FINteroperability in Health 2011

1. INTEGRATING THE HEALTHCARE ENTERPISEValue of IHE Profiles and testing for cross-institutional health services FINteroperabilityin Health 2011 Charles Parisot, IHE International Board & IHE-Europe Steering Committee, GE healthcare

2. IETF IHTSDO Interoperability: From a problem to a solution Profile Development Base Standards eHealth Projects Project Specific Extensions Profiling Organizations are well established 2

3. Testing at Connectathons IHE Demonstrations Develop technical specifications Products with IHE Identify available standards (e.g. HL7, DICOM, IETF, OASIS) Timely access to information Document Use Case Requirements Easy to integrate products Standards Adoption Process IHEInternational IHE Europe & IHE National

4. The IHE Development Domains Radiologysince 1998 Cardiologysince 2004 Pathologysince 2006 Laboratorysince 2004 Eye Caresince 2006 (Healthcare)IT Infrastructuresince 2003 Radiation Oncologysince 2004 QualityResearch & Public Healthsince 2006 Patient Care Coordinationsince 2004 Patient Care Devicessince 2005 13 Years of Steady Evolution 1998 – 2011 PharmacySince 2009 since 2008

5. International Growth of IHE Switzerland Netherlands Germany Turkey Canada Austria Taiwan France Japan China USA Italy UK Spain 2005 2006 2000 2007 1999 2001 2002 2003 2004 2009 2008 2010 • Local Deployment, National Extensions • Promotional & Live Demonstration Events • Over 400 Organizational Members (see www.ihe.net/governance) Malaysia Australia Pragmatic global standards harmonization + best practices sharing 5

6. What is IHE, how much adopted ? • ISO Health Informatics: TR28380 Global Standards Adoption – IHE Process and Profiles • Home Health: CONTINUA and IHE work together. Partners in EU Project Smart Personal Health • Widespread adoption of IHE Profiles by National and Regional Projects around the world: USA, Europe, Asia • US National Health Information Network (NwHIN) leverages IHE profiles (XCA, XDR, XCPD, BPPC, ATNA) • 12 Country European epSOS Project: IHE-Europe hosting Industry Team, support project interoperability conformance testing (XCA, XCPD, ATNA, XUA, BPPC, CDA Content Modules from PCC). • In use in several national and regional projects (Austria, France, South Africa, Italy, Netherlands, USA, Japan, Switzerland, Canada) • EU Commission eHealthInterop Mandate 403 leverages IHE process • European HITCH project to roadmap conformance testing and certification leverages the IHE testing experience 6

7. eHealth and Interoperability: What’s new in IHE Profiles ? • Patient Care Devices • Patient Care Coordination • Radiology • IT Infrastructure • And more: Pharmacy, Eye Care, Endoscopy, Dentistry Domains

8. eHealth and Interoperability: What’s new in IHE Profiles ? • Patient Care Devices • Patient Care Coordination, Radiology • IT Infrastructure • Testing, Tools and Connectathons • And more: Pharmacy, Eye Care, Endoscopy, Dentistry Domains

9. 9 General Device - Communication Architecture Courtesy: Continua Alliance

10. 10 Single data interface architecture: all Continua Personal Health Devices, all IHE-PCD Medical Devices, and all IHE EMRs!

11. DEC Profile: PCD-01 Transaction • It profiles HL7 V2.6 + IEEE Device Data Terminology • IHE DEC Profile: PCD-01 transaction • Two transport: TCP/IP+MLLP or WS (ITI TF App V) • One profiled message format (HL7 V2.6): compact, common • One simple data model for all devices (data levels, values, units, etc.) • IHE RTM Profile: Rosetta Terminology Mapping For each specific home and care device (over 300): • Consistent ‘containment hierarchy’ and value sets for coded data • Consistent use of units-of-measure for enumerated values A revolution: a consistentapproach to importing device data in a medical record

12. eHealth and Interoperability: What’s new in IHE Profiles ? • Patient Care Devices • Patient Care Coordination • Radiology • IT Infrastructure • Testing, Tools and Connectathons • And more: Pharmacy, Eye Care, Endoscopy, Dentistry Domains

13. Patient Care Coordination • Strategy to define library of “practical” reusable “data modules” (or template, molecules, archetypes, data element models) for CDA Rel 2 now reaching maturity : • Initiated by IHE PCC moved to HL7 with CCD Implementation Guide • PCC TF includes now over 300 “modules” aligned with CCD • All IHE domains defining CDA R2 based Document Content profiles (PCC, Lab, Pharmacy, QRPH, ITI) reuse same module library. • Consistency across IHE Doc Content Profiles and HL7 implementation Guides under review under auspices of US ONC. Minor discrepancies consolidated and place under OHT-Model Driven Health Tools. A consistentapproach to standardized modular definition of clinical content

14. Road to semantic interoperability: a huge step Header • Terminology Value Sets: • Snomed • ICD • LOINC • IEEE • Etc. Templates Modules Data Elements Archetypes Result in a Flexible but Consistent set of Document Types Section A Section B CDA Rel2 Section K A revolution: a consistentapproach to standardized modular definition of clinical content Section L

15. Patient Care Coordination • Maternal and Baby Care now supported with a complete set of CDA documents: • Antepartum Education (APE) • Antepartum Laboratory (APL) • Antepartum History and Physical (APHP) • Antepartum Summary (APS) • Labor and Delivery History and Physical (LDHP) • Labor and Delivery Summary (LDS) • Maternal Discharge Summary (MDS) • Newborn Discharge Summary (NDS) • Postpartum Visit Summary (PPVS) All relying on the standardized modular definition of clinical content

16. eHealth and Interoperability: What’s new in IHE Profiles ? • Patient Care Devices • Patient Care Coordination • Radiology • IT Infrastructure • Testing, Tools and Connectathons • And more: Pharmacy, Eye Care, Endoscopy, Dentistry Domains

17. Radiology • XDS-I continues to receive much attention • Multi-Community Clarifications with XCA-I • Implementation is now widespread and feedback is positive • Radiation Exposure Monitoring ready for prime time • Most new modality products support REM to track actual exposure • Imaging Departments: PACS, RIS, dedicated applications emerging • Some national dose registries in pilot • Regulations made explicit in many countries

18. eHealth and Interoperability: What’s new in IHE Profiles ? • Patient Care Devices • Patient Care Coordination • Radiology • IT Infrastructure • Testing, Tools and Connectathons • And more: Pharmacy, Eye Care, Endoscopy, Dentistry Domains

19. IT Infrastructure Growing understanding of the strength and breadth of the “XD*” family of profiles • XDM on e-mail for ubiquitous pt-to-pt send or CD/USBfor media • XDR on SOAP/WS for point-to-point exchange • XDS for registry-centric exchange in a “community”* • XCA for peer to peer federation of “communities”* To be combined with different patient identification strategies: • PDQ Shared stable source of Identities* • PIX for “MPI” centric patient Id linkage • XCPD for discovery & ID linkage across communities • XCPD for location discovery with a shared source of identities* * Most likely suited for Finland

20. IT Infrastructure XDSand related Profiles extend deployment: • Off-the shelf sharing of records/documents (Finns invention !) • Robust service: submission sets, replace/amend, etc. • Open source and support by well over 100 products (infrastructure & EPRs). • Projects range from communities (a few hospitals/clinics) to regions and nations. A few registries/repositories with more than 1 million patients. • Implementation feedback is positive: moving beyond interfacing to user experience.

21. IHE, Global Standards-Based Profiles Adopted in National & Regional Projects (sample) Austria Lower Austria NETHERLANDS Friesland Natn’l Mamography Italy Conto Corrente Venetto - Friuli VITL-Vermont FranceDMP Quebec, Toronto,Alberta, British ColumbiaCanada Infoway SuisseSt Gallen Lausane Wales Imaging France Imaging IDF Boston Medical Center - MA For more complete list see: tinyurl.com/wwXDS Philadelphia HIE Belgium Flemish-Leuven KeyHIE Pennsylvania CareSpark – TN & VA SHARP CA South Africa THINC- New York NCHICA – N. Carolina Providence Health System - OR CHINA-Shanghai Imaging Info Sharing CHINA-MoH Lab results sharing JAPAN-Nagoya Imaging Info Sharing, Nationwide PDI guideline 21 21

22. IT Infrastructure Completed the regional & national infrastructure needs: • Terminology Value Set distribution/updates with extended SVS profile: • Retrieve value Sets by unique identifier • Queries to search and access value set descriptions • Healthcare Provider Directory (HPD) • Based on LDAP • Support Provider Persons or Provider Organizations or both (with optional relationships) • Security and Privacy increasingly better understood: • Encryption and Audit Trail (ATNA) • Basic Patient Privacy Consent (BPPC) • User Assertion (XUA) now enriched with explicit attributes

23. XDW - Necessity Many different worldwide projects have as goals to paperless/digitizing of clinical processes. At the bases of all these projects there is the management of workflows across multiple organizations: • For example various eReferral, chronic care workflows • Flexible nature and processes for these workflows • Clinical, economic, social and organizational impact value

24. XDW – Key Elements Focuses on the Cross-Enterprise Workflow for Document Sharing in support of workflow document and status management. Key elements: • Managing multi-organizational workflows • Workflow associated information in referenced documents • Tracking the past steps of the workflow related to specific clinical event that triggered it • Flexibility: any entities to join in workflow • Generic workflow infrastructure: workflow specifics are known only in point of care systems (Workflow federation)

25. A Use Case Example of XDW (1) Creation of eReferral Document Creation of Clinical Report Workflow Document (3) Workflow Document (1) Workflow Document (4) Workflow Document (2)

26. A Use Case Example of XDW (3) WorkflowDocument Structure

27. XDW Standards • XDW: a new content profile for a workflow management document • No new transaction are introduced. Leverages existing ITI IHE Profiles: • XDS.b, DSUB, BPPC, ATNA, • No XDS Metadata extension expected, but specific rules about Metadata content and update rules for the workflow Document • Public Comment opens late May 2011 (one month) • Trial implementation available in August 2011.

28. eHealth and Interoperability: What’s new in IHE Profiles ? • Patient Care Devices • Patient Care Coordination • Radiology • IT Infrastructure • Testing, Tools and Connectathons • And more: Pharmacy, Eye Care, Endoscopy, Dentistry Domains

29. Implementation Tools Open source implementations are available for XDS, XCA, XCPD, PIX, PDQ, ATNA, CT, and more: HIE-OS under Source Forge http://sourceforge.net/projects/hieos/ Microsoft under codeplexhttp://ihe.codeplex.com/ NIST under Source Forge http://sourceforge.net/projects/iheos/ OHT – IHE Profiles Charter https://iheprofiles.projects.openhealthtools.org OHT – Model Driven Health Tools-Charter https://mdht.projects.openhealthtools.org 29

30. Testing at Connectathons IHE Demonstrations Develop technical specifications Products with IHE Identify available standards (e.g. HL7, DICOM, IETF, OASIS) Timely access to information Document Use Case Requirements Easy to integrate products Interoperability Testing Needs an Ecosystem

31. IHE Connectathon • Open invitation to vendor and other implementers community • Advanced testing tools (GAZELLE) • Testing organized and supervised by project management team • Thousands of cross-vendor tests performed • Results recorded and published

32. IHE Connectathons 2011 Connectathon: Chicago, USA, January 17-21, 2011 Pisa, ITALY, April 11-15, 2011 Australia, July 2011 Japan, October 2011 Massive yearly events : 70-80 vendors 250-300 engineers 100-120 systems ….integrated in 5 days

33. Interoperability: From a problem to a policy Countries/Regions with such a process: Austria (ELGA, Regions) France (ASIP) USA (NwHIN) Italy (Venetto, etc.) China (MoH) Switzerland (ehealthsuisse) Canada (Infoway) IETF Recognized: Profile A Profile B Profile C….. eHealth ProjectsInteroperability Specifications Base Standards Profile Development & Testing Simple and EffectiveProfile RecognitionProcess & Policy Leverage Synergies of Global Standards and Profiles 33

34. IHE- Roles of Different levels International Governance IHE International Board Global Profile Development Radiology IT Infrastructure Laboratory Cardiology Patient Care Coordination Pathology InternationalUse Cases & Profiles Radiation Oncology Patient Care Devices Eye Care Public Health, Quality and Research Pharmacy Open to all Stakeholders Regional Profile Deployment European CoordinationTesting & Education IHE Europe Austria France Germany Netherlands National Engagement Projects IHEFinland Italy Switzerland Spain UK Turkey 34

35. IHE based “Interoperability” experience has demonstrated significant benefits to national and regional programs: • Reduce specification consensus time • Simplify implementation efforts • Reuse of testing tools and processes • Shared implementation experience 35

36. Providers and Vendors Working Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings http://www.ihe.net