Oct, 2010 IHE Orientation-TurMIA1

INTEGRATING THE INTEGRATING THE HEALTHCARE HEALTHCARE

ENTERPISE (IHE)ENTERPISE (IHE)Orientation Workshop(2)Orientation Workshop(2)

TurkMIA Conference-10TurkMIA Conference-10Charles Parisot, IHE-Europe Steering Committee & International Board member, GE healthcare

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AgendaAgenda

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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Understanding the IHE InitiativeUnderstanding the IHE Initiative

IHE has a clear focusIHE has a clear focus

IHE is a healthcare domain-based initiativeIHE is a healthcare domain-based initiative

IHE creates synergies for interoperability testing IHE creates synergies for interoperability testing across domainsacross domains

IHE addresses the standards adoption processIHE addresses the standards adoption process

IHE is both regional and multi-nationalIHE is both regional and multi-national

IHE is both user lead and vendor drivenIHE is both user lead and vendor driven

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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)

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

Develop Develop technical technical

specificationsspecifications

Develop Develop technical technical

specificationsspecifications

Testing at Testing at ConnectathonsConnectathonsTesting at Testing at ConnectathonsConnectathons IHE IHE

DemonstrationsDemonstrationsIHE IHE DemonstrationsDemonstrations

Products Products with IHEwith IHEProducts Products with IHEwith IHE

Timely access to Timely access to informationinformationTimely access to Timely access to informationinformation Easy to integrate Easy to integrate

productsproductsEasy to integrate Easy to integrate productsproducts

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IHE Organizational StructureIHE Organizational Structure

Contributing &Participating

Vendors

Regional Deployment

ACCACCEACEP

JAHISJIRAJRS

METI-MLHWMEDIS-DCJAMI

RSNA SFRSFIL

SIRMBIREuroRec

COCIREAR-ECRDRG

ESC

Professional Societies / SponsorsACPGMSIHIMSS

Global Development

Radiology

Cardiology

ITInfrastructure

Patient CareCoordination

Patient CareDevices

Laboratory

Pathology

Eye CareRadiationOncology

Public Health, Quality and Research

IHE International Board

IHE Europe & Middle East

IHE America

France

USACanada

IHE Asia-Oceania

Japan

Korea Taiwan

Netherlands

Spain Sweden UKItaly

Germany

Israel

China

Austria

Australia

Turkey

Swiss

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IHE SponsorsIHE SponsorsProfessional societiesProfessional societies

Healthcare Information Management Systems Society (HIMSS)Healthcare Information Management Systems Society (HIMSS) Radiological Society of North America (RSNA)Radiological Society of North America (RSNA) British Institute of Radiology (BIR), British Computer Society (BCSBritish Institute of Radiology (BIR), British Computer Society (BCS German Radiology Society (DRG)German Radiology Society (DRG) GMSIH (IT France), SFIL (laboratory), French National Project (DMP)GMSIH (IT France), SFIL (laboratory), French National Project (DMP) European Society of Cardiology……Many other European SocietiesEuropean Society of Cardiology……Many other European Societies American College of Physicians (ACP), American College of American College of Physicians (ACP), American College of

Emergency Physicians (ACEP) …Many other American healthcare Emergency Physicians (ACEP) …Many other American healthcare societies (ACCE), (AAO), (ASTRO), etc.societies (ACCE), (AAO), (ASTRO), etc.

JAHIS (IT Japan), JIRA, JRS….Many other Japanese SocietiesJAHIS (IT Japan), JIRA, JRS….Many other Japanese Societies And many more….And many more….

Health AuthoritiesHealth Authorities

NICTIZ (Netherlands), ASIP (F), ELGA (Austria), Infoway (Canada), NICTIZ (Netherlands), ASIP (F), ELGA (Austria), Infoway (Canada), etc.etc.

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IHE Participants and RelationshipsIHE Participants and RelationshipsParticipants include:Participants include: Users - Clinicians, Staff, Administrators, CIOs, GovernmentsUsers - Clinicians, Staff, Administrators, CIOs, Governments Vendors of Information Systems and EquipmentVendors of Information Systems and Equipment ConsultantsConsultants

Relationship with Standards Development Organizations Relationship with Standards Development Organizations (SDOs):(SDOs): HL7, DICOM, ISO, CDISC, IEEE and many othersHL7, DICOM, ISO, CDISC, IEEE and many others Adoption process approved via ISO/TC 215, IHE profiles to be published Adoption process approved via ISO/TC 215, IHE profiles to be published

as ISO Technical Reportsas ISO Technical Reports Other Profiling Organizations such as Continua (Consumer Devices)Other Profiling Organizations such as Continua (Consumer Devices)

National Adoption of IHE ProfilesNational Adoption of IHE Profiles DMP(France), ELGA(Austria), HITSP (USA), Infoway (Canada), many DMP(France), ELGA(Austria), HITSP (USA), Infoway (Canada), many

others worldwide…..others worldwide…..

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IHE International Governance - MembershipIHE International Governance - Membership

Membership: Membership: www.ihe.net/governance Members are Organizations–Sign Governance & IP once.Members are Organizations–Sign Governance & IP once. Three Organizational Categories: User, Developer, General Three Organizational Categories: User, Developer, General

InterestInterest Member designates a primary/alternate representatives to Member designates a primary/alternate representatives to

one of more Committees (Domains, Test& Tools, MarCom).one of more Committees (Domains, Test& Tools, MarCom). Elect Committee co-chairs. One User & one vendor Elect Committee co-chairs. One User & one vendor

recommended for Planning Committeesrecommended for Planning Committees Regional and National IHE Committee members required to Regional and National IHE Committee members required to

become members of IHE International.become members of IHE International. Over 300 Member organizations. About half users/half Over 300 Member organizations. About half users/half

VendorsVendors

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IHE International Governance – Others CommitteesIHE International Governance – Others Committees

IHE Regional or National Deployment Committees are IHE Regional or National Deployment Committees are independent entities with their own governance but close independent entities with their own governance but close collaborative relationship with IHE International. collaborative relationship with IHE International.

IHE International Board empowers “Regional and IHE International Board empowers “Regional and National Committee”. 3 year commitment, renewable. National Committee”. 3 year commitment, renewable.

Oversees Testing and Tools CommitteeOversees Testing and Tools Committee

Coordinates the various Regional and National Committees.Coordinates the various Regional and National Committees.

Oversees Marketing & Communication CommitteeOversees Marketing & Communication Committee

Consistency of communication among Domains within IHE Consistency of communication among Domains within IHE International and various Regional and National Committees.International and various Regional and National Committees.

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All Participants:All Participants:Become a member of relevant domain’s Planning or Technical Become a member of relevant domain’s Planning or Technical CommitteesCommittees

Become a member of relevant Regional/National CommitteesBecome a member of relevant Regional/National Committees

Help to shape IHE’s future directionHelp to shape IHE’s future direction

Offer Clinical Use Case Input to Drive IHE Profile DevelopmentOffer Clinical Use Case Input to Drive IHE Profile Development

Respond to Public Comments of Domain SupplementsRespond to Public Comments of Domain Supplements

Attend Educational Workshops/WebminarsAttend Educational Workshops/Webminars

As a Vendor ParticipantAs a Vendor ParticipantParticipate in Connect-a-thons and DemonstrationsParticipate in Connect-a-thons and Demonstrations

As a Provider/Consultant ParticipantAs a Provider/Consultant ParticipantAttend Demonstrations and include IHE Integration Profiles in Attend Demonstrations and include IHE Integration Profiles in your RFPs and Integration Projects.your RFPs and Integration Projects.

How can I participate?How can I participate?

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What can you do?What can you do?

Learn about IHE, Learn about IHE, www.ihe.net

Insist on relevant IHE profiles compliance in Insist on relevant IHE profiles compliance in your RFPs and contract documents:your RFPs and contract documents:

Select Integration Profiles, and Appropriate Select Integration Profiles, and Appropriate Actor(s) Actor(s)

Ask vendors for their products “IHE Ask vendors for their products “IHE Integration Statements”Integration Statements”

Need more interoperability ? Need more interoperability ?

Contribute to IHE CommitteesContribute to IHE Committees

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AgendaAgenda

Part 2:

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

HOW TO USE IHE RESOURCES: hands on experience

AgendaAgenda

From IHE Profiles to conformance testing, closing the implementation gap

Helping the implementers, testing tools, connectathons

How to use other IHE resources: hands on experience

Technical Frameworks: navigating, Q&A

Test tools: finding, using, configuring

Participating in the testing process

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Connectathon14

Connectathon

Started in 1998 in the USA

Europe started in 2001

Japan in 2003

China and Australia have now joined

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Purpose

Test implementation of the IHE integration and content profiles within product/open source Verify that the vendors did a good job

Verify that what the committees specified is clear ! Verify that the Technical Frameworks are not ambiguous Verify that that the Technical Committee did not miss

anything

Build a community of computer geeks who loves local brewed beers and have fun working together to connect healthcare

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From the vendor perspectiveFrom the vendor perspective

Unique Opportunity for vendors to test their implementations of the IHE integration profiles

Controlled environment Customer is not present ! Not in a clinical production environment

Specialists available From SDO From the peer companies

Bugs are identified and most of the time fixed !!!!

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

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From the user perspectiveFrom the user perspective

Unique Opportunity to engage potential vendors and user own implementation tested for conformance to IHE integration and content profiles

Controlled environment User community in IHE designate the Connectathon Monitors ! Not in a clinical production environmentSpecialists available From SDO From the vendor companiesBugs are identified and most of the time fixed, before the product is installed !!!!

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

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But…But…

Testing in interoperability is (always) sub-optimal

Only a part of all the possible tests are performed

A system successful at the connectathon is not guaranteed to be error free !!!!

But, …. it is the most thorough interoperability conformance widely available

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From the IHE perspectiveFrom the IHE perspective

Feedback from the vendor communityDid the profile development committee do

a good job ?Did the developed integration or content

profile responds to the expectations of the vendors and meets the intended user need ?

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Maturity of IHE Connectathons Maturity of IHE Connectathons

We have reached now our cruising speed

NA and EU Connectathon are very alike. Japanese Connectathon is now mature.

Connectathon also used as an IHE promoting tool Workshop in parallel to the Connectathon VIP visits Visitors are truly impressed !!

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The IHE testing processThe IHE testing process

UsersUsers

Sponsors:Sponsors:ProjectProjectManagementManagementTeamTeam

Vendors/Vendors/ImplementersImplementers

UsersUsersDemonstrationsDemonstrations

DevelopDevelopTesting ToolsTesting Tools

Testing ToolsTesting Tools

ImplementImplementProfile ActorsProfile Actors

In-HouseIn-HouseTestingTesting

ConnectathonConnectathon

DemonstrationDemonstration

DeployedDeployedSystemsSystems

Testing ResultsTesting Results

ApprovesApprovesTest LogsTest Logs

IHE Technical Framework (Profiles Specification)

Product +Product +IntegrationIntegrationStatementStatement

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Unit Testing & Peer TestingUnit Testing & Peer Testing

22/05/08 Projet IHE-Dev Inria Rennes

Specifications/Standards

Implementation A

Vendor A

Implementation B

Vendor B

Unit testing

Peer Testing

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Both Unit Testing & Peer TestingBoth Unit Testing & Peer Testing

Need to have unit testing in the IHE Testing process

Important to perform unit testing in advance of the peer testing

Peer testing takes place during the testing event (connectathon).

Need to perform unit testing as well during the connectathon.

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Pre-connectathon

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Pre-connectathonPre-connectathon

Registration Open to all, even non IHE members Choice of what can be tested Actors for a Profile

Exchange of configuration parameters IP addresses Assigning authorities, Addresses, AE Title OID Certificates Affinity domain specification (e.g. XDS Meta-data)

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Pre-connectathon

Unit testing using Gazelle test tools

In-house testing for vendors to get ready

Vendors return Gazelle tool logs

Upon log return, and positive analysis, participation to Connectathon event is accepted by IHE Technical Project Mgr

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At connectathon

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Connectathon TestingConnectathon Testing

3 types of test to be performed

“No-peer” tests “Peer to peer” tests “Workflow” tests (multi peers)

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5 days5 days

Configured up and running by Monday morning 11 am Set up time

Till Friday noon : Free “peer to peer” and “no peer” testing

From Wednesday till Friday noon : Directed “workflow” testing

Enough time to test 4-6 solid profiles and 1-2 new profiles per participating system

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MonitorsMonitors

Report to IHE Technical Project Mgr

Volunteers, trained and screened

Independent from vendors. Selected by IHE Countries users.

Standard knowledegeable

Verify tests

Act as moderator between vendors

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ResultsResults

To be successful Pre-connectathon test validated Each peer to peer test needs to be verified with at

least 3 peers A vendor may fail for an actor in a profile but pass

for the others

IHE does not report failure. Vendors have access to their own detailed test results (track issues).

Vendors shall publish their products integration statements Market/Contractual sanction

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Connect-a-thon Results BrowserConnect-a-thon Results Browser

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Connectathon Results BrowserConnectathon Results Browser

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Connectathon Results BrowserConnectathon Results Browser

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What does it mean ? What does it mean ?

The Company was successful at the connectathon for an actor/integration profile combination

Results express a company maturity and willingness to collaborate. Does not guaranty product conformity, but enables market/contractual commitments by vendors to their customers

Product conformity commitment: This is the role of the « IHE integration statements »

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IHE Integration StatementIHE Integration StatementProduct vendors take the next stepProduct vendors take the next step

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Technical FrameworksTechnical Frameworks

One per Domain

They are the reference, the tools are not !

Written and reviewed by Vendors and Users

Freely available on http://www.ihe.net

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Organization of the TFOrganization of the TF

Volume 1 Description of the Integration/content profiles and

actors Dependencies between actors and profiles Use cases

Volume 2 and followings Description of the transactions with reference to

used standards

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TF Life CycleTF Life CycleEvery year : New integration profiles Change Proposal

Integration Profile proposed as Supplements Public Comment Trial Implementation Final Text

Once in Final Text integration into the main document.

No concept of profile version (Corrections are applied). Non backward changes result in a new profile.

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IHE WikiIHE Wiki

http://wiki.ihe.net A lot of information. Used for supporting on-going

work by Committees• Committee planning / minutes /in development documents• General membership/Chairs

http://ihewiki.wustl.edu/ Wiki for connectathon organization and management Code exchange XDS implementation page …

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Gazelle Objectives

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ObjectivesObjectivesImprove the overall quality of testing Conformance and Interoperability

Broaden the use of the application. Open Source Licence (Apache).

Build a framework for Healthcare interoperability testing

Synchronous testing of multiple systems

Multilingual

Scalable

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5 Context of Use5 Context of Use

Connectathon

Virtual Connectathon

Company Internal Testing tool

Healthcare Enterprise Testing tool

Governmental/Certification organizations

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Gazelle Architecture

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Gazelle ArchitectureGazelle Architecture

Proxy

System Under Test

Network

GazelleTest Engine

Control Configuration Info

Feedback

ExternalValidation Services

Tests Scenario

GazelleActor

(Simulators)

Gazelle Control System

ExternalValidation Services

ExternalValidationServices

ExternalValidation Services

GazelleActor

(Simulators)

GazelleActor

(Simulators)

GazelleActor

(Simulators)

GazelleActor

(Simulators)

System Under TestSystem Under TestSystem

Under Test

Database

22/05/08 Projet IHE-Dev Inria Rennes46

System under testSystem under test

More than one system can be tested at the same time

Management of System Under Test Web application to provide instructions

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ParticipantsParticipants

3 IHE Regions North America : MIR Europe : INRIA Japan : Shizuoka University

DVTK

NIST

Tiani-Spirit

David Clunie

Offis

Open to more participants

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Project ManagementProject Management

Testing and Tool Committee Overview of IHE testing activities Choice of the license Approve Connectathon Organizers

Testing Management Group Project Management Eric and Steve

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More Resources - More Resources - www.ihe.net

Frequently Asked QuestionsFrequently Asked Questions

Integration Profiles in Technical Frameworks:Integration Profiles in 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 ConnectathonsParticipation in Committees and Connectathons

Oct, 2010 IHE Orientation-TurMIA51