himss 20051 ihe, interoperability for regional health information organizations charles parisot, ge...
TRANSCRIPT
HIMSS 2005 1
IHE, Interoperability for Regional Health Information Organizations
Charles Parisot, Charles Parisot, GE HealthcareGE Healthcare
Mike Henderson, Mike Henderson, Eastern InformaticsEastern Informatics
IHE IT Technical Committee Co-ChairsIHE IT Technical Committee Co-Chairs
HIMSS 2005 2
W W W . I H E . N E TW W W . I H E . N E T
Providers and VendorsWorking Together to Deliver
Interoperable Health Information SystemsIn the Enterprise
and Across Care Settings
HIMSS 2005 3
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
HIMSS 2005 4
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.
HIMSS 2005 5
Framework for Strategic Action
• President Bush’s 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.
HIMSS 2005 6
Four Major Goals
1. Inform Clinical Practice– Incentivize EHR adoption
– Reduce risk of EHR investment
– Promote EHR diffusion in rural & underserved
2. Interconnect Clinicians– Foster regional collaborations
– Develop a national health information network
– Coordinate federal health information systems
HIMSS 2005 7
Four Major Goals
3. Personalize Care– Encourage use of PHRs
– Enhance informed consumer choice
– Promote use of telehealth systems
4. Improve Population Health– Unify public health surveillance architectures
– Streamline quality and health status monitoring
– Accelerate discovery and dissemination
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
PlusIHE Response to the NHIN RFI.
www.himss.org/content/files/IHERFIResponseandCoverLetter1.pdf
HIMSS 2005 8
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 We need standards for how to
implement standards!implement standards!
HIMSS 2005 9
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 What is the effective way to establish those
“standards” for how to implement standards ?“standards” for how to implement standards ?
HIMSS 2005 10
Need for a Standards Implementation Process
StandardsStandards
DemandDemand
?OfferOfferStandardsStandardsStandardsStandards
UserProjects
HIMSS 2005 11
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.
HIMSS 2005 12
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 IHE’s positive impact now expanded to address:– radiology, cardiology, laboratory– enterprise healthcare IT infrastructures– cross-enterprise healthcare IT infrastructures
HIMSS 2005 13
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
HIMSS 2005 14
A Proven Standards Adoption Process
IHEIntegrationProfiles B
IHEIntegrationProfile A
Easy toIntegrateProducts
IHEIHEConnect-a-thonConnect-a-thon
ProductWith IHE
IHEIHEDemonstrationDemonstration
User Site
RFPRFP
StandardsStandardsStandardsStandardsStandardsStandards
IHETechnical
Framework
Product IHE IntegrationStatement
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
IHE Connect-a-thonResults
HIMSS 2005 15
IHE
EHR- Longitudinal Record
IHE Cardiology
IHE Laboratory
IHE Radiology
IHE
Oncology
IHE
Future Domain
IHE
IT Infrastructure Intra-Enterprise
Cross-Enterprise
14 Integration Profiles
1 Integration Profile
3 Integration Profiles
9 Integration Profiles
Achievements and expanding scope
Over 100 vendors involved world-wide, 4 Technical Frameworks27 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.
HIMSS 2005 16
**HIMSS web-based survey in November 2004 – 163 participants
6%
14%
18%
28%
35%
Fewer Point-to-PointInterfaces
Improved Use of Data
Enhanced PatientSafety
Improved Access toData
Improved ClincalWorkflow
22%
30%
52%
56%
Other
Increased Sales
Technical Framework ProvidesInformation to Marketing Staff
Reduced Deployment Costs
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 2005 17
HIMSS “RHIO” withHIMSS “RHIO” withIHE-XDS Cross-enterpriseIHE-XDS Cross-enterprise
doc sharingdoc sharing
Experience your HIMSS-WideElectronic Health Record
Ambulatory Showcase BoothAmbulatory Showcase Booth
HomeHome
PCP
MultispecialtyMultispecialtyClinicClinic
Diag CenterDiag Center
Vendor BoothVendor Booth
Vendor BoothVendor Booth
Vendor BoothVendor Booth
Vendor BoothVendor Booth
Vendor BoothVendor Booth
Vendor BoothVendor Booth
Vendor BoothVendor Booth
Vendor BoothVendor Booth
Cross-enterprise Showcase Booth
Cardiology Workup
ComprehensivePatient Care
RadiologyRadiology CoordinatedCoordinatedPatient EvaluationPatient Evaluation
ITInfrastructure
HIMSS 2005 18
community
Clinical Encounter
Clinical IT System Index of patient records(Document-level)
1-Patient Authorized
Inquiry
Temporary Aggregate Patient History
4-Patient data presented to
Physician
Sharing SystemSharing System
3-Records3-RecordsReturnedReturned
Referenceto records
Laboratory Results Specialist Record
Hospital Record
2-Referenceto Records for Inquiry
Sharing records that have been publishedSharing records that have been published
HIMSS 2005 19
Standards selection for IHE XDSStandards selection for IHE XDSNo single standard can address
Cross-enterprise Document Sharing
Marriage of healthcare standards facilitates implementation and leverages complementary
technologies (e.g. security & privacy).
HealthcareContent Standards
HL7 CDA, CEN EHRcomHL7, ASTM CCR
DICOM, etc.
Internet StandardsHTML, HTTP,
ISO, PDF, JPEG, etc.
Electronic BusinessStandards
ebXML Registry, SOAP, etc.
HIMSS 2005 20
Acute Care (Inpatient)
PCPs and Clinics (Ambulatory)
Long Term Care
Other Specialized Careor Diagnostics Services
Registering and accessing Documents
EHR-CR: Care Record systemssupporting care delivery
Document Registry
DocumentRepository
EHR-LR:Longitudinal Recordas usedacross encounters
Submission of Document References
Retrieval of selected Documents
HIMSS 2005 21
Document Consumer
Retrieve Document
Query Documents
Patient Identity Source
Patient Identity Feed
Document Source
Document Registry
Document Repository
Provide & Register Document Set
Register Document Set
XDS Actors and Transactions
HIMSS 2005 22
IHE Profiles for a RHIOIntegration Profiles completed by HIMSS 2005
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical
documents forming a patient electronic health record
New
Patient Identifier Cross-referencing
Map patient identifiers across independent identification
domains
Patient Demographics QueryNew
2004
Consistent TimeCoordinate time across
networked systems
Audit Trail & Node Authentication
Centralized privacy audit trail and node to node authentication
to create a secured domain.
New
2004
Personnel White PageAccess to workforcecontact information
New
Patient Identifier Cross-referencing
Map patient identifiers across independent identification
domains
HIMSS 2005 23
Patient Identification ManagementEnterprises using PIX Cross Referencing with XDS
XDS Document Registry
XDSDocument
Repository
Patient Identity Source
Patient Patient Identification Identification
Domain CDomain C
Patient Patient Identification Identification Domain XADDomain XAD
Patient Patient Identification Identification Domain D2Domain D2
DocumentEntryDm=XADPid=Px
Patient Identifier X-Ref Mgr
Patient Identifier X-Ref Mgr
Patient Identity FeedDm=XAD, Pid=Px
Patient IDConsumer
Dm=CPid=Pc
XDS Document Source
XDS Doc
Dm=XADPid=Px
XDS Doc
Provide&Register Doc Set
Patient IDConsumer
XDS Document Consumer
Dm=D2Pid=Pd
Dm=XADPid=Px
Query Docs
HIMSS 2005 24
IHE Profiles for RHIOs What is available and what will be added in 2005
Patient Identifier Cross-referencing
Map patient identifiers across independent identification
domains
Consistent TimeCoordinate time across
networked systems
Audit Trail & Node Authentication
Centralized privacy audit trail and node to node authentication
to create a secured domain.
Patient Demographics Query
Personnel White PageAccess to workforcecontact information
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical
documents forming a patient electronic health record
Notification of Document Availability
Notification of a remote provider/ health enterprise
Cross-enterprise User Identity and
Accountability
Authentication & Auditing: Basis for Access Control
Imaging Information Content
Format of the Document Content and associated coded vocabulary
For Display Document Content
Format of the Document ContentLab Results Document Content
Format of the Document Content and associated coded vocabulary
Continuity of Care Document Content
Format of the Document Contentand associated coded vocabulary
HIMSS 2005 25
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)
HIMSS 2005 26
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 IHE’s scope. They remains RHIOs’ responsibility.
IHE IT Infrastructure Committee:
Tuesday 15th 1:00-3:00 pm HIMSS Room A134
HIMSS 2005 27
W W W . I H E . N E TW W W . I H E . N E T
Thank YouThank YouQuestions ?Questions ?