IHE in North America

Chris CarrChris CarrDirector of Informatics/Staff Liaison to IHEDirector of Informatics/Staff Liaison to IHE

Radiological Society of North AmericaRadiological Society of North America

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IHE North AmericaIHE North America

• What?/Who? What?/Who?

• OrganizationOrganization

• TestingTesting

• ImplementationImplementation

• Learn more/Get involvedLearn more/Get involved

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Regional Deployment CommitteeRegional Deployment Committee

• Multinational association assembled to Multinational association assembled to oversee testing and implementation oversee testing and implementation activitiesactivities

• Two national deployment committees:Two national deployment committees:– IHE CanadaIHE Canada– IHE USAIHE USA

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IHE Canada – Established 2007IHE Canada – Established 2007

Part of Standards Collaborative

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IHE USA – Established 2008IHE USA – Established 2008

• Initial sponsors and supporters:Initial sponsors and supporters:– HIMSSHIMSS– RSNARSNA– American Academy of Ophthalmology (AAO)American Academy of Ophthalmology (AAO)– American College of Cardiology (ACC)American College of Cardiology (ACC)– American College of Physicians (ACP)American College of Physicians (ACP)– American College of Clinical Engineering American College of Clinical Engineering

(ACCE)(ACCE) – American College of Emergency Physicians American College of Emergency Physicians

(ACEP) (ACEP) – American Society for Therapeutic Radiation American Society for Therapeutic Radiation

Oncology (ASTRO)Oncology (ASTRO)Preparing for incorporation in Q2 2009

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Deployment Committee Deployment Committee ResponsibilitiesResponsibilities

• Sponsor and oversee testingSponsor and oversee testing

• Support development of test toolsSupport development of test tools

• Conduct demonstrations and Conduct demonstrations and education eventseducation events

• Establish relationships with national Establish relationships with national HIT agencies, EHR initiatives, etc.HIT agencies, EHR initiatives, etc.

• Develop any national extensions to Develop any national extensions to IHE Technical FrameworksIHE Technical Frameworks

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Connectathon History: Connectathon History: 1999-20091999-2009

• Continuous, steady expansion in Continuous, steady expansion in scope and participation in scope and participation in Connectathon:Connectathon:– 1999: 15 companies, 24 systems1999: 15 companies, 24 systems– 2009: 77 companies, 126 systems2009: 77 companies, 126 systems

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Connectathon HistoryConnectathon History

• 1999: First IHE Connectathon1999: First IHE Connectathon• 1999 - present: Continual expansion of scope 1999 - present: Continual expansion of scope

and participationand participation• 2001: First IHE-Europe Connectathon2001: First IHE-Europe Connectathon• 2002: First IHE-Japan Connectathon2002: First IHE-Japan Connectathon• 2005: First multi-domain North American 2005: First multi-domain North American

Connectathon: Cardio, IT, RadiologyConnectathon: Cardio, IT, Radiology• 2008: Testing Coordinated with HITSP2008: Testing Coordinated with HITSP

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What is a Connectathon?What is a Connectathon?

• Face-to-face interoperability testing eventFace-to-face interoperability testing event• Tests implementation of Integration Profiles: Tests implementation of Integration Profiles:

integration capabilities defined in IHE Technical integration capabilities defined in IHE Technical FrameworksFrameworks

• Testing structured and supervised by Technical Testing structured and supervised by Technical Project Management TeamProject Management Team

• Successful results recorded and published by event Successful results recorded and published by event sponsorssponsors

• Used as preparation for IHE demonstrations eventsUsed as preparation for IHE demonstrations events• Primary purpose: foster adoption of standards-based Primary purpose: foster adoption of standards-based

solutions in productssolutions in products

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ConnectathonConnectathon

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Connectathon ResultsConnectathon Results

•Tool contains Connectathon results from 2001 to present

•Part of the testing management tool

•Development underway to build a new PRODUCT REGISTRY including specific vendors product implementations of Integration Profiles

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Integration StatementsIntegration Statements

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Integration Statements on Integration Statements on www.ihe.net

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Product Registry – coming soon!

http://product-registry.ihe.net/

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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

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16

Canada Health Infoway: Standards Used in Diagnostic Imaging

• No single standard addresses DI Requirements

Internet StandardsXML, PDF, JPEG, JPIP, MIME,

HTTP, FTP, UTF-8, …

Electronic BusinessStandards

ebXML, Web Services

HealthcareContent, Messaging, Terminology

HL7/CDA, DICOMSNOMED CT, LOINC,

ICD-10CA, CCI

EHRS Blueprint v2Privacy & SecurityPrivacy Legislation

IHE Integration ProfilesRad: XDS-I, SWF, PIR, CPI, PGP, KIN, PDI

IS: XDS, PIX, PDQ, ATNA, EUA , XUA, BPPC, CT

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DI Data Sharing in the EHR Environment

HL7 DICOM XDSTransactions:

INFOSTRUCTURE

POS

Registries Data& Services

EHR Data& Services

BusinessRules

EHRIndex

MessageStructures

Terminology Services

Security MgmtData

Privacy Data Terminology

Longitudinal Record Services

HIAL

ClientRegistry

ProviderRegistry

LocationRegistry

Communication Bus

Common Services

SharedHealth Record

DIRepository

EHR Viewer

Physician/Provider

RISPACS EMR/CPOE

CT US

DI ClinicsHospitals

RIS PACSHIS

CT MRI US

PACS• DI Studies• Presentation states• Measurements

RIS• Orders• Reports

Imaging Modalities• DI Studies• Presentation states

XDS Doc Registry

XDS DocumentRepository

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

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VA IHE Success StoryVA IHE Success Story

• All VA DICOM image acquisition uses IHE Radiology Transactions to interface modalities to PACS: – #5 - Modality Worklist Provided - download patient and

study

– #8 - Modality Images Stored - send images to the PACS

• 200 different models of radiology instruments interfaced• Exactly the same IHE DICOM

interface to Consults for

ophthalmology (eye care), dentistry,

endoscopy, pathology, and cardiology.• The VA will not purchase a new modality unless it

supports both of these capabilities.

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IHE: Supporting HHS/ONC GoalsIHE: Supporting HHS/ONC Goals

Healthcare Information Technology

Standards Panel (HITSP)

Nationwide Health Information

Network Architecture

Projects (NHIN)

Health Information Security and

Privacy Collaboration

(HISPC)

Certification Commission for

Healthcare Information Technology

(CCHIT)American Health

Information Community National eHealth Collaborative

Standards harmonization Standards harmonization and adoptionand adoption

Interoperability testingInteroperability testing

Security and privacy standardsSecurity and privacy standards Specifications for standards-Specifications for standards-based EHR functionality to based EHR functionality to support RHIOssupport RHIOs

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HITSP Recommended StandardsHITSP Recommended Standards

• BiosurveillanceBiosurveillance– ICD-9CM – International Classification of Diseases v. 9 Clinical ICD-9CM – International Classification of Diseases v. 9 Clinical

ModificationsModifications– ICD-10 CM – Diagnoses and ProceduresICD-10 CM – Diagnoses and Procedures– IHE-XDS – Integrating the Healthcare Enterprise (IHE) Cross-IHE-XDS – Integrating the Healthcare Enterprise (IHE) Cross-

Enterprise Document SharingEnterprise Document Sharing– IHE-XDS Lab – IHE Laboratory Report Document SharingIHE-XDS Lab – IHE Laboratory Report Document Sharing– IHE-RFD – IHE Retrieve Form for Data CaptureIHE-RFD – IHE Retrieve Form for Data Capture– IHE-PIX – IHE Patient Identification Cross-ReferencingIHE-PIX – IHE Patient Identification Cross-Referencing– IHE-RAD – XDS-I – IHE Cross-Enterprise Sharing of ImagesIHE-RAD – XDS-I – IHE Cross-Enterprise Sharing of Images– IHE-NAV – IHE Notification of Document AvailabilityIHE-NAV – IHE Notification of Document Availability– IHE-XDS-MS – IHE Medical Summary Document SharingIHE-XDS-MS – IHE Medical Summary Document Sharing– ISO/TC215 -DTS 25237 - Health Informatics PseudonymisationISO/TC215 -DTS 25237 - Health Informatics Pseudonymisation– LOINC – Logical Observation Identifiers Names and CodesLOINC – Logical Observation Identifiers Names and Codes– NCCLS – National Committee for Clinical Laboratory NCCLS – National Committee for Clinical Laboratory

StandardsStandards– RxNorm – National Library of Medicine RxNormRxNorm – National Library of Medicine RxNorm

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HITSP Recommended StandardsHITSP Recommended Standards

• Consumer EmpowermentConsumer Empowerment– IHE-XDS – Integrating the Healthcare Enterprise (IHE) IHE-XDS – Integrating the Healthcare Enterprise (IHE)

Cross-Enterprise Document SharingCross-Enterprise Document Sharing– IHE-PIX – IHE Patient Identification Cross-ReferencingIHE-PIX – IHE Patient Identification Cross-Referencing– IHE-PDQ – IHE Patient Demographics QueryIHE-PDQ – IHE Patient Demographics Query– Health Level Seven (HL7) CDA R2 – HL7 Clinical Health Level Seven (HL7) CDA R2 – HL7 Clinical

Document Architecture Release 2Document Architecture Release 2– HL7 CCD – HL7 Continuity of Care Document HL7 CCD – HL7 Continuity of Care Document with with

mappings from ASTM E 2369-05 Continuity of Care Record mappings from ASTM E 2369-05 Continuity of Care Record (CCR), X12 N 270/271 and NCPDP Script 8.1.(CCR), X12 N 270/271 and NCPDP Script 8.1.

– HL7 EHR Systems Functional Model Draft Standard for HL7 EHR Systems Functional Model Draft Standard for Trial Use (DSTU)Trial Use (DSTU)

– Logical Observation Identifiers Names and Codes Logical Observation Identifiers Names and Codes (LOINC)(LOINC)

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• Electronic Health Record ExchangeElectronic Health Record Exchange– IHE-XDS Lab – IHE Laboratory Report Document SharingIHE-XDS Lab – IHE Laboratory Report Document Sharing

– IHE-PIX – IHE Patient Identification Cross-ReferencingIHE-PIX – IHE Patient Identification Cross-Referencing

– IHE-PDQ – IHE Patient Demographics QueryIHE-PDQ – IHE Patient Demographics Query

– Health Level Seven (HL7) CDA R2 – HL7 Clinical Document Health Level Seven (HL7) CDA R2 – HL7 Clinical Document Architecture Release 2Architecture Release 2

– HL7 v. 2.5HL7 v. 2.5

– Clinical Laboratory Improvement Amendments (CLIA)Clinical Laboratory Improvement Amendments (CLIA)

– Logical Observation Identifiers Names and Codes (LOINC)Logical Observation Identifiers Names and Codes (LOINC)

– Health Insurance Portability and Accountability Act (HIPAA)Health Insurance Portability and Accountability Act (HIPAA)

– Systematized Nomenclature of Medicine – Clinical Terms Systematized Nomenclature of Medicine – Clinical Terms (SNOMED – CT)(SNOMED – CT)

– Unified Code for Units of Measure (UCUM)Unified Code for Units of Measure (UCUM)

HITSP Recommended StandardsHITSP Recommended Standards

IHE contributes to HITSP’s successIHE contributes to HITSP’s success

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HITSP and Federal ProcurementHITSP 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.

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Testing – HITSP, CCHIT and Testing – HITSP, CCHIT and NHINNHIN

• HITSP interoperability pilot testing HITSP interoperability pilot testing performed at IHE Connectathonperformed at IHE Connectathon

• CCHIT, NIST and IHE have agreement CCHIT, NIST and IHE have agreement to collaborate on testing toolsto collaborate on testing tools

• NIST and IHE collaborated to provide NIST and IHE collaborated to provide testing services for first NHIN testing testing services for first NHIN testing event in August 2008event in August 2008

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IHE Testing ToolsIHE Testing Tools

• 11 years experience automating HIT 11 years experience automating HIT interoperability testinginteroperability testing

• Test management tool evolving to Test management tool evolving to support remote testingsupport remote testing

• Close partnership with National Close partnership with National Institute of Standards and Institute of Standards and TechnologyTechnology

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IHE Testing Tools: Project Gazelle

Proxy

System Under Test

Network

GazelleTest Engine

Control

Configuration Info

Feedback

ExternalValidation Services

Tests Scenario

Actor Simulators

Gazelle Control System

ExternalValidation ServicesExternal

Validation ServicesExternalValidation Services Actor Simulators

Actor SimulatorsActor Simulators

Actor Simulators

System Under TestSystem Under Test

System Under Test

Database

22/05/08 Projet IHE-Dev Inria Rennes

DemographicService

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More Resources -More Resources - www.ihe.net

• Integration Profiles/Technical Integration Profiles/Technical FrameworksFrameworks

• Connectathon ResultsConnectathon Results• Product Registry – coming soon!Product Registry – coming soon!• Webinar and presentation materialsWebinar and presentation materials• Committee/domain activities Committee/domain activities • Governance and Membership MaterialsGovernance and Membership Materials

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Providers and VendorsProviders and Vendors

Working Together to DeliverWorking Together to Deliver

Interoperable Health Information SystemsInteroperable Health Information Systems

in the Enterprisein the Enterprise

and Across Care Settingsand Across Care Settings

http://www.ihe.net