1 INTEGRATING THE HEALTHCARE ENTERPRISE (IHE): AN INTERNATIONAL APPROACH TO THE DEVELOPMENT OF IMPLEMENTATION GUIDES FOR ELECTRONIC HEALTH RECORD SYSTEMS The 14th Congress of the International Federation of Health Records Organizations (IFHRO) held in conjunction with the 76 th National Convention and Exhibit of the American Health Information Management Association (AHIMA) October 13, 2004
2 Presenter Deborah Kohn, MPH, RHIA, CHE, CPHIMS Principal Dak Systems Consulting San Mateo, CA
3 Disclaimer Deborah Kohn has made every effort to be as accurate as possible in providing information for this presentation. Any variation from the accuracy of content in this presentation must not be construed as intentional. Information provided in this presentation does not constitute a product, organization, or individual endorsement or rejection by AHIMA or Deborah Kohn. AHIMA and Deborah Kohn make no guarantees, warranties, or representations of any kind Deborah Kohn
4 Agenda Introduction What is IHE? What is Interoperability? Background IHE Around the World IHE Technical Frameworks Other IHE Benefits / Deliverables IHE and EHR Systems
5 IHE Integrating the Healthcare Enterprise A multinational healthcare initiative that develops and publishes domain-based (e.g., radiology, laboratory, etc.) Technical Frameworks (i.e., implementation guides) that consist of internationally-accepted and vendor-neutral implementations of existing healthcare IT data standards, such as Health Level 7 (HL7) Digital Imaging and Communications in Medicine (DICOM)
6 Technical Frameworks The Technical Frameworks allow the established IT data standards to be implemented in a uniform fashion.
7 Benefits Healthcare organizations (HCOs) that implement information systems by following the IHE Technical Frameworks (guidelines) achieve effective systems integration and interoperability
8 Interoperability sharing data between different software, residing on different hardware, from different software and hardware vendors allowing the seamless passing of vital health information from application to application, system to system, and setting to setting within and across the healthcare enterprise
9 Results HCOs that implement information systems by following the IHE Technical Frameworks (guidelines): save time and money support optimal patient care
10 The DICOM Standard First published in 1985 Initially, DICOM specified the hardware connection (i.e., interface) for transferring unstructured image data in and out of diagnostic imaging equipment in Radiology departments. PACS started to be implemented, requiring interfaces to other information systems in the enterprise. Despite DICOM compliance, HCOs could not achieve interoperability.
11 The HL7 Standard First published in 1987 Initially, HL7 specified working interfaces for a wide range of clinical and administrative structured data messages (e.g., patient registration, order entry, and observation reporting), allowing disparate healthcare applications to exchange data. HL7 lacked an information model for the management of the data. Consequently, most healthcare information system developers interpreted and implemented the HL7 standard in a conflicting, non-uniform, and proprietary manner. Despite HL7 compliance, HCOs could not achieve interoperability.
12 IHE Then Established in 1998 by HIMSS and RSNA To resolve this standards dilemma To help decrease the costs of implementations in the area of multiple vendor systems integration
13 IHE Then Developed the first versions of the IHE Radiology Technical Framework to define how to use DICOM and HL7 to resolve common information system communication tasks that span multiple information systems in radiology For example, one standard allowed 28 characters in an order form field, while the other standard allowed only 25 characters.
14 IHE Now Includes: standards organizations ACR-NEMA HL7 Internet Engineering Task Force professional societies that supervise the IHE documentation, testing, promotional requirements, and demonstrations HIMSS RSNA American College of Cardiology (ACC) American College of Clinical Engineering (ACCE)
15 IHE Now Includes: medical specialists, care providers, IT professionals who define the Technical Framework needs eighty (and growing), image modality, medical device, and healthcare information system vendors from Europe, Asia and North America that embed the Technical Frameworks into their systems / products
16 IHE Now Includes: developed and published Technical Frameworks Radiology Laboratory IT Infrastructure
17 IHE Soon Expanding to include other: standards organizations Institute of Electrical and Electronics Engineers (IEEE) for IEEE s Medical Information Bus (MIB P1073) for communication between bedside instruments and other medical devices and healthcare information systems American Society for Testing and Materials (ASTM) for ASTM s Healthcare Informatics Committee 31 s consensus-based Continuity of Care Record (CCR) standards developed and published Technical Frameworks Cardiology EHR - Cross-Enterprise Clinical Document Sharing (XDS)
18 IHE Around The World IHE North America United States HIMSS RSNA ACC ACCE Canada Canada Health Infoway Canadian Association of Radiology
19 IHE Around The World IHE Europe France Germany Italy Scandinavia United Kingdom European Association of Radiology
20 IHE Around The World IHE Asia Japan South Korea Taiwan Japanese Association for Hospital Information Systems Japanese Radiological Society
21 Technical Frameworks The Technical Frameworks (i.e., the internationally-accepted and vendor-neutral implementation guides) allow the established IT data standards to be implemented in a uniform fashion.
22 Technical Frameworks The Technical Frameworks are process - oriented; i.e., they are organized by problem / solution scenarios OR specific sets of capabilities of integrated systems The processes are referred to as Integration Profiles.
23 Integration Profiles For example, version 5.5 of the IHE Radiology Technical Framework includes the following twelve Integration Profiles: Basic Security Consistent Presentation of Images Key Image Notes Evidence Documents Simple Image and Numeric Report Access to Radiology Information Scheduled Workflow Presentation of Grouped Procedures Post-Processing Workflow Reporting Workflow Charge Posting Patient Information Reconciliation
24 Integration Profiles For example, version 1.0 of the IHE IT Infrastructure Technical Framework includes the following five Integration Profiles: Retrieve Information for Display Enterprise User Authentication Patient Identifier Cross-Referencing Patient Synchronized Applications Consistent Time
25 Technical Frameworks The Technical Frameworks identify the products (or information systems or components of information systems) that produce, manage or act on information associated with the operational process (or Integration Profile) in the enterprise. The Technical Frameworks refer to these products as Actors.
26 Actors For example, the IHE Radiology Technical Framework has identified over twenty Actors: The Image Acquirer Actor - the imaging modality The Order Filler Actor - the radiology information system The Order Placer Actor - the healthcare information system.
27 Technical Frameworks The Technical Frameworks define the data standards-based interactions involved in the processes and required to integrate the information flow between the information systems to accomplish a particular task. The Technical Frameworks refer to these standards-based interactions as Transactions.
28 Transactions In other words, Transactions are interactions or exchanges of information between actors. For each transaction, specific standards are used to transfer the required information through a message. Because IHE specifies in detail the terms of the transactions, nothing is left for further interpretation!
29 Transactions For example, the IHE Radiology Technical Framework has identified almost fifty Transactions: Patient Registration Procedure Scheduled Storage Commitment Retrieve Images.
30 Technical Frameworks Other Benefits help HCOs to determine the need to upgrade existing products to implement the required standards-based transactions help to specify the transactions when HCOs consider healthcare information systems and products for purchase, such as in Requests for Proposals (RFPs)
31 Technical Frameworks For example: The product shall meet the requirements of the IHE Technical Framework. The product shall implement the following IHE actors. The required actors shall support the following IHE Integration Profiles. Which IHE Integration Profiles does your product support on which systems? The Radiology Information System shall meet the following requirements: Integration Profile: Scheduled Workflow Actors: Order Filler and Performed Procedure Step Manager Required Transactions: 1, 2, 3, 4, 5, 6, 7, 11, 12, 20, and 21
32 Other IHE Deliverables publishes Product Evaluation Worksheets that provide convenient tools for evaluating the IHE capabilities of the domain-based products issues Integration Statements to vendors IHE does not certify products.
33 Other IHE Deliverables supports public demonstrations (e.g., at HIMSS) and related educational activities to promote the deployment and maintain the Technical Frameworks by HCOs and healthcare IT vendors supports rigorous cross-vendor testing to ensure a high degree of conformity with the Technical Frameworks
34 Connect-a-thon Cross-vendor testing an annual, weeklong, interoperabilitytesting event featured in North America, Europe, and Asia offers vendors the unique opportunity to remove barriers to integration that otherwise would have to be determined at the customer s site and expense
35 IHE and EHR Systems After over a decade of talk, in the last year there has been a great deal of movement within both the public and private sectors in encouraging all healthcare providers to migrate from paper- and film-based health records to systems that electronically generate, store, and manage health information.
36 IHE and EHR Systems For example, for the next two years, the United States will be moving forward with the Draft Standard for Trial Use on the Electronic Health Record System (EHR-S) Functional Model and Standard. Currently, this Draft Standard for Trial Use provides a national reference model that outlines the following EHR-S functions: Direct care Supportive care Infrastructure
37 Interoperable EHR Systems Because of IHE, today, available electronic information systems that communicate freely across different vendor platforms include: patient registration / admission / discharge / transfer systems diagnostic imaging systems (PACS) order communication systems radiology and laboratory information systems reporting systems patient scheduling systems. Each system contributes pieces of patient information that, when integrated, make up the complete EHR-S.
38 IHE and EHR Systems Other initiatives are in process to create a nationally accepted, common data set of patient information that can be electronically passed from one clinician to the next when a patient transfers to a different caregiver or is referred to a new healthcare setting.
39 Portable EHR Systems Agreeing to and identifying the common data set as well as the method of transmission are key considerations for another standards dilemma known as portability. Portability supports the realization of patients longitudinal health records (i.e., pre-natal to post-mortem), in a lifetime consisting of dozens of patient encounters with dozens of diverse providers and provider organizations.
40 Portable EHR Systems IHE has proposed that its IT Infrastructure Technical Framework separate the EHR into two, distinct concepts: an EHR-LR (Longitudinal Record) for communicating health information across care episodes and among providers the evolving EHR-CR (Care Record) for specific clinical care information within provider organizations
41 Portable EHR Systems IHE IT Infrastructure Technical Framework would leverage existing healthcare IT data standards, such as HL7 s Clinical Document Architecture (CDA) ASTM s CCR
42 IHE and EHR Systems With IHE continuing to collaborate with well-established standards bodies and other EHR-related initiatives worldwide HCOs can be sure that their needs for EHR-S interoperability and portability will be met more cost-effectively and rapidly Vendors can focus on executing solutions to achieve them
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