HIMSS 20051 IHE, Interoperability for Regional Health Information Organizations Charles Parisot, GE Healthcare Mike Henderson, Eastern Informatics IHE

HIMSS 2005 1

IHE, Interoperability for Regional Health Information Organizations

Charles Parisot, Charles Parisot, GE HealthcareGE Healthcare

Mike Henderson, Mike Henderson, Eastern InformaticsEastern Informatics

IHE IT Technical Committee Co-ChairsIHE IT Technical Committee Co-Chairs

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W W W . I H E . N E TW W W . I H E . N E T

Providers and VendorsWorking Together to Deliver

Interoperable Health Information SystemsIn the Enterprise

and Across Care Settings

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State of the Union Addresses

“By computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care.”

President George W. Bush January 20, 2004

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And the beat goes on…..

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

President George W. Bush April 26, 2004

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

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Framework for Strategic Action

• President Bush’s April 27th executive order called for the creation of the Office of the National Coordinator of Health Information Technology (ONCHIT). A report was required within 90 days of office creation.

• The Framework for Strategic Action was released by Department of Health and Human Services Secretary Tommy Thompson and newly appointed National Coordinator of Health Information Technology, David Brailer, MD, at the NHII Summit in July, 2004.

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Four Major Goals

1. Inform Clinical Practice– Incentivize EHR adoption

– Reduce risk of EHR investment

– Promote EHR diffusion in rural & underserved

2. Interconnect Clinicians– Foster regional collaborations

– Develop a national health information network

– Coordinate federal health information systems

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Four Major Goals

3. Personalize Care– Encourage use of PHRs

– Enhance informed consumer choice

– Promote use of telehealth systems

4. Improve Population Health– Unify public health surveillance architectures

– Streamline quality and health status monitoring

– Accelerate discovery and dissemination

Thousands of EHRs to interconnect,Through a “thin” National Health Information Network.

Make connectivity open, consistent, step-wise and evolutionary !IHE can accelerate and simplify the process.

See:13 Organization Collaborative NHIN RFI Response

PlusIHE Response to the NHIN RFI.

www.himss.org/content/files/IHERFIResponseandCoverLetter1.pdf

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Standards Alone Are Not Enough

• Managing the domain boundaries with mapping of information flow across boundaries

• Standards offer generality, ambiguity and alternatives.

• Vendor proprietary interests

• Complexity!!

We need standards for how to We need standards for how to

implement standards!implement standards!

HIMSS 2005 9

Connecting Standards to Care

• Care providers must work with vendors to coordinate the implementation of standards to meet their needs– Care providers need to identify the key interoperability

problems they face– Drive industry to develop and make available

standards-based solutions– Implementers need to follow common guidelines in

purchasing and integrating systems that deliver these solutions

What is the effective way to establish those What is the effective way to establish those

“standards” for how to implement standards ?“standards” for how to implement standards ?

HIMSS 2005 10

Need for a Standards Implementation Process

StandardsStandards

DemandDemand

?OfferOfferStandardsStandardsStandardsStandards

UserProjects

HIMSS 2005 11

What is Integrating the Healthcare Enterprise ?

• IHE provides a common framework for passing health information seamlessly:– within the healthcare enterprise

– across multiple healthcare enterprises

– for local, regional & national health information networks.

• IHE is sponsored by healthcare professional associations (ACC, HIMSS, RSNA, etc.).

• IHE drives standards adoption to address specific clinical needs.

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IHE Maturity and Acceptance

• More than 100 healthcare vendors worldwide have contributed to IHE and the delivery of ready-to-integrate products to benefit healthcare enterprises of all sizes.

• IT professionals & clinicians appreciate IHE’s positive impact now expanded to address:– radiology, cardiology, laboratory– enterprise healthcare IT infrastructures– cross-enterprise healthcare IT infrastructures

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Understanding the IHE Initiative

• IHE has a clear focus

• IHE is a healthcare domain-based initiative

• IHE creates synergies for interoperability testing across domains

• IHE addresses the standards adoption process

• IHE is both regional and multi-national

• IHE is both user-led and vendor-driven

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A Proven Standards Adoption Process

IHEIntegrationProfiles B

IHEIntegrationProfile A

Easy toIntegrateProducts

IHEIHEConnect-a-thonConnect-a-thon

ProductWith IHE

IHEIHEDemonstrationDemonstration

User Site

RFPRFP

StandardsStandardsStandardsStandardsStandardsStandards

IHETechnical

Framework

Product IHE IntegrationStatement

IHE Integration Profiles at the heart of IHE :– Detailed selection of standards and options each solving a specific integration problem– A growing set of effective provider/vendor agreed solutions– Vendors can implement with ROI– Providers can deploy with stability

IHE Connect-a-thonResults

HIMSS 2005 15

IHE

EHR- Longitudinal Record

IHE Cardiology

IHE Laboratory

IHE Radiology

IHE

Oncology

IHE

Future Domain

IHE

IT Infrastructure Intra-Enterprise

Cross-Enterprise

14 Integration Profiles

1 Integration Profile



Achievements and expanding scope

Over 100 vendors involved world-wide, 4 Technical Frameworks27 Integration Profiles, Testing at yearly Connectathons,

Demonstrations at major exhibitions world-wide

To claim compliance to IHE Integration Profiles vendors shall publish for each product an IHE Integration Statement.

HIMSS 2005 16

**HIMSS web-based survey in November 2004 – 163 participants

6%

14%

18%

28%

35%

Fewer Point-to-PointInterfaces

Improved Use of Data

Enhanced PatientSafety

Improved Access toData

Improved ClincalWorkflow

22%

30%

52%

56%

Other

Increased Sales

Technical Framework ProvidesInformation to Marketing Staff

Reduced Deployment Costs

IHE Survey Results

– 92% of respondents were aware of IHE

– Potential benefits of IHE Improved clinical workflow + access of data = 63%

– Benefits of IHE products Reduce deployment costs

= 56%

HIMSS 2005 17

HIMSS “RHIO” withHIMSS “RHIO” withIHE-XDS Cross-enterpriseIHE-XDS Cross-enterprise

doc sharingdoc sharing

Experience your HIMSS-WideElectronic Health Record

Ambulatory Showcase BoothAmbulatory Showcase Booth

HomeHome

PCP

MultispecialtyMultispecialtyClinicClinic

Diag CenterDiag Center

Vendor BoothVendor Booth








Cross-enterprise Showcase Booth

Cardiology Workup

ComprehensivePatient Care

RadiologyRadiology CoordinatedCoordinatedPatient EvaluationPatient Evaluation

ITInfrastructure

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community

Clinical Encounter

Clinical IT System Index of patient 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

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Standards selection for IHE XDSStandards selection for IHE XDSNo single standard can address

Cross-enterprise Document Sharing

Marriage of healthcare standards facilitates implementation and leverages complementary

technologies (e.g. security & privacy).

HealthcareContent Standards

HL7 CDA, CEN EHRcomHL7, ASTM CCR

DICOM, etc.

Internet StandardsHTML, HTTP,

ISO, PDF, JPEG, etc.

Electronic BusinessStandards

ebXML Registry, SOAP, etc.

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Acute Care (Inpatient)

PCPs and Clinics (Ambulatory)

Long Term Care

Other Specialized Careor Diagnostics Services

Registering and accessing Documents

EHR-CR: Care Record systemssupporting care delivery

Document Registry

DocumentRepository

EHR-LR:Longitudinal Recordas usedacross encounters

Submission of Document References

Retrieval of selected Documents

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Document Consumer

Retrieve Document

Query Documents

Patient Identity Source

Patient Identity Feed

Document Source

Document Registry

Document Repository

Provide & Register Document Set

Register Document Set

XDS Actors and Transactions

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IHE Profiles for a RHIOIntegration Profiles completed by HIMSS 2005

Cross-Enterprise Document Sharing

Registration, distribution and access across health enterprises of clinical

documents forming a patient electronic health record

New

Patient Identifier Cross-referencing

Map patient identifiers across independent identification

domains

Patient Demographics QueryNew

2004

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

2004

Personnel White PageAccess to workforcecontact information

New



domains

HIMSS 2005 23

Patient Identification ManagementEnterprises using PIX Cross Referencing with XDS

XDS Document Registry

XDSDocument

Repository

Patient Identity Source

Patient Patient Identification Identification

Domain CDomain C

Patient Patient Identification Identification Domain XADDomain XAD

Patient Patient Identification Identification Domain D2Domain D2

DocumentEntryDm=XADPid=Px

Patient Identifier X-Ref Mgr

Patient Identifier X-Ref Mgr

Patient Identity FeedDm=XAD, Pid=Px

Patient IDConsumer

Dm=CPid=Pc

XDS Document Source

XDS Doc

Dm=XADPid=Px

XDS Doc

Provide&Register Doc Set

Patient IDConsumer

XDS Document Consumer

Dm=D2Pid=Pd

Dm=XADPid=Px

Query Docs

HIMSS 2005 24

IHE Profiles for RHIOs What is available and what will be added in 2005



domains

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

Personnel White PageAccess to workforcecontact information

Cross-Enterprise Document Sharing

Registration, distribution and access across health enterprises of clinical

documents forming a patient electronic health record

Notification of Document Availability

Notification of a remote provider/ health enterprise

Cross-enterprise User Identity and

Accountability

Authentication & Auditing: Basis for Access Control

Imaging Information Content

Format of the Document Content and associated coded vocabulary

For Display Document Content

Format of the Document ContentLab Results Document Content

Format of the Document Content and associated coded vocabulary

Continuity of Care Document Content

Format of the Document Contentand associated coded vocabulary

HIMSS 2005 25

Local & Regional RHIOs Infrastructure and Interoperability

• Cross-Enterprise Document Sharing (XDS) minimizes clinical data management by the infrastructure. Transparency = Ease of Evolution

• XDS works with other IHE Integration Profiles:– Audit Trail and Node Authentication (ATNA) and Consistent Time (CT)– Patient Id Cross-referencing (PIX)– Patient Demographics Query (PDQ)

• In 2005, IHE plans to finish base set of integration profiles to build regional health networks and interoperable EHRs:– Security: Identity Management+ Accountability– Content Profiles: DICOM, HL7-CDA/CCR, HL7-Lab, PDF.– Notification of Document Availability (with XDS document reference)

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IHE: RHIOs’ Interoperability Partner

• IHE offers a solid technical foundation to establish interoperability for RHIOs.

• Standards-based, open, multi-vendor, provider-led.

• Yearly progress, validation testing built in, backed by a proven process. Implementation by many vendors.

• RHIOs’ technical architects’ needs direct IHE involvement. Policies easier to establish when based on solid IHE Technical Framework, but are beyond IHE’s scope. They remains RHIOs’ responsibility.

IHE IT Infrastructure Committee:

Tuesday 15th 1:00-3:00 pm HIMSS Room A134

HIMSS 2005 27

W W W . I H E . N E TW W W . I H E . N E T

Thank YouThank YouQuestions ?Questions ?