november 11, 2004 ihe and ehr seminar

November 11, 2004 IHE and EHR Seminar1

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

Process and Influence on Radiology and Clinical Workflow

Charles Parisot, GE Healthcare

IHE IT Infrastructure Technical Committee Co-chair

IHE and EHR SeminarIHE and EHR SeminarHelsinki, November 11, 2004Helsinki, November 11, 2004


AgendaAgenda

IHE Goals, Organization and Deliverables

IHE Integration Profiles and Influence on Clinical Workflow


Goals of IHEGoals of IHESpeed up the rate and quality of integration in healthcare environments

Foster communication among vendors and care providers

Prove that integration is attainable based on standards

Improve the efficiency and effectiveness of clinical practice

Improve interoperability among care domains and build foundation for the EHR

Integration solutions within the healthcare enterprise and across healthcare enterprises


Understanding the IHE InitiativeUnderstanding the IHE Initiative

IHE has a clear focus

IHE is a healthcare domain-based initiative

IHE creates synergies for interoperability testing across domains

IHE addresses the standards adoption process

IHE is both regional and multi-national

IHE is both user lead and vendor driven


IHE: Domain-based for a stepwise approachIHE: Domain-based for a stepwise approach

CardiologyCardiologyLabora-Labora-ttoryory

Pharmacy,…..Pharmacy,…..RadiologRadiologyy

Patient Identifier Linkage, Registries, SecurityPatient Identifier Linkage, Registries, Security

Electronic Health RecordElectronic Health Record

Other (e.g. Access Control, eHealthWorkflows)Other (e.g. Access Control, eHealthWorkflows)

Patient ManagementPatient Management

Order ManagementOrder Management


IHE

EHR- Longitudinal Record

IHE Cardiology

IHE Laboratory

IHE Radiology

IHE

Future Domain

IHE

Future Domain

IHE

IT Infrastructure Intra-Enterprise

Cross-Enterprise

14 Integration Profiles




IHE 2004 – Four Active Domains IHE 2004 – Four Active Domains

4 Technical Frameworks with 31 Integration ProfilesTesting at yearly Connectathons in three continents

Demonstrations at major conferences world-wide

Provider-Vendor cooperation to accelerate standards adoption


A Proven Standards Adoption ProcessA Proven Standards Adoption Process

IHEIntegrationProfiles B

IHEIntegrationProfile A

Easy toIntegrateProducts

IHEIHEConnect-a-thonConnect-a-thon

ProductWith IHE

IHEIHEDemonstrationDemonstration

User Site

RFPRFP

StandardsStandards

IHETechnical

Framework

Product IHE IntegrationStatement

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

IHE Connect-a-thonResults


IHE ProcessIHE ProcessUsers identify desired functionality that require coordination and communication among multiple systems E.g., departmental workflow, single sign-on, sharing of documents

Find and document standards-based transactions among systems to achieve desired functionality Apply necessary constraints to eliminate useless wiggle room

Provide process and tools to encourage vendors to implement MESA software test tools + Connect-a-thon interoperability testing event

Provide tools and education to help users acquire and integrate systems using these solutions Connect-a-thon results and public demonstrations Integration statements


IHE Contributors & ParticipantsIHE Contributors & ParticipantsSocieties Representing Healthcare Segments RSNA, HIMSS, ACC, CAR, CHI, ACCE, Many Other Professional

Societies… Any Healthcare Stakeholder Organization

Users Clinicians, Medical Staff, Administrators, CIOs, …

Information Systems & Equipment (e.g. imaging) Vendors

Consultants

In addition, active liaison with Standards Development Organizations (SDOs) HL7, DICOM, NCCLS, ASTM, ISO, others …


IHE Organizational StructureIHE Organizational Structure

IHE Europe

IHE North America

France

USA Canada

IHE Asia-Oceania

Japan

KoreaTaiwan

Netherlands Spain Sweden

UKItalyGermany

Norway

Regional Deployment

RadiologyPlanning Committee

RadiologyTechnical Committee

IT InfrastructurePlanning Committee

IT InfrastructureTechnical Committee

Pharmacy ExploratorySub-Committee

Global Development

CardiologyPlanning Committee

CardiologyTechnical Committee

LaboratoryPlanning and Technical

Committee

IHE Strategic Development Committee

ACC ITAC/CHITTAHIMSS CHIRSNA CAR

JAHISJIRAJRS

METI-MLHWMEDIS-DCJAMI

GMSIHSFRSFIL

SIRMBIREuroRec

COCIREAR-ECRDRG

ESCProfessional Societies / SponsorsProfessional Societies / Sponsors Contributing and participatingContributing and participating

VendorsVendors


IHE Domains Milestones – 20 month cycleIHE Domains Milestones – 20 month cycleDevelopmentDevelopment and and DeploymentDeployment

Proposed Supplement Scope

Approved Supplement Scope

Public Comment of Supplements Sponsors announce Connectathon/Demos with set of

Implementation Profiles

Final Intgr-profile + 9 ---

- 10 ---

- 7 ---

- 2 ---

Trial Implementation Intgr-profile 0 ---Connectathon/Demo Vendor Participant Registered

+ 2 ---

Vendor Participants pass Connectathon

+ 5 ---

+ 6 --- Demo &Education Material

Vendors release products with IHE Integration

Statements---


How to participate to IHE?How to participate to IHE?As a User or Vendor Contributor

Become a member of relevant Domains Planning or Technical Committees

Become a member of relevant Regional/National Committees

As a Vendor ParticipantRespond to Public Comments of Domain Supplements

Attend Yearly IHE Regional Educational/Workshops

Participate to Regional Connect-a-thons and Demonstrations

As a User/Consultant ParticipantRespond to Public Comments of Domain Supplements

Attend Yearly Regional Educational/Workshops

Attend Demonstrations and include IHE Integration Profiles in your RFPs and Integration Projects.

IHE Canada, your entry point


What IHE is NOT!What IHE is NOT!

A standards development organization Uses established standards (HL7, DICOM, others)

to address specific clinical needs Activity complementary to SDOs, formal

relationship with HL7, ISO, DICOM, NCCLS, etc.

Simply a demonstration project Demos, only one means to the end—adoption Backed up by documentation, tools, testing, and

publication of information


Benefits to IHE ParticipantsBenefits to IHE ParticipantsClinicians Improved workflow Information when and where needed Fewer opportunities for errors Fewer tedious tasks/repeated work

Administrators Improved efficiency Best of breed opportunities Decreased cost and complexity of interface

deployment and management


Benefits to IHE ParticipantsBenefits to IHE ParticipantsVendors Align product interoperability with industry

consensus Decreased cost and complexity of interface

installation and management Focus competition on functionality/service space not

information transport space

SDOs Rapid feedback to adjust standards to real-world Establishment of critical mass and widespread

adoption

Plus, IHE meets fixed deadlinesPlus, IHE meets fixed deadlines


IHE Technical FrameworksIHE Technical Frameworks


Key IHE ConceptsKey IHE Concepts• Generalized Systems Generalized Systems -> -> ActorsActors

• Interactions between Actors Interactions between Actors -> -> TransactionsTransactions

• Problem/Solution ScenariosProblem/Solution Scenarios -> -> IntegrationIntegration ProfilesProfiles

• For each Integration Profile:For each Integration Profile:

• the context is described (which real-world problem)the context is described (which real-world problem)

• the actors are defined (what systems are involved)the actors are defined (what systems are involved)

• the transactions are defined (what must they do)the transactions are defined (what must they do)


Key concept: Key concept: Integration ProfileIntegration Profile

Examples:

Enterprise User Authentication

Retrieve Information for Display

Laboratory Scheduled Workflow

Echo Laboratory Workflow

Cross-Enterprise Document Sharing

Referenced standard

(e.g. HL7)Detailed messaging info --------------------------Roles

Integration Profile

Actor Actor Actor…

Tra

nsac

tion

Tra

nsac

tion

Tra

nsac

tion

Tra

nsac

tion

Tra

nsac

tion

………

Solves an Integration Problem: A collection of real world information exchange capabilities supported by a set of specific Actors using Standards-based Transactions


IHE ConnectathonIHE Connectathon

Open invitation to vendor community

Advanced testing tools (MESA)

Testing organized and supervised by project management team

Thousands of cross-vendor tests performed

Results recorded and published


Massive yearly events :Massive yearly events :40-50 vendors40-50 vendors120-160 engineers120-160 engineers70-80 systems70-80 systems…….integrated in 5 days.integrated in 5 days

IHE ConnectathonsIHE Connectathons

Vendors do not pass…Vendors do not pass…until an IHE Project Manager attest it !until an IHE Project Manager attest it !


Integration StatementsIntegration Statements


Leveraging IHE Integration Leveraging IHE Integration StatementsStatements

Vendors Claim IHE Compliance in an explicit way Can rely on an objective and thorough specification

(IHE Technical Framework) Willing to accept contractual commitments Willing to correct “implementation errors”

Buyers Can compare product integration capabilities Simplify and strengthen their RFPs Can leverage a public and objective commitment Decreased cost and complexity of interface deployment and

management


Participating and Contributing Vendors (America)Participating and Contributing Vendors (America)Agfa HealthCareAllscriptsAlgotec Systems, Ltd.BerdyCamtronicsCanon Medical SystemsCapMedCarefxCedara Software Corp.Cerner CorporationCSISTDictaphoneDR SystemsDynamic ImagingEastern InformaticsEastman Kodak CompanyEmageonEclipsysEPICETIAMFujifilm Medical SystemsGE HealthcareHealthrampHeartlab

Novell

Opentext

Procom

Philips Medical Systems

RASNA Imaging Systems

Sectra

Sentillion

Siemens Medical Solutions

Softmedical

Stentor, Inc

StorCOMM, Inc

Swissray International, Inc

Tiani Medgraph AG

Toshiba America Medical Sys.

UltraVisual Medical Systems

Vital Images, Inc.

Voxar Limited

WebMD

XIMIS

Hitachi Medical Corporation

Hologic, Inc

IDX Systems Corporation

IMCO Technologies

InSiteOne

INFINITT

Intersystems

Konica Minolta

Marotech, Inc.

McKesson Information Soln.

Medcon

MedCommons

Medical Manager Health Sys.

Mediface Co., Ltd.

MediNotes

Merge eFilm

MidMark

Misys

Mortara

NextGenIn yellow, companies with IHE Committees Chairs (Summer 2004)


Participating and Contributing Vendors (Europe)Participating and Contributing Vendors (Europe)AGFA HealthcareAISoftw@re Medical SolutionsAlgotec ARES SA aycan Digitalsysteme ConVisDEDALUSDianoemaEastman Kodak Company Ebit SanitaEDL ELFIN s.r.l. Engineering Sanità Enti LocaliESAOTEETIAM Ferrania Fujifilm GE HealthcareGMD GIE Convergence-Profils

Rogan-Delft

Sago spa

Sectra Imtec AB

Siemens Medical Solutions

Soluzioni Informatiche srl

Stentor Inc.

Swissray Medical AG

Symphonie On Line

Synapsis

TELEMIS S.A.

TIANI MEDGRAPH AG

TOREX GAP Medical

Toshiba Medical Systems

TSI groupe europMedica

VEPRO AG

VISUS Technology Transfer

WAID

XR PARTNER

GWI Research

IASI Srl

IdeoPass

Image Device-Cerner Company

INFINITT

INOVIT

McKesson

MED2RAD

MEDASYS SA

Medavis

Medigration GmbH

MEDIMON Ltd.

MEDOS AG

Merge eFilm

METAFORA

Konica Minolta Europe

Omnilab

Philips Medical Systems

Rasna Imaging Systems

RAYPAX INC.

In yellow, companies with IHE Committees Chairs (Summer 2004)


Participating and Contributing Vendors (Asia)Participating and Contributing Vendors (Asia)Japan

AGFA Gevaert JapanEBM JapanINFINITT JapanA&TCanonGoodmanClimb Medical SystemsKonica Minolta MGShimadzuSONYToshiba Medical SystemsToyo TechnicaNihon KohdenOlympusNECPioneer (Marotech)HitachiHitachi MedicoFujitsuFuji Film MedicalYokogawa

TaiwanINFINITTShing ShianINQ GENTEPTah Ya

KoreaAGFA Korea GE Healthcare KoreaINFINITTLG CNS Marotech, Inc.Medical StandardPeoplenet CommunicationsSamsung SDS


IHE approach to standardsIHE approach to standards

IHE, starts from user defined needs and priorities in a domain

Then selects the standards that: Best address the problem Have the broadest practical acceptance (world-

wide) Are Technically stable Offer potential reuse/integration with other existing

or future integration profiles.

Problem & effectiveness drives standards selection

On-going dialogue with HL7, ISO TC215, DICOM, OASIS, IETF, etc.


Continuity & Integrity of Patient Information

Clinical Workflow Optimization

Foster Communication Among Diverse Medical Information Systems

Avoid Repeating Tasks

Eliminate Data Redundancy

Healthcare Needs AddressedHealthcare Needs Addressedby the IHE Initiativeby the IHE Initiative

Improving the Patient Care Process


AgendaAgenda

IHE Goals, Organization and Deliverables

IHE Integration Profiles and Influence on Clinical Workflow


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


imagesstored

patientinformation

RIS

examination orders

imagesretrieved

HIS

PACS

procedurescheduled

Prefetch any relevantprior studies

modalityworklist

report

report

ADT (Registration)

Order Placer

Order Filler

Print Server

FilmFolder

Image Manager& Archive

FilmLightbox

report ReportRepository

ImageDisplay

Modality

acquisitionacquisitionin-progressin-progressacquisitioncompleted

acquisitioncompleted

imagesprinted

AcquisitionModality

Example: IHE Rad Scheduled WorkflowExample: IHE Rad Scheduled Workflow


Store ImagesStore Images

Storage CommitmentStorage CommitmentStorageStorage

CommitmentCommitment

List of ImagesList of Images

PACS &PACS &ArchiveArchive

RISRIS

ModalityModalityPerformedPerformedProcedure Procedure StepStep

Performed Step:Performed Step:

Status = CompletedStatus = CompletedPerformed CT HeadPerformed CT HeadPat Name/ID, Dose, Pat Name/ID, Dose,

Accession #, Study UIDAccession #, Study UIDComplete List of ImagesComplete List of Images

A Closed LoopA Closed Loop•Update IS SchedulingUpdate IS Scheduling

•Match Procedure with OrderMatch Procedure with Order•Support Billing Based on MPPSSupport Billing Based on MPPS

•Avoid Reading incomplete ProceduresAvoid Reading incomplete Procedures

IHE Scheduled WorkflowIHE Scheduled Workflow

Modality WorklistModality Worklist

WorklistWorklist

Procedure ScheduledProcedure Scheduled

Patient Registration/UpdatePatient Registration/UpdateOrder ManagementOrder Management

November 11, 2004 IHE and EHR Seminar

IHE Workflow ConceptsIHE Workflow Concepts

Procedure Steps : The smallest unit of work in the workflow:

SCHEDULED PROCEDURE STEP: ‘A unit of work to do’

PERFORMED PROCEDURE STEP: ‘A unit of work done’

IHE identifies four fundemental workflow information units :IHE identifies four fundemental workflow information units :

REQUESTED PROCEDURE : : A Unit of Reporting WorkA Unit of Reporting Workwithwith associated codified, billable acts associated codified, billable acts

ORDER : A request for radiologic A request for radiologic

serviceservice

IHE and EHR Seminar36

AcquisitionModality

AcquisitionModality

Multiple Modality StepsMultiple Modality Steps

ORDERA request for RadiologicService

Radiology Department

Set of Codifiable,

Billable, ActsOne or more series of images

PerformedProcedure

Step P1

ScheduledProcedure

Step B

RequestedProcedure

1

ScheduledProcedure

Step A

Report

One or more series of images

PerformedProcedure

Step P2

DICOMModality Worklist

DICOMModality Worklist


MODALITY

IHE – IHE – Presentation of Grouped ProceduresPresentation of Grouped Procedures

Requested Requested Procedure:Procedure:

CHESTCHEST

Report:Report:CHESTCHEST

Requested Requested Procedure:Procedure:ABDOMENABDOMEN

Report:Report:ABDOMENABDOMEN

Performs a single exam

Operatorgroups

2 procedures

Chest Chest ViewView

Abdomen Abdomen ViewView

RIS / PACS

Chest Chest ViewView

Abdomen Abdomen ViewViewScheduled

ProcedureStep Chest Scheduled

ProcedureStep Abdo


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


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

Enterprise User AuthenticationEnterprise User Authentication

Provide users a single nameand centralized authentication

processacross all systems


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


Introduction:EHR Cross-Enterprise Document SharingEHR Cross-Enterprise Document Sharing

First step towards the First step towards the longitudinal dimension of the EHRlongitudinal dimension of the EHR

Focus:Focus: Support document sharing between Support document sharing between EHRs in different care settings and EHRs in different care settings and organizations organizations


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 and IT 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.


Workshops and Connect-a-thonWorkshops and Connect-a-thon

IHE Workshops: September 13-15 2004 – North America February 7-10 2005 – Europe

2005 IHE Connect-a-thons: January 17-21 – North America February – Japan April 25-29 – Europe (week before HL7 in NL) To Be Announced – Taiwan and Korea.


HIMSS 2005 Interoperability ShowcaseHIMSS 2005 Interoperability ShowcaseHIMSS 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)


Infrastructure and InteroperabilityInfrastructure and InteroperabilityCross-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) Patient Id Cross-referencing (PIX) Patient Demographics Query (PDQ)

In 2005, IHE plans to complement a set of integration profiles to build regional Health networks, candidates: Security: Identity Management + Info for Access Control Content Profiles: DICOM, 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, IHE,

the effective bridgethe effective bridgebetween information between information exchange standards exchange standards and their practical useand their practical use

in healthcare in healthcare


IHE today, more info.IHE today, more info.

IHE Radiology www.rsna.org/ihe TF RAD V5.5 + 4 Trial Impl. Supplements

IHE IT Infrastructure www.himss.org/ihe TF ITI V1.1 + 4 Trial Impl. Supplements

IHE Laboratory www. himss.org/ihe TF LAB V1.0

IHE Cardiology www.acc.org/quality/ihe.htmTF CARD V1.0 for Trial Implementation

IHE Europe IHE Europe IHE–Europe.org