Health Information Exchange Health Information Exchange One size does not fit all.One size does not fit all.

Dr Peter MacIsaac, Dr Peter MacIsaac,

Secretary IHE Australia, Secretary IHE Australia,

eHealth Consultant – Hewlett Packard Enterprise ServiceseHealth Consultant – Hewlett Packard Enterprise Services

18/07/2011 2Blair Butterfield – eHealth InitiativeBlair Butterfield – eHealth Initiative

Australian PC-EHR conceptAustralian PC-EHR concept

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Australian PC-EHR conceptAustralian PC-EHR concept

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Health Information Exchange -HIEHealth Information Exchange -HIE

Health information exchange (HIE) is the Health information exchange (HIE) is the transmission of healthcare-related data transmission of healthcare-related data among facilities, health information among facilities, health information organizations (HIO) and government organizations (HIO) and government agencies according to national standards.agencies according to national standards.

(US Office National Coordinator)(US Office National Coordinator)

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Health Information ExchangeHealth Information Exchange

Health information exchange (HIE) is the Health information exchange (HIE) is the transmission of healthcare-related data transmission of healthcare-related data among facilities, health information among facilities, health information organizations (HIO) and government organizations (HIO) and government agencies according to national standards.agencies according to national standards.

(US Office National Coordinator)(US Office National Coordinator)

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This is a very broad and inclusive definitionThis is a very broad and inclusive definition

Types of HIETypes of HIE

MessagingMessaging

Data SynchronisationData Synchronisation

Data aggregationData aggregation

PortalsPortals

Common health recordCommon health record

Shared healthcare recordShared healthcare record CentralisedCentralised FederatedFederated

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There was the There was the PAS then came: PAS then came:

RadiologyRadiologyLabLabEDEDOperating theatre…Operating theatre…

GP systems…GP systems…....

One Size does not fit allOne Size does not fit all

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Types of HIETypes of HIEMessaging Messaging Point to pointPoint to point Essentially two modelsEssentially two models

• Application to application (point to point)Application to application (point to point)• Using a messaging intermediary or serviceUsing a messaging intermediary or service

Messaging transportMessaging transport HL7, DICOM, Webservices, File Transfer etc.HL7, DICOM, Webservices, File Transfer etc.

Messaging payloadsMessaging payloads Data synchronisation eg. Patient identity/ADTData synchronisation eg. Patient identity/ADT Information delivery e.g. reports, discharge summaryInformation delivery e.g. reports, discharge summary Electronic test orderingElectronic test ordering Electronic transfer of prescriptionsElectronic transfer of prescriptions

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Types of HIETypes of HIE

Application synchronisation or linkage across Application synchronisation or linkage across multiple sitesmultiple sites Shared applications across sitesShared applications across sites Same software e.g. GP software running in different Same software e.g. GP software running in different

locations or mobile and home-baselocations or mobile and home-base Same software running in different organisationsSame software running in different organisations Issues of data compatibility due to local build or Issues of data compatibility due to local build or

customisationcustomisation

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Types of HIETypes of HIEAccess to common data – data aggregationAccess to common data – data aggregation Central operational data store for health transactions Central operational data store for health transactions

from multiple applicationsfrom multiple applications• Use for point of care – record aggregation or single patient view Use for point of care – record aggregation or single patient view • Management dashboardsManagement dashboards

Central data warehouse used for Central data warehouse used for reporting/analytics/researchreporting/analytics/research

Many organisations haveMany organisations have multiple duplicated data multiple duplicated data storesstores

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Types of HIETypes of HIE

PortalsPortals External access point to another systemExternal access point to another system Does not required pre-existing clinical information Does not required pre-existing clinical information

systems – may use web browsersystems – may use web browser Patient, staff or external healthcare providersPatient, staff or external healthcare providers May access single organisations EMRMay access single organisations EMR May access a composite record drawn from many May access a composite record drawn from many

applications (single or multiple organisations)applications (single or multiple organisations) May access third party systemsMay access third party systems

e.g. health insurance, Medicare. e.g. health insurance, Medicare.

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Types of HIETypes of HIE

Share healthcare records Share healthcare records Support information sharing as patients move Support information sharing as patients move

through healthcare systemthrough healthcare system Support consumer engagement with their Support consumer engagement with their

healthcarehealthcare

ModelsModels CentralisationCentralisation Federation – index and retrieveFederation – index and retrieve

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Types of HIETypes of HIE

Common electronic health recordsCommon electronic health records Usually Internet deliveredUsually Internet delivered Used by all participantsUsed by all participants Specialist care record, care planning or Specialist care record, care planning or

coordinated carecoordinated care Access to consolidated view of patient/clientAccess to consolidated view of patient/client Usually secondary to main records systemUsually secondary to main records system

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Type of HIEType of HIE

Centralised Shared Healthcare RecordCentralised Shared Healthcare Record Record or summary data sent from source to a Record or summary data sent from source to a

centralised common EHRcentralised common EHR e.g. UK NHS Spinee.g. UK NHS Spine e.g. Canada HealthInfowaye.g. Canada HealthInfoway Australia’s HealthAustralia’s HealthConnectConnect Mark 1 – 2003 Mark 1 – 2003

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One size does not fit allOne size does not fit allIndex and retrieveIndex and retrieve Within or between organisationsWithin or between organisations Information is placed in a secure accessible repository or Information is placed in a secure accessible repository or

specific secure access systems used to access primary dataspecific secure access systems used to access primary data• May be a copy (static data)May be a copy (static data)• May be a link to extract May be a link to extract

information or reportinformation or report (dynamic data) (dynamic data)

Basic description of contentBasic description of content (metadata) stored in a (metadata) stored in a common index – common index – no or limited patient datano or limited patient data

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Important characteristics of HIEImportant characteristics of HIECross organisation communicationCross organisation communication

Patient consent and privacyPatient consent and privacy

Multivendor systemsMultivendor systems

Focus on single patient view over time: Focus on single patient view over time: aggregation and longitudinal E.H.R aggregation and longitudinal E.H.R

Use of a common architectureUse of a common architecture Standards approachStandards approach Scalable – local to nationalScalable – local to national Extensible in function Extensible in function

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Growth in al models of HIE - USAGrowth in al models of HIE - USA

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KLAS Enterprises 2011KLAS Enterprises 2011

IHE based HIEsIHE based HIEs

18/07/2011 20Where in the world is XDS?

Customer SuccessesCustomer Successes

A private, not for profit, 626 A private, not for profit, 626 licensed bed, academic licensed bed, academic medical center medical center emphasizing community emphasizing community based care.based care.Boston HealthNet 1995, Boston HealthNet 1995, includes BMC, Boston Univ includes BMC, Boston Univ School of Medicine, 15 School of Medicine, 15 Community health centersCommunity health centersCommunity Information Community Information Exchange (CIE) focus on Exchange (CIE) focus on sharing medications, problems, sharing medications, problems, allergies, and lab resultsallergies, and lab resultsAccess directly from Access directly from physician’s EMRphysician’s EMReReferral portal utilizes the eReferral portal utilizes the CIE base infrastructureCIE base infrastructure

Supports the IHE frameworkSupports the IHE framework

HIE Snapshot GE/IHE – U.S.HIE Snapshot GE/IHE – U.S.

Addressing critical needs Addressing critical needs across Vermontacross Vermont

Medication history to Medication history to clinicians in the ERclinicians in the ER

Chronic disease Chronic disease management - patient data management - patient data from EMRs to data centerfrom EMRs to data center

Lab results electronically Lab results electronically delivered to physician EMRsdelivered to physician EMRs

Supports the IHE frameworkSupports the IHE framework

Connecting physicians and Connecting physicians and healthcare professionals in healthcare professionals in a 31-county region a 31-county region

13 member organizations13 member organizations

Data from 8 hospitals and 31 Data from 8 hospitals and 31 clinicsclinics

Used in 3 emergency Used in 3 emergency departments and 3 primary departments and 3 primary care clinicscare clinics

2.6 million patient records2.6 million patient records

345,000 patient 345,000 patient authorizationsauthorizations

Supports the IHE frameworkSupports the IHE framework

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USA USA (Philapdelphia Region)(Philapdelphia Region)

Philadelphia Health Info Exchange in service since 2005. Philadelphia Health Info Exchange in service since 2005. Focused on images and reports sharing.Focused on images and reports sharing.

5 Hospitals + Imaging Center + Public Health5 Hospitals + Imaging Center + Public Health The Hospital of the University of Pennsylvania The Hospital of the University of Pennsylvania Thomas Jefferson University Hospital Thomas Jefferson University Hospital Children’s Hospital of Philadelphia Children’s Hospital of Philadelphia Presbyterian Medical Center Presbyterian Medical Center Pennsylvania Hospital Pennsylvania Hospital UPHS Community Radiology UPHS Community Radiology Philadelphia Department of Public HealthPhiladelphia Department of Public Health

Migration to XDS, ATNA, PIX and XDS-I completed in Migration to XDS, ATNA, PIX and XDS-I completed in 2007.2007.

Demonstrated live at RSNA-Chicago Nov 2007Demonstrated live at RSNA-Chicago Nov 2007

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DiagnosticDiagnostic I Imaging Exchangemaging Exchange

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Italy Italy (Genoa Region)(Genoa Region)

Azienda Sanitaria Locale n. 4 Chiavarese

Conto Corrente Salute

Azienda Sanitaria Locale n. 4 Chiavarese

Conto Corrente Salute

Cooperazione e condivisioneCooperazione e condivisione

Asl 4 Chiavarese; Dipartimento di Medicina

Diagnostica e Terapie Speciali dell’Università di Padova

IHE – Commissione nazionale Italia

alcune aziende ICT esperte in soluzioni “e-health” (Rasna Medical Systems, Soluzioni Informatiche);

A.S.L. 4CHIAVARESEA.S.L. 4CHIAVARESE

per la realizzazione di un prodotto open-source su J2EE che implementa il profilo IHE XDS.

E’ stato attivato un Work Group composto da:

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Italy Italy (Genoa Region)(Genoa Region)

In service since January 2006. In service since January 2006.

4 Hospitals and 500 physician offices.4 Hospitals and 500 physician offices.

EMRs import and export documents from their local EMRs import and export documents from their local records.records.

All vendor products required to pass IHE-Europe All vendor products required to pass IHE-Europe connectathon in April 2005.connectathon in April 2005.

Patients chose to join through one of their care providerPatients chose to join through one of their care provider

Infrastructure includes:Infrastructure includes: XDS RegistryXDS Registry XDS Repository shared at the regional levelXDS Repository shared at the regional level PIX for patient Id linkingPIX for patient Id linking Doc content is CDA with PDF content. Plan in place to move to CDA rel 2 with 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.structured data. IHE (XD*-Lab) CDA Lab primary candidate.

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Austria Austria (Lower Austria and (Lower Austria and National)National)

Lower Austria Region (around Vienna) Deployed Lower Austria Region (around Vienna) Deployed in 2007 - Operational. 1.5 Million patients on-line. in 2007 - Operational. 1.5 Million patients on-line. 11 hospitals connected. 11 hospitals connected.

Use IHE profiles: Use IHE profiles: XDS, PIX, XDS-SD, ATNA, XUA, BPPC.XDS, PIX, XDS-SD, ATNA, XUA, BPPC.

National project launched in 2007 (ELGA). Given National project launched in 2007 (ELGA). Given the success to deploy the first region is about the success to deploy the first region is about one year.one year.

Roll-out includes:Roll-out includes: Ministry backing of IHE conformance (IHE-Eu Connectathon)Ministry backing of IHE conformance (IHE-Eu Connectathon) Extending to Ambulatory Physicians in 2008Extending to Ambulatory Physicians in 2008 Step-wise introduction of structured and coded content with HL7 CDA Step-wise introduction of structured and coded content with HL7 CDA

based IHE Content Profiles.based IHE Content Profiles.

LowerAustria

Austria

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Support for PC-EHR CommunitySupport for PC-EHR Community

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http://ihe-australia.wikispaces.com/PCEHRhttp://ihe-australia.wikispaces.com/PCEHR

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Reference and ResourcesReference and Resources

US State Health Information Exchange Cooperative Agreement Program

Where in the world is XDS?Where in the world is XDS?

http://www.youtube.com/watch?http://www.youtube.com/watch?v=JwngzRPaw-w v=JwngzRPaw-w

http://www.nationalehealth.org/NHIN-U/http://www.nationalehealth.org/NHIN-U/

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Useful LinksUseful Links

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www.ihe.netwww.ihe.net

www.ihe.net.auwww.ihe.net.au

http://ihe-australia.wikispaces.comhttp://ihe-australia.wikispaces.com

http://wiki.ihe.nethttp://wiki.ihe.net

http://motorcycleguy.blogspot.com/2010/01/http://motorcycleguy.blogspot.com/2010/01/where-in-world-is-xds.htmlwhere-in-world-is-xds.html

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