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Laboratory toAmbulatory EHR Workflows
Laboratory toAmbulatory EHR Workflows
Charles ParisotGE Healthcare
IHE IT Infrastructure Technical Committee co-chair
July 2005 Interoperability for Lab - IHE Canada2
W W W . I H E . N E TW W W . I H E . N E T
Providers and VendorsProviders and Vendors
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
July 2005 Interoperability for Lab - IHE Canada3
Lab to Ambulatory EHR Interoperability Lab to Ambulatory EHR Interoperability WorkflowsWorkflows
• Two primary workflows models are used around the world:
– Contract to Lab model: the ambulatory physician is the lab customer and sends the patient or specimen to selected lab.
– Collaborative Lab Model: the patient selects lab and follows physician’s lab prescription.
• Both models exist is most countries but one of the two often is the most prevalent
• Workflow contains two time segments:
– Electronic Order/Real-Time Result Communication: ordering physician, patient and laboratory. Completes when result “delivered”.
– Access to Historical Results: Same patient but in later encounters need access to previous performed lab studies.
Does IHE offers today the corresponding basic interoperability Does IHE offers today the corresponding basic interoperability ??
July 2005 Interoperability for Lab - IHE Canada4
Patient Administration
Clinical laboratoryWard or EHR
Lab-1: Placer order
Lab-2: Filler order
Rad1, Rad-12
Patient demographics & visit
Lab-5: Results
Rad-1, Rad-12
Lab-3: Results
Lab-4: Work order
Order Result
Tracker
ADT
Automation Manager
Order Placer
Order Filler
IHE Laboratory: LSWFIHE Laboratory: LSWF
What is different in hospitals and ambulatory ?What is different in hospitals and ambulatory ?
Different
Applicable
Non Relevant
July 2005 Interoperability for Lab - IHE Canada5
Lab to Ambulatory EHR Interoperability Lab to Ambulatory EHR Interoperability WorkflowsWorkflows
Contract toLab Model
CollaborativeLab Model
eOrder
Access HistoricalLab Results
Assessment and use case positioning (non-acute care)
Access toOther
RecordsReal-Time
ResultPaperOrder
July 2005 Interoperability for Lab - IHE Canada6
Lab to Ambulatory EHR Interoperability Lab to Ambulatory EHR Interoperability WorkflowsWorkflows
Contract toLab Model
CollaborativeLab Model
eOrder
Access HistoricalLab Results
Assessment and use case positioning (non-acute care)
?
?
Access toOther
RecordsReal-Time
Result
IHE Lab ScheduledWorkflow
IHE Lab scheduled Workflow
Important ?
Real Time Result : critical for acute care and possibly ambulatory contract, not obvious for collaborative model.
PaperOrder
?
July 2005 Interoperability for Lab - IHE Canada7
Lab to Ambulatory EHR Interoperability Lab to Ambulatory EHR Interoperability First Set of ConclusionsFirst Set of Conclusions
• IHE Lab Scheduled Workflow has a critical role to play:
– Solid and proven specification with HL7 V2.5 critical improvements
– Bring the rigor and effectiveness of IHE
– Consistent approach for laboratories in acute care and ambulatory
– Best springboard to HLV3 and Infoway strategic direction
• Remaining gaps that need to be addressed by a LSWF Integration Profile Extension (multi-jurisdiction ?):
– Results and Orders Coded Terminology
– Jurisdictions specific elements
• Need a address the historical lab results access case in a non-lab specific manner
– This is the topic of the next presentation
Sharing Laboratory Resultsin
Regional & National Networks
Sharing Laboratory Resultsin
Regional & National Networks
Charles ParisotGE Healthcare
IHE IT Infrastructure Technical Committee co-chair
July 2005 Interoperability for Lab - IHE Canada9
Local & Regional RHIOs Infrastructure and Local & Regional RHIOs Infrastructure and InteroperabilityInteroperability
• IHE has been focusing significant efforts on cross-enterprise health information sharing for the past three years
• We will provide an update on this work and some of the major accomplishments in this area that do benefit the access to laboratory results.
• Discuss what can be implemented today.
July 2005 Interoperability for Lab - IHE Canada10
Selected IHE Integration Profiles for RHIOsSelected IHE Integration Profiles for RHIOsWhat is available and is added in 2005What is available and is added in 2005
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
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
Lab Results Document Content
Format of the Document Content and associated coded vocabulary For Display Document
Format of the Document ContentImaging Information Sharing
Format of the Document Content and associated coded vocabulary
Medical Summary Document Content
Format of the Document Contentand associated coded vocabulary
Cross-enterprise User Authentication
Authentication & Auditing: Basis for Access Control
Document Digital Signature
Attesting “true-copy and origin
Patient Identifier Cross-referencing
Map patient identifiers across independent identification
domains
July 2005 Interoperability for Lab - IHE Canada11
HIMSS 2005 – HIMSS 2005 – Show-Wide InteroperabilityShow-Wide InteroperabilityVendor System
Ambulatory Showcase BoothAmbulatory Showcase Booth
HomeHome
PCP
MultispecialtyMultispecialtyClinicClinic
Diag 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
HL7 BoothHL7 Booth
HIMSS “RHIO” withCross-enterprise
doc sharing (17 vendors)
July 2005 Interoperability for Lab - IHE Canada12
HIMSS 2005 InteroperabilityHIMSS 2005 InteroperabilityShow Case VendorsShow Case Vendors
Leadership LevelLeadership Level
CapMed/SanDiskCapMed/SanDiskEclipsysEclipsysGE HealthcareGE HealthcareIDXIDXInterSystemsInterSystemsKryptiqKryptiqQuovadx/CareScienceQuovadx/CareScienceSiemensSiemensWebMDWebMD
Participant LevelParticipant LevelAllscriptsAllscripts
Cedara Cedara
CernerCerner
Dictaphone Dictaphone
Eastman KodakEastman Kodak
EclipsysEclipsys
EmageonEmageon
EpicEpic
ETIAMETIAM
INFINITT Tech.INFINITT Tech.
MedcomSoft MedcomSoft
MediNotesMediNotes
MedCommonsMedCommons
MidMarkMidMark
Mortara Instrument, IncMortara Instrument, IncNational Institute National Institute ofof Standards & TechnologyStandards & Technology
NextGenNextGen
NovellNovell
Open TextOpen Text
SentillionSentillion
Supporter LevelSupporter LevelAccessPtAccessPt AGFAAGFA dbMotiondbMotion Dinmar – OacisDinmar – OacisEMCEMC HealthvisionHealthvision HealthrampHealthramp McKessonMcKesson
Valco Data SystemsValco Data Systems
July 2005 Interoperability for Lab - IHE Canada13
IHE North America Vendors (2004-2005)IHE North America Vendors (2004-2005)
• Agfa HealthCare • Allscripts • Camtronics Medical
Systems • Cedara Software Corp. • Cerner Corporation • Dictaphone Corporation • Dynamic Imaging, LLC • Eastman Kodak Company • Eclipsys • Emageon • Epic Systems
Corporation • ETIAM • FujiFilm Medical
Systems, USA, Inc. • GE Healthcare • Heartlab, Inc • Hitachi Medical
Corporation
• Hologic • IDX Systems Corp. • INFINITT Technology • InSite One, Inc. • Intelerad Medical
Systems • InterSystems
Corporation • Konica-Minolta Medical
Imaging, USA, Inc. • Kryptiq • Marotech • McKesson Information
Solutions • MedCommons Inc. • MedCon, Inc. • Merge eFilm • Mortara Instrument,
Inc. • Novell, Inc. • Philips Medical
Systems
• QRS Diagnostic • Quovadx • St. Jude Medical A.B. • Sectra Imtec A.B. • St. Jude Medical A.B. • Sectra Imtec A.B. • Sentillion • Siemens Medical
Solutions • Stentor • Swissray International,
Inc. • Tiani Medgraph A.G. • Tiani Spirit Gmbh • Toshiba Medical
Systems Company • Vital Images • WebMD Practice
Services
July 2005 Interoperability for Lab - IHE Canada14
community
Clinical Encounter
Clinical IT System Index of patients records(Document-level)
Temporary Aggregate Patient History
4-Patient data presented to
Physician
Sharing SystemSharing System
Clinic Record Specialist Record
Hospital Record
2-Referenceto Records for Inquiry
IHE-XDS : Cross-Enterprise Document SharingIHE-XDS : Cross-Enterprise Document Sharing
3-Records3-RecordsReturnedReturned
ReferenceReferenceto recordsto records
Shared Document Repository
July 2005 Interoperability for Lab - IHE Canada15
community
Clinical Encounter
Clinical IT System Index of patients records(Document-level)
Temporary Aggregate Patient History
4-Patient data presented to
Physician
Sharing SystemSharing System
Clinic Record Specialist Record
Hospital Record
2-Referenceto Records for Inquiry
Document Content shared by IHE-XDSDocument Content shared by IHE-XDS
3-Records3-RecordsReturnedReturned
ReferenceReferenceto recordsto records
Shared Document Repository
Secured Sharing of:• Medical Summaries• Images & reports• ECG Reports• PDFs• Lab Results
+ Notif of Doc Avail.
July 2005 Interoperability for Lab - IHE Canada16
community
Clinical Encounter or PHR access
Portal
Index of patients records(Document-level)
Temporary Aggregate Patient History
4-Patient data presented to
Physician or Patient
Sharing SystemSharing System
Clinic Record Specialist Record
Hospital Record
2-Referenceto Records for Inquiry
Full Integration of Portals (Doc & Patients)Full Integration of Portals (Doc & Patients)
3-Records3-RecordsReturnedReturned
ReferenceReferenceto recordsto records
Shared Document Repository
July 2005 Interoperability for Lab - IHE Canada17
Sharing Lab Results with XDSSharing Lab Results with XDSin a Regional Health Information Networkin a Regional Health Information Network
Lab B
Physician Office
Regional Health Regional Health Information Information NetworkNetwork
Lab A
Hospital-to-Lab
Lab-to-Physicians
Hospital A
July 2005 Interoperability for Lab - IHE Canada18
Sharing Lab Results with XDSSharing Lab Results with XDSin a Regional Health Information Networkin a Regional Health Information Network
Lab B
Physician Office
Regional Health Regional Health Information Information NetworkNetwork
Lab A
Hospital A
Cross-Cross-Enterprise Enterprise RegistryRegistry
July 2005 Interoperability for Lab - IHE Canada19
Sharing Lab Results with XDSSharing Lab Results with XDSin a Regional Health Information Networkin a Regional Health Information Network
Lab B
Physician Office
Regional Health Regional Health Information Information NetworkNetwork
Lab A
Hospital A
Cross-Cross-Enterprise Enterprise RegistryRegistry
Query for Query for Documents Documents
Register Lab Report Register Lab Report for sharingfor sharing
PriorLab Report
Register Lab Report Register Lab Report for sharingfor sharing
July 2005 Interoperability for Lab - IHE Canada20
Sharing Lab Results with XDSSharing Lab Results with XDSin a Regional Health Information Networkin a Regional Health Information Network
Lab B
Physician Office
Regional Health Regional Health Information Information NetworkNetwork
Lab A
Hospital A
Cross-Cross-Enterprise Enterprise RegistryRegistry
Prior Lab Report
Query for Query for documents documents
Lab ReportLab Report
Patient Id= 3547F45• Report 5/21/1998 : BloodWork B• Report 2/18/2005 : Glucose A
Notification of Notification of Doc AvailabilityDoc Availability
July 2005 Interoperability for Lab - IHE Canada21
IHE: Lab Report SharingIHE: Lab Report SharingReady to be implemented ? Ready to be implemented ?
• Gap 1: What standard for a Lab Report Document ?
– Today: wrap a complete result in “HL7 V2.x” into an XDS Document. Already demonstrated at HIMSS 2005.
– Mid-Term goal: represent lab result as CDA-R2 document with HL7 V3 Lab clinical statements (same as those of the real-time result message). IHE Lab to initiate work in 2006.
• Gap 2: Jurisdiction extensions
• Gap 3: Laboratory Terminology definition. Likely a national effort initially.
July 2005 Interoperability for Lab - IHE Canada22
IHE: Interoperability for Health Info IHE: Interoperability for Health Info NetworksNetworks
• By starting with a secured document sharing infrastructure, establish a generic platform on which to extend clinical content (more structure & coded terminology, specialized content).
• Solid SAML 2.0 authentication and document digital signature (need a PKI).
• Practical HL7 V3 approach with CDA-R2 (medical summaries) and other content (e.g. imaging, legacy content, PDF, etc.).
• Establishing a critical mass of products implementations, both in clinical applications and infrastructure for deployment in 2006.
• An architecture that caters to various regional and national architectures: centralized, decentralized and mixed.
• IHE-XDS is in use in Italy, with projects in Canada (Newfoundland), Norway and France.
July 2005 Interoperability for Lab - IHE Canada23
Lab to Ambulatory EHR Interoperability Lab to Ambulatory EHR Interoperability WorkflowsWorkflows
Contract toLab Model
CollaborativeLab Model
InitialOrder
Access HistoricalLab Results
Assessment and use case positioning (non-acute care)
XDS +
XDS +
Access toOther
RecordsReal-Time
Result
IHE Lab ScheduledWorkflow
IHE Lab scheduled Workflow
Important ?
Lab regional networks need to look beyond the classical lab Lab regional networks need to look beyond the classical lab messaging approaches used in hospital where real-time result messaging approaches used in hospital where real-time result
are critical are critical Document Sharing Document Sharing
PaperOrder
XDS +
XDS +
July 2005 Interoperability for Lab - IHE Canada24
Lab to Ambulatory EHR Interoperability Lab to Ambulatory EHR Interoperability ConclusionsConclusions
• IHE Lab Scheduled Workflow has a critical role to play:
– Solid and proven specification with HL7 V2.5 critical improvements
– Bring the rigor and effectiveness of IHE
– Consistent approach for laboratories in acute care and ambulatory
– Best springboard to HLV3 and Infoway strategic direction
• Access to historical lab results in a non-lab specific manner is critical:
– Leverage IHE Cross-enterprise Document Sharing and associated Integration profiles (e.g. security).
– Critical rationalization for ambulatory HER that will need to access other type of record than lab reports.
• Remaining gaps that need to be addressed (multi-jurisdiction ?):
– Results and Orders Coded Terminology
– Jurisdictions specific elements
July 2005 Interoperability for Lab - IHE Canada25
More information….More information….
• IHE Web sites: www.ihe.net• Technical Frameworks, Supplements:http://www.ihe.net/Technical_Framework/index.cfm
• Non-Technical Brochures :• Calls for Participation
• IHE Fact Sheet and FAQ
• IHE Integration Profiles: Guidelines for Buyers
• IHE Connect-a-thon Results
• Vendor Products Integration Statements
July 2005 Interoperability for Lab - IHE Canada26
W W W . I H E . N E TW W W . I H E . N E T
Providers and VendorsProviders and Vendors
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