1September, 2005 What IHE Delivers

IHE 2006 Workshop, June 2006IHE 2006 Workshop, June 2006Charles Parisot, GE HealthcareCharles Parisot, GE HealthcareIT Infrastructure co-chair Technical CommitteeIT Infrastructure co-chair Technical Committee

IHE support for RHIOs, IHE support for RHIOs, and community Health and community Health Information ExchangeInformation Exchange

http://www.ihe.net/Events/upload/IHE%20Support%20for%20RHIOs-V5-Charles.ppthttp://www.ihe.net/Events/upload/IHE%20Support%20for%20RHIOs-V5-Charles.ppt

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1 - Distinguish “edge” HIT systems from 1 - Distinguish “edge” HIT systems from information exchange infrastructureinformation exchange infrastructure

Edge HIT System

NHIN Subnetwork

Edge to Edge Communication

Edge HIT System

Critic

al B

ou

nd

ary

Critic

al B

ou

nd

ary

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2 - Support multiple architectures2 - Support multiple architectures

Centralized, distributed, federated, etc.Centralized, distributed, federated, etc.

Clinic

Hospital Practice

Document Registry

?Registry Locator

CentralizedRepository

Clinic

Hospital

Practice

Document Registry

Different business models, cost, legacy systems, etc.Different business models, cost, legacy systems, etc.

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3 - Enrich Incrementally, no rip and replace3 - Enrich Incrementally, no rip and replace

Has been the hallmark of IHE for many yearsHas been the hallmark of IHE for many years

Think long-term, but specify & implement what is Think long-term, but specify & implement what is needed todayneeded today

Steal good ideas, learn form others’ mistakesSteal good ideas, learn form others’ mistakes

Listen and collaborateListen and collaborate

Reuse, reuse previous Integration ProfilesReuse, reuse previous Integration Profiles

If a clear use case cannot be specified in 6 months, If a clear use case cannot be specified in 6 months, and implemented for testing in the next 6 month, and implemented for testing in the next 6 month, rethink.rethink.

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Step-wise IHE RHIO strategyStep-wise IHE RHIO strategy1.1. Start with “Document Sharing” with patient identifiers managementStart with “Document Sharing” with patient identifiers management

2.2. Establish basic security Establish basic security (pipe encryption and node authentication)(pipe encryption and node authentication)

3.3. Grow document sharing content to deliver multi-level interoperability Grow document sharing content to deliver multi-level interoperability (enabling coded information) (enabling coded information) with medical summaries & imaging infowith medical summaries & imaging info

20052005

20062006

20072007

What is introduced in 2006-2007 ?What is introduced in 2006-2007 ?

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Step-wise IHE RHIO strategyStep-wise IHE RHIO strategy1.1. Start with “Document Sharing” with patient identifiers managementStart with “Document Sharing” with patient identifiers management

2.2. Establish basic security Establish basic security (pipe encryption and node authentication)(pipe encryption and node authentication)

3.3. Grow document sharing content to deliver multi-level interoperability Grow document sharing content to deliver multi-level interoperability (enabling coded information) (enabling coded information) with medical summaries & imaging infowith medical summaries & imaging info

4.4. Introduce point-point interchange by disfeaturing “document sharing” to Introduce point-point interchange by disfeaturing “document sharing” to enable upward evolutionenable upward evolution

5.5. Grown content to cover info exchange to support common care Grown content to cover info exchange to support common care coordination use cases, basic diagnostics/therapeutic information, and coordination use cases, basic diagnostics/therapeutic information, and simple patient input.simple patient input.

6.6. Extend security by leveraging existing edge system security capabilities to Extend security by leveraging existing edge system security capabilities to enable basic RHIO policiesenable basic RHIO policies

20052005

20062006

20072007

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Step-wise IHE RHIO strategyStep-wise IHE RHIO strategy1.1. Start with “Document Sharing” with patient identifiers managementStart with “Document Sharing” with patient identifiers management

2.2. Establish basic security Establish basic security (pipe encryption and node authentication)(pipe encryption and node authentication)

3.3. Grow document sharing content to deliver multi-level interoperability Grow document sharing content to deliver multi-level interoperability (enabling coded information) (enabling coded information) with medical summaries & imaging infowith medical summaries & imaging info

4.4. Introduce point-point interchange by disfeaturing “document sharing” to Introduce point-point interchange by disfeaturing “document sharing” to enable upward evolutionenable upward evolution

5.5. Grown content to cover info exchange to support common care coordination Grown content to cover info exchange to support common care coordination use cases, basic diagnostics/therapeutic information, and simple patient use cases, basic diagnostics/therapeutic information, and simple patient input.input.

6.6. Extend security by leveraging existing edge system security capabilities to Extend security by leveraging existing edge system security capabilities to enable basic RHIO policiesenable basic RHIO policies

7.7. Progressive introduction of consistent of coded terminologies…..Progressive introduction of consistent of coded terminologies…..

8.8. Cross-enterprise workflows (e.g. lab & radiology orders …….Cross-enterprise workflows (e.g. lab & radiology orders …….

9.9. Federation of XDS domains ……Federation of XDS domains ……

10.10. X-Enterprise User Authentication-Federated identity ……X-Enterprise User Authentication-Federated identity ……

20052005

20062006

20072007

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Sharing, Sending, Interchanging and TransactingSharing, Sending, Interchanging and Transacting

Health Information Exchange or RHIOHealth Information Exchange or RHIO

PublishPublish

PullPullStructuredStructuredobjectsobjects

PullPull

Send toSend to

WriteWrite ReadRead

SwitchSwitch

InterchangeInterchangeMediaMedia

Send toSend to

TransactionsTransactionsWorkflowWorkflow

MgrMgrWorkflowWorkflow

MgrMgr

Info Info RequestorRequestor

Data Data RepositoryRepositoryQuery / ResponseQuery / Response

XDSXDS

XDPXDP

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IHE Integration Profiles for Health Info NetsIHE Integration Profiles for Health Info NetsWhat What is availableis available and and has been addedhas been added in 2005 and in 2005 and is for 2006is for 2006

Patient Demographics Query

Patient Identifier Cross-referencing

Map patient identifiers across independent identification

domains

Cross-Enterprise Document Sharing

Registration, distribution and access across health enterprises of clinical

documents forming a patient

electronic health record

Cross-enterprise Document Point-Point Interchange

Media-CD/USB & e-mail push

Emergency Referrals

Format of the Document Content and associated coded vocabulary

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 ContentImaging Information

Format of the Document Content and associated coded vocabulary

Medical Summary (Meds, Allergies, Pbs)

Format of the Document Contentand associated coded vocabulary

Consistent TimeCoordinate time across networked

systems

Audit Trail & Node Authentication

Centralized privacy audit trail and node to node authentication to create

a secured domain.

Basic Patients Privacy Consents

Establish Consents & Enable Access Control

Document Digital Signature

Attesting “true-copy and origin

Notification of Document Availability

Notification of a remote provider/ health enterprise

Request Formfor Data Capture

External form with custom import/export scripting

Patient Id MgtPatient Id MgtSecuritySecurityClinical and PHRClinical and PHRContentContent

Health Data ExchangeHealth Data Exchange OtherOther

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Health Information Exchanges Interoperability: Health Information Exchanges Interoperability: Cross-enterprise Document SharingCross-enterprise Document Sharing

Cross-Enterprise Document Sharing minimizes Cross-Enterprise Document Sharing minimizes clinical/admin data management by the infrastructure. clinical/admin data management by the infrastructure. Transparency = Ease of EvolutionTransparency = Ease of Evolution

Patients/consumers have guaranteed portability and Patients/consumers have guaranteed portability and providers may share information without concerns of providers may share information without concerns of aggregation errors.aggregation errors.Digital Documents = Patients Digital Documents = Patients andand providers empowerment providers empowerment

Supports Supports both centralized and decentralizedboth centralized and decentralized repository repository architectures. Ease of architectures. Ease of federationfederation nationally. nationally. Flexible Flexible privacy,privacy, Flexibility of configurationsFlexibility of configurations

Has received major support world-wide: Has received major support world-wide: National & regional projects, NHIN contractors, US EHR National & regional projects, NHIN contractors, US EHR Vendor Assoc., complements Vendor Assoc., complements Connecting for Health RLSConnecting for Health RLS..

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Exchange of EHR & PHR Content, Exchange of EHR & PHR Content, Array of document content with many common modulesArray of document content with many common modules

XDS-MSXDS-MSMedicalMedical

DocumentsDocuments

MedicalMedicalSummariesSummaries

ReferralReferral DischargeDischargeSummarySummary

BCCPBCCP

ConsentConsent

EDREDR

EmergencyEmergencyDepartmentDepartment

ReferralReferral

PPHPPPHP

PreprocedurePreprocedureHistory andHistory and

PhysicalPhysical

History andHistory andPhysicalPhysical

XPHRXPHR

PHR UpdatePHR Update

XDS-LABXDS-LAB

Lab ReportLab Report

PHR ExtractPHR Extract

XPHRXPHR

PHR UpdatePHR Update

PHR ExtractPHR Extract

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e.g. Exchange of PHR Contente.g. Exchange of PHR Content

The Exchange of Personal Health Record The Exchange of Personal Health Record Content (XPHR) provides a standards-based Content (XPHR) provides a standards-based specification for enabling interoperability of specification for enabling interoperability of core personal health information between:core personal health information between: a Personal Health Record and a Personal Health Record and either an EHR or another PHR System either an EHR or another PHR System

Supports interchange of PHR Information:Supports interchange of PHR Information: DemographicsDemographics Insurance InformationInsurance Information Medications, Problems, AllergiesMedications, Problems, Allergies Health HistoryHealth History Other InformationOther Information

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PHR System

Internet

Community

Index of patients records(Document-level)

Aggregate Patient Info

Sharing SystemSharing System

Health PayerRecord

Specialist RecordHospital Record

2-Reference2-Referenceto Records to Records for Inquiryfor Inquiry

PHR Systems another edge systemPHR Systems another edge systemNeeds sharing records/documents: IHE-XDSNeeds sharing records/documents: IHE-XDS

4 - Health data 4 - Health data presented to presented to

PatientPatient

SharedRepository of

Documents

Repository ofDocuments

3-Records3-RecordsReturnedReturned

ReferenceReferenceto recordsto records

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IHE Integration StatementsIHE Integration Statements

Explicit claim by the implementor/vendor,Explicit claim by the implementor/vendor, for for a specific product versiona specific product version

Lists IHE Integration Profiles, Actors & OptionsLists IHE Integration Profiles, Actors & Options

Short (1 page) & SweetShort (1 page) & Sweet

Compare apples with apples. Compare apples with apples.

http://http://www.ihe.netwww.ihe.net/resources//resources/ihe_integration_statements.cfmihe_integration_statements.cfm

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Building a RHIO with IHEBuilding a RHIO with IHELeverage a large body of international contributions Leverage a large body of international contributions and experiences. Submit your gaps.and experiences. Submit your gaps.

Suggested ApproachSuggested Approach Define Use Cases of interestDefine Use Cases of interest Match against existing IHE Integration ProfilesMatch against existing IHE Integration Profiles For each use case selected, develop a “RHIO interoperability For each use case selected, develop a “RHIO interoperability

specification” that builds by reference upon the selected set of specification” that builds by reference upon the selected set of IHE Integration Profiles. Include in RFP.IHE Integration Profiles. Include in RFP.

Request vendors (infrastructure and edge systems) to submit Request vendors (infrastructure and edge systems) to submit proposed product IHE Integration Statementsproposed product IHE Integration Statements

Verify vendor participation in IHE ConnectathonVerify vendor participation in IHE Connectathon

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IHE Integration Profiles for Health Info NetsIHE Integration Profiles for Health Info NetsWhat What is availableis available and and has been addedhas been added in 2005 and in 2005 and is for 2006is for 2006

Patient Demographics Query

Patient Identifier Cross-referencing

Map patient identifiers across independent identification

domains

Cross-Enterprise Document Sharing

Registration, distribution and access across health enterprises of clinical

documents forming a patient

electronic health record

Cross-enterprise Document Point-Point Interchange

Media-CD/USB & e-mail push

Emergency Referrals

Format of the Document Content and associated coded vocabulary

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 ContentImaging Information

Format of the Document Content and associated coded vocabulary

Medical Summary (Meds, Allergies, Pbs)

Format of the Document Contentand associated coded vocabulary

Consistent TimeCoordinate time across networked

systems

Audit Trail & Node Authentication

Centralized privacy audit trail and node to node authentication to create

a secured domain.

Basic Patients Privacy Consents

Establish Consents & Enable Access Control

Document Digital Signature

Attesting “true-copy and origin

Notification of Document Availability

Notification of a remote provider/ health enterprise

Request Formfor Data Capture

External form with custom import/export scripting

Patient Id MgtPatient Id MgtSecuritySecurityClinical and PHRClinical and PHRContentContent

Health Data ExchangeHealth Data Exchange OtherOther

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