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The fundamentals of IHE Integrating Enterprises and building standards-based regional and national health information networks

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Title: The fundamentals of IHE Integrating Enterprises and building standards-based regional and national health information networks


1
The fundamentals of IHEIntegrating Enterprises
and building standards-based regional and
national health information networks
  • Israel Association for Medical Information
    Tel-Aviv May 17, 2006
  • Charles ParisotGE Healthcare IHE IT
    Infrastructure Technical Co-chair

2
Standards are critical but alone are not enough
  • Standards offer generality, ambiguity and
    alternatives
  • Standard Implementation Guides are focused on a
    single standard
  • Increasing complexity

IHE provides a standard process for implementing
multiple standards!
3
Connecting standards to care
  • Care providers work with vendors to coordinate
    the implementation of standards to meet their
    needs
  • Care providers identify the key interoperability
    problems they face
  • Drive industry to develop and make available
    standards-based solutions
  • Implementers follow common guidelines in
    purchasing and integrating systems that deliver
    these solutions

IHE, effective way to establish those
standards for how to implement standards
4
What is Integrating the Healthcare Enterprise?
  • IHE provides a common framework for passing
    health information seamlessly
  • within the healthcare enterprise
  • across multiple healthcare enterprises
  • for local, regional national health information
    networks
  • IHE is sponsored by healthcare professional
    associations HIMSS, RSNA, ACC, ACCE, ESC, SFR,
    BIR, GMSIH, etc.
  • IHE drives standards adoption to address specific
    clinical needs

5
IHE Maturity and Acceptance
  • More than 40 user organizations close to 200
    healthcare vendors worldwide have contributed to
    IHE
  • Delivery of ready-to-integrate products to
    benefit healthcare enterprises of all sizes
  • In clinical use today in enterprises and regional
    networks
  • IHE scope, today and in the future
  • radiology, cardiology, laboratory, oncology, eye
    care, devices
  • enterprise healthcare IT infrastructures
  • cross-enterprise healthcare IT infrastructures
  • RHIOs and NHIN

6
Proven Standards Adoption Process
7
IHE Connectathon
8
Achievements and Expanding Scope
Close to 200 vendors involved world-wide, 5
Technical Frameworks 48 Integration Profiles,
Testing at Connectathons Demonstrations at major
conferences world-wide
9
IHE Organizational Structure
IHE Domain-related Planning Committee and
Technical Committee
Global DevelopmentRadiology,IT
Infrastructure,Cardiology,Lab, etc.
contribute
Participants
10
What is IHE NOT?
  • Not a standard, although it leverages them
  • A vendor initiative, although they participate
  • Not a certifying authority, although IHE provides
    compliance testing
  • Not simply a demonstration project
  • Demos are only one means to the end Adoption
  • Backed up by documentation, tools, testing, and
    publication of Technical Frameworks and Product
    Integration Statements.

IHE, critical for standardizing interoperability
11
IHE 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

12
IHE Technical FrameworksImplementation Guide for
each Integration Profile
13
IHE Solutions within the Enterprise
EMR - HIS
14
IHE Solutions within the Enterprise 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

15
IHE Solutions within the Enterprise Laboratory
EMR - HIS
EnterpriseIT Infrastructure
RIS
CIS
LIS
-Radiation Therapy -Patient Care
Devices -Pathology
-Eye Care
  • Laboratory Integration Profiles
  • Laboratory Scheduled Workflow
  • Laboratory Information Reconciliation
  • Laboratory Point Of Care Testing
  • Laboratory Device Automation
  • Laboratory Code Set Distribution

PACS
Img Acq
Cath
ECG
Auto Mgr
Analyzer
Cardiology
Laboratory
Radiology
16
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

RIS
CIS
LIS
-Radiation Therapy -Patient Care
Devices -Pathology
-Eye Care
PACS
Img Acq
Cath
ECG
Auto Mgr
Analyzer
Cardiology
Laboratory
Radiology
17
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
18
IHE Scheduled Workflow (SWF) and Patient
Information Reconciliation (PIR)
  • SWF Fulfilling a request for imaging service
    with maximum efficiency?
  • How do I avoid reentering information on
    modalities?
  • How do I avoid entering in my RIS what my
    modality already knows ?
  • How do I ensure that in all cases no study is
    lost, remains unread, or read incomplete.
  • How do I ensure that all necessary information is
    automatically on my PACS and RIS?
  • PIR Fulfilling a request for imaging service in
    the absence of key information?
  • How do I deal with trauma and non-registered
    patients?
  • What if the ADT/ Patient Registration is down?
  • What if the Order Placer is down?

19
Scheduled Workflow Profile
acquisitioncompleted
20
IHE for Regional or National EHRSharing Health
Recordsacross different care settings
21
Sharing and Accessing Electronic Health Records
  • IHE offers interoperability for local, regional,
    specific, or national health information exchange
  • Goal is to enable exchange between providerss
    EHR systems and ancillary IT systems (Lab,
    Pharma, Payers) and personal health record
    systems.
  • Objective is to empower the consumer in having
    shared EHR information between all of its
    potential healthcare providers (if authorized)
    and self.
  • IHE goal is not
  • To create a perfect health record, the truth
    about a patient health.
  • To create an other health record, next to the
    one(s) managed by the provider and the consumer.

22
Introduced at HIMSS in 2005 IHE-XDS
Community or sub-network
Repository ofDocuments
Repository ofDocuments
23
Health Information Exchanges Interoperability
Cross-enterprise Digital Document Sharing
  • Cross-Enterprise Document Sharing minimizes
    clinical data management by the 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
  • Workflows addressed in a second step in a much
    simpler manner.Point-to-Point messages best
    suited for workflows mgt

24
Cross-Enterprise Document Sharing (XDS)
Standards Used
HealthcareContent Standards HL7 CDA, CEN
EHRcomHL7, DICOM
Internet Standards HTML, HTTP,ISO, PDF, JPEG
Electronic BusinessStandards ebXML Registry,
SOAP
  • Implemented world-wide by more than 30
    vendors/open source. Final text published August
    2005.
  • Adopted in several national regional projects
    (Italy, France, Canada, Austria, USA, etc.)
  • IHE XDS, based on ISO 15000 standard15800
    Google references (Jan 06) ? 38900 (April 06)

25
Cross-Enterprise Document Sharing (XDS) Clinical
Information in the Digital Document
  • Two categories of standards used

XDS Doc Content
XDS Infrastructure (Document sources,
consumers,registries, repostories)
26
IHE-XDS is part of a family of profiles
  • Regional, national, local or disease centric
    networks need a consistent set of Integration
    Profiles
  • Nine Integration Profiles completed and tested,
    plus seven in development Standards-based
    interoperability building blocks for
  • Rich Document Content for end-to-end application
    interoperability. Available is a structured
    medical summary (incl meds, allergies, pbs) and
    imaging information (incl. Images and reports).
    More in development.
  • Patient identification management
  • Security and privacy
  • Basic workflow (Notif of doc availbility)

IHE-XDS related IHE Integration profiles
provide a complete interoperability solution
27
IHE Integration Profiles for Health Info
NetsWhat is available and has been added in 2005
and is for 2006
28
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
29
XDS-MS Medical Summary (HL7 CDA)


Level 1
Structured and Coded Header


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


Time of Service, etc.



S
t
r
u
c
t
u
r
e
d

C
o
n
t
e
n
t

w
i
t
h

c
o
d
e
d

s
e
c
t
i
o
n
s


Level 2
S
t
r
u
c
t
u
r
e
d

C
o
n
t
e
n
t

w
i
t
h

c
o
d
e
d

s
e
c
t
i
o
n
s


Title
-
coded sections with non
-
structured


Reason for Referral

nor coded content (text, lists, tables).




Vital Signs


? Simple Viewing (XML Style sheet)




M
e
d
i
c
a
t
i
o
n

M
e
d
i
c
a
t
i
o
n









Studies





A
l
l
e
r
g
i
e
s

A
l
l
e
r
g
i
e
s









Social History





P
P
r
r
o
o
b
b
l
l
e
e
m
m
s
s





XDS-MS enables both semantical interoperability
and simple viewing !





Care Plan

30
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 !
31
HIMSS Feb 2006 Interoperability Showcase
32
Successful showcase - Over 3000 visitors
  • Real-world implementations. Effective IHE
    interoperability
  • 36 vendor products EHR Ancillary IT systems,
    PHR systems, Registries, Repositories, MPIs, etc.
  • 4 Federal entities or grantees (VA, DoD, NIST,
    CDC/UW)
  • All implementations passed IHE Connectathon tests
  • Scenario focused on health information exchange
  • Within the enterprise (Cardiology, Radiology,
    etc.)
  • Across inpatient and physician offices care
    settings in a RHIO for health status information
    (meds, allergies, pbs, etc.), reports, images,
    legacy docs
  • Empowered with your own health record
  • Show-wide record submission and access (11 vendor
    booths)
  • HIMSS RHIO Infrastructure secured access
    communications, distributed repositories,
    document registries, patient Id X-referencing

33
HIMSS IHE Interoperability ShowcaseFebruary 2006
Participants
Leadership Level Blue Ware Cerner GE Healthcare
IDX IBM Initiate Systems InterSystems MiSys
Healthcare Quovadx Siemens
34
Endorsements
  • National Regional Projects
  • Italy
  • Canada
  • Austria
  • France
  • Japan
  • USA (NHIN prototypes and RHIOs)
  • Vendors
  • US EHR Vendor Association (95 market)
    Interoperability Roadmap www.himssehrva.org
  • Europe COCIR

35
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36
Participating and Contributing Vendors (America)
Epic Systems Corp. ETIAM Fujifilm GE
Healthcare Heartlab HIPAAT Inc. Hitachi Medical
Corp. Hologic Hx Technologies IDX Systems
Corporation Imco Technologies INFINITT Initiate
Systems Inc. InSiteOne Intelerad Medical
Systems IBM Intersystems Corporation Konica
Minolta Kryptic Marotech, Inc. McKesson
  • Agfa HealthCare
  • Algotec
  • Allscripts Healthcare
  • Berdy
  • Blueware
  • Camtronics
  • Canon Medical Systems
  • CapMed
  • Cardiac Science Corp.
  • Carefx
  • Cedara Software Corp.
  • Cerner Corporation
  • CGI-AMS
  • CSIST
  • Dictaphone
  • DR Systems
  • Dynamic Imaging
  • Eastman Kodak Company
  • EBM Technologies

Raining Data RASNA Imaging Systems ScImage
Inc. Sectra Imtec Sentillion Shimadzu
Corp Siemens Medical Solutns Softmedical Stentor,
Inc St. Jude Medical StorCOMM, Inc Swissray
International, Inc Tiani-Spirit Toshiba Medical
Systems T-Systems UltraVisual Medical Syst. Vital
Images, Inc. Voxar Limited WebMD Practice
Services Witt Biomedical Corp. XIMIS
MedAccessPlus Health MedCommons
Inc Medcon Medical Informatics Eng. Medical
Manager Health Mediface Co. Medinotes Medis
Medical Imaging Merge eFilm Misys MNI
Medicos Mortara NextGen Novell Open Text
Corp. Philips Medical Systems Procom
Technology Prosolv Cardiovascular QRS
Diagnostics Quovadx RADinfo Systems
In yellow, companies with IHE Committees Chairs
(Spring 2006)
37
Participating and Contributing Vendors (Europe)
AGFA Healthcare AISoftw_at_re Medical Algotec ARES
SA aycan Digitalsysteme CEGEDIM Cerner
Corp. CHILI CMT Medical Tech. Conto Corrente
Salute ConVis CTI Mirada Solutions Data
Processing SPA DEDALUS Dianoema Eastman Kodak Co.
Ebit Sanita EDL ELFIN s.r.l. Engineering
Sanità ESAOTE
MEDASYS SA Medavis Medical Communications Medigrat
ion GmbH MEDIMON Ltd. MEDIWARE MEDOS AG Merge
eFilm METAFORA Mevis Diagnostics Konica
Minolta Omnilab Philips Medical
Systems POLYMEDIS Rasna Imaging Systems RAYPAX
INC. REM Rogan-Delft Sago spa Sectra Imtec AB
SeeBeyond Technology
ETIAM Ferrania Fujifilm GE Healthcare GIE
Convergence-Profils Global Imaging Online GWI
Research Hi. tech IASI Srl IdeoPass INFINITT
INFOPATIENT INOVIT INSIEL Intersystems
Corp. Invita ITZ Medicom iSoft McKesson MED2RAD
MEDarchiver
Siemens Medical Soluzioni Informatiche srl
Stentor Inc. St. Jude Swissray Medical AG
Symphonie On Line Synapsis Synchro-Med TECHNIDA
TA TELEMIS S.A. Tiani-Sprit Tomtec Imaging
TOREX GAP Medical Toshiba Medical Systems TSI
groupe europMedica T-Systems Uni-medicine VEPRO
AG VISUS Technology Transfer WAID XR PARTNER
In yellow, companies with IHE Committees Chairs
(Winter 2005)
38
Participating and Contributing Vendors (Asia)
Taiwan INFINITT Shing Shian INQ GEN TEP Tah Ya
Japan EBMJ PSP PANASONIC ALOKA KONICA
MINOLTA Hitachi Medical Co. KODAK HITACHI SBS INFO
COM CLIMBMS TECHMATRIX CANON VIEWSEND
Japan ITEC WINTCS NEC AGFA JMAC GEYMS AJS TOSHIBA
YOKOGAWA GOODMAN FUJITSU AANDT FUJIFILM
Korea AGFA Korea GE Healthcare Korea INFINITT LG
CNS Marotech, Inc. Medical Standard Peoplenet
Communications Samsung SDS
39
What can you do?
  • Learn about IHE
  • Insist on IHE 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 ?
  • Join IHE Israel
  • Contribute to Global IHE Committees

40
Call for Tenders
  • Be Brief (but ineffective) ?
  • The system must support DICOM
  • The system must support HL7
  • Be Effective (but lengthy) ?
  • The system must support the following DICOM or
    HL7 services according to the following 100 pages
    of specifications
  • Be Both brief and effective
  • Quote IHE profiles and actors The system must
    support the IHE Scheduled Workflow as the Order
    Filler actor.
  • Request IHE Integration Statements
  • Version 2.1 of the SuperX CT supports IHE
    Scheduled Workflow, Patient Information
    Reconciliation and Key Image Note as an
    Acquisition Modality

41
IHE Integration Statements
  • Explicit claim by the vendor, for a specific
    product version
  • Lists profiles, actors, options
  • Short (1 page) Sweet
  • Compare apples with apples. e.g. The number of
    IHE Integration Profiles actually delivered on
    different PACS products varies greatly
  • http//www.ihe.net/resources/ ihe_integration_
    statements.cfm

42
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 ? IHE Israel
  • Help to shape IHEs future direction
  • As a Vendor Participant
  • Respond to Public Comments of Domain Supplements
  • Attend Educational Workshops
  • Participate in Connect-a-thons and Demonstrations
  • As a Provider/Consultant Participant
  • Respond to Public Comments of Domain Supplements
  • Attend Educational Workshops
  • Include IHE Integration Profiles in your RFPs and
    Integration Projects.

43
IHE Web site www.IHE .net
  • Frequently Asked Questions
  • Integration Profiles in Technical Frameworks
    See Volume 1 of each TF for Use cases
  • Cardiology
  • IT Infrastructure
  • Laboratory
  • Patient Care Coordination
  • Radiology
  • Connectathon Result www.ihe.net/Events/connectath
    on_results.cfm
  • Vendor Products Integration Statements
  • Participation in Committees Connectathons

44
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