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Implementing IHE in Regional Health Information Networks

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Define a medical summary format for clinical documents containing at a minimum: Problems ... Record the patient privacy consent(s) ... – PowerPoint PPT presentation

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Title: Implementing IHE in Regional Health Information Networks


1
Implementing IHE in Regional Health Information
Networks
  • IHE Europe 2006 - Changing the Way Healthcare
    Connects
  • IHE Presentation at the World of Health IT show,
  • October 2006
  • Alexander Ihls, Stakeholder PCC, IHE Germany

2
Actors in Regional Healtcare
  • General Practitioners (GPs)
  • Family Doctors
  • Medical Specialist
  • Hospitals
  • Emergency Department (ED)
  • Inpatient care, surgeries
  • Homecare
  • Patient self-care
  • Nurses

3
IHE Domains
  • Cardiology
  • Eye Care
  • IT Infrastructure
  • e.g. Cross-Enterprise Document Sharing (XDS)
  • Laboratory
  • Patient Care Coordination
  • Patient Care Devices
  • Radiology
  • Mammography
  • Nuclear Medicine

4
Patient Care Coordination
  • The Patient Care Coordination (PCC) domain was
    established in July 2005 to deal with integration
    issues that cross providers, patient problems or
    time.

5
Profile Roadmap
  • Year 2005-2006 (Trial Implementation)
  • Medical Summary MS Acute Care Discharge to
    PCP, PCP Referral to Specialist
  • Unstructured Document CDA-wrapped PDF
  • Year 2006-2007 (Development Testing)
  • Medical Summary MS ED Referral EDR
  • Pre-procedure HP PPHP
  • Basic Patient Privacy Consents BPPC
  • Exchange Personal Health Record XPHR
  • Coordination with Laboratory Domain XDS-LAB
  • Future (Profile Document / White Paper)
  • Medical Summary MS Discharge to LTC
  • Forms Display for Data Capture (e.g. clinical
    research)

6
PCC Profiles
PCC Domain
Medical Summary XDS-MS
Exchange of Patient Health Record Data (XPHR)
Basic Patient Privacy Consent (BPPC)
Emergency Department Referral (EDR)
Preprocedural History and Physical (PPHP)
Sharing Laboratory Reports (XDS-LAB)
7
Medical Summary Profiles
8
Abstract
  • Define a medical summary format for clinical
    documents containing at a minimum
  • Problems
  • Allergies
  • Medications
  • Pointers to other material

Medical Summaries
9
Value Proposition
  • Leverage Clinical Documents ontology
  • A common mechanism for transfer of encoded
    clinical data embedded in documents
  • Basis for ongoing harmonization of CCR/CCD
  • Enhances Clinical Documents criteria for key use
    cases
  • Inpatient to Primary Care Provider
  • Primary Care Provider to Specialist
  • To be enhanced in future years to support
  • Home Care
  • Long Term Care

Medical Summaries
10
Key Technical Properties
  • Document Transfer (Integration Profile)
  • XDS/XDP for document sharing.
  • NAV for notification.
  • XDS Folders to support organization.
  • XDS Submission Sets to support packaging.
  • Identification of Master document or Manifest
  • Document Content (Content Profile)
  • CDA Release 2.0
  • Care Record Summaries Implementation Guide

Medical Summaries
11
PCC Profiles
PCC Domain
Medical Summary XDS-MS
Exchange of Patient Health Record Data (XPHR)
Basic Patient Privacy Consent (BPPC)
Preprocedural History and Physical (PPHP)
Emergency Department Referral (EDR)
Sharing Laboratory Reports (XDS-LAB)
12
Use Case
  • Health care provider determines that a patient
    needs to go to the ED
  • Provider creates an ED referral package using his
    or her EHR
  • Upon arrival, the ED provider identifies the
    patient as a referral
  • The posted referral package is imported into the
    Emergency Department Information System (EDIS)

Provide access to critical health information
in ED information systems in a standard manner\
ED Referral
13
Value Proposition
  • Nearly 5000 EDs in US
  • Significant percentage of ED visits are referrals
  • Shortage of critical health data for emergency
    department patients
  • Need to improve communication of intended patient
    care plans to ED providers and ensure that no
    pertinent data is lost
  • Streamline workflow by obviating telephone calls
    between busy clinicians

ED Referral
14
Scope
  • EHR system capable of creating a care record
    summary would be capable of creating a referral
    package for a receiving system
  • The emergency department information systems
    (EDIS) will need to retrieve and read and display
    this data.

ED Referral
15
PCC Profiles
PCC Domain
Medical Summary XDS-MS
Exchange of Patient Health Record Data (XPHR)
Basic Patient Privacy Consent (BPPC)
Emergency Department Referral (EDR)
Preprocedural History and Physical (PPHP)
Sharing Laboratory Reports (XDS-LAB)
16
Abstract
  • The Basic Patient Privacy Consents (BPPC) profile
    provide mechanisms to
  • Record the patient privacy consent(s),
  • Mark documents published to XDS with the patient
    privacy consent that was used to authorize the
    publication,
  • Enforce the privacy consent appropriate to the
    use.

Basic Patient Privacy Consents
17
Scope
  • Document Sources and Document Consumers in an XDS
    Affinity Domain
  • Document Sources and Document Receivers using
    Cross Enterprise Point-to-Point Document Sharing

Basic Patient Privacy Consents
18
Value Proposition
  • An Affinity Domain can
  • develop privacy policies,
  • and implement them with role-based or other
    access control mechanisms supported by EHR
    systems.
  • A patient can
  • Be made aware of an institutions privacy
    policies.
  • Have an opportunity to selectively control access
    to their healthcare information.

Basic Patient Privacy Consents
19
Key Technical Properties
  • Human Readable Consents
  • Machine Processable
  • Support for standards-based Role-Based Access
    Control

Basic Patient Privacy Consents
20
Standards and Profiles Used
  • CDA Release 2.0
  • XDS Scanned Documents
  • Document Digital Signature
  • Cross Enterprise Document Sharing
  • Cross Enterprise Point-to-Point Document Sharing

Basic Patient Privacy Consents
21
PCC Profiles
PCC Domain
Medical Summary XDS-MS
Exchange of Patient Health Record Data (XPHR)
Basic Patient Privacy Consent (BPPC)
Emergency Department Referral (EDR)
Preprocedural History and Physical (PPHP)
Sharing Laboratory Reports (XDS-LAB)
22
Use Case
  • HP documentation required prior to procedure
    that is designed to assess
  • Procedure Risk
  • Anesthesia Risk
  • Factors influencing procedure after-care
    decisions
  • Desired outcomes
  • Minimize injury during procedure
  • Optimize procedure after-care

Pre-procedure HP
23
Scope
  • To identify the required and optional PPHP
    document content templates including
  • CDA Document Header
  • CDA Document Type(s)
  • CDA Section Types
  • CDA Entry Types

Pre-procedure HP
24
Value Proposition
  • A procedure risk assessment must be present and
    evaluated by the operative and after-care teams
    before the patient is allowed to have the
    procedure. Missing information is frequently a
    reason for canceling the procedure for the day,
    which leads to expensive underutilization of
    resources and dissatisfied patients. Further,
    incomplete information about the patients
    clinical or home status may create a situation
    where a procedure is performed that ultimately
    results in an injury, inadequate aftercare or
    other undesirable outcome.

Pre-procedure HP
25
Key Technical Properties
  • PPHP Profile inherits specifications required for
    other IHE PCC Medical Documents
  • PPHP Profile follows documentation practices for
    all IHE PCC Medical Documents
  • PPHP Profile emphasizes re-usability of CDA
    template identifiers in order to reduce
    un-necessary variability in IHE Content Profiles

Pre-procedure HP
26
Standards Used
  • IHE Medical Document Content Profiles
  • HL7 Reference Information Model ANSI Standard
  • HL7 CDA R2 ANSI Standard
  • HL7 Care Provision Domain DSTU (in process)
  • Implementation Guides
  • HL7 Care Record Summary CDA R2 Implementation
    Guide (in process)
  • HL7/ASTM Continuity of Care Document
    Implementation Guide (in process)

27
PCC Profiles
PCC Domain
Medical Summary XDS-MS
Exchange of Patient Health Record Data (XPHR)
Basic Patient Privacy Consent (BPPC)
Emergency Department Referral (EDR)
Preprocedural History and Physical (PPHP)
Sharing Laboratory Reports (XDS-LAB)
28
Abstract
  • The Exchange of Personal Health Record Content
    (XPHR) provides a standards-based specification
    for managing the interchange of documents between
    a Personal Health Record and an EHR System to
    enable better interoperability between these
    systems.

Exchange of PHR Content
29
Scope
  • Personal Health Record (PHR) Systems
  • Electronic Health Record (EHR) Systems

Exchange of PHR Content
30
Value Proposition
  • Supports interchange of PHR Information
  • Demographics
  • Insurance Information
  • Medications, Problems, Allergies
  • Health History
  • Other Information

Exchange of PHR Content
31
Standards Used
  • CDA Release 2.0
  • ASTM Continuity of Care (CCR) Data Set
  • ASTM/HL7 Continuity of Care Document (CCD)
  • HL7 Care Record Summary
  • AHIMA PHR Common Data Elements
  • XDS, XDP
  • Document Digital Signature

Exchange of PHR Content
32
Key Technical Properties
  • Information is Human Readable
  • and Machine Processable
  • Support Static and Dynamic Information Sharing
    Domains (XDS and XDP)
  • Protects Information using Digital Signature
  • Update Model for EHR to PHR Changes

Exchange of PHR Content
33
PCC Profiles
PCC Domain
Medical Summary XDS-MS
Exchange of Patient Health Record Data (XPHR)
Basic Patient Privacy Consent (BPPC)
Emergency Department Referral (EDR)
Preprocedural History and Physical (PPHP)
Sharing Laboratory Reports (XDS-LAB)
34
Scope
  • The clinical laboratory report is
  • A report of a set of final results (the
    fulfillment process being completed) to be shared
    as historical information.
  • Human-readable, shared between care providers of
    various specialties and patients (e.g. through a
    PHR)
  • May contain machine readable coded entries
    (decision support, bio-surveillance)
  • All clinical laboratory specialties in scope,
    except
  • Blood banks (blood products out of scope, but
    blood tests in scope)
  • Pathology (has its dedicated domain in IHE)

Sharing of Lab Reports
35
Value Proposition
  • Use case 1 Hospital lab report ? RHIO ? EHRs At
    discharge time, a hospital physician selects the
    most significant laboratory reports produced
    during patient stay, and issues these reports
    individually to a health information exchange
    (e.g. XDS Affinity Domain) shared by a number of
    healthcare enterprises and primary care
    providers.
  • Use case 2 Ambulatory lab report ? RHIO ? PHRA
    private laboratory having signed a final report
    for a patient, sends this report in an electronic
    format to the patient record in the national EHR.
  • Use case 3 Lab report ? PHRA physician reviews
    the results received from a reference laboratory
    for his patient. The doctor, as requested by the
    patient, sends this laboratory report in the
    patients personal health record in an electronic
    format.
  • Use case 4 Lab report automatically shared ?
    RHIOA community or hospital laboratory,
    systematically (with some degree of automatism)
    shares its final reports with a regional
    healthcare network.
  • Use case 5 Hospitals EHR Lab report ? RHIOAt
    discharge time of an inpatient, a hospital
    physician selects the most significant lab
    results, produced by one or more laboratories of
    the healthcare enterprise during patient stay,
    and builds a cumulative report sent to an health
    info exchange shared by a number of healthcare
    enterprises and primary care providers.

Sharing of Lab Reports
36
Standards Used
  • CDA Release 2.0
  • ASTM/HL7 Continuity of Care Document (CCD)
  • HL7 V3 Laboratory DMIM
  • HL7 Care Record Summary
  • LOINC SNOMED
  • HIPAA Lab Claim Attachment NPRM
  • IHE XDS (registry/repository) XDP (pt-pt)
  • Document Digital Signature

Sharing of Lab Reports
37
Key Technical Properties
  • Information is Human Readable (two levels of
    sections) and machine processable
  • Full alignments with HL7 V3 lab messages
  • Supports custom report organizations and results
    rendering regulations (e.g. CLIA in the USA).
  • Complements the real-time result return to
    ordering provider (e.g. ELINCS).
  • Used both in sharing (XDS) pt-pt interchange
    (XDP)
  • May protect Information using Digital Signature

Sharing of Lab Reports
38
PCC Wrap-up
39
PCC RoadMap
  • Care Transfers
  • Medical Summary 2005
  • EDR, PPHP 2006
  • Labs 2006-7
  • Growth Charts
  • Consumer Empowerment
  • PHR 2006
  • Consents 2006
  • Provider Ordering
  • Ambulatory Ordering 2006
  • Medication Lists 2007
  • Clinical Data Reuse
  • Clinical Trials (RFD) 2006-7
  • Biosurveillance 2007-8

40
How to Get Involved?
  • 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 Educational Workshops
  • Participate in Connect-a-thons and Demonstrations
  • As a Provider/Consultant Participant
  • Respond to Public Comments of Domain Supplements
  • Attend the Educational Workshops
  • Attend Demonstrations and include IHE Integration
    Profiles in your RFPs and Integration Projects.

41
More Information
  • IHE Web Site - http//www.ihe-europe.net
  • Technical Frameworks
  • Technical Framework Supplements Trial
    Implementation
  • Calls for Participation
  • IHE Fact Sheet and FAQ
  • IHE Integration Profiles Guidelines for Buyers
  • IHE Connectathon Results
  • Vendors Product Integration Statements
  • Sponsors IHE sites
  • http//www.himss.org/IHE
  • http//www.rsna.org/IHE
  • http//www.acc.org/quality/ihe.htm

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