INTEGRATING THE HEALTHCARE ENTERPRISE

Pathway to Interoperability

IT Infrastructure Planning CommitteeMichael Nusbaum – MH Nusbaum & Assoc

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Contents

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Base StandardsBase Standards eHealth ProjectseHealth Projects

Interoperability:Highest Cause of Health IT project failures

Health Interoperability Standards: how can we realize the promise ?

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IHTSDOIHTSDO

IETFIETF

Profile Profile DevelopmentDevelopment

Base StandardsBase Standards eHealth ProjectseHealth Projects

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Interoperability: From a problem to a solution

Profiling Organizations Have Emerged

IHTSDOIHTSDO

IETFIETF

Specific ExtensionsSpecific Extensions

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Standards: Necessary…Not 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 IHE provides a standard process for implementing multiple standardsimplementing multiple standards

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

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IHE: A forum for agreeing on how to implement IHE: A forum for agreeing on how to implement standards and processes for making it happenstandards and processes for making it happen

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IHE: A Framework for Interoperability

A common technical 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

Is IHE novel? Adopted?

What are the alternatives ? Ignore the issue Pick key standards, and hope for the best Rely on robust standards harmonization

ISO Health Informatics: TR28380 Global Standards Adoption – IHE Process and Profiles

Widespread adoption of IHE Profiles by National and Regional Projects around the world: USA, Canada, Europe, Asia

Home Health: CONTINUA and IHE work together.

12 Country European epSOS Project (IHE-Europe hosting Industry Team).

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Document Use Case Requirements

Identify available standards (e.g. HL7, DICOM, IETF, OASIS)

Develop technical specifications

Testing at Connectathons

IHEDemonstrations

Products declare IHE

Timely access to information Easy to integrate

products

RFPs with IHE reqs

IHE is a Proven Standards Adoption ProcessRecognized by the International Standards Organization: TR 28380

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IHE Organizational Structure

Contributing &Participating

Vendors

Example Deployment CommitteesExample Deployment Committees

IHE Europe

IHE North America

France

USA

Canada

IHE Asia-Oceania

Japan

Korea Australia

Netherlands

Spain Sweden UKItaly

Germany

Norway

China

Austria

Professional Societies / Sponsors

IHE International Board

Global Development DomainsGlobal Development Domains

Radiology

Cardiology

ITInfrastructure

Patient CareCoordination

Patient CareDevices

Laboratory

Pathology

Eye CareRadiationOncology

Public Health, Quality and Research

Pharmacy

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Endoscopy Dentistry

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14 Years of Steady Evolution 1998 – 2011

The IHE Development Domains

Pharmacysince 2009

Pathologysince 2006

Radiation Oncologysince 2004

Radiologysince 1998

Cardiologysince 2004

Patient Care Devicessince 2005

Patient Care Coordinationsince 2004

Eye Caresince 2006

QualityResearch & Public Health

since 2006

Laboratorysince 2004

(Healthcare)IT Infrastructure

since 2003

Endoscopysince 2010

Dentistrysince 2010

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International Participation in IHE

France

Local DeploymentNational ExtensionsPromotional & Live Demonstration EventsFunding

USA

Germany

Italy

JapanUK

Canada

Korea

Taiwan

Norway

Netherlands

SpainChina

Austria

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Pragmatic global standards harmonization + best practices sharing

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Australia

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IHE SponsorsProfessional societies: Healthcare Information Management Systems Society (HIMSS) American College of Physicians (ACP), American College of Emergency Physicians (ACEP) American College of Obstetricians and Gynecologists (ACOG) Many other American Professional Societies (ACCE), (AAO), (ASTRO), etc. British Institute of Radiology (BIR), British Computer Society (BCS) German Radiology Society (DRG) …ASIP (IT France), SFIL (laboratory), French

National Project (DMP), European Society of Cardiology Radiological Society of North America (RSNA) JAHIS (IT Japan), JIRA, JRS,… And many more

Government Agencies: French National Project (ASIP-Santé) Dutch National Project (NICTIZ) Austrian National Project (ELGA) Canada Health Infoway (CHI) Regional projects (Italy, USA, Japan) and many more…..

IHE Connectathon

Open invitation to any vendor and other implementers

Advanced IHE testing tools (MESA, GAZELLE)

Testing organized and supervised by independent project management team

Thousands of cross-vendor tests performed

Results recorded and published http://connectathon-results.ihe-europe.net/

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IHE N.A. Connectathon Tested Systems

Radiology

40 Systems

Cardiology

30 Systems

Devices

20 Systems

Intra-enterprise InteroperabilityEnterprise-level: 44 Systems

Cross-enterprise Interoperability

EHR/PHR/Edge Systems

2008: 14 Systems2009: 24 Systems

2010: 56 Systems

HIE/HIO Infrastructure

2008: 5 Systems2009: 6 Systems

2010: 30 Systems

HIMSS Interoperability Showcase

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IHE, Global Standards-Based Profiles Adopted in National & Regional Projects

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http://tinyurl.com/WWXDS

IHE, Global Standards-Based Profiles Adopted in National & Regional Projects

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http://tinyurl.com/WWXDS

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Supplies infrastructure for sharing healthcare information, which is independent of any particular clinical domain.

An infrastructure interoperability component represents a common IT function that is used as a building block for a variety of use cases... a necessary ingredient, but rarely visible to the end user.

These components may be embedded in an application, but are often deployed as a shared resource within a health information exchange environment.

The IT Infrastructure Domain

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Categories of Healthcare Communication Services

Security/PrivacySecurity/Privacy

Health RecordSharing

Patient and Provider Identity Management

WorkflowEnablers

Source persisted and attested health

records

2 or more entitiessynchronize

a task

e.g. access last 6 mo. historical labs &

encounter summariese.g. order lab test, track

status and receive results

HospitalsExchange of Health Information

Support Management

ITI Strategic FocusCategory Description

Patient and Provider Identity

Profiles in the Patient and Provider Identity category support the management of patient, provider and healthcare organization identity including their localization. This includes the ability to look up, cross-reference, update, remove, merge, link and general management of identities.

Health Record Sharing

Profiles in the Health Record Sharing category support the ability to share patient specific healthcare information within and across Enterprises. This includes the ability to submit, locate/list, push, pull and retrieve patient specific healthcare information.

Security and Privacy Profiles in the Security and Privacy category support the ability to ensure that healthcare information is managed consistent with a reasonable set of security and privacy policies.

Workflow Enablers Profiles in the Workflow Enablers category support standard sequences for performing workflow activities.

Support Management Profiles in the support management category support the ability to share information needed for interoperable healthcare management such as clinical coding, technical or IT management information

http://wiki.ihe.net/index.php?title=ITI_Strategic_Planning

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More Information

IHE Web site: www.ihe.net IHE official materialTechnical Framework documents

IHE Wiki site: wiki.ihe.net IHE committee pages Implementation Notes Ongoing committee work

IHE ITI technical committee mailing list http://www.ihe.net/IT_infra/committeesAt the bottom of the page is a place to join the mailing list

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