Interoperability and IHE : solutions for user problems

(1)

INTEGRATING THE

HEALTHCARE ENTERPISE

Interoperability and IHE :

solutions for user problems

IHE

IHE--Europe Europe Connectathon Connectathon WorkshopWorkshop

Charles

(2)

2

Or,

…

_…

.

_.

Realizing the promise of

standardized information

exchange in health

(3)

Connecting standards to reality and care

delivery

Care providers, authorities and IT professionals

work with solutions developers to coordinate

the implementation of standards to meet their

needs

Care providers identify the key interoperability problems

they face

Drive industry to develop and make available

standards-based solutions

Implementers follow common guidelines in purchasing

and integrating systems that deliver these solutions

More than 300 IHE members/stakeholders work together

(4)

4

Standards Adoption Process

Document Use Case Requirements

Document Use Case

Requirements

Identify available standards (e.g. HL7, DICOM, IETF, OASIS)

Identify available

standards (

standards (e.g. HL7, e.g. HL7, DICOM, IETF, OASIS)

DICOM, IETF, OASIS)

Develop technical specifications Develop Develop technical technical specifications specifications Testing at Connectathons Testing at Testing at Connectathons Connectathons _IHE Demonstrations IHE IHE Demonstrations Demonstrations Products with IHE Products Products with IHE with IHE Timely access to information Timely access to Timely access to information

information _{Easy to integrate}

products

Easy to integrate

products

(5)

11 Years of Steady Evolution 1998

11 Years of Steady Evolution 1998 –– 20092009

The IHE Development Domains

Pharmacy NEW 2009 Pathology since 2006 Radiation Oncology since 2004 Radiology since 1998 Cardiology since 2004

Patient Care Devices

since 2005

Patient Care Coordination

since 2004

Eye Care

since 2006

Quality

Research & Public Health

since 2006 Laboratory since 2004 (Healthcare) IT Infrastructure since 2003

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6 6

6

IHE Organizational Structure

Contributing & Participating

Vendors

Regional Deployment

IHE Europe IHE North America

France USA Canada IHE Asia-Oceania Japan Korea Taiwan Netherlands Spain Sweden UK Italy Germany Norway China Austria ACC ACCE ACEP JAHIS JIRA JRS METI-MLHW MEDIS-DC JAMI RSNA SFR SFIL SIRM BIR EuroRec COCIR EAR-ECR DRG ESC

Professional Societies / Sponsors

ACP GMSI HIMSS

IHE International Board

Global Development Radiology Cardiology IT Infrastructure Patient Care Coordination Patient Care Devices Laboratory Pathology Eye Care Radiation Oncology

Public Health, Quality and Research

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International Growth of IHE

France

Local Deployment, National Extensions Promotional & Live Demonstration Events

Over 300 Organizational Members (all stakeholders)

USA USA Germany Germany Italy Italy Japan Japan UK UK Canada Canada Taiwan Taiwan Netherlands Netherlands Spain Spain Austria Austria 1 9 9 9 2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3 2 0 0 4 2 0 0 5 2 0 0 6 2 0 0 7 2 0 0 9 2 0 0 8 Australia Australia 2 0 1 0 China China Turkey Turkey Malaysia Malaysia Switzerland Switzerland

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8

An Alternative ?

Have each project s

Have each project selects independently their standards:elects independently their standards: The same requirement addressed with a different mix of

The same requirement addressed with a different mix of

standards in different projects

Large effort and time needed for detailed interoperability

specifications (12 to 24 months, several man years)

Even larger effort to develop custom conformance test

tools, and organize own testing efforts (many man years).

Initial implementation cost are very high, and on

Initial implementation cost are very high, and on--going going costs only increase. No reuse benefit from other

costs only increase. No reuse benefit from other eHealtheHealth projects. projects.

Projects shall drive their own requirements but address Projects shall drive their own requirements but address them by reusing as much as possible robust standards

them by reusing as much as possible robust standards- -based profiles specifications

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IHE Sponsors

Professional societies:

Healthcare Information Management Systems Society (HIMSS)Healthcare Information Management Systems Society (HIMSS)

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 Cardiology……European Society of Cardiology……Many other European SocietiesMany other European Societies

Radiological Society of North America (RSNA) Radiological Society of North America (RSNA)

American College of Physicians (ACP), American College of Emergency American College of Physicians (ACP), American College of Emergency Physicians (ACEP)

Physicians (ACEP) ……Many other American healthcare societies (ACCE), (AAO), Many other American healthcare societies (ACCE), (AAO), (ASTRO), etc.

(ASTRO), etc.

JAHIS (IT Japan), JIRA, JRS…JAHIS (IT Japan), JIRA, JRS….Many other Japanese Societies.Many other Japanese Societies

And many more…And many more…..

Governmental Agencies:

French National Project (ASIP)French National Project (ASIP)

Dutch National Project (NICTIZ)Dutch National Project (NICTIZ)

Austrian National Project (ELGA)Austrian National Project (ELGA)

Canada Health Infoway Canada Health Infoway (CHI)(CHI)

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10

Standards Adoption Process

Document Use Case Requirements

Document Use Case

Requirements

Identify available standards (e.g. HL7, DICOM, IETF, OASIS)

Identify available

standards (

standards (e.g. HL7, e.g. HL7, DICOM, IETF, OASIS)

DICOM, IETF, OASIS)

Develop technical specifications Develop Develop technical technical specifications specifications Testing at Connectathons Testing at Testing at Connectathons Connectathons _IHE Demonstrations IHE IHE Demonstrations Demonstrations Products with IHE Products Products with IHE with IHE Timely access to information Timely access to Timely access to information

information _{Easy to integrate}

products

Easy to integrate

products

(11)

IHE Solutions

within

_within

the Enterprise

_{the Enterprise}

eMPI eMPI User Auth User Auth Enterprise Enterprise IT Infrastructure IT Infrastructure Laboratory Laboratory LIS LIS Auto Mgr

Auto Mgr AnalyzerAnalyzer

EMR - HIS

EMR

-

HIS

Cardiology

CIS

Cath

Cath ECGECG

Radiology Radiology RIS RIS PACS PACS Img Acq Img Acq Eye Care Eye Care Pathology Pathology Radiation Therapy Radiation Therapy Therapy Plan Therapy Plan Img Acq Img Acq Treatment Treatment

Intensive Care Unit

Nursing Station Nursing Station Devices Devices Devices Devices Home Home Hub Hub Devices Devices Pharmacy Pharmacy Established Established Feb 2009 Feb 2009

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12

IHE Solutions within the Enterprise

3 Examples

eMPI eMPI User Auth User Auth Enterprise Enterprise IT Infrastructure IT Infrastructure Laboratory Laboratory LIS LIS Auto Mgr

Auto Mgr AnalyzerAnalyzer

EMR - HIS

EMR

-

HIS

Cardiology

CIS

Cath

Cath ECGECG

Radiology Radiology RIS RIS PACS PACS Img Acq Img Acq Eye Care Eye Care Pathology Pathology Radiation Therapy Radiation Therapy Therapy Plan Therapy Plan Img Acq Img Acq Treatment Treatment

Intensive Care Unit

Nursing Station Nursing Station Devices Devices Devices Devices Home Home Hub Hub Devices Devices Pharmacy Pharmacy Established Established Feb 2009 Feb 2009

Cardiology Integration Profiles

Cardiac Catheterization Lab Workflow Cardiac Catheterization Lab Workflow Echocardiography Lab Workflow

Echocardiography Lab Workflow

Retrieve ECG for Display Retrieve ECG for Display Displayable Reports

Displayable Reports

Cath

Cathand Echo Evidence Documentsand Echo Evidence Documents

IT Infrastructure Integration Profiles

Patient Administration Management Patient Administration Management Patient Demographics Query

Patient Demographics Query

Patient Identifier Cross

Patient Identifier Cross--referencingreferencing Retrieve Information for Display

Retrieve Information for Display

Enterprise User Authentication Enterprise User Authentication Consistent Time

Consistent Time

Patient Synchronized Applications Patient Synchronized Applications Audit Trail and Node Authentication

Audit Trail and Node Authentication

Personnel White Pages Personnel White Pages Shared Value Sets

Shared Value Sets

Radiology Integration Profiles

Radiology Scheduled Workflow Radiology Scheduled Workflow Patient Information Reconciliation

Patient Information Reconciliation

Access to Radiology Information Access to Radiology Information Portable Data for Imaging

Portable Data for Imaging

Consistent Presentation of Images Consistent Presentation of Images Key Image Note

Key Image Note

Presentation of Grouped Procedures Presentation of Grouped Procedures Evidence Documents

Evidence Documents

Audit trail and Node Authentication

Audit trail and Node Authentication ((RadRadoption)option)

Teaching Files and Clinical Trials Export

Post

Post--processing Workflowprocessing Workflow Reporting Workflow

Reporting Workflow

Charge Posting Charge Posting

Simple Image and Numeric Reports

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IHE Solutions

–

_–

Cross

_Cross

-

_-

Enterprises

_Enterprises

Leverage established standards to allow rapid deployment and

plan for future

Pragmatic, Ease of Evolution Pragmatic, Ease of Evolution

Enable architectural freedom (patient vs. provider centric,

centralized vs. decentralized, scalable (from office to

enterprise to IDN to Regional and National Networks)

Configuration

Configuration flexibilityflexibility

Support breakthrough use cases: variety of care settings, care

coordination, public health, PHR, EHR

Interoperability for broad constituencies Interoperability for broad constituencies

IHE: Offers consistent, standards

-

based record

sharing for

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Principles for a Regional/National

eHealth

Network

1. Set a standards based boundaries with stable/proven/unambiguous interoperability specifications (profiles of well accepted standards):

2. Keep things simple and robust within the standards-based boundary (365x24 availability, costs, new use cases, etc.).

Create your own boundary or leverage IHE profiles ?

IHE Profiles come with testing tools, process, shared experience, open source, a broader community, multi-vendor and stability

Health

Health Information Information Sharing Infrastructure

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IHE–Based

–

Health Info Exchange

IHE supports these requirements:

To meet the needs of the various stakeholders

With a wide array of standards to reduce cost and accelerate deployment of HIEs

With flexibility to accommodate a wide range of

architectures and business models across the world

No rip and replace of edge systems, different levels of

interoperability

Ensure reuse of implementations, sharing of experience Forward looking way to enable interconnection into a

National Health Information Network

Allowing increasingly sophisticated security and privacy

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Community

Clinical Encounter

Clinical IT System

Health Info Exchange

Clinic Record _{Specialist Record} Hospital Record

Registering Health Records:IHE

-

XDS

1 1--ReferenceReference to records to records Repository of Repository of Documents Documents Repository of Repository of Documents Documents Index of Index of patients records patients records

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Community

Clinical IT System

Aggregate Patient Info

4

4--Patient data Patient data presented to presented to Physician Physician

HIE

Clinic Record _{Specialist Record} Hospital Record

2

2--ReferenceReference to Records to Records

Access to Shared Records : IHE

-

_-

XDS

_XDS

3 3--RecordsRecords Returned Returned Repository of Repository of Documents Documents Repository of Repository of Documents Documents Index of Index of patients records patients records

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Health Information Exchanges Interoperability:

Cross

-

enterprise Document Sharing

Cross

Cross--Enterprise Document Sharing simplifies clinical Enterprise Document Sharing simplifies clinical

data management by defining interoperable infrastructure.

Transparency = Ease of Evolution

Patients have guaranteed portability and providers may

share information without concerns of aggregation errors.

Digital Documents = Patients

Digital Documents = Patients andand providers empowermentproviders 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

(health records). Complements to interactive workflow or

dynamic access to data.

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Implementing IHE today in Regional and National

Health Networks: Most Popular Services

Sharing of Sharing of Patient Patient Summaries Summaries (

(InclInclPrescriptions)Prescriptions)

Sharing of Sharing of Laboratory Laboratory Results Results Sharing of Sharing of Radiology Radiology Info Info Sharing of Sharing of Cardiology Cardiology Info Info Sharing of Documents Sharing of Documents Point

Point--toto--Point Push(XDR), Sharing(XDS), Federated(XCA), Media and ePoint Push(XDR), Sharing(XDS), Federated(XCA), Media and e--mail(XDM)mail(XDM)

Audit Trail Audit Trail and and Secured Secured Connection Connection Digital Digital Signature Signature Privacy Privacy and and Consent Consent Patient Patient Identification Identification Mgt Mgt Provider Provider Directory Directory Termi Termi- -nology nology Services Services Sharing of Sharing of Scanned Scanned Docs Docs Content Content Middle Middle- -ware ware

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2 IHE, Global Standards

IHE, Global Standards

-

Based Profiles

Adopted in National & Regional Projects

Quebec, Toronto, Alberta, British Columbia

Canada Infoway

THINC- New York NCHICA – N. Carolina Italy Conto Corrente Salute Venetto - Friuli Boston Medical Center - MA Philadelphia HIE CHINA-MoH Lab results sharing CHINA-Shanghai

Imaging Info Sharing

JAPAN-Nagoya Imaging Info Sharing, Nationwide PDI guideline South Africa VITL-Vermont CareSpark – TN & VA NETHERLANDS Friesland Natn’l Mamography Lower Austria Austria France DMP Walles (Imaging-Tender) Belgium Flemish-Leuven Suisse St Gallen Lausane Providence Health System -OR KeyHIE Pennsylvania see

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Austria

(Lower Austria and National)

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

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

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

Roll-out includes:

Ministry backing of IHE conformance (IHE-Eu Connectathon) Extending to Ambulatory Physicians in 2010

Step-wise introduction of structured and coded content with HL7 CDA based IHE Content Profiles.

Lower Austria

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Italy

(Genoa Region)

In service since January 2006.

4 Hospitals and 500 physician offices.

EMRs import and export documents from their local records.

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

Patients chose to join through one of their care provider Infrastructure includes:

XDS Registry

XDS Repository shared at the regional level PIX for patient Id linking

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.

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Italy

(Veneto and Friuli Regions)

Veneto (Venice), 40 hospitals connected with XDS: Sharing lab reports, prescriptions, images, simple summaries.

Used initially for telemedicine, now extended to regional health records

All vendor products required to pass IHE-Europe Connectathon Friuli (Trieste):

Tender issued in September 2009

Interconnection of hospitals for imaging sharing: • Radiology

• Cardiology

• Nuclear Medicine Use XDS, XDS-I

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Rapid Growth of IHE/HITSP projects in the US

In operational use:

Boston Medical Center (MA) CareSpark (TN)

Fox Chase Health Information Exchange (Philadelphia PA) Keystone Health Information Exchange (KeyHIE) PA

NHIN: Kaiser Permanente/Veterans Administration Penn Passport (University of Pennsylvania)

Providence Health System & Services (OR) South Shore (MA)

VITL (HIE for State of Vermont)

Implementation in-progress

Central Florida RHIO

California prison health System Decatur Hospital and Practices Harrison Medical Center

North Carolina Health Info. and Comm. Alliance Wake Forest Medical Center

NHIN: MedVirginia/SSA (NHIN 2.0 spec)

Planned:

Exeter Health information Exchange (Exeter, NH) Chesapeake Regional Info. System (CRISP)

SHARP Communities (CA)

Please let us know if

your project is

missing

missing (see(see tinyurl

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USA (Other)

HITSP accepted 25 IHE Integration profiles for: Lab results

distribution and sharing, Registration and Medication History for Consumers, Biosurveillance.

NHIN Specifications (published Jan 2010) leverage IHE Profiles: XDS, XDR, XCA, XCPD, etc.).

NHIN Connect (open source) includes support for above IHE profiles (XDR planned for next release).

Several Open Source implementation available for XDS, XDR, XCA, ATNA:

IHEOS (NIST Source Forge) Open Health Tools (OHT-IBM) Microsoft Codeplex

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Canada

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

4 infrastructure tenders awarded in 2007/8 targeting over 1/3 of Canadian patients covered:

Toronto East Network - Ontario

Montreal McGill - Quebec

Alberta

British Columbia

Includes XDS, ATNA, PIX and XDS-I.

XDS deployment planned for 2010 in Ontario and 2011 in Quebec, Alberta, British Columbia.

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France

(National DMP)

National Interoperability Specifications have confirmed endorsement of IHE profiles: XDS, ATNA, XUA, PIX/PDQ, XDS-I, etc.

3 Regional pilots in clinical use.

National XDS Infrastructure Tender issued in Fall 2009. Awarded in Feb 2010.

First availability early 2011. Target 2 Million patients after one year, and 13 millions by fifth year.

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Example of other projects

China

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

Israel, Jordan, Palestinian Authority

Middle east Consortium for infectious Disease Surveillance(XDS, ATNA,

XD*Lab)

Belgium

Leuven Region

Netherlands

Friesland, 5 hospitals sharing cardiac patient information (XDS) Amsterdam region network contract awarded late 2009. XDS-I.

Japan

Nagoya region network project operational late 2008. XDS, XDS-I Kobe with imaging info sharing

South Africa

Operational since 2008.

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IHE, Global Standards

-

Based Profiles

Adopted in National & Regional Projects

Quebec, Toronto, Alberta, British Columbia

Canada Infoway

THINC- New York NCHICA – N. Carolina Italy Conto Corrente Salute Venetto - Friuli Boston Medical Center - MA Philadelphia HIE CHINA-MoH CHINA-Shanghai _JAPAN-Nagoya South Africa VITL-Vermont CareSpark – TN & VA NETHERLANDS Friesland Natn’l Mamography Lower Austria Austria France DMP Walles (Imaging-Tender) Belgium Flemish-Leuven Suisse St Gallen Lausane Providence Health System -KeyHIE Pennsylvania see

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What can you do?

Learn about IHE,

Learn about IHE, www.www.iheihe.net.net

Insist on relevant IHE profiles compliance in your

RFPs

RFPs and contract documents:and contract documents:

Select Integration and Content Profiles, and Select Integration and Content Profiles, and Appropriate Actor(s)

Appropriate Actor(s)

Ask vendors for their products Ask vendors for their products ““IHE Integration IHE Integration Statements

Statements””..

Need more interoperability ?

Contribute to IHE CommitteesContribute to IHE Committees

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IHE Web site:

www.IHE .net

Frequently Asked

Frequently Asked QuestionsQuestions

Integration Profiles in Technical Frameworks:

See 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

PharmacyPharmacy

Connectathon

Connectathon Result: Result: www.www.iheihe.net/.net/ConnectathonConnectathon/Results/Results Vendor Products Integration Statements