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IHE-Denmark-X-Enterprise-V11

VIEWS: 3 PAGES: 30

									    Integrating the Healthcare Enterprise




 IHE for cross-enterprise
     interoperability
                     Charles Parisot, GE Healthcare
          IHE IT Infrastructure Technical Committee Co-chair
                         IHE Europe Committee



                 Copenhagen, March 17th 2005
March 17, 2005                 1           IHE and medical Standards in Denmark
             Providers and Vendors
         Working Together to Deliver
Interoperable Health Information Systems
                  In the Enterprise
           and Across Care Settings

                 WWW.IHE.NET
                                          o g
              W W W . I H E – Europe.medicalrStandards in Denmark
 March 17, 2005           2       IHE and
IHE drives healthcare standards based-integration

                       Prof. Societies Sponsorship
                     Healthcare Providers & Vendors

Healthcare IT Standards                                     General IT Standards
     HL7, DICOM, etc.                                              Internet, ISO, etc.

                                        IHE
                                       Process

         Interoperable Healthcare IT
           Solution Specifications Healthcare IT
                        Interoperable
             IHE Integration Profile Specifications Healthcare IT
                           Solution Interoperable
                             IHE Integration Profile Specifications Healthcare IT
                                           Solution Interoperable
                                             IHE Integration Profile Specifications
                                                           Solution
                                                         IHE Integration Profile

    March 17, 2005                        3                IHE and medical Standards in Denmark
A Proven Standards Adoption Process
                                                    Product IHE Integration
                                                          Statement
                               IHE Connect-a-thon
                                     Results

                            IHE                                                          Easy to
                                                    Product
                         Technical                                                      Integrate
                                                    With IHE
                        Framework                                                       Products

                              IHE
  Standards                 IHE
                          Integration
                        Integration
                           Profiles B
                                             IHE                IHE                 User Site
                         Profile A      Connect-a-thon      Demonstration



                                                                                             RFP
IHE Integration Profiles at the heart of IHE :
    Detailed selection of standards and options each solving a specific integration problem
    A growing set of effective provider/vendor agreed solutions
    Vendors can implement with ROI
    Providers can deploy with stability
    Process started in1998 with continuous improvements

       March 17, 2005                          4               IHE and medical Standards in Denmark
         Achievements and expanding scope
    Over 100 vendors involved world-wide, 4 Technical Frameworks
       27 Integration Profiles, Testing at yearly Connectathons,
           Demonstrations at major exhibitions world-wide
                                           IHE
                                EHR- Longitudinal Record
Cross-Enterprise                          IHE
                                   IT Infrastructure
Intra-Enterprise

       IHE                          9 Integration Profiles                    IHE
     Radiology                                                             Cardiology
14 Integration Profiles                                                 3 Integration Profiles

                      IHE                                         IHE
                   Laboratory                                Future Domain
                                         IHE                         Patient care Coordination, Quality,
        1 Integration Profile          Oncology                      Pharmacy, Anatomical Pathology,
                                                                     Surgery, etc.
 To claim compliance to IHE Integration Profiles vendors shall
    publish for each product an IHE Integration Statement.
   March 17, 2005                            5               IHE and medical Standards in Denmark
IHE IT Infrastructure 2004-2005
New                                                                                                   New
                                   Retrieve Information
                                   Retrieve Information                     Personnel White Page
   Cross-Enterprise                     for Display
                                        for Display                             Access to workforce
  Document Sharing                                                              contact information
                                      Access patient’s clinical
                                     Access a a patient’s clinical
Registration, distribution and      information and documents a
                                 information and documents in in
   access across health            format ready to be presented
                                          a format ready to be
                                                                            Patient Demographics
   enterprises of clinical             to the requesting user
                                               presented                            Query    New
documents forming a patient            to the requesting user
  electronic health record
                                                                             Patient Synchronized
                                                              New                Applications
                                     Audit Trail & Node                          Synchronize multiple
                                      Authentication                       applications on a desktop to the
                                  Centralized privacy audit trail                    same patient
  Patient Identifier             and node to node authentication
                                                                                Enterprise User
   Patient Identifier
Cross-referencing for              to create a secured domain.
                                                                                Enterprise User
                                                                                Authentication
  Cross-referencing
          MPI                                                                   Authentication
         for MPI
  Map patient identifiers                                                    Provide users a single name
     Map patient identifiers
     across independent               Consistent Time                       and centralized authentication
       across independent
   identification domains            Coordinate time across                            process
     identification domains           networked systems                          across all systems



    March 17, 2005                             6                     IHE and medical Standards in Denmark
Introduction:
EHR Cross-Enterprise Document Sharing


    Enables the seamless information sharing
   between healthcare IT systems (e.g. EHRs)
        serving all types of care delivery
       organizations in a region or nation.




    March 17, 2005     7       IHE and medical Standards in Denmark
Sharing records that have been published
community

                                                     Laboratory Results     Specialist Record
                               Hospital Record


                                                                                       Reference
                                                                                       to records

        4-Patient data
         presented to
          Physician

                                                     3-Records
                                                     Returned
                         Clinical IT System                                    Index of patients records

                                                          Sharing System
                                                                                  (Document-level)
                          Temporary Aggregate
                             Patient History           1-Patient                   2-Reference
                                                      Authorized                    to Records
ClinicalMarch 17, 2005
         Encounter                               8                                  for Inquiry
                                                        Inquiry IHE and medical Standards in Denmark
       Building and accessing Documents
EHR-LR:                               Documents Registry
Longitudinal Record
as used
across-encounters
                                                                        Long Term Care




                       Acute Care
Document               (Inpatient)
Repository                                         Other Specialized Care
                                                   or Diagnostics Services

                   PCPs and Clinics
                   (Ambulatory)             EHR-CR: Care Record systems
                                            supporting care delivery
                                                 Submission of Document References

                                                 Retrieve of selected Documents
      March 17, 2005                        9            IHE and medical Standards in Denmark
                   XDS – Value Proposition
Foundation for Health IT Infrastructures: Shared
Electronic Health Record, in a community, region, etc.

Effective means to contribute and access clinical
documents across health enterprises.

Scalable sharing of documents between private
physicians, clinics, long term care, pharmacy, acute
care with different clinical IT systems.

Easy access: Care providers are offered means to
query and retrieve clinical documents of interest.


  March 17, 2005            10     IHE and medical Standards in Denmark
                  XDS - Value Proposition
Distributed: Each Care delivery organization “publishes” clinical
information for others. Actual documents may remain in the
source EHR-CR.

Cross-Enterprise: A Registry provides an index for published
information to authorized care delivery organizations belonging
to the same clinical affinity domain (e.g. an RHIO).

Document Centric: Published clinical data is organized into
“clinical documents”. using agreed standard document types
(HL7-CDA, PDF, DICOM, etc.)

Document Content Neutral: Document content is processed only
by source and consumer IT systems.

Standardized Registry Attributes: Queries based on meaningful
attributes ensure deterministic document searches.

 March 17, 2005             11          IHE and medical Standards in Denmark
 IHE XDS Integration Profile: Key Concepts
XDS Document

  A set of attested clinical information (structured or not) which
  form an element of a patient record to be shared. It may
  already exist within the source IT system.


XDS Submission Set
  A set of documents related to a patient that a (team of)
  clinician(s) in the same source system have decided to make
  available to potential consumers.


XDS Folder
A means to group documents for a number of other reasons:
  Team work across several physicians,
  Episode of care,
  Emergency information for a patient, etc.
XDS leaves open the use of folders to affinity domain clinicians.

    March 17, 2005             12          IHE and medical Standards in Denmark
        XDS Actors and Transactions

                                           Patient
                                       Identity Source

                               Patient Identity
                                          Feed
                                                               Query
                                          Document           Documents            Document
                                           Registry                               Consumer

                                                  Register
                                                  Document Set

                  Provide & Register                                 Retrieve
                    Document Set                                    Document
Document                                  Document
 Source                                   Repository




 March 17, 2005                            14               IHE and medical Standards in Denmark
                            Security for XDS
        Leverages IHE Audit Trail & Node Authentication
ATNA creates a secured domain:
• User Accountability (Audit trail)
• Node-to-Node Access Control
                                          Patient Identity
• Node-level user authentication              Source Secured
• User access control provided by node
                                   Patient
                                                       Node

BUT Registry/repository based           Identity
                                                                                 Secured
User-Level Access Control and              Feed                     Query         Node
policy agreements is beyond XDS..                                 Documents       Document
                                            Document
                                                                                  Consumer
                                    Secured Registry
                                      Node
                                                   Register
                                                   Document Set
                        Provide&Register                              Retrieve
                          Document Set                               Document
         Secured Node
          Document                          Document
           Source                           Repository
                   Secured                              Secured
                     Node                                Node


      March 17, 2005                       15              IHE and medical Standards in Denmark
Integration Model 1:
EHR-CR with Repository at Source
An EHR-CR completes a phase of care for a patient where it:
    Has these documents available as Repository Actor.
    Registers documents with a Registry actor.
Any other EHR-CR may query the Registry actor, and chose to
retrieve some of these documents from any Document Repository
Actor.
EHR-CR                                                      EHR-CR


                                    Document
                      2 Register     Registry
    Document Source                              3 Query           Document
                                                                   Consumer
        Document
        Repository
                                   4 Retrieve



    March 17, 2005                 16           IHE and medical Standards in Denmark
Integration Model 2:
EHR-LR with Third Party Repository
An EHR-CR completes a phase of care for a patient where it:
   Provides the documents to a Repository Actor of its choice.
   Documents are Registered with a Registry Actor.
Any other EHR-CR may query the Registry actor, and chose to
retrieve some of these documents from any Document
Repository Actor.
 EHR-CR                                                            EHR-CR


                                        Document
                                         Registry
                                                         3 Query         Document
                                                                         Consumer
    Document Source                 2 Register

                                                    4 Retrieve
                      1 Provide &
                                      Document
                      Register        Repository


 March 17, 2005                          17                 IHE and medical Standards in Denmark
Integration Model 3:
EHR-CR feed a EHR-CR/EHR-LR hub
An EHR-CR completes a phase of care for a patient where it:
    Provides and Registers a set of documents to a Document
     Repository in an EHR-CR.
The EHR-CR Consumer Actor has the documents and may
respond to queries and provide them to other document
consumers.

EHR-CR                                            EHR-CR
                                                              Document
                                                              Consumer
    Document Source
                                                             Document
                      1 Provide & Register                    Registry
                                                             Document
                                                             Repository




    March 17, 2005                   18      IHE and medical Standards in Denmark
Patient Access also possible

A patient accesses own record:
 Query and Retrieve a set of documents using for
  example a portal application that offers the ability
  to display documents’ content.
This is a particular case of an EHR-CR, where the
patient is interested her/his own care. Patient may
also register and provide documents.




  March 17, 2005        19        IHE and medical Standards in Denmark
    Standards selection for IHE XDS
                   No single standard can address
                 Cross-enterprise Document Sharing



         Electronic Business          Internet Standards
              Standards                   XML, HTTP,
   ebXML Registry, ebMS, SOAP, etc.        ISO, etc.

                            Healthcare
                         Content Standards
                         HL7 CDA, CEN EHRcom
                            HL7, ASTM CCR
                              DICOM, etc.


   Marriage of healthcare standards facilitates
 implementation and leverages complementary
     technologies (e.g. security & privacy).
March 17, 2005                 20         IHE and medical Standards in Denmark
                      How real is XDS ?
      Specification work since Nov 2003
      Under Public Comments June-July 2004
                600 constructive comments received.
                Validity of XDS approach confirmed (e.g. CfH Collaborative Response).
      Stable specification IHE Technical Framework Published Aug 15th,
      2004 (TI Supplement)

      IHE Connectathon - January 2005 (USA)
                14 Vendors passed
      HIMSS Feb 2005 - show-wide demonstration
                17 EHRs, 800 patients, 7700 documents registered, 41000 queries.
      IHE Connectathon - April 2005 (Europe)
                22 Vendors registered

Several Implementation Projects by health authorities in 2005
Italy: Linguini & Veneto Regions - Canada: Newfoundland – France: Trials – Norway-Region

     March 17, 2005                      21               IHE and medical Standards in Denmark
                 HIMSS Highlights




March 17, 2005         22    IHE and medical Standards in Denmark
             HIMSS IHE Highlights
HIMSS: 700 Exhibitors - 23,000 Attendees
Over 2000 visited the IHE Booth.
49 participants in IHE Interoperability booth
15 vendors participated in XDS from their booth
732 Attendees registered for their own EHR
7,772 Documents registered in XDS Registry
40,984 Queries to XDS Registry
US National IT Coordinator (Dr Brailer) held his press
conference in IHE Booth and thanked IHE. 50 members
of press toured.

  March 17, 2005          23         IHE and medical Standards in Denmark
Over 700 attendees experienced their
HIMSS-Wide Electronic Health Record
Cross-enterprise Showcase Booth
                                               Vendor Booth
                          Coordinated
 Radiology
                       Patient Evaluation
                                                            Vendor Booth
   Comprehensive
    Patient Care
                                    IT                             Vendor Booth
                              Infrastructure
   Cardiology Workup
                                                                  Vendor Booth
                           HIMSS “RHIO” with
                        IHE-XDS Cross-enterprise                      Vendor Booth
                              doc sharing
               PCP
                                                                  Vendor Booth
                           Diag Center
      Home

                   Multispecialty                         Vendor Booth
                       Clinic
    Ambulatory Showcase Booth                  HL7 Demo Booth
    March 17, 2005         24                    IHE and medical Standards in Denmark
             IHE Profiles for a RHIO
       Available Integration Profiles completed
                                                                      Patient Demographics
                                                                              Query
                                                                    New

                                                                           Patient Identifier
                                                                          Cross-referencing
                                                                      Map patient identifiers across
                                                                       independent identification
                                                                                domains
                                                                      2004
                                                                                          New
                                     Audit Trail & Node              Personnel White Page
  Cross-Enterprise                    Authentication                      Access to workforce
 Document Sharing                 Centralized privacy audit trail         contact information
                                 and node to node authentication
Registration, distribution and     to create a secured domain.
   access across health             New
   enterprises of clinical
documents forming a patient           Consistent Time
  electronic health record           Coordinate time across
                    New               networked systems
                                                    2004
   March 17, 2005                       25                    IHE and medical Standards in Denmark
                              IHE Profiles for RHIOs
              What is available and what will be added in 2005

         Imaging Information                                                  Patient Demographics
                  Content                                                             Query
       Format of the Document
     For Display Document Content
       and associated coded vocabulary        Notification of
               Content                                                            Patient Identifier
    Format of the Document
  Lab Results Document Content             Document Availability                 Cross-referencing
            Content                          Notification of a remote         Map patient identifiers across
   Continuity of Care
 Format of the Document Content             provider/ health enterprise        independent identification
 and associated coded vocabulary
  Document Content                                                                      domains
Format of the Document Content
and associated coded vocabulary


                                             Audit Trail & Node               Personnel White Page
Cross-Enterprise Document                     Authentication                      Access to workforce
         Sharing                                                                  contact information
                                          Centralized privacy audit trail
                                         and node to node authentication
Registration, distribution and access      to create a secured domain.
across health enterprises of clinical                                         Cross-enterprise User
   documents forming a patient                                                    Identity and
      electronic health record                                                   Accountability
                                              Consistent Time
                                             Coordinate time across             Authentication & Auditing:
                                              networked systems                  Basis for Access Control


      March 17, 2005                            26                    IHE and medical Standards in Denmark
                                                         Continuity of Care
                  IHE and HL7 V3                         Document Content
                                                      Format of the Document Content
                                                      and associated coded vocabulary
IHE relies only on approved standards.
HL7 V2 is widely used. Official relation with HL7, effective
cooperation with HL7 affiliate world-wide.
Early 2005, foundations elements of HL7 V3 have been approved,
but only a few “application level” are.
One of this element based on HL7 V3 based on the RIM has been
approved in January 2005: CDA Release 2 (nothing to do with
HL7V2).
IHE considers that HL7 CDA based on HL7-V3-RIM as the strategic
means to introduce HL7V3 in the real world.
In 2005, IHE is developing in cooperation with HL7 an integration
profile for “care record summary”. It will allow the sharing with
XDS of the basic care information in a form both structured and
human displayable in a consistent manner.

 March 17, 2005               27           IHE and medical Standards in Denmark
Push-like Integration :
Adding Notifications
Using « an e-mail notification that need not be secured» to turn a
Pull Model into a like Push Model.



                                                                  EHR-CR
                                              Document
                      Register                 Registry

                                                              3 Query
     Document
      Source                                                             Document
      Document                                                           Consumer
      Repository
                                 4 Retrieve
                             Notification




  March 17, 2005                 28                   IHE and medical Standards in Denmark
Local & Regional RHIOs Infrastructure
         and Interoperability
Cross-Enterprise Document Sharing (XDS)
minimizes clinical data management by the
infrastructure. Transparency = Ease of Evolution
XDS works with other IHE Integration Profiles:
 Audit Trail and Node Authentication (ATNA) and Consistent Time (CT)
 Patient Id Cross-referencing (PIX)
 Patient Demographics Query (PDQ)

In 2005, IHE plans to finish base set of integration
profiles to build regional health networks and
interoperable EHRs:
 Security: Identity Management+ Accountability
 Content Profiles: DICOM, HL7-CDA-r2/CCR, HL7-Lab, PDF.
 Notification of Document Availability (with XDS document reference)

  March 17, 2005               29           IHE and medical Standards in Denmark
  IHE: RHIOs’ Interoperability Partner

IHE offers a solid technical foundation to establish
interoperability for Regional/National Health Information
Organizations (RHIO).
Standards-based, open, multi-vendor, provider-led.
Yearly progress, validation testing built in, backed by a
proven process. Implementation by many vendors.
IHE welcomes RHIOs’ technical architects’ active
involvement.
The IHE Technical Framework accelerates RHIOs pilot
project development (XDS Affinity Domain Concept).


  March 17, 2005          30         IHE and medical Standards in Denmark
             Providers and Vendors
         Working Together to Deliver
Interoperable Health Information Systems
                  In the Enterprise
           and Across Care Settings

                 WWW.IHE.NET
                          E                o g
              W W W . I H 31 – Europe.medicalrStandards in Denmark
 March 17, 2005                    IHE and

								
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