IHE integration profiles: XDS – Cross Enterprise Sharing of Healthcare Information

1. IHE integration profiles: XDS – Cross Enterprise Sharing ofHealthcare Information Charles Parisot, GE healthcare, ITI Plan co-chair IHE-Europe at WHIT, October 2007

2. Presentation Objectives • What is cross-enterprise document sharing • Support of semantic interoperability • Adoption of IHE in Europe and world-wide in regional and national eHealth projects

3. Health Information Exchanges:Linking diverse Care Delivery and Personal Health Records Integrated Care Delivery EMR’s Hospital Personal Health Record Hospital Group Lab/pathology eHealthInformation Exchange Radiology Pharmacy Physician Offices Hospital Multi-Practitioner Clinics Hospital Group Specific Registries Building an eHealth Infrastruture is easy…. Integrating current and existing HIT systems is the challenge !

4. Interoperability Dimensions for eHealth Info Nets Examples: Care Record Service (includes Meds, allergies, diagnosis, labs, etc.) Examples: ePrescription (Orders) Laboratory Order/Results Examples: Immunization Queries Targeted Medication History Content Infrastructure Health IT HealthRecords Sharing Dynamic Queries Workflow Transactions Security Privacy Id Mgt From EHR Vendor Association Interop Roadmap: www.ehrva.org

5. SubmitDoc Meta-data + References SubmitDoc Meta-data + References Query for DocsReferences Retrieve Documents Retrieve Documents DocumentRepository Submit Documents Document Consumer Document Registry/Repository Model: Document Registry DocumentRepository Document Source Document Source

6. Publish Documents/Records Summaries, (Labs, D/Cs, Image Reports/Links, etc.) Patient Identity Feed Query for shared Id Register Document Save Document IHE PIX / XDS Personal Health Record Results PATIENTS Registries PUBLIC HEALTH LAB EMR /HIS EMR / PMS PIX mgr XDS Rep Other Practices Hospital Lab Lab XDS Reg PACS Archive PACS Archive PHARMACY INSURANCES Clinics/GPs Rx History Claim Data Practice Mgmt EMR EMR-Hosted EMR-Lite Portal

7. Consume Documents/Records (Summaries, Labs, D/Cs, Image Reports/Links, etc.) Patient Id Feed Query for Patient Query for Documents Retrieve Documents IHE PIX / XDS Personal Health Record Results PATIENTS Registries PUBLIC HEALTH LAB EMR / PMS EMR / PMS PIX mgr XDS Rep Other Practices Hospital Lab Lab XDS Reg PACS Archive PACS Archive PHARMACY INSURANCES Clinics/GPs Rx History Claim Data EMR Practice Mgmt EMR-Hosted EMR-Lite Portal

8. Health Information Exchanges Interoperability: Cross-enterprise Document Sharing • Performance, Scalability and Cost:Registry and Repository are simple and efficient • Content Evolution:Registry and Repositories support any document content (e.g. enable use of HL7 CDA, DICOM, PDF, etc.). • Real end-to-end structured data:not only a portal view, easy to integrate in healthcare applications • Supports centralized and distributed approaches.Repositories centralized or distributed.XDS Domains may be federated. • Real Interoperability:Standards and profiles in place, proven and in use • Products are available:over 100 vendors world-wide. Tested at IHE Connectathons. Selected by a significant number of regional and national programs world-wide

9. Shared DocumentRepository Example: Providing Access to Prior Health Information Longitudinal Record as usedacross-encounters Public Health Long Term Care Acute Care (Inpatient) Other Specialized Careor Diagnostics Services PCPs and Clinics (Ambulatory) Encounter Medical Summary (med-prescribed & dispensed, allergies, pbs/diagnosis, etc) Lab Report (structured & coded tests results) Radiology Report and Images EKG Report

10. PreSurgery PPHP Consent BPPC Emergency EDER Scanned Doc XDS-SD Laboratory XD*-Lab Discharge &Referrals XDS-MS PHR Exchange XPHR Imaging XDS-I Doc Sharing XDS Pt-Pt DocInterchange XDR MediaInterchange XDM Related Profiles for Semantic Interoperability Terminologies (e.g. SNOMED, LOINC, etc. Doc Content Profiles Doc Exchange Integration Profiles

11. IHE Profiles for Health Info Nets Broad Healthcare Information & Web Services Web Services Record Sharing Dynamic Queries Workflow Transactions Security Privacy Id Mgt • Scanned Doc • Imaging • Lab Reports • Med Summary • Personal Record Extract • Emergency Record • Etc… • Query Existing Data (med, allegies, immunizations, etc.) • General Requests • Request Form for Data capture Content • Consent Mgt • Digit Sign Docs • Audit Trail-Node Authentication • User Authentication • PIX • PDQ • Doc Sharing • X-Community • Pt-Pt Doc Trf • Media Interchange Infrastructure Introduced in 2007: XDS.b, XCA, PIX/PDQ V3, QED, RFD, XUA

12. Document Registry Document Registry Longitudinal Recordas usedacross-encounters Longitudinal Recordas usedacross-encounters Long Term Care Long Term Care Regional Network A Regional Network B Acute Care (Inpatient) Acute Care (Inpatient) Other Specialized Careor Diagnostics Services Other Specialized Careor Diagnostics Services PCPs and Clinics (Ambulatory) PCPs and Clinics (Ambulatory) DocumentRepository DocumentRepository Hierarchical ExchangeCross Community Information Exchange (XCA, ATNA, PIX, PDQ) Which community holds records for a patient ? CommunityLocator service IHE XCA Transactions CrossCommunity Bridge CrossCommunity Bridge Cross Community Bridge • Each region notifies Community Location Service when new patient is registered or first data is stored. • Cross Community Bridges query Community Locator Service • Cross-Community Bridges query and retrieve records • Spans across XDS and non-XDS based communities. Regional Network C Non-XDS based Community

13. Lower Austria Austria IHE, global standards-based profiles adopted by several national & regional projects Netherland Amsterdam Italy (Conto Corrente Salute) UK CfH (Radiology WF) Denmark (Funen) Italy (Veneto) Spain (Aragon) FranceDMP Quebec, Toronto,Alberta, British ColumbiaCanada Infoway VITL-Vermont Boston Medical Center - MA Philadelphia HIE CPHIC – Pennsylvania CareSpark – TN & VA South Africa THINC- New York NCHICA – N. Carolina Malaysia CHINA-MoH Lab results sharing JAPAN-Nagoya Imaging Info Sharing CHINA-Shanghai Imaging Info Sharing

14. Committed National Programs:IHE XDS, PIX, PDQ, ATNA, CT, etc. • Austria • Lower Austria Region (NOMED WAN): live since end of 2006, 1.5 Million Patients, Entire Country (ELGA) by 2008. • Italy • 4 regional projects. Genoa region, live since early 2006. National deployment planned. • Canada • 7 regional projects coordinated by Infoway. Scheduled to go on-line in 2008. • France • Implementation tender to be awarded in September 2007. • USA • IHE Profiles adopted formally by HHS at Federal level (HITSP). Several regional projects: VT, NC, CareSpark, CPHC, Philiadelphia Ex, CT, etc. • Netherlands • Amsterdam region network project launched with NICTIZ. Implementation early 2008. • Japan • One implemented project. One pilot (Nagoya) to be on-line late 2007. • China: • MoH selected XDS and XD*-Lab (CDA) for two large pilots (2008). XDS-I in Shanghai. • South Africa • One regional network project awarded in 2007 - 2008 production.

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

16. More Resources - www.ihe.net • Frequently Asked Questions • Integration Profiles in Technical Frameworks:www.ihe.net/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: • www.ihe-europe.org