Interoperability and Integrating the Healthcare Enterprise

Transcription

1 Interoperability and Integrating the Healthcare Enterprise Nicholas Brown Thanks to Dave Plummer and Mark Shafarman for some slides 24th January

2 Overview What is Interoperability? What is IHE? What are DICOM and HL7? What is an IHE Integration Profile? Conclusions 2

3 What is Interoperability? It means that my systems work properly Something everyone wants Something the salesman says you will get But just saying: I I want Interoperability for my systems is like saying: I I want my system to behave the way I want but I m I m not telling you exactly what that is Like saying Give me a good meal 3

4 Getting interoperability If I say give me steak and chips then I am more likely to get what I want than just saying give me a good meal BUT you may think I mean Rare filet steak and French Fries WHEN I am thinking Well cooked rump steak with frozen crinkle chips We are not interoperating 4

5 Clinical Interoperability Definition A status which exists for two application entities with regard to a defined clinical task, when one application entity can accept data from the other and provide IT support for the defined task in a satisfactory manner. Note: the task may be one step in support of a clincal procedure which is performed in a number of steps. 5

6 Obtaining Interoperability Instead of saying I I want interoperability say: I I want my new system to accept this specific data from that system and process it in this particular way and produce results in this way Good chance of getting it Can be specified in purchase contract 6

7 Obtaining Interoperability a) Define task(s) that must be performed a) Defi b) Specify information and processing required to support task(s) c) Specify the data elements and data communication for a solution d) Implement systems to do the job 7

8 Sending and accepting the data doing the right thing with it An essential aspect of interoperability is the ability of one application entity to accept data from the other application entity The fact that an application entity is able to receive the correct data (as shown by message conformity testing) does not mean that clinical interoperability will be achieved The application entity must act on the data in such a way that the work of the department is supported smoothly 8

9 Clinical Interoperability - two use case Classes Healthcare delivery Diagnostic Procedures Therapy Procedures Preventive Procedures Patient management 9

10 Clinical Interoperability - two use case Classes Healthcare delivery - Messages Diagnostic Procedures Therapy Procedures Preventive Procedures Patient management Stored Documents - Document access - Document content analysis - Information presentation 10

11 Obtaining Interoperability IHE methodology principles a) Define task(s) that must be performed Users must be involved b) Specify information and processing required to support task(s) Joint effort by users and suppliers c) Specify the data elements and data communication for a solution Parts of standards in existing products d) Implement systems to do the job Run annual testing sessions for suppliers Exhibition demonstrations (multi-vendor) a) Defi 11

12 IHE Standards Adoption Process Testing at Connectathons Develop technical specifications IHE Demonstrations Identify available standards (e.g. HL7, Products with IHE DICOM, IETF, OASIS) Timely access to Document Use Case information12 Requirements Easy to integrate products

13 IHE, Annual Cycle Proven Standards Adoption Process Demonstration (National shows) Installation on site Multi-vendors test at the annual Connect-a-thon thon Clinicians identify clinical problems to be addressed Vendors implement the profile in their Choice of relevant products standards (HL7, CEN, DICOM, Engineers from vendors W3C, Oasis ) collaborate to define technical specification 13

14 IHE Connectathon, Barcelona April participants, 120+ systems 60+ systems developers 2006 Focus: Cardiology, IT Infrastructure, Patient Care Coordination, Laboratory, Radiology monitored test cases 14

15 IHE 2006 Eight Active Domains Over 100 vendors involved world-wide, wide, 5 Technical Frameworks 37 Integration Profiles, Testing at yearly Connectathons Demonstrations at major conferences world-wide wide Electronic Health Record Radiology 14 Integration Profiles Laboratory 5 Integration Profiles IHE IT Infrastructure 13 Integration Profiles Cardiology 4 Integration Profiles Patient Care Coordination 1 Integration Profile Future Domains Pathology Oncology Patient Care Devices 15

16 IHE Global Developments Evolution of IHE Domains Integration Profiles Solutions to Real-World Interoperability Needs & Problems: Within Clinical Departments e.g.: Radiology Cardiology Lab... Across Departmental & Institutional Boundaries XDS RHIOs EHR Enablers RHIOs (Regional Healthcare Information Organizations) Radiology (18) Patient Care Devices (1) Patient Care Coordination (5) Radiation Oncology (1) Laboratory (6) Cardiology (7) IT Infrastructure for Healthcare (17) Veterinarian Endoscopy (1) Eye Care / (3) Ophthalmology Pharmacy Pathology (1) Year 1 (1999) Year 2 (2000) Year 3 (2001) Year 4 (2002) Year 5 (2003) Year 6 (2004) Year 7 (2005) Year 8 (2006) 16

17 Who is IHE? IHE (International) Strategic Development Committee Sponsors Co-Chairs supervises reports Global IHE North America IHE Europe IHE Asia/Oceania Regional & National Deployment Delegates IHE Domain-related Planning and Technical Committees contribute Participants Global Development: IT Infrastructure, Radiology, Cardiology, Lab, etc. Interoperability 17

18 IHE-UK IHE-UK Steering committee IHE-UK Imaging and Oncology TC Others to be formed IT Infrastructure Document sharing, PIX, Consistent time, etc. Pharmacy Labs 18

19 IHE-UK Projects 2008 IHE-Europe Europe Connectathon Oxford VIP visits Major meeting during the connectathon Sharing documents and streamlining workflow - please attend Follow up technical meeting Strengthening the Steering committee More professional user body reps More supplier body reps Promoting IHE Documents sharing 19

20 For more information ihe.net ihe-europe.org ihe-uk.org 20

21 What is an IHE Integration Profile? For a given clinical function e.g. Scheduled Workflow management IHE defines an INTEGRATION PROFILE (set of small clinical tasks) The INTEGRATION PROFILE: Identifies the Actors and Transactions Specifies the standard(s) (HL7, DICOM ) Profiles (selects parts and constrains values) of those standard provisions (a standard profile) Specifies the sequence of events 21

22 IHE Technical Framework ADT Order Placer Department System Scheduler/ Order Filler Image Manager/ PPS Manager Acquisition Modality Register J.Doe Detailed standards implementation guides Cardiology IT Infrastructure Laboratory Radiology.. Patient Registration [RAD-1] Placer Order Management One or the New [RAD-2] other methods of creating an order is used Filler Order Management - Schedule New [RAD-3] Procedure Procedure Scheduled [RAD-4] Query Modality Worklist [RAD-5] Modality Procedure Modality Procedure Perform Filler Order Step In Progress Step In Progress Acquisition Mgmt - Status [CARD-1] [CARD-1] Update [RAD-3] Modality Procedure Modality Procedure Patient Reconciliation Filler Order Step Completed Step Completed J.Doe -> Mgmt - Status [RAD-7] [RAD-7] J.Smith Update [RAD-3] Patient Update/ ADT Pt. Registration [RAD-1] Patient Update/ Merge [RAD-12] Patient Update [RAD-12] Merge [RAD-12] Pt. Registration [RAD-1] Patient Update [RAD-12] Placer Order Management [RAD-2] Filler Order Management [RAD-3] DSS/ Order Filler Order Placer Modality PS in Progress [CARD-1] Procedure Scheduled [RAD-4] Modality PS Completed [RAD-7] Patient Update [RAD-12] Procedure Updated [RAD-13] Instance Availability Notification [RAD-49] Evidence Image Display Modality PS in Progress [CARD-1] Creator Modality PS Completed [RAD-7] Query Images [RAD-14] Storage Modality Image/Evidence Retrieve Images/Evidence [CARD-4] Performed Commitment Stored [CARD-2] Procedure [CARD-3] Step Manager Image Image Manager Archive Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7] Storage Modality Image/Evidence Commitment Stored [CARD-2] [CARD-3] Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7] Acquisition Modality Query Modality Worklist [RAD-5] 22

23 Scheduled Workflow Patient Registration ADT Patient Registration Order Placer Image Creator Filler Order Management Placer Order Management Storage Commit Q /R Images Image Display Images Stored Department System Scheduler Order Filler Image Archive Procedure Scheduled Image Manager PPS In-Progress / Completed Modality Worklist Images Availability Query Performed Procedure Step Manager PPS In-Progress / Completed Storage Commit Images Stored Acquisition Modality PPS In-Progress / Completed 23

24 IHE System Transactions Overview Patient Registration ADT Patient Registration Order Placer HIS Patient Update Storage Commit Image Creator Filler Order Management Department System Scheduler Order Filler Placer Order Management RIS PPS In-Progress / Completed Modality Worklist Procedure Scheduled Images Availability Query Performed Procedure Step Manager Patient Update Procedure Update PPS In-Progress / Completed Image Display Q /R Key Image Q /R IMAGING: Note Presentation Q /R Sates Images PACS Workstations Image Archive Image Manager Modalities Storage Commit Images Stored Acquisition Modality Images Stored Present. State Stored Present. State Stored Key Image Note Stored Key Image Note Stored PPS In-Progress / Completed 24

25 The IHE Methodology 1 1. Identify a real problem when using existing software Not just one user s s idea Not just one suppliers idea 2. Define the use case carefully 3. Include the use case in the list of projects for approval by the strategic development committee (global) which allocates resources 4. Create a group of experts to seek a solution using standards already in use 25

26 The IHE Methodology 2 5. Create a technical specification containing: The use case Standard profiles of data items required for solution Standard profiles of data exchange required for solution The processing to be applied to support the use case (a profile is a subset of the content of a standard) 6. Perform trial implementations of the specification 7. Add the specification to the IHE Technical Framework of IHE Integration Profiles 8. Include the Integration Profile for testing at the next annual test session (connectathon) 26

27 The IHE Methodology 3 9. Test that participant supplier s s software can interoperate with that of three other suppliers (the specification may be amended at the connectathon where the Integration Profile is first tested) 10. List on the IHE website companies whose software has passed the test for the IHE Integration Profile) customers can purchase products which claim to support the integration profile 11. Sponsor multi-vendor demonstrations of IHE Integration Profiles at user conferences 27

28 IHE Connectathon Delivers 1 Message conformance testing for connectivity of applications AND Tests of supplier software applications to determine that the appropriate action has been taken on receipt of data as specified in the IHE Integration Profile i.e. it tests for clinical interoperability (Each supplier system must show that it can interoperate with three other supplier systems) 28

29 IHE Connectathon Delivers 2 Connectathon Group tests A set of different supplier systems must demonstrate end to end interoperability for all the Transactions within an IHE Integration Profile 29

30 Benefits to suppliers Clear requirement specifications from users Easy implementation of systems that interoperate Connectathon: testing their software with a number of different suppliers. They can learn more in one week at the connectathon than several months at base Reduced costs of commissioning on site 30

31 Benefits to users Users benefit because they can know exactly what functionality will be implemented in purchased products for which conformance to IHE specifications is stated Easy resolution of any interoperability problems that do arise at commissioning Easy replacement of systems Easy extension of networked systems Future proofing of investment 31

32 For more information ihe.net ihe-europe.org ihe-uk.org 32

33 What is HL7 V2? HL7 is to electronic messaging within the hospital what DICOM is to electronic messaging within the imaging department. Much bigger and older than DICOM Has a current version 2 but is working hard on version 3 which has an extensive modelling methodology all its own 33

34 DICOM HL7 Ver. 2 Spec 1993 Minimal model Modules Item ID by Tag Defined field lengths Unlimited nesting Binary big TCP/IP protocol Stored data included XML version (ISO OIDs) ANSI standard 1987 No model Segments Item ID by position No field length limit Limited nesting ASCII small Not specified Stored data included XML version Event driven 34

35 DICOM example Module Patient Patient Patient Patient General Study General Study General Study General Study General Study Item name Item ID Patient's Name (0010,0010) Patient ID (0010,0020) Birth Date (0010,0030) Patient's Sex (0010,0040) (0010,0010) 64 (0010,0020) 64 LEN DT 64 PN 64 LO DA (0010,0030) 8 DA (0010,0040) 16 CS Study Inst UID (0020,000D) 64 UI Study Date (0008,0020) 8 DA Study Time (0008,0030) 16 TM Study ID (0020,0010) 16 SH Accession No (0008,0050) 16 SH 35

36 HL7 OBX - The name/value pair segment SEQ LEN DT R/O RP/# TBL# ITEM# DATA ELEMENT NAME SI ID CE ST * CE ST ID NM ID ID TS ST TS CE XCN. O R R C R... Y Y/5 Y Set ID - Observational Simple Value Type Observation Identifier Observation Sub-ID Observation Value Units References Range Abnormal Flags Probability Nature of Abnormal Test Observ Result Status Date Last Obs Normal Values User Defined Access Checks Date/Time of the Observation Producer's ID Responsible Observer. 36

37 IHE Actors and Transactions ADT Pt Registration Dept sys Scheduler/ Order Filler Report Manager Modality Worklist Provided Procedure Scheduled Procedure Update Reports Acquisition Modality Image manager Report Reader Modality Image Stored Image Archive 37

38 IHE Message Sequence ADT Dept Scheduler Modality Image Manager Registration Procedure Scheduled Modality worklist Image Stored Report Creator Report Manager Report Reader Report submission Retrieve Report 38

39 IHE Technical Framework Documents Available for free download 39