Accelerating Healthcare Standards Adoption with IHE Process

1. Process and IT InfrastructureStandards Drive Healthcare Solutions San Diego, Jan 2004 Charles Parisot IHE Planning Committees: IT, Radiology, Laboratory, Cardiology GE Medical Systems – Information Technology

2. Outline • IHE Process Overview • IHE for IT Infrastructure • IHE for Laboratory • IHE for Radiology • IHE Cardiology established first output expected for end of 2004

3. IHE Process Overview IHE introduces a novel process to accelerate the adoption and to facilitate use of standards in healthcare

4. IHE Mission Bring together stakeholders to implement standards for communicating clinical and operational data safely and efficiently throughout the healthcare enterprise

5. IHE Vision To provide relevant patient information at the point of care to support caregiver decision-making and optimal patient care

6. What is IHE? • A joint initiative to improve systems integration • Process for coordinated adoption of standards • Clinicians/IT staff define needs • Vendors develop solutions—Technical Framework • Professional societies supervise documentation, testing and demonstration/promotion

7. Goals of IHE • Speed up the rate and quality of integration in healthcare environments • Foster communication among vendors • Prove that integration is attainable based on standards • Improve the efficiency and effectiveness of clinical practice

8. What IHE is NOT! • A standards development organization • Uses established standards (HL7, DICOM, RFCs, others) to address specific clinical needs • Activity complementary to SDOs, formal relationship with HL7 and DICOM. • Simply a demonstration project • Demos only one means to the end—adoption • Backed up by documentation, tools, testing, and publication of information

9. IHE Participants • Societies Representing Healthcare Segments • ( Radiology, Lab, IT Professional Societies… ) • Users • ( Clinicians, Medical Staff, Administrators, CIOs, … ) • Information Systems Vendors • Clinical Systems and Device Vendors • Standards Development Organizations (SDOs) • HL7 • DICOM • Others …

10. Benefits to IHE Participants • Clinicians • Improved workflow • Information when and where needed • Fewer opportunities for errors • Fewer tedious tasks/repeated work • Administrators • Improved efficiency • Best of breed opportunities • Decreased cost and complexity of interface deployment and management

11. Benefits to IHE Participants • Vendors • Decreased cost and complexity of interface installation and management • Validation of integration at Connectathon • Focus competition on functionality/service space not information transport space • SDOs • Rapid feedback to adjust standards to real-world • Establishment of critical mass and widespread adoption

12. Product IHE IntegrationStatement IHEConnectathon IHEDemonstration Product With IHE Easy to Integrate Products Standards IHEIntegration Profiles B IHEIntegration Profile A RFP A Proven Standards Adoption Process IHE ConnectathonResults 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

13. Result Matrix of the Radiology Connectathon

14. The Annual “Connectathon” • Unprecedented Cross-Vendor Testing • Voluntary Participation • Neither a Demo nor a Certification • Well Designed End-to-End Scenarios • Advanced Testing Tools • Unprecedented Pool of Technical Talent • Connectathon for IT InfrastructureSan Diego January 26-30, 2004 • Connectathon for IT Infrastructure, Laboratory & Radiology - Padova (Italy) March 29-April 2, 2004 • Connectathon for Radiology and IT InfrastructureTokyo – March 2004 • Connectathon for Radiology - Chicago October 2004

15. IHE Resources Proven process with strong participation Five years of documentation, testing, demos Technical Framework MESA Tools and Connectathon 2003: 36 vendors in USA 2003: 43 vendors in Europe Strong recognition and credibility of concept Promotional opportunities at major professional venues world-wide: HIMSS, RSNA, JRC, Hopital Expo, DRG, UKRC, SIRM, JFR, Medica

16. Radiology Laboratory Cardiology National Extensions National Extensions National Extensions National Extensions National Extensions National Extensions National Extensions National Extensions Global Development IHE Domains andRegions IT Infrastructure IHE Technical Framework Local Deployment IHE North America IHE Europe EAR, ECR, COCIR IHE Asia Japan JIRA, JAHIS, METI, JRS, JSRT, JAMI France GMSIH, SFR, SFL, United States of America HIMSS, RSNA, ACCE, ACC Germany DRG, ZVEI Korea Canada Infoway, CAR, Italy SIRM, Taiwan United Kingdom BIR, RCR, NHS, Norway, Sweden, Dennemark IHE Connectathons, Education, Demonstrations

17. 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)

18. Actors • Represent a set of roles and responsibilities performed by a system • A real-world system may support several IHE Actors Examples: • Order Placer • Order Filler • Patient Identifier Cross-Referencing Mgr • Laboratory Automation • Report Creator

19. Transactions • Unambiguously defines how actors communicate • Using existing standards such as HL7 or DICOM to accomplish a specific task. Examples:  • Procedure Scheduled • ADT Update • Retrieve Document for Display

20. Integration Profiles IHE Integration Profiles define a collection of real world functionality and group together the necessary Actors and Transactions to make it work. Examples:  • Enterprise User Authentication • Retrieve Information for Display • Laboratory Scheduled Workflow • Patient Information Reconciliation

21. Patient Management Order Management Patient Identifier Linkage, Registries, Security Electronic Health Record Enterprise Scheduling Labora- tory Pharmacy,….. Radiology Cardiology IHE: A stepwise approach

22. IHE Integration Statement

23. HL7 & IHEJoint Demonstrationat HIMSS 2004

24. New at HIMSS in 2004 • In 2002 and 2003, IHE and HL7 have held separate demonstration • HL7 demos were « throw away » • IHE demos were « radiology centric » • IHE is now in Healthcare IT - 5 new profiles to be showcased at HIMSS 2004 • HL7 and IHE have decided this year to combine their demos and convey a 2 tier message: • HL7 broad in scope but leaves choices for interoperability • IHE Profiles are narrow in scope but high interoperability

25. HL7-IHE Interoperability demo • Demo scenario integrates 3 components: • - IHE IT Integration Profiles, and selected domain specific Profiles (e.g. Radiology). • - HL7 standard functions • - HL7 draft standard functions • Demo highlights how each component feeds into other and contributes to successful driving of standards in healthcare solutions.

26. HL7-IHE Interoperability demo • Live technology & product interoperability demonstration • At the center of the commercial exhibit floor at HIMSS, February 2004 • Promoted by HIMSS-signage show-wide.

27. Product XYZfrom Vendor T The Product World…..

28. Actor Actor Actor The IHE World…. IHETransaction IHETransaction IHE Actor IHE Actor IHETransaction

29. Actor Actor Actor Poduct XYZfrom Vendor T Mapping IHE to Products IHETransaction IHETransaction IHE Actor IHE Actor IHETransaction

30. The IHE Technical Approach • Identify the transactions required to integrate a specific information flow between several information systems/devices • For each transaction, select a single standard (e.g.HL7 messages, RFC) for use in implementing the transaction • Specify in detail the use of the standard in implementing the transaction

31. IHE : An Integration ProfileA Solution to an Integration Problem Actorscooperating throughTransactionsto perform a specifictask Report Creator 24: Report Submission Structured Report Export: 28  Report Manager Enterprise Report Repository 25: Report Issuing Report Repository External Report Repository Access 26: Query Reports 27: Retrieve Reports Report Reader

32. Overview of IHE IT Infrastructure Integration Profiles

33. Retrieve Information for Display Retrieve Information for Display Enterprise User Authentication Enterprise User Authentication Patient Synchronized Applications Patient Synchronized Applications 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 Synchronize multiple applications on a desktop to the same patient Synchronize multiple applications on a desktop to the same patient Provide users a single nameandcentralized authentication processacross all systems Provide users a single nameandcentralized authentication processacross all systems Patient Identifier Cross-referencing for MPI Patient Identifier Cross-referencing for MPI Consistent Time Consistent Time Coordinate time across networked systems Coordinate time across networked systems Map patient identifiers across independent identification domains Map patient identifiers across independent identification domains IHE IT Infrastructure5 Integration Profiles

34. Retrieve Information for Display Retrieve Information for Display Enterprise User Authentication Enterprise User Authentication Patient Synchronized Applications Patient Synchronized Applications 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 Synchronize multiple applications on a desktop to the same patient Synchronize multiple applications on a desktop to the same patient Provide users a single nameandcentralized authentication processacross all systems Provide users a single nameandcentralized authentication processacross all systems Patient Identifier Cross-referencing for MPI Patient Identifier Cross-referencing for MPI Consistent Time Consistent Time Coordinate time across networked systems Coordinate time across networked systems Map patient identifiers across independent identification domains Map patient identifiers across independent identification domains IHE IT Infrastructure5 Integration Profiles

35. Retrieve Information for Display Abstract / Scope • Simple and rapid access to patient information • Access to existing persistent documents in well-known presentation formats: CDA, PDF, JPEG. • Access to specific key patient-centric information for presentation to a clinician : allergies, current medications, summary of reports, etc.. • Links with other IHE profiles - Enterprise User Authentication & Patient Identifier Cross-referencing.

36. Retrieve Information for Display Value Proposition: • User Convenience: • Healthcare providers can "see" the information. A significant integration step. • Workflows from within the users’ on-screen workspace or application. • Complements multiple simultaneous apps workflow of Patient Synchronized Apps • Broad Enterprise-Wide access to information: • Web technology for simple clients • Clinical data handling fully assumed by the information source that holds clinical data.

37. Retrieve Information for Display Key Technical Properties: • Standards Used: • Web Services (WSDL for HTTP Get). • General purpose IT Presentation Formats: XHTML, PDF, JPEG plus CDA L1. • Client may be off-the-shelf browser or display application. • Two services : • Retrieve of Specific Information: • Patient centric: patient ID • Type of Request (see next slide) • Date, Time, nMostRecent • Retrieve a Document • Object Unique Instance Identifier (OID) • Type of Request • Content Type Expected

38. Retrieve Specific Info for Display [11] Summary of All Reports Retrieve Document for Display [12] Summary of Laboratory Reports Summary of Radiology Reports Summary of Cardiology Reports Summary of Surgery Reports Summary of Intensive Care Reports Summary of Emergency Reports Summary of Discharge Reports List of Allergies Persistent Document List of Medications Retrieve Information for Display Display Information Source Transaction Diagram Types ofRequests

39. Retrieve Information for Display Retrieve Information for Display Enterprise User Authentication Enterprise User Authentication Patient Synchronized Applications Patient Synchronized Applications 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 Synchronize multiple applications on a desktop to the same patient Synchronize multiple applications on a desktop to the same patient Provide users a single nameandcentralized authentication processacross all systems Provide users a single nameandcentralized authentication processacross all systems Patient Identifier Cross-referencing for MPI Patient Identifier Cross-referencing for MPI Consistent Time Consistent Time Coordinate time across networked systems Coordinate time across networked systems Map patient identifiers across independent identification domains Map patient identifiers across independent identification domains IHE IT Infrastructure5 Integration Profiles

40. Patient Synchronized Applications Abstract / Scope • Patient synchronization of multiple disparate applications • Single patient selection • When combined with PIX Profile, allows patient synchronization across patient identity domains

41. Patient Synchronized Applications Value Proposition: • User Convenience: • Eliminates the repetitive task of selecting the patient in each application • Permits the user to select the patient in the application for which they are most familiar and / or appropriate to the clinical workflow • Patient Safety: • Ensures all data being viewed across applications is for the same patient

42. Patient Synchronized Applications Key Technical Properties: • Standards Used: • HL7 Context Management “CCOW” Standard, Version 1.4 • Support for both Windows and Web Technology • Support of “Patient Subject” • IHE Constraints: • Specifies use of Patient.Id.IdList item • Ensures maximum interoperability with PIX Profile • Protects against future deprecation of patient identifier items (HL7 2.3.1, 2.4, 2.5, CCOW).

43. Patient Synchronized Applications Transaction Diagram

44. Retrieve Information for Display Retrieve Information for Display Enterprise User Authentication Enterprise User Authentication Patient Synchronized Applications Patient Synchronized Applications 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 Synchronize multiple applications on a desktop to the same patient Synchronize multiple applications on a desktop to the same patient Provide users a single nameandcentralized authentication processacross all systems Provide users a single nameandcentralized authentication processacross all systems Patient Identifier Cross-referencing for MPI Patient Identifier Cross-referencing for MPI Consistent Time Consistent Time Coordinate time across networked systems Coordinate time across networked systems Map patient identifiers across independent identification domains Map patient identifiers across independent identification domains IHE IT Infrastructure5 Integration Profiles

45. Patient Identifier Cross-referencingAbstract / Scope • Allow all enterprise participants to register the identifiers they use for patients in their domain • Support domain systems’ queries for other systems’ identifiers for their patients • Optionally, notify domain systems when other systems update identifiers for their patients

46. Patient Identifier Cross-referencingValue Proposition • Maintain all systems’ identifiers for a patient in a single location • Use any algorithms (encapsulated) to find matching patients across disparate identifier domains • Lower cost for synchronizing data across systems • No need to force identifier and format changes onto existing systems • Leverages standards and transactions already used within IHE

47. Patient Identifier Cross-referencingID Domains & Transactions

48. Patient Identifier Cross-referencingKey Technical Properties Standards Used • HL7 Version 2.3.1 and Version 2.4 • ADT Registration and Update Trigger Events • A01: inpatient admission • A04: outpatient registration • A05: pre-admission • A08: patient update • A40: merge patient • Queries for Corresponding Identifiers (ADT^Q23/K23) • Notification of Identifiers Lists Updates (ADT^A31) Key Properties • ADTs remain in charge of their domains • No need for a master ID or MRN, but supported as another ID domain

49. Retrieve Information for Display Retrieve Information for Display Enterprise User Authentication Enterprise User Authentication Patient Synchronized Applications Patient Synchronized Applications 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 Synchronize multiple applications on a desktop to the same patient Synchronize multiple applications on a desktop to the same patient Provide users a single nameandcentralized authentication processacross all systems Provide users a single nameandcentralized authentication processacross all systems Patient Identifier Cross-referencing for MPI Patient Identifier Cross-referencing for MPI Consistent Time Consistent Time Coordinate time across networked systems Coordinate time across networked systems Map patient identifiers across independent identification domains Map patient identifiers across independent identification domains IHE IT Infrastructure5 Integration Profiles

50. Enterprise User AuthenticationAbstract / Scope • Support a single enterprise governed by a single set of security policies and having a common network domain. • Establish one name per user that can then be used on all of the devices and software in a healthcare enterprise. • Facilitate centralized user authentication management. • Provide users with single sign-on.