November 11, 2004 IHE and EHR Seminar
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Transcript of November 11, 2004 IHE and EHR Seminar
November 11, 2004 IHE and EHR Seminar1
Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise
Process and Influence on Radiology and Clinical Workflow
Charles Parisot, GE Healthcare
IHE IT Infrastructure Technical Committee Co-chair
IHE and EHR SeminarIHE and EHR SeminarHelsinki, November 11, 2004Helsinki, November 11, 2004
November 11, 2004 IHE and EHR Seminar2
AgendaAgenda
IHE Goals, Organization and Deliverables
IHE Integration Profiles and Influence on Clinical Workflow
November 11, 2004 IHE and EHR Seminar3
Goals of IHEGoals of IHESpeed 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
Integration solutions within the healthcare enterprise and across healthcare enterprises
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Understanding the IHE InitiativeUnderstanding 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 lead and vendor driven
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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
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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
5 Integration Profiles
3 Integration Profiles
9 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
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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
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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
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IHE Contributors & ParticipantsIHE Contributors & ParticipantsSocieties Representing Healthcare Segments RSNA, HIMSS, ACC, CAR, CHI, ACCE, Many 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 …
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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
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IHE Domains Milestones – 20 month cycleIHE Domains Milestones – 20 month cycleDevelopmentDevelopment and and DeploymentDeployment
Proposed Supplement Scope
Approved Supplement Scope
Public Comment of Supplements 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 Participants pass Connectathon
+ 5 ---
+ 6 --- Demo &Education Material
Vendors release products with IHE Integration
Statements---
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How to participate to IHE?How to participate to IHE?As a User or Vendor Contributor
Become a member of relevant Domains Planning or Technical Committees
Become a member of relevant Regional/National Committees
As a Vendor ParticipantRespond to Public Comments of Domain Supplements
Attend Yearly IHE Regional Educational/Workshops
Participate to Regional Connect-a-thons and Demonstrations
As a User/Consultant ParticipantRespond to Public Comments of Domain Supplements
Attend Yearly Regional Educational/Workshops
Attend Demonstrations and include IHE Integration Profiles in your RFPs and Integration Projects.
IHE Canada, your entry point
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What IHE is NOT!What IHE is NOT!
A standards development organization Uses established standards (HL7, DICOM, others)
to address specific clinical needs Activity complementary to SDOs, formal
relationship with HL7, ISO, 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
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Benefits to IHE ParticipantsBenefits to IHE ParticipantsClinicians Improved workflow Information when and where needed Fewer opportunities for errors Fewer tedious tasks/repeated work
Administrators Improved efficiency Best of breed opportunities Decreased cost and complexity of interface
deployment and management
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Benefits to IHE ParticipantsBenefits to IHE ParticipantsVendors 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
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IHE Technical FrameworksIHE Technical Frameworks
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Key IHE ConceptsKey IHE Concepts• Generalized Systems Generalized Systems -> -> ActorsActors
• Interactions between Actors Interactions between Actors -> -> TransactionsTransactions
• Problem/Solution ScenariosProblem/Solution Scenarios -> -> IntegrationIntegration ProfilesProfiles
• For each Integration Profile:For each Integration Profile:
• the context is described (which real-world problem)the context is described (which real-world problem)
• the actors are defined (what systems are involved)the actors are defined (what systems are involved)
• the transactions are defined (what must they do)the transactions are defined (what must they do)
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Key concept: Key concept: Integration ProfileIntegration Profile
Examples:
Enterprise User Authentication
Retrieve Information for Display
Laboratory Scheduled Workflow
Echo Laboratory Workflow
Cross-Enterprise Document Sharing
Referenced standard
(e.g. HL7)Detailed messaging info --------------------------Roles
Integration Profile
Actor Actor Actor…
Tra
nsac
tion
Tra
nsac
tion
Tra
nsac
tion
Tra
nsac
tion
Tra
nsac
tion
………
Solves an Integration Problem: A collection of real world information exchange capabilities supported by a set of specific Actors using Standards-based Transactions
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IHE ConnectathonIHE Connectathon
Open invitation to vendor community
Advanced testing tools (MESA)
Testing organized and supervised by project management team
Thousands of cross-vendor tests performed
Results recorded and published
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Massive yearly events :Massive yearly events :40-50 vendors40-50 vendors120-160 engineers120-160 engineers70-80 systems70-80 systems…….integrated in 5 days.integrated in 5 days
IHE ConnectathonsIHE Connectathons
Vendors do not pass…Vendors do not pass…until an IHE Project Manager attest it !until an IHE Project Manager attest it !
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Integration StatementsIntegration Statements
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Leveraging IHE Integration Leveraging IHE Integration StatementsStatements
Vendors Claim IHE Compliance in an explicit way Can rely on an objective and thorough specification
(IHE Technical Framework) Willing to accept contractual commitments Willing to correct “implementation errors”
Buyers Can compare product integration capabilities Simplify and strengthen their RFPs Can leverage a public and objective commitment Decreased cost and complexity of interface deployment and
management
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Participating and Contributing Vendors (America)Participating and Contributing Vendors (America)Agfa HealthCareAllscriptsAlgotec Systems, Ltd.BerdyCamtronicsCanon 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)
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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)
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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
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IHE approach to standardsIHE approach to standards
IHE, starts from user defined needs and priorities in a domain
Then selects the standards that: Best address the problem Have the broadest practical acceptance (world-
wide) Are Technically stable Offer potential reuse/integration with other existing
or future integration profiles.
Problem & effectiveness drives standards selection
On-going dialogue with HL7, ISO TC215, DICOM, OASIS, IETF, etc.
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Continuity & Integrity of Patient Information
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
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AgendaAgenda
IHE Goals, Organization and Deliverables
IHE Integration Profiles and Influence on Clinical Workflow
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IHE Radiology Integration ProfilesIHE Radiology Integration Profiles
Patient Info.
Recon-ciliation
Access to Radiology Information
Consistent Present-ation of Images
Basic Security
-
EvidenceDocs
KeyImageNotes
Simple Image & Numeric Reports
Presentation of Grouped Procedures
Post-
Processing Workflow
Reporting Workflow
Charge Posting
Scheduled Workflow
Portable Data for Imaging
NMImage
New
Extensions
New
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imagesstored
patientinformation
RIS
examination orders
imagesretrieved
HIS
PACS
procedurescheduled
Prefetch any relevantprior studies
modalityworklist
report
report
ADT (Registration)
Order Placer
Order Filler
Print Server
FilmFolder
Image Manager& Archive
FilmLightbox
report ReportRepository
ImageDisplay
Modality
acquisitionacquisitionin-progressin-progressacquisitioncompleted
acquisitioncompleted
imagesprinted
AcquisitionModality
Example: IHE Rad Scheduled WorkflowExample: IHE Rad Scheduled Workflow
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Store ImagesStore Images
Storage CommitmentStorage CommitmentStorageStorage
CommitmentCommitment
List of ImagesList of Images
PACS &PACS &ArchiveArchive
RISRIS
ModalityModalityPerformedPerformedProcedure Procedure StepStep
Performed Step:Performed Step:
Status = CompletedStatus = CompletedPerformed CT HeadPerformed CT HeadPat Name/ID, Dose, Pat Name/ID, Dose,
Accession #, Study UIDAccession #, Study UIDComplete List of ImagesComplete List of Images
A Closed LoopA Closed Loop•Update IS SchedulingUpdate IS Scheduling
•Match Procedure with OrderMatch Procedure with Order•Support Billing Based on MPPSSupport Billing Based on MPPS
•Avoid Reading incomplete ProceduresAvoid Reading incomplete Procedures
IHE Scheduled WorkflowIHE Scheduled Workflow
Modality WorklistModality Worklist
WorklistWorklist
Procedure ScheduledProcedure Scheduled
Patient Registration/UpdatePatient Registration/UpdateOrder ManagementOrder Management
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IHE Workflow ConceptsIHE Workflow Concepts
Procedure Steps : The smallest unit of work in the workflow:
SCHEDULED PROCEDURE STEP: ‘A unit of work to do’
PERFORMED PROCEDURE STEP: ‘A unit of work done’
IHE identifies four fundemental workflow information units :IHE identifies four fundemental workflow information units :
REQUESTED PROCEDURE : : A Unit of Reporting WorkA Unit of Reporting Workwithwith associated codified, billable acts associated codified, billable acts
ORDER : A request for radiologic A request for radiologic
serviceservice
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AcquisitionModality
AcquisitionModality
Multiple Modality StepsMultiple Modality Steps
ORDERA request for RadiologicService
Radiology Department
Set of Codifiable,
Billable, ActsOne or more series of images
PerformedProcedure
Step P1
ScheduledProcedure
Step B
RequestedProcedure
1
ScheduledProcedure
Step A
Report
One or more series of images
PerformedProcedure
Step P2
DICOMModality Worklist
DICOMModality Worklist
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MODALITY
IHE – IHE – Presentation of Grouped ProceduresPresentation of Grouped Procedures
Requested Requested Procedure:Procedure:
CHESTCHEST
Report:Report:CHESTCHEST
Requested Requested Procedure:Procedure:ABDOMENABDOMEN
Report:Report:ABDOMENABDOMEN
Performs a single exam
Operatorgroups
2 procedures
Chest Chest ViewView
Abdomen Abdomen ViewView
RIS / PACS
Chest Chest ViewView
Abdomen Abdomen ViewViewScheduled
ProcedureStep Chest Scheduled
ProcedureStep Abdo
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Laboratory IHE Integration ProfilesLaboratory IHE Integration Profiles
Laboratory Device Automation (LDA)
In Process –TI Nov 2004In Process –TI Nov 2004
Pre-analytic process, analysis and post-analytical treatment
Laboratory Scheduled Workflow (LSWF)Completed in 2003Completed in 2003
Tests performed by a laboratory for an identified
inpatient or outpatient
Laboratory Patient Information Reconciliation (LPIR) In ProcessIn Process
Tests performed on an unidentified or misidentified patient
Laboratory Code Set Distribution (LCSD) In ProcessIn Process
Sharing the batteries and tests code sets throughout the enterprise
Laboratory Point Of Care Testing (LPOCT) In Process –TI Nov 2004In Process –TI Nov 2004
Tests performed on point of care or patient’s bedside
In Dev.
In Dev.
In Dev.
In Dev.
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IHE Cardiology 2004-2005IHE Cardiology 2004-2005
Retrieve Information for Display
Access a patient’s clinical information and documents in a format ready to be
presentedto the requesting user
EchoCardiography Worklflow
Admit, order, schedule, acquire images, notify of completed
steps, on fixed and mobile stress echo modalities.
Cardiac Catheterization Workflow
Scheduled & unscheduled acquisition and management of cathlab information, notification
of completed steps.
Provide high-quality ECG and related reportsto the enterprise and outside in a ready-to-display format
Retrieve ECG for Display
New
New
New
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IHE IT Infrastructure 2004-2005IHE IT Infrastructure 2004-2005
Enterprise User AuthenticationEnterprise User Authentication
Provide users a single nameand centralized authentication
processacross all systems
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Retrieve Information for Display
Access a patient’s clinical information and documents in
a format ready to be presented
to the requesting user
Patient Identifier Cross-referencing
for MPIMap patient identifiers
across independent identification domains
Patient Identifier Cross-referencing for
MPI
Map patient identifiers across independent
identification domains
Synchronize multiple applications on a desktop to the
same patient
Patient Synchronized Applications
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
Patient Demographics Query New
Personnel White PageAccess to workforcecontact information
New
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical
documents forming a patient electronic health record
New
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Introduction:EHR Cross-Enterprise Document SharingEHR Cross-Enterprise Document Sharing
First step towards the First step towards the longitudinal dimension of the EHRlongitudinal dimension of the EHR
Focus:Focus: Support document sharing between Support document sharing between EHRs in different care settings and EHRs in different care settings and organizations organizations
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Acute Care (Inpatient)
PCPs and Clinics (Ambulatory)
Long Term Care
Other Specialized Careor Diagnostics Services
Sharing and accessing DocumentsSharing and accessing Documents
EHR-CR: EHR-CR: Care RecordCare Record systems systemssupportingsupporting care delivery care delivery
Documents Registry
DocumentRepository
EHR-LR:EHR-LR:Longitudinal RecordLongitudinal Recordas usedas usedacross-encountersacross-encounters
Submission of Document References
Retrieve of selected Documents
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Standards selection for IHE XDSStandards selection for IHE XDSNo single standard can address
Cross-enterprise Document Sharing
Marriage of healthcare and IT standards facilitates implementation and leverages complementary
technologies (e.g. security & privacy).
HealthcareContent Standards
HL7 CDA, CEN EHRcomASTM CCRDICOM, etc.
Internet StandardsHTML, HTTP,
ISO, PDF, JPEG, etc.
Electronic BusinessStandards
ebXML Registry, SOAP, etc.
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Workshops and Connect-a-thonWorkshops and Connect-a-thon
IHE Workshops: September 13-15 2004 – North America February 7-10 2005 – Europe
2005 IHE Connect-a-thons: January 17-21 – North America February – Japan April 25-29 – Europe (week before HL7 in NL) To Be Announced – Taiwan and Korea.
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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.
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 that publish/share documents (CCR, CDA, HL7-lab, PDF)
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Infrastructure and InteroperabilityInfrastructure and InteroperabilityCross-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) Patient Id Cross-referencing (PIX) Patient Demographics Query (PDQ)
In 2005, IHE plans to complement a set of integration profiles to build regional Health networks, candidates: Security: Identity Management + Info for Access Control Content Profiles: DICOM, HL7-CDA, HL7-Lab, PDF (legacy) Provider Notification (with doc reference) and Point-to-point Transfer Dynamic Clinical Data Mgt (Allergy lists, Problem Lists)
Prioritization of Candidate Integration Profiles November-December 2004. Technical development January-July 2005. Open to all.
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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
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IHE today, more info.IHE today, more info.
IHE Radiology www.rsna.org/ihe TF RAD V5.5 + 4 Trial Impl. Supplements
IHE IT Infrastructure www.himss.org/ihe TF ITI V1.1 + 4 Trial Impl. Supplements
IHE Laboratory www. himss.org/ihe TF LAB V1.0
IHE Cardiology www.acc.org/quality/ihe.htmTF CARD V1.0 for Trial Implementation
IHE Europe IHE Europe IHE–Europe.org