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INTEGRATING THE HEALTHCARE ENTERPISE (IHE) Orientation Workshop. International HL7 Interoperability Conference-10 Carlos Guilherme Costa, Product Manager, Alert, IHE US & Eu Connectathon participant Julio Carau, Director, Hospital de Clinicas "Dr. Manuel Quintela", Montevideo, Uruguay.

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Integrating the healthcare enterpise ihe orientation workshop

INTEGRATING THE HEALTHCARE ENTERPISE (IHE)Orientation Workshop

International HL7 Interoperability Conference-10

Carlos Guilherme Costa, Product Manager, Alert, IHE US & Eu Connectathon participant

Julio Carau, Director,Hospital de Clinicas "Dr. Manuel Quintela", Montevideo, Uruguay


Agenda
Agenda

This Morning:

Part 1: THE IHE STANDARDS ADOPTION PROCESS: achieving practical interoperability

This Afternoon:

Part 2:

USERS AND VENDORS WORKING TOGETHER: how can I contribute & benefit from IHE

HOW TO USE IHE RESOURCES: hands on experience


Agenda1
Agenda

Part 1: THE IHE STANDARDS ADOPTION PROCESS: achieving practical interoperability

3


Ihe a framework for interoperability
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


Standards necessary not sufficient
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


Ihe connecting standards to care
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


Standards adoption process

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


Stakeholder benefits
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


Ihe implementation strategy
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 Regional and National Networks) 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


Radiologysince 1998

PharmacyNEW 2009

Cardiologysince 2004

Pathologysince 2006

Laboratorysince 2004

Eye Caresince 2006

(Healthcare)IT Infrastructuresince 2003

QualityResearch & Public Healthsince 2006

Radiation Oncologysince 2004

Patient Care Devicessince 2005

Patient Care Coordinationsince 2004

The IHE Development Domains

12 Years of Steady Growth 1998 – 2010


International growth of ihe
International Growth of IHE

Switzerland

Netherlands

Germany

Turkey

Canada

Austria

Taiwan

France

Japan

China

USA

Italy

UK

Spain

2005

2006

2000

2007

1999

2001

2002

2003

2004

2009

2008

2010

  • Local Deployment, National Extensions

  • Promotional & Live Demonstration Events

  • Over 300 Organizational Members (all stakeholders)

Malaysia

Australia

Pragmatic global standards harmonization + best practices sharing

11


Ihe integration profiles model
IHE Integration Profiles - Model

  • Actors in precisely defined roles

    • Abstracts a specific function of information system

  • …Executing precisely defined transactions

    • Using existing standards

  • ……To solve real world interoperability problems

    • Specifying Integration Profiles


Key ihe concepts
Key IHE Concepts

  • Generalized Systems -> Actors

  • Interactions between Actors -> Transactions

  • Problem/Solution Scenarios -> IntegrationProfiles

  • For each Integration Profile:

    • the context is described (which real-world problem)

    • the actors are defined (what systems are involved)

    • the transactions are defined (what must they do)


The product world

Product XYZfrom Vendor T

The Product World…..


The ihe world

Actor

Actor

Actor

The IHE World….

IHETransaction

IHETransaction

IHE Actor

IHE Actor

IHETransaction


Mapping ihe to products

Actor

Actor

Actor

Product XYZfrom Vendor T

Mapping IHE to Products

IHETransaction

IHETransaction

IHE Actor

IHE Actor

IHETransaction


Organization of technical frameworks
Organization of Technical Frameworks

  • Volume 1: Integration and content Profiles

    • Describes clinical need and use cases

    • Identifies :

      • the actors and transactions or,

      • content modules

  • Volume 2+ of Technical Framework

    • Provides implementation specification for transactions or content modules


Ihe and service oriented architectures
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 (not always) based on Web Services.

    • Standardizing Services “offered” along with the “protocols” is 20 years old (Open System Interconnect). Good, but a 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


Standards adoption process1

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


Ihe connectathon
IHE Connectathon

  • Open invitation to vendor and other implementors community

  • Advanced testing tools (GAZELLE)

  • Testing organized and supervised by project management team

  • Thousands of cross-vendor tests performed

  • Results recorded and published


Vendors do not pass…

until an IHE Project Manager attest it !

IHE Connectathons

Massive yearly events :

70-80 vendors

250-300 engineers

100-120 systems

….integrated in 5 days

Last Connectathon:

Chicago, USA, January 11-15, 2010

Bordeaux, France, April 12-16, 2010



Leveraging ihe integration statements
Leveraging IHE Integration Statements

  • Vendors

    • Claim IHE Compliance in an explicit way

    • Can rely on an objective and thorough specification(IHE Technical Framework)

    • Willing to accept contractual commitments

    • Willing to correct “implementation errors”

  • Buyers

    • Can compare product integration capabilities

    • Simplify and strengthen their RFPs

    • Can leverage a public and objective commitment

    • Decreased cost and complexity of interface deployment and management


Ihe demonstrations not an ihe connectathon
IHE Demonstrations: NOT an IHE Connectathon

IHE Connectathon is about qualifying “real-world implementations”. Strict process and controlled technical testing activity.

 It is the stick !

IHE demonstration is about education and promotion about what some “connectathon tested implementations” can achieve.

 It is the carrot !

Implementations participating to an IHE Demonstration are required to have passed an IHE Connectahon. Not all vendors and products are demonstrated.

24




Implementation tools 1
Implementation Tools (1)

Open source implementations are available for XDS, XCA, XCPD, PIX, PDQ, ATNA, CT, and more:

Microsoft under codeplex http://ihe.codeplex.com/

NIST under Source Forge http://sourceforge.net/projects/iheos/

HIE-OS under Source Forgehttp://sourceforge.net/projects/hieos/

FHA CONNECT http://www.connectopensource.org

More on the next page…..

27


Open source implementations are available for XDS, XCA, XCPD, PIX, PDQ, ATNA, CT, and more, from Open Health Tools: http://www.projects.openhealthtools.org

OHT – IHE Profiles (Charter)https://iheprofiles.projects.openhealthtools.org

OHT – Open Exchange (Forge)

https://openexchange.projects.openhealthtools.org

OHT – Model Driven Health Tools (Charter) https://mdht.projects.openhealthtools.org

Implementation Tools (2)


Providers and Vendors XCPD, PIX, PDQ, ATNA, CT, and more, from

Working Together to Deliver

Interoperable Health Information Systems

in the Enterprise and

Across Care Settings

http://www.ihe.net


Requirements for an open hie ehr
Requirements for an open HIE/EHR XCPD, PIX, PDQ, ATNA, CT, and more, from

  • Bring trust and ease of use for healthcare professionals:

    • Care delivery organizations choose information to share:

      • Based on patient health status

      • When they see fit (discharge, end of encounter, etc.)

      • What information to share (pick relevant documents, and content elements).

    • Care delivery organizations access patient info through:

      • Their own local EMR (if they have one)

      • Through a shared portal/service otherwise.

    • When accessing patient info:

      • Find quickly if relevant information is available or not (single query)

      • May select among relevant records (may be done in background)

      • Among them chose to import whole or part in local patient record


Requirements for an open hie ehr 2
Requirements for an open HIE/EHR(2) XCPD, PIX, PDQ, ATNA, CT, and more, from

  • Bring trust and privacy to patients:

    • Only authorized organizations and authenticated healthcare providers may transact in the HIE:

      • Each node or IT system interfaced is strongly authenticated

      • Each user shall be authenticated on the edge system

      • All traffic trough the infrastructure is encrypted

    • Patient consent needs multiple choices or levels

      • Unless opt-in, no data about a specific patient may be shared

      • Several data sharing policies offered to the patient consent

      • Each shared record/document is assigned to specific policies (or not shared) at encounter time.

      • Healthcare providers may only access records/documents compatible with their role.


Categories of healthcare communication services
Categories of Healthcare Communication Services XCPD, PIX, PDQ, ATNA, CT, and more, from

HIEs and Shared EHRs

Hospitals

Patient and Provider ID Mgt

e.g. access to last 6 months historical labs and encounter summaries

e.g. get a current list of allergies or med list from a source

e.g. order a lab test, track status and receive results

Security

Document

Sharing

Dynamic

Information

Access

Workflow

Management

Source-persisted and attested health records

Specific info snapshot

provided on demand

2 or more entities

synchronize

a task


Categories of healthcare communication services1
Categories of Healthcare Communication Services XCPD, PIX, PDQ, ATNA, CT, and more, from

HIEs and Shared EHRs

Hospitals

Patient and Provider ID Mgt

Medical Summary (XDS-MS)

e.g. access to last 6 months historical labs and encounter summaries

e.g. get a current list of allergies or med list from a source

e.g. order a lab test, track status and receive results

Security

Cross-Enterprise Document Sharing (XDS)

Document

Sharing

Dynamic

Information

Access

Workflow

Management

Source-persisted and attested health records

Specific info snapshot

provided on demand

2 or more entities

synchronize

a task

Patient Id Cross-Referencing (PIX)


Ihe profiles specifications
IHE Profiles Specifications XCPD, PIX, PDQ, ATNA, CT, and more, from

  • Go to: www.ihe.net/Technical_framework

  • For XDS:Under IT Infrastructure

    • E.g. IT Infrastructure Technical Framework (XDS.b)

  • For PIX:Under IT Infrastructure

    • E.g. IT Infrastructure Technical Framework (PIX, HL7V2)

    • Or PIXV3 supplement (PIX HL7 V3).

  • For XDS-MS: Under Patient Care Coordination

    • E.g. PCC Technical framework (XDS-MS)


The ihe global standards adoption process
The IHE Global Standards Adoption Process XCPD, PIX, PDQ, ATNA, CT, and more, from

First Step: Propose a Use case for Interoperability

35


Patient identifier cross referencing for mpi services
Patient Identifier Cross-referencing for MPI XCPD, PIX, PDQ, ATNA, CT, and more, from Services

  • Allow all enterprise participants to register the identifiers they use for patients in their domain

  • Participants retain control over their own domain’s patient index(es)

  • Support domain systems’ queries for mapping across other systems’ identifiers for their patients

  • Optionally, notify domain systems when other systems update identifiers mapping for their patients


Patient identifier cross referencing for mpi value proposition
Patient Identifier Cross-referencing for MPI XCPD, PIX, PDQ, ATNA, CT, and more, from Value Proposition

  • Maintain and linked all systems’ identifiers for a patient in a single location

  • Use any algorithms (encapsulated) to find matching patients across disparate identifier domains

  • Lower cost for synchronizing data across systems

    • No need to force identifier and format changes onto existing systems

  • Leverages standards and transactions already used within IHE


The ihe global standards adoption process1
The IHE Global Standards Adoption Process XCPD, PIX, PDQ, ATNA, CT, and more, from

Second Step: Propose a design and select standards for such an IHE Profile

38


Patient identifier cross referencing for mpi transaction diagram
Patient Identifier Cross-referencing for MPI XCPD, PIX, PDQ, ATNA, CT, and more, from Transaction Diagram


Patient identifier cross referencing for mpi process flow showing id domains transactions
Patient Identifier Cross-referencing for MPI XCPD, PIX, PDQ, ATNA, CT, and more, from Process Flow Showing ID Domains & Transactions


Patient identifier cross referencing for mpi

B:X456 XCPD, PIX, PDQ, ATNA, CT, and more, from C: ?

B:X456C: 2RT

Patient

Identity

Cross References

Patient Identifier Cross-referencing for MPI


Patient identifier cross referencing for mpi actors
Patient Identifier Cross-referencing for MPI XCPD, PIX, PDQ, ATNA, CT, and more, from Actors

Patient Identity Source

  • Definition

    • Assigns patient identities within its own domain

    • Notifies Patient Identifier Cross-reference Manager of all events related to patient identification (creation, merge, etc.)

    • Example: Registration (ADT) Actor in IHE Radiology Scheduled Workflow (SWF) Profile

  • Transaction Supported - Required

    • Patient Identity Feed [ITI-8] (as sender)


Patient identifier cross referencing for mpi actors1
Patient Identifier Cross-referencing for MPI XCPD, PIX, PDQ, ATNA, CT, and more, from Actors

Patient Identifier Cross-reference Consumer

  • Definition

    • Requires information about patient identifiers in other domains

    • Requests patient identifier information from Patient Identifier Cross-reference Manager

  • Transaction Supported - Required

    • PIX Query [ITI-9] (as sender)

  • Transaction Supported - Optional

    • PIX Update Notification [ITI-10] (as receiver)


Patient identifier cross referencing for mpi actors2
Patient Identifier Cross-referencing for MPI XCPD, PIX, PDQ, ATNA, CT, and more, from Actors

Patient Identifier Cross-reference Manager

  • Definition

    • Serves a well-defined set of Patient Identifier Domains

    • Receives patient identifier information from Patient Identity Source Actors

    • Manages cross-referencing of identifiers across domains

  • Transactions Supported - Required

    • Patient Identity Feed [ITI-8] (as receiver)

    • PIX Query [ITI-9] (as receiver)

    • PIX Update Notification [ITI-10] (as sender)


Patient identifier cross referencing for mpi standards used 2 profiles
Patient Identifier Cross-referencing for MPI XCPD, PIX, PDQ, ATNA, CT, and more, from Standards Used: 2 Profiles

PIX: HL7 Version 2.5

  • ADT Registration and Update Trigger Events (HL7 2.3.1)

    • A01: inpatient admission

    • A04: outpatient registration

    • A05: pre-admission

    • A08: patient update

    • A40: merge patient

  • Queries for Corresponding Identifiers (ADT^Q23/K23)

  • Notification of Identifiers Lists Updates (ADT^A31)

    PIX V3: HL7 V3

  • Leverage Web Services (harmonized WS by IHE Appendix V)


The ihe global standards adoption process2
The IHE Global Standards Adoption Process XCPD, PIX, PDQ, ATNA, CT, and more, from

Third Step: Engage implementers for Testing Trial Implementation profile at Connectathons

Fourth Step:Based on lessons learned from Connectathons implementers, correct/clarify Profile and Publish as “Final Text” in Domain Technical Framework.

 Will be presented in part 2

46


Ihe offers a broad collection of profiles
IHE offers a broad collection of Profiles XCPD, PIX, PDQ, ATNA, CT, and more, from

Use Cases addressed are specified in a series of Domain Technical Frameworks (Volume 1)

Two broad classes of profiles: Integration (how to move the data) and Content (what the data conveys).

A few example of “cross-enterprise” integration and content profiles

Complete list on: www.ihe.net/technical_framework

47


Hospital Record XCPD, PIX, PDQ, ATNA, CT, and more, from

1-Reference

to records

Clinic Record

Specialist Record

Index of

patients records

Clinical IT System

Health Info Exchange

Clinical Encounter

Registering Health Records:IHE-XDS

Community

Repository ofDocuments

Repository ofDocuments


Hospital Record XCPD, PIX, PDQ, ATNA, CT, and more, from

Clinic Record

Specialist Record

3-Records

Returned

4-Patient data presented to Physician

Aggregate Patient Info

Index of

patients records

Clinical IT System

HIE

2-Reference

to Records for Inquiry

Clinical Encounter

Access to Shared Records : IHE-XDS

Community

Repository ofDocuments

Repository ofDocuments


Health information exchanges interoperability cross enterprise document sharing
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.


Cross enterprise document sharing xds standards used
Cross-Enterprise Document Sharing (XDS) Cross-enterprise Document SharingStandards Used

  • Implemented world-wide by over 150 vendors/open source.

  • Adopted in several national & regional projects:Italy, Austria, Canada, USA, Japan, South Africa, France, Netherlands, etc.)

HealthcareContent Standards

HL7 CDA header extract

HL7 data types

Electronic BusinessStandards

ebXML Registry, SOAP,

Web Services …

Internet Standards

HTTP, IETF, W3C, …


Why is ihe xds a breakthrough
Why is IHE-XDS a breakthrough ? Cross-enterprise Document Sharing

  • 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 (Feeding a central web server is view only and 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 on-demand pull in a variety of centralized or distributed architectures.

Offer a consistent, standards-based and functional record sharing for EHRs, PHRs & other IT Systems


Combining IHE Profiles Cross-enterprise Document SharingDocument Content & Modes of Document Exchange

Doc Content Profiles (Semantics content)

Scanned Doc

XDS-SD

Pre-Surgery

PPHP

Functional Status Assesment

FSA

Consent

BPPC

Emergency

EDR

PHR Exchange

XPHR

Discharge &Referrals

XDS-MS

Imaging

XDS-I

Laboratory

XD*-Lab

Document Exchange Integration Profiles

Document

SharingXDS / XCA

Reliable Pt-PtInterchange

XDR

MediaInterchange

XDM


Typically, a patient goes through a sequence of encounters in different Care Settings

Long Term Care

Acute Care (Hospital)

Other Specialized Care(incl. Diagnostics Services)

GPs and Clinics (Ambulatory)

Continuity of Care:

Patient Longitudinal Record


Building and accessing Documents in different Care Settings

DocumentRepository

Submission of Document References

Retrieve of selected Documents

Documents Registry

Longitudinal Recordas usedacross-encounters

Long Term Care

Acute Care (Inpatient)

Other Specialized Careor Diagnostics Services

Care Record systemssupporting care delivery

PCPs and Clinics (Ambulatory)


Cross enterprise document sharing xds b actor transaction diagram
Cross-Enterprise Document Sharing (XDS.b) in different Care Settings Actor/Transaction Diagram


XDS – Value Proposition in different Care Settings

  • Foundation for Health IT Infrastructures: Shared Electronic Health Record, in a community, region, etc.

  • Effective means to contribute and access clinical documents across health enterprises.

  • Scalable sharing of documents between private physicians, clinics, long term care, pharmacy, acute care with different clinical IT systems.

  • Easy access: Care providers are offered means to query and retrieve clinical documents of interest.


XDS - Value Proposition in different Care Settings

  • Distributed: Each Care delivery organization “publishes” clinical information for others. Actual documents may remain in the source EHR

  • Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain (e.g. a region).

  • Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (HL7-CDA, PDF, DICOM, etc.)

  • Document Content Neutral: Document content is processed only by source and consumer IT systems.

  • Standardized Registry Attributes: Queries based on meaningful attributes ensure deterministic document searches.


How real is xds
How real is XDS ? in different Care Settings

  • Stable specification IHE Technical Framework Published

  • XDS.b Supplement that offers:

    • Use most recent Web Services stds (MTOM/XOP)

    • Allow Retrieve sets of Documents in one transaction

    • Same services

  • First implementation in clinical use in region of Genoa - Italy) since early 2006.

  • Several since: Lower Austria region, State of Vermont, Nagoya city, South Africa region, Dutch regions, etc.

  • Adopted by several national programs world-wide

  • 4 open source toolkits available, numerous product implementations in EMRs and Infrastructure offerings.


Ihe global standards based profiles adopted in national regional projects sample
IHE, Global Standards-Based Profiles in different Care Settings Adopted in National & Regional Projects (sample)

Austria

Lower

Austria

NETHERLANDS

Friesland

Natn’l Mamography

Italy Conto Corrente

Venetto - Friuli

VITL-Vermont

FranceDMP

Quebec, Toronto,Alberta, British ColumbiaCanada Infoway

SuisseSt Gallen

Lausane

Wales

Imaging

France Imaging IDF

Boston Medical Center - MA

For more complete list see: tinyurl.com/wwXDS

Philadelphia HIE

Belgium

Flemish-Leuven

KeyHIE Pennsylvania

CareSpark – TN & VA

SHARP CA

South Africa

THINC- New York

NCHICA – N. Carolina

Providence Health System - OR

CHINA-Shanghai

Imaging Info Sharing

CHINA-MoH

Lab results sharing

JAPAN-Nagoya

Imaging Info Sharing,

Nationwide PDI guideline

60

60


Ihe xds is part of a family of profiles
IHE-XDS is part of a family of profiles in different Care Settings

  • Regional, national, local or disease centric networks need a consistent set of Integration Profiles

  • Fifthteen Integration Profiles completed and tested, plus five 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


IHE Integration Profiles for Health Info Nets in different Care Settings What is available and in trial implementation

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

ObGyn Documents

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 Assertion

Format of the Document Content and associated coded vocabulary

Patient Identifier Cross-referencing

Imaging Information

Format of the Document Content

Provides Trusted Identity

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

Document Subscription and Notification

Cross-Enterprise Document Pt-Pt Reliable Interchange

Consistent Time

Coordinate time across networked systems

Cross-Enterprise Document Media Interchange

Cross-Community Access

Security & Privacy

Clinical and PHR Content

Patient ID Mgmt

Health Data Exchange

Other

Final Text Approved

Trial Implementation-2009–Final Txt 2010


Xds ms medical summary or phr extract exchange profile based on hl7 cda rel 2 and hl7 ccd ig

Level 3 in different Care Settings

Text Structure

Med, Problems and Allergies

Entry

as highly structured text.

Coded Section

Coded Section

Coded Section

Text easy to import/parse

Entry

Entry

Entry

Level 3

Med Problems a

nd

Text Structure

Allergies have a

Entry

fine-grain structure with

optional coding. Coding

Scheme explicitly identified.

Text Structure

Entry

XDS-MS Medical Summary or PHR Extract ExchangeProfile based on HL7 CDA Rel 2 and HL7 CCD IG

Level 1

Structured and Coded Header

Patient, A

uthor, Authenticator, Institution,

Header always structured and coded

Time of Service, etc.

Level 2

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coded sections with non

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Reason for Referral

nor coded content (text, lists, tables).

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Vital Signs

 Simple Viewing (XML Style sheet)

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Social History

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XDS-MS and XPHR enable both semantic interoperability & simple viewing !

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Care Plan


Use of a shared xds infrastructure to access radiology reports and images xds i
Use of a shared XDS infrastructure to access Radiology Reports and Images (XDS-I)

Between Radiology and :

  • Imaging specialists

  • Non-imaging clinicians

Hospital

PACS Y

Radiology -to-Radiology

Radiology -to-Physicians

PACS Z

Imaging Center

Physician Practice

Same XDS Infrastructure (Registry and Repositories) for medical summaries and imaging information !


Providers and Vendors Reports and Images (XDS-I)

Working Together to Deliver

Interoperable Health Information Systems

AndAcross Care Settings

 Intra Hospital Workflows and Information Access

in the Enterprise

http://www.ihe.net


Ihe solutions within the enterprise

Enterprise Reports and Images (XDS-I)IT Infrastructure

eMPI

User Auth

RIS

CIS

LIS

PACS

Img Acq

Cath

ECG

Auto Mgr

Analyzer

Cardiology

Laboratory

Radiology

IHE Solutions within the Enterprise

EMR - HIS

Eye Care

Pathology

HomeHub

Therapy Plan

Nursing Station

EstablishedFeb 2009

Img Acq

Treatment

Devices

Devices

Devices

Intensive Care Unit

Pharmacy

Radiation Therapy


Ihe solutions within the enterprise example cardiology
IHE Solutions within the Enterprise Reports and Images (XDS-I)Example: Cardiology

EnterpriseIT Infrastructure

eMPI

User Auth

RIS

CIS

LIS

PACS

Img Acq

Cath

ECG

Auto Mgr

Analyzer

Cardiology

Laboratory

Radiology

EMR - HIS

Eye Care

Pathology

Cardiology Integration Profiles

Cardiac Catheterization Lab Workflow

Echocardiography Lab Workflow

Retrieve ECG for Display

Displayable Reports

Cath and Echo Evidence Documents

HomeHub

Therapy Plan

Nursing Station

EstablishedFeb 2009

Img Acq

Treatment

Devices

Devices

Devices

Intensive Care Unit

Pharmacy

Radiation Therapy

67


Ihe solutions within the enterprise example it infrastructure
IHE Solutions within the Enterprise Reports and Images (XDS-I)Example: IT Infrastructure

EnterpriseIT Infrastructure

eMPI

User Auth

RIS

CIS

LIS

PACS

Img Acq

Cath

ECG

Auto Mgr

Analyzer

Cardiology

Laboratory

Radiology

EMR - HIS

IT Infrastructure Integration Profiles

Patient Administration Management

Patient Demographics Query

Patient Identifier Cross-referencing

Retrieve Information for Display

Enterprise User Authentication

Consistent Time

Patient Synchronized Applications

Audit Trail and Node Authentication

Personnel White Pages

Shared Value Sets

Eye Care

Pathology

HomeHub

Therapy Plan

Nursing Station

EstablishedFeb 2009

Img Acq

Treatment

Devices

Devices

Devices

Intensive Care Unit

Pharmacy

Radiation Therapy

68


Ihe solutions within the enterprise example radiology
IHE Solutions within the Enterprise Reports and Images (XDS-I)Example: Radiology

EnterpriseIT Infrastructure

eMPI

User Auth

RIS

CIS

LIS

PACS

Img Acq

Cath

ECG

Auto Mgr

Analyzer

Cardiology

Laboratory

Radiology

EMR - HIS

Radiology Integration Profiles

Radiology Scheduled Workflow

Patient Information Reconciliation

Access to Radiology Information

Portable Data for Imaging

Consistent Presentation of Images

Key Image Note

Presentation of Grouped Procedures

Evidence Documents

Audit trail and Node Authentication (Rad option)

Teaching Files and Clinical Trials Export

Post-processing Workflow

Reporting Workflow

Charge Posting

Simple Image and Numeric Reports

Eye Care

Pathology

HomeHub

Therapy Plan

Nursing Station

EstablishedFeb 2009

Img Acq

Treatment

Devices

Devices

Devices

Intensive Care Unit

Pharmacy

Radiation Therapy

69


Ihe solutions within the enterprise example laboratory
IHE Solutions within the Enterprise Reports and Images (XDS-I)Example: Laboratory

EnterpriseIT Infrastructure

eMPI

User Auth

RIS

CIS

LIS

PACS

Img Acq

Cath

ECG

Auto Mgr

Analyzer

Cardiology

Laboratory

Radiology

EMR - HIS

Eye Care

Pathology

Laboratory Integration Profiles

Laboratory Testing Workflow

Laboratory Information Reconciliation

Laboratory Point Of Care Testing

Laboratory Device Automation

Laboratory Code Set Distribution

Laboratory BarCode

HomeHub

Therapy Plan

Nursing Station

EstablishedFeb 2009

Img Acq

Treatment

Devices

Devices

Devices

Intensive Care Unit

Pharmacy

Radiation Therapy

70


Laboratory testing workflow ltw laboratory device automation lda
Laboratory Testing Workflow (LTW) Reports and Images (XDS-I)& Laboratory Device Automation (LDA)

Placer order

Order Placer

Order Filler

Filler order

Work order

Results

Results

Automation Manager

Order Result Tracker

Work Order Steps

Query & download modes

Tests results

Pre/post processor

Analyzer

LTW

LDA

Profiles based on HL7 V2.5.1

Solid implementation experience


Ihe solutions within the enterprise example patient care devices
IHE Solutions within the Enterprise Reports and Images (XDS-I)Example: Patient Care Devices

EnterpriseIT Infrastructure

eMPI

User Auth

RIS

CIS

LIS

PACS

Img Acq

Cath

ECG

Auto Mgr

Analyzer

Cardiology

Laboratory

Radiology

EMR - HIS

Patient Care Devices Profiles

Device Enterprise Communication (DEC)

Alarm Communication Mgt (ACM)

Subscribe to Patient Data (SPD)

Patient Identity Binding (PIB)

Rosetta Terminology Mapping (RTM)

Eye Care

Pathology

HomeHub

Therapy Plan

Nursing Station

EstablishedFeb 2009

Img Acq

Treatment

Devices

Devices

PersonalDevices

Intensive Care Unit

Pharmacy

Radiation Therapy

72


Providers and Vendors Reports and Images (XDS-I)

Working Together to Deliver

Interoperable Health Information Systems

in the Enterprise

and Across Care Settings

http://www.ihe.net


Agenda2
Agenda Reports and Images (XDS-I)

Part 1: THE IHE STANDARDS ADOPTION PROCESS: achieving practical interoperability

This Afternoon:

Part 2:

USERS AND VENDORS WORKING TOGETHER: how can I contribute & benefit from IHE

HOW TO USE IHE RESOURCES: hands on experience

74


See you for Part 2, this afternoon Reports and Images (XDS-I)


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