최신 IHE 동향 INFINITT Healthcare 조상욱

Transcription

1 최신 IHE 동향 INFINITT Healthcare 조상욱

2 NHIN

3 United States Nationwide Health Information Interoperability The American Health Information Community (AHIC), a 2005 federally-chartered commission made up of leaders from public and private health sectors, was formed to provide recommendations on how to make health records digital and interoperable, and assure that the privacy and security of those records are protected, in a smooth, market-led way. At the same time, the Department of Health and Human Services, through the Office of the National Coordinator for Health IT (ONC) awarded contracts to 1) identify interoperability standards to facilitate the exchange of patient data (HITSP), 2) define a process for certifying that health IT products comply with appropriate standards (CCHIT), and 3) develop a series of prototypes to establish the requirements of a nationwide health information network (NHIN). These activities share the goal of widespread adoption of interoperable electronic health records within 10 years through public-private collaboration. ANSI in cooperation with strategic partners HIMSS, Booz Allen Hamilton, and Advanced Technology Institute was awarded this contract to advance this goal. This standards harmonization collaborative established the Healthcare Information Technology Standards Panel (HITSP).

4 ONC (The Office of the National Coordinator for Health Information Technology) The Office of the National Coordinator for Health Information Technology (ONC) is at the forefront of the administration s health IT efforts and is a resource to the entire health system to support the adoption of health information technology and the promotion of nationwide health information exchange to improve health care. ONC is organizationally located within the Office of the Secretary for the U.S. Department of Health and Human Services (HHS). ONC is the principal Federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information. The position of National Coordinator was created in 2004, through an Executive Order, and legislatively mandated in the Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009.

5 NHIN

6 NHIN

7 HITSP Harmonizing standards to support the Nationwide Health Information Network The Healthcare Information Technology Standards Panel (HITSP) is a multi-stakeholder coordinating body designed to provide the process within which affected parties can identify, select, and harmonize standards for communicating healthcare information throughout the healthcare spectrum. HITSP functions as a partnership of the public and private sectors and operates with a neutral and inclusive governance model administered by the American National Standards Institute. The American Health Information Community (AHIC), as the representative of public and private health sector stakeholders, identified the Use Cases (available at hitsp.org) that drove the initial efforts of the HITSP. Nationwide public and private health sector priorities continue to focus the efforts of the HITSP. The use case driven HITSP harmonization process is implemented by formally chartered Technical Committees. The volunteers that comprise a Technical Committee follow an 8 step process, depicted below. < HITSP Document >

8 Example Interoperability Specification Standards HITSP Named Standards Accredited Standards Committee (ASC) X12 Insurance Subcommittee (X12N) Implementation Guides Version plus Addenda A1 Accredited Standards Committee (ASC) X12 Standards Release American Society for Testing and Materials (ASTM) Standard Specification for Continuity of Care Record (CCR): # E Council for Affordable Quality Health Care (CAQH) Committee on Operating Rules for Information Exchange (CORE) Phase I Operating Rules Federal Medication Terminologies Health Level Seven (HL7) Version 3.0 Continuity of Care Document (CCD) Health Level Seven (HL7) Version 3.0 Clinical Document Architecture (CDA/CDA R2) Health Level Seven (HL7) Version 2.5 Health Level Seven (HL7) EHR System Functional Model Draft Standard for Trial Use (DSTU) * Integrating the Healthcare Enterprise (IHE) Laboratory Technical Framework Supplement Revision 1.0 Integrating the Healthcare Enterprise (IHE) Patient Care Coordination (PCC) Technical Framework Revision 1.0 Logical Observation Identifiers Names and Codes (LOINC ) National Council for Prescription Drug Programs (NCPDP) SCRIPT Standard Version 8.1

9 from Article.. 1. IHE Profile로보는변화 2. 신규 Profile Review 3. 인기 Profile Review 4. IHE의 미래

10 What Is IHE??? Integrating the Healthcare Enterprise

11 Domain Anatomic Pathology Cardiology Eye Care IT Infrastructure Laboratory Patient Care Coordination Patient Care Devices Radiation Oncology Radiology (The First Domain)

12 Radiology Profiles Patient Info. Reconciliation Scheduled Workflow NM Image Presentation of Grouped Procedures Mammo Image Reporting Workflow Image Fusion Evidence Document Import Reconciliation Workflow Consistent Presentation of Images Post- Processing Workflow Charge Posting Key Image Notes Teaching Files & Clinical Export Simple Image & Num Reports Cross-Enterprise Document Sharing for Imaging Portable Data for Imaging Access to Radiology Information Audit Trail & Node Authentication Radiology Option

13 Radiology Profiles Radiology SWF Scheduled Workflow PIR Patient Information Reconciliation PWF Post-Processing Workflow RWF Reporting Workflow IRWF Import Reconciliation Workflow PDI Portable Data for Imaging NM Nuclear Medicine Image MAMMO Mammography Image ED Evidence Documents SINR Simple Image and Numeric Report KIN Key Image Note CPI Consistent Presentation of Images PGP Presentation of Grouped Procedures FUS Image Fusion XDS-I Cross-enterprise Document Sharing for Imaging TCE Teaching File and Clinical Trial Export ARI Access to Radiology Information ATNA Audit Trail and Node Authentication CHG Charge Posting

14 IT Infrastructure Profiles

15 IT Infrastructure Profiles IT Infrastructure CT ATNA RID EUA PIX PSA PDQ XDS PWP XDM XDR XDS-SD PIX/PDQ/v3 Consistent Time Audit Trail and Node Authentication Request Information for Display Enterprise User Authentication Patient Identifier Cross Referencing Patient Synchronized Aplication Patient Demographic Query Cross-Enterprise Document Sharing Personnel White Pages Cross-Enterprise Document Media Interchange Cross-Enterprise Document Reliable Interchange Cross-Enterprise Sharing of Scanned Documents Patient Identifier Cross-Reference and Patient Demographic Query for Hl7v3

16 Cardiology Profiles Cardiology Profile CATH ECHO ED STRESS DRPT ECG Cardiac Cath WOrkflow Echocardiography Workflow Evidence Documents Stress Testing Workflow Displayable Reports Retrieve ECG for Display

17 IHE Profile로 보는 변화

18 2004 CHG SWF PIR CPI ARI PWP KIN SEC 1 Domain 10 Profiles PGP SINR

19 Domains 100+ Profiles (incl. approximately 50 of trial profiles)

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22 IHE International

23 Trials Pharmacy Domain Anatomy Pathology Domain Cardiology DRPT (Trial) : Displayable Reports IT Infrastructure XDR (Trial) : Cross-Enterprise Document Reliable Interchange PIX/PDQ/v3 (Trial) : Patient Identifier RFD (Trial) : Retrieve From for Data capture Asynchronous Web Services Exchange (Trial) XCA (Trial) : Cross-Community Access XCPD (Trial) : Cross-Community Patient Discovery XDS Patient Identity Merge (Trial) DRR (Trial) : Document-based Referral Request DSG (Trial) : Document Digital Signature DSUB (Trial) : Document Metadata Subscription Multi-Patient Queries (Trial) NAV (Trial) : Notification of Document Availability Pediatric Demographics Option for PIX and PDQ (Trial) SVS (Trial) : Sharing Value Sets

24 Trials Laboratory ILW (Trial) : Inter-Laboratory Workflow Patient Care Coordination QED (Trial) : Query for Existing Data APR (Trial) : Antepartum Record Supplement CM (Trial) : Care Management Content Modules Supplement (Trial) EDES (Trial) : Emergency Department Encounter Summary ETC (Trial) : EMS Transfer of Care IC (Trial) : Immunization Content Supplement LDR (Trial) : Labor and Delivery Record Supplement PPOC (Trial) : Patient Plan of Care Supplement RCG (Trial) : Request for Clinical Guidance Patient Care Devices ACM (Trial) : Alarm Communication Management ICDO (Trial) : Implantable Device Cardiac Observation PIV (Trial) : Point-of-Care Infusion Verification SPD (Trial) : Subscribe to Patient Data PIB (Trial) : Patient Identity Binding

25 Trials Quality, Research and Public Health CRD (Trial) : Clinical Research Document DSC (Trial) : Drug Safety Content MCH (Trial) : Mother and Child Health RPE (Trial) : Retrieve Protocol for Execution Radiology FUS (Trial) : Image Fusion XDS-I.b (Trial) : Cross-Enterprise Document Sharing for Imaging BIR (Trial) : Basic Image Review Extensions to the PDI (Trial) MDI (Trial) : MR Diffusion Imaging PIC (Trial) : CT/MR Perfusion Imaging with Contrast MAWF (Trial) : Mammography Acquisition Workflow REM (Trial) : Radiation Exposure Monitoring NMI with Cardiac Option (Trial)

26 신규Profile Review

27 Anatomy Pathology APW (Anatomy Pathology Workflow) 2008년 11월 1.2로 개정되면서, 기존 Pathology 포함 임상병리에서 샘플 채취 후 조직검사 등에 대한 처리 SWF와 유사하나, Order Result Tracker라는 새로운 Actor가 존재 임상병리, 임상부검, 세포병리, 조직검사 등

28 Anatomy Pathology Anatomy Pathology Reporting to Public Health (ARPH) 질병관리센터(CDC)에 의해 제안된 프로파일 미국과 캐나다의 경우 이미 암정보를 위한 레지스트리 구성 당 프로파일은 IHE International 을 위함. 전송 프로토톨 HL7v2.x

29 Cardiology DRPT : Displayable Reports

30 Radiology Radiation Exposure Monitoring

31 Patient Care Coordination LDR : Labor and Delivery Record

32 Registry? Repository? Report?

33 XDS Profile Review

34 XDS XDS 관련 프로파일이 가장 눈에 띄게 늘어남. 직접적 관련 있는 프로파일 XDS.b XDS-I.b BPPC : Basic Patient Privacy Consents XCA : Cross Community Access XDM : Cross-Enterprise Document Media Interchange XDS-SD : XDS for Scanned Doc XDS-MS : XDS for Medical Summary XUA : Cross User Authentication PDQ : Patient Demographic Query PIX : Patient Identifier Cross Referencing XCPD : Cross-Community Patient Discovery XDR : Cross-Enterprise Document Reliable Interchange NAV : Notification of Document Availability SVS : Sharing Value Sets

35 XDS의 변천 PROBLEM!!!

36 XDS의 변천 SUMMARY!?

37 XDS의 변천 MEDIA?

38 XDS의 변천 IMAGE!!!

39 XDS의 변천 SECURITY

40 XDS의 변천 NOTIFY!

41 XDS의 변천 COMMUNITY

42 XCA

43 IHE의 미래

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45 NHIN

46 NHIN

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48 Continua

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54 Testing Profiles IHE PCD(Patient Care Devices)Domain DEC (Device Enterprise Communication) RTM (Rosetta Terminology Mapping) IHE ITI(ITInfrastructure)Domain CT (Consistent Time) PAM (Patient Administration Management) ITI TF-2x Appendix V: Web Services Device-to to-manager connectivity will be tested as Showcase Testing Event

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56 Thank you