INTEGRATING THE HEALTHCARE ENTERPRISE Pathway to Interoperability

1. INTEGRATING THE HEALTHCARE ENTERPRISE Pathway to Interoperability IT Infrastructure Planning Committee Michael Nusbaum – MH Nusbaum & Assoc

2. Contents

3. IETF IHTSDO Interoperability:Highest Cause of Health IT project failures eHealth Projects Base Standards Health Interoperability Standards: how can we realize the promise ?

4. Profiling Organizations Have Emerged IETF IHTSDO Interoperability: From a problem to a solution eHealth Projects Base Standards Profile Development Specific Extensions 4

5. Standards: 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 5

6. 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

7. IHE: A Framework for Interoperability A common technical framework for harmonizing and implementing multiple standards Application-to-application System-to-system Setting-to-setting Enables seamless health information movement within and between enterprises, regions, nations Promotes unbiased selection and coordinated use of established healthcare and IT standards to address specific clinical needs

8. What are the alternatives ? Ignore the issue Pick key standards, and hope for the best Rely on robust standards harmonization ISO Health Informatics: TR28380 Global Standards Adoption – IHE Process and Profiles Widespread adoption of IHE Profiles by National and Regional Projects around the world: USA, Canada, Europe, Asia Home Health: CONTINUA and IHE work together. 12 Country European epSOS Project (IHE-Europe hosting Industry Team). Is IHE novel? Adopted? 8

9. Testing at Connectathons Develop technical specifications Identify available standards (e.g. HL7, DICOM, IETF, OASIS) Document Use Case Requirements Timely access to information Easy to integrate products IHE is a Proven Standards Adoption ProcessRecognized by the International Standards Organization: TR 28380 IHE Demonstrations Products declare IHE RFPs with IHE reqs

10. IHE North America IHE Asia-Oceania China Japan Canada USA Korea Australia IHE Europe Austria France Germany Netherlands Italy Norway Spain UK Sweden Contributing & ParticipatingVendors IHE Organizational Structure IHE International Board Global Development Domains Example Deployment Committees Radiology IT Infrastructure Laboratory Cardiology Patient Care Coordination Pathology Radiation Oncology Patient Care Devices Eye Care Public Health, Quality and Research Pharmacy Dentistry Endoscopy Professional Societies / Sponsors 10 10 10

11. Cardiologysince 2004 Laboratorysince 2004 (Healthcare)IT Infrastructuresince 2003 Radiation Oncologysince 2004 The IHE Development Domains 14 Years of Steady Evolution 1998 – 2011 Dentistrysince 2010 Radiologysince 1998 Endoscopysince 2010 Pharmacysince 2009 Pathologysince 2006 Eye Caresince 2006 QualityResearch & Public Healthsince 2006 Patient Care Coordinationsince 2004 Patient Care Devicessince 2005

12. International Participation in IHE Netherlands Germany Norway Canada Austria Taiwan France Japan Korea China USA Italy UK Spain 2005 2006 2000 2007 1999 2001 2002 2003 2004 2008 2009 Australia • Local Deployment • National Extensions • Promotional & Live Demonstration Events • Funding Pragmatic global standards harmonization + best practices sharing

13. IHE Sponsors Professional societies: Healthcare Information Management Systems Society (HIMSS) American College of Physicians (ACP), American College of Emergency Physicians (ACEP) American College of Obstetricians and Gynecologists (ACOG) Many other American Professional Societies (ACCE), (AAO), (ASTRO), etc. British Institute of Radiology (BIR), British Computer Society (BCS) German Radiology Society (DRG) …ASIP (IT France), SFIL (laboratory), French National Project (DMP), European Society of Cardiology Radiological Society of North America (RSNA) JAHIS (IT Japan), JIRA, JRS,… And many more Government Agencies: French National Project (ASIP-Santé) Dutch National Project (NICTIZ) Austrian National Project (ELGA) Canada Health Infoway (CHI) Regional projects (Italy, USA, Japan) and many more….. 13

14. IHE Connectathon • Open invitation to any vendor and other implementers • Advanced IHE testing tools (MESA, GAZELLE) • Testing organized and supervised by independent project management team • Thousands of cross-vendor tests performed • Results recorded and published http://connectathon-results.ihe-europe.net/

15. IHE N.A. Connectathon Tested Systems EHR/PHR/Edge Systems 2008: 14 Systems 2009: 24 Systems 2010: 56 Systems HIE/HIO Infrastructure 2008: 5 Systems 2009: 6 Systems 2010: 30 Systems Cross-enterprise Interoperability Intra-enterprise Interoperability Enterprise-level: 44 Systems Radiology 40 Systems Cardiology 30 Systems Devices 20 Systems

16. HIMSS Interoperability Showcase 16

17. IHE, Global Standards-Based Profiles Adopted in National & Regional Projects http://tinyurl.com/WWXDS

18. IHE, Global Standards-Based Profiles Adopted in National & Regional Projects http://tinyurl.com/WWXDS

19. The IT Infrastructure Domain • Supplies infrastructure for sharing healthcare information, which is independent of any particular clinical domain. • An infrastructure interoperability component represents a common IT function that is used as a building block for a variety of use cases... a necessary ingredient, but rarely visible to the end user. • These components may be embedded in an application, but are often deployed as a shared resource within a health information exchange environment.

20. Categories of Healthcare Communication Services Patient and Provider Identity Management Security/Privacy Exchange of Health Information Hospitals e.g. access last 6 mo. historical labs & encounter summaries Support Management e.g. order lab test, track status and receive results Health Record Sharing Workflow Enablers Source persisted and attested health records 2 or more entities synchronize a task

21. ITI Strategic Focus http://wiki.ihe.net/index.php?title=ITI_Strategic_Planning

22. More Information • IHE Web site: www.ihe.net • IHE official material • Technical Framework documents • IHE Wiki site: wiki.ihe.net • IHE committee pages • Implementation Notes • Ongoing committee work • IHE ITI technical committee mailing list • http://www.ihe.net/IT_infra/committees • At the bottom of the page is a place to join the mailing list