Docstoc

IHE-Patient Summary and Approach-V4.ppt - IHE Update

Document Sample
IHE-Patient Summary and Approach-V4.ppt - IHE Update Powered By Docstoc
					      Integrating the Healthcare
           Enterprise (IHE)
 Approach and Patient Summary

Presented by Charles Parisot, IHE Europe
IT Infrastructure Planning Committee co-Chair
eHealth interoperability ad hoc group
January 17, 2007

September, 2005                 1               What IHE Delivers
              Agenda
IHE, a proven multi-stakeholder process

IHE, what can be leveraged

IHE Medical Summaries, a solid base,
potential for European national extensions




                                          2
                  What is
  Integrating the Healthcare Enterprise?
It implements a methodology which enables users and
suppliers to work together to obtain clinical
interoperability
IHE tailors existing standards to fit the IT requirements for
specific clinical tasks
The IHE Technical Framework document specifies clinical
tasks and how to use profiles of existing standards to
support them
Annual test sessions enable suppliers to test their
application software for conformance with the IHE
Technical Framework
Purchasers can buy systems that are known to
interoperate

                                                       3
What is IHE?




               4
                                Who is IHE?

               IHE (International) Strategic Development Committee
   Sponsors
   Co-Chairs                                          reports
                                supervises                                           Global

 IHE NorthAmerica

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

                                             contribute
                                         Participants


                                                                                          5
IHE-EUR countries and participants
                 •   Denmark                                       •    Netherlands
                 •   France                                        •    Norway
                 •   Germany                                       •    Spain
                 •   Israel                                        •    Sweden
                 •   Italy                                         •    United Kingdom
                     Users, HC Authorities
                     40% local vendors
                     60% international vendors
                      Example: IHE-Netherlands
                      Users                     Vendors                                      Government /
                                                                                             Associations
                      Amphia                    Agfa                   Medical Phit          APC Platform
                                                Forcare                Nucletron
                      Antonius Mesos                                                         NICTIZ
                                                Chipsoft               Oldelft Benelux
                      Amsterdam MC
                                                D&A Medical            Philips               HL7 Nederland
                      AZ Maastricht             GE Healthcare          RVC
                                                                                             OIZ
                      Ned. Ver. Radiologie      Getronics              Sectra
                      Ned. Ver. Kl. Chemie      H2W                    Siemens               TNO
                                                IBM                    Verdonk, Klooster &
                      Ned. Ver. Microbiologie
                                                ICT Healthcare         Associates
                      MC Leeuwarden                                    Welch Allyn Cardio
                                                Initiate Systems
                      UMC Nijmegen                                     Control
                                                iSOFT
                      UMC Groningen             Leones
                      VUmc




                                                                                                      6
                                            Evolution of IHE Domains
IHE Global Developments
                                                                                                                                                          Veterinarian

Integration Profiles – Solutions to Real-World Interoperability                                                                                           Endoscopy (1)

                                      Needs & Problems:                                                                                                   Eye Care / (3)
                                                                                                                                                          Ophthalmology


 Within               Clinical Departments e.g.:                                                                                                          Pharmacy
                 Radiology                                                                                                                             Pathology (1)
                 Cardiology
                 Lab                                                                                                                 Patient Care Devices (1)

                 ...                                                                                                             Patient Care Coordination (5)

 Across          Departmental &                                                                                                   Radiation Oncology (1)

         Institutional Boundaries – XDS                                                                                            Laboratory (6)
                  Regional/national Healthcare Information Exchange
                  HIT Enablers                                                                                                    Cardiology (7)

                                                                                                            IT Infrastructure for Healthcare (17)

                                                                               Radiology (18)




                                                                                                                                        Year 7 (2005)




                                                                                                                                                                 Year 8 (2006)
 Year 1 (1999)




                            Year 2 (2000)




                                               Year 3 (2001)




                                                               Year 4 (2002)




                                                                                            Year 5 (2003)




                                                                                                                  Year 6 (2004)
                                                                                                                                                           7
                     IHE, Annual Cycle
         Proven Standards Adoption Process
                              Installation
                                on site
         Demonstration
        (National shows)


  Multi-vendors                                   Clinicians identify
test at the annual                                  clinical problems
 Connect-a-thon                                      to be addressed

   Vendors implement
    the profile in their                           Choice of relevant
        products                              standards (HL7, CEN, DICOM,
                     Engineers from vendors          W3C, Oasis…)
                       collaborate to define
                      technical specification

                                                                 8
IHE Technical Framework


                                                                                   Order           Department System              Image
                                                             ADT                                      Scheduler/                                           Acquisition
                                                                                   Placer                                        Manager/
                                                                                                      Order Filler              PPS Manager                 Modality

                                                                    Register J.Doe

                                                             Patient
                                                             Registration [RAD-1]
                                                                                            Placer Order
                                                                                            Management–
                                                               One or the                   New [RAD-2]
                                                               other methods
                                                               of creating an
                                                               order is used                Filler Order
                                                                                            Management -           Schedule
                                                                                            New [RAD-3]            Procedure

                                                                                                                 Procedure
                                                                                                                 Scheduled [RAD-4]

                                                                                                                      Query Modality Worklist [RAD-5]
                                                                                                                Modality Procedure       Modality Procedure         Perform
                                                                                        Filler Order            Step In Progress         Step In Progress           Acquisition
                                                                                        Mgmt - Status           [CARD-1]                 [CARD-1]
                                                                                        Update [RAD-3]




 Detailed standards       Pt. Registration [RAD-1] 
                                                             Patient Reconciliation
                                                                   J.Doe ->
                                                                   J.Smith

                                                                              ADT
                                                                   Patient Update/
                                                                                        Filler Order
                                                                                        Mgmt - Status
                                                                                        Update [RAD-3]
                                                                                                               Modality Procedure
                                                                                                               Step Completed
                                                                                                               [RAD-7]



                                                                                                               Patient Update/
                                                                                                                                          Modality Procedure
                                                                                                                                          Step Completed
                                                                                                                                          [RAD-7]




 implementation
                                                                   Merge [RAD-12]
                          Patient Update [RAD-12]                                                             Merge [RAD-12]
                                                                                                                          Pt. Registration [RAD-1]
                                                                                                                          Patient Update [RAD-12]
                                                                Placer Order Management [RAD-2]
                                                                Filler Order Management [RAD-3]
                                         DSS/ Order Filler                                                             Order Placer

                           Modality PS in Progress [CARD-1]                     Procedure Scheduled [RAD-4]




 guides
                           Modality PS Completed [RAD-7]                        Patient Update [RAD-12]
                                                                                 Procedure Updated [RAD-13]
                                                                                 Instance Availability Notification [RAD-49]

                                                                                                           Evidence
                                                                                                                                         Image Display
                                  Modality PS in Progress [CARD-1]                                         Creator
                                  Modality PS Completed [RAD-7]

                                                                                                                                                       Query Images [RAD-14]




  
                                                                                           Storage                 Modality Image/Evidence           Retrieve Images/Evidence [CARD-4]


      Cardiology           Performed
                           Procedure
                          Step Manager
                                                                                       Commitment
                                                                                         [CARD-3]


                                                                                                    Image
                                                                                                   Manager
                                                                                                                     Stored [CARD-2]



                                                                                                                    Image
                                                                                                                    Archive




  
                               Modality PS in Progress [CARD-1]


      IT Infrastructure        Modality PS Completed [RAD-7]

                                                                                           Storage
                                                                                       Commitment 
                                                                                         [CARD-3]
                                                                                                                      Modality Image/Evidence
                                                                                                                       Stored [CARD-2]

                               Modality PS in Progress [CARD-1]




  
                               Modality PS Completed [RAD-7]



      Laboratory               Query Modality Worklist [RAD-5]
                                                                                                           Acquisition
                                                                                                            Modality




     Radiology
     …..
                                                                                                                                                                                            9
                IHE Connectathon
• Open invitation to the Software Developer
  Community
• Advance testing tools (MESA) applied
• Compliance Testing organized and supervised by
  the sponsors of IHE
                300

• Thousands     275
                                          IHE-EUR                                        280


                250                       Connectathon                       250

  of            225

  cross-system  200

                175
                                                                 180
                                                                                                       Dom ain s
                                                                                                       In t e g rat ion p rofil
  tests         150
                                                     135
                                                                                                       Act ors
                                                                                                       Com p an ie s
                125                                                                  120
  performed     100
                                        100                              99
                                                                                                       Syst e m s
                                                                                                       Part icip an t s
                                                             79         75
                                                74
                 75                                                                 63
                                    57
                 50                            43           46
                             35    33
                 25     18
                       11
                                                                                                 000
                  0                                                                                      10
                      2001        2002        2003         2004        2005        2006        2007
    IHE Connectathon, Barcelona April 2006
•300+ participants, 120+ systems
•60+ systems developers
•2006 Focus:
      Cardiology, IT Infrastructure,
      Patient Care Coordination,
      Laboratory, Radiology
•2800+ monitored test cases




                                        11
Regional and National EHR Projects
Many EHR projects world-wide,
Some country-wide, some regional,
Different stages of implementation,…




                                       12
  IHE based Regional and National EHR Projects
            Operational and planned




              Toronto, Quebec, Alberta, BC
                    Canada Infoway           MA-Share – MA
                                                      New York
                                                        HIE                        Austria


                                              Philadelphia       France
                                                   HIE            DMP

                           THINC- New York                                  Italy (Conto
                           NCHICA – N. Carolina                           Corrente Salute)



   CHINA-MoH
Lab results sharing



                                                                                             13
              Agenda
IHE, a proven multi-stakeholder process

IHE, what can be leveraged

IHE Medical Summaries, a solid base,
potential for European national extensions




                                          14
      IHE Integration Profiles for Health Info Nets
What is available and has been added in 2005 and is for 2006
              Info Exchange Security                                                  Id Mgt
Content




                  Emergency Referrals
                    PHR Extracts
               Format of the Document Content                                      Patient Demographics
             Format of the Document
            ECG ReportDocumentvocabulary
              and associated coded Content       Cross-enterprise User                     Query
            and associated coded vocabulary                                                                   V3
         Lab Results Document                       Authentication                                           Option
          Format of the Document Content           Authentication & Auditing:
                   Content
        Scanned Documents
          and associated coded vocabulary                                             Patient Identifier
        Format of the Document Content             Enhanced Access Control
       Imaging Information
      Format of the Documentvocabulary
        and associated coded Content                                                 Cross-referencing
       Medical Summary                                                             Map patient identifiers across
     Format of the Document Content                  Document Digital               independent identification
     and(associated coded vocabulary
         Meds, Allergies, Pbs)
                                                        Signature                            domains
 Format of the Document Content
                                                 Attesting “true-copy and origin
 and associated coded vocabulary



           Cross-Enterprise                         Audit Trail & Node
                                                                                        Request Form
                                                     Authentication                    for Data Capture
          Document Sharing
     Registration, distribution and access       Centralized privacy audit trail    External form with custom
     across health enterprises of clinical      and node to node authentication      import/export scripting
     documents forming a patient                  to create a secured domain.
     electronic health record        Stored
                                   Queries
                                                                                        Notification of
            Cross-enterprise                         Consistent Time                 Document Availability
          Document Interchange                      Coordinate time across            Notification of a remote
          Media-CD/USB & e-mail push                 networked systems               provider/ health enterprise
                                                                                                        15
Cross Enterprise Document Sharing
  Prototyped in 2003, matured in 2004-2005
    HL7 and IHE Joint Demonstration at HIMSS 2004
    ISO 15000 (ebRS) and tracks Web Services & SOA. Further step
       with WS-I in 2007.
  Implemented by 20+ Vendors
  Available Commercially in US, Europe and now in Asia
  Open Source Communities
      O3 (Univ Trieste & Padova)
      RIDE EU Project
      IHEOS
      Eclipse Open Healthcare Framework
  Named in Specifications by more than 5 countries
  Appears in more than 10 regional and national projects
  underway.
                                                            16
 Profile example in a region: XDS (Document Sharing)

    Longitudinal Record
    as used                      Documents Registry
    across-encounters


                                                                  Long Term Care




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

              PCPs and Clinics              Submission of Document References
              (Ambulatory)                  Query for Document References
                                            Retrieve of selected Documents

                                                                             17
   Federation of XDS and non-XDS Domains
                                       Leverage Cross-Community Sharing Architecture
                                                                 Which registry holds
                                                                 records for a patient ?                                                 Registry
                                                                                                                                      Locator service                                           National Network A
   National or Regional
   Network B                                                                                                                                                                                          Non-IHE
                                                                                                                              IHE Transactions                                         Cross-         National
        Longitudinal Record
                                Documents Registry
                                                                                          Cross-                                                                                       Domain
        as used
        across-encounters
                                                                    Long Term Care        Domain                                                                                       Bridge         EHR
                                                                                          Bridge
                        Acute Care                                                                                                                                                                      XDS Affinity Domain (NHIN sub-network)


    Document            (Inpatient)
    Repository                                     Other Specialized Care
                                                   or Diagnostics Services

                    PCPs and Clinics
                    (Ambulatory)
                                                                                                                                                     Cross-Domain
                                                                                                                                                     Bridge
                                                                                                                                                                                           National or Regional
                                                                                                                                                                                            Networks not required to be
  National Network C                                                                                                               Registry
                                                                                                                                Locator service
                                                                                                                                                                                            IHE-based
                                                                                                                                                                                           Mapping to & from IHE
        IHE based Sub-Networks                                                                                                                                                              Transactions performed by
                                                                                                                                       Non-IHE Sub-Net
                    Documents Registry
   Longitudinal Record
                                                                                              Documents Registry
                                                                             Longitudinal Record
                                                                                                                                                                                            X-Domain bridges
   as used
   across-encounters
                                                    Long Term Care
                                                                             as used
                                                                             across-encounters
                                                                                                                         Long Term Care
                                                                                                                                          Integrated                                       Mapping practical as most
                                                                                                                                                                                            European projects use
Document
                 Acute Care
                 (Inpatient)
                                                                         Document
                                                                                        Acute Care
                                                                                        (Inpatient)
                                                                                                                                           Delivery                                         variants of structured
                                       Other Specialized Care                                               Other Specialized Care
                                                                         Repository
Repository

             PCPs and Clinics
                                       or Diagnostics Services
                                                                                      PCPs and Clinics
                                                                                                            or Diagnostics Services
                                                                                                                                           Network
                                                                                                                                              XDS Affinity Domain (NHIN sub-network)        document sharing
             (Ambulatory)                                                             (Ambulatory)




                                                                                                                                                                                                                                                 18
              Agenda
IHE, a proven multi-stakeholder process

IHE, what can be leveraged

IHE Medical Summaries, a solid base,
potential for European national extensions




                                          19
            Medical Summaries
EU Stakeholder group study (Rossi Mori) has confirmed
 There is a significant variety of “medical summaries” (in
  use or in plan) across the European countries. Some of
  the differences are:
   •   scope/use case driven
   •   due to national specificities
   •   from the technical standard used
IHE Patient Care Coordination:
 Is well engaged with the scope/use case driven
  differences
 Plan to address national specificities based on the
  stakeholder WG analysis, and the interest of the countries
 2007 is the year IHE-Europe has set to finalize a “family”
  of patient summaries for several European countries with
  a common core.
                                                       20
 Care Coordination Content Profiles
     Consent
                                  XDS-MS                 Lab Report

                                    Medical
                                   Documents


                   Antenatal        Medical                 Care
   History and       Care          Summaries            Assessments
    Physical       Summary

  Preprocedure                              Discharge
                               Referral
   History and                              Summary
    Physical
                                                            PHR
                                                           Extract
2005-2006        Emergency     Emergency
                 Department    Department
2006-2007           Note
                                                            PHR
                                Referral                   Update
2007-2008

     Includes data needed to support emergency data set
             and prescription/medication history
                                                             21
      Rossi-Mori EU survey mapping to XDS-MS
No of                          Section
Countries

all         details about patient                Structured and Coded Header
not               identifier, name               Patient, Author, Authenticator, Institution,
asked                                            etc.
                  (date of birth, gender)
all - BE          address
                                                Structured Content with coded
12          history                             sections:
 11               medication history                Reason for Referral
 9                immunisations                     Vital Signs
 5                family history                    Medication
13          allergies, alerts, risks, special           Structured Text
            needs                                       Section
                                                                             Coded Section
12          ongoing medications                                              Entries
                                                   Studies
10          test results (lab and images)          Allergies
10          details about family doctor                 Structured Text
                                                        Section              Coded Section
9           active problems                        Social History           Entries
6           details about insurance                Problems
6           emergency contact (next of kin)             Structured Text
                                                        Section              Coded Section
4           care plans                             Care Plan                Entries 22
not asked   (exemptions)
IHE flexibility in leveraging standards for
             Document Format
Content Format leverages Specific Standards
 HL7 CDA Release 2.0
 HL7/ASTM Continuity of Care Document
 CEN 13606
 LOINC, SNOMED (if applicable)
 Others as Needed (e.g. PDF)
IHE is defining a library of Reusable Parts
 Document Types
 Sections (only title is coded)
 Entries (clinical info semantically coded)


                                               23
                  In Conclusion
  IHE is a user & vendor driven initiative.

  IHE is dedicated to interoperability of IT systems in
  healthcare with proven methodology.

  IHE Integration and Content Profiles are already used in
  Europe and world-wide.

  IHE is experienced with patient summaries.
IHE ready to engage in fostering a consistent family of
 patient summary documents and a sharing infrastructure
 between countries and regions in Europe.



                                                          24
WWW.IHE-EUROPE.ORG   25

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:53
posted:12/26/2010
language:English
pages:25