IHE, Interoperability for Regional Health Information Organizations

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IHE, Interoperability for Regional Health
Information Organizations

• Charles Parisot, GE Healthcare
• Mike Henderson, Eastern Informatics
• IHE IT Technical Committee Co-Chairs

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• Providers and Vendors
• Working Together to Deliver
• Interoperable Health Information Systems
• In the Enterprise
• and Across Care Settings

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State of the Union Addresses

• By computerizing health records, we can avoid
  dangerous medical mistakes, reduce costs and
  improve care.
• President George W. Bush
• January 20, 2004

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And the beat goes on..

• . most Americans will have electronic health
  records within the next 10 years

President George W. Bush April 26, 2004 In a
public address to the American Association of
Community Colleges, the President outlined a plan
whose goal is to assure better delivery of
healthcare in the United States.
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Framework for Strategic Action

• President Bushs April 27th executive order
  called for the creation of the Office of the
  National Coordinator of Health Information
  Technology (ONCHIT). A report was required
  within 90 days of office creation.
• The Framework for Strategic Action was released
  by Department of Health and Human Services
  Secretary Tommy Thompson and newly appointed
  National Coordinator of Health Information
  Technology, David Brailer, MD, at the NHII Summit
  in July, 2004.

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Four Major Goals

• Inform Clinical Practice
• Incentivize EHR adoption
• Reduce risk of EHR investment
• Promote EHR diffusion in rural underserved
• Interconnect Clinicians
• Foster regional collaborations
• Develop a national health information network
• Coordinate federal health information systems

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Four Major Goals
Thousands of EHRs to interconnect, Through a
thin National Health Information Network. Make
connectivity open, consistent, step-wise and
evolutionary ! IHE can accelerate and simplify
the process. See 13 Organization Collaborative
NHIN RFI Response Plus IHE Response to the NHIN
RFI. www.himss.org/content/files/IHERFIResponseand
CoverLetter1.pdf

• Personalize Care
• Encourage use of PHRs
• Enhance informed consumer choice
• Promote use of telehealth systems
• Improve Population Health
• Unify public health surveillance architectures
• Streamline quality and health status monitoring
• Accelerate discovery and dissemination

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Standards Alone Are Not Enough

• Managing the domain boundaries with mapping of
  information flow across boundaries
• Standards offer generality, ambiguity and
  alternatives.
• Vendor proprietary interests
• Complexity!!

We need standards for how to implement standards!
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Connecting Standards to Care

• Care providers must work with vendors to
  coordinate the implementation of standards to
  meet their needs
• Care providers need to identify the key
  interoperability problems they face
• Drive industry to develop and make available
  standards-based solutions
• Implementers need to follow common guidelines in
  purchasing and integrating systems that deliver
  these solutions

What is the effective way to establish those
standards for how to implement standards ?
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Need for a Standards Implementation Process
Standards
Standards
Standards
UserProjects
Offer
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What is Integrating the
Healthcare Enterprise ?

• IHE provides a common framework for passing
  health information seamlessly
• within the healthcare enterprise
• across multiple healthcare enterprises
• for local, regional national health information
  networks.
• IHE is sponsored by healthcare professional
  associations (ACC, HIMSS, RSNA, etc.).
• IHE drives standards adoption to address specific
  clinical needs.

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IHE Maturity and Acceptance

• More than 100 healthcare vendors worldwide have
  contributed to IHE and the delivery of
  ready-to-integrate products to benefit healthcare
  enterprises of all sizes.
• IT professionals clinicians appreciate IHEs
  positive impact now expanded to address
• radiology, cardiology, laboratory
• enterprise healthcare IT infrastructures
• cross-enterprise healthcare IT infrastructures

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Understanding the IHE Initiative

• IHE has a clear focus
• IHE is a healthcare domain-based initiative
• IHE creates synergies for interoperability
  testing across domains
• IHE addresses the standards adoption process
• IHE is both regional and multi-national
• IHE is both user-led and vendor-driven

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A Proven Standards Adoption Process
IHETechnicalFramework
User Site

• IHE Integration Profiles at the heart of IHE
• Detailed selection of standards and options each
  solving a specific integration problem
• A growing set of effective provider/vendor agreed
  solutions
• Vendors can implement with ROI
• Providers can deploy with stability

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Achievements and expanding scope
Over 100 vendors involved world-wide, 4 Technical
Frameworks 27 Integration Profiles, Testing at
yearly Connectathons, Demonstrations at major
exhibitions world-wide
To claim compliance to IHE Integration Profiles
vendors shall publish for each product an IHE
Integration Statement.
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IHE Survey Results

• 92 of respondents were aware of IHE
• Potential benefits of IHE ?
• Improved clinical workflow access of data
  63
• Benefits of IHE products ?
• Reduce deployment costs
• 56

HIMSS web-based survey in
November 2004 163 participants
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Experience your HIMSS-WideElectronic Health
Record
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Sharing records that have been published
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Standards selection for IHE XDS No single
standard can addressCross-enterprise Document
Sharing
Internet Standards HTML, HTTP,ISO, PDF, JPEG,
etc.
Electronic BusinessStandards ebXML Registry,
SOAP, etc.
HealthcareContent Standards HL7 CDA, CEN
EHRcomHL7, ASTM CCRDICOM, etc.
Marriage of healthcare standards facilitates
implementation and leverages complementary
technologies (e.g. security privacy).
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Registering and accessing Documents
Document Registry
EHR-LRLongitudinal Recordas usedacross
encounters
Long Term Care
Acute Care (Inpatient)
Other Specialized Careor Diagnostics Services
EHR-CR Care Record systemssupporting care
delivery
PCPs and Clinics (Ambulatory)
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XDS Actors and Transactions
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IHE Profiles for a RHIOIntegration Profiles
completed by HIMSS 2005
New
2004
New
New
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Patient Identification ManagementEnterprises
using PIX Cross Referencing with XDS
Patient Identity Source
Patient Identification Domain C
Patient Identification Domain D2
Patient Identification Domain XAD
XDS Document Registry
DmD2 PidPd
DmC PidPc
XDS Document Repository
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IHE Profiles for RHIOs What is
available and what will be added in 2005
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Local Regional RHIOs Infrastructure and
Interoperability

• Cross-Enterprise Document Sharing (XDS) minimizes
  clinical data management by the infrastructure.
  Transparency Ease of Evolution
• XDS works with other IHE Integration Profiles
• Audit Trail and Node Authentication (ATNA) and
  Consistent Time (CT)
• Patient Id Cross-referencing (PIX)
• Patient Demographics Query (PDQ)
• In 2005, IHE plans to finish base set of
  integration profiles to build regional health
  networks and interoperable EHRs
• Security Identity Management Accountability
• Content Profiles DICOM, HL7-CDA/CCR, HL7-Lab,
  PDF.
• Notification of Document Availability (with XDS
  document reference)

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IHE RHIOs Interoperability Partner

• IHE offers a solid technical foundation to
  establish interoperability for RHIOs.
• Standards-based, open, multi-vendor,
  provider-led.
• Yearly progress, validation testing built in,
  backed by a proven process. Implementation by
  many vendors.
• RHIOs technical architects needs direct IHE
  involvement. Policies easier to establish when
  based on solid IHE Technical Framework, but are
  beyond IHEs scope. They remains RHIOs
  responsibility.
• ? IHE IT Infrastructure Committee
• Tuesday 15th 100-300 pm HIMSS Room A134

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• Thank YouQuestions ?