of Evolution, increase efficiencies. XDS needs other IHE Integration Profiles:  Audit Trail and Node Authentication (ATNA)  Patient Id Cross-referencing (PIX)  Patient Demographics Query (PDQ) In 2005, IHE plans to complement a set of integration profiles to build a RHIO, candidates:  Security: Identity Management + Info for Access Control  Content Profiles: Core CCR, HL7-CDA, HL7-Lab, PDF (legacy)  Provider Notification (with doc reference) and Point-to-point Transfer  Dynamic Clinical Data Mgt (Allergy lists, Problem Lists)  Prioritization of Candidate Integration Profiles November-December Technical development January-July Open to all.

Nov 30, 2004IT International Update 10 IHE Radiology Integration Profiles Patient Info. Recon- ciliation Access to Radiology Information Consistent Present- ation of Images Basic Security - Evidence Docs Key Image Notes Simple Image & Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled Workflow Portable Data for Imaging NM Image New Extensions New

Nov 30, 2004IT International Update 11 Laboratory IHE Integration Profiles In Process –TI Nov 2004 Laboratory Device Automation (LDA) In Process –TI Nov 2004 Pre-analytic process, analysis and post-analytical treatment Laboratory Scheduled Workflow (LSWF) Completed in 2003 Tests performed by a laboratory for an identified inpatient or outpatient In Process Laboratory Patient Information Reconciliation (LPIR) In Process Tests performed on an unidentified or misidentified patient In Process Laboratory Code Set Distribution (LCSD) In Process Sharing the batteries and tests code sets throughout the enterprise In Process –TI Nov 2004 Laboratory Point Of Care Testing (LPOCT) In Process –TI Nov 2004 Tests performed on point of care or patient’s bedside In Dev.

Nov 30, 2004IT International Update 12 IHE Cardiology Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user EchoCardiography Worklflow Admit, order, schedule, acquire images, notify of completed steps, on fixed and mobile stress echo modalities. Cardiac Catheterization Workflow Scheduled & unscheduled acquisition and management of cathlab information, notification of completed steps. Provide high-quality ECG and related reports to the enterprise and outside in a ready-to-display format Retrieve ECG for Display New

Nov 30, 2004IT International Update 13 ACC 2005 IHE Demonstration 11 vendors: AgfaGE Healthcare Schiller CamtronicsHeartlab Philips CernerIDX Toshiba Emageon Medcon Scenario:  Emergency Cath, Change of Lab mid-procedure  Scheduled Echo+Mobile Modality, Stress Echo Echo demo planned for ASE (Boston June 2005) Full demonstration planned for ESC (August 2005) ACC sponsors the testing and demonstration of IHE interoperability in their exhibit – March 2005