1. September, 2005What IHE Delivers 1 IHE in regional and national health information exchange around the WORLD HIMSS Interoperability Showcase February 2007 Charles Parisot (GE)

2. 2 International Adoption of IHE France   Local Deployment   National Extensions (Local Adaptions)   Promotional & Live Demonstration Events   Funding USAGermanyItalyJapanUKCanadaKoreaTaiwan Norway HollandSpainChina Year 1 (1999) Year 2 (2000) Year 3 (2001) Year 4 (2002) Year 5 (2003) Year 6 (2004) Year 7 (2005) Year 8 (2006) Pragmatic global standards harmonization + best practices sharing

3. 3 IHE Organizational Structure ACC ACP HIMSS RSNA JAHIS JIRA JRS METI-MLHW MEDIS-DC JAMI GMSIH SFR SFIL ACCE SIRM BIR EuroRec COCIR EAR-ECR DRG ESC Professional Societies / Sponsors Contributing & Participating Vendors IHE (International) Strategic Development Committee Global Development Radiology Cardiology IT Infrastructure Patient Care Coordination Patient Care Devices Laboratory Pathology EyecareRadiation Oncology IHE Europe IHE North America France USA Canada IHE Asia-Oceania Japan KoreaTaiwan Netherlands Spain Sweden UK Italy Germany Norway Regional Deployment China

4. 4 National and Regional projects It is difficult to provide a simple summary view of these projects: These slides reflect information publicly available and current based on author’s knowledge. IHE offers 18 Integration & Content profiles applicable in health information exchange for communities, regions or nations. Each project discussed here uses different subsets of these profiles (IHE Modularity). These projects are multi-year and projects with complex decision making processes.

5. 5 Community or sub-network Clinical Encounter Clinical IT System Sharing System Clinic Record Specialist Record Hospital Record Introduced at HIMSS in 2005 : IHE-XDS 1-Reference to records Repository of Documents Index of patients records

6. 6 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

7. 7 IHE Integration Profiles for Health Info Nets What is available and is added in 2006-2007 Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record 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 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 originSecurity 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 Cross-Enterprise Document Pt-Pt Reliable Interchange Final Text Approved Trial Implementation-2006 – Final Txt 2007 Cross-Enterprise Document Media Interchange

8. 8 Sharing and Accessing Electronic Health Records IHE offers interoperability for local, regional, specific, or national health information exchange Goal is to enable exchange between providers’ clinical and administrative systems and ancillary IT systems (EHRs,Lab, Pharma, Payers, etc.) and personal health record systems. Objective is to empower the consumers in having “shared EHR information” between all of its potential healthcare providers (if authorized) and self. Objective is to empower the providers in choosing when and what information to share, and to trust the information they may use in the care of their patients.

9. 9 Categories of Healthcare Communication Services Most HIEs in the World chose to start with Document Sharing 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 RHIOs

10. 10 IHE, the only sets of harmonized global standards already adopted by several national & regional projects Quebec, Toronto, Alberta, British Columbia Canada Infoway Denmark (Funen) Italy (Veneto) Spain (Aragon) Austria THINC- New York NCHICA – N. Carolina Italy (Conto Corrente Salute) MA-Share – MA France DMP UK CfH (Radiology WF) Philadelphia HIE CHINA-MoH Lab results sharing State Project – NY CHINA-Shangai Imaging Info Sharing JAPAN-Nogaya Imaging Info Sharing

11. 11 Italy (Genoa Region)

12. 12 Italy (Genoa Region) In service since January 2006. 4 Hospitals and 500 physician offices. EMRs import and export documents from their local records. All vendor products required to pass IHE-Europe connectathon in April 2005. Patients chose to join through one of their care provider Infrastructure includes:  XDS Registry  XDS Repository shared at the regional level  PIX for patient Id linking  Doc content is CDA with PDF content. Plan in place to move to CDA rel 2 with structured data. IHE (XD*-Lab) CDA Lab primary candidate.

13. 13 France (National DMP) Prototype RFP call for tender mid-2005. 3 small prototypes in place, confirmed requirement to use to IHE profiles: XDS, ATNA, PIX, etc. Encourage vendors to submitt their products to the IHE- Europe Connectathon (April 2006-Berlin). Infrastructure to include:  XDS Registry  XDS Repositories shared at the regional level  PIX for patient Id linking and ATNA for audit trail and node authentication.  Doc content to be: CDA rel 2 patient summary (close to XDS-MS), Hprim with migration to IHE XD*-Lab for Lab, Scanned Doc (PDF) and imaging (XDS-I).

14. 14 USA (Philapdelphia Region) Philadelphia Health Info Exchange in service since 2005. Focused on images and reports sharing. 5 Hospitals + Imaging Center + Public Health  The Hospital of the University of Pennsylvania  Thomas Jefferson University Hospital  Children’s Hospital of Philadelphia  Presbyterian Medical Center  Pennsylvania Hospital  UPHS Community Radiology  Philadelphia Department of Public Health Migration to XDS, ATNA, PIX and XDS-I in 2006 to be completed early 2007. Demonstrated live at RSNA-Chicago Nov 2006

15. 15 USA (Other) New York State issued an RFP for imaging info sharing communities based on XDS-I. Responses due January 2007. HITSP (HHS sponsored) approved 8 IHE Integration profiles for: Lab results distribution and sharing, Registration and Medication History for Consumers, Biosurveillance. 2 NHIN Pilots (CSC and IBM) leverage IHE profiles (Med Summaries and Lab). Several RHIOs projects are actively planning the use of IHE  North Carolina  Tennessee  Vermont  ….

16. 16 Canada Canada Health Infoway: national Commitment to XDS/XDS-I for imaging sharing 3 infrastructure tenders awarded and 1 more to come early 2007 resulting in over 1/3 of Canadian patients covered:  Toronto East Network - Ontario  Montreal McGill - Quebec  Alberta  British Columbia Includes XDS, ATNA, PIX and XDS-I. Planned to become live January 2008 in Quebec, 1Q 2008 in Ontario, Alberta, British Columbia. Telehealth Project launched (remote consultation), based on XDS.

17. 17 Other Commitments Austria  Lower Austria Region: schedule to get live in 4Q 2006. China:  MoH selected XDS and XD*-Lab (CDA) for two large pilots.  XDS-I in Shangai. Netherlands  Amsterdam region network project launched Nov 2006. XDS-I followed by XD*-Lab. Japan  Nagoya region network project launched in 2006. XDS, XDS-I Sweden  Gotteborg region network project launched in 2006. XDS, XDS-I

18. 18 Community Network B Document Registry Practice Clinic Hospitals Hospital Diag Test Other Practice Hospital Community Network C Document Registry Practice Clinic Hospitals HIMSS RHIO: Network of networks The largest multi-vendor RHIO Prototype ever built ! 18 edge systems 4 infrastructure systems 5 edge systems 4 infrastructure systems 13 edge systems 3 infrastructure systems 3 infrastructure systems Community Network A Document Registry Practice Clinic Hospitals Diag Test

19. 19 IHE, the only sets of harmonized global standards already adopted by several national & regional projects Quebec, Toronto, Alberta, British Columbia Canada Infoway Denmark (Funen) Italy (Veneto) Spain (Aragon) Austria THINC- New York NCHICA – N. Carolina Italy (Conto Corrente Salute) MA-Share – MA France DMP UK CfH (Radiology WF) Philadelphia HIE CHINA-MoH Lab results sharing State Project – NY CHINA-Shangai Imaging Info Sharing JAPAN-Nogaya Imaging Info Sharing

20. September, 2005What IHE Delivers 20