An introduction to integrating the health enterprise
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An Introduction to Integrating the Health Enterprise. Dr Vincent McCauley Chair, IHE Australia. Radiology. IT Infrastructure. Laboratory. Cardiology. Patient Care Coordination. Pathology. IHE Europe. Austria. France. Germany. Netherlands. Radiation Oncology. Patient Care Devices.

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An introduction to integrating the health enterprise

An Introduction toIntegrating the HealthEnterprise

Dr Vincent McCauley Chair, IHE Australia


An introduction to integrating the health enterprise

Radiology

IT

Infrastructure

Laboratory

Cardiology

Patient Care

Coordination

Pathology

IHE Europe

Austria

France

Germany

Netherlands

Radiation

Oncology

Patient Care

Devices

Eye Care

Italy

Norway

Spain

UK

Sweden

Public Health, Quality

and Research

IHE Asia-Pacific

Australia

Malaysia

New Zealand

Professional Societies / Sponsors

ACC

ACCE

ACEP

HISA

ACP

GMSIHIMSS

HL7 AUS

Contributing &

ParticipatingVendors

ESC

COCIR

EAR-ECR

DRG

RANZCR

SIRM

BIR

EuroRec

RACS

RSNA SFRSFIL

MSIA

JAHISJIRAJRS

METI-MLHW

MEDIS-DCJAMI

IHE Organizational Structure

IHE International Board

Global Development

Regional Deployment

IHE North America

IHE Asia

USA

China

Japan

Canada

Korea

Taiwan

2


Ihe australia organisational structure

IHE Australia Organisational Structure

  • IHE Australia Sponsors

    - Health Informatics Society of Australia (HISA)

    - Health Level Seven (HL7) Australia

    - Medical Software Industry Association (MSIA)

    - Royal Australasian College of Radiologists (RANZCR)

  • Some Australian Supporting IHE members

    - Health Information Management Society (HIMMS)

    - Royal Australian College of Surgeons (RACS)

    - Australian Diagnostic Imaging Association (ADIA)


Ihe domains

IHE Domains

  • Radiology

  • Cardiology

  • Radiation Oncology

  • IT Infrastructure

  • Patient Care Coordination

  • Patient Care devices

  • Laboratory, Pathology, Eye Care.

  • Pharmacy

  • Quality Research and Public Health


An introduction to integrating the health enterprise

IHE Value Proposition

  • IHE Solutions are Driven by Strategic Healthcare Lead Users that collaborate with Healthcare Vendors

  • IHE Solutions are Generic, Reusable and Interoperable based on Healthcare Standards: DICOM, HL7, RFC

  • IHE Solutions Optimize the Clinical Workflows

  • IHE Deployment process – Connectathon, Integration Statements and Users Success Stories information helps to refine the product “Business Case”

  • IHE Technical Framework specification describes the Global IHE solutions at a High Level for Planning & Marketing and in details for products Architects and Engineering development


An introduction to integrating the health enterprise

IHE Benefits

  • Clinical Users

    • Greater access to consistent information

    • Fewer errors, fewer tedious tasks

  • Buyers

    • Specify/purchase RFP’s integration capabilities easily and Freedom to acquire “Best of Breed” systems

  • IT Professionals

    • Faster, more predictable integration projects

    • Facilitate cooperation of competing vendors

  • Administrators

    • Increased throughput - Better scheduling

    • Reduce Cost


Ihe profile examples

IHE Profile Examples

  • (XDS/XDS-I) Cross-Enterprise Document Sharing for Imaging

    • Shares clinical documents, images, diagnostic reports and related information between healthcare enterprises

  • (PIX) Patient ID Cross-referencing

    • Cross-index patient IDs across multiple sites

  • (PDQ) Patient Demographics Query

    • Query and retrieve a patient’s demographic and visit information

  • (ATNA) Audit Trail and Node Authentication

    • Systems Authentication

    • Audit events management

  • (BPPC) Basic Patient Privacy and Consent

    • Patient privacy consents & enforcement


Ihe problem solution process

IHE Problem Solution Process

  • User driven, Vendor led – A standardised process ISO TR28380

  • Working with vendors, care providers and standards organizations, IHE:

    • Distills a clear description of the problem (Users)

    • Determines the right way to solve it using standards (Vendors)(IHE Profile)

    • Documents the solution in an implementation guide (IHE Technical Framework)

    • Coordinates cross-vendor testing of the solution (IHE Connectathon)

    • Demonstrates vendor implementations (IHE Showcase)

      Go see the rest of the profiles


Ihe testing process

IHE Testing Process

Users

Testing Results

Deploy

Systems

Testing Tools

Sponsors:Project

Management

Team

Develop

Testing Tools

Approves

Test Logs

Connectathon

Product +IntegrationStatement

Implement

Profile Actors

In-House

Testing

Vendors

Sponsors:

Exhibits

Demonstration

IHE Technical Framework (IHE Profile Specifications)


What is a connectathon

What is a Connectathon?

Cross-vendor, live, supervised, structured tests

  • All participating vendors’ products tested together in the same place/time

  • Experts from each vendor available for immediate problem resolution… fixes are done in minutes, not months!!

  • Each vendor tests with multiple trading partners (actual product to actual product)

  • Testing of real-world clinical scenarios using IHE Integration Profiles


A simple ihe profile portable data for imaging

PACS

[Media Importer]

PC Browser

Image Display

[Media Reader]

Printer

[Media Reader]

John Doe

A “simple” IHE Profile - Portable Data for Imaging

DICOM

Media

Creator

DICOM Data

DICOM

Web Data(Optional)

CD

Required to cleanup Patient ID, Acc#, etc.

DICOM

Web Data


An introduction to integrating the health enterprise

IHE Integration Profiles for Health Info Nets

Basic Patients Privacy Consents

Emergency Referrals

PHR Extracts/Updates

Format of the Document Content and associated coded vocabulary

Establish Consents & Enable Access Control

Patient Demographics Query

ECG Report Document

Format of the Document Content and associated coded vocabulary

Lab Results Document Content

Format of the Document Content and associated coded vocabulary

Scanned Documents

Cross-Enterprise User Attestation

Format of the Document Content and associated coded vocabulary

Patient Identifier Cross-referencing

Imaging Information

Format of the Document Content

User Attributes fro Access Control

Medical Summary

(Meds, Allergies, Pbs)

Format of the Document Content and associated coded vocabulary

Map patient identifiers across independent identification domains

Document Digital Signature

Format of the Document Content

and associated coded vocabulary

Attesting “true-copy and origin

Cross-Enterprise Document Sharing

Audit Trail & Node Authentication

Request Formfor Data Capture

Registration, distribution and access across health enterprises of clinical documents forming a longitudinal record

Centralized privacy audit trail and node to node authentication to create a secured domain.

External form with custom import/export scripting

Notification of Document Availability

Cross-Enterprise Document Pt-Pt Reliable Interchange

Consistent Time

Notification of a remote provider/ health enterprise

Coordinate time across networked systems

Cross-Community Access

Cross-Enterprise Document Media Interchange

Security & Privacy

Clinical and PHR Content

Patient ID Mgmt

Health Data Exchange

Other

Final Text Approved

Trial Implementation-2007 –Final Txt 2008


Ihe global standards based profiles adopted by several national regional projects

Austria

IHE, global standards-based profiles adopted by several national & regional projects

Lower

Austria

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

KeyHIE – Pennsylvania

CareSpark – TN & VA

South Africa

NCHICA – N. Carolina

Malaysia

Singapore

CHINA-MoH

Lab results sharing

JAPAN-Nagoya

Imaging Info Sharing

CHINA-Shanghai

Imaging Info Sharing


Ihe problem solution process1

IHE Problem Solution Process


From standards to solving a use case

From Standards to Solving a Use Case

Business Use Case

  • NeHTA

  • PIP WG

  • Standards Australia

Interoperability Specifications

+ Constructs

Standards Adoption/Profiling

Technical Use Case Driven

IHE

HL7, OMG,

X12, DICOM, ISO, W3C etc…

Base Standards

Foundations


Ihe australia conformance testing

IHE AustraliaConformanceTesting

  • IHE Conformance Testing supervised by NATA accredited Testing Laboratory (AHML)

Certification

Interoperability Specifications

+ Constructs

Standards Adoption/Profiling

Technical Use Case Driven

Base Standards

Foundations


Ihe chicago connectathon 2010

IHE Chicago Connectathon 2010


Ihe chicago connectathon 20101

IHE Chicago Connectathon 2010


Ihe chicago connectathon 20102

IHE Chicago Connectathon 2010

  • 104 vendors

  • 150 applications

  • 498 engineers

  • Approx. $2 million in employee costs over 5 days

  • 77 IHE Profiles


Australian secure messaging specification development process

Australian Secure Messaging Specification development process

  • DoHA PIP GP eHealth initiative January 2009

  • Initial NeHTA Secure Message Delivery (SMD) specification

  • Joint Vendor (MSIA) / NEHTA working group refined specification

    - 25 Vendors, 6 meetings, 9 days

    - Technical sub-committee – 6 vendors, 4 meetings 8 days


Australian secure messaging specification development process1

Australian Secure Messaging Specification development process

  • Output of PIP Working Group submitted to Standards Australia Nov 2009

    - 3 Technical Specifications + 1 technical report

  • Standards Task force

  • Rapid public comment and publication => Four publications January 2010

  • ATS-5822:2010 – Secure messaging delivery


Australian secure messaging specification development process2

Australian Secure Messaging Specification development process

  • Continuing work by Conformance/Compliance subcommitee

  • NEHTA alpha code available March 2010


Secure messaging connectathon

Secure Messaging Connectathon

  • Funded by DoHA, contribution by vendors

  • Testing single standard – Secure Message Delivery ATS-5822:2010

  • Standardised content available as IHE Australia profiles for eResults (ATS 5201:2010) and eReferral

  • Master Class and testing streams


Secure messaging connectathon tooling

Secure Messaging ConnectathonTooling

  • Test management using Gazelle (IHE International)

  • Java alpha code (NEHTA)

  • Pre-connectathon remote capability testing (AHML)

  • Connectathon Functional Test harness and process (AHML)


Useful links

Useful Links

www.ihe.net

www.ihe.net.au

http://ihe-australia.wikispaces.com

http://wiki.ihe.net

http://motorcycleguy.blogspot.com/2010/01/where-in-world-is-xds.html


Italy genoa region

Italy (Genoa Region)


Italy genoa region1

Italy (Genoa Region)

  • In service since January 2006.

  • 4 Hospitals and 500 physician offices.

  • EMRs import and export documents from their local records.

  • All vendor products required to pass IHE-Europe connectathon in April 2005.

  • 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.


Austria lower austria and national

Lower

Austria

Austria

Austria (Lower Austria and National)

  • Lower Austria Region (around Vienna) Deployed in 2007 - Operational. 1.5 Million patients on-line. 11 hospitals connected.

  • Use IHE profiles: XDS, PIX, XDS-SD, ATNA, XUA, BPPC.

  • National project launched in 2007 (ELGA). Given the success to deploy the first region is about one year.

  • Roll-out includes:

    • Ministry backing of IHE conformance (IHE-Eu Connectathon)

    • Extending to Ambulatory Physicians in 2008

    • Step-wise introduction of structured and coded content with HL7 CDA based IHE Content Profiles.


Usa philapdelphia region

USA (Philapdelphia Region)

  • Philadelphia Health Info Exchange in service since 2005. 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 2007.

  • Demonstrated live at RSNA-Chicago Nov 2007


Usa other

USA (Other)

  • HITSP (HHS sponsored) accepted 8 IHE Integration profiles for: Lab results distribution and sharing, Registration and Medication History for Consumers, 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


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