IHE Orientation Workshop: Achieving Interoperability in Healthcare

1. INTEGRATING THE HEALTHCARE ENTERPISE (IHE)Orientation Workshop (2) International HL7 Interoperability Conference-10 Carlos Guilherme Costa, Product Manager, Alert, IHE US & Eu Connectathon participant Julio Carau, Director,Hospital de Clinicas "Dr. Manuel Quintela", Montevideo, Uruguay

2. Agenda Part 1: THE IHE STANDARDS ADOPTION PROCESS: achieving practical interoperability This Afternoon: Part 2: USERS AND VENDORS WORKING TOGETHER: how can I contribute & benefit from IHE HOW TO USE IHE RESOURCES: hands on experience 2

3. Understanding the IHE Initiative • IHE has a clear focus • IHE is a healthcare domain-based initiative • IHE creates synergies for interoperability testing across domains • IHE addresses the standards adoption process • IHE is both regional and multi-national • IHE is both user lead and vendor driven

4. Testing at Connectathons IHE Demonstrations Develop technical specifications Products with IHE Identify available standards (e.g. HL7, DICOM, IETF, OASIS) Timely access to information Document Use Case Requirements Easy to integrate products Standards Adoption Process

5. Global Development IHE America IHE Asia-Oceania China Japan Radiology IT Infrastructure Laboratory Canada USA Australia Korea Taiwan Cardiology Patient Care Coordination Pathology IHE Europe & Middle East Radiation Oncology Patient Care Devices Eye Care Austria France Germany Netherlands Turkey Public Health, Quality and Research Italy Israel Spain UK Sweden Swiss Professional Societies / Sponsors ACC ACCE ACEP ACP GMSIHIMSS Contributing & ParticipatingVendors COCIR EAR-ECR DRG SIRM BIR EuroRec RSNA SFRSFIL ESC JAHISJIRAJRS METI-MLHW MEDIS-DCJAMI IHE Organizational Structure IHE International Board Regional Deployment 5

6. IHE Sponsors Professional societies Healthcare Information Management Systems Society (HIMSS) Radiological Society of North America (RSNA) British Institute of Radiology (BIR), British Computer Society (BCS German Radiology Society (DRG) GMSIH (IT France), SFIL (laboratory), French National Project (DMP) European Society of Cardiology……Many other European Societies American College of Physicians (ACP), American College of Emergency Physicians (ACEP) …Many other American healthcare societies (ACCE), (AAO), (ASTRO), etc. JAHIS (IT Japan), JIRA, JRS….Many other Japanese Societies And many more…. Health Authorities NICTIZ (Netherlands), ASIP (F), ELGA (Austria), Infoway (Canada), etc.

7. IHE Participants and Relationships • Participants include: • Users - Clinicians, Staff, Administrators, CIOs, Governments • Vendors of Information Systems and Equipment • Consultants • Relationship with Standards Development Organizations (SDOs): • HL7, DICOM, ISO, CDISC, IEEE and many others • Adoption process approved via ISO/TC 215, IHE profiles to be published as ISO Technical Reports • Other Profiling Organizations such as Continua (Consumer Devices) • National Adoption of IHE Profiles • DMP(France), ELGA(Austria), HITSP (USA), Infoway (Canada), many others worldwide…..

8. IHE International Governance - Membership • Membership: www.ihe.net/governance • Members are Organizations–Sign Governance & IP once. • Three Organizational Categories: User, Developer, General Interest • Member designates a primary/alternate representatives to one of more Committees (Domains, Test& Tools, MarCom). • Elect Committee co-chairs. One User & one vendor recommended for Planning Committees • Regional and National IHE Committee members required to become members of IHE International. • Over 300 Member organizations. About half users/half Vendors

9. IHE International Governance – Others Committees • IHE Regional or National Deployment Committees are independent entities with their own governance but close collaborative relationship with IHE International. • IHE International Board empowers “Regional and National Committee”. 3 year commitment, renewable. • Oversees Testing and Tools Committee • Coordinates the various Regional and National Committees. • Oversees Marketing & Communication Committee • Consistency of communication among Domains within IHE International and various Regional and National Committees.

10. How can I participate? All Participants: • Become a member of relevant domain’s Planning or Technical Committees • Become a member of relevant Regional/National Committees • Help to shape IHE’s future direction • Offer Clinical Use Case Input to Drive IHE Profile Development • Respond to Public Comments of Domain Supplements • Attend Educational Workshops/Webminars As a Vendor Participant • Participate in Connect-a-thons and Demonstrations As a Provider/Consultant Participant • Attend Demonstrations and include IHE Integration Profiles in your RFPs and Integration Projects.

11. What can you do? • Learn about IHE, www.ihe.net • Insist on relevant IHE profiles compliance in your RFPs and contract documents: • Select Integration Profiles, and Appropriate Actor(s) • Ask vendors for their products “IHE Integration Statements” • Need more interoperability ? • Contribute to IHE Committees

12. Agenda Part 2: USERS AND VENDORS WORKING TOGETHER: how can I contribute & benefit from IHE HOW TO USE IHE RESOURCES: hands on experience 12

13. Agenda From IHE Profiles to conformance testing, closing the implementation gap Helping the implementers, testing tools, connectathons How to use other IHE resources: hands on experience Technical Frameworks: navigating, Q&A Test tools: finding, using, configuring Participating in the testing process 13

14. Connectathon 14

15. Connectathon Started in 1998 in the USA Europe started in 2001 Japan in 2003 China and Australia have now joined 15

16. Purpose Test implementation of the IHE integration and content profiles within product/open source Verify that the vendors did a good job Verify that what the committees specified is clear ! Verify that the Technical Frameworks are not ambiguous Verify that that the Technical Committee did not miss anything Build a community of computer geeks who loves local brewed beers and have fun working together to connect healthcare 16

17. From the vendor perspective Unique Opportunity for vendors to test their implementations of the IHE integration profiles Controlled environment Customer is not present ! Not in a clinical production environment Specialists available From SDO From the peer companies Bugs are identified and most of the time fixed !!!! Connectathon Results http://www.ihe.net/Connectathon/index.cfm 17

18. From the user perspective Unique Opportunity to engage potential vendors and user own implementation tested for conformance to IHE integration and content profiles Controlled environment User community in IHE designate the Connectathon Monitors ! Not in a clinical production environment Specialists available From SDO From the vendor companies Bugs are identified and most of the time fixed, before the product is installed !!!! Connectathon Results http://www.ihe.net/Connectathon/index.cfm 18

19. But… Testing in interoperability is (always) sub-optimal Only a part of all the possible tests are performed A system successful at the connectathon is not guaranteed to be error free !!!! But, …. it is the most thorough interoperability conformance widely available 19

20. From the IHE perspective Feedback from the vendor community Did the profile development committee do a good job ? Did the developed integration or content profile responds to the expectations of the vendors and meets the intended user need ? 20

21. Maturity of IHE Connectathons We have reached now our cruising speed NA and EU Connectathon are very alike. Japanese Connectathon is now mature. Connectathon also used as an IHE promoting tool Workshop in parallel to the Connectathon VIP visits Visitors are truly impressed !! 21

22. The IHE testing process Users Testing Results Deployed Systems Testing Tools Sponsors:Project Management Team Develop Testing Tools Approves Test Logs Connectathon Product +IntegrationStatement Implement Profile Actors In-House Testing Vendors/Implementers Users Demonstrations Demonstration IHE Technical Framework (Profiles Specification) 22

23. Unit Testing & Peer Testing Vendor B Vendor A Implementation A Implementation B Peer Testing Unit testing Specifications/Standards 22/05/08 Projet IHE-Dev Inria Rennes 23

24. Both Unit Testing & Peer Testing Need to have unit testing in the IHE Testing process Important to perform unit testing in advance of the peer testing Peer testing takes place during the testing event (connectathon). Need to perform unit testing as well during the connectathon. 24

25. Pre-connectathon 25

26. Pre-connectathon Registration Open to all, even non IHE members Choice of what can be tested  Actors for a Profile Exchange of configuration parameters IP addresses Assigning authorities, Addresses, AE Title OID Certificates Affinity domain specification (e.g. XDS Meta-data) 26

27. Pre-connectathon Unit testing using Gazelle test tools In-house testing for vendors to get ready Vendors return Gazelle tool logs Upon log return, and positive analysis, participation to Connectathon event is accepted by IHE Technical Project Mgr 27

28. At connectathon 28

29. Connectathon Testing 3 types of test to be performed “No-peer” tests “Peer to peer” tests “Workflow” tests (multi peers) 29

30. 5 days Configured up and running by Monday morning 11 am Set up time Till Friday noon : Free “peer to peer” and “no peer” testing From Wednesday till Friday noon : Directed “workflow” testing Enough time to test 4-6 solid profiles and 1-2 new profiles per participating system 30

31. Monitors Report to IHE Technical Project Mgr Volunteers, trained and screened Independent from vendors. Selected by IHE Countries users. Standard knowledegeable Verify tests Act as moderator between vendors 31

32. Results To be successful Pre-connectathon test validated Each peer to peer test needs to be verified with at least 3 peers A vendor may fail for an actor in a profile but pass for the others IHE does not report failure. Vendors have access to their own detailed test results (track issues). Vendors shall publish their products integration statements  Market/Contractual sanction 32

33. Connect-a-thon Results Browser 33

34. Connectathon Results Browser 34

35. Connectathon Results Browser 35 35

36. What does it mean ? The Company was successful at the connectathon for an actor/integration profile combination Results express a company maturity and willingness to collaborate. Does not guaranty product conformity, but enables market/contractual commitments by vendors to their customers Product conformity commitment: This is the role of the « IHE integration statements » 36

37. IHE Integration StatementProduct vendors take the next step 37

38. Technical Frameworks One per Domain They are the reference, the tools are not ! Written and reviewed by Vendors and Users Freely available on http://www.ihe.net 38

39. Organization of the TF Volume 1 Description of the Integration/content profiles and actors Dependencies between actors and profiles Use cases Volume 2 and followings Description of the transactions with reference to used standards 39

40. TF Life Cycle Every year : New integration profiles Change Proposal Integration Profile proposed as Supplements Public Comment Trial Implementation Final Text Once in Final Text integration into the main document. No concept of profile version (Corrections are applied). Non backward changes result in a new profile. 40

41. IHE Wiki http://wiki.ihe.net A lot of information. Used for supporting on-going work by Committees Committee planning / minutes /in development documents General membership/Chairs http://ihewiki.wustl.edu/ Wiki for connectathon organization and management Code exchange XDS implementation page … 41

42. Gazelle Objectives 42

43. Objectives Improve the overall quality of testing Conformance and Interoperability Broaden the use of the application. Open Source Licence (Apache). Build a framework for Healthcare interoperability testing Synchronous testing of multiple systems Multilingual Scalable 43

44. 5 Context of Use Connectathon Virtual Connectathon Company Internal Testing tool Healthcare Enterprise Testing tool Governmental/Certification organizations 44

45. Gazelle Architecture 45

46. Gazelle Architecture Gazelle Control System Database External Validation Services External Validation Services Gazelle Actor (Simulators) Configuration Info External Validation Services Gazelle Test Engine Gazelle Actor (Simulators) External Validation Services Control Gazelle Actor (Simulators) Gazelle Actor (Simulators) Feedback Gazelle Actor (Simulators) System Under Test System Under Test System Under Test System Under Test Tests Scenario Proxy Network 22/05/08 Projet IHE-Dev Inria Rennes 46

47. System under test More than one system can be tested at the same time Management of System Under Test Web application to provide instructions 47

48. Participants 3 IHE Regions North America : MIR Europe : INRIA Japan : Shizuoka University DVTK NIST Tiani-Spirit David Clunie Offis Open to more participants 48

49. Project Management Testing and Tool Committee Overview of IHE testing activities Choice of the license Approve Connectathon Organizers Testing Management Group Project Management Eric and Steve 49

50. More Resources - www.ihe.net • Frequently Asked Questions • Integration Profiles in Technical Frameworks: • Cardiology • IT Infrastructure • Laboratory • Patient Care Coordination • Patient Care Devices • Radiation Oncology • Radiology • Connectathon Results • Vendor Products Integration Statements • Participation in Committees and Connectathons