IHE Changing the Way Healthcare Connects in COMMUNITIES

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IHE Changing the Way Healthcare Connects in
COMMUNITIES

• HIMSS Interoperability Showcase February 2007
• Keith Boone (GE), Vassil Peytchev (Epic), Larry
  McKnight (Siemens), George Cole (Allscripts)

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Requirements for an open RHIO/HIE(1)

• Bring trust and ease of use for healthcare
  professionals
• Care delivery organizations choose information to
  share
• Based on patient situation
• When they see fit (discharge, end of encounter,
  etc.)
• What information to share (pick relevant types of
  documents, and content elements).
• Care delivery organizations access patient
  information through
• their own EMR (if they have one), or
• through a shared portal otherwise.
• When accessing patient info
• Find quickly if relevant information is available
  or not (single query).
• May select among relevant documents, which ones
  to see (may be done in background)
• Among those of interest, chose to import in whole
  or part in its own EMR Chart (responsibility).

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Requirements for an open RHIO/HIE(2)

• Bring trust and privacy to patients
• Only authorized organizations and authenticated
  healthcare providers may transact in the HIE
• Each node or IT system interfaced is strongly
  authenticated
• Each user shall be authenticated on the edge
  system (where context is best known)
• All traffic trough the infrastructure is
  encrypted
• Shared Document Registry does not contain patient
  clinical data only generic information (minimum
  metadata repository reference)
• Patient consent needs multiple choices or levels
• Unless opt-in, no data about a specific patient
  may be shared
• Several data sharing policies offered to the
  patient consent
• Each shared document is assigned to specific
  policies (or not shared) at encounter time.
• Healthcare providers may only access documents
  compatible with their role.

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IHE - Connecting standards to care

• Care providers and IT professionals work with
  vendors 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
  standards-based solutions
• Implementers follow common guidelines in
  purchasing and integrating systems that deliver
  these solutions

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Categories of Healthcare Communication Services
HIEs and RHIOs
Hospitals
Patient and Provider ID Mgt
e.g. access to last 6 months historical labs and
encounter summaries
e.g. order a lab test, track status and receive
results
e.g. get a current list of allergies or med list
from a source
Security
Document Sharing
Dynamic Information Access
Workflow Management
Source persisted and attested health records
Specific info snapshot provided on demand
2 or more entities synchronize a task
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Introduced at HIMSS in 2005 IHE-XDS
Community or sub-network
Repository ofDocuments
Repository ofDocuments
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Introduced at HIMSS in 2005 IHE-XDS
Community or sub-network
Repository ofDocuments
Repository ofDocuments
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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.

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Cross-Enterprise Document Sharing (XDS)
Standards Used
HealthcareContent Standards HL7 CDA, CEN
EHRcomHL7, ASTM CCRDICOM
Internet Standards HTML, HTTP,ISO, PDF, JPEG
Electronic BusinessStandards ebXML Registry,
SOAP, Web Services

• Implemented world-wide by more than 50
  vendors/open source. Final text published
  December 2006.
• Adopted in several national regional projects
  (Italy, France, Canada, Austria, USA, Japan,
  Netherlands, Sweden, etc.)
• IHE XDS 42,300 Google references (Feb 07)

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Why is IHE-XDS a breakthrough ?

• It based on an International Standards ebXML
  registry OASIS and ISO standard, Web
  Service/Soap/XML.
• Sharing of digital documents as attested by the
  source, meets the most urgent needs. A proven
  healthcare community data-sharing paradigm
  (Message feeding a central web server hinders use
  of EHRs).
• Efficient to support all types of Health IT
  Systems (IDNs, Hospitals, Ambulatory, Pharmacy,
  Diagnostics Centers, etc.) and all types of
  information (summaries, meds, images, lab
  reports, ECGs, etc.), structured and
  unstructured.
• Meets both the needs of push communication by
  info sources and on-demand pull in a variety of
  centralized or distributed architectures.

Offer a consistent, standards-based and
functional record sharing for EHRs, PHRs other
IT Systems
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IHE-XDS Infrastructure Components

• Audit Record Repository (ATNA) Receive audit
  records from other actors and securely store for
  audit purposes. ATNA also authenticates
  peer-nodes and encrypt communications.
• Time Server (CT) Provides consistent definition
  of date/time enabling time synchronization across
  multiple systems. Enables events associated with
  patients to be sorted reliably in chronological
  order.
• Document Registry (XDS) Queryable index of
  metadata and references to all documents shared
  within a connected community (XDS Affinity
  Domain)
• Document Repository (XDS) Supports storage and
  retrieval of clinical information (as documents).
  May be centralized or distributed.
• Patient Identifier Cross Reference Manager (PIX)
  Reconciles information on patients from
  multiple domains to a single, cross referenced
  set of IDs for each given patient.
• Patient Demographics Supplier (PDQ) Returns
  demographic information and identifiers for
  patients based on specified demographic criteria.

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XDS Scenario use of ATNA CT
PMS
XDS Document Registry
Register Document
Query Document
Secured Messaging
Retrieve Document
Provide Register Docs
Maintain Time
Maintain Time
Record Audit Event
Maintain Time
Record Audit Event
Record Audit Event
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XDS Scenario use of PIX PDQ
PDQ Query to Acquire Affinity Domain Patient ID
Patient Identity Feed
Patient Identity XRef Mgr
Patient Identity Feed
Affinity Domain Patient Identity Source
Patient Identity Feed
Patient Identity Feed
PIX Query
Document Registry
PIX Query
Register (using Pt ID)
Query Document (using Pt Id)
Provide Register Docs
Retrieve Document
PACS
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IHE-XDS is part of a family of profiles

• Regional, national, local or disease centric
  networks need a consistent set of Integration
  Profiles
• Eight Integration Profiles completed and tested,
  plus ten ready to implement Standards-based
  interoperability building blocks for
• Rich Document Content for end-to-end application
  interoperability.
• Patient identification management
• Security and privacy
• Notification and data capture

IHE-XDS related IHE Integration profiles
provide a complete interoperability solution
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IHE Integration Profiles for Health Info Nets
What is available and is added in 2006-2007
Clinical and PHR Content
Emergency Referrals
PHR Extracts/Updates
Format of the Document Content and associated
coded vocabulary
ECG Report Document
Format of the Document Content and associated
coded vocabulary
Lab Results Document Content
Format of the Document Content and associated
coded vocabulary
Scanned Documents
Format of the Document Content and associated
coded vocabulary
Imaging Information
Format of the Document Content
Medical Summary (Meds, Allergies, Pbs)
Format of the Document Content and associated
coded vocabulary
Format of the Document Content and associated
coded vocabulary
Health Data Exchange
Cross-Enterprise Document Sharing
Registration, distribution and access across
health enterprises of clinical documents forming
a patient electronic health record
Final Text Approved
Trial Implementation-2006 Final Txt 2007
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Combining IHE ProfilesDocument Content Modes
of Document Exchange
Doc Content Profiles (Semantics content)
Scanned Doc XDS-SD
Consent BPPC
Emergency EDR
Pre-Surgery PPHP
PHR Exchange XPHR
Discharge Referrals XDS-MS
Imaging XDS-I
Laboratory XD-Lab
Document Exchange Integration Profiles
Document SharingXDS
MediaInterchange XDM
Reliable Pt-PtInterchange XDR
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XDS-MS Medical Summary or PHR Extract
ExchangeProfile based on HL7 CDA Rel 2 and
ASTM/HL7 CCD


Level 1
Structured and Coded Header


Patient, A
uthor, Authenticator, Institution,
Header always structured and coded


Time of Service, etc.



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Reason for Referral

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Vital Signs


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Allergies have a


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Social History

Scheme explicitly identified.




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XDS-MS and XPHR enable both semantic
interoperability simple viewing !




Care Plan

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Use of a shared XDS infrastructure to access
Radiology Reports and Images (XDS-I)

• Between Radiology and
• Imaging specialists
• Non-imaging clinicians

Hospital
PACS Y
Radiology -to-Radiology
Radiology -to-Physicians
PACS Z
Imaging Center
Physician Practice
Same XDS Infrastructure (Registry and
Repositories) for medical summaries and imaging
information !
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HIMSS RHIO Network of networksThe largest
multi-vendor RHIO Prototype ever built !
3 infrastructure systems
18 edge systems4 infrastructure systems
13 edge systems3 infrastructure systems
5 edge systems 4 infrastructure systems
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IHE based Regional and National EHR Projects
Operational and Planned
To learn more, attend IHE in regional and
national health information exchange around the
WORLD (Tuesday Wednesday, here)
Toronto, Quebec, Alberta, BCCanada Infoway
MA-Share MA
New York HIE
Austria
Vermont RHIO
FranceDMP
Philadelphia HIE
THINC- New York NCHICA N. Carolina
Italy (Conto Corrente Salute)
CHINA-MoH Lab results sharing
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Compliance with US National Health Info
NetHITSP Interoperability Specs and CCHIT Roadmap
Clinical and PHR Content
Security
Patient ID Mgmt
Emergency Referrals
PHR Extracts/Updates
Format of the Document Content and associated
coded vocabulary
Basic Patients Privacy Consents
Patient Demographics Query
ECG Report Document
Format of the Document Content and associated
coded vocabulary
Lab Results Document Content
Establish Consents Enable Access Control
Format of the Document Content and associated
coded vocabulary
Scanned Documents
Patient Identifier Cross-referencing
Format of the Document Content and associated
coded vocabulary
Imaging Information
Format of the Document Content
Medical Summary (Meds, Allergies, Pbs)
Format of the Document Content and associated
coded vocabulary
Map patient identifiers across independent
identification domains
Document Digital Signature
Format of the Document Content and associated
coded vocabulary
Attesting true-copy and origin
Health Data Exchange
Audit Trail Node Authentication
Cross-Enterprise Document Sharing
Centralized privacy audit trail and node to node
authentication to create a secured domain.
Registration, distribution and access across
health enterprises of clinical documents forming
a patient electronic health record
Consistent Time
Cross-Enterprise Document Media Interchange
Coordinate time across networked systems
Cross-Enterprise Document Reliable Interchange
Accepted by HITSPCCHIT in 2006
Candidates for HITSPCCHIT in 2007
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Leverage IHE for your RHIO/HIE !

• EMR from most vendors have/plan support two way
  IHE interface. Choice of Infrastructure Vendors.
  (www.himssEHRVA.org Interop. Roadmap, HIMSS
  Interop. Showcase).
• Thin and efficient Infrastructure for Health Info
  Exchange
• Solid content-independent Thin Infrastructure
  Profiles XDS, PIX, PDQ, ATNA, CT, BPPC
• Broad Choice of Content Profiles XDS-MS
  XPHR(Chart), XDS-SD(Scan doc), XDS-I(Imaging),
  XD-Lab, ECG, etc.
• Leverage investments and experience world-wide
• Choose either (or mix) a federated or a
  centralized HIE
• Get both an HIE with portal data access and two
  way data exchange
• Public domain architecture and specifications,
  simplify RFP process and implementation for both
  vendors and RHIO/SNO.

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IHEBased 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 of
  HIEs into a National Health Information Network
• Allowing increasingly sophisticated security and
  privacy protections

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How can I participate?

• As a Provider or Vendor Contributor
• Offer Clinical Use Case Input to Drive IHE
  Profile Development
• Become a member of relevant domains Planning or
  Technical Committees
• Become a member of relevant Regional/National
  Committees
• Help to shape IHEs future direction
• As a Vendor Participant
• Respond to Public Comments of Domain Supplements
• Attend the June Educational Workshop
• Participate in Connect-a-thons and Demonstrations
• As a Provider/Consultant Participant
• Respond to Public Comments of Domain Supplements
• Attend the June Educational Workshop
• Attend Demonstrations and include IHE Integration
  Profiles in your RFPs and Integration Projects.

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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
• Radiation Oncology
• Radiology
• Connectathon Result www.ihe.net/Events/connectath
  on_results.cfm
• Vendor Products Integration Statements
• Participation in Committees Connectathons

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