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1April 21, 2005 IHE Patient Care Coordination
Patient Care Coordination, April 21th-22nd 2005
Charles Parisot,GE Healthcare IT
IHE IT Infrastructure Technical Committee Co-chair
Interoperability for Sharing Interoperability for Sharing Medical SummariesMedical Summaries
April 21, 2005 IHE Patient Care Coordination2
W W W . I H E . N E TW W W . I H E . N E T
Providers and VendorsProviders and VendorsWorking Together to DeliverWorking Together to Deliver
Interoperable Health Information SystemsInteroperable Health Information Systemsin the Enterprisein the Enterprise
and Across Care Settingsand Across Care Settings
April 21, 2005 IHE Patient Care Coordination3
Standards Are CriticalStandards Are Criticalbut Alone Are Not Enoughbut Alone Are Not Enough
Managing the domain boundaries with mapping of information flow across boundariesStandards offer generality, ambiguity and alternativesStandards Implementation Guides are focused on a single standardVendor proprietary interestsComplexity!!
We need a standard process for how to We need a standard process for how to implement multiple standards!implement multiple standards!
April 21, 2005 IHE Patient Care Coordination4
Connecting Standards to CareConnecting Standards to CareCare providers must work with vendors to coordinate the implementation of standards to meet their needs
Care providers need to identify the key interoperability problems they faceDrive industry to develop and make available standards-based solutionsImplementers need to follow common guidelines in purchasing and integrating systems that deliver these solutions
What is the effective way to establish those What is the effective way to establish those ““standardsstandards”” for how to implement standards ?for how to implement standards ?
April 21, 2005 IHE Patient Care Coordination5
Prof. Societies Sponsorship
Healthcare Providers & Vendors
Healthcare IT StandardsHL7, DICOM, etc.
General IT Standards Internet, ISO, etc.
IHE Process
Driving healthcare standardsDriving healthcare standards--based integration based integration
IHE Integration Profile: A well-defined and tested solutionto a specific information exchange problem
Interoperable Healthcare IT Solution Specifications
IHE Integration Profile Interoperable Healthcare IT
Solution Specifications IHE Integration Profile
Interoperable Healthcare IT Solution Specifications
IHE Integration Profile Interoperable Healthcare IT
Solution Specifications IHE Integration Profile
April 21, 2005 IHE Patient Care Coordination6
What is What is Integrating the Healthcare Enterprise ?Integrating the Healthcare Enterprise ?
IHE provides a common framework for passing health information seamlessly:
within the healthcare enterpriseacross multiple healthcare enterprisesfor local, regional & national health information networks.
IHE is sponsored by healthcare professional associations.
IHE drives standards adoption to address specific clinical needs.
April 21, 2005 IHE Patient Care Coordination7
IHE
EHR- Longitudinal Record
IHE Cardiology
IHE Laboratory
IHE Radiology
IHE Oncology
New IHE Domains
IHE
IT Infrastructure Intra-Enterprise
Cross-Enterprise
14 Integration Profiles
1 Integration Profile
3 Integration Profiles
9 Integration Profiles
Patient care coordination, Ophthalmology, Surgery, Pharmacy, Quality in 2005
Achievements and expanding scope15 Active national chapters on 4 continents, 4 Technical Frameworks
27 Integration Profiles, Testing at yearly Connectathons,Demonstrations at major exhibitions world-wide
April 21, 2005 IHE Patient Care Coordination8
Achievements and expanding scope15 Active national chapters on 4 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.
IHE
EHR- Longitudinal Record
IHE Cardiology
IHE Laboratory
IHE Radiology
IHE Oncology
Patient Care Coordination
IHE
IT Infrastructure Intra-Enterprise
Cross-Enterprise
14 Integration Profiles
1 Integration Profile
3 Integration Profiles
9 Integration Profiles
Medical Summary Document Content Integration Profile
April 21, 2005 IHE Patient Care Coordination9
A Proven Standards Adoption ProcessA Proven Standards Adoption Process
IHEIntegrationProfiles B
IHEIntegrationProfile A
Easy toIntegrateProducts
IHEIHEConnectConnect--aa--thonthon
ProductWith IHE
IHEIHEDemonstrationDemonstration
User Site
RFPRFP
StandardsStandards(e.g. ASTM(e.g. ASTM--CCRCCR
HL7 CDA)HL7 CDA)
Product IHE IntegrationStatement
IHE Connect-a-thonResults
IHE Integration Profiles at the heart of IHE :Detailed selection of standards and options each solving a specific integration problemA growing set of effective provider/vendor agreed solutionsVendors can implement with ROIProviders can deploy with stabilityProcess started in1998 with continuous improvements
Requirements
April 21, 2005 IHE Patient Care Coordination10
The IHE Process for products in 2006 ? The IHE Process for products in 2006 ?
IHEIntegrationProfiles B
IHEIntegrationProfile A
Easy toIntegrateProducts
IHEIHEConnectConnect--aa--thonthon
ProductWith IHE
IHEIHEDemonstrationDemonstration
User Site
RFPRFP
StandardsStandards(e.g. ASTM(e.g. ASTM--CCRCCR
HL7 CDA)HL7 CDA)
Product IHE IntegrationStatement
IHE Connect-a-thonResults
Requirements
AprilApril--May 2005May 2005MayMay--August 2005 ?August 2005 ?
January 2006 ?January 2006 ?
February 2006 ?February 2006 ?
Products Products 20062006
April 21, 2005 IHE Patient Care Coordination11
Massive yearly events :Massive yearly events :6060--70 vendors70 vendors120120--160 engineers160 engineersOver 100 systemsOver 100 systems…….integrated in 5 days.integrated in 5 days
IHE ConnectathonsIHE Connectathons
Vendors do not passVendors do not pass……until an IHE Project Manager attest it !until an IHE Project Manager attest it !
April 21, 2005 IHE Patient Care Coordination12
Participating and Contributing Vendors (America)Participating and Contributing Vendors (America)Agfa HealthCareAlgotec Systems, Ltd.BerdyCamtronicsCanon Medical SystemsCarefxCedara Software
CorporationCerner CorporationCSISTDictaphoneDR SystemsDynamic ImagingEastern InformaticsEastman Kodak CompanyEmageonEclipsysFujifilm Medical Systems
ProcomPhilips Medical SystemsRASNA Imaging SystemsSectraSentillionSiemens Medical SolutionsSoftmedicalStentor, IncStorCOMM, IncSwissray International, IncTiani Medgraph AGToshiba America Medical
SystemsUltraVisual Medical SystemsVital Images, Inc.Voxar LimitedWebMDXIMIS
GE HealthcareHeartlabHitachi Medical CorporationHologic, IncIDX Systems CorporationIMCO TechnologiesInSiteOneINFINITTKonica Minolta Marotech, Inc.McKesson Information
SolutionsMedconMedical Manager Health
SystemsMediface Co., Ltd.Merge eFilmMortara
In yellow, companies with IHE Committees Chairs (Summer 2004)
13April 21, 2005 IHE Patient Care Coordination
HIMSS 2005 HIMSS 2005 –– ShowShow--Wide InteroperabilityWide InteroperabilityVendor System
Ambulatory Showcase BoothAmbulatory Showcase Booth
HomeHome
PCP
MultispecialtyMultispecialtyClinicClinic
Diag Diag CenterCenter
CrossCross--enterprise Showcase Boothenterprise Showcase Booth
Cardiology
RadiologyIT
Infrastructure
In-Patient/Out-patient
VendorVendor BoothBooth
VendorVendor BoothBooth
VendorVendor BoothBooth
VendorVendor BoothBooth
VendorVendor BoothBooth
VendorVendor BoothBooth
VendorVendor BoothBooth
HL7 BoothHL7 Booth
AllscriptsCapMedCerner
EclipsysGE Healthcare
IDXInfinitt
InterSystemsKryptiq
MedCommonsMediNotesNextGenOpenTextSiemens
HIMSS “RHIO” withCross-enterprise
doc sharing
April 21, 2005 IHE Patient Care Coordination14
HIMSS 2005 InteroperabilityHIMSS 2005 InteroperabilityShow Case VendorsShow Case Vendors
Leadership LevelLeadership LevelCapMedCapMed//SanDiskSanDiskEclipsysEclipsysGE HealthcareGE HealthcareIDXIDXInterSystemsInterSystemsKryptiqKryptiqQuovadxQuovadx//CareScienceCareScienceSiemensSiemensWebMDWebMD
Participant LevelParticipant LevelAllscriptsAllscriptsCedara Cedara CernerCernerDictaphone Dictaphone Eastman KodakEastman KodakEclipsysEclipsysEmageonEmageonEpicEpicETIAMETIAMINFINITT Tech.INFINITT Tech.
MedcomSoft MedcomSoft MediNotesMediNotesMedCommonsMedCommonsMidMarkMidMarkMortaraMortara Instrument, IncInstrument, IncNational Institute National Institute ofof
Standards and TechnologyStandards and TechnologyNextGenNextGenNovellNovellOpen TextOpen TextSentillionSentillion
Supporter LevelSupporter LevelAccessPtAccessPt AGFAAGFA dbMotiondbMotion DinmarDinmar –– OacisOacisEMCEMC HealthvisionHealthvision HealthrampHealthramp McKessonMcKesson
ValcoValco Data SystemsData Systems
April 21, 2005 IHE Patient Care Coordination15
community
Clinical Encounter
Clinical IT System Index of patients records(Document-level)
Temporary Aggregate Patient History
4-Patient data presented to
Physician
Sharing SystemSharing System
33--RecordsRecordsReturnedReturned
Referenceto records
Clinic Record Specialist Record
Hospital Record
2-Referenceto Records for Inquiry
At HIMSS in 2005 : IHEAt HIMSS in 2005 : IHE--XDSXDS
April 21, 2005 IHE Patient Care Coordination16
community
Clinical Encounter
Clinical IT System Index of patients records(Document-level)
Temporary Aggregate Patient History
33--RecordsRecordsReturnedReturned
Referenceto records
Laboratory Results Specialist Record
Hospital Record
2-Referenceto Records for Inquiry
At HIMSS in 2005 : IHEAt HIMSS in 2005 : IHE--XDSXDS
Sharing SystemSharing System
Shared prototype content:• Medical Summaries (Pre-CCR)• Discharge Summaries (CDA-R1)• Lab Results (HL7)• Other (PDF)
April 21, 2005 IHE Patient Care Coordination17
community
Clinical Encounter
Clinical IT System Index of patients records(Document-level)
1-Patient Authorized
Inquiry
Temporary Aggregate Patient History
33--RecordsRecordsReturnedReturned
Referenceto records
Laboratory Results Specialist Record
Hospital Record
2-Referenceto Records for Inquiry
Demo a RHIO with IHE at HIMSS 2006 ?Demo a RHIO with IHE at HIMSS 2006 ?
Sharing SystemSharing System
Secured Sharing of:• Medical Summaries• Lab Results• Images & reports• ECG Reports• Other PDFs+ Notif of Doc Avail.
April 21, 2005 IHE Patient Care Coordination18
IHE Profiles for IHE Profiles for RHIOsRHIOsWhat is available and what needs to be added in 2005What is available and what needs to be added in 2005
Patient Identifier Cross-referencing
Map patient identifiers across independent identification
domains
Consistent TimeCoordinate 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
Personnel White PageAccess to workforcecontact information
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical
documents forming a patient electronic health record
Notification of Document Availability
Notification of a remote provider/ health enterprise
Imaging Information Content
Format of the Document Content and associated coded vocabulary
For Display Document Content
Format of the Document ContentLab Results Document Content
Format of the Document Content and associated coded vocabulary
Continuity of Care Document Content
Format of the Document Contentand associated coded vocabulary
Cross-enterprise User Identity and
AccountabilityAuthentication & Auditing: Basis for Access Control
Document Digital Signature
Attesting “true-copy and origin
April 21, 2005 IHE Patient Care Coordination19
IHE Profiles for IHE Profiles for RHIOsRHIOsWhat is available and what needs to be added in 2005What is available and what needs to be added in 2005
Patient Identifier Cross-referencing
Map patient identifiers across independent identification
domains
Consistent TimeCoordinate 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
Personnel White PageAccess to workforcecontact information
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical
documents forming a patient electronic health record
Notification of Document Availability
Notification of a remote provider/ health enterprise
Imaging Information Content
Format of the Document Content and associated coded vocabulary
For Display Document Content
Format of the Document ContentLab Results Document Content
Format of the Document Content and associated coded vocabulary
Medical Summary Document Content
Format of the Document Contentand associated coded vocabulary
Cross-enterprise User Identity and
AccountabilityAuthentication & Auditing: Basis for Access Control
Document Digital Signature
Attesting “true-copy and origin
Medical Summary Document Content
Information Structure and Format of the Document Content
and Associated Coded Vocabulary
April 21, 2005 IHE Patient Care Coordination20
Patient Care CoordinationPatient Care CoordinationBroad industry consensus that medical summaries are the most critical clinical content building block:
Promoted by physician associationsSupported by Standards development: CCR, CDAConfirmed by HIMSS IHE Interoperability ShowcaseSupport of EHR Vendors Association and CCHIT
The issue is no longer if, or when (ASAP) but what is the first step to deliver for clinical use in 2006 ?Need to define an interoperable content scope for “a medical summary document” that delivers:
A significant quality and efficiency step for practitionersA reasonable scope for vendors with existing EHR products A practical deployment, use and maintenance. Affordable !The capability for further richness and computer processing to be added in subsequent incremental steps
April 21, 2005 IHE Patient Care Coordination21
Launching Patient Care CoordinationLaunching Patient Care CoordinationSuccess Factors:
Clear physicians and nurses leadership and sponsorshipAvailability of standards and support of developersWillingness of EHR Vendors to implement resulting integration profileInterest of Certification Commission to leverage resulting integration profile
Is Schedule too aggressive ?IHE has 7 years of experience and success in such efforts with aproven process spanning from integration profile to implemented productsSeveral years of Standards investments in ASTM and HL7 with rapidly maturing standards, near-ready to be used.We have the car, we need a determined team of care providers to lead the process.
April 21, 2005 IHE Patient Care Coordination22
Success depends on CollaborationSuccess depends on CollaborationProviders need confidence that EHR will support medical summaries consistentlyPatients need confidence that most current information is available and reusable.Vendors need confidence that providers will be satisfied Healthcare policy and financers need confidence that quality and efficiency will improve.
1+1+1+1 = 10
April 21, 2005 IHE Patient Care Coordination23
W W W . I H E . N E TW W W . I H E . N E T
Providers and VendorsProviders and VendorsWorking Together to DeliverWorking Together to Deliver
Interoperable Health Information SystemsInteroperable Health Information Systemsin the Enterprisein the Enterprise
and Across Care Settingsand Across Care Settings