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					Integrating the Healthcare Enterprise

 An Interoperability Process for Enabling the
              National Agenda

                Joyce Sensmeier MS, RN, BC, CPHIMS
                    Director of Professional Services
        Healthcare Information and Management Systems Society

  November 17, 2004           1
        2004 State of the Union
“By computerizing health records, we can
 avoid dangerous medical mistakes,
 reduce costs and improve care.”

                    President George W. Bush
                    January 20, 2004

November 17, 2004             2
        And the beat goes on…..

   “ …. most Americans will have electronic
    health records within the next 10 years”

President George W. Bush April 26, 2004
In a public address to the American Association of Community
Colleges, the President outlined a plan whose goal is to assure
better delivery of healthcare in the United States.

  November 17, 2004         3
Framework for Strategic Action

   President Bush’s April 27th executive order called for
   the creation of the Office of the National Coordinator
   of Health Information Technology (ONCHIT). A report
   was required within 90 days of office creation.
   The Framework for Strategic Action was released by
   Department of Health and Human Services Secretary
   Tommy Thompson and newly appointed National
   Coordinator of Health Information Technology, David
   Brailer, MD at the NHII Summit in July, 2004.

November 17, 2004         4
Framework for Strategic Action
  Report includes:
    12 strategies to achieve four major goals
    Information from DoD, VA, and OPM on
     how their areas can advance the adoption
     of HIT
    A catalog of identifiable federal HIT

November 17, 2004       5
                     Four Major Goals
1.    Inform Clinical Practice
          Incentivize EHR adoption
          Reduce risk of EHR investment
          Promote EHR diffusion in rural & underserved
2.    Interconnect Clinicians
          Foster regional collaborations
          Develop a national health information network
          Coordinate federal health information systems

 November 17, 2004               6
                     Four Major Goals
3.    Personalize Care
          Encourage use of PHRs
          Enhance informed consumer choice
          Promote use of telehealth systems
4.    Improve Population Health
          Unify public health surveillance architectures
          Streamline quality and health status monitoring
          Accelerate discovery and dissemination

 November 17, 2004               7
       Impact on Healthcare IT

 Technology trends can no longer develop
 in a void
 Systems must connect with each other
   Organizational
   Local
   National
   Global
 Public/Private partnerships needed

November 17, 2004    8
  Development and Adoption of a
National Health Information Network
  Request for Information – Interoperability
    Announced in Federal Register November 15th
    HHS is seeking input on how widespread
     interoperability of health information technologies
     and health information exchange can be achieved
    Encouraging collaboration and unified response
    Opportunity for members to contribute
    See Top Line report at and
     respond to survey

November 17, 2004         9
  What is IHE - Integrating the
   Healthcare Enterprise?
A joint initiative to improve systems
integration and interoperability
 Process for coordinated adoption of standards
 Clinicians/IT staff define needs
 Vendors and IT Professionals develop solutions
        Technical Framework
 Professional societies supervise documentation, testing
   and demonstration/promotion

 November 17, 2004             10
Understanding the IHE Initiative
IHE has a clear focus
IHE is a domain-based initiative
IHE creates synergies for interoperability testing
across domains
IHE addresses the standards adoption process
IHE is both regional and multi-national
IHE is both user lead and vendor driven

 November 17, 2004      11
                    Goals of IHE
  Speed up the rate and quality of integration in
  healthcare environments
  Foster communication among vendors and care
  Prove that integration is attainable based on
  Improve the efficiency and effectiveness of clinical
  Improve interoperability among care domains and
  build foundation for the EHR
  Provide integration solutions used within and across
  healthcare enterprises

November 17, 2004         12
IHE: Domain-based for a stepwise approach
                                       Patient Management

                                      Order Management

              Patient Identifier Linkage, Registries, Security

                                     Electronic Health Record

                Other (e.g. Access Control, eHealthWorkflows)

 Radiology            Labora-        Cardiology   Pharmacy,…..

  November 17, 2004             13
                    IHE 2004 – Four Active Domains
              4 Technical Frameworks with 31 Integration Profiles
              Testing at yearly Connectathons in three continents
               Demonstrations at major conferences world-wide

                                  EHR- Longitudinal Record
Cross-Enterprise                            IHE
                                     IT Infrastructure

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

                      IHE                                           IHE
                   Laboratory                                  Future Domain
         5 Integration Profiles
                                      Future Domain
Provider-Vendor cooperation to accelerate standards adoption
       November 17, 2004                      14
A Proven Standards Adoption Process
                            IHE Connect-a-thon   Product IHE Integration
                                  Results              Statement

                          IHE                                                        Easy to
                       Technical                                                    Integrate
                                                  With IHE
                      Framework                                                     Products

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

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

       November 17, 2004                    15
         IHE Technical Frameworks

Detailed   standards implementation

    –IT Infrastructure
     November 17, 2004                 16
                    IHE Connectathon
  Open invitation to vendor community
  Advance testing tools (MESA)
  Testing organized and supervised by
  project management team
  Thousands of cross-vendor tests performed
  Results recorded and published

November 17, 2004         17
November 17, 2004   18
November 17, 2004   19
                Integration Statements

November 17, 2004        20
                      IHE Process
Users identify desired functionality that require
coordination and communication among multiple systems
 E.g., departmental workflow, single sign-on, sharing of documents

Find and document standards-based transactions among
systems to achieve desired functionality
 Apply necessary constraints to eliminate useless wiggle room

Provide process and tools to encourage vendors to
 MESA software test tools + Connect-a-thon interoperability testing event

Provide tools and education to help users acquire and
integrate systems using these solutions
 Connect-a-thon results and public demonstrations
 Integration statements

  November 17, 2004               21
                    What IHE is NOT!
  A standards development organization
    Uses established standards (HL7, DICOM, CCR,
     others) to address specific clinical needs
    Activity complementary to SDOs, formal
     relationship with HL7, DICOM, NCCLS, etc.
  Simply a demonstration project
    Demos only one means to the end—adoption
    Backed up by documentation, tools, testing, and
       publication of information

November 17, 2004           22
             IHE Organizational Structure
             Multi-Domain & Multi-National
                IHE (International) Strategic Development Committee
    Co-Chairs                                          reports
                                 supervises                                           Global

 IHE North

 IHE Europe                             IHE Domain-related
                                     Planning Committee and
 IHE Asia/Oceania                      Technical Committee
                                                           Global Development:
Regional &                                                   Radiology,           Interoperability
National             Delegates
                                                             IT Infrastructure,
Deployment                                                   Cardiology,
                                                             Lab, etc.
     National Extensions

        November 17, 2004                         23
IHE Contributors & Participants
Societies Representing Healthcare Segments
  RSNA, HIMSS, ACC, ACCE, AACC, Other Professional Societies…
  Any Healthcare Stakeholder Organization
  Clinicians, Medical Staff, Administrators, CIOs, …
Information Systems & Equipment (e.g. imaging) Vendors
In addition, active liaison with Standards Development
Organizations (SDOs)
  HL7, DICOM, NCCLS, ASTM, ISO, others

 November 17, 2004            24
   Participating and Contributing Vendors (America)
Agfa HealthCare                Hitachi Medical Corporation      Novell
Allscripts                     Hologic, Inc                     Opentext
Algotec Systems, Ltd.
                               IDX Systems Corporation          Procom
Canon Medical Systems          IMCO Technologies                Philips Medical Systems
CapMed                         InSiteOne                        RASNA Imaging Systems
Carefx                         INFINITT                         Sectra
Cedara Software Corp.          InterSystems                     Sentillion
Cerner Corporation
                               Konica Minolta                   Siemens Medical Solutions
Dictaphone                     Marotech, Inc.                   Softmedical
DR Systems                     McKesson Information Soln.       Stentor, Inc
Dynamic Imaging                Medcon
                                                                StorCOMM, Inc
Eastern Informatics            MedCommons
Eastman Kodak Company                                           Swissray International, Inc
                               Medical Manager Health Sys.
Emageon                                                         Tiani Medgraph AG
Eclipsys                       Mediface Co., Ltd.
                                                                Toshiba America Medical Sys.
EPIC                           MediNotes
                                                                UltraVisual Medical Systems
ETIAM                          Merge eFilm
Fujifilm Medical Systems                                        Vital Images, Inc.
GE Healthcare                                                   Voxar Limited
Healthramp                     Misys
Heartlab                       Mortara
                               NextGen                          XIMIS
In yellow, companies with IHE Committees Chairs (Summer 2004)
         November 17, 2004                   25
   Participating and Contributing Vendors (Europe)
AGFA Healthcare                   GWI Research                   Rogan-Delft
AISoftw@re Medical Solutions      IASI Srl                       Sago spa
Algotec                           IdeoPass                       Sectra Imtec AB
ARES SA                           Image Device-Cerner            Siemens Medical Solutions
aycan Digitalsysteme                 Company                     Soluzioni Informatiche srl
ConVis                            INFINITT                       Stentor Inc.
DEDALUS                           INOVIT                         Swissray Medical AG
Dianoema                          McKesson                       Symphonie On Line
Eastman Kodak Company             MED2RAD                        Synapsis
Ebit Sanita                       MEDASYS SA                     TELEMIS S.A.
EDL                               Medavis                        TIANI MEDGRAPH AG
ELFIN s.r.l.                      Medigration GmbH               TOREX GAP Medical
Engineering Sanità Enti Locali    MEDIMON Ltd.                   Toshiba Medical Systems
ESAOTE                            MEDOS AG                       TSI groupe europMedica
ETIAM                             Merge eFilm                    VEPRO AG
Ferrania                          METAFORA                       VISUS Technology Transfer
                                  Konica Minolta Europe          WAID
GE Healthcare
                                  Omnilab                        XR PARTNER
                                  Philips Medical Systems
GIE Convergence-Profils
                                  Rasna Imaging Systems
                                  RAYPAX INC.
                In yellow, companies with IHE Committees Chairs (Summer 2004)
       November 17, 2004                    26
Participating and Contributing Vendors (Asia)
                    Japan                  Taiwan
 AGFA Gevaert Japan              INFINITT
 EBM Japan                       Shing Shian
                                 INQ GEN
 Goodman                         Tah Ya
 Climb Medical Systems
 Konica Minolta MG
 Toshiba Medical Systems                   Korea
 Toyo Technica                   AGFA Korea
 Nihon Kohden                    GE Healthcare Korea
 Olympus                         INFINITT
                                 LG CNS
 Pioneer (Marotech)
 Hitachi                         Marotech, Inc.
 Hitachi Medico                  Medical Standard
 Fujitsu                         Peoplenet Communications
 Fuji Film Medical               Samsung SDS

November 17, 2004           27
  Benefits to IHE Participants
      Improved workflow
      Information when and where needed
      Fewer opportunities for errors
      Fewer tedious tasks/repeated work
      Improved report turn around time
    Improved efficiency
    Best of breed opportunities
    Decreased cost and complexity of interface deployment and
    Improved accuracy of charge processing/reimbursement

November 17, 2004            28
  Benefits to IHE Participants
  Health Plans
    Improved accuracy, completeness of billing/claims
    Improved turn around time for claims processing
    Align product interoperability with industry consensus
    Decreased cost and complexity of interface installation and
    Focus competition on functionality/service space not
     information transport space
    Rapid feedback to adjust standards to real-world
    Establishment of critical mass and widespread adoption

   Plus, IHE meets fixed deadlines
November 17, 2004            29
            IHE Organizational Structure
                               IHE Strategic Development Committee

    Regional Deployment                                             Global Development
 IHE North America                  IHE Asia-Oceania

                                             Japan               Radiology          IT Infrastructure        Cardiology
   USA         Canada
                                                             Planning Committee    Planning Committee    Planning Committee
                                    Taiwan           Korea
                                                                 Radiology          IT Infrastructure        Cardiology
                                                             Technical Committee   Technical Committee   Technical Committee

                    IHE Europe                                              Laboratory
                                                                                                    Pharmacy Exploratory
                                                                       Planning and Technical
      France     Germany       Italy            UK                           Committee

   Netherlands     Spain      Sweden          Norway

Professional Societies / Sponsors                                                           Contributing and participating
   ACC ITAC/CHITTA GMSIH               COCIR   SIRM   ESC        JAHIS    METI-MLHW         Vendors
   HIMSS CHI              SFR          EAR-ECR BIR               JIRA     MEDIS-DC
         November 17,SFIL  2004        DRG     EuroRec 30        JRS      JAMI
Organization of the IHE Initiative
IHE distributes its operations between a
regional/national level and an international level
IHE operates on overlapping yearly cycle
IHE leverages dependencies and complementary
interests between stakeholders
IHE is an open and flexible organization

 A novel approach to meet these challenges

 November 17, 2004      31
IHE Domains Milestones – 20 month cycle
         Development               and           Deployment
  Proposed Supplement Scope - 10 ---

   Approved Supplement Scope - 7 ---

   Public Comment Intgr-profile - 2 ---           Sponsors announce
                                             Connectathon/Demos with set of
                                                Implementation Profiles
Trial Implementation Intgr-profile 0 ---
                                         Connectathon/Demo Vendor
                                  + 2 ---
                                         Participant Registered
                                              Vendor Participant passed
                                  + 5 ---

                                  + 6 ---             Demo &
                                                   Education Material
       Final Intgr-profile        + 9 ---
                                       ---   Vendors release products with
      November 17, 2004           32          IHE Integration Statements
 Healthcare Needs Addressed
      by the IHE Initiative
Continuity & integrity of patient information
Improved patient safety and access to data
Clinical workflow optimization
Foster communication among diverse medical
information systems
Avoid repeating tasks
Eliminate data redundancy

       Improving the Patient Care Process

November 17, 2004       33
  HIMSS 2005 Interoperability Showcase
HIMSS leverages its sponsorship of IHE to demonstrate practical
  interoperability in two large Showcase Exhibits:
  Cross-enterprise sharing of health information in the acute care
  (18 vendors) and ambulatory (14 vendors).
  HIMSS Showcase exhibits linked with vendor booths (10
  vendors) show-wide and the Health Level Seven Demo.
  Show-wide interactive environment demonstrating attendees
  “patient” record in a “HIMSS RHIO”. Uses IHE Cross-
  enterprise Document Sharing:
        Around a central document registry
        Distributed document repositories
        17 EHR systems that publish/share documents (CCR, CDA, HL7-lab,

      November 17, 2004            34
HIMSS 2005 Interoperability Showcase
  A national vision of a connected and interoperable healthcare
  The Interoperability and Ambulatory IT Showcase exhibit areas will
  feature cross-enterprise sharing of health information in the acute care
  and ambulatory environment within the framework of a Regional Health
  Information Organization (RHIO)
  These hands-on exhibits linked with vendor booths will create a highly
  interactive environment to demonstrate practical interoperability featuring
  standards-based connectivity across the health care enterprises from
  acute care to ambulatory care IT.
  Feb. 13-17, 2005 -- Interoperability Showcases:
  2005 Annual HIMSS Conference & Exhibition
  Dallas, TX
One of the most significant healthcare industry efforts of the 21st century.
   HIMSS has taken a leadership role in making this vision a reality.

   November 17, 2004               35
  “This showcase allows multiple
  organizations to demonstrate cross-
  vendor integration and interoperability
  and is a prime example of the type of
  private-sector collaboration we are
  seeking to move our agenda forward.
  HIMSS has taken a leadership role in
  demonstrating the application of
  cross-enterprise interoperability. ”
         Dr. David Brailer, National Coordinator of HIT

November 17, 2004             36
HIMSS 2005 Interoperability Showcases

  Cross-enterprise Showcase
    4,000 square feet on exhibit floor – located near
     attendee registration
    Focus on cross-enterprise interoperability of an
     electronic health record and document sharing
  Ambulatory Care Showcase
    4,000 square feet on exhibit floor - adjacent to
     Cross-enterprise Showcase
    Focus on interoperability of IT applications in
     ambulatory care in a variety of settings

November 17, 2004         37
    HIMSS 2005 Interoperability Showcases
  Three participation opportunities for vendors
  Vendors chose among 15 existing integration profiles.
  May participate from own vendor booth in addition to Showcase booths.

Interoperability Showcase Booth

              laboratory          IT                             Vendor Booth
 cardiology                 Infrastructure
         radiology                           Cross-enterprise         Vendor Booth
                                               doc sharing
                                        (Choice of XDS,PWP,RID,PDQ)
Ambulatory Showcase Booth

   Pharma ?
    November 17, 2004                   38
  Cross-enterprise Showcase
  Technical demonstration
    Featuring the IHE framework enabling standards-based
       health information exchange within and across multiple
       healthcare enterprises, available in products today
  Clinical scenarios
    Focusing on clinician access and document sharing within
     the acute care environment and across multiple settings
    Includes the Continuity of Care Record (CCR), radiology
     images, cardiology reports, laboratory results, etc.
  Connectivity with
      Ambulatory Care Showcase
      Health Level Seven (HL7) Demonstration
      Participating vendors booths
      Show-wide attendee registration and access at ‘Surf the
       Web’ kiosks

November 17, 2004              39
  Cross-enterprise Showcase
  Interoperability Theater
    Featuring learning sessions on:
         •   Outcomes of national demonstrations and industry
             research projects
         •   Regional health information exchange initiatives
         •   Federal agency interoperability initiatives
         •   Standards development initiatives and related activities
         •   Issues, products and insights from industry leaders

November 17, 2004                 40
  Cross-enterprise Showcase
  Visionary demonstrations of the future in healthcare –
  Organizational participants
    Featuring initiatives, collaborations, and standards development
       activities in support of interoperability
        • Center for Information Technology and Leadership (CITL)

        • Continuity of Care Record (CCR)

        • Department of Defense (DoD) – Data sharing project

        • ISO TC 215 Health Informatics

        • Liberty Alliance

        • MEDecision

        • Medical Device Interoperability – IEEE - ACCE

        • Oregon Health Information Infrastructure

        • Santa Barbara County Health Data Exchange

        • Veterans Health Administration – VISTA Imaging

        • University of Washington Personal Health Record Project

November 17, 2004               41
November 17, 2004   42
  Ambulatory Care Showcase
  Demonstration of interoperability across a
  variety of settings including a free-standing
  diagnostic enter, a large clinic, a small
  practice and the patient’s home
  Use cases will guide the attendee through the
  settings in the normal course of care
  Theater area for related presentations
    Invited speakers and Leadership level only
  Product placement near demonstration

November 17, 2004        43

         the effective bridge
         between information
         exchange standards
        and their practical use
            in healthcare
November 17, 2004   44
   Opportunities for Participation
As a User or Vendor Contributor
  Become a member of relevant Domains Planning or Technical
  Committees or HIMSS IHE SIG (Special Interest Group)
  Become a member of relevant Regional/National Committees
  Attend the HIMSS 2005 Interoperability Showcases
As a Vendor Participant
  Respond to Public Comments of Domain Supplements
  Attend Yearly in September Educational/Workshops
  Participate in Connect-a-thons and Demonstrations
As a User/Consultant Participant
  Respond to Public Comments of Domain Supplements
  Attend Yearly in September Educational/Workshops
  Attend Demonstrations and include IHE Integration Profiles in your
  RFPs and Integration Projects.
   November 17, 2004             45
      IHE expanding, more info...
•    IHE Radiology 
     Chris Carr
     IHE Connectathon for IT January 17-21, 2005
•    IHE IT Infrastructure 
     Joyce Sensmeier
     HIMSS Interoperability Demonstrations February 13 -17, 2005
•    IHE Laboratory  www.
     Karima Bourquard
     Framework in Public Comment, feedback due Nov 15th
     IHE Connectathon for Lab March 2005
•    IHE Cardiology 
     IHE Connectathon for Cardiology January 2005
     First Demo ACC March 2005

    November 17, 2004           46
               More information….
IHE Web sites:
Technical Frameworks:
     •   ITI V1.0, RAD V5.5, LAB V1.0
Technical Framework Supplements - Trial Implementation
     •   May 2004: Radiology
     •   August 2004: Cardiology, IT Infrastructure
Non-Technical Brochures :
     •   Calls for Participation
     •   IHE Fact Sheet and FAQ
     •   IHE Integration Profiles: Guidelines for Buyers
     •   IHE Connect-a-thon Results
     •   Vendor Products Integration Statements
 November 17, 2004                  47

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