september, 2005what ihe delivers 1 integrating the healthcare enterpise (ihe) orientation workshop...
TRANSCRIPT
1September, 2005 What IHE Delivers
INTEGRATING THE INTEGRATING THE HEALTHCARE HEALTHCARE
ENTERPISE (IHE)ENTERPISE (IHE)Orientation WorkshopOrientation Workshop
International HL7 Interoperability Conference-08International HL7 Interoperability Conference-08Charles Parisot, Charles Parisot, IHE Europe, GE Healthcare, Buc, FranceIHE Europe, GE Healthcare, Buc, France
Eric Poiseau, Eric Poiseau, IHE Europe Technical Project Manager, INRIA RennesIHE Europe Technical Project Manager, INRIA Rennes
2
AgendaAgenda
08:30-10:30 THE IHE STANDARDS ADOPTION PROCESS: 08:30-10:30 THE IHE STANDARDS ADOPTION PROCESS: achieving practical interoperability achieving practical interoperability - - Charles ParisotCharles Parisot
Coffee BreakCoffee Break
11:00-12:30 USERS AND VENDORS WORKING TOGETHER: 11:00-12:30 USERS AND VENDORS WORKING TOGETHER: how can I contribute & benefit from IHE how can I contribute & benefit from IHE – Charles Parisot– Charles Parisot
Lunch BreakLunch Break
13:30-15:00 HOW TO USE IHE RESOURCES: hands on 13:30-15:00 HOW TO USE IHE RESOURCES: hands on experienceexperience – Eric Poiseau– Eric Poiseau
3
AgendaAgenda
08:30-10:30 THE IHE STANDARDS ADOPTION 08:30-10:30 THE IHE STANDARDS ADOPTION PROCESS: achieving practical interoperabilityPROCESS: achieving practical interoperability
Coffee BreakCoffee Break
11:00-12:30 USERS AND VENDORS WORKING TOGETHER: 11:00-12:30 USERS AND VENDORS WORKING TOGETHER: how can I contribute & benefit from IHE how can I contribute & benefit from IHE – Charles Parisot– Charles Parisot
Lunch BreakLunch Break
13:30-15:00 HOW TO USE IHE RESOURCES: hands on 13:30-15:00 HOW TO USE IHE RESOURCES: hands on experience experience – Eric Poiseau– Eric Poiseau
444
IHE: A Framework for InteroperabilityIHE: A Framework for Interoperability
A common framework for harmonizing and A common framework for harmonizing and implementing multiple standardsimplementing multiple standards Application-to-applicationApplication-to-application System-to-systemSystem-to-system Setting-to-settingSetting-to-setting
Enables seamless health information movement Enables seamless health information movement within and between enterprises, regions, nationswithin and between enterprises, regions, nations
Promotes unbiased selection and coordinated use Promotes unbiased selection and coordinated use of established healthcare of established healthcare andand IT standards to IT standards to address specific clinical needsaddress specific clinical needs
5
Standards: Necessary…Not SufficientStandards: Necessary…Not Sufficient
Standards areStandards are Foundational - to interoperability and communicationsFoundational - to interoperability and communications Broad - varying interpretations and implementationsBroad - varying interpretations and implementations Narrow - may not consider relationships between Narrow - may not consider relationships between
standards domainsstandards domains Plentiful - often redundant or disjointedPlentiful - often redundant or disjointed Focused - standards implementation guides focus only Focused - standards implementation guides focus only
on a single standardon a single standard
IHE provides a standard process for IHE provides a standard process for implementing multiple standardsimplementing multiple standards
6
IHE: Connecting Standards to CareIHE: Connecting Standards to Care
Healthcare professionals work with industryHealthcare professionals work with industry
Coordinate implementation of standards to Coordinate implementation of standards to meet clinical and administrative needsmeet clinical and administrative needs Clinicians and HIT professionals identify the key Clinicians and HIT professionals identify the key
interoperability problems they faceinteroperability problems they face Providers and industry work together to develop and Providers and industry work together to develop and
make available standards-based solutionsmake available standards-based solutions Implementers follow common guidelines in Implementers follow common guidelines in
purchasing and integrating effective systemspurchasing and integrating effective systems
IHE: A forum for agreeing on how to implement IHE: A forum for agreeing on how to implement standards and processes for making it happenstandards and processes for making it happen
7
Standards Adoption ProcessStandards Adoption Process
Document Use Case Document Use Case RequirementsRequirementsDocument Use Case Document Use 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
8
Stakeholder BenefitsStakeholder BenefitsHealthcare providers and support staffHealthcare providers and support staff Improved workflowsImproved workflows Information whenever and wherever neededInformation whenever and wherever needed Fewer opportunities for errorsFewer opportunities for errors Fewer tedious tasks/repeated workFewer tedious tasks/repeated work Improved report turnaround timeImproved report turnaround time
VendorsVendors Align product interoperability with industry consensusAlign product interoperability with industry consensus Decreased cost and complexity of interface installation and Decreased cost and complexity of interface installation and
managementmanagement Focus competition on functionality/service space not information Focus competition on functionality/service space not information
transport spacetransport space
SDOsSDOs Rapid feedback to adjust standards to real-worldRapid feedback to adjust standards to real-world Establishment of critical mass and widespread adoptionEstablishment of critical mass and widespread adoption
9
IHE Implementation StrategyIHE Implementation Strategy
Leverage established standards to allow rapid deployment and Leverage established standards to allow rapid deployment and plan for futureplan for futurePragmatic, Ease of EvolutionPragmatic, Ease of Evolution
Enable architectural freedom (patient vs. provider centric, Enable architectural freedom (patient vs. provider centric, centralized vs. decentralized, scalable (from office to centralized vs. decentralized, scalable (from office to enterprise to IDN to RHIO) enterprise to IDN to RHIO) ConfigurationConfiguration flexibilityflexibility
Support breakthrough use cases: variety of care settings, care Support breakthrough use cases: variety of care settings, care coordination, public health, PHR, EHRcoordination, public health, PHR, EHRInteroperability for broad constituenciesInteroperability for broad constituencies
IHE: Offers consistent, standards-based record IHE: Offers consistent, standards-based record sharing for EHRs and other information systemssharing for EHRs and other information systems
10
Growth in IHE DomainsGrowth in IHE Domains
Radiology (18 profiles)
IT Infrastructure for Healthcare (20 profiles)
Cardiology (7 profiles)
Laboratory (6 profiles)
Radiation Oncology (3 profiles)
Patient Care Coord. (5 profiles)
Patient Care Devices (3 profiles)
Pathology
Eye Care (4 profiles)
19
99
• Over 200 vendors involved world-wideOver 200 vendors involved world-wide• 8 Technical Frameworks8 Technical Frameworks• 64 Integration Profiles64 Integration Profiles
• Testing at “Connectathons” world-wideTesting at “Connectathons” world-wide• Demonstrations at major conferences Demonstrations at major conferences
world-wideworld-wide
VeterinaryEndoscopyPharmacy
Public Health, Quality and Research
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
111111
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
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
88
Pragmatic global standards harmonization + best practices sharing Pragmatic global standards harmonization + best practices sharing
Australia
12
IHE Integration Profiles - ModelIHE Integration Profiles - Model
Actors in precisely defined rolesActors in precisely defined roles Abstracts a specific function of information systemAbstracts a specific function of information system
……Executing precisely defined transactionsExecuting precisely defined transactions Using existing standardsUsing existing standards
…………To solve real world interoperabilityTo solve real world interoperability problems problems Specifying Integration ProfilesSpecifying Integration Profiles
13
IHE Technical FrameworksIHE Technical FrameworksImplementation Guide for each Integration ProfileImplementation Guide for each Integration Profile
An Integration Profile :An Integration Profile : A Set of A Set of ActorsActors Exchanging Exchanging TransactionsTransactions
Query Modality Worklist [RAD-5]
ADT Order Placer
Register J.Doe
AcquisitionModality
Placer OrderManagement –New [RAD-2]
Patient Reconciliation
Department System Scheduler/Order Filler
Schedule Procedure
Procedure Scheduled [RAD-4]
Modality Procedure Step Completed [RAD-7]J.Doe ->
J.Smith
Patient Update/Merge [RAD-12]
Modality Procedure Step Completed [RAD-7]
PatientRegistration [RAD-1]
Patient Update/
Merge [RAD-12]
Modality Procedure Step In Progress [CARD-1]
Modality Procedure Step In Progress [CARD-1]
Perform Acquisition
Filler Order Mgmt - Status Update [RAD-3]
Filler Order Mgmt - Status Update [RAD-3]
ImageManager/
PPS Manager
Filler Order Management -New [RAD-3]
One or the other methods of creating an order is used
Query Modality Worklist [RAD-5]
ADT Order Placer
Register J.Doe
AcquisitionModality
Placer OrderManagement –New [RAD-2]
Patient Reconciliation
Department System Scheduler/Order Filler
Schedule Procedure
Procedure Scheduled [RAD-4]
Modality Procedure Step Completed [RAD-7]J.Doe ->
J.Smith
Patient Update/Merge [RAD-12]
Modality Procedure Step Completed [RAD-7]
PatientRegistration [RAD-1]
Patient Update/
Merge [RAD-12]
Modality Procedure Step In Progress [CARD-1]
Modality Procedure Step In Progress [CARD-1]
Perform Acquisition
Filler Order Mgmt - Status Update [RAD-3]
Filler Order Mgmt - Status Update [RAD-3]
ImageManager/
PPS Manager
Filler Order Management -New [RAD-3]
One or the other methods of creating an order is used
Use casesUse casesProcess FlowsProcess Flows
For each transaction:For each transaction: Std referencedStd referenced Options specifiedOptions specified Mapping requiredMapping required
Pt. Registration [RAD-1] Patient Update [RAD-12]
Pt. Registration [RAD-1] Patient Update [RAD-12]
Placer Order Management [RAD-2] Filler Order Management [RAD-3]
ADT
Query Images [RAD-14] Retrieve Images/Evidence [CARD-4]
Image Display
Modality Image/Evidence Stored [CARD-2]
Storage Commitment
[CARD-3]
Procedure Scheduled [RAD-4]
Procedure Updated [RAD-13]
Query Modality Worklist [RAD-5]
Performed Procedure
Step Manager
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Order Placer
Acquisition Modality
ImageManager
ImageArchive
DSS/ Order Filler
Patient Update [RAD-12]
Modality Image/Evidence Stored [CARD-2]
Storage Commitment
[CARD-3]
Evidence Creator Modality PS in Progress [CARD-1]
Modality PS Completed [RAD-7]
Instance Availability Notification [RAD-49]
Pt. Registration [RAD-1] Patient Update [RAD-12]
Pt. Registration [RAD-1] Patient Update [RAD-12]
Placer Order Management [RAD-2] Filler Order Management [RAD-3]
ADT
Query Images [RAD-14] Retrieve Images/Evidence [CARD-4]
Image Display
Modality Image/Evidence Stored [CARD-2]
Storage Commitment
[CARD-3]
Procedure Scheduled [RAD-4]
Procedure Updated [RAD-13]
Query Modality Worklist [RAD-5]
Performed Procedure
Step Manager
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Order Placer
Acquisition Modality
ImageManager
ImageArchive
DSS/ Order Filler
Patient Update [RAD-12]
Modality Image/Evidence Stored [CARD-2]
Storage Commitment
[CARD-3]
Evidence Creator Modality PS in Progress [CARD-1]
Modality PS Completed [RAD-7]
Instance Availability Notification [RAD-49]
ActorsActors TransactionsTransactions
14
Organization of Technical FrameworksOrganization of Technical Frameworks
Volume 1: Integration and content Volume 1: Integration and content ProfilesProfilesDescribes clinical need and use casesDescribes clinical need and use cases Identifies :Identifies :
• the actors and transactions or,the actors and transactions or,• content modulescontent modules
Volume 2+ of Technical FrameworkVolume 2+ of Technical FrameworkProvides implementation specification for Provides implementation specification for
transactions or content modulestransactions or content modules
15
Key IHE ConceptsKey IHE Concepts
• Generalized Systems Generalized Systems -> -> ActorsActors
• Interactions between Actors Interactions between Actors -> -> TransactionsTransactions
• Problem/Solution ScenariosProblem/Solution Scenarios -> -> IntegrationIntegration ProfilesProfiles
• For each Integration Profile:For each Integration Profile:
• the context is described (which real-world problem)the context is described (which real-world problem)
• the actors are defined (what systems are involved)the actors are defined (what systems are involved)
• the transactions are defined (what must they do)the transactions are defined (what must they do)
16
11stst key concept: key concept: ActorActorRepresents a set of application roles and Represents a set of application roles and responsibilities performed by a systemresponsibilities performed by a system
Always supported by a real-world systemAlways supported by a real-world system
A real-world system may support several IHE A real-world system may support several IHE ActorsActors
Examples:Examples: Order PlacerOrder Placer Order FillerOrder Filler Patient Admission, Discharge and Transfer (ADT)Patient Admission, Discharge and Transfer (ADT) Laboratory Automation ManagerLaboratory Automation Manager Point Of Care AnalyzerPoint Of Care Analyzer
IHE leaves the definition of products to users and vendors
17
22ndnd key concept: key concept: TransactionTransactionA set of interactions or A set of interactions or
messages defined between messages defined between
two Actors for a specific two Actors for a specific
task. task.
Defines unambiguously how Defines unambiguously how
the Actors must cooperate the Actors must cooperate
to achieve this task.to achieve this task.
Using existing standards Using existing standards
such as HL7, DICOM, NCCLS such as HL7, DICOM, NCCLS
etc.etc.
Order Placer
Order Filler
New order
Order accepted
Battery replaced
Acknowledgement
Status change
Acknowledgement
Example: Transaction LAB-1
« Placer order management »
Order Placer
Order Filler
→ Placer order management [LAB-1]
IHE defines transactions at a user-level workflow
18
33rdrd key concept: key concept: Integration ProfileIntegration Profile
Examples: Examples:
Enterprise User AuthenticationEnterprise User Authentication
Retrieve Information for DisplayRetrieve Information for Display
Laboratory Scheduled WorkflowLaboratory Scheduled Workflow
Echo Laboratory WorkflowEcho Laboratory Workflow
Cross-Enterprise Document Cross-Enterprise Document SharingSharing
Referenced standard
(e.g. HL7)Detailed messaging info --------------------------Roles
Integration Profile
Actor Actor Actor…
Tra
nsac
tion
Tra
nsac
tion
Tra
nsac
tion
Tra
nsac
tion
Tra
nsac
tion
………
Solves an Integration Problem: A collection of real world information exchange capabilities supported by a set of specific Actors using Standards-based Transactions
19
The Product World…..The Product World…..
Product XYZfrom Vendor T
20
The IHE World….The IHE World….
IHE ActorIHE Actor
ActorActorActorActor
ActorActor
IHEIHETransactionTransactionIHEIHE
TransactionTransaction
IHEIHETransactionTransaction
IHE ActorIHE Actor
21
Mapping IHE to ProductsMapping IHE to Products
Product XYZfrom Vendor T
IHE ActorIHE Actor
ActorActorActorActor
ActorActor
IHEIHETransactionTransactionIHEIHE
TransactionTransaction
IHEIHETransactionTransaction
IHE ActorIHE Actor
22
IHE and Service Oriented ArchitecturesIHE and Service Oriented Architectures
SOA is a powerful business driven design methodologySOA is a powerful business driven design methodology
SOA “wraps” interoperability in “services”, but does not SOA “wraps” interoperability in “services”, but does not solve interoperability:solve interoperability:
E.g. Web Services may or may not be used in SOA. IHE Profiles are E.g. Web Services may or may not be used in SOA. IHE Profiles are largely (not always) based on Web Services.largely (not always) based on Web Services.
Standardizing Services “offered” along with the “protocols” is 20 Standardizing Services “offered” along with the “protocols” is 20 years old (Open System Interconnect). Good, but a precise Service years old (Open System Interconnect). Good, but a precise Service definition does not result in compatibility “on the wire”.definition does not result in compatibility “on the wire”.
IHE Integration profiles are supportive of Service Oriented IHE Integration profiles are supportive of Service Oriented Architecture, but do not “require” them. Service Aware !Architecture, but do not “require” them. Service Aware !
Bits have to be compatible on the wire: Bits have to be compatible on the wire: No way to avoid specifying transaction & No way to avoid specifying transaction &
contentcontent
23
Standards Adoption ProcessStandards Adoption Process
Document Use Case Document Use Case RequirementsRequirementsDocument Use Case Document Use 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
24
IHE ConnectathonIHE Connectathon
Open invitation to vendor and other Open invitation to vendor and other implementors communityimplementors community
Advanced testing tools (MESA, KUDO, Advanced testing tools (MESA, KUDO, GAZELLE)GAZELLE)
Testing organized and supervised by project Testing organized and supervised by project management teammanagement team
Thousands of cross-vendor tests performedThousands of cross-vendor tests performed
Results recorded and publishedResults recorded and published
25
Massive yearly events :Massive yearly events :70-80 vendors70-80 vendors250-300 engineers250-300 engineers100-120 systems100-120 systems…….integrated in 5 days.integrated in 5 days
IHE ConnectathonsIHE Connectathons
Vendors do not pass…Vendors do not pass…until an IHE Project Manager attest it !until an IHE Project Manager attest it !
Next Connectathon: Next Connectathon: Wien, Austria, April 20-24, 2008Wien, Austria, April 20-24, 2008
26
www.ihe.net/Events/connectathon_results.cfmwww.ihe.net/Events/connectathon_results.cfm
27
Leveraging IHE Integration StatementsLeveraging IHE Integration Statements
VendorsVendors Claim IHE Compliance in an explicit wayClaim IHE Compliance in an explicit way Can rely on an objective and thorough specificationCan rely on an objective and thorough specification
(IHE Technical Framework)(IHE Technical Framework) Willing to accept contractual commitments Willing to accept contractual commitments Willing to correct “implementation errors”Willing to correct “implementation errors”
BuyersBuyers Can compare product integration capabilitiesCan compare product integration capabilities Simplify and strengthen their RFPsSimplify and strengthen their RFPs Can leverage a public and objective commitmentCan leverage a public and objective commitment Decreased cost and complexity of interface deployment and Decreased cost and complexity of interface deployment and
managementmanagement
28
Example: 2008 HIMSS Interoperability ShowcaseExample: 2008 HIMSS Interoperability Showcase
Next Demonstration at WoHIT, Next Demonstration at WoHIT, Copenhagen, Nov 4-6, 2008Copenhagen, Nov 4-6, 2008
29
Feb 2008 HIMSS Interoperability ShowcaseFeb 2008 HIMSS Interoperability Showcase
Next Demonstration at WoHIT, Next Demonstration at WoHIT, Copenhagen, Nov 4-6, 2008Copenhagen, Nov 4-6, 2008
30
Featured this year in the HIMSS Showcase…Featured this year in the HIMSS Showcase…
76 connected applications, 32 IHE profiles76 connected applications, 32 IHE profiles
Secured Health Information Exchange with Secured Health Information Exchange with broad contentbroad content
Clinical Scenarios, focusing on clinician and Clinical Scenarios, focusing on clinician and patient access and information sharing patient access and information sharing across the continuum of careacross the continuum of care
Population Health, Quality and ResearchPopulation Health, Quality and Research
Privacy and SecurityPrivacy and Security
HITSP Interoperability SpecificationsHITSP Interoperability Specifications
Vendors Vendors ConnectedConnected 5151
SupportersSupporters 2222
TotalTotal 7373
Health information exchange with patient care devicesHealth information exchange with patient care devices
Personal health record solutionsPersonal health record solutions
Financial and administrative systems for billing and claims attachments Financial and administrative systems for billing and claims attachments (CAQH/CORE)(CAQH/CORE)
Expanded distributed demonstration in an HIE format showing connectivity Expanded distributed demonstration in an HIE format showing connectivity with vendor boothswith vendor booths
The 2008 Cast:The 2008 Cast:
31
Providers and VendorsProviders and Vendors
Working Together to DeliverWorking Together to Deliver
Interoperable Health Information Systems Interoperable Health Information Systems
in the Enterprise andin the Enterprise and
Across Care SettingsAcross Care Settings
Health Information Exchange (HIE)Health Information Exchange (HIE)or shared EHRor shared EHR
http://www.ihe.net
32
Requirements for an open HIE/EHRRequirements for an open HIE/EHR
Bring trust and ease of use for healthcare professionals:Bring trust and ease of use for healthcare professionals:
Care delivery organizations choose information to share:Care delivery organizations choose information to share:• Based on patient health statusBased on patient health status
• When they see fit (discharge, end of encounter, etc.)When they see fit (discharge, end of encounter, etc.)
• What information to share (pick relevant types of documents, and content elements).What information to share (pick relevant types of documents, and content elements).
Care delivery organizations access patient information through:Care delivery organizations access patient information through:• their own local EMR (if they have one), or their own local EMR (if they have one), or
• through a shared portal/service otherwise.through a shared portal/service otherwise.
When accessing patient info:When accessing patient info:• Find quickly if relevant information is available or not (single query).Find quickly if relevant information is available or not (single query).
• May select among relevant records, which ones to see (may be done in background)May select among relevant records, which ones to see (may be done in background)
• Among those of interest, chose to import in whole or part in its own EMR patient record Among those of interest, chose to import in whole or part in its own EMR patient record (responsibility).(responsibility).
33
Requirements for an open HIE/EHR(2)Requirements for an open HIE/EHR(2)
Bring trust and privacy to patients:Bring trust and privacy to patients:
Only authorized organizations and authenticated healthcare Only authorized organizations and authenticated healthcare providers may transact in the HIE:providers may transact in the HIE:
• Each node or IT system interfaced is strongly authenticatedEach node or IT system interfaced is strongly authenticated
• Each user shall be authenticated on the edge system (where context is best known)Each user shall be authenticated on the edge system (where context is best known)
• All traffic trough the infrastructure is encryptedAll traffic trough the infrastructure is encrypted
Patient consent needs multiple choices or levelsPatient consent needs multiple choices or levels
• Unless opt-in, no data about a specific patient may be sharedUnless opt-in, no data about a specific patient may be shared
• Several data sharing policies offered to the patient consentSeveral data sharing policies offered to the patient consent
• Each shared record/document is assigned to specific policies (or not shared) Each shared record/document is assigned to specific policies (or not shared) at encounter time.at encounter time.
• Healthcare providers may only access records/documents compatible with Healthcare providers may only access records/documents compatible with their role.their role.
34
Categories of Healthcare Communication ServicesCategories of Healthcare Communication Services
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 Shared EHRs
35
Categories of Healthcare Communication ServicesCategories of Healthcare Communication Services
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 Shared EHRs
Cross-Enterprise Cross-Enterprise Document Sharing (XDS)Document Sharing (XDS)
Patient Id Cross-Patient Id Cross-Referencing (PIX)Referencing (PIX)
Medical Summary Medical Summary (XDS-MS)(XDS-MS)
36
IHE Profiles SpecificationsIHE Profiles Specifications
Go to: Go to: www.www.iheihe.net/Technical_frameworks.net/Technical_frameworks
For XDS:Under IT InfrastructureFor XDS:Under IT Infrastructure IT Infrastructure Technical Framework 5.0 (XDS.b)IT Infrastructure Technical Framework 5.0 (XDS.b) Until 5.0 published: use XDS.b+XDS Stored Query Until 5.0 published: use XDS.b+XDS Stored Query
supplements.supplements.
For PIX:Under IT InfrastructureFor PIX:Under IT Infrastructure IT Infrastructure Technical Framework 4.0 or 5.0 (PIX, IT Infrastructure Technical Framework 4.0 or 5.0 (PIX,
HL7V2)HL7V2) Or PIXV3 supplement (PIX HL7 V3).Or PIXV3 supplement (PIX HL7 V3).
For For XDSXDS-MS: Under Patient Care Coordination-MS: Under Patient Care Coordination PCC Technical framework 3.0PCC Technical framework 3.0
37
Patient Identifier Cross-referencing for MPIPatient Identifier Cross-referencing for MPIServicesServices
Allow all enterprise participants to register the Allow all enterprise participants to register the identifiers they use for patients in their domainidentifiers they use for patients in their domain
Participants retain control over their own Participants retain control over their own domain’s patient index(es)domain’s patient index(es)
Support domain systems’ queries for other Support domain systems’ queries for other systems’ identifiers for their patientssystems’ identifiers for their patients
Optionally, notify domain systems when other Optionally, notify domain systems when other systems update identifiers for their patientssystems update identifiers for their patients
38
Patient Identifier Cross-referencing for MPIPatient Identifier Cross-referencing for MPIValue PropositionValue Proposition
Maintain all systems’ identifiers for a patient in a Maintain all systems’ identifiers for a patient in a single locationsingle location
Use any algorithms (encapsulated) to find matching Use any algorithms (encapsulated) to find matching patients across disparate identifier domainspatients across disparate identifier domains
Lower cost for synchronizing data across systemsLower cost for synchronizing data across systems No need to force identifier and format changes onto existing No need to force identifier and format changes onto existing
systemssystems
Leverages standards and transactions already used Leverages standards and transactions already used within IHE within IHE
39
Patient Identifier Cross-referencing for MPIPatient Identifier Cross-referencing for MPITransaction DiagramTransaction Diagram
40
Patient Identifier Cross-referencing for MPIPatient Identifier Cross-referencing for MPIProcess Flow Showing ID Domains & TransactionsProcess Flow Showing ID Domains & Transactions
Patient Identification Domain A
Other IHE Actor
Identity Patient
Cross References
Patient Identity Consumer
Patient Identification Domain C
Patient Identity
Feed Patient Identity
Source
Patient Identity Cross-reference
Manager
Patient Identification Cross-reference Domain
Patient Identity Feed & Patient Identity References
Internal Domain transactions
Other IHE Actor
Patient Identity Cross References
Patient Identity Consumer
Patient Identification Domain B
Patient Identity
Feed Patient Identity
Source
Internal Domain transactions
41
Patient Identifier Cross-referencing for MPIPatient Identifier Cross-referencing for MPI
Patient Identification Domain A
Patient Identification Domain C
Id=X456 Id=Y921 Id=D456 Id=DF45
Patient Identification
Cross-reference Domain
Patient Identification Domain B
Id=123 Id=235
Id=3TY Id=2RT
Patient Identity Cross-reference Manager
B:X456 = C:2RT A:123 = B:Y921 = C:3TY B:D456 A:235 = B:DF45 A:678
Patient Identity Consumer
B:X456C: 2RT
IdentityPatient
Cross References
B:X456C: ?
42
Patient Identifier Cross-referencing for MPIPatient Identifier Cross-referencing for MPIActorsActors
Patient Identity SourcePatient Identity Source DefinitionDefinition
• Assigns patient identities within its own domainAssigns patient identities within its own domain• Notifies Patient Identifier Cross-reference Manager of all events Notifies Patient Identifier Cross-reference Manager of all events
related to patient identification (creation, merge, etc.)related to patient identification (creation, merge, etc.)• Example: Registration (ADT) Actor in IHE Radiology Scheduled Example: Registration (ADT) Actor in IHE Radiology Scheduled
Workflow (SWF) ProfileWorkflow (SWF) Profile Transaction Supported - RequiredTransaction Supported - Required
• Patient Identity Feed [ITI-8] (as sender)Patient Identity Feed [ITI-8] (as sender)
43
Patient Identifier Cross-referencing for MPIPatient Identifier Cross-referencing for MPIActorsActors
Patient Identifier Cross-reference ConsumerPatient Identifier Cross-reference Consumer DefinitionDefinition
• Requires information about patient identifiers in other domainsRequires information about patient identifiers in other domains• Requests patient identifier information from Patient Identifier Requests patient identifier information from Patient Identifier
Cross-reference ManagerCross-reference Manager Transaction Supported - RequiredTransaction Supported - Required
• PIX Query [ITI-9] (as sender)PIX Query [ITI-9] (as sender) Transaction Supported - OptionalTransaction Supported - Optional
• PIX Update Notification [ITI-10] (as receiver)PIX Update Notification [ITI-10] (as receiver)
44
Patient Identifier Cross-referencing for MPIPatient Identifier Cross-referencing for MPIActorsActors
Patient Identifier Cross-reference ManagerPatient Identifier Cross-reference Manager DefinitionDefinition
• Serves a well-defined set of Patient Identifier DomainsServes a well-defined set of Patient Identifier Domains• Receives patient identifier information from Patient Identity Source Receives patient identifier information from Patient Identity Source
ActorsActors• Manages cross-referencing of identifiers across domainsManages cross-referencing of identifiers across domains
Transactions Supported - RequiredTransactions Supported - Required• Patient Identity Feed [ITI-8] (as receiver)Patient Identity Feed [ITI-8] (as receiver)• PIX Query [ITI-9] (as receiver)PIX Query [ITI-9] (as receiver)• PIX Update Notification [ITI-10] (as sender)PIX Update Notification [ITI-10] (as sender)
45
Patient Identifier Cross-referencing for MPIPatient Identifier Cross-referencing for MPIStandards Used: 2 ProfilesStandards Used: 2 Profiles
PIX: HL7 Version 2.5PIX: HL7 Version 2.5 ADT Registration and Update Trigger EventsADT Registration and Update Trigger Events
• A01: inpatient admissionA01: inpatient admission• A04: outpatient registrationA04: outpatient registration• A05: pre-admissionA05: pre-admission• A08: patient updateA08: patient update• A40: merge patientA40: merge patient
Queries for Corresponding Identifiers Queries for Corresponding Identifiers (ADT^Q23/K23)(ADT^Q23/K23) Notification of Identifiers Lists Updates Notification of Identifiers Lists Updates (ADT^A31)(ADT^A31)
PIX V3: HL7 V3PIX V3: HL7 V3 Leverage Web Services (harmonized WS by IHE Leverage Web Services (harmonized WS by IHE
Appendix V)Appendix V)
46
PIX Integration Profile & MPIPIX Integration Profile & MPIThe typical viewThe typical view
Patient Identification Domain C
Patient Identity Cross-reference Manager
Patient Identification Domain A(Master Domain)
Patient Identification Domain B
Master (A) PatientIdentity Source
PIX Server acting as MPI
47
PIX Integration Profile & MPIPIX Integration Profile & MPI The Equivalent IHE ModelThe Equivalent IHE Model
Patient Identification Domain C
Patient Identity Cross-reference Manager
Patient Identification Domain A(Master Domain)
Patient Identification Domain B
Master (A) PatientIdentity Source
Linking PIX Server
48
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
49
Health Information Exchanges Interoperability: Health Information Exchanges Interoperability: Cross-enterprise Document SharingCross-enterprise Document Sharing
Cross-Enterprise Document Sharing simplifies clinical Cross-Enterprise Document Sharing simplifies clinical data management by defining interoperable infrastructure. data management by defining interoperable infrastructure.
Transparency = Ease of EvolutionTransparency = Ease of Evolution
Patients have guaranteed portability and providers may Patients have guaranteed portability and providers may share information without concerns of aggregation errors.share information without concerns of aggregation errors.Digital Documents = Patients Digital Documents = Patients andand providers empowerment providers empowerment
Supports Supports both centralized and decentralizedboth centralized and decentralized repository repository architectures. Ease of architectures. Ease of federationfederation nationally. nationally. Flexible Flexible privacy, privacy, Flexibility of configurationsFlexibility of configurations
Addresses the need for a longitudinal healthcare data Addresses the need for a longitudinal healthcare data (health records). Complements to interactive workflow or (health records). Complements to interactive workflow or dynamic access to data. dynamic access to data.
50
Cross-Enterprise Document Sharing (XDS) Cross-Enterprise Document Sharing (XDS) Standards UsedStandards Used
HealthcareContent StandardsHL7 CDA header extract
Internet StandardsHTML, HTTP,ISO, IETF …
Electronic BusinessStandards
ebXML Registry, SOAP, Web Services …
Implemented world-wide by close to 100 vendors/open Implemented world-wide by close to 100 vendors/open source.source.
Adopted in several national & regional projects:Adopted in several national & regional projects:Italy, Austria, Canada, USA, Japan, South Africa, France, etc.)Italy, Austria, Canada, USA, Japan, South Africa, France, etc.)
51
Why is IHE-XDS a breakthrough ?Why is IHE-XDS a breakthrough ?
It based on an International Standards; ebXML registry: OASIS and It based on an International Standards; ebXML registry: OASIS and ISO standard, Web Service/Soap/XML.ISO standard, Web Service/Soap/XML.
Sharing of digital documents as “attested by the source”, meets the Sharing of digital documents as “attested by the source”, meets the most urgent needs. A most urgent needs. A provenproven healthcare community healthcare community data-sharingdata-sharing paradigm (paradigm (Message feeding a central web server hinders use of EHRsMessage feeding a central web server hinders use of EHRs).).
Efficient to support Efficient to support all types of Health IT Systemsall types of Health IT Systems (IDNs, Hospitals, (IDNs, Hospitals, Ambulatory, Pharmacy, Diagnostics Centers, etc.) and Ambulatory, Pharmacy, Diagnostics Centers, etc.) and all types of all types of informationinformation (summaries, meds, images, lab reports, ECGs, etc.), (summaries, meds, images, lab reports, ECGs, etc.), structured and unstructuredstructured and unstructured..
Meets both the needs of push communication by info sources and on-Meets both the needs of push communication by info sources and on-demand pull in a variety of centralized or distributed architectures.demand pull in a variety of centralized or distributed architectures.
Offer a consistent, standards-based and functional Offer a consistent, standards-based and functional record sharing for EHRs, PHRs & other IT Systemsrecord sharing for EHRs, PHRs & other IT Systems
52
Combining IHE ProfilesCombining IHE ProfilesDocument Content & Modes of Document ExchangeDocument Content & Modes of Document Exchange
Document Exchange Integration ProfilesDocument Exchange Integration Profiles
DocumentDocument SharingSharing
XDSXDS
MediaMediaInterchangeInterchange
XDMXDM
Reliable Pt-PtReliable Pt-PtInterchangeInterchange
XDRXDR
Doc Content Profiles Doc Content Profiles (Semantics content)(Semantics content)
Scanned DocScanned Doc
XDS-SDXDS-SD
LaboratoryLaboratory
XD*-LabXD*-LabPHR PHR
ExchangeExchange
XPHRXPHR
Discharge &Discharge &ReferralsReferrals
XDS-MSXDS-MS
ImagingImaging
XDS-IXDS-I
ConsentConsent
BPPCBPPCEmergencyEmergency
EDREDRPre-Pre-
SurgerySurgery
PPHPPPHP
Functional Status Functional Status AssesmentAssesment
FSAFSA
53
Acute Care (Hospital)
GPs and Clinics (Ambulatory)
Long Term Care
Other Specialized Care(incl. Diagnostics Services)
Continuity of Care: Patient Longitudinal RecordPatient Longitudinal Record
Typically, a patient goes through a sequence of encounters in different Care Settings
54
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
55
Cross-Enterprise Document Sharing (XDS.b) Cross-Enterprise Document Sharing (XDS.b) Actor/Transaction DiagramActor/Transaction Diagram
Document Consumer
Retrieve Document Set
Query Documents
Patient Identity Source
Patient Identity Feed
Document Source
Document Registry
Document Repository
Provide&Register Document Set
Register Document Set
56
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.
57
XDS - Value PropositionXDS - Value Proposition
Distributed: Each Care delivery organization “publishes” clinical information for others. Actual documents may remain in the source EHR
Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain (e.g. a region).
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.
58
XDS DocumentXDS Document
XDS Submission SetXDS Submission Set
XDS FolderXDS Folder
IHE XDS Integration Profile: Key ConceptsKey Concepts
59
Document Repository and RegistryDocument Repository and RegistryExample of Submission RequestExample of Submission Request
Document RepositoriesDocument Repositories
Document RegistryDocument RegistrySubmission RequestSubmission Request
Document
Document
DocumentEntry
DocumentEntry
SubmissionSet1
Folder A
60
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 recordform an element of a patient record to be shared. It may 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 clinician(s) in the same source systemthe same source system have decided to make have decided to make available at available at one point in timeone point in time to potential consumers. 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
61
How real is XDS ?How real is XDS ?Stable specification IHE Technical Framework Published Stable specification IHE Technical Framework Published Aug 15Aug 15thth, 2004 (TI Supplement), 2004 (TI Supplement)
XDS.b Supplement that offers:XDS.b Supplement that offers: Use most recent Web Services stds (MTOM/XOP)Use most recent Web Services stds (MTOM/XOP) Allow Retrieve sets of Documents in one transactionAllow Retrieve sets of Documents in one transaction Same servicesSame services
First implementation in clinical use in region of Genoa - First implementation in clinical use in region of Genoa - Italy) since early 2006.Italy) since early 2006.
Several since: Lower Austria region, State of Vermont, Several since: Lower Austria region, State of Vermont, Nagoya city, South Africa region, 2 Dutch regions, etc.Nagoya city, South Africa region, 2 Dutch regions, etc.
Adopted by several national programs world-wideAdopted by several national programs world-wide
4 open source toolkits available, numerous product 4 open source toolkits available, numerous product implementations in EHRs and Infrastructure offerings.implementations in EHRs and Infrastructure offerings.
62
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)
THINC- New YorkNCHICA – N. Carolina
Italy (Conto Corrente
Salute)
Boston Medical
Center - MA
FranceDMP
UK CfH(Radiology WF)
Philadelphia HIE
CHINA-MoHLab results sharing
CPHIC – Pennsylvani
a
CHINA-ShanghaiImaging Info Sharing
JAPAN-NagayaImaging Info Sharing
South Africa
Malaysia
VITL-Vermont
CareSpark – TN & VA
NetherlandAmsterdam
LowerAustria
Austria
63
IHE-XDS is part of a family of profilesIHE-XDS is part of a family of profiles
Regional, national, local or disease centric networks need Regional, national, local or disease centric networks need a consistent set of Integration Profilesa consistent set of Integration Profiles
EightEight Integration Profiles completed and tested, plus Integration Profiles completed and tested, plus tenten ready to implement = Standards-based interoperability ready to implement = Standards-based interoperability building blocks forbuilding blocks for Rich Document Content for end-to-end application interoperability.Rich Document Content for end-to-end application interoperability. Patient identification managementPatient identification management Security and privacySecurity and privacy Notification and data captureNotification and data capture
IHE-XDS + related IHE Integration profiles provide a IHE-XDS + related IHE Integration profiles provide a complete interoperability solutioncomplete interoperability solution
64
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
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 Assertion
Provides Trusted Identity
65
XDS-MS and XPHR enable both semantic XDS-MS and XPHR enable both semantic interoperability & simple viewing !interoperability & simple viewing !
SSttrruuccttuurreedd CCoonntteenntt wwii tthh ccooddeedd sseecctt iioonnss::
Reason for Referral Vital Signs
MMeeddiiccaattiioonn
Studies AAlllleerrggiieess
Social History PPrroobblleemmss
Care Plan
XDS-MS Medical Summary or PHR Extract ExchangeXDS-MS Medical Summary or PHR Extract ExchangeProfile based on HL7 CDA Rel 2 and HL7 CCD IGProfile based on HL7 CDA Rel 2 and HL7 CCD IG
Structured and Coded Header Patient, Author, Authenticator, Institution, Time of Service, etc.
Header always structured and coded
Title-coded sections with non-structured nor coded content (text, lists, tables). Simple Viewing (XML Style sheet)
Level 1Level 1
Level 2Level 2
Text StructureEntry
Text Structure Entry
Med, Problems and Allergies as highly structured text. Text easy to import/parse
Text StructureEntry
Level 3Level 3
Med Problems and Allergies have afine-grain structure with optional coding. Coding Scheme explicitly identified.
Coded Section Entry
Coded Section Entry
Coded Section Entry
Level 3Level 3
66
Use of a shared XDS infrastructure to access Use of a shared XDS infrastructure to access Radiology Reports and Images (XDS-I)Radiology Reports and Images (XDS-I)
HospitalHospital
Imaging CenterImaging CenterPhysician PracticePhysician Practice
Between Radiology and :Between Radiology and :• Imaging specialistsImaging specialists• Non-imaging cliniciansNon-imaging clinicians PACS Y
PACS Z
Radiology -to-Radiology -to-RadiologyRadiology
Radiology -to-Radiology -to-PhysiciansPhysicians
Same XDS InfrastructureSame XDS Infrastructure (Registry and Repositories) (Registry and Repositories)
for medical summaries and imaging information !for medical summaries and imaging information !
67
Community Clinic
Lab Info. System
PACS
Teaching Hospital
PACS
ED Application
EHR System
Physician Office
EHR System
XDS Scenario + use of ATNA & CTXDS Scenario + use of ATNA & CT
PMS
Retrieve DocumentRetrieve Document
Register DocumentRegister DocumentQuery DocumentQuery Document
XDS Document Registry
ATNA Audit record repository CT Time server
Record AuditRecord AuditEventEvent
MaintainMaintainTimeTime
MaintainMaintainTimeTimeRecord AuditRecord Audit
EventEvent
Maintain TimeMaintain TimeProvide & Register Docs
Record AuditRecord AuditEventEvent
XDS Document Repository
XDSDocumen
t Reposito
rySecured MessagingSecured Messaging
68
Community Clinic
Lab Info. System
PACS
Teaching Hospital
PACS
ED Application
EHR System
Physician Office
EHR System
XDS Scenario + use of PIX & PDQXDS Scenario + use of PIX & PDQ
A87631
PACS
L-716
Affinity Domain Patient Identity Source
M8354673993
Retrieve Document Provide & Register Docs
Register (using Pt ID)Query Document (using Pt Id)
Patient Identity Feed
Document Registry
14355M8354673993
L-716
A87631
Patient Identity Feed
PIX Query
PIX Query
Patient Identity Feed
Patient Identity XRef MgrPatient Identity FeedPDQ Query to Acquire Affinity Domain Patient ID
M8354673993
A87631L-716
M8354673993
XDS Document Repository
XDSDocument
Repository
ATNA Audit record repository CT Time server
69
Providers and VendorsProviders and Vendors
Working Together to DeliverWorking Together to Deliver
Interoperable Health Information Systems Interoperable Health Information Systems
in the Enterprise in the Enterprise
AndAnd Across Care SettingsAcross Care Settings
Intra Hospital Workflows and Information AccessIntra Hospital Workflows and Information Access
http://www.ihe.net
70
IHE Solutions within the EnterpriseIHE Solutions within the Enterprise
eMPIeMPIUser AuthUser Auth
EnterpriseEnterpriseIT InfrastructureIT Infrastructure
LaboratoryLaboratory
LISLIS
Auto MgrAuto Mgr AnalyzerAnalyzer
EMR - HISEMR - HISEMR - HISEMR - HIS
CardiologyCardiology
CISCIS
CathCath ECGECG
RadiologyRadiology
RISRIS
PACSPACSImg AcqImg Acq
Eye CareEye Care
PathologyPathology
Radiation TherapyRadiation Therapy
Therapy PlanTherapy Plan
Img AcqImg AcqTreatmentTreatment
Intensive Care UnitIntensive Care Unit
Nursing StationNursing Station
DevicesDevicesDevicesDevices
HomeHomeHubHub
DevicesDevicesPharmacyPharmacy
Being establishedBeing established
71
IHE Solutions within the Enterprise IHE Solutions within the Enterprise Example: CardiologyExample: Cardiology
RadiologyRadiology CardiologyCardiology LaboratoryLaboratory
EnterpriseEnterpriseIT InfrastructureIT Infrastructure
EMR - HISEMR - HIS
RISRIS
PACSPACSImg AcqImg Acq
CISCIS
CathCath ECGECG
LISLIS
Auto MgrAuto Mgr AnalyzerAnalyzer
-Radiation-Radiation Therapy Therapy
-Patient Care-Patient Care Devices Devices
-Pathology-Pathology
-Eye Care-Eye Care
Cardiology Integration ProfilesCardiology Integration ProfilesCardiac Catheterization Lab WorkflowCardiac Catheterization Lab Workflow
Echocardiography Lab WorkflowEchocardiography Lab Workflow
Retrieve ECG for DisplayRetrieve ECG for Display
Displayable ReportsDisplayable Reports
Cath and Echo Evidence DocumentsCath and Echo Evidence Documents
eMPIeMPIUser AuthUser Auth
72
IHE Solutions within the EnterpriseIHE Solutions within the EnterpriseIT Infrastructure (Enterprise)IT Infrastructure (Enterprise)
RadiologyRadiology CardiologyCardiology LaboratoryLaboratory
RISRIS
PACSPACSImg AcqImg Acq
CISCIS
CathCath ECGECG
LISLIS
Auto MgrAuto Mgr AnalyzerAnalyzer
-Radiation-Radiation Therapy Therapy
-Patient Care-Patient Care Devices Devices
-Pathology-Pathology
-Eye Care-Eye Care
eMPIeMPIUser AuthUser Auth
EMR - HISEMR - HIS
IT Infrastructure Integration ProfilesIT Infrastructure Integration ProfilesPatient Administration ManagementPatient Administration Management
Patient Demographics Query Patient Demographics Query
Patient Identifier Cross-referencingPatient Identifier Cross-referencing
Retrieve Information for DisplayRetrieve Information for Display
Enterprise User AuthenticationEnterprise User Authentication
Consistent TimeConsistent Time
Patient Synchronized ApplicationsPatient Synchronized Applications
Audit Trail and Node AuthenticationAudit Trail and Node Authentication
Personnel White PagesPersonnel White Pages
Shared Value SetsShared Value Sets
EnterpriseEnterpriseIT InfrastructureIT Infrastructure
73
IHE Solutions within the Enterprise IHE Solutions within the Enterprise RadiologyRadiology
RadiologyRadiology CardiologyCardiology LaboratoryLaboratory
EnterpriseEnterpriseIT InfrastructureIT Infrastructure
EMR - HISEMR - HIS
RISRIS
PACSPACSImg AcqImg Acq
CISCIS
CathCath ECGECG
LISLIS
Auto MgrAuto Mgr AnalyzerAnalyzer
-Radiation-Radiation Therapy Therapy
-Patient Care-Patient Care Devices Devices
-Pathology-Pathology
-Eye Care-Eye Care
eMPIeMPIUser AuthUser Auth
Radiology Integration ProfilesRadiology Integration Profiles
Radiology Scheduled WorkflowRadiology Scheduled Workflow
Patient Information ReconciliationPatient Information Reconciliation
Access to Radiology InformationAccess to Radiology Information
Portable Data for ImagingPortable Data for Imaging
Consistent Presentation of ImagesConsistent Presentation of Images
Key Image NoteKey Image Note
Presentation of Grouped ProceduresPresentation of Grouped Procedures
Evidence DocumentsEvidence Documents
Audit trail and Node Authentication Audit trail and Node Authentication (Rad option)(Rad option)
Teaching Files and Clinical Trials ExportTeaching Files and Clinical Trials Export
Post-processing WorkflowPost-processing Workflow
Reporting WorkflowReporting Workflow
Charge PostingCharge Posting
Simple Image and Numeric ReportsSimple Image and Numeric Reports
How to use IHE ?How to use IHE ?
IHEIHE Radiology Radiology
HandbookHandbook
74
IHE Solutions within the Enterprise IHE Solutions within the Enterprise Example: Example: LaboratoryLaboratory
RadiologyRadiology CardiologyCardiology LaboratoryLaboratory
EnterpriseEnterpriseIT InfrastructureIT Infrastructure
EMR - HISEMR - HIS
RISRIS
PACSPACSImg AcqImg Acq
CISCIS
CathCath ECGECG
LISLIS
Auto MgrAuto Mgr AnalyzerAnalyzer
-Radiation-Radiation Therapy Therapy
-Patient Care-Patient Care Devices Devices
-Pathology-Pathology
-Eye Care-Eye Care
Laboratory Integration ProfilesLaboratory Integration ProfilesLaboratory Testing WorkflowLaboratory Testing Workflow
Laboratory Information Reconciliation Laboratory Information Reconciliation
Laboratory Point Of Care TestingLaboratory Point Of Care Testing
Laboratory Device Automation Laboratory Device Automation
Laboratory Code Set DistributionLaboratory Code Set Distribution
Laboratory BarCodeLaboratory BarCode
eMPIeMPIUser AuthUser Auth
75
General scope of LAB TFGeneral scope of LAB TF
Ordering, placing, scheduling and performing clinical Ordering, placing, scheduling and performing clinical
laboratory tests on in vitro specimen, within acute care laboratory tests on in vitro specimen, within acute care
settingssettings
Tests in lab as well as at the point of care. Chemistry and Tests in lab as well as at the point of care. Chemistry and
Microbiology included with thorough examplesMicrobiology included with thorough examples
Sharing laboratory reports within a wide community of care Sharing laboratory reports within a wide community of care
providersproviders
Anatomic pathology addressed by a separate domain in IHEAnatomic pathology addressed by a separate domain in IHE
76
Organization of LAB Technical Framework rel 2.1Organization of LAB Technical Framework rel 2.1
Volume 1: Use Cases, Profiles, actors, dependenciesVolume 1: Use Cases, Profiles, actors, dependencies
Volume 2: Description of message-based transactionsVolume 2: Description of message-based transactions
Volume 3: Document-based transaction (lab report)Volume 3: Document-based transaction (lab report)
Volume 4: Common subset of LOINC test codesVolume 4: Common subset of LOINC test codes
Openly available at: Openly available at: www.ihe.net/technicalwww.ihe.net/technical__frameworksframeworks
77
Lab TF Rel 2: Integration ProfilesLab TF Rel 2: Integration ProfilesW
orkflowW
orkflowC
ontentC
ontent
Laboratory Testing Workflow (LTW)Laboratory Device Automation (LDA)Laboratory Point Of Care Testing (LPOCT)Laboratory Code Sets Distribution (LCSD)Laboratory Barcode Labeling (LBL)
Sharing Laboratory Reports (XD-LAB)V3:V3:
CDA CDA
V2.5V2.5
HL7HL7
Subset of LO
INC
test S
ubset of LOIN
C test
codescodes
78
Dependencies toward IHE IT InfrastructureDependencies toward IHE IT Infrastructure
79
Lab TF Rel 2: Integration ProfilesLab TF Rel 2: Integration ProfilesW
orkflowW
orkflowC
ontentC
ontent
Laboratory Testing Workflow (LTW)Laboratory Device Automation (LDA)Laboratory Point Of Care Testing (LPOCT)Laboratory Code Sets Distribution (LCSD)Laboratory Barcode Labeling (LBL)
Sharing Laboratory Reports (XD-LAB)V3:V3:
CDA CDA
V2.5V2.5
HL7HL7
Subset of LO
INC
test S
ubset of LOIN
C test
codescodes
80
Laboratory Testing Workflow (LTW) Laboratory Testing Workflow (LTW) & Laboratory Device Automation (LDA)& Laboratory Device Automation (LDA)
Order FillerOrder Placer
Order Result Tracker
Placer order
Filler order
ResultsResults Work order
LTW LDA
Work Order Steps
Query & download modes
AnalyzerPre/post
processor
Automation Manager
Tests results
Profiles based on HL7 V2.5.1Profiles based on HL7 V2.5.1Solid implementation experienceSolid implementation experience
81
IHE Profiles SpecificationsIHE Profiles Specifications
Go to: Go to: www.www.iheihe.net/Technical_frameworks.net/Technical_frameworks
For LTW:Under LaboratoryFor LTW:Under Laboratory Laboratory Technical Framework 2.1 (LTW, LDA)Laboratory Technical Framework 2.1 (LTW, LDA)
82
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
http://www.ihe.net
83September, 2005 What IHE Delivers
Coffee BreakCoffee Break
84
AgendaAgenda
08:30-10:30 THE IHE STANDARDS ADOPTION PROCESS: 08:30-10:30 THE IHE STANDARDS ADOPTION PROCESS: achieving practical interoperability achieving practical interoperability - - Charles ParisotCharles Parisot
Coffee BreakCoffee Break
11:00-12:30 USERS AND VENDORS WORKING 11:00-12:30 USERS AND VENDORS WORKING TOGETHER: how can I contribute & benefit from TOGETHER: how can I contribute & benefit from IHE IHE – Charles Parisot– Charles Parisot
Lunch BreakLunch Break
13:30-15:00 HOW TO USE IHE RESOURCES: hands on 13:30-15:00 HOW TO USE IHE RESOURCES: hands on experience experience – Eric Poiseau– Eric Poiseau
85
Understanding the IHE InitiativeUnderstanding the IHE Initiative
IHE has a clear focusIHE has a clear focus
IHE is a healthcare domain-based initiativeIHE is a healthcare domain-based initiative
IHE creates synergies for interoperability testing IHE creates synergies for interoperability testing across domainsacross domains
IHE addresses the standards adoption processIHE addresses the standards adoption process
IHE is both regional and multi-nationalIHE is both regional and multi-national
IHE is both user lead and vendor drivenIHE is both user lead and vendor driven
86
Standards Adoption ProcessStandards Adoption Process
Document Use Case Document Use Case RequirementsRequirementsDocument Use Case Document Use 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
878787
IHE Organizational StructureIHE Organizational Structure
Contributing &Participating
Vendors
Regional Deployment
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
Global Development
Radiology
Cardiology
ITInfrastructure
Patient CareCoordination
Patient CareDevices
Laboratory
Pathology
Eye CareRadiationOncology
Public Health, Quality and Research
IHE International Board
888888
IHE SponsorsIHE SponsorsProfessional societies (stakeholder representation)Professional societies (stakeholder representation)
Healthcare Information Management Systems Society (HIMSS)Healthcare Information Management Systems Society (HIMSS) Radiological Society of North America (RSNA)Radiological Society of North America (RSNA) British Institute of Radiology (BIR), British Computer Society (BCSBritish Institute of Radiology (BIR), British Computer Society (BCS German Radiology Society (DRG)German Radiology Society (DRG) GMSIH (IT France), SFIL (laboratory), French National Project (DMP)GMSIH (IT France), SFIL (laboratory), French National Project (DMP) European Society of CardiologyEuropean Society of Cardiology …………Many other European SocietiesMany other European Societies American College of Physicians (ACP), American College of American College of Physicians (ACP), American College of
Emergency Physicians (ACEP) Emergency Physicians (ACEP) ……Many other American healthcare societies (ACCE), (AAO), Many other American healthcare societies (ACCE), (AAO),
(ASTRO), etc.(ASTRO), etc. JAHIS (IT Japan), and many other Japanese SocietiesJAHIS (IT Japan), and many other Japanese Societies And many more….And many more….
89
IHE Participants and RelationshipsIHE Participants and RelationshipsParticipants include:Participants include: Users - Clinicians, Staff, Administrators, CIOs, GovernmentsUsers - Clinicians, Staff, Administrators, CIOs, Governments Vendors of Information Systems and EquipmentVendors of Information Systems and Equipment ConsultantsConsultants
Relationship with Standards Development Organizations Relationship with Standards Development Organizations (SDOs):(SDOs): HL7, DICOM, ISO, CDISC, ASTM, W3C, IEEE, IETF, and many othersHL7, DICOM, ISO, CDISC, ASTM, W3C, IEEE, IETF, and many others Approved via ISO/TC 215 allowing for IHE profiles to be published as Approved via ISO/TC 215 allowing for IHE profiles to be published as
ISO deliverablesISO deliverables
National Adoption of Healthcare IT Standards and IHE ProfilesNational Adoption of Healthcare IT Standards and IHE Profiles DMP(France), ELGA(Austria), HITSP (USA), Infoway (Canada), many DMP(France), ELGA(Austria), HITSP (USA), Infoway (Canada), many
others worldwide…..others worldwide…..
909090
IHE Organizational StructureIHE Organizational Structure
Contributing &Participating
Vendors
Regional Deployment
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
Global Development
Radiology
Cardiology
ITInfrastructure
Patient CareCoordination
Patient CareDevices
Laboratory
Pathology
Eye CareRadiationOncology
Public Health, Quality and Research
IHE International Board
91
IHE International Governance - MembershipIHE International Governance - Membership
Membership: Membership: www.ihe.net/governancewww.ihe.net/governance Members are Organizations–Sign Governance & IP once.Members are Organizations–Sign Governance & IP once. Three Organizational Categories: User, Developer, General Three Organizational Categories: User, Developer, General
InterestInterest Member designates a primary/alternate representatives to Member designates a primary/alternate representatives to
one of more Committees (Domains, Test& Tools, MarCom).one of more Committees (Domains, Test& Tools, MarCom). Voting rights lost after three missed meetings, regained at Voting rights lost after three missed meetings, regained at
second meetingsecond meeting Elect Committee (or sub-Committee) co-chairs. One User Elect Committee (or sub-Committee) co-chairs. One User
& one vendor recommended for Planning Committees& one vendor recommended for Planning Committees Regional and National IHE Committee members required to Regional and National IHE Committee members required to
become members of IHE International.become members of IHE International.
92
IHE International Governance – Others CommitteesIHE International Governance – Others Committees
IHE Regional or National Deployment Committees are IHE Regional or National Deployment Committees are independent entities with their own governance but close independent entities with their own governance but close collaborative relationship with IHE International. collaborative relationship with IHE International.
IHE International Board empowers “Regional and IHE International Board empowers “Regional and National Committee”. 3 year commitment, renewable. National Committee”. 3 year commitment, renewable.
Oversees Testing and Tools CommitteeOversees Testing and Tools Committee
Coordinates the various Regional and National Committees.Coordinates the various Regional and National Committees.
Oversees Marketing & Communication CommitteeOversees Marketing & Communication Committee
Consistency of communication among Domains within IHE Consistency of communication among Domains within IHE International and various Regional and National Committees.International and various Regional and National Committees.
93
As a Provider or Vendor ContributorAs a Provider or Vendor Contributor
Offer Clinical Use Case Input to Drive IHE Profile DevelopmentOffer Clinical Use Case Input to Drive IHE Profile Development
Become a member of relevant domain’s Planning or Technical Become a member of relevant domain’s Planning or Technical CommitteesCommittees
Become a member of relevant Regional/National CommitteesBecome a member of relevant Regional/National Committees
Help to shape IHE’s future directionHelp to shape IHE’s future direction
As a Vendor ParticipantAs a Vendor Participant
Respond to Public Comments of Domain SupplementsRespond to Public Comments of Domain Supplements
Attend the June Educational WorkshopAttend the June Educational Workshop
Participate in Connect-a-thons and DemonstrationsParticipate in Connect-a-thons and Demonstrations
As a Provider/Consultant ParticipantAs a Provider/Consultant Participant
Respond to Public Comments of Domain SupplementsRespond to Public Comments of Domain Supplements
Attend the June Educational Workshop Attend the June Educational Workshop
Attend Demonstrations and include IHE Integration Profiles in your RFPs Attend Demonstrations and include IHE Integration Profiles in your RFPs and Integration Projects.and Integration Projects.
How can I participate?How can I participate?
94
What can you do?What can you do?
Learn about IHE, Learn about IHE, www.ihe.netwww.ihe.net
Insist on relevant IHE profiles compliance in Insist on relevant IHE profiles compliance in your RFPs and contract documents:your RFPs and contract documents:
Select Integration Profiles, and Appropriate Select Integration Profiles, and Appropriate Actor(s) Actor(s)
Ask vendors for their products “IHE Ask vendors for their products “IHE Integration Statements”.Integration Statements”.
Need more interoperability ? Need more interoperability ?
Contribute to IHE CommitteesContribute to IHE Committees
95
IHE Web site:IHE Web site: www.IHE .netwww.IHE .net Frequently AskedFrequently Asked QuestionsQuestions
Integration Profiles in Technical Frameworks: Integration Profiles in Technical Frameworks: See Volume 1 of each TF for Use casesSee Volume 1 of each TF for Use cases
CardiologyCardiology Eye CareEye Care IT InfrastructureIT Infrastructure LaboratoryLaboratory Patient Care CoordinationPatient Care Coordination Patient Care DevicesPatient Care Devices PathologyPathology QualityQuality Radiation Oncology Radiation Oncology RadiologyRadiology
Connectathon Result: Connectathon Result: www.ihe.net/Events/connectathon_results.cfmwww.ihe.net/Events/connectathon_results.cfm
Vendor Products Integration StatementsVendor Products Integration Statements
96
How to ParticipateHow to Participate
As a User or Vendor Committee MemberAs a User or Vendor Committee Member
Become a member of relevant Domains Planning Become a member of relevant Domains Planning or Technical Committeesor Technical Committees
As a User, Consultant or Vendor Interested As a User, Consultant or Vendor Interested ObserverObserver
Provide Public Comments on Technical Provide Public Comments on Technical Framework SupplementsFramework Supplements
Attend Demonstrations, Educational Events and Attend Demonstrations, Educational Events and WorkshopsWorkshops
97
More Resources - More Resources - www.www.iheihe.net.net
Frequently Asked QuestionsFrequently Asked Questions
Integration Profiles in Technical Frameworks:Integration Profiles in Technical Frameworks: CardiologyCardiology IT InfrastructureIT Infrastructure LaboratoryLaboratory Patient Care CoordinationPatient Care Coordination Patient Care DevicesPatient Care Devices Radiation OncologyRadiation Oncology RadiologyRadiology
Connectathon ResultsConnectathon Results
Vendor Products Integration StatementsVendor Products Integration Statements
Participation in Committees and ConnectathonsParticipation in Committees and Connectathons
98September, 2005 What IHE Delivers