INTEGRATING THE HEALTHCARE ENTERPISE Critical Contribution to Interoperability Worldwide

1. INTEGRATING THE HEALTHCARE ENTERPISE Critical Contribution to Interoperability Worldwide International HL7 Interoperability Conference-10 Charles Parisot, IHE IT Infrastructure Co-Chair, GE Healthcare

2. Objective Present a practical and proven process to accelerate the adoption of health information exchange standards in South America to enable the development of National and Regional eHealth Networks

3. eHealth and Interoperability: why is action needed ?

4. Interoperability: Major Cause of Health IT project failures IETF IHTSDO Base Standards eHealth Projects Health Interop. Standards: Ignore & Face Consequences 5

5. Interoperability:Major Cause of Health IT project failures IETF IHTSDO Base Standards eHealth Projects Health Interop. Standards: Chaos with projects choice 6

6. eHealth and Interoperability: How should we act ?

7. Interoperability: From a problem to a solution IETF IHTSDO Profile Development eHealth Projects Project Specific Extensions Profiling Organizations Have Emerged 8

8. IHE Message:Standards are Necessary…Not Sufficient Standards are Foundational - to interoperability and communications Broad - varying interpretations and implementations Narrow - may not consider relationships between standards domains Plentiful - often redundant or disjointed Focused - standards implementation guides focus only on a single standard IHE provides a standard process for implementing multiple standards 9

9. IHE: Connecting Standards to Care Healthcare professionals work with industry Coordinate implementation of standards to meet clinical and administrative needs Clinicians and HIT professionals identify the key interoperability problems they face Providers and industry work together to develop and make available standards-based solutions Implementers follow common guidelines in purchasing and integrating effective systems IHE: A forum for agreeing on how to implement standards and processes for making it happen 10

10. IHE Standards Adoption ProcessAdopted by International Standards Organization: TR 28380 Testing at Connectathons IHE Demonstrations Develop technical specifications Products with IHE Identify available standards (e.g. HL7, DICOM, IETF, OASIS) Improve Safety, Quality and Effectiveness Document Use Case Requirements Easy to integrate products 11

11. Radiologysince 1998 PharmacyNEW 2009 Cardiologysince 2004 Pathologysince 2006 Laboratorysince 2004 Eye Caresince 2006 (Healthcare)IT Infrastructuresince 2003 QualityResearch & Public Healthsince 2006 Radiation Oncologysince 2004 Patient Care Devicessince 2005 Patient Care Coordinationsince 2004 The IHE Development Domains 12 Years of Steady Evolution 1998 – 2010 13

12. Is IHE novel, how much adopted ? IHE adopted by: The European Commission and eHealth Interop Mandate 403: endorses IHE process ISO Health Informatics: TR28380 Global Standards Adoption – IHE Process and Profiles Widespread adoption of IHE Profiles by National and Regional Projects around the world: North America, Europe, Asia Tele Health: CONTINUA and IHE work together. 12 Country European epSOS Project (IHE-Europe hosting Industry Team, performing testing). 14

13. International Growth of IHE Switzerland Netherlands Germany Turkey Canada Austria Taiwan France Japan China USA Italy UK Spain 2005 2006 2000 2007 1999 2001 2002 2003 2004 2009 2008 2010 • Local Deployment, National Extensions • Promotional & Live Demonstration Events • Over 300 Organizational Members (all stakeholders) Malaysia Australia Pragmatic global standards harmonization + best practices sharing 15

14. IHE Implementation Strategy Leverage established standards to allow rapid deployment and plan for futurePragmatic, Ease of Evolution Enable architectural freedom (patient vs. provider centric, centralized vs. decentralized, scalable (from office to enterprise to IDN to Regional and National Networks)Configurationflexibility Support breakthrough use cases: variety of care settings, care coordination, public health, PHR, EHRInteroperability for broad constituencies IHE: Offers consistent, standards-based record sharing for EHRs and other information systems 16

15. Implementing IHE today in Regional and National Health Networks: Key Services Sharing of Patient Summaries (Incl Prescriptions) Sharing of Laboratory Results Sharing of Radiology Info Sharing of Cardiology Info Sharing of Scanned Docs Content HL7/PDF DICOM HL7 HL7 HL7PDF DICOM/HL7 Sharing of Records/Documents W3C/OASIS/HL7 Infra-structure Audit Trail and Secured Connection Digital Signature Privacy and Consent Patient Identification Mgt Provider Directory Termi-nology Services HL7 IETF/HL7 HL7 HL7 W3C/ITU HL7 17

16. Example: Patient Id Mgt Interoperability 3 IHE Profiles: XCPD: Cross-Community Patient Discovery Patient Identity Mgr Based on HL7 V2 and HLV3+Web Services Widely used world-wide. Patient Identity Mgr PDQ: Patient Demographics Query PIX: Patient Identifiers Cross-referencing e.g. Point of care, Insurance 18

17. IHE, Global Standards-Based Profiles Adopted in National & Regional Projects Austria Lower Austria NETHERLANDS Friesland Natn’l Mamography Italy Conto Corrente Venetto - Friuli VITL-Vermont FranceDMP Quebec, Toronto,Alberta, British ColumbiaCanada Infoway SuisseSt Gallen Lausane Wales Imaging France Imaging IDF Boston Medical Center - MA Philadelphia HIE Belgium Flemish-Leuven KeyHIE Pennsylvania CareSpark – TN & VA SHARP CA South Africa THINC- New York NCHICA – N. Carolina Providence Health System - OR CHINA-Shanghai Imaging Info Sharing CHINA-MoH Lab results sharing JAPAN-Nagoya Imaging Info Sharing, Nationwide PDI guideline 19 19

18. eHealth and Interoperability: How to act in South America

19. Role of IHE for the a Country I. Identify Interoperability Problems. Collect requirements and promote them at the global level II. Specify Integration Profiles. Select existing IHE profiles that match own State requirements and/or engage Country experts in the development of new IHE profiles. Organize technical training for implementers. III. Test Systems at the Connectathon. Recruit implementers from own State to present systems to be tested at an existing Connectathon. Contribute to IHE test tools development. Evaluate possible organization of a South American Connectathon. IV. Publish Integration Statements Drive vendors to publish their product IHE integration statements. Organize support for national projects interoperability testing. 21

20. Interoperability: From a problem to a policy Countries/Regions with such a process: Austria (ELGA) France (ASIP) Canada (Infoway), USA (HITSP) Italy (Veneto) Recognized: Profile A Profile B Profile C….. eHealth ProjectsInteroperability Specifications Base Standards Profile Development & Testing IHE in the SA Countries IETF Simple and EffectiveProfile RecognitionProcess & Policy Leverage Synergies of Global Standards and Profiles 22

21. Addressing the challenge Tasks to accomplish : Selection of specific standards Development of detailed interoperability specifications Test systems compliance. Countries to consider: Join IHE international to contribute and benefit from existing standards Ground IHE expertise in South America Leverage the market synergies across South America Accelerate development of national technical interoperability strategies IETF Standards IHE in SA Countries Profiles & Tests National Agencies & Competence Centers Interop Specs eHealth Projects

22. eHealth and Interoperability Organized as a collaborative framework Leverages IHE International Involves all key stakeholders in own Country Ministry of Health Healthcare Providers Health IT professionals Industry, etc.  Establishes foundation for a larger market by reducing cost and accelerating procurement of interoperable Clinical IT products 24

23. Creation of National IHE Step 1: Decision on principle. Two/three sponsors. Agreement on governance. Create Steering Committee. Designate Secretariat. Chair sends application to IHE International Application approved by IHE International Board. Seat on IHE Board. Step 2: Accept members. Approve work program and work groups. Step 3: For first use case (s), propose initial set of IHE Profiles for country adoption and agree on national extensions. Step 4:Approve initial set of IHE Profiles adopted with national extensions. Repeat steps 3 and step 4 to broaden scope of interoperability 25

24. Thank You! 26