Local Deployment National Extensions Promotional & Live Demonstration Events Funding

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1 IHE- what it is, the current global l situation ti and offering HIMSS February 2008 Finish Delegation Charles Parisot (GE) IT Infrastructure Planning co-chair September, What IHE Delivers

2 International Growth of IHE Local Deployment National Extensions Promotional & Live Demonstration Events Funding Spain Netherlands China Australia Austria Norway Taiwan Korea Japan UK Canada USA Italy Germany France Pragmatic global standards harmonization + best practices sharing 2

3 IHE Organizational Structure IHE International Board Regional Deployment Global Development IHE North America IHE Asia-Oceania Canada China Japan Radiology IT Infrastructure Laboratory USA Korea Taiwan Cardiology Patient Care Coordination Pathology IHE Europe Radiation Oncology Patient Care Devices Eye Care Austria France Germany Netherlands Italy Norway Spain Sweden UK Public Health, Quality and Research Professional Societies / Sponsors ACC ACP RSNA COCIR SIRM ESC JAHIS METI-MLHW ACCE GMSI SFR EAR-ECR BIR JIRA MEDIS-DC ACEP HIMSS SFIL DRG EuroRec JRS JAMI Contributing & Participating Vendors 3

4 Growth in IHE Domains Over 200 vendors involved world-wide wide 8 Technical Frameworks 64 Integration Profiles Testing at Connectathons world-wide wide Demonstrations at major conferences world-widewide Each domain serves part of the hospital IT interoperability Veterinary Endoscopy Pharmacy Quality Pathology Patient Care Devices (3 profiles) Patient Care Coord. (5 profiles) Radiation Oncology (3 profiles) Eye Care (4 profiles) Laboratory (6 profiles) Cardiology (7 profiles) IT Infrastructure for Healthcare (20 profiles) Radiology (18 profiles)

5 IHE The Business Case for Hospitals System Integration, the hospital nightmare: An average hospital has 20 to 60 health IT systems from 8 to 15 vendors. Systems are pair-wise integrated, through locally specified solutions based on customized standards. It is expensive, complex and hard to maintain. 5

6 IHE The Business Case for Hospitals Re-engineering engineering System Integration : Leverage standards-based, robust and innovative solutions refocus customization to value-addadd Reduce RFP costs with common guidelines in purchasing and integrating systems that deliver these solutions It works, IHE did it with your vendors! Lets look at specific solutions. Today over 300 products support one or more IHE profile: Ask for an IHE Integration Statement. 6

7 IHE Model Actors in precisely defined roles Abstracts a specific function of information system Executing gp precisely defined transactions Using existing standards To solve real world interoperability problems Specifying ing Integration Profiles 7

8 IHE Technical Frameworks Implementation Guide for each Integration Profile An Integration Profile : A Set of Actors Exchanging g Transactions Use cases Process Flows ADT Order Department System Image Placer Scheduler/ Manager/ Order Filler PPS Manager Register J.Doe Patient Registration [RAD-1] Placer Order Management One or the New [RAD-2] other methods of creating an order is used Filler Order Management - Schedule New [RAD-3] Procedure Acquisition Modality Procedure Scheduled [RAD-4] Actors Transactions Patient Reconciliation J.Doe -> J.Smith Filler Order Mgmt - Status Update [RAD-3] Filler Order Mgmt - Status Update [RAD-3] Query Modality Worklist [RAD-5] Modality Procedure Modality Procedure Step In Progress Step In Progress [CARD-1] [CARD-1] Modality Procedure Modality Procedure Step Completed Step Completed [RAD-7] [RAD-7] Perform Acquisition ADT Pt. Registration [RAD-1] Patient Update [RAD-12] Pt. Registration [RAD-1] DSS/ Order Filler Placer Order Management [RAD-2] Filler Order Management [RAD-3] Patient Update [RAD-12] Order Placer Modality PS in Progress [CARD-1] Procedure Scheduled [RAD-4] Modality PS Completed [RAD-7] Patient Update [RAD-12] Procedure Updated [RAD-13] Instance Availability Notification [RAD-49] Evidence Modality PS in Progress [CARD-1] Creator Image Display Modality PS Completed [RAD-7] Query Images [RAD-14] Storage Modality Image/Evidence Retrieve Images/Evidence [CARD-4] Performed Commitment Stored [CARD-2] Procedure [CARD-3] Step Sep Manager Patient Update/ Merge [RAD-12] For each transaction: Std referenced Options specified Mapping required Patient Update/ Merge [RAD-12] Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7] Image Manager Image Archive Modality y PS in Progress [CARD-1] Modality PS Completed [RAD-7] Query Modality Worklist [RAD-5] Storage Modality Image/Evidence Commitment Stored [CARD-2] [CARD-3] Acquisition Modality 8

9 IHE Solutions within the Enterprise Enterprise IT Infrastructure empi EMR - HIS User Auth RIS CIS LIS -Radiation Therapy Img Acq Radiology PACS Cath ECG Cardiology Auto Mgr Analyzer Laboratory -Patient Care Devices -Pathology -Eye Care 9

10 1 2 Cath Lab Workflow The Cure for: Error prone data entry: Multiple re-entry of Patient ID Uncoordinated with Hospital Information System Results fragmented across IHE Cath Workflow Profile includes Electrophysiology lab Unidentified patients (emergency) systems Inconsistently time-tagged Custom solutions needed for data sharing Difficult to manage Un-ordered cath exams Change of rooms during procedure Ad hoc scheduling of cath labs 10

11 Stress Workflow ~85% of stress tests are multi- modality (ECG + imaging) ~0% of current architectures manage ECG and imaging workflow and results in an integrated manner Poor adherence to ACC/ASNC nuclear image display requirements IHE Stress Testing Profile and IHE Nuclear Medicine Image Profile 11

12 IHE Solutions within the Enterprise Cardiology Enterprise IT Infrastructure empi EMR - HIS User Auth RIS CIS LIS -Radiation Therapy Img Acq Radiology PACS Cath ECG Cardiology Auto Mgr Analyzer Laboratory -Patient Care Devices -Pathology Cardiology Integration Profiles Cardiac Catheterization Lab Workflow Echocardiography Lab Workflow Retrieve ECG for Display Displayable Reports Cath and Echo Evidence Documents Implanted Device Observations 12

13 IHE Solutions within the Enterprise Enterprise IT Infrastructure empi EMR - HIS User Auth RIS CIS LIS -Radiation Therapy Img Acq Radiology PACS Cath ECG Cardiology Auto Mgr Analyzer Laboratory -Patient Care Devices -Pathology -Eye Care 13

14 Laboratory Scheduled Workflow - Value Proposition A comprehensive workflow approach Address specimen linkage most lab specialties: Blood gases, Chemistry, Hematology, Immunology, Laboratory, Microbiology, Mycobacteriology, Mycology, Serology, Toxicology, Virology. Provides workflow improvement Increases continuity and integrity of clinical data Decreases user need for manual tasks. Spans ordering, conformity of specimens, lab automation, ti results delivery. Externally placed order with identified specimens Externally placed order with specimens unidentified or to be collected by the laboratory Internally placed order with specimens identified by third party or collected by the laboratory 14

15 IHE Solutions within the Enterprise Laboratory Enterprise IT Infrastructure empi EMR - HIS User Auth RIS CIS Img Acq Laboratory PACS Integration Cath Profiles ECG Radiology Laboratory Scheduled Workflow Cardiology Laboratory Barcode Labeling Laboratory Point Of Care Testing Laboratory Device Automation ti Laboratory Code Set Distribution Auto Mgr LIS Analyzer Laboratory -Radiation Therapy -Patient Care Devices -Pathology -Eye Care 15

16 IHE Solutions within the Enterprise Enterprise IT Infrastructure empi EMR - HIS User Auth RIS CIS LIS -Radiation Therapy Img Acq Radiology PACS Cath ECG Cardiology Auto Mgr Analyzer Laboratory -Patient Care Devices -Pathology -Eye Care 16

17 Scheduled Workflow & patient Info reconciliation Backbone of IHE Radiology: Integrates Registration, Scheduling, Acquisition Workflow and Image Content Preserve Order Continuity, improve Demographic Integrity, synchronized Worklists Reliable Storage, Improve Order Tracking Reduce Integration Effort at Site Combines use of HL7 and DICOM standards 17

18 IHE Solutions within the Enterprise Radiology Enterprise IT Infrastructure empi Img Acq Radiology RIS PACS How to use IHE? IHE Radiology Handbook EMR - HIS Radiology Integration Profiles Radiology Scheduled Workflow Patient Information Reconciliation Access to Radiology Information Portable CIS Data for Imaging Consistent Presentation of Images User Auth LIS Key Cath Image Note ECG Auto Mgr Presentation Cardiology of Grouped Procedures Laboratory Evidence Documents Analyzer Audit trail and Node Authentication (Rad option) Teaching Files and Clinical i l Trials Export Post-processing Workflow Reporting Workflow Charge Posting Simple Image and Numeric Reports Media Import Reconciliation Workflow -Radiation Therapy -Patient Care Devices 18 -Pathology -Eye Care

19 IHE Solutions within the Enterprise Enterprise IT Infrastructure empi EMR - HIS User Auth RIS CIS LIS -Radiation Therapy Img Acq Radiology PACS Cath ECG Cardiology Auto Mgr Analyzer Laboratory -Patient Care Devices -Pathology -Eye Care 19

20 Patient Administration Mgt (PAM) CCHIT plan for 2009 Coordinates exchange of patient registrations, updates, and movements for all clinical areas Information may be received and processed by consuming applications in any clinical domain Optionally allows unambiguous updating of historic patient movement events Demographic and encounter tracking works in both inpatient and ambulatory care settings Standardizes on HL7 V2.5 and its conformance structures 20

21 Patient Administration Management Actor & Transaction: flexibility and compatibility Patient Demographics Consumer Patient Encounter Source Patient Encounter Management [ITI-031] Flexible Actor grouping Patient Demographics Source Patient Identity Feed [ITI-030] Patient Identity Feed [ITI-030] Patient Demographics Source OR Patient Encounter Source Patient Demographics Consumer Patient Encounter Consumer Patient t Encounter Management [ITI-031] Patient Encounter Consumer 21

22 IHE Solutions within the Enterprise IT Infrastructure (Enterprise) Enterprise IT Infrastructure empi EMR - HIS User Auth Img Acq Radiology RIS IT Infrastructure Integration CIS Profiles Patient Administration Management Patient Demographics Query PACS Cath ECG referencing Cardiology Patient Identifier Cross-referencingreferencing Retrieve Information for Display Enterprise User Authentication Consistent Time Patient Synchronized Applications Audit Trail and Node Authentication Personnel White Pages Auto Mgr LIS Analyzer Laboratory -Radiation Therapy -Patient Care Devices -Pathology -Eye Care 22

23 National and Regional projects It is difficult to provide a simple summary view of these projects: These slides reflect information publicly available and current based on author s knowledge. IHE offers 24 Integration & Content profiles applicable in health information exchange for communities, regions or nations. Each project discussed here uses different subsets of these profiles (IHE Modularity). These projects are multi-year and projects with complex decision making processes. 23

24 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 clinical and administrative systems and ancillary IT systems (EHRs,Lab, Pharma, Payers, etc.) and personal health record systems. Objective is to empower the consumers in having shared EHR information between all of its potential healthcare providers (if authorized) and self. Objective is to empower the providers in choosing when and what information to share, and to trust the information they may use in the care of their patients. 24

25 Introduced at HIMSS in 2005 : IHE-XDS Community or sub-network Hospital Record Repository of Documents 4-Patient data presented to Physician 3-Records Returned Clinic Record 1-Reference to records Specialist Record Repository of Documents Clinical Encounter Clinical IT System Aggregate Patient Info Sharing System Index of patients records 2-Reference to Records for Inquiry 25

26 IHE Integration Profiles for Health Info Nets What is available and has been added in 2007 Clinical and PHR Content Emergency Referrals PHR Extracts/Updates ECG Format Report of the Document Document Content Lab and Results associated Document coded vocabulary Format of the Document Content Scanned and associated Content Documents coded vocabulary Format of the Document Content Imaging and associated Information coded vocabulary Medical Summary Format of the Document Content and associated coded vocabulary Format of the Document Content Format of the Document Content and (Meds, associated Allergies, coded Pbs) vocabulary Format of the Document Content and associated coded vocabulary Health Data Exchange Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a longitudinal record Cross-Enterprise Document Pt-Pt Reliable Interchange Cross-Enterprise Document Media Interchange Cross-Community Community Access Security & Privacy Basic Patients Privacy Consents Establish Consents & Enable Access Control Cross-Enterprise User Attestation User Attributes fro Access Control Document Digital Signature Attesting true-copy and origin Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. Consistent Time Coordinate time across networked systems Patient ID Mgmt Patient Demographics Query Patient Identifier Cross-referencing Map patient t identifiers across independent identification domains Other Request Form for Data Capture External form with custom import/export t scripting Notification of Document Availability Notification of a remote provider/ health enterprise Final Text Approved 26 Trial Implementation-2007 Final Txt 2008

27 IHE, global standards-based profiles adopted by several national & regional projects UK CfH (Radiology WF) Netherland Amsterdam France DMP Denmark (Funen) Italy (Veneto) Spain (Aragon) Lower Austria Austria Italy (Conto Corrente Salute) Quebec, Toronto, Alberta, British Columbia Canada Infoway VITL-VermontVermont Boston Medical Center - MA South Africa Philadelphia HIE KeyHIE Pennsylvania CareSpark TN & VA CHINA-Shanghai Imaging Info Sharing Malaysia Singapore CHINA-MoH Lab results sharing JAPAN-Nagoya Imaging Info Sharing NCHICA N. Carolina 27

28 Italy (Genoa Region) A.S.L. 4 CHIAVARESE Azienda Sanitaria Locale n. 4 Chiavarese Cooperazione e condivisione E stato attivato un Work Group composto da: Asl 4 Chiavarese; Dipartimento di Medicina Diagnostica Conto e Corrente Terapie Speciali dell Università di Padova IHE Commissione Salute nazionale Italia alcune aziende ICT esperte in soluzioni e-health (Rasna Medical Systems, Soluzioni Informatiche); per la realizzazione di un prodotto open-source su J2EE che implementa il profilo IHE XDS. 28

29 Italy (Genoa Region) In service since January Hospitals and 500 physician offices. EMRs import and export documents from their local records. All vendor products required to pass IHE-Europe Europe connectathon in April Patients chose to join through one of their care provider Infrastructure includes: XDS Registry XDS Repository shared at the regional level PIX for patient Id linking Doc content is CDA with PDF content. Plan in place to move to CDA rel 2 with structured data. IHE (XD*-Lab) CDA Lab primary candidate. 29

30 Austria (Lower Austria and National) Lower Austria Lower Austria Region (around Vienna) Deployed in Operational. 1.5 Million patients on-line. 11 hospitals connected. Use IHE profiles: XDS, PIX, XDS-SD, SD, ATNA, XUA, BPPC. Austria National project launched in 2007 (ELGA). Given the success to deploy the first region is about one year. Roll-out out includes: Ministry backing of IHE conformance (IHE-Eu Eu Connectathon) Extending to Ambulatory Physicians in 2008 Step-wise introduction of structured and coded content with HL7 CDA based IHE Content Profiles. 30

31 USA (Philapdelphia Region) Philadelphia Health Info Exchange in service since Focused on images and reports sharing. 5 Hospitals + Imaging Center + Public Health The Hospital of the University of Pennsylvania Thomas Jefferson University Hospital Children s Hospital of Philadelphia Presbyterian Medical Center Pennsylvania Hospital UPHS Community Radiology Philadelphia Department of Public Health Migration to XDS, ATNA, PIX and XDS-I completed in Demonstrated live at RSNA-Chicago Nov

32 USA (Other) HITSP (HHS sponsored) accepted 8 IHE Integration profiles for: Lab results distribution and sharing, Registration and Medication History for Consumers, s, Biosurveillance. 2 NHIN-1 Pilots (CSC and IBM) leveraged IHE profiles (Med Summaries and Lab). South Shore, MA: Operational (Inpatient and Emergency Dept) NHIN-2 Trial Implementations (NCHICA, Virginia & CareSpark HIEs) Several HIEs projects are actively planning the use of IHE Vermont State KeyHIE (PA) ehealthconnecticut Boston Medical Center and affiliated clinics ser.lnk 32

33 Canada Canada Health Infoway: national Commitment to XDS/XDS- I for imaging sharing 3 infrastructure tenders awarded in 2007 and 1 more to come early 2008 resulting in over 1/3 of Canadian patients covered: Toronto East Network - Ontario Montreal McGill - Quebec Alberta British Columbia Includes XDS, ATNA, PIX and XDS-I. Planned to become live 2008 in Quebec, Ontario, Alberta, British Columbia. 33

34 France (National DMP) Prototype RFP call for tender mid Confirmed requirement to use to IHE profiles: XDS, ATNA, XUA, BPPC, etc. Encourage vendors to submit their products to the IHE- Europe Connectathon (April 2007-Berlin). Implementation ti plan under revision. i Infrastructure to include: XUA from User Authentication ti ti Portal and BPPC for privacy XDS Registry/XDS Repositories ATNA for audit trail and node authentication. Doc content to be: CDA rel 2 patient summary (close to XDS-MS), Hprim with migration to IHE XD*-Lab for Lab, Scanned Doc (PDF) and imaging (XDS-I). 34

35 China Other Commitments MoH selected XDS and XD*-Lab (CDA) for lab info sharing. XDS-I in Shanghai. Israel, Jordan, Palestinian Authority Public Health Info Affinity Domain (XDS, ATNA, XD*Lab) Middle east Consortium for infectious Disease Surveillance Netherlands Amsterdam region network project launched XDS-I. Japan Nagoya region network project operational late XDS, XDS-I Kobe with imaging i info sharing South Africa National project launched in Tender awarded. Operational in

36 September, What IHE Delivers