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Integrating the Healthcare Enterprise. IHE, beyond cardiology and radiology An interoperability strategy for the enterprise. Charles Parisot, GE Healthcare IHE IT Infrastructure Co-chair. IHE 2004 achievements and expanding scope. Over 80 vendors involved world-wide, 4 Technical Frameworks - PowerPoint PPT Presentation
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August 31, 2004 IHE European Cardiology1
Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise
IHE, beyond cardiology and radiologyAn interoperability strategy for the enterprise
Charles Parisot, GE Healthcare
IHE IT Infrastructure Co-chair
August 31, 2004 IHE European Cardiology5
IHE
EHR- Longitudinal Record
IHE Cardiology
IHE Laboratory
IHE Radiology
IHE
Future Domain
IHE
Future Domain
IHE
IT Infrastructure Intra-Enterprise
Cross-Enterprise
14 Integration Profiles
5 Integration Profile
3 Integration Profiles
9 Integration Profiles
IHE 2004 achievements and expanding scope IHE 2004 achievements and expanding scope
Over 80 vendors involved world-wide, 4 Technical Frameworks31 Integration Profiles, Testing at yearly Connectathons,
Demonstrations at major exhibitions world-wide
Provider-Vendor cooperation to accelerate standards adoption
August 31, 2004 IHE European Cardiology8
IHE: A stepwise approachIHE: A stepwise approach
CardiologyCardiologyLabora-Labora-ttoryory
Pharmacy,…..Pharmacy,…..RadiologRadiologyy
Patient Identifier Linkage, Registries, SecurityPatient Identifier Linkage, Registries, Security
Electronic Health RecordElectronic Health Record
Enterprise SchedulingEnterprise Scheduling
Patient ManagementPatient Management
Order ManagementOrder Management
August 31, 2004 IHE European Cardiology9
Key IHE ConceptsKey IHE Concepts• Generalized Systems Generalized Systems -> -> ActorsActors
• Interactions between Actors Interactions between Actors -> -> TransactionsTransactions
• Problem/Solution ScenariosProblem/Solution Scenarios -> -> IntegrationIntegration ProfilesProfiles
• For each Integration Profile:For each Integration Profile:
• the context is described (which real-world problem)the context is described (which real-world problem)
• the actors are defined (what systems are involved)the actors are defined (what systems are involved)
• the transactions are defined (what must they do)the transactions are defined (what must they do)
August 31, 2004 IHE European Cardiology10
IHE Radiology Integration profilesIHE Radiology Integration profiles
-
Pa
tient
Info
rma
tion
Rec
onc
ilia
tion
Access to Radiology Information
Consistent Presentation
of Images
Basic Security
Evidence Documents
Key Image Notes
Simple Image and Numeric
Reports
Presentation of Grouped Procedures
Post-Processing Workflow
Reporting Workflow
Charge Posting
Scheduled Workflow
August 31, 2004 IHE European Cardiology11
IHE Penetration in RadiologyIHE Penetration in Radiology
Now entering Year 6 !!
50+ vendors worldwide
100+ systems in annual Connectathons
Geographic spread U.S., France, Germany, Japan, Italy, Korea, Taiwan, U.K,
Norway, Netherlands, Spain, etc.
Well over 100 commercial products available
August 31, 2004 IHE European Cardiology12
IHE IT Infrastructure 2004-2005IHE IT Infrastructure 2004-2005
Enterprise User AuthenticationEnterprise User Authentication
Provide users a single nameand centralized authentication
processacross all systems
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Retrieve Information for Display
Access a patient’s clinical information and documents in
a format ready to be presented
to the requesting user
Patient Identifier Cross-referencing
for MPIMap patient identifiers
across independent identification domains
Patient Identifier Cross-referencing for
MPI
Map patient identifiers across independent
identification domains
Synchronize multiple applications on a desktop to the
same patient
Patient Synchronized Applications
Consistent TimeCoordinate time across
networked systems
Audit Trail & Node Authentication
Centralized privacy audit trail and node to node authentication
to create a secured domain.
New
Patient Demographics Query New
Personnel White PageAccess to workforcecontact information
New
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical
documents forming a patient electronic health record
New
August 31, 2004 IHE European Cardiology13
IHE Penetration in IT Infrastructure IHE Penetration in IT Infrastructure and Laboratoryand Laboratory
Has just completed Year 1 !!
About 20 vendors worldwide
40+ systems in annual Connectathons
Geographic spread U.S., France, Italy, Japan, Germany, etc.
Commercial products appearing
August 31, 2004 IHE European Cardiology14
IHE Laboratory Integration ProfilesIHE Laboratory Integration Profiles
Laboratory Scheduled Workflow (LSWF) done in 2003
Tests performed by a laboratory for an identified inpatient or outpatient
Laboratory Patient Information Reconciliation
(LPIR) year 2004Tests performed on an unidentified
or misidentified patient
Laboratory Code Set Distribution (LCSD) year 2004
Sharing the batteries and tests code sets throughout the enterprise
Laboratory Device Automation (LDA) year 2004
Pre-analytic process, analysis and post-analytical treatment
Laboratory Point Of Care Testing (LPOCT) year 2004
Tests performed on point of care or patient’s bedside
August 31, 2004 IHE European Cardiology16
An Example ofAn Example ofIHE IT InfrastructureIHE IT Infrastructure
Integration ProfileIntegration Profile
August 31, 2004 IHE European Cardiology17
Introduction:EHR Cross-Enterprise Document SharingEHR Cross-Enterprise Document Sharing
First step towards the First step towards the longitudinal dimension of the EHRlongitudinal dimension of the EHR
Focus:Focus: Support document sharing between Support document sharing between EHRs in different care settings and EHRs in different care settings and organizations organizations
August 31, 2004 IHE European Cardiology18
Acute Care (Inpatient)
GPs and Clinics (Ambulatory)
Long Term Care
Other Specialized Care(incl. Diagnostics Services)
Continuity of Care: Patient Longitudinal RecordPatient Longitudinal Record
Typically, a patient goes through a sequence of encounters in different Care Settings
August 31, 2004 IHE European Cardiology19
community
Clinical Encounter
Clinical IT System
RecordsRecordsSentSent
Laboratory Results Specialist Record
Hospital Record
Finding the records of a patient-Manual & tediousFinding the records of a patient-Manual & tedious
The challenge: Finding and accessing easilydocuments from other care providers In the community.
August 31, 2004 IHE European Cardiology20
community
Clinical Encounter
Clinical IT System Index of patients records(Document-level)
1-Patient Authorized
Inquiry
Temporary Aggregate Patient History
4-Patient data presented to
Physician
Sharing SystemSharing System
3-Records3-RecordsReturnedReturned
Referenceto records
Laboratory Results Specialist Record
Hospital Record
2-Referenceto Records for Inquiry
Sharing records that have been publishedSharing records that have been published
August 31, 2004 IHE European Cardiology21
Acute Care (Inpatient)
PCPs and Clinics (Ambulatory)
Long Term Care
Other Specialized Careor Diagnostics Services
Building and accessing DocumentsBuilding and accessing Documents
EHR-CR: EHR-CR: Care RecordCare Record systems systemssupportingsupporting care delivery care delivery
Documents Registry
DocumentRepository
EHR-LR:EHR-LR:Longitudinal RecordLongitudinal Recordas usedas usedacross-encountersacross-encounters
Submission of Document References
Retrieve of selected Documents
August 31, 2004 IHE European Cardiology22
XDS – Value PropositionXDS – Value PropositionFoundation 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.
August 31, 2004 IHE European Cardiology23
XDS - Value PropositionXDS - Value PropositionDistributed: Each Care delivery organization “publishes” clinical information for others. Actual documents may remain in the source EHR-CR.
Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain (e.g. an LHII).
Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (HL7-CDA, ASTM-CCR, PDF, DICOM, etc.).
Document Content Neutral: Document content is processed only by source and consumer IT systems.
Standardized Registry Attributes: to ensure deterministic document searches.
August 31, 2004 IHE European Cardiology24
XDS – ConclusionXDS – Conclusion• Foundation for EHR & Health IT Infrastructures
• Effective contribution and access to shared documents across all types of health enterprises
• Scalable, Flexible and Easy access
XDS to be one of the major highlights of 2005 Annual HIMSS Conference & Exhibition. Dallas, Tex., Feb. 13-17:
used as a foundation for an on-site demonstration of interoperability in support of a National Health Information Networks.
Attendees at the conference will be able to create and share their own health records across vendor booths as well as in the ambulatory and acute care settings on the conference exhibit floor.
August 31, 2004 IHE European Cardiology25
How real is XDS ?How real is XDS ?
Specification work since Nov 2003Specification work since Nov 2003
Under Public Comments June-July 2004Under Public Comments June-July 2004 600 constructive comments received, 600 constructive comments received,
Stable specification IHE TF Aug 15Stable specification IHE TF Aug 15thth, 2004, 2004
IHE Connectathon January 2005 (USA)IHE Connectathon January 2005 (USA)
HIMSS Feb 2005 show-wide demonstrationHIMSS Feb 2005 show-wide demonstration
IHE Connectathon April 2005 (Europe)IHE Connectathon April 2005 (Europe)
August 31, 2004 IHE European Cardiology26
IHE, IHE,
The practical solutions to the The practical solutions to the effective useeffective use
of information exchange of information exchange standards in healthcarestandards in healthcare
August 31, 2004 IHE European Cardiology28
More information….More information….IHE Web sites:
http://www.ihe-europe.orghttp://www.himss.org/IHEhttp://www.rsna.org/IHEhttp://www.acc.org/quality/ihe.htm.
Technical Frameworks:• ITI V1.0, RAD V5.5, LAB V1.0, CARD V1.0
Technical Framework Supplements - Trial Implementation• May 2004: Radiology• August 2004: Cardiology, IT Infrastructure• December 2004: Laboratory
Non-Technical Brochures :• IHE Fact Sheet and FAQ• IHE Integration Profiles: Guidelines for Buyers• IHE Connect-a-thon Results• Vendor Products Integration Statements