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Interoperability Shining Across a Connected Nation

Interoperability Shining Across a Connected Nation. HL7-IHE Demonstration HIMSS 2004. Brought to you by…. Health Level Seven Model-based standards for healthcare Integrating the Healthcare Enterprise Integration Profiles for healthcare. Speakers.

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Interoperability Shining Across a Connected Nation

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  1. InteroperabilityShining Across a Connected Nation HL7-IHE Demonstration HIMSS 2004

  2. Brought to you by… • Health Level Seven • Model-based standards for healthcare • Integrating the Healthcare Enterprise • Integration Profiles for healthcare

  3. Speakers • Liora Alschuler, Project Director, HL7-IHE Interoperability Demonstration • Co-chair, HL7 Structured Documents TC & Marketing • Co-editor, HL7 Clinical Document Architecture (CDA)

  4. Participants

  5. Partners • Supporting organizations providing expertise, technology and guidance • American College of Physicians • Centers for Disease Control & Prevention • CDISC • Duke University Medical Center • Food & Drug Administration • OASIS • Massachusetts Medical Society • National Institute for Standards & Technology • UC David, Medical Informatics

  6. Sponsors • Members of HL7 & IHE providing financial support • HIMSS • RSNA • InterfaceWare • Omnicell • SeeBeyond • Siemens

  7. What is it? • A laboratory and a test-bed for standards development and implementation • An opportunity to deploy and debug new and emerging standards-based solutions • A vehicle to communicate to industry how standards have evolved, what problems they solve and what work remains to be done

  8. How is the demo created? • Open participation • Membership in HL7 &/or IHE required • Supported by participation fees and host organizations • Design criteria • Participants choose what to put into play • Must utilize an HL7 standard, draft standard or IHE Integration Profile

  9. How is it all put together? • Virtual healthcare IT community by the numbers: • 10k+ conference call minutes • 100+ Email listserver • 5-day January 2004 Connectathon • 4-member Demo Executive Committee from HL7 & IHE • 2-day September 2003 workshop • 1 very patient Technical Manager • 1/2 overworked Project Director

  10. What is there to see? • Standards & Profiles in support of: • Continuity of Care • Patient Safety • Public Health • Clinical Trials • Each of these illustrated in a scenario based on actual case or protocol

  11. How are the scenarios developed? • Careful planning • Written by physicians drawing from actual cases • Participants volunteer to support aspects of one or more scenarios plus… • Spontaneous combustion • brokered claims attachments • third party document discovery, retrieval • EMR/document integration • Incendiary actions • hyperlinking documents and PACS images • distributed repositories, central registry

  12. 2004 • Breakthroughs • Highlights & accomplishments • A design and prototype for the future • Barriers • Report card on standards development & implementation • Based on demo as test bed

  13. Highlights Firsts: • Annotated Electro-cardiogram, submissions • CDA College of American Pathology tumor report, • CDA Continuity of Care Record (CCR) • Clinical Document Architecture Release 2 (ballot draft) • Distributed, standards-based decision support • Document-based HIPAA claims attachments • End-to-end, standards-based electronic clinical trial data submission • End-user Authentication profile • Hyperlink between electronic document and PACS image • Nationally Notifiable Disease report • Open-source metadata registry for ubiquitous access to distributed information • Patient Information Cross-reference profile • Patient Synchronized Applications • Retrieve Information for Display profile • Re-use of electronic clinical documents to support a claim • Structured Product Labeling • Third-party brokered claims attachments • Version 3/CDA Templates

  14. List of “firsts” • Unprecedented interoperability • 1999: paid developer • 2000-01: cajoled • 2002-03: accommodated • 2004: flood gates opened Why now? • Collaboration • Maturity of standards & profiles

  15. Collaboration • At the technical implementation level • HL7 & IHE • & other standards bodies: SNOMED, CDISC, ASTM, OASIS, X12N, DICOM, LOINC • Support from HIMSS • Involvement of professional societies (ACP, MMS) • “New” player: CDISC (5 of the standards listed) • Integration of clinical trial information gathering with clinical practice is powerful idea

  16. Readiness • Readiness of • New standards & profiles (RIM, IHE IT) • Marketplace (tools, talent) • Government support (NIST, CDC, FDA, DHHS) • Key applications • Metadata registry: model-based, RID, PIX • Brokers: three cross-enterprise brokers, two institutional brokers • vEHR: greater OTS maturity working with more sophisticated standards & profiles

  17. Breakthrough is spelled… • Brokered services • Imaging integration • Integration with clinical trials • Continuity of care • National Health Information Infrastructure

  18. Brokered Services • Claims • Clinical trials

  19. From Continuity of Care scenario Imaging Integration, Tumor Reporting, Claims Processing Imaging RIS Workstation Dictation Server Payer Repository Broker EMR Broker PCP eForms Registry Tumor Registry Pathology Hospital Surgery Brokered Claim; Registry Discovery For patient chart and Tumor Registry; CCR back to PCP

  20. From Clinical Trials scenario Integrating Patient Care with Support for Research and Drug Development Dictation Repository Imaging Hospital PCP Query broker, trusted 3rd party FDA Hospital ? Registry Central Lab Core Lab Sponsor Patients seen at PCP, hospitals ECGs sent to Core Lab; annotated on site or at Core Lab

  21. Brokered Services • Claims • Easily implemented • Based on years of collaboration between HL7 & X12N on claims attachment processing & coding • New proposal fits with current clinical workflow • Discharge summary (EMR output) • Pathology report (eForms/EMR) • Clinical trials • Early days but very large potential

  22. Imaging Integration • Pictures & words • Context management with DICOM/IHE query/retrieve • Metadata registry to pull two CDA documents • One from dictation • One translated from DICOM SR into CDA • DICOM SR2CDA includes embedded link • Link rendered in HTML connects document on web browser to remote related image on remote PACS • Image retrieved for web rendering in jpg

  23. from Continuity of Care Scenario Imaging Integration, Tumor Reporting, Claims Processing Imaging RIS Workstation Dictation Server Identity server EMR PCP eForms Registry Hospital Surgery Surgeon reviews imaging reports RID query, CDA link to PACS, reg/rep for consulting report

  24. Integration with clinical trials • Fastest clinical trial on record • Come see clinical trials scenario

  25. Continuity of care • Full cycle • Across applications, platforms • Across standards • Standard vocabularies

  26. From Continuity of Care scenario Imaging Integration, Tumor Reporting, Claims Processing EMR Imaging Virtual EHR eForms PCP Transform Registry/repository Virtual EHR EMR Hospital Secure transport Dictation EMR Lab Imaging Referrals plus clinical documentation Push referrals; Pull/discover full documentation

  27. NHII • NHII Goals of demo: • Support rapid, cost-effective adoption of National Health Information Infrastructure objectives • Advance the electronic capture, access, use, exchange and storage of quality healthcare data

  28. NHII • Metadata registry for patient records • Persistent objects stored in distributed repositories • Accessed through query profile • Store, retrieve by EHR, dictation, portal, servers, vEHR, brokers • Patient identifier cross referencing for records from different domains • Registry/repository for standards • Guidelines registry/repository • Public health reporting using lab and clinical data • Standard vocabulary • For bioterrorism & tumor registry • Electronic claims attachments • Unsolicited from hospital EMR • Brokered third-party service to small provider • Continuity of Care Record • Based on work from professional societies, collaborating standards organizations • Using standard model and vocabulary • Integrated with EMRs at PCP, hospital, imaging center • Produced by EMR and by desktop eForms application

  29. Bottom line • Model-based interoperability • Profile-based implementation The workshop is live… See posters, tours

  30. Report Card • Identify gaps, areas for improvement, areas of progress • Compare with HL7 HIMSS Demo, 2003

  31. Demo Report Card Summary 2003 • Continuity of care: • Certain level of systems integration routine within enterprise • With few exceptions, stops at enterprise boundary • Decision support: • Physician-aided requires distributed access • Computerized limited by processible data • Reporting: • Building infrastructure for reporting and surveillance • Limited by processible data 2003

  32. Demo Report Card Summary 2003 • Strengths: ADT; labs • Emerging strengths: common approach to document metadata, readable, transferable documents; findings-based reporting and decision support; • Weaknesses: business and technical infrastructure for distributed access; • Priority: distributed security and privacy infrastructure; business models for sharing information on shared patient population across business units; processible findings 2003

  33. Report Card 2004 • Continuity of care • Distributed access to distributed information: works • Imaging integration: expanding outside of imaging infrastructure, into IT • Brokered services: great, but lacking PKI infrastructure • Model-based data integration: promising, vocabulary mapping, templates required • Authentication: implementable • Authorization/access control: no solutions

  34. Report Card 2004 • Decision Support • Physician-based: • Great strides forward in distributed access • Computerized: • Good on labs • Propagation of rules from central repository: great, but needs more testing • Vocabulary for medications still MIA • What will we do with richer coded clinical data? • Need more work on model/vocabulary integration to facilitate authoring • Need to test further with decision support • Push limits of EHR/document/EHR integration

  35. Report Card 2004 • Reporting (public health, safety) • Coordination of state & federal levels based on shared model, vocabulary • Template-driven reporting required, still needs coordination of model, vocabulary • Alerts: still not making it out of the EMRs in standards-based messaging

  36. Report Card 2004 Summary • Strengths • Distributed access • Distributed patient identifier referencing • Brokered services

  37. Report Card 2004 Summary • Emerging strengths • Clinical data sharing • Distributed clinical decision support • Role of clinical documents • Standards-based authentication • Clinical data in support of clinical trials

  38. Report Card 2004 Summary • Weaknesses: • Patient interaction • Clinical content coordination with vocabulary • Template formalism • Standards-based secure communication • Access control

  39. Report Card 2004 Conclusions • Breakthrough year • Unprecendented development & implementation • The work continues

  40. Special thanks to • Mallinckrodt Institute of Radiology • Patient Identifier Cross Referencing (PIX) server • Fred Behlen, Laitek Technologies • DICOM SR to CDA transformation • The SIMI Group • State Department of Health application • Michael Palmer, Zurich Biotech • SAS to ODM conversion • NorthEast Monitoring • Corelab software integrating aECGs • CSS Informatics • FDA Patient Profile Viewer • AMPS • FDA aECG Viewer • Amnon Shabo, IBM Haifa • Sample CDA Botulism Case Report • Data Conversion Labs • Sample Structured Product Labeling transformation

  41. Demo Executive Committee • HL7 • Karen Van Hentenryck, HL7 Associate Director • Landen Bain, Co-chair, HL7 Marketing Committee • IHE • Joyce Sensmeier, HIMSS • Chris Carr, RSNA

  42. Invitation to Tour • Guided Tours start on the quarter hour • Self-guided Tours anytime • Maps available at Reception • Complete a tour, win a prize • Get each location initialled by participant • Go to reception with completed map • Enter a business card to win • HL7 Working Group Registration (drawing 1/day) • HIMSS 2005 Registration (drawing 1/week)

  43. Start Start Continuity of Care Tour Start Clinical Trials Tour Patient Safety Tour Public Health Tour Start PIX Patient Identifier Cross Referencing (V2)1, 11 PSA Patient Synchronized Application (CCOW) 1, 14, 18,28, 29, 30, RID Retrieve Information for Display1,8, 10,11,15,18,29, 30 RIM Reference Information Model (V3)2, 4,6, 7, 9, 10, 11, 12, 13, 16,19,20,21, 22, 23, 24, 25, 26, 27,32 SDS Submissions Data Standard (CDISC)20, 21 SPL Structured Product Label (CDA)19 SWF Scheduled Work Flow (V2, DICOM)1,2,3,29,31 V2 Version 2 messaging1,5,6, 8, 9,11,12,17,18,22,25,26,32 V3 Version 3 messaging 4,9,10,11,16,19,20,21,22,24,27,32 aECG Annotated ECG (V3)4, 16, 19, 20,21, 27 Arden Arden Syntax Medical Logic Modules 17, 19, 26 CCOW Clinical Context Object Workgroup1,14, 15, 17, 18, 28, 29, 30 CDA Clinical Document Architecture (RIM)2, 6, 7, 9, 10, 11, 12, 13, 20, 22, 23, 24, 25, 26, 32 CT Integration Profile for Consistent Time1, 2, 18, 30 EUA Enterprise User Authentication (Kerberos)1, 2, 14, 18, 28, 30 Integration Profiles: 1, 2, 3, 6, 8, 10, 11, 14, 15, 18, 28, 29, 30, 31 LDM Lab Data Model (V3, CDISC)20 ODM Operational Data Model (CDISC)20, 21 Walking Tour Tour Guide HL7-IHE Interoperability Demonstration Booth 4638 GE CWeb • Take A Tour, Win A Prize! • Get a stamp at every stop on a tour • Take stamped Tour Guide to receptionist • Enter to win a Prize! • -HL7 Registration or • -HIMSS 2005 Registration GE RA600 1 2 Kodak Carefx/GE 3 4 GE Solar Mortara ACP/FDA 19 15 14 5 GE MUSE DigitalInfuzion Misys 16 Guided tours on the quarter hour; Self-guided tours any time 20 18 17 AISLE 6 MS InfoPath Dictaphone GE ED Eclipsys 7 C L A S S R O O M DCRI 8 21 Berdy SNOMED Soarian Siemens OL T H E A T E R Philips Adobe 9 CommerceNet 13 CDC/UCDavis MS BTS 23 24 25 26 27 Kryptiq 22 12 10 31 32 30 29 28 Raining Data 11 Ximis Epic NIST Sentillion INFINITT GE CPortal AISLE

  44. Thank you • Questions? • Tours starting now • This presentation available on www.rsna.org/IHE/hl7ihedemo

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