Interoperability Workshop

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							             Panel Session:
          Development in the IHE
                Domains

IHE Workshop 2006
IHE Domain Co-chairs

September, 2005        1    What IHE Delivers
                   IT Infrastructure


IHE Workshop 2006
Glen Marshall, Siemens
Co-chair ITI Technical Committee
 September, 2005                   2   What IHE Delivers
        IHE IT Infrastructure
IT Infrastructure is...
 IT that enables computer applications
   •   Operating platforms
   •   Computer languages




                                          application

                                                        application

                                                                      application

                                                                                        application
   •   Computing hardware
   •   Networks
 IT that serves multiple applications           Infrastructure
   •   Security
   •   Databases
   •   Interfaces




                                                                                    3
                      IHE IT Infrastructure
              Emergency Referrals
         Patient Created Summaries
          Format of the Document Content                                      Patient Demographics
       ECG Report Document
         and associated coded vocabulary
        Format of the Document Content                                                Query
        and associated coded vocabulary
     Lab Results Document                     Patient Consent
      Format of the Document Content
               Content
    Scanned Documents
      and associated coded vocabulary                                             Patient Identifier
    Format of the Document Content
   Imaging Information                         Document Digital                  Cross-referencing
    and associated coded Content
  Format of the Documentvocabulary                Signature
   Medical Summary                         Attesting “true-copy and origin    Map patient identifiers across
 Format of the Document Content                                                independent identification
 and(associated coded vocabulary
     Meds, Allergies, Pbs)
                                                                                        domains
Format of the Document Content               Notice of Document
and associated coded vocabulary                  Availability
                                            Know about new information


      Cross-Enterprise                                                           Audit Trail & Node
                                                                                  Authentication
     Document Sharing
 Registration, distribution and access
 across health enterprises of clinical     Support for                        Centralized privacy audit trail
                                                                             and node to node authentication
                                                                               to create a secured domain.
    documents forming a patient
       electronic health record
                                             RHIOs
      Cross-enterprise                                                             Consistent Time
   Document Point-to-Point                                                        Coordinate time across
        Interchange                                                                networked systems
     Media-CD/USB & e-mail push

                                                                                                      4
     IHE IT Infrastructure
Profiles - Medical Information
 Document Sharing
   • XDS – Cross-Enterprise Document Sharing
   • XDS Stored Query
    XDS-SD – XDS Scanned Documents
    XDP – Cross-Enterprise Document Interchange
   • NAV – Notification of Document Availability
   • RID – Retrieve Information for Display

 Patient Management
   • PAM – Patient Administration Management
   • PDQ – Patient Demographics Query
   • PIX – Patient Identifier Cross-referencing
   • PSA – Patient Synchronized Applications

RFD – Retrieve Form for Data Capture
                                               5
     IHE IT Infrastructure
Profiles - Security
 ATNA – Audit Trial and Node Authentication
 CT – Consistent Time
 DSG – Document Digital Signature
 EUA – Enterprise Use Authentication
 PWP – Personnel White Pages




                                               6
                      Patient Care
                      Coordination


IHE Workshop 2006
John Donnelly, Intepro Solutions
Co-chair, PCC Technical Committee
 September, 2005                    7   What IHE Delivers
     Primary Membership
Physician Associations & Colleges
 ACP, AAP, AAFP, FACEP
EMR & Other Department System Vendors
 Ambulatory, Inpatient, Emergency Dept
PHR Vendors
 PC-based systems, Portal solutions
Other Stakeholders in HIT
 Clinical research initiatives, Public health agencies




                                                      8
           Profile Roadmap
Year 2005-2006 (Trial Implementation)
 Medical Summary [MS] – Acute Care Discharge to PCP,
  PCP Referral to Specialist
 Unstructured Document – CDA-wrapped pdf
Year 2006-2007 (Development & Testing)
   Medical Summary [MS] – ED Referral [EDR]
   Pre-procedure H&P [PPHP]
   Basic Patient Privacy Consents [BPPC]
   Exchange Personal Health Record [XPHR]
Future (Profile Document / White Paper)
 Medical Summary [MS] – Discharge to LTC
 Forms Display for Data Capture (e.g. clinical research)



                                                            9
Domain Visibility & Support
HIMSS Annual Conference
 2006 HIMSS ‘RHIO’ Showcase – 30+ vendors exchanged
  XDS-MS, XDS-pdf documents
 Informational Presentations from Providers & HIT Vendors
ACC Annual Conference
 2006 ACC Interoperability Showcase – vendors exchanged
  XDS-pdf documents
 Informational Presentations from HIT Vendors
Physician Association Annual Meetings
 Informational Presentations Planned
Real-world RHIO Participation
 NHIIN “Pilot” RHIO’s
 Independent Community-sponsored RHIO’s



                                                             10
                      Cardiology


IHE Workshop 2006
Bob Baumgartner, McKesson
Co-chair, IHE Cardiology Technical Committee
 September, 2005                     11        What IHE Delivers
Primary Membership Sponsors
Physician Associations & Colleges
 Primary: ACC, ESC
 Specialty: ASE, ASNC, HRS, SCAI, CTA


Vendor Participation– ACC Demonstrators 2006:
 Leadership Level:                         Implementer Level: (cont)
    • GE Healthcare                            • ProSolv CardioVascular
    • Heartlab, An Agfa Company                • Siemens Medical Solutions
    • McKesson                                 • Toshiba Medical Solutions
 Implementer Level:                           • Witt Biomedical Corporation
    • Camtronics – An Emageon               Supporter Level:
      Company                                  • Cerner Corporation
    • Cardiac Science Corporation              • GOODMAN Healthcare IT
    • Medical Informatics Engineering, Inc       Solutions
    • MediNotes Corporation                    • LUMEDX
    • Medis medical imaging systems, bv        • St. Jude Medical
    • Philips Medical Systems

                                                                        12
                Profile Roadmap
Year 2004-2006 (Final Text)
   Cath Workflow (Cath)
   Echo Workflow (Echo)
   Retrieve ECG for Display (ECG)
   Evidence Documents (ED) for Cath and Echo
   Displayable Reports (DRPT) <<withdrawn for modifications>>
Year 2006-2007 (Trial Implementation)
   Stress Test Workflow (STRESS)
   Implanted Device Cardiac Observations (IDCO)
   Nuclear Medicine (NM) Cardiology Option
   Cross Enterprise Document Sharing (XDS)
   Cross Enterprise Document Sharing – Imaging (XDS-I)
   Cross Enterprise Document Sharing – Medical Summary (XDS-MS)



                                                                 13
           Profile Roadmap
Future
 Finalize Displayable Reports (DRPT)
 Evidence Document Templates
   •   Stress Measurements
   •   Nuclear Cardiology Measurements
 Data Harvesting
 Portable Data for Imaging (PDI – DVD Support)
 EP Urgent Implantable Device Cardiac
  Identification (PDQ-IDC)



                                                  14
Domain Visibility & Support
ACC Annual Conference
 2005 and 2006 ACC Interoperability Showcase
 Educational Workshops and Session
ESC Annual Conference
 2005 and 2006 ACC Interoperability Showcase
 Educational Workshops and Session
Specialty Hands-On Demonstrations
 ASE 2006
 ASNC 2007 and 2008
 HRS 2007
Additional Conference Representation
   CT Angiography
   SCAI
   Computers in Cardiology
   American College of Cardiology Administrators (ACCA)


                                                           15
                           Eye Care



IHE Workshop 2006
Jim Riggi, Medflow, Inc.
Co-Chair IHE Eye Care Technical Committee
 September, 2005               16           What IHE Delivers
        Introducing IHE Eye Care
•   Targeting all eye care providers
    •   Ophthalmology and Optometry

•   Roots in DICOM WG9 (Ophthalmology)
    •   OP and Stereo modules approved
    •   OTM and Refractive SR work items in progress

•   AAO is the sponsoring organization
    •   Dr. Flora Lum, AAO, coordinator
    •   Don Van Syckle, DVS Consulting

•   Planning Committee
    •   Mike Schmidt, Carl Zeiss Meditec
    •   Dr. Mark Horton, U.S. Indian Health Services

•   Technical Committee co-chairs
    •   Jim Riggi, Medflow
    •   Peter Kuzmak, U.S. Dept. of Veteran Affairs
                                                       17
18
        IHE Eye Care – Plan for 2006

•   Informal Efforts 2005
    •   Participation at HIMSS IHE Showcase:    February 2005
    •   Participation at VEHU Showcase:         May 2005
    •   AAO Showcase:                           October 2005

•   Development Schedule
    •   Planning Committee decision:            October 2005
    •   Issue Public Comment version:           March 2006
    •   Public Comment Due:                     April 2006
    •   Issue Trial Implementation version:     May 2006
    •   Connectathon:                           October 2006
    •   AAO Showcase:                           November 2006

•   Year 1 Profiles
    •   Eye Care Scheduled Workflow (EYECARE)
    •   Charge Posting (CHG)
    •   Eye Care Evidence Documents [ECED]

                                                           19
IHE Eye Care Connectathon
Open invitation to vendor community
Week of October 9th
RSNA headquarters, Chicago
Prerequisite to participate in the AAO
Annual Meeting Interoperability Showcase
Application: Contact Flora Lum,
flum@aao.org, (415) 561-8592



                                       20
                          Laboratory



IHE Workshop 2006
François Macary, AGFA HealthCare
Co-Chair Laboratory Committee

 September, 2005                   21   What IHE Delivers
Primary membership (sponsors & contributors)

  Biomedical scientists in professional societies
    SFIL (Fr)
    In discussion for the future: ACLA, AACC (US)
  National Healthcare IT bodies
      GMSIH (Fr)
      JAHIS (Jp)
      HIMSS (US)
      In discussion for the future: CHCF (US)
  EHR vendors (France, Japan, UK, Germany, USA)
  LIS vendors (France, Italy, UK, some in US)
  Automation Managers vendors (Japan, Italy, France)
  Analyzers & robotic devices vendors (Japan)

                                                     22
     Laboratory domain production
                             2003     Start      1st profile  LSWF
Contributing countries
     France                 2004                Cx-thon Eur.
     Japan                  2005                Cx-thon Eur., Asia, US
     Germany
                             Sept.   4 new IPs   LIR, LPOCT, LCSD, LDA
     Italy                   05
     The Netherlands
                             2006                Cx-thon Eur., Asia, US
     UK
     US
                             June    XDS-LAB     “Sharing Lab reports”
                              06     CDA R2      For Pub. Com. until Aug 15
Current Co-Chairs                     based
elected in mid-2004:         Sept.
                              06                 T rial Implementation release
Yoshimitsu Takagi, Hitachi
Francois Macary, Agfa HC     2007                Cx-thon US, Eur. Asia

                                                                         23
 Current projects: Future profiles

  Specimen Labeling Workflow (SLW)
  EHR to Lab Interoperability (In discussion with
  ELINCS)



Face to face meeting scheduled for early September:
1. Process comments to XDS-LAB  Trial Implementation
2. Finalize SLW  Public Comment
3. Launch ELINCS for Connectathon 2007


                                                      24
             Patient Care Devices



IHE Workshop 2006
Todd Cooper
Co-chair, PCD Technical Committee
 September, 2005                    25   What IHE Delivers
 Primary Membership Sponsors
 Physician Associations & Colleges
   ACCE
 Medical Device Vendors
   Patient monitors, ventilators, pumps, home health
 Purchasers / Providers
   Acute care – ED, ICU, OR (…for Year 1)
 Other Stakeholders in HIT
   Regulatory & Public health agencies

 Over   100 PCD members … in the first year!
                                                    26
           Profile Roadmap
Year 0: 2005 (Domain Created)
 Organizational meeting 2005-Sept in D.C.
 Charter: Use Cases w/at least one regulated medical device
Year 1: 2006-2007 (Development & Testing)
 Enterprise communication of PCD data [ECPCDD]
 Filter PCD Data [FPCDD]
 Patient Identification Association [PIDA]
 Content Profile: Monitors, ventilators, infusion pumps
 Public comment starts end 2006 June
Future…
 PCD Plug-n-Play Interoperability
 Real-time data archiving & communication
 Alarm management … wireless/mobile … home health … !

                                                           27
Domain Visibility & Support
HIMSS Annual Conference
 2005 & 2006: Booth in IHE Showcase
 2006: Showcase presentation … “standing room only”
Industry Survey
 2005: Survey within HIMSS / IHE re. PCD priorities
 2006: Survey widened to include many other groups
Presentations at Conferences
 IHE PCD Presentations at conferences such as AAMI &
  APSF




                                                        28
                  Radiology


Kevin O’Donnell, Toshiba Medical Systems
Co-chair, IHE Radiology Planning Cmte

September, 2005          29                What IHE Delivers
                IHE Radiology
Scope:
 Radiology including Nuclear Medicine, Mammography


Vendors
 Acquisition Modalities, RIS, PACS, Workstations, Displays, Printers


Established 1998 (first IHE domain)
Sponsor: RSNA
Supporters: COCIR, DRG, EAR, ECR, EuroPACS,
GMSIH, JIRA, JAHIS, JRS, JSRT, METI, MEDIS-DC,
SFR, SIRM


                                                               30
   IHE Radiology - Deployment
In active use:
 Robust Vendor Participation at Connectathons
  (78 of 150 Systems in Chicago)
 Over 200 IHE Integration Statements published
 IHE Profiles appearing in User Purchasing Processes


Most implemented Profiles
 Scheduled Workflow
 Patient Information Reconciliation
 Consistent Presentation of Images
 Portable Data for Imaging
                                                   31
   IHE Radiology - Achievements
Year 1998-2006
 Basic radiology workflows
   Acquisition, Post-Processing, Reporting, Teaching
    Files/Clinical Trials, CD/Hardcopy Import

 Handling imaging content
   Measurements, CAD Results, NM, Mammo, Fusion,
    Presentation States, Reports, Key Image Notes

 Distribution of imaging information
   on CDs, to EHRs, keeping Audit Trails

                                                        32
IHE Radiology – Recent Direction
 Facilitate deployment of IHE Profiles in the Market
  Users Handbook (2005 Edition)
  PDI Demo at RSNA 2005
  XDS-I Demo at RSNA 2006

 Expand focus to integration and workflow spanning
 departments/enterprises/regions
  XDS-I
  Importation Workflow

 Expand support for specialties
  Address NM, Mammography and others

 Planning/Roadmap Discussions underway

                                                  33
                   Radiation Oncology


IHE Workshop 2006
Keith La Plain, Varian Medical Systems
Co-Chair, IHE-RO Planning Committee

 September, 2005                      35   What IHE Delivers
Primary Membership Sponsors

Radiation Oncology Vendors
 Delivery Devices – Linacs, Cobalt, Brachytherapy
 Simulators
 Treatment Planning Systems
 Oncology Information Systems
Physician Associations & Colleges
 ASTRO
 AAPM (American Association of Physicists in Medicine)
 ATC (Advanced Technology Consortium)




                                                          36
               Profile Roadmap
Year 2005-2006 (Initial Implementation)
  Image Set Contouring
  Storage & Retrieval
     • Structure Set
     • Geometric Plan
     • Dosimetric Plan
     • Dose
  Multi Series Image Review
  Combined CT Storage
Year 2006-2007
    RT Plan – enlarging scope of objects : wedges, arcs
    Scheduling of Treatment Delivery - GPWL
    Fusion (Multi-modality)
    Query / Retrieve
Future
  Further RT Plan enlargement
  4D Support for gating, breath-hold, adaptive therapy




                                                           37
Domain Visibility & Support
ASTRO Annual Conference
 2006 ASTRO : Inaugural IHE-RO Showcase
Other Potential Conferences
 AAPM
 HIMSS
 RSNA




                                           38
Questions?

             39