IHE Changing the Way Healthcare Connects in COMMUNITIES

1. IHE Changing the Way Healthcare Connects in COMMUNITIES HIMSS Interoperability Showcase February 2007 Keith Boone (GE), Vassil Peytchev (Epic), Larry McKnight (Siemens), George Cole (Allscripts)

2. Requirements for an open RHIO/HIE(1) • Bring trust and ease of use for healthcare professionals: • Care delivery organizations choose information to share: • Based on patient situation • When they see fit (discharge, end of encounter, etc.) • What information to share (pick relevant types of documents, and content elements). • Care delivery organizations access patient information through: • their own EMR (if they have one), or • through a shared portal otherwise. • When accessing patient info: • Find quickly if relevant information is available or not (single query). • May select among relevant documents, which ones to see (may be done in background) • Among those of interest, chose to import in whole or part in its own EMR Chart (responsibility).

3. Requirements for an open RHIO/HIE(2) • 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 (where context is best known) • All traffic trough the infrastructure is encrypted • Shared Document Registry does not contain patient clinical data only generic information (minimum metadata + repository reference) • 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 document is assigned to specific policies (or not shared) at encounter time. • Healthcare providers may only access documents compatible with their role.

4. IHE - Connecting standards to care • Care providers and IT professionals work with vendors to coordinate the implementation of standards to meet their needs • Care providers identify the key interoperability problems they face • Drive industry to develop and make available standards-based solutions • Implementers follow common guidelines in purchasing and integrating systems that deliver these solutions

5. Categories of Healthcare Communication Services HIEs and RHIOs 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

6. Hospital Record 1-Reference to records Clinic Record Specialist Record Index of patients records Clinical IT System Sharing System Clinical Encounter Introduced at HIMSS in 2005 : IHE-XDS Community or sub-network Repository ofDocuments Repository ofDocuments

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

8. 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.

9. Cross-Enterprise Document Sharing (XDS) Standards Used HealthcareContent Standards HL7 CDA, CEN EHRcomHL7, ASTM CCRDICOM … • Implemented world-wide by more than 50 vendors/open source. Final text published December 2006. • Adopted in several national & regional projects (Italy, France, Canada, Austria, USA, Japan, Netherlands, Sweden, etc.) • IHE XDS: 42,300 “Google” references (Feb’ 07) Electronic BusinessStandards ebXML Registry, SOAP, Web Services … Internet Standards HTML, HTTP,ISO, PDF, JPEG …

10. 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 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

11. EHR System ED Application Physician Office XDS Document Repository PACS XDSDocument Repository EHR System PACS Lab Info. System Teaching Hospital Community Clinic ATNA Audit record repository CT Time server XDS Scenario + use of ATNA & CT PMS XDS Document Registry Query Document Register Document Secured Messaging Retrieve Document Provide & Register Docs Maintain Time Maintain Time Record Audit Event Maintain Time Record Audit Event Record Audit Event

12. A87631 A87631 A87631 14355 M8354673993 M8354673993 M8354673993 M8354673993 EHR System ED Application Physician Office XDS Document Repository PACS XDS Document Repository EHR System PACS Lab Info. System L-716 L-716 L-716 Teaching Hospital Community Clinic ATNA Audit record repository CT Time server XDS Scenario + use of PIX & PDQ PDQ Query to Acquire Affinity Domain Patient ID Patient Identity Feed Patient Identity XRef Mgr Patient Identity Feed Affinity Domain Patient Identity Source Patient Identity Feed Patient Identity Feed PIX Query Document Registry PIX Query Query Document (using Pt Id) Register (using Pt ID) Provide & Register Docs Retrieve Document PACS

13. 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

14. IHE Integration Profiles for Health Info NetsWhat is available and is added in 2006-2007 Security Patient ID Mgmt Basic Patients Privacy Consents Patient Demographics Query Establish Consents & Enable Access Control Patient Identifier Cross-referencing Map patient identifiers across independent identification domains Document Digital Signature Attesting “true-copy and origin Audit Trail & Node Authentication Other Centralized privacy audit trail and node to node authentication to create a secured domain. Request Formfor Data Capture External form with custom import/export scripting Consistent Time Notification of Document Availability Cross-Enterprise Document Pt-Pt Reliable Interchange Coordinate time across networked systems Notification of a remote provider/ health enterprise Cross-Enterprise Document Media Interchange Clinical and PHR Content Emergency Referrals PHR Extracts/Updates Format of the Document Content and associated coded vocabulary 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 Format of the Document Content and associated coded vocabulary Imaging Information Format of the Document Content Medical Summary (Meds, Allergies, Pbs) Format of the Document Content and associated coded 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 patient electronic health record Final Text Approved Trial Implementation-2006 –Final Txt 2007

15. Combining IHE ProfilesDocument Content & Modes of Document Exchange Doc Content Profiles (Semantics content) Scanned Doc XDS-SD Pre-Surgery PPHP Consent BPPC Emergency EDR PHR Exchange XPHR Discharge &Referrals XDS-MS Imaging XDS-I Laboratory XD*-Lab Document Exchange Integration Profiles Document SharingXDS Reliable Pt-PtInterchange XDR MediaInterchange XDM

16. Level 3 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 Text Structure Entry Text Structure Entry XDS-MS Medical Summary or PHR Extract ExchangeProfile based on HL7 CDA Rel 2 and ASTM/HL7 CCD Level 1 Structured and Coded Header Patient, A uthor, Authenticator, Institution, Header always structured and coded Time of Service, etc. Level 2 S t r u c t u r e d C o n t e n t w i t h c o d e d s e c t i o n s : S t r u c t u r e d C o n t e n t w i t h c o d e d s e c t i o n s : Title - coded sections with non - structured · Reason for Referral nor coded content (text, lists, tables). · · Vital Signs  Simple Viewing (XML Style sheet) · · M e d i c a t i o n M e d i c a t i o n · Studies · · A l l e r g i e s A l l e r g i e s Level 3 Med Problems a nd Allergies have a fine-grain structure with optional coding. Coding · Social History Scheme explicitly identified. · · P r o b l e m s P r o b l e m s XDS-MS and XPHR enable both semantic interoperability & simple viewing ! · Care Plan

17. 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 !

18. Community Network B Community Network A Document Registry Document Registry Practice Practice Hospitals Practice Hospitals Practice Hospitals Hospital Practice Practice Hospital Practice Hospitals Hospital Practice Hospitals Practice Hospitals Practice Diag Test Clinic Clinic Clinic Diag Test Clinic Other Clinic Clinic Clinic Clinic Community Network C Document Registry Hospitals Practice Hospitals Practice Clinic HIMSS RHIO: Network of networksThe largest multi-vendor RHIO Prototype ever built ! 3 infrastructure systems 18 edge systems4 infrastructure systems 13 edge systems3 infrastructure systems 5 edge systems 4 infrastructure systems

19. IHE based Regional and National EHR Projects Operational and Planned To learn more, attend: IHE in regional and national health information exchange around the WORLD (Tuesday & Wednesday, here) Toronto, Quebec, Alberta, BCCanada Infoway MA-Share – MA New York HIE Austria Vermont RHIO FranceDMP Philadelphia HIE THINC- New York NCHICA – N. Carolina Italy (Conto Corrente Salute) CHINA-MoH Lab results sharing

20. Compliance with US National Health Info NetHITSP Interoperability Specs and CCHIT Roadmap Other Request Formfor Data Capture External form with custom import/export scripting Notification of Document Availability Notification of a remote provider/ health enterprise Clinical and PHR Content Security Patient ID Mgmt Emergency Referrals PHR Extracts/Updates Format of the Document Content and associated coded vocabulary Basic Patients Privacy Consents Patient Demographics Query ECG Report Document Format of the Document Content and associated coded vocabulary Lab Results Document Content Establish Consents & Enable Access Control Format of the Document Content and associated coded vocabulary Scanned Documents Format of the Document Content and associated coded vocabulary Patient Identifier Cross-referencing Imaging Information Format of the Document Content 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 Health Data Exchange Audit Trail & Node Authentication Cross-Enterprise Document Sharing Centralized privacy audit trail and node to node authentication to create a secured domain. Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Consistent Time Cross-Enterprise Document Media Interchange Coordinate time across networked systems Cross-Enterprise Document Reliable Interchange Accepted by HITSP&CCHIT in 2006 Candidates for HITSP&CCHIT in 2007

21. Leverage IHE for your RHIO/HIE ! • EMR from most vendors have/plan support “two way” IHE interface. Choice of Infrastructure Vendors. (www.himssEHRVA.org Interop. Roadmap, HIMSS Interop. Showcase). • Thin and efficient Infrastructure for Health Info Exchange • Solid content-independent “Thin” Infrastructure Profiles: XDS, PIX, PDQ, ATNA, CT, BPPC • Broad Choice of Content Profiles: XDS-MS & XPHR(Chart), XDS-SD(Scan doc), XDS-I(Imaging), XD*-Lab, ECG, etc. • Leverage investments and experience world-wide • Choose either (or mix) a federated or a centralized HIE • Get both an HIE with portal data access and two way data exchange • Public domain architecture and specifications, simplify RFP process and implementation for both vendors and RHIO/SNO.

22. IHE–Based – Health Info Exchange • IHE supports these requirements: • To meet the needs of the various stakeholders • With a wide array of standards to reduce cost and accelerate deployment of HIEs • With flexibility to accommodate a wide range of architectures and business models across the world • No rip and replace of edge systems, different levels of interoperability • Ensure reuse of implementations, sharing of experience • Forward looking way to enable interconnection of HIEs into a National Health Information Network • Allowing increasingly sophisticated security and privacy protections

24. How can I participate? As a Provider or Vendor Contributor • Offer Clinical Use Case Input to Drive IHE Profile Development • Become a member of relevant domain’s Planning or Technical Committees • Become a member of relevant Regional/National Committees • Help to shape IHE’s future direction As a Vendor Participant • Respond to Public Comments of Domain Supplements • Attend the June Educational Workshop • Participate in Connect-a-thons and Demonstrations As a Provider/Consultant Participant • Respond to Public Comments of Domain Supplements • Attend the June Educational Workshop • Attend Demonstrations and include IHE Integration Profiles in your RFPs and Integration Projects.

25. IHE Web site:www.IHE .net • Frequently AskedQuestions • Integration Profiles in Technical Frameworks: See Volume 1 of each TF for Use cases • Cardiology • Eye Care • IT Infrastructure • Laboratory • Patient Care Coordination • Radiation Oncology • Radiology • Connectathon Result: www.ihe.net/Events/connectathon_results.cfm • Vendor Products Integration Statements • Participation in Committees & Connectathons