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Integrating the Healthcare Enterprise

Integrating the Healthcare Enterprise. New Integration Profiles - Summary. Courtesy of IHE Committees. IHE Scope. IHE Radiology – Integration Profiles. Scheduled Workflow. Charge. Patient Information Reconciliation. Posting. Admission, Order Management, Scheduling, Store, Retrieve.

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Integrating the Healthcare Enterprise

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  1. Integrating the Healthcare Enterprise New Integration Profiles - Summary Courtesy of IHE Committees

  2. IHE Scope IHE Europe Educational Event

  3. IHE Radiology – Integration Profiles Scheduled Workflow Charge Patient Information Reconciliation Posting Admission, Order Management, Scheduling, Store, Retrieve Manage Worklists, Track Status,Perform &NotifyAcquisitionRelated Steps Presentation of Reporting Post - ReconcileWorklists,StatusandData Objects ForUnknownPatientsandDemographicsChanges Grouped Processing Workflow Procedures Workflow Manage NMImage Manage Manage individual worklists, track worklists, track procedure image status, perform status, perform subsets from a & notify & notify image multi - procedure diagnostic processing & acquisition for reporting steps CAD steps viewing & reporting Simple Image Evidence Consistent Key Image Create,Store,Manage,Retrieve &UseImages and Numeric c Documents Presentation of Notes Reports Images Create, store, Create, store, Create, store, Create, store, manage, retrieve & manage, retrieve & manage, retrieve & manage, retrieve use objects to flag use simple use objects for & use objects to significant images diagnostic reports hardcopy and record study with optional image softcopy grayscale evidence links & presentation states Portable Data for Imaging Access to Radiology Information Basic Security New New IHE Europe Educational Event

  4. IHE Radiology - new • Portable Data for Imaging Profile (PDI) • NM Image Profile • Departmental Workflow IHE Europe Educational Event

  5. Portable Data for Imaging (PDI) • Single Media format definition must be able to support full range of viewing/ import uses • For patient personal records • For referral • For enterprise data interchange • For printing • Media interoperability validation • Browser compatibility IHE Europe Educational Event

  6. PDI – Key principles • Three major use case categories considered: • Media Export (creation of media) • Media Viewing (reading & immediate viewing of media) • Media Import (reading and import of media for use in other IHE workflows) • Single new Transaction (Distribute Imaging Information on Media) defines the required content/ structure of the media. • DICOM DIR (DICOM Part 10) • “web-viewable” data derived from the DICOM data (HTML, JPEG) IHE Europe Educational Event

  7. PDI – Actors and Transactions Distribute Imaging Information on Media Display Image Display Portable Media Creator Report Reader Print Composer Media Importer IHE Europe Educational Event

  8. Nuclear Medicine (NM) Image Profile • New “content” Profile – No new actors or transactions • Profile describes how actors must create, store and retrieve NM Images • Options added to Images Stored Transactions, Query Images and Retrieve Images Transactions IHE Europe Educational Event

  9. Departmental Workflow • Adds options to SWF (2 Supplements) • Appointment Notification • Gives the OF/DSS an option to notify Order Placer of date and time of scheduled examinations. • Using HL7 SIU message • Instance Availability Notification • Gives the Image Manager an option to notify Order Filler and other workflow management actors of availability status of evidence objects. • Alternative to Image Availability Query transaction • Based on DICOM Supplement 93 IHE Europe Educational Event

  10. IHE IT Infrastructure – Integration Profiles 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 Europe Educational Event

  11. IHE IT Infrastructure - new • New Integration Profiles • Patient Demographic Query (PDQ) • Personnel White Pages (PWP) • Audit Trail Node Authentication (ATNA) • Cross-Enterprise Document Sharing (XDS) • ITI Infrastructure has a multi-year roadmap • XDS-related content profiles • Security : Role based authorization • LDAP based applications : e.g. PKI, Configuration management IHE Europe Educational Event

  12. Patient Demographic Query ( PDQ) • Goal: Allow quick retrieval of common patient name, identifier, and location to enable proper patient tracking • Will answer common “questions”: • I have a patient ID and what name, demographics, etc. go with it? • I have partial demographics, e.g. name, and need to find a patient ID? • Based on well established HL7 technologies, though may push the HL7 standard and require Z-queries IHE Europe Educational Event

  13. Personnel White Pages (PWP) • Goal: • Electronic Staff Directory • Provide access to basic information about the human workforce members (email,phone nr) • Single place to store&update • Technology used: • LDAP directory, X500 scheme, HL7 naming scheme IHE Europe Educational Event

  14. Audit Trail & Node Authentication (ATNA) • Scope : • Node authentication, using device certificates • Centralized audit trails • NTP Server • Extends the IHE radiology oriented Basic Security profile (defined in 2002) to be applicable on enterprise level. • Addition of IETF Common Audit Trail message payload • Addition of Reliable Syslog transport protocol IHE Europe Educational Event

  15. ATNA - Backward compatibility • ATNA is backward compatible with Basic Security • Existing applications, supporting Basic Security are ATNA compliant • Basic security is deprecated • No further extensions • New applications are encouraged to use new message format, transport mechanism IHE Europe Educational Event

  16. Cross Document Sharing (XDS) • Focus: • Support document sharing among EHRs in different care settings and organizations IHE Europe Educational Event

  17. XDS – Key principles • Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (HL7-CDA, ASTM-CCR, PDF, DICOM, etc.) • Document Content Neutral: Document content is processed only by source and consumer IT systems. • Distributed: Each Care delivery organization “publishes” clinical information for others. Actual documents may remain in the Care delivery organization. • Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain (e.g. an LHII). • Standardized Registry Attributes:Queries based on meaningful attributes ensure deterministic document searches. IHE Europe Educational Event

  18. XDS – Architecture DocumentRepository Submission of Document References Retrieve of selected Documents Documents Registry Long Term Care Acute Care (Inpatient) Other Specialized Careor Diagnostics Services PCPs and Clinics (Ambulatory) EHR-CR: Care Record systemssupporting care delivery IHE Europe Educational Event

  19. Standards for XDS No single standard addresses XDS Requirements Electronic BusinessStandards ebXML, SOAP … Internet Standards HTML, HTTP,ISO, PDF, JPEG … HealthcareContent Standards HL7 CDA, CEN EHRcomHL7, ASTM CCRDICOM … IHE Europe Educational Event

  20. Other IHE Expansion Domains • IHE Pathology • Explorative phase in Europe (France) • IHE Endoscopy • Explorative phase in Japan & USA • IHE Oncology • Explorative phase in Japan & USA • IHE Dermatology • Explorative phase in Europe (Spain) • IHE Pharmacy / Medication Administration: • Exploratory Phase in USA IHE Europe Educational Event

  21. More information…. • IHE Web sites: • http://www.ihe.net • http://ihe-europe.org • http://www.rsna.org/IHE • http://www.acc.org/quality/ihe.htm • http://ihe-nl.org • Technical Frameworks: • ITI V1.0, RAD V5.5, LAB V1.0, CARDIO V1.0 • Non-Technical Brochures : • IHE Europe Business Case • IHE Fact Sheet and FAQ • IHE Integration Profiles: Guidelines for Buyers • IHE Connectathon Results • Vendor Products Integration Statements IHE Europe Educational Event

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