1September, 2005 What IHE Delivers

IHE in regional and national IHE in regional and national Health Information ExchangesHealth Information Exchanges

around thearound theWORLD WORLD

AsiaPac Interoperability Showcase April 2008AsiaPac Interoperability Showcase April 2008Didi Davis, Sr. Director, IHE, HIMSSDidi Davis, Sr. Director, IHE, HIMSS

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International Growth of IHEInternational Growth of IHE

France

Local Deployment National Extensions Promotional & Live Demonstration Events Funding

USA

Germany

Italy

JapanUK

Canada

Korea

Taiwan

Norway

Netherlands

SpainChina

Austria

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20

01

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02

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03

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04

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06

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07

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Pragmatic global standards harmonization + best practices sharing Pragmatic global standards harmonization + best practices sharing

Australia

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IHE Organizational StructureIHE Organizational Structure

Contributing &Participating

Vendors

IHE Europe

IHE North America

France

USA

Canada

IHE Asia-Oceania

Japan

Korea Taiwan

Netherlands

Spain Sweden UKItaly

Germany

Norway

China

Austria

ACCACCEACEP

JAHISJIRAJRS

METI-MLHWMEDIS-DCJAMI

RSNA SFRSFIL

SIRMBIREuroRec

COCIREAR-ECRDRG

ESC

Professional Societies / SponsorsACPGMSIHIMSS

IHE International Board

Regional Deployment Global Development

Radiology

Cardiology

ITInfrastructure

Patient CareCoordination

Patient CareDevices

Laboratory

Pathology

Eye CareRadiationOncology

Public Health, Quality and Research

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National and Regional projectsNational and Regional projects

It is difficult to provide a simple summary view of these It is difficult to provide a simple summary view of these projects:projects:

These slides reflect information publicly available and These slides reflect information publicly available and current based on author’s knowledge.current based on author’s knowledge.

IHE offers 24 Integration & Content profiles applicable IHE offers 24 Integration & Content profiles applicable in health information exchange for communities, in health information exchange for communities, regions or nations. Each project discussed here uses regions or nations. Each project discussed here uses different subsets of these profiles (IHE Modularity).different subsets of these profiles (IHE Modularity).

These projects are multi-year and projects with These projects are multi-year and projects with complex decision making processes.complex decision making processes.

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Categories of Healthcare Communication ServicesCategories of Healthcare Communication ServicesMost HIEs in the World chose to start with Document SharingMost HIEs in the World chose to start with Document Sharing

Security

DocumentSharing

Patient and Provider ID Mgt

DynamicInformation

Access

WorkflowManagement

Source persisted and attested health

records

Specific info snapshot

provided on demand

2 or more entitiessynchronize

a task

e.g. access to last 6 months historical

labs and encounter summaries

e.g. order a lab test, track status and receive results

e.g. get a current list of allergies or med list from a source

HospitalsHIEs and RHIOs

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Sharing and Accessing Electronic Health Sharing and Accessing Electronic Health RecordsRecords

IHE offers interoperability for local, regional, specific, or IHE offers interoperability for local, regional, specific, or national health information exchangenational health information exchange

Goal is to enable exchange between providers’ clinical Goal is to enable exchange between providers’ clinical and administrative systems and ancillary IT systems and administrative systems and ancillary IT systems (EHRs,Lab, Pharma, Payers, etc.) and personal health (EHRs,Lab, Pharma, Payers, etc.) and personal health record systems.record systems.

Objective is to empower the consumersObjective is to empower the consumers in having in having “shared EHR information” between all of its potential “shared EHR information” between all of its potential healthcare providers (if authorized) and self.healthcare providers (if authorized) and self.

Objective is to empower the providersObjective is to empower the providers in choosing when in choosing when and what information to share, and to trust the and what information to share, and to trust the information they may use in the care of their patients.information they may use in the care of their patients.

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Community orsub-network

Clinical Encounter

Clinical IT System

Sharing SystemSharing System

Clinic Record Specialist Record

Hospital Record

Introduced at HIMSS in 2005 : IHE-XDSIntroduced at HIMSS in 2005 : IHE-XDS

1-Reference1-Referenceto recordsto records

Repository ofRepository ofDocumentsDocuments

Repository ofRepository ofDocumentsDocuments

Index of Index of patients recordspatients records

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Community orsub-network

Clinical Encounter

Clinical IT System

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 2005 : IHE-XDSIntroduced at HIMSS in 2005 : IHE-XDS

3-Records3-RecordsReturnedReturned

1-Reference1-Referenceto recordsto records

Repository ofRepository ofDocumentsDocuments

Repository ofRepository ofDocumentsDocuments

Index of Index of patients recordspatients records

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IHE Integration Profiles for Health Info NetsIHE Integration Profiles for Health Info Nets What What is availableis available and and has been added in 2007has been added in 2007

Emergency Referrals Format of the Document Content

and associated coded vocabulary PHR Extracts/Updates

Format of the Document Content and associated coded vocabulary

ECG Report Document

Format of the Document Content and associated coded vocabulary

Lab Results Document Content

Format of the Document Content and associated coded vocabulary

Scanned Documents Format of the Document ContentImaging Information

Format of the Document Content and associated coded vocabulary

Medical Summary (Meds, Allergies, Pbs)

Format of the Document Contentand associated coded vocabulary

Clinical and PHR ContentClinical and PHR Content

Health Data ExchangeHealth Data Exchange

Patient Demographics Query

Patient Identifier Cross-referencing

Map patient identifiers across independent identification

domains

Notification of Document Availability

Notification of a remote provider/ health enterprise

Request Formfor Data Capture

External form with custom import/export scripting

Patient ID MgmtPatient ID Mgmt

OtherOther

Final Text ApprovedFinal Text Approved

Trial Implementation-2007 Trial Implementation-2007 –– Final Txt 2008Final Txt 2008

Cross-Enterprise Document Sharing

Registration, distribution and access across health enterprises of clinical

documents forming a longitudinal record

Cross-Enterprise Document Pt-Pt Reliable InterchangeCross-Enterprise Document

Media InterchangeCross-Community Access

Security & PrivacySecurity & Privacy

Consistent TimeCoordinate time across networked

systems

Audit Trail & Node Authentication

Centralized privacy audit trail and node to node authentication to create

a secured domain.

Basic Patients Privacy Consents

Establish Consents & Enable Access Control

Document Digital Signature

Attesting “true-copy and origin

Cross-Enterprise User Attestation

User Attributes fro Access Control

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IHE, global standards-based profiles adopted by IHE, global standards-based profiles adopted by several national & regional projectsseveral national & regional projects

Quebec, Toronto,Alberta, British Columbia

Canada Infoway

Denmark (Funen)Italy (Veneto)Spain (Aragon)

NCHICA – N. Carolina

Italy (Conto Corrente

Salute)

Boston Medical

Center - MA

FranceDMP

UK CfH(Radiology WF)

Philadelphia HIE

CHINA-MoHLab results sharing

KeyHIE – Pennsylvani

a

CHINA-ShanghaiImaging Info Sharing

JAPAN-NagoyaImaging Info Sharing

South Africa

MalaysiaSingapore

VITL-Vermont

CareSpark – TN & VA

NetherlandAmsterdam

LowerAustria

Austria

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Italy Italy (Genoa Region)(Genoa Region)

Azienda Sanitaria Locale n. 4 Chiavarese

Conto Corrente Salute

Azienda Sanitaria Locale n. 4 Chiavarese

Conto Corrente Salute

Cooperazione e condivisioneCooperazione e condivisione

Asl 4 Chiavarese; Dipartimento di Medicina

Diagnostica e Terapie Speciali dell’Università di Padova

IHE – Commissione nazionale Italia

alcune aziende ICT esperte in soluzioni “e-health” (Rasna Medical Systems, Soluzioni Informatiche);

A.S.L. 4CHIAVARESEA.S.L. 4CHIAVARESE

per la realizzazione di un prodotto open-source su J2EE che implementa il profilo IHE XDS.

E’ stato attivato un Work Group composto da:

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Italy Italy (Genoa Region)(Genoa Region)

In service since January 2006. In service since January 2006.

4 Hospitals and 500 physician offices.4 Hospitals and 500 physician offices.

EMRs import and export documents from their local EMRs import and export documents from their local records.records.

All vendor products required to pass IHE-Europe All vendor products required to pass IHE-Europe connectathon in April 2005.connectathon in April 2005.

Patients chose to join through one of their care providerPatients chose to join through one of their care provider

Infrastructure includes:Infrastructure includes: XDS RegistryXDS Registry XDS Repository shared at the regional levelXDS Repository shared at the regional level PIX for patient Id linkingPIX for patient Id linking Doc content is CDA with PDF content. Plan in place to move to CDA rel 2 with Doc content is CDA with PDF content. Plan in place to move to CDA rel 2 with

structured data. IHE (XD*-Lab) CDA Lab primary candidate.structured data. IHE (XD*-Lab) CDA Lab primary candidate.

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Austria Austria (Lower Austria and (Lower Austria and National)National)

Lower Austria Region (around Vienna) Deployed Lower Austria Region (around Vienna) Deployed in 2007 - Operational. 1.5 Million patients on-line. in 2007 - Operational. 1.5 Million patients on-line. 11 hospitals connected. 11 hospitals connected.

Use IHE profiles: Use IHE profiles: XDS, PIX, XDS-SD, ATNA, XUA, BPPC.XDS, PIX, XDS-SD, ATNA, XUA, BPPC.

National project launched in 2007 (ELGA). Given National project launched in 2007 (ELGA). Given the success to deploy the first region is about the success to deploy the first region is about one year.one year.

Roll-out includes:Roll-out includes: Ministry backing of IHE conformance (IHE-Eu Connectathon)Ministry backing of IHE conformance (IHE-Eu Connectathon) Extending to Ambulatory Physicians in 2008Extending to Ambulatory Physicians in 2008 Step-wise introduction of structured and coded content with HL7 CDA Step-wise introduction of structured and coded content with HL7 CDA

based IHE Content Profiles.based IHE Content Profiles.

LowerAustria

Austria

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USA USA (Philapdelphia Region)(Philapdelphia Region)

Philadelphia Health Info Exchange in service since 2005. Philadelphia Health Info Exchange in service since 2005. Focused on images and reports sharing.Focused on images and reports sharing.

5 Hospitals + Imaging Center + Public Health5 Hospitals + Imaging Center + Public Health The Hospital of the University of Pennsylvania The Hospital of the University of Pennsylvania Thomas Jefferson University Hospital Thomas Jefferson University Hospital Children’s Hospital of Philadelphia Children’s Hospital of Philadelphia Presbyterian Medical Center Presbyterian Medical Center Pennsylvania Hospital Pennsylvania Hospital UPHS Community Radiology UPHS Community Radiology Philadelphia Department of Public HealthPhiladelphia Department of Public Health

Migration to XDS, ATNA, PIX and XDS-I completed in Migration to XDS, ATNA, PIX and XDS-I completed in 2007.2007.

Demonstrated live at RSNA-Chicago Nov 2007Demonstrated live at RSNA-Chicago Nov 2007

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USA (Other)USA (Other)HITSP (HHS sponsored) accepted 8 IHE Integration profiles HITSP (HHS sponsored) accepted 8 IHE Integration profiles for: Lab results distribution and sharing, Registration and for: Lab results distribution and sharing, Registration and Medication History for Consumers, Biosurveillance.Medication History for Consumers, Biosurveillance.

2 NHIN-1 Pilots (CSC and IBM) leveraged IHE profiles (Med 2 NHIN-1 Pilots (CSC and IBM) leveraged IHE profiles (Med Summaries and Lab).Summaries and Lab).

South Shore, MA: Operational (Inpatient and Emergency Dept)South Shore, MA: Operational (Inpatient and Emergency Dept)

NHIN-2 Trial Implementations NHIN-2 Trial Implementations (NCHICA, Virginia & CareSpark HIEs)(NCHICA, Virginia & CareSpark HIEs)

Several HIEs projects are actively planning the use of IHESeveral HIEs projects are actively planning the use of IHE Vermont StateVermont State KeyHIE (PA)KeyHIE (PA) eHealthConnecticuteHealthConnecticut Boston Medical Center and affiliated clinicsBoston Medical Center and affiliated clinics

Launch Internet Explorer Browser.lnk

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CanadaCanadaCanada Health Infoway: national Commitment to XDS/XDS-Canada Health Infoway: national Commitment to XDS/XDS-I for imaging sharing I for imaging sharing

3 infrastructure tenders awarded in 2007 and 1 more to 3 infrastructure tenders awarded in 2007 and 1 more to come early 2008 resulting in over 1/3 of Canadian patients come early 2008 resulting in over 1/3 of Canadian patients covered:covered: Toronto East Network - OntarioToronto East Network - Ontario Montreal McGill - QuebecMontreal McGill - Quebec AlbertaAlberta British ColumbiaBritish Columbia

Includes XDS, ATNA, PIX and XDS-I.Includes XDS, ATNA, PIX and XDS-I.

Planned to become live 2008 in Quebec, Ontario, Alberta, Planned to become live 2008 in Quebec, Ontario, Alberta, British Columbia.British Columbia.

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France France (National DMP)(National DMP)

Prototype RFP call for tender mid-2005. Confirmed Prototype RFP call for tender mid-2005. Confirmed requirement to use to IHE profiles: requirement to use to IHE profiles: XDS, ATNA, XUA, BPPC, etc.XDS, ATNA, XUA, BPPC, etc.

Encourage vendors to submit their products to the IHE-Encourage vendors to submit their products to the IHE-Europe Connectathon (April 2007-Berlin).Europe Connectathon (April 2007-Berlin).

Implementation plan under revision.Implementation plan under revision.

Infrastructure to include:Infrastructure to include: XUA from User Authentication Portal and BPPC for privacyXUA from User Authentication Portal and BPPC for privacy XDS Registry/XDS Repositories XDS Registry/XDS Repositories ATNA for audit trail and node authentication.ATNA for audit trail and node authentication. Doc content to be: CDA rel 2 patient summary (close to XDS-MS), Hprim with Doc content to be: CDA rel 2 patient summary (close to XDS-MS), Hprim with

migration to IHE XD*-Lab for Lab, Scanned Doc (PDF) and imaging (XDS-I). migration to IHE XD*-Lab for Lab, Scanned Doc (PDF) and imaging (XDS-I).

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Other CommitmentsOther CommitmentsChinaChina MoH selected XDS and XD*-Lab (CDA) for lab info sharing.MoH selected XDS and XD*-Lab (CDA) for lab info sharing. XDS-I in Shanghai.XDS-I in Shanghai.

Israel, Jordan, Palestinian AuthorityIsrael, Jordan, Palestinian Authority Public Health Info Affinity Domain (XDS, ATNA, XD*Lab)Public Health Info Affinity Domain (XDS, ATNA, XD*Lab) Middle east Consortium for infectious Disease SurveillanceMiddle east Consortium for infectious Disease Surveillance

NetherlandsNetherlands Amsterdam region network project launched 2007. XDS-I.Amsterdam region network project launched 2007. XDS-I.

JapanJapan Nagoya region network project operational late 2007. XDS, XDS-INagoya region network project operational late 2007. XDS, XDS-I Kobe with imaging info sharingKobe with imaging info sharing

South AfricaSouth Africa National project launched in 2007. Tender awarded. Operational National project launched in 2007. Tender awarded. Operational

in 2008.in 2008.

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IHE, global standards-based profiles adopted by IHE, global standards-based profiles adopted by several national & regional projectsseveral national & regional projects

Quebec, Toronto,Alberta, British Columbia

Canada Infoway

Denmark (Funen)Italy (Veneto)Spain (Aragon)

NCHICA – N. Carolina

Italy (Conto Corrente

Salute)

Boston Medical

Center - MA

FranceDMP

UK CfH(Radiology WF)

Philadelphia HIE

CHINA-MoHLab results sharing

KeyHIE – Pennsylvani

a

CHINA-ShanghaiImaging Info Sharing

JAPAN-NagoyaImaging Info Sharing

South Africa

MalaysiaSingapore

VITL-Vermont

CareSpark – TN & VA

NetherlandAmsterdam

LowerAustria

Austria

20September, 2005 What IHE Delivers