IHE and Medical Standards in Denmark - Driving Interoperability in Healthcare

1. Integrating the Healthcare Enterprise IHE for cross-enterprise interoperability • Charles Parisot, GE Healthcare • IHE IT Infrastructure Technical Committee Co-chair • IHE Europe Committee • Copenhagen, March 17th 2005 IHE and medical Standards in Denmark

2. W W W . I H E . N E T Providers and Vendors Working Together to Deliver Interoperable Health Information Systems In the Enterprise and Across Care Settings W W W . I H E – Europe. o r g IHE and medical Standards in Denmark

3. IHE drives healthcare standards based-integration IHE and medical Standards in Denmark

4. A Proven Standards Adoption Process Product IHE IntegrationStatement IHEConnect-a-thon IHEDemonstration Product With IHE Easy to Integrate Products Standards IHEIntegration Profiles B IHEIntegration Profile A RFP IHE Connect-a-thonResults IHETechnicalFramework User Site IHE Integration Profiles at the heart of IHE : • Detailed selection of standards and options each solving a specific integration problem • A growing set of effective provider/vendor agreed solutions • Vendors can implement with ROI • Providers can deploy with stability • Process started in1998 with continuous improvements IHE and medical Standards in Denmark

5. Achievements and expanding scope Over 100 vendors involved world-wide, 4 Technical Frameworks 27 Integration Profiles, Testing at yearly Connectathons, Demonstrations at major exhibitions world-wide Patient care Coordination, Quality, Pharmacy, Anatomical Pathology, Surgery, etc. To claim compliance to IHE Integration Profiles vendors shall publish for each product an IHE Integration Statement. IHE and medical Standards in Denmark

6. 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 IHE and medical Standards in Denmark

7. Introduction: EHR Cross-Enterprise Document Sharing Enables the seamless information sharing between healthcare IT systems (e.g. EHRs) serving all types of care delivery organizations in a region or nation. IHE and medical Standards in Denmark

8. Sharing records that have been published community Hospital Record Laboratory Results Reference to records Specialist Record 4-Patient data presented to Physician Temporary Aggregate Patient History Index of patients records (Document-level) 3-Records Returned Clinical IT System Sharing System 2-Reference to Records for Inquiry 1-Patient Authorized Inquiry Clinical Encounter IHE and medical Standards in Denmark

9. Building 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 IHE and medical Standards in Denmark

10. XDS – Value Proposition • Foundation for Health IT Infrastructures: Shared Electronic Health Record, in a community, region, etc. • Effective means to contribute and access clinical documents across health enterprises. • Scalable sharing of documents between private physicians, clinics, long term care, pharmacy, acute care with different clinical IT systems. • Easy access: Care providers are offered means to query and retrieve clinical documents of interest. IHE and medical Standards in Denmark

11. XDS - Value Proposition • Distributed: Each Care delivery organization “publishes” clinical information for others. Actual documents may remain in the source EHR-CR. • Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain (e.g. an RHIO). • Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (HL7-CDA, PDF, DICOM, etc.) • Document Content Neutral: Document content is processed only by source and consumer IT systems. • Standardized Registry Attributes:Queries based on meaningful attributes ensure deterministic document searches. IHE and medical Standards in Denmark

12. IHE XDS Integration Profile: Key Concepts XDS Document • A set of attested clinical information (structured or not) which form an element of a patient record to be shared. It may already exist within the source IT system. XDS Submission Set • A set of documents related to a patient that a (team of) clinician(s) in the same source system have decided to make available to potential consumers. XDS Folder A means to group documents for a number of other reasons: • Team work across several physicians, • Episode of care, • Emergency information for a patient, etc. XDS leaves open the use of folders to affinity domain clinicians. IHE and medical Standards in Denmark

13. XDS Actors and Transactions IHE and medical Standards in Denmark

14. Security for XDSLeverages IHE Audit Trail & Node Authentication • ATNA creates a secured domain: • User Accountability (Audit trail) • Node-to-Node Access Control • Node-level user authentication • User access control provided by node • BUT Registry/repository based User-Level Access Control and policy agreements is beyond XDS.. Patient Identity Source Secured Node Patient Identity Feed Secured Node Query Documents Document Consumer Document Registry Secured Node Register Document Set Provide&RegisterDocument Set Retrieve Document Secured Node Document Repository Document Source Secured Node Secured Node IHE and medical Standards in Denmark

15. Integration Model 1: EHR-CR with Repository at Source • An EHR-CR completes a phase of care for a patient where it: • Has these documents available as Repository Actor. • Registers documents with a Registry actor. • Any other EHR-CR may query the Registry actor, and chose to retrieve some of these documents from any Document Repository Actor. IHE and medical Standards in Denmark

16. Integration Model 2: EHR-LR with Third Party Repository • An EHR-CR completes a phase of care for a patient where it: • Provides the documents to a Repository Actor of its choice. • Documentsare Registered with a Registry Actor. • Any other EHR-CR may query the Registry actor, and chose to retrieve some of these documents from any Document Repository Actor. IHE and medical Standards in Denmark

17. Integration Model 3: EHR-CR feed a EHR-CR/EHR-LR hub • An EHR-CR completes a phase of care for a patient where it: • Provides and Registers a set of documents to a Document Repository in an EHR-CR. • The EHR-CR Consumer Actor has the documents and may respond to queries and provide them to other document consumers. IHE and medical Standards in Denmark

18. Patient Access also possible • A patient accesses own record: • Query and Retrieve a set of documents using for example a portal application that offers the ability to display documents’ content. • This is a particular case of an EHR-CR, where the patient is interested her/his own care. Patient may also register and provide documents. IHE and medical Standards in Denmark

19. Standards selection for IHE XDS No single standard can addressCross-enterprise Document Sharing Electronic BusinessStandards ebXML Registry, ebMS, SOAP, etc. Internet Standards XML, HTTP,ISO, etc. HealthcareContent Standards HL7 CDA, CEN EHRcomHL7, ASTM CCRDICOM, etc. Marriage of healthcare standards facilitates implementation and leverages complementary technologies (e.g. security & privacy). IHE and medical Standards in Denmark

20. How real is XDS ? • Specification work since Nov 2003 • Under Public Comments June-July 2004 • 600 constructive comments received. • Validity of XDS approach confirmed (e.g. CfH Collaborative Response). • Stable specification IHE Technical Framework Published Aug 15th, 2004 (TI Supplement) • IHE Connectathon - January 2005 (USA) • 14 Vendors passed • HIMSS Feb 2005 - show-wide demonstration • 17 EHRs, 800 patients, 7700 documents registered, 41000 queries. • IHE Connectathon - April 2005 (Europe) • 22 Vendors registered Several Implementation Projects by health authorities in 2005 Italy: Linguini & Veneto Regions - Canada: Newfoundland – France: Trials – Norway-Region IHE and medical Standards in Denmark

21. HIMSS Highlights IHE and medical Standards in Denmark

22. HIMSS IHE Highlights • HIMSS: 700 Exhibitors - 23,000 Attendees • Over 2000 visited the IHE Booth. • 49 participants in IHE Interoperability booth • 15 vendors participated in XDS from their booth • 732 Attendees registered for their own EHR • 7,772 Documents registered in XDS Registry • 40,984 Queries to XDS Registry • US National IT Coordinator (Dr Brailer) held his press conference in IHE Booth and thanked IHE. 50 members of press toured. IHE and medical Standards in Denmark

23. Over 700 attendees experienced their HIMSS-Wide Electronic Health Record Vendor Booth Vendor Booth Vendor Booth Vendor Booth Vendor Booth Vendor Booth Radiology ComprehensivePatient Care CoordinatedPatient Evaluation HIMSS “RHIO” with IHE-XDS Cross-enterprisedoc sharing PCP Diag Center Vendor Booth Home MultispecialtyClinic HL7 Demo Booth Ambulatory Showcase Booth Cross-enterprise Showcase Booth ITInfrastructure Cardiology Workup IHE and medical Standards in Denmark

24. Personnel White Page Access to workforcecontact information Patient Identifier Cross-referencing Cross-Enterprise Document Sharing Map patient identifiers across independent identification domains 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. New Consistent Time Coordinate time across networked systems 2004 IHE Profiles for a RHIOAvailable Integration Profiles completed New 2004 New New IHE and medical Standards in Denmark

25. Lab Results Document Content For Display Document Content Imaging Information 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 Format of the Document Content and associated coded vocabulary Patient Identifier Cross-referencing Cross-Enterprise Document Sharing Notification of Document Availability 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. Cross-enterprise User Identity and Accountability Consistent Time Authentication & Auditing: Basis for Access Control Coordinate time across networked systems IHE Profiles for RHIOsWhat is available and what will be added in 2005 IHE and medical Standards in Denmark

26. Continuity of Care Document Content Format of the Document Content and associated coded vocabulary IHE and HL7 V3 • IHE relies only on approved standards. • HL7 V2 is widely used. Official relation with HL7, effective cooperation with HL7 affiliate world-wide. • Early 2005, foundations elements of HL7 V3 have been approved, but only a few “application level” are. • One of this element based on HL7 V3 based on the RIM has been approved in January 2005: CDA Release 2 (nothing to do with HL7V2). • IHE considers that HL7 CDA based on HL7-V3-RIM as the strategic means to introduce HL7V3 in the real world. • In 2005, IHE is developing in cooperation with HL7 an integration profile for “care record summary”. It will allow the sharing with XDS of the basic care information in a form both structured and human displayable in a consistent manner. IHE and medical Standards in Denmark

27. 3 Query 4 Retrieve Notification Push-like Integration : Adding Notifications • Using « an e-mail notification that need not be secured» to turn a Pull Model into a like Push Model. EHR-CR Document Registry Register Document Source DocumentConsumer Document Repository IHE and medical Standards in Denmark

28. Local & Regional RHIOs Infrastructure and Interoperability • Cross-Enterprise Document Sharing (XDS) minimizes clinical data management by the infrastructure. Transparency = Ease of Evolution • XDS works with other IHE Integration Profiles: • Audit Trail and Node Authentication (ATNA) and Consistent Time (CT) • Patient Id Cross-referencing (PIX) • Patient Demographics Query (PDQ) • In 2005, IHE plans to finish base set of integration profiles to build regional health networks and interoperable EHRs: • Security: Identity Management+ Accountability • Content Profiles: DICOM, HL7-CDA-r2/CCR, HL7-Lab, PDF. • Notification of Document Availability (with XDS document reference) IHE and medical Standards in Denmark

29. IHE: RHIOs’ Interoperability Partner • IHE offers a solid technical foundation to establish interoperability for Regional/National Health Information Organizations (RHIO). • Standards-based, open, multi-vendor, provider-led. • Yearly progress, validation testing built in, backed by a proven process. Implementation by many vendors. • IHE welcomes RHIOs’ technical architects’ active involvement. • The IHE Technical Framework accelerates RHIOs pilot project development (XDS Affinity Domain Concept). IHE and medical Standards in Denmark

30. W W W . I H E . N E T Providers and Vendors Working Together to Deliver Interoperable Health Information Systems In the Enterprise and Across Care Settings W W W . I H E – Europe. o r g IHE and medical Standards in Denmark