May, 2010IHE Orientation-Rio de Janeiro 1 INTEGRATING THE HEALTHCARE ENTERPISE (IHE) Orientation Workshop International HL7 Interoperability Conference-10

May, 2010 IHE Orientation-Rio de Janeiro1

INTEGRATING THE INTEGRATING THE HEALTHCARE HEALTHCARE

ENTERPISE (IHE)ENTERPISE (IHE)Orientation WorkshopOrientation Workshop

International HL7 Interoperability Conference-10International HL7 Interoperability Conference-10Carlos Guilherme Costa, Product Manager, Alert, IHE US & Eu Connectathon participant

Julio Carau, Director, Hospital de Clinicas "Dr. Manuel Quintela", Montevideo, Uruguay

2

AgendaAgenda

This Morning:

Part 1: THE IHE STANDARDS ADOPTION PROCESS: achieving practical interoperability

This Afternoon:

Part 2:

USERS AND VENDORS WORKING TOGETHER: how can I contribute & benefit from IHE

HOW TO USE IHE RESOURCES: hands on experience

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AgendaAgenda


4

IHE: A Framework for InteroperabilityIHE: A Framework for Interoperability

A common framework for harmonizing and A common framework for harmonizing and implementing multiple standardsimplementing multiple standards Application-to-applicationApplication-to-application System-to-systemSystem-to-system Setting-to-settingSetting-to-setting

Enables seamless health information movement Enables seamless health information movement within and between enterprises, regions, nationswithin and between enterprises, regions, nations

Promotes unbiased selection and coordinated use Promotes unbiased selection and coordinated use of established healthcare of established healthcare andand IT standards to IT standards to address specific clinical needsaddress specific clinical needs

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Standards: Necessary…Not SufficientStandards: Necessary…Not Sufficient

Standards areStandards are Foundational - to interoperability and communicationsFoundational - to interoperability and communications Broad - varying interpretations and implementationsBroad - varying interpretations and implementations Narrow - may not consider relationships between Narrow - may not consider relationships between

standards domainsstandards domains Plentiful - often redundant or disjointedPlentiful - often redundant or disjointed Focused - standards implementation guides focus only Focused - standards implementation guides focus only

on a single standardon a single standard

IHE provides a standard process for IHE provides a standard process for implementing multiple standardsimplementing multiple standards

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IHE: Connecting Standards to CareIHE: Connecting Standards to Care

Healthcare professionals work with industryHealthcare professionals work with industry

Coordinate implementation of standards to Coordinate implementation of standards to meet clinical and administrative needsmeet clinical and administrative needs Clinicians and HIT professionals identify the key Clinicians and HIT professionals identify the key

interoperability problems they faceinteroperability problems they face Providers and industry work together to develop and Providers and industry work together to develop and

make available standards-based solutionsmake available standards-based solutions Implementers follow common guidelines in Implementers follow common guidelines in

purchasing and integrating effective systemspurchasing and integrating effective systems

IHE: A forum for agreeing on how to implement IHE: A forum for agreeing on how to implement standards and processes for making it happenstandards and processes for making it happen

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Standards Adoption ProcessStandards Adoption Process

Document Use Case Document Use Case RequirementsRequirementsDocument Use Case Document Use Case RequirementsRequirements

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


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

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Stakeholder BenefitsStakeholder BenefitsHealthcare providers and support staffHealthcare providers and support staff Improved workflowsImproved workflows Information whenever and wherever neededInformation whenever and wherever needed Fewer opportunities for errorsFewer opportunities for errors Fewer tedious tasks/repeated workFewer tedious tasks/repeated work Improved report turnaround timeImproved report turnaround time

VendorsVendors Align product interoperability with industry consensusAlign product interoperability with industry consensus Decreased cost and complexity of interface installation and Decreased cost and complexity of interface installation and

managementmanagement Focus competition on functionality/service space not information Focus competition on functionality/service space not information

transport spacetransport space

SDOsSDOs Rapid feedback to adjust standards to real-worldRapid feedback to adjust standards to real-world Establishment of critical mass and widespread adoptionEstablishment of critical mass and widespread adoption

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IHE Implementation StrategyIHE Implementation Strategy

Leverage established standards to allow rapid deployment and Leverage established standards to allow rapid deployment and plan for futureplan for futurePragmatic, Ease of EvolutionPragmatic, Ease of Evolution

Enable architectural freedom (patient vs. provider centric, Enable architectural freedom (patient vs. provider centric, centralized vs. decentralized, scalable (from office to centralized vs. decentralized, scalable (from office to enterprise to IDN to Regional and National Networks) enterprise to IDN to Regional and National Networks) ConfigurationConfiguration flexibilityflexibility

Support breakthrough use cases: variety of care settings, care Support breakthrough use cases: variety of care settings, care coordination, public health, PHR, EHRcoordination, public health, PHR, EHRInteroperability for broad constituenciesInteroperability for broad constituencies

IHE: Offers consistent, standards-based record IHE: Offers consistent, standards-based record sharing for EHRs and other information systemssharing for EHRs and other information systems

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12 Years of Steady Growth 1998 – 201012 Years of Steady Growth 1998 – 2010

The IHE Development DomainsThe IHE Development Domains

PharmacyNEW 2009

Pathologysince 2006

Radiation Oncologysince 2004

Radiologysince 1998

Cardiologysince 2004

Patient Care Devicessince 2005

Patient Care Coordinationsince 2004

Eye Caresince 2006

QualityResearch & Public Health

since 2006

Laboratorysince 2004

(Healthcare)IT Infrastructure

since 2003

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International Growth of IHEInternational Growth of IHE

FranceFrance

Local Deployment, National ExtensionsPromotional & Live Demonstration EventsOver 300 Organizational Members (all stakeholders)

USAUSA

GermanyGermany

ItalyItaly

JapanJapanUKUK

CanadaCanadaTaiwanTaiwan

NetherlandsNetherlandsSpainSpain

AustriaAustria

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99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

09

Pragmatic global standards harmonization + best practices sharing Pragmatic global standards harmonization + best practices sharing

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08

AustraliaAustralia

20

10

ChinaChina

TurkeyTurkey

MalaysiaMalaysia

SwitzerlandSwitzerland

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IHE Integration Profiles - ModelIHE Integration Profiles - Model

Actors in precisely defined rolesActors in precisely defined roles Abstracts a specific function of information systemAbstracts a specific function of information system

……Executing precisely defined transactionsExecuting precisely defined transactions Using existing standardsUsing existing standards

…………To solve real world interoperabilityTo solve real world interoperability problems problems Specifying Integration ProfilesSpecifying Integration Profiles

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Key IHE ConceptsKey IHE Concepts

• Generalized Systems Generalized Systems -> -> ActorsActors

• Interactions between Actors Interactions between Actors -> -> TransactionsTransactions

• Problem/Solution ScenariosProblem/Solution Scenarios -> -> IntegrationIntegration ProfilesProfiles

• For each Integration Profile:For each Integration Profile:

• the context is described (which real-world problem)the context is described (which real-world problem)

• the actors are defined (what systems are involved)the actors are defined (what systems are involved)

• the transactions are defined (what must they do)the transactions are defined (what must they do)

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The Product World…..The Product World…..

Product XYZfrom Vendor T

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The IHE World….The IHE World….

IHE ActorIHE Actor

ActorActorActorActor

ActorActor

IHEIHETransactionTransactionIHEIHE

TransactionTransaction

IHEIHETransactionTransaction

IHE ActorIHE Actor

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Mapping IHE to ProductsMapping IHE to Products

Product XYZfrom Vendor T

IHE ActorIHE Actor

ActorActorActorActor

ActorActor

IHEIHETransactionTransactionIHEIHE

TransactionTransaction

IHEIHETransactionTransaction

IHE ActorIHE Actor

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Organization of Technical FrameworksOrganization of Technical Frameworks

Volume 1: Integration and content Volume 1: Integration and content ProfilesProfilesDescribes clinical need and use casesDescribes clinical need and use cases Identifies :Identifies :

• the actors and transactions or,the actors and transactions or,• content modulescontent modules

Volume 2+ of Technical FrameworkVolume 2+ of Technical FrameworkProvides implementation specification for Provides implementation specification for

transactions or content modulestransactions or content modules

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IHE and Service Oriented ArchitecturesIHE and Service Oriented ArchitecturesSOA is a powerful business driven design methodologySOA is a powerful business driven design methodology

SOA “wraps” interoperability in “services”, but does not SOA “wraps” interoperability in “services”, but does not solve interoperability:solve interoperability:

E.g. Web Services may or may not be used in SOA. IHE Profiles are E.g. Web Services may or may not be used in SOA. IHE Profiles are largely (not always) based on Web Services.largely (not always) based on Web Services.

Standardizing Services “offered” along with the “protocols” is 20 years Standardizing Services “offered” along with the “protocols” is 20 years old (Open System Interconnect). Good, but a Service definition does old (Open System Interconnect). Good, but a Service definition does not result in compatibility “on the wire”.not result in compatibility “on the wire”.

IHE Integration profiles are supportive of Service Oriented IHE Integration profiles are supportive of Service Oriented Architecture, but do not “require” use of SOA. IHE is Service Architecture, but do not “require” use of SOA. IHE is Service Aware !Aware !

Bits have to be compatible on the wire: Bits have to be compatible on the wire: No way to avoid specifying transaction & contentNo way to avoid specifying transaction & content

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Standards Adoption ProcessStandards Adoption Process

Document Use Case Document Use Case RequirementsRequirementsDocument Use Case Document Use Case RequirementsRequirements







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

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IHE ConnectathonIHE Connectathon

Open invitation to vendor and other Open invitation to vendor and other implementors communityimplementors community

Advanced testing tools (GAZELLE)Advanced testing tools (GAZELLE)

Testing organized and supervised by project Testing organized and supervised by project management teammanagement team

Thousands of cross-vendor tests performedThousands of cross-vendor tests performed

Results recorded and publishedResults recorded and published

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Massive yearly events :Massive yearly events :70-80 vendors70-80 vendors250-300 engineers250-300 engineers100-120 systems100-120 systems…….integrated in 5 days.integrated in 5 days

IHE ConnectathonsIHE Connectathons

Vendors do not pass…Vendors do not pass…until an IHE Project Manager attest it !until an IHE Project Manager attest it !

Last Connectathon: Last Connectathon: Chicago, USA, January 11-15, 2010Chicago, USA, January 11-15, 2010Bordeaux, France, April 12-16, 2010Bordeaux, France, April 12-16, 2010

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http://www.ihe.net/Connectathon/index.cfmhttp://www.ihe.net/Connectathon/index.cfm

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Leveraging IHE Integration StatementsLeveraging IHE Integration Statements

VendorsVendors Claim IHE Compliance in an explicit wayClaim IHE Compliance in an explicit way Can rely on an objective and thorough specificationCan rely on an objective and thorough specification

(IHE Technical Framework)(IHE Technical Framework) Willing to accept contractual commitments Willing to accept contractual commitments Willing to correct “implementation errors”Willing to correct “implementation errors”

BuyersBuyers Can compare product integration capabilitiesCan compare product integration capabilities Simplify and strengthen their RFPsSimplify and strengthen their RFPs Can leverage a public and objective commitmentCan leverage a public and objective commitment Decreased cost and complexity of interface deployment and Decreased cost and complexity of interface deployment and

managementmanagement

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IHE Demonstrations: NOT an IHE ConnectathonIHE Demonstrations: NOT an IHE Connectathon

IHE ConnectathonIHE Connectathon is about is about qualifyingqualifying “real-world “real-world implementations”. Strict process and controlled implementations”. Strict process and controlled technical testing activity.technical testing activity.

It is the stick !It is the stick !

IHE demonstrationIHE demonstration is about is about education and promotioneducation and promotion about what some “connectathon tested about what some “connectathon tested implementations” can achieve.implementations” can achieve.

It is the carrot !It is the carrot !

Implementations participating to an IHE Implementations participating to an IHE Demonstration are required to have passed an IHE Demonstration are required to have passed an IHE Connectahon. Not all vendors and products are Connectahon. Not all vendors and products are demonstrated.demonstrated.

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HIMSS Interoperability ShowcaseHIMSS Interoperability Showcase

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Example: 2010 HIMSS Interoperability ShowcaseExample: 2010 HIMSS Interoperability Showcase

Implementation Tools (1)Implementation Tools (1)

Open source implementations are available for XDS, XCA, XCPD, PIX, PDQ, ATNA, CT, and more:

Microsoft under codeplex http://ihe.codeplex.com/

NIST under Source Forge http://sourceforge.net/projects/iheos/

HIE-OS under Source Forgehttp://sourceforge.net/projects/hieos/

FHA CONNECT http://www.connectopensource.org

More on the next page…..

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http://ihe.codeplex.com/





http://sourceforge.net/projects/iheos/

http://sourceforge.net/projects/hieos/

http://www.connectopensource.org/



September, 2005 28

Open source implementations are available for XDS, XCA, XCPD, PIX, PDQ, ATNA, CT, and more, from Open Health Tools: http://www.projects.openhealthtools.orgOHT – IHE Profiles (Charter)https://iheprofiles.projects.openhealthtools.org

OHT – Open Exchange (Forge)https://openexchange.projects.openhealthtools.org

OHT – Model Driven Health Tools (Charter) https://mdht.projects.openhealthtools.org

Implementation Tools (2)Implementation Tools (2)

http://www.projects.openhealthtools.org/

https://iheprofiles.projects.openhealthtools.org/

https://openexchange.projects.openhealthtools.org/

https://mdht.projects.openhealthtools.org/

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Providers and VendorsProviders and Vendors

Working Together to DeliverWorking Together to Deliver

Interoperable Health Information Systems Interoperable Health Information Systems

in the Enterprise andin the Enterprise and

http://www.ihe.net

Across Care SettingsAcross Care Settings

http://www.ihe.net/

http://www.ihe.net/

http://www.ihe.net/

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Requirements for an open HIE/EHRRequirements for an open HIE/EHRBring trust and ease of use for healthcare professionals:Bring trust and ease of use for healthcare professionals:

Care delivery organizations choose information to share:Care delivery organizations choose information to share:• Based on patient health statusBased on patient health status

• When they see fit When they see fit (discharge, end of encounter, etc.)(discharge, end of encounter, etc.)

• What information to share What information to share (pick relevant documents, and content elements).(pick relevant documents, and content elements).

Care delivery organizations access patient info through:Care delivery organizations access patient info through:• Their own local EMR Their own local EMR (if they have one)(if they have one)

• Through a shared portal/service otherwise.Through a shared portal/service otherwise.

When accessing patient info:When accessing patient info:• Find quickly if relevant information is available or not Find quickly if relevant information is available or not (single query)(single query)

• May select among relevant records May select among relevant records (may be done in background)(may be done in background)

• Among them chose to import whole or part in local patient record Among them chose to import whole or part in local patient record

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Requirements for an open HIE/EHR(2)Requirements for an open HIE/EHR(2)Bring trust and privacy to patients:Bring trust and privacy to patients:

Only authorized organizations and authenticated Only authorized organizations and authenticated healthcare providers may transact in the HIE:healthcare providers may transact in the HIE:

• Each node or IT system interfaced is strongly authenticatedEach node or IT system interfaced is strongly authenticated

• Each user shall be authenticated on the edge systemEach user shall be authenticated on the edge system

• All traffic trough the infrastructure is encryptedAll traffic trough the infrastructure is encrypted

Patient consent needs multiple choices or levelsPatient consent needs multiple choices or levels• Unless opt-in, no data about a specific patient may be sharedUnless opt-in, no data about a specific patient may be shared

• Several data sharing policies offered to the patient consentSeveral data sharing policies offered to the patient consent

• Each shared record/document is assigned to specific policies Each shared record/document is assigned to specific policies (or not shared)(or not shared) at encounter time. at encounter time.

• Healthcare providers may only access records/documents Healthcare providers may only access records/documents compatible with their role.compatible with their role.

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Categories of Healthcare Communication ServicesCategories of Healthcare Communication Services

Security

DocumentSharing

Patient and Provider ID Mgt

DynamicInformation

Access

WorkflowManagement

Source-persisted and attested health

records

Specific info snapshot

provided on demand

2 or more entitiessynchronize

a task

e.g. access to last 6 months historical

labs and encounter summaries

e.g. order a lab test, track status and receive results

e.g. get a current list of allergies or med list from a source

HospitalsHIEs and Shared EHRs

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Categories of Healthcare Communication ServicesCategories of Healthcare Communication Services

Security

DocumentSharing

Patient and Provider ID Mgt

DynamicInformation

Access

WorkflowManagement

Source-persisted and attested health

records

Specific info snapshot

provided on demand

2 or more entitiessynchronize

a task

e.g. access to last 6 months historical

labs and encounter summaries

e.g. order a lab test, track status and receive results

e.g. get a current list of allergies or med list from a source

HospitalsHIEs and Shared EHRs

Cross-Enterprise Cross-Enterprise Document Sharing (XDS)Document Sharing (XDS)

Patient Id Cross-Patient Id Cross-Referencing (PIX)Referencing (PIX)

Medical Summary Medical Summary (XDS-MS)(XDS-MS)

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IHE Profiles SpecificationsIHE Profiles Specifications

Go to: Go to: www.ihe.net/Technical_framework

For XDS:Under IT InfrastructureFor XDS:Under IT Infrastructure E.g. IT Infrastructure Technical Framework (XDS.b)E.g. IT Infrastructure Technical Framework (XDS.b)

For PIX:Under IT InfrastructureFor PIX:Under IT Infrastructure E.g. IT Infrastructure Technical Framework (PIX, HL7V2)E.g. IT Infrastructure Technical Framework (PIX, HL7V2) Or PIXV3 supplement (PIX HL7 V3).Or PIXV3 supplement (PIX HL7 V3).

For For XDSXDS-MS: Under Patient Care Coordination-MS: Under Patient Care Coordination E.g. PCC Technical framework (XDS-MS)E.g. PCC Technical framework (XDS-MS)

http://www.ihe.net/Technical_framework



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The IHE Global Standards Adoption ProcessThe IHE Global Standards Adoption Process

First Step: First Step: Propose a Use case for InteroperabilityPropose a Use case for Interoperability

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Patient Identifier Cross-referencing for MPIPatient Identifier Cross-referencing for MPIServicesServices

Allow all enterprise participants to register the Allow all enterprise participants to register the identifiers they use for patients in their domainidentifiers they use for patients in their domain

Participants retain control over their own domain’s Participants retain control over their own domain’s patient index(es)patient index(es)

Support domain systems’ queries for mapping across Support domain systems’ queries for mapping across other systems’ identifiers for their patientsother systems’ identifiers for their patients

Optionally, notify domain systems when other systems Optionally, notify domain systems when other systems update identifiers mapping for their patientsupdate identifiers mapping for their patients

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Patient Identifier Cross-referencing for MPIPatient Identifier Cross-referencing for MPIValue PropositionValue Proposition

Maintain and linked all systems’ identifiers for a Maintain and linked all systems’ identifiers for a patient in a single locationpatient in a single location

Use any algorithms (encapsulated) to find matching Use any algorithms (encapsulated) to find matching patients across disparate identifier domainspatients across disparate identifier domains

Lower cost for synchronizing data across systemsLower cost for synchronizing data across systems No need to force identifier and format changes onto existing No need to force identifier and format changes onto existing

systemssystems

Leverages standards and transactions already used Leverages standards and transactions already used within IHE within IHE

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Second Step: Second Step: Propose a design and select standards for Propose a design and select standards for such an IHE Profilesuch an IHE Profile

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Patient Identifier Cross-referencing for MPIPatient Identifier Cross-referencing for MPITransaction DiagramTransaction Diagram

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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 Identification Domain B

Patient Identity

Feed Patient Identity

Source

Internal Domain transactions

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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


B:X456C: 2RT

IdentityPatient

Cross References

B:X456C: ?

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Patient Identifier Cross-referencing for MPIPatient Identifier Cross-referencing for MPIActorsActors

Patient Identity SourcePatient Identity Source DefinitionDefinition

• Assigns patient identities within its own domainAssigns patient identities within its own domain• Notifies Patient Identifier Cross-reference Manager of all events Notifies Patient Identifier Cross-reference Manager of all events

related to patient identification (creation, merge, etc.)related to patient identification (creation, merge, etc.)• Example: Registration (ADT) Actor in IHE Radiology Scheduled Example: Registration (ADT) Actor in IHE Radiology Scheduled

Workflow (SWF) ProfileWorkflow (SWF) Profile Transaction Supported - RequiredTransaction Supported - Required

• Patient Identity Feed [ITI-8] (as sender)Patient Identity Feed [ITI-8] (as sender)

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Patient Identifier Cross-reference ConsumerPatient Identifier Cross-reference Consumer DefinitionDefinition

• Requires information about patient identifiers in other domainsRequires information about patient identifiers in other domains• Requests patient identifier information from Patient Identifier Requests patient identifier information from Patient Identifier

Cross-reference ManagerCross-reference Manager Transaction Supported - RequiredTransaction Supported - Required

• PIX Query [ITI-9] (as sender)PIX Query [ITI-9] (as sender) Transaction Supported - OptionalTransaction Supported - Optional

• PIX Update Notification [ITI-10] (as receiver)PIX Update Notification [ITI-10] (as receiver)

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Patient Identifier Cross-reference ManagerPatient Identifier Cross-reference Manager DefinitionDefinition

• Serves a well-defined set of Patient Identifier DomainsServes a well-defined set of Patient Identifier Domains• Receives patient identifier information from Patient Identity Source Receives patient identifier information from Patient Identity Source

ActorsActors• Manages cross-referencing of identifiers across domainsManages cross-referencing of identifiers across domains

Transactions Supported - RequiredTransactions Supported - Required• Patient Identity Feed [ITI-8] (as receiver)Patient Identity Feed [ITI-8] (as receiver)• PIX Query [ITI-9] (as receiver)PIX Query [ITI-9] (as receiver)• PIX Update Notification [ITI-10] (as sender)PIX Update Notification [ITI-10] (as sender)

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Patient Identifier Cross-referencing for MPIPatient Identifier Cross-referencing for MPIStandards Used: 2 ProfilesStandards Used: 2 Profiles

PIX: HL7 Version 2.5PIX: HL7 Version 2.5 ADT Registration and Update Trigger Events (HL7 2.3.1)ADT Registration and Update Trigger Events (HL7 2.3.1)

• A01: inpatient admissionA01: inpatient admission• A04: outpatient registrationA04: outpatient registration• A05: pre-admissionA05: pre-admission• A08: patient updateA08: patient update• A40: merge patientA40: merge patient

Queries for Corresponding Identifiers Queries for Corresponding Identifiers (ADT^Q23/K23)(ADT^Q23/K23) Notification of Identifiers Lists Updates Notification of Identifiers Lists Updates (ADT^A31)(ADT^A31)

PIX V3: HL7 V3PIX V3: HL7 V3 Leverage Web Services (harmonized WS by IHE Leverage Web Services (harmonized WS by IHE

Appendix V)Appendix V)

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Third Step: Third Step: Engage implementers for Testing Trial Implementation Engage implementers for Testing Trial Implementation profile at Connectathonsprofile at Connectathons

Fourth Step:Fourth Step:Based on lessons learned from Connectathons Based on lessons learned from Connectathons implementers, correct/clarify Profile and Publish as implementers, correct/clarify Profile and Publish as “Final Text” in Domain Technical Framework.“Final Text” in Domain Technical Framework.

Will be presented in part 2Will be presented in part 2

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IHE offers a broad collection of ProfilesIHE offers a broad collection of Profiles

Use Cases addressed are specified in a series of Domain Use Cases addressed are specified in a series of Domain Technical Frameworks (Volume 1)Technical Frameworks (Volume 1)

Two broad classes of profiles: Integration (how to move Two broad classes of profiles: Integration (how to move the data) and Content (what the data conveys).the data) and Content (what the data conveys).

A few example of “cross-enterprise” integration and A few example of “cross-enterprise” integration and content profilescontent profiles

Complete list on: Complete list on: www.ihe.net/technical_framework

http://www.ihe.net/technical_frameworks



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Community

Clinical Encounter

Clinical IT System

Health Info ExchangeHealth Info Exchange

Clinic Record Specialist Record

Hospital Record

Registering Health Records:IHE-XDSRegistering Health Records:IHE-XDS

1-Reference1-Referenceto recordsto records

Repository ofRepository ofDocumentsDocuments


Index of Index of patients recordspatients records

49

Community

Clinical Encounter

Clinical IT System

Aggregate Patient Info

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

PhysicianPhysician

HIEHIE

Clinic Record Specialist Record

Hospital Record

2-Reference2-Referenceto Records to Records for Inquiryfor Inquiry

Access to Shared Records : IHE-XDSAccess to Shared Records : IHE-XDS

3-Records3-RecordsReturnedReturned



Index of Index of patients recordspatients records

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

Cross-Enterprise Document Sharing simplifies clinical Cross-Enterprise Document Sharing simplifies clinical data management by defining interoperable infrastructure. data management by defining interoperable infrastructure.

Transparency = Ease of EvolutionTransparency = Ease of Evolution

Patients have guaranteed portability and providers may Patients have guaranteed portability and providers may share information without concerns of aggregation errors.share information without concerns of aggregation errors.Digital Documents = Patients Digital Documents = Patients andand providers empowerment providers empowerment

Supports Supports both centralized and decentralizedboth centralized and decentralized repository repository architectures. Ease of architectures. Ease of federationfederation nationally. nationally. Flexible Flexible privacy, privacy, Flexibility of configurationsFlexibility of configurations

Addresses the need for a longitudinal healthcare data Addresses the need for a longitudinal healthcare data (health records). Complements to interactive workflow or (health records). Complements to interactive workflow or dynamic access to data. dynamic access to data.

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Cross-Enterprise Document Sharing (XDS) Cross-Enterprise Document Sharing (XDS) Standards UsedStandards Used

HealthcareContent StandardsHL7 CDA header extract

HL7 data types

Internet StandardsHTTP, IETF, W3C, …

Electronic BusinessStandards

ebXML Registry, SOAP, Web Services …

Implemented world-wide by over 150 vendors/open source.Implemented world-wide by over 150 vendors/open source.

Adopted in several national & regional projects:Adopted in several national & regional projects:Italy, Austria, Canada, USA, Japan, South Africa, France, Netherlands, Italy, Austria, Canada, USA, Japan, South Africa, France, Netherlands, etc.)etc.)

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Why is IHE-XDS a breakthrough ?Why is IHE-XDS a breakthrough ?

It based on an International Standards; ebXML registry: OASIS and It based on an International Standards; ebXML registry: OASIS and ISO standard, Web Service/Soap/XML.ISO standard, Web Service/Soap/XML.

Sharing of digital documents as “attested by the source”, meets the Sharing of digital documents as “attested by the source”, meets the most urgent needs. A most urgent needs. A provenproven healthcare community healthcare community data-sharingdata-sharing paradigm paradigm ((Feeding a central web server is view only and hinders use of EHRsFeeding a central web server is view only and hinders use of EHRs).).

Efficient to support Efficient to support all types of Health IT Systemsall types of Health IT Systems (IDNs, Hospitals, (IDNs, Hospitals, Ambulatory, Pharmacy, Diagnostics Centers, etc.) and Ambulatory, Pharmacy, Diagnostics Centers, etc.) and all types of all types of informationinformation (summaries, meds, images, lab reports, ECGs, etc.), (summaries, meds, images, lab reports, ECGs, etc.), structured and unstructuredstructured and unstructured..

Meets both the needs of push communication by info sources and on-Meets both the needs of push communication by info sources and on-demand pull in a variety of centralized or distributed architectures.demand pull in a variety of centralized or distributed architectures.

Offer a consistent, standards-based and functional Offer a consistent, standards-based and functional record sharing for EHRs, PHRs & other IT Systemsrecord sharing for EHRs, PHRs & other IT Systems

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Combining IHE ProfilesCombining IHE ProfilesDocument Content & Modes of Document ExchangeDocument Content & Modes of Document Exchange

Document Exchange Integration ProfilesDocument Exchange Integration Profiles

DocumentDocument SharingSharing

XDS / XCAXDS / XCA

MediaMediaInterchangeInterchange

XDMXDM

Reliable Pt-PtReliable Pt-PtInterchangeInterchange

XDRXDR

Doc Content Profiles Doc Content Profiles (Semantics content)(Semantics content)

Scanned DocScanned Doc

XDS-SDXDS-SD

LaboratoryLaboratory

XD*-LabXD*-LabPHR PHR

ExchangeExchange

XPHRXPHR

Discharge &Discharge &ReferralsReferrals

XDS-MSXDS-MS

ImagingImaging

XDS-IXDS-I

ConsentConsent

BPPCBPPCEmergencyEmergency

EDREDRPre-Pre-

SurgerySurgery

PPHPPPHP

Functional Status Functional Status AssesmentAssesment

FSAFSA

54

Acute Care (Hospital)

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

55

Acute Care (Inpatient)

PCPs and Clinics (Ambulatory)

Long Term Care

Other Specialized Careor Diagnostics Services

Building and accessing DocumentsBuilding and accessing Documents

Care RecordCare Record systems systemssupportingsupporting care delivery care delivery

Documents Registry

DocumentRepository

Longitudinal RecordLongitudinal Recordas usedas usedacross-encountersacross-encounters

Submission of Document References

Retrieve of selected Documents

56

Cross-Enterprise Document Sharing (XDS.b) Cross-Enterprise Document Sharing (XDS.b) Actor/Transaction DiagramActor/Transaction Diagram

Document Consumer

Retrieve Document Set

Query Documents

Patient Identity Source

Patient Identity Feed

Document Source

Document Registry

Document Repository

Provide&Register Document Set

Register Document Set

57

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.

58

XDS - Value PropositionXDS - Value Proposition

Distributed: Each Care delivery organization “publishes” clinical information for others. Actual documents may remain in the source EHR

Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain (e.g. a region).

Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (HL7-CDA, 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.

59

How real is XDS ?How real is XDS ?Stable specification IHE Technical Framework PublishedStable specification IHE Technical Framework Published

XDS.b Supplement that offers:XDS.b Supplement that offers: Use most recent Web Services stds (MTOM/XOP)Use most recent Web Services stds (MTOM/XOP) Allow Retrieve sets of Documents in one transactionAllow Retrieve sets of Documents in one transaction Same servicesSame services

First implementation in clinical use in region of Genoa - First implementation in clinical use in region of Genoa - Italy) since early 2006.Italy) since early 2006.

Several since: Lower Austria region, State of Vermont, Several since: Lower Austria region, State of Vermont, Nagoya city, South Africa region, Dutch regions, etc.Nagoya city, South Africa region, Dutch regions, etc.

Adopted by several national programs world-wideAdopted by several national programs world-wide

4 open source toolkits available, numerous product 4 open source toolkits available, numerous product implementations in EMRs and Infrastructure offerings.implementations in EMRs and Infrastructure offerings.

60

IHE, Global Standards-Based Profiles IHE, Global Standards-Based Profiles Adopted in National & Regional Projects (sample)Adopted in National & Regional Projects (sample)

Quebec, Toronto,Alberta, British ColumbiaCanada Infoway

THINC- New YorkNCHICA – N. Carolina

Italy Conto CorrenteVenetto - Friuli

Boston Medical

Center - MA

Philadelphia HIE

CHINA-MoHLab results sharing

CHINA-ShanghaiImaging Info Sharing

JAPAN-NagoyaImaging Info Sharing,

Nationwide PDI guideline

South Africa

VITL-Vermont

CareSpark – TN & VA

NETHERLANDSFriesland

Natn’l Mamography

LowerAustria

Austria

FranceDMPWales

Imaging

BelgiumFlemish-Leuven

SuisseSt GallenLausane

Providence Health

System - OR

KeyHIE Pennsylvani

a

SHARP CA

France Imaging

IDF

60

For more complete list see:For more complete list see: tinyurl.com/wwXDS tinyurl.com/wwXDS

61

IHE-XDS is part of a family of profilesIHE-XDS is part of a family of profiles

Regional, national, local or disease centric networks need Regional, national, local or disease centric networks need a consistent set of Integration Profilesa consistent set of Integration Profiles

FifthteenFifthteen Integration Profiles completed and tested, plus Integration Profiles completed and tested, plus fivefive ready to implement = Standards-based ready to implement = Standards-based interoperability building blocks forinteroperability building blocks for Rich Document Content for end-to-end application interoperability.Rich Document Content for end-to-end application interoperability. Patient identification managementPatient identification management Security and privacySecurity and privacy Notification and data captureNotification and data capture

IHE-XDS + related IHE Integration profiles provide a IHE-XDS + related IHE Integration profiles provide a complete interoperability solutioncomplete interoperability solution

62

IHE Integration Profiles for Health Info NetsIHE Integration Profiles for Health Info Nets What What is availableis available and and in trial implementationin trial implementation

Emergency Referrals Format of the Document Content

and associated coded vocabulary PHR Extracts/Updates

Format of the Document Content and associated coded vocabulary

ObGyn Documents


Lab Results Document Content


Scanned Documents Format of the Document ContentImaging Information


Medical Summary (Meds, Allergies, Pbs)

Format of the Document Contentand associated coded vocabulary

Clinical and PHR ContentClinical and PHR Content

Health Data ExchangeHealth Data Exchange

Patient Demographics Query

Patient Identifier Cross-referencing

Map patient identifiers across independent identification

domains

Document Subscription and

Notification

Request Formfor Data Capture

External form with custom import/export scripting

Patient ID MgmtPatient ID Mgmt

OtherOther

Final Text ApprovedFinal Text Approved

Trial Implementation-2009Trial Implementation-2009–– Final Txt 2010Final Txt 2010

Cross-Enterprise Document Sharing

Registration, distribution and access across health enterprises of clinical

documents forming a longitudinal record

Cross-Enterprise Document Pt-Pt Reliable InterchangeCross-Enterprise Document

Media InterchangeCross-Community Access

Security & PrivacySecurity & Privacy

Consistent TimeCoordinate time across networked

systems

Audit Trail & Node Authentication

Centralized privacy audit trail and node to node authentication to create

a secured domain.

Basic Patients Privacy Consents

Establish Consents & Enable Access Control

Document Digital Signature

Attesting “true-copy and origin

Cross-Enterprise User Assertion

Provides Trusted Identity

63

XDS-MS and XPHR enable both semantic XDS-MS and XPHR enable both semantic interoperability & simple viewing !interoperability & simple viewing !

SSttrruuccttuurreedd CCoonntteenntt wwii tthh ccooddeedd sseecctt iioonnss::

Reason for Referral Vital Signs

MMeeddiiccaattiioonn

Studies AAlllleerrggiieess

Social History PPrroobblleemmss

Care Plan

XDS-MS Medical Summary or PHR Extract ExchangeXDS-MS Medical Summary or PHR Extract ExchangeProfile based on HL7 CDA Rel 2 and HL7 CCD IGProfile based on HL7 CDA Rel 2 and HL7 CCD IG

Structured and Coded Header Patient, Author, Authenticator, Institution, Time of Service, etc.

Header always structured and coded

Title-coded sections with non-structured nor coded content (text, lists, tables). Simple Viewing (XML Style sheet)

Level 1Level 1

Level 2Level 2

Text StructureEntry

Text Structure Entry

Med, Problems and Allergies as highly structured text. Text easy to import/parse

Text StructureEntry

Level 3Level 3

Med Problems and Allergies have afine-grain structure with optional coding. Coding Scheme explicitly identified.

Coded Section Entry

Coded Section Entry

Coded Section Entry

Level 3Level 3

64

Use of a shared XDS infrastructure to access Use of a shared XDS infrastructure to access Radiology Reports and Images (XDS-I)Radiology Reports and Images (XDS-I)

HospitalHospital

Imaging CenterImaging CenterPhysician PracticePhysician Practice

Between Radiology and :Between Radiology and :• Imaging specialistsImaging specialists• Non-imaging cliniciansNon-imaging clinicians PACS Y

PACS Z

Radiology -to-Radiology -to-RadiologyRadiology

Radiology -to-Radiology -to-PhysiciansPhysicians

Same XDS InfrastructureSame XDS Infrastructure (Registry and Repositories) (Registry and Repositories)

for medical summaries and imaging information !for medical summaries and imaging information !

65



Interoperable Health Information Systems Interoperable Health Information Systems

AndAnd Across Care SettingsAcross Care Settings

Intra Hospital Workflows and Information AccessIntra Hospital Workflows and Information Access

http://www.ihe.net

in the Enterprisein the Enterprise

http://www.ihe.net/

http://www.ihe.net/

http://www.ihe.net/

66

IHE Solutions within the EnterpriseIHE Solutions within the Enterprise

eMPIeMPIUser AuthUser Auth

EnterpriseEnterpriseIT InfrastructureIT Infrastructure


LISLIS

Auto MgrAuto Mgr AnalyzerAnalyzer

EMR - HISEMR - HISEMR - HISEMR - HIS

CardiologyCardiology

CISCIS

CathCath ECGECG

RadiologyRadiology

RISRIS

PACSPACSImg AcqImg Acq

Eye CareEye Care

PathologyPathology

Radiation TherapyRadiation Therapy

Therapy PlanTherapy Plan

Img AcqImg AcqTreatmentTreatment

Intensive Care UnitIntensive Care Unit

Nursing StationNursing Station

DevicesDevicesDevicesDevices

HomeHomeHubHub

DevicesDevicesPharmacyPharmacy

EstablishedEstablishedFeb 2009Feb 2009

67

IHE Solutions within the Enterprise IHE Solutions within the Enterprise Example: Example: CardiologyCardiology




LISLIS




CISCIS

CathCath ECGECG

RadiologyRadiology

RISRIS


Eye CareEye Care

PathologyPathology







HomeHomeHubHub



Cardiology Integration ProfilesCardiology Integration ProfilesCardiac Catheterization Lab WorkflowCardiac Catheterization Lab WorkflowEchocardiography Lab WorkflowEchocardiography Lab WorkflowRetrieve ECG for DisplayRetrieve ECG for DisplayDisplayable ReportsDisplayable ReportsCath and Echo Evidence DocumentsCath and Echo Evidence Documents

68

IHE Solutions within the Enterprise IHE Solutions within the Enterprise Example: Example: IT InfrastructureIT Infrastructure




LISLIS




CISCIS

CathCath ECGECG

RadiologyRadiology

RISRIS


Eye CareEye Care

PathologyPathology







HomeHomeHubHub



IT Infrastructure Integration ProfilesIT Infrastructure Integration ProfilesPatient Administration ManagementPatient Administration ManagementPatient Demographics Query Patient Demographics Query Patient Identifier Cross-referencingPatient Identifier Cross-referencingRetrieve Information for DisplayRetrieve Information for DisplayEnterprise User AuthenticationEnterprise User AuthenticationConsistent TimeConsistent TimePatient Synchronized ApplicationsPatient Synchronized ApplicationsAudit Trail and Node AuthenticationAudit Trail and Node AuthenticationPersonnel White PagesPersonnel White PagesShared Value SetsShared Value Sets

69

IHE Solutions within the EnterpriseIHE Solutions within the EnterpriseExample: Example: RadiologyRadiology




LISLIS




CISCIS

CathCath ECGECG

RadiologyRadiology

RISRIS


Eye CareEye Care

PathologyPathology







HomeHomeHubHub



Radiology Integration ProfilesRadiology Integration ProfilesRadiology Scheduled WorkflowRadiology Scheduled WorkflowPatient Information ReconciliationPatient Information ReconciliationAccess to Radiology InformationAccess to Radiology InformationPortable Data for ImagingPortable Data for ImagingConsistent Presentation of ImagesConsistent Presentation of ImagesKey Image NoteKey Image NotePresentation of Grouped ProceduresPresentation of Grouped ProceduresEvidence DocumentsEvidence DocumentsAudit trail and Node Authentication Audit trail and Node Authentication (Rad option)(Rad option)

Teaching Files and Clinical Trials ExportTeaching Files and Clinical Trials ExportPost-processing WorkflowPost-processing WorkflowReporting WorkflowReporting WorkflowCharge PostingCharge PostingSimple Image and Numeric ReportsSimple Image and Numeric Reports

70

IHE Solutions within the Enterprise IHE Solutions within the Enterprise Example: Example: LaboratoryLaboratory




LISLIS




CISCIS

CathCath ECGECG

RadiologyRadiology

RISRIS


Eye CareEye Care

PathologyPathology







HomeHomeHubHub



Laboratory Integration ProfilesLaboratory Integration ProfilesLaboratory Testing WorkflowLaboratory Testing WorkflowLaboratory Information Reconciliation Laboratory Information Reconciliation Laboratory Point Of Care TestingLaboratory Point Of Care Testing Laboratory Device Automation Laboratory Device Automation Laboratory Code Set DistributionLaboratory Code Set DistributionLaboratory BarCodeLaboratory BarCode

71

Laboratory Testing Workflow (LTW) Laboratory Testing Workflow (LTW) & Laboratory Device Automation (LDA)& Laboratory Device Automation (LDA)

Order FillerOrder Placer

Order Result Tracker

Placer order

Filler order

ResultsResults Work order

LTW LDA

Work Order Steps

Query & download modes

AnalyzerPre/post

processor

Automation Manager

Tests results

Profiles based on HL7 V2.5.1Profiles based on HL7 V2.5.1Solid implementation experienceSolid implementation experience

72

IHE Solutions within the EnterpriseIHE Solutions within the EnterpriseExample: Example: Patient Care DevicesPatient Care Devices




LISLIS




CISCIS

CathCath ECGECG

RadiologyRadiology

RISRIS


Eye CareEye Care

PathologyPathology







HomeHomeHubHub

PersonalPersonalDevicesDevices

PharmacyPharmacy


Patient Care Devices ProfilesPatient Care Devices ProfilesDevice Enterprise Communication (DEC) Device Enterprise Communication (DEC) Alarm Communication Mgt (ACM) Alarm Communication Mgt (ACM) Subscribe to Patient Data (SPD)Subscribe to Patient Data (SPD)Patient Identity Binding (PIB)Patient Identity Binding (PIB)Rosetta Terminology Mapping (RTM)Rosetta Terminology Mapping (RTM)

73



Interoperable Health Information SystemsInteroperable Health Information Systems

in the Enterprisein the Enterprise

and Across Care Settingsand Across Care Settings

http://www.ihe.net

http://www.ihe.net/

http://www.ihe.net/

http://www.ihe.net/

74

AgendaAgenda


This Afternoon:

Part 2:

USERS AND VENDORS WORKING TOGETHER: how can I contribute & benefit from IHE

HOW TO USE IHE RESOURCES: hands on experience

May, 2010 IHE Orientation-Rio de Janeiro75

See you for Part 2, this afternoonSee you for Part 2, this afternoon