View
217
Download
0
Category
Preview:
Citation preview
Standardisierung von Standardisierung von EPAsEPAs--IHEIHE--
Andreas KassnerAndreas KassnerVHitG e.V.VHitG e.V.
IHEIHE--DeutschlandDeutschland „„vendorvendor“ “ coco--chairchair
IntegratingIntegrating thethe Healthcare EnterpriseHealthcare Enterprise
InteroperabilitätInteroperabilität –– ganzganz einfacheinfach
IHE : Integrating the Healthcare Enterprise IHE : Integrating the Healthcare Enterprise IHE : Integrating the Healthcare Enterprise
Professional Societies SponsorshipHealthcare Providers & Vendors
Healthcare IT StandardsHL7, DICOM, etc.
Allgemeine IT StandardsInternet, ISO, etc.
Interoperable Healthcare IT Solution Specifications
IHE Integration ProfileInteroperable Healthcare IT
Solution SpecificationsIHE Integration Profile
Interoperable Healthcare IT Solution Specifications
IHE Integration ProfileInteroperable Healthcare IT
Solution SpecificationsIHE Integration Profile
IHEProzess
IHEIHE--EUR Länder und TeilnehmerEUR Länder und Teilnehmer• Denmark• France• Germany• Israel • Italy
Users, HC Authorities, Vendors:Users, HC Authorities, Vendors:40% 40% nationalenationale LLöösungsanbietersungsanbieter60% multi60% multi--nationalenationale HerstellerHersteller
• Netherlands• Norway• Spain • Sweden• United Kingdom
BeispielBeispiel: IHE: IHE--NetherlandsNetherlands
Medical Phit
Nucletron
Oldelft Benelux
Philips
RVC
Sectra
Siemens
Verdonk, Klooster & Associates
Welch AllynCardio Control
APC Platform
NICTIZ
HL7 Nederland
OIZ
TNO
Agfa
Forcare
Chipsoft
D&A Medical
GE Healthcare
Getronics
H2W
IBM
ICT Healthcare
Initiate Systems
iSOFT
Leones
Amphia
Antonius Mesos
Amsterdam MC
AZ Maastricht
Ned. Ver. Radiologie
Ned. VerLeeuwarden
UMC Nijmegen
UMC Groningen
. Kl. Chemie
Ned. Ver. Microbiologie
MC Vumc
Government /Associations
VendorsUsers
Evolution Evolution derder IHE IHE DomänenDomänen
Radiology (18)
IT Infrastructure for Healthcare (17)
Cardiology (7)
Laboratory (6)
Radiation Oncology (1)
Patient Care Coordination (5)
Patient Care Devices (1)
Pathology (1)
Pharmacy
Veterinarian
Endoscopy (1)
Eye Care / (3)Ophthalmology
Yea
r 1
(199
9)
Yea
r 2
(200
0)
Yea
r 3
(200
1)
Yea
r 4
(200
2)
Yea
r 5
(200
3)
Yea
r 6
(200
4)
Yea
r 7
(200
5)
Yea
rY
ear
8 (2
006)
8 (2
006)
IHE Globale Entwicklung
Integrationsprofile – Lösung für Real-World Bedarf & Probleme:
Innerhalb Medizinischer Einrichtungen:o Radiologieo Kardiologieo Laboro ...
Einrichtungsübergreifend – XDSo RHIOs (Regional Healthcare Information Organizations)
o EHR Enablers
Electronic Health Record
Cardiology
Laboratory
Radiology
Oncology
Future
Domains
IHE
IT Infrastructure
14 Integration Profiles
5 Integration Profiles
4 Integration Profiles
1133 IInntteeggrraattiioonn PPrrooffiilleess
Patient Care Coordination
1 Integration Profile
Patient Care
Devices
Pathology
Eye Care
Was Was istist IHE IT Infrastructure?IHE IT Infrastructure?
IHE XDS in IHE XDS in regionalenregionalen und national und national ProjektenProjekten
Canada Infoway
HITSP InteropSpecifications
Denmark (Funen)Italy (Veneto)Spain (Aragon)
Austria
THINC- New YorkNCHICA – N. Carolina
Italy (Conto Corrente Salute)
MA-Share – MAFranceDMP
Philadelphia HIE
CHINA-MoHLab results sharing
Acute Care (Inpatient)
GPs and Clinics (Ambulatory)
Long Term Care
Other Specialized Care(incl. Diagnostics Services)
Continuity of Care:Patient Longitudinal RecordPatient Longitudinal Record
Fallbezogen!
Typischerweise besucht einPatient in vielen Besuchen eineReihe von Einrichtungen
Profil XDS (Profil XDS (DokumentenaustauschDokumentenaustausch))
Was Was istist IHE IT Infrastructure?IHE IT Infrastructure?
Consistent TimeCoordinate time across
networked systems
Audit Trail & Node Authentication
Centralized privacy audit trail and node to node authentication
to create a secured domain.
Patient Demographics Query
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical
documents forming a patient electronic health record
Patient Identifier Cross-referencing
Map patient identifiers across independent identification
domains
Emergency Referrals
Format of the Document Content and associated coded vocabulary
Patient Created Summaries
Format of the Document Content and associated coded vocabulary
ECG Report Document
Format of the Document Content and associated coded vocabulary
Lab Results Document Content
Format of the Document Content and associated coded vocabulary
Scanned Documents
Format of the Document Content
Cross-enterpriseDocument Point-to-Point
InterchangeMedia-CD/USB & e-mail push
Imaging Information
Format of the Document Content and associated coded vocabulary
Medical Summary (Meds, Allergies, Pbs)
Format of the Document Contentand associated coded vocabulary
Document Digital Signature
Attesting “true-copy and origin
Notice of Document Availability
Know about new information
Support for Support for RHIOsRHIOs
Patient Consent
XDS XDS SzenarioSzenario
PMS
Physician Office
EHR System
Teaching Hospital
XDS Clinical Affinity Domain
Community Clinic
Lab Info. System
PACS
PACS
Retrieve Document
Provide & Register
Register Document(using Patient ID)
Query Document(using Patient ID)
Document RegistryDocument
Repository
Document Repository
ED Application
PDQ Query to Acquire XAD Patient ID
PDQ Query to Acquire XAD Patient ID
ATNA CT
Audit record repository Time server
Patient Demographics Supplier
Record AuditEvent
MaintainTime
MaintainTime
MaintainTime
Record AuditEvent
Document Consumer
Retrieve Document
Query Documents
Patient Identity Source
Patient IdentityFeed
Document Source
Document Registry
Document Repository
Provide&Register Document Set
Register Document Set
AkteureAkteure undund TransaktionenTransaktionen -- XDSXDS
IHEIHE--XDSXDSZentralisierteZentralisierte ArchitekturArchitektur
Document Consumer
Retrieve Document
Query Documents
Patient Identity Source
Patient IdentityFeed
Document Source
Document Registry
Document Repository Provide&Register
Document Set
Document Source
Document Source
Document Source
Document Consumer
Document Consumer
Document Consumer
Document Consumer
Retrieve Document
Query Documents
Patient Identity Source
Patient IdentityFeed
Document Source
Document Registry
Document Repository
RegisterDocument Set
IHEIHE--XDSXDSDezentralisierteDezentralisierte ArchitekturArchitektur
Document Consumer
Document Consumer
Document Consumer
Document Source
Document RepositoryDocument
Source
Document RepositoryDocument
Source
Document Repository
Document Consumer
Retrieve Document
Query Documents
Patient Identity Source
Patient IdentityFeed
Document Source
Document Registry
Document Repository
RegisterDocument Set Document
Repository
Document Source
Provide & Register Document Set
IHEIHE--XDSXDSGemischteGemischte ArchitekturArchitektur
Document Source
Document Source
Document Source
Document Consumer
Document Consumer
Document Consumer
Document Source
Document RepositoryDocument
Source
Document RepositoryDocument
Source
Document Repository
RegistryRegistry MetadataMetadata
Basierend auf HL7 CDA R1 (ANSI) ; HL7 CDA R2 (Draft) ; EHR ENV 13606 (CEN-Draft)
Patient IDService Start and Stop TimeDocument Creation TimeDocument Class Code and Display NamePractice Setting Code and Display NameHealthcare Facility Type Code and Display NameAvailable Status (Available, Deprecated)Document Unique ID...
Die komplette Liste enthält 33 Attribute, plus freie Definitionen
KlassendiagrammKlassendiagrammXDSSubmissionSet
authorInstitution
authorPerson
authorRole
authorSpecialty
comments
contentTypeCode
patientID
sourceID
submissionTime
uniqueID
XDSDocumentEntry
authorInstitutionauthorPersonauthorRoleauthorSpecialtyavailabilityStatusclassCodeconfidentialityCodecreationTimeentryUUIDeventCodeListformatCodehashhealthcareFacilityTypeCodelanguageCodelegalAuthenticatormimeTypeparentDocumentIDpatientIDpracticeSettingCodeserviceStartTimeserviceStopTimesizesourcePatientIDsourcePatientInfotitletypeCodeuniqueIDURI
+
Einige allgemeine Attribute:
•author
•patient
•document source
•encounter
Andere enthalten logische / technische Informationen
•title
•type of document
•eventCodeList
•classCode
•availabilityCode
•confidentialityCode
•formatCode
•language
•MIME Type
•size
XDSFolder
codeList
comments
lastUpdateTime
patientID
uniqueID
+
*+
RegistryPackage ExtrinsicObject
vgl. HL7 CDA
Document Relationships von HL7Document Relationships von HL7
APND (append)
Aktuelles Dokument ist eine Erweiterung zu Elterndokument
RPLC (replace)
Aktuelles Dokument ersetzt das Elterndokument
XFRM (transform)
Aktuelles Dokument ist eine Transformation des Elterndokuments
XFRM_RPLC (transform with replace)
Aktuelles Dokument ist beides, Transformation und Ersatz einesElterndokuments
parent *1current
parentDocumentID
Document Repository and RegistryDocument Repository and RegistryExample of Submission RequestExample of Submission Request
Document RepositoriesDocument Repositories
Document RegistryDocument RegistrySubmission RequestSubmission Request
Document
Document
DocumentEntry
DocumentEntry
SubmissionSet1
Folder A
CrossCross--Enterprise Document Sharing (XDS) Enterprise Document Sharing (XDS) StandardsStandards
XDS Infrastructure StandardsOASIS/ebXML
Registry Information Model v2.0
• Basis of XDS Registry Information Model
Registry Services Specifications v2.0
• Registry Services
Messaging Services Specifications v2.0
• Offline protocols
ISO/IEC 9075 Database Language SQL
Registry Query Language
SOAP with Attachments
Protocol for communication with XDS Registries and Repositories
SHA-1 [FIPS 180-1]
Document Hashes
Internet StandardsInternet Standards
HTTP
Protocol for Retrieve Document
Online SOAP bindings
SMTP
Offline ebMS bindings
IETF
Language Identifiers
MIME
Document Type codes
PDF, JPEG, HTML
XDS Document Content
UTF-8
Encoding of Registry Attributes
CrossCross--Enterprise Document Sharing (XDS) Enterprise Document Sharing (XDS) StandardsStandards
XDS Infrastructure Standards (cont)
HL7 Version 2.3.1
Messages for Patient Identity Management
HL7 Version 2.5
Datatypes for XDS Registry Attribute values
HL7 CDA Release 1
XDS Document concept definition
Source of XDS Document Entry Attributes
DICOM, ASTM CCR, HL7 CDA Release 2, CEN EHRcom
Sources of XDS Document Entry Attributes
XDS Community A
Cross Cross CommunityCommunity DiscoveryDiscoveryBuild an index of patient data locations
Several identifying communities
Controlled by attributes
RLS/PIX+
XDS Community B
XDS Registry
XDS Repository
Cross Community
Bridge
Cross Community
Bridge
PDQ Server
XDS Registry
Community Attribute Search Engine
Cross CommunitySearcher
(1)
(2)
(3)(4)
(8)
(5)
(6)
(7)
(1)
XDS Repository
Akteurmodell (Akteurmodell (eFAeFA v1.1)v1.1)
»Case«
IdentityManagement
Case Registry
PatientIdentity Feed
TokenService
Patient Care CoordinationPatient Care Coordination
Adressiert die Integration von Leistungserbringern überEinrichtungsgrenzen, klinische Fragestellung und Zeit
Berücksichtigt allgemeine und spezielle medizinischeAspekte, ebenso wie technische Infrastruktur
Bildet Workflow und Informationsaustausch ab in kooperativen Netzen
In 2005 begonnen, heute 5 Profile
PCC ProfilesPCC Profiles
Medical Summaries
ED Referral
ExchangingPHR
Content
AntenatalCare
Summary
EmergencyDepartment
Report
PreprocedureHistory and
Physical
BasicPatientPrivacyConsent
LabReport
CareAssessments
20052005--060620062006--070720072007--0808In
teg
rati
on
Co
nte
nt
Query for Dynamic Clinical Data
PCC TF as Library of TemplatesPCC TF as Library of Templates
LAB
Problems
Vitals
Result
Problem
Obs
SeverityReferral
Documents Sections Entries Parts
XPHR Vital
Emergency Department ReferralEmergency Department ReferralAbstractAbstract
Define a referral format for "heads-up" call
Supports Medical Summary Content
Special Needs of Emergency Department• Expected Time of Arrival
• Mode of Arrival
• Disposition/Orders
Emergency Department ReferralEmergency Department ReferralUse CaseUse Case
1. The patient undergoes assessments by a triage nurse, is assigned a triage category (i.e. emergent, urgent, non-urgent).
2. The patient is then registered and demographic data is obtained.
3. The patient undergoes additional assessments by a primary RN,
4. The patient is seen by an ED physician who performs a history and physical, orders various diagnostic tests, determines a course of therapy, orders medications to be administered in the ED and performs procedures on the patient.
5. Upon completion of ED care, the patient is either admitted to the hospital, discharged from the ED, or transferred to another facility.
Exchange of PHR ContentExchange of PHR ContentAbstractAbstract
Hilft beim Austausch von Dokumentenzwischen PHR und EHR Systemen
Unterstützt verschiedenste Mechanismenzur Übersetzung/Übermittlung
Beinhaltet PHR Update
Basic Patient Privacy Consents (BPPC)Basic Patient Privacy Consents (BPPC)AbstractAbstract
Konzepte zur:
Patientenzustimmung(en)
Indentifizierung von Policies unter denen ein DokumentAuthorisiert veröffentlicht werden soll
“Zwingt” zur Einhaltung des Datenschutzes und derPatientenzustimmung
AntepartumAntepartum SummarySummary
Pregnant diabetic patient is seen by obstetrician in office for initial visit.
Ultrasound performed to determine gestational age.
Patient sent for perinatology consult as a high risk patient.
Patient returns to perinatologist biweekly for blood testing andultrasounds when necessary in addition to regular ob visits.
Perinatologist reports back to obstetrician after each visit.
Patient arrives at labor and delivery at the hospital.
Obstetrician delivers by Cesarean Section after anesthesia.
Obstetrician provides postpartum care.
Functional Status AssessmentFunctional Status Assessment
The Institute of Medicine has determined that a high risk for errors occurs during the transfer of care.
The Functional Status Assessment Profile (FSA) supports the handoff of assessment information between practitioners during transfers of care, cross-enterprise or intra-enterprise.
Transfer of physician documentation provides medical assessment, diagnosis and treatment information.
Transfer of nursing documentation provides assessment and treatment of human response (psychosocial, physiologic, emotional and spiritual) of patient/family to changing conditions.
Key Technical PropertiesKey Technical Properties
Considerations for scales Scales chosen are evidence based with strong reliability and validity.
Widely accepted cross-enterprise or required/recommended by accrediting agencies
Content ScalesNumeric Rating Scale (NRS-11) for Pain
Braden Scale for Predicting Pressure Sore Risk©
Geriatric Depression Scale (GDS)
Minimum Data Set – Section G
Query for Existing Data ProfileQuery for Existing Data Profile
Exchange of information between Data Repositories and Clinical Data Consumers for:
1. Drug Safety2. Public Health, Biosurveillance and Disease Registries3. Identifying Qualifying Patients
1. Clinical Trials2. Disease Management
4. Quality Reporting5. Claims Submission
Actors and Transactions Actors and Transactions
[PCC-2]Query Medications
[PCC-1]Query Vital Signs
[PCC-3]Query Immunizations
[PCC-4]Query Diagnostic Data
[PCC-5]Query Problems and Allergies
Beispiel Beispiel UseUse CaseCase -- PAMPAM
Herangehensweisen Herangehensweisen Elektronische PatientenaktenElektronische Patientenakten
Quelle: Kees Smedema
... ... demnächstdemnächst in IT Infrastructurein IT InfrastructureNext step 2007
XDS FederationPIX and PDQ using HL7 v3Web Services Transport for IHE TransactionsXUA – Cross-Enterprise User AuthenticationRisk Management Planning White Paper
Candidates 2008Scheduling ( PCC)Wide-area patient acessMobile applications
Candidates 2009Remote service accessAnonymizationPseudonymisierungPatient-controlled access
IHE ConnectathonIHE Connectathon• Offene Einladung an die Software Entwickler Community
• Es werden moderne Testtools (MESA) genutzt
• Konformanztest organisiert und überwacht durch die neutrale Prüfer von IHE
• Tausende systemübergreifende Tests durchgeführt
IHEIHE--EUREURConnectathonConnectathon
2001 2002 2003 2004 2005 2006 20070
25
50
75
100
125
150
175
200
225
250
275
300
11
3343 46
7563
0
18
57
74 79
99
120
0
35
100
135
180
250
280
0
Dom ains
Integrat ion profil
Actors
Com panies
System s
Part icipants
Document Use Case Requirements
Identify available standards (e.g. HL7, DICOM, IETF, OASIS)
Develop technical
specifications
Testing at Connectathons IHE
Demonstrations
Products with IHE
Timely access to information Easy to integrate
products
DerDer jährlichejährliche IHE IHE ProzessProzess
RessourcenRessourcen
http://www.ihe.net
http://wiki.ihe.net/index.php
http://www.ihe-europe.org
XDS Open Source: http://www.eclipse.org/ohf/index.php
VielenVielen DankDankfürfür IhreIhre
AufmerksamkeitAufmerksamkeit
Andreas KassnerAndreas Kassner
andreas.kassner@vhitg.deandreas.kassner@vhitg.de
Use Case: Multiple primary residences
Use Case: Between two XDS Affinity Domains
Use Case: Patient Move
Use Case: Vacationer Vacationer: A patient
Use Case: Mergers, aquisitions, divestitures. A large healthcarecorporation, Bigco, acquires a small local hospital, Smallco.
Divestitures
A healthcare facility splits into two new organizations: Newco1 and Newco2.
Use Case: Transitory Alliances A medical facility and a researchfacility form a short term alliance for a research project.
Use Case: Surveillance, CDC pseudonimized
Use Case: PHR Services
Use Case: Remote Consulting.
Recommended