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IHE for Regional Health Information Networks

IHE for Regional Health Information Networks. HIMSS Interoperability Showcase February 2006 IHE IT Infrastructure, Patient Care Coordination, Radiology Dan Russler(Mckesson), Charles Parisot (GE),Sonja Baro(Mc Kesson), Keith Boone(Dictaphone), Rick Stevens(IBM), Did Davis(Eclipsys).

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IHE for Regional Health Information Networks

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  1. IHE for Regional Health Information Networks HIMSS Interoperability Showcase February 2006 IHE IT Infrastructure, Patient Care Coordination, Radiology Dan Russler(Mckesson), Charles Parisot (GE),Sonja Baro(Mc Kesson), Keith Boone(Dictaphone), Rick Stevens(IBM), Did Davis(Eclipsys)

  2. Standards are critical but alone are not enough • Standards offer generality, ambiguity and alternatives • Standard Implementation Guides are focused on a single standard • Increasing complexity IHE provides a standard process for implementing multiple standards!

  3. Connecting standards to care • Care providers work with vendors 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 What is the effective way to establish those “standards” for how to implement standards ?

  4. IHE 2006 – Nine Active Domains Over 100 vendors involved world-wide,5 Technical Frameworks 37 Integration Profiles, Testing at Connectathons Demonstrations at major conferences world-wide

  5. What is IHE NOT? • Not a standard, although it leverages them • A vendor initiative, although they participate • Not a certifying authority, although IHE provides testing that should be leveraged by certification • Not simply a demonstration project • Demos are only one means to the end: Adoption • Backed up by documentation, tools, testing, and publication of Technical Frameworks and Product Integration Statements.

  6. IHE Model • Actors in precisely defined roles • Abstracts a specific function of information system • …Executing precisely defined transactions • Using existing standards • ……To solve real world interoperability problems • Specifying Integration Profiles

  7. An Integration Profile : • A Set of Actors • Exchanging Transactions Use casesProcess Flows Actors Transactions • For each transaction: • Std referenced • Options specified • Mapping required IHE Technical FrameworksImplementation Guide for each Integration Profile

  8. Sharing and Accessing Electronic Health Records • IHE offers interoperability for local, regional, specific, or national health information exchange • Goal is to enable exchange between providers’s EHR systems and ancillary IT systems (Lab, Pharma, Payers) and personal health record systems. • Objective is to empower the consumer in having “shared EHR information” between all of its potential healthcare providers (if authorized) and self. • IHE goal is not: • To create a “consolidated health record”, the truth about a patient health. • To create an other health record, next to the one(s) managed by the provider and the consumer.

  9. Hospital Record Reference to records Clinic Record Specialist Record 3-Records Returned 4-Patient data presented to Physician Aggregate Patient Info Index of patients records (Document-level) Clinical IT System Sharing System 2-Reference to Records for Inquiry Clinical Encounter Introduced at HIMSS in 2005 : IHE-XDS Community or sub-network Repository ofDocuments Repository ofDocuments

  10. Health Information Exchanges Interoperability: Cross-enterprise Document Sharing • Cross-Enterprise Document Sharing minimizes clinical data management by the infrastructure. Transparency = Ease of Evolution • Patients have guaranteed portability and providers may share information without concerns of aggregation errors.Digital Documents = Patients and providers empowerment • Supports both centralized and decentralized repository architectures. Ease of federation nationally. Flexible privacy,Flexibility of configurations • Workflows addressed in a second step in a much simpler manner.Point-to-Point messages best suited for workflows mgt

  11. Cross-Enterprise Document Sharing (XDS) Standards Used HealthcareContent Standards HL7 CDA, CEN EHRcomHL7, ASTM CCRDICOM … • Implemented world-wide by more than 30 vendors/open source. Final text published August 2005. • Adopted in several national & regional projects (Italy, France, Canada, Austria, USA, etc.) • IHE XDS: 15800 “Google” references (Jan’ 06) Electronic BusinessStandards ebXML Registry, SOAP … Internet Standards HTML, HTTP,ISO, PDF, JPEG …

  12. Medical Summaries (HL7 CDA/CRS+V3) • Imaging (DICOM) • ECG Reports (PDF+) • Next lab, nursing, etc. Cross-Enterprise Document Sharing (XDS) Standards Used Two “categories” of standards used XDS Doc Content XDS Infrastructure (Document sources, consumers,registries, repostories)

  13. Why is IHE-XDS a breakthrough ? • It based on an International Standards; ebXML registry: OASIS and ISO standard, Web Service/Soap/XML. • Sharing of digital documents as “attested by the source”, meets the most urgent needs. A proven healthcare community data-sharing paradigm (Message feeding a central web server hinders use of EHRs). • Efficient to support all types of Health IT Systems (IDNs, Hospitals, Ambulatory, Pharmacy, Diagnostics Centers, etc.) and all types of information (summaries, meds, images, lab reports, ECGs, etc.), structured and unstructured. • Meets both the needs of point-to-point push communication and on-demand pull in a variety of centralized or distributed architectures. Offer a consistent, standards-based and functional record sharing for EHRs, PHRs & other IT Systems

  14. IHE-XDS Infrastructure Components • Audit Record Repository (ATNA) – Receive audit records from other actors and securely store for audit purposes. ATNA also authenticates peer-nodes and encrypt communications. • Time Server (CT) – Provides consistent definition of date/time enabling time synchronization across multiple systems. Enables events associated with patients to be sorted reliably in chronological order. • Document Registry (XDS) – Queryable index of metadata and references to all documents shared within a connected community (XDS Affinity Domain) • Document Repository (XDS) – Supports storage and retrieval of clinical information (as documents). May be centralized or distributed. • Patient Identifier Cross Reference Manager (PIX) – Reconciles information on patients from multiple domains to a single, cross referenced set of ids for each given patient. • Patient Demographics Supplier (PDQ) – Returns demographic information and identifiers for patients based on specified demographic criteria.

  15. EHR System ED Application Physician Office XDS Document Repository PACS XDSDocument Repository EHR System PACS Lab Info. System Teaching Hospital Community Clinic ATNA Audit record repository CT Time server XDS Affinity Domain (NHIN sub-network) XDS Scenario + use of ATNA & CT PMS XDS Document Registry Query Document Register Document Secured Messaging Retrieve Document Provide & Register Docs Maintain Time Maintain Time Record Audit Event Maintain Time Record Audit Event Record Audit Event

  16. A87631 A87631 A87631 14355 M8354673993 M8354673993 M8354673993 M8354673993 EHR System ED Application Physician Office XDS Document Repository PACS XDS Document Repository EHR System PACS Lab Info. System L-716 L-716 L-716 Teaching Hospital Community Clinic ATNA Audit record repository CT Time server XDS Affinity Domain (NHIN sub-network) XDS Scenario + use of PIX & PDQ PDQ Query to Acquire Affinity Domain Patient ID Patient Identity Feed Patient Identity XRef Mgr Patient Identity Feed Affinity Domain Patient Identity Source Patient Identity Feed Patient Identity Feed PIX Query Document Registry PIX Query Query Document (using Pt Id) Register (using Pt ID) Provide & Register Docs Retrieve Document PACS

  17. Patient Identity XRef Mgr State RHIO Cross-state IDN Cancer Treatment A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 14355 14355 14355 14355 14355 14355 14355 14355 14355 14355 14355 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 RegistryLocator service Patient Identity XRef Mgr Patient Identity XRef Mgr Patient Identity XRef Mgr Patient Identity XRef Mgr Patient Identity XRef Mgr Patient Identity XRef Mgr Patient Identity XRef Mgr Patient Identity XRef Mgr Affinity Domain Patient Identity Source Affinity Domain Patient Identity Source Affinity Domain Patient Identity Source Affinity Domain Patient Identity Source Affinity Domain Patient Identity Source Affinity Domain Patient Identity Source Affinity Domain Patient Identity Source Affinity Domain Patient Identity Source Affinity Domain Patient Identity Source EHR System EHR System EHR System EHR System EHR System EHR System EHR System EHR System ED Application ED Application ED Application ED Application ED Application ED Application ED Application ED Application EHR System EHR System EHR System PatientIdentityFeed PatientIdentityFeed PatientIdentityFeed PatientIdentityFeed PatientIdentityFeed PatientIdentityFeed PatientIdentityFeed PatientIdentityFeed ED Application ED Application ED Application PACS PACS PACS PACS PACS PACS PACS PACS PIX Query PIX Query PIX Query PIX Query PIX Query PIX Query PIX Query PIX Query Physician Office Physician Office Physician Office RegistryLocator service RegistryLocator service NHIN Backbone EHR System EHR System EHR System EHR System EHR System EHR System EHR System EHR System PACS PACS PACS PACS PACS PACS PACS PACS PACS PACS PACS PACS PACS PACS PACS PACS Lab Info. System Lab Info. System Lab Info. System Lab Info. System Lab Info. System Lab Info. System Lab Info. System Lab Info. System PatientIdentityFeed Document Registry XDS Document Repository PACS PACS PACS RegistryLocator service XDS Document Repository State RHIO PIX Query EHR System EHR System EHR System Sub-Network Sub-Network Sub-Network PACS PACS PACS Patient Identity XRef Mgr Patient Identity XRef Mgr PACS Lab Info. System Lab Info. System Lab Info. System L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 Affinity Domain Patient Identity Source Affinity Domain Patient Identity Source Integrated Delivery Network Teaching Hospital Teaching Hospital Teaching Hospital PatientIdentityFeed PatientIdentityFeed Document Registry Document Registry XDS Document Repository XDS Document Repository Community Clinic Community Clinic Community Clinic XDS Document Repository XDS Document Repository ATNA Audit record repository ATNA Audit record repository ATNA Audit record repository PIX Query PIX Query CT Time server CT Time server CT Time server PACS PACS XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) Federation of XDS and non-XDS DomainsLeverage Connecting for Health RLS – 2006-2007 Development Which regisry holds records for a patient ? Sub-Network

  18. IHE-XDS is part of a family of profiles • Regional, national, local or disease centric networks need a consistent set of Integration Profiles • Nine Integration Profiles completed and tested, plus seven in development = Standards-based interoperability building blocks for • Rich Document Content for end-to-end application interoperability. Available is a structured medical summary (incl meds, allergies, pbs) and imaging information (incl. Images and reports). More in development. • Patient identification management • Security and privacy • Basic workflow (Notif of doc availbility) IHE-XDS + related IHE Integration profiles provide a complete interoperability solution

  19. Scanned Documents Lab Results Document Content ECG Report Document Patient Created Summaries Emergency Referrals Cross-enterprise User Authentication Format of the Document Content and associated coded vocabulary Format of the Document Content Format of the Document Content and associated coded vocabulary Format of the Document Content and associated coded vocabulary Format of the Document Content and associated coded vocabulary Patient Identifier Cross-referencing Authentication & Auditing: Enhanced Access Control Cross-Enterprise Document Sharing Map patient identifiers across independent identification domains Imaging Information Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Patient Demographics Query Medical Summary (Meds, Allergies, Pbs) Format of the Document Content and associated coded vocabulary Document Digital Signature Audit Trail & Node Authentication Format of the Document Content and associated coded vocabulary Attesting “true-copy and origin Centralized privacy audit trail and node to node authentication to create a secured domain. Consistent Time Notification of Document Availability Cross-enterpriseDocument Interchange Notification of a remote provider/ health enterprise Coordinate time across networked systems Media-CD/USB & e-mail push IHE Integration Profiles for Health Info NetsWhat is available and has been added in 2005 and is for 2006

  20. Cross-Enterprise Sharing of Medical Summaries (XDS-MS) Patient Examination or Discharge Discharge or Referral Document Created Referred Physician Notification Document Registry EMR EMR Review ofMedical Summary Report Repository MedicalSummary The Cross-Enterprise Sharing of Medical Summaries Integration Profile solves the problem of transferring summary patient information between providers in different clinical settings.

  21. Level 3 Text Structure Med, Problems and Allergies Entry required as highly structured Coded Section Coded Section Coded Section text. Text easy to import/parse Entry Entry Entry Level 3 Text Structure Entry Med Problems a nd Allergies have a required fine - grain structure with optional coding. Coding Scheme not standardized, Text Structure but explicitly identified. Entry XDS-MS Medical Summary Level 1 Structured and Coded Header Patient, A uthor, Authenticator, Institution, Header always structured and coded Time of Service, etc. Level 2 S t r u c t u r e d C o n t e n t w i t h c o d e d s e c t i o n s : S t r u c t u r e d C o n t e n t w i t h c o d e d s e c t i o n s : Title - coded sections with non - structured · Reason for Referral nor coded content (text, lists, tables). · · Vital Signs  Simple Viewing (XML Style sheet) · · M e d i c a t i o n M e d i c a t i o n · Studies · · A l l e r g i e s A l l e r g i e s · Social History · · P r o b l e m s P r o b l e m s XDS-MS enables both semantical interoperability and simple viewing ! · Care Plan

  22. Use of a shared XDS infrastructure to access Radiology Reports and Images (XDS-I) Between Radiology and : • Imaging specialists • Non-imaging clinicians Hospital PACS Y Radiology -to-Radiology Radiology -to-Physicians PACS Z Imaging Center Physician Practice Same XDS Infrastructure (Registry and Repositories) for medical summaries and imaging information !

  23. Implementer Level Allscripts Canon CapMed Cardiac Science CGI-AMS CompassCare CPSI Dictaphone DR Systems Eastman Kodak Eclipsys Epic Systems HIPAAT HX Technologies INFINITT Technology Kryptiq McKesson MedAccess Plus Medical Informatics MediNotes MNI National Institute of Sci & Tech NextGen Healthcare Philips Medical ScImage Witt Biomedical DMP–French Natl. Personal EHR Health Level 7 HTP IEEE Midmark Diagostics Group HIMSS RHIO Federation Liberty Alliance Univ. of Washington Supporter Level: Acuo Bond Carefx Clearcube Organizational participant: American Coll. of Clinical Eng. Catholic Healthcare West US Dept of Defense US Dept of Veterans Affairs Dairyland EMC Identrus Intel Mediserve Medkey Motion Comp. Picis Pulse Sentillion HIMSS IHE Interoperability ShowcaseFebruary 2006 Participants Leadership Level Blue Ware Cerner GE Healthcare +IDX IBM Initiate Systems InterSystems MiSys Healthcare Quovadx Siemens

  24. What can you do? • Learn about IHE • Insist on IHE compliance in your RFPs and contract documents: • Select Integration Profiles, and Appropriate Actor(s) • Ask vendors for their products “IHE Integration Statements”. • Need more interoperability ? • Contribute to IHE Committees

  25. Participating and Contributing Vendors (America) Epic Systems Corp. ETIAM Fujifilm GE Healthcare Heartlab HIPAAT Inc. Hitachi Medical Corp. Hologic Hx Technologies IDX Systems Corporation Imco Technologies INFINITT Initiate Systems Inc. InSiteOne Intelerad Medical Systems IBM Intersystems Corporation Konica Minolta Kryptic Marotech, Inc. McKesson MedAccessPlus Health MedCommons Inc Medcon Medical Informatics Eng. Medical Manager Health Mediface Co. Medinotes Medis Medical Imaging Merge eFilm Misys MNI Medicos Mortara NextGen Novell Open Text Corp. Philips Medical Systems Procom Technology Prosolv Cardiovascular QRS Diagnostics Quovadx RADinfo Systems Raining Data RASNA Imaging Systems ScImage Inc. Sectra Imtec Sentillion Shimadzu Corp Siemens Medical Solutns’ Softmedical Stentor, Inc St. Jude Medical StorCOMM, Inc Swissray International, Inc Tiani-Spirit Toshiba Medical Systems T-Systems UltraVisual Medical Syst. Vital Images, Inc. Voxar Limited WebMD Practice Services Witt Biomedical Corp. XIMIS Agfa HealthCare Algotec Allscripts Healthcare Berdy Blueware Camtronics Canon Medical Systems CapMed Cardiac Science Corp. Carefx Cedara Software Corp. Cerner Corporation CGI-AMS CSIST Dictaphone DR Systems Dynamic Imaging Eastman Kodak Company EBM Technologies Eclipsys Emageon In yellow, companies with IHE Committees Chairs (Spring 2006)

  26. Participating and Contributing Vendors (Europe) AGFA Healthcare AISoftw@re Medical Algotec ARES SA aycan Digitalsysteme CEGEDIM Cerner Corp. CHILI CMT Medical Tech. Conto Corrente Salute ConVis CTI Mirada Solutions Data Processing SPA DEDALUS Dianoema Eastman Kodak Co. Ebit Sanita EDL ELFIN s.r.l. Engineering Sanità ESAOTE ETIAM Ferrania Fujifilm GE Healthcare GIE Convergence-Profils Global Imaging Online GWI Research Hi. tech IASI Srl IdeoPass INFINITT INFOPATIENT INOVIT INSIEL Intersystems Corp. Invita ITZ Medicom iSoft McKesson MED2RAD MEDarchiver MEDASYS SA Medavis Medical Communications Medigration GmbH MEDIMON Ltd. MEDIWARE MEDOS AG Merge eFilm METAFORA Mevis Diagnostics Konica Minolta Omnilab Philips Medical Systems POLYMEDIS Rasna Imaging Systems RAYPAX INC. REM Rogan-Delft Sago spa Sectra Imtec AB SeeBeyond Technology Siemens Medical Soluzioni Informatiche srl Stentor Inc. St. Jude Swissray Medical AG Symphonie On Line Synapsis Synchro-Med TECHNIDATA TELEMIS S.A. Tiani-Sprit Tomtec Imaging TOREX GAP Medical Toshiba Medical Systems TSI groupe europMedica T-Systems Uni-medicine VEPRO AG VISUS Technology Transfer WAID XR PARTNER In yellow, companies with IHE Committees Chairs (Winter 2005)

  27. Participating and Contributing Vendors (Asia) Taiwan INFINITT Shing Shian INQ GEN TEP Tah Ya Japan EBMJ PSP PANASONIC ALOKA KONICA MINOLTA Hitachi Medical Co. KODAK HITACHI SBS INFOCOM CLIMBMS TECHMATRIX CANON VIEWSEND Japan ITEC WINTCS NEC AGFA JMAC GEYMS AJS TOSHIBA YOKOGAWA GOODMAN FUJITSU AANDT FUJIFILM Korea AGFA Korea GE Healthcare Korea INFINITT LG CNS Marotech, Inc. Medical Standard Peoplenet Communications Samsung SDS

  28. How can I participate? As a Provider or Vendor Contributor • Offer Clinical Use Case Input to Drive IHE Profile Development • Become a member of relevant domain’s Planning or Technical Committees • Become a member of relevant Regional/National Committees • Help to shape IHE’s future direction As a Vendor Participant • Respond to Public Comments of Domain Supplements • Attend the June Educational Workshop • Participate in Connect-a-thons and Demonstrations As a Provider/Consultant Participant • Respond to Public Comments of Domain Supplements • Attend the June Educational Workshop • Attend Demonstrations and include IHE Integration Profiles in your RFPs and Integration Projects.

  29. IHE Web site:www.IHE .net • Frequently AskedQuestions • Integration Profiles in Technical Frameworks: See Volume 1 of each TF for Use cases • Cardiology • IT Infrastructure • Laboratory • Patient Care Coordination • Radiology • Connectathon Result: www.ihe.net/Events/connectathon_results.cfm • Vendor Products Integration Statements • Participation in Committees & Connectathons

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