HL7 UK, London October 26, 2005 Charles Parisot GE Healthcare Information Technologies

Strategies for Implementing the Digital Healthcare Community

Practical conditions for business adoption of standards HL7 UK, LondonOctober 26, 2005Charles ParisotCharles ParisotGE Healthcare Information TechnologiesGE Healthcare Information Technologies

HL7 UK 2006 - The future of Integration 2 25-26 October 2006

Topics

• Interoperability and digital communities

• Critical success factors for standards adoption

• Establishing a digital community framework at the international level

• Examples of successful interoperability

• Summary


Open, standards-based interoperability critical to building a digital community •Congratulations to

standards development and implementation organizations

•Interoperability creates markets… e.g. $1B+ PACS

•More importantly… Interoperability transforms patient care

•GE interoperability at: http://www.gehealthcare.com/usen/interoperability


Standards in the real-world

• One sort of healthcare interoperability standards… Those that are adopted !

• Multiplicity of Standards development organizations in healthcare… necessity given the breadth, complexity and technological evolution, but each one needs to be global by domain.

• Calculated risks to Introduce new standards…. require the first line stakeholders: vendors and providers to gain confidence to implement (focused use cases).

• Interoperability Standards are deployed in incremental steps.

• A Standards Implementation Process needed to orchestrate: Requires an implementation “conductor”.


Vendors, Clinicians & CIO’s key to driving interoperability as stakeholders•Clinicians… Quality of care, safety, productivity, affordability

•CIOs… Cost effective, plug-n-play, “future-proof”

•Vendors… Reliability, ready to implement standards, speed to market


Proven Standards Adoption Process: IHE

Document use Document use case case requirementsrequirements

Document use Document use case case requirementsrequirements

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

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

Develop Develop technical technical

specificationsspecifications

Develop Develop technical technical

specificationsspecifications

Testing at Testing at connectathonsconnectathonsTesting at Testing at connectathonsconnectathons

IHE IHE demonstrationsdemonstrationsIHE IHE demonstrationsdemonstrations

Products Products with IHEwith IHEProducts Products with IHEwith IHE

Timely access to Timely access to informationinformationTimely access to Timely access to informationinformation

Easy to integrate Easy to integrate productsproductsEasy to integrate Easy to integrate productsproducts


Sharing a Common Framework Internationally ?

•Belief that differences in health systems create insurmountable barriers and requires national customization. Over 10 countries are already rushing down this path.

Many believe that it cannot be done, it is already in progress. Loosing time ? No, results with faster and cheaper deployment

•Once one realizes that challenge is to “connect” the IT systems used in thousands of point of care. This is the primary interface to address with a globally harmonized standards-based framework

•Much energy spent creatinginternationally agreed standards

•Only partially true for clinical information. Languages, some existing codifications, and order in deployment strategies shall be accommodated.


US EHR Vendor Association: A roadmap Phase-in of Communication Services

available

6 mos to2yrs

2yrs +

Phase 4: Active Quality Reporting

& Health SurveillancePhase 3: Advanced Clinical Support & Access Control

Phase 2: Share Diagnostic Results &

Therapeutic Information

Phase 1: Share Care Status Information

From: www.himssehrva.org


Realizing the complementary roles of document sharing and of message

based transactionsEnd-Point System To End-Point SystemInterchange

End-Point Systems to National Infrastructure Sub-network Communication

From HIMSS EHRVA Response to ONCHIT RFI, January 2005

e.g. EMR e.g. Lab, PACSEMR, etc.

• Thin set of Health Net Services – facilitates information exchange• End-Point System services exist at two distinct levels • Net/Subnet communication level – e.g., IHE/XDS (Cross-enterprise Doc. Sharing)

• Peer-to-Peer level – transparent to infrastructure, e.g., doc content / type

Internet

Document Sharing

Dynamic Information

Mgmt

... ... Med

icat

i ons

PushNotificati

on( eRx,

eReferral )Transaction

Mgmt

Clinical Content Clinical Content

Security &Identity

Historical Documents

DynamicQueries

WorkflowTransaction

Record Locator ServicesRecord Locator Services

Patient &Provider ID Mgmt

AccessControl

CD

A

Lab

resu

lts

PD

F

Rad

iolo

gy

Allerg

ies

Med

icati

on

s

Internet

Document Sharing

Dynamic Information

Mgmt

... ... Med

icat

i ons

PushNotificati

on( eRx,

eReferral )Transaction

Mgmt

Clinical Content Clinical Content

Record Locator ServicesRecord Locator Services

Patient &Provider ID Mgmt

AccessControl

Med

Su

mm

aie

s

Lab

resu

lts

Scan

Docs

Rad

iolo

gy

Allerg

ies

Med

icati

on

s


Community orsub-network

Clinical EncounterClinical Encounter

Clinical IT SystemClinical IT System Index of patients records(Document-level)

Aggregate Aggregate Patient InfoPatient Info

4-Patient data 4-Patient data presented to presented to

PhysicianPhysician

Sharing SystemSharing System

Clinic RecordClinic Record Specialist RecordSpecialist Record

Hospital RecordHospital Record

2-Reference2-Referenceto Records to Records for Inquiryfor Inquiry

Indexing Patient Centric Documents : IHE-XDSIndexing Patient Centric Documents : IHE-XDS

3-Records3-RecordsReturnedReturned

ReferenceReferenceto recordsto records

Repository ofDocuments

Repository ofDocuments


Doc Exchange Integration ProfilesDoc Exchange Integration Profiles

Document Content and Modes of Document Exchange

Doc Content Profiles Doc Content Profiles (CDA R2+V3-RMIM+DICOM+PDF)(CDA R2+V3-RMIM+DICOM+PDF)

Doc SharingDoc Sharing

XDSXDS

MediaMediaInterchangeInterchange

XDMXDM

Pt-Pt DocPt-Pt DocInterchangeInterchange

XDRXDR

LaboratoryLaboratory

XD*-LabXD*-LabPatientPatientInputInput

XPHRXPHR

ConsentConsent

BPPCBPPCEmergencyEmergency

EDREDRPrePre

SurgerySurgery

PPHPPPHP

Scanned DocScanned Doc

XDS-SDXDS-SD

Discharge &Discharge &ReferralsReferrals

XDS-MSXDS-MS

ImagingImaging

XDS-IXDS-I


IHE & Regional and National Projects Today

Canada Infoway

HITSP InteroperabilitySpecifications

Denmark (Funen)Italy (Veneto)Spain (Aragon)

Austria

THINC- New YorkNCHICA – N. Carolina

Italy (Conto CorrenteSalute)

MA-Share – MAIHIE – INMendicino - CA

FranceDMP

UK CfHRadiology


Summary• Interoperability for national

influences local strategies… internet vs. intranet

•Modular approach allows incremental build-out of digital communities

• IHE Showcases are demo’ing profiles that will be used to build regional/national nets.

•Today… Count on GE for interoperability leadership

•Tomorrow… Count on GE to enable personalized health information exchange
