Prsentation PowerPoint

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Organizing IHE Integration Profiles related to
the Electronic Health Record Initial
Thoughts IHE ITI Tech Committee - December 2003
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IHE Integration Profiles Focused on the EHR

• An IHE Integration Profile organizes a set of
  coordinated, standards-based transactions between
  a subset of the functional components of
  healthcare enterprises in order to address a
  specific clinical or infrastructure need.
• IHE develops such solutions for IT systems
  integration in a stepwise and pragmatic manner,
  focusing on the most common integration
  challenges.
• IHE has developed close to 20 Integration
  Profiles focuses on Radiology, Laboratory, IT
  Infrastructure (MPI, Security, etc.) and is now
  expanding to Cardiology. This is an
  intra-enterprise, bottom-up approach.
• In this proposal, IHE explains how it intends to
  approach the longitudinal dimension of the EHR
  with a distributed, cross-enterprise, document
  centric, top-down point of view.
• The strategy is to progressively bridge the two
  approaches as new integration profiles are
  developed.
• Feedback on this approach and expanding
  collaborations are sought.

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Continuity of Care Patient Longitudinal Record
Across Encounters
Nursing Homes
Acute Care (Inpatient)
Other Specialized Careor Diagnostics Services
A typical patient goes through a sequence of
encounters in different Care Setting (incl.
Diagnostics Services).
GPs and Clinics (Outpatient)
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Integration Feeding Accessing the
Longitudinal Health Record Information

EHR-LR
Acute Care (Inpatient)
Nursing Homes
Other Specialized Careor Diagnostics Services
GPs and Clinics (Outpatient)
The EHR-LR (Longitudinal Record) brings together
patient encounter information managed by multiple
care delivery systems
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Two types of Integration Health Record as used
during care delivery Health Record
as used across-encounters
Care Delivery Process
EHR-CR EHR information supporting immediate
care delivery EHR-LR EHR information supporting
long term care delivery
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EHR-LR Actors Directory Repository Actors
EHR-LR Directory
EHR-LR Documents Repository Custodian for an
unspecified time of Documents recorded from
patient encounters.
EHR-LR Documents Repository Custodian for an
unspecified time of Documents recorded from
patient encounters.
EHR-LR Virtual Documents Repository Custodian for
an unspecified time of Documents recorded from
local patient encounters.
EHR-CR
EHR-CR
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Key Statements EHR-LR Fundamentals

• The EHR-LR (Longitudinal Record) brings together
  patient encounter information managed by multiple
  care delivery systems, ranging from EHR-CR
  (Care-delivery Record) in a large hospital
  network all the way down to a single practice
  management system.
• EHR-LR will be cross-enterprise and may include
  one or more clinical domain and will be typically
  collected over a large period of time.
• EHR-LR includes repositories of encounter data
  that contribute to the patients longitudinal
  healthcare record. EHR-LR data will be stored in
  multiple repositories (depts., sites, domains).
• Encounter data includes some information/state/wor
  kflow info that may not end up in the EHR-LR.

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Key Statements What is in the EHR-LR ?

• The EHR-LR data is made of discrete, persistent,
  clinical documents accessed by a unique
  identifier. It may also contain other dynamic
  objects (e.g. prescription status, allergy lists,
  etc.) which are not addressed at this time.
• EHR-LR data will follow relevant clinical domain
  standards defined by field experts. Their
  content and codification will evolve according to
  the clinical needs.
• At the end of an encounter, new document(s) are
  published to the EHR-LR. These new EHR-LR
  documents will either be kept in the EHR-CR where
  they are created or pushed to a separate EHR-LR
  repository.
• Conversion between EHR-CR internal data formats
  and the standard EHR-LR document is the
  responsibility of the EHR-CR.

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Key Statements IHE Constraints

• The domains of EHR-LR are primarily clinical.
  Other information and services are needed to
  provide a complete view of the patient
  longitudinal record (e.g. demographics, security,
  consents IHE has already addressed some).
• The EHR-LR and EHR-CR repositories may be using
  different Patient Ids. The longitudinal view is
  provided by cross-patient identification
  services.
• The way data is stored and managed by the EHR-CR
  is out of scope of the EHR-LR IHE Integration
  Profiles.

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Key Statements Accessing EHR-LR

• EHR-LR shall provide a list of available
  documents for a patient. Logical directories will
  be used to provide such lists.
• The location and filtering of documents is the
  responsibility of the EHR-LR and not of the
  consumer applications. The EHR-LR will use
  meta-information about the documents it tracks to
  provide this service.
• The EHR-LR must provide with full content
  fidelity all clinical documents that have been
  registered.
• Documents may include references to other
  documents such as images, waveforms, etc.
• In addition, the EHR-LR may optionally provide
  clinical data to consumer applications based on
  processing, extracting, or combining the content
  of multiple existing documents.

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Key Statements Deploying IHE EHR-LR Profiles

• EHR-LR will likely be initially focused on
  certain specialties (cardiology, oncology, etc),
  disease, or on key information for continuity of
  care (CCR summaries only) and expand
  progressively.

Now includes disease.
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Integration Profiles Current Profiles vs
EHR-LR Profiles
EHR-LR
Acute Care (Inpatient)
Nursing Homes
EHR-CR
EHR-CR
EHR-CR
Other Specialized Careor Diagnostics Services
Patient Access
EHR-CR
EHR-LR The Longitudinal Record of a persons
health EHR-CR Care-delivery Record
GPs and Clinics (Outpatient)
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EHR-LR Integration Profiles Infrastructure(s)
Content(s)
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Some examples applying this EHR Concept

• Following are three examples where the same
  EHR-LR integration concept would be applicable
• GP Office in multiple IDNs with an EHR-LR ASP GP
  linkage to acute care
• Cardiologist Practices and Inpatient a domain
  specific longitudinal record
• Region or Country-Wide a broad cross-domain
  longitudinal record
• These examples largely rely on the same set of
  core-EHR-LR IHE Integration Profiles, but used
  with different configurations and policies. The
  EHR-LR documents content would greatly vary.
• These examples are not intended to be exhaustive,
  but attempt to demonstrate the balance that IHE
  is looking for a reasonably broad set of use
  cases that would share the same infrastructure
  (i.e. set of actors and transactions).

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Example GP Office in multiple IDNswith an
EHR-LR ASP
One Directory by IDN. Holds a reference to all
encountersknown by the IDN, including those from
the GP
EHR-LR Patient/Encounter Level Directory
EHR-LR Patient/Encounter Level Directory
This Encounter Directory manages allencounters
form the GP. It is an EHR-LR ASP. This ASP
system is also theprimary EHR-CR or all
documentscreated by the GPs encounters.
EHR-LR Encounter/Documents Level Directory
EHR-LR Documents Repository
GP Practice Clinical Record Entry Document
Creator and Consumer
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Example Cardiologist Practices and Inpatient
IDN and associated Cardiologists establisha
Central Directory. Holds a reference to all
encountersknown by the IDN and Cardiologist
EHR-LR Patient/Encounter Level Directory
EHR-LR Encounter/Documents Level Directory
This Encounter Directory manages allencounters
form the Cardiologists.It is an EHR-LR with all
documentscreated by Cardiology encounters.
EHR-LR Documents Repository
Cardiologist Practice Clinical Record Document
Creator and Consumer
CardiologyInpatient Clinical Record Document
Creator and Consumer
Cardiologist Practice Clinical Record Document
Creator and Consumer
CardiologyInpatient Clinical Record Document
Creator and Consumer
Cardiologist Practice Clinical Record Document
Creator and Consumer
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Example Regional or Country-Wide (e.g. NHII)
One such Patient Directory by region. Shadows
copies. Knows all lower leveldirectories where
encounters are identified.
EHR-LR Patient Level Directory
One such P/E Directory by region. Holds a
reference to all encountersmade in the region.
EHR-LR Patient/Encounter Level Directory
EHR-LR Patient/Encounter Level Directory
One such E/D Directory by EncounterCustodian
used by the health delivery entity where the
encounter happen
EHR-LR Encounter/Documents Level Directory
EHR-LR Encounter/Documents Level Directory
EHR-LR Documents Repository
EHR-LR Encounter/Documents Level Directory
One or more document repository by document
custodians used by the health delivery entity
where the encounter happen or external.
EHR-LR Documents Repository
EHR-LR Documents Repository
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EHR-LR Use Cases Actors Transactions Concepts
EHR-LR Patient Directory
EHR-LR Patient Directory
EHR-CR
EHR-LR
EHR-LR Patient Directory
QueryDoc List
EHR-LR Patient Directory
EHR-LR Encounter Directory
EHR-LR Encounter Directory
EHR-CR
Document Consumer
EHR-LR Documents Repository Custodian for an
unspecified time of Documents recorded from
patient encounters.
Register Doc
EHR-LR Documents Repository Custodian for an
unspecified time of Documents recorded from
patient encounters.
Register and Provide Doc
RetrieveDoc
Document Creator
EHR-LR Documents Virtual Repository Custodian for
an unspecified time of Documents recorded from
local patient encounters.
Not all transactions necessary to ensure
management of a distributed and dynamic EHR-LR
are depicted in this illustration.
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IHE Integration Profiles Focused on the EHR

• IHE proposes an approach to obtaining a
  longitudinal view of the EHR, with a distributed,
  cross-enterprise, document centric solution.
• The strategy is to progressively bridge the gap
  between the EHR-LR Integration Profiles and the
  domain integration profiles as new integration
  profiles are developed.
• Feedback on this approach and expanding
  collaborations are sought.
• Is this a useful brick ?
• The proposed strategy is a scoping exercise to
  address one of the many integration problems in
  the realization of the EHR vision. IHE does not
  claim to master and address the definition and
  all aspects of a complete and interoperable EHR
  System.
• In collaboration with well established standards
  bodies and other EHR related initiatives
  world-wide (EHRCOM, CCR, HL7, etc.), IHE expects
  to contribute at a more cost-effective and rapid
  deployment.

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Draft IHE IT Infrastructure Roadmap In support
of the IHE Integration Profiles focused on the
EHR Draft for Comments 11/03 To be finalized
January 2004.
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IHE IT Infrastructure Roadmap HIMSS 2004 (1)
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IHE IT Infrastructure Roadmap - Next Stage (2)
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IHE IT Infrastructure Roadmap Stage 3
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IHE IT Infrastructure Roadmap Stage 4
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IHE IT Infrastructure Roadmap Stage 5