IHE for RHIOs, PHR and EHR systems interoperability

1. IHE for RHIOs, PHR and EHR systems interoperability Charles Parisot, GE HealthcareIT Infrastructure co-chair Technical Committee BCBSA, St Louis, June, 2006

2. Standards are critical but alone are not enough • Standards offer generality, ambiguity and alternatives • Standard Implementation Guides are focused on a single standard • Increasing complexity IHE provides a standard process for implementing multiple standards!

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

4. What is Integrating the Healthcare Enterprise? • IHE provides a common framework for passing health information seamlessly: • within the healthcare enterprise • across multiple healthcare enterprises • for local, regional & nationalhealth information networks • IHE is sponsored by healthcare professional associations: HIMSS, RSNA, ACC, ACP, ACCE, ESC, SFR, BIR, GMSIH, etc. • IHE drives standards adoption to address specific clinical or administrative needs

5. IHE Maturity and Acceptance • More than 40 professional organizations & close to 200 healthcare vendors worldwide have contributed to IHE  American College of Physicians (ACP) now a sponsor • Delivery of ready-to-integrate products to benefit healthcare enterprises of all sizes • In clinical use today in enterprises and regional networks • IHE scope, today and in the future • radiology, cardiology, laboratory, oncology, eye care, devices • enterprise healthcare IT infrastructures • cross-enterprise healthcare IT infrastructures • Care coordination, PHR, quality and administrative • RHIO’s and NHIN

6. Testing at Connectathons IHE Demonstrations Develop technical specifications Products with IHE Identify available standards (e.g. HL7, DICOM, IETF, OASIS) Document Use Case Requirements Easy to integrate products Timely access to information Proven Standards Adoption Process

7. IHE 2006 – Nine Active Domains Close to 200 vendors involved world-wide,5 Technical Frameworks 51 Integration Profiles, Testing at Connectathons Demonstrations at major conferences world-wide

8. Introduced at HIMSS in 2005 & 2006 Sharing records/documents: IHE-XDS Health Payer Record Hospital Record Repository ofDocuments Specialist Record SharedRepository ofDocuments Reference to records 4 - Health data presented to Patient 3-Records Returned Aggregate Patient Info Index of patients records (Document-level) Internet Sharing System 2-Reference to Records for Inquiry PHR System Community

9. Health Information Exchanges Interoperability: Cross-enterprise Document Sharing • Cross-Enterprise Document Sharing minimizes clinical/admin data management by the infrastructure. Transparency = Ease of Evolution • Patients/consumers have guaranteed portability and providers may share information without concerns of aggregation errors.Digital Documents = Patients and providers empowerment • Supports both centralized and decentralized repository architectures. Ease of federation nationally. Flexible privacy,Flexibility of configurations • Has received major support world-wide: National & regional projects, NHIN contractors, US EHR Vendor Assoc., complements Connecting for Health RLS.

10. Cross-Enterprise Document Sharing (XDS) Standards Used HealthcareContent Standards HL7 CDA, CEN EHRcomHL7, ASTM CCRDICOM … • Implemented world-wide by more than 30 vendors/open source. Final text published August 2005. • Adopted in several national & regional projects (Italy, France, Canada, Austria, US-NHIN Contractors, RHIOs, etc.). Leverage by US EHR Vendor Association Interoperability Roadmap. • IHE XDS : 40,000 “Google” references (June’ 06) Electronic BusinessStandards ebXML Registry, SOAP … Internet Standards HTML, HTTP,ISO, PDF, JPEG …

11. Cross-Enterprise Document Sharing (XDS) Standards Used at the Document Content Level Ease of reuse of data (financial, clinical and consumer) XDS Doc Content • Medical Summaries (HL7 CDA/CRS+V3) • Imaging (DICOM) • ECG Reports, PDFs • Lab, PHR Extract (CDA) XDS Infrastructure (Document sources, consumers,registries, repostories)

12. Why is IHE-XDS a breakthrough ? • Sharing of digital documents as “attested by the source”, meets the most urgent needs. A proven healthcare community data-sharing paradigm (Message feeding to web servers hinders use of EHRs & PHRs). • Efficient to support all types of Health IT Systems (IDNs, Hospitals, Ambulatory, Pharmacy, Payers, Diagnostics Centers, etc.) and all types of information (summaries, meds, images, lab reports, ECGs, etc.), structured and unstructured. Offer a consistent, standards-based and functional record sharing for EHRs, PHRs & other IT Systems

13. IHE-XDS is part of a family of profiles • Regional, national, local or disease centric networks need a consistent set of Integration Profiles • Nine Integration Profiles completed and tested, plus eight ready to implement = Standards-based interoperability building blocks for • Rich Document Content (structured & simple) for end-to-end application interoperability. • Patient identification management • Security and privacy • Basic workflow IHE-XDS + related IHE Integration profiles provide a complete interoperability solution

14. IHE Integration Profiles for Health Info NetsWhat is available and has been added in 2005 and is for 2006 Lab Results Document Content ECG Report Document PHR Extracts Emergency Referrals Scanned Documents Basic Patients Privacy Consents 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 Establish Consents & Enable Access Control Cross-Enterprise Document Sharing Map patient identifiers across independent identification domains V3Option Imaging Information Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Patient Demographics Query Medical Summary (Meds, Allergies, Pbs) Format of the Document Content and associated coded vocabulary Document Digital Signature Audit Trail & Node Authentication Format of the Document Content and associated coded vocabulary Attesting “true-copy and origin Request Formfor Data Capture Centralized privacy audit trail and node to node authentication to create a secured domain. External form with custom import/export scripting StoredQueries XDS/RLSFederation Consistent Time Notification of Document Availability Cross-enterprise Document Point-Point Interchange Notification of a remote provider/ health enterprise Coordinate time across networked systems Media-CD/USB & e-mail push

15. IHE-XDS Infrastructure Components • Audit Record Repository (ATNA) – Receive audit records from other actors and securely store for audit purposes. ATNA also authenticates peer-nodes and encrypt communications. • Time Server (CT) – Provides consistent definition of date/time enabling time synchronization across multiple systems. Enables events associated with patients to be sorted reliably in chronological order. • Document Registry (XDS) – Queryable index of metadata and references to all documents shared within a connected community (XDS Affinity Domain) • Document Repository (XDS) – Supports storage and retrieval of clinical information (as documents). May be centralized or distributed. • Patient Identifier Cross Reference Manager (PIX) – Reconciles information on patients from multiple domains to a single, cross referenced set of ids for each given patient. • Patient Demographics Supplier (PDQ) – Returns demographic information and identifiers for patients based on specified demographic criteria.

16. EHR System ED Application Physician Office XDS Document Repository PACS XDSDocument Repository EHR System PACS Lab Info. System Teaching Hospital Community Clinic ATNA Audit record repository CT Time server XDS Affinity Domain (NHIN sub-network) XDS Scenario + use of ATNA & CTShowcased at HIMSS 2006 PMS XDS Document Registry Query Document Register Document Secured Messaging Retrieve Document Provide & Register Docs Maintain Time Maintain Time Record Audit Event Maintain Time Record Audit Event Record Audit Event

17. A87631 A87631 A87631 14355 M8354673993 M8354673993 M8354673993 M8354673993 EHR System ED Application Physician Office XDS Document Repository PACS XDS Document Repository EHR System PACS Lab Info. System L-716 L-716 L-716 Teaching Hospital Community Clinic ATNA Audit record repository CT Time server XDS Affinity Domain (NHIN sub-network) XDS Scenario + use of PIX & PDQ Showcased at HIMSS 2006 PDQ Query to Acquire Affinity Domain Patient ID Patient Identity Feed Patient Identity XRef Mgr Patient Identity Feed Affinity Domain Patient Identity Source Patient Identity Feed Patient Identity Feed PIX Query Document Registry PIX Query Query Document (using Pt Id) Register (using Pt ID) Provide & Register Docs Retrieve Document PACS

18. Send to Send to Switch Interchange Media Write Read Workflow Mgr Workflow Mgr Transactions Flexible Infrastructure: Sharing, Sending and Interchanging Health Information Exchange or RHIO XDS Structuredobjects Pull Publish Pull XDP

19. Level 3 Text Structure Med, Problems and Allergies Entry required as highly structured Coded Section Coded Section Coded Section text. Text easy to import/parse Entry Entry Entry Level 3 Text Structure Entry Med Problems a nd Allergies have a required fine - grain structure with optional coding. Coding Scheme not standardized, Text Structure but explicitly identified. Entry XDS-MS Medical Summary Level 1 Structured and Coded Header Patient, A uthor, Authenticator, Institution, Header always structured and coded Time of Service, etc. Level 2 S t r u c t u r e d C o n t e n t w i t h c o d e d s e c t i o n s : S t r u c t u r e d C o n t e n t w i t h c o d e d s e c t i o n s : Title - coded sections with non - structured · Reason for Referral nor coded content (text, lists, tables). · · Vital Signs  Simple Viewing (XML Style sheet) · · M e d i c a t i o n M e d i c a t i o n · Studies · · A l l e r g i e s A l l e r g i e s · Social History · · P r o b l e m s P r o b l e m s XDS-MS enables both semantical interoperability and simple viewing ! · Care Plan

20. Use of a shared XDS infrastructure to access Radiology Reports and Images (XDS-I) Between Radiology and : • Imaging specialists • Non-imaging clinicians Hospital PACS Y Radiology -to-Radiology Radiology -to-Physicians PACS Z Imaging Center Physician Practice Same XDS Infrastructure (Registry and Repositories) for medical summaries and imaging information ! Showcased at HIMSS 2006, planned RSNA Nov 2006

21. XDS-MS MedicalDocuments PPHP BCCP MedicalSummaries History andPhysical Consent XPHR Referral DischargeSummary PHR Extract PreprocedureHistory andPhysical EDR EmergencyDepartmentReferral XDSLAB PHR Update CDA Lab XPHR PHR Extract PHR Update Exchange of PHR Content

22. Exchange of PHR ContentAbstract • The Exchange of Personal Health Record Content (XPHR) provides a standards-based specification for enabling interoperability of core personal health information between: • a Personal Health Record and • either an EHR or another PHR System • Supports interchange of PHR Information: • Demographics • Insurance Information • Medications, Problems, Allergies • Health History • Other Information

23. Exchange of PHR InformationStandards Used • CDA Release 2.0 • ASTM Continuity of Care Data Set • ASTM/HL7 Continuity of Care Document • HL7 Care Record Summary • AHIMA PHR Common Data Elements • IHE XDS and XDP (Point-Point Media/Netwok • Document Digital Signature

24. Exchange of PHR InformationKey Technical Properties • Information is Human Readable • and Machine Processable • Support Point-to-Point (XDP) and Information Sharing Domains (XDS) • Protects Information using Digital Signature • Update Model for EHR to PHR Changes XPHR issued for Public Comment on June 15th, 2006 Comments due July 15th, 2006

25. Implementer Level Allscripts Canon CapMed Cardiac Science CGI-AMS CompassCare CPSI Dictaphone DR Systems Eastman Kodak Eclipsys Epic Systems HIPAAT HX Technologies INFINITT Technology Kryptiq McKesson MedAccess Plus Medical Informatics MediNotes MNI National Institute of Sci & Tech NextGen Healthcare Philips Medical ScImage Witt Biomedical DMP–French Natl. Personal EHR Health Level 7 HTP IEEE Midmark Diagostics Group HIMSS RHIO Federation Liberty Alliance Univ. of Washington Supporter Level: Acuo Bond Carefx Clearcube Organizational participant: American Coll. of Clinical Eng. Catholic Healthcare West US Dept of Defense US Dept of Veterans Affairs Dairyland EMC Identrus Intel Mediserve Medkey Motion Comp. Picis Pulse Sentillion HIMSS IHE Interoperability ShowcaseFebruary 2006 Participants Leadership Level Blue Ware Cerner GE Healthcare +IDX IBM Initiate Systems InterSystems MiSys Healthcare Quovadx Siemens

26. Results • Over 3000 attendees visited the HIMSS RHIO Showcase • 37 vendors demonstrated 48 systems • 700 attendees created and tracked their own health record • 63 educational sessions were presented • 5 International delegations • 3 VIP tours • 16 clinical scenarios were demonstrated

27. IHE Integration Profiles for Health Info NetsWhat is available and has been added in 2005 and is for 2006 Lab Results Document Content ECG Report Document PHR Extracts Emergency Referrals Scanned Documents Basic Patients Privacy Consents 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 Establish Consents & Enable Access Control Cross-Enterprise Document Sharing Map patient identifiers across independent identification domains V3Option Imaging Information Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Patient Demographics Query Medical Summary (Meds, Allergies, Pbs) Format of the Document Content and associated coded vocabulary Document Digital Signature Audit Trail & Node Authentication Format of the Document Content and associated coded vocabulary Attesting “true-copy and origin Request Formfor Data Capture Centralized privacy audit trail and node to node authentication to create a secured domain. External form with custom import/export scripting StoredQueries XDS/RLSFederation Consistent Time Notification of Document Availability Cross-enterprise Document Point-Point Interchange Notification of a remote provider/ health enterprise Coordinate time across networked systems Media-CD/USB & e-mail push

28. Patient Identity XRef Mgr State RHIO Cross-state IDN Cancer Treatment A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 A87631 14355 14355 14355 14355 14355 14355 14355 14355 14355 14355 14355 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 RegistryLocator service Patient Identity XRef Mgr Patient Identity XRef Mgr Patient Identity XRef Mgr Patient Identity XRef Mgr Patient Identity XRef Mgr Patient Identity XRef Mgr Patient Identity XRef Mgr Patient Identity XRef Mgr Affinity Domain Patient Identity Source Affinity Domain Patient Identity Source Affinity Domain Patient Identity Source Affinity Domain Patient Identity Source Affinity Domain Patient Identity Source Affinity Domain Patient Identity Source Affinity Domain Patient Identity Source Affinity Domain Patient Identity Source Affinity Domain Patient Identity Source EHR System EHR System EHR System EHR System EHR System EHR System EHR System EHR System ED Application ED Application ED Application ED Application ED Application ED Application ED Application ED Application EHR System EHR System EHR System PatientIdentityFeed PatientIdentityFeed PatientIdentityFeed PatientIdentityFeed PatientIdentityFeed PatientIdentityFeed PatientIdentityFeed PatientIdentityFeed ED Application ED Application ED Application PACS PACS PACS PACS PACS PACS PACS PACS PIX Query PIX Query PIX Query PIX Query PIX Query PIX Query PIX Query PIX Query Physician Office Physician Office Physician Office RegistryLocator service RegistryLocator service NHIN Backbone EHR System EHR System EHR System EHR System EHR System EHR System EHR System EHR System PACS PACS PACS PACS PACS PACS PACS PACS PACS PACS PACS PACS PACS PACS PACS PACS Lab Info. System Lab Info. System Lab Info. System Lab Info. System Lab Info. System Lab Info. System Lab Info. System Lab Info. System PatientIdentityFeed Document Registry XDS Document Repository PACS PACS PACS RegistryLocator service XDS Document Repository State RHIO PIX Query EHR System EHR System EHR System Sub-Network Sub-Network Sub-Network PACS PACS PACS Patient Identity XRef Mgr Patient Identity XRef Mgr PACS Lab Info. System Lab Info. System Lab Info. System L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 L-716 Affinity Domain Patient Identity Source Affinity Domain Patient Identity Source Integrated Delivery Network Teaching Hospital Teaching Hospital Teaching Hospital PatientIdentityFeed PatientIdentityFeed Document Registry Document Registry XDS Document Repository XDS Document Repository Community Clinic Community Clinic Community Clinic XDS Document Repository XDS Document Repository ATNA Audit record repository ATNA Audit record repository ATNA Audit record repository PIX Query PIX Query CT Time server CT Time server CT Time server PACS PACS XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) Federation of XDS and non-XDS DomainsLeverage Connecting for Health RLS – White Paper Which regisry holds records for a patient ? Sub-Network

29. PHR Extract PHR Update Personal Health Record Service Provider Consumer at Home Medical Summaries Laboratory Reports Imaging Info, ECGs Emergency, H&P. Physician Office / Clinic IHE - Payer-PHR-EHR interoperabilitywith a RHIO Insurance Internet RHIO or Hospital Acute Care / ED Pharmacy

30. Insurance Personal Health Record Service Provider Consumer at Home Internet PHR Extract Medical Summaries Laboratory Reports Imaging Info, ECGs Emergency, H&P. Physician Office / Clinic IHE - Payer-PHR-EHR interoperabilityno RHIO or “RHIO in the PHR” Hospital Acute Care / ED Pharmacy

31. A87631 14355 M8354673993 M8354673993 M8354673993 EHR System Physician Office Query Document XDS Document Repository XDS Document Repository PACS Lab Info. System L-716 L-716 L-716 Community Clinic ATNA Audit record repository CT Time server XDS Affinity Domain (NHIN sub-network) A “PHR Centric RHIO” Patient Identity XRef Mgr PHR Application Affinity Domain Patient Identity Source Document Registry Provide & Register Docs Query Document (using Pt Id) Register (using Pt ID) Retrieve Document PHR Servce Provider

32. A87631 14355 M8354673993 M8354673993 M8354673993 M8354673993 M8354673993 EHR System Physician Office PACS Lab Info. System L-716 L-716 L-716 Community Clinic ATNA Audit record repository CT Time server XDS Affinity Domain (NHIN sub-network) Addresses the PRH-EHR Systems linkage PDQ Query to Acquire Affinity Domain Patient ID Patient Identity Feed Patient Identity XRef Mgr PHR Application Patient Identity Feed Affinity Domain Patient Identity Source PHR System Patient Identity Feed Patient Identity Feed Document Registry XDS Document Repository PIX Query XDS Document Repository Query Document (using Pt Id) Register (using Pt ID) Provide & Register Docs Retrieve Document PHR Servce Provider

33. How can I participate? As a Sponsor: professional associations As a Contributor • Offer Clinical Use Case Input to Drive IHE Profile Development • Become a member of relevant domain’s Planning or Technical Committees • Become a member of relevant Regional/National Committees • Help to shape IHE’s future direction As an Implementor Participant • Respond to Public Comments of Domain Supplements • Attend Educational Workshops • Participate in Connect-a-thons and Demonstrations • Include IHE Integration Profiles in Products and Integration Projects.

34. Healthcare payers community and IHE • Payers are key users of HIT Interoperability. • Encourage your involvement as standards implementation is a priority • Leverage existing IHE Integration Profiles • Clinical and Financial information increased integration • IHE has demonstrated: • Effectiveness and focus on practical industry needs, openness. • Collaboration with Standards Development Organizations (ISO, HL7, DICOM, ASTM, OASIS, IETF, etc). • Acceleration of national initiatives (HITSP, NHIN Contracts, CCHIT Roadmap). • IHE Workshop: June 19-21, Chicago • Change the way healthcare connects: Application deadline Sept 15, 2006, Testing January 2007, HIMSS showcase February 2007.

35. IHE Web site:www.IHE .net • Frequently AskedQuestions • Integration Profiles in Technical Frameworks: See Volume 1 of each TF for Use cases • Cardiology • IT Infrastructure • Laboratory • Patient Care Coordination • Radiology • Connectathon Result: www.ihe.net/Events/connectathon_results.cfm • Products Integration Statements • Participation in Committees & Connectathons

37. Participating and Contributing Vendors (America) Epic Systems Corp. ETIAM Fujifilm GE Healthcare Heartlab HIPAAT Inc. Hitachi Medical Corp. Hologic Hx Technologies IDX Systems Corporation Imco Technologies INFINITT Initiate Systems Inc. InSiteOne Intelerad Medical Systems IBM Intersystems Corporation Konica Minolta Kryptic Marotech, Inc. McKesson MedAccessPlus Health MedCommons Inc Medcon Medical Informatics Eng. Medical Manager Health Mediface Co. Medinotes Medis Medical Imaging Merge eFilm Misys MNI Medicos Mortara NextGen Novell Open Text Corp. Philips Medical Systems Procom Technology Prosolv Cardiovascular QRS Diagnostics Quovadx RADinfo Systems Raining Data RASNA Imaging Systems ScImage Inc. Sectra Imtec Sentillion Shimadzu Corp Siemens Medical Solutns’ Softmedical Stentor, Inc St. Jude Medical StorCOMM, Inc Swissray International, Inc Tiani-Spirit Toshiba Medical Systems T-Systems UltraVisual Medical Syst. Vital Images, Inc. Voxar Limited WebMD Practice Services Witt Biomedical Corp. XIMIS Agfa HealthCare Algotec Allscripts Healthcare Berdy Blueware Camtronics Canon Medical Systems CapMed Cardiac Science Corp. Carefx Cedara Software Corp. Cerner Corporation CGI-AMS CSIST Dictaphone DR Systems Dynamic Imaging Eastman Kodak Company EBM Technologies Eclipsys Emageon In yellow, companies with IHE Committees Chairs (Spring 2006)

38. Participating and Contributing Vendors (Europe) AGFA Healthcare AISoftw@re Medical Algotec ARES SA aycan Digitalsysteme CEGEDIM Cerner Corp. CHILI CMT Medical Tech. Conto Corrente Salute ConVis CTI Mirada Solutions Data Processing SPA DEDALUS Dianoema Eastman Kodak Co. Ebit Sanita EDL ELFIN s.r.l. Engineering Sanità ESAOTE ETIAM Ferrania Fujifilm GE Healthcare GIE Convergence-Profils Global Imaging Online GWI Research Hi. tech IASI Srl IdeoPass INFINITT INFOPATIENT INOVIT INSIEL Intersystems Corp. Invita ITZ Medicom iSoft McKesson MED2RAD MEDarchiver MEDASYS SA Medavis Medical Communications Medigration GmbH MEDIMON Ltd. MEDIWARE MEDOS AG Merge eFilm METAFORA Mevis Diagnostics Konica Minolta Omnilab Philips Medical Systems POLYMEDIS Rasna Imaging Systems RAYPAX INC. REM Rogan-Delft Sago spa Sectra Imtec AB SeeBeyond Technology Siemens Medical Soluzioni Informatiche srl Stentor Inc. St. Jude Swissray Medical AG Symphonie On Line Synapsis Synchro-Med TECHNIDATA TELEMIS S.A. Tiani-Sprit Tomtec Imaging TOREX GAP Medical Toshiba Medical Systems TSI groupe europMedica T-Systems Uni-medicine VEPRO AG VISUS Technology Transfer WAID XR PARTNER In yellow, companies with IHE Committees Chairs (Winter 2005)

39. Participating and Contributing Vendors (Asia) Taiwan INFINITT Shing Shian INQ GEN TEP Tah Ya Japan EBMJ PSP PANASONIC ALOKA KONICA MINOLTA Hitachi Medical Co. KODAK HITACHI SBS INFOCOM CLIMBMS TECHMATRIX CANON VIEWSEND Japan ITEC WINTCS NEC AGFA JMAC GEYMS AJS TOSHIBA YOKOGAWA GOODMAN FUJITSU AANDT FUJIFILM Korea AGFA Korea GE Healthcare Korea INFINITT LG CNS Marotech, Inc. Medical Standard Peoplenet Communications Samsung SDS

40. IHE Integration Statements • Explicit claim by the implementor/vendor, for a specific product version • Lists IHE Integration Profiles, Actors & Options • Short (1 page) & Sweet • Compare apples with apples. http://www.ihe.net/resources/ ihe_integration_statements.cfm