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IHE EU-Conference & WorkshopFebruary 7, 2005
IHE IT Infrastructure
Established Integration Profiles
Charles Parisot, GE HealthcareCharles Parisot, GE Healthcare
IHE IT Infrastructure co-chairIHE IT Infrastructure co-chair
Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise
February 7, 2005 IHE EU-Conference & Workshop
www.IHE-europe.orgwww.IHE-europe.org
W W W . I H E . N E TW W W . I H E . N E T
Providers and VendorsComing Together to Deliver
Interoperable Health Information SystemsWithin and Between Enterprises and Settings
February 7, 2005 IHE EU-Conference & Workshop
Retrieve Information for Display
Access a patient’s clinical information and documents in
a format ready to be presented
to the requesting user
Consistent TimeCoordinate time across
networked systems
Synchronize multiple applications on a desktop to the
same patient
Patient Synchronized Applications
Enterprise User Authentication
Provide users a single nameand centralized authentication
processacross all systems
Patient Identifier Cross-referencing for
MPI
Map patient identifiers across independent
identification domains
IHE IT Infrastructure 2003-2004IHE IT Infrastructure 2003-2004IHE IT Infrastructure 2004-2005IHE IT Infrastructure 2004-2005
Audit Trail & Node Authentication
Centralized privacy audit trail and node to node authentication
to create a secured domain.
New
Patient Demographics Query New
Personnel White PageAccess to workforcecontact information
New
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical
documents forming a patient electronic health record
New
Consistent TimeCoordinate time across
networked systems
Synchronize multiple applications on a desktop to the
same patient
Patient Synchronized Applications
Enterprise User Authentication
Provide users a single nameand centralized authentication
processacross all systems
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Retrieve Information for Display
Access a patient’s clinical information and documents in
a format ready to be presented
to the requesting user
Patient Identifier Cross-referencing for
MPI
Map patient identifiers across independent
identification domains
IHE IT Infrastructure 2003-2004IHE IT Infrastructure 2003-2004
February 7, 2005 IHE EU-Conference & Workshop
IHE IT Infrastructure 2004-2005IHE IT Infrastructure 2004-2005Patient IdentityPatient Identity
Patient Identifier Cross-referencing
for MPIMap patient identifiers
across independent identification domains
Patient Identifier Cross-referencing for
MPI
Map patient identifiers across independent
identification domains
Synchronize multiple applications on a desktop to the
same patient
Patient Synchronized Applications
Patient Demographics Query New
February 7, 2005 IHE EU-Conference & Workshop
IHE IT Infrastructure 2004-2005IHE IT Infrastructure 2004-2005SecuritySecurity
Enterprise User AuthenticationEnterprise User Authentication
Provide users a single nameand centralized authentication
processacross all systems
Consistent TimeCoordinate time across
networked systems
Audit Trail & Node Authentication
Centralized privacy audit trail and node to node authentication
to create a secured domain.
New
Personnel White PageAccess to workforcecontact information
New
February 7, 2005 IHE EU-Conference & Workshop
IHE IT Infrastructure 2004-2005IHE IT Infrastructure 2004-2005 Access to Patient RecordsAccess to Patient Records
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Retrieve Information for Display
Access a patient’s clinical information and documents in
a format ready to be presented
to the requesting user
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical
documents forming a patient electronic health record
New
February 7, 2005 IHE EU-Conference & Workshop
IHE IT InfrastructureIHE IT InfrastructureEstablished Integration ProfilesEstablished Integration Profiles
Enterprise User AuthenticationEnterprise User Authentication
Provide users a single nameand centralized authentication
processacross all systems
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Retrieve Information for Display
Access a patient’s clinical information and documents in
a format ready to be presented
to the requesting user
Patient Identifier Cross-referencing
for MPIMap patient identifiers
across independent identification domains
Patient Identifier Cross-referencing for
MPI
Map patient identifiers across independent
identification domains
Synchronize multiple applications on a desktop to the
same patient
Patient Synchronized Applications
Consistent TimeCoordinate time across
networked systems
February 7, 2005 IHE EU-Conference & Workshop
IHE IT InfrastructureIHE IT Infrastructure
Enterprise User AuthenticationEnterprise User Authentication
Provide users a single nameand centralized authentication
processacross all systems
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Retrieve Information for Display
Access a patient’s clinical information and documents in
a format ready to be presented
to the requesting user
Synchronize multiple applications on a desktop to the
same patient
Patient Synchronized Applications
Consistent TimeCoordinate time across
networked systems
Patient Identifier Cross-referencing for
MPI
Map patient identifiers across independent
identification domains
February 7, 2005 IHE EU-Conference & Workshop
Patient Identifier Cross-referencing for MPIPatient Identifier Cross-referencing for MPIAbstract / ScopeAbstract / Scope
Allow all enterprise participants to register the identifiers they use for patients in their domain
Participants retain control over their own domain’s patient index(es)
Support domain systems’ queries for other systems’ identifiers for their patients
Optionally, notify domain systems when other systems update identifiers for their patients
February 7, 2005 IHE EU-Conference & Workshop
Patient Identifier Cross-referencing for MPIPatient Identifier Cross-referencing for MPIValue PropositionValue Proposition
Maintain all systems’ identifiers for a patient in a single location
Use any algorithms (encapsulated) to find matching patients across disparate identifier domains
Lower cost for synchronizing data across systems No need to force identifier and format changes onto existing
systems
Leverages standards and transactions already used within IHE
February 7, 2005 IHE EU-Conference & Workshop
Patient Identifier Cross-referencing for MPIPatient Identifier Cross-referencing for MPITransaction DiagramTransaction Diagram
February 7, 2005 IHE EU-Conference & Workshop
Patient Identifier Cross-referencing for MPIPatient Identifier Cross-referencing for MPIProcess Flow Showing ID Domains & TransactionsProcess Flow Showing ID Domains & Transactions
Patient Identification Domain A
Other IHE Actor
Identity Patient
Cross References
Patient Identity Consumer
Patient Identification Domain C
Patient Identity
Feed Patient Identity
Source
Patient Identity Cross-reference
Manager
Patient Identification Cross-reference Domain
Patient Identity Feed & Patient Identity References
Internal Domain transactions
Other IHE Actor
Patient Identity Cross References
Patient Identity Consumer
Patient Identification Domain B
Patient Identity
Feed Patient Identity
Source
Internal Domain transactions
February 7, 2005 IHE EU-Conference & Workshop
Patient Identifier Cross-referencing for MPIPatient Identifier Cross-referencing for MPI
Patient Identification Domain A
Patient Identification Domain C
Id=X456 Id=Y921 Id=D456 Id=DF45
Patient Identification
Cross-reference Domain
Patient Identification Domain B
Id=123 Id=235
Id=3TY Id=2RT
Patient Identity Cross-reference Manager
B:X456 = C:2RT A:123 = B:Y921 = C:3TY B:D456 A:235 = B:DF45 A:678
Patient Identity Consumer
B:X456C: 2RT
IdentityPatient
Cross References
B:X456C: ?
February 7, 2005 IHE EU-Conference & Workshop
Patient Identifier Cross-referencing for MPIPatient Identifier Cross-referencing for MPIStandards UsedStandards Used
HL7 Version 2.5 ADT Registration and Update Trigger Events
• A01: inpatient admission• A04: outpatient registration• A05: pre-admission• A08: patient update• A40: merge patient
Queries for Corresponding Identifiers (ADT^Q23/K23) Notification of Identifiers Lists Updates (ADT^A31)
February 7, 2005 IHE EU-Conference & Workshop
PIX Integration Profile & MPIPIX Integration Profile & MPIThe typical viewThe typical view
Patient Identification Domain C
Patient Identity Cross-reference Manager
Patient Identification Domain A(Master Domain)
Patient Identification Domain B
Master (A) PatientIdentity Source
Master PatientIndex
February 7, 2005 IHE EU-Conference & Workshop
PIX Integration Profile & MPIPIX Integration Profile & MPI The Equivalent IHE ModelThe Equivalent IHE Model
Patient Identification Domain C
Patient Identity Cross-reference Manager
Patient Identification Domain A(Master Domain)
Patient Identification Domain B
Master (A) PatientIdentity Source
Master PatientIndex
February 7, 2005 IHE EU-Conference & Workshop
IHE IT InfrastructureIHE IT Infrastructure
Enterprise User AuthenticationEnterprise User Authentication
Provide users a single nameand centralized authentication
processacross all systems
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Retrieve Information for Display
Access a patient’s clinical information and documents in
a format ready to be presented
to the requesting user
Patient Identifier Cross-referencing
for MPIMap patient identifiers
across independent identification domains
Patient Identifier Cross-referencing for
MPI
Map patient identifiers across independent
identification domains
Synchronize multiple applications on a desktop to the
same patient
Patient Synchronized Applications
Consistent TimeCoordinate time across
networked systems
Retrieve Information for Display
Access a patient’s clinical information and documents in a format ready to be
presentedto the requesting user
February 7, 2005 IHE EU-Conference & Workshop
Simple and rapid access to patient information
Access to existing persistent documents in well-known presentation formats: CDA, PDF, JPEG.
Access to specific key patient-centric information for presentation to a clinician : allergies, current medications, summary of reports, etc..
Links with other IHE profiles - Enterprise User Authentication, Patient Identifier Cross-referencing and Cross Enterprise Document Sharing
Retrieve Information for DisplayRetrieve Information for DisplayAbstract / ScopeAbstract / Scope
February 7, 2005 IHE EU-Conference & Workshop
User Convenience: Healthcare providers can "see" the information. A significant
integration step.
Workflows from within the users’ on-screen workspace or application.
Complements multiple simultaneous apps workflow of Patient Synchronized Apps
Broad Enterprise-Wide access to information: Web technology for simple clients Clinical data handling fully assumed by the information source that
holds clinical data.
Retrieve Information for DisplayRetrieve Information for DisplayValue PropositionValue Proposition
February 7, 2005 IHE EU-Conference & Workshop
Standards Used: Web Services (WSDL for HTTP Get). General purpose IT Presentation Formats: XHTML, PDF, JPEG, CDA L1 (HL7)
Client may be off-the-shelf browser or display application.
Two services : Retrieve of Specific Information:
• Patient centric: patient ID• Type of Request (see next slide)• Date, Time, nMostRecent
Retrieve a Document• Object Unique Instance Identifier (OID)• Type of Request• Content Type Expected
Retrieve Information for DisplayRetrieve Information for DisplayKey Technical PropertiesKey Technical Properties
February 7, 2005 IHE EU-Conference & Workshop
Transaction Diagram
Retrieve Information for DisplayRetrieve Information for Display
Display InformationSource
Retrieve Specific Info for Display [11]
Summary of All ReportsSummary of Laboratory ReportsSummary of Radiology ReportsSummary of Cardiology ReportsSummary of Surgery ReportsSummary of Intensive Care ReportsSummary of Emergency ReportsSummary of Discharge ReportsList of AllergiesList of Medications
Retrieve Document for Display [12]
Persistent Document
Types ofRequests
February 7, 2005 IHE EU-Conference & Workshop
Query Keys – Transaction [11]Query Keys – Transaction [11]Retrieve Specific Information for DisplayRetrieve Specific Information for Display
Parameter Name
RequestType
patientID
lowerDateTime
upperDateTime
MostRecentResults
REQ
R
R
O
O
R
Description
requestType specifies what type of information shall be retrieved. This parameter shall always be valued.
This attribute identifies the subject of the results being queried for. Its value shall include identification of assigning authority.
Used to constrain the earliest date/time of creation of information.
Used to constrain the latest date/time of creation of information.
The numeric value that indicates the number of most recent results to be included into the response, i.e., 1 indicates to provide the latest result.
February 7, 2005 IHE EU-Conference & Workshop
Query Keys – Transaction [12]Query Keys – Transaction [12]Retrieve Document for DisplayRetrieve Document for Display
Parameter Name
RequestType
DocumentUID
Description
This parameter is required to have a value of “DOCUMENT”.
Identifies document’s UID as known to both actors.
REQ
R
R
PreferredContentType
This parameter is required to identify the preferred format: JPEG. PDF, CDA L1 that the document is to be provided (as MIME content type).
R
February 7, 2005 IHE EU-Conference & Workshop
IHE IT Infrastructure 2004-2005IHE IT Infrastructure 2004-2005
Enterprise User AuthenticationEnterprise User Authentication
Provide users a single nameand centralized authentication
processacross all systems
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Retrieve Information for Display
Access a patient’s clinical information and documents in
a format ready to be presented
to the requesting user
Patient Identifier Cross-referencing
for MPIMap patient identifiers
across independent identification domains
Patient Identifier Cross-referencing for
MPI
Map patient identifiers across independent
identification domains
Synchronize multiple applications on a desktop to the
same patient
Patient Synchronized Applications
Consistent TimeCoordinate time across
networked systems
Synchronize multiple applications on a desktop to the same patient
Patient Synchronized Applications
February 7, 2005 IHE EU-Conference & Workshop
Abstract / Scope
Patient Synchronization of Multiple Disparate Applications
Single Patient Selection
When combined with PIX Profile, allows patient synchronization across patient identifier domains
When combined with EUA Profile, provides user Single Sign-on (SSO)
Patient Synchronized ApplicationsPatient Synchronized Applications
February 7, 2005 IHE EU-Conference & Workshop
Value Proposition
User Convenience: Eliminates the repetitive task of selecting the patient in each application Permits the user to select the patient in the application for which they are
most familiar and / or appropriate to the clinical workflow
Patient Safety: Ensures all data being viewed across applications is for the same patient
Leverage Single Development Effort: Allows vendors to leverage single CCOW enablement effort to support
multiple actors:• Patient Context Participant (PSA)• User Context Participant (EUA)
Patient Synchronized ApplicationsPatient Synchronized Applications
February 7, 2005 IHE EU-Conference & Workshop
Patient Synchronized ApplicationsPatient Synchronized ApplicationsActorsActors
Context Manager ActorThe IHE Context Manager Actor may encompass more than a CCOW context manager function. It may include a number of other components such as the context management registry and patient mapping agent.
Patient Context Participant ActorThe Patient Context Participant Actor shall respond to all patient context changes. This actor shall set the patient context provided the application has patient selection capability.
February 7, 2005 IHE EU-Conference & Workshop
Transactions Diagram
Patient Synchronized ApplicationsPatient Synchronized Applications
These transactions are required for both Actors for compliance
February 7, 2005 IHE EU-Conference & Workshop
Key Technical Properties
Standards Used: HL7 Context Management “CCOW” Standard, Version 1.4 Support for both Windows and Web Technology Support of “Patient Subject”
IHE Constraints: Specifies use of Patient.Id.IdList item
• Ensures maximum interoperability with PIX Profile• Protects against future deprecation of patient identifier items (HL7
2.3.1, 2.4, 2.5, CCOW).
Patient Synchronized ApplicationsPatient Synchronized Applications
February 7, 2005 IHE EU-Conference & Workshop
IHE IT Infrastructure 2004-2005IHE IT Infrastructure 2004-2005
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Retrieve Information for Display
Access a patient’s clinical information and documents in
a format ready to be presented
to the requesting user
Patient Identifier Cross-referencing
for MPIMap patient identifiers
across independent identification domains
Patient Identifier Cross-referencing for
MPI
Map patient identifiers across independent
identification domains
Synchronize multiple applications on a desktop to the
same patient
Patient Synchronized Applications
Enterprise User Authentication
Provide users a single nameand centralized authentication process
across all systems
Consistent Time
Coordinate time across networked systems
February 7, 2005 IHE EU-Conference & Workshop
Enterprise User AuthenticationEnterprise User AuthenticationScopeScope
Support a single enterprise governed by a single set of security policies and having a common network domain.
Establish one name per user to be used for all IT applications and devices.
Facilitate centralized user authentication management.
Provide users with single sign-on.
February 7, 2005 IHE EU-Conference & Workshop
Enterprise User AuthenticationEnterprise User AuthenticationValue PropositionValue Proposition
Meet a basic security requirement User authentication is necessary for most applications and data
access operations.
Achieve cost savings/containment Centralize user authentication management Simplify multi-vendor implementations
Provide workflow improvement for users Increase user acceptance through simplicity Decrease user task-switching time.
More effective security protection Consistency and simplicity yields greater assurance.
February 7, 2005 IHE EU-Conference & Workshop
Consistent TimeConsistent TimeScope and Value PropositionScope and Value Proposition
Meet a basic security requirement
System clocks and time stamps of the many computers in a network must be synchronized.
Lack of consistent time creates a “security hole” for attackers. Synchronization ±1 second is generally sufficient.
Achieve cost savings/containment
Use the Network Time Protocol (NTP) standard defined in RFC 1305.
Leverage exisisting Internet NTP services, a set-up option for mainstream operating systems.
February 7, 2005 IHE EU-Conference & Workshop
EUA and CTEUA and CTKey Technical PropertiesKey Technical Properties
Standards Used Kerberos v5 (RFC 1510)
• Stable since 1993, • Widely implemented on current operating system platforms• Successfully withstood attacks in its 10-year history• Fully interoperable among all platforms
HL7 CCOW, user subject Network Time Protocol (RFC 1305)
Minimal Application Changes Eliminate application-specific, non-interoperable
authentication Replace less secure proprietary security techniques Leverage NTP interfaces built-into operating systems
February 7, 2005 IHE EU-Conference & Workshop
Enterprise User AuthenticationEnterprise User AuthenticationKey AttributesKey Attributes
Limited network overhead
Kerberos is network-efficient, developed at a time when high-speed networks were rare.
CCOW is similarly network-efficient
Kerberos and CCOW work with any user authentication technology
Tokens, biometric technologies, smart cards, … Specific implementations require some proprietary
components, e.g., biometric devices. Once user authentication is complete, network transactions
are the same for all technologies.
February 7, 2005 IHE EU-Conference & Workshop
Enterprise User AuthenticationEnterprise User AuthenticationTransaction Diagram with CCOW OptionTransaction Diagram with CCOW Option
February 7, 2005 IHE EU-Conference & Workshop
Consistent TimeConsistent TimeTransaction DiagramTransaction Diagram
Maintain Time [ITI-1]↑
Time Server
Time Client
February 7, 2005 IHE EU-Conference & Workshop
IHE IT InfrastructureIHE IT Infrastructure
Enterprise User AuthenticationEnterprise User Authentication
Provide users a single nameand centralized authentication
processacross all systems
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Retrieve Information for Display
Access a patient’s clinical information and documents in
a format ready to be presented
to the requesting user
Patient Identifier Cross-referencing
for MPIMap patient identifiers
across independent identification domains
Patient Identifier Cross-referencing for
MPI
Map patient identifiers across independent
identification domains
Synchronize multiple applications on a desktop to the
same patient
Patient Synchronized Applications
Consistent TimeCoordinate time across
networked systems
February 7, 2005 IHE EU-Conference & Workshop
Synergy between IHE IT Int. ProfilesSynergy between IHE IT Int. ProfilesRID with EUA/CT & PIXRID with EUA/CT & PIX
Display
Client AuthenticationAgent
Time Client
Information Source
KerberosAuthentication
Server
TimeServer
Patient Identity Consumer
Patient Identity X-ref
Manager
Example of support ofmultiple actors/profiles
40
February 7, 2005 IHE EU-Conference & Workshop
Synergy between IHE IT Int. ProfilesSynergy between IHE IT Int. ProfilesApps with PSA, EUA & PIXApps with PSA, EUA & PIX
Application A
Client AuthenticationAgent
Time Client KerberosAuthentication
Server
TimeServer
Patient Identity Consumer
Patient Identity X-ref
Manager
Context Manager
Application BContext participant
Context participant
Example of support ofmultiple actors/profiles
41
February 7, 2005 IHE EU-Conference & Workshop
A Pause for A Pause for Questions ?Questions ?
www.IHE-europe.orgwww.IHE-europe.org
W W W . I H E . N E TW W W . I H E . N E T
Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise
February 7, 2005 IHE EU-Conference & Workshop
Retrieve Information for Display
Access a patient’s clinical information and documents in
a format ready to be presented
to the requesting user
Consistent TimeCoordinate time across
networked systems
Synchronize multiple applications on a desktop to the
same patient
Patient Synchronized Applications
Enterprise User Authentication
Provide users a single nameand centralized authentication
processacross all systems
Patient Identifier Cross-referencing for
MPI
Map patient identifiers across independent
identification domains
IHE IT Infrastructure 2003-2004IHE IT Infrastructure 2003-2004IHE IT Infrastructure 2004-2005IHE IT Infrastructure 2004-2005
Audit Trail & Node Authentication
Centralized privacy audit trail and node to node authentication
to create a secured domain.
New
Patient Demographics Query New
Personnel White PageAccess to workforcecontact information
New
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical
documents forming a patient electronic health record
New
Consistent TimeCoordinate time across
networked systems
Synchronize multiple applications on a desktop to the
same patient
Patient Synchronized Applications
Enterprise User Authentication
Provide users a single nameand centralized authentication
processacross all systems
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Retrieve Information for Display
Access a patient’s clinical information and documents in
a format ready to be presented
to the requesting user
Patient Identifier Cross-referencing for
MPI
Map patient identifiers across independent
identification domains
IHE IT Infrastructure 2003-2004IHE IT Infrastructure 2003-2004
February 7, 2005 IHE EU-Conference & Workshop
IHE IT Infrastructure 2004-2005IHE IT Infrastructure 2004-2005
Enterprise User AuthenticationEnterprise User Authentication
Provide users a single nameand centralized authentication
processacross all systems
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Retrieve Information for Display
Access a patient’s clinical information and documents in
a format ready to be presented
to the requesting user
Map patient identifiers across independent
identification domains
Patient Identifier Cross-referencing for
MPI
Synchronize multiple applications on a desktop to the
same patient
Patient Synchronized Applications
Consistent TimeCoordinate time across
networked systems
Audit Trail & Node Authentication
Centralized privacy audit trail and node to node authentication
to create a secured domain.
New
Patient Demographics Query New
Personnel White PageAccess to workforcecontact information
New
Cross-Enterprise Document Sharing
Registration, distribution and access
across health enterprisesof clinical documents forming
a distributed patient electronic health record
New
February 7, 2005 IHE EU-Conference & Workshop
Introduction:EHR Cross-Enterprise Document SharingEHR Cross-Enterprise Document Sharing
First step towards the First step towards the longitudinal dimension of the EHRlongitudinal dimension of the EHR
Focus:Focus: Support document sharing between Support document sharing between EHRs in different care settings and EHRs in different care settings and organizations organizations
February 7, 2005 IHE EU-Conference & Workshop
Acute Care (Inpatient)
GPs and Clinics (Ambulatory)
Long Term Care
Other Specialized Care(incl. Diagnostics Services)
Continuity of Care: Patient Longitudinal RecordPatient Longitudinal Record
Typically, a patient goes through a sequence of encounters in different Care Settings
February 7, 2005 IHE EU-Conference & Workshop
community
Clinical Encounter
Clinical IT System
RecordsRecordsSentSent
Laboratory Results Specialist Record
Hospital Record
Finding the records of a patient-Manual & tediousFinding the records of a patient-Manual & tedious
The challenge: Finding and accessing easilydocuments from other care providers In the community.
February 7, 2005 IHE EU-Conference & Workshop
community
Clinical Encounter
Clinical IT System Index of patients records(Document-level)
1-Patient Authorized
Inquiry
Temporary Aggregate Patient History
4-Patient data presented to
Physician
Sharing SystemSharing System
3-Records3-RecordsReturnedReturned
Referenceto records
Laboratory Results Specialist Record
Hospital Record
2-Referenceto Records for Inquiry
Sharing records that have been publishedSharing records that have been published
February 7, 2005 IHE EU-Conference & Workshop
Acute Care (Inpatient)
PCPs and Clinics (Ambulatory)
Long Term Care
Other Specialized Careor Diagnostics Services
Building and accessing DocumentsBuilding and accessing Documents
EHR-CR: EHR-CR: Care RecordCare Record systems systemssupportingsupporting care delivery care delivery
Documents Registry
DocumentRepository
EHR-LR:EHR-LR:Longitudinal RecordLongitudinal Recordas usedas usedacross-encountersacross-encounters
Submission of Document References
Retrieve of selected Documents
February 7, 2005 IHE EU-Conference & Workshop
XDS – Value PropositionXDS – Value PropositionFoundation for Health IT Infrastructures: Shared Electronic Health Record, in a community, region, etc.
Effective means to contribute and access clinical documents across health enterprises.
Scalable sharing of documents between private physicians, clinics, long term care, pharmacy, acute care with different clinical IT systems.
Easy access: Care providers are offered means to query and retrieve clinical documents of interest.
February 7, 2005 IHE EU-Conference & Workshop
XDS - Value PropositionXDS - Value PropositionDistributed: Each Care delivery organization “publishes” clinical information for others. Actual documents may remain in the source EHR-CR.
Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain (e.g. an LHII).
Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (HL7-CDA, ASTM-CCR, PDF, DICOM, etc.)
Document Content Neutral: Document content is processed only by source and consumer IT systems.
Standardized Registry Attributes: Queries based on meaningful attributes ensure deterministic document searches.
February 7, 2005 IHE EU-Conference & Workshop
Integration Model 1: EHR-CR with Repository at SourceEHR-CR with Repository at Source An EHR-CR completes a phase of care for a patient where it:
Has these documents available as Repository Actor.
Registers documents with a Registry actor.
Any other EHR-CR may query the Registry actor, and chose to retrieve some of these documents from any Document Repository Actor.
EHR-CR
Register
4 Retrieve
3 Query
2
Document Source Document Consumer
Document Repository
Document Registry
EHR-CR
February 7, 2005 IHE EU-Conference & Workshop
Integration Model 2:EHR-LR with Third Party RepositoryEHR-LR with Third Party Repository An EHR-CR completes a phase of care for a patient where it:
Provides the documents to a Repository Actor of its choice.
Documents are Registered with a Registry Actor.
Any other EHR-CR may query the Registry actor, and chose to retrieve some of these documents from any Document Repository Actor.
EHR-CR
2 Register
4 Retrieve
3 Query
Document Source
Document Consumer
Document Repository
Document Registry
EHR-CR
1 Provide & Register
February 7, 2005 IHE EU-Conference & Workshop
Integration Model 3: EHR-CR feed a EHR-CR/EHR-LR hubEHR-CR feed a EHR-CR/EHR-LR hubAn EHR-CR completes a phase of care for a patient where it:
Provides and Registers a set of documents to a Document Repository in an EHR-CR.
The EHR-CR Consumer Actor has the documents and may respond to queries and provide them to other document consumers.
Document Source
Document Consumer
Document Repository
Document Registry
EHR-CR
1 Provide & Register
EHR-CR
February 7, 2005 IHE EU-Conference & Workshop
Patient Access also possiblePatient Access also possible
A patient accesses own record:
Query and Retrieve a set of documents using for example a portal application that offers the ability to display documents’ content.
This is a particular case of an EHR-CR, where the patient is interested her/his own care. Patient may also register and provide documents.
February 7, 2005 IHE EU-Conference & Workshop
Conclusion:Conclusion:IHE Cross-Enterprise Document SharingIHE Cross-Enterprise Document Sharing
IHE XDS is a critical element to enable sharing of health information between EHR Systems.
Access Control and Doc Content Profiles are on the IHE Roadmap for 2005.
In collaborationcollaboration with well established standards bodies (HL7, ASTM, CEN, OASIS, IETF, DICOM, etc.) and other EHR related initiatives world-wide (EuroREC, etc.), IHE is contributing to a more contributing to a more cost-effective and rapid deploymentcost-effective and rapid deployment of community, regional and national health IT infrastructures.
February 7, 2005 IHE EU-Conference & Workshop
How real is XDS ?How real is XDS ?Specification work since Nov 2003Specification work since Nov 2003
Public Comments June-July 2004Public Comments June-July 2004 600 constructive comments received. 600 constructive comments received. Validity of XDS approach confirmed around the worldValidity of XDS approach confirmed around the world..
Stable specification IHE Technical Framework Stable specification IHE Technical Framework Published Aug 15Published Aug 15thth, 2004 (TI Supplement), 2004 (TI Supplement)
IHE Connectathon - January 2005 (USA)-17 vendorsIHE Connectathon - January 2005 (USA)-17 vendors
HIMSS Feb 2005 - show-wide demonstrationHIMSS Feb 2005 - show-wide demonstration
IHE Connectathon - April 2005 (Europe)-27 vendorsIHE Connectathon - April 2005 (Europe)-27 vendors
Several Implementation Projects by health authorities in 2005
February 7, 2005 IHE EU-Conference & Workshop
Exposition d’interopérabilité HIMSS 2005Exposition d’interopérabilité HIMSS 2005
Organisée par HIMSS, un des sponsors IHE aux USA.
Intégrant les milieux hospitaliers et ambulatoires :
partage inter-entreprise de l’information de santé entre les milieux de soins hospitaliers et ambulatoires.
Intégrant les dossier patient électroniques sur les stands des fournisseurs:
milieu hautement interactif, basé sur les normes, visant à démontrer l’interopérabilité pratique entre les entreprises de soins.
February 7, 2005 IHE EU-Conference & Workshop
Exposition d’interopérabilité HIMSS 2005Exposition d’interopérabilité HIMSS 2005
Visiteurs géreront leur dossier de soin électronique au sein du « réseau régional HIMSS ».
Environnement communiquant s’appuyant sur le profil IHE Cross-enterprise Document Sharing:
Bati autour d’un « XDS document registry » central.
Des « XDS ocument repositories » distribués.
17 DES qui publient/partagent divers documents (Résumé Patient-CCR, HL7-CDA, HL7-lab, PDF).
February 7, 2005 IHE EU-Conference & Workshop
Exposition d’interopérabilité HIMSS 2005Exposition d’interopérabilité HIMSS 2005
Partage d’information inter-entreprise en milieu hospitalier, 20 fournisseurs:
Cedara Gusrada/Care Science NISTDictaphone IDX NovellEastman Kodak InterSystems Open TextEclipsys Infinitt SentillionEmageon Kryptiq SiemensEpic MedCommons Univ. Of WashingtonGE Healthcare Mortara Instruments
Fournisseurs testés au connectathon présentant un produit:
Partage d’Information en milieu ambulatoire, 13 fournisseurs:
Allscripts GE Healthcare MidMarkCapMed/SanDisk IDX NextGenCerner Krytiq WebMDEclipsys MedcomSoft ETIAM MediNotes
February 7, 2005 IHE EU-Conference & Workshop
HIMSS 2005 – HIMSS 2005 – Show-Wide InteroperabilityShow-Wide Interoperability
Vendor System
Ambulatory Showcase BoothAmbulatory Showcase Booth
HomeHome
PCP
MultispecialtyMultispecialtyClinicClinic
Diag CenterDiag Center
Cross-enterprise Showcase BoothCross-enterprise Showcase Booth
Cardiology
RadiologyIT
Infrastructure
In-Patient/Out-patient
Vendor BoothVendor Booth
Vendor BoothVendor Booth
Vendor BoothVendor Booth
Vendor BoothVendor Booth
Vendor BoothVendor Booth
Vendor BoothVendor Booth
Vendor BoothVendor Booth
Vendor BoothVendor Booth
AllscriptsCapMedCerner
EclipsysGE Healthcare
IDXInfinitt
InterSystemsKrytiq
MedCommonsMediNotesNextGenOpenTextSiemensWebMD
HIMSS “RHIO” withCross-enterprise
doc sharing
February 7, 2005 IHE EU-Conference & Workshop
Secured Node
Document Consumer
Retrieve Document
Query Documents
Patient Identity Source
Patient Identity
Feed
Document Source
Document Registry
Document Repository
Provide&RegisterDocument Set
RegisterDocument Set
Secured Node
Secured Node
Secured Node
Secured Node
Secured Node
ATNA crée un domaine sécurisé sur internet:• User Accountability (Audit trail)
• Node-to-Node Access Control
• Node-level user authentication
Les Contrôles d’accèsutilisateurs sont prévuspour 2005.
Sécurité pour XDSSécurité pour XDSSe base sur le Profil IHE Audit Trail & Node Authentication
February 7, 2005 IHE EU-Conference & Workshop
IHE IT Infrastructure 2004-2005IHE IT Infrastructure 2004-2005
Enterprise User AuthenticationEnterprise User Authentication
Provide users a single nameand centralized authentication
processacross all systems
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Retrieve Information for Display
Access a patient’s clinical information and documents in
a format ready to be presented
to the requesting user
Patient Identifier Cross-referencing
for MPIMap patient identifiers
across independent identification domains
Patient Identifier Cross-referencing for
MPI
Map patient identifiers across independent
identification domains
Synchronize multiple applications on a desktop to the
same patient
Patient Synchronized Applications
Consistent TimeCoordinate time across
networked systems
Audit Trail & Node Authentication
Centralized privacy audit trail and node to node authentication
to create a secured domain.
New
Personnel White PageAccess to workforcecontact information
New
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical
documents forming a patient electronic health record
New
Patient Demographics Query
New
Retrieval of a patient list including patient names,
identifiers, contacts, and visit information
February 7, 2005 IHE EU-Conference & Workshop
Patient Demographics QueryPatient Demographics QueryAbstract/ScopeAbstract/Scope
Allow quick retrieval of a patient list including common patient names, identifiers, contacts, and visit information
Enable selection of correct patient when full identification data may not be available
Limits access to only a subset of demographic and visit information
February 7, 2005 IHE EU-Conference & Workshop
Patient Demographics QueryPatient Demographics QueryValue PropositionValue Proposition
Enables access on demand to diverse systems and devices
Participants that do not need continual synchronization of patient registration information
Devices that cannot participate in monitoring of ADT feeds, e.g.:
• Small-footprint devices
• Low-memory devices
February 7, 2005 IHE EU-Conference & Workshop
Patient Demographics QueryPatient Demographics QueryValue Proposition (cont’d)Value Proposition (cont’d)
Allow search on full or partial data
Retrieve information from any domain to which the client has query access
Allows use of matching algorithm (e.g., soundex) to find near matches
February 7, 2005 IHE EU-Conference & Workshop
IHE IT Infrastructure 2004-2005IHE IT Infrastructure 2004-2005
Enterprise User AuthenticationEnterprise User Authentication
Provide users a single nameand centralized authentication
processacross all systems
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Retrieve Information for Display
Access a patient’s clinical information and documents in
a format ready to be presented
to the requesting user
Patient Identifier Cross-referencing
for MPIMap patient identifiers
across independent identification domains
Patient Identifier Cross-referencing for
MPI
Map patient identifiers across independent
identification domains
Synchronize multiple applications on a desktop to the
same patient
Patient Synchronized Applications
Consistent TimeCoordinate time across
networked systems
Patient Demographics Query New
Personnel White PageAccess to workforcecontact information
New
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical
documents forming a patient electronic health record
New
Audit Trail & Node Authentication
Centralized privacy audit trail and node to node
authentication to create a secured domain.
New
February 7, 2005 IHE EU-Conference & Workshop
IHE and SecurityIHE and Security
User Identity PWP, EUA
User Authentication EUA
Node Authentication ATNA
Security Audit Trails ATNA
Data Integrity Controls CT, ATNA TLS option
Data Confidentiality ATNA TLS option
Access Controls Future item in IHE roadmap
February 7, 2005 IHE EU-Conference & Workshop
ScopeScope
Defines basic security features for an individual system for use as part of the security and privacy environment for a healthcare enterprise.
Extends the IHE radiology oriented Basic Security profile (defined in 2002) to be applicable to other healthcare uses.
Supports two categories of network environments
First of a family of profiles with different kinds of authentication.
February 7, 2005 IHE EU-Conference & Workshop
IHE makes cross-node security management easy:
Only a simple manual certificate installation is needed.
Separate the authentication, authorization, and accountability functions to accommodate the needs of different approaches.
Enforcement driven by ‘a posteriori audits’ and real-time visibility.
IHE Goal with ATNA
February 7, 2005 IHE EU-Conference & Workshop
Integrating trusted nodes
System A System B
Secured SystemSecure network
• Strong authentication of remote node (digital certificates)• network traffic encryption is not required, it is optional
Secured System
• Local access control (authentication of user)
• Audit trail with:• Real-time access • Time synchronization
Central Audit TrailRepository
February 7, 2005 IHE EU-Conference & Workshop
IHE IT Infrastructure 2004-2005IHE IT Infrastructure 2004-2005
Enterprise User AuthenticationEnterprise User Authentication
Provide users a single nameand centralized authentication
processacross all systems
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Retrieve Information for Display
Access a patient’s clinical information and documents in
a format ready to be presented
to the requesting user
Patient Identifier Cross-referencing
for MPIMap patient identifiers
across independent identification domains
Patient Identifier Cross-referencing for
MPI
Map patient identifiers across independent
identification domains
Synchronize multiple applications on a desktop to the
same patient
Patient Synchronized Applications
Consistent TimeCoordinate time across
networked systems
Audit Trail & Node Authentication
Centralized privacy audit trail and node to node authentication
to create a secured domain.
New
Patient Demographics Query New
Personnel White Page
Access to workforcecontact information
NewCross-Enterprise
Document Sharing
Registration, distribution and access across health enterprises of clinical
documents forming a patient electronic health record
New
February 7, 2005 IHE EU-Conference & Workshop
Personnel White Pages (PWP) – Personnel White Pages (PWP) – Abstract/ScopeAbstract/Scope
Provide access to basic information about the human workforce membersDoes not include Patients
Defines method for finding the PWP
Defines query/access method
Defines attributes of interest
February 7, 2005 IHE EU-Conference & Workshop
Personnel White Pages (PWP) – Personnel White Pages (PWP) – Value PropositionValue Proposition
Single Authoritative Knowledge Base Reduce duplicate and unconnected user info database Single place to update
• Name Changes• New Phone Number• Additional Addresses
Enhance Workflow and Communications Providing information necessary to make connections
• Phone Number• Email Address• Postal Address
February 7, 2005 IHE EU-Conference & Workshop
Personnel White Pages (PWP) – Personnel White Pages (PWP) – Value Proposition Value Proposition
Enhance User Interactions Provide user friendly identities and lists
• List of members• Displayable name of a user• Initials query
Contributes to Identity Management Additional methods of identity cross verification
• Name, address, phone number, email• Cross reference with Enterprise User Authentication identity
Future expansion likely will contain certificates
February 7, 2005 IHE EU-Conference & Workshop
PWP - TransactionsPWP - Transactions
PersonnelWhitePages
ConsumerQuery for Healthcare Workforce Member Info
Provide access to healthcare staff informationProvide access to healthcare staff information to systems in a standard manner. to systems in a standard manner.
PersonnelWhite Pages
Directory
DNS Server
Find PersonnelWhite Pages
February 7, 2005 IHE EU-Conference & Workshop
Thank YouThank You
Questions ?Questions ?
W W W . I H E . N E TW W W . I H E . N E T
Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise
