Leveraging IHE to build RHIO Interoperability

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Leveraging IHE to buildRHIO Interoperability
Charles Parisot GE Healthcare IHE IT
Infrastructure Technical Committee co-chair
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• Providers and Vendors
• Working Together to Deliver
• Interoperable Health Information Systems
• in the Enterprise
• and Across Care Settings

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Selected IHE Integration Profiles for RHIOsWhat
is available and is added in 2005
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HIMSS 2005 Show-Wide Interoperability
Vendor System
HIMSS RHIO with Cross-enterprisedoc sharing
(17 vendors)
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HIMSS 2005 InteroperabilityShow Case Vendors

• Leadership Level
• CapMed/SanDisk
• Eclipsys
• GE Healthcare
• IDX
• InterSystems
• Kryptiq
• Quovadx/CareScience
• Siemens
• WebMD

Supporter Level AccessPt AGFA dbMotion Dinmar
Oacis EMC Healthvision Healthramp McKesson Va
lco Data Systems
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IHE North America Vendors (2004-2005)

• Hologic
• IDX Systems Corp.
• INFINITT Technology
• InSite One, Inc.
• Intelerad Medical Systems
• InterSystems Corporation
• Konica-Minolta Medical Imaging, USA, Inc.
• Kryptiq
• Marotech
• McKesson Information Solutions
• MedCommons Inc.
• MedCon, Inc.
• Merge eFilm
• Mortara Instrument, Inc.
• Novell, Inc.
• Philips Medical Systems

• QRS Diagnostic
• Quovadx
• St. Jude Medical A.B.
• Sectra Imtec A.B.
• St. Jude Medical A.B.
• Sectra Imtec A.B.
• Sentillion
• Siemens Medical Solutions
• Stentor
• Swissray International, Inc.
• Tiani Medgraph A.G.
• Tiani Spirit Gmbh
• Toshiba Medical Systems Company
• Vital Images
• WebMD Practice Services

• Agfa HealthCare
• Allscripts
• Camtronics Medical Systems
• Cedara Software Corp.
• Cerner Corporation
• Dictaphone Corporation
• Dynamic Imaging, LLC
• Eastman Kodak Company
• Eclipsys
• Emageon
• Epic Systems Corporation
• ETIAM
• FujiFilm Medical Systems, USA, Inc.
• GE Healthcare
• Heartlab, Inc
• Hitachi Medical Corporation

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At HIMSS in 2005 IHE-XDS
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At HIMSS in 2005 IHE-XDS

• Shared prototype content
• Medical Summaries (Pre-CCR)
• Discharge Summaries (CDA-R1)
• Lab Results (HL7)
• Other (PDF)

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Demo a RHIO with IHE at HIMSS 2006 ?

• Secured Sharing of
• Medical Summaries
• Images reports
• ECG Reports
• PDFs
• Lab Results ?
• Notif of Doc Avail.

1-Patient Authorized Inquiry
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Document Life Cycle Management
Addendum to a registered document
Time
A two-way relationship between Original and
Addendum
Document
Addendum
Addendum
Replacing a registered document by a new document
Document 1 (Approved)
Time
A two-way relationship between Original and
Replacement Document.
Replacement
Replacement Document
Document 1 (Deprecated)
Registering an alternate form or a signature for
a registered document
Transform
A two-way relationship between Original and
Transform (alternative format with same scope or
DSG).
Document 2 (transform)
Document 1 (Approved)
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Local Regional RHIOs Infrastructure and
Interoperability

• Cross-Enterprise Document Sharing (XDS) minimizes
  clinical data management by the infrastructure.
  Transparency Ease of Evolution
• XDS works with other IHE Integration Profiles
  patient Id mgt, security, etc. Flexibility of
  RHIO configuration
• With introduction of new Integration Profiles,
  IHE ready to build regional health networks
  linking interoperable EHRs. Major milestone for
  2006 RHIO projects
• Goal is to offer a consistent, standards-based
  and functional for EHRs and other ancillary
  systems.

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Creating a Health Information Network with IHE
Tier 1 EHRs and Ancillaries
Care Delivery IT system
Care Delivery IT system
Care Delivery IT system
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Creating a Health Information Network with IHE
Tier 2 Community HIN
What and Where ?
Care Delivery IT system
Care Delivery IT system
XDS Document Registry
Care Delivery IT system
XDS Document Repository
XDS Document Repository
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Creating a Health Information Network with IHE
Who, What and Where ?
Who, What and Where ?
Tier 2 Community HIN
C-HIN Patient Identity Source
Patient Demo Supplier
Care Delivery IT system
Care Delivery IT system
XDS Document Registry
Patient Id X-Ref Mgr
PDQ Consumer
Care Delivery IT system
Patient Id X-Ref Mgr
XDS Document Repository
XDS Document Repository
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Creating a Health Information Network with IHE
Time Server
Tier 2 Community HIN
C-HIN Patient Identity Source
Patient Demo Supplier
Care Delivery IT system
Care Delivery IT system
XDS Document Registry
Patient Id X-Ref Mgr
PDQ Consumer
Who, What When and Where ?
Care Delivery IT system
Patient Id X-Ref Mgr
XDS Document Repository
XDS Document Repository
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Creating a Health Information Network with IHE
Time Server
Tier 2 Community HIN
C-HIN Patient Identity Source
Patient Demo Supplier
Care Delivery IT system
Care Delivery IT system
XDS Document Registry
Patient Id X-Ref Mgr
PDQ Consumer
Who, What When and Where ? Trusted !
Care Delivery IT system
Patient Id X-Ref Mgr
XDS Document Repository
XDS Document Repository
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Security for XDSLeverages IHE Audit Trail Node
AuthenticationA formal Security and Privacy
profile is provided for XDS

• ATNA creates a secured domain
• User Accountability (Audit trail)
• Node-to-Node Access Control
• Node-level user authentication
• User access control provided by node
• BUT Registry/repository based User-Level Access
  Control and policy agreements is beyond XDS.
• User-level Access Control is
• provided by XUA

Patient Identity Source
Secured Node
Patient Identity Feed
Secured Node
Query Documents
Document Consumer
Document Registry
Secured Node
Register Document Set
ProvideRegisterDocument Set
Retrieve Document
Secured Node
Document Repository
Document Source
Secured Node
Secured Node
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Cross-Enterprise User AuthenticationTransaction
Diagram
XDS Repository
Identity Provider
2 Request Assertion (of who this user is)
5 Authentication Assertion
3 Request User ID
1 XDS Retrieve
Record Auditable Event
4 User Identity
ATNA Audit Repository
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Is it possible to federate multiple XDS-based HIN
?
Tier2 Community-HINs e.g. XDS Affinity Domain
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Federating Tier 2 Health Information NetworksOn
IHE Roadmap for 2006-2007 X-Registry
Federation(Addressed by ebXML Registry 3.0)
What are the document registries where a patient
has information ?
Federated Identification
Patient / Registry Locator Service
Tier 3 HIN e.g. State Level
RG
T2 C-HIN B e.g. XDS Affinity Domain
RG
Managed Identification
T2 C-HIN D e.g. XDS Affinity Domain
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Federating Tier 2 Health Information NetworksOn
IHE Roadmap for 2006-2007 X-Registry Federation
Integrating existing IDNs Adaptor Registry
Federated Identification
Patient / Registry Locator Service
Tier 3 HIN e.g. State Level
RG
T2 C-HIN B e.g. XDS Affinity Domain
RG Adapt
RG
Managed Identification
RG Adapt
T2 C-HIN A e.g. IDN
T2 C-HIN D e.g. XDS Affinity Domain
T2 C-HIN C e.g. IDN
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Federating Tier 3 Health Information NetworksOn
IHE Roadmap for 2006-2007 X-Registry
Communication
Nation-Wide Health Info network (Tier 4)
Patient / Registry Locator Service
Patient / Registry Locator Service
Patient / Registry Locator Service
e.g. State HIN
RG
RG
RG
T1-RHIO B e.g. XDS Affinity Domain
RG
T1-RHIO A e.g. IDN
T1-RHIO D e.g. XDS Affinity Domain
T1-RHIO C e.g. IDN
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IHE RHIOs Interoperability Partner

• IHE offers a solid technical foundation to
  establish interoperability for RHIOs.
• Standards-based, open, multi-vendor,
  provider-led.
• Yearly progress, validation testing built in,
  backed by a proven process. Implementation by
  many vendors.
• IHE welcomes RHIOs technical architects active
  involvement.
• The IHE Technical Framework accelerates RHIOs
  pilot development (e.g. XDS Affinity Domain).
• This is being applied Norway, Italy, then
  Canada, soon USA, France, ?

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Clinicians access XDS Servicesthrough their
clinical IT system (EHRs)
DocumentRepositories
Index of patients records (Document-level)
ClinicalIT System
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Sharing Radiology Reports and Images with XDSin
a Regional Health Information Network
Regional Health Information Network
Radiology Enterprise B
PACS B
Radiology-to-radiology
Radiology-to-Physicians
PACS A
Radiology Enterprise A
Physician Office
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Sharing Radiology Reports and Imagesin a
Regional Health Information Network
Regional Health Information Network
Radiology Enterprise B
PACS B

• Patient Id 3547F45
• Report 5/21/1998 CT Head ?B
• Study 5/21/1998 CT Head ?B
• Report 2/18/2005 Chest Xray ?A
• Study 2/18/2005 Chest Xray ?A

Cross-Enterprise Registry
PACS A
Radiology Enterprise A
Physician Office
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Physicians and Systems within a Regional Health
Network - Routine Imaging Referral
Regional Health Information Network
Radiology Enterprise B
Cross-Enterprise Registry

• Patient Id 3547F45
• Report 5/21/1998 CT Head ?B
• Study 5/21/1998 CT Head ?B

Radiology Enterprise A
Physician Office
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Physicians and Systems within a Regional Health
Network - Routine Imaging Referral
Regional Health Information Network
Radiology Enterprise B
Cross-Enterprise Registry
Radiology Enterprise A
Physician Office
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Physicians and Systems within a Regional Health
Network for a Routine Imaging Referral
Regional Health Information Network
Radiology Enterprise B

• Patient Id 3547F45
• Report 5/21/1998 CT Head ?B
• Study 5/21/1998 CT Head ?B
• Report 2/18/2005 Chest Xray ?A
• Study 2/18/2005 Chest Xray ?A

Cross-Enterprise Registry
Radiology Enterprise A
Physician Office
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Regional Health Information NetworkImages and
reports part of a shared health record
Regional Health Information Network
Enterprise B
Register Documents for sharing
Retrieve Prior Documents
Retrieve PriorDocuments
Cross-Enterprise Registry
Register Documents for sharing
Query for Documents
Query for documents
Notification of Doc Availability
Retrieve Documents
Enterprise A
Physician Office
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Requirements for care delivery IT system in a
RHIO(e.g. EHR, Lab, Imaging, etc.)
Audit Trail Node Authentication
Centralized privacy audit trail and node to node
authentication to create a secured domain.
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IHE Interoperability for RHIOs

• By starting with a secured document sharing
  infrastructure, RHIOs have a a platform on which
  to build clinical content (more structure coded
  terminology, specialized content).
• Solid SAML 2.0 authentication and document
  digital signature (need a PKI).
• Practical HL7 V3 approach with CDA-R2 and other
  content (e.g. imaging, CCR, legacy, PDF, etc.).
• Establishing a critical mass of products
  implementations, both in clinical applications
  and infrastructure for deployment in 2006.
• An architecture that caters to various RHIOs
  architectures centralized, decentralized and
  mixed (operational decision).

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More information.

• IHE Web sites www.ihe.net
• Technical Frameworks, Supplements
• Fill in relevant supplements and frameworks
• Non-Technical Brochures
• Calls for Participation
• IHE Fact Sheet and FAQ
• IHE Integration Profiles Guidelines for Buyers
• IHE Connect-a-thon Results
• Vendor Products Integration Statements

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IHE Patient Id management for RHIOsUse of PIX
and PDQ Integration Profiles
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Patient Identification ManagementPIX Cross
Referencing (coexist with PDQ)
Patient Identity Source
Patient Identification Domain C
Patient Identification Domain D2
Patient Identification Domain XAD
XDS Document Registry


DmD2 PidPd
DmC PidPc
XDS Document Repository
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Patient Identification ManagementPDQ Discovery
Local mapping (coexist with PIX)
Patient Identity Source
Patient Identification Domain C
Patient Identification Domain D2
Patient Identification Domain XAD
XDS Document Registry


XDS Document Repository
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• Providers and Vendors
• Working Together to Deliver
• Interoperable Health Information Systems
• in the Enterprise
• and Across Care Settings