INTEGRATING THE HEALTHCARE ENTERPISE IHE Orientation Workshop

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INTEGRATING THE HEALTHCARE ENTERPISE
(IHE)Orientation Workshop

• International HL7 Interoperability Conference-08
• Charles Parisot, IHE Europe, GE Healthcare, Buc,
  France
• Eric Poiseau, IHE Europe Technical Project
  Manager, INRIA Rennes

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Agenda

• 0830-1030 THE IHE STANDARDS ADOPTION PROCESS
  achieving practical interoperability - Charles
  Parisot
• Coffee Break
• 1100-1230 USERS AND VENDORS WORKING TOGETHER
  how can I contribute benefit from IHE Charles
  Parisot
• Lunch Break
• 1330-1500 HOW TO USE IHE RESOURCES hands on
  experience Eric Poiseau

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Agenda

• 0830-1030 THE IHE STANDARDS ADOPTION PROCESS
  achieving practical interoperability
• Coffee Break
• 1100-1230 USERS AND VENDORS WORKING TOGETHER
  how can I contribute benefit from IHE Charles
  Parisot
• Lunch Break
• 1330-1500 HOW TO USE IHE RESOURCES hands on
  experience Eric Poiseau

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IHE A Framework for Interoperability

• A common framework for harmonizing and
  implementing multiple standards
• Application-to-application
• System-to-system
• Setting-to-setting
• Enables seamless health information movement
  within and between enterprises, regions, nations
• Promotes unbiased selection and coordinated use
  of established healthcare and IT standards to
  address specific clinical needs

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Standards NecessaryNot Sufficient

• Standards are
• Foundational - to interoperability and
  communications
• Broad - varying interpretations and
  implementations
• Narrow - may not consider relationships between
  standards domains
• Plentiful - often redundant or disjointed
• Focused - standards implementation guides focus
  only on a single standard

IHE provides a standard process for implementing
multiple standards
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IHE Connecting Standards to Care

• Healthcare professionals work with industry
• Coordinate implementation of standards to meet
  clinical and administrative needs
• Clinicians and HIT professionals identify the key
  interoperability problems they face
• Providers and industry work together to develop
  and make available standards-based solutions
• Implementers follow common guidelines in
  purchasing and integrating effective systems

IHE A forum for agreeing on how to implement
standards and processes for making it happen
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Standards Adoption Process
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Stakeholder Benefits

• Healthcare providers and support staff
• Improved workflows
• Information whenever and wherever needed
• Fewer opportunities for errors
• Fewer tedious tasks/repeated work
• Improved report turnaround time
• Vendors
• Align product interoperability with industry
  consensus
• Decreased cost and complexity of interface
  installation and management
• Focus competition on functionality/service space
  not information transport space
• SDOs
• Rapid feedback to adjust standards to real-world
• Establishment of critical mass and widespread
  adoption

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IHE Implementation Strategy

• Leverage established standards to allow rapid
  deployment and plan for futurePragmatic, Ease of
  Evolution
• Enable architectural freedom (patient vs.
  provider centric, centralized vs. decentralized,
  scalable (from office to enterprise to IDN to
  RHIO) Configuration flexibility
• Support breakthrough use cases variety of care
  settings, care coordination, public health, PHR,
  EHRInteroperability for broad constituencies

IHE Offers consistent, standards-based record
sharing for EHRs and other information systems
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Growth in IHE Domains

• Over 200 vendors involved world-wide
• 8 Technical Frameworks
• 64 Integration Profiles
• Testing at Connectathons world-wide
• Demonstrations at major conferences world-wide

Public Health, Quality and Research
Pathology
Patient Care Devices (3 profiles)
Patient Care Coord. (5 profiles)
Radiation Oncology (3 profiles)
Eye Care (4 profiles)
Laboratory (6 profiles)
Cardiology (7 profiles)
IT Infrastructure for Healthcare (20 profiles)
Radiology (18 profiles)
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
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International Growth of IHE
Australia

• Local Deployment
• National Extensions
• Promotional Live Demonstration Events
• Funding

Pragmatic global standards harmonization best
practices sharing
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IHE Integration Profiles - Model

• Actors in precisely defined roles
• Abstracts a specific function of information
  system
• Executing precisely defined transactions
• Using existing standards
• To solve real world interoperability
  problems
• Specifying Integration Profiles

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IHE Technical FrameworksImplementation Guide for
each Integration Profile
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Organization of Technical Frameworks

• Volume 1 Integration and content Profiles
• Describes clinical need and use cases
• Identifies
• the actors and transactions or,
• content modules
• Volume 2 of Technical Framework
• Provides implementation specification for
  transactions or content modules

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Key IHE Concepts

• Generalized Systems -gt Actors
• Interactions between Actors -gt Transactions
• Problem/Solution Scenarios -gt Integration
  Profiles
• For each Integration Profile
• the context is described (which real-world
  problem)
• the actors are defined (what systems are
  involved)
• the transactions are defined (what must they do)

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1st key concept Actor

• Represents a set of application roles and
  responsibilities performed by a system
• Always supported by a real-world system
• A real-world system may support several IHE
  Actors
• Examples
• Order Placer
• Order Filler
• Patient Admission, Discharge and Transfer (ADT)
• Laboratory Automation Manager
• Point Of Care Analyzer

IHE leaves the definition of products to users
and vendors
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2nd key concept Transaction

• A set of interactions or messages defined between
  two Actors for a specific task.
• Defines unambiguously how the Actors must
  cooperate to achieve this task.
• Using existing standards such as HL7, DICOM,
  NCCLS etc.

Example Transaction LAB-1  Placer order
management 
IHE defines transactions at a user-level workflow
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3rd key concept Integration Profile
Solves an Integration Problem A collection of
real world information exchange capabilities
supported by a set of specific Actors using
Standards-based Transactions

• Examples 
• Enterprise User Authentication
• Retrieve Information for Display
• Laboratory Scheduled Workflow
• Echo Laboratory Workflow
• Cross-Enterprise Document Sharing

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The Product World..
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The IHE World.
IHETransaction
IHETransaction
IHE Actor
IHE Actor
IHETransaction
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Mapping IHE to Products
IHETransaction
IHETransaction
IHE Actor
IHE Actor
IHETransaction
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IHE and Service Oriented Architectures

• SOA is a powerful business driven design
  methodology
• SOA wraps interoperability in services, but
  does not solve interoperability
• E.g. Web Services may or may not be used in SOA.
  IHE Profiles are largely (not always) based on
  Web Services.
• Standardizing Services offered along with the
  protocols is 20 years old (Open System
  Interconnect). Good, but a precise Service
  definition does not result in compatibility on
  the wire.
• IHE Integration profiles are supportive of
  Service Oriented Architecture, but do not
  require them. Service Aware !
• Bits have to be compatible on the wire No way
  to avoid specifying transaction content

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Standards Adoption Process
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IHE Connectathon

• Open invitation to vendor and other implementors
  community
• Advanced testing tools (MESA, KUDO, GAZELLE)
• Testing organized and supervised by project
  management team
• Thousands of cross-vendor tests performed
• Results recorded and published

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IHE Connectathons
Massive yearly events 70-80 vendors 250-300
engineers 100-120 systems .integrated in 5 days
Next Connectathon Wien, Austria, April 20-24,
2008
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www.ihe.net/Events/connectathon_results.cfm
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Leveraging IHE Integration Statements

• Vendors
• Claim IHE Compliance in an explicit way
• Can rely on an objective and thorough
  specification(IHE Technical Framework)
• Willing to accept contractual commitments
• Willing to correct implementation errors
• Buyers
• Can compare product integration capabilities
• Simplify and strengthen their RFPs
• Can leverage a public and objective commitment
• Decreased cost and complexity of interface
  deployment and management

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Example 2008 HIMSS Interoperability Showcase
Next Demonstration at WoHIT, Copenhagen, Nov
4-6, 2008
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Feb 2008 HIMSS Interoperability Showcase
Next Demonstration at WoHIT, Copenhagen, Nov
4-6, 2008
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Featured this year in the HIMSS Showcase

• 76 connected applications, 32 IHE profiles
• Secured Health Information Exchange with broad
  content
• Clinical Scenarios, focusing on clinician and
  patient access and information sharing across the
  continuum of care
• Population Health, Quality and Research
• Privacy and Security
• HITSP Interoperability Specifications

The 2008 Cast

• Health information exchange with patient care
  devices
• Personal health record solutions
• Financial and administrative systems for billing
  and claims attachments (CAQH/CORE)
• Expanded distributed demonstration in an HIE
  format showing connectivity with vendor booths

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• Providers and Vendors
• Working Together to Deliver
• Interoperable Health Information Systems
• in the Enterprise and
• Across Care Settings
• ? Health Information Exchange (HIE)or shared EHR

http//www.ihe.net
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Requirements for an open HIE/EHR

• Bring trust and ease of use for healthcare
  professionals
• Care delivery organizations choose information to
  share
• Based on patient health status
• When they see fit (discharge, end of encounter,
  etc.)
• What information to share (pick relevant types of
  documents, and content elements).
• Care delivery organizations access patient
  information through
• their own local EMR (if they have one), or
• through a shared portal/service otherwise.
• When accessing patient info
• Find quickly if relevant information is available
  or not (single query).
• May select among relevant records, which ones to
  see (may be done in background)
• Among those of interest, chose to import in whole
  or part in its own EMR patient record
  (responsibility).

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Requirements for an open HIE/EHR(2)

• Bring trust and privacy to patients
• Only authorized organizations and authenticated
  healthcare providers may transact in the HIE
• Each node or IT system interfaced is strongly
  authenticated
• Each user shall be authenticated on the edge
  system (where context is best known)
• All traffic trough the infrastructure is
  encrypted
• Patient consent needs multiple choices or levels
• Unless opt-in, no data about a specific patient
  may be shared
• Several data sharing policies offered to the
  patient consent
• Each shared record/document is assigned to
  specific policies (or not shared) at encounter
  time.
• Healthcare providers may only access
  records/documents compatible with their role.

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Categories of Healthcare Communication Services
HIEs and Shared EHRs
Hospitals
Patient and Provider ID Mgt
e.g. access to last 6 months historical labs and
encounter summaries
e.g. order a lab test, track status and receive
results
e.g. get a current list of allergies or med list
from a source
Security
Document Sharing
Dynamic Information Access
Workflow Management
Source-persisted and attested health records
Specific info snapshot provided on demand
2 or more entities synchronize a task
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Categories of Healthcare Communication Services
HIEs and Shared EHRs
Hospitals
Patient and Provider ID Mgt
Medical Summary (XDS-MS)
e.g. access to last 6 months historical labs and
encounter summaries
e.g. order a lab test, track status and receive
results
e.g. get a current list of allergies or med list
from a source
Security
Cross-Enterprise Document Sharing (XDS)
Document Sharing
Dynamic Information Access
Workflow Management
Source-persisted and attested health records
Specific info snapshot provided on demand
2 or more entities synchronize a task
Patient Id Cross-Referencing (PIX)
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IHE Profiles Specifications

• Go to www.ihe.net/Technical_frameworks
• For XDSUnder IT Infrastructure
• IT Infrastructure Technical Framework 5.0 (XDS.b)
• Until 5.0 published use XDS.bXDS Stored Query
  supplements.
• For PIXUnder IT Infrastructure
• IT Infrastructure Technical Framework 4.0 or 5.0
  (PIX, HL7V2)
• Or PIXV3 supplement (PIX HL7 V3).
• For XDS-MS Under Patient Care Coordination
• PCC Technical framework 3.0

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Patient Identifier Cross-referencing for
MPIServices

• Allow all enterprise participants to register the
  identifiers they use for patients in their domain
• Participants retain control over their own
  domains patient index(es)
• Support domain systems queries for other
  systems identifiers for their patients
• Optionally, notify domain systems when other
  systems update identifiers for their patients

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Patient Identifier Cross-referencing for
MPIValue Proposition

• Maintain all systems identifiers for a patient
  in a single location
• Use any algorithms (encapsulated) to find
  matching patients across disparate identifier
  domains
• Lower cost for synchronizing data across systems
• No need to force identifier and format changes
  onto existing systems
• Leverages standards and transactions already used
  within IHE

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Patient Identifier Cross-referencing for
MPITransaction Diagram
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Patient Identifier Cross-referencing for
MPIProcess Flow Showing ID Domains Transactions
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Patient Identifier Cross-referencing for MPI
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Patient Identifier Cross-referencing for
MPIActors

• Patient Identity Source
• Definition
• Assigns patient identities within its own domain
• Notifies Patient Identifier Cross-reference
  Manager of all events related to patient
  identification (creation, merge, etc.)
• Example Registration (ADT) Actor in IHE
  Radiology Scheduled Workflow (SWF) Profile
• Transaction Supported - Required
• Patient Identity Feed ITI-8 (as sender)

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Patient Identifier Cross-referencing for
MPIActors

• Patient Identifier Cross-reference Consumer
• Definition
• Requires information about patient identifiers in
  other domains
• Requests patient identifier information from
  Patient Identifier Cross-reference Manager
• Transaction Supported - Required
• PIX Query ITI-9 (as sender)
• Transaction Supported - Optional
• PIX Update Notification ITI-10 (as receiver)

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Patient Identifier Cross-referencing for
MPIActors

• Patient Identifier Cross-reference Manager
• Definition
• Serves a well-defined set of Patient Identifier
  Domains
• Receives patient identifier information from
  Patient Identity Source Actors
• Manages cross-referencing of identifiers across
  domains
• Transactions Supported - Required
• Patient Identity Feed ITI-8 (as receiver)
• PIX Query ITI-9 (as receiver)
• PIX Update Notification ITI-10 (as sender)

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Patient Identifier Cross-referencing for
MPIStandards Used 2 Profiles

• PIX HL7 Version 2.5
• ADT Registration and Update Trigger Events
• A01 inpatient admission
• A04 outpatient registration
• A05 pre-admission
• A08 patient update
• A40 merge patient
• Queries for Corresponding Identifiers
  (ADTQ23/K23)
• Notification of Identifiers Lists Updates
  (ADTA31)
• PIX V3 HL7 V3
• Leverage Web Services (harmonized WS by IHE
  Appendix V)

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PIX Integration Profile MPIThe typical view
PIX Server acting as MPI
Patient Identity Cross-reference Manager
Master (A) PatientIdentity Source
Patient Identification Domain A (Master Domain)
Patient Identification Domain B
Patient Identification Domain C
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PIX Integration Profile MPI The Equivalent IHE
Model
Linking PIX Server
Patient Identity Cross-reference Manager
Patient Identification Domain A (Master Domain)
Master (A) PatientIdentity Source
Patient Identification Domain B
Patient Identification Domain C
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Introduced at HIMSS in 2005 IHE-XDS
Community or sub-network
Repository ofDocuments
Repository ofDocuments
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Health Information Exchanges Interoperability
Cross-enterprise Document Sharing

• Cross-Enterprise Document Sharing simplifies
  clinical data management by defining
  interoperable infrastructure. Transparency
  Ease of Evolution
• Patients have guaranteed portability and
  providers may share information without concerns
  of aggregation errors.Digital Documents
  Patients and providers empowerment
• Supports both centralized and decentralized
  repository architectures. Ease of federation
  nationally. Flexible privacy, Flexibility of
  configurations
• Addresses the need for a longitudinal healthcare
  data (health records). Complements to
  interactive workflow or dynamic access to data.

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Cross-Enterprise Document Sharing (XDS)
Standards Used
HealthcareContent Standards HL7 CDA header
extract
Internet Standards HTML, HTTP,ISO, IETF
Electronic BusinessStandards ebXML Registry,
SOAP, Web Services

• Implemented world-wide by close to 100
  vendors/open source.
• Adopted in several national regional
  projectsItaly, Austria, Canada, USA, Japan,
  South Africa, France, etc.)

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Why is IHE-XDS a breakthrough ?

• It based on an International Standards ebXML
  registry OASIS and ISO standard, Web
  Service/Soap/XML.
• Sharing of digital documents as attested by the
  source, meets the most urgent needs. A proven
  healthcare community data-sharing paradigm
  (Message feeding a central web server hinders use
  of EHRs).
• Efficient to support all types of Health IT
  Systems (IDNs, Hospitals, Ambulatory, Pharmacy,
  Diagnostics Centers, etc.) and all types of
  information (summaries, meds, images, lab
  reports, ECGs, etc.), structured and
  unstructured.
• Meets both the needs of push communication by
  info sources and on-demand pull in a variety of
  centralized or distributed architectures.

Offer a consistent, standards-based and
functional record sharing for EHRs, PHRs other
IT Systems
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Combining IHE ProfilesDocument Content Modes
of Document Exchange
Doc Content Profiles (Semantics content)
Scanned Doc XDS-SD
Pre-Surgery PPHP
Functional Status Assesment FSA
Consent BPPC
Emergency EDR
PHR Exchange XPHR
Discharge Referrals XDS-MS
Imaging XDS-I
Laboratory XD-Lab
Document Exchange Integration Profiles
Document SharingXDS
MediaInterchange XDM
Reliable Pt-PtInterchange XDR
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Typically, a patient goes through a sequence of
encounters in different Care Settings
Long Term Care
Acute Care (Hospital)
Other Specialized Care(incl. Diagnostics
Services)
GPs and Clinics (Ambulatory)
Continuity of Care Patient Longitudinal Record
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Building and accessing Documents
Documents Registry
EHR-LRLongitudinal Recordas usedacross-encount
ers
Long Term Care
Acute Care (Inpatient)
Other Specialized Careor Diagnostics Services
EHR-CR Care Record systemssupporting care
delivery
PCPs and Clinics (Ambulatory)
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Cross-Enterprise Document Sharing (XDS.b)
Actor/Transaction Diagram
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XDS Value Proposition

• Foundation for Health IT Infrastructures Shared
  Electronic Health Record, in a community, region,
  etc.
• Effective means to contribute and access clinical
  documents across health enterprises.
• Scalable sharing of documents between private
  physicians, clinics, long term care, pharmacy,
  acute care with different clinical IT systems.
• Easy access Care providers are offered means to
  query and retrieve clinical documents of interest.

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XDS - Value Proposition

• Distributed Each Care delivery organization
  publishes clinical information for others.
  Actual documents may remain in the source EHR
• Cross-Enterprise A Registry provides an index
  for published information to authorized care
  delivery organizations belonging to the same
  clinical affinity domain (e.g. a region).
• Document Centric Published clinical data is
  organized into clinical documents. using
  agreed standard document types (HL7-CDA, PDF,
  DICOM, etc.)
• Document Content Neutral Document content is
  processed only by source and consumer IT systems.
• Standardized Registry Attributes Queries based
  on meaningful attributes ensure deterministic
  document searches.

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IHE XDS Integration Profile Key Concepts

• XDS Document
• XDS Submission Set
• XDS Folder

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Document Repository and RegistryExample of
Submission Request
Document Registry
Document Repositories
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IHE XDS Integration Profile Key Concepts

• XDS Document
• A set of attested clinical information
  (structured or not) which form an element of a
  patient record to be shared. It may already
  exist within the source IT system.
• XDS Submission Set
• A set of documents related to a patient that a
  (team of) clinician(s) in the same source system
  have decided to make available at one point in
  time to potential consumers.
• XDS Folder
• A means to group documents for a number of other
  reasons
• Team work across several physicians,
• Episode of care,
• Emergency information for a patient, etc.
• XDS leaves open the use of folders to affinity
  domain clinicians.

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How real is XDS ?

• Stable specification IHE Technical Framework
  Published Aug 15th, 2004 (TI Supplement)
• XDS.b Supplement that offers
• Use most recent Web Services stds (MTOM/XOP)
• Allow Retrieve sets of Documents in one
  transaction
• Same services
• First implementation in clinical use in region of
  Genoa - Italy) since early 2006.
• Several since Lower Austria region, State of
  Vermont, Nagoya city, South Africa region, 2
  Dutch regions, etc.
• Adopted by several national programs world-wide
• 4 open source toolkits available, numerous
  product implementations in EHRs and
  Infrastructure offerings.

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IHE, global standards-based profiles adopted by
several national regional projects
Lower Austria
Netherland Amsterdam
Italy (Conto Corrente Salute)
UK CfH (Radiology WF)
Denmark (Funen) Italy (Veneto) Spain (Aragon)
FranceDMP
Quebec, Toronto,Alberta, British ColumbiaCanada
Infoway
VITL-Vermont
Boston Medical Center - MA
Philadelphia HIE
CPHIC Pennsylvania
CareSpark TN VA
South Africa
THINC- New York NCHICA N. Carolina
CHINA-MoH Lab results sharing
JAPAN-Nagaya Imaging Info Sharing
Malaysia
CHINA-Shanghai Imaging Info Sharing
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IHE-XDS is part of a family of profiles

• Regional, national, local or disease centric
  networks need a consistent set of Integration
  Profiles
• Eight Integration Profiles completed and tested,
  plus ten ready to implement Standards-based
  interoperability building blocks for
• Rich Document Content for end-to-end application
  interoperability.
• Patient identification management
• Security and privacy
• Notification and data capture

IHE-XDS related IHE Integration profiles
provide a complete interoperability solution
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IHE Integration Profiles for Health Info Nets
What is available and has been added in 2007
Security Privacy
Clinical and PHR Content
Patient ID Mgmt
Health Data Exchange
Other
Final Text Approved
Final Txt 2008
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XDS-MS Medical Summary or PHR Extract
ExchangeProfile based on HL7 CDA Rel 2 and HL7
CCD IG


Level 1
Structured and Coded Header


Patient, A
uthor, Authenticator, Institution,
Header always structured and coded


Time of Service, etc.



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Vital Signs


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XDS-MS and XPHR enable both semantic
interoperability simple viewing !




Care Plan

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Use of a shared XDS infrastructure to access
Radiology Reports and Images (XDS-I)

• Between Radiology and
• Imaging specialists
• Non-imaging clinicians

Hospital
PACS Y
Radiology -to-Radiology
Radiology -to-Physicians
PACS Z
Imaging Center
Physician Practice
Same XDS Infrastructure (Registry and
Repositories) for medical summaries and imaging
information !
67
XDS Scenario use of ATNA CT
PMS
XDS Document Registry
Register Document
Query Document
Secured Messaging
Retrieve Document
Provide Register Docs
Maintain Time
Maintain Time
Record Audit Event
Maintain Time
Record Audit Event
Record Audit Event
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XDS Scenario use of PIX PDQ
PDQ Query to Acquire Affinity Domain Patient ID
Patient Identity Feed
Patient Identity XRef Mgr
Patient Identity Feed
Affinity Domain Patient Identity Source
Patient Identity Feed
Patient Identity Feed
PIX Query
Document Registry
PIX Query
Register (using Pt ID)
Query Document (using Pt Id)
Provide Register Docs
Retrieve Document
PACS
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• Providers and Vendors
• Working Together to Deliver
• Interoperable Health Information Systems
• in the Enterprise
• And Across Care Settings
• ? Intra Hospital Workflows and Information Access

http//www.ihe.net
70
IHE Solutions within the Enterprise
EMR - HIS
Eye Care Pathology
HomeHub
Therapy Plan
Nursing Station
Being established
Img Acq
Treatment
Devices
Devices
Devices
Intensive Care Unit
Radiation Therapy
Pharmacy
71
IHE Solutions within the Enterprise Example
Cardiology
EMR - HIS
EnterpriseIT Infrastructure
RIS
CIS
LIS
-Radiation Therapy -Patient Care
Devices -Pathology
-Eye Care
PACS
Img Acq
Cath
ECG
Auto Mgr
Analyzer
Cardiology
Laboratory
Radiology

• Cardiology Integration Profiles
• Cardiac Catheterization Lab Workflow
• Echocardiography Lab Workflow
• Retrieve ECG for Display
• Displayable Reports
• Cath and Echo Evidence Documents

72
IHE Solutions within the EnterpriseIT
Infrastructure (Enterprise)
EMR - HIS
EnterpriseIT Infrastructure

• IT Infrastructure Integration Profiles
• Patient Administration Management
• Patient Demographics Query
• Patient Identifier Cross-referencing
• Retrieve Information for Display
• Enterprise User Authentication
• Consistent Time
• Patient Synchronized Applications
• Audit Trail and Node Authentication
• Personnel White Pages
• Shared Value Sets

RIS
CIS
LIS
-Radiation Therapy -Patient Care
Devices -Pathology
-Eye Care
PACS
Img Acq
Cath
ECG
Auto Mgr
Analyzer
Cardiology
Laboratory
Radiology
73
IHE Solutions within the Enterprise Radiology
EMR - HIS
EnterpriseIT Infrastructure

• Radiology Integration Profiles
• Radiology Scheduled Workflow
• Patient Information Reconciliation
• Access to Radiology Information
• Portable Data for Imaging
• Consistent Presentation of Images
• Key Image Note
• Presentation of Grouped Procedures
• Evidence Documents
• Audit trail and Node Authentication (Rad option)
• Teaching Files and Clinical Trials Export
• Post-processing Workflow
• Reporting Workflow
• Charge Posting
• Simple Image and Numeric Reports

RIS
CIS
LIS
-Radiation Therapy -Patient Care
Devices -Pathology
-Eye Care
PACS
Img Acq
Cath
ECG
Auto Mgr
Analyzer
Cardiology
Laboratory
Radiology
How to use IHE ? ?IHE Radiology Handbook
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IHE Solutions within the Enterprise Example
Laboratory
EMR - HIS
EnterpriseIT Infrastructure
RIS
CIS
LIS
-Radiation Therapy -Patient Care
Devices -Pathology
-Eye Care

• Laboratory Integration Profiles
• Laboratory Testing Workflow
• Laboratory Information Reconciliation
• Laboratory Point Of Care Testing
• Laboratory Device Automation
• Laboratory Code Set Distribution
• Laboratory BarCode

PACS
Img Acq
Cath
ECG
Auto Mgr
Analyzer
Cardiology
Laboratory
Radiology
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General scope of LAB TF

• Ordering, placing, scheduling and performing
  clinical laboratory tests on in vitro specimen,
  within acute care settings
• Tests in lab as well as at the point of care.
  Chemistry and Microbiology included with thorough
  examples
• Sharing laboratory reports within a wide
  community of care providers
• Anatomic pathology addressed by a separate domain
  in IHE

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Organization of LAB Technical Framework rel 2.1

• Volume 1 Use Cases, Profiles, actors,
  dependencies
• Volume 2 Description of message-based
  transactions
• Volume 3 Document-based transaction (lab report)
• Volume 4 Common subset of LOINC test codes
• Openly available at www.ihe.net/technical_framewo
  rks

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Lab TF Rel 2 Integration Profiles
HL7
Workflow
Laboratory Testing Workflow (LTW) Laboratory
Device Automation (LDA) Laboratory Point Of Care
Testing (LPOCT) Laboratory Code Sets Distribution
(LCSD) Laboratory Barcode Labeling (LBL)
V2.5
Content
Sharing Laboratory Reports (XD-LAB)
V3 CDA
78
Dependencies toward IHE IT Infrastructure
79
Lab TF Rel 2 Integration Profiles
HL7
Workflow
Laboratory Testing Workflow (LTW) Laboratory
Device Automation (LDA) Laboratory Point Of Care
Testing (LPOCT) Laboratory Code Sets Distribution
(LCSD) Laboratory Barcode Labeling (LBL)
V2.5
Content
Sharing Laboratory Reports (XD-LAB)
V3 CDA
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Laboratory Testing Workflow (LTW) Laboratory
Device Automation (LDA)
Placer order
Order Filler
Order Placer
Filler order
Results
Work order
Results
Automation Manager
Order Result Tracker
Work Order Steps Query download modes
Tests results
Pre/post processor
Analyzer
LTW
LDA
Profiles based on HL7 V2.5.1 Solid implementation
experience
81
IHE Profiles Specifications

• Go to www.ihe.net/Technical_framework
• For LTWUnder Laboratory
• Laboratory Technical Framework 2.1 (LTW, LDA)

82

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

http//www.ihe.net
83
Coffee Break
84
Agenda

• 0830-1030 THE IHE STANDARDS ADOPTION PROCESS
  achieving practical interoperability - Charles
  Parisot
• Coffee Break
• 1100-1230 USERS AND VENDORS WORKING TOGETHER
  how can I contribute benefit from IHE Charles
  Parisot
• Lunch Break
• 1330-1500 HOW TO USE IHE RESOURCES hands on
  experience Eric Poiseau

85
Understanding the IHE Initiative

• IHE has a clear focus
• IHE is a healthcare domain-based initiative
• IHE creates synergies for interoperability
  testing across domains
• IHE addresses the standards adoption process
• IHE is both regional and multi-national
• IHE is both user lead and vendor driven

86
Standards Adoption Process
87
IHE Organizational Structure
IHE International Board
Regional Deployment
87
88
IHE Sponsors

• Professional societies (stakeholder
  representation)
• Healthcare Information Management Systems Society
  (HIMSS)
• Radiological Society of North America (RSNA)
• British Institute of Radiology (BIR), British
  Computer Society (BCS
• German Radiology Society (DRG)
• GMSIH (IT France), SFIL (laboratory), French
  National Project (DMP)
• European Society of Cardiology
• Many other European Societies
• American College of Physicians (ACP), American
  College of Emergency Physicians (ACEP)
• Many other American healthcare societies (ACCE),
  (AAO), (ASTRO), etc.
• JAHIS (IT Japan), and many other Japanese
  Societies
• And many more.

88
89
IHE Participants and Relationships

• Participants include
• Users - Clinicians, Staff, Administrators, CIOs,
  Governments
• Vendors of Information Systems and Equipment
• Consultants
• Relationship with Standards Development
  Organizations (SDOs)
• HL7, DICOM, ISO, CDISC, ASTM, W3C, IEEE, IETF,
  and many others
• Approved via ISO/TC 215 allowing for IHE profiles
  to be published as ISO deliverables
• National Adoption of Healthcare IT Standards and
  IHE Profiles
• DMP(France), ELGA(Austria), HITSP (USA), Infoway
  (Canada), many others worldwide..

90
IHE Organizational Structure
IHE International Board
Regional Deployment
90
91
IHE International Governance - Membership

• Membership www.ihe.net/governance
• Members are OrganizationsSign Governance IP
  once.
• Three Organizational Categories User, Developer,
  General Interest
• Member designates a primary/alternate
  representatives to one of more Committees
  (Domains, Test Tools, MarCom).
• Voting rights lost after three missed meetings,
  regained at second meeting
• Elect Committee (or sub-Committee) co-chairs.
  One User one vendor recommended for Planning
  Committees
• Regional and National IHE Committee members
  required to become members of IHE International.

92
IHE International Governance Others Committees

• IHE Regional or National Deployment Committees
  are independent entities with their own
  governance but close collaborative relationship
  with IHE International.
• IHE International Board empowers Regional and
  National Committee. 3 year commitment,
  renewable.
• Oversees Testing and Tools Committee
• Coordinates the various Regional and National
  Committees.
• Oversees Marketing Communication Committee
• Consistency of communication among Domains
  within IHE International and various Regional and
  National Committees.

93
How can I participate?

• As a Provider or Vendor Contributor
• Offer Clinical Use Case Input to Drive IHE
  Profile Development
• Become a member of relevant domains Planning or
  Technical Committees
• Become a member of relevant Regional/National
  Committees
• Help to shape IHEs future direction
• As a Vendor Participant
• Respond to Public Comments of Domain Supplements
• Attend the June Educational Workshop
• Participate in Connect-a-thons and Demonstrations
• As a Provider/Consultant Participant
• Respond to Public Comments of Domain Supplements
• Attend the June Educational Workshop
• Attend Demonstrations and include IHE Integration
  Profiles in your RFPs and Integration Projects.

94
What can you do?

• Learn about IHE, www.ihe.net
• Insist on relevant IHE profiles compliance in
  your RFPs and contract documents
• Select Integration Profiles, and Appropriate
  Actor(s)
• Ask vendors for their products IHE Integration
  Statements.
• Need more interoperability ?
• Contribute to IHE Committees

95
IHE Web site www.IHE .net

• Frequently Asked Questions
• Integration Profiles in Technical Frameworks
  See Volume 1 of each TF for Use cases
• Cardiology
• Eye Care
• IT Infrastructure
• Laboratory
• Patient Care Coordination
• Patient Care Devices
• Pathology
• Quality
• Radiation Oncology
• Radiology
• Connectathon Result www.ihe.net/Events/connectath
  on_results.cfm
• Vendor Products Integration Statements

96
How to Participate

• As a User or Vendor Committee Member
• Become a member of relevant Domains Planning or
  Technical Committees
• As a User, Consultant or Vendor Interested
  Observer
• Provide Public Comments on Technical Framework
  Supplements
• Attend Demonstrations, Educational Events and
  Workshops

97
More Resources - www.ihe.net

• Frequently Asked Questions
• Integration Profiles in Technical Frameworks
• Cardiology
• IT Infrastructure
• Laboratory
• Patient Care Coordination
• Patient Care Devices
• Radiation Oncology
• Radiology
• Connectathon Results
• Vendor Products Integration Statements
• Participation in Committees and Connectathons

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