Critical contribution to interoperability in Europe and World-wide

Transcription

1 INTEGRATING THE HEALTHCARE ENTERPISE Critical contribution to interoperability in Europe and World-wide ehealth na štartovacej čiare Conference Charles Parisot, IHE Europe, GE Healthcare, Buc, France 1

2 Or,. Realizing the promise of standardized information exchange in health 2

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 3

4 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 4

5 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 5

6 An Alternative? Have each project selects independently their standards: The same requirement addressed with a different mix of standards in different projects Large effort and time needed for detailed interoperability specifications (12 to 24 months, several man years) Even larger effort to develop custom conformance test tools, and organize own testing efforts (many man years). Initial implementation cost are very high, and on-going costs only increase. No reuse benefit from other ehealth projects. Projects shall drive their own requirements but address them by reusing as much as possible robust standardsbased profiles specifications 6

7 Standards Adoption Process Develop technical specifications Identify available standards (e.g. HL7, DICOM, IETF, OASIS) Testing at Connectathons IHE Demonstrations Products with IHE Document Use Case Requirements Timely access to information Easy to integrate products 7

8 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 8

9 The IHE Development Domains Pharmacy NEW Years of Steady Evolution Pathology since 2006 Radiology since 1998 Cardiology since 2004 Eye Care since 2006 Laboratory since 2004 Quality Research & Public Health since 2006 (Healthcare) IT Infrastructure since 2003 Radiation Oncology since 2004 Patient Care Devices since 2005 Patient Care Coordination since

10 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 Italy France Norway Germany Netherlands Spain Sweden UK Public Health, Quality and Research Pharmacy Professional Societies / Sponsors ACC ACCE ACEP ACP GMSI HIMSS RSNA SFR SFIL COCIR EAR-ECR DRG SIRM BIR EuroRec ESC JAHIS JIRA JRS METI-MLHW MEDIS-DC JAMI Contributing & Participating Vendors 10 10

11 International Growth of IHE Local Deployment National Extensions Promotional & Live Demonstration Events Funding Spain China Netherlands Norway Taiwan Austria Malaysia Australia Japan UK Korea Canada USA Italy Germany France Pragmatic global standards harmonization + best practices sharing 11

12 Professional societies: IHE Sponsors Healthcare Information Management Systems Society (HIMSS) British Institute of Radiology (BIR), British Computer Society (BCS German Radiology Society (DRG) GMSIH (IT France), SFIL (laboratory), French National Project (DMP) European Society of Cardiology Many other European Societies Radiological Society of North America (RSNA) American College of Physicians (ACP), American College of Emergency Physicians (ACEP) Many other American healthcare societies (ACCE), (AAO), (ASTRO), etc. JAHIS (IT Japan), JIRA, JRS.Many other Japanese Societies And many more. Governmental Agencies: French National Project (GIP-DMP) Dutch National Project (NICTIZ) Austrian National Project (ELGA) Canada Health Infoway (CHI) Regional projects (Italy, USA, Japan) and many more.. 12

13 IHE Participants and Relationships Participants include: Users - Clinicians, Staff, Administrators, CIOs, Governments Vendors of Information Systems and Equipment Consultants National Adoption of Healthcare IT Standards and IHE Profiles DMP (France), ELGA(Austria), HITSP (USA), Infoway (Canada), many others worldwide.. 13

14 IHE International Governance - Membership Membership: Members are Organizations Sign Governance & Intellectual Property policy. Three Organizational Categories: User, Developer, General Interest Membership is international, free and open to all. Over 250 Members. 50% Users - 50% Vendors Relationship with Standards Development Organizations (SDOs): HL7, DICOM, ISO, CDISC, IEEE, CEN and others IHE Process and Profiles Approved by ISO/TC 215 (ISO TR28380) 14

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

16 IHE Connectathons Massive yearly events : vendors engineers systems.integrated in 5 days Last Connectathon: Wien, Austria, April 20-24, 2008 Vendors do not pass until an IHE Project Manager attest it! 16

17 IHE Connectathon Open invitation to any vendor and other implementors Advanced IHE testing tools (MESA, KUDO, GAZELLE) Testing organized and supervised by independent project management team Thousands of cross-vendor tests performed Results recorded and published / Connectathon / Results 17

18 18

19 HIMSS Interoperability Showcase Last Demonstration at HIMSS, Chicago - April

20 Example: 2009 HIMSS Interoperability Showcase 20

21 IHE Solutions within the Enterprise Enterprise IT Infrastructure empi EMR - HIS User Auth RIS CIS LIS Eye Care Img Acq Radiology PACS Cath Cardiology ECG Auto Mgr Analyzer Laboratory Pathology Therapy Plan Img Acq Treatment Radiation Therapy Established Feb 2009 Pharmacy Nursing Station Devices Devices Intensive Care Unit Home Hub Devices 21

22 IHE Solutions within the Enterprise 3 Examples Enterprise IT Infrastructure empi EMR - HIS Cardiology Integration Profiles Cardiac Catheterization Lab Workflow Echocardiography Lab Workflow Retrieve ECG for Display User Auth Displayable Reports Cath and Echo Evidence Documents Img Acq RIS Radiology PACS Personnel White Pages Radiation Therapy Cath IT Infrastructure Integration Profiles Patient Administration Management Therapy Plan Patient Demographics Query Patient Identifier Cross-referencing Retrieve Information for Display Img Acq Enterprise User Authentication Consistent Treatment Time Patient Synchronized Applications Audit Trail and Node Authentication Shared Value Sets CIS Cardiology Established Feb 2009 Pharmacy ECG Auto Mgr LIS Analyzer Devices Devices Intensive Care Unit Eye Care Pathology Radiology Integration Profiles Radiology Scheduled Workflow Patient Information Reconciliation Access to Radiology Laboratory Information Portable Data for Imaging Consistent Presentation of Images Key Image Note Presentation of Grouped Procedures Evidence Documents Audit trail Nursing and Node Authentication Station(Rad option) Teaching Files and Clinical Trials Export Post-processing Workflow Reporting Workflow Charge Posting Simple Image and Numeric Reports Home Hub Devices 22

23 IHE Implementation Strategy Leverage established standards to allow rapid deployment and plan for future Pragmatic, Ease of Evolution Enable architectural freedom (patient vs. provider centric, centralized vs. decentralized, scalable (from office to enterprise to IDN to Regional and National Networks) Configuration flexibility Support breakthrough use cases: variety of care settings, care coordination, public health, PHR, EHR Interoperability for broad constituencies IHE: Offers consistent, standards-based record sharing for EHRs and other information systems 23

24 Registering Health Records:IHE-XDS Community Hospital Record Repository of Documents Clinic Record 1-Reference to records Specialist Record Repository of Documents Clinical IT System Index of patients records Health Info Exchange Clinical Encounter 26

25 Access to Shared Records : IHE-XDS Community Hospital Record Repository of Documents 4-Patient data presented to Physician 3-Records Returned Clinic Record Specialist Record Repository of Documents Clinical Encounter Clinical IT System Aggregate Patient Info HIE Index of patients records 2-Reference to Records for Inquiry 27

26 Health Information Exchanges Interoperability: Cross-enterprise Document Sharing Cross-Enterprise Document Sharing simplifies clinical data management by defining interoperable infrastructure. Transparency = Ease of Evolution Patients have guaranteed portability and providers may share information without concerns of aggregation errors. Digital Documents = Patients and providers empowerment Supports both centralized and decentralized repository architectures. Ease of federation nationally. Flexible privacy, Flexibility of configurations Addresses the need for a longitudinal healthcare data (health records). Complements to interactive workflow or dynamic access to data. 28

27 IHE and Service Oriented Architectures SOA is a powerful business driven design methodology SOA wraps interoperability in services, but does not solve interoperability: E.g. Web Services may or may not be used in SOA. IHE Profiles are largely based on Web Services. Standardizing Services offered along with the protocols is good, but a precise Service Definition does not result in compatibility on the wire. IHE Integration profiles are supportive of Service Oriented Architecture, but do not require use of SOA. IHE is Service Aware! Bits have to be compatible on the wire: No way to avoid specifying transaction & content 29

28 Why is IHE-XDS a breakthrough? It based on an International Standards; ebxml registry: OASIS and ISO standard, Web Service/Soap/XML. Sharing of digital documents as attested by the source, meets the most urgent needs. A proven healthcare community data-sharing paradigm (Message feeding a central web server hinders use of EHRs). Efficient to support all types of Health IT Systems (IDNs, Hospitals, Ambulatory, Pharmacy, Diagnostics Centers, etc.) and all types of information (summaries, meds, images, lab reports, ECGs, etc.), structured and unstructured. Meets both the needs of push communication by info sources and ondemand pull in a variety of centralized or distributed architectures. Offer a consistent, standards-based and functional record sharing for EHRs, PHRs & other IT Systems 30

29 Combining IHE Profiles Document Content & Modes of Document Exchange Doc Content Profiles (Semantics content) Scanned Doc XDS-SD Consent BPPC Emergency EDR Pre- Surgery PPHP Functional Status Assesment FSA Imaging XDS-I Laboratory XD*-Lab Discharge & Referrals XDS-MS PHR Exchange XPHR Document Sharing XDS Reliable Pt-Pt Interchange XDR Media Interchange XDM Document Exchange Integration Profiles 31

30 How real is XDS? Stable specification Published in IHE ITI Technical Framework + XDS.b Supplement First implementation in clinical use in region of Genoa - Italy) since early Several since: Lower Austria region, State of Vermont, Nagoya city, South Africa region, 2 Dutch regions, 3 US regions, etc. Adopted by several national programs world-wide 4 open source toolkits available, numerous product implementations in EHRs and Infrastructure offerings. 36

31 IHE, Global Standards-Based Profiles Adopted in National & Regional Projects NETHERLANDS Friesland UK CfH (Radiology WF) France DMP Lower Austria Austria Suisse St Gallen Italy (Conto Corrente Salute) Quebec, Toronto, Alberta, British Columbia Canada Infoway VITL-Vermont Boston Medical Center - MA Philadelphia HIE KeyHIE Pennsylvania CareSpark TN & VA South Africa CHINA-Shanghai Imaging Info Sharing Malaysia CHINA-MoH Lab results sharing JAPAN-Nagoya Imaging Info Sharing, Nationwide PDI guideline THINC- New York NCHICA N. Carolina 37

32 IHE-XDS is part of a family of profiles Regional, national, local or disease centric networks need a consistent set of Integration Profiles Eight Integration Profiles completed and tested, plus ten ready to implement = Standards-based interoperability building blocks for Rich Document Content for end-to-end application interoperability. Patient identification management Security and privacy Notification and data capture IHE-XDS + related IHE Integration profiles provide a complete interoperability solution 38

33 IHE Integration Profiles for Health Info Nets What is available and in trial implementation 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 Format Imaging and associated of the Information Document coded Content vocabulary Medical Summary Format of the Document Content and associated coded vocabulary 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 Access Security & Privacy Basic Patients Privacy Consents Establish Consents & Enable Access Control Cross-Enterprise User Assertion Provides Trusted Identity 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 identifiers across independent identification domains Other Request Form for Data Capture External form with custom import/export scripting Notification of Document Availability Notification of a remote provider/ health enterprise Final Text Approved 39 Trial Implementation-2008 Final Txt 2009

34 XDS-MS Medical Summary or PHR Extract Exchange Profile based on HL7 CDA Rel 2 and HL7 CCD Structured and Coded Header Patient, Author, Authenticator, Institution, Time of Service, etc. Level 1 Header always structured and coded Structured Content with coded sections: Reason for Referral Vital Signs Medication Text Structure Entry Studies Allergies Text Structure Entry Social History Problems Coded Section Entry Coded Section Entry Level 2 Level 3 Level 3 Title-coded sections with non-structured nor coded content (text, lists, tables). Simple Viewing (XML Style sheet) Med, Problems and Allergies as highly structured text. Text easy to import/parse Med Problems and Allergies have a fine-grain structure with optional coding. Coding Scheme explicitly identified. Text Structure Entry Care Plan Coded Section Entry XDS-MS and XPHR enable both semantic interoperability & simple viewing! 40

35 Use of a shared XDS infrastructure to access Radiology Reports and Images (XDS-I) Between Radiology and : Imaging specialists Non-imaging clinicians PACS Y Radiology -to- Physicians Hospital Radiology -to- Radiology PACS Z Physician Practice Imaging Center Same XDS Infrastructure (Registry and Repositories) for medical summaries and imaging information! 41

36 Implementing IHE today in Regional and National Health Networks: Most Popular Services Sharing of Patient Summaries (Incl Prescriptions) Sharing of Laboratory Results Sharing of Radiology Info Sharing of Cardiology Info Sharing of Scanned Docs Content Sharing of Documents Audit Trail and Secured Connection Digital Signature Privacy and Consent Patient Identification Mgt Provider Directory Terminology Services Middleware

37 Implementing IHE today in Regional and National Health Networks: Implementation Hospital Record Repository of Documents Specialist Record Repository of Documents Insurance Record Index of patients records Clinical IT System Aggregate View of Patient Info Patient Registry HIE Personal Health Portal Aggregate View of Citizen Info Clinical Encounter

38 Access to Shared Records : IHE-XDS Community Hospital Record Repository of Documents 4-Patient data presented to Physician 3-Records Returned Clinic Record Specialist Record Repository of Documents Clinical Encounter Clinical IT System Aggregate Patient Info HIE Index of patients records 2-Reference to Records for Inquiry 44

39 What can you do? Learn about IHE, Insist on relevant IHE profiles compliance in your RFPs and contract documents: Select Integration and Content Profiles, and Appropriate Actor(s) Ask vendors for their products IHE Integration Statements. Need more interoperability? Contribute to IHE Committees Support or create your national IHE 45

40 IHE Web site: Frequently Asked Questions Integration Profiles in Technical Frameworks: See Volume 1 of each TF for Use cases Cardiology Eye Care IT Infrastructure Laboratory Patient Care Coordination Patient Care Devices Pathology Quality Radiation Oncology Radiology Pharmacy Connectathon Result: Vendor Products Integration Statements 46

41 Providers and Vendors Working Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings