Standardisierung von EPAs -IHE-services.informatik.hs-mannheim.de/~kis/lu/vortraege/Kassner... · Standardisierung von EPAs-IHE-Andreas Kassner VHitG e.V. IHE-Deutschland „vendor“

Standardisierung von Standardisierung von EPAsEPAs--IHEIHE--

Andreas KassnerAndreas KassnerVHitG e.V.VHitG e.V.

IHEIHE--DeutschlandDeutschland „„vendorvendor“ “ coco--chairchair

IntegratingIntegrating thethe Healthcare EnterpriseHealthcare Enterprise

InteroperabilitätInteroperabilität –– ganzganz einfacheinfach

IHE : Integrating the Healthcare Enterprise IHE : Integrating the Healthcare Enterprise IHE : Integrating the Healthcare Enterprise

Professional Societies SponsorshipHealthcare Providers & Vendors

Healthcare IT StandardsHL7, DICOM, etc.

Allgemeine IT StandardsInternet, ISO, etc.

Interoperable Healthcare IT Solution Specifications

IHE Integration ProfileInteroperable Healthcare IT

Solution SpecificationsIHE Integration Profile

Interoperable Healthcare IT Solution Specifications

IHE Integration ProfileInteroperable Healthcare IT

Solution SpecificationsIHE Integration Profile

IHEProzess

IHEIHE--EUR Länder und TeilnehmerEUR Länder und Teilnehmer• Denmark• France• Germany• Israel • Italy

Users, HC Authorities, Vendors:Users, HC Authorities, Vendors:40% 40% nationalenationale LLöösungsanbietersungsanbieter60% multi60% multi--nationalenationale HerstellerHersteller

• Netherlands• Norway• Spain • Sweden• United Kingdom

BeispielBeispiel: IHE: IHE--NetherlandsNetherlands

Medical Phit

Nucletron

Oldelft Benelux

Philips

RVC

Sectra

Siemens

Verdonk, Klooster & Associates

Welch AllynCardio Control

APC Platform

NICTIZ

HL7 Nederland

OIZ

TNO

Agfa

Forcare

Chipsoft

D&A Medical

GE Healthcare

Getronics

H2W

IBM

ICT Healthcare

Initiate Systems

iSOFT

Leones

Amphia

Antonius Mesos

Amsterdam MC

AZ Maastricht

Ned. Ver. Radiologie

Ned. VerLeeuwarden

UMC Nijmegen

UMC Groningen

. Kl. Chemie

Ned. Ver. Microbiologie

MC Vumc

Government /Associations

VendorsUsers

Evolution Evolution derder IHE IHE DomänenDomänen

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

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

rY

ear

8 (2

006)

8 (2

006)

IHE Globale Entwicklung

Integrationsprofile – Lösung für Real-World Bedarf & Probleme:

Innerhalb Medizinischer Einrichtungen:o Radiologieo Kardiologieo Laboro ...

Einrichtungsübergreifend – XDSo RHIOs (Regional Healthcare Information Organizations)

o EHR Enablers

Electronic Health Record

Cardiology

Laboratory

Radiology

Oncology

Future

Domains

IHE

IT Infrastructure

14 Integration Profiles



1133 IInntteeggrraattiioonn PPrrooffiilleess

Patient Care Coordination

1 Integration Profile

Patient Care

Devices

Pathology

Eye Care

Was Was istist IHE IT Infrastructure?IHE IT Infrastructure?

IHE XDS in IHE XDS in regionalenregionalen und national und national ProjektenProjekten

Canada Infoway

HITSP InteropSpecifications

Denmark (Funen)Italy (Veneto)Spain (Aragon)

Austria

THINC- New YorkNCHICA – N. Carolina

Italy (Conto Corrente Salute)

MA-Share – MAFranceDMP

Philadelphia HIE

CHINA-MoHLab results sharing

Acute Care (Inpatient)

GPs and Clinics (Ambulatory)

Long Term Care

Other Specialized Care(incl. Diagnostics Services)

Continuity of Care:Patient Longitudinal RecordPatient Longitudinal Record

Fallbezogen!

Typischerweise besucht einPatient in vielen Besuchen eineReihe von Einrichtungen

Profil XDS (Profil XDS (DokumentenaustauschDokumentenaustausch))

Was Was istist IHE IT Infrastructure?IHE IT Infrastructure?

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

Patient Created Summaries


ECG Report Document


Lab Results Document Content


Scanned Documents

Format of the Document Content

Cross-enterpriseDocument Point-to-Point

InterchangeMedia-CD/USB & e-mail push

Imaging Information


Medical Summary (Meds, Allergies, Pbs)

Format of the Document Contentand associated coded vocabulary

Document Digital Signature

Attesting “true-copy and origin

Notice of Document Availability

Know about new information

Support for Support for RHIOsRHIOs

Patient Consent

XDS XDS SzenarioSzenario

PMS

Physician Office

EHR System

Teaching Hospital

XDS Clinical Affinity Domain

Community Clinic

Lab Info. System

PACS

PACS

Retrieve Document

Provide & Register

Register Document(using Patient ID)

Query Document(using Patient ID)

Document RegistryDocument

Repository

Document Repository

ED Application

PDQ Query to Acquire XAD Patient ID

PDQ Query to Acquire XAD Patient ID

ATNA CT

Audit record repository Time server

Patient Demographics Supplier

Record AuditEvent

MaintainTime

MaintainTime

MaintainTime

Record AuditEvent

Document Consumer

Retrieve Document

Query Documents

Patient Identity Source

Patient IdentityFeed

Document Source

Document Registry

Document Repository

Provide&Register Document Set

Register Document Set

AkteureAkteure undund TransaktionenTransaktionen -- XDSXDS

IHEIHE--XDSXDSZentralisierteZentralisierte ArchitekturArchitektur

Document Consumer

Retrieve Document

Query Documents



Document Source

Document Registry

Document Repository Provide&Register

Document Set

Document Source

Document Source

Document Source

Document Consumer

Document Consumer

Document Consumer

Document Consumer

Retrieve Document

Query Documents



Document Source

Document Registry

Document Repository

RegisterDocument Set

IHEIHE--XDSXDSDezentralisierteDezentralisierte ArchitekturArchitektur

Document Consumer

Document Consumer

Document Consumer

Document Source

Document RepositoryDocument

Source


Source

Document Repository

Document Consumer

Retrieve Document

Query Documents



Document Source

Document Registry

Document Repository

RegisterDocument Set Document

Repository

Document Source

Provide & Register Document Set

IHEIHE--XDSXDSGemischteGemischte ArchitekturArchitektur

Document Source

Document Source

Document Source

Document Consumer

Document Consumer

Document Consumer

Document Source


Source


Source

Document Repository

RegistryRegistry MetadataMetadata

Basierend auf HL7 CDA R1 (ANSI) ; HL7 CDA R2 (Draft) ; EHR ENV 13606 (CEN-Draft)

Patient IDService Start and Stop TimeDocument Creation TimeDocument Class Code and Display NamePractice Setting Code and Display NameHealthcare Facility Type Code and Display NameAvailable Status (Available, Deprecated)Document Unique ID...

Die komplette Liste enthält 33 Attribute, plus freie Definitionen

KlassendiagrammKlassendiagrammXDSSubmissionSet

authorInstitution

authorPerson

authorRole

authorSpecialty

comments

contentTypeCode

patientID

sourceID

submissionTime

uniqueID

XDSDocumentEntry

authorInstitutionauthorPersonauthorRoleauthorSpecialtyavailabilityStatusclassCodeconfidentialityCodecreationTimeentryUUIDeventCodeListformatCodehashhealthcareFacilityTypeCodelanguageCodelegalAuthenticatormimeTypeparentDocumentIDpatientIDpracticeSettingCodeserviceStartTimeserviceStopTimesizesourcePatientIDsourcePatientInfotitletypeCodeuniqueIDURI

+

Einige allgemeine Attribute:

•author

•patient

•document source

•encounter

Andere enthalten logische / technische Informationen

•title

•type of document

•eventCodeList

•classCode

•availabilityCode

•confidentialityCode

•formatCode

•language

•MIME Type

•size

XDSFolder

codeList

comments

lastUpdateTime

patientID

uniqueID

+

*+

RegistryPackage ExtrinsicObject

vgl. HL7 CDA

Document Relationships von HL7Document Relationships von HL7

APND (append)

Aktuelles Dokument ist eine Erweiterung zu Elterndokument

RPLC (replace)

Aktuelles Dokument ersetzt das Elterndokument

XFRM (transform)

Aktuelles Dokument ist eine Transformation des Elterndokuments

XFRM_RPLC (transform with replace)

Aktuelles Dokument ist beides, Transformation und Ersatz einesElterndokuments

parent *1current

parentDocumentID

Document Repository and RegistryDocument Repository and RegistryExample of Submission RequestExample of Submission Request

Document RepositoriesDocument Repositories

Document RegistryDocument RegistrySubmission RequestSubmission Request

Document

Document

DocumentEntry

DocumentEntry

SubmissionSet1

Folder A

CrossCross--Enterprise Document Sharing (XDS) Enterprise Document Sharing (XDS) StandardsStandards

XDS Infrastructure StandardsOASIS/ebXML

Registry Information Model v2.0

• Basis of XDS Registry Information Model

Registry Services Specifications v2.0

• Registry Services

Messaging Services Specifications v2.0

• Offline protocols

ISO/IEC 9075 Database Language SQL

Registry Query Language

SOAP with Attachments

Protocol for communication with XDS Registries and Repositories

SHA-1 [FIPS 180-1]

Document Hashes

Internet StandardsInternet Standards

HTTP

Protocol for Retrieve Document

Online SOAP bindings

SMTP

Offline ebMS bindings

IETF

Language Identifiers

MIME

Document Type codes

PDF, JPEG, HTML

XDS Document Content

UTF-8

Encoding of Registry Attributes

CrossCross--Enterprise Document Sharing (XDS) Enterprise Document Sharing (XDS) StandardsStandards

XDS Infrastructure Standards (cont)

HL7 Version 2.3.1

Messages for Patient Identity Management

HL7 Version 2.5

Datatypes for XDS Registry Attribute values

HL7 CDA Release 1

XDS Document concept definition

Source of XDS Document Entry Attributes

DICOM, ASTM CCR, HL7 CDA Release 2, CEN EHRcom

Sources of XDS Document Entry Attributes

XDS Community A

Cross Cross CommunityCommunity DiscoveryDiscoveryBuild an index of patient data locations

Several identifying communities

Controlled by attributes

RLS/PIX+

XDS Community B

XDS Registry

XDS Repository

Cross Community

Bridge

Cross Community

Bridge

PDQ Server

XDS Registry

Community Attribute Search Engine

Cross CommunitySearcher

(1)

(2)

(3)(4)

(8)

(5)

(6)

(7)

(1)

XDS Repository

Akteurmodell (Akteurmodell (eFAeFA v1.1)v1.1)

»Case«

IdentityManagement

Case Registry

PatientIdentity Feed

TokenService

Patient Care CoordinationPatient Care Coordination

Adressiert die Integration von Leistungserbringern überEinrichtungsgrenzen, klinische Fragestellung und Zeit

Berücksichtigt allgemeine und spezielle medizinischeAspekte, ebenso wie technische Infrastruktur

Bildet Workflow und Informationsaustausch ab in kooperativen Netzen

In 2005 begonnen, heute 5 Profile

PCC ProfilesPCC Profiles

Medical Summaries

ED Referral

ExchangingPHR

Content

AntenatalCare

Summary

EmergencyDepartment

Report

PreprocedureHistory and

Physical

BasicPatientPrivacyConsent

LabReport

CareAssessments

20052005--060620062006--070720072007--0808In

teg

rati

on

Co

nte

nt

Query for Dynamic Clinical Data

PCC TF as Library of TemplatesPCC TF as Library of Templates

LAB

Problems

Vitals

Result

Problem

Obs

SeverityReferral

Documents Sections Entries Parts

XPHR Vital

Emergency Department ReferralEmergency Department ReferralAbstractAbstract

Define a referral format for "heads-up" call

Supports Medical Summary Content

Special Needs of Emergency Department• Expected Time of Arrival

• Mode of Arrival

• Disposition/Orders

Emergency Department ReferralEmergency Department ReferralUse CaseUse Case

1. The patient undergoes assessments by a triage nurse, is assigned a triage category (i.e. emergent, urgent, non-urgent).

2. The patient is then registered and demographic data is obtained.

3. The patient undergoes additional assessments by a primary RN,

4. The patient is seen by an ED physician who performs a history and physical, orders various diagnostic tests, determines a course of therapy, orders medications to be administered in the ED and performs procedures on the patient.

5. Upon completion of ED care, the patient is either admitted to the hospital, discharged from the ED, or transferred to another facility.

Exchange of PHR ContentExchange of PHR ContentAbstractAbstract

Hilft beim Austausch von Dokumentenzwischen PHR und EHR Systemen

Unterstützt verschiedenste Mechanismenzur Übersetzung/Übermittlung

Beinhaltet PHR Update

Basic Patient Privacy Consents (BPPC)Basic Patient Privacy Consents (BPPC)AbstractAbstract

Konzepte zur:

Patientenzustimmung(en)

Indentifizierung von Policies unter denen ein DokumentAuthorisiert veröffentlicht werden soll

“Zwingt” zur Einhaltung des Datenschutzes und derPatientenzustimmung

AntepartumAntepartum SummarySummary

Pregnant diabetic patient is seen by obstetrician in office for initial visit.

Ultrasound performed to determine gestational age.

Patient sent for perinatology consult as a high risk patient.

Patient returns to perinatologist biweekly for blood testing andultrasounds when necessary in addition to regular ob visits.

Perinatologist reports back to obstetrician after each visit.

Patient arrives at labor and delivery at the hospital.

Obstetrician delivers by Cesarean Section after anesthesia.

Obstetrician provides postpartum care.

Functional Status AssessmentFunctional Status Assessment

The Institute of Medicine has determined that a high risk for errors occurs during the transfer of care.

The Functional Status Assessment Profile (FSA) supports the handoff of assessment information between practitioners during transfers of care, cross-enterprise or intra-enterprise.

Transfer of physician documentation provides medical assessment, diagnosis and treatment information.

Transfer of nursing documentation provides assessment and treatment of human response (psychosocial, physiologic, emotional and spiritual) of patient/family to changing conditions.

Key Technical PropertiesKey Technical Properties

Considerations for scales Scales chosen are evidence based with strong reliability and validity.

Widely accepted cross-enterprise or required/recommended by accrediting agencies

Content ScalesNumeric Rating Scale (NRS-11) for Pain

Braden Scale for Predicting Pressure Sore Risk©

Geriatric Depression Scale (GDS)

Minimum Data Set – Section G

Query for Existing Data ProfileQuery for Existing Data Profile

Exchange of information between Data Repositories and Clinical Data Consumers for:

1. Drug Safety2. Public Health, Biosurveillance and Disease Registries3. Identifying Qualifying Patients

1. Clinical Trials2. Disease Management

4. Quality Reporting5. Claims Submission

Actors and Transactions Actors and Transactions

[PCC-2]Query Medications

[PCC-1]Query Vital Signs

[PCC-3]Query Immunizations

[PCC-4]Query Diagnostic Data

[PCC-5]Query Problems and Allergies

Beispiel Beispiel UseUse CaseCase -- PAMPAM

Herangehensweisen Herangehensweisen Elektronische PatientenaktenElektronische Patientenakten

Quelle: Kees Smedema

... ... demnächstdemnächst in IT Infrastructurein IT InfrastructureNext step 2007

XDS FederationPIX and PDQ using HL7 v3Web Services Transport for IHE TransactionsXUA – Cross-Enterprise User AuthenticationRisk Management Planning White Paper

Candidates 2008Scheduling ( PCC)Wide-area patient acessMobile applications

Candidates 2009Remote service accessAnonymizationPseudonymisierungPatient-controlled access

IHE ConnectathonIHE Connectathon• Offene Einladung an die Software Entwickler Community

• Es werden moderne Testtools (MESA) genutzt

• Konformanztest organisiert und überwacht durch die neutrale Prüfer von IHE

• Tausende systemübergreifende Tests durchgeführt

IHEIHE--EUREURConnectathonConnectathon

2001 2002 2003 2004 2005 2006 20070

25

50

75

100

125

150

175

200

225

250

275

300

11

3343 46

7563

0

18

57

74 79

99

120

0

35

100

135

180

250

280

0

Dom ains

Integrat ion profil

Actors

Com panies

System s

Part icipants

Document Use Case Requirements

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

Develop technical

specifications

Testing at Connectathons IHE

Demonstrations

Products with IHE

Timely access to information Easy to integrate

products

DerDer jährlichejährliche IHE IHE ProzessProzess

RessourcenRessourcen

http://www.ihe.net

http://wiki.ihe.net/index.php

http://www.ihe-europe.org

XDS Open Source: http://www.eclipse.org/ohf/index.php

VielenVielen DankDankfürfür IhreIhre

AufmerksamkeitAufmerksamkeit

Andreas KassnerAndreas Kassner

[email protected]@vhitg.de

Use Case: Multiple primary residences

Use Case: Between two XDS Affinity Domains

Use Case: Patient Move

Use Case: Vacationer Vacationer: A patient

Use Case: Mergers, aquisitions, divestitures. A large healthcarecorporation, Bigco, acquires a small local hospital, Smallco.

Divestitures

A healthcare facility splits into two new organizations: Newco1 and Newco2.

Use Case: Transitory Alliances A medical facility and a researchfacility form a short term alliance for a research project.

Use Case: Surveillance, CDC pseudonimized

Use Case: PHR Services

Use Case: Remote Consulting.