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Integrating the Healthcare Enterprise

Integrating the Healthcare Enterprise. Laboratory Workflow, Point of Care Testing and other new Profiles. Francois Macary, GWI Medica France Charles Parisot, GE Healthcare IHE Laboratory Planning and Technical Committee. Table Of Content. Overview of IHE The story f rom the beginning

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Integrating the Healthcare Enterprise

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  1. Integrating the Healthcare Enterprise Laboratory Workflow, Point of Care Testing and other new Profiles Francois Macary, GWI Medica France Charles Parisot, GE Healthcare • IHE Laboratory Planning and Technical Committee IHE Interoperability Workshop

  2. Table Of Content • Overview of IHE • The story from the beginning • Definition and goals • Process and key concepts • The Laboratory Technical Framework • Beginning and scope • Laboratory Scheduled Workflow • Laboratory Point Of Care Testing • Laboratory device Automation • Laboratory Code Set Distribution IHE Interoperability Workshop

  3. Overview of IHE • The story from the beginning IHE Interoperability Workshop

  4. Integrating the Healthcare Enterprise 2002 1997  2000 2001 HIMSS & RSNA EAR, COCIR, GMSIH, DRG JAHIS, JIRA, JRS, … Japan Europe US 2004 2003 New technical frameworks: Laboratory, IT Infrastructure New TF: Cardiology Extensions to the other TF New countries New countries IHE Interoperability Workshop

  5. Overview of IHE • Definition and goals IHE Interoperability Workshop

  6. The need that brought IHE • Bring the correct information, in time to care providers • Share information between the various systems • Induce system vendors to build these information links • Choose standards to support these exchanges • Build a framework to evacuate optionality and ambiguity from these standards IHE Interoperability Workshop

  7. 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 IHE Interoperability Workshop

  8. 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 IHE Interoperability Workshop

  9. What IHE is NOT! • A standards development organization • Uses established standards (HL7, DICOM, …) • Activity complementary to SDOs, formal relationship with HL7 and DICOM. • A static structure • Rather a dynamic process driven by volunteers • A demonstration project • Demos are only one means to the end — adoption • The main outcomes are the technical frameworks documentation, the tools, and the testing and validating sessions (connectathon). IHE Interoperability Workshop

  10. Overview of IHE • Process and key concepts IHE Interoperability Workshop

  11. IHE Process • Users and vendors work together to identify and design solutions for integration problems • Intensive process with annual cycles: • Identify key healthcare workflows and integration problems • Research & select standards to specify a solution • Write, review and publish IHE Technical Framework • Implement the Technical Framework within products • Perform cross-testing at “Connectathon” IHE Interoperability Workshop

  12. IHE Domains and Regions IT Infrastructure Radiology Laboratory Cardiology Technical Frameworks Local Deployment IHE North America IHE Europe EAR, ECR, COCIR IHE Asia Japan JIRA, JAHIS, METI, JRS, JSRT, JAMI France GMSIH, SFR, SFIL, 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, Denmark, Spain, … IHE Connectathons, Education, Demonstrations Global Development IHE Interoperability Workshop

  13. 1st key concept: Actor • Represents 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 Admission Transfer and Discharge (ADT) • Laboratory Automation Manager • Point Of Care Analyzer IHE Interoperability Workshop

  14. 2nd key concept: Transaction Order Placer Order Filler New order Order accepted Battery replaced Acknowledgement Status change Acknowledgement Example: Transaction LAB-1 « Placer order management » • A set of interactions defined between two Actors for a specific task. • Defines unambiguously how the Actors must cooperate to achieve this task. • Using existing standards such as HL7 or DICOM IHE Interoperability Workshop

  15. 3rd key concept: Integration Profile Integration Profile … Actor Actor Actor … … … Transaction Transaction Transaction Transaction Transaction Referenced standard (HL7) Detailed messaging info -------------------------- Roles A collection of real world functionalities supported by Actors using Transactions Examples:  • Enterprise User Authentication • Retrieve Information for Display • Laboratory Scheduled Workflow • Laboratory Point Of Care Testing IHE Interoperability Workshop

  16. The Laboratory Technical Framework • Beginning and scope IHE Interoperability Workshop

  17. IHE Lab Key Events • End 2002, two groups establish contacts: Japan (JAHIS) and France (SFIL, HPRIM, GMSIH) • May 2003 (Perugia): Creation of one IHE international Laboratory Technical Committee. The Netherland, Italy and Germany join in. • June (London): Decision on Scope of IHE Lab year 1. • September (Memphis): Presentation of the first draft to HL7 Orders & Obervations • November (Paris): Laboratory Technical Framework Trial Implementation version released. • April 2004 (Padova): European connectathon: 13 European companies validate their solution with the Laboratory Technical Framework. • June 2004 (Paris): Launch Year 2 with 4 new profiles. NCCLS participated. IHE Interoperability Workshop

  18. Scope • Integrate the clinical laboratory in the enterprise • Ordering, scheduling and performing clinical laboratory tests • Delivering the observation results to the medical staff, at various steps of validation. • All specialties working on specimen, not on the patient itself. • Anatomo-pathology and blood banks excluded IHE Interoperability Workshop

  19. Laboratory IHE Integration Profiles Laboratory Scheduled Workflow (LSWF) Completed in 2003 Laboratory Point Of Care Testing (LPOCT) In Process –TI Nov 2004 Tests performed by a laboratory for an identified inpatient or outpatient Tests performed on point of care or patient’s bedside Laboratory Patient Information Reconciliation (LPIR) In Process Laboratory Device Automation (LDA)In Process –TI Nov 2004 Tests performed on an unidentified or misidentified patient Pre-analytic process, analysis and post-analytical treatment Laboratory Code Set Distribution (LCSD) In Process Sharing the batteries and tests code sets throughout the enterprise IHE Interoperability Workshop

  20. The LaboratoryIHE Technical Framework • Laboratory Scheduled Workflow IHE Interoperability Workshop

  21. LSWF: Three major use cases • Externally placed order with identified specimens • The ordering provider collects the specimens and uniquely identifies them (in the order sent in the message as well as on the container with a barcode label) • Externally placed order with specimens unidentified or to be collected by the laboratory • Filler order with specimens identified by the laboratory IHE Interoperability Workshop

  22. LSWF: Workflow Clinical validation Technical validation Selected standard: HL7 version 2.5 IHE Interoperability Workshop

  23. Example 1: Microbiology with two specimens and three germs Day 1 at 8:10: Order placed Day 1 at 8:20: Specimens checked, order scheduled Day 1 at 14:46: Partial urin results not validated Day 2 at 09:40: Antibiogram order generated / urin Day 2 at 09:45: Antibiogram order generated / pus Day 3 at 11:30: Final validated results IHE Interoperability Workshop

  24. Example 2: Glucose tolerance study on a series of specimens Step 1: Order placed with first specimens Step 2: order scheduled and started, one broken tube Step 3: Partial results not validated Step 4: Last specimens provided Step 5: Last specimens accepted Step 6: Last results from AM Step 7: Final validated results IHE Interoperability Workshop

  25. The Laboratory Technical Framework • Laboratory Point Of Care Testing IHE Interoperability Workshop

  26. LPOCT Scope • Specialties addressed: • Tests that can be performed on analyzers used on the point of care or on patient’s bedside, under the supervision of a clinical laboratory • In vitro specimen testing • Tests on a specimen taken from the patient, not on the patient itself. • Tests that do not need pre-analytic processing of the specimen • Two general use cases: • Testing on a point of care device permanently connected to the network • Testing on a point of care device periodically connected to the network IHE Interoperability Workshop

  27. LPOCT Workflow ADT ITI: Patient Demographic Query Laboratory LAB-11: Initiate patient specimen testing Point Of Care Data Manager LAB-14: Complete Observation Set LAB-16: Order Query Point Of Care Result Generator LAB-13: Raw observation set LAB-15: POCRG Handling Order Filler Tecnical validation Clinical validation IHE Interoperability Workshop

  28. LPOCT without LSWF permanent connection between POCRG and POCDM ADT Order Filler POCDM POCRG patient specimen to test LAB-11: Initiate patient testing ITI Patient demographic query Test performed, observations produced LAB-13: Raw observation set LAB-14 Accepted observation set Perform clinical validation IHE Interoperability Workshop

  29. LAB-2: Filler Order Management Order Placer LAB-1: Placer Order Management Order Result Tracker LAB-3: Order Results Management LPOCT coupled with LSWF Patient admit and update ADT Patient admit and update ITI Patient demographic query LAB-11: Initiate testing Point Of Care Data Manager LAB-14: Completed observation set LAB-13: Raw observation set LAB-16: Order query Point Of Care Results Generator LAB-15: Handling of POCRG Order Filler IHE Interoperability Workshop

  30. LPOCT coupled with LSWF placer order created after the test ADT Order Placer Order Filler POCDM POCRG Order Result Tracker Patient admit Patient specimen to test LAB-11: initiate patient testing LAB-12: Patient query Test performed, observations produced LAB-13: Raw observation set LAB-2: Create placer order LAB-14 Accepted observation set LAB-1: Order status change clinical validation LAB-3: Order validated results IHE Interoperability Workshop

  31. LPOCT coupled with LSWF placer order created before testing ADT Order Placer Order Filler POCDM POCRG Order Result Tracker Patient admit Order entered LAB-1: New order Patient specimen to test LAB-11: initiate patient testing LAB-12: Patient query Test performed, observations produced LAB-13: Raw observation set LAB-14 Accepted observation set LAB-1: Order status change clinical validation LAB-3: Order validated results IHE Interoperability Workshop

  32. Key selected standard: POCT1-A from NCCLS POCT1-A Observation Recipient IHE Order Filler POCT1-A Observation Reviewer IHE Point Of Care Data Manager • Use case 1: Unordered observation - Recipient should place an order  HL7 v2.5: message ORU^R30 • Use case 2: New observation – Recipient should search for an existing order  HL7 v2.5: message ORU^R31 • Use case 3: Preordered observation with order information  HL7 v2.5: message ORU^R32 POCT1-A meets IHE requirements.Extensions are real time patient identification with Patient Demographics Query (ITI-PDQ-HL7) and LSWF Integration. IHE Interoperability Workshop

  33. The Laboratory Technical Framework • Laboratory Device Automation IHE Interoperability Workshop

  34. LDA Workflow Automation Manager LAB-21 WOSA download LAB-25 Query for WOS LAB-26 WOS performed LAB-25 Query for WOS LAB-26 WOS performed LAB-24 WOS download LAB-24 WOS download LAB-22 Query for WOSA LAB-23 WOSA performed Pre-analyzer Analyzer Post-analyzer Aliquoter, decapper,, robotic conveyer, … Performs the tests and delivers the results recapper, refrigerated storage, WOS: Work Order Step WOSA: Work Order Step with analysis (tests and results) Download bebore specimen arrival, or query triggered by specimen arrival on the device Chosen standard: HL7 v2.5 Chapter 13 (Lab Automation) IHE Interoperability Workshop

  35. The Laboratory Technical Framework • Laboratory Code Set Distribution IHE Interoperability Workshop

  36. LCSD Workflow Order Filler Enterprise Common Repository … Laboratory Code Set Master LAB-xx: Laboratory Code Set Management Laboratory Code Set Consumer Order Placer Order Result Tracker Automation Manager Order Filler … Chosen standard: HL7 V2.5, Master Files (chapter 8) IHE Interoperability Workshop

  37. Laboratory Code Set Distribution Use Case 1 Laboratory Code Set Master Laboratory Code Set Consumer Creates observation/ test/battery codes Laboratory Code Set Management (REP) Replaces Observation/Test/Battery Code Sets All Observation, Test and Battery code sets of the Consumer are replaced by the code sets sent by the Master. This Use Case is mainly used for initialization. IHE Interoperability Workshop

  38. Laboratory Code Set Distribution Use Case 2 Laboratory Code Set Master Laboratory Code Set Consumer Updates observation/ test/battery codes Laboratory Code Set Management (UPD) Updates Observation/Test/Battery Code Sets Observation, Test and Battery codes of the Consumer are updated by codes sent by the Master. Updates are at the record level : add record(s), delete record(s), update record(s). IHE Interoperability Workshop

  39. The Laboratory Technical Framework • Laboratory Patient Information Reconciliation IHE Interoperability Workshop

  40. Laboratory Patient Information Reconciliation • Match clinical lab observations produced on specimens collected from misidentified or unidentified patient with the patient’s record. • Match clinical lab observations produced on specimens with orders created afterwards, either in the Order Placer or in the Order Filler application. IHE Interoperability Workshop

  41. Laboratory Patient Information ReconciliationUse Cases 1, 2, 3 • Unidentified Patient registered at ADT. Clinical lab tests ordered at Order Placer level. • Unidentified Patient registered at ADT . Clinical lab tests ordered at Order Filler level. • Clinical lab tests performed on laboratory automation bebore creation of the order. The Unidentified Patient cases cover scenarios in which the care situation requires that tests be ordered immediately, even before proper Patient registration. It also covers the scenario of tests performed before the order is entered, no matter the patient is identified or not. IHE Interoperability Workshop

  42. LPIR Use Case 1 Unidentified Patient registered at ADT and ordered at Order Placer IHE Interoperability Workshop

  43. LPIR Use Case 2 Unidentified Patient registered at ADT and ordered at Order Filler IHE Interoperability Workshop

  44. LPIR Use Case 3 Tests performed on laboratory devices prior to the order IHE Interoperability Workshop

  45. More information…. • IHE Web sites with Lab Information: http://www.himss.org/IHE http://www.rsna.org/IHE http://www.gmsih.fr/IHE IHE Interoperability Workshop

  46. Thank you for your attention… IHE Interoperability Workshop

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