Electronic Health Records and XDS the IHE approach

Transcription

1 Electronic Health Records and XDS the IHE approach Bill Majurski National Institute of Standards and Technology (NIST) Berthold B. Wein IHE-D User Co-Chair, Aachen, Germany

2 Overview Expectations as user XDS family IHE approach Conclusion

3 Expectations EHR Relevant and reliable information On time Where ever Readable and understandable Extendable Secure Safe

4 Definition of EHR An Electronic Health Record (EHR) can be described as a repository of information regarding the health of a subject of care in computer processable form, stored and transmitted securely, and accessible by multiple authorised users. It has a commonly agreed logical information model which is independent of EHR systems. Its primary purpose is the support of continuing, efficient and quality integrated health care and it contains information which is retrospective, concurrent and prospective. [ISO/TR 20514:2005]

5 Key Properties of EHR Patient centered: The EHR stores information about the health status of individually identified patients (citizens, customers), i.e. not anonymous or summarised data for public health / epidemiology research. Health related: The EHR stores health related information, i.e. not administrative, financial etc. This includes data from health care, but may also include other health related information provided by the patient himself (off-the-shelf medicine, sports activities etc.) Longitudinal: The EHR contains information from cradle to grave, i.e. is not restricted to a particular episode of care. Cross enterprise: The EHR contains information created from different health providers (i.e., more than a typical HIS system in a hospital)

6 The Value of an EHR eprescribing: Extract information about the patient s current medication, allergies and diagnoses, check risk of adverse drug interactions Laboratory: Combine new lab results and historical results from the EHR to show long-term trends Telemedicine: Use EHR as a vehicle to offer high-quality diagnostic services to under-served (e.g. rural) areas Research and public health: Extract anonymous data from the EHR for research and political guidance purposes Home care: Integrate care provided at the patient s home with the EHR many more...

7 EHR and the e-health IT Infrastructure Hospital Radiology (Modality, PACS, RIS, Reporting WS,...) Laboratory (Analyser, Reporting Console, LIS,...) Cardiology (Modality, Device Control, CIS,...) Pathology (Reports, [P-]PACS, PIS,...) Administration (Billing System, Staff organisation, HIS,...)... Practice WHERE IS EHR? General or Specialist Practice Information System

8 IHE approach Bottom up Repository of information regarding the health of a subject of care in computer processable form, stored and transmitted securely, and accessible by multiple authorised users Facilitating secure information exchange

9 IHE and the EHR IHE s answer to the issues of EHR implementation is a collection of Integration Profiles for Cross-enterprise Document Sharing There are multiple Integration Profiles because different projects have different needs some countries have national Patient IDs, others do not data protection laws different per country different kinds of medical data: reports, images, signals... Multiple Integration Profiles can be combined to address the needs of one EHR project Think of a LEGO bricks approach

10 IHE-XDS family XDS XDR XDM XCA XUA ATNA PIX PDQ CT (Cross-enterprise Document Sharing) (XDS Reliable Interchange) (XDS Media Interchange) (Cross-community Access) (Cross-enterprise User Authentication) (Audit Trail and Node Authentication) (Patient Identifier Cross-Referencing) (Patient Demographic Query) (Consistent Time) Support Profiles

11 XDS Family of Integration Profiles XDS: Cross-enterprise Document Sharing Store, register, find and access medical documents of any type The basic foundation for the XDS Family of IPs ATNA: Audit Trail and Node Authentication Basic security functions: centralized audit trail, authentication of systems (not users), optional encryption for transport connections Required by IHE for all XDS implementations

12 XDS Support Profiles PIX: Patient Identifier Cross-referencing managing multiple local Patient IDs per patient look-up service for cross references support for Master Patient Index (MPI) PDQ: Patient Demographics Query find Patient ID based on name, birthdate, sex etc. CT: Consistent Time synchronize all systems to common time needed for audit trail, access rights etc.

13 XDR: XDS Reliable Interchange XDS Support Profiles point-to-point exchange of clinical documents, e. g. through XDM: XDS Media Interchange exchange of clinical documents on storage media (CD-R, DVD-R etc.) XCA: Cross-Community Access federation of multiple XDS installations XUA: Cross-enterprise User Authentication user authentication in a distributed system

14 XDS Content Profiles Content Profiles define document formats and XDS extensions for specific applications: XDS-MS: Medical Summaries BPPC: Basic Patient Privacy Consents (under develop) XPHR: Exchange of Personal Health Record Content PPHP: Pre-procedure History and Physical EDR: Emergency Department Referral XDS-SD: Scanned Documents (open for discussion) XDS-Lab: Lab Reports XDS-I: DICOM Images

15 XDS: Big Picture Distributed: Each Care delivery organization publishes clinical information for others. Actual documents may remain in the source system. Cross-Enterprise: A Registry provides an index for published documents that can be queried! Document Centric: Published clinical data is organized into clinical documents. using agreed standard document types (HL7-CDA/CCD, PDF, DICOM, etc.)

16 XDS: Big Picture Document Content Neutral: Document content is processed only by source and consumer systems. Infrastructure is generic. Standardized Registry Attributes: Documents are described by standardized set of attributes. Standardized queries supported by all vendors.

17 XDS Transaction Diagram Patient Identity Feed Patient Identity Source Document Registry Query Documents Document Consumer Document Source Provide and Register Document Set Document Repository Register Document Set Retrieve Document

18 Support Profiles Patient Identifier Cross-referencing (PIX)

19 Patient Identifier Cross-referencing (PIX) Allow all enterprise participants to register the identifiers they use for patients in their domain Participants retain control over their own domain s patient index(es) Support domain systems queries for other systems identifiers for their patients Optionally, notify domain systems when other systems update identifiers for their patients

20 Patient Identifier Cross-referencing (PIX) Maintain all systems identifiers for a patient in a single location Use any algorithms (encapsulated) to find matching patients across disparate identifier domains Lower cost for synchronizing data across systems No need to force identifier and format changes onto existing systems

21 PIX Transaction Diagram Patient Identity Source Patient Identity Consumer Patient Identity Feed [ITI-8] - PIX Query [ITI-9] - PIX Update Notification [ITI-10] Patient Identity Cross reference Manager

22 Showing ID PIX: Process Flow ID Domains & Transactions Patient Identification Domain A Patient Identity Feed & Patient Identity References Patient Identity Cross-reference Manager Patient Identification Cross-references Domain Patient Identity Feed Patient Identity Source Patient Identity Cross References Patient Identity Feed Patient Identity Source Patient Identity Cross References Internal Domain transactions Other IHE Actor Patient Identity Consumer Patient Identification Domain B Internal Domain transactions Other IHE Actor Patient Identity Consumer Patient Identification Domain C

23 Patient Identifier Cross-referencing (PIX) Id=123 Id=235 Patient Identification Domain A Patient Identity Cross-reference Manager A: 123 A: 235 A:678 = = B: X456 B: Y921 B: D456 B: DF45 = = C: 2RT C: 3TY Patient Identification Cross-references Domain Id=X456 Id=Y921 Id=D456 Id=DF45 Patient Identification Domain B Id=3TY Id=2RT Patient Identification Domain C B:? C:2RT Patient ID Cross-Refs Patient Identity Consumer B:X456 C:2RT

24 Support Profiles Patient Demographic Query (PDQ)

25 Patient Demographics Query (PDQ) Allow quick retrieval of a patient list including common patient names, identifiers, contacts, and visit information Enable selection of correct patient when full identification data may not be available Limits access to only a subset of demographic and visit information

26 Patient Demographics Query (PDQ) Enables access on demand to diverse systems and devices Participants that do not need continual synchronization of patient registration information Devices that cannot participate in monitoring of ADT feeds, e.g.: Small-footprint devices Low-memory devices

27 Patient Demographics Query (PDQ) Allow search on full or partial data Retrieve information from any domain to which the client has query access Allows use of matching algorithm (e.g., soundex) to find near matches

28 PDQ Transaction Diagram Patient Demographics Supplier A departmental system that is connected on demand to the registration system. Patient Demographics Query Patient Demographics and Visit Query Patient Demographics Consumer Diverse systems including bedside monitors, physician office systems, lab applications, mobile blood bank registries; might be any system at the point of contact.

29 XDS Configurations Understanding how the actors work together

30 XDS: PIX/PDQ integration Patient Demographics Query Patient Demographics Supplier Document Source Patient Demographics Query Provide and Register Document Set Patient Identity Feed Patient Identity Source Document Registry Document Repository Register Document Set Query Documents Retrieve Document Document Consumer PIX Query PIX XREF Manager PIX Query

31 XCA: Cross Community Access Community Network B Which community holds records for a patient? National Network A Document Registry Practice Practice Practice Hospitals Practice Hospitals Practice Hospitals Hospital Hospital Hospital Diag Test Clinic Clinic Clinic Clinic Other Cross Community Gateway IHE transactions Cross Community Gateway Non-IHE National EHR Community Network C Practice Practice Clinic Document Registry Hospitals Hospitals Cross Community Gateway Cross-Community Gateways query and retrieve records (2007 & future) National or Regional Networks not required to be IHE-based Mapping to & from IHE Transactions performed by X-Community Gateways

32 IHE in Regional Projects Worldwide UK CfH (Radiology WF) France DMP Denmark (Funen) Italy (Veneto) Spain (Aragon) Austria ELGA Italy (Conto Corrente Salute) Quebec, Toronto, Alberta, British Columbia Canada Infoway MA-Share MA JAPAN-Kobe Summary Sharing State Project NY JAPAN-Nogaya Imaging Info Sharing Philadelphia HIE CHINA-Shanghai Imaging Info Sharing CHINA-MoH Lab results sharing Australian Connectathon JULY 2008 THINC- New York NCHICA N. Carolina

33 Conclusion IHE does not solve at present the complete EHR - capabilities IHE is a start for growing together by using standard information exchange modules in a secure way Definition and practice of country specific necessities will take a good part of the projects to gain working policies and structures in future

34 Still Questions? Thank you for your attention!