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1September, 2005 What IHE Delivers
IHE in regional and national IHE in regional and national Health Information ExchangesHealth Information Exchanges
around thearound theWORLD WORLD
AsiaPac Interoperability Showcase April 2008AsiaPac Interoperability Showcase April 2008Didi Davis, Sr. Director, IHE, HIMSSDidi Davis, Sr. Director, IHE, HIMSS
222
International Growth of IHEInternational Growth of IHE
France
Local Deployment National Extensions Promotional & Live Demonstration Events Funding
USA
Germany
Italy
JapanUK
Canada
Korea
Taiwan
Norway
Netherlands
SpainChina
Austria
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99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
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Pragmatic global standards harmonization + best practices sharing Pragmatic global standards harmonization + best practices sharing
Australia
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IHE Organizational StructureIHE Organizational Structure
Contributing &Participating
Vendors
IHE Europe
IHE North America
France
USA
Canada
IHE Asia-Oceania
Japan
Korea Taiwan
Netherlands
Spain Sweden UKItaly
Germany
Norway
China
Austria
ACCACCEACEP
JAHISJIRAJRS
METI-MLHWMEDIS-DCJAMI
RSNA SFRSFIL
SIRMBIREuroRec
COCIREAR-ECRDRG
ESC
Professional Societies / SponsorsACPGMSIHIMSS
IHE International Board
Regional Deployment Global Development
Radiology
Cardiology
ITInfrastructure
Patient CareCoordination
Patient CareDevices
Laboratory
Pathology
Eye CareRadiationOncology
Public Health, Quality and Research
4
National and Regional projectsNational and Regional projects
It is difficult to provide a simple summary view of these It is difficult to provide a simple summary view of these projects:projects:
These slides reflect information publicly available and These slides reflect information publicly available and current based on author’s knowledge.current based on author’s knowledge.
IHE offers 24 Integration & Content profiles applicable IHE offers 24 Integration & Content profiles applicable in health information exchange for communities, in health information exchange for communities, regions or nations. Each project discussed here uses regions or nations. Each project discussed here uses different subsets of these profiles (IHE Modularity).different subsets of these profiles (IHE Modularity).
These projects are multi-year and projects with These projects are multi-year and projects with complex decision making processes.complex decision making processes.
5
Categories of Healthcare Communication ServicesCategories of Healthcare Communication ServicesMost HIEs in the World chose to start with Document SharingMost HIEs in the World chose to start with Document Sharing
Security
DocumentSharing
Patient and Provider ID Mgt
DynamicInformation
Access
WorkflowManagement
Source persisted and attested health
records
Specific info snapshot
provided on demand
2 or more entitiessynchronize
a task
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
HospitalsHIEs and RHIOs
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Sharing and Accessing Electronic Health Sharing and Accessing Electronic Health RecordsRecords
IHE offers interoperability for local, regional, specific, or IHE offers interoperability for local, regional, specific, or national health information exchangenational health information exchange
Goal is to enable exchange between providers’ clinical Goal is to enable exchange between providers’ clinical and administrative systems and ancillary IT systems and administrative systems and ancillary IT systems (EHRs,Lab, Pharma, Payers, etc.) and personal health (EHRs,Lab, Pharma, Payers, etc.) and personal health record systems.record systems.
Objective is to empower the consumersObjective is to empower the consumers in having in having “shared EHR information” between all of its potential “shared EHR information” between all of its potential healthcare providers (if authorized) and self.healthcare providers (if authorized) and self.
Objective is to empower the providersObjective is to empower the providers in choosing when in choosing when and what information to share, and to trust the and what information to share, and to trust the information they may use in the care of their patients.information they may use in the care of their patients.
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Community orsub-network
Clinical Encounter
Clinical IT System
Sharing SystemSharing System
Clinic Record Specialist Record
Hospital Record
Introduced at HIMSS in 2005 : IHE-XDSIntroduced at HIMSS in 2005 : IHE-XDS
1-Reference1-Referenceto recordsto records
Repository ofRepository ofDocumentsDocuments
Repository ofRepository ofDocumentsDocuments
Index of Index of patients recordspatients records
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Community orsub-network
Clinical Encounter
Clinical IT System
Aggregate Patient Info
4-Patient data 4-Patient data presented to presented to
PhysicianPhysician
Sharing SystemSharing System
Clinic Record Specialist Record
Hospital Record
2-Reference2-Referenceto Records to Records for Inquiryfor Inquiry
Introduced at HIMSS in 2005 : IHE-XDSIntroduced at HIMSS in 2005 : IHE-XDS
3-Records3-RecordsReturnedReturned
1-Reference1-Referenceto recordsto records
Repository ofRepository ofDocumentsDocuments
Repository ofRepository ofDocumentsDocuments
Index of Index of patients recordspatients records
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IHE Integration Profiles for Health Info NetsIHE Integration Profiles for Health Info Nets What What is availableis available and and has been added in 2007has been added in 2007
Emergency Referrals Format of the Document Content
and associated coded vocabulary PHR Extracts/Updates
Format of the Document Content and associated coded vocabulary
ECG Report Document
Format of the Document Content and associated coded vocabulary
Lab Results Document Content
Format of the Document Content and associated coded vocabulary
Scanned Documents Format of the Document ContentImaging Information
Format of the Document Content and associated coded vocabulary
Medical Summary (Meds, Allergies, Pbs)
Format of the Document Contentand associated coded vocabulary
Clinical and PHR ContentClinical and PHR Content
Health Data ExchangeHealth Data Exchange
Patient Demographics Query
Patient Identifier Cross-referencing
Map patient identifiers across independent identification
domains
Notification of Document Availability
Notification of a remote provider/ health enterprise
Request Formfor Data Capture
External form with custom import/export scripting
Patient ID MgmtPatient ID Mgmt
OtherOther
Final Text ApprovedFinal Text Approved
Trial Implementation-2007 Trial Implementation-2007 –– Final Txt 2008Final Txt 2008
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical
documents forming a longitudinal record
Cross-Enterprise Document Pt-Pt Reliable InterchangeCross-Enterprise Document
Media InterchangeCross-Community Access
Security & PrivacySecurity & Privacy
Consistent TimeCoordinate time across networked
systems
Audit Trail & Node Authentication
Centralized privacy audit trail and node to node authentication to create
a secured domain.
Basic Patients Privacy Consents
Establish Consents & Enable Access Control
Document Digital Signature
Attesting “true-copy and origin
Cross-Enterprise User Attestation
User Attributes fro Access Control
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IHE, global standards-based profiles adopted by IHE, global standards-based profiles adopted by several national & regional projectsseveral national & regional projects
Quebec, Toronto,Alberta, British Columbia
Canada Infoway
Denmark (Funen)Italy (Veneto)Spain (Aragon)
NCHICA – N. Carolina
Italy (Conto Corrente
Salute)
Boston Medical
Center - MA
FranceDMP
UK CfH(Radiology WF)
Philadelphia HIE
CHINA-MoHLab results sharing
KeyHIE – Pennsylvani
a
CHINA-ShanghaiImaging Info Sharing
JAPAN-NagoyaImaging Info Sharing
South Africa
MalaysiaSingapore
VITL-Vermont
CareSpark – TN & VA
NetherlandAmsterdam
LowerAustria
Austria
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Italy Italy (Genoa Region)(Genoa Region)
Azienda Sanitaria Locale n. 4 Chiavarese
Conto Corrente Salute
Azienda Sanitaria Locale n. 4 Chiavarese
Conto Corrente Salute
Cooperazione e condivisioneCooperazione e condivisione
Asl 4 Chiavarese; Dipartimento di Medicina
Diagnostica e Terapie Speciali dell’Università di Padova
IHE – Commissione nazionale Italia
alcune aziende ICT esperte in soluzioni “e-health” (Rasna Medical Systems, Soluzioni Informatiche);
A.S.L. 4CHIAVARESEA.S.L. 4CHIAVARESE
per la realizzazione di un prodotto open-source su J2EE che implementa il profilo IHE XDS.
E’ stato attivato un Work Group composto da:
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Italy Italy (Genoa Region)(Genoa Region)
In service since January 2006. In service since January 2006.
4 Hospitals and 500 physician offices.4 Hospitals and 500 physician offices.
EMRs import and export documents from their local EMRs import and export documents from their local records.records.
All vendor products required to pass IHE-Europe All vendor products required to pass IHE-Europe connectathon in April 2005.connectathon in April 2005.
Patients chose to join through one of their care providerPatients chose to join through one of their care provider
Infrastructure includes:Infrastructure includes: XDS RegistryXDS Registry XDS Repository shared at the regional levelXDS Repository shared at the regional level PIX for patient Id linkingPIX for patient Id linking Doc content is CDA with PDF content. Plan in place to move to CDA rel 2 with Doc content is CDA with PDF content. Plan in place to move to CDA rel 2 with
structured data. IHE (XD*-Lab) CDA Lab primary candidate.structured data. IHE (XD*-Lab) CDA Lab primary candidate.
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Austria Austria (Lower Austria and (Lower Austria and National)National)
Lower Austria Region (around Vienna) Deployed Lower Austria Region (around Vienna) Deployed in 2007 - Operational. 1.5 Million patients on-line. in 2007 - Operational. 1.5 Million patients on-line. 11 hospitals connected. 11 hospitals connected.
Use IHE profiles: Use IHE profiles: XDS, PIX, XDS-SD, ATNA, XUA, BPPC.XDS, PIX, XDS-SD, ATNA, XUA, BPPC.
National project launched in 2007 (ELGA). Given National project launched in 2007 (ELGA). Given the success to deploy the first region is about the success to deploy the first region is about one year.one year.
Roll-out includes:Roll-out includes: Ministry backing of IHE conformance (IHE-Eu Connectathon)Ministry backing of IHE conformance (IHE-Eu Connectathon) Extending to Ambulatory Physicians in 2008Extending to Ambulatory Physicians in 2008 Step-wise introduction of structured and coded content with HL7 CDA Step-wise introduction of structured and coded content with HL7 CDA
based IHE Content Profiles.based IHE Content Profiles.
LowerAustria
Austria
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USA USA (Philapdelphia Region)(Philapdelphia Region)
Philadelphia Health Info Exchange in service since 2005. Philadelphia Health Info Exchange in service since 2005. Focused on images and reports sharing.Focused on images and reports sharing.
5 Hospitals + Imaging Center + Public Health5 Hospitals + Imaging Center + Public Health The Hospital of the University of Pennsylvania The Hospital of the University of Pennsylvania Thomas Jefferson University Hospital Thomas Jefferson University Hospital Children’s Hospital of Philadelphia Children’s Hospital of Philadelphia Presbyterian Medical Center Presbyterian Medical Center Pennsylvania Hospital Pennsylvania Hospital UPHS Community Radiology UPHS Community Radiology Philadelphia Department of Public HealthPhiladelphia Department of Public Health
Migration to XDS, ATNA, PIX and XDS-I completed in Migration to XDS, ATNA, PIX and XDS-I completed in 2007.2007.
Demonstrated live at RSNA-Chicago Nov 2007Demonstrated live at RSNA-Chicago Nov 2007
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USA (Other)USA (Other)HITSP (HHS sponsored) accepted 8 IHE Integration profiles HITSP (HHS sponsored) accepted 8 IHE Integration profiles for: Lab results distribution and sharing, Registration and for: Lab results distribution and sharing, Registration and Medication History for Consumers, Biosurveillance.Medication History for Consumers, Biosurveillance.
2 NHIN-1 Pilots (CSC and IBM) leveraged IHE profiles (Med 2 NHIN-1 Pilots (CSC and IBM) leveraged IHE profiles (Med Summaries and Lab).Summaries and Lab).
South Shore, MA: Operational (Inpatient and Emergency Dept)South Shore, MA: Operational (Inpatient and Emergency Dept)
NHIN-2 Trial Implementations NHIN-2 Trial Implementations (NCHICA, Virginia & CareSpark HIEs)(NCHICA, Virginia & CareSpark HIEs)
Several HIEs projects are actively planning the use of IHESeveral HIEs projects are actively planning the use of IHE Vermont StateVermont State KeyHIE (PA)KeyHIE (PA) eHealthConnecticuteHealthConnecticut Boston Medical Center and affiliated clinicsBoston Medical Center and affiliated clinics
Launch Internet Explorer Browser.lnk
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CanadaCanadaCanada Health Infoway: national Commitment to XDS/XDS-Canada Health Infoway: national Commitment to XDS/XDS-I for imaging sharing I for imaging sharing
3 infrastructure tenders awarded in 2007 and 1 more to 3 infrastructure tenders awarded in 2007 and 1 more to come early 2008 resulting in over 1/3 of Canadian patients come early 2008 resulting in over 1/3 of Canadian patients covered:covered: Toronto East Network - OntarioToronto East Network - Ontario Montreal McGill - QuebecMontreal McGill - Quebec AlbertaAlberta British ColumbiaBritish Columbia
Includes XDS, ATNA, PIX and XDS-I.Includes XDS, ATNA, PIX and XDS-I.
Planned to become live 2008 in Quebec, Ontario, Alberta, Planned to become live 2008 in Quebec, Ontario, Alberta, British Columbia.British Columbia.
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France France (National DMP)(National DMP)
Prototype RFP call for tender mid-2005. Confirmed Prototype RFP call for tender mid-2005. Confirmed requirement to use to IHE profiles: requirement to use to IHE profiles: XDS, ATNA, XUA, BPPC, etc.XDS, ATNA, XUA, BPPC, etc.
Encourage vendors to submit their products to the IHE-Encourage vendors to submit their products to the IHE-Europe Connectathon (April 2007-Berlin).Europe Connectathon (April 2007-Berlin).
Implementation plan under revision.Implementation plan under revision.
Infrastructure to include:Infrastructure to include: XUA from User Authentication Portal and BPPC for privacyXUA from User Authentication Portal and BPPC for privacy XDS Registry/XDS Repositories XDS Registry/XDS Repositories ATNA for audit trail and node authentication.ATNA for audit trail and node authentication. Doc content to be: CDA rel 2 patient summary (close to XDS-MS), Hprim with Doc content to be: CDA rel 2 patient summary (close to XDS-MS), Hprim with
migration to IHE XD*-Lab for Lab, Scanned Doc (PDF) and imaging (XDS-I). migration to IHE XD*-Lab for Lab, Scanned Doc (PDF) and imaging (XDS-I).
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Other CommitmentsOther CommitmentsChinaChina MoH selected XDS and XD*-Lab (CDA) for lab info sharing.MoH selected XDS and XD*-Lab (CDA) for lab info sharing. XDS-I in Shanghai.XDS-I in Shanghai.
Israel, Jordan, Palestinian AuthorityIsrael, Jordan, Palestinian Authority Public Health Info Affinity Domain (XDS, ATNA, XD*Lab)Public Health Info Affinity Domain (XDS, ATNA, XD*Lab) Middle east Consortium for infectious Disease SurveillanceMiddle east Consortium for infectious Disease Surveillance
NetherlandsNetherlands Amsterdam region network project launched 2007. XDS-I.Amsterdam region network project launched 2007. XDS-I.
JapanJapan Nagoya region network project operational late 2007. XDS, XDS-INagoya region network project operational late 2007. XDS, XDS-I Kobe with imaging info sharingKobe with imaging info sharing
South AfricaSouth Africa National project launched in 2007. Tender awarded. Operational National project launched in 2007. Tender awarded. Operational
in 2008.in 2008.
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IHE, global standards-based profiles adopted by IHE, global standards-based profiles adopted by several national & regional projectsseveral national & regional projects
Quebec, Toronto,Alberta, British Columbia
Canada Infoway
Denmark (Funen)Italy (Veneto)Spain (Aragon)
NCHICA – N. Carolina
Italy (Conto Corrente
Salute)
Boston Medical
Center - MA
FranceDMP
UK CfH(Radiology WF)
Philadelphia HIE
CHINA-MoHLab results sharing
KeyHIE – Pennsylvani
a
CHINA-ShanghaiImaging Info Sharing
JAPAN-NagoyaImaging Info Sharing
South Africa
MalaysiaSingapore
VITL-Vermont
CareSpark – TN & VA
NetherlandAmsterdam
LowerAustria
Austria
20September, 2005 What IHE Delivers