IHE (Integrating the Healthcare Enterprise): A solutio n for Payer-Provider Interoperability?

1. Mike Nusbaum, BASc, MHSA, FHIMSS President MH Nusbaum & Associates Ltd. IHE (Integrating the Healthcare Enterprise):A solution for Payer-Provider Interoperability? An Introduction to the “Plumbing”

2. Today’s Agenda… • Introduce IHE, it’s products & processes • How can IHE serve the Payer community? • Opportunities… • Q&A

3. The Case for Standards

4. Why do we need IHE? • IHE Profiles address real-world problems • IHE Profiles make standards implementable • Compliance to IHE Profiles maximizes opportunity for plug-compatible interoperability • IHE can accelerate adoption and implementation of standards • The IHE Process ensures rigor and robustness: • reliance on established standards • extensive engagement with stakeholders, incl. public comment • profile maintenance • conformance testing in a real-world environment • attestation (not yet certification)

5. Interoperability:Highest Cause of Health IT project failures IETF IHTSDO Base Standards eHealth Projects

6. Profiling Organizations Have Emerged IETF IHTSDO From a problem to a solution Base Standards Profile Development eHealth Projects Specific Extensions 6

7. Standards: Necessary… but not sufficient • Standards are • Foundational - to interoperability and communications • Broad - varying interpretations and implementations • Narrow - may not consider relationships between standards domains • Plentiful - often redundant or disjointed • Focused - standards implementation guides focus only on a single standard IHE provides a standard process for implementing multiple standards

8. Connecting Standards to Care • Healthcare professionals work with industry • Coordinate implementation of standards to meet clinical and administrative needs • Clinicians and HIT professionals identify the key interoperability problems they face • Providers and industry work together to develop and make available standards-based solutions • Implementers follow common guidelines in purchasing and integrating effective systems IHE: A forum for agreeing on how to implement standards and processes for making it happen

9. IHE: A Framework for Interoperability A common technical framework for harmonizing and implementing multiple standards Application-to-application System-to-system Setting-to-setting Enables seamless health information movement within and between enterprises, regions, nations Promotes unbiased selection and coordinated use of established healthcare and IT standards to address specific clinical needs

10. What are the alternatives ? Ignore the issue Pick key standards, and hope for the best Rely on robust standards harmonization ISO Health Informatics: TR28380 Global Standards Adoption – IHE Process, Profiles and Implementation Widespread adoption of IHE Profiles by National and Regional Projects around the world: USA, Canada, Europe, Asia Home Health: CONTINUA and IHE work together. 12 Country European epSOS Project (IHE-Europe hosting Industry Team). Is IHE a novel idea? Has IHE been adopted?

11. IHE North America IHE Asia-Oceania China Japan Canada USA Korea Australia IHE Europe Austria France Germany Netherlands Italy Norway Spain UK Sweden Contributing & ParticipatingVendors IHE International Organizational Structure IHE International Board Global Development Domains Example Deployment Committees Radiology IT Infrastructure Laboratory Cardiology Patient Care Coordination Pathology Radiation Oncology Patient Care Devices Eye Care Public Health, Quality and Research Pharmacy Dentistry Endoscopy Professional Societies / Sponsors 11 11 11

12. Cardiologysince 2004 Laboratorysince 2004 (Healthcare)IT Infrastructuresince 2003 Radiation Oncologysince 2004 The IHE Development Domains 15 Years of Steady Evolution 1998 – 2012 Dentistrysince 2010 Radiologysince 1998 Endoscopysince 2010 Pharmacysince 2009 Pathologysince 2006 Eye Caresince 2006 QualityResearch & Public Healthsince 2006 Patient Care Coordinationsince 2004 Patient Care Devicessince 2005

13. International Participation in IHE Netherlands Germany Norway Canada Austria Taiwan France Japan Korea China USA Italy UK Spain 2005 2006 2000 2007 1999 2001 2002 2003 2004 2009 2008 Australia • Local Deployment • National Extensions • Promotional & Live Demonstration Events • Funding Pragmatic global standards harmonization + best practices sharing

14. IHE Sponsors Professional societies: Healthcare Information Management Systems Society (HIMSS) American College of Physicians (ACP), American College of Emergency Physicians (ACEP) American College of Obstetricians and Gynecologists (ACOG) Many other American Professional Societies (ACCE), (AAO), (ASTRO), etc. British Institute of Radiology (BIR), British Computer Society (BCS) German Radiology Society (DRG) …ASIP (IT France), SFIL (laboratory), French National Project (DMP), European Society of Cardiology Radiological Society of North America (RSNA) JAHIS (IT Japan), JIRA, JRS,… And many more Government Agencies: French National Project (ASIP-Santé) Dutch National Project (NICTIZ) Austrian National Project (ELGA) Canada Health Infoway (CHI) Regional projects (Italy, USA, Japan) and many more…..

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

16. What is a Connectathon? • Cross-vendor, live, supervised, structured testing event • All participating vendors’ products tested together in the same place/time • Experts from each vendor available for immediate problem resolution… fixes are done in minutes, not months!! • Each vendor tests with multiple trading partners (actual product to actual product) • Testing of real-world clinical scenarios using IHE Integration Profiles

17. IHE Product Registry • A website to search IHE Integration Statements published by vendors • Helps users find products that match their needs • Product Registry maintains a database of actors/profiles in vendors’ integration statements • Product Registry points to Integration Statement on vendor’s web site

18. RegisteringIHE Integration Statements

19. Product Registry Usage • Approximately 410 Integration Statements in the database • Over 100 companies registered • Average 280 visits per month

20. IHE Integration Statement

21. Product Registry Links • IHE Integration Statement template • http://tinyurl.com/62ymvtc • Link to Product Registry : • http://product-registry.ihe.net • Documentation : • http://gazelle.ihe.net/content/product-registry • Support • http://gazelle.ihe.net/jira/PR

22. HIMSS Interoperability Showcase

23. Where in the World is XDS and CDA Link

24. Of interest to payers… • XD* family of IT infrastructure profiles • XDS, XDR, XDM, XDS-SD • XCA • Content profiles that leverage the XD* family • XDS-MS, XD-LAB, XDS-I • CDA (C-CDA) harmonized templates that carry clinical data exchanged amongst healthcare stakeholders

25. Opportunities • Is there an interest in setting up a domain to address payer needs? • International or US-realm? • Implications • Approach • Next steps

26. Thank you!!!Questions? Find out more at ihe.net