IHE support for RHIOs, and community Health Information Exchange

1. http://www.ihe.net/Events/upload/IHE%20Support%20for%20RHIOs-V5-Charles.ppthttp://www.ihe.net/Events/upload/IHE%20Support%20for%20RHIOs-V5-Charles.ppt IHE support for RHIOs, and community Health Information Exchange IHE 2006 Workshop, June 2006 Charles Parisot, GE HealthcareIT Infrastructure co-chair Technical Committee

2. 1 - Distinguish “edge” HIT systems from information exchange infrastructure

3. 2 - Support multiple architectures Centralized, distributed, federated, etc. Different business models, cost, legacy systems, etc.

4. 3 - Enrich Incrementally, no rip and replace • Has been the hallmark of IHE for many years • Think long-term, but specify & implement what is needed today • Steal good ideas, learn form others’ mistakes • Listen and collaborate • Reuse, reuse previous Integration Profiles • If a clear use case cannot be specified in 6 months, and implemented for testing in the next 6 month, rethink.

5. Step-wise IHE RHIO strategy 2005 • Start with “Document Sharing” with patient identifiers management • Establish basic security (pipe encryption and node authentication) • Grow document sharing content to deliver multi-level interoperability (enabling coded information) with medical summaries & imaging info 2006 What is introduced in 2006-2007 ? 2007

6. Step-wise IHE RHIO strategy 2005 • Start with “Document Sharing” with patient identifiers management • Establish basic security (pipe encryption and node authentication) • Grow document sharing content to deliver multi-level interoperability (enabling coded information) with medical summaries & imaging info • Introduce point-point interchange by disfeaturing “document sharing” to enable upward evolution • Grown content to cover info exchange to support common care coordination use cases, basic diagnostics/therapeutic information, and simple patient input. • Extend security by leveraging existing edge system security capabilities to enable basic RHIO policies 2006 2007

7. Step-wise IHE RHIO strategy 2005 • Start with “Document Sharing” with patient identifiers management • Establish basic security (pipe encryption and node authentication) • Grow document sharing content to deliver multi-level interoperability (enabling coded information) with medical summaries & imaging info • Introduce point-point interchange by disfeaturing “document sharing” to enable upward evolution • Grown content to cover info exchange to support common care coordination use cases, basic diagnostics/therapeutic information, and simple patient input. • Extend security by leveraging existing edge system security capabilities to enable basic RHIO policies • Progressive introduction of consistent of coded terminologies….. • Cross-enterprise workflows (e.g. lab & radiology orders ……. • Federation of XDS domains …… • X-Enterprise User Authentication-Federated identity …… 2006 2007

8. Sharing, Sending, Interchanging and Transacting Health Information Exchange or RHIO Structuredobjects XDS Pull Publish Pull Send to Send to XDP Switch Interchange Media Write Read Workflow Mgr Workflow Mgr Transactions Data Repository Info Requestor Query / Response

9. IHE Integration Profiles for Health Info NetsWhat is available and has been added in 2005 and is for 2006 Scanned Documents Lab Results Document Content ECG Report Document Emergency Referrals PHR Extracts/Updates Basic Patients Privacy Consents Format of the Document Content and associated coded vocabulary Format of the Document Content and associated coded vocabulary Format of the Document Content and associated coded vocabulary Format of the Document Content and associated coded vocabulary Format of the Document Content Patient Identifier Cross-referencing Establish Consents & Enable Access Control Cross-Enterprise Document Sharing Map patient identifiers across independent identification domains Imaging Information Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Patient Demographics Query Medical Summary (Meds, Allergies, Pbs) Format of the Document Content and associated coded vocabulary Document Digital Signature Audit Trail & Node Authentication Format of the Document Content and associated coded vocabulary Attesting “true-copy and origin Request Formfor Data Capture Centralized privacy audit trail and node to node authentication to create a secured domain. External form with custom import/export scripting Consistent Time Notification of Document Availability Cross-enterprise Document Point-Point Interchange Notification of a remote provider/ health enterprise Coordinate time across networked systems Media-CD/USB & e-mail push Clinical and PHRContent Security Patient Id Mgt Health Data Exchange Other

10. Health Information Exchanges Interoperability: Cross-enterprise Document Sharing • Cross-Enterprise Document Sharing minimizes clinical/admin data management by the infrastructure. Transparency = Ease of Evolution • Patients/consumers have guaranteed portability and providers may share information without concerns of aggregation errors.Digital Documents = Patients and providers empowerment • Supports both centralized and decentralized repository architectures. Ease of federation nationally. Flexible privacy,Flexibility of configurations • Has received major support world-wide: National & regional projects, NHIN contractors, US EHR Vendor Assoc., complements Connecting for Health RLS.

11. XDS-MS MedicalDocuments PPHP BCCP MedicalSummaries History andPhysical Consent XPHR Referral DischargeSummary PHR Extract PreprocedureHistory andPhysical EDR EmergencyDepartmentReferral XDS-LAB PHR Update Lab Report XPHR PHR Extract PHR Update Exchange of EHR & PHR Content, Array of document content with many common modules

12. e.g. Exchange of PHR Content • The Exchange of Personal Health Record Content (XPHR) provides a standards-based specification for enabling interoperability of core personal health information between: • a Personal Health Record and • either an EHR or another PHR System • Supports interchange of PHR Information: • Demographics • Insurance Information • Medications, Problems, Allergies • Health History • Other Information

13. PHR Systems another edge systemNeeds sharing records/documents: IHE-XDS Health Payer Record Hospital Record Repository ofDocuments Specialist Record SharedRepository ofDocuments Reference to records 4 - Health data presented to Patient 3-Records Returned Aggregate Patient Info Index of patients records (Document-level) Internet Sharing System 2-Reference to Records for Inquiry PHR System Community

14. IHE Integration Statements • Explicit claim by the implementor/vendor, for a specific product version • Lists IHE Integration Profiles, Actors & Options • Short (1 page) & Sweet • Compare apples with apples. http://www.ihe.net/resources/ ihe_integration_statements.cfm

15. Building a RHIO with IHE • Leverage a large body of international contributions and experiences. Submit your gaps. • Suggested Approach • Define Use Cases of interest • Match against existing IHE Integration Profiles • For each use case selected, develop a “RHIO interoperability specification” that builds by reference upon the selected set of IHE Integration Profiles. Include in RFP. • Request vendors (infrastructure and edge systems) to submit proposed product IHE Integration Statements • Verify vendor participation in IHE Connectathon

16. IHE Integration Profiles for Health Info NetsWhat is available and has been added in 2005 and is for 2006 Scanned Documents Lab Results Document Content ECG Report Document Emergency Referrals PHR Extracts/Updates Basic Patients Privacy Consents Format of the Document Content and associated coded vocabulary Format of the Document Content and associated coded vocabulary Format of the Document Content and associated coded vocabulary Format of the Document Content and associated coded vocabulary Format of the Document Content Patient Identifier Cross-referencing Establish Consents & Enable Access Control Cross-Enterprise Document Sharing Map patient identifiers across independent identification domains Imaging Information Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Patient Demographics Query Medical Summary (Meds, Allergies, Pbs) Format of the Document Content and associated coded vocabulary Document Digital Signature Audit Trail & Node Authentication Format of the Document Content and associated coded vocabulary Attesting “true-copy and origin Request Formfor Data Capture Centralized privacy audit trail and node to node authentication to create a secured domain. External form with custom import/export scripting Consistent Time Notification of Document Availability Cross-enterprise Document Point-Point Interchange Notification of a remote provider/ health enterprise Coordinate time across networked systems Media-CD/USB & e-mail push Clinical and PHRContent Security Patient Id Mgt Health Data Exchange Other