May 2011 Value of IHE1

INTEGRATING THE HEALTHCARE ENTERPISEValue of IHE Profiles and testing for cross-

institutional health services

FINteroperability in Health 2011Charles Parisot, IHE International Board & IHE-Europe Steering Committee,

GE healthcare

Interoperability: From a problem to a solution

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Profile Development eHealth Projects

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Project Specific ExtensionsIHTSDO

IETF

Profiling Organizations are well established

Base Standards

IHE Europe & IHE NationalIHE

International

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Standards Adoption Process

Document Use Case RequirementsDocument Use Case Requirements

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

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

Develop technical

specifications

Develop technical

specifications

Testing at ConnectathonsTesting at Connectathons

IHE DemonstrationsIHE Demonstrations

Products with IHEProducts with IHE

Timely access to informationTimely access to information Easy to integrate

productsEasy to integrate products

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13 Years of Steady Evolution 1998 – 2011

The IHE Development Domains

PharmacySince 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

since 2008

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International Growth of IHE

France

Local Deployment, National Extensions Promotional & Live Demonstration Events Over 400 Organizational Members

(see www.ihe.net/governance)

USA

Germany

Italy

JapanUK

CanadaTaiwan

NetherlandsSpain

Austria

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Pragmatic global standards harmonization + best practices sharing

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Australia

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China

Turkey

Malaysia

Switzerland

What is IHE, how much adopted ?ISO Health Informatics: TR28380 Global Standards Adoption – IHE Process and Profiles

Home Health: CONTINUA and IHE work together. Partners in EU Project Smart Personal Health

Widespread adoption of IHE Profiles by National and Regional Projects around the world: USA, Europe, Asia US National Health Information Network (NwHIN) leverages IHE profiles

(XCA, XDR, XCPD, BPPC, ATNA) 12 Country European epSOS Project: IHE-Europe hosting Industry

Team, support project interoperability conformance testing (XCA, XCPD, ATNA, XUA, BPPC, CDA Content Modules from PCC).

In use in several national and regional projects (Austria, France, South Africa, Italy, Netherlands, USA, Japan, Switzerland, Canada)

EU Commission eHealth Interop Mandate 403 leverages IHE process European HITCH project to roadmap conformance testing and

certification leverages the IHE testing experience

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eHealth and Interoperability: What’s new in IHE Profiles ?

Patient Care Devices

Patient Care Coordination

Radiology

IT Infrastructure

And more: Pharmacy, Eye Care, Endoscopy, Dentistry Domains

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eHealth and Interoperability: What’s new in IHE Profiles ?

Patient Care DevicesPatient Care Coordination, Radiology

IT Infrastructure

Testing, Tools and Connectathons

And more: Pharmacy, Eye Care, Endoscopy, Dentistry Domains

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9Courtesy: Continua Alliance

General Device - Communication Architecture

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Single data interface architecture: all Continua Personal Health Devices, all IHE-PCD Medical Devices, and all IHE EMRs!

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DEC Profile: PCD-01 TransactionIt profiles HL7 V2.6 + IEEE Device Data Terminology

IHE DEC Profile: PCD-01 transaction

Two transport: TCP/IP+MLLP or WS (ITI TF App V)

One profiled message format (HL7 V2.6): compact, common

One simple data model for all devices (data levels, values, units, etc.)

IHE RTM Profile: Rosetta Terminology Mapping

For each specific home and care device (over 300): Consistent ‘containment hierarchy’ and value sets for coded data Consistent use of units-of-measure for enumerated values

A revolution: a consistent approachto importing device data in a medical record

eHealth and Interoperability: What’s new in IHE Profiles ?

Patient Care Devices

Patient Care CoordinationRadiology

IT Infrastructure

Testing, Tools and Connectathons

And more: Pharmacy, Eye Care, Endoscopy, Dentistry Domains

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Patient Care CoordinationStrategy to define library of “practical” reusable “data modules” (or template, molecules, archetypes, data element models) for CDA Rel 2 now reaching maturity :

Initiated by IHE PCC moved to HL7 with CCD Implementation Guide

PCC TF includes now over 300 “modules” aligned with CCD

All IHE domains defining CDA R2 based Document Content profiles (PCC, Lab, Pharmacy, QRPH, ITI) reuse same module library.

Consistency across IHE Doc Content Profiles and HL7 implementation Guides under review under auspices of US ONC. Minor discrepancies consolidated and place under OHT-Model Driven Health Tools.

A consistent approachto standardized modular definition of clinical content

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Road to semantic interoperability: a huge step

A revolution: a consistent approachto standardized modular definition of clinical content

Terminology Value Sets:• Snomed• ICD• LOINC• IEEE• Etc.

TemplatesModulesData ElementsArchetypes

CDA Rel2

Header

Section A

Section B

Section L

Section K

Result in a Flexible but Consistent set of Document Types

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Patient Care CoordinationMaternal and Baby Care now supported with a complete set of CDA documents: Antepartum Education (APE) Antepartum Laboratory (APL) Antepartum History and Physical (APHP) Antepartum Summary (APS) Labor and Delivery History and Physical (LDHP) Labor and Delivery Summary (LDS) Maternal Discharge Summary (MDS) Newborn Discharge Summary (NDS) Postpartum Visit Summary (PPVS)

All relying on the standardized modular definition of clinical content

eHealth and Interoperability: What’s new in IHE Profiles ?

Patient Care Devices

Patient Care Coordination

RadiologyIT Infrastructure

Testing, Tools and Connectathons

And more: Pharmacy, Eye Care, Endoscopy, Dentistry Domains

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RadiologyXDS-I continues to receive much attention Multi-Community Clarifications with XCA-I Implementation is now widespread and feedback is positive

Radiation Exposure Monitoring ready for prime time Most new modality products support REM to track actual

exposure Imaging Departments: PACS, RIS, dedicated applications

emerging Some national dose registries in pilot Regulations made explicit in many countries

eHealth and Interoperability: What’s new in IHE Profiles ?

Patient Care Devices

Patient Care Coordination

Radiology

IT InfrastructureTesting, Tools and Connectathons

And more: Pharmacy, Eye Care, Endoscopy, Dentistry Domains

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IT InfrastructureGrowing understanding of the strength and breadth of the “XD*” family of profiles

XDM on e-mail for ubiquitous pt-to-pt send or CD/USB for media XDR on SOAP/WS for point-to-point exchange

XDS for registry-centric exchange in a “community”* XCA for peer to peer federation of “communities”*

To be combined with different patient identification strategies:

PDQ Shared stable source of Identities* PIX for “MPI” centric patient Id linkage XCPD for discovery & ID linkage across communities

XCPD for location discovery with a shared source of identities*

* Most likely suited for Finland

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IT Infrastructure

XDS and related Profiles extend deployment: Off-the shelf sharing of records/documents (Finns

invention !) Robust service: submission sets, replace/amend, etc. Open source and support by well over 100 products

(infrastructure & EPRs). Projects range from communities (a few

hospitals/clinics) to regions and nations. A few registries/repositories with more than 1 million patients.

Implementation feedback is positive: moving beyond interfacing to user experience.

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IHE, Global Standards-Based Profiles 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

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For more complete list see: tinyurl.com/wwXDS

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IT Infrastructure

Completed the regional & national infrastructure needs:

Terminology Value Set distribution/updates with extended SVS profile:

• Retrieve value Sets by unique identifier• Queries to search and access value set descriptions

Healthcare Provider Directory (HPD)• Based on LDAP• Support Provider Persons or Provider Organizations or both (with

optional relationships)

Security and Privacy increasingly better understood:• Encryption and Audit Trail (ATNA)• Basic Patient Privacy Consent (BPPC)• User Assertion (XUA) now enriched with explicit attributes

XDW - Necessity

Many different worldwide projects have as goals to paperless/digitizing of clinical processes. At the bases of all these projects there is the management of workflows across multiple organizations:

For example various eReferral, chronic care workflows Flexible nature and processes for these workflows Clinical, economic, social and organizational impact

value

XDW – Key Elements

Focuses on the Cross-Enterprise Workflow for Document Sharing in support of workflow document and status management.

Key elements:

Managing multi-organizational workflows

Workflow associated information in referenced documents

Tracking the past steps of the workflow related to specific clinical event that triggered it

Flexibility: any entities to join in workflow

Generic workflow infrastructure: workflow specifics are known only in point of care systems (Workflow federation)

Creation of eReferral Document

Creation of Clinical Report

A Use Case Example of XDW (1)

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Workflow Document (1) Workflow

Document (2)Workflow Document

(3)

Workflow Document

(4)

A Use Case Example of XDW (3)

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WorkflowDocumentStructure

XDW StandardsXDW: a new content profile for a workflow management document

No new transaction are introduced. Leverages existing ITI IHE Profiles:

XDS.b, DSUB, BPPC, ATNA,

No XDS Metadata extension expected, but specific rules about Metadata content and update rules for the workflow Document

Public Comment opens late May 2011 (one month)

Trial implementation available in August 2011.

eHealth and Interoperability: What’s new in IHE Profiles ?

Patient Care Devices

Patient Care Coordination

Radiology

IT Infrastructure

Testing, Tools and ConnectathonsAnd more: Pharmacy, Eye Care, Endoscopy, Dentistry Domains

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Implementation Tools

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

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

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

NIST under Source Forge http://sourceforge.net/projects/iheos/ OHT – IHE Profiles Charter https://iheprofiles.projects.openhealthtools.org

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

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Interoperability Testing Needs an Ecosystem

Document Use Case RequirementsDocument Use Case Requirements

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

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

Develop technical

specifications

Develop technical

specifications

Testing at ConnectathonsTesting at Connectathons IHE

DemonstrationsIHE Demonstrations

Products with IHEProducts with IHE

Timely access to informationTimely access to information Easy to integrate

productsEasy to integrate products

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IHE Connectathon

Open invitation to vendor and other implementers community

Advanced testing tools (GAZELLE)

Testing organized and supervised by project management team

Thousands of cross-vendor tests performed

Results recorded and published

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IHE Connectathons2011 Connectathon: Chicago, USA, January 17-21, 2011Pisa, ITALY, April 11-15, 2011Australia, July 2011Japan, October 2011

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

Profile Development

& Testing

Base Standards

eHealth ProjectsInteroperability Specifications

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Interoperability: From a problem to a policy

IETF

Countries/Regions with such a process:Austria (ELGA, Regions)France (ASIP)USA (NwHIN)Italy (Venetto, etc.)China (MoH)Switzerland (ehealth suisse)Canada (Infoway)

Simple and EffectiveProfile

RecognitionProcess &

Policy

Leverage Synergies of Global Standards and Profiles

Recognized:Profile AProfile BProfile C…..

IHE- Roles of Different levels

Regional Profile Deployment

IHE Europe

France Netherlands

Spain Turkey UKItaly

Germany

Switzerland

Austria

Radiology

Cardiology

ITInfrastructure

Patient CareCoordination

Patient CareDevices

Laboratory

Pathology

Eye CareRadiationOncology

Public Health, Quality and Research

Pharmacy

IHEFinland

National EngagementProjects

European CoordinationTesting & Education

InternationalUse Cases & Profiles

International Governance IHE International Board

Global Profile Development

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Open to all

Stakeholders

IHE based “Interoperability” experience has demonstrated significant benefits to national

and regional programs: Reduce specification consensus time Simplify implementation efforts Reuse of testing tools and processes Shared implementation experience

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Providers and Vendors

Working Together to Deliver

Interoperable Health Information Systems

in the Enterprise

and Across Care Settings

http://www.ihe.net

May 2011 Value of IHE37