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Leveraging IHE to build RHIO Interoperability

http://ihe.univ-rennes1.fr/data/editable/organization/PCC_WS_2005/Interoperability_Workshop_IHE%20for%20a%20RHIO-3.ppt. Leveraging IHE to build RHIO Interoperability. Charles Parisot GE Healthcare IHE IT Infrastructure Technical Committee co-chair. W W W . I H E . N E T.

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Leveraging IHE to build RHIO Interoperability

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  1. http://ihe.univ-rennes1.fr/data/editable/organization/PCC_WS_2005/Interoperability_Workshop_IHE%20for%20a%20RHIO-3.ppthttp://ihe.univ-rennes1.fr/data/editable/organization/PCC_WS_2005/Interoperability_Workshop_IHE%20for%20a%20RHIO-3.ppt Leveraging IHE to buildRHIO Interoperability Charles Parisot GE Healthcare IHE IT Infrastructure Technical Committee co-chair

  2. W W W . I H E . N E T Providers and Vendors Working Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings Interoperability Strategy Workshop

  3. Lab Results Document Content For Display Document Medical Summary Document Content Imaging Information Sharing Format of the Document Content and associated coded vocabulary Format of the Document Content Format of the Document Content and associated coded vocabulary Format of the Document Content and associated coded vocabulary Notification of Document Availability Patient Identifier Cross-referencing Cross-Enterprise Document Sharing Notification of a remote provider/ health enterprise Map patient identifiers across independent identification domains Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Document Digital Signature Patient Demographics Query Attesting “true-copy and origin Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. Cross-enterprise User Authentication Consistent Time Authentication & Auditing: Basis for Access Control Coordinate time across networked systems Selected IHE Integration Profiles for RHIOsWhat is available and is added in 2005 Interoperability Strategy Workshop

  4. HIMSS 2005 –Show-Wide Interoperability Cross-enterprise Showcase Booth ITInfrastructure Radiology Vendor Booth Vendor Booth Vendor Booth Vendor Booth Vendor Booth Vendor Booth In-Patient/Out-patient Cardiology PCP Diag Center MultispecialtyClinic Home Vendor Booth Ambulatory Showcase Booth HL7 Booth Vendor System HIMSS “RHIO” with Cross-enterprisedoc sharing (17 vendors) Interoperability Strategy Workshop

  5. HIMSS 2005 InteroperabilityShow Case Vendors Participant Level Allscripts Cedara Cerner Dictaphone Eastman Kodak Eclipsys Emageon Epic ETIAM INFINITT Tech. MedcomSoft MediNotes MedCommons MidMark Mortara Instrument, Inc National Institute of Standards & Technology NextGen Novell Open Text Sentillion Leadership Level CapMed/SanDisk Eclipsys GE Healthcare IDX InterSystems Kryptiq Quovadx/CareScience Siemens WebMD Supporter Level AccessPt AGFA dbMotion Dinmar – Oacis EMC Healthvision Healthramp McKesson Valco Data Systems Interoperability Strategy Workshop

  6. IHE North America Vendors (2004-2005) • Hologic • IDX Systems Corp. • INFINITT Technology • InSite One, Inc. • Intelerad Medical Systems • InterSystems Corporation • Konica-Minolta Medical Imaging, USA, Inc. • Kryptiq • Marotech • McKesson Information Solutions • MedCommons Inc. • MedCon, Inc. • Merge eFilm • Mortara Instrument, Inc. • Novell, Inc. • Philips Medical Systems • QRS Diagnostic • Quovadx • St. Jude Medical A.B. • Sectra Imtec A.B. • St. Jude Medical A.B. • Sectra Imtec A.B. • Sentillion • Siemens Medical Solutions • Stentor • Swissray International, Inc. • Tiani Medgraph A.G. • Tiani Spirit Gmbh • Toshiba Medical Systems Company • Vital Images • WebMD Practice Services • Agfa HealthCare • Allscripts • Camtronics Medical Systems • Cedara Software Corp. • Cerner Corporation • Dictaphone Corporation • Dynamic Imaging, LLC • Eastman Kodak Company • Eclipsys • Emageon • Epic Systems Corporation • ETIAM • FujiFilm Medical Systems, USA, Inc. • GE Healthcare • Heartlab, Inc • Hitachi Medical Corporation Interoperability Strategy Workshop

  7. At HIMSS in 2005 : IHE-XDS community Hospital Record Clinic Record 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 Clinical Encounter Interoperability Strategy Workshop

  8. At HIMSS in 2005 : IHE-XDS community Hospital Record Laboratory Results Reference to records Specialist Record Temporary Aggregate Patient History Index of patients records (Document-level) 3-Records Returned Clinical IT System Sharing System 2-Reference to Records for Inquiry Clinical Encounter • Shared prototype content: • Medical Summaries (Pre-CCR) • Discharge Summaries (CDA-R1) • Lab Results (HL7) • Other (PDF) Interoperability Strategy Workshop

  9. Demo a RHIO with IHE at HIMSS 2006 ? community Hospital Record Laboratory Results Reference to records Specialist Record Temporary Aggregate Patient History Index of patients records (Document-level) 3-Records Returned Clinical IT System Sharing System 2-Reference to Records for Inquiry Clinical Encounter • Secured Sharing of: • Medical Summaries • Images & reports • ECG Reports • PDFs • Lab Results ? • + Notif of Doc Avail. 1-Patient Authorized Inquiry Interoperability Strategy Workshop

  10. Document Life Cycle Management Addendum to a registered document Time A two-way relationship between Original and Addendum Document Addendum Addendum Replacing a registered document by a new document Document 1 (Approved) Time A two-way relationship between Original and Replacement Document. Replacement Document 1 (Deprecated) Replacement Document Registering an alternate form or a signature for a registered document Transform A two-way relationship between Original and Transform (alternative format with same scope or DSG). Document 1 (Approved) Document 2 (transform) Interoperability Strategy Workshop

  11. Local & Regional RHIOs Infrastructure and Interoperability • Cross-Enterprise Document Sharing (XDS) minimizes clinical data management by the infrastructure. Transparency = Ease of Evolution • XDS works with other IHE Integration Profiles: patient Id mgt, security, etc. Flexibility of RHIO configuration • With introduction of new Integration Profiles, IHE ready to build regional health networks linking interoperable EHRs. Major milestone for 2006 RHIO projects • Goal is to offer a consistent, standards-based and functional for EHRs and other ancillary systems. Interoperability Strategy Workshop

  12. Creating a Health Information Network with IHE Tier 1 EHRs and Ancillaries Care Delivery IT system Care Delivery IT system Care Delivery IT system Interoperability Strategy Workshop

  13. Creating a Health Information Network with IHE DocumentEntries XDS Document Repository Tier 2 Community HIN What and Where ? Care Delivery IT system Care Delivery IT system XDS Document Registry Care Delivery IT system XDS Document Repository XDS Document Repository Interoperability Strategy Workshop

  14. Creating a Health Information Network with IHE DocumentEntries XDS Document Repository Who, What and Where ? Who, What and Where ? Tier 2 Community HIN C-HIN Patient Identity Source Patient Demo Supplier Care Delivery IT system Care Delivery IT system XDS Document Registry Patient Id X-Ref Mgr PDQ Consumer Care Delivery IT system Patient Id X-Ref Mgr XDS Document Repository XDS Document Repository Interoperability Strategy Workshop

  15. Creating a Health Information Network with IHE DocumentEntries XDS Document Repository Time Server Tier 2 Community HIN C-HIN Patient Identity Source Patient Demo Supplier Care Delivery IT system Care Delivery IT system XDS Document Registry Patient Id X-Ref Mgr PDQ Consumer Who, What When and Where ? Care Delivery IT system Patient Id X-Ref Mgr XDS Document Repository XDS Document Repository Interoperability Strategy Workshop

  16. Creating a Health Information Network with IHE DocumentEntries XDS Document Repository Time Server Tier 2 Community HIN C-HIN Patient Identity Source Patient Demo Supplier Care Delivery IT system Care Delivery IT system XDS Document Registry Patient Id X-Ref Mgr PDQ Consumer Who, What When and Where ? Trusted ! Care Delivery IT system Patient Id X-Ref Mgr XDS Document Repository XDS Document Repository Interoperability Strategy Workshop

  17. Security for XDSLeverages IHE Audit Trail & Node AuthenticationA formal Security and Privacy profile is provided for XDS • ATNA creates a secured domain: • User Accountability (Audit trail) • Node-to-Node Access Control • Node-level user authentication • User access control provided by node • BUT Registry/repository based User-Level Access Control and policy agreements is beyond XDS. • User-level Access Control is • provided by XUA Patient Identity Source Secured Node Patient Identity Feed Secured Node Query Documents Document Consumer Document Registry Secured Node Register Document Set Provide&RegisterDocument Set Retrieve Document Secured Node Document Repository Document Source Secured Node Secured Node Interoperability Strategy Workshop

  18. Cross-Enterprise User AuthenticationTransaction Diagram XDS Repository Identity Provider 2 Request Assertion (of who this user is) 5 Authentication Assertion 3 Request User ID 1 XDS Retrieve Record Auditable Event ATNA Audit Repository 4 User Identity Interoperability Strategy Workshop

  19. Is it possible to federate multiple XDS-based HIN ? Time Server Time Server Time Server Time Server Time Server Tier 2 Community HIN Tier 2 Community HIN Tier 2 Community HIN Tier 2 Community HIN Tier 2 Community HIN C-HIN Patient Identity Source C-HIN Patient Identity Source C-HIN Patient Identity Source C-HIN Patient Identity Source C-HIN Patient Identity Source Patient Demo Supplier Patient Demo Supplier Patient Demo Supplier Patient Demo Supplier Patient Demo Supplier Care Delivery IT system Care Delivery IT system Care Delivery IT system Care Delivery IT system Care Delivery IT system Care Delivery IT system Care Delivery IT system Care Delivery IT system Care Delivery IT system Care Delivery IT system XDS Document Registry XDS Document Registry XDS Document Registry XDS Document Registry XDS Document Registry Patient Id X-Ref Mgr Patient Id X-Ref Mgr Patient Id X-Ref Mgr Patient Id X-Ref Mgr Patient Id X-Ref Mgr PDQ Consumer PDQ Consumer PDQ Consumer PDQ Consumer PDQ Consumer DocumentEntries DocumentEntries DocumentEntries DocumentEntries DocumentEntries XDS Document Repository XDS Document Repository XDS Document Repository XDS Document Repository XDS Document Repository Care Delivery IT system Care Delivery IT system Care Delivery IT system Care Delivery IT system Care Delivery IT system Patient Id X-Ref Mgr Patient Id X-Ref Mgr Patient Id X-Ref Mgr Patient Id X-Ref Mgr Patient Id X-Ref Mgr Who, What When and Where ? Trusted ! Who, What When and Where ? Trusted ! Who, What When and Where ? Trusted ! Who, What When and Where ? Trusted ! Who, What When and Where ? Trusted ! XDS Document Repository XDS Document Repository XDS Document Repository XDS Document Repository XDS Document Repository XDS Document Repository XDS Document Repository XDS Document Repository XDS Document Repository XDS Document Repository Tier2 Community-HINs e.g. XDS Affinity Domain Interoperability Strategy Workshop

  20. Federating Tier 2 Health Information NetworksOn IHE Roadmap for 2006-2007: X-Registry Federation(Addressed by ebXML Registry 3.0) What are the document registries where a patient has information ? Federated Identification Patient / Registry Locator Service Tier 3 HIN e.g. State Level RG T2 C-HIN B e.g. XDS Affinity Domain RG Managed Identification T2 C-HIN D e.g. XDS Affinity Domain Interoperability Strategy Workshop

  21. Federating Tier 2 Health Information NetworksOn IHE Roadmap for 2006-2007: X-Registry Federation Integrating existing IDNs: Adaptor + Registry Federated Identification Patient / Registry Locator Service Tier 3 HIN e.g. State Level RG T2 C-HIN B e.g. XDS Affinity Domain RG +Adapt RG RG +Adapt Managed Identification T2 C-HIN Ae.g. IDN T2 C-HIN D e.g. XDS Affinity Domain T2 C-HIN C e.g. IDN Interoperability Strategy Workshop

  22. Federating Tier 3 Health Information NetworksOn IHE Roadmap for 2006-2007: X-Registry Communication Patient / Registry Locator Service Patient / Registry Locator Service Patient / Registry Locator Service Patient / Registry Locator Service e.g. State HIN e.g. State HIN e.g. State HIN e.g. State HIN RG RG RG RG RG RG RG RG RG RG RG RG T1-RHIO B e.g. XDS Affinity Domain RG RG RG RG T1-RHIO B e.g. XDS Affinity Domain T1-RHIO B e.g. XDS Affinity Domain T1-RHIO B e.g. XDS Affinity Domain T1-RHIO Ae.g. IDN T1-RHIO D e.g. XDS Affinity Domain T1-RHIO Ae.g. IDN T1-RHIO Ae.g. IDN T1-RHIO Ae.g. IDN T1-RHIO D e.g. XDS Affinity Domain T1-RHIO D e.g. XDS Affinity Domain T1-RHIO D e.g. XDS Affinity Domain T1-RHIO C e.g. IDN T1-RHIO C e.g. IDN T1-RHIO C e.g. IDN T1-RHIO C e.g. IDN Nation-Wide Health Info network (Tier 4) Patient / Registry Locator Service Patient / Registry Locator Service Patient / Registry Locator Service e.g. State HIN RG RG RG T1-RHIO B e.g. XDS Affinity Domain RG T1-RHIO Ae.g. IDN T1-RHIO D e.g. XDS Affinity Domain T1-RHIO C e.g. IDN Interoperability Strategy Workshop

  23. IHE: RHIOs’ Interoperability Partner • IHE offers a solid technical foundation to establish interoperability for RHIOs. • Standards-based, open, multi-vendor, provider-led. • Yearly progress, validation testing built in, backed by a proven process. Implementation by many vendors. • IHE welcomes RHIOs’ technical architects’ active involvement. • The IHE Technical Framework accelerates RHIOs pilot development (e.g.XDS Affinity Domain). • This is being applied: Norway, Italy, then Canada, soon USA, France, ? Interoperability Strategy Workshop

  24. Clinicians access XDS Servicesthrough their clinical IT system (EHRs) 4-Patient data presented to Physician 3-Documents Returned Temporary Aggregate Patient History 3-Reference to Docs from Inquiry 2- Inquiry for Docs 1-Expression of a need for additional information Clinical Encounter DocumentRepositories Index of patients records (Document-level) ClinicalIT System Interoperability Strategy Workshop

  25. Sharing Radiology Reports and Images with XDSin a Regional Health Information Network Regional Health Information Network Radiology Enterprise B PACS B Radiology-to-radiology Radiology-to-Physicians PACS A Physician Office Radiology Enterprise A Interoperability Strategy Workshop

  26. Sharing Radiology Reports and Imagesin a Regional Health Information Network Regional Health Information Network Radiology Enterprise B PACS B • Patient Id= 3547F45 • Report 5/21/1998 : CT Head B • Study 5/21/1998 : CT Head B • Report 2/18/2005 : Chest Xray A • Study 2/18/2005 : Chest Xray A Cross-Enterprise Registry PACS A Physician Office Radiology Enterprise A Interoperability Strategy Workshop

  27. Physicians and Systems within a Regional Health Network - Routine Imaging Referral Register Imaging Information for sharing Priorimaging Reports & Studies Register Imaging Information for sharing Query for Documents Regional Health Information Network Radiology Enterprise B Cross-Enterprise Registry • Patient Id= 3547F45 • Report 5/21/1998 : CT Head B • Study 5/21/1998 : CT Head B Physician Office Radiology Enterprise A Interoperability Strategy Workshop

  28. Physicians and Systems within a Regional Health Network - Routine Imaging Referral Register Imaging Information for sharing Register Imaging Information for sharing Notification of Doc Availability Regional Health Information Network Radiology Enterprise B Cross-Enterprise Registry Physician Office Radiology Enterprise A Interoperability Strategy Workshop

  29. Physicians and Systems within a Regional Health Network for a Routine Imaging Referral Prior Imaging Report & Study Query for documents Notification of Doc Availability Imaging Report & Study Regional Health Information Network Radiology Enterprise B • Patient Id= 3547F45 • Report 5/21/1998 : CT Head B • Study 5/21/1998 : CT Head B • Report 2/18/2005 : Chest Xray A • Study 2/18/2005 : Chest Xray A Cross-Enterprise Registry Physician Office Radiology Enterprise A Interoperability Strategy Workshop

  30. Regional Health Information NetworkImages and reports part of a shared health record Regional Health Information Network Enterprise B Register Documents for sharing Retrieve Prior Documents Retrieve PriorDocuments Cross-Enterprise Registry Register Documents for sharing Query for Documents Query for documents Notification of Doc Availability Retrieve Documents Physician Office Enterprise A Interoperability Strategy Workshop

  31. Medical Summary Document Content Imaging Information Sharing Lab Results Document Content For Display Document Content Format of the Document Content and associated coded vocabulary Format of the Document Content Format of the Document Content and associated coded vocabulary Format of the Document Content and associated coded vocabulary Notification of Document Availability Patient Identifier Cross-referencing Cross-Enterprise Document Sharing Notification of a remote provider/ health enterprise or or Map patient identifiers across independent identification domains Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Document Digital Signature Patient Demographics Query Cross-enterprise User Authentication Attesting “true-copy and origin Authentication & Auditing: Basis for Access Control Consistent Time Coordinate time across networked systems Requirements for care delivery IT system in a RHIO(e.g. EHR, Lab, Imaging, etc.) Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. Interoperability Strategy Workshop

  32. IHE: Interoperability for RHIOs’ • By starting with a secured document sharing infrastructure, RHIOs have a a platform on which to build clinical content (more structure & coded terminology, specialized content). • Solid SAML 2.0 authentication and document digital signature (need a PKI). • Practical HL7 V3 approach with CDA-R2 and other content (e.g. imaging, CCR, legacy, PDF, etc.). • Establishing a critical mass of products implementations, both in clinical applications and infrastructure for deployment in 2006. • An architecture that caters to various RHIOs architectures: centralized, decentralized and mixed (operational decision). Interoperability Strategy Workshop

  33. More information…. • IHE Web sites: www.ihe.net • Technical Frameworks, Supplements • Fill in relevant supplements and frameworks • Non-Technical Brochures : • Calls for Participation • IHE Fact Sheet and FAQ • IHE Integration Profiles: Guidelines for Buyers • IHE Connect-a-thon Results • Vendor Products Integration Statements Interoperability Strategy Workshop

  34. IHE Patient Id management for RHIOsUse of PIX and PDQ Integration Profiles Interoperability Strategy Workshop

  35. Patient Identification ManagementPIX Cross Referencing (coexist with PDQ) Patient Identity Feed Dm=XAD, Pid=Px Patient Identity X-Ref Mgr Patient Identity X-Ref Mgr DocumentEntry Dm=XAD Pid=Px XDS Document Consumer XDS Document Source Query Docs Dm=XAD Pid=Px Patient ID Consumer Dm=XAD Pid=Px Provide&Register Doc Set Patient ID Consumer XDS Doc XDS Doc Patient Identity Source Patient Identification Domain C Patient Identification Domain D2 Patient Identification Domain XAD XDS Document Registry Dm=D2 Pid=Pd Dm=C Pid=Pc XDS Document Repository Interoperability Strategy Workshop

  36. Patient Identification ManagementPDQ Discovery + Local mapping (coexist with PIX) Patient Identity Feed Dm=XAD, Pid=Px Patient Demographics Supplier DocumentEntry Dm=XAD Pid=Px XDS Document Consumer XDS Document Source Query Docs Dm=XAD Pid=Px PatientDemo Consumer Dm=XAD Pid=Px Provide&Register Doc Set Demo graphics Patient Demo Consumer Demo graphics XDS Doc XDS Doc Patient Identity Source Patient Identification Domain C Patient Identification Domain D2 Patient Identification Domain XAD XDS Document Registry XDS Document Repository Interoperability Strategy Workshop

  37. W W W . I H E . N E T Providers and Vendors Working Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings Interoperability Strategy Workshop

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