September, 2005 What IHE Delivers

Charles Parisot, Charles Parisot, GE healthcare, ITI Plan co-chairGE healthcare, ITI Plan co-chair

IHE-Europe at WHIT, October 2007IHE-Europe at WHIT, October 2007

IHE integration profiles: XDS – Cross Enterprise Sharing of

Healthcare Information

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Presentation ObjectivesPresentation Objectives

What is cross-enterprise document sharingWhat is cross-enterprise document sharing

Support of semantic interoperabilitySupport of semantic interoperability

Adoption of IHE in Europe and world-wide in Adoption of IHE in Europe and world-wide in regional and national eHealth projectsregional and national eHealth projects

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Health Information Exchanges:Health Information Exchanges:Linking diverse Care Delivery and Personal Health RecordsLinking diverse Care Delivery and Personal Health Records

eHealth Information Exchange

HospitalGroup

Integrated Care Delivery EMR’s

HospitalGroup

Hospital

Hospital Multi-Practitioner

Clinics

Physician Offices

Lab/pathology

Radiology

Pharmacy

Personal Health Record

Specific Registries

Building an eHealth Infrastruture is easy….Building an eHealth Infrastruture is easy….Integrating current and existing HIT systems is the challenge !Integrating current and existing HIT systems is the challenge !

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Content

Content

Interoperability Dimensions for eHealth Info NetsInteroperability Dimensions for eHealth Info Nets

ITIT

HealthHealth

InfrastructurInfrastructuree

SecuritySecurityPrivacyPrivacy Id MgtId Mgt

HealthHealthRecordsRecordsSharingSharing

WorkflowWorkflowTransactionsTransactions

DynamicDynamicQueriesQueries

From EHR Vendor Association Interop Roadmap: www.ehrva.org

Examples:Examples:

ePrescriptionePrescription(Orders)(Orders)

Laboratory Laboratory Order/ResultsOrder/Results

Examples:Examples:

Care Record Care Record ServiceService

(includes Meds, (includes Meds, allergies, allergies,

diagnosis, labs, diagnosis, labs, etc.)etc.)

Examples:Examples:

Immunization Immunization QueriesQueries

Targeted Targeted Medication Medication

HistoryHistory

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DocumentDocumentSourceSource

DocumentDocumentSourceSource

Document Registry/Repository Model:Document Registry/Repository Model:

DocumentDocumentRepositoryRepository Submit

Doc Meta-data+ References

SubmitDocuments

DocumentDocumentRepositoryRepository

SubmitDoc Meta-data+ References

DocumentDocumentRegistryRegistry

RetrieveDocuments

Query for DocsReferences

DocumentDocumentConsumerConsumer

RetrieveDocuments

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IHE PIX / XDSIHE PIX / XDS

PATIENTS

PUBLIC HEALTH

Hospital Other Practices

PHARMACY

Clinics/GPsINSURANCES

Personal Health Record

Claim Data

Registries

LAB

Results

Rx History

Practice Mgmt

XDSRep

PIX mgr

XDS Reg

Save DocumentRegister Document

Publish Documents/RecordsSummaries, (Labs, D/Cs, Image Reports/Links, etc.)

EMR

EMR-Hosted

EMR-Lite

Portal

EMR /HIS

PACS Archive

EMR / PMS

PACS Archive

LabLab

Patient Identity FeedQuery for shared Id

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IHE PIX / XDSIHE PIX / XDS

PATIENTS

PUBLIC HEALTH

Hospital Other Practices

PHARMACY

Clinics/GPsINSURANCES

Personal Health Record

Claim Data

Registries

LAB

Results

Rx History

Practice Mgmt

XDSRep

PIX mgr

XDS Reg

Consume Documents/Records(Summaries, Labs, D/Cs, Image Reports/Links, etc.)

Patient Id FeedQuery for Patient

Query forDocuments Retrieve

Documents

EMR

EMR-Hosted

EMR-Lite

Portal

EMR / PMS

PACS Archive

EMR / PMS

PACS Archive

LabLab

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Health Information Exchanges Interoperability: Health Information Exchanges Interoperability: Cross-enterprise Document SharingCross-enterprise Document Sharing

• Performance, Scalability and Cost: Registry and Repository are simple and efficient

• Content Evolution: Registry and Repositories support any document content (e.g. enable use of HL7 CDA, DICOM, PDF, etc.).

• Real end-to-end structured data: not only a portal view, easy to integrate in healthcare applications

• Supports centralized and distributed approaches. Repositories centralized or distributed. XDS Domains may be federated.

• Real Interoperability: Standards and profiles in place, proven and in use

• Products are available: over 100 vendors world-wide. Tested at IHE Connectathons.

Selected by a significant number of regional and national programs world-wide

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Example: Example: Providing Access to Prior Health InformationProviding Access to Prior Health Information

Acute Care (Inpatient)

PCPs and Clinics (Ambulatory)

Long Term Care

Other Specialized Careor Diagnostics Services

Shared DocumentRepository

Longitudinal Record as usedacross-encounters

Encounter Medical Summary (med-prescribed & dispensed, allergies, pbs/diagnosis, etc)Lab Report (structured & coded tests results)

Radiology Report and Images

EKG Report

PublicHealth

1010Doc Exchange Integration ProfilesDoc Exchange Integration Profiles

Related Profiles for Semantic InteroperabilityRelated Profiles for Semantic Interoperability

Doc Content ProfilesDoc Content Profiles

Doc SharingDoc Sharing

XDSXDS

MediaMediaInterchangeInterchange

XDMXDM

Pt-Pt DocPt-Pt DocInterchangeInterchange

XDRXDR

ConsentConsent

BPPCBPPCEmergencyEmergency

EDEREDERPrePre

SurgerySurgery

PPHPPPHP

Scanned DocScanned Doc

XDS-SDXDS-SD

LaboratoryLaboratory

XD*-LabXD*-LabPHR PHR

ExchangeExchange

XPHRXPHR

Discharge &Discharge &ReferralsReferrals

XDS-MSXDS-MS

ImagingImaging

XDS-IXDS-I

TerminologiesTerminologies(e.g. SNOMED, LOINC, etc.(e.g. SNOMED, LOINC, etc.

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IHE Profiles for Health Info NetsIHE Profiles for Health Info Nets Broad Healthcare Information & Broad Healthcare Information & Web Services Web Services

SecuritySecurityPrivacyPrivacy Id MgtId Mgt

RecordRecordSharingSharing

WorkflowWorkflowTransactionsTransactions

DynamicDynamicQueriesQueries

Doc Doc SharingSharingX-CommunityX-CommunityPt-Pt Doc Trf Pt-Pt Doc Trf Media InterchangeMedia Interchange

Query Query Existing Existing Data Data (med, (med, allegies, allegies, immunizations, immunizations, etc.)etc.)

PIXPIXPDQPDQ

Scanned DocScanned Doc ImagingImagingLab ReportsLab Reports Med SummaryMed Summary Personal Personal

Record ExtractRecord ExtractEmergency Emergency

RecordRecord Etc…Etc…

Content

Content

InfrastructurInfrastructuree

General General RequestsRequests

Request Request Form for Form for Data Data capturecapture

Web ServicesWeb Services

Introduced in 2007: Introduced in 2007: XDS.b, XCA, PIX/PDQ V3, QED, RFD, XUAXDS.b, XCA, PIX/PDQ V3, QED, RFD, XUA

Consent Consent MgtMgt

Digit Sign Digit Sign DocsDocs

Audit Audit Trail-Node Trail-Node AuthenticAuthenticationation

User User AuthenticAuthenticationation

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Regional Network BRegional Network B

Acute Care (Inpatient)

PCPs and Clinics (Ambulatory)

Long Term Care

Other Specialized Careor Diagnostics Services

Document Registry

DocumentRepository

Longitudinal Recordas usedacross-encounters

Regional Network CRegional Network C

Regional Network ARegional Network A

Acute Care (Inpatient)

PCPs and Clinics (Ambulatory)

Long Term Care

Other Specialized Careor Diagnostics Services

Document Registry

DocumentRepository

Longitudinal Recordas usedacross-encounters

Hierarchical ExchangeHierarchical ExchangeCross Community Information Exchange (XCA, ATNA, PIX, PDQ)Cross Community Information Exchange (XCA, ATNA, PIX, PDQ)

Cross Community Cross Community BridgeBridge

Which community holds Which community holds records for a patient ?records for a patient ?

CrossCrossCommunityCommunityBridgeBridge

CrossCrossCommunityCommunityBridgeBridge

CommunityCommunityLocator serviceLocator service

Each region notifies Community Each region notifies Community Location Service when new Location Service when new patient is registered or first data is patient is registered or first data is stored.stored.

Cross Community Bridges query Cross Community Bridges query Community Locator ServiceCommunity Locator Service

Cross-Community Bridges query Cross-Community Bridges query and retrieve recordsand retrieve records

Spans across XDS and non-XDS Spans across XDS and non-XDS based communities.based communities.

IHE XCA IHE XCA TransactionsTransactions

Non-XDS basedNon-XDS basedCommunityCommunity

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IHE, global standards-based profiles adopted by IHE, global standards-based profiles adopted by several national & regional projectsseveral national & regional projects

Quebec, Toronto,Alberta, British Columbia

Canada Infoway

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

THINC- New YorkNCHICA – N. Carolina

Italy (Conto Corrente

Salute)

Boston Medical

Center - MA

FranceDMP

UK CfH(Radiology WF)

Philadelphia HIE

CHINA-MoHLab results sharing

CPHIC – Pennsylvani

a

CHINA-ShanghaiImaging Info Sharing

JAPAN-NagoyaImaging Info Sharing

South Africa

Malaysia

VITL-Vermont

CareSpark – TN & VA

NetherlandAmsterdam

LowerAustria

Austria

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Committed National Committed National Programs:Programs:

IHE XDS, PIX, PDQ, ATNA, CT, etc.IHE XDS, PIX, PDQ, ATNA, CT, etc.Austria Lower Austria Region (NOMED WAN): live since end of 2006, 1.5 Million Patients, Entire Country

(ELGA) by 2008.

Italy 4 regional projects. Genoa region, live since early 2006. National deployment planned.

Canada 7 regional projects coordinated by Infoway. Scheduled to go on-line in 2008.

France Implementation tender to be awarded in September 2007.

USA IHE Profiles adopted formally by HHS at Federal level (HITSP). Several regional projects: VT, NC,

CareSpark, CPHC, Philiadelphia Ex, CT, etc.

Netherlands Amsterdam region network project launched with NICTIZ. Implementation early 2008.

Japan One implemented project. One pilot (Nagoya) to be on-line late 2007.

China: MoH selected XDS and XD*-Lab (CDA) for two large pilots (2008). XDS-I in Shanghai.

South Africa One regional network project awarded in 2007 - 2008 production.

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StakeholdersStakeholders

Working Together to DeliverWorking Together to Deliver

Interoperable Health Information SystemsInteroperable Health Information Systems

in the Enterprisein the Enterprise

and Across Care Settingsand Across Care Settings

http://www.ihe.net

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More Resources - More Resources - www.www.iheihe.net.net Frequently Asked QuestionsFrequently Asked Questions

Integration Profiles in Technical Frameworks:Integration Profiles in Technical Frameworks:www.ihe.net/technical_frameworkswww.ihe.net/technical_frameworks : :

CardiologyCardiology IT InfrastructureIT Infrastructure LaboratoryLaboratory Patient Care CoordinationPatient Care Coordination Patient Care DevicesPatient Care Devices Radiation OncologyRadiation Oncology RadiologyRadiology

Connectathon ResultsConnectathon Results

Vendor Products Integration StatementsVendor Products Integration Statements

Participation in Committees and Connectathons:Participation in Committees and Connectathons:

www.ihe-europe.orgwww.ihe-europe.org

September, 2005 What IHE Delivers