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Integrating the Healthcare Enterprise

Integrating the Healthcare Enterprise. What is IHE ?. Charles Parisot, GE Healthcare IHE IT Infrastructure Technical Committee Co-chair IHE Europe Committee Copenhagen, March 17th 2005. W W W . I H E . N E T. Providers and Vendors Working Together to Deliver

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Integrating the Healthcare Enterprise

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  1. Integrating the Healthcare Enterprise What is IHE ? • Charles Parisot, GE Healthcare • IHE IT Infrastructure Technical Committee Co-chair • IHE Europe Committee • Copenhagen, March 17th 2005 IHE and medical Standards in Denmark

  2. W W W . I H E . N E T Providers and Vendors Working Together to Deliver Interoperable Health Information Systems In the Enterprise and Across Care Settings W W W . I H E – Europe. o r g IHE and medical Standards in Denmark

  3. Connecting Standards to Care • Care providers must work with industry to coordinate the implementation of standards to meet their needs • Care providers need to identify the key interoperability problems they face • Drive industry to develop and make available standards-based solutions • Implementers need to follow common guidelines in purchasing and integrating systems that deliver these solutions What is the effective way to establish those “standards” for how to implement standards ? IHE and medical Standards in Denmark

  4. Need for a Standards Implementation Process Demand ? Standards Standards Standards UserProjects Offer IHE and medical Standards in Denmark

  5. Goals of IHE • Speed up the rate and quality of integration in healthcare environments • Foster communication among vendors and care providers (the implementors) • 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 IHE and medical Standards in Denmark

  6. Understanding 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 IHE and medical Standards in Denmark

  7. IHE: Domain-based for a stepwise approach Patient Management Order Management Patient Identifier Linkage, Registries, Security Electronic Health Record Other (e.g. Access Control, eHealthWorkflows) Labora- tory Pharmacy,….. Radiology Cardiology IHE and medical Standards in Denmark

  8. IHE 2005 – Five Active Domains 4 Technical Frameworks with 27 Integration Profiles Testing at yearly Connectathons in three continents Demonstrations at major conferences world-wide Patient Care Coordination Surgery, Pharma, Quality Provider-Vendor cooperation to accelerate standards adoption IHE and medical Standards in Denmark

  9. A Proven Standards Adoption Process IHE Connect-a-thonResults Product IHE IntegrationStatement IHEConnect-a-thon IHEDemonstration Product With IHE Easy to Integrate Products Standards IHEIntegration Profiles B IHEIntegration Profile A RFP IHETechnicalFramework User Site 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 and medical Standards in Denmark

  10. IHE Process • Users 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 IHE and medical Standards in Denmark

  11. IHE Contributors & Participants • Societies Representing Healthcare Segments • EAR, GMSIH, ESC, RSNA, SFIL, HIMSS, ACC, 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, CEN, NCCLS, ISO, others … IHE and medical Standards in Denmark

  12. IHE Strategic Development Committee Global Development RadiologyPlanning Committee IT Infrastructure Planning Committee CardiologyPlanning Committee CardiologyPlanning Committee IT Infrastructure Technical Committee Radiology Technical Committee Cardiology Technical Committee Cardiology Technical Committee LaboratoryPlanning and TechnicalCommittee Pharmacy Exploratory Sub-Committee Professional Societies / Sponsors Contributing and participatingVendors ACC ITAC/CHITTAHIMSS CHIRSNA CAR GMSIH SFRSFIL COCIR EAR-ECR DRG SIRM BIR EuroRec ESC JAHISJIRAJRS METI-MLHW MEDIS-DCJAMI IHE Organizational Structure Regional Deployment IHE North America IHE Asia Japan USA Canada Taiwan Korea IHE Europe France Germany Italy UK Denmark Netherlands Spain Sweden Norway IHE and medical Standards in Denmark

  13. Proposed Supplement Scope Approved Supplement Scope Public Comment Intgr-profile Sponsors announce Connectathon/Demos with set of Implementation Profiles Trial Implementation Intgr-profile Connectathon/Demo Vendor Participant Registered + 2 --- Vendor Participant passed Connectathon + 5 --- Demo &Education Material + 6 --- Final Intgr-profile + 9 --- Vendors release products with IHE Integration Statements --- IHE Process – 20 month yearly cycleDevelopment and Deployment - 10 --- - 7 --- - 2 --- 0 --- IHE and medical Standards in Denmark

  14. 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 IHE and medical Standards in Denmark

  15. IHE Technical Frameworks IHE and medical Standards in Denmark

  16. Key IHE Concepts • Generalized Systems -> Actors • Interactions between Actors -> Transactions • Problem/Solution Scenarios -> IntegrationProfiles • For each Integration Profile: • the context is described (which real-world problem) • the actors are defined (what systems are involved) • the transactions are defined (what must they do) IHE and medical Standards in Denmark

  17. 1st key concept: Actor • Represents a set of application roles and responsibilities performed by a system • Always supported by a real-world system • A real-world system may support several IHE Actors Examples: • Order Placer • Order Filler • Patient Admission, Discharge and Transfer (ADT) • Laboratory Automation Manager • Point Of Care Analyzer IHE leaves the definition of products to users and vendors IHE and medical Standards in Denmark

  18. 2nd key concept: Transaction Order Placer Order Filler New order Order accepted Battery replaced → Placer order management [LAB-1] Acknowledgement Status change Order Placer Order Filler Acknowledgement Example: Transaction LAB-1 « Placer order management » • A set of interactions or messages defined between two Actors for a specific task. • Defines unambiguously how the Actors must cooperate to achieve this task. • Using existing standards such as HL7, DICOM, NCCLS etc. IHE defines transactions at a user-level workflow IHE and medical Standards in Denmark

  19. 3rd key concept: Integration Profile Integration Profile … Actor Actor Actor … … … Transaction Transaction Transaction Transaction Transaction Referenced standard (e.g. HL7) Detailed messaging info -------------------------- Roles • Solves an Integration Problem: • A collection of real world information exchange capabilities supported by a set of specific Actors using Standards-based Transactions Examples:  • Enterprise User Authentication • Retrieve Information for Display • Laboratory Scheduled Workflow • Echo Laboratory Workflow • Cross-Enterprise Document Sharing IHE and medical Standards in Denmark

  20. The Product World….. Product XYZfrom Vendor T IHE and medical Standards in Denmark

  21. The IHE World…. Actor Actor Actor IHETransaction IHETransaction IHE Actor IHE Actor IHETransaction IHE and medical Standards in Denmark

  22. Mapping IHE to Products Actor Actor Actor Product XYZfrom Vendor T IHETransaction IHETransaction IHE Actor IHE Actor IHETransaction IHE and medical Standards in Denmark

  23. IHE 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 IHE and medical Standards in Denmark

  24. Vendors do not pass… until an IHE Project Manager attest it ! IHE Connectathons Massive yearly events : 40-50 vendors 120-160 engineers 70-80 systems ….integrated in 5 days IHE and medical Standards in Denmark

  25. IHE and medical Standards in Denmark

  26. Integration Statements IHE and medical Standards in Denmark

  27. Leveraging IHE Integration Statements • 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 IHE and medical Standards in Denmark

  28. Participating and Contributing Vendors (Europe) AGFA Healthcare AISoftw@re Medical Solutions Algotec ARES SA aycan Digitalsysteme ConVis DEDALUS Dianoema Eastman Kodak Company Ebit Sanita EDL ELFIN s.r.l. Engineering Sanità Enti Locali ESAOTE ETIAM Ferrania Fujifilm GE Healthcare GMD GIE Convergence-Profils 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. 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 In yellow, companies with IHE Committees Chairs (Summer 2004) IHE and medical Standards in Denmark

  29. Participating and Contributing Vendors (America) GE Healthcare Heartlab Hitachi Medical Corporation Hologic, Inc IDX Systems Corporation IMCO Technologies InSiteOne INFINITT Konica Minolta Marotech, Inc. McKesson Information Solutions Medcon Medical Manager Health Systems Mediface Co., Ltd. Merge eFilm Mortara 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 Systems UltraVisual Medical Systems Vital Images, Inc. Voxar Limited WebMD XIMIS Agfa HealthCare Algotec Systems, Ltd. Berdy Camtronics Canon Medical Systems Carefx Cedara Software Corporation Cerner Corporation CSIST Dictaphone DR Systems Dynamic Imaging Eastern Informatics Eastman Kodak Company Emageon Eclipsys Fujifilm Medical Systems In yellow, companies with IHE Committees Chairs (Summer 2004) IHE and medical Standards in Denmark

  30. Participating and Contributing Vendors (Asia) Taiwan INFINITT Shing Shian INQ GEN TEP Tah Ya Japan AGFA Gevaert Japan EBM Japan INFINITT Japan A&T Canon Goodman Climb Medical Systems Konica Minolta MG Shimadzu SONY Toshiba Medical Systems Toyo Technica Nihon Kohden Olympus NEC Pioneer (Marotech) Hitachi Hitachi Medico Fujitsu Fuji Film Medical Yokogawa Korea AGFA Korea GE Healthcare Korea INFINITT LG CNS Marotech, Inc. Medical Standard Peoplenet Communications Samsung SDS IHE and medical Standards in Denmark

  31. Achievements and expanding scope Over 100 vendors involved world-wide, 4 Technical Frameworks 27 Integration Profiles, Testing at yearly Connectathons, Demonstrations at major exhibitions world-wide Patient care Coordination, Quality, Pharmacy, Anatomical Pathology, Surgery, etc. To claim compliance to IHE Integration Profiles vendors shall publish for each product an IHE Integration Statement. IHE and medical Standards in Denmark

  32. IHE Radiology Integration Profiles Extensions Charge Posting Presentation of Grouped Procedures Reporting Workflow New KeyImageNotes Simple Image & Numeric Reports NMImage Consistent Present-ation of Images EvidenceDocs New Access to Radiology Information Portable Data for Imaging Scheduled Workflow - Patient Info. Recon-ciliation Post-Processing Workflow Basic Security IHE and medical Standards in Denmark

  33. Scheduled Workflow Profile report Registration Film Lightbox Image Manager & Archive Orders Filled Film Folder Diagnostic Workstation Film Report Repository Orders Placed AcquisitionModality acquisitioncompleted acquisitionin-progress imagesprinted Modality acquisitioncompleted IHE and medical Standards in Denmark

  34. “Departmental Actors” in SWF IHE Actors: • DSS / Order Filler • PPS Manager • Image Manager /Archive • Acquisition Modality • Evidence Creator • Image Display IHE and medical Standards in Denmark

  35. Example of Radiology Use Cases • Local policy calls for ADT to pre-register ER patients (“John Doe”, “Jane Doe”): • Case 1: Unidentified Patient registered at ADT and order is placed at Order Placer. • Case 2: Unidentified Patient registered at ADT and order is placed at DSS/Order Filler. • Case 3: Unidentified Patient registered at ADT but acquisition completed at Modality prior to order. IHE and medical Standards in Denmark

  36. Unidentified Patient - Case 3 Department System Image Order ADT Database/Scheduler/ Manager Placer Modality Order Filler Register J.Doe Patient Registration [1] Filler Order Mgmt New Order [3] Schedule Procedure Procedure Scheduled [4] Images Acquired Modality Procedure Modality Procedure Step Completed [7] Step Completed [7] Patient Reconciliation J.Doe -> J.Smith Patient Patient Update [12] Update [12] IHE and medical Standards in Denmark

  37. Laboratory IHE Integration Profiles In Dev. Laboratory Scheduled Workflow (LSWF) Completed in 2003 Laboratory Point Of Care Testing (LPOCT) In Process –TI Nov 2004 Tests performed by a laboratory for an identified inpatient or outpatient Tests performed on point of care or patient’s bedside In Dev. In Dev. Laboratory Patient Information Reconciliation (LPIR) In Process Laboratory Device Automation (LDA)In Process –TI Nov 2004 Tests performed on an unidentified or misidentified patient Pre-analytic process, analysis and post-analytical treatment Laboratory Code Set Distribution (LCSD) In Process In Dev. Sharing the batteries and tests code sets throughout the enterprise IHE and medical Standards in Denmark

  38. IHE Cardiology 2004-2005 Retrieve Information for Display EchoCardiography Worklflow Access a patient’s clinical information and documents in a format ready to be presentedto the requesting user Admit, order, schedule, acquire images, notify of completed steps, on fixed and mobile stress echo modalities. New Retrieve ECG for Display Provide high-quality ECG and related reports to the enterprise and outside in a ready-to-display format New Cardiac Catheterization Workflow New Scheduled & unscheduled acquisition and management of cathlab information, notification of completed steps. IHE and medical Standards in Denmark

  39. IHE IT Infrastructure 2004-2005 Personnel White Page New Access to workforcecontact information New Retrieve Information for Display Retrieve Information for Display Cross-Enterprise Document Sharing Access a patient’s clinical information and documents in a format ready to be presentedto the requesting user Access a patient’s clinical information and documents in a format ready to be presentedto the requesting user Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Patient Demographics Query New Audit Trail & Node Authentication New Centralized privacy audit trail and node to node authentication to create a secured domain. Enterprise User Authentication Enterprise User Authentication Consistent Time Provide users a single nameand centralized authentication processacross all systems Coordinate time across networked systems Patient Synchronized Applications Synchronize multiple applications on a desktop to the same patient Patient Identifier Cross-referencing for MPI Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Map patient identifiers across independent identification domains IHE and medical Standards in Denmark

  40. Imaging Information Content Simple Document Content For Display Document Content Lab Results Document Content Continuity of Care Document Content Personnel White Page Access to workforcecontact information Format of the Document Content and associated coded vocabulary Format of the Document Content and associated coded vocabulary Format of the Document Content and associated coded vocabulary Format of the Document Content Format of the Document Content and associated coded vocabulary Patient Identifier Cross-referencing Cross-Enterprise Document Sharing Cross-Enterprise Notification Map patient identifiers across independent identification domains Notification of a remote provider/ health enterprise Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Patient Demographics Query Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. User Identity, Authentication and Permissions Consistent Time Enable Basic Access Control Coordinate time across networked systems IHE Integration Profiles for a “Regional/National Health Info Organization”Includes Integration Profiles in development in 2005 IHE and medical Standards in Denmark

  41. Interoperability within the Enterprise, As well as, Interoperability Across Care Settings More on this, in this afternoon presentation…. IHE and medical Standards in Denmark

  42. W W W . I H E . N E T Providers and Vendors Working Together to Deliver Interoperable Health Information Systems In the Enterprise and Across Care Settings W W W . I H E – Europe. o r g IHE and medical Standards in Denmark

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