IHE, Interoperability for Regional Health Information Organizations

1. IHE, Interoperability for Regional Health Information Organizations Charles Parisot, GE Healthcare Mike Henderson, Eastern Informatics IHE IT Technical Committee Co-Chairs

2. W W W . I H E . N E T Providers and Vendors Working Together to Deliver Interoperable Health Information Systems In the Enterprise and Across Care Settings

3. State of the Union Addresses “By computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care.” President George W. Bush January 20, 2004

4. And the beat goes on….. “ …. most Americans will have electronic health records within the next 10 years” President George W. Bush April 26, 2004 In a public address to the American Association of Community Colleges, the President outlined a plan whose goal is to assure better delivery of healthcare in the United States.

5. Framework for Strategic Action • President Bush’s April 27th executive order called for the creation of the Office of the National Coordinator of Health Information Technology (ONCHIT). A report was required within 90 days of office creation. • The Framework for Strategic Action was released by Department of Health and Human Services Secretary Tommy Thompson and newly appointed National Coordinator of Health Information Technology, David Brailer, MD, at the NHII Summit in July, 2004.

6. Four Major Goals • Inform Clinical Practice • Incentivize EHR adoption • Reduce risk of EHR investment • Promote EHR diffusion in rural & underserved • Interconnect Clinicians • Foster regional collaborations • Develop a national health information network • Coordinate federal health information systems

7. Four Major Goals Thousands of EHRs to interconnect, Through a “thin” National Health Information Network. Make connectivity open, consistent, step-wise and evolutionary ! IHE can accelerate and simplify the process. See: 13 Organization Collaborative NHIN RFI Response Plus IHE Response to the NHIN RFI. www.himss.org/content/files/IHERFIResponseandCoverLetter1.pdf • Personalize Care • Encourage use of PHRs • Enhance informed consumer choice • Promote use of telehealth systems • Improve Population Health • Unify public health surveillance architectures • Streamline quality and health status monitoring • Accelerate discovery and dissemination

8. Standards Alone Are Not Enough • Managing the domain boundaries with mapping of information flow across boundaries • Standards offer generality, ambiguity and alternatives. • Vendor proprietary interests • Complexity!! We need standards for how to implement standards!

9. Connecting Standards to Care • Care providers must work with vendors to coordinate the implementation of standards to meet their needs • Care providers need to identify the key interoperability problems they face • Drive industry to develop and make available standards-based solutions • Implementers need to follow common guidelines in purchasing and integrating systems that deliver these solutions What is the effective way to establish those “standards” for how to implement standards ?

10. Need for a Standards Implementation Process ? Demand Standards Standards Standards UserProjects Offer

11. What is Integrating the Healthcare Enterprise ? • IHE provides a common framework for passing health information seamlessly: • within the healthcare enterprise • across multiple healthcare enterprises • for local, regional & national health information networks. • IHE is sponsored by healthcare professional associations (ACC, HIMSS, RSNA, etc.). • IHE drives standards adoption to address specific clinical needs.

12. IHE Maturity and Acceptance • More than 100 healthcare vendors worldwide have contributed to IHE and the delivery of ready-to-integrate products to benefit healthcare enterprises of all sizes. • IT professionals & clinicians appreciate IHE’s positive impact now expanded to address: • radiology, cardiology, laboratory • enterprise healthcare IT infrastructures • cross-enterprise healthcare IT infrastructures

13. Understanding the IHE Initiative • IHE has a clear focus • IHE is a healthcare domain-based initiative • IHE creates synergies for interoperability testing across domains • IHE addresses the standards adoption process • IHE is both regional and multi-national • IHE is both user-led and vendor-driven

14. A Proven Standards Adoption Process IHE Connect-a-thonResults Product IHE IntegrationStatement IHEConnect-a-thon IHEDemonstration Product With IHE Easy to Integrate Products Standards Standards Standards IHEIntegration Profiles B IHEIntegration Profile A RFP IHETechnicalFramework User Site IHE Integration Profiles at the heart of IHE : • Detailed selection of standards and options each solving a specific integration problem • A growing set of effective provider/vendor agreed solutions • Vendors can implement with ROI • Providers can deploy with stability

15. Achievements and expanding scope Over 100 vendors involved world-wide, 4 Technical Frameworks 27 Integration Profiles, Testing at yearly Connectathons, Demonstrations at major exhibitions world-wide To claim compliance to IHE Integration Profiles vendors shall publish for each product an IHE Integration Statement.

16. IHE Survey Results • 92% of respondents were aware of IHE • Potential benefits of IHE  Improved clinical workflow + access of data = 63% • Benefits of IHE products  Reduce deployment costs = 56% **HIMSS web-based survey in November 2004 – 163 participants

17. Experience your HIMSS-WideElectronic Health Record Cross-enterprise Showcase Booth Vendor Booth Vendor Booth Vendor Booth Vendor Booth Vendor Booth Vendor Booth Radiology ComprehensivePatient Care CoordinatedPatient Evaluation HIMSS “RHIO” with IHE-XDS Cross-enterprisedoc sharing ITInfrastructure PCP Diag Center Vendor Booth Home Cardiology Workup MultispecialtyClinic Vendor Booth Ambulatory Showcase Booth

18. Sharing records that have been published community Hospital Record Laboratory Results Reference to records Specialist Record 4-Patient data presented to Physician Temporary Aggregate Patient History Index of patient records (Document-level) 3-Records Returned Clinical IT System Sharing System 2-Reference to Records for Inquiry 1-Patient Authorized Inquiry Clinical Encounter

19. Standards selection for IHE XDS No single standard can addressCross-enterprise Document Sharing Electronic BusinessStandards ebXML Registry, SOAP, etc. Internet Standards HTML, HTTP,ISO, PDF, JPEG, etc. HealthcareContent Standards HL7 CDA, CEN EHRcomHL7, ASTM CCRDICOM, etc. Marriage of healthcare standards facilitates implementation and leverages complementary technologies (e.g. security & privacy).

20. DocumentRepository Submission of Document References Retrieval of selected Documents Registering and accessing Documents Document Registry EHR-LR:Longitudinal Recordas usedacross encounters Long Term Care Acute Care (Inpatient) Other Specialized Careor Diagnostics Services EHR-CR: Care Record systemssupporting care delivery PCPs and Clinics (Ambulatory)

21. XDS Actors and Transactions

22. Personnel White Page Access to workforcecontact information Patient Identifier Cross-referencing Patient Identifier Cross-referencing Cross-Enterprise Document Sharing Map patient identifiers across independent identification domains Map patient identifiers across independent identification domains Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Patient Demographics Query Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. New Consistent Time Coordinate time across networked systems 2004 IHE Profiles for a RHIOIntegration Profiles completed by HIMSS 2005 New 2004 New New

23. Patient Identification ManagementEnterprises using PIX Cross Referencing with XDS Patient Identity Feed Dm=XAD, Pid=Px Patient Identifier X-Ref Mgr Patient Identifier X-Ref Mgr DocumentEntry Dm=XAD Pid=Px XDS Document Consumer XDS Document Source Query Docs Dm=XAD Pid=Px Patient ID Consumer Dm=XAD Pid=Px Provide&Register Doc Set Patient ID Consumer XDS Doc XDS Doc Patient Identity Source Patient Identification Domain C Patient Identification Domain D2 Patient Identification Domain XAD XDS Document Registry Dm=D2 Pid=Pd Dm=C Pid=Pc XDS Document Repository

24. Lab Results Document Content For Display Document Content Continuity of Care Document Content Imaging Information Content Personnel White Page Access to workforcecontact information Format of the Document Content and associated coded vocabulary Format of the Document Content and associated coded vocabulary Format of the Document Content Format of the Document Content and associated coded vocabulary Patient Identifier Cross-referencing Cross-Enterprise Document Sharing Notification of Document Availability Map patient identifiers across independent identification domains Notification of a remote provider/ health enterprise Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Patient Demographics Query Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. Cross-enterprise User Identity and Accountability Consistent Time Authentication & Auditing: Basis for Access Control Coordinate time across networked systems IHE Profiles for RHIOsWhat is available and what will be added in 2005

25. Local & Regional RHIOs Infrastructure and Interoperability • Cross-Enterprise Document Sharing (XDS) minimizes clinical data management by the infrastructure. Transparency = Ease of Evolution • XDS works with other IHE Integration Profiles: • Audit Trail and Node Authentication (ATNA) and Consistent Time (CT) • Patient Id Cross-referencing (PIX) • Patient Demographics Query (PDQ) • In 2005, IHE plans to finish base set of integration profiles to build regional health networks and interoperable EHRs: • Security: Identity Management+ Accountability • Content Profiles: DICOM, HL7-CDA/CCR, HL7-Lab, PDF. • Notification of Document Availability (with XDS document reference)

26. IHE: RHIOs’ Interoperability Partner • IHE offers a solid technical foundation to establish interoperability for RHIOs. • Standards-based, open, multi-vendor, provider-led. • Yearly progress, validation testing built in, backed by a proven process. Implementation by many vendors. • RHIOs’ technical architects’ needs direct IHE involvement. Policies easier to establish when based on solid IHE Technical Framework, but are beyond IHE’s scope. They remains RHIOs’ responsibility.  IHE IT Infrastructure Committee: Tuesday 15th 1:00-3:00 pm HIMSS Room A134

27. W W W . I H E . N E T Thank YouQuestions ?