1. September, 2005What IHE Delivers Michael H. Zaroukian, MD, PhD, FACP Chief Medical Information Officer Associate Professor of Medicine Michigan State University Integrating the Healthcare Enterprise Achieving Interoperability through Implementation of Standards January 16, 2007

2. 1 Presentation Objectives IHE: What? Why? Who? How organized? Healthcare provider role in developing IHE framework Healthcare provider role in developing IHE framework Why standards are not enough IHE process for standards adoption and implementation Benefits, growth, strategies, integration How to leverage IHE to enable interoperability in Enterprises Enterprises Health information exchanges (HIEs) Health information exchanges (HIEs)

3. 2 IHE: A Framework for Interoperability A common framework for harmonizing and implementing multiple standards Application-to-application System-to-system Setting-to-setting Enables seamless health information movement within and between enterprises, regions, nations Promotes unbiased selection and coordinated use of established healthcare and IT standards to address specific clinical needs

4. 3 Why IHE? A Patient-centered Example

5. 4 Interoperability: Redesigning the Office Visit

6. 5 IHE Sponsors 1997: Founded in Radiology (RSNA) and IT (HIMSS) Many professional societies (stakeholder representation) American Academy of Ophthalmology (AAO) American Academy of Ophthalmology (AAO) American College of Cardiology (ACC) American College of Cardiology (ACC) American College of Physicians (ACP) American College of Physicians (ACP) American College of Clinical Engineering (ACCE) American College of Clinical Engineering (ACCE) American College of Emergency Physicians (ACEP) American College of Emergency Physicians (ACEP) American Society for Therapeutic Radiation Oncology (ASTRO) American Society for Therapeutic Radiation Oncology (ASTRO) GMSIH (IT France), JAHIS (IT Japan), SFIL (laboratory) GMSIH (IT France), JAHIS (IT Japan), SFIL (laboratory) Healthcare Information Management Systems Society (HIMSS) Healthcare Information Management Systems Society (HIMSS) Radiological Society of North America (RSNA) Radiological Society of North America (RSNA) And many more…. And many more….

7. 6 IHE Participants and Relationships Participants include: Users - Clinicians, Staff, Administrators, CIOs, Governments (e.g. NIST, VA). Users - Clinicians, Staff, Administrators, CIOs, Governments (e.g. NIST, VA). Vendors - Information Systems and Equipment Vendors - Information Systems and Equipment e.g., imaging, cardiology, devices e.g., imaging, cardiology, devices Consultants Consultants Maintains formal liaison with Standards Development Organizations (SDOs): HL7, DICOM, ISO (Liaison D), others HL7, DICOM, ISO (Liaison D), others ISO TC215 (including ANSI) approved IHE Process and Profiles to be published as technical reports Concerns expressed by some AHIC members not founded Concerns expressed by some AHIC members not founded

8. 7 IHE Organizational Structure ACC ACP HIMSS RSNA JAHIS JIRA JRS METI-MLHW MEDIS-DC JAMI GMSIH SFR SFIL 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 Pharmacy / Medication Admin Radiation Oncology IHE Europe IHE North America France USA Canada IHE Asia-Oceania Japan KoreaTaiwan Netherlands Spain Sweden UK Italy Germany Norway Regional Deployment China

9. 8 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

10. 9 Standards: Necessary…Not Sufficient Standards are Foundational - to interoperability and communications Foundational - to interoperability and communications Broad - varying interpretations and implementations Broad - varying interpretations and implementations Narrow - may not consider relationships between standards domains Narrow - may not consider relationships between standards domains Plentiful - often redundant or disjointed Plentiful - often redundant or disjointed Focused - standards implementation guides focus only on a single standard Focused - standards implementation guides focus only on a single standard IHE provides a standard process for implementing multiple standards

11. 10 IHE: Connecting Standards to Care Healthcare professionals work with industry Coordinate implementation of standards to meet clinical and administrative needs Clinicians and HIT professionals identify the key interoperability problems they face Clinicians and HIT professionals identify the key interoperability problems they face Providers and industry work together to develop and make available standards-based solutions Providers and industry work together to develop and make available standards-based solutions Implementers follow common guidelines in purchasing and integrating effective systems Implementers follow common guidelines in purchasing and integrating effective systems IHE: A forum for agreeing on how to implement standards and processes for making it happen

12. 11 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

13. 12 Stakeholder Benefits Healthcare providers and support staff Improved workflows Improved workflows Information whenever and wherever needed Information whenever and wherever needed Fewer opportunities for errors Fewer opportunities for errors Fewer tedious tasks/repeated work Fewer tedious tasks/repeated work Improved report turnaround time Improved report turnaround timeVendors Align product interoperability with industry consensus Align product interoperability with industry consensus Decreased cost and complexity of interface installation and management Decreased cost and complexity of interface installation and management Focus competition on functionality/service space not information transport space Focus competition on functionality/service space not information transport spaceSDOs Rapid feedback to adjust standards to real-world Rapid feedback to adjust standards to real-world Establishment of critical mass and widespread adoption Establishment of critical mass and widespread adoption

14. 13 Growth in IHE Domains Radiology (18) IT Infrastructure for Healthcare (17) Cardiology (7) Laboratory (6) Radiation Oncology (1) Patient Care Coordination (5) Patient Care Devices (1) Quality Eye Care (3) Veterinary Endoscopy Pathology Pharmacy IHE Global Developments Integration Profiles (# X) – Solutions to Real-World Interoperability Needs & Problems: Within Clinical Departments e.g.: Within Clinical Departments e.g.: Radiology Radiology Cardiology Cardiology Lab Lab...... Across Departmental & Institutional Boundaries – XDS Across Departmental & Institutional Boundaries – XDS RHIOs (Regional Healthcare Information Organizations) RHIOs (Regional Healthcare Information Organizations) EHR Enablers EHR Enablers Year 1 (1999)Year 2 (2000)Year 3 (2001) Year 4 (2002) Year 5 (2003)Year 6 (2004) Year 7 (2005) Year 8 (2006)Year 9 (2007)

15. 14 IHE Implementation Strategy Leverage established standards to allow rapid deployment and plan for future Pragmatic, Ease of Evolution Enable architectural freedom (patient vs. provider centric, centralized vs. decentralized, scalable (from office to enterprise to IDN to RHIO) Configuration flexibility Support breakthrough use cases: variety of care settings, care coordination, public health, PHR, EHR Interoperability for broad constituencies IHE: Offers consistent, standards-based record sharing for EHRs and other information systems

16. 15 IHE based Regional and National EHR Projects (Operational and Planned) Toronto, Quebec, Alberta, BC Canada Infoway Austria THINC- New York NCHICA – N. Carolina Italy (Conto Corrente Salute) MA-Share – MA France DMP Philadelphia HIE CHINA-MoH Lab results sharing New York HIE

17. 16 IHE Integration Profiles for Health Info Nets What is available and has been added in 2005 and 2006 Patient Demographics Query Patient Identifier Cross-referencing Map patient identifiers across independent identification domains Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Cross-enterprise Document Point-Point Interchange Media-CD/USB & e-mail push 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 origin 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 Security Clinical and PHR Content Health Data Exchange Other

18. 17 IHE: Supporting HHS Goals for NHIN Healthcare Information Technology Standards Panel (HITSP) Nationwide Health Information Network Architecture Projects (NHIN) Health Information Security and Privacy Collaboration (HISPC) Certification Commission for Healthcare Information Technology (CCHIT) American Health Information Community Standards harmonization and adoption Interoperability testing Security and privacy standards Specifications for standards- based EHR functionality to support RHIOs

19. 18 HITSP Recommended Standards Biosurveillance ICD-9CM – International Classification of Diseases v. 9 Clinical Modifications ICD-9CM – International Classification of Diseases v. 9 Clinical Modifications ICD-10 CM – Diagnoses and Procedures ICD-10 CM – Diagnoses and Procedures IHE-XDS – Integrating the Healthcare Enterprise (IHE) Cross- Enterprise Document Sharing IHE-XDS – Integrating the Healthcare Enterprise (IHE) Cross- Enterprise Document Sharing IHE-XDS Lab – IHE Laboratory Report Document Sharing IHE-XDS Lab – IHE Laboratory Report Document Sharing IHE-RFD – IHE Retrieve Form for Data Capture IHE-RFD – IHE Retrieve Form for Data Capture IHE-PIX – IHE Patient Identification Cross-Referencing IHE-PIX – IHE Patient Identification Cross-Referencing IHE-RAD – XDS-I – IHE Cross-Enterprise Sharing of Images IHE-RAD – XDS-I – IHE Cross-Enterprise Sharing of Images IHE-NAV – IHE Notification of Document Availability IHE-NAV – IHE Notification of Document Availability IHE-XDS-MS – IHE Medical Summary Document Sharing IHE-XDS-MS – IHE Medical Summary Document Sharing ISO/TC215 -DTS 25237 - Health Informatics Pseudonymisation ISO/TC215 -DTS 25237 - Health Informatics Pseudonymisation LOINC – Logical Observation Identifiers Names and Codes LOINC – Logical Observation Identifiers Names and Codes NCCLS – National Committee for Clinical Laboratory Standards NCCLS – National Committee for Clinical Laboratory Standards RxNorm – National Library of Medicine RxNorm RxNorm – National Library of Medicine RxNorm IHE contributes to HITSPs success

20. 19 HITSP Recommended Standards Consumer Empowerment IHE-XDS – Integrating the Healthcare Enterprise (IHE) Cross-Enterprise Document Sharing IHE-XDS – Integrating the Healthcare Enterprise (IHE) Cross-Enterprise Document Sharing IHE-PIX – IHE Patient Identification Cross-Referencing IHE-PIX – IHE Patient Identification Cross-Referencing IHE-PDQ – IHE Patient Demographics Query IHE-PDQ – IHE Patient Demographics Query Health Level Seven (HL7) CDA R2 – HL7 Clinical Document Architecture Release 2 Health Level Seven (HL7) CDA R2 – HL7 Clinical Document Architecture Release 2 HL7 CCD – HL7 Continuity of Care Document with mappings from ASTM E 2369-05 Continuity of Care Record (CCR), X12 N 270/271 and NCPDP Script 8.1. HL7 CCD – HL7 Continuity of Care Document with mappings from ASTM E 2369-05 Continuity of Care Record (CCR), X12 N 270/271 and NCPDP Script 8.1. HL7 EHR Systems Functional Model Draft Standard for Trial Use (DSTU) HL7 EHR Systems Functional Model Draft Standard for Trial Use (DSTU) Logical Observation Identifiers Names and Codes (LOINC) Logical Observation Identifiers Names and Codes (LOINC)

21. 20 HITSP Recommended Standards Electronic Health Record Exchange IHE-XDS Lab – IHE Laboratory Report Document Sharing IHE-XDS Lab – IHE Laboratory Report Document Sharing IHE-PIX – IHE Patient Identification Cross-Referencing IHE-PIX – IHE Patient Identification Cross-Referencing IHE-PDQ – IHE Patient Demographics Query IHE-PDQ – IHE Patient Demographics Query Health Level Seven (HL7) CDA R2 – HL7 Clinical Document Architecture Release 2 Health Level Seven (HL7) CDA R2 – HL7 Clinical Document Architecture Release 2 HL7 v. 2.5 HL7 v. 2.5 Clinical Laboratory Improvement Amendments (CLIA) Clinical Laboratory Improvement Amendments (CLIA) Logical Observation Identifiers Names and Codes (LOINC) Logical Observation Identifiers Names and Codes (LOINC) Health Insurance Portability and Accountability Act (HIPAA) Health Insurance Portability and Accountability Act (HIPAA) Systematized Nomenclature of Medicine – Clinical Terms (SNOMED – CT) Systematized Nomenclature of Medicine – Clinical Terms (SNOMED – CT) Unified Code for Units of Measure (UCUM) Unified Code for Units of Measure (UCUM)

22. 21 2007 HIMSS Interoperability Showcase February 26 – March 1, 2007 9,000 square feet of exhibit space 67 Showcase participants Secured HIExchange with broad content HIE with patient care devices Personal health record solutions New directions focus (Life Sciences Bio-Pharma, HL7 v3.0 PIX/PDQ, ELINCS Lab) HITSP interoperability specifications Financial and administrative systems (CAQH/CORE) Expanded distributed demonstration in a RHIO format Focused tours – International, VIP, Congressional Theater – Education sessions Morial Convention Center, New Orleans, LA

23. 22 How to Participate As a User or Vendor Committee Member Become a member of relevant Domains Planning or Technical Committees As a User, Consultant or Vendor Interested Observer Provide Public Comments on Technical Framework Supplements Attend Demonstrations, Educational Events and Workshops

24. 23 How to Use IHE As a Vendor Implementer Implement IHE Integration Profiles Test systems through Connectathon process Publish an IHE Integration Statement for products As a User Implementer or Consultant Use IHE Integration Profiles to develop interoperability strategy Use Connectathon Results and Integration Statements to evaluate vendors Demand IHE Integration Profile compliance in RFPs

25. 24 Providers and Vendors Working Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings http://www.ihe.net

26. 25 More Resources - www.ihe.net www.ihe.net Frequently Asked Questions Integration Profiles in Technical Frameworks: Cardiology Cardiology IT Infrastructure IT Infrastructure Laboratory Laboratory Patient Care Coordination Patient Care Coordination Patient Care Devices Patient Care Devices Radiation Oncology Radiation Oncology Radiology Radiology Connectathon Results Vendor Products Integration Statements Participation in Committees and Connectathons

27. September, 2005What IHE Delivers