march 17, 2005ihe and medical standards in denmark 1 integrating the healthcare enterprise ihe for...

March 17, 2005 IHE and medical Standards in Denmark1

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

IHE for cross-enterprise interoperability

Charles Parisot, GE Healthcare

IHE IT Infrastructure Technical Committee Co-chair

IHE Europe Committee

Copenhagen, March 17th 2005Copenhagen, March 17th 2005


W W W . I H E . N E TW W W . I H E . N E T

Providers and VendorsProviders and Vendors

Working Together to DeliverWorking Together to Deliver

Interoperable Health Information SystemsInteroperable Health Information Systems

In the EnterpriseIn the Enterprise

and Across Care Settingsand Across Care Settings

W W W . I H E – Europe. o r gW W W . I H E – Europe. o r g


Prof. Societies Sponsorship

Healthcare Providers & Vendors

Healthcare IT Standards HL7, DICOM, etc.

General IT Standards Internet, ISO, etc.

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

IHE Process

IHE drives healthcare standards based-integration IHE drives healthcare standards based-integration


A Proven Standards Adoption ProcessA Proven Standards Adoption Process

IHEIntegrationProfiles B

IHEIntegrationProfile A

Easy toIntegrateProducts

IHEIHEConnect-a-thonConnect-a-thon

ProductWith IHE

IHEIHEDemonstrationDemonstration

User Site

RFPRFP

StandardsStandards

IHETechnical

Framework

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 problem A growing set of effective provider/vendor agreed solutions Vendors can implement with ROI Providers can deploy with stability Process started in1998 with continuous improvements


IHE

EHR- Longitudinal Record

IHE Cardiology

IHE Laboratory

IHE Radiology

IHE

Oncology

IHE

Future Domain

IHE

IT Infrastructure Intra-Enterprise

Cross-Enterprise

14 Integration Profiles

1 Integration Profile



Achievements and expanding scopeOver 100 vendors involved world-wide, 4 Technical Frameworks

27 Integration Profiles, Testing at yearly Connectathons,Demonstrations at major exhibitions world-wide

To claim compliance to IHE Integration Profiles vendors shall publish for each product an IHE Integration Statement.

Patient care Coordination, Quality, Pharmacy, Anatomical Pathology, Surgery, etc.


IHE IT Infrastructure 2004-2005IHE IT Infrastructure 2004-2005

Enterprise User AuthenticationEnterprise User Authentication

Provide users a single nameand centralized authentication

processacross 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 presented

to the requesting user

Patient Identifier Cross-referencing

for MPIMap 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

Consistent TimeCoordinate time across

networked systems

Audit Trail & Node Authentication

Centralized privacy audit trail and node to node authentication

to create a secured domain.

New

Patient Demographics Query New

Personnel White PageAccess to workforcecontact information

New

Cross-Enterprise Document Sharing

Registration, distribution and access across health enterprises of clinical

documents forming a patient electronic health record

New


Introduction:EHR Cross-Enterprise Document SharingEHR Cross-Enterprise Document Sharing

Enables the seamless information sharing Enables the seamless information sharing between healthcare IT systems (e.g. EHRs) between healthcare IT systems (e.g. EHRs)

servingserving all types of care delivery all types of care delivery organizations in a region or nation.organizations in a region or nation.


community

Clinical Encounter

Clinical IT System Index of patients records(Document-level)

1-Patient Authorized

Inquiry

Temporary Aggregate Patient History

4-Patient data presented to

Physician

Sharing SystemSharing System

3-Records3-RecordsReturnedReturned

Referenceto records

Laboratory Results Specialist Record

Hospital Record

2-Referenceto Records for Inquiry

Sharing records that have been publishedSharing records that have been published


Acute Care (Inpatient)

PCPs and Clinics (Ambulatory)

Long Term Care

Other Specialized Careor Diagnostics Services

Building and accessing DocumentsBuilding and accessing Documents

EHR-CR: EHR-CR: Care RecordCare Record systems systemssupportingsupporting care delivery care delivery

Documents Registry

DocumentRepository

EHR-LR:EHR-LR:Longitudinal RecordLongitudinal Recordas usedas usedacross-encountersacross-encounters

Submission of Document References

Retrieve of selected Documents


XDS – Value PropositionXDS – Value PropositionFoundation for Health IT Infrastructures: Shared Electronic Health Record, in a community, region, etc.

Effective means to contribute and access clinical documents across health enterprises.

Scalable sharing of documents between private physicians, clinics, long term care, pharmacy, acute care with different clinical IT systems.

Easy access: Care providers are offered means to query and retrieve clinical documents of interest.


XDS - Value PropositionXDS - Value PropositionDistributed: Each Care delivery organization “publishes” clinical information for others. Actual documents may remain in the source EHR-CR.

Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain (e.g. an RHIO).

Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (HL7-CDA, PDF, DICOM, etc.)

Document Content Neutral: Document content is processed only by source and consumer IT systems.

Standardized Registry Attributes: Queries based on meaningful attributes ensure deterministic document searches.


XDS DocumentXDS Document

A set of attested clinical information (structured or not) which A set of attested clinical information (structured or not) which form an element of a patient record to be shared. It may form an element of a patient record to be shared. It may already exist within the source IT system.already exist within the source IT system.

XDS Submission SetXDS Submission Set

A set of documents related to a patient that a (team of) A set of documents related to a patient that a (team of) clinician(s) in the same source system have decided to make clinician(s) in the same source system have decided to make available to potential consumers.available to potential consumers.

XDS FolderXDS FolderA means to group documents for a number of other reasons:A means to group documents for a number of other reasons:

Team work across several physicians,Team work across several physicians,

Episode of care, Episode of care,

Emergency information for a patient, etc.Emergency information for a patient, etc.

XDS leaves open the use of folders to affinity domain clinicians.XDS leaves open the use of folders to affinity domain clinicians.

IHE XDS Integration Profile: Key ConceptsKey Concepts


Document Consumer

Retrieve Document

Query Documents

Patient Identity Source

Patient Identity Feed

Document Source

Document Registry

Document Repository

Provide & Register Document Set

Register Document Set

XDS Actors and TransactionsXDS Actors and Transactions


Secured Node

Document Consumer

Retrieve Document

Query Documents

Patient Identity Source

Patient Identity

Feed

Document Source

Document Registry

Document Repository

Provide&RegisterDocument Set

RegisterDocument Set

Secured Node

Secured Node

Secured Node

Secured Node

Secured Node

ATNA creates a secured domain:• User Accountability (Audit trail)

• Node-to-Node Access Control

• Node-level user authentication

• User access control provided by node BUT Registry/repository based User-Level Access Control and policy agreements is beyond XDS..

Security for XDSSecurity for XDSLeverages IHE Audit Trail & Node Authentication


Integration Model 1: EHR-CR with Repository at SourceEHR-CR with Repository at Source An EHR-CR completes a phase of care for a patient where it:

Has these documents available as Repository Actor.

Registers documents with a Registry actor.

Any other EHR-CR may query the Registry actor, and chose to retrieve some of these documents from any Document Repository Actor.

EHR-CR

Register

4 Retrieve

3 Query

2

Document Source Document Consumer

Document Repository

Document Registry

EHR-CR


Integration Model 2:EHR-LR with Third Party RepositoryEHR-LR with Third Party Repository An EHR-CR completes a phase of care for a patient where it:

Provides the documents to a Repository Actor of its choice.

Documents are Registered with a Registry Actor.

Any other EHR-CR may query the Registry actor, and chose to retrieve some of these documents from any Document Repository Actor.

EHR-CR

2 Register

4 Retrieve

3 Query

Document Source

Document Consumer

Document Repository

Document Registry

EHR-CR

1 Provide & Register


Integration Model 3: EHR-CR feed a EHR-CR/EHR-LR hubEHR-CR feed a EHR-CR/EHR-LR hubAn EHR-CR completes a phase of care for a patient where it:

Provides and Registers a set of documents to a Document Repository in an EHR-CR.

The EHR-CR Consumer Actor has the documents and may respond to queries and provide them to other document consumers.

Document Source

Document Consumer

Document Repository

Document Registry

EHR-CR

1 Provide & Register

EHR-CR


Patient Access also possiblePatient Access also possible

A patient accesses own record:

Query and Retrieve a set of documents using for example a portal application that offers the ability to display documents’ content.

This is a particular case of an EHR-CR, where the patient is interested her/his own care. Patient may also register and provide documents.


Standards selection for IHE XDSStandards selection for IHE XDSNo single standard can address

Cross-enterprise Document Sharing

Marriage of healthcare standards facilitates implementation and leverages complementary

technologies (e.g. security & privacy).

HealthcareContent Standards

HL7 CDA, CEN EHRcomHL7, ASTM CCR

DICOM, etc.

Internet StandardsXML, HTTP,

ISO, etc.

Electronic BusinessStandards

ebXML Registry, ebMS, SOAP, etc.


How real is XDS ?How real is XDS ?Specification work since Nov 2003Specification work since Nov 2003

Under Public Comments June-July 2004Under Public Comments June-July 2004

600 constructive comments received. 600 constructive comments received. Validity of XDS approach confirmed Validity of XDS approach confirmed (e.g. CfH Collaborative Response).(e.g. CfH Collaborative Response).

Stable specification IHE Technical Framework Published Aug 15Stable specification IHE Technical Framework Published Aug 15 thth, , 2004 (TI Supplement)2004 (TI Supplement)

IHE Connectathon - January 2005 (USA)IHE Connectathon - January 2005 (USA) 14 Vendors passed14 Vendors passed

HIMSS Feb 2005 - show-wide demonstrationHIMSS Feb 2005 - show-wide demonstration 17 EHRs, 800 patients, 7700 documents registered, 41000 queries.17 EHRs, 800 patients, 7700 documents registered, 41000 queries.

IHE Connectathon - April 2005 (Europe)IHE Connectathon - April 2005 (Europe) 22 Vendors registered22 Vendors registered

Several Implementation Projects by health authorities in 2005 Italy: Linguini & Veneto Regions - Canada: Newfoundland – France: Trials – Norway-Region


HIMSS HighlightsHIMSS Highlights


HIMSS IHE HighlightsHIMSS IHE HighlightsHIMSS: 700 Exhibitors - 23,000 Attendees

Over 2000 visited the IHE Booth.

49 participants in IHE Interoperability booth

15 vendors participated in XDS from their booth

732 Attendees registered for their own EHR

7,772 Documents registered in XDS Registry

40,984 Queries to XDS Registry

US National IT Coordinator (Dr Brailer) held his press conference in IHE Booth and thanked IHE. 50 members of press toured.


HIMSS “RHIO” withHIMSS “RHIO” withIHE-XDS Cross-enterpriseIHE-XDS Cross-enterprise

doc sharingdoc sharing

Over 700 attendees experienced their Over 700 attendees experienced their HIMSS-Wide Electronic Health RecordHIMSS-Wide Electronic Health Record

Ambulatory Showcase BoothAmbulatory Showcase Booth

HomeHome

PCP

MultispecialtyMultispecialtyClinicClinic

Diag CenterDiag Center

Vendor BoothVendor Booth







HL7 Demo BoothHL7 Demo Booth

Cardiology Workup

Comprehensive

Patient Care

RadiologyRadiology CoordinatedCoordinated

Patient EvaluationPatient Evaluation

ITInfrastructure

Cross-enterprise Showcase BoothCross-enterprise Showcase Booth


IHE Profiles for a RHIOIHE Profiles for a RHIOAvailable Integration Profiles completedAvailable Integration Profiles completed




New


Map patient identifiers across independent identification

domains

Patient Demographics QueryNew

2004


networked systems




New

2004


New


IHE Profiles for RHIOsIHE Profiles for RHIOs What is available and what will be added in 2005What is available and what will be added in 2005


Map patient identifiers across independent identification

domains


networked systems




Patient Demographics Query





Notification of Document Availability

Notification of a remote provider/ health enterprise

Cross-enterprise User Identity and

Accountability

Authentication & Auditing: Basis for Access Control

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


IHE and HL7 V3IHE and HL7 V3Continuity of Care Document Content

Format of the Document Contentand associated coded vocabulary

IHE relies only on approved standards.

HL7 V2 is widely used. Official relation with HL7, effective cooperation with HL7 affiliate world-wide.

Early 2005, foundations elements of HL7 V3 have been approved, but only a few “application level” are.

One of this element based on HL7 V3 based on the RIM has been approved in January 2005: CDA Release 2 (nothing to do with HL7V2).

IHE considers that HL7 CDA based on HL7-V3-RIM as the strategic means to introduce HL7V3 in the real world.

In 2005, IHE is developing in cooperation with HL7 an integration profile for “care record summary”. It will allow the sharing with XDS of the basic care information in a form both structured and human displayable in a consistent manner.


EHR-CR

Push-like Integration : Adding NotificationsAdding Notifications

Using « an e-mail notification that need not be secured» to turn a Pull Model into a like Push Model.

4 Retrieve

3 QueryDocument

Source DocumentConsumerDocument

Repository

Document Registry

NotificationNotification

Register


Local & Regional RHIOs Infrastructure Local & Regional RHIOs Infrastructure and Interoperabilityand Interoperability

Cross-Enterprise Document Sharing (XDS) minimizes clinical data management by the infrastructure. Transparency = Ease of Evolution

XDS works with other IHE Integration Profiles: Audit Trail and Node Authentication (ATNA) and Consistent Time (CT) Patient Id Cross-referencing (PIX) Patient Demographics Query (PDQ)

In 2005, IHE plans to finish base set of integration profiles to build regional health networks and interoperable EHRs: Security: Identity Management+ Accountability Content Profiles: DICOM, HL7-CDA-r2/CCR, HL7-Lab, PDF. Notification of Document Availability (with XDS document reference)


IHE: RHIOs’ Interoperability PartnerIHE: RHIOs’ Interoperability Partner

IHE offers a solid technical foundation to establish interoperability for Regional/National Health Information Organizations (RHIO).

Standards-based, open, multi-vendor, provider-led.

Yearly progress, validation testing built in, backed by a proven process. Implementation by many vendors.

IHE welcomes RHIOs’ technical architects’ active involvement.

The IHE Technical Framework accelerates RHIOs pilot project development (XDS Affinity Domain Concept).


W W W . I H E . N E TW W W . I H E . N E T

Providers and VendorsProviders and Vendors

Working Together to DeliverWorking Together to Deliver

Interoperable Health Information SystemsInteroperable Health Information Systems

In the EnterpriseIn the Enterprise

and Across Care Settingsand Across Care Settings

W W W . I H E – Europe. o r gW W W . I H E – Europe. o r g

march 17, 2005ihe and medical standards in denmark 1 integrating the healthcare enterprise ihe for...

Documents

heart of ihe

products ihe

healthcare enterprise

medical standards

ge healthcare ihe

integration slide

access clinical documents

patient care coordination