Implementing IHE in Regional Health Information Networks

1. Implementing IHE in Regional Health Information Networks IHE Europe 2006 - Changing the Way Healthcare Connects IHE Presentation at the World of Health IT show, October 2006 Alexander Ihls, Stakeholder PCC, IHE Germany

2. Actors in Regional Healtcare • General Practitioners (GPs) • Family Doctors • Medical Specialist • Hospitals • Emergency Department (ED) • Inpatient care, surgeries • Homecare • Patient self-care • Nurses

3. IHE Domains • Cardiology • Eye Care • IT Infrastructure • e.g. Cross-Enterprise Document Sharing (XDS) • Laboratory • Patient Care Coordination • Patient Care Devices • Radiology • Mammography • Nuclear Medicine

4. Patient Care Coordination • The Patient Care Coordination (PCC) domain was established in July 2005 to deal with integration issues that cross providers, patient problems or time.

5. Profile Roadmap • Year 2005-2006 (Trial Implementation) • Medical Summary [MS] – Acute Care Discharge to PCP, PCP Referral to Specialist • Unstructured Document – CDA-wrapped PDF • Year 2006-2007 (Development & Testing) • Medical Summary [MS] – ED Referral [EDR] • Pre-procedure H&P [PPHP] • Basic Patient Privacy Consents [BPPC] • Exchange Personal Health Record [XPHR] • Coordination with Laboratory Domain [XDS-LAB] • Future (Profile Document / White Paper) • Medical Summary [MS] – Discharge to LTC • Forms Display for Data Capture (e.g. clinical research)

6. PCC Profiles PCC Domain Medical Summary XDS-MS Exchange of Patient Health Record Data (XPHR) Basic Patient Privacy Consent (BPPC) Emergency Department Referral (EDR) Preprocedural History and Physical (PPHP) Sharing Laboratory Reports (XDS-LAB)

7. Medical Summary Profiles

8. Abstract • Define a medical summary format for clinical documents containing at a minimum: Problems Allergies Medications Pointers to other material Medical Summaries

9. Value Proposition • Leverage Clinical Documents ontology • A common mechanism for transfer of encoded clinical data embedded in documents • Basis for ongoing harmonization of CCR/CCD • Enhances Clinical Documents criteria for key use cases: • Inpatient to Primary Care Provider • Primary Care Provider to Specialist • To be enhanced in future years to support: • Home Care • Long Term Care Medical Summaries

10. Key Technical Properties • Document Transfer (Integration Profile) • XDS/XDP for document sharing. • NAV for notification. • XDS Folders to support organization. • XDS Submission Sets to support packaging. • Identification of “Master” document or Manifest • Document Content (Content Profile) • CDA Release 2.0 • Care Record Summaries Implementation Guide Medical Summaries

11. PCC Profiles PCC Domain Medical Summary XDS-MS Exchange of Patient Health Record Data (XPHR) Basic Patient Privacy Consent (BPPC) Emergency Department Referral (EDR) Preprocedural History and Physical (PPHP) Sharing Laboratory Reports (XDS-LAB)

12. Use Case • Health care provider determines that a patient needs to go to the ED • Provider creates an ED referral package using his or her EHR • Upon arrival, the ED provider identifies the patient as a referral • The posted referral package is imported into the Emergency Department Information System (EDIS) Provide access to critical health information in ED information systems in a standard manner\ ED Referral

13. Value Proposition • Nearly 5000 EDs in US • Significant percentage of ED visits are referrals • Shortage of critical health data for emergency department patients • Need to improve communication of intended patient care plans to ED providers and ensure that no pertinent data is lost • Streamline workflow by obviating telephone calls between busy clinicians ED Referral

14. Scope • EHR system capable of creating a care record summary would be capable of creating a referral package for a receiving system • The emergency department information systems (EDIS) will need to retrieve and read and display this data. ED Referral

15. PCC Profiles PCC Domain Medical Summary XDS-MS Exchange of Patient Health Record Data (XPHR) Basic Patient Privacy Consent (BPPC) Emergency Department Referral (EDR) Preprocedural History and Physical (PPHP) Sharing Laboratory Reports (XDS-LAB)

16. Abstract • The Basic Patient Privacy Consents (BPPC) profile provide mechanisms to: • Record the patient privacy consent(s), • Mark documents published to XDS with the patient privacy consent that was used to authorize the publication, • Enforce the privacy consent appropriate to the use. Basic Patient Privacy Consents

17. Scope • Document Sources and Document Consumers in an XDS Affinity Domain • Document Sources and Document Receivers using Cross Enterprise Point-to-Point Document Sharing Basic Patient Privacy Consents

18. Value Proposition • An Affinity Domain can • develop privacy policies, • and implement them with role-based or other access control mechanisms supported by EHR systems. • A patient can • Be made aware of an institutions privacy policies. • Have an opportunity to selectively control access to their healthcare information. Basic Patient Privacy Consents

19. Key Technical Properties • Human Readable Consents • Machine Processable • Support for standards-based Role-Based Access Control Basic Patient Privacy Consents

20. Standards and Profiles Used • CDA Release 2.0 • XDS Scanned Documents • Document Digital Signature • Cross Enterprise Document Sharing • Cross Enterprise Point-to-Point Document Sharing Basic Patient Privacy Consents

21. PCC Profiles PCC Domain Medical Summary XDS-MS Exchange of Patient Health Record Data (XPHR) Basic Patient Privacy Consent (BPPC) Emergency Department Referral (EDR) Preprocedural History and Physical (PPHP) Sharing Laboratory Reports (XDS-LAB)

22. Use Case • H&P documentation required prior to procedure that is designed to assess: • Procedure Risk • Anesthesia Risk • Factors influencing procedure after-care decisions • Desired outcomes • Minimize injury during procedure • Optimize procedure after-care Pre-procedure H&P

23. Scope • To identify the required and optional PPHP document content templates including: • CDA Document Header • CDA Document Type(s) • CDA Section Types • CDA Entry Types Pre-procedure H&P

24. Value Proposition • A procedure risk assessment must be present and evaluated by the operative and after-care teams before the patient is allowed to have the procedure. Missing information is frequently a reason for canceling the procedure for the day, which leads to expensive underutilization of resources and dissatisfied patients. Further, incomplete information about the patient’s clinical or home status may create a situation where a procedure is performed that ultimately results in an injury, inadequate aftercare or other undesirable outcome. Pre-procedure H&P

25. Key Technical Properties • PPHP Profile inherits specifications required for other IHE PCC Medical Documents • PPHP Profile follows documentation practices for all IHE PCC Medical Documents • PPHP Profile emphasizes re-usability of CDA template identifiers in order to reduce un-necessary variability in IHE Content Profiles Pre-procedure H&P

26. Standards Used • IHE Medical Document Content Profiles • HL7 Reference Information Model ANSI Standard • HL7 CDA R2 ANSI Standard • HL7 Care Provision Domain DSTU (in process) • Implementation Guides • HL7 Care Record Summary CDA R2 Implementation Guide (in process) • HL7/ASTM Continuity of Care Document Implementation Guide (in process)

27. PCC Profiles PCC Domain Medical Summary XDS-MS Exchange of Patient Health Record Data (XPHR) Basic Patient Privacy Consent (BPPC) Emergency Department Referral (EDR) Preprocedural History and Physical (PPHP) Sharing Laboratory Reports (XDS-LAB)

28. Abstract • The Exchange of Personal Health Record Content (XPHR) provides a standards-based specification for managing the interchange of documents between a Personal Health Record and an EHR System to enable better interoperability between these systems. Exchange of PHR Content

29. Scope • Personal Health Record (PHR) Systems • Electronic Health Record (EHR) Systems Exchange of PHR Content

30. Value Proposition • Supports interchange of PHR Information • Demographics • Insurance Information • Medications, Problems, Allergies • Health History • Other Information Exchange of PHR Content

31. Standards Used • CDA Release 2.0 • ASTM Continuity of Care (CCR) Data Set • ASTM/HL7 Continuity of Care Document (CCD) • HL7 Care Record Summary • AHIMA PHR Common Data Elements • XDS, XDP • Document Digital Signature Exchange of PHR Content

32. Key Technical Properties • Information is Human Readable • and Machine Processable • Support Static and Dynamic Information Sharing Domains (XDS and XDP) • Protects Information using Digital Signature • Update Model for EHR to PHR Changes Exchange of PHR Content

33. PCC Profiles PCC Domain Medical Summary XDS-MS Exchange of Patient Health Record Data (XPHR) Basic Patient Privacy Consent (BPPC) Emergency Department Referral (EDR) Preprocedural History and Physical (PPHP) Sharing Laboratory Reports (XDS-LAB)

34. Scope • The clinical laboratory report is: • A report of a set of final results (the fulfillment process being completed) to be shared as “historical information”. • Human-readable, shared between care providers of various specialties and patients (e.g. through a PHR) • May contain machine readable coded entries (decision support, bio-surveillance) • All clinical laboratory specialties in scope, except: • Blood banks (blood products out of scope, but blood tests in scope) • Pathology (has its dedicated domain in IHE) Sharing of Lab Reports

35. Value Proposition • Use case 1: Hospital lab report  RHIO  EHRsAt discharge time, a hospital physician selects the most significant laboratory reports produced during patient stay, and issues these reports individually to a health information exchange (e.g. XDS Affinity Domain) shared by a number of healthcare enterprises and primary care providers. • Use case 2: Ambulatory lab report  RHIO  PHRA private laboratory having signed a final report for a patient, sends this report in an electronic format to the patient record in the national EHR. • Use case 3: Lab report  PHRA physician reviews the results received from a reference laboratory for his patient. The doctor, as requested by the patient, sends this laboratory report in the patient’s personal health record in an electronic format. • Use case 4: Lab report automatically shared  RHIOA community or hospital laboratory, systematically (with some degree of automatism) shares its final reports with a regional healthcare network. • Use case 5: Hospital’s EHR Lab report  RHIOAt discharge time of an inpatient, a hospital physician selects the most significant lab results, produced by one or more laboratories of the healthcare enterprise during patient stay, and builds a cumulative report sent to an health info exchange shared by a number of healthcare enterprises and primary care providers. Sharing of Lab Reports

36. Standards Used • CDA Release 2.0 • ASTM/HL7 Continuity of Care Document (CCD) • HL7 V3 Laboratory DMIM • HL7 Care Record Summary • LOINC & SNOMED • HIPAA Lab Claim Attachment NPRM • IHE XDS (registry/repository) & XDP (pt-pt) • Document Digital Signature Sharing of Lab Reports

37. Key Technical Properties • Information is Human Readable (two levels of sections) and machine processable • Full alignments with HL7 V3 lab messages • Supports custom report organizations and results rendering regulations (e.g. CLIA in the USA). • Complements the real-time result return to ordering provider (e.g. ELINCS). • Used both in sharing (XDS) & pt-pt interchange (XDP) • May protect Information using Digital Signature Sharing of Lab Reports

38. PCC Wrap-up

39. PCC RoadMap • Care Transfers • Medical Summary 2005 • EDR, PPHP 2006 • Labs 2006-7 • Growth Charts • Consumer Empowerment • PHR 2006 • Consents 2006 • Provider Ordering • Ambulatory Ordering 2006 • Medication Lists 2007 • Clinical Data Reuse • Clinical Trials (RFD) 2006-7 • Biosurveillance 2007-8

40. How to Get Involved? 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 Educational Workshops • Participate in Connect-a-thons and Demonstrations As a Provider/Consultant Participant • Respond to Public Comments of Domain Supplements • Attend the Educational Workshops • Attend Demonstrations and include IHE Integration Profiles in your RFPs and Integration Projects.

41. IHE Web Site - http://www.ihe-europe.net Technical Frameworks Technical Framework Supplements – Trial Implementation Calls for Participation IHE Fact Sheet and FAQ IHE Integration Profiles: Guidelines for Buyers IHE Connectathon Results Vendors’ Product Integration Statements Sponsors’ IHE sites http://www.himss.org/IHE http://www.rsna.org/IHE http://www.acc.org/quality/ihe.htm More Information Questions?