Integrating the Healthcare Enterprise

1. Integrating the Healthcare Enterprise HIMSS Demonstration XDS Document Content Specifications Keith W. Boone – Dictaphone Corporation IHE IT Infrastructure Technical Committee IHE Interoperability Workshop

2. Agenda • Why do we need Document Content Profiles? • HIMSS Demo Document Content Prototypes • CCR Details • Demonstration Scenario IHE Interoperability Workshop

3. Clinicians access XDS Services 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 patient information Clinical Encounter DocumentRepositories Index of patients records (Document-level) ClinicalIT System IHE Interoperability Workshop

4. Querying for Documents Patient Id • The four main axes for Document Queries: • Which Patient ? • What Type of Document ? 3 interrelated sub-dimensions: Facility Type Document Class Event Type • By Groups of Documents • By time of Services • 10 additional attributes to query. Folder Facility Type Document Class Practice Setting SubmissionSet Time of Services XDS core Meta-Data derived from HL7 CDA and CEN EHRcom IHE Interoperability Workshop

5. Why Document Content Profiles • Define Standards and/or Versions of Format used • Content Constraints • Define Mandatory and Required Components • Mandatory – Must be present • Required – Must be present when known • Reduce Variations – eliminate choices • Map data-types between standards • Define Vocabularies used in Registry Fields • Simplifies query • Define Process Flows for use of the Content • May Introduce New Actors and Transactions to define process flows IHE Interoperability Workshop

6. IHE Roadmap - Building upon XDS CCR, CDA, PDF,HL7, JPEG, etc. eReferral XDSCross-Enterprise Document Sharing. • XDS is a foundation building block for cross-enterprise EHR: • Document Content Integration Profiles, e.g., CDA, PDF, HL7 or JPEG used to transfer medical records, labs, images, et cetera. • Process Flow Profiles, e.g. Define process flows using XDS and a collection of Document Content Profiles IHE Interoperability Workshop

7. DemonstrationPrototype Document Content • CDA – Clinical Document Architecture • Release 1 • ANSI/HL7 Standard • PDF – Portable Document Format • HL7 – V2.5 Lab Reports • CCR – Continuity of Care Record • ASTM Work in Progress IHE Interoperability Workshop

8. CDA ContentStandards and Profiles • CDA Release 1.0 • Balloted Standard by ANSI/HL7 • Claims Attachments • LOINC • Logical Observation and Identifier Codes • Supporting Vocabularies IHE Interoperability Workshop

9. CDA Content Profile Overview • Document Content Integration Profile • Defines content and mapping • Required CDA Elements • service_tmr, originator, originatating_organization, organization.nm, person_name • Mapping CDA Schema to Registry Fields • MIME Type: text/xml • Type Conversions • Identifiers • Dates and Times • Patient Demographics • Vocabulary • Patient Identifiers in XDS Domain • Based on LOINC Document Type Vocabularies IHE Interoperability Workshop

10. PDF Content Profile Overview • Document Content Profile • Defines Content only, no Mapping – registry content supplied by Document Source • Standards and Profiles • Portable Document Format V4 • Archivable Document Subset • MIME Type application/pdf • Vocabulary • Use XDS Affinity Domain Defined Vocabularies IHE Interoperability Workshop

11. HL7 - Lab Report Content Overview • Document Content Profile • Defines Content and Mapping • HL7 V2.5 to Registry • Some Registry Content provided by Document Source • HL7 V2.5 • Balloted Standard by ANSI/HL7 • Constrained to a V2.5 subset supported by most Lab/EHR systems • Consistent with IHE Transaction: LAB-Order Results Management • Vocabulary: LOINC • Logical Observation and Identifier Codes • Supporting Vocabulary for test Codes • Lab test results available as if received through an HL7 V2 feed. IHE Interoperability Workshop

12. Continuity of Care Record Provides a mechanism for exchange of relevant patient information between providers and the patient to ensure continuity of care. • Standard defined by ASTM • Initiated by MMS • Data elements of CCR are identified • XML schema for exchange is a work in progress IHE Interoperability Workshop

13. Continuity of Care Record • Document Content Profile • Defines Content and Mapping • October 8th Draft • MIME Type: text/xml • Document Class: Referral • Document Type: X-CCR • Constrained to certain Data Elements • Vocabulary • To be determined • Mapping from Content to Registry • Patient Identifier in XDS Patient Identity Domain • Type Conversions • Identities • Dates and Times • Patient and Provider Names • Patient Demographics IHE Interoperability Workshop

14. CCR Demo Data Element Categories • Identifiers • Problem and Reason for Referral • Past Medical History • Medications and Allergies • Patient Health Status • Vital Signs • Recent lab and x-ray tests • New stat tests ordered • Advance Directives • Plan of Care IHE Interoperability Workshop

15. Sample Scenario This is a sample similar to what will be used in the HIMSS Demonstration. Patient arrives at PCP office complaining of coughing up blood • Chest x-ray from nearby radiology imaging center demonstrates a lung mass. • PCP communicates with nearby Specialist Thoracic Surgeon • PCP discusses patient specific data and shares documents securely with specialist on same day of patient visit • PCP completes referral CCR to specialist • Includes documentation of recent and past studies and history • Signed document is part of patient record and protected for proper access • Specialist returns a CCR to PCP for follow-up care IHE Interoperability Workshop

16. Use Case • Goal in context • Consultation between primary care providers and specialists • Collaboration with the right people to treat efficiently and eliminate error • Scope • Cross Enterprise Document Sharing • Pre-Condition • Participants are linked to leverage collaborative technologies IHE Interoperability Workshop

17. Stakeholders and Interests • Primary Care Provider • Provides appropriate patient care using available medical records. • Active participation in patient care for continuity and follow-up • Specialist Physician • Immediate access to patient data • Availability of input from PCP and other specialists • Ability to provide high quality patient care • Patient • Quick and proper care • Minimal inconvenience • Independence from place of care • Other participants in patient care • Easy workflow • Minimum delay • Access to right information at the right time IHE Interoperability Workshop

18. Success Verification • Patient arrives at PCP office with problem, obtains chest film & results on same day of visit • Specialist is notified by PCP of the problem on the same day • PCP discusses patient specific data and shares documents securely • PCP completes referral CCR to specialist with appropriate and relevant documentation and sends patient for admission to specialist’s inpatient service • Specialist responds with CCR to PCP to provide for appropriate follow-up care • The signed and completed documents become part of patient record and are protected for proper access IHE Interoperability Workshop

19. CCR Demo Plan • Sample Scenario • This presentation • CCR Content Profile • To be Finalized by October 8th • Vendor Applications • Due October 15th • Indicate ASTM-CCR on Demo Application • Draft Schema and Implementation Guide • To be Finalized by October 8th • Need Reviewers IHE Interoperability Workshop

20. CCR Demonstration Development Schedule IHE Interoperability Workshop

21. Questions? IHE Interoperability Workshop

22. More information…. • IHE Web sites: http://www.himss.org/IHE http://www.rsna.org/IHE http://www.acc.org/quality/ihe.htm. • Technical Frameworks: • ITI V1.0, RAD V5.5, LAB V1.0 • Technical Framework Supplements - Trial Implementation • May 2004: Radiology • August 2004: Cardiology, IT Infrastructure • 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 IHE Interoperability Workshop