september, 2005what ihe delivers 1 didi davis, director of ihe, himss national committee on vital...
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1September, 2005 What IHE Delivers
Didi Davis, Director of IHE, HIMSSDidi Davis, Director of IHE, HIMSS
National Committee on Vital and Health National Committee on Vital and Health Statistics (NCVHS) Statistics (NCVHS)
July 27, 2006July 27, 2006
IHE Testimony IHE Testimony
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Connecting standards to healthcare deliveryConnecting standards to healthcare delivery
Care providers work with vendors to Care providers work with vendors to coordinate the implementation of standards coordinate the implementation of standards to meet their needsto meet their needs Care providers identify the key interoperability Care providers identify the key interoperability
problems they faceproblems they face Drive industry to develop and make available Drive industry to develop and make available
standards-based solutionsstandards-based solutions Implementers follow common guidelines in Implementers follow common guidelines in
purchasing and integrating systems that deliver these purchasing and integrating systems that deliver these solutionssolutions
IHE, effective way to establish those IHE, effective way to establish those
“standards” for how to implement standards“standards” for how to implement standards
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What is What is Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise??
IHE provides a IHE provides a common frameworkcommon framework for passing for passing health information seamlessly:health information seamlessly: withinwithin the healthcare enterprise the healthcare enterprise acrossacross multiple healthcare enterprises multiple healthcare enterprises for local, regional & nationalfor local, regional & national health information networkshealth information networks
IHE is sponsored by IHE is sponsored by healthcare professional healthcare professional associationsassociations: HIMSS, RSNA, ACC, ACP, ACCE, : HIMSS, RSNA, ACC, ACP, ACCE, ESC, SFR, BIR, GMSIH, etc.ESC, SFR, BIR, GMSIH, etc.
IHE IHE drives standards adoptiondrives standards adoption to address specific to address specific clinical or administrative needsclinical or administrative needs
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IHE Organizational StructureIHE Organizational StructureMulti-Domain & Multi-NationalMulti-Domain & Multi-National
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
SponsorCo-Chairs
Global
Interoperability
IHE Domain-related Planning and
Technical Committees
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Proven Standards Adoption ProcessProven Standards Adoption Process
Document Use Document Use Case Case RequirementsRequirements
Document Use Document Use Case Case RequirementsRequirements
Identify available Identify available standards (standards (e.g. HL7, e.g. HL7, DICOM, IETF, OASIS)DICOM, IETF, OASIS)
Identify available Identify available standards (standards (e.g. HL7, e.g. HL7, DICOM, IETF, OASIS)DICOM, IETF, OASIS)
Develop Develop technical technical
specificationsspecifications
Develop Develop technical technical
specificationsspecifications
Testing at Testing at ConnectathonsConnectathonsTesting at Testing at ConnectathonsConnectathons
IHE IHE DemonstrationsDemonstrationsIHE IHE DemonstrationsDemonstrations
Products Products with IHEwith IHEProducts Products with IHEwith IHE
Timely access to Timely access to informationinformationTimely access to Timely access to informationinformation
Easy to integrate Easy to integrate productsproductsEasy to integrate Easy to integrate productsproducts
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Electronic Health Record
Cardiology
Laboratory
Radiology
Oncology
Future
Domains
IHE
IT Infrastructure
17 Integration Profiles
7 Integration Profiles
7 Integration Profiles
1166 IInntteeggrraattiioonn PPrrooffiilleess
Patient Care Coordination
4 Integration Profile
Patient Care
Devices
Pathology
Eye Care
IHE 2006 – Nine Active Domains IHE 2006 – Nine Active Domains Close to 200 vendors involved world-wide,Close to 200 vendors involved world-wide, 5 Technical Frameworks5 Technical Frameworks
51 Integration Profiles, Testing at Connectathons51 Integration Profiles, Testing at ConnectathonsDemonstrations at major conferences world-wideDemonstrations at major conferences world-wide
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NCVHS Discussion Template of NHIN NCVHS Discussion Template of NHIN
Draft – NCVHS - 071406
Confidentiality and SecurityC
on
fiden
tiality and
Secu
rity
Electronic health records
E-prescribing systems
Public health systems
ImmunizationRegistries
Personalhealth
records
Other edgesystems
Otheredge
systems
Policy
Edge System Examples:
Confidentiality & Security
Network Functional RequirementsExamples:
Patient Data/Record LocationTransportSecurity
(e.g., Audit Trails, Authentication)
Co
nfid
entiality &
Secu
rityPolicy
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Requirement 1: Allow “edge” systems to Requirement 1: Allow “edge” systems to retain functionality and autonomyretain functionality and autonomy
Edge HIT System
NHIN Subnetwork
Edge to Edge Communication
Edge HIT SystemC
ritica
l Bo
un
da
ry
Critic
al B
ou
nd
ary
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Requirement 2: Allow Flexibility to Requirement 2: Allow Flexibility to support multiple architecturessupport multiple architectures
A broad range of architectures are supported (centralized, distributed, federated).
Clinic
Hospital Practice
Document Registry
?Registry Locator
CentralizedRepository
Clinic
Hospital
Practice
Document Registry
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Requirement 3: Provide Incremental PhasesRequirement 3: Provide Incremental Phases
Phase 1: Share Care Status Information
Phase 2: Diagnostic Results and Therapeutic Information
Phase 3: Clinical Decision Support and Advanced Access Control
Phase 4: Active Quality Reporting and Health Surveillance
available
6 mos to1 yr
2YRs +
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Some of the BenefitsSome of the Benefits
Recognize simple hard costs Recognize simple hard costs savings: paper, fax, admin laborsavings: paper, fax, admin labor
Improve information access:Improve information access:((duplicate procedures, duplicate procedures, safety, safety, collaboration) collaboration)
Data-drivenData-drivenClinical Decision MakingClinical Decision Making
Healthcare Healthcare Information Information
TransparencyTransparency
available
6 mos to1 yr
2YRs +
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Community orsub-network
Clinical Encounter
Clinical IT System Index of patients records(Document-level)
Aggregate Patient Info
4-Patient data 4-Patient data presented to presented to
PhysicianPhysician
Sharing SystemSharing System
Clinic Record Specialist Record
Hospital Record
2-Reference2-Referenceto Records to Records for Inquiryfor Inquiry
Introduced at HIMSS in 2006 : IHE-XDSIntroduced at HIMSS in 2006 : IHE-XDS
3-Records3-RecordsReturnedReturned
ReferenceReferenceto recordsto records
Repository ofDocuments
Repository ofDocuments
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2006 Interoperability Showcase2006 Interoperability Showcase
More than 3,000 attendees visited the ShowcaseMore than 3,000 attendees visited the Showcase
37 vendors demonstrated 48 health information 37 vendors demonstrated 48 health information technology (IT) systems in a RHIO formattechnology (IT) systems in a RHIO format
700 attendees created and tracked their own 700 attendees created and tracked their own electronic health record (EHR)electronic health record (EHR)
63 educational sessions presented63 educational sessions presented
5 international delegations visited the Showcase5 international delegations visited the Showcase
Three HIMSS 2006 keynote speakers toured the Three HIMSS 2006 keynote speakers toured the Showcase Showcase
16 clinical scenarios - EHR and personal health record 16 clinical scenarios - EHR and personal health record (PHR) systems, and multiple care delivery settings(PHR) systems, and multiple care delivery settings
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General ImpressionsGeneral Impressions
“ “I was impressed with the progress I saw in the I was impressed with the progress I saw in the Interoperability Showcase over the past year. I am Interoperability Showcase over the past year. I am encouraged by the vendor industry’s demonstration encouraged by the vendor industry’s demonstration of the real potential for interoperability. This type of of the real potential for interoperability. This type of collaboration is required for us to realize the collaboration is required for us to realize the potential for information technology in healthcare.”potential for information technology in healthcare.”
Dr. David Brailer, Dr. David Brailer, Vice Chairman, American Health Information Vice Chairman, American Health Information Community and former National Coordinator, Health Information Community and former National Coordinator, Health Information TechnologyTechnology
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HIE RequirementsHIE Requirements Considered Considered TimingTiming
Security/AuditingSecurity/Auditing Y Y Phase I - FoundationalPhase I - Foundational
Patient IdentityPatient Identity YY Phase I - FoundationalPhase I - Foundational
Definition of what is sharedDefinition of what is shared YY Ongoing thru all PhasesOngoing thru all Phases
Data location; local or centralized?Data location; local or centralized? YY Phase 1 - FoundationalPhase 1 - Foundational
Workflow ConsiderationsWorkflow Considerations YY Phases 1, 2, 3Phases 1, 2, 3
Public Health NeedsPublic Health Needs YY Phase 2Phase 2
Patient’s rolePatient’s role YY Phase 3, 4Phase 3, 4
Adaptability to future changesAdaptability to future changes YY Phase 3, 4Phase 3, 4
What’s Missing or Needs Clarity?
Nation-Wide Nation-Wide coordination of coordination of policies, resources and policies, resources and
priorities – ONC Initiatives and priorities – ONC Initiatives and Contracts for unifying regionsContracts for unifying regions
• The AHIC Community serves as The AHIC Community serves as hub for identifying breakthrough hub for identifying breakthrough opportunitiesopportunities
• CCHIT focuses on developing a CCHIT focuses on developing a mechanism for certification of mechanism for certification of health care IT productshealth care IT products
• HITSP bringing together all HITSP bringing together all relevant stakeholders to identify relevant stakeholders to identify appropriate IT standardsappropriate IT standards
• HISPC is a partnership focused HISPC is a partnership focused on addressing variations in on addressing variations in business policy and state law business policy and state law that affect privacy and security that affect privacy and security
• NHIN focuses on interoperability NHIN focuses on interoperability pilots starting in 2006pilots starting in 2006
Health Information Technology Standards
Panel (HITSP)
Nation-Wide Health
Information Network
Architecture Projects(NHIN)
The Health Information Security and
Privacy Collaboration
(HISPC)
The Certification Commission
for Health Information Technology
(CCHIT) American Health
Information Community
• Chaired by HHS Secretary Leavitt• Seven federal agency representatives• Six health industry members• One IT industry member (Intel)• One employer (Pepsi)• One state health department member (IN)
The National Health IT Effort
September, 2005 17
HITSP Harmonization ProcessHITSP Harmonization Process
II
RequirementsAnalysis
III
Standards Identification
V
Standards Selection
VII
InspectionTest
VIII
InteroperabilitySpecification
Dissemination
IXHarmonization Process Management
Begin
Support
Receive
Request
IV
Gaps/ Overlaps
Resolution
VI
InteroperabilitySpecification Construction
I
Harmonization Request
September, 2005 18
The Role of IHEThe Role of IHE
Models for HarmonizationModels for Harmonization Mapping of standards which have different levels of Mapping of standards which have different levels of
granularitygranularity Preferred standards and evolution over timePreferred standards and evolution over time UnificationUnification
Building BlocksBuilding Blocks
Implementation Guides/Interoperability SpecificationsImplementation Guides/Interoperability Specifications
Architecture and ContextArchitecture and Context
Process ExpertiseProcess Expertise Standard v. Implementation GuideStandard v. Implementation Guide TestingTesting
Pilots such as those in MassachusettsPilots such as those in Massachusetts
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More information….More information….
IHE Web site: IHE Web site: http://www.ihe.nethttp://www.ihe.net
http://www.himss.org/IHE http://www.himss.org/IHE http://www.rsna.org/IHEhttp://www.rsna.org/IHEhttp://www.acc.org/quality/ihe.htmhttp://www.acc.org/quality/ihe.htm
Technical FrameworksTechnical Frameworks
Technical Framework Supplements – Trial ImplementationTechnical Framework Supplements – Trial Implementation
Non-Technical Brochures :Non-Technical Brochures :
Calls for ParticipationCalls for Participation IHE Fact Sheet and FAQIHE Fact Sheet and FAQ IHE Integration Profiles: Guidelines for BuyersIHE Integration Profiles: Guidelines for Buyers IHE Connect-a-thon ResultsIHE Connect-a-thon Results Vendor Products Integration StatementsVendor Products Integration Statements
Questions?
Questions?
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