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The IHE Initiative Mission, Process, Achievements, Plans. Raymond Peter Zambuto, MS, CCE, FASHE, FHIMSS, FACCE President, Technology in Medicine, Inc. Co-Chair, IHE PCD Domain. Presentation Objectives. IHE: What? Why? Who? How organized? Healthcare provider role in developing IHE framework

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the ihe initiative mission process achievements plans

The IHE InitiativeMission, Process, Achievements, Plans

Raymond Peter Zambuto,

MS, CCE, FASHE, FHIMSS, FACCE

President, Technology in Medicine, Inc.

Co-Chair, IHE PCD Domain

presentation objectives
Presentation Objectives
  • IHE: What? Why? Who? How organized?
    • Healthcare provider role in developing IHE framework
  • Why standards are not enough
  • IHE process for standards adoption and implementation
  • Benefits, growth, strategies, integration
  • How to leverage IHE to enable interoperability in
    • Enterprises
    • Health information exchanges (HIEs)
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
slide4

Why IHE? A Patient-centered Example

Photo Courtesy of Philips Medical Systems

slide5

Why IHE? A Patient-centered Example

Photo Courtesy of Philips Medical Systems

ihe sponsors
IHE Sponsors
  • 1997: Founded in Radiology (RSNA) and IT (HIMSS)
  • Many professional societies (stakeholder representation)
    • American Academy of Ophthalmology (AAO)
    • American College of Cardiology (ACC)
    • American College of Physicians (ACP)
    • American College of Clinical Engineering (ACCE)
    • American College of Emergency Physicians (ACEP)
    • American Society for Therapeutic Radiation Oncology (ASTRO)
    • GMSIH (IT France), JAHIS (IT Japan), SFIL (laboratory)
    • Healthcare Information Management Systems Society (HIMSS)
    • Radiological Society of North America (RSNA)
    • And many more….
ihe participants and relationships
IHE Participants and Relationships
  • Participants include:
    • Users - Clinicians, Staff, Administrators, CIOs, Governments (e.g. NIST, VA).
    • Vendors - Information Systems and Equipment
      • e.g., imaging, cardiology, devices
    • Consultants
  • Maintains formal liaison with Standards Development Organizations (SDOs):
    • HL7, DICOM, ISO (Liaison D), others
  • ISO TC215 (including ANSI) approved IHE Process and Profiles to be published as technical reports
    • Concerns expressed by some AHIC members not founded
slide8

IHE (International) Strategic Development Committee

Global Development

Regional Deployment

IHE North America

IHE Asia-Oceania

China

Japan

Radiology

IT

Infrastructure

Laboratory

Canada

USA

Korea

Taiwan

Cardiology

Patient Care

Coordination

Pathology

IHE Europe

Radiation

Oncology

Patient Care

Devices

Pharmacy /

Medication Admin

Netherlands

France

Germany

Italy

Spain

UK

Norway

Sweden

Professional Societies / Sponsors

ACC

ACP

HIMSSRSNA

Contributing &

ParticipatingVendors

GMSIH

SFRSFIL

COCIR

EAR-ECR

DRG

SIRM

BIR

EuroRec

ESC

JAHISJIRAJRS

METI-MLHW

MEDIS-DCJAMI

IHE Organizational Structure

international adoption of ihe
International Adoption of IHE

Norway

Germany

Holland

Canada

Taiwan

France

Japan

Korea

China

Spain

USA

Italy

UK

Year 7 (2005)

Year 8 (2006)

Year 1 (1999)

Year 2 (2000)

Year 3 (2001)

Year 4 (2002)

Year 5 (2003)

Year 6 (2004)

  • Local Deployment
  • National Extensions (Local Adaptions)
  • Promotional & Live Demonstration Events
  • Funding

Pragmatic global standards harmonization + best practices sharing

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
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

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
growth in ihe domains
Growth in IHE Domains

Veterinary

Endoscopy

Pathology

Pharmacy

  • IHE Global Developments
  • Integration Profiles (# X) – Solutions to Real-World Interoperability Needs & Problems:
  • Within Clinical Departments e.g.:
    • Radiology
    • Cardiology
    • Lab
    • ...
  • Across Departmental &Institutional Boundaries – XDS
    • RHIOs (Regional Healthcare Information Organizations)
    • EHR Enablers

Quality

Patient Care Devices (1)

Patient Care Coordination (5)

Radiation Oncology (1)

Eye Care (3)

Laboratory (6)

Cardiology (7)

IT Infrastructure for Healthcare (17)

Radiology (18)

Year 5 (2003)

Year 6 (2004)

Year 8 (2006)

Year 9 (2007)

Year 4 (2002)

Year 7 (2005)

Year 1 (1999)

Year 2 (2000)

Year 3 (2001)

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 RHIO) 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

ihe based regional and national ehr projects operational and planned
IHE based Regional and National EHR Projects (Operational and Planned)

Toronto, Quebec, Alberta, BCCanada Infoway

MA-Share – MA

New York HIE

Austria

FranceDMP

Philadelphia HIE

THINC- New York

NCHICA – N. Carolina

Italy (Conto

Corrente Salute)

CHINA-MoH

Lab results sharing

slide17

IHE Integration Profiles for Health Info NetsWhat is available and has been added in 2005 and 2006

Scanned Documents

Lab Results Document Content

ECG Report Document

Emergency Referrals

PHR Extracts/Updates

Basic Patients Privacy Consents

Format of the Document Content and associated coded vocabulary

Format of the Document Content and associated coded vocabulary

Format of the Document Content and associated coded vocabulary

Format of the Document Content and associated coded vocabulary

Format of the Document Content

Patient Identifier Cross-referencing

Establish Consents & Enable Access Control

Cross-Enterprise Document Sharing

Map patient identifiers across independent identification domains

Imaging Information

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

Patient Demographics Query

Medical Summary

(Meds, Allergies, Pbs)

Format of the Document Content and associated coded vocabulary

Document Digital Signature

Audit Trail & Node Authentication

Format of the Document Content

and associated coded vocabulary

Attesting “true-copy and origin

Request Formfor Data Capture

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

External form with custom import/export scripting

Consistent Time

Notification of Document Availability

Cross-enterprise Document Point-Point Interchange

Notification of a remote provider/ health enterprise

Coordinate time across networked systems

Media-CD/USB & e-mail push

Clinical and PHRContent

Security

Patient ID Mgmt

Health Data Exchange

Other

ihe supporting hhs goals for nhin
IHE: Supporting HHS Goals for NHIN

Certification Commission for Healthcare Information Technology (CCHIT)

Healthcare Information Technology Standards Panel (HITSP)

American Health Information Community

Health Information Security and Privacy Collaboration (HISPC)

Nationwide Health Information Network Architecture Projects(NHIN)

Standards harmonization and adoption

Interoperability testing

Specifications for standards-based EHR functionality to support RHIOs

Security and privacy standards

hitsp recommended standards
HITSP Recommended Standards
  • Biosurveillance
    • ICD-9CM – International Classification of Diseases v. 9 Clinical Modifications
    • ICD-10 CM – Diagnoses and Procedures
    • IHE-XDS – Integrating the Healthcare Enterprise (IHE) Cross-Enterprise Document Sharing
    • IHE-XDS Lab – IHE Laboratory Report Document Sharing
    • IHE-RFD – IHE Retrieve Form for Data Capture
    • IHE-PIX – IHE Patient Identification Cross-Referencing
    • IHE-RAD – XDS-I – IHE Cross-Enterprise Sharing of Images
    • IHE-NAV – IHE Notification of Document Availability
    • IHE-XDS-MS – IHE Medical Summary Document Sharing
    • ISO/TC215 -DTS 25237 - Health Informatics Pseudonymisation
    • LOINC – Logical Observation Identifiers Names and Codes
    • NCCLS – National Committee for Clinical Laboratory Standards
    • RxNorm – National Library of Medicine RxNorm

IHE contributes to HITSP’s success

hitsp recommended standards1
HITSP Recommended Standards
  • Consumer Empowerment
    • IHE-XDS – Integrating the Healthcare Enterprise (IHE) Cross-Enterprise Document Sharing
    • IHE-PIX – IHE Patient Identification Cross-Referencing
    • IHE-PDQ – IHE Patient Demographics Query
    • Health Level Seven (HL7) CDA R2 – HL7 Clinical Document Architecture Release 2
    • HL7 CCD – HL7 Continuity of Care Document with mappings from ASTM E 2369-05 Continuity of Care Record (CCR), X12 N 270/271 and NCPDP Script 8.1.
    • HL7 EHR Systems Functional Model Draft Standard for Trial Use (DSTU)
    • Logical Observation Identifiers Names and Codes (LOINC)
hitsp recommended standards2
HITSP Recommended Standards
  • Electronic Health Record Exchange
    • IHE-XDS Lab – IHE Laboratory Report Document Sharing
    • IHE-PIX – IHE Patient Identification Cross-Referencing
    • IHE-PDQ – IHE Patient Demographics Query
    • Health Level Seven (HL7) CDA R2 – HL7 Clinical Document Architecture Release 2
    • HL7 v. 2.5
    • Clinical Laboratory Improvement Amendments (CLIA)
    • Logical Observation Identifiers Names and Codes (LOINC)
    • Health Insurance Portability and Accountability Act (HIPAA)
    • Systematized Nomenclature of Medicine – Clinical Terms (SNOMED – CT)
    • Unified Code for Units of Measure (UCUM)
2007 himss interoperability showcase february 26 march 1 2007
2007 HIMSS Interoperability ShowcaseFebruary 26 – March 1, 2007

Morial Convention Center, New Orleans, LA

  • 9,000 square feet of exhibit space
  • 67 Showcase participants
  • Secured HIExchange with broad content
  • HIE with patient care devices
  • Personal health record solutions
  • New directions focus (Life Sciences Bio-Pharma, HL7 v3.0 PIX/PDQ, ELINCS Lab)
  • HITSP interoperability specifications
  • Financial and administrative systems (CAQH/CORE)
  • Expanded distributed demonstration in a RHIO format
  • Focused tours – International, VIP, Congressional
  • Theater – Education sessions
how to participate
How to Participate

As a User or Vendor Committee Member

  • Become a member of relevant Domains Planning or Technical Committees

As a User, Consultant or Vendor Interested Observer

  • Provide Public Comments on Technical Framework Supplements
  • Attend Demonstrations, Educational Events and Workshops
how to use ihe
How to Use IHE

As a Vendor Implementer

  • Implement IHE Integration Profiles
  • Test systems through Connectathon process
  • Publish an IHE Integration Statement for products

As a User Implementer or Consultant

  • Use IHE Integration Profiles to develop interoperability strategy
  • Use Connectathon Results and Integration Statements to evaluate vendors
  • Demand IHE Integration Profile compliance in RFPs
slide25
Providers and Vendors

Working Together to Deliver

Interoperable Health Information Systems

in the Enterprise

and Across Care Settings

http://www.ihe.net

more resources www ihe net
More Resources - www.ihe.net
  • Frequently Asked Questions
  • Integration Profiles in Technical Frameworks:
    • Cardiology
    • IT Infrastructure
    • Laboratory
    • Patient Care Coordination
    • Patient Care Devices
    • Radiation Oncology
    • Radiology
  • Connectathon Results
  • Vendor Products Integration Statements
  • Participation in Committees and Connectathons