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HIE Around the Worls

HIE Around the Worls. EHRs and IHE Overview. Chris Lindop GE Healthcare Radiology Committee Co-chair IHE Australia Board. XDS in Europe. Agenda. IHE operations in Europe EU projects and IHE Notable EHR projects in Europe using IHE. 3. IHE-Europe.

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HIE Around the Worls

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  1. HIE Around the Worls EHRs and IHEOverview Chris Lindop GE Healthcare Radiology Committee Co-chair IHE Australia Board

  2. XDS in Europe

  3. Agenda IHE operations in Europe EU projects and IHE Notable EHR projects in Europe using IHE 3

  4. IHE-Europe • Coordination and harmonisation of european national initiatives • IHE national initiatives • Aimed at deployment of IHE at national level • Active national initiatives • Austria, Denmark, Finland, France, Germany, Israel, Italy, Norway, Spain, Sweden, The Netherlands, United Kingdom • New initiatives • Switzerland and Turkey will kick off in 2010 4

  5. IHE-Europe • Organisation and management of IHE CAT • CAT 2009 held in Vienna, Austria • 73 companies registered • 230 engineers participated • 94 systems, 27 of which registered for XDS • XDS and XCA witnessed the most increase in systems • CAT 2010 will be held in Bordeaux, France • 10th anniversary connect-a-thon • Venue will be the Cité Mondiale • CAT 2011 will be held in Pisa, Italy 5

  6. Challenges • Healthcare systems are under pressure • Citizens’ expectations for high-quality care • Demographic changes • Increased prevalence of chronic diseases • Shortage of Health Professionals • Patient safety issues • Rising healthcare costs, medical progress Source: EC 6

  7. Challenges • Changes are needed in the way • healthcare is delivered • medical knowledge is managed and transferred in clinical practice • EC vision for health • ICT to support the paradigm shift • From “curative care‟ to “preventive care‟, from “hospital-based‟ to “patient-centred‟ throughout Europe • by • Using ICT to enable collaborative and personalised care • Supporting dynamic healthcare systems • Aiming at sustainability of healthcare systems • Interoperability Source: EC 7

  8. Projects • IHE Europe is involved in eHealth projects • epSOS • Calliope • HITCH • eHealth Interop Mandate 403 • Smart PHS • Smart Personal Health Systems • IHE Europe is contributing to the development of eHealth in Europe 8

  9. epSOS • epSOS stands for • European Patients Smart Open Services • Europe-wide project • 27 beneficiaries representing twelve EU-member states • IHE • Ministry of Health • Germany, Denmark, Austria, The Netherlands, Spain, Sweden, UK, France • Open eHealth initiative • large scale European pilot of patient summary and electronic prescription • www.epsos.eu 9

  10. epSOS • The goal • to develop a practical eHealth framework • to develop ICT infrastructure • Enabling • secure access to patient health information between different european healthcare systems • basic patient summaries • ePrescriptions 10

  11. epSOS • National entitities test services in pilot applications, which interconnect national solutions • based on advanced and distinct use cases and associated infrastructural components • Aims at delivering both a methodological process and durable implementations • building blocks • These building blocks will form the basis for a longer term, pan-european approach to develop interoperable service solutions 11

  12. Calliope • Calliope stands for • CALL for interOPErability • Calliope is • a network of collaborating organisations • mandated with the planning and implementation of eHealth • Calliope comprises • 28 founding members including • 17 organisations representing national governments and eHealth competence centres • 11 EU-level stakeholder organisations of health professionals, patients, health insurers and industry 12

  13. Calliope • Creating an open forum • to support the implementation of interoperable eHealth infrastructures and services across Europe • to build a unique cross-stakeholder platform • aspiring to governing principles • supported by a communication infrastructure and knowledge management tools • to review and advance the EC interoperability recommendation • to add value to eHealth standardisation initiatives • to propose a European roadmap for eHealth interoperability • www.calliope-network.eu/ 13

  14. Mandate 403 to provide a consistent set of standards to address the needs of the rapidly-evolving field of eHealth for the benefit of future healthcare provision three European Standards Organisations (ESOs), CEN, CENELEC and ETSI, accepted this mandate from the European Commission requires active collaboration with COCIR, EHTEL, ISO/TC 215, IHE, HL7, Eurorec, IHTSDO, GS1, IEEE, DICOM 14

  15. Mandate 403 • requirements driven and collaborative • primary goal is not to develop new standards • populate use cases with existing international standards when possible • collaborate with standards fora, consortia and SDOs • Reuse and encourage reuse 15

  16. Deployment • IHE Europe is also active in sustaining deployment through IHE national initiatives • stimulate regional projects at national level • provide guidance if needed • support communication if needed • success stories 16

  17. EHR Experiences - UK • PACS integration project in Wales • the pilot phase involves 7 PACS in 4 organisations around Cardiff • phase 2 will include 10 more PACS in another 4 organisations • this includes PACS from 6 different vendors. • the project will be providing • integration WITHIN organisations (different PACS vendors) • between organisations • project will be based on XDS/XDS-I Data courtesyof IHE-UK 17

  18. EHR Experiences - NL • Friesland Regional Cardiogy Network • Clinical setting • Sharing cardiology-related data for transfer of patients (cardiac surgery) • Data shared • Cardiac images (multi-frame runs), ECGs, patient status • Setting • 5 hospitals – one central site • Benefits achieved • Full availability of clinical data through XDS browser • Import of data to local viewing environment Data courtesyofForcare/IHE-NL 18

  19. EHR Experiences - NL • Connectivity network for breast cancer screening • Clinical setting • Sharing breast cancer screening results to hospitals forclinical follow-up • Data shared • Mammography images, reports • Setting • One central screening PACS (1m exams/year) • 4% referral / retrieval rate • 100 Dutch hospitals • Benefits achieved • Full availability of clinical data through XDS browser • Import of data to local viewing environment Data courtesyofForcare/IHE-NL 19

  20. EHR Experiences - IT • Health Optimum Veneto • telemedicine project for different specialties • phase 1 • duration • 18 months May 2004 to January 2006 • purpose • market validation of organizational models based on telemedicine services • actors involved • 11 healthcare Providers in Veneto Region • 3 European Member States: Italy (Veneto Region), Spain(Gobierno de Aragona), Denmark (County of Funen) Data courtesyofArsenal.it/IHE-I 20

  21. EHR Experiences - IT • Health Optimum Veneto • phase 2 • duration • 24 months June 2007 to May 2009 • purpose • deploying organizational models based on telemedicine services • actors involved • 23 healthcare Providers in Veneto Region • 5 European Member States: Italy, Spain, Denmark, Sweden Data courtesyofArsenal.it/IHE-I 21

  22. EHR Experiences - IT • Health Optimum Veneto • Services • Oral anti-coagulant therapy • Stroke management • Neuro-surgical tele-counseling • 36 peripheral hospitals without neurosurgery/neuroradiology units are linked to 7 neurosurgical centres • Tele-laboratory • 80 peripheral sites are going to be linked to hospital LIS systems Data courtesyofArsenal.it/IHE-I 22

  23. EHR Experiences - IT • Health Optimum Veneto • Mixing XDS and non-XDS solutions • XDS architecture adopted • Treviso, Belluno, Venezia, Verona, Padova • Non-XDS architecture • Rovigo, Vicenza • Central governance systems • managing, including remote monitoring, all equipment involved in the interoperability platform • providing the semantic interoperability • allowing to perform the statistical analysis of data and proper reporting of services Data courtesyofArsenal.it/IHE-I 23

  24. EHR Experiences - IT • Health Optimum Veneto • interoperability guidelines adhering to • IHE XDS (Cross-Enterprise Document Sharing), XDS-I (XDS for Imaging) and NAV (Notification of Document Availability) profiles • IHE XCA (Cross-Community Access) profile • IHE PCC (Patient Care Coordination) profile • authoritative ICT standards: ebXML, CDA2, DICOM, HL7, PKCS#7, etc… Data courtesyofArsenal.it/IHE-I 24

  25. Thank You for Your Attention Lapo Bertini 25

  26. XDS in Japan

  27. Network Structure of RHIE System by XDS for Stroke Care in Nagoya

  28. Nagoya XDS project Backed by Ministries 4 Emergency hospitals, 3 Rehab facilities(now) Profiles and standards Integrating XDS with PIX, PDQ and ATNA Enhancing XUA, NAV with access control based on XACML Excerpting XDS metadata from CDA header part Based on ebXML ebRIM3.0/ebRS3.0 (supporting XDS storedQuery), while XDS.a was specified on ebXML2.1. (Being ahead of XDS.b.)

  29. Updates in Japan 2009 Regional Health Network Subsidy 10 Billion JPY (100 M$) x 10 3 Billion JPY (30 M$) x 30 XDS, PIX, PDQ, ATNA,,, Online Reimbursement Claim Mandated even to 90000 clinics IPv6+IKE Can be used for other destination

  30. XDS in North America

  31. IHE and Canada Health Infoway • CHI has worked on development of IHE profiles, eg, XDS and XDS-I • CHI contractors have provided testing oversight at Connectathons • CHI contributed to development of testing tools • CHI has specified IHE profiles as “Pan-Canadian Standards” • Numerous implementation projects using IHE profiles

  32. Canada Health Infoway: Standards Used in Diagnostic Imaging EHRS Blueprint v2 Privacy & Security Privacy Legislation HealthcareContent, Messaging, Terminology HL7/CDA, DICOM SNOMED CT, LOINC, ICD-10CA, CCI Internet Standards XML, PDF, JPEG, JPIP, MIME, HTTP, FTP, UTF-8, … Electronic BusinessStandards ebXML, Web Services • No single standard addresses DI Requirements IHE Integration Profiles Rad: XDS-I, SWF, PIR, CPI, PGP, KIN, PDI IS: XDS, PIX, PDQ, ATNA, EUA , XUA, BPPC, CT 32

  33. DI Data Sharing in the EHR Environment Longitudinal Record Services Common Services Communication Bus SharedHealth Record DI Repository XDS Document Registry • Registry entries • Metadata XDS Document / DI Repository • Manifests • Document Sets • Images • Reports • Relevant images • Presentation states • Measurements • Other evidence docs EHR Data& Services Registries Data& Services XDS Doc Registry BusinessRules EHRIndex MessageStructures Terminology Services Security MgmtData Privacy Data Terminology HIAL EHR Viewer Physician/Provider PACS • DI Studies • Presentation states • Measurements RIS • Orders • Reports Imaging Modalities • DI Studies • Presentation states PACS PACS HIS RIS EMR/CPOE RIS XDS Document Repository DI Repository US US MRI CT CT DI Clinics Hospitals DICOM HL7 Transactions: XDS INFOSTRUCTURE ClientRegistry ProviderRegistry LocationRegistry POS 33

  34. IHE: Supporting HHS/ONC Goals Certification Commission for Healthcare Information Technology (CCHIT) Healthcare Information Technology Standards Panel (HITSP) American Health Information Community National eHealth Collaborative Standards harmonization and adoption Interoperability testing Health Information Security and Privacy Collaboration (HISPC) Nationwide Health Information Network Architecture Projects(NHIN) Specifications for standards-based EHR functionality to support RHIOs Security and privacy standards

  35. HITSP Recommended Standards • Biosurveillance • ICD-9CM – International Classification of Diseases v. 9 Clinical Modifications • ICD-10 CM – Diagnoses and Procedures • IHE-XDS – Integrating the Healthcare Enterprise (IHE) Cross-Enterprise Document Sharing • IHE-XDS Lab – IHE Laboratory Report Document Sharing • IHE-RFD – IHE Retrieve Form for Data Capture • IHE-PIX – IHE Patient Identification Cross-Referencing • IHE-RAD – XDS-I – IHE Cross-Enterprise Sharing of Images • IHE-NAV – IHE Notification of Document Availability • IHE-XDS-MS – IHE Medical Summary Document Sharing • ISO/TC215 -DTS 25237 - Health Informatics Pseudonymisation • LOINC – Logical Observation Identifiers Names and Codes • NCCLS – National Committee for Clinical Laboratory Standards • RxNorm – National Library of Medicine RxNorm

  36. HITSP Recommended Standards • Consumer Empowerment • IHE-XDS – Integrating the Healthcare Enterprise (IHE) Cross-Enterprise Document Sharing • IHE-PIX – IHE Patient Identification Cross-Referencing • IHE-PDQ – IHE Patient Demographics Query • Health Level Seven (HL7) CDA R2 – HL7 Clinical Document Architecture Release 2 • HL7 CCD – HL7 Continuity of Care Document with mappings from ASTM E 2369-05 Continuity of Care Record (CCR), X12 N 270/271 and NCPDP Script 8.1. • HL7 EHR Systems Functional Model Draft Standard for Trial Use (DSTU) • Logical Observation Identifiers Names and Codes (LOINC)

  37. HITSP Recommended Standards • Electronic Health Record Exchange • IHE-XDS Lab – IHE Laboratory Report Document Sharing • IHE-PIX – IHE Patient Identification Cross-Referencing • IHE-PDQ – IHE Patient Demographics Query • Health Level Seven (HL7) CDA R2 – HL7 Clinical Document Architecture Release 2 • HL7 v. 2.5 • Clinical Laboratory Improvement Amendments (CLIA) • Logical Observation Identifiers Names and Codes (LOINC) • Health Insurance Portability and Accountability Act (HIPAA) • Systematized Nomenclature of Medicine – Clinical Terms (SNOMED – CT) • Unified Code for Units of Measure (UCUM) IHE contributes to HITSP’s success

  38. HITSP and Federal Procurement • Former HHS Secretary Leavitt “recognized” the work product of HITSP, meaning that it will be used in for federal purchasing specifications for all affected health IT systems as of Jan. 1, 2009.

  39. Testing – HITSP, CCHIT and NHIN • HITSP interoperability pilot testing performed at IHE Connectathon • CCHIT, NIST and IHE have agreement to collaborate on testing tools • NIST and IHE collaborated to provide testing services for first NHIN testing event in August 2008

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