1. Integrating the Healthcare Enterprise
What is IHE ?
Charles Parisot, GE Healthcare
IHE IT Infrastructure Technical Committee Co-chair
IHE Europe Committee
Copenhagen, March 17th 2005
March 17, 2005
IHE and medical Standards in Denmark

2. Working Together to Deliver Interoperable Health Information Systems
W W W . I H E . N E T
Providers and Vendors
Working Together to Deliver
Interoperable Health Information Systems
In the Enterprise
and Across Care Settings
W W W . I H E – Europe. o r g
March 17, 2005
IHE and medical Standards in Denmark

3. Connecting Standards to Care
Care providers must work with industry to coordinate the implementation of standards to meet their needs
Care providers need to identify the key interoperability problems they face
Drive industry to develop and make available standards-based solutions
Implementers need to follow common guidelines in purchasing and integrating systems that deliver these solutions
What is the effective way to establish those “standards” for how to implement standards ?
March 17, 2005
IHE and medical Standards in Denmark

4. Need for a Standards Implementation Process?
Standards
Standards
Standards
User Projects
Offer
Demand
March 17, 2005
IHE and medical Standards in Denmark

5. IHE and medical Standards in Denmark
Goals of IHE
Speed up the rate and quality of integration in healthcare environments
Foster communication among vendors and care providers (the implementors)
Prove that integration is attainable based on standards
Improve the efficiency and effectiveness of clinical practice
Improve interoperability among care domains and build foundation for the EHR
Integration solutions within the healthcare enterprise and across healthcare enterprises
March 17, 2005
IHE and medical Standards in Denmark

6. Understanding the IHE Initiative
IHE has a clear focus
IHE is a healthcare domain-based initiative
IHE creates synergies for interoperability testing across domains
IHE addresses the standards adoption process
IHE is both regional and multi-national
IHE is both user lead and vendor driven
March 17, 2005
IHE and medical Standards in Denmark

7. IHE: Domain-based for a stepwise approach
Patient Management
Order Management
Labora-
tory
Cardiology
Pharmacy,…..
Radiology
Patient Identifier Linkage, Registries, Security
Electronic Health Record
Other (e.g. Access Control, eHealthWorkflows)
March 17, 2005
IHE and medical Standards in Denmark

8. IHE 2005 – Five Active Domains
4 Technical Frameworks with 27 Integration Profiles
Testing at yearly Connectathons in three continents
Demonstrations at major conferences world-wide
Patient Care Coordination
Surgery, Pharma, Quality
Provider-Vendor cooperation to accelerate standards adoption
March 17, 2005
IHE and medical Standards in Denmark

9. A Proven Standards Adoption Process
IHE Connect-a-thon Results
Product IHE Integration Statement
IHE Connect-a-thon
Product
With IHE
IHE Demonstration
Easy to
Integrate
Products
IHE Technical Framework
Standards
IHE Integration
Profiles B
Profile A
User Site
RFP
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
March 17, 2005
IHE and medical Standards in Denmark

10. IHE and medical Standards in Denmark
IHE Process
Users identify desired functionality that require coordination and communication among multiple systems
E.g., departmental workflow, single sign-on, sharing of documents
Find and document standards-based transactions among systems to achieve desired functionality
Apply necessary constraints to eliminate useless wiggle room
Provide process and tools to encourage vendors to implement
MESA software test tools + Connect-a-thon interoperability testing event
Provide tools and education to help users acquire and integrate systems using these solutions
Connect-a-thon results and public demonstrations
Integration statements
March 17, 2005
IHE and medical Standards in Denmark

11. IHE Contributors & Participants
Societies Representing Healthcare Segments
EAR, GMSIH, ESC, RSNA, SFIL, HIMSS, ACC, Many Other Professional Societies…
Any Healthcare Stakeholder Organization
Users
Clinicians, Medical Staff, Administrators, CIOs, …
Information Systems & Equipment (e.g. imaging) Vendors
Consultants
In addition, active liaison with Standards Development Organizations (SDOs)
HL7, DICOM, CEN, NCCLS, ISO, others …
March 17, 2005
IHE and medical Standards in Denmark

12. IHE Organizational Structure
IHE Strategic Development Committee
Regional Deployment
Cardiology Planning Committee
Cardiology
Technical Committee
Radiology Planning Committee
Radiology
IT Infrastructure
Planning Committee
Pharmacy Exploratory
Sub-Committee
Global Development
Laboratory Planning and Technical Committee
IHE North America
IHE Asia
Japan
USA
Canada
Taiwan
Korea
IHE Europe
France
Germany
Italy UK
Denmark
Netherlands
Spain
Sweden
Norway
ACC ITAC/CHITTA HIMSS CHI RSNA CAR
JAHIS JIRA JRS
METI-MLHW
MEDIS-DC JAMI
GMSIH
SFR SFIL
SIRM
BIR
EuroRec
COCIR
EAR-ECR
DRG
ESC
Professional Societies / Sponsors
Contributing and participating Vendors
March 17, 2005
IHE and medical Standards in Denmark

13. Organization of the IHE Initiative
IHE distributes its operations between a regional/national level and an international level
IHE is not a standards development organization
IHE operates on overlapping yearly cycle
IHE leverages dependencies and complementary interests between stakeholders
IHE is an open and flexible organization
A novel approach to meet these challenges
March 17, 2005
IHE and medical Standards in Denmark

14. IHE and medical Standards in Denmark
IHE Process
Users and vendors work together to identify and design solutions for integration problems
Intensive process with annual cycles:
Identify key healthcare workflows and integration problems
Research & select standards to specify a solution
Write, review and publish IHE Technical Framework
Perform cross-testing at “Connectathon”
Demonstrations at tradeshows (HIMSS/RSNA…)
**Consider making the cycle graphic
Incremental approach: Can’t solve all at once
Connectathon – Practical measure of progress, Validates the integration work accomplished. Refer the Scorecard.
Demo – promotes standards based integration to users/purchasers
March 17, 2005
IHE and medical Standards in Denmark

15. IHE Process – 20 month yearly cycle Development and Deployment
Approved Supplement Scope
Proposed Supplement Scope
Public Comment Intgr-profile
Trial Implementation Intgr-profile
Sponsors announce Connectathon/Demos with set of Implementation Profiles
Connectathon/Demo Vendor Participant Registered
0 ---
Vendor Participant passed Connectathon
Demo & Education Material
Final Intgr-profile
Vendors release products with IHE Integration Statements
---
March 17, 2005
IHE and medical Standards in Denmark

16. IHE and medical Standards in Denmark
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, ISO, DICOM, NCCLS, etc.
Simply a demonstration project
Demos, only one means to the end—adoption
Backed up by documentation, tools, testing, and publication of information
March 17, 2005
IHE and medical Standards in Denmark

17. IHE Technical Frameworks
March 17, 2005
IHE and medical Standards in Denmark

18. IHE and medical Standards in Denmark
Key IHE Concepts
Generalized Systems -> Actors
Interactions between Actors -> Transactions
Problem/Solution Scenarios -> Integration Profiles
For each Integration Profile:
the context is described (which real-world problem)
the actors are defined (what systems are involved)
the transactions are defined (what must they do)
Generalized the systems because there are many ways vendors can bundle products.
Some PACS may include a Report Creator, others may not.
Some Modalities may include a Print Composer, others may not.
March 17, 2005
IHE and medical Standards in Denmark

19. IHE and medical Standards in Denmark
1st key concept: Actor
Represents a set of application roles and responsibilities performed by a system
Always supported by a real-world system
A real-world system may support several IHE Actors
Examples:
Order Placer
Order Filler
Patient Admission, Discharge and Transfer (ADT)
Laboratory Automation Manager
Point Of Care Analyzer
An IHE Actor is an abstract functional unit playing a specific set of roles and supporting a specific set of transactions to share information with other actors.
A real-world system (e.g. a Laboratory Information System) is not an Actor. It may implement one or more Actors (e.g. Order Filler, Information Source).
IHE leaves the definition of products to users and vendors
March 17, 2005
IHE and medical Standards in Denmark

20. 2nd key concept: Transaction
A set of interactions or messages defined between two Actors for a specific task.
Defines unambiguously how the Actors must cooperate to achieve this task.
Using existing standards such as HL7, DICOM, NCCLS etc.
Example: Transaction LAB-1
« Placer order management »
Order
Placer
Filler
→ Placer order management [LAB-1]
Order
Placer
Order
Filler
New order
Order accepted
Battery replaced
Acknowledgement
A transaction is a set of interactions defined between two actors to fulfill a specific task such as « placer order management ». It defines how the Actors cooperate to achieve this task.
Each interaction is triggered by a real-world event (e.g. a new clinical testing order is placed for a patient by the medical staff). The interaction usually involves two messages (question and answer, event and acknowledgement). The messages are taken from an existing standard and their usage is fully described, to get rid of options and remove ambiguities.
Status change
Acknowledgement
IHE defines transactions at a user-level workflow
March 17, 2005
IHE and medical Standards in Denmark

21. 3rd key concept: Integration Profile
Solves an Integration Problem:
A collection of real world information exchange capabilities supported by a set of specific Actors using Standards-based Transactions
Integration Profile
Actor …
Transaction
Examples: 
Enterprise User Authentication
Retrieve Information for Display
Laboratory Scheduled Workflow
Echo Laboratory Workflow
Cross-Enterprise Document Sharing
Referenced standard (e.g. HL7)
Detailed messaging info
Roles
The Integration Profile is the global answer to a healthcare communication issue. For instance « Laboratory Scheduled Workflow » how the various systems of the hospital must interact with one another to establish the integrity of laboratory orders and observations throughout the hospital.
March 17, 2005
IHE and medical Standards in Denmark

22. Product XYZ from Vendor T
The Product World…..
Product XYZ from Vendor T
March 17, 2005
IHE and medical Standards in Denmark

23. IHE and medical Standards in Denmark
The IHE World….
Actor
Actor
IHE Transaction
IHE Transaction
IHE Actor
Actor
IHE Actor
IHE Transaction
March 17, 2005
IHE and medical Standards in Denmark

24. Mapping IHE to Products
Product XYZ from Vendor T
Actor
Actor
IHE Transaction
IHE Transaction
IHE Actor
Actor
IHE Actor
IHE Transaction
March 17, 2005
IHE and medical Standards in Denmark

25. IHE and medical Standards in Denmark
IHE Connectathon
Open invitation to vendor community
Advanced testing tools (MESA)
Testing organized and supervised by project management team
Thousands of cross-vendor tests performed
Results recorded and published
March 17, 2005
IHE and medical Standards in Denmark

26. IHE and medical Standards in Denmark
IHE Connectathons
Massive yearly events :
40-50 vendors
engineers
70-80 systems
….integrated in 5 days
Vendors do not pass…
until an IHE Project Manager attest it !
March 17, 2005
IHE and medical Standards in Denmark

27. IHE and medical Standards in Denmark
March 17, 2005
IHE and medical Standards in Denmark

28. Integration Statements
March 17, 2005
IHE and medical Standards in Denmark

29. Leveraging IHE Integration Statements
Vendors
Claim IHE Compliance in an explicit way
Can rely on an objective and thorough specification (IHE Technical Framework)
Willing to accept contractual commitments
Willing to correct “implementation errors”
Buyers
Can compare product integration capabilities
Simplify and strengthen their RFPs
Can leverage a public and objective commitment
Decreased cost and complexity of interface deployment and management
March 17, 2005
IHE and medical Standards in Denmark

30. Participating and Contributing Vendors (Europe)
AGFA Healthcare
Medical Solutions
Algotec
ARES SA
aycan Digitalsysteme
ConVis
DEDALUS
Dianoema
Eastman Kodak Company
Ebit Sanita
EDL
ELFIN s.r.l.
Engineering Sanità Enti Locali
ESAOTE
ETIAM
Ferrania
Fujifilm
GE Healthcare
GMD
GIE Convergence-Profils
GWI Research
IASI Srl
IdeoPass
Image Device-Cerner Company
INFINITT
INOVIT
McKesson
MED2RAD
MEDASYS SA
Medavis
Medigration GmbH
MEDIMON Ltd.
MEDOS AG
Merge eFilm
METAFORA
Konica Minolta Europe
Omnilab
Philips Medical Systems
Rasna Imaging Systems
RAYPAX INC.
Rogan-Delft
Sago spa
Sectra Imtec AB
Siemens Medical Solutions
Soluzioni Informatiche srl
Stentor Inc.
Swissray Medical AG
Symphonie On Line
Synapsis
TELEMIS S.A.
TIANI MEDGRAPH AG
TOREX GAP Medical
Toshiba Medical Systems
TSI groupe europMedica
VEPRO AG
VISUS Technology Transfer
WAID
XR PARTNER
In yellow, companies with IHE Committees Chairs (Summer 2004)
March 17, 2005
IHE and medical Standards in Denmark

31. Participating and Contributing Vendors (America)
Agfa HealthCare
Algotec Systems, Ltd.
Berdy
Camtronics
Canon Medical Systems
Carefx
Cedara Software Corporation
Cerner Corporation
CSIST
Dictaphone
DR Systems
Dynamic Imaging
Eastern Informatics
Eastman Kodak Company
Emageon
Eclipsys
Fujifilm Medical Systems
GE Healthcare
Heartlab
Hitachi Medical Corporation
Hologic, Inc
IDX Systems Corporation
IMCO Technologies
InSiteOne
INFINITT
Konica Minolta
Marotech, Inc.
McKesson Information Solutions
Medcon
Medical Manager Health Systems
Mediface Co., Ltd.
Merge eFilm
Mortara
Procom
Philips Medical Systems
RASNA Imaging Systems
Sectra
Sentillion
Siemens Medical Solutions
Softmedical
Stentor, Inc
StorCOMM, Inc
Swissray International, Inc
Tiani Medgraph AG
Toshiba America Medical Systems
UltraVisual Medical Systems
Vital Images, Inc.
Voxar Limited
WebMD
XIMIS
In yellow, companies with IHE Committees Chairs (Summer 2004)
March 17, 2005
IHE and medical Standards in Denmark

32. Participating and Contributing Vendors (Asia)
Japan
AGFA Gevaert Japan
EBM Japan
INFINITT Japan
A&T
Canon
Goodman
Climb Medical Systems
Konica Minolta MG
Shimadzu
SONY
Toshiba Medical Systems
Toyo Technica
Nihon Kohden
Olympus
NEC
Pioneer (Marotech)
Hitachi
Hitachi Medico
Fujitsu
Fuji Film Medical
Yokogawa
Taiwan
INFINITT
Shing Shian
INQ GEN
TEP
Tah Ya
Korea
AGFA Korea
GE Healthcare Korea
INFINITT
LG CNS
Marotech, Inc.
Medical Standard
Peoplenet Communications
Samsung SDS
March 17, 2005
IHE and medical Standards in Denmark

33. Achievements and expanding scope
Over 100 vendors involved world-wide, 4 Technical Frameworks
27 Integration Profiles, Testing at yearly Connectathons,
Demonstrations at major exhibitions world-wide
Patient care Coordination, Quality, Pharmacy, Anatomical Pathology, Surgery, etc.
To claim compliance to IHE Integration Profiles vendors shall publish for each product an IHE Integration Statement.
March 17, 2005
IHE and medical Standards in Denmark

34. IHE Radiology Integration Profiles
Charge Posting
Portable Data for Imaging
NM Image
New
Extensions
Scheduled Workflow -
Presentation of Grouped Procedures
Reporting Workflow
Patient Info. Recon-ciliation
Post-Processing Workflow
Consistent Present- ation of Images
Evidence Docs
Key Image Notes
Simple Image & Numeric Reports
Access to Radiology Information
Basic Security
March 17, 2005
IHE and medical Standards in Denmark

35. acquisition completed acquisition in-progress acquisition completed
Scheduled Workflow Profile
Report
Repository
Registration
report
Diagnostic
Workstation
Film
Lightbox
Orders Placed
Image Manager
& Archive
Film
Folder
Specifies transactions that function to maintain the integrity of patient, image, and order information across systems
Integrates modalities with information and imaging systems
Biggest Value of IHE
Smooth flow of patient, image and order information across systems
Status updates of orders
Orders Filled
Acquisition Modality
acquisition completed
Film
acquisition in-progress
acquisition completed
images printed
Modality
March 17, 2005
IHE and medical Standards in Denmark

36. “Departmental Actors” in SWF
IHE Actors:
DSS / Order Filler
PPS Manager
Image Manager / Archive
Acquisition Modality
Evidence Creator
Image Display
Acq. Modality
(Primary Radiology Data Source)
Evidence Creator
(Auxiliary Radiology Data Source)
Image Manager/Archive
(Primary Radiology Data Management)
March 17, 2005
IHE and medical Standards in Denmark

37. Example of Radiology Use Cases
Local policy calls for ADT to pre-register ER patients (“John Doe”, “Jane Doe”):
Case 1: Unidentified Patient registered at ADT and order is placed at Order Placer.
Case 2: Unidentified Patient registered at ADT and order is placed at DSS/Order Filler.
Case 3: Unidentified Patient registered at ADT but acquisition completed at Modality prior to order.
March 17, 2005
IHE and medical Standards in Denmark

38. Unidentified Patient - Case 3
ADT
Order
Placer
Image
Manager
Modality
Department System
Database/Scheduler/
Order Filler
Filler Order Mgmt
New Order [3]
Procedure
Scheduled [4]
Patient Reconciliation
J.Doe ->
J.Smith
Patient
Update [12]
Schedule Procedure
Images
Acquired
Step Completed [7]
Modality Procedure
Register
J.Doe
Update [12]
Registration [1]
March 17, 2005
IHE and medical Standards in Denmark

39. Laboratory IHE Integration Profiles
In Dev.
Laboratory Scheduled Workflow (LSWF)
Completed in 2003
Tests performed by a laboratory for an identified inpatient or outpatient
Laboratory Point Of Care Testing (LPOCT) In Process –TI Nov 2004
Tests performed on point of care or patient’s bedside
Laboratory Patient Information Reconciliation (LPIR) In Process
Tests performed on an unidentified or misidentified patient
Laboratory Code Set Distribution (LCSD) In Process
Sharing the batteries and tests code sets throughout the enterprise
Laboratory Device Automation (LDA) In Process –TI Nov 2004
Pre-analytic process, analysis
and post-analytical treatment
Year one (2003) brought the first integration profile « Laboratory Scheduled Workflow ». This profile supports the most common situation: The tests are placed to and performed by a clinical laboratory on specimens collected from a patient correctly identified in the hospital.
Year two (2004) is expected to complete the framework with four more profiles:
« Laboratory Patient Information Reconciliation » profile provides the messaging to resolve all the exceptional situations: Tests performed on an unidentified patient. Urgent tests performed before the order was generated. Merging of a misidentified patient…
« Laboratory Point Of Care Testing » supports specimen testing on the point of care or on the patient’s bedside, by the care unit staff, under the overall supervision of a clinical laboratory.
« Laboratory Device Automation » describes the messaging between the laboratory automation manager and all the automated devices (analyzers, robotic decappers, centrifuges, conveyors, aliquoters, …).
« Laboratory Code Set Distribution » enables the various actors to rely on a common dictionary of tests and batteries.
Some of these new profiles will be achieved in 2004, some others may need one more cycle.
March 17, 2005
IHE and medical Standards in Denmark

40. IHE Cardiology 2004-2005 Retrieve ECG for Display
New
Retrieve ECG for Display
Provide high-quality ECG and related reports
to the enterprise and outside in a ready-to-display format
New
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
New
Scheduled & unscheduled acquisition and management of cathlab information, notification of completed steps.
March 17, 2005
IHE and medical Standards in Denmark

41. IHE IT Infrastructure 2004-2005
Audit Trail & Node Authentication
Centralized privacy audit trail and node to node authentication to create a secured domain.
New
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
Retrieve Information for Display
Access a patient’s clinical information and documents in a format ready to be presented to the requesting user
Patient Synchronized Applications
Synchronize multiple applications on a desktop to the same patient
Patient Identifier Cross-referencing for MPI
Enterprise User Authentication
Provide users a single name and centralized authentication process across all systems
Patient Identifier Cross-referencing for MPI
Map patient identifiers across independent identification domains
Consistent Time
Coordinate time across networked systems
Map patient identifiers across independent identification domains
March 17, 2005
IHE and medical Standards in Denmark

42. IHE Integration Profiles for a “Regional/National Health Info Organization” Includes Integration Profiles in development in 2005
Patient Demographics Query
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
Cross-Enterprise Notification
Notification of a remote provider/ health enterprise
Patient Identifier Cross-referencing
Map patient identifiers across independent identification domains
Lab Results Document Content
Format of the Document Content and associated coded vocabulary
Continuity of Care Document Content
Format of the Document Content
and associated coded vocabulary
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record
Audit Trail & Node Authentication
Centralized privacy audit trail and node to node authentication to create a secured domain.
Personnel White Page
Access to workforce contact information
User Identity, Authentication and Permissions
Enable Basic Access Control
Consistent Time
Coordinate time across networked systems
March 17, 2005
IHE and medical Standards in Denmark

43. IHE and medical Standards in Denmark
Interoperability within the Enterprise,
As well as,
Interoperability Across Care Settings
More on this, in this afternoon presentation….
March 17, 2005
IHE and medical Standards in Denmark

44. Working Together to Deliver Interoperable Health Information Systems
W W W . I H E . N E T
Providers and Vendors
Working Together to Deliver
Interoperable Health Information Systems
In the Enterprise
and Across Care Settings
W W W . I H E – Europe. o r g
March 17, 2005
IHE and medical Standards in Denmark