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An Introduction to Integrating the Health Enterprise

An Introduction to Integrating the Health Enterprise. Dr Vincent McCauley Chair, IHE Australia. Radiology. IT Infrastructure. Laboratory. Cardiology. Patient Care Coordination. Pathology. IHE Europe. Austria. France. Germany. Netherlands. Radiation Oncology. Patient Care Devices.

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An Introduction to Integrating the Health Enterprise

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  1. An Introduction toIntegrating the HealthEnterprise Dr Vincent McCauley Chair, IHE Australia

  2. Radiology IT Infrastructure Laboratory Cardiology Patient Care Coordination Pathology IHE Europe Austria France Germany Netherlands Radiation Oncology Patient Care Devices Eye Care Italy Norway Spain UK Sweden Public Health, Quality and Research IHE Asia-Pacific Australia Malaysia New Zealand Professional Societies / Sponsors ACC ACCE ACEP HISA ACP GMSIHIMSS HL7 AUS Contributing & ParticipatingVendors ESC COCIR EAR-ECR DRG RANZCR SIRM BIR EuroRec RACS RSNA SFRSFIL MSIA JAHISJIRAJRS METI-MLHW MEDIS-DCJAMI IHE Organizational Structure IHE International Board Global Development Regional Deployment IHE North America IHE Asia USA China Japan Canada Korea Taiwan 2

  3. IHE Australia Organisational Structure • IHE Australia Sponsors - Health Informatics Society of Australia (HISA) - Health Level Seven (HL7) Australia - Medical Software Industry Association (MSIA) - Royal Australasian College of Radiologists (RANZCR) • Some Australian Supporting IHE members - Health Information Management Society (HIMMS) - Royal Australian College of Surgeons (RACS) - Australian Diagnostic Imaging Association (ADIA)

  4. IHE Domains • Radiology • Cardiology • Radiation Oncology • IT Infrastructure • Patient Care Coordination • Patient Care devices • Laboratory, Pathology, Eye Care. • Pharmacy • Quality Research and Public Health

  5. IHE Value Proposition • IHE Solutions are Driven by Strategic Healthcare Lead Users that collaborate with Healthcare Vendors • IHE Solutions are Generic, Reusable and Interoperable based on Healthcare Standards: DICOM, HL7, RFC • IHE Solutions Optimize the Clinical Workflows • IHE Deployment process – Connectathon, Integration Statements and Users Success Stories information helps to refine the product “Business Case” • IHE Technical Framework specification describes the Global IHE solutions at a High Level for Planning & Marketing and in details for products Architects and Engineering development

  6. IHE Benefits • Clinical Users • Greater access to consistent information • Fewer errors, fewer tedious tasks • Buyers • Specify/purchase RFP’s integration capabilities easily and Freedom to acquire “Best of Breed” systems • IT Professionals • Faster, more predictable integration projects • Facilitate cooperation of competing vendors • Administrators • Increased throughput - Better scheduling • Reduce Cost

  7. IHE Profile Examples • (XDS/XDS-I) Cross-Enterprise Document Sharing for Imaging • Shares clinical documents, images, diagnostic reports and related information between healthcare enterprises • (PIX) Patient ID Cross-referencing • Cross-index patient IDs across multiple sites • (PDQ) Patient Demographics Query • Query and retrieve a patient’s demographic and visit information • (ATNA) Audit Trail and Node Authentication • Systems Authentication • Audit events management • (BPPC) Basic Patient Privacy and Consent • Patient privacy consents & enforcement

  8. IHE Problem Solution Process • User driven, Vendor led – A standardised process ISO TR28380 • Working with vendors, care providers and standards organizations, IHE: • Distills a clear description of the problem (Users) • Determines the right way to solve it using standards (Vendors)(IHE Profile) • Documents the solution in an implementation guide (IHE Technical Framework) • Coordinates cross-vendor testing of the solution (IHE Connectathon) • Demonstrates vendor implementations (IHE Showcase) Go see the rest of the profiles

  9. IHE Testing Process Users Testing Results Deploy Systems Testing Tools Sponsors:Project Management Team Develop Testing Tools Approves Test Logs Connectathon Product +IntegrationStatement Implement Profile Actors In-House Testing Vendors Sponsors: Exhibits Demonstration IHE Technical Framework (IHE Profile Specifications)

  10. What is a Connectathon? Cross-vendor, live, supervised, structured tests • All participating vendors’ products tested together in the same place/time • Experts from each vendor available for immediate problem resolution… fixes are done in minutes, not months!! • Each vendor tests with multiple trading partners (actual product to actual product) • Testing of real-world clinical scenarios using IHE Integration Profiles

  11. PACS [Media Importer] PC Browser Image Display [Media Reader] Printer [Media Reader] John Doe A “simple” IHE Profile - Portable Data for Imaging DICOM Media Creator DICOM Data DICOM Web Data(Optional) CD Required to cleanup Patient ID, Acc#, etc. DICOM Web Data

  12. IHE Integration Profiles for Health Info Nets Basic Patients Privacy Consents Emergency Referrals PHR Extracts/Updates Format of the Document Content and associated coded vocabulary Establish Consents & Enable Access Control Patient Demographics Query 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 Cross-Enterprise User Attestation Format of the Document Content and associated coded vocabulary Patient Identifier Cross-referencing Imaging Information Format of the Document Content User Attributes fro Access Control Medical Summary (Meds, Allergies, Pbs) Format of the Document Content and associated coded vocabulary Map patient identifiers across independent identification domains Document Digital Signature Format of the Document Content and associated coded vocabulary Attesting “true-copy and origin Cross-Enterprise Document Sharing Audit Trail & Node Authentication Request Formfor Data Capture Registration, distribution and access across health enterprises of clinical documents forming a longitudinal record Centralized privacy audit trail and node to node authentication to create a secured domain. External form with custom import/export scripting Notification of Document Availability Cross-Enterprise Document Pt-Pt Reliable Interchange Consistent Time Notification of a remote provider/ health enterprise Coordinate time across networked systems Cross-Community Access Cross-Enterprise Document Media Interchange Security & Privacy Clinical and PHR Content Patient ID Mgmt Health Data Exchange Other Final Text Approved Trial Implementation-2007 –Final Txt 2008

  13. Austria IHE, global standards-based profiles adopted by several national & regional projects Lower Austria Netherland Amsterdam Italy (Conto Corrente Salute) UK CfH (Radiology WF) Denmark (Funen) Italy (Veneto) Spain (Aragon) FranceDMP Quebec, Toronto,Alberta, British ColumbiaCanada Infoway VITL-Vermont Boston Medical Center - MA Philadelphia HIE KeyHIE – Pennsylvania CareSpark – TN & VA South Africa NCHICA – N. Carolina Malaysia Singapore CHINA-MoH Lab results sharing JAPAN-Nagoya Imaging Info Sharing CHINA-Shanghai Imaging Info Sharing

  14. IHE Problem Solution Process

  15. From Standards to Solving a Use Case Business Use Case • NeHTA • PIP WG • Standards Australia Interoperability Specifications + Constructs Standards Adoption/Profiling Technical Use Case Driven IHE HL7, OMG, X12, DICOM, ISO, W3C etc… Base Standards Foundations

  16. IHE AustraliaConformanceTesting • IHE Conformance Testing supervised by NATA accredited Testing Laboratory (AHML) Certification Interoperability Specifications + Constructs Standards Adoption/Profiling Technical Use Case Driven Base Standards Foundations

  17. IHE Chicago Connectathon 2010

  18. IHE Chicago Connectathon 2010

  19. IHE Chicago Connectathon 2010 • 104 vendors • 150 applications • 498 engineers • Approx. $2 million in employee costs over 5 days • 77 IHE Profiles

  20. Australian Secure Messaging Specification development process • DoHA PIP GP eHealth initiative January 2009 • Initial NeHTA Secure Message Delivery (SMD) specification • Joint Vendor (MSIA) / NEHTA working group refined specification - 25 Vendors, 6 meetings, 9 days - Technical sub-committee – 6 vendors, 4 meetings 8 days

  21. Australian Secure Messaging Specification development process • Output of PIP Working Group submitted to Standards Australia Nov 2009 - 3 Technical Specifications + 1 technical report • Standards Task force • Rapid public comment and publication => Four publications January 2010 • ATS-5822:2010 – Secure messaging delivery

  22. Australian Secure Messaging Specification development process • Continuing work by Conformance/Compliance subcommitee • NEHTA alpha code available March 2010

  23. Secure Messaging Connectathon • Funded by DoHA, contribution by vendors • Testing single standard – Secure Message Delivery ATS-5822:2010 • Standardised content available as IHE Australia profiles for eResults (ATS 5201:2010) and eReferral • Master Class and testing streams

  24. Secure Messaging ConnectathonTooling • Test management using Gazelle (IHE International) • Java alpha code (NEHTA) • Pre-connectathon remote capability testing (AHML) • Connectathon Functional Test harness and process (AHML)

  25. Useful Links www.ihe.net www.ihe.net.au http://ihe-australia.wikispaces.com http://wiki.ihe.net http://motorcycleguy.blogspot.com/2010/01/where-in-world-is-xds.html

  26. Italy (Genoa Region)

  27. Italy (Genoa Region) • In service since January 2006. • 4 Hospitals and 500 physician offices. • EMRs import and export documents from their local records. • All vendor products required to pass IHE-Europe connectathon in April 2005. • Patients chose to join through one of their care provider • Infrastructure includes: • XDS Registry • XDS Repository shared at the regional level • PIX for patient Id linking • Doc content is CDA with PDF content. Plan in place to move to CDA rel 2 with structured data. IHE (XD*-Lab) CDA Lab primary candidate.

  28. Lower Austria Austria Austria (Lower Austria and National) • Lower Austria Region (around Vienna) Deployed in 2007 - Operational. 1.5 Million patients on-line. 11 hospitals connected. • Use IHE profiles: XDS, PIX, XDS-SD, ATNA, XUA, BPPC. • National project launched in 2007 (ELGA). Given the success to deploy the first region is about one year. • Roll-out includes: • Ministry backing of IHE conformance (IHE-Eu Connectathon) • Extending to Ambulatory Physicians in 2008 • Step-wise introduction of structured and coded content with HL7 CDA based IHE Content Profiles.

  29. USA (Philapdelphia Region) • Philadelphia Health Info Exchange in service since 2005. Focused on images and reports sharing. • 5 Hospitals + Imaging Center + Public Health • The Hospital of the University of Pennsylvania • Thomas Jefferson University Hospital • Children’s Hospital of Philadelphia • Presbyterian Medical Center • Pennsylvania Hospital • UPHS Community Radiology • Philadelphia Department of Public Health • Migration to XDS, ATNA, PIX and XDS-I completed in 2007. • Demonstrated live at RSNA-Chicago Nov 2007

  30. USA (Other) • HITSP (HHS sponsored) accepted 8 IHE Integration profiles for: Lab results distribution and sharing, Registration and Medication History for Consumers, Biosurveillance. • 2 NHIN-1 Pilots (CSC and IBM) leveraged IHE profiles (Med Summaries and Lab). • South Shore, MA: Operational (Inpatient and Emergency Dept) • NHIN-2 Trial Implementations (NCHICA, Virginia & CareSpark HIEs) • Several HIEs projects are actively planning the use of IHE • Vermont State • KeyHIE (PA) • eHealthConnecticut • Boston Medical Center and affiliated clinics

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