leveraging ihe to build rhio interoperability

Leveraging IHE to buildRHIO InteroperabilityLeveraging IHE to buildRHIO Interoperability

Charles ParisotGE Healthcare

IHE IT Infrastructure Technical Committee co-chair

http://ihe.univ-rennes1.fr/data/editable/organization/PCC_WS_2005/Interoperability_Workshop_IHE%20for%20a%20RHIO-3.ppt

June 28-29, 2005 Interoperability Strategy Workshop2

W W W . I H E . N E TW W W . I H E . N E T

Providers and VendorsProviders and Vendors

Working Together to DeliverWorking Together to Deliver

Interoperable Health Information SystemsInteroperable Health Information Systems

in the Enterprisein the Enterprise

and Across Care Settingsand Across Care Settings


Lab Results Document Content

Format of the Document Content and associated coded vocabulary

For Display Document

Format of the Document Content

Selected IHE Integration Profiles for RHIOsSelected IHE Integration Profiles for RHIOsWhat is available and is added in 2005What is available and is added in 2005

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

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

Imaging Information Sharing


Medical Summary Document Content

Format of the Document Contentand associated coded vocabulary

Cross-enterprise User Authentication

Authentication & Auditing: Basis for Access Control

Document Digital Signature

Attesting “true-copy and origin

Patient Identifier Cross-referencing

Map patient identifiers across independent identification

domains


HIMSS 2005 – HIMSS 2005 – Show-Wide InteroperabilityShow-Wide InteroperabilityVendor System

Ambulatory Showcase BoothAmbulatory Showcase Booth

HomeHome

PCP

MultispecialtyMultispecialtyClinicClinic

Diag Center

Cross-enterprise Showcase BoothCross-enterprise Showcase Booth

Cardiology

RadiologyIT

Infrastructure

In-Patient/Out-patient

Vendor BoothVendor Booth







HL7 BoothHL7 Booth

HIMSS “RHIO” withCross-enterprise

doc sharing (17 vendors)


HIMSS 2005 InteroperabilityHIMSS 2005 InteroperabilityShow Case VendorsShow Case Vendors

Leadership LevelLeadership Level

CapMed/SanDiskCapMed/SanDiskEclipsysEclipsysGE HealthcareGE HealthcareIDXIDXInterSystemsInterSystemsKryptiqKryptiqQuovadx/CareScienceQuovadx/CareScienceSiemensSiemensWebMDWebMD

Participant LevelParticipant LevelAllscriptsAllscripts

Cedara Cedara

CernerCerner

Dictaphone Dictaphone

Eastman KodakEastman Kodak

EclipsysEclipsys

EmageonEmageon

EpicEpic

ETIAMETIAM

INFINITT Tech.INFINITT Tech.

MedcomSoft MedcomSoft

MediNotesMediNotes

MedCommonsMedCommons

MidMarkMidMark

Mortara Instrument, IncMortara Instrument, IncNational Institute National Institute ofof Standards & TechnologyStandards & Technology

NextGenNextGen

NovellNovell

Open TextOpen Text

SentillionSentillion

Supporter LevelSupporter LevelAccessPtAccessPt AGFAAGFA dbMotiondbMotion Dinmar – OacisDinmar – OacisEMCEMC HealthvisionHealthvision HealthrampHealthramp McKessonMcKesson

Valco Data SystemsValco Data Systems


IHE North America Vendors (2004-2005)IHE North America Vendors (2004-2005)

• Agfa HealthCare • Allscripts • Camtronics Medical

Systems • Cedara Software Corp. • Cerner Corporation • Dictaphone Corporation • Dynamic Imaging, LLC • Eastman Kodak Company • Eclipsys • Emageon • Epic Systems

Corporation • ETIAM • FujiFilm Medical

Systems, USA, Inc. • GE Healthcare • Heartlab, Inc • Hitachi Medical

Corporation

• Hologic • IDX Systems Corp. • INFINITT Technology • InSite One, Inc. • Intelerad Medical

Systems • InterSystems

Corporation • Konica-Minolta Medical

Imaging, USA, Inc. • Kryptiq • Marotech • McKesson Information

Solutions • MedCommons Inc. • MedCon, Inc. • Merge eFilm • Mortara Instrument,

Inc. • Novell, Inc. • Philips Medical

Systems

• QRS Diagnostic • Quovadx • St. Jude Medical A.B. • Sectra Imtec A.B. • St. Jude Medical A.B. • Sectra Imtec A.B. • Sentillion • Siemens Medical

Solutions • Stentor • Swissray International,

Inc. • Tiani Medgraph A.G. • Tiani Spirit Gmbh • Toshiba Medical

Systems Company • Vital Images • WebMD Practice

Services


community

Clinical Encounter

Clinical IT System Index of patients records(Document-level)

Temporary Aggregate Patient History

4-Patient data presented to

Physician

Sharing SystemSharing System

3-Records3-RecordsReturnedReturned

Referenceto records

Clinic Record Specialist Record

Hospital Record

2-Referenceto Records for Inquiry

At HIMSS in 2005 : IHE-XDSAt HIMSS in 2005 : IHE-XDS


community

Clinical Encounter




Referenceto records

Laboratory Results Specialist Record

Hospital Record


At HIMSS in 2005 : IHE-XDSAt HIMSS in 2005 : IHE-XDS


Shared prototype content:• Medical Summaries (Pre-CCR)• Discharge Summaries (CDA-R1)• Lab Results (HL7)• Other (PDF)


community

Clinical Encounter


1-Patient Authorized

Inquiry



Referenceto records

Laboratory Results Specialist Record

Hospital Record


Demo a RHIO with IHE at HIMSS 2006 ?Demo a RHIO with IHE at HIMSS 2006 ?


Secured Sharing of:• Medical Summaries• Images & reports• ECG Reports• PDFs• Lab Results ?+ Notif of Doc Avail.


Document Life Cycle ManagementDocument Life Cycle Management

A two-way relationship between Original and Addendum

Document

Addendum

Document 1(Approved)

Addendum

ReplacementDocument

Replacement

Document 1(Deprecated)

Document 2(transform)

Transform

Document 1(Approved)

A two-way relationship between Original and Replacement Document.

A two-way relationship between Original and Transform (alternative format with same scope or DSG).

TimeAddendum to a registered document

Replacing a registered document by a new document

Registering an alternate form or a signature for a registered document

Time


Local & Regional RHIOs Infrastructure and Local & Regional RHIOs Infrastructure and InteroperabilityInteroperability

• Cross-Enterprise Document Sharing (XDS) minimizes clinical data management by the infrastructure. Transparency = Ease of Evolution

• XDS works with other IHE Integration Profiles: patient Id mgt, security, etc. Flexibility of RHIO configuration

• With introduction of new Integration Profiles, IHE ready to build regional health networks linking interoperable EHRs. Major milestone for 2006 RHIO projects

• Goal is to offer a consistent, standards-based and functional for EHRs and other ancillary systems.


Creating a Health Information Network with IHECreating a Health Information Network with IHE

CareDelivery IT system



Tier 1 EHRsand Ancillaries





XDS Document Registry

DocumentEntries


Tier 2 Community HINWhat and Where ?

XDSDocument Repository








C-HIN Patient Identity Source

DocumentEntries

PDQ Consumer


Tier 2 Community HIN

Patient Demo Supplier

Patient Id X-Ref Mgr





Who, What and Where ?Who, What and Where ?







DocumentEntries

PDQ Consumer









Time Server

Who, What When and Where ?







DocumentEntries

PDQ Consumer









Time Server

Who, What When and Where ?Trusted !


Secured Node

Document Consumer

Retrieve Document

Query Documents

Patient Identity Source

Patient Identity

Feed

Document Source

Document Registry

Document Repository

Provide&RegisterDocument Set

RegisterDocument Set

Secured Node

Secured Node

Secured Node

Secured Node

Secured Node

ATNA creates a secured domain:• User Accountability (Audit trail)

• Node-to-Node Access Control

• Node-level user authentication

• User access control provided by node

BUT Registry/repository based User-Level Access Control and policy agreements is beyond XDS.

User-level Access Control is

provided by XUA

Security for XDSSecurity for XDSLeverages IHE Audit Trail & Node Authentication

A formal Security and Privacy profile is provided for XDS


Cross-Enterprise User AuthenticationCross-Enterprise User Authentication

Transaction DiagramTransaction Diagram

IdentityProvider

2 Request Assertion (of who this user is)

1 XD

S Retrieve

3 Req

uest U

ser ID

4 User

Iden

tity

5 Authentication Assertion

RecordAuditableEvent

ATNAAudit

Repository

XDS Repository


Is it possible to federate Is it possible to federate multiple XDS-based HIN ? multiple XDS-based HIN ?





DocumentEntries

PDQ Consum

er









Time Server






DocumentEntries

PDQ Consum

er









Time Server






DocumentEntries

PDQ Consum

er









Time Server






DocumentEntries

PDQ Consum

er









Time Server






DocumentEntries

PDQ Consum

er









Time Server


Tier2 Community-HINse.g. XDS Affinity Domain


Federating Tier 2 Health Information NetworksFederating Tier 2 Health Information NetworksOn IHE Roadmap for 2006-2007: X-Registry FederationOn IHE Roadmap for 2006-2007: X-Registry Federation

(Addressed by ebXML Registry 3.0)(Addressed by ebXML Registry 3.0)

Patient / Registry Locator Service

Managed Identification

Federated Identification

T2 C-HIN Be.g. XDS Affinity Domain

T2 C-HIN De.g. XDS Affinity Domain

RG

RG

What are the document registries where a patient has information ?What are the document registries where a patient has information ?

Tier 3 HINe.g. State Level


Federating Tier 2 Health Information NetworksFederating Tier 2 Health Information NetworksOn IHE Roadmap for 2006-2007: X-Registry FederationOn IHE Roadmap for 2006-2007: X-Registry Federation


T2 C-HIN A e.g. IDN

Tier 3 HINe.g. State Level

Managed Identification

Federated Identification

T2 C-HIN Be.g. XDS Affinity Domain

T2 C-HIN Ce.g. IDN

T2 C-HIN De.g. XDS Affinity Domain

RG +AdaptRG +Adapt RG

RG

Integrating existing IDNs: Integrating existing IDNs: Adaptor + RegistryAdaptor + Registry


Federating Tier 3 Health Information NetworksFederating Tier 3 Health Information NetworksOn IHE Roadmap for 2006-2007: X-Registry CommunicationOn IHE Roadmap for 2006-2007: X-Registry Communication

Patient / Registry

Locator Service

T1-RHIO A e.g. IDN

e.g. State HIN

T1-RHIO Be.g. XDS Affinity Domain

T1-RHIO Ce.g. IDN

T1-RHIO De.g. XDS Affinity Domain

RGRG RG

RG

Patient / Registry

Locator Service

T1-RHIO A e.g. IDN

e.g. State HIN


T1-RHIO Ce.g. IDN


RGRG RG

RG



Patient /

Registry

Locator

Service

T1-RHIO A e.g. IDN

e.g. State HIN


T1-RHIO Ce.g. IDN


RGRG RG

RG

Patient /

Registry

Locator

Service

T1-RHIO A e.g. IDN

e.g. State HIN


T1-RHIO Ce.g. IDN


RGRG RG

RG

Patient /

Registry

Locator

Service

T1-RHIO A e.g. IDN

e.g. State HIN


T1-RHIO Ce.g. IDN


RGRG RG

RG

Nation-Wide Health Info network (Tier 4)


IHE: RHIOs’ Interoperability PartnerIHE: 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.

• IHE welcomes RHIOs’ technical architects’ active involvement.

• The IHE Technical Framework accelerates RHIOs pilot development (e.g. XDS Affinity Domain).

• This is being applied: Norway, Italy, then Canada, soon USA, France, ?


Clinical EncounterClinical Encounter ClinicalClinicalIT SystemIT System 1-Expression of a 1-Expression of a

need for additional need for additional informationinformation

Index of patients records(Document-level)


3-Documents3-DocumentsReturnedReturned

DocumentRepositories

4-Patient data 4-Patient data presented to presented to

PhysicianPhysician

3-Reference3-Referenceto Docs from to Docs from

InquiryInquiry2- Inquiry 2- Inquiry for Docs for Docs

Clinicians access XDS ServicesClinicians access XDS Servicesthrough their clinical IT system (EHRs)through their clinical IT system (EHRs)


Sharing Radiology Reports and Images with XDSSharing Radiology Reports and Images with XDSin a Regional Health Information Networkin a Regional Health Information Network

Radiology Enterprise A

Radiology Enterprise B

Physician Office

Regional Health Regional Health Information Information NetworkNetwork

PACS B

PACS A

Radiology-to-radiology

Radiology-to-Physicians


Sharing Radiology Reports and ImagesSharing Radiology Reports and Imagesin a Regional Health Information Networkin a Regional Health Information Network



Physician Office


Cross-Cross-Enterprise Enterprise RegistryRegistry

Patient Id= 3547F45• Report 5/21/1998 : CT Head B• Study 5/21/1998 : CT Head B• Report 2/18/2005 : Chest Xray A• Study 2/18/2005 : Chest Xray A

PACS B

PACS A


Physicians and Systems within a Regional Health Physicians and Systems within a Regional Health Network - Routine Imaging ReferralNetwork - Routine Imaging Referral



Physician Office


Query for Query for Documents Documents

Register Imaging Register Imaging Information for Information for

sharingsharing

Priorimaging

Reports & Studies


Register Imaging Register Imaging Information for Information for sharingsharing

Patient Id= 3547F45• Report 5/21/1998 : CT Head B• Study 5/21/1998 : CT Head B


Physicians and Systems within a Regional Health Physicians and Systems within a Regional Health Network - Routine Imaging ReferralNetwork - Routine Imaging Referral



Physician Office


Register Imaging Register Imaging Information for Information for

sharingsharing


Notification of Notification of Doc AvailabilityDoc Availability

Register Imaging Register Imaging Information for Information for sharingsharing


Physicians and Systems within a Regional Health Physicians and Systems within a Regional Health Network for a Routine Imaging ReferralNetwork for a Routine Imaging Referral



Physician Office

Prior Imaging Report & Study


Query for Query for documents documents

Imaging Report Imaging Report & Study& Study


Patient Id= 3547F45• Report 5/21/1998 : CT Head B• Study 5/21/1998 : CT Head B• Report 2/18/2005 : Chest Xray A• Study 2/18/2005 : Chest Xray A



Regional Health Information Regional Health Information NetworkNetworkImages and reports Images and reports part of a sharedpart of a shared health record health record

Enterprise A

Enterprise B

Physician Office

Retrieve Prior Documents

Query for Query for Documents Documents


Query for Query for documents documents

Retrieve Retrieve DocumentsDocuments

Register Documents Register Documents for sharingfor sharing

Retrieve Prior

Documents


Register Documents Register Documents for sharingfor sharing



oror

Lab Results Document Content


For Display Document Content

Format of the Document Content

Requirements for care delivery IT system in a RHIORequirements for care delivery IT system in a RHIO(e.g. EHR, Lab, Imaging, etc.)(e.g. EHR, Lab, Imaging, etc.)

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

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

Imaging Information Sharing


Medical Summary Document Content

Format of the Document Contentand associated coded vocabulary

Document Digital Signature

Attesting “true-copy and origin

Patient Identifier Cross-referencing

Map patient identifiers across independent identification

domains

Cross-enterprise User Authentication

Authentication & Auditing: Basis for Access Control


IHE: Interoperability for RHIOs’IHE: Interoperability for RHIOs’

• By starting with a secured document sharing infrastructure, RHIOs have a a platform on which to build clinical content (more structure & coded terminology, specialized content).

• Solid SAML 2.0 authentication and document digital signature (need a PKI).

• Practical HL7 V3 approach with CDA-R2 and other content (e.g. imaging, CCR, legacy, PDF, etc.).

• Establishing a critical mass of products implementations, both in clinical applications and infrastructure for deployment in 2006.

• An architecture that caters to various RHIOs architectures: centralized, decentralized and mixed (operational decision).


More information….More information….

• IHE Web sites: www.ihe.net• Technical Frameworks, Supplements

– Fill in relevant supplements and frameworks

• Non-Technical Brochures :• Calls for Participation

• IHE Fact Sheet and FAQ

• IHE Integration Profiles: Guidelines for Buyers

• IHE Connect-a-thon Results

• Vendor Products Integration Statements

http://www.ihe.net/


IHE Patient Id management IHE Patient Id management for RHIOsfor RHIOs

Use of PIX and PDQ Integration ProfilesUse of PIX and PDQ Integration Profiles


Patient Identification ManagementPatient Identification ManagementPIX Cross Referencing (coexist with PDQ)PIX Cross Referencing (coexist with PDQ)


XDSDocument

Repository


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 Identity X-Ref Mgr

Patient Identity 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


Patient Identification ManagementPatient Identification ManagementPDQ Discovery + Local mapping (coexist with PIX)PDQ Discovery + Local mapping (coexist with PIX)


XDSDocument

Repository


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 Demographics Supplier Patient Identity

FeedDm=XAD, Pid=Px

PatientDemoConsumer

XDS Document Source

XDS Doc

Dm=XADPid=Px

Demographics

XDS Doc

Provide&Register Doc Set

Patient DemoConsumer

XDS Document Consumer

Demographics

Dm=XADPid=Px

Query Docs


W W W . I H E . N E TW W W . I H E . N E T

Providers and VendorsProviders and Vendors

Working Together to DeliverWorking Together to Deliver

Interoperable Health Information SystemsInteroperable Health Information Systems

in the Enterprisein the Enterprise

and Across Care Settingsand Across Care Settings

leveraging ihe to build rhio interoperability

Documents

jude medical

flexibility of rhio

approveda twoway relationship

sectra imtec

replacement document

registered documentreplacing

secured sharing

tiani medgraph