September, 2005What IHE Delivers 1 Presented by Charles Parisot, IHE Europe IT Infrastructure Planning Committee co-Chair eHealth interoperability ad hoc

1September, 2005 What IHE Delivers

Presented by Charles Parisot, IHE Europe Presented by Charles Parisot, IHE Europe IT Infrastructure Planning Committee co-ChairIT Infrastructure Planning Committee co-Chair

eHealth interoperability eHealth interoperability ad hocad hoc group groupJanuary 17, 2007January 17, 2007

Integrating the Healthcare Integrating the Healthcare Enterprise (IHE)Enterprise (IHE)

Approach and Patient SummaryApproach and Patient Summary

2

Agenda Agenda

IHE, a proven multi-stakeholder processIHE, a proven multi-stakeholder process

IHE, what can be leveragedIHE, what can be leveraged

IHE Medical Summaries, a solid base, IHE Medical Summaries, a solid base, potential for European national extensions potential for European national extensions

3

What is What is Integrating the Healthcare Enterprise?Integrating the Healthcare Enterprise?

It implements a methodology which enables users and It implements a methodology which enables users and suppliers to work together to obtain clinical suppliers to work together to obtain clinical interoperabilityinteroperability

IHE tailors existing standards to fit the IT requirements for IHE tailors existing standards to fit the IT requirements for specific clinical tasks specific clinical tasks

The IHE Technical Framework document specifies clinical The IHE Technical Framework document specifies clinical tasks and how to use profiles of existing standards to tasks and how to use profiles of existing standards to support themsupport them

Annual test sessions enable suppliers to test their Annual test sessions enable suppliers to test their application software for conformance with the IHE application software for conformance with the IHE Technical FrameworkTechnical Framework

Purchasers can buy systems that are known to Purchasers can buy systems that are known to interoperate interoperate

4

What is IHE?What is IHE?

5

Participants

contribute

Global Development:IT Infrastructure,Radiology,Cardiology,Lab, etc.

Delegates

IHE Europe

IHE NorthAmerica

IHE Asia/Oceania

Regional &NationalDeployment

supervises reports

IHE (International) Strategic Development Committee

SponsorsCo-Chairs

Global

Interoperability

IHE Domain-related Planning and

Technical Committees

Who is IHE?Who is IHE?

6

IHE-EUR countries and participantsIHE-EUR countries and participants

• Denmark• France• Germany• Israel • Italy

Users, HC AuthoritiesUsers, HC Authorities

40% local vendors40% local vendors60% international vendors60% international vendors

• Netherlands • Norway• Spain • Sweden • United Kingdom

Example: IHE-NetherlandsExample: IHE-Netherlands

UsersUsers VendorsVendors Government /Government /AssociationsAssociations

AmphiaAmphia

Antonius MesosAntonius Mesos

Amsterdam MCAmsterdam MC

AZ Maastricht AZ Maastricht

Ned. Ver. RadiologieNed. Ver. Radiologie

Ned. Ver. Kl. ChemieNed. Ver. Kl. Chemie

Ned. Ver. MicrobiologieNed. Ver. Microbiologie

MCMC LeeuwardenLeeuwarden

UMC NijmegenUMC Nijmegen

UMC GroningenUMC Groningen

VUmcVUmc

AgfaAgfa

ForcareForcare

ChipsoftChipsoft

D&A MedicalD&A Medical

GE HealthcareGE Healthcare

GetronicsGetronics

H2WH2W

IBMIBM

ICT HealthcareICT Healthcare

Initiate SystemsInitiate Systems

iSOFTiSOFT

LeonesLeones

Medical PhitMedical Phit

NucletronNucletron

Oldelft BeneluxOldelft Benelux

PhilipsPhilips

RVCRVC

SectraSectra

SiemensSiemens

Verdonk, Klooster & Verdonk, Klooster & AssociatesAssociates

Welch Allyn Cardio Welch Allyn Cardio ControlControl

APC PlatformAPC Platform

NICTIZNICTIZ

HL7 NederlandHL7 Nederland

OIZOIZ

TNOTNO

7

Evolution of IHE DomainsEvolution of IHE Domains

Radiology (18)

IT Infrastructure for Healthcare (17)

Cardiology (7)

Laboratory (6)

Radiation Oncology (1)

Patient Care Coordination (5)

Patient Care Devices (1)

Pathology (1)

Pharmacy

IHE Global Developments

Integration Profiles – Solutions to Real-World Interoperability Needs & Problems:

Within Clinical Departments e.g.:RadiologyCardiologyLab...

Across Departmental &Institutional Boundaries – XDS

Regional/national Healthcare Information ExchangeHIT Enablers

Veterinarian

Endoscopy (1)

Eye Care / (3)Ophthalmology

Yea

r 1

(199

9)

Yea

r 2

(200

0)

Yea

r 3

(200

1)

Yea

r 4

(200

2)

Yea

r 5

(200

3)

Yea

r 6

(200

4)

Yea

r 7

(200

5)

Yea

r 8

(200

6)Y

ear

8 (2

006)

8

IHE, Annual CycleIHE, Annual CycleProven Standards Adoption ProcessProven Standards Adoption Process

InstallationInstallationon siteon site

DemonstrationDemonstration(National shows)(National shows)

Vendors implementVendors implementthe profile in theirthe profile in their

productsproducts

Multi-vendorsMulti-vendorstest at the annualtest at the annualConnect-a-thonConnect-a-thon

Engineers from vendorsEngineers from vendors collaborate to define collaborate to define

technical specification technical specification

Clinicians identifyClinicians identifyclinical problemsclinical problems to be addressed to be addressed

Choice of relevantChoice of relevantstandards (HL7, CEN, DICOM,standards (HL7, CEN, DICOM,

W3C, Oasis…) W3C, Oasis…)

9

IHE Technical FrameworkIHE Technical Framework

Detailed standards Detailed standards implementation implementation guidesguides CardiologyCardiology IT InfrastructureIT Infrastructure LaboratoryLaboratory RadiologyRadiology ……....

Pt. Registration [RAD-1] Patient Update [RAD-12]


Placer Order Management [RAD-2] Filler Order Management [RAD-3]

ADT

Query Images [RAD-14] Retrieve Images/Evidence [CARD-4]

Image Display

Modality Image/Evidence Stored [CARD-2]

Storage Commitment

[CARD-3]

Procedure Scheduled [RAD-4]

Procedure Updated [RAD-13]

Query Modality Worklist [RAD-5]

Performed Procedure

Step Manager

Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]



Order Placer

Acquisition Modality

ImageManager

ImageArchive

DSS/ Order Filler

Patient Update [RAD-12]


Storage Commitment

[CARD-3]

Evidence Creator Modality PS in Progress [CARD-1]

Modality PS Completed [RAD-7]

Instance Availability Notification [RAD-49]



Placer Order Management [RAD-2] Filler Order Management [RAD-3]

ADT

Query Images [RAD-14] Retrieve Images/Evidence [CARD-4]

Image Display


Storage Commitment

[CARD-3]


Procedure Updated [RAD-13]


Performed Procedure

Step Manager




Order Placer

Acquisition Modality

ImageManager

ImageArchive

DSS/ Order Filler

Patient Update [RAD-12]


Storage Commitment

[CARD-3]

Evidence Creator Modality PS in Progress [CARD-1]

Modality PS Completed [RAD-7]

Instance Availability Notification [RAD-49]


ADT Order Placer

Register J.Doe

AcquisitionModality

Placer OrderManagement –New [RAD-2]

Patient Reconciliation

Department System Scheduler/Order Filler

Schedule Procedure


Modality Procedure Step Completed [RAD-7]J.Doe ->

J.Smith

Patient Update/Merge [RAD-12]

Modality Procedure Step Completed [RAD-7]

PatientRegistration [RAD-1]

Patient Update/

Merge [RAD-12]

Modality Procedure Step In Progress [CARD-1]


Perform Acquisition

Filler Order Mgmt - Status Update [RAD-3]


ImageManager/

PPS Manager

Filler Order Management -New [RAD-3]

One or the other methods of creating an order is used


ADT Order Placer

Register J.Doe

AcquisitionModality

Placer OrderManagement –New [RAD-2]

Patient Reconciliation

Department System Scheduler/Order Filler

Schedule Procedure


Modality Procedure Step Completed [RAD-7]J.Doe ->

J.Smith

Patient Update/Merge [RAD-12]

Modality Procedure Step Completed [RAD-7]

PatientRegistration [RAD-1]

Patient Update/

Merge [RAD-12]



Perform Acquisition



ImageManager/

PPS Manager

Filler Order Management -New [RAD-3]

One or the other methods of creating an order is used

10

IHE ConnectathonIHE Connectathon

• Open invitation to the Open invitation to the Software Developer Software Developer CommunityCommunity

• Advance testing tools (MESA) Advance testing tools (MESA) appliedapplied• Compliance Testing Compliance Testing organized and supervisedorganized and supervised by by

the sponsors of IHEthe sponsors of IHE• Thousands Thousands

of of cross-system cross-system tests tests performedperformed

2001 2002 2003 2004 2005 2006 20070

50

100

150

200

250

300

11

3343 46

7563

0

18

57

74 79

99

120

0

35

100

135

180

250

280

0

DomainsIntegration profilActorsCompaniesSystemsParticipants

IHE-EURIHE-EURConnectathonConnectathon

11

IHE Connectathon, Barcelona April 2006IHE Connectathon, Barcelona April 2006

•300+ participants, 120+ systems300+ participants, 120+ systems•60+ systems developers60+ systems developers•2006 Focus: 2006 Focus:

Cardiology, IT Infrastructure, Cardiology, IT Infrastructure,

Patient Care Coordination, Patient Care Coordination, Laboratory, RadiologyLaboratory, Radiology

•2800+ monitored test cases2800+ monitored test cases

12

Regional and National EHR Projects Regional and National EHR Projects

Many EHR projects world-wide, Many EHR projects world-wide, Some country-wide, some regional,Some country-wide, some regional,Different stages of implementation,…Different stages of implementation,…

13

IHE based Regional and National EHR Projects IHE based Regional and National EHR Projects Operational and planned Operational and planned

Toronto, Quebec, Alberta, BCCanada Infoway

Austria

THINC- New YorkNCHICA – N. Carolina

Italy (Conto Corrente Salute)

MA-Share – MA

FranceDMP

Philadelphia

HIE

CHINA-MoHLab results sharing

New York HIE

14

Agenda Agenda




15

IHE Integration Profiles for Health Info NetsIHE Integration Profiles for Health Info NetsWhat What is availableis available and and has been addedhas been added in 2005 and in 2005 and is for 2006is for 2006

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

Patient Identifier Cross-referencing

Map patient identifiers across independent identification

domains

Emergency Referrals

Format of the Document Content and associated coded vocabulary

PHR Extracts


ECG Report Document


Lab Results Document Content


Scanned Documents

Format of the Document Content

Cross-enterprise User Authentication

Authentication & Auditing: Enhanced Access Control

Cross-enterpriseDocument InterchangeMedia-CD/USB & e-mail push

Notification of Document Availability

Notification of a remote provider/ health enterprise

Imaging Information


Medical Summary (Meds, Allergies, Pbs)

Format of the Document Contentand associated coded vocabulary

Document Digital Signature

Attesting “true-copy and origin

Request Formfor Data Capture

External form with custom import/export scripting

V3V3OptionOption

StoredStoredQueriesQueries

Info Exchange Security Id MgtInfo Exchange Security Id Mgt

Con

ten

tC

on

ten

t

16

Cross Enterprise Document SharingCross Enterprise Document SharingPrototyped in 2003, matured in 2004-2005Prototyped in 2003, matured in 2004-2005 HL7 and IHE Joint Demonstration at HIMSS 2004HL7 and IHE Joint Demonstration at HIMSS 2004 ISO 15000 (ebRS) and tracks Web Services & SOA. Further step ISO 15000 (ebRS) and tracks Web Services & SOA. Further step

with WS-I in 2007.with WS-I in 2007.

Implemented by 20+ VendorsImplemented by 20+ Vendors

Available Commercially in US, Europe and now in AsiaAvailable Commercially in US, Europe and now in Asia

Open Source CommunitiesOpen Source Communities O3 (Univ Trieste & Padova)O3 (Univ Trieste & Padova) RIDE EU ProjectRIDE EU Project IHEOSIHEOS Eclipse Open Healthcare FrameworkEclipse Open Healthcare Framework

Named in Specifications by more than 5 countriesNamed in Specifications by more than 5 countries

Appears in more than 10 regional and national projects Appears in more than 10 regional and national projects underway.underway.

17

Profile example in a region: XDS (Document Sharing)Profile example in a region: XDS (Document Sharing)

Acute Care (Inpatient)

PCPs and Clinics (Ambulatory)

Long Term Care

Other Specialized Careor Diagnostics Services

Documents Registry

DocumentRepository

Longitudinal Recordas usedacross-encounters

Submission of Document References

Retrieve of selected DocumentsQuery for Document References

18

Federation of XDS and non-XDS DomainsFederation of XDS and non-XDS DomainsLeverage Cross-Community Sharing Architecture Leverage Cross-Community Sharing Architecture

National Network ANational Network A

XDS Affinity Domain (NHIN sub-network)

Non-IHE Non-IHE National National EHREHR

Cross-DomainCross-DomainBridgeBridge

Which registry holds Which registry holds records for a patient ?records for a patient ?

Cross-Cross-DomainDomainBridgeBridge

Cross-Cross-DomainDomainBridgeBridge

RegistryRegistryLocator serviceLocator service

IHE TransactionsIHE Transactions

National or Regional National or Regional Networks not required to be Networks not required to be IHE-basedIHE-based

Mapping to & from IHE Mapping to & from IHE Transactions performed by Transactions performed by X-Domain bridgesX-Domain bridges

Mapping practical as most Mapping practical as most European projects use European projects use variants of structured variants of structured document sharingdocument sharing

National or Regional National or Regional Network BNetwork B



Long Term Care


Documents Registry

DocumentRepository


National Network CNational Network C

IHE based Sub-NetworksIHE based Sub-Networks

XDS Affinity Domain (NHIN sub-network)

IntegratedIntegratedDeliveryDeliveryNetworkNetwork

RegistryRegistryLocator serviceLocator service

Non-IHE Sub-NetNon-IHE Sub-Net



Long Term Care


Documents Registry

DocumentRepository




Long Term Care


Documents Registry

DocumentRepository


19

Agenda Agenda




20

Medical SummariesMedical SummariesEU Stakeholder group study (Rossi Mori) has confirmedEU Stakeholder group study (Rossi Mori) has confirmed

There is a significant variety of “medical summaries” (in There is a significant variety of “medical summaries” (in use or in plan) across the European countries. Some of use or in plan) across the European countries. Some of the differences are:the differences are:

• scope/use case drivenscope/use case driven• due to national specificitiesdue to national specificities• from the technical standard usedfrom the technical standard used

IHE Patient Care Coordination:IHE Patient Care Coordination:

Is well engaged with the scope/use case driven Is well engaged with the scope/use case driven differencesdifferences

Plan to address national specificities based on the Plan to address national specificities based on the stakeholder WG analysis, and the interest of the countriesstakeholder WG analysis, and the interest of the countries

2007 is the year IHE-Europe has set to finalize a “family” 2007 is the year IHE-Europe has set to finalize a “family” of patient summaries for several European countries with of patient summaries for several European countries with a common core. a common core.

21

Care Coordination Content ProfilesCare Coordination Content Profiles

XDS-MSXDS-MSMedicalMedical

DocumentsDocuments

ReferralReferral

ConsentConsent

EmergencyEmergencyDepartmentDepartment

ReferralReferral

PreprocedurePreprocedureHistory andHistory and

PhysicalPhysical

History andHistory andPhysicalPhysical

PHR PHR UpdateUpdate

2005-20062005-20062006-20072006-20072007-20082007-2008

Lab ReportLab Report

PHR PHR ExtractExtract

EmergencyEmergencyDepartmentDepartment

NoteNote

AntenatalAntenatalCareCare

SummarySummary

CareCareAssessmentsAssessments

DischargeDischargeSummarySummary

MedicalMedicalSummariesSummaries

Includes data needed to support emergency data setIncludes data needed to support emergency data setand prescription/medication historyand prescription/medication history

22

SSttrruuccttuurreedd CCoonntteenntt wwiitthh ccooddeedd sseeccttiioonnss::

RReeaassoonn ffoorr RReeffeerrrraall VViittaall SSiiggnnss MMeeddiiccaattiioonn

SSttuuddiieess AAlllleerrggiieess

SSoocciiaall HHiissttoorryy PPrroobblleemmss

CCaarree PPllaann

Structured Text Section

Structured Text Section

Structured and Coded Header Patient, Author, Authenticator, Institution, etc.

Coded Section Entries

Coded Section Entries

Structured Text Section Coded Section

Entries

Rossi-Mori EU survey Rossi-Mori EU survey mapping tomapping to XDS-MS XDS-MSNo of No of CountriesCountries

SectionSection

allall

not not askedasked

all - BEall - BE

details about details about patientpatient

identifier, nameidentifier, name

(date of birth, gender)(date of birth, gender)

addressaddress

1212 1111

99

55

historyhistorymedication historymedication historyimmunisationsimmunisationsfamily historyfamily history

1313 allergies, alerts, risks, special allergies, alerts, risks, special needsneeds

1212 ongoing medicationsongoing medications

1010 test resultstest results (lab and images) (lab and images)

1010 details about details about family doctorfamily doctor

99 active problemsactive problems

66 details about details about insuranceinsurance

66 emergency contactemergency contact (next of kin) (next of kin)

44 care planscare plansnot askednot asked ((exemptionsexemptions))

23

IHE flexibility in leveraging standards for IHE flexibility in leveraging standards for Document FormatDocument Format

Content Format leverages Specific StandardsContent Format leverages Specific Standards HL7 CDA Release 2.0HL7 CDA Release 2.0 HL7/ASTM Continuity of Care DocumentHL7/ASTM Continuity of Care Document CEN 13606CEN 13606 LOINC, SNOMED (if applicable)LOINC, SNOMED (if applicable) Others as Needed (e.g. PDF)Others as Needed (e.g. PDF)

IHE is defining a library of Reusable PartsIHE is defining a library of Reusable Parts Document TypesDocument Types Sections (only title is coded)Sections (only title is coded) Entries (clinical info semantically coded)Entries (clinical info semantically coded)

24

In ConclusionIn Conclusion

IHE is a IHE is a user & vendoruser & vendor driven initiative. driven initiative.

IHE is IHE is dedicated to interoperabilitydedicated to interoperability of IT systems in of IT systems in healthcare with healthcare with proven methodologyproven methodology..

IHE Integration and Content Profiles are IHE Integration and Content Profiles are already usedalready used in in Europe and world-wide.Europe and world-wide.

IHE is experienced with patient summaries.IHE is experienced with patient summaries.

IHE ready to engage in fostering a consistent family of IHE ready to engage in fostering a consistent family of patient summary documents and a sharing infrastructure patient summary documents and a sharing infrastructure between countries and regions in Europe.between countries and regions in Europe.

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