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Health Information Exchange One size does not fit all.

Health Information Exchange One size does not fit all. Dr Peter MacIsaac, Secretary IHE Australia, eHealth Consultant – Hewlett Packard Enterprise Services. Blair Butterfield – eHealth Initiative. Australian PC-EHR concept. Australian PC-EHR concept. Health Information Exchange -HIE.

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Health Information Exchange One size does not fit all.

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  1. Health Information Exchange One size does not fit all. Dr Peter MacIsaac, Secretary IHE Australia, eHealth Consultant – Hewlett Packard Enterprise Services

  2. Blair Butterfield – eHealth Initiative

  3. Australian PC-EHR concept

  4. Australian PC-EHR concept

  5. Health Information Exchange -HIE Health information exchange (HIE) is the transmission of healthcare-related data among facilities, health information organizations (HIO) and government agencies according to national standards. (US Office National Coordinator)

  6. Health Information Exchange Health information exchange (HIE) is the transmission of healthcare-related data among facilities, health information organizations (HIO) and government agencies according to national standards. (US Office National Coordinator) This is a very broad and inclusive definition

  7. Types of HIE • Messaging • Data Synchronisation • Data aggregation • Portals • Common health record • Shared healthcare record • Centralised • Federated There was the PAS then came: Radiology Lab ED Operating theatre… GP systems…..

  8. One Size does not fit all

  9. Types of HIE • Messaging • Point to point • Essentially two models • Application to application (point to point) • Using a messaging intermediary or service • Messaging transport • HL7, DICOM, Webservices, File Transfer etc. • Messaging payloads • Data synchronisation eg. Patient identity/ADT • Information delivery e.g. reports, discharge summary • Electronic test ordering • Electronic transfer of prescriptions

  10. Types of HIE • Application synchronisation or linkage across multiple sites • Shared applications across sites • Same software e.g. GP software running in different locations or mobile and home-base • Same software running in different organisations • Issues of data compatibility due to local build or customisation

  11. Types of HIE • Access to common data – data aggregation • Central operational data store for health transactions from multiple applications • Use for point of care – record aggregation or single patient view • Management dashboards • Central data warehouse used for reporting/analytics/research • Many organisations have multiple duplicated data stores

  12. Types of HIE • Portals • External access point to another system • Does not required pre-existing clinical information systems – may use web browser • Patient, staff or external healthcare providers • May access single organisations EMR • May access a composite record drawn from many applications (single or multiple organisations) • May access third party systems e.g. health insurance, Medicare.

  13. Types of HIE • Share healthcare records • Support information sharing as patients move through healthcare system • Support consumer engagement with their healthcare • Models • Centralisation • Federation – index and retrieve

  14. Types of HIE • Common electronic health records • Usually Internet delivered • Used by all participants • Specialist care record, care planning or coordinated care • Access to consolidated view of patient/client • Usually secondary to main records system

  15. Type of HIE • Centralised Shared Healthcare Record • Record or summary data sent from source to a centralised common EHR • e.g. UK NHS Spine • e.g. Canada HealthInfoway • Australia’s HealthConnect Mark 1 – 2003

  16. One size does not fit all • Index and retrieve • Within or between organisations • Information is placed in a secure accessible repository or specific secure access systems used to access primary data • May be a copy (static data) • May be a link to extract information or report (dynamic data) • Basic description of content (metadata) stored in a common index – no or limited patient data

  17. Important characteristics of HIE • Cross organisation communication • Patient consent and privacy • Multivendor systems • Focus on single patient view over time: aggregation and longitudinal E.H.R • Use of a common architecture • Standards approach • Scalable – local to national • Extensible in function

  18. Growth in al models of HIE - USA KLAS Enterprises 2011

  19. IHE based HIEs Where in the world is XDS?

  20. Customer Successes

  21. HIE Snapshot GE/IHE – U.S. Connecting physicians and healthcare professionals in a 31-county region • 13 member organizations • Data from 8 hospitals and 31 clinics • Used in 3 emergency departments and 3 primary care clinics • 2.6 million patient records • 345,000 patient authorizations • Supports the IHE framework Addressing critical needs across Vermont • Medication history to clinicians in the ER • Chronic disease management - patient data from EMRs to data center • Lab results electronically delivered to physician EMRs • Supports the IHE framework A private, not for profit, 626 licensed bed, academic medical center emphasizing community based care. • Boston HealthNet 1995, includes BMC, Boston Univ School of Medicine, 15 Community health centers • Community Information Exchange (CIE) focus on sharing medications, problems, allergies, and lab results • Access directly from physician’s EMR • eReferral portal utilizes the CIE base infrastructure • Supports the IHE framework

  22. 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

  23. Diagnostic Imaging Exchange

  24. Italy (Genoa Region)

  25. 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.

  26. 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.

  27. Support for PC-EHR Community http://ihe-australia.wikispaces.com/PCEHR Link to site

  28. Reference and Resources • US State Health Information Exchange Cooperative Agreement Program • Where in the world is XDS? • http://www.youtube.com/watch?v=JwngzRPaw-w • http://www.nationalehealth.org/NHIN-U/

  29. Useful Links www.ihe.net www.ihe.net.au http://ihe-australia.wikispaces.com http://wiki.ihe.net http://motorcycleguy.blogspot.com/2010/01/where-in-world-is-xds.html

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