HL7 UK, London October 26, 2005 Charles Parisot GE Healthcare Information Technologies

1. Strategies for Implementing the Digital Healthcare CommunityPractical conditions for business adoption of standards HL7 UK, London October 26, 2005 Charles Parisot GE Healthcare Information Technologies

2. Topics • Interoperability and digital communities • Critical success factors for standards adoption • Establishing a digital community framework at the international level • Examples of successful interoperability • Summary

3. Open, standards-based interoperability critical to building a digital community • Congratulations tostandards development and implementation organizations • Interoperability creates markets… e.g. $1B+ PACS • More importantly… Interoperability transforms patient care • GE interoperability at: http://www.gehealthcare.com/usen/interoperability

4. Standards in the real-world • One sort of healthcare interoperability standards… Those that are adopted ! • Multiplicity of Standards development organizations in healthcare… necessity given the breadth, complexity and technological evolution, but each one needs to be global by domain. • Calculated risks to Introduce new standards…. require the first line stakeholders: vendors and providers to gain confidence to implement (focused use cases). • Interoperability Standards are deployed in incremental steps. • A Standards Implementation Process needed to orchestrate: Requires an implementation “conductor”.

5. Vendors, Clinicians & CIO’s key to driving interoperability as stakeholders • Clinicians… Quality of care, safety, productivity, affordability • CIOs… Cost effective, plug-n-play, “future-proof” • Vendors… Reliability, ready to implement standards, speed to market

6. Testing at connectathons IHE demonstrations Develop technical specifications Products with IHE Identify available standards (e.g. HL7, DICOM, IETF, OASIS) Document use case requirements Easy to integrate products Timely access to information Proven Standards Adoption Process: IHE

7. Sharing a Common Framework Internationally ? • Much energy spent creatinginternationally agreed standards • Belief that differences in health systems create insurmountable barriers and requires national customization. Over 10 countries are already rushing down this path. • Only partially true for clinical information. Languages, some existing codifications, and order in deployment strategies shall be accommodated. • Once one realizes that challenge is to “connect” the IT systems used in thousands of point of care. This is the primary interface to address with a globally harmonized standards-based framework Many believe that it cannot be done, it is already in progress. Loosing time ? No, results with faster and cheaper deployment

8. 2yrs + Phase 4: Active Quality Reporting & Health Surveillance Phase 3: Advanced Clinical Support & Access Control 6 mos to 2yrs Phase 2: Share Diagnostic Results & Therapeutic Information available Phase 1: Share Care Status Information US EHR Vendor Association: A roadmapPhase-in of Communication Services From: www.himssehrva.org

9. Security & Identity Historical Documents Dynamic Queries Workflow Transaction End-Point System To End-Point System Interchange Clinical Content Push Notification ( eRx, eReferral ) Patient & Provider ID Mgmt Access Control s n o Medications Lab results i Radiology t Clinical Content Allergies a c i d PDF CDA e Push Notification ( eRx, eReferral ) . . Patient & Provider ID Mgmt Access Control . . M . . s Med Summaies n o Medications Document Sharing Lab results Dynamic Information Mgmt Transaction Mgmt i Scan Docs Radiology t Allergies a c i d e . . . . M . . Record Locator Services e.g. EMR Document Sharing Dynamic Information Mgmt Transaction Mgmt Internet End-Point Systems to National Infrastructure Sub-network Communication Record Locator Services Internet Realizing the complementary roles of document sharing and of message based transactions e.g. Lab, PACS EMR, etc. • Thin set of Health Net Services – facilitates information exchange • End-Point System services exist at two distinct levels • Net/Subnet communication level – e.g., IHE/XDS (Cross-enterprise Doc. Sharing) • Peer-to-Peer level – transparent to infrastructure, e.g., doc content / type From HIMSS EHRVA Response to ONCHIT RFI, January 2005

10. Hospital Record Reference to records Clinic Record Specialist Record 3-Records Returned 4-Patient data presented to Physician Aggregate Patient Info Index of patients records (Document-level) Clinical IT System Sharing System 2-Reference to Records for Inquiry Clinical Encounter Indexing Patient Centric Documents : IHE-XDS Community or sub-network Repository ofDocuments Repository ofDocuments

11. PreSurgery PPHP Consent BPPC Emergency EDR Scanned Doc XDS-SD Laboratory XD*-Lab Discharge &Referrals XDS-MS PatientInput XPHR Imaging XDS-I Pt-Pt DocInterchange XDR MediaInterchange XDM Document Content and Modes of Document Exchange Doc Content Profiles (CDA R2+V3-RMIM+DICOM+PDF) Doc Exchange Integration Profiles Doc Sharing XDS

12. IHE & Regional and National Projects Today FranceDMP UK CfH Radiology Canada Infoway Austria MA-Share – MA IHIE – IN Mendicino - CA Denmark (Funen) Italy (Veneto) Spain (Aragon) HITSP Interoperability Specifications Italy (Conto CorrenteSalute) THINC- New York NCHICA – N. Carolina

13. Summary • Interoperability for national influences local strategies… internet vs. intranet • Modular approach allows incremental build-out of digital communities • IHE Showcases are demo’ing profiles that will be used to build regional/national nets. • Today… Count on GE for interoperability leadership • Tomorrow… Count on GE to enable personalized health information exchange