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Michael H. Zaroukian, MD, PhD, FACP Chief Medical Information Officer

Integrating the Healthcare Enterprise Achieving Interoperability through Implementation of Standards. Michael H. Zaroukian, MD, PhD, FACP Chief Medical Information Officer Associate Professor of Medicine Michigan State University. January 16, 2007. Presentation Objectives.

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Michael H. Zaroukian, MD, PhD, FACP Chief Medical Information Officer

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  1. Integrating the Healthcare EnterpriseAchieving Interoperability through Implementation of Standards Michael H. Zaroukian, MD, PhD, FACP Chief Medical Information Officer Associate Professor of Medicine Michigan State University January 16, 2007

  2. Presentation Objectives • IHE: What? Why? Who? How organized? • Healthcare provider role in developing IHE framework • Why standards are not enough • IHE process for standards adoption and implementation • Benefits, growth, strategies, integration • How to leverage IHE to enable interoperability in • Enterprises • Health information exchanges (HIEs)

  3. IHE: A Framework for Interoperability • A common 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

  4. Why IHE? A Patient-centered Example

  5. Interoperability: Redesigning the Office Visit

  6. IHE Sponsors • 1997: Founded in Radiology (RSNA) and IT (HIMSS) • Many professional societies (stakeholder representation) • American Academy of Ophthalmology (AAO) • American College of Cardiology (ACC) • American College of Physicians (ACP) • American College of Clinical Engineering (ACCE) • American College of Emergency Physicians (ACEP) • American Society for Therapeutic Radiation Oncology (ASTRO) • GMSIH (IT France), JAHIS (IT Japan), SFIL (laboratory) • Healthcare Information Management Systems Society (HIMSS) • Radiological Society of North America (RSNA) • And many more….

  7. IHE Participants and Relationships • Participants include: • Users - Clinicians, Staff, Administrators, CIOs, Governments (e.g. NIST, VA). • Vendors - Information Systems and Equipment • e.g., imaging, cardiology, devices • Consultants • Maintains formal liaison with Standards Development Organizations (SDOs): • HL7, DICOM, ISO (Liaison D), others • ISO TC215 (including ANSI) approved IHE Process and Profiles to be published as technical reports • Concerns expressed by some AHIC members not founded

  8. IHE (International) Strategic Development Committee Global Development Regional Deployment IHE North America IHE Asia-Oceania China Japan Radiology IT Infrastructure Laboratory Canada USA Korea Taiwan Cardiology Patient Care Coordination Pathology IHE Europe Radiation Oncology Patient Care Devices Pharmacy / Medication Admin Netherlands France Germany Italy Spain UK Norway Sweden Professional Societies / Sponsors ACC ACP HIMSSRSNA Contributing & ParticipatingVendors GMSIH SFRSFIL COCIR EAR-ECR DRG SIRM BIR EuroRec ESC JAHISJIRAJRS METI-MLHW MEDIS-DCJAMI IHE Organizational Structure

  9. Norway Germany Holland Canada Taiwan France Japan Korea China Spain USA Italy UK Year 7 (2005) Year 8 (2006) Year 1 (1999) Year 2 (2000) Year 3 (2001) Year 4 (2002) Year 5 (2003) Year 6 (2004) International Adoption of IHE • Local Deployment • National Extensions (Local Adaptions) • Promotional & Live Demonstration Events • Funding Pragmatic global standards harmonization + best practices sharing

  10. Standards: Necessary…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

  11. IHE: 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

  12. 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

  13. Stakeholder Benefits • Healthcare providers and support staff • Improved workflows • Information whenever and wherever needed • Fewer opportunities for errors • Fewer tedious tasks/repeated work • Improved report turnaround time • Vendors • Align product interoperability with industry consensus • Decreased cost and complexity of interface installation and management • Focus competition on functionality/service space not information transport space • SDOs • Rapid feedback to adjust standards to real-world • Establishment of critical mass and widespread adoption

  14. Veterinary Endoscopy Pathology Pharmacy Growth in IHE Domains IHE Global Developments Integration Profiles (# X) – Solutions to Real-World Interoperability Needs & Problems: • Within Clinical Departments e.g.: • Radiology • Cardiology • Lab • ... • Across Departmental &Institutional Boundaries – XDS • RHIOs (Regional Healthcare Information Organizations) • EHR Enablers Quality Patient Care Devices (1) Patient Care Coordination (5) Radiation Oncology (1) Eye Care (3) Laboratory (6) Cardiology (7) IT Infrastructure for Healthcare (17) Radiology (18) Year 5 (2003) Year 6 (2004) Year 8 (2006) Year 9 (2007) Year 4 (2002) Year 7 (2005) Year 1 (1999) Year 2 (2000) Year 3 (2001)

  15. IHE Implementation Strategy • Leverage established standards to allow rapid deployment and plan for futurePragmatic, Ease of Evolution • Enable architectural freedom (patient vs. provider centric, centralized vs. decentralized, scalable (from office to enterprise to IDN to RHIO) Configurationflexibility • Support breakthrough use cases: variety of care settings, care coordination, public health, PHR, EHRInteroperability for broad constituencies IHE: Offers consistent, standards-based record sharing for EHRs and other information systems

  16. IHE based Regional and National EHR Projects (Operational and Planned) Toronto, Quebec, Alberta, BCCanada Infoway MA-Share – MA New York HIE Austria FranceDMP Philadelphia HIE THINC- New York NCHICA – N. Carolina Italy (Conto Corrente Salute) CHINA-MoH Lab results sharing

  17. IHE Integration Profiles for Health Info NetsWhat is available and has been added in 2005 and 2006 Scanned Documents Lab Results Document Content ECG Report Document Emergency Referrals PHR Extracts/Updates Basic Patients Privacy Consents 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 Format of the Document Content and associated coded vocabulary Format of the Document Content Patient Identifier Cross-referencing Establish Consents & Enable 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 Request Formfor Data Capture Centralized privacy audit trail and node to node authentication to create a secured domain. External form with custom import/export scripting Consistent Time Notification of Document Availability Cross-enterprise Document Point-Point Interchange Notification of a remote provider/ health enterprise Coordinate time across networked systems Media-CD/USB & e-mail push Clinical and PHRContent Security Patient ID Mgmt Health Data Exchange Other

  18. Certification Commission for Healthcare Information Technology (CCHIT) Healthcare Information Technology Standards Panel (HITSP) American Health Information Community Health Information Security and Privacy Collaboration (HISPC) Nationwide Health Information Network Architecture Projects(NHIN) IHE: Supporting HHS Goals for NHIN Standards harmonization and adoption Interoperability testing Specifications for standards-based EHR functionality to support RHIOs Security and privacy standards

  19. HITSP Recommended Standards • Biosurveillance • ICD-9CM – International Classification of Diseases v. 9 Clinical Modifications • ICD-10 CM – Diagnoses and Procedures • IHE-XDS – Integrating the Healthcare Enterprise (IHE) Cross-Enterprise Document Sharing • IHE-XDS Lab – IHE Laboratory Report Document Sharing • IHE-RFD – IHE Retrieve Form for Data Capture • IHE-PIX – IHE Patient Identification Cross-Referencing • IHE-RAD – XDS-I – IHE Cross-Enterprise Sharing of Images • IHE-NAV – IHE Notification of Document Availability • IHE-XDS-MS – IHE Medical Summary Document Sharing • ISO/TC215 -DTS 25237 - Health Informatics Pseudonymisation • LOINC – Logical Observation Identifiers Names and Codes • NCCLS – National Committee for Clinical Laboratory Standards • RxNorm – National Library of Medicine RxNorm IHE contributes to HITSP’s success

  20. HITSP Recommended Standards • Consumer Empowerment • IHE-XDS – Integrating the Healthcare Enterprise (IHE) Cross-Enterprise Document Sharing • IHE-PIX – IHE Patient Identification Cross-Referencing • IHE-PDQ – IHE Patient Demographics Query • Health Level Seven (HL7) CDA R2 – HL7 Clinical Document Architecture Release 2 • HL7 CCD – HL7 Continuity of Care Document with mappings from ASTM E 2369-05 Continuity of Care Record (CCR), X12 N 270/271 and NCPDP Script 8.1. • HL7 EHR Systems Functional Model Draft Standard for Trial Use (DSTU) • Logical Observation Identifiers Names and Codes (LOINC)

  21. HITSP Recommended Standards • Electronic Health Record Exchange • IHE-XDS Lab – IHE Laboratory Report Document Sharing • IHE-PIX – IHE Patient Identification Cross-Referencing • IHE-PDQ – IHE Patient Demographics Query • Health Level Seven (HL7) CDA R2 – HL7 Clinical Document Architecture Release 2 • HL7 v. 2.5 • Clinical Laboratory Improvement Amendments (CLIA) • Logical Observation Identifiers Names and Codes (LOINC) • Health Insurance Portability and Accountability Act (HIPAA) • Systematized Nomenclature of Medicine – Clinical Terms (SNOMED – CT) • Unified Code for Units of Measure (UCUM)

  22. 2007 HIMSS Interoperability ShowcaseFebruary 26 – March 1, 2007 Morial Convention Center, New Orleans, LA • 9,000 square feet of exhibit space • 67 Showcase participants • Secured HIExchange with broad content • HIE with patient care devices • Personal health record solutions • New directions focus (Life Sciences Bio-Pharma, HL7 v3.0 PIX/PDQ, ELINCS Lab) • HITSP interoperability specifications • Financial and administrative systems (CAQH/CORE) • Expanded distributed demonstration in a RHIO format • Focused tours – International, VIP, Congressional • Theater – Education sessions

  23. How to Participate As a User or Vendor Committee Member • Become a member of relevant Domains Planning or Technical Committees As a User, Consultant or Vendor Interested Observer • Provide Public Comments on Technical Framework Supplements • Attend Demonstrations, Educational Events and Workshops

  24. How to Use IHE As a Vendor Implementer • Implement IHE Integration Profiles • Test systems through Connectathon process • Publish an IHE Integration Statement for products As a User Implementer or Consultant • Use IHE Integration Profiles to develop interoperability strategy • Use Connectathon Results and Integration Statements to evaluate vendors • Demand IHE Integration Profile compliance in RFPs

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

  26. More Resources - www.ihe.net • Frequently Asked Questions • Integration Profiles in Technical Frameworks: • Cardiology • IT Infrastructure • Laboratory • Patient Care Coordination • Patient Care Devices • Radiation Oncology • Radiology • Connectathon Results • Vendor Products Integration Statements • Participation in Committees and Connectathons

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