integrating the healthcare enterprise

Nov 30, 2004 IT International Update1

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

IHE Update

Charles Parisot, GE Healthcare

IHE IT Infrastructure Technical Committee Co-chair


IHE IT Infrastructure 2004-2005IHE IT Infrastructure 2004-2005

Enterprise User AuthenticationEnterprise User Authentication

Provide users a single nameand centralized authentication

processacross all systems

Retrieve Information for Display

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 presented

to the requesting user

Patient Identifier Cross-referencing

for MPIMap patient identifiers

across independent identification domains

Patient Identifier Cross-referencing for

MPI

Map patient identifiers across independent

identification domains

Synchronize multiple applications on a desktop to the

same patient

Patient Synchronized Applications

Consistent TimeCoordinate time across

networked systems

Audit Trail & Node Authentication

Centralized privacy audit trail and node to node authentication

to create a secured domain.

New

Patient Demographics Query New

Personnel White PageAccess to workforcecontact information

New

Cross-Enterprise Document Sharing

Registration, distribution and access across health enterprises of clinical

documents forming a patient electronic health record

New


Acute Care (Inpatient)

PCPs and Clinics (Ambulatory)

Long Term Care

Other Specialized Careor Diagnostics Services

Sharing and accessing DocumentsSharing and accessing Documents

EHR-CR: EHR-CR: Care RecordCare Record systems systemssupportingsupporting care delivery care delivery

Documents Registry

DocumentRepository

EHR-LR:EHR-LR:Longitudinal RecordLongitudinal Recordas usedas usedacross-encountersacross-encounters

Submission of Document References

Retrieve of selected Documents


Standards selection for IHE XDSStandards selection for IHE XDSNo single standard can address

Cross-enterprise Document Sharing

Marriage of healthcare standards facilitates implementation and leverages complementary

technologies (e.g. security & privacy).

HealthcareContent Standards

HL7 CDA, CEN EHRcomASTM CCRDICOM, etc.

Internet StandardsHTML, HTTP,

ISO, PDF, JPEG, etc.

Electronic BusinessStandards

ebXML Registry, SOAP, etc.


HIMSS 2005 Interoperability ShowcasesHIMSS 2005 Interoperability ShowcasesHIMSS 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 Showcase exhibits linked 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)


HIMSS 2005 Interoperability ShowcasesHIMSS 2005 Interoperability Showcases

cross-enterprise sharing of health information in the acute care, 18 vendors:

Cedara GE Healthcare Mortara InstrumentsDictaphone IDX NISTEastman Kodak InterSystems NovellEclipsys Infinitt Technology Open TextEmageon Kryptiq SentillionEPIC MedCommons Siemens

ambulatory sharing of health information, 14 vendors:Allscripts GE Healthcare MidMarkCapMed/SanDisk Healthramp MisysCerner IDX NextGenEclipsys Krytiq WebMDETIAM MediNotes

HIMSS sponsors the testing and demonstration of IHE interoperability in two large Showcase Exhibits:


HIMSS 2005 – HIMSS 2005 – Show-Wide InteroperabilityShow-Wide Interoperability

Vendor System

Ambulatory Showcase BoothAmbulatory Showcase Booth

HomeHome

PCP

MultispecialtyMultispecialtyClinicClinic

Diag CenterDiag Center

Cross-enterprise Showcase BoothCross-enterprise Showcase Booth

Cardiology Radiology

RadiologyIT

Infrastructure& Lab

In-Patient/Out-patient

Vendor BoothVendor Booth








AllscriptsEclipsys

GE Healthcare

HealthrampIDX

InfinittInterSystems

MedCommonsNovell

OpenTextSiemens

HIMSS “RHIO” withCross-enterprise

doc sharing


Imaging Information Content

Format of the Document Content and associated coded vocabulary

Simple Document Content


For Display Document Content

Format of the Document ContentLab Results Document Content


IHE Profiles for a “Regional Health Info Organization”IHE Profiles for a “Regional Health Info Organization”What are the gaps to be filled in 2005 ?What are the gaps to be filled in 2005 ?

Patient Identifier Cross-referencing

Map patient identifiers across independent identification

domains

Consistent TimeCoordinate time across

networked systems

Audit Trail & Node Authentication

Centralized privacy audit trail and node to node authentication

to create a secured domain.

Patient Demographics Query

Personnel White PageAccess to workforcecontact information

Cross-Enterprise Document Sharing

Registration, distribution and access across health enterprises of clinical

documents forming a patient electronic health record

User Identity, Authentication and

Permissions

Enable Basic Access Control

Cross-Enterprise Notification

Notification of a remote provider/ health enterpriseContinuity of Care

Document ContentFormat of the Document Contentand associated coded vocabulary


Infrastructure and InteroperabilityInfrastructure and InteroperabilityCross-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.


IHE Radiology Integration ProfilesIHE Radiology Integration Profiles

Patient Info.

Recon-ciliation

Access to Radiology Information

Consistent Present-ation of Images

Basic Security

-

EvidenceDocs

KeyImageNotes

Simple Image & Numeric Reports

Presentation of Grouped Procedures

Post-

Processing Workflow

Reporting Workflow

Charge Posting

Scheduled Workflow

Portable Data for Imaging

NMImage

New

Extensions

New


Laboratory IHE Integration ProfilesLaboratory IHE Integration Profiles

Laboratory Device Automation (LDA)

In Process –TI Nov 2004In Process –TI Nov 2004

Pre-analytic process, analysis and post-analytical treatment

Laboratory Scheduled Workflow (LSWF)Completed in 2003Completed in 2003

Tests performed by a laboratory for an identified

inpatient or outpatient

Laboratory Patient Information Reconciliation (LPIR) In ProcessIn Process

Tests performed on an unidentified or misidentified patient

Laboratory Code Set Distribution (LCSD) In ProcessIn Process

Sharing the batteries and tests code sets throughout the enterprise

Laboratory Point Of Care Testing (LPOCT) In Process –TI Nov 2004In Process –TI Nov 2004

Tests performed on point of care or patient’s bedside

In Dev.

In Dev.

In Dev.

In Dev.


IHE Cardiology 2004-2005IHE Cardiology 2004-2005


Access a patient’s clinical information and documents in a format ready to be

presentedto the requesting user

EchoCardiography Worklflow

Admit, order, schedule, acquire images, notify of completed

steps, on fixed and mobile stress echo modalities.

Cardiac Catheterization Workflow

Scheduled & unscheduled acquisition and management of cathlab information, notification

of completed steps.

Provide high-quality ECG and related reportsto the enterprise and outside in a ready-to-display format

Retrieve ECG for Display

New

New

New


ACC 2005 IHE DemonstrationACC 2005 IHE Demonstration

11 vendors:Agfa GE Healthcare SchillerCamtronics Heartlab PhilipsCerner IDX 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)

ACC sponsors the testing and demonstration of IHE interoperability in their exhibit – March 2005