november 17, 2004 1 integrating the healthcare enterprise an interoperability process for enabling...

November 17, 2004 1

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

An Interoperability Process for Enabling the National Agenda

Joyce Sensmeier MS, RN, BC, CPHIMS

Director of Professional Services

Healthcare Information and Management Systems Society

HIMSS

November 17, 2004 2

2004 State of the Union 2004 State of the Union AddressAddress

“By computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care.”

President George W. Bush January 20, 2004

November 17, 2004 3

And the beat goes on…..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.

November 17, 2004 4

Framework for Strategic ActionFramework 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.

November 17, 2004 5

Framework for Strategic ActionFramework for Strategic Action

Report includes:12 strategies to achieve four major goals Information from DoD, VA, and OPM on

how their areas can advance the adoption of HIT

A catalog of identifiable federal HIT programs

http://www.hhs.gov/onchit/framework/

November 17, 2004 6

Four Major GoalsFour 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

November 17, 2004 7

Four Major GoalsFour 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

November 17, 2004 8

Impact on Healthcare ITImpact on Healthcare IT

Technology trends can no longer develop in a void

Systems must connect with each other Organizational Local National Global

Public/Private partnerships needed

November 17, 2004 9

Development and Adoption of a Development and Adoption of a National Health Information NetworkNational Health Information Network

Request for Information – Interoperability Announced in Federal Register November 15th

HHS is seeking input on how widespread interoperability of health information technologies and health information exchange can be achieved

Encouraging collaboration and unified response Opportunity for members to contribute See Top Line report at www.himss.org and

respond to survey

November 17, 2004 10

What is IHE - Integrating the What is IHE - Integrating the Healthcare Enterprise?Healthcare Enterprise?

A joint initiative to improve systems integration and interoperability Process for coordinated adoption of standards Clinicians/IT staff define needs Vendors and IT Professionals develop solutions

Technical Framework

Professional societies supervise documentation, testing and demonstration/promotion


Understanding the IHE InitiativeUnderstanding the IHE InitiativeIHE has a clear focus

IHE is a 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 lead and vendor driven


Goals of IHEGoals of IHE

Speed up the rate and quality of integration in healthcare environments

Foster communication among vendors and care providers

Prove that integration is attainable based on standards

Improve the efficiency and effectiveness of clinical practice

Improve interoperability among care domains and build foundation for the EHR

Provide integration solutions used within and across healthcare enterprises


IHE: Domain-based for a stepwise approachIHE: Domain-based for a stepwise approach

CardiologyCardiologyLabora-Labora-ttoryory

Pharmacy,…..Pharmacy,…..RadiologRadiologyy

Patient Identifier Linkage, Registries, SecurityPatient Identifier Linkage, Registries, Security

Electronic Health RecordElectronic Health Record

Other (e.g. Access Control, eHealthWorkflows)Other (e.g. Access Control, eHealthWorkflows)

Patient ManagementPatient Management

Order ManagementOrder Management


IHE

EHR- Longitudinal Record

IHE Cardiology

IHE Laboratory

IHE Radiology

IHE

Future Domain

IHE

Future Domain

IHE

IT Infrastructure Intra-Enterprise

Cross-Enterprise

14 Integration Profiles




IHE 2004 – Four Active Domains IHE 2004 – Four Active Domains

4 Technical Frameworks with 31 Integration ProfilesTesting at yearly Connectathons in three continents

Demonstrations at major conferences world-wide

Provider-Vendor cooperation to accelerate standards adoption


A Proven Standards Adoption ProcessA Proven Standards Adoption Process

IHEIntegrationProfiles B

IHEIntegrationProfile A

Easy toIntegrateProducts

IHEIHEConnect-a-thonConnect-a-thon

ProductWith IHE

IHEIHEDemonstrationDemonstration

User Site

RFPRFP

StandardsStandards

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


IHE Technical FrameworksIHE Technical Frameworks

Detailed standards implementation guides

–Cardiology

–IT Infrastructure

–Lab

–Radiology


IHE ConnectathonIHE Connectathon

Open invitation to vendor community

Advance testing tools (MESA)

Testing organized and supervised by project management team

Thousands of cross-vendor tests performed

Results recorded and published


Integration StatementsIntegration Statements


IHE ProcessIHE ProcessUsers identify desired functionality that require coordination and communication among multiple systems E.g., departmental workflow, single sign-on, sharing of documents

Find and document standards-based transactions among systems to achieve desired functionality Apply necessary constraints to eliminate useless wiggle room

Provide process and tools to encourage vendors to implement MESA software test tools + Connect-a-thon interoperability testing event

Provide tools and education to help users acquire and integrate systems using these solutions Connect-a-thon results and public demonstrations Integration statements


What IHE is NOT!What IHE is NOT!

A standards development organization Uses established standards (HL7, DICOM, CCR,

others) to address specific clinical needs Activity complementary to SDOs, formal

relationship with HL7, DICOM, NCCLS, etc.

Simply a demonstration project Demos only one means to the end—adoption Backed up by documentation, tools, testing, and

publication of information


IHE Organizational StructureIHE Organizational StructureMulti-Domain & Multi-NationalMulti-Domain & Multi-National

Participants

contribute

Global Development:Radiology,IT Infrastructure,Cardiology,Lab, etc.

Delegates

IHE Europe

IHE North America

IHE Asia/Oceania

Regional &NationalDeployment

supervises reports

IHE (International) Strategic Development Committee

SponsorsCo-Chairs

Global

Interoperability

IHE Domain-related Planning Committee and

Technical Committee

National Extensions


IHE Contributors & ParticipantsIHE Contributors & Participants

Societies Representing Healthcare Segments RSNA, HIMSS, ACC, ACCE, AACC, Other Professional Societies… Any Healthcare Stakeholder Organization

Users Clinicians, Medical Staff, Administrators, CIOs, …

Information Systems & Equipment (e.g. imaging) Vendors

Consultants

In addition, active liaison with Standards Development Organizations (SDOs) HL7, DICOM, NCCLS, ASTM, ISO, others


Participating and Contributing Vendors (America)Participating and Contributing Vendors (America)Agfa HealthCareAllscriptsAlgotec Systems, Ltd.CamtronicsCanon Medical SystemsCapMedCarefxCedara Software Corp.Cerner CorporationCSISTDictaphoneDR SystemsDynamic ImagingEastern InformaticsEastman Kodak CompanyEmageonEclipsysEPICETIAMFujifilm Medical SystemsGE HealthcareHealthrampHeartlab

Novell

Opentext

Procom

Philips Medical Systems

RASNA Imaging Systems

Sectra

Sentillion

Siemens Medical Solutions

Softmedical

Stentor, Inc

StorCOMM, Inc

Swissray International, Inc

Tiani Medgraph AG

Toshiba America Medical Sys.

UltraVisual Medical Systems

Vital Images, Inc.

Voxar Limited

WebMD

XIMIS

Hitachi Medical Corporation

Hologic, Inc

IDX Systems Corporation

IMCO Technologies

InSiteOne

INFINITT

InterSystems

Konica Minolta

Marotech, Inc.

McKesson Information Soln.

Medcon

MedCommons

Medical Manager Health Sys.

Mediface Co., Ltd.

MediNotes

Merge eFilm

MidMark

Misys

Mortara

NextGenIn yellow, companies with IHE Committees Chairs (Summer 2004)


Participating and Contributing Vendors (Europe)Participating and Contributing Vendors (Europe)AGFA HealthcareAISoftw@re Medical SolutionsAlgotec ARES SA aycan Digitalsysteme ConVisDEDALUSDianoemaEastman Kodak Company Ebit SanitaEDL ELFIN s.r.l. Engineering Sanità Enti LocaliESAOTEETIAM Ferrania Fujifilm GE HealthcareGMD GIE Convergence-Profils

Rogan-Delft

Sago spa

Sectra Imtec AB

Siemens Medical Solutions

Soluzioni Informatiche srl

Stentor Inc.

Swissray Medical AG

Symphonie On Line

Synapsis

TELEMIS S.A.

TIANI MEDGRAPH AG

TOREX GAP Medical

Toshiba Medical Systems

TSI groupe europMedica

VEPRO AG

VISUS Technology Transfer

WAID

XR PARTNER

GWI Research

IASI Srl

IdeoPass

Image Device-Cerner Company

INFINITT

INOVIT

McKesson

MED2RAD

MEDASYS SA

Medavis

Medigration GmbH

MEDIMON Ltd.

MEDOS AG

Merge eFilm

METAFORA

Konica Minolta Europe

Omnilab

Philips Medical Systems

Rasna Imaging Systems

RAYPAX INC.

In yellow, companies with IHE Committees Chairs (Summer 2004)


Participating and Contributing Vendors (Asia)Participating and Contributing Vendors (Asia)Japan

AGFA Gevaert JapanEBM JapanINFINITT JapanA&TCanonGoodmanClimb Medical SystemsKonica Minolta MGShimadzuSONYToshiba Medical SystemsToyo TechnicaNihon KohdenOlympusNECPioneer (Marotech)HitachiHitachi MedicoFujitsuFuji Film MedicalYokogawa

TaiwanINFINITTShing ShianINQ GENTEPTah Ya

KoreaAGFA Korea GE Healthcare KoreaINFINITTLG CNS Marotech, Inc.Medical StandardPeoplenet CommunicationsSamsung SDS


Benefits to IHE ParticipantsBenefits to IHE Participants

Clinicians Improved workflow Information when and where needed Fewer opportunities for errors Fewer tedious tasks/repeated work Improved report turn around time

Administrators Improved efficiency Best of breed opportunities Decreased cost and complexity of interface deployment and

management Improved accuracy of charge processing/reimbursement


Benefits to IHE ParticipantsBenefits to IHE ParticipantsHealth Plans Improved accuracy, completeness of billing/claims Improved turn around time for claims processing

Vendors Align product interoperability with industry consensus Decreased cost and complexity of interface installation and

management Focus competition on functionality/service space not information

transport space

SDOs Rapid feedback to adjust standards to real-world Establishment of critical mass and widespread adoption

Plus, IHE meets fixed deadlinesPlus, IHE meets fixed deadlines


IHE Organizational StructureIHE Organizational Structure

IHE Europe

IHE North America

France

USA Canada

IHE Asia-Oceania

Japan

KoreaTaiwan

Netherlands Spain Sweden

UKItalyGermany

Norway

Regional Deployment

RadiologyPlanning Committee

RadiologyTechnical Committee

IT InfrastructurePlanning Committee

IT InfrastructureTechnical Committee

Pharmacy ExploratorySub-Committee

Global Development

CardiologyPlanning Committee

CardiologyTechnical Committee

LaboratoryPlanning and Technical

Committee

IHE Strategic Development Committee

ACC ITAC/CHITTAHIMSS CHIRSNA CAR

JAHISJIRAJRS

METI-MLHWMEDIS-DCJAMI

GMSIHSFRSFIL

SIRMBIREuroRec

COCIREAR-ECRDRG

ESCProfessional Societies / SponsorsProfessional Societies / Sponsors Contributing and participatingContributing and participating

VendorsVendors


Organization of the IHE InitiativeOrganization of the IHE InitiativeIHE distributes its operations between a regional/national level and an international level

IHE operates on overlapping yearly cycle

IHE leverages dependencies and complementary interests between stakeholders

IHE is an open and flexible organization

A novel approach to meet these challenges


IHE Domains Milestones – 20 month cycleIHE Domains Milestones – 20 month cycleDevelopmentDevelopment and and DeploymentDeployment

Proposed Supplement Scope

Approved Supplement Scope

Public Comment Intgr-profile Sponsors announce Connectathon/Demos with set of

Implementation Profiles

Final Intgr-profile + 9 ---

- 10 ---

- 7 ---

- 2 ---

Trial Implementation Intgr-profile 0 ---Connectathon/Demo Vendor Participant Registered

+ 2 ---

Vendor Participant passed Connectathon

+ 5 ---

+ 6 --- Demo &Education Material

Vendors release products with IHE Integration

Statements---


Continuity & integrity of patient information

Improved patient safety and access to data

Clinical workflow optimization

Foster communication among diverse medical information systems

Avoid repeating tasks

Eliminate data redundancy

Healthcare Needs AddressedHealthcare Needs Addressedby the IHE Initiativeby the IHE Initiative

Improving the Patient Care Process


HIMSS 2005 Interoperability ShowcaseHIMSS 2005 Interoperability ShowcaseHIMSS leverages its sponsorship of IHE to demonstrate practical

interoperability in two large Showcase Exhibits:

Cross-enterprise sharing of health information in the acute care (18 vendors) and ambulatory (14 vendors).

HIMSS Showcase exhibits linked with vendor booths (10 vendors) show-wide and the Health Level Seven Demo.

Show-wide interactive environment demonstrating attendees “patient” record in a “HIMSS RHIO”. Uses IHE Cross-enterprise Document Sharing:

Around a central document registry

Distributed document repositories

17 EHR systems that publish/share documents (CCR, CDA, HL7-lab, PDF)


HIMSS 2005 Interoperability ShowcaseHIMSS 2005 Interoperability ShowcaseA national vision of a connected and interoperable healthcare infrastructure

The Interoperability and Ambulatory IT Showcase exhibit areas will feature cross-enterprise sharing of health information in the acute care and ambulatory environment within the framework of a Regional Health Information Organization (RHIO)

These hands-on exhibits linked with vendor booths will create a highly interactive environment to demonstrate practical interoperability featuring standards-based connectivity across the health care enterprises from acute care to ambulatory care IT.

Feb. 13-17, 2005 -- Interoperability Showcases:2005 Annual HIMSS Conference & ExhibitionDallas, TX

One of the most significant healthcare industry efforts of the 21st century.HIMSS has taken a leadership role in making this vision a reality.


“This showcase allows multiple organizations to demonstrate cross-vendor integration and interoperability and is a prime example of the type of private-sector collaboration we are seeking to move our agenda forward. HIMSS has taken a leadership role in demonstrating the application of cross-enterprise interoperability. ”

Dr. David Brailer, National Coordinator of HIT


HIMSS 2005 Interoperability ShowcasesHIMSS 2005 Interoperability Showcases

Cross-enterprise Showcase 4,000 square feet on exhibit floor – located near

attendee registration Focus on cross-enterprise interoperability of an

electronic health record and document sharing

Ambulatory Care Showcase 4,000 square feet on exhibit floor - adjacent to

Cross-enterprise Showcase Focus on interoperability of IT applications in

ambulatory care in a variety of settings


HIMSS 2005 Interoperability ShowcasesHIMSS 2005 Interoperability Showcases

Ambulatory Showcase Booth

Vendor Booth

Vendor BoothCross-enterprisedoc sharing

(Choice of XDS,PWP,RID,PDQ)

Interoperability Showcase Booth

cardiology

laboratory

radiology

ITInfrastructure

laboratorylaboratoryradiology

Pharma ?Pharma ?

Three participation opportunities for vendors Vendors chose among 15 existing integration profiles.May participate from own vendor booth in addition to Showcase booths.


Cross-enterprise ShowcaseCross-enterprise ShowcaseTechnical demonstration Featuring the IHE framework enabling standards-based health

information exchange within and across multiple healthcare enterprises, available in products today

Clinical scenarios Focusing on clinician access and document sharing within the acute

care environment and across multiple settings Includes the Continuity of Care Record (CCR), radiology images,

cardiology reports, laboratory results, etc.

Connectivity with Ambulatory Care Showcase Health Level Seven (HL7) Demonstration Participating vendors booths Show-wide attendee registration and access at ‘Surf the Web’ kiosks


Cross-enterprise ShowcaseCross-enterprise Showcase

Interoperability Theater

Featuring learning sessions on:• Outcomes of national demonstrations and industry

research projects• Regional health information exchange initiatives• Federal agency interoperability initiatives• Standards development initiatives and related activities• Issues, products and insights from industry leaders


Cross-enterprise ShowcaseCross-enterprise ShowcaseVisionary demonstrations of the future in healthcare – Organizational participants Featuring initiatives, collaborations, and standards development

activities in support of interoperability• Center for Information Technology and Leadership (CITL)• Continuity of Care Record (CCR)• Department of Defense (DoD) – Data sharing project• ISO TC 215 Health Informatics• Liberty Alliance• MEDecision• Medical Device Interoperability – IEEE - ACCE• Oregon Health Information Infrastructure• Santa Barbara County Health Data Exchange• Veterans Health Administration – VISTA Imaging• University of Washington Personal Health Record Project


Ambulatory Care ShowcaseAmbulatory Care Showcase

Demonstration of interoperability across a variety of settings including a free-standing diagnostic enter, a large clinic, a small practice and the patient’s home

Use cases will guide the attendee through the settings in the normal course of care

Theater area for related presentations Invited speakers and Leadership level only

Product placement near demonstration


IHE, IHE,

the effective bridgethe effective bridgebetween information between information exchange standards exchange standards and their practical useand their practical use

in healthcare in healthcare


Opportunities for ParticipationOpportunities for ParticipationAs a User or Vendor Contributor

Become a member of relevant Domains Planning or Technical Committees or HIMSS IHE SIG (Special Interest Group)

Become a member of relevant Regional/National Committees

Attend the HIMSS 2005 Interoperability Showcases

As a Vendor ParticipantRespond to Public Comments of Domain Supplements

Attend Yearly in September Educational/Workshops

Participate in Connect-a-thons and Demonstrations

As a User/Consultant ParticipantRespond to Public Comments of Domain Supplements

Attend Yearly in September Educational/Workshops

Attend Demonstrations and include IHE Integration Profiles in your RFPs and Integration Projects.


IHE expanding, more info...IHE expanding, more info...• IHE Radiology www.rsna.org/ihe

Chris Carr [email protected] IHE Connectathon for IT January 17-21, 2005

• IHE IT Infrastructure www.himss.org/ihe Joyce Sensmeier [email protected]

HIMSS Interoperability Demonstrations February 13 -17, 2005 www.interoperabilityshowcase.org

• IHE Laboratory www. himss.org/ihe Karima Bourquard [email protected] Framework in Public Comment, feedback due Nov 15th

IHE Connectathon for Lab March 2005

• IHE Cardiology http://www.acc.org/quality/ihe.htm IHE Connectathon for Cardiology January 2005First Demo ACC March 2005


More information….More information….IHE Web sites:

http://www.himss.org/IHEhttp://www.rsna.org/IHEhttp://www.acc.org/quality/ihe.htm.

Technical Frameworks:• ITI V1.0, RAD V5.5, LAB V1.0

Technical Framework Supplements - Trial Implementation• May 2004: Radiology• August 2004: Cardiology, IT Infrastructure

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

november 17, 2004 1 integrating the healthcare enterprise an interoperability process for enabling...

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