Buying IT Systems with Interoperability Built-In Fact or Fiction?? Michael H. Nusbaum HIMSS Virtual Conference November 7 th, 2007

Buying IT Systems with Interoperability Built-In

Fact or Fiction??

Michael H. Nusbaum

HIMSS Virtual ConferenceNovember 7th, 2007

Interoperability… the holy grail!

Interoperating professionally

Interoperating with life

Interoperability…

• …is the ability of two or more systems or components to exchange information accurately, completely, securely and verifiably when and where needed. and to use the information that has been exchanged.

• Semantic health care interoperability also assures the clear and persistent communication of meaning

[Mayo Clinic, 2006]

Why is HIT Interoperability Important?

Clients/Patients

Pharmacy

Laboratory

DiagnosticHospital Emergency

Homecare

Community Care Center

Clinic Emergency Services

Specialist Clinic

Buying IT with“Under-the-covers Interoperability”

HITVendor

Product “A”

HITVendor “B”Product “B”

Buying IT with“External Interoperability”

HITVendor “A”Product “A”

Inte

rfac

e E

ng

ine

HITVendor “B”Product “B”

Buying IT with“Interoperability Built-in”

HITVendor “A”Product “A”

HITVendor “C”Product “C”

Key Criteria

• “Semantic Interoperability”

• Standards-based

• Vendor-agnostic

• Consultative process

• Vendor testing for conformance

• Opportunity to demonstrate and market

• Adoption in vendor products

Integrating theHealthcare Enterprise

IHE is a standards based, global initiative that vendors, purchasers

and implementers can use to define, test and implement

interoperable healthcare solutions

Why IHE is Different

IHE is actively involved with a realistic approach to integration

Use of IHE Integration Profiles in RFP’s means having the

information you need to get the results you want

IHE provides a standard process forimplementing multiple standards

Standards are a critical step in achieving interoperability, BUT…

They are very broad - varying interpretations andimplementations

There may be more than one standard for a given domain, sometimes even redundant or disjointed

Standards implementation guides focus on only one standard, however when building a system or application you will need to consider many, including the relationships between standards domains

IHE provides a common set of tools, and a common, dependable framework for harmonizing and then implementing multiple standards.

Benefits of this approach:Seamless sharing of health informationwithin and between organizations,regions, States, and countries

Application to applicationSystem to systemSetting-to-setting

Expert, unbiased, selection and coordination of established healthcare and IT standards to address specific clinical needs.

Interoperability: Redesigning the Office Visit

Who is involved?

IHE: A forum for agreeing on how to implement standards and processes for making it happen

The Profile development process

Timely access to informationTimely access to information

Easy to integrate productsEasy to integrate products

Products with IHEProducts with IHE

IHE DemonstrationsIHE Demonstrations

Develop technical

specifications (profiles)

Develop technical

specifications (profiles)

Document Use Case Requirements

Document Use Case Requirements

Identify available standards (e.g. HL7, DICOM, IETF, OASIS)

Identify available standards (e.g. HL7, DICOM, IETF, OASIS)

Testing at ConnectathonsTesting at Connectathons

The Use CaseA clinician would like to look at previous imaging studies of a patient. While they are available, they were taken on “ABC” System, and the Clinician has “XYZ” system

The Integration ProfileConsistent Presentation of Images Integration Profile specifies a number of transactions that maintain the consistency of presentation for grayscale images

Example of an Integration Profile



Cross-Enterprise Document Sharing

Registration, distribution and access across health enterprises of clinical

documents forming a patient

electronic health record

Emergency Referrals Format of the Document Content

and associated coded vocabulary PHR Extracts/Updates

Format of the Document Content and associated coded vocabulary

ECG Report Document


Lab Results Document Content


Scanned Documents Format of the Document ContentImaging Information


Medical Summary (Meds, Allergies, Pbs)

Format of the Document Contentand associated coded vocabulary

Consistent TimeCoordinate time across networked

systems

Audit Trail & Node Authentication

Centralized privacy audit trail and node to node authentication to create

a secured domain.

Basic Patients Privacy Consents

Establish Consents & Enable Access Control

Document Digital Signature

Attesting “true-copy and origin

SecuritySecurityClinical and PHR ContentClinical and PHR Content

Health Data ExchangeHealth Data Exchange

Patient Demographics Query

Patient Identifier Cross-referencing

Map patient identifiers across independent identification

domains

Notification of Document Availability

Notification of a remote provider/ health enterprise

Request Formfor Data Capture

External form with custom import/export scripting

Patient ID MgmtPatient ID Mgmt

OtherOther

Cross-Enterprise Document Pt-Pt Reliable Interchange

Final Text ApprovedFinal Text Approved

Trial Implementation-2006 Trial Implementation-2006 –– Final Txt 2007Final Txt 2007

Cross-Enterprise Document Media Interchange

IHE Technical Frameworks

Pt. Registration [RAD-1] Patient Update [RAD-12]


Placer Order Management [RAD-2] Filler Order Management [RAD-3]

ADT

Query Images [RAD-14] Retrieve Images/Evidence [CARD-4]

Image Display

Modality Image/Evidence Stored [CARD-2]

Storage Commitment

[CARD-3]

Procedure Scheduled [RAD-4]

Procedure Updated [RAD-13]

Query Modality Worklist [RAD-5]

Performed Procedure

Step Manager

Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]



Order Placer

Acquisition Modality

ImageManager

ImageArchive

DSS/ Order Filler

Patient Update [RAD-12]


Storage Commitment

[CARD-3]

Evidence Creator Modality PS in Progress [CARD-1]

Modality PS Completed [RAD-7]

Instance Availability Notification [RAD-49]



Placer Order Management [RAD-2] Filler Order Management [RAD-3]

ADT

Query Images [RAD-14] Retrieve Images/Evidence [CARD-4]

Image Display


Storage Commitment

[CARD-3]


Procedure Updated [RAD-13]


Performed Procedure

Step Manager




Order Placer

Acquisition Modality

ImageManager

ImageArchive

DSS/ Order Filler

Patient Update [RAD-12]


Storage Commitment

[CARD-3]

Evidence Creator Modality PS in Progress [CARD-1]

Modality PS Completed [RAD-7]

Instance Availability Notification [RAD-49]


ADT Order Placer

Register J.Doe

AcquisitionModality

Placer OrderManagement –New [RAD-2]

Patient Reconciliation

Department System Scheduler/Order Filler

Schedule Procedure


Modality Procedure Step Completed [RAD-7]J.Doe ->

J.Smith

Patient Update/Merge [RAD-12]

Modality Procedure Step Completed [RAD-7]

PatientRegistration [RAD-1]

Patient Update/

Merge [RAD-12]

Modality Procedure Step In Progress [CARD-1]


Perform Acquisition

Filler Order Mgmt - Status Update [RAD-3]


ImageManager/

PPS Manager

Filler Order Management -New [RAD-3]

One or the other methods of creating an order is used


ADT Order Placer

Register J.Doe

AcquisitionModality

Placer OrderManagement –New [RAD-2]

Patient Reconciliation

Department System Scheduler/Order Filler

Schedule Procedure


Modality Procedure Step Completed [RAD-7]J.Doe ->

J.Smith

Patient Update/Merge [RAD-12]

Modality Procedure Step Completed [RAD-7]

PatientRegistration [RAD-1]

Patient Update/

Merge [RAD-12]



Perform Acquisition



ImageManager/

PPS Manager

Filler Order Management -New [RAD-3]

One or the other methods of creating an order is used

Detailed standards implementation guides

http://www.ihe.net/Technical_Framework/index.cfm

The Connectathon in 60 seconds

2008 North America Connectathon

Date: Jan. 28 – Feb 1, 2008Place: Hyatt Regency, ChicagoIncludes a 1-day conference and tour

What happens after the Connectathon?

Successful results (specific by IHE profile/actor) are published by the sponsors

Vendors self-certify, by publishing IHE Integration Statements

Only vendors who are successful are entitled to participate in Interoperability Showcasedemonstrations

2008 HIMSS Interoperability ShowcaseFebruary 24 – 28, 2007 • Orlando, FL

• 15% of the total show conference (or more than 3,600 attendees) visited the Interoperability Showcase.

• 76 participating organizations with 51 vendors demonstrated interoperability among 74 health information technology systems including EHRs, Cardiology, Radiology, Laboratory, Infrastructure and patient care device vendors.

• Over 700 attendees created and tracked their own EHR.

• 49 educational sessions were presented. • 5international delegations (France, Germany,

Holland, China and Japan) visited the showcase.

• 4 HIMSS07 keynote speakers and Congressional leaders from six states attended the showcase.

Last year…

RFPs & Integration Statements

Requiring vendors to publish their products’ Requiring vendors to publish their products’ IHE Integration Statements IHE Integration Statements provide a very effective pressure point for market-driven interoperabilityprovide a very effective pressure point for market-driven interoperability

Be Brief?“The system must support HL7”

Be Effective?“The system must support the following HL7 V2 messages

according to the following 100 pages of specifications”

Be Both!!“The system must support IHE Patient ID Cross-reference as a Patient

Identifier Source actor”

Integration StatementVersion 2.1 of the Enterprise HIS supports IHE Patient Id Cross-

referencing as Patient Identifier Source actor

How to Participate, and use IHE

As an Interested Observer: Provide Public Comments - your knowledge and experience is critical

As a Provider: Ask for IHE integration statements in your RFPs

As a Committee Member: Become a member of relevant Domains Planning or Technical Committees and help plan or develop the profiles

As a Vendor or Implementer: Implement IHE Integration Profiles, Test sytems at the Connectathon, Publish an IHE integration statement for products

Healthcare providers and support staff

o Improved workflowso Information whenever and wherever neededo Fewer opportunities for errorso Fewer tedious tasks/repeated worko Improved report turnaround time

Benefits

Vendorso Align product interoperability with industry

consensus

o Decreased cost and complexity of interface installation and management

o Focus competition on functionality/service, not information transport

Growth in IHE Domains

Radiology (18)

IT Infrastructure for Healthcare (17)

Cardiology (7)

Laboratory (6)

Radiation Oncology (1)

Patient Care Coordination (5)

Patient Care Devices (1)

Quality

Eye Care (3)

Veterinary

Endoscopy

Pathology

Pharmacy

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

r 8

(200

6)

Yea

r 9

(200

7)

Toronto, Quebec, Alberta, BCCanada Health Infoway

Austria

THINC- New YorkNCHICA – N. Carolina

Italy (Conto Corrente Salute)

MA-Share – MA

FranceDMP

Philadelphia

HIE

CHINA-MoHLab results sharing

New York HIE

IHE-based Regional and National EHR Projects (Operational and Planned)

Currently accepted by HITSP

– XDS– XDS-MS– XDS-I– XD*Lab– PIX– PDQ– NAV– RFD

Example:Example: IHE adoption in the US IHE adoption in the USUnder consideration by HITSP for 2007

• Security Profiles– CT– ATNA– BPPC– DSG– XUA

• Current Interoperability Specifications Under Review– XDM– EDES– QED– XDS.b– XCA (Pending)

Example:Example: IHE adoption in Canada IHE adoption in Canada• IHE-Canada• XDS-I Profile• PIX/PDQ/v3

Providers and Vendors

Working Together to Deliver

Interoperable Health Information Systems

in the Enterprise

and Across Care Settings

Questions?

[email protected]