1. September, 2005What IHE Delivers 1 Presented by Charles Parisot, IHE Europe IT Infrastructure Planning Committee co-Chair eHealth interoperability ad hoc group January 17, 2007 Integrating the Healthcare Enterprise (IHE) Approach and Patient Summary

2. 2 Agenda IHE, a proven multi-stakeholder process IHE, what can be leveraged IHE Medical Summaries, a solid base, potential for European national extensions

3. 3 What is Integrating the Healthcare Enterprise? It implements a methodology which enables users and suppliers to work together to obtain clinical interoperability IHE tailors existing standards to fit the IT requirements for specific clinical tasks The IHE Technical Framework document specifies clinical tasks and how to use profiles of existing standards to support them Annual test sessions enable suppliers to test their application software for conformance with the IHE Technical Framework Purchasers can buy systems that are known to interoperate

4. 4 What is IHE?

5. 5 Participants contribute Global Development: IT Infrastructure, Radiology, Cardiology, Lab, etc. Delegates IHE Europe IHE NorthAmerica IHE Asia/Oceania Regional & National Deployment supervises reports IHE (International) Strategic Development Committee Sponsors Co-Chairs Global Interoperability IHE Domain-related Planning and Technical Committees Who is IHE?

6. 6 IHE-EUR countries and participants Denmark France Germany Israel Italy Users, HC Authorities 40% local vendors 60% international vendors Netherlands Norway Spain Sweden United Kingdom Example: IHE-Netherlands UsersVendors Government / Associations Amphia Antonius Mesos Amsterdam MC AZ Maastricht Ned. Ver. Radiologie Ned. Ver. Kl. Chemie Ned. Ver. Microbiologie MC Leeuwarden UMC Nijmegen UMC Groningen VUmcAgfaForcareChipsoft D&A Medical GE Healthcare GetronicsH2WIBM ICT Healthcare Initiate Systems iSOFTLeones Medical Phit Nucletron Oldelft Benelux PhilipsRVCSectraSiemens Verdonk, Klooster & Associates Welch Allyn Cardio Control APC Platform NICTIZ HL7 Nederland OIZTNO

7. 7 Evolution of IHE Domains Radiology (18) IT Infrastructure for Healthcare (17) Cardiology (7) Laboratory (6) Radiation Oncology (1) Patient Care Coordination (5) Patient Care Devices (1) Pathology (1) Pharmacy IHE Global Developments Integration Profiles – Solutions to Real-World Interoperability Needs & Problems: Within Clinical Departments e.g.: Radiology Cardiology Lab... Across Departmental & Institutional Boundaries – XDS Regional/national Healthcare Information Exchange HIT Enablers Veterinarian Endoscopy (1) Eye Care / (3) Ophthalmology Year 1 (1999)Year 2 (2000)Year 3 (2001)Year 4 (2002)Year 5 (2003)Year 6 (2004) Year 7 (2005) Year 8 (2006)

8. 8 IHE, Annual Cycle Proven Standards Adoption Process Installation on site Demonstration (National shows) Vendors implement the profile in their products Multi-vendors test at the annual Connect-a-thon Engineers from vendors collaborate to define technical specification Clinicians identify clinical problems to be addressed Choice of relevant standards (HL7, CEN, DICOM, W3C, Oasis…)

9. 9 IHE Technical Framework Detailed standards implementation guides Cardiology Cardiology IT Infrastructure IT Infrastructure Laboratory Laboratory Radiology Radiology ….. …..

10. 10 IHE Connectathon Open invitation to the Software Developer Community Open invitation to the Software Developer Community Advance testing tools (MESA) applied Advance testing tools (MESA) applied Compliance Testing organized and supervised by the sponsors of IHE Compliance Testing organized and supervised by the sponsors of IHE Thousands of cross-system tests performed Thousands of cross-system tests performed IHE-EUR Connectathon

11. 11 IHE Connectathon, Barcelona April 2006 300+ participants, 120+ systems300+ participants, 120+ systems 60+ systems developers60+ systems developers 2006 Focus: Cardiology, IT Infrastructure, Patient Care Coordination, Laboratory, Radiology2006 Focus: Cardiology, IT Infrastructure, Patient Care Coordination, Laboratory, Radiology 2800+ monitored test cases2800+ monitored test cases

12. 12 Regional and National EHR Projects Many EHR projects world-wide, Some country-wide, some regional, Different stages of implementation,…

13. 13 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

14. 14 Agenda IHE, a proven multi-stakeholder process IHE, what can be leveraged IHE Medical Summaries, a solid base, potential for European national extensions

15. 15 IHE Integration Profiles for Health Info Nets What is available and has been added in 2005 and is for 2006 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 Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Patient Identifier Cross-referencing Map patient identifiers across independent identification domains Emergency Referrals Format of the Document Content and associated coded vocabulary PHR Extracts 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 Cross-enterprise User Authentication Authentication & Auditing: Enhanced Access Control Cross-enterprise Document Interchange Media-CD/USB & e-mail push Notification of Document Availability Notification of a remote provider/ health enterprise 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 Document Digital Signature Attesting true-copy and origin Request Form for Data Capture External form with custom import/export scripting V3 Option Stored Queries Info Exchange Security Id Mgt Content

16. 16 Cross Enterprise Document Sharing Prototyped in 2003, matured in 2004-2005 HL7 and IHE Joint Demonstration at HIMSS 2004 HL7 and IHE Joint Demonstration at HIMSS 2004 ISO 15000 (ebRS) and tracks Web Services & SOA. Further step with WS-I in 2007. ISO 15000 (ebRS) and tracks Web Services & SOA. Further step with WS-I in 2007. Implemented by 20+ Vendors Available Commercially in US, Europe and now in Asia Open Source Communities O3 (Univ Trieste & Padova) O3 (Univ Trieste & Padova) RIDE EU Project RIDE EU Project IHEOS IHEOS Eclipse Open Healthcare Framework Eclipse Open Healthcare Framework Named in Specifications by more than 5 countries Appears in more than 10 regional and national projects underway.

17. 17 Profile example in a region: XDS (Document Sharing) Acute Care (Inpatient) PCPs and Clinics (Ambulatory) Long Term Care Other Specialized Care or Diagnostics Services Documents Registry Document Repository Longitudinal Record as used across-encounters Submission of Document References Retrieve of selected Documents Query for Document References

18. 18 Federation of XDS and non-XDS Domains Leverage Cross-Community Sharing Architecture National Network A XDS Affinity Domain (NHIN sub-network) Non-IHE National EHR Cross-DomainBridge Which registry holds records for a patient ? Cross- Domain Bridge Bridge Registry Locator service IHE Transactions National or Regional Networks not required to be IHE-based National or Regional Networks not required to be IHE-based Mapping to & from IHE Transactions performed by X-Domain bridges Mapping to & from IHE Transactions performed by X-Domain bridges Mapping practical as most European projects use variants of structured document sharing Mapping practical as most European projects use variants of structured document sharing National or Regional Network B Acute Care (Inpatient) PCPs and Clinics (Ambulatory) Long Term Care Other Specialized Care or Diagnostics Services Documents Registry Document Repository Longitudinal Record as used across-encounters National Network C IHE based Sub-Networks XDS Affinity Domain (NHIN sub-network) IntegratedDeliveryNetwork Registry Locator service Non-IHE Sub-Net Acute Care (Inpatient) PCPs and Clinics (Ambulatory) Long Term Care Other Specialized Care or Diagnostics Services Documents Registry Document Repository Longitudinal Record as used across-encounters Acute Care (Inpatient) PCPs and Clinics (Ambulatory) Long Term Care Other Specialized Care or Diagnostics Services Documents Registry Document Repository Longitudinal Record as used across-encounters

19. 19 Agenda IHE, a proven multi-stakeholder process IHE, what can be leveraged IHE Medical Summaries, a solid base, potential for European national extensions

20. 20 Medical Summaries EU Stakeholder group study (Rossi Mori) has confirmed There is a significant variety of medical summaries (in use or in plan) across the European countries. Some of the differences are: There is a significant variety of medical summaries (in use or in plan) across the European countries. Some of the differences are: scope/use case driven scope/use case driven due to national specificities due to national specificities from the technical standard used from the technical standard used IHE Patient Care Coordination: Is well engaged with the scope/use case driven differences Is well engaged with the scope/use case driven differences Plan to address national specificities based on the stakeholder WG analysis, and the interest of the countries Plan to address national specificities based on the stakeholder WG analysis, and the interest of the countries 2007 is the year IHE-Europe has set to finalize a family of patient summaries for several European countries with a common core. 2007 is the year IHE-Europe has set to finalize a family of patient summaries for several European countries with a common core.

21. 21 Care Coordination Content Profiles XDS-MS Medical Documents Referral Consent Emergency Department Referral Preprocedure History and Physical History and Physical PHR Update 2005-2006 2006-2007 2007-2008 Lab Report PHR Extract Emergency Department Note Antenatal Care Summary Care Assessments Discharge Summary Medical Summaries Includes data needed to support emergency data set and prescription/medication history

22. 22 Rossi-Mori EU survey mapping to XDS-MS No of Countries Sectionall not asked all - BE details about patient identifier, name (date of birth, gender) address 12 11 11 9 5history medication history immunisations family history 13 allergies, alerts, risks, special needs 12 ongoing medications 10 test results (lab and images) 10 details about family doctor 9 active problems 6 details about insurance 6 emergency contact (next of kin) 4 care plans not asked (exemptions)

23. 23 IHE flexibility in leveraging standards for Document Format Content Format leverages Specific Standards HL7 CDA Release 2.0 HL7 CDA Release 2.0 HL7/ASTM Continuity of Care Document HL7/ASTM Continuity of Care Document CEN 13606 CEN 13606 LOINC, SNOMED (if applicable) LOINC, SNOMED (if applicable) Others as Needed (e.g. PDF) Others as Needed (e.g. PDF) IHE is defining a library of Reusable Parts Document Types Document Types Sections (only title is coded) Sections (only title is coded) Entries (clinical info semantically coded) Entries (clinical info semantically coded)

24. 24 In Conclusion IHE is a user & vendor driven initiative. IHE is dedicated to interoperability of IT systems in healthcare with proven methodology. IHE Integration and Content Profiles are already used in Europe and world-wide. IHE is experienced with patient summaries. IHE ready to engage in fostering a consistent family of patient summary documents and a sharing infrastructure between countries and regions in Europe. IHE ready to engage in fostering a consistent family of patient summary documents and a sharing infrastructure between countries and regions in Europe.

25. 25 WWW.IHE-EUROPE.ORG