Enhancing Healthcare Interoperability: IHE Global Standards Adoption Process

1. Showcasing Interoperability National Center for Public Health Informatics (NCPHI) Monthly Partner Call Lori Fourquet e-HealthSign LLC

2. What is “Integrating the Healthcare Enterprise”? • A 10-year public-private initiative • Driven by end-users, IHE improves patient care by harmonizing electronic health information exchange • Enables approved standards to seamlessly pass health information among care providers on a local, regional and national level • IHE Frameworks are freely available to all • The IHE Global Standards Adoption process as approved by the International Standards Organization (ISO) as a Technical Report 28380 in August 2007

3. 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

4. International Growth of IHE Australia Netherlands Germany Norway Canada Austria Taiwan France Japan Korea China USA Italy UK Spain 2005 2006 2000 2007 1999 2001 2002 2003 2004 2088 • Local Deployment • National Extensions • Promotional & Live Demonstration Events • Funding Pragmatic global standards harmonization + best practices sharing 4

5. Austria IHE, global standards-based profiles adopted by several national & regional projects Lower Austria Netherland Amsterdam Italy (Conto Corrente Salute) UK CfH (Radiology WF) Denmark (Funen) Italy (Veneto) Spain (Aragon) FranceDMP Quebec, Toronto,Alberta, British ColumbiaCanada Infoway VITL-Vermont Boston Medical Center - MA Philadelphia HIE KeyHIE – Pennsylvania CareSpark – TN & VA South Africa NCHICA – N. Carolina Malaysia Singapore CHINA-MoH Lab results sharing JAPAN-Nagoya Imaging Info Sharing CHINA-Shanghai Imaging Info Sharing

6. Where are Public Health Interests Addressed in IHE? • New Domain: Quality, Research, and Public Health • Leverages profile initiatives from multiple domains • Current Domain Initiatives in: • IHE Quality, Research, and Public Health • IHE Patient Care Coordination • IHE IT Infrastructure

7. QRPH White papers • Patient-Level Export of Quality Data • Identifies a set if IT Infrastructure and Patient Care Coordination profiles that can be used to retrieve quality data from multiple systems for quality reporting and aggregation. This framework can be extended to research and public health purposes • White Paper: Performance Measurement Data Element Structured for EHR Extraction • Intended to identify a standard mechanism to enable extraction of quality measures from Electronic Health Record Systems

8. QRPH Profiles • Clinical Research Data Capture (CRD) • CRD describes the content and format to be used within the Pre-population Data transaction described within the RFD Integration Profile. The purpose of this profile is to support a standard set of data in CCD format which the Form Filler provides for use in Clinical Research • Drug Safety Content Profile (DSC) • DSC describes the content and format to be used within the Pre-population Data transaction described within the RFD Integration Profile. The purpose of this profile is to support a standard set of data in CCD format which the Form Filler provides for use in reporting adverse events as it relates to Drug Safety.

9. IHE PCC Profiles FunctionalStatusAssessments ImmunizationRegistryContent (C78) Medical Summaries (C48) ED Referral ExchangingPHRContent (C32) EmergencyDepartmentEncounter Summary (C28) AntepartumCare Summary AntepartumRecord CancerRegistryContent Integration Content Query for Existing Data (TP21) 2005-062006-072007-082008-09 Care Management

10. Query for Existing DataValue Proposition • Exchange of information between Data Repositories and Clinical Data Consumers for: • Drug Safety • Public Health, Biosurveillance and Disease Registries • Identifying Qualifying Patients • Clinical Trials • Disease Management • Quality Reporting • Claims Submission • Using a single standard for query • Compatible with CCD vs. • 30-60 HL7 V2.X Interfaces @ $10-20K/Inteface HITSP TP21, Quality

11. Immunization ContentValue Proposition • The value of Immunization Information Systems (IISs) improves as the patient immunization histories it maintains become more complete. • Although IIS use by public health and safety net providers is widespread, IISs are challenged to obtain electronic interfaces to provider EMRs • EMR implementers spend 10-20K per year per HL7 V2 connection • Connections tend to be one-off in spite of HL7 V2 standards and the existence of implementation guides. • The trend is toward unified HL7 V3 XML-based interactions including Continuity of Care Document (CCD) and compatible V3 document standards • Immunization Content strives to provide a bridge between Version 2 and Version 3 HITSP C78, Immunization and Response Management

12. Cancer Registry Pathology ReportValue Proposition • ~ 2 Million cancers diagnosed each year in the US • ~ 95% of these cancers have one or more pathology reports • The US federally mandates reporting • serves as the foundation to reduce illness and death from cancer • Making use of the EHR and IHE methodology • reduce time and resources required to meet federal mandates • improve the timeliness of reporting • Being proposed to IHE Pathology for 2009 NEW DIRECTIONS DEMONSTRATION

13. Care ManagementScope Capability to specify care guidelines and gather pertinent information for: • Public Health • Cancer Registries • Immunization Information Systems (Registries) • EHR Systems • Chronic Disease Management • Care Management Systems • EHR Systems • Other Health IT Systems Content for Newborn Screening and Diabetes under development Watch for 2010 demonstrations

14. IT Infrastructure Components Supporting Public Health • Cross-Enterprise Document Sharing • Cross-Enterprise Document Reliable Interchange (XDR) • Cross-Enterprise Document Media Interchange (XDM) • Patient Identifier Cross Reference Manager (PIX) • Patient Demographics Supplier (PDQ) • Retrieve Form for Data Capture (RFD) • Audit Record Repository (ATNA) • Time Server (CT) • Personnel White Pages (PWP) • Cross-Enterprise User Assertion (XUA) • Cross Community Access (XCA) • Basic Patient Privacy Consents (BPPC) • Cross-enterprise Sharing of Scanned Documents (XDS-SD) • Document Digital Signature (DSG)

15. 2008 IT Infrastructure Profiles Supporting Public Health • Pediatric Demographics • Expands patient demographics for PIX/PDQ to include supported attributes of interest to immunization registries • Referral Requests • Addresses a means to a way to convey the referral request in a form suitable for automatic processing • Key to improved coordination of care (e.g. safety-net, under-insured, uninsured) • Emergency Contact Registry • White paper addressing bridge between the emergency response person identification and health record systems • Next of kin contact is a first step in a longer term interoperability initiative in support of emergency response

16. 2008 IT Infrastructure Profiles Supporting Public Health • Sharing Value Sets • Addresses synchronization of content terminologies across applications • Key to semantic interoperability for quality, research and public health analysis. • Publish/Subscribe Infrastructure for XDS.b • Currently, required to poll the Document Registry for new documents & updates • Add support for a publish/subscribe method of receiving new information for patients of interest. • e.g. Public Health Monitoring for certain conditions • e.g. Subscribe to neighboring state conditions of interest

17. 2008/2009 Development • QRPH • Chronic Disease Management Reporting - Profile • Retrieve Protocol for Execution - Profile • Maternal child health - Profile • Diabetes Care Management - White Paper • Performance Quality Report - Profile • New-born screening - Planning White Paper • Pseudonymization - Planning Committee/ITI White Paper • IT Infrastructure • Publish and Subscribe - Profile • Multi-Patient Query - Profile

18. HITSP Support for IHE Connectathon • Foster development and implementation of the HITSP ISs • Increase awareness of available guidance and support • Encourage participation in HITSP Technical Committees • Ensure 'fitness for use' of HITSP Interoperability Specifications • Debug • Identify improvements • Encourage and support vendor application demonstrations supporting HITSP at the HIMSS Showcase

19. HITSP Accepted and Recognized Solutions • IS01 - Electronic Health Records Laboratory Results Reporting • IS02 – Biosurveillance • IS03 - Consumer Empowerment and Access to Clinical Information via Networks • IS04 - Emergency Responder Electronic Health Record • IS05 - Consumer Empowerment and Access to Clinical Information via Media • IS06 – Quality • IS07 - Medication Management

20. On The Way (January 2009) • IS08 - Personalized Healthcare • IS09 - Consultation and Transfers of Care  • IS10 - Immunizations and Response Management • IS11 - Public Health Case Reporting • IS12 - Patient - Provider Secure Messaging • IS77 - Remote Monitoring

21. IHE Profiles and HITSP Additional Constraints

22. IHE Profiles and HITSPNo Constraints

23. Panel Approved • C64 – PWP – Personnel White Pages • C78, C72 – Immunization Content • T67 – DRR – Referral • C76 – Drug Safety Profile

24. HITSP Population Perspective TC • Mondays   1 – 3 PM EST    Quality IS and Measure Configuration • Stroke • VTE • Emergency Department • New constructs: QRDA, Clinical Decision Support • Mondays   3 – 4 PM EST    Public Health Case Reporting and Consumer Adverse Event Reporting (new extension) • Alert review • Data Content Update (Pending CSTE, CDC, AHRQ reports) • Mondays   4 – 5 PM EST    Immunization and Response Management • Supply Chain Management • Non-vaccine medication administration • Thursday  3 – 4 PM EST    Newborn Screening (new use case) • Thursday   4 – 5 PM EST    Maternal and Child Health (new extension)

25. Overview of 2009 Population Health Scenarios • Alignment with HITSP Use Cases • IS 02 – Biosurveillance • IS 06 – Quality • IS 10 – Immunization and Response Management • IS 11 – Public Health Case Reporting • Quality (above) • Public Health Initiatives in IHE • Immunization Scenario (same as above) • Cancer Registry – New Directions • Clinical Research • Drug Safety (also indicated in HITSP Use Case) • Clinical Trials

26. Scenarios • Many of the following scenarios have specific sponsors driving the demonstration goals • Most of the scenarios are still undergoing review for clinical accuracy • Extended technical options are listed, but may be adjusted based on capabilities • Some of the scenarios include HITSP constructs with no IHE equivalent

27. Quality (HITSP IS06)

28. Biosurveillance & Public Health Case Reporting:Bi-directional Communications (HITSP IS02, IS11)

29. Immunization (HITSP IS10)

30. IHE Public Health New DirectionsCancer Registries

31. Additional Scenarios Clinical Research not Specifically Covered • Drug Safety • Leveraging IHE Drug Safety Profile as constrained by HITSP. This is a late profile and not part of the current connectathon tests • Clinical Trials and Drug Safety • One variant is expected to include Digital Signature as a collaborative initiative with CDISC and SAFE Biopharma • The specific scenario will be generated through efforts between CDISC and SAFE Biopharma

32. HIMSS 2009 Interoperability Showcase More public health scenarios Participation by Implementation Testbeds Security and Policy More content available for PHIN 2009

33. Lori Reed-Fourquet, E-HealthSIgn 1056 Durham Road Wallingford, Ct. 06492 phone: (203)294-0479 Fax: (203) 294-9623 e-mail: lori.fourquet@sbcglobal.net Questions?