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Integrating the Healthcare Enterprise

Integrating the Healthcare Enterprise. XDS Cross -enterprise D ocument S haring Overview and Concepts. Charles Parisot, GE Healthcare IHE IT Infrastructure Technical Committee Co-chair. Presentations on XDS. XDS – Part 1: Overview and Concepts XDS – Part 2: Integration Profile Details

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Integrating the Healthcare Enterprise

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  1. Integrating the Healthcare Enterprise XDS Cross-enterprise Document Sharing Overview and Concepts • Charles Parisot, GE Healthcare • IHE IT Infrastructure Technical Committee Co-chair IHE Interoperability Worshop

  2. Presentations on XDS • XDS – Part 1: Overview and Concepts • XDS – Part 2: Integration Profile Details • XDS – Part 3: Transactions • Examples of document content demonstrated with XDS(e.g. CDA, CCR, HL7V2Lab, PDF). This presentation is Part 1 IHE Interoperability Worshop

  3. 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 Interoperability Worshop

  4. 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 Patient Demographics Query New Audit Trail & Node Authentication Registration, distribution and access across health enterprises of clinical documents forming a distributed patient electronic health record 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 Map patient identifiers across independent identification domains IHE Interoperability Worshop

  5. Introduction: EHR Cross-Enterprise Document Sharing First step towards the longitudinal dimension of the EHR Focus: Support document sharing between EHRs in different care settings and organizations IHE Interoperability Worshop

  6. Agenda • Managing a longitudinal patient record. • Cross-enterprise Document Sharing (XDS), operations. • Contribution of documents, organization tools for the physicians • Using XDS in a cardiac care scenario. • Choosing the standards for XDS • Implementation Models • More technical details IHE Interoperability Worshop

  7. Typically, a patient goes through a sequence of encounters in different Care Settings Long Term Care Acute Care (Inpatient) Other Specialized Care(incl. Diagnostics Services) GPs and Clinics (Ambulatory) Continuity of Care: Patient Longitudinal Record IHE Interoperability Worshop

  8. community Hospital Record Laboratory Results Specialist Record Records Sent Clinical Encounter Finding the records of a patient-Manual & tedious The challenge: Finding and accessing easily documents from other care providers In the community. Clinical IT System IHE Interoperability Worshop

  9. Sharing records that have been published community Hospital Record Laboratory Results Reference to records Specialist Record 4-Patient data presented to Physician Temporary Aggregate Patient History Index of patients records (Document-level) 3-Records Returned Clinical IT System Sharing System 2-Reference to Records for Inquiry 1-Patient Authorized Inquiry Clinical Encounter IHE Interoperability Worshop

  10. Building and accessing Documents DocumentRepository Submission of Document References Retrieve of selected Documents Documents Registry EHR-LR:Longitudinal Recordas usedacross-encounters Long Term Care Acute Care (Inpatient) Other Specialized Careor Diagnostics Services PCPs and Clinics (Ambulatory) EHR-CR: Care Record systemssupporting care delivery IHE Interoperability Worshop

  11. XDS – Value Proposition • Foundation for Health IT Infrastructures: Shared Electronic Health Record, in a community, region, etc. • Effective means to contribute and access clinical documents across health enterprises. • Scalable sharing of documents between private physicians, clinics, long term care, pharmacy, acute care with different clinical IT systems. • Easy access: Care providers are offered means to query and retrieve clinical documents of interest. IHE Interoperability Worshop

  12. XDS - Value Proposition • Distributed: Each Care delivery organization “publishes” clinical information for others. Actual documents may remain in the source EHR-CR. • 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). • 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. • Standardized Registry Attributes:Queries based on meaningful attributes ensure deterministic document searches. IHE Interoperability Worshop

  13. IHE XDS Integration Profile: Key Concepts • XDS Document • XDS Submission Set • XDS Folder IHE Interoperability Worshop

  14. Document Repository and RegistryExample of Submission Request Submission Request Folder A SubmissionSet 1 DocumentEntry DocumentEntry Document Document Document Registry Document Repositories IHE Interoperability Worshop

  15. IHE XDS Integration Profile: Key Concepts XDS Document • A set of attested clinical information (structured or not) which form an element of a patient record to be shared. It may already exist within the source IT system. XDS Submission Set • A set of documents related to a patient that a (team of) clinician(s) in the same source system have decided to make available to potential consumers. XDS Folder A means to group documents for a number of other reasons: • Team work across several physicians, • Episode of care, • Emergency information for a patient, etc. XDS leaves open the use of folders to affinity domain clinicians. IHE Interoperability Worshop

  16. Cardiac Care Scenario (1) IHE Interoperability Worshop

  17. Cardiac Care Scenario (2) IHE Interoperability Worshop

  18. Integration Model 1: EHR-CR with Repository at Source • An EHR-CR completes a phase of care for a patient where it: • Has these documents available as Repository Actor. • Registers documents with a Registry actor. • Any other EHR-CR may query the Registry actor, and chose to retrieve some of these documents from any Document Repository Actor. IHE Interoperability Worshop

  19. Integration Model 2: EHR-LR with Third Party Repository • An EHR-CR completes a phase of care for a patient where it: • Provides the documents to a Repository Actor of its choice. • Documentsare Registered with a Registry Actor. • Any other EHR-CR may query the Registry actor, and chose to retrieve some of these documents from any Document Repository Actor. IHE Interoperability Worshop

  20. Integration Model 3: EHR-CR feed a EHR-CR/EHR-LR hub • An EHR-CR completes a phase of care for a patient where it: • Provides and Registers a set of documents to a Document Repository in an EHR-CR. • The EHR-CR Consumer Actor has the documents and may respond to queries and provide them to other document consumers. IHE Interoperability Worshop

  21. Patient Access also possible • A patient accesses own record: • Query and Retrieve a set of documents using for example a portal application that offers the ability to display documents’ content. • This is a particular case of an EHR-CR, where the patient is interested her/his own care. Patient may also register and provide documents. IHE Interoperability Worshop

  22. Standards selection for IHE XDS No single standard can addressCross-enterprise Document Sharing Electronic BusinessStandards ebXML, SOAP, etc. Internet Standards HTML, HTTP,ISO, PDF, JPEG, etc. HealthcareContent Standards HL7 CDA, CEN EHRcomHL7, ASTM CCRDICOM, etc. Marriage of healthcare standards facilitates implementation and leverages complementary technologies (e.g. security & privacy). IHE Interoperability Worshop

  23. Conclusion: IHE Cross-Enterprise Document Sharing • IHE does not claim with XDS to address all aspects of a complete and interoperable EHR System. • Access Control and Doc Content Profiles are on the IHE Roadmap for 2005. • In collaboration with well established standards bodies (HL7, ASTM, CEN, OASIS, IETF, DICOM, etc.) and other EHR related initiatives world-wide (EuroREC, etc.), IHE expects to contribute at a more cost-effective and rapid deployment of community, regional and national health IT infrastructures. IHE Interoperability Worshop

  24. XDS – Conclusion • Foundation for EHR & Health IT Infrastructures • Effective contribution and access to shared documents across all types of health enterprises • Scalable, Flexible and Easy access • XDS to be one of the major highlights of 2005 Annual HIMSS Conference & Exhibition. Dallas, Tex., Feb. 13-17: • used as a foundation for an on-site demonstration of interoperability in support of a National Health Information Networks. • Attendees at the conference will be able to create and share their own health records across vendor booths as well as in the ambulatory and acute care settings on the conference exhibit floor. IHE Interoperability Worshop

  25. How real is XDS ? • Specification work since Nov 2003 • Under Public Comments June-July 2004 • 600 constructive comments received. • Validity of XDS approach confirmed (e.g. CfH Roadmap). • Stable specification IHE Technical Framework Published Aug 15th, 2004 (TI Supplement) • IHE Connectathon - January 2005 (USA) • HIMSS Feb 2005 - show-wide demonstration • IHE Connectathon - April 2005 (Europe) Several Implementation Projects by health authorities in 2005 IHE Interoperability Worshop

  26. More information…. • Web sites: www.himss.org/ihe www.rsna.org/ihe www.ihe-europe.org • IHE IT Infrastructure Technical Framework - V 1.0 - Final Text (5 Integration profiles) • IHE IT Infrastructure Technical Framework Supplements for 2004-2005 Trial Implementation (4 Integration Profiles) • Issue resolutions at http://forums.rsna.org, IHE forum,IT Infrastructure sub-forum. • Non-Technical Brochures : • IHE Brochure, IHE Fact Sheet • IHE Connectathon Results • IHE Products Integration Statements IHE Interoperability Worshop

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