INTEGRATING THE HEALTHCARE ENTERPISE Interoperability and IHE : solutions for user problems IHE-Europe Europe Connectathon Workshop Charles Parisot,, GE Healthcare, IT Infrastructure co-chair chair 1
Or,. Realizing the promise of standardized information exchange in health 2
Connecting standards to reality and care delivery Care providers, authorities and IT professionals work with solutions developers to coordinate the implementation of standards to meet their needs Care providers identify the key interoperability problems they face Drive industry to develop and make available standardsbased solutions Implementers follow common guidelines in purchasing and integrating systems that deliver these solutions More than 300 IHE members/stakeholders work together in an open and transparent way to advance practical interoperability
Standards Adoption Process Develop technical specifications Identify available standards ( standards (e.g. HL7, DICOM, IETF, OASIS) Testing at Connectathons IHE Demonstrations Products with IHE Document Use Case Requirements Timely access to information Easy to integrate products 4
The IHE Development Domains Pharmacy NEW 2009 11 Years of Steady Evolution 1998 2009 Pathology since 2006 Radiology since 1998 Cardiology since 2004 Eye Care since 2006 Laboratory since 2004 Quality Research & Public Health since 2006 (Healthcare) IT Infrastructure since 2003 Radiation Oncology since 2004 Patient Care Devices since 2005 Patient Care Coordination since 2004 5
IHE Organizational Structure IHE International Board Regional Deployment Global Development IHE North America IHE Asia-Oceania Canada China Japan Radiology IT Infrastructure Laboratory USA Korea Taiwan Cardiology Patient Care Coordination Pathology IHE Europe Radiation Oncology Patient Care Devices Eye Care Austria Italy France Norway Germany Netherlands Spain Sweden UK Public Health, Quality and Research Pharmacy Professional Societies / Sponsors ACC ACCE ACEP ACP GMSI HIMSS RSNA SFR SFIL COCIR EAR-ECR DRG SIRM BIR EuroRec ESC JAHIS JIRA JRS METI-MLHW MEDIS-DC JAMI Contributing & Participating Vendors 6 6
International Growth of IHE Local Deployment, National Extensions Promotional & Live Demonstration Events Over 300 Organizational Members (all stakeholders) Japan Spain Netherlands Taiwan Canada UK China Australia Austria Switzerland Malaysia Turkey USA France Italy Germany 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Pragmatic global standards harmonization + best practices sharing 7
An Alternative? Have each project selects s independently their standards: The same requirement addressed with a different mix of standards in different projects Large effort and time needed for detailed interoperability specifications (12 to 24 months, several man years) Even larger effort to develop custom conformance test tools, and organize own testing efforts (many man years). Initial implementation cost are very high, and on-going costs only increase. No reuse benefit from other ehealth projects. Projects shall drive their own requirements but address them by reusing as much as possible robust standards- based profiles specifications 8
Professional societies: IHE Sponsors Healthcare Information Management Systems Society (HIMSS) British Institute of Radiology (BIR), British Computer Society (BCS( German Radiology Society (DRG) GMSIH (IT France), SFIL (laboratory), French National Project (DMP) European Society of Cardiology Many other European Societies Radiological Society of North America (RSNA) American College of Physicians (ACP), American College of Emergency Physicians (ACEP) Many other American healthcare societies (ACCE), (AAO), (ASTRO), etc. JAHIS (IT Japan), JIRA, JRS.Many other Japanese Societies And many more. Governmental Agencies: French National Project (ASIP) Dutch National Project (NICTIZ) Austrian National Project (ELGA) Canada Health Infoway (CHI) Regional projects (Italy, USA, Japan) and many more.. 9
Standards Adoption Process Develop technical specifications Identify available standards ( standards (e.g. HL7, DICOM, IETF, OASIS) Testing at Connectathons IHE Demonstrations Products with IHE Document Use Case Requirements Timely access to information Easy to integrate products 10
IHE Solutions within the Enterprise Enterprise IT Infrastructure empi EMR - HIS User Auth RIS CIS LIS Eye Care Img Acq Radiology PACS Cath Cardiology ECG Auto Mgr Analyzer Laboratory Pathology Therapy Plan Treatment Img Acq Radiation Therapy Established Feb 2009 Pharmacy Nursing Station Devices Devices Intensive Care Unit Home Hub Devices 11
IHE Solutions within the Enterprise 3 Examples Enterprise IT Infrastructure empi EMR - HIS Cardiology Integration Profiles Cardiac Catheterization Lab Workflow Echocardiography Lab Workflow Retrieve ECG for Display Displayable Reports Cath and Echo Evidence Documents User Auth Img Acq RIS Radiology PACS Personnel White Pages Radiation Shared Value Sets Therapy Cath IT Infrastructure Integration Profiles Patient Administration Management Therapy Plan Patient Demographics Query Patient Identifier Cross-referencing referencing Retrieve Information for Display Enterprise User Authentication Consistent Treatment Time Img Acq Patient Synchronized Applications Audit Trail and Node Authentication CIS Cardiology Established Feb 2009 Pharmacy ECG Auto Mgr LIS Analyzer Devices Devices Intensive Care Unit Eye Care Pathology Radiology Integration Profiles Radiology Scheduled Workflow Patient Information Reconciliation Access to Radiology Laboratory Information Portable Data for Imaging Consistent Presentation of Images Key Image Note Presentation of Grouped Procedures Evidence Documents Audit trail Nursing and Node Authentication Station (Rad option) Teaching Files and Clinical Trials Export Post-processing Workflow Reporting Workflow Charge Posting Simple Image and Numeric Reports Home Hub Devices 12
IHE Solutions Cross-Enterprises Leverage established standards to allow rapid deployment and plan for future Pragmatic, Ease of Evolution Enable architectural freedom (patient vs. provider centric, centralized vs. decentralized, scalable (from office to enterprise to IDN to Regional and National Networks) Configuration flexibility Support breakthrough use cases: variety of care settings, care coordination, public health, PHR, EHR Interoperability for broad constituencies IHE: Offers consistent, standards-based record sharing for EHRs and other information systems 13
Principles for a Regional/National ehealth Network 1. Set a standards based boundaries with stable/proven/unambiguous interoperability specifications (profiles of well accepted standards): Health Information Sharing Infrastructure 2. Keep things simple and robust within the standards-based boundary (365x24 availability, costs, new use cases, etc.). Create your own boundary or leverage IHE profiles? IHE Profiles come with testing tools, process, shared experience, open source, a broader community, multi-vendor and stability
IHE Based Health Info Exchange IHE supports these requirements: To meet the needs of the various stakeholders With a wide array of standards to reduce cost and accelerate deployment of HIEs With flexibility to accommodate a wide range of architectures and business models across the world No rip and replace of edge systems, different levels of interoperability Ensure reuse of implementations, sharing of experience Forward looking way to enable interconnection into a National Health Information Network Allowing increasingly sophisticated security and privacy protections
Registering Health Records:IHE-XDS Community Hospital Record Repository of Documents Clinic Record 1-Reference to records Specialist Record Repository of Documents Clinical IT System Index of patients records Health Info Exchange Clinical Encounter 16
Access to Shared Records : IHE-XDS Community Clinic Record Hospital Record Repository of Documents 3-Records 4-Patient data Returned presented to Physician Specialist Record Repository of Documents Clinical Encounter Clinical IT System Aggregate Patient Info HIE Index of patients records 2-Reference to Records for Inquiry 17
Health Information Exchanges Interoperability: Cross-enterprise Document Sharing Cross-Enterprise Document Sharing simplifies clinical data management by defining interoperable infrastructure. Transparency = Ease of Evolution Patients have guaranteed portability and providers may share information without concerns of aggregation errors. Digital Documents = Patients and providers empowerment Supports both centralized and decentralized repository architectures. Ease of federation nationally. Flexible privacy, Flexibility of configurations Addresses the need for a longitudinal healthcare data (health records). Complements to interactive workflow or dynamic access to data. 18
Implementing IHE today in Regional and National Health Networks: Most Popular Services Sharing of Patient Summaries (Incl Prescriptions) Sharing of Laboratory Results Sharing of Radiology Info Sharing of Cardiology Info Sharing of Scanned Docs Content Sharing of Documents Point-to to-point Push(XDR), Sharing(XDS), Federated(XCA), Media and e-mail(xdm) e Audit Trail and Secured Connection Digital Signature Privacy and Consent Patient Identification Mgt Provider Directory Services Termi- nology Middle- ware
NETHERLANDS Friesland Natn l Mamography Walles (Imaging-Tender) IHE, Global Standards-Based Profiles Adopted in National & Regional Projects France DMP Lower Austria Austria Suisse St Gallen Lausane Italy Conto Corrente Salute Venetto - Friuli Quebec, Toronto, Alberta, British Columbia Canada Infoway VITL-Vermont Boston Medical Center - MA see tinyurl.com/.com/wwxds Philadelphia HIE Belgium Flemish-Leuven KeyHIE Pennsylvania CareSpark TN & VA South Africa CHINA-Shanghai Imaging Info Sharing CHINA-MoH Lab results sharing JAPAN-Nagoya Imaging Info Sharing, Nationwide PDI guideline Providence Health System - OR THINC- New York NCHICA N. Carolina 2
Austria (Lower Austria and National) Lower Austria Lower Austria Region (around Vienna) Deployed in 2007 - Operational. 1.5 Million patients on-line. 11 hospitals connected. Use IHE profiles: XDS, PIX, XDS-SD, ATNA, XUA, BPPC. Austria National project launched in 2007 (ELGA). Given the success to deploy the first region is about one year. Roll-out includes: Ministry backing of IHE conformance (IHE-Eu Connectathon) Extending to Ambulatory Physicians in 2010 Step-wise introduction of structured and coded content with HL7 CDA based IHE Content Profiles.
Italy (Genoa Region) In service since January 2006. 4 Hospitals and 500 physician offices. EMRs import and export documents from their local records. All vendor products required to pass IHE-Europe connectathon in April 2005. Patients chose to join through one of their care provider Infrastructure includes: XDS Registry XDS Repository shared at the regional level PIX for patient Id linking 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.
Italy (Veneto and Friuli Regions) Veneto (Venice), 40 hospitals connected with XDS: Sharing lab reports, prescriptions, images, simple summaries. Used initially for telemedicine, now extended to regional health records All vendor products required to pass IHE-Europe Connectathon Friuli (Trieste): Tender issued in September 2009 Interconnection of hospitals for imaging sharing: Radiology Cardiology Nuclear Medicine Use XDS, XDS-I
Rapid Growth of IHE/HITSP projects in the US In operational use: Boston Medical Center (MA) CareSpark (TN) Fox Chase Health Information Exchange (Philadelphia PA) Keystone Health Information Exchange (KeyHIE) PA NHIN: Kaiser Permanente/Veterans Administration Penn Passport (University of Pennsylvania) Providence Health System & Services (OR) South Shore (MA) VITL (HIE for State of Vermont) Please let us know if Implementation in-progress your project is Central Florida RHIO missing (see California prison health System Decatur Hospital and Practices tinyurl.com/.com/wwxds) Harrison Medical Center North Carolina Health Info. and Comm. Alliance Wake Forest Medical Center NHIN: MedVirginia/SSA (NHIN 2.0 spec) Planned: Exeter Health information Exchange (Exeter, NH) Chesapeake Regional Info. System (CRISP) SHARP Communities (CA)
USA (Other) HITSP accepted 25 IHE Integration profiles for: Lab results distribution and sharing, Registration and Medication History for Consumers, Biosurveillance. NHIN Specifications (published Jan 2010) leverage IHE Profiles: XDS, XDR, XCA, XCPD, etc.). NHIN Connect (open source) includes support for above IHE profiles (XDR planned for next release). Several Open Source implementation available for XDS, XDR, XCA, ATNA: IHEOS (NIST Source Forge) Open Health Tools (OHT-IBM) Microsoft Codeplex MOSS (Misys Open Source-OHT) t Explorer Browser.lnk
Canada Canada Health Infoway: national Commitment to XDS/XDS- I for imaging sharing 4 infrastructure tenders awarded in 2007/8 targeting over 1/3 of Canadian patients covered: Toronto East Network - Ontario Montreal McGill - Quebec Alberta British Columbia Includes XDS, ATNA, PIX and XDS-I. XDS deployment planned for 2010 in Ontario and 2011 in Quebec, Alberta, British Columbia.
France (National DMP) National Interoperability Specifications have confirmed endorsement of IHE profiles: XDS, ATNA, XUA, PIX/PDQ, XDS-I, etc. 3 Regional pilots in clinical use. National XDS Infrastructure Tender issued in Fall 2009. Awarded in Feb 2010. First availability early 2011. Target 2 Million patients after one year, and 13 millions by fifth year.
Example of other projects China MoH selected XDS and XD*-Lab (CDA) for lab info sharing. XDS-I in Shanghai. Israel, Jordan, Palestinian Authority Middle east Consortium for infectious Disease Surveillance(XDS, ATNA, XD*Lab) Belgium Leuven Region Netherlands Friesland, 5 hospitals sharing cardiac patient information (XDS) Amsterdam region network contract awarded late 2009. XDS-I. Japan Nagoya region network project operational late 2008. XDS, XDS-I Kobe with imaging info sharing South Africa Operational since 2008. Decision to expand to entire country. National project launched in 2007.
NETHERLANDS Friesland Natn l Mamography Walles (Imaging-Tender) IHE, Global Standards-Based Profiles Adopted in National & Regional Projects France DMP Lower Austria Austria Suisse St Gallen Lausane Italy Conto Corrente Salute Venetto - Friuli Quebec, Toronto, Alberta, British Columbia Canada Infoway VITL-Vermont Boston Medical Center - MA see tinyurl.com/.com/wwxds Philadelphia HIE Belgium Flemish-Leuven KeyHIE Pennsylvania CareSpark TN & VA South Africa CHINA-Shanghai Imaging Info Sharing CHINA-MoH Lab results sharing JAPAN-Nagoya Imaging Info Sharing, Nationwide PDI guideline Providence Health System - OR THINC- New York NCHICA N. Carolina 2
What can you do? Learn about IHE, www.ihe ihe.net Insist on relevant IHE profiles compliance in your RFPs and contract documents: Select Integration and Content Profiles, and Appropriate Actor(s) Ask vendors for their products IHE Integration Statements. Need more interoperability? Contribute to IHE Committees Support or create your national IHE 30
IHE Web site: www.ihe.net Frequently Asked Questions Integration Profiles in Technical Frameworks: See Volume 1 of each TF for Use cases Cardiology Eye Care IT Infrastructure Laboratory Patient Care Coordination Patient Care Devices Pathology Quality Radiation Oncology Radiology Pharmacy Connectathon Result: www. www.ihe.net/.net/connectathon/results Vendor Products Integration Statements 31
Providers and Vendors Working Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings http://www.ihe ihe.net www.ihe ihe-europe.net 32