1. Leveraging IHE for Interoperability in the Enterprise Michael H. Nusbaum MH Nusbaum & Associates michael@mhnusbaum.com John T. Donnelly IntePro Solutions jtdonnelly@intepro.biz IHE IT Infrastructure Planning Committee

2. Healthcare in America is Broken 1.Not Enough Time 2.Not Enough Money 3.Not Enough Courage 4.Not Enough Brain 5.Anecdotal versus Evidence Based Medicine 6.Quality / Safety concerns 7.Inefficient Processes 8.No UNIVERSAL PATIENT Identification 9.No Standards for the Use of Standards

3. Healthcare IT is Broken Dis-Integrated Workflow Dis-Integrated Information Flow Dis-Integrated Systems Dis-Integrated Patient Care

4. What is IHE? A process, with an intensive annual cycle –Define problems –Define technical solutions Common information model Common vocabulary Use existing standards –Test product solutions between vendors –Deploy these solutions in products –Educate the public

5. What is IHE NOT? Not a standard Not a standards development organization Not a certifying authority Not simply a demonstration project –Demos are only one means to the end: Adoption –Backed up by documentation, tools, testing, and publication of information

6. Integrating the Healthcare Enterprise IHE provides a common framework for passing health information seamlessly: –within the healthcare enterprise –across multiple healthcare enterprises –for local, regional & national health information networks. IHE is sponsored by healthcare professional associations (ACC, HIMSS, RSNA, etc.). IHE drives standards adoption to address specific clinical needs.

7. More than 100 healthcare vendors worldwide have contributed to IHE and the delivery of ready-to-integrate products to benefit healthcare enterprises of all sizes. IHE scope, today and in the future –radiology, cardiology, laboratory –enterprise healthcare IT infrastructures –cross-enterprise healthcare IT infrastructures –RHIOs –NHIN IHE Maturity and Acceptance

8. Leadership Level CapMed/SanDiskEclipsys GE Healthcare IDXInterSystemsKryptiqQuovadx/CareScienceSiemensWebMD Participant LevelAllscriptsCedaraCernerDictaphone Eastman Kodak EclipsysEmageonEpicETIAM INFINITT Tech. MedcomSoftMediNotesMedCommonsMidMark Mortara Instrument, Inc National Institute of Standards and Technology Standards and TechnologyNextGenNovell Open Text Sentillion Supporter Level AccessPtAGFAdbMotionDinmar – Oacis EMCHealthvisionHealthrampMcKesson Valco Data Systems Vendors demonstrating at the Interoperability Showcases

9. IHE Integration Profile: A well-defined and tested solution to a specific information exchange problem Driving healthcare through standards-based integration

10. Achievements and expanding scope 14 Active national chapters on 3 continents, 4 Technical Frameworks 27 Integration Profiles, Testing at yearly Connectathons, Demonstrations at major exhibitions world-wide Vendors claim compliance to IHE Integration Profiles by publishing an IHE Integration Statement for each product.

11. IHE Organizational Structure Multi-Domain & Multi-National Participants contribute Global Development: Radiology, IT Infrastructure, Cardiology, Lab, etc. Delegates IHE Europe IHE North America IHE Asia/Oceania Regional & National Deployment supervises reports IHE (International) Strategic Development Committee Sponsors Co-Chairs Global Interoperability IHE Domain-related Planning Committee and Technical Committee National Extensions

12. Goals of IHE Speed up the rate and quality of integration in healthcare environments Foster communication among vendors and care providers Prove that integration is attainable based on standards Improve the efficiency and effectiveness of clinical practice Improve interoperability among care domains and build a foundation for the EHR Provide integration solutions used within and across healthcare enterprises

13. IHE Deliverables Venue(s) for communication Integration Profiles Technical Framework Connect-a-thon Public Demonstrations

14. Vendor expertise Integration Profile Proposed solution Using existing standards IHE Technical Framework details solution Vendor implements solution into REAL product Vendor tests solution at Connect-a-thon Professional Societies Demonstrate/Educate That solution exists Healthcare Site Includes IHE in RFP The IHE Process Provider expertise

15. 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 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 IHE Connect-a-thon Results IHE Facilitates Standards Adoption

16. Connect-a-thon 300 people 100 different products 50 vendors 5 days

17. Connect-a-thon Results (on ihe.net) Vendors Integration Profiles Actors

18. Integration Statements

19. IHE Model Actors in precisely defined roles –Abstract the notion of information system Executing precisely defined transactions –Using existing standards Solve real world process problem

20. Integration Profiles for 2005 Workflow Security Identity Management EHR NEW for 2005

21. Cross-Enterprise Document Sharing (XDS) Transaction Overview Document Source Document Consumer Document Registry Document Repository Provide & Register Document Set[ITI-15] Register Document Set [ITI-14] Retrieve Document [ITI-17] Query Documents [ITI-16] Patient Ident. Source Patient Identity Feed [ITI – 18] An Affinity Domain is made up of a well defined set of Document Repositories, Document Sources and Consumers that have agreed to share clinical documents registered into a single Document Registry.

22. IHE Technical Specifications

23. Continuity & Integrity of Patient Information Improved Patient Safety Through Ubiquitous Access to Data Clinical Workflow Optimization Efficient Integration of Clinical Events to Administrative/ Billing Requirements Enterprise Healthcare Needs Addressed by IHE Improving the Patient Care Process

24. Benefits of IHE Clinicians –Timely access to complete and consistent patient information –Improved workflow Less paper, less sneakernet Fewer redundant steps –Fewer manual processes, fewer opportunities for error

25. Benefits of IHE Purchasers of Systems –True interoperability –Cheaper, less complicated deployments –Easier management of interfaces –Improved workflow

26. Benefits of IHE Vendors –Synergistic development across products –Cheaper, less complicated deployments Fewer site specific customizations –Support of common workflow and information models –Better use of standards –Focus competition on features and functionality, rather than on interoperability

27. IHE Works! 22 user success stories deploying IHE (www.ihe.net) Complex problematic processes involving heterogeneous information systems Step-wise pragmatic process that yields real-world product solutions Uses existing standards First, within the Enterprise –patient centric, bottom-up approach Now, address longitudinal dimension of the EHR with an inter-enterprise, patient centric, top-down approach

28. HIMSS RHIO with IHE-XDS Cross-enterprise doc sharing Attendee Registration Experience your HIMSS-Wide Electronic Health Record Ambulatory Showcase Booth Home PCP Multispecialty Clinic Diag Center Cross-enterprise Showcase Booth Cardiology Workup Comprehensive Patient Care Radiology Coordinated Patient Evaluation IT Infrastructure Vendor Booth HL7 Demonstration Allscripts CapMed Cerner Eclipsys GE Healthcare IDX Infinitt InterSystems Kryptiq MedCommons MediNotes NextGen OpenText Siemens WebMD

29. Technical demonstration –Featuring the IHE framework enabling standards-based health information exchange within and across multiple healthcare enterprises, available in products today Clinical scenarios –Focusing on clinician access and document sharing within the acute care environment and across multiple settings –Includes the Continuity of Care Record (CCR), radiology images, cardiology reports, laboratory results, etc. Cross-Enterprise Showcase

30. Ambulatory Care Showcase Demonstration of interoperability across a variety of settings, including a multi-specialty clinic and diagnostic center, a small primary care practice and the patients home Use cases will guide the attendee through the settings in the normal course of care Vendors display IHE and other interoperability solutions for effective continuity of care Theater area for related presentations

31. **HIMSS web-based survey in November 2004 – 163 participants IHE Survey Results –92% of respondents were aware of IHE –Potential benefits of IHE Improved clinical workflow + access of data = 63% –Benefits of IHE products Reduce deployment costs = 56%

32. What can you do? Learn about IHE Participate on IHE Committees Insist on IHE compliance in your RFPs and contract documents

33. As a Provider or Vendor Contributor Offer Clinical Use Case Input to Drive IHE Profile Development Become a member of relevant domains Planning or Technical Committees or HIMSS IHE SIG (Special Interest Group) Become a member of relevant Regional/National Committees Help to shape IHEs future direction As a Vendor Participant Respond to Public Comments of Domain Supplements Attend the September Educational/Workshops Participate in Connect-a-thons and Demonstrations As a Provider/Consultant Participant Respond to Public Comments of Domain Supplements Attend the September Educational/Workshops Attend Demonstrations and include IHE Integration Profiles in your RFPs and Integration Projects. How can I participate?

34. the effective bridge between information exchange standards and their practical use in healthcare

35. Providers and Vendors Working Together to Deliver Interoperable Health Information Systems in the Enterprise and across Care Settings

36. Lets hear from the users!!

37. Thank You! Questions ? Integrating the Healthcare Enterprise Integrating the Healthcare Enterprise www.ihe.net