integrating the healthcare enterprise ihe technical committee status ihe iti plan committee -...
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Integrating the Healthcare EnterpriseIHE Technical Committee Status
IHE ITI Plan Committee - February 2004
IHE IT Infrastructure-2004IHE IT Infrastructure-20045 Integration Profiles5 Integration Profiles
Enterprise User Authentication
Provide users a single nameand
centralized authentication process
across all systems
Enterprise User Authentication
Provide users a single nameand
centralized authentication process
across all systems
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Patient Identifier Cross-referencing
for MPI
Map patient identifiers across independent
identification domains
Patient Identifier Cross-referencing
for MPI
Map patient identifiers across independent
identification domains
Synchronize multiple applications on a desktop to the same patient
Patient Synchronized Applications
Synchronize multiple applications on a desktop to the same patient
Patient Synchronized Applications
Consistent Time
Coordinate time across networked
systems
Consistent Time
Coordinate time across networked
systems
IHE IT Infrastructure – Plan for 2004-2005
• IT Infrastructure Development Plan:• IHE ITI Planning Committee decision:IHE ITI Planning Committee decision: mid-Februarymid-February• Issue Public Comment version: June 2004• Public Comment Due: July 2004• Issue Trial Implementation version: Issue Trial Implementation version: August 2004August 2004• IHE Connectathon: January 2005• HIMSS Demo: HIMSS Demo: February 2005February 2005
• Profiles discussed this week are:• Audit Trail and Node AuthenticationAudit Trail and Node Authentication• Personnel White Page Directory Personnel White Page Directory • Patient Demographics QueryPatient Demographics Query• EHR-Cross-Enterprise Clinical Document SharingEHR-Cross-Enterprise Clinical Document Sharing
IHE Authentication Audit TrailIHE Authentication Audit TrailScope
– Ensures that only permitted system/devices connect to network
Authentication is node-to-node Note: User authentication covered by the EUA profile or local
procedures.
– Support for a central repository of audit information. Facilitates audit review and includes:
General security events such as logins, file access, and detection of unauthorized activity
Healthcare privacy events such as access to patient data and applications.
Imaging privacy/security events such as access to patient images.
IHE Authentication and AuditIHE Authentication and Audit
Key technical properties– Node-to-node authentication uses X.509
certificates, but PKI is not specified by IHE yet.– Audit messages use a standardized XML format
(IETF RFC Pending)– Transport for audit messages may use syslog or
reliable syslog– Backwards compatibility with IHE Radiology (year
2002) is preserved.
Personnel White Pages DirectoryPersonnel White Pages DirectoryScopeScope
WhitePagesServer
Healthcare Staff Info
Provide access to healthcare staff informationProvide access to healthcare staff information to systems in a standard manner. to systems in a standard manner.
Lab Reporting
ElectronicElectronicMedicalMedicalRecordsRecords
Pharma
Healthcare Staff Info
Healthcare Staff Info
Personnel White Pages DirectoryPersonnel White Pages DirectoryTechnical PropertiesTechnical Properties
LDAP based directory location service
LDAP based requests of person info leveraging inetOrgPerson.
Specializes for Healthcare: Contact Info (Phone Numbers, email address, etc), and user interface friendly info (Salutation, First name, Last name, office building, user certificate list-no PKI).
Access certificate revocation list (no use rule defined).
Patient Demographics QueryPatient Demographics QueryAbstract/ScopeAbstract/Scope
Allow quick retrieval of common patient name, identifier, and location in a standard manner at the point of care.
Enable selection of correct patient when full identification data may not be available
Protect patient- and enterprise-sensitive clinical information
Patient Demographics QueryPatient Demographics QueryKey Technical PropertiesKey Technical Properties
Employs HL7 Conformance Based Queries– Defined in HL7 Version 2.5, Chapter 5– Query by Parameter (QBP) with Segment Pattern
Response (RSP)
User enters identifiers for patients of interest Server returns information in HL7 V2.5 patient
data segments.
Introduction:EHR Cross-EnterpriseEHR Cross-EnterpriseClinical Document SharingClinical Document Sharing
First step towards the First step towards the longitudinal dimension of the EHRlongitudinal dimension of the EHR::
Focus:Focus: Clinical Information Exchange between EHRs in Clinical Information Exchange between EHRs in care settings to communicate with a distributed care settings to communicate with a distributed longitudinal EHR.longitudinal EHR.
Goal:Goal: Meet a broad range of EHR-LR (Longitudinal Record) Meet a broad range of EHR-LR (Longitudinal Record) needs with a needs with a distributed, distributed, cross-enterprise, cross-enterprise, document centric document centric
document content generic document content generic
Acute Care (Inpatient)
GPs and Clinics (Outpatient)
Nursing Homes
Other Specialized Care(incl. Diagnostics Services)
Continuity of Care: Patient Longitudinal RecordPatient Longitudinal Record
Typically, a patient goes through a sequence of encounters in different Care Setting
Acute Care (Inpatient)
GPs and Clinics (Outpatient)
Nursing Homes
Other Specialized Careor Diagnostics Services
EHR-LR Integration Profiles: Publishing & Accessing the EHR-LRPublishing & Accessing the EHR-LR
EHR-LR
The EHR-LR (Longitudinal Record) brings together patient encounter information managed by multiple care delivery systems
Care Delivery Process
Selection of informations
Decide toAssess demand For care
Actions to order
Define an action plan
Identification End ofEncounter
Define healthcareObjective
EHR-Solution = EHR-LR (Longitudinal Record) + EHR-CR (Care Delivery Record)
Two types of Integration : EHR-CR: Health Record as used during care deliveryEHR-LR: Health Record as used across-encounters
EHR-CR
Read
EHR-LR EHR-LR
Read
EHR-LR
CreateUpdate
Key Statements:EHR-LR FundamentalsEHR-LR Fundamentals
• Brings together patient encounter information managed by all types of care delivery systems.
• Cross-enterprise, possibly across large geographical regions, and may include many clinical domains.
• Typically collected and retained over a large period of time, providing a deep historic record for the patient.
• Supported by multiple repositories that contribute to the patient’s longitudinal healthcare record.
• Encounter data will very likely include some clinical documents, state and workflow information that will not be stored in the EHR-LR.
Key Statements: What is in the EHR-LR?What is in the EHR-LR?
• The EHR-LR data is made of discrete, persistent, clinical documents accessed by an unique identifier.
• It may also contain other dynamic objects which are not being addressed by IHE at this time.
• Metadata will be provided with each document by the EHR-CR and will be stored in the EHR-LR.
• EHR-LR data formats will follow relevant clinical domain standards defined by field experts. EHR-CR is responsible for converting its internal data formats to the standard EHR-LR documents.
• EHR-LR documents will kept in the EHR-CR or pushed to a separate EHR-LR repository.
Key Statements: IHE EHR Profiles ConstraintsIHE EHR Profiles Constraints
• Although the EHR-LR data domains are primarily clinical, other information and services are needed to provide a complete view of the patient longitudinal record. These include patient demographics, access security, consent policies and others – some have already been addressed by IHE integration profiles.
• The EHR-LR and EHR-CR repositories may be using different Patient Identification numbers. The longitudinal view is made possible by using standard cross-patient identification services (IHE PIX Integration Profile).
• The way data is stored and managed internally by the EHR-CR is out of scope for the EHR-LR IHE Integration Profiles.
Key Statements: Accessing the EHR-LRAccessing the EHR-LR
• EHR-LR shall make available a list of all published documents for a given patient/selection parameters.
• The selection of documents is the responsibility of the EHR-LR and not of the consumer applications. This is possible because of the document metadata kept in the EHR-LR.
• The EHR-LR must ensure full content fidelity for all clinical documents that have been published.
• The actual location of any particular document shall be transparent to the consumer application.
• EHR-CR may provide clinical data by processing, extracting, or combining multiple documents.
Key Statements: Deploying IHE EHR-LR ProfilesDeploying IHE EHR-LR Profiles
• The deployment of EHR-LR integration profiles will initially be focused on a small number of specialties (cardiology, oncology, etc), disease, and/or on key information for continuity of care (e.g. CCR summaries).
• The scope of the EHR-LR profiles will expand progressively as other specialties are included in the use cases.
EHR-CR Source– Healthcare point of service system where clinical
information is first collected EHR-LR Directory
– Index and metadata database for all published clinical documents
EHR-LR Documents Repository– Maintains and stores published EHR-LR documents
EHR-CR Consumer– Application system that needs access to EHR-LR
documents and information
EHR-LR Integration Profile: Key Actors (Application Roles)Key Actors (Application Roles)
Integration Model 1: EHR-LR with Source RepositoryEHR-LR with Source Repository
1. An EHR-CR completes a phase of care for a patient where it:
1. Registers documents with an EHR-LR Directory actor.
2. Keeps these documents in an EHR-LR Repository actor.
2. Any other EHR-CR may query an EHR-LR Directory actor, find out about documents related to all phases of care for the patient and chose to retrieve some of these documents from any EHR-LR Repository Actor (Used in use Case 1 & 2).
EHR-CRSource
EHR-LRDirectory
EHR-LRRepository
EHR-LRConsumer
Register
Retrieve
Query
Integration Model 2:EHR-LR with Third Party RepositoryEHR-LR with Third Party Repository
1. An EHR-CR completes a phase of care for a patient where it:
1. Registers documents with an EHR-LR Directory Actor.
2. Provides these documents to an EHR-LR Repository Actor.
2. Any other EHR-CR may query an EHR-LR Directory Actor, find out about documents related to all phases of care for the patient and chose to retrieve some of these documents from any EHR-LR Repository Actor (Used in use Case 1 & 2).
EHR-CREHR-CRSourceSource
EHR-LREHR-LRDirectoryDirectory
EHR-LREHR-LRRepositoryRepository
EHR-LR EHR-LR ConsumerConsumer
Register
Retrieve
Query
Provide-Transfer
EHR-CR EHR-CR ConsumerConsumer
Integration Model 3: Direct Patient Transfer-Referral Direct Patient Transfer-Referral
1. An EHR-CR completes a phase of care for a patient where it:
• Registers and Provides an EHR-CR Recipient Actor that a specific set of documents (newly created and priors of interest documents) are available from an EHR-LR Repository
2. The EHR-CR Recipient Actor receive both the registration and the documents.
EHR-CREHR-CRSourceSource
Register
Provide-Transfer
EHR-LREHR-LRDirectoryDirectory
EHR-LREHR-LRRepositoryRepository
Conclusion:Conclusion:EHR Cross-Enterprise Document SharingEHR Cross-Enterprise Document Sharing
• Leverages HL7 CDA (Clinical Document Architecture) and ASTM CCR (Continuity of Care Record).
• The proposed strategy addresses one of the key integration problems in the realization of the EHR vision. IHE does not claim to master and address the definition and all aspects of a complete and interoperable EHR System.
• In collaboration with well established standards bodies and other EHR related initiatives world-wide (EHRCOM, CCR, HL7, etc.), IHE expects to contribute at a more cost-effective and rapid deployment.
IHE IT Infrastructure
• To join IT Infrastructure planning or technical committee:
• Contact Joyce Sensmeier, HIMSS. [email protected]
• Suggest new profiles to IHE IT Infrastructure Planning
• Produce new profiles in IHE IT Infrastructure Technical Committee