September, 2005What IHE Delivers Michael H. Zaroukian, MD, PhD, FACP Chief Medical Information...
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Transcript of September, 2005What IHE Delivers Michael H. Zaroukian, MD, PhD, FACP Chief Medical Information...
September, 2005 What IHE Delivers
Michael H. Zaroukian, MD, PhD, FACP Michael H. Zaroukian, MD, PhD, FACP
Chief Medical Information OfficerChief Medical Information Officer
Associate Professor of MedicineAssociate Professor of Medicine
Michigan State University Michigan State University
Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise
Achieving Interoperability through Achieving Interoperability through Implementation of StandardsImplementation of Standards
January 16, 2007January 16, 2007
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Presentation ObjectivesPresentation Objectives
IHE: What? Why? Who? How organized? IHE: What? Why? Who? How organized? Healthcare provider role in developing IHE frameworkHealthcare provider role in developing IHE framework
Why standards are not enoughWhy standards are not enough
IHE process for standards adoption and IHE process for standards adoption and implementationimplementation
Benefits, growth, strategies, integrationBenefits, growth, strategies, integration
How to leverage IHE to enable interoperability inHow to leverage IHE to enable interoperability in EnterprisesEnterprises Health information exchanges (HIEs)Health information exchanges (HIEs)
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IHE: A Framework for InteroperabilityIHE: A Framework for Interoperability
A common framework for harmonizing and A common framework for harmonizing and implementing multiple standardsimplementing multiple standards Application-to-application System-to-system Setting-to-setting
Enables seamless health information movement Enables seamless health information movement within and between enterprises, regions, nationswithin and between enterprises, regions, nations
Promotes unbiased selection and coordinated use Promotes unbiased selection and coordinated use of established healthcare of established healthcare andand IT standards to IT standards to address specific clinical needsaddress specific clinical needs
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Why IHE? A Patient-centered ExampleWhy IHE? A Patient-centered Example
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Interoperability: Redesigning the Office VisitInteroperability: Redesigning the Office Visit
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IHE SponsorsIHE Sponsors1997: Founded in Radiology (RSNA) and IT (HIMSS)1997: Founded in Radiology (RSNA) and IT (HIMSS)
Many professional societies (stakeholder representation)Many professional societies (stakeholder representation) American Academy of Ophthalmology (AAO)American Academy of Ophthalmology (AAO) American College of Cardiology (ACC)American College of Cardiology (ACC) American College of Physicians (ACP)American College of Physicians (ACP)
American College of Clinical Engineering (ACCE)American College of Clinical Engineering (ACCE) American College of Emergency Physicians (ACEP) American College of Emergency Physicians (ACEP) American Society for Therapeutic Radiation Oncology (ASTRO)American Society for Therapeutic Radiation Oncology (ASTRO) GMSIH (IT France), JAHIS (IT Japan), SFIL (laboratory)GMSIH (IT France), JAHIS (IT Japan), SFIL (laboratory) Healthcare Information Management Systems Society (HIMSS)Healthcare Information Management Systems Society (HIMSS) Radiological Society of North America (RSNA)Radiological Society of North America (RSNA) And many more….And many more….
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IHE Participants and RelationshipsIHE Participants and Relationships
Participants include:Participants include: Users - Clinicians, Staff, Administrators, CIOs, Governments (e.g. Users - Clinicians, Staff, Administrators, CIOs, Governments (e.g.
NIST, VA).NIST, VA). Vendors - Information Systems and EquipmentVendors - Information Systems and Equipment
• e.g., imaging, cardiology, devicese.g., imaging, cardiology, devices ConsultantsConsultants
Maintains formal liaison with Standards Development Maintains formal liaison with Standards Development Organizations (SDOs):Organizations (SDOs): HL7, DICOM, ISO (Liaison D), othersHL7, DICOM, ISO (Liaison D), others
ISO TC215 (including ANSI) approved IHE Process and ISO TC215 (including ANSI) approved IHE Process and Profiles to be published as technical reportsProfiles to be published as technical reports Concerns expressed by some AHIC members not foundedConcerns expressed by some AHIC members not founded
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IHE Organizational StructureIHE Organizational Structure
ACCACPHIMSSRSNA
JAHISJIRAJRS
METI-MLHWMEDIS-DCJAMI
GMSIHSFRSFIL
SIRMBIREuroRec
COCIREAR-ECRDRG
ESC
Professional Societies / Sponsors Contributing &Participating
Vendors
IHE (International) Strategic Development Committee
Global Development
Radiology
Cardiology
ITInfrastructure
Patient CareCoordination
Patient CareDevices
Laboratory
Pathology
Pharmacy /Medication Admin
RadiationOncology
IHE Europe
IHE North America
France
USA
Canada
IHE Asia-Oceania
Japan
Korea Taiwan
Netherlands
Spain Sweden UK
ItalyGermany
Norway
Regional Deployment
China
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International Adoption of IHEInternational Adoption of IHE
France
Local Deployment National Extensions (Local Adaptions) Promotional & Live Demonstration Events Funding
USA
Germany
Italy
JapanUK
Canada
Korea
Taiwan
Norway
Holland
SpainChina
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Pragmatic global standards harmonization + best practices sharing Pragmatic global standards harmonization + best practices sharing
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Standards: Necessary…Not SufficientStandards: Necessary…Not Sufficient
Standards areStandards are Foundational - to interoperability and communicationsFoundational - to interoperability and communications Broad - varying interpretations and implementationsBroad - varying interpretations and implementations Narrow - may not consider relationships between Narrow - may not consider relationships between
standards domainsstandards domains Plentiful - often redundant or disjointedPlentiful - often redundant or disjointed Focused - standards implementation guides focus only Focused - standards implementation guides focus only
on a single standardon a single standard
IHE provides a standard process for IHE provides a standard process for implementing multiple standardsimplementing multiple standards
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IHE: Connecting Standards to CareIHE: Connecting Standards to Care
Healthcare professionals work with industryHealthcare professionals work with industry
Coordinate implementation of standards to Coordinate implementation of standards to meet clinical and administrative needsmeet clinical and administrative needs Clinicians and HIT professionals identify the key Clinicians and HIT professionals identify the key
interoperability problems they faceinteroperability problems they face Providers and industry work together to develop and Providers and industry work together to develop and
make available standards-based solutionsmake available standards-based solutions Implementers follow common guidelines in Implementers follow common guidelines in
purchasing and integrating effective systemspurchasing and integrating effective systems
IHE: A forum for agreeing on how to implement IHE: A forum for agreeing on how to implement standards and processes for making it happenstandards and processes for making it happen
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Standards Adoption ProcessStandards Adoption Process
Document Use Case Document Use Case RequirementsRequirementsDocument Use Case Document Use Case RequirementsRequirements
Identify available Identify available standards (standards (e.g. HL7, e.g. HL7, DICOM, IETF, OASIS)DICOM, IETF, OASIS)
Identify available Identify available standards (standards (e.g. HL7, e.g. HL7, DICOM, IETF, OASIS)DICOM, IETF, OASIS)
Develop Develop technical technical
specificationsspecifications
Develop Develop technical technical
specificationsspecifications
Testing at Testing at ConnectathonsConnectathonsTesting at Testing at ConnectathonsConnectathons IHE IHE
DemonstrationsDemonstrationsIHE IHE DemonstrationsDemonstrations
Products Products with IHEwith IHEProducts Products with IHEwith IHE
Timely access to Timely access to informationinformationTimely access to Timely access to informationinformation Easy to integrate Easy to integrate
productsproductsEasy to integrate Easy to integrate productsproducts
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Stakeholder BenefitsStakeholder BenefitsHealthcare providers and support staffHealthcare providers and support staff Improved workflowsImproved workflows Information whenever and wherever neededInformation whenever and wherever needed Fewer opportunities for errorsFewer opportunities for errors Fewer tedious tasks/repeated workFewer tedious tasks/repeated work Improved report turnaround timeImproved report turnaround time
VendorsVendors Align product interoperability with industry consensusAlign product interoperability with industry consensus Decreased cost and complexity of interface installation and Decreased cost and complexity of interface installation and
managementmanagement Focus competition on functionality/service space not information Focus competition on functionality/service space not information
transport spacetransport space
SDOsSDOs Rapid feedback to adjust standards to real-worldRapid feedback to adjust standards to real-world Establishment of critical mass and widespread adoptionEstablishment of critical mass and widespread adoption
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Growth in IHE DomainsGrowth in IHE Domains
Radiology (18)
IT Infrastructure for Healthcare (17)
Cardiology (7)
Laboratory (6)
Radiation Oncology (1)
Patient Care Coordination (5)
Patient Care Devices (1)
Quality
Eye Care (3)
Veterinary
Endoscopy
Pathology
Pharmacy
IHE Global DevelopmentsIHE Global DevelopmentsIntegration Profiles (# X) – Solutions to Real-World Interoperability Integration Profiles (# X) – Solutions to Real-World Interoperability
Needs & Problems:Needs & Problems:
Within Clinical Departments e.g.:Within Clinical Departments e.g.:RadiologyRadiologyCardiologyCardiologyLabLab ......
Across Departmental &Across Departmental &Institutional Boundaries – XDSInstitutional Boundaries – XDS
RHIOsRHIOs (Regional Healthcare Information Organizations) (Regional Healthcare Information Organizations)
EHR EnablersEHR Enablers
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IHE Implementation StrategyIHE Implementation Strategy
Leverage established standards to allow rapid deployment and Leverage established standards to allow rapid deployment and plan for futureplan for futurePragmatic, Ease of EvolutionPragmatic, Ease of Evolution
Enable architectural freedom (patient vs. provider centric, Enable architectural freedom (patient vs. provider centric, centralized vs. decentralized, scalable (from office to centralized vs. decentralized, scalable (from office to enterprise to IDN to RHIO) enterprise to IDN to RHIO) ConfigurationConfiguration flexibilityflexibility
Support breakthrough use cases: variety of care settings, care Support breakthrough use cases: variety of care settings, care coordination, public health, PHR, EHRcoordination, public health, PHR, EHRInteroperability for broad constituenciesInteroperability for broad constituencies
IHE: Offers consistent, standards-based record IHE: Offers consistent, standards-based record sharing for EHRs and other information systemssharing for EHRs and other information systems
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IHE based Regional and National EHR Projects IHE based Regional and National EHR Projects (Operational and Planned)(Operational and Planned)
Toronto, Quebec, Alberta, BCCanada Infoway
Austria
THINC- New YorkNCHICA – N. Carolina
Italy (Conto Corrente Salute)
MA-Share – MA
FranceDMP
Philadelphia
HIE
CHINA-MoHLab results sharing
New York HIE
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IHE Integration Profiles for Health Info NetsIHE Integration Profiles for Health Info NetsWhat What is availableis available and has been added and has been added in 2005in 2005 and and 20062006
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 MgmtPatient ID MgmtSecuritySecurityClinical and PHRClinical and PHRContentContent
Health Data ExchangeHealth Data Exchange OtherOther
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IHE: Supporting HHS Goals for NHINIHE: Supporting HHS Goals for NHIN
Healthcare Information
Technology Standards Panel (HITSP)
Nationwide Health Information Network Architecture Projects
(NHIN)
Health Information Security and Privacy
Collaboration (HISPC)
Certification Commission for
Healthcare Information
Technology (CCHIT)
American Health Information Community
Standards harmonization Standards harmonization and adoptionand adoption
Interoperability testingInteroperability testing
Security and privacy standardsSecurity and privacy standardsSpecifications for standards-Specifications for standards-based EHR functionality to based EHR functionality to support RHIOssupport RHIOs
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HITSP Recommended StandardsHITSP Recommended StandardsBiosurveillanceBiosurveillance ICD-9CM – International Classification of Diseases v. 9 Clinical ICD-9CM – International Classification of Diseases v. 9 Clinical
ModificationsModifications ICD-10 CM – Diagnoses and ProceduresICD-10 CM – Diagnoses and Procedures IHE-XDS – Integrating the Healthcare Enterprise (IHE) Cross-IHE-XDS – Integrating the Healthcare Enterprise (IHE) Cross-
Enterprise Document SharingEnterprise Document Sharing IHE-XDS Lab – IHE Laboratory Report Document SharingIHE-XDS Lab – IHE Laboratory Report Document Sharing IHE-RFD – IHE Retrieve Form for Data CaptureIHE-RFD – IHE Retrieve Form for Data Capture IHE-PIX – IHE Patient Identification Cross-ReferencingIHE-PIX – IHE Patient Identification Cross-Referencing IHE-RAD – XDS-I – IHE Cross-Enterprise Sharing of ImagesIHE-RAD – XDS-I – IHE Cross-Enterprise Sharing of Images IHE-NAV – IHE Notification of Document AvailabilityIHE-NAV – IHE Notification of Document Availability IHE-XDS-MS – IHE Medical Summary Document SharingIHE-XDS-MS – IHE Medical Summary Document Sharing ISO/TC215 -DTS 25237 - Health Informatics PseudonymisationISO/TC215 -DTS 25237 - Health Informatics Pseudonymisation LOINC – Logical Observation Identifiers Names and CodesLOINC – Logical Observation Identifiers Names and Codes NCCLS – National Committee for Clinical Laboratory StandardsNCCLS – National Committee for Clinical Laboratory Standards RxNorm – National Library of Medicine RxNormRxNorm – National Library of Medicine RxNorm
IHE contributes to HITSP’s successIHE contributes to HITSP’s success
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HITSP Recommended StandardsHITSP Recommended Standards
Consumer EmpowermentConsumer Empowerment IHE-XDS – Integrating the Healthcare Enterprise (IHE) IHE-XDS – Integrating the Healthcare Enterprise (IHE)
Cross-Enterprise Document SharingCross-Enterprise Document Sharing IHE-PIX – IHE Patient Identification Cross-ReferencingIHE-PIX – IHE Patient Identification Cross-Referencing IHE-PDQ – IHE Patient Demographics QueryIHE-PDQ – IHE Patient Demographics Query Health Level Seven (HL7) CDA R2 – HL7 Clinical Document Health Level Seven (HL7) CDA R2 – HL7 Clinical Document
Architecture Release 2Architecture Release 2 HL7 CCD – HL7 Continuity of Care Document HL7 CCD – HL7 Continuity of Care Document with mappings with mappings
from ASTM E 2369-05 Continuity of Care Record (CCR), X12 N from ASTM E 2369-05 Continuity of Care Record (CCR), X12 N 270/271 and NCPDP Script 8.1.270/271 and NCPDP Script 8.1.
HL7 EHR Systems Functional Model Draft Standard for Trial HL7 EHR Systems Functional Model Draft Standard for Trial Use (DSTU)Use (DSTU)
Logical Observation Identifiers Names and Codes (LOINC)Logical Observation Identifiers Names and Codes (LOINC)
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HITSP Recommended StandardsHITSP Recommended Standards
Electronic Health Record ExchangeElectronic Health Record Exchange IHE-XDS Lab – IHE Laboratory Report Document SharingIHE-XDS Lab – IHE Laboratory Report Document Sharing IHE-PIX – IHE Patient Identification Cross-ReferencingIHE-PIX – IHE Patient Identification Cross-Referencing IHE-PDQ – IHE Patient Demographics QueryIHE-PDQ – IHE Patient Demographics Query Health Level Seven (HL7) CDA R2 – HL7 Clinical Document Health Level Seven (HL7) CDA R2 – HL7 Clinical Document
Architecture Release 2Architecture Release 2 HL7 v. 2.5HL7 v. 2.5 Clinical Laboratory Improvement Amendments (CLIA)Clinical Laboratory Improvement Amendments (CLIA) Logical Observation Identifiers Names and Codes (LOINC)Logical Observation Identifiers Names and Codes (LOINC) Health Insurance Portability and Accountability Act (HIPAA)Health Insurance Portability and Accountability Act (HIPAA) Systematized Nomenclature of Medicine – Clinical Terms Systematized Nomenclature of Medicine – Clinical Terms
(SNOMED – CT)(SNOMED – CT) Unified Code for Units of Measure (UCUM)Unified Code for Units of Measure (UCUM)
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2007 HIMSS Interoperability Showcase2007 HIMSS Interoperability ShowcaseFebruary 26 – March 1, 2007February 26 – March 1, 2007
9,000 square feet of exhibit space 9,000 square feet of exhibit space
67 Showcase participants67 Showcase participants
Secured HIExchange with broad Secured HIExchange with broad contentcontent
HIE with patient care devicesHIE with patient care devices
Personal health record solutionsPersonal health record solutions
New directions focus (Life Sciences New directions focus (Life Sciences Bio-Pharma, HL7 v3.0 PIX/PDQ, Bio-Pharma, HL7 v3.0 PIX/PDQ, ELINCS Lab)ELINCS Lab)
HITSP interoperability specificationsHITSP interoperability specifications
Financial and administrative systems Financial and administrative systems (CAQH/CORE)(CAQH/CORE)
Expanded distributed demonstration Expanded distributed demonstration in a RHIO formatin a RHIO format
Focused tours – International, VIP, Focused tours – International, VIP, CongressionalCongressional
Theater – Education sessionsTheater – Education sessions
Morial Convention Center, New Orleans, LAMorial Convention Center, New Orleans, LA
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How to ParticipateHow to Participate
As a User or Vendor Committee MemberAs a User or Vendor Committee Member
Become a member of relevant Domains Planning Become a member of relevant Domains Planning or Technical Committeesor Technical Committees
As a User, Consultant or Vendor Interested As a User, Consultant or Vendor Interested ObserverObserver
Provide Public Comments on Technical Provide Public Comments on Technical Framework SupplementsFramework Supplements
Attend Demonstrations, Educational Events and Attend Demonstrations, Educational Events and WorkshopsWorkshops
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How to Use IHEHow to Use IHE
As a Vendor ImplementerAs a Vendor ImplementerImplement IHE Integration ProfilesImplement IHE Integration Profiles
Test systems through Connectathon processTest systems through Connectathon process
Publish an IHE Integration Statement for productsPublish an IHE Integration Statement for products
As a User Implementer or ConsultantAs a User Implementer or ConsultantUse IHE Integration Profiles to develop Use IHE Integration Profiles to develop interoperability strategyinteroperability strategy
Use Connectathon Results and Integration Use Connectathon Results and Integration Statements to evaluate vendorsStatements to evaluate vendors
Demand IHE Integration Profile compliance in RFPsDemand IHE Integration Profile compliance in RFPs
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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
http://www.ihe.net
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More Resources - More Resources - www.ihe.netwww.ihe.net
Frequently Asked QuestionsFrequently Asked Questions
Integration Profiles in Technical Frameworks:Integration Profiles in Technical Frameworks: CardiologyCardiology IT InfrastructureIT Infrastructure LaboratoryLaboratory Patient Care CoordinationPatient Care Coordination Patient Care DevicesPatient Care Devices Radiation OncologyRadiation Oncology RadiologyRadiology
Connectathon ResultsConnectathon Results
Vendor Products Integration StatementsVendor Products Integration Statements
Participation in Committees and ConnectathonsParticipation in Committees and Connectathons
September, 2005 What IHE Delivers