Integrating the Healthcare Enterprise

1. Integrating the Healthcare Enterprise IHE Update • Charles Parisot, GE Healthcare • IHE IT Infrastructure Technical Committee Co-chair IT International Update

2. IHE IT Infrastructure 2004-2005 Personnel White Page New Access to workforcecontact information New Retrieve Information for Display Retrieve Information for Display Cross-Enterprise Document Sharing Access a patient’s clinical information and documents in a format ready to be presentedto the requesting user Access a patient’s clinical information and documents in a format ready to be presentedto the requesting user Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Patient Demographics Query New Audit Trail & Node Authentication New Centralized privacy audit trail and node to node authentication to create a secured domain. Enterprise User Authentication Enterprise User Authentication Consistent Time Provide users a single nameand centralized authentication processacross all systems Coordinate time across networked systems Patient Synchronized Applications Synchronize multiple applications on a desktop to the same patient Patient Identifier Cross-referencing for MPI Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Map patient identifiers across independent identification domains IT International Update

3. Sharing and accessing Documents DocumentRepository Submission of Document References Retrieve of selected Documents Documents Registry EHR-LR:Longitudinal Recordas usedacross-encounters Long Term Care Acute Care (Inpatient) Other Specialized Careor Diagnostics Services PCPs and Clinics (Ambulatory) EHR-CR: Care Record systemssupporting care delivery IT International Update

4. Standards selection for IHE XDS No single standard can addressCross-enterprise Document Sharing Electronic BusinessStandards ebXML Registry, SOAP, etc. Internet Standards HTML, HTTP,ISO, PDF, JPEG, etc. HealthcareContent Standards HL7 CDA, CEN EHRcomASTM CCRDICOM, etc. Marriage of healthcare standards facilitates implementation and leverages complementary technologies (e.g. security & privacy). IT International Update

5. HIMSS 2005 Interoperability Showcases HIMSS leverages its sponsorship of IHE to demonstrate practical interoperability in two large Showcase Exhibits: • cross-enterprise sharing of health information in the acute care (18 vendors) and ambulatory (14 vendors). • HIMSS Showcaseexhibitslinked with vendor booths (10 vendors) show-wide. • Show-wide interactive environment demonstrating attendees “patient” record in a “HIMSS RHIO”. Uses IHE Cross-enterprise Document Sharing: • Around a central document registry • Distributed document repositories • 17 EHR that publish/share documents (CCR, CDA, HL7-lab, PDF) IT International Update

6. HIMSS 2005 Interoperability Showcases HIMSS sponsors the testing and demonstration of IHE interoperability in two large Showcase Exhibits: • cross-enterprise sharing of health information in the acute care, 18 vendors: CedaraGE HealthcareMortara Instruments DictaphoneIDXNIST Eastman KodakInterSystemsNovell EclipsysInfinitt TechnologyOpen Text EmageonKryptiqSentillion EPICMedCommonsSiemens • ambulatory sharing of health information, 14 vendors: AllscriptsGE HealthcareMidMark CapMed/SanDiskHealthrampMisys CernerIDXNextGen EclipsysKrytiqWebMD ETIAMMediNotes IT International Update

7. Cross-enterprise Showcase Booth ITInfrastructure & Lab Radiology Vendor Booth Vendor Booth Vendor Booth Vendor Booth Vendor Booth Vendor Booth In-Patient/Out-patient Cardiology Radiology PCP Diag Center MultispecialtyClinic Home Vendor Booth Ambulatory Showcase Booth Vendor Booth Vendor System HIMSS 2005 – Show-Wide Interoperability Allscripts Eclipsys GE Healthcare Healthramp IDX Infinitt InterSystems MedCommons Novell OpenText Siemens HIMSS “RHIO” with Cross-enterprisedoc sharing IT International Update

8. Imaging Information Content Simple Document Content For Display Document Content Lab Results Document Content Continuity of Care Document Content Personnel White Page Access to workforcecontact information 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 Format of the Document Content and associated coded vocabulary Patient Identifier Cross-referencing Cross-Enterprise Document Sharing Cross-Enterprise Notification Map patient identifiers across independent identification domains Notification of a remote provider/ health enterprise Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Patient Demographics Query Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. User Identity, Authentication and Permissions Consistent Time Enable Basic Access Control Coordinate time across networked systems IHE Profiles for a “Regional Health Info Organization”What are the gaps to be filled in 2005 ? IT International Update

9. Infrastructure and Interoperability • Cross-Enterprise Document Sharing (XDS) minimizes clinical data management by the infrastructure. Transparency = Ease of Evolution, increase efficiencies. • XDS needs other IHE Integration Profiles: • Audit Trail and Node Authentication (ATNA) • Patient Id Cross-referencing (PIX) • Patient Demographics Query (PDQ) • In 2005, IHE plans to complement a set of integration profiles to build a RHIO, candidates: • Security: Identity Management + Info for Access Control • Content Profiles: Core CCR, HL7-CDA, HL7-Lab, PDF (legacy) • Provider Notification (with doc reference) and Point-to-point Transfer • Dynamic Clinical Data Mgt (Allergy lists, Problem Lists)  Prioritization of Candidate Integration Profiles November-December 2004. Technical development January-July 2005. Open to all. IT International Update

10. IHE Radiology Integration Profiles Extensions Charge Posting Presentation of Grouped Procedures Reporting Workflow New KeyImageNotes Simple Image & Numeric Reports NMImage Consistent Present-ation of Images EvidenceDocs New Access to Radiology Information Portable Data for Imaging Scheduled Workflow - Patient Info. Recon-ciliation Post-Processing Workflow Basic Security IT International Update

11. Laboratory IHE Integration Profiles In Dev. Laboratory Scheduled Workflow (LSWF) Completed in 2003 Laboratory Point Of Care Testing (LPOCT) In Process –TI Nov 2004 Tests performed by a laboratory for an identified inpatient or outpatient Tests performed on point of care or patient’s bedside In Dev. In Dev. Laboratory Patient Information Reconciliation (LPIR) In Process Laboratory Device Automation (LDA)In Process –TI Nov 2004 Tests performed on an unidentified or misidentified patient Pre-analytic process, analysis and post-analytical treatment Laboratory Code Set Distribution (LCSD) In Process In Dev. Sharing the batteries and tests code sets throughout the enterprise IT International Update

12. IHE Cardiology 2004-2005 Retrieve Information for Display EchoCardiography Worklflow Access a patient’s clinical information and documents in a format ready to be presentedto the requesting user Admit, order, schedule, acquire images, notify of completed steps, on fixed and mobile stress echo modalities. New Retrieve ECG for Display Provide high-quality ECG and related reports to the enterprise and outside in a ready-to-display format New Cardiac Catheterization Workflow New Scheduled & unscheduled acquisition and management of cathlab information, notification of completed steps. IT International Update

13. ACC 2005 IHE Demonstration ACC sponsors the testing and demonstration of IHE interoperability in their exhibit – March 2005 • 11 vendors: Agfa GE Healthcare Schiller CamtronicsHeartlabPhilips CernerIDX Toshiba Emageon Medcon • Scenario: • Emergency Cath, Change of Lab mid-procedure • Scheduled Echo+Mobile Modality, Stress Echo • Echo demo planned for ASE (Boston June 2005) • Full demonstration planned for ESC (August 2005) IT International Update