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An Introduction to Integrating the Health Enterprise

An Introduction to Integrating the Health Enterprise. Dr Vincent McCauley Chair, IHE Australia IHE Education Seminar, July 2011. Radiology. IT Infrastructure. Laboratory. Cardiology. Patient Care Coordination. Pathology. IHE Europe. Austria. France. Germany. Netherlands. Radiation

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An Introduction to Integrating the Health Enterprise

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  1. An Introduction toIntegrating the HealthEnterprise Dr Vincent McCauley Chair, IHE Australia IHE Education Seminar, July 2011

  2. 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

  3. 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 Association (HIMAA) - Royal Australian College of Surgeons (RACS) - Australian Diagnostic Imaging Association (ADIA)

  4. IHE Domains • Radiology • Cardiology • Radiation Oncology • IT Infrastructure • Patient Care Coordination • Patient Care devices • Laboratory, Pathology, Eye Care. • Pharmacy • Quality Research and Public Health

  5. 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

  6. 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

  7. IHE Profile Examples • (XDS/XDS-I) Cross-Enterprise Document/Image Sharing • 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

  8. 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

  9. 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)

  10. 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

  11. 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

  12. IHE Integration Profiles for Health Info NetsWhat is available and in trial implementation Basic Patients Privacy Consents Establish Consents & Enable Access Control Cross-Enterprise User Assertion Provides Trusted Identity Document Digital Signature Attesting “true-copy and origin Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. 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 CDA/CCDBased Emergency Referrals PHR Extracts/Updates Format of the Document Content and associated coded vocabulary 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 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 Format of the Document Content and associated coded vocabulary Health Data Exchange Other Cross-Enterprise Document Sharing Request Formfor Data Capture Registration, distribution and access across health enterprises of clinical documents forming a longitudinal record External form with custom import/export scripting Notification of Document Availability Document Metadata Subscription Pub/sub on registered docs Final Text Approved 12 Trial Implementation-2009 –Final Txt 2010

  13. IHE, Global Standards-Based Profiles Adopted in National & Regional Projects Austria Lower Austria NETHERLANDS Friesland Natn’l Mamography Italy Conto Corrente Salute Venetto - Friuli VITL-Vermont FranceDMP Quebec, Toronto,Alberta, British ColumbiaCanada Infoway SuisseSt Gallen Lausane Walles (Imaging-Tender) Boston Medical Center - MA Philadelphia HIE Belgium Flemish-Leuven KeyHIE Pennsylvania CareSpark – TN & VA 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 13

  14. IHE Problem Solution Process

  15. Quebec, Toronto,Alberta, British ColumbiaCanada Infoway KeyHIE Pennsylvania CareSpark – TN & VA THINC- New York NCHICA – N. Carolina IHE, Global Standards-Based Profiles Adopted in US National & Regional Projects VITL-Vermont Harrison Med Center SouthShore Decatur Hosp & Practices Boston Medical Center - MA Providence HIE MedVirginia-SSA Philadelphia HIE SHARP Community Wake Forest California Prisons CentralFlorida NHIN – Trial Implementation http://tinyurl.com/WWXDS

  16. 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

  17. IHE Australia Conformance Testing • IHE Conformance Testing supervised by NATA accredited Testing Laboratory (AHML) Certification Interoperability Specifications + Constructs Standards Adoption/Profiling Technical Use Case Driven Base Standards Foundations

  18. IHE Chicago Connectathon 2010

  19. IHE Chicago Connectathon 2010

  20. IHE Chicago Connectathon 2010

  21. IHE Chicago Connectathon 2010 • 104 vendors • 150 applications • 498 engineers • Approx. $2 million in employee costs over 5 days • 77 IHE Profiles

  22. 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

  23. 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

  24. Australian Secure Messaging Specification development process • Continuing work by Conformance/Compliance subcommitee • NEHTA alpha code available March 2010

  25. 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

  26. Secure Messaging ConnectathonTooling • Test management using Gazelle (IHE International) • Java alpha code (NEHTA) • Pre-connectathon remote capability testing (AHML) • Connectathon SMD Functional Test harness and process (AHML) • 6 implementations completed testing

  27. Useful Links www.ihe.net www.ihe.net.au http://ihe-australia.wikispaces.com http://wiki.ihe.net

  28. 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.

  29. 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.

  30. 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

  31. 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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