IHE Essentials

1. IHE Essentials ePharmacy Workshop Jan. 2008 G. Claeys (geert.claeys@agfa.com ) Co-chair IHE Europe Development Committee (ad interim)

2. IHE Mission IHE = Integrating the Healthcare Enterprise Improve the quality and cost of healthcare by removing the real-world interoperability barriers on departmental, hospital or regional level in a pragmatic way

3. IHE Global Approach • Close co-operation between users and vendors • Users identify the integration problems • Vendors provide technical solutions • Profile existing standards (e.g. DICOM, HL7,..) • Agile development & deployment process • Incremental releases every year • Test driven

4. IHE Organisation • Started in 1999 • Association of users, vendors and public healthcare authorities • More than 100 participating vendors (major healthcare imaging&IT companies) • Global development committees • Develop technical frameworks • Regional and national deployment committees • Present in all continents (NAFTA, Europe, Asia Pacific) • Marketing, education • Testing

5. Participating Vendors (Europe) AGFA Healthcare AISoftw@re Medical Algotec ARES SA aycan Digitalsysteme CEGEDIM Cerner Corp. CHILI CMT Medical Tech. Conto Corrente Salute ConVis CTI Mirada Solutions Data Processing SPA DEDALUS Dianoema Eastman Kodak Co. Ebit Sanita EDL ELFIN s.r.l. Engineering Sanità ESAOTE ETIAM Ferrania Fujifilm GE Healthcare GIE Convergence-Profils Global Imaging Online GWI Research Hi. tech IASI Srl IdeoPass INFINITT INFOPATIENT INOVIT INSIEL Intersystems Corp. Invita ITZ Medicom iSoft McKesson MED2RAD MEDarchiver MEDASYS SA Medavis Medical Communications Medigration GmbH MEDIMON Ltd. MEDIWARE MEDOS AG Merge eFilm METAFORA Mevis Diagnostics Konica Minolta Omnilab Philips Medical Systems POLYMEDIS Rasna Imaging Systems RAYPAX INC. REM Rogan-Delft Sago spa Sectra Imtec AB SeeBeyond Technology Siemens Medical Soluzioni Informatiche srl Stentor Inc. St. Jude Swissray Medical AG Symphonie On Line Synapsis Synchro-Med TECHNIDATA TELEMIS S.A. Tiani-Sprit Tomtec Imaging TOREX GAP Medical Toshiba Medical Systems TSI groupe europMedica T-Systems Uni-medicine VEPRO AG VISUS Technology Transfer WAID XR PARTNER In yellow, companies with IHE Committees Chairs (Winter 2005)

6. IHE- Expanding Scope Total : 52 Integration Profiles

7. 20 Months IHE Development & Deployment process • Identify critical healthcare workflows and integration problems • Research & select existing standards to implement a solution • Write, review and publish IHE Technical Framework • Develop trial implementations • Perform cross-testing at “Connectathon” • Demonstrate at tradeshows (HIMSS/RSNA…)

8. IHE Building Blocks • IHE Technical Framework • IHE Validation Process • IHE Integration Statements

9. IHE Technical Framework • Describes the different integration solutions (domain specific) • Radiology, IT Infrastructure, Cardiology, Lab, .. • Key concepts are domain neutral • Integration Profile • Transactions • Actors • Data model • Country & Regional specialization • Limited : max. 5% • Based on existing standards eHealth Application eHealth Application IHE Integration Profiles IT Standards (http, ebxml) Healthcare Standards (HL7, DICOM)

10. Integration Profiles - Principles • Solution for real-world interoperability problems (bottom-up approach) • Integration Profiles are orthogonal • IPs are independent of each other • Applications may combine multiple Integration Profiles • E.g. Information access + security

11. Integration Profile … Actor Actor Actor … … … Transaction Transaction Transaction Transaction Transaction Referenced standard (HL7) Detailed messaging info -------------------------- Roles IHE Integration Profiles - Content • Set of Transactions among Actors • Actor = logical entity (e.g. modality, image manager, order filler) • Transaction = Sequence of messages among Actors • Messages : e.g. HL7, DICOM, ebXML,. • Profiling existing standards • Map data models, message content • “Restrict the options” • Clarify the semantics : accession nr

12. Patient Registration (HIS):ADT focal point for patient registration information Order Placer (HIS):Focal Point for Order Management Department Scheduler (RIS):Focal Point for Requested Procedure Managent Breaks Order into Requested Procedures Schedules steps for each Requested Procedure Acquisition Modality:Focal Point for Performed Procedure Steps A PPS tracks one or more series of Images Image Manager/Archive Image Manager/Archive (PACS) Focal Point For Imaging Study. Manages images Triggers reading when all expected PPS are completed Modality IHE Actors ADT Patient Registration Order Placer Dept Scheduler

13. IHE Transactions - Example

14. Scheduled Workflow: Use Case report Registration Film Lightbox Image Manager & Archive Orders Filled Film Folder Diagnostic Workstation Film Report Repository Orders Placed AcquisitionModality acquisitioncompleted acquisitionin-progress imagesprinted Modality acquisitioncompleted

15. IHE Validation Process • Goal : • Validate implementations of IHE TF in products • Approach • IHE is not a certification authority • IHE stimulates auto-validation • Vendors are responsible for validating and documenting IHE implementations • IHE provide tools and infrastructure • IHE Validation tools • Mesa toolkit • Connectathon • IHE Integration statement

16. MESA Test Toolkit • Software library • Emulate the various actors in the different implementation profiles • Supports single product, single vendor testing • Pre-requisite for connectathon participation • Implementers submit test logs prior to connectathon

17. Connectathon • Connectathon = connectivity marathon • Validate the Integration Profiles for a particular IHE demo • Pre-requisite for participating at IHE demos • 1 week validation session in Europe, USA and Japan • End-to-end scenario testing • Multi-product; multi-vendor; multi-domain • Connectathon 2006 : 70 vendors, 120+ products, 200 persons • Results are published on www.ihe-europe.org

18. IHE Integration Statements • Document the IHE implementation per product • Content : • List of supported actors • List of supported integration profiles (per actor) • “contractual” commitment • Published on company website; referenced from IHE website

19. IHE Cross-Enterprise Document Sharing(XDS)

20. IHE XDS - Use Cases • Patient referral (GP to Hospital) • Patient discharge (Hospital to GP) • Medical summary for Ambulatory care and acute care • Personal Health record

21. IHE XDS – Architecture 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

22. IHE XDS Actors and Transactions Patient Identity Source Patient Identity Feed 1-N Query Registry Affinity Domain 1 Document Registry Document Consumer 1-N Register Document Set Provide & Register DocumentSet Retrieve Document 1-N Document Source Document Repository 1-N

23. Healthcare Application Standards • DICOM : imaging applications (modalities, PACS) • HL7 : adminstrative applications (e.g. clinical lab, reporting, patient admin.) • Snomed, Loinc : medical terminology & coding IT Standards • IETF • W3C • Oasis • JPEG Domain focused Technology focus No single standard addresses all XDS Requirements

24. XDS Content model • All clinical information is stored in documents • Document format is domain specific (IHE PCC) : • Clinical Reports : PDF (plain text) -> CDA (coded text, subset of HL7v3 RIM) • Images : DICOM, JPEG2000 (part 1, part 2) • Video : MPEG2 -> MPEG4 • Measurements (vector graphics) : SVG

25. XDS-MS Medical Summary

28. IHE Resources • Technical Framework • www.ihe.net/Technical_Framework/index.cfm • Volume 1 – Profiles • Volume 2 – Transaction • www.ihe.net – New profiles and transactions • Practice: Connectathon Testing • www.ihe.net and www.connectathon.net

29. Questions?

30. Thank You.