november 17, 2004 1 integrating the healthcare enterprise an interoperability process for enabling...
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November 17, 2004 1
Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise
An Interoperability Process for Enabling the National Agenda
Joyce Sensmeier MS, RN, BC, CPHIMS
Director of Professional Services
Healthcare Information and Management Systems Society
HIMSS
November 17, 2004 2
2004 State of the Union 2004 State of the Union AddressAddress
“By computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care.”
President George W. Bush January 20, 2004
November 17, 2004 3
And the beat goes on…..And the beat goes on…..
“ …. most Americans will have electronic health records within the next 10 years”
President George W. Bush April 26, 2004
In a public address to the American Association of Community Colleges, the President outlined a plan whose goal is to assure better delivery of healthcare in the United States.
November 17, 2004 4
Framework for Strategic ActionFramework for Strategic Action
President Bush’s April 27th executive order called for the creation of the Office of the National Coordinator of Health Information Technology (ONCHIT). A report was required within 90 days of office creation.
The Framework for Strategic Action was released by Department of Health and Human Services Secretary Tommy Thompson and newly appointed National Coordinator of Health Information Technology, David Brailer, MD at the NHII Summit in July, 2004.
November 17, 2004 5
Framework for Strategic ActionFramework for Strategic Action
Report includes:12 strategies to achieve four major goals Information from DoD, VA, and OPM on
how their areas can advance the adoption of HIT
A catalog of identifiable federal HIT programs
http://www.hhs.gov/onchit/framework/
November 17, 2004 6
Four Major GoalsFour Major Goals
1. Inform Clinical Practice Incentivize EHR adoption Reduce risk of EHR investment Promote EHR diffusion in rural & underserved
2. Interconnect Clinicians Foster regional collaborations Develop a national health information network Coordinate federal health information systems
November 17, 2004 7
Four Major GoalsFour Major Goals
3. Personalize Care Encourage use of PHRs Enhance informed consumer choice Promote use of telehealth systems
4. Improve Population Health Unify public health surveillance architectures Streamline quality and health status monitoring Accelerate discovery and dissemination
November 17, 2004 8
Impact on Healthcare ITImpact on Healthcare IT
Technology trends can no longer develop in a void
Systems must connect with each other Organizational Local National Global
Public/Private partnerships needed
November 17, 2004 9
Development and Adoption of a Development and Adoption of a National Health Information NetworkNational Health Information Network
Request for Information – Interoperability Announced in Federal Register November 15th
HHS is seeking input on how widespread interoperability of health information technologies and health information exchange can be achieved
Encouraging collaboration and unified response Opportunity for members to contribute See Top Line report at www.himss.org and
respond to survey
November 17, 2004 10
What is IHE - Integrating the What is IHE - Integrating the Healthcare Enterprise?Healthcare Enterprise?
A joint initiative to improve systems integration and interoperability Process for coordinated adoption of standards Clinicians/IT staff define needs Vendors and IT Professionals develop solutions
Technical Framework
Professional societies supervise documentation, testing and demonstration/promotion
November 17, 2004 11
Understanding the IHE InitiativeUnderstanding the IHE InitiativeIHE has a clear focus
IHE is a domain-based initiative
IHE creates synergies for interoperability testing across domains
IHE addresses the standards adoption process
IHE is both regional and multi-national
IHE is both user lead and vendor driven
November 17, 2004 12
Goals of IHEGoals of IHE
Speed up the rate and quality of integration in healthcare environments
Foster communication among vendors and care providers
Prove that integration is attainable based on standards
Improve the efficiency and effectiveness of clinical practice
Improve interoperability among care domains and build foundation for the EHR
Provide integration solutions used within and across healthcare enterprises
November 17, 2004 13
IHE: Domain-based for a stepwise approachIHE: Domain-based for a stepwise approach
CardiologyCardiologyLabora-Labora-ttoryory
Pharmacy,…..Pharmacy,…..RadiologRadiologyy
Patient Identifier Linkage, Registries, SecurityPatient Identifier Linkage, Registries, Security
Electronic Health RecordElectronic Health Record
Other (e.g. Access Control, eHealthWorkflows)Other (e.g. Access Control, eHealthWorkflows)
Patient ManagementPatient Management
Order ManagementOrder Management
November 17, 2004 14
IHE
EHR- Longitudinal Record
IHE Cardiology
IHE Laboratory
IHE Radiology
IHE
Future Domain
IHE
Future Domain
IHE
IT Infrastructure Intra-Enterprise
Cross-Enterprise
14 Integration Profiles
5 Integration Profiles
3 Integration Profiles
9 Integration Profiles
IHE 2004 – Four Active Domains IHE 2004 – Four Active Domains
4 Technical Frameworks with 31 Integration ProfilesTesting at yearly Connectathons in three continents
Demonstrations at major conferences world-wide
Provider-Vendor cooperation to accelerate standards adoption
November 17, 2004 15
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 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
IHE Connect-a-thonResults
November 17, 2004 16
IHE Technical FrameworksIHE Technical Frameworks
Detailed standards implementation guides
–Cardiology
–IT Infrastructure
–Lab
–Radiology
November 17, 2004 17
IHE ConnectathonIHE Connectathon
Open invitation to vendor community
Advance testing tools (MESA)
Testing organized and supervised by project management team
Thousands of cross-vendor tests performed
Results recorded and published
November 17, 2004 18
November 17, 2004 19
November 17, 2004 20
Integration StatementsIntegration Statements
November 17, 2004 21
IHE ProcessIHE ProcessUsers identify desired functionality that require coordination and communication among multiple systems E.g., departmental workflow, single sign-on, sharing of documents
Find and document standards-based transactions among systems to achieve desired functionality Apply necessary constraints to eliminate useless wiggle room
Provide process and tools to encourage vendors to implement MESA software test tools + Connect-a-thon interoperability testing event
Provide tools and education to help users acquire and integrate systems using these solutions Connect-a-thon results and public demonstrations Integration statements
November 17, 2004 22
What IHE is NOT!What IHE is NOT!
A standards development organization Uses established standards (HL7, DICOM, CCR,
others) to address specific clinical needs Activity complementary to SDOs, formal
relationship with HL7, DICOM, NCCLS, etc.
Simply a demonstration project Demos only one means to the end—adoption Backed up by documentation, tools, testing, and
publication of information
November 17, 2004 23
IHE Organizational StructureIHE Organizational StructureMulti-Domain & Multi-NationalMulti-Domain & Multi-National
Participants
contribute
Global Development:Radiology,IT Infrastructure,Cardiology,Lab, etc.
Delegates
IHE Europe
IHE North America
IHE Asia/Oceania
Regional &NationalDeployment
supervises reports
IHE (International) Strategic Development Committee
SponsorsCo-Chairs
Global
Interoperability
IHE Domain-related Planning Committee and
Technical Committee
National Extensions
November 17, 2004 24
IHE Contributors & ParticipantsIHE Contributors & Participants
Societies Representing Healthcare Segments RSNA, HIMSS, ACC, ACCE, AACC, Other Professional Societies… Any Healthcare Stakeholder Organization
Users Clinicians, Medical Staff, Administrators, CIOs, …
Information Systems & Equipment (e.g. imaging) Vendors
Consultants
In addition, active liaison with Standards Development Organizations (SDOs) HL7, DICOM, NCCLS, ASTM, ISO, others
November 17, 2004 25
Participating and Contributing Vendors (America)Participating and Contributing Vendors (America)Agfa HealthCareAllscriptsAlgotec Systems, Ltd.CamtronicsCanon Medical SystemsCapMedCarefxCedara Software Corp.Cerner CorporationCSISTDictaphoneDR SystemsDynamic ImagingEastern InformaticsEastman Kodak CompanyEmageonEclipsysEPICETIAMFujifilm Medical SystemsGE HealthcareHealthrampHeartlab
Novell
Opentext
Procom
Philips Medical Systems
RASNA Imaging Systems
Sectra
Sentillion
Siemens Medical Solutions
Softmedical
Stentor, Inc
StorCOMM, Inc
Swissray International, Inc
Tiani Medgraph AG
Toshiba America Medical Sys.
UltraVisual Medical Systems
Vital Images, Inc.
Voxar Limited
WebMD
XIMIS
Hitachi Medical Corporation
Hologic, Inc
IDX Systems Corporation
IMCO Technologies
InSiteOne
INFINITT
InterSystems
Konica Minolta
Marotech, Inc.
McKesson Information Soln.
Medcon
MedCommons
Medical Manager Health Sys.
Mediface Co., Ltd.
MediNotes
Merge eFilm
MidMark
Misys
Mortara
NextGenIn yellow, companies with IHE Committees Chairs (Summer 2004)
November 17, 2004 26
Participating and Contributing Vendors (Europe)Participating and Contributing Vendors (Europe)AGFA HealthcareAISoftw@re Medical SolutionsAlgotec ARES SA aycan Digitalsysteme ConVisDEDALUSDianoemaEastman Kodak Company Ebit SanitaEDL ELFIN s.r.l. Engineering Sanità Enti LocaliESAOTEETIAM Ferrania Fujifilm GE HealthcareGMD GIE Convergence-Profils
Rogan-Delft
Sago spa
Sectra Imtec AB
Siemens Medical Solutions
Soluzioni Informatiche srl
Stentor Inc.
Swissray Medical AG
Symphonie On Line
Synapsis
TELEMIS S.A.
TIANI MEDGRAPH AG
TOREX GAP Medical
Toshiba Medical Systems
TSI groupe europMedica
VEPRO AG
VISUS Technology Transfer
WAID
XR PARTNER
GWI Research
IASI Srl
IdeoPass
Image Device-Cerner Company
INFINITT
INOVIT
McKesson
MED2RAD
MEDASYS SA
Medavis
Medigration GmbH
MEDIMON Ltd.
MEDOS AG
Merge eFilm
METAFORA
Konica Minolta Europe
Omnilab
Philips Medical Systems
Rasna Imaging Systems
RAYPAX INC.
In yellow, companies with IHE Committees Chairs (Summer 2004)
November 17, 2004 27
Participating and Contributing Vendors (Asia)Participating and Contributing Vendors (Asia)Japan
AGFA Gevaert JapanEBM JapanINFINITT JapanA&TCanonGoodmanClimb Medical SystemsKonica Minolta MGShimadzuSONYToshiba Medical SystemsToyo TechnicaNihon KohdenOlympusNECPioneer (Marotech)HitachiHitachi MedicoFujitsuFuji Film MedicalYokogawa
TaiwanINFINITTShing ShianINQ GENTEPTah Ya
KoreaAGFA Korea GE Healthcare KoreaINFINITTLG CNS Marotech, Inc.Medical StandardPeoplenet CommunicationsSamsung SDS
November 17, 2004 28
Benefits to IHE ParticipantsBenefits to IHE Participants
Clinicians Improved workflow Information when and where needed Fewer opportunities for errors Fewer tedious tasks/repeated work Improved report turn around time
Administrators Improved efficiency Best of breed opportunities Decreased cost and complexity of interface deployment and
management Improved accuracy of charge processing/reimbursement
November 17, 2004 29
Benefits to IHE ParticipantsBenefits to IHE ParticipantsHealth Plans Improved accuracy, completeness of billing/claims Improved turn around time for claims processing
Vendors Align product interoperability with industry consensus Decreased cost and complexity of interface installation and
management Focus competition on functionality/service space not information
transport space
SDOs Rapid feedback to adjust standards to real-world Establishment of critical mass and widespread adoption
Plus, IHE meets fixed deadlinesPlus, IHE meets fixed deadlines
November 17, 2004 30
IHE Organizational StructureIHE Organizational Structure
IHE Europe
IHE North America
France
USA Canada
IHE Asia-Oceania
Japan
KoreaTaiwan
Netherlands Spain Sweden
UKItalyGermany
Norway
Regional Deployment
RadiologyPlanning Committee
RadiologyTechnical Committee
IT InfrastructurePlanning Committee
IT InfrastructureTechnical Committee
Pharmacy ExploratorySub-Committee
Global Development
CardiologyPlanning Committee
CardiologyTechnical Committee
LaboratoryPlanning and Technical
Committee
IHE Strategic Development Committee
ACC ITAC/CHITTAHIMSS CHIRSNA CAR
JAHISJIRAJRS
METI-MLHWMEDIS-DCJAMI
GMSIHSFRSFIL
SIRMBIREuroRec
COCIREAR-ECRDRG
ESCProfessional Societies / SponsorsProfessional Societies / Sponsors Contributing and participatingContributing and participating
VendorsVendors
November 17, 2004 31
Organization of the IHE InitiativeOrganization of the IHE InitiativeIHE distributes its operations between a regional/national level and an international level
IHE operates on overlapping yearly cycle
IHE leverages dependencies and complementary interests between stakeholders
IHE is an open and flexible organization
A novel approach to meet these challenges
November 17, 2004 32
IHE Domains Milestones – 20 month cycleIHE Domains Milestones – 20 month cycleDevelopmentDevelopment and and DeploymentDeployment
Proposed Supplement Scope
Approved Supplement Scope
Public Comment Intgr-profile Sponsors announce Connectathon/Demos with set of
Implementation Profiles
Final Intgr-profile + 9 ---
- 10 ---
- 7 ---
- 2 ---
Trial Implementation Intgr-profile 0 ---Connectathon/Demo Vendor Participant Registered
+ 2 ---
Vendor Participant passed Connectathon
+ 5 ---
+ 6 --- Demo &Education Material
Vendors release products with IHE Integration
Statements---
November 17, 2004 33
Continuity & integrity of patient information
Improved patient safety and access to data
Clinical workflow optimization
Foster communication among diverse medical information systems
Avoid repeating tasks
Eliminate data redundancy
Healthcare Needs AddressedHealthcare Needs Addressedby the IHE Initiativeby the IHE Initiative
Improving the Patient Care Process
November 17, 2004 34
HIMSS 2005 Interoperability ShowcaseHIMSS 2005 Interoperability ShowcaseHIMSS leverages its sponsorship of IHE to demonstrate practical
interoperability in two large Showcase Exhibits:
Cross-enterprise sharing of health information in the acute care (18 vendors) and ambulatory (14 vendors).
HIMSS Showcase exhibits linked with vendor booths (10 vendors) show-wide and the Health Level Seven Demo.
Show-wide interactive environment demonstrating attendees “patient” record in a “HIMSS RHIO”. Uses IHE Cross-enterprise Document Sharing:
Around a central document registry
Distributed document repositories
17 EHR systems that publish/share documents (CCR, CDA, HL7-lab, PDF)
November 17, 2004 35
HIMSS 2005 Interoperability ShowcaseHIMSS 2005 Interoperability ShowcaseA national vision of a connected and interoperable healthcare infrastructure
The Interoperability and Ambulatory IT Showcase exhibit areas will feature cross-enterprise sharing of health information in the acute care and ambulatory environment within the framework of a Regional Health Information Organization (RHIO)
These hands-on exhibits linked with vendor booths will create a highly interactive environment to demonstrate practical interoperability featuring standards-based connectivity across the health care enterprises from acute care to ambulatory care IT.
Feb. 13-17, 2005 -- Interoperability Showcases:2005 Annual HIMSS Conference & ExhibitionDallas, TX
One of the most significant healthcare industry efforts of the 21st century.HIMSS has taken a leadership role in making this vision a reality.
November 17, 2004 36
“This showcase allows multiple organizations to demonstrate cross-vendor integration and interoperability and is a prime example of the type of private-sector collaboration we are seeking to move our agenda forward. HIMSS has taken a leadership role in demonstrating the application of cross-enterprise interoperability. ”
Dr. David Brailer, National Coordinator of HIT
November 17, 2004 37
HIMSS 2005 Interoperability ShowcasesHIMSS 2005 Interoperability Showcases
Cross-enterprise Showcase 4,000 square feet on exhibit floor – located near
attendee registration Focus on cross-enterprise interoperability of an
electronic health record and document sharing
Ambulatory Care Showcase 4,000 square feet on exhibit floor - adjacent to
Cross-enterprise Showcase Focus on interoperability of IT applications in
ambulatory care in a variety of settings
November 17, 2004 38
HIMSS 2005 Interoperability ShowcasesHIMSS 2005 Interoperability Showcases
Ambulatory Showcase Booth
Vendor Booth
Vendor BoothCross-enterprisedoc sharing
(Choice of XDS,PWP,RID,PDQ)
Interoperability Showcase Booth
cardiology
laboratory
radiology
ITInfrastructure
laboratorylaboratoryradiology
Pharma ?Pharma ?
Three participation opportunities for vendors Vendors chose among 15 existing integration profiles.May participate from own vendor booth in addition to Showcase booths.
November 17, 2004 39
Cross-enterprise ShowcaseCross-enterprise ShowcaseTechnical demonstration Featuring the IHE framework enabling standards-based health
information exchange within and across multiple healthcare enterprises, available in products today
Clinical scenarios Focusing on clinician access and document sharing within the acute
care environment and across multiple settings Includes the Continuity of Care Record (CCR), radiology images,
cardiology reports, laboratory results, etc.
Connectivity with Ambulatory Care Showcase Health Level Seven (HL7) Demonstration Participating vendors booths Show-wide attendee registration and access at ‘Surf the Web’ kiosks
November 17, 2004 40
Cross-enterprise ShowcaseCross-enterprise Showcase
Interoperability Theater
Featuring learning sessions on:• Outcomes of national demonstrations and industry
research projects• Regional health information exchange initiatives• Federal agency interoperability initiatives• Standards development initiatives and related activities• Issues, products and insights from industry leaders
November 17, 2004 41
Cross-enterprise ShowcaseCross-enterprise ShowcaseVisionary demonstrations of the future in healthcare – Organizational participants Featuring initiatives, collaborations, and standards development
activities in support of interoperability• Center for Information Technology and Leadership (CITL)• Continuity of Care Record (CCR)• Department of Defense (DoD) – Data sharing project• ISO TC 215 Health Informatics• Liberty Alliance• MEDecision• Medical Device Interoperability – IEEE - ACCE• Oregon Health Information Infrastructure• Santa Barbara County Health Data Exchange• Veterans Health Administration – VISTA Imaging• University of Washington Personal Health Record Project
November 17, 2004 42
November 17, 2004 43
Ambulatory Care ShowcaseAmbulatory Care Showcase
Demonstration of interoperability across a variety of settings including a free-standing diagnostic enter, a large clinic, a small practice and the patient’s home
Use cases will guide the attendee through the settings in the normal course of care
Theater area for related presentations Invited speakers and Leadership level only
Product placement near demonstration
November 17, 2004 44
IHE, IHE,
the effective bridgethe effective bridgebetween information between information exchange standards exchange standards and their practical useand their practical use
in healthcare in healthcare
November 17, 2004 45
Opportunities for ParticipationOpportunities for ParticipationAs a User or Vendor Contributor
Become a member of relevant Domains Planning or Technical Committees or HIMSS IHE SIG (Special Interest Group)
Become a member of relevant Regional/National Committees
Attend the HIMSS 2005 Interoperability Showcases
As a Vendor ParticipantRespond to Public Comments of Domain Supplements
Attend Yearly in September Educational/Workshops
Participate in Connect-a-thons and Demonstrations
As a User/Consultant ParticipantRespond to Public Comments of Domain Supplements
Attend Yearly in September Educational/Workshops
Attend Demonstrations and include IHE Integration Profiles in your RFPs and Integration Projects.
November 17, 2004 46
IHE expanding, more info...IHE expanding, more info...• IHE Radiology www.rsna.org/ihe
Chris Carr [email protected] IHE Connectathon for IT January 17-21, 2005
• IHE IT Infrastructure www.himss.org/ihe Joyce Sensmeier [email protected]
HIMSS Interoperability Demonstrations February 13 -17, 2005 www.interoperabilityshowcase.org
• IHE Laboratory www. himss.org/ihe Karima Bourquard [email protected] Framework in Public Comment, feedback due Nov 15th
IHE Connectathon for Lab March 2005
• IHE Cardiology http://www.acc.org/quality/ihe.htm IHE Connectathon for Cardiology January 2005First Demo ACC March 2005
November 17, 2004 47
More information….More information….IHE Web sites:
http://www.himss.org/IHEhttp://www.rsna.org/IHEhttp://www.acc.org/quality/ihe.htm.
Technical Frameworks:• ITI V1.0, RAD V5.5, LAB V1.0
Technical Framework Supplements - Trial Implementation• May 2004: Radiology• August 2004: Cardiology, IT Infrastructure
Non-Technical Brochures :• Calls for Participation• IHE Fact Sheet and FAQ• IHE Integration Profiles: Guidelines for Buyers• IHE Connect-a-thon Results• Vendor Products Integration Statements