september, 2005what ihe delivers 1 ihe essentials epharmacy workshop jan. 2008 g. claeys...
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1September, 2005 What IHE Delivers
IHE Essentials IHE Essentials ePharmacy Workshop Jan. 2008ePharmacy Workshop Jan. 2008
G. Claeys ([email protected] )G. Claeys ([email protected] )
Co-chair IHE Europe Development Committee (ad interim)Co-chair IHE Europe Development Committee (ad interim)
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IHE MissionIHE Mission
IHE = Integrating the Healthcare Enterprise
Improve the quality and cost of healthcare by
removing the real-world interoperability barriers
ondepartmental, hospital or regional level
in a pragmatic waya pragmatic way
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IHE Global ApproachIHE Global Approach
Close Close co-operationco-operation between users and vendors between users and vendors Users identify the integration problems Users identify the integration problems Vendors provide technical solutionsVendors provide technical solutions
Profile Profile existingexisting standards (e.g. DICOM, HL7,..) standards (e.g. DICOM, HL7,..)
AgileAgile development & deployment process development & deployment process Incremental releases every yearIncremental releases every year Test drivenTest driven
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IHE OrganisationIHE OrganisationStarted in 1999Started in 1999
Association of users, vendors and public healthcare Association of users, vendors and public healthcare authoritiesauthorities More than 100 participating vendors (major healthcare imaging&IT More than 100 participating vendors (major healthcare imaging&IT
companies)companies)
Global development committeesGlobal development committees Develop technical frameworksDevelop technical frameworks
Regional and national deployment committeesRegional and national deployment committees Present in all continents (NAFTA, Europe, Asia Pacific) Present in all continents (NAFTA, Europe, Asia Pacific) Marketing, educationMarketing, education TestingTesting
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AGFA HealthcareAGFA Healthcare
AISoftw@re MedicalAISoftw@re Medical
Algotec Algotec
ARES SA ARES SA
aycan Digitalsysteme aycan Digitalsysteme
CEGEDIMCEGEDIM
Cerner Corp.Cerner Corp.
CHILICHILI
CMT Medical Tech.CMT Medical Tech.
Conto Corrente SaluteConto Corrente Salute
ConVisConVis
CTI Mirada SolutionsCTI Mirada Solutions
Data Processing SPAData Processing SPA
DEDALUSDEDALUS
DianoemaDianoema
Eastman Kodak Co. Eastman Kodak Co.
Ebit SanitaEbit Sanita
EDL EDL
ELFIN s.r.l. ELFIN s.r.l.
Engineering SanitàEngineering Sanità
ESAOTEESAOTE
MEDASYS SAMEDASYS SA
MedavisMedavis
Medical CommunicationsMedical Communications
Medigration GmbH Medigration GmbH MEDIMON Ltd. MEDIMON Ltd.
MEDIWAREMEDIWARE
MEDOS AG MEDOS AG
Merge eFilm Merge eFilm
METAFORA METAFORA
Mevis Diagnostics Mevis Diagnostics
Konica Minolta Konica Minolta
Omnilab Omnilab
Philips Medical SystemsPhilips Medical Systems
POLYMEDISPOLYMEDIS
Rasna Imaging SystemsRasna Imaging Systems
RAYPAX INC. RAYPAX INC.
REMREM
Rogan-DelftRogan-Delft
Sago spa Sago spa
Sectra Imtec AB Sectra Imtec AB
SeeBeyond TechnologySeeBeyond Technology
ETIAMETIAM
Ferrania Ferrania
Fujifilm Fujifilm
GE HealthcareGE Healthcare
GIE Convergence-Profils GIE Convergence-Profils
Global Imaging Online Global Imaging Online
GWI Research GWI Research
Hi. techHi. tech
IASI Srl IASI Srl
IdeoPass IdeoPass
INFINITT INFINITT
INFOPATIENTINFOPATIENT
INOVITINOVIT
INSIELINSIEL
Intersystems Corp.Intersystems Corp.
InvitaInvita
ITZ MedicomITZ Medicom
iSoftiSoft
McKesson McKesson
MED2RAD MED2RAD
MEDarchiverMEDarchiver
In yellow, companies with IHE Committees Chairs (Winter 2005)
Siemens MedicalSiemens Medical
Soluzioni Informatiche srl Soluzioni Informatiche srl
Stentor Inc. Stentor Inc.
St. JudeSt. Jude
Swissray Medical AG Swissray Medical AG
Symphonie On LineSymphonie On Line
Synapsis Synapsis
Synchro-MedSynchro-Med
TECHNIDATATECHNIDATA
TELEMIS S.A. TELEMIS S.A.
Tiani-SpritTiani-Sprit
Tomtec Imaging Tomtec Imaging
TOREX GAP MedicalTOREX GAP Medical
Toshiba Medical SystemsToshiba Medical Systems
TSI groupe europMedica TSI groupe europMedica
T-SystemsT-Systems
Uni-medicineUni-medicine
VEPRO AG VEPRO AG
VISUS Technology VISUS Technology Transfer Transfer
WAIDWAID
XR PARTNERXR PARTNER
Participating Vendors (Europe)Participating Vendors (Europe)
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Electronic Health Record
Cardiology
Laboratory
Radiology
Oncology
Future
Domains
IHE
IT Infrastructure
19 Integration Profiles
5 Integration Profiles
8 Integration Profiles
1144 IInntteeggrraattiioonn PPrrooffiilleess
Patient Care Coordination
6 Integration Profile
Patient Care
Devices
Pathology
Eye Care
Total : 52 Integration Profiles
IHE- Expanding ScopeIHE- Expanding Scope
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IHE Development & Deployment IHE Development & Deployment processprocess
Identify critical healthcare workflows and Identify critical healthcare workflows and integration problemsintegration problems
Research & select existing standards to Research & select existing standards to implement a solutionimplement a solution
Write, review and publish IHE Technical Write, review and publish IHE Technical FrameworkFramework
Develop trial implementationsDevelop trial implementations
Perform cross-testing at “Connectathon”Perform cross-testing at “Connectathon”
Demonstrate at tradeshows (HIMSS/RSNA…)Demonstrate at tradeshows (HIMSS/RSNA…)
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IHE Building BlocksIHE Building Blocks
IHE Technical FrameworkIHE Technical Framework
IHE Validation ProcessIHE Validation Process
IHE Integration StatementsIHE Integration Statements
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IHE Technical FrameworkIHE Technical Framework
Describes the different integration solutions Describes the different integration solutions (domain specific)(domain specific) Radiology, IT Infrastructure, Cardiology, Lab, ..Radiology, IT Infrastructure, Cardiology, Lab, ..
Key concepts are domain neutralKey concepts are domain neutral Integration ProfileIntegration Profile TransactionsTransactions ActorsActors Data modelData model
Country & Regional specializationCountry & Regional specialization Limited : max. 5%Limited : max. 5%
Based on existing standards Based on existing standards
IT
Standards
(http, ebxml)
Healthcare
Standards
(HL7, DICOM)
IHE
Integration Profiles
eHealth
Application
eHealth
Application
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Integration Profiles - Integration Profiles - PrinciplesPrinciples
Solution for real-world interoperability Solution for real-world interoperability problems (bottom-up approach)problems (bottom-up approach)
Integration Profiles are orthogonalIntegration Profiles are orthogonal IPs are independent of each otherIPs are independent of each other Applications may combine multiple Integration Applications may combine multiple Integration
ProfilesProfiles• E.g. Information access + securityE.g. Information access + security
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IHE Integration Profiles - ContentIHE Integration Profiles - Content
Set of Transactions among Set of Transactions among ActorsActors
Actor = logical entity (e.g. Actor = logical entity (e.g. modality, image manager, order modality, image manager, order filler)filler)
Transaction = Sequence of Transaction = Sequence of messages among Actors messages among Actors
Messages : e.g. HL7, DICOM, Messages : e.g. HL7, DICOM, ebXML,.ebXML,.
Profiling existing standards Profiling existing standards Map data models, message contentMap data models, message content ““Restrict the options” Restrict the options” Clarify the semantics : accession nrClarify the semantics : accession nr
Referenced standard
(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
………
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IHE IHE ActorsActorsADT PatientRegistration
OrderPlacer
DeptScheduler
ImageManager/Archive
Modality
Patient Registration (HIS):Patient Registration (HIS):ADT focal point for patient registration informationADT focal point for patient registration information
Department Scheduler (RIS):Department Scheduler (RIS):Focal Point for Requested Procedure ManagentFocal Point for Requested Procedure ManagentBreaks Order into Requested ProceduresBreaks Order into Requested ProceduresSchedules steps for each Requested ProcedureSchedules steps for each Requested Procedure
Acquisition Modality:Acquisition Modality:Focal Point for Performed Procedure StepsFocal Point for Performed Procedure StepsA PPS tracks one or more series of ImagesA PPS tracks one or more series of Images
Image Manager/Archive (PACS)Image Manager/Archive (PACS)Focal Point For Imaging Study. Manages imagesFocal Point For Imaging Study. Manages imagesTriggers reading when all expected PPS are completedTriggers reading when all expected PPS are completed
Order Placer (HIS):Order Placer (HIS):Focal Point for Order ManagementFocal Point for Order Management
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IHE Transactions - ExampleIHE Transactions - Example
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imagesstored
patientinformation
RIS
examination orders
imagesretrieved
HIS
PACS
procedurescheduled
Prefetch any relevantprior studies
modalityworklist
report
report
Registration
Orders Placed
Orders Filled
Film
FilmFolder
Image Manager& Archive
FilmLightbox
report ReportRepository
DiagnosticWorkstation
Modality
acquisitionacquisitionin-progressin-progressacquisitioncompleted
acquisitioncompleted
imagesprinted
AcquisitionModality
Scheduled Workflow: Use CaseScheduled Workflow: Use Case
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IHE Validation ProcessIHE Validation Process
Goal :Goal : Validate implementations of IHE TF in productsValidate implementations of IHE TF in products
ApproachApproach IHE is not a certification authorityIHE is not a certification authority IHE stimulates auto-validationIHE stimulates auto-validation
• Vendors are responsible for validating and documenting IHE Vendors are responsible for validating and documenting IHE implementationsimplementations
• IHE provide tools and infrastructureIHE provide tools and infrastructure
IHE Validation toolsIHE Validation tools Mesa toolkitMesa toolkit ConnectathonConnectathon IHE Integration statementIHE Integration statement
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MESA Test ToolkitMESA Test Toolkit
Software librarySoftware library
Emulate the various actors in the different Emulate the various actors in the different implementation profilesimplementation profiles
Supports single product, single vendor Supports single product, single vendor testing testing
Pre-requisite for connectathon participationPre-requisite for connectathon participation Implementers submit test logs prior to connectathon Implementers submit test logs prior to connectathon
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Connectathon Connectathon Connectathon = connectivity Connectathon = connectivity marathonmarathon
Validate the Integration Validate the Integration Profiles for a particular IHE Profiles for a particular IHE demodemo Pre-requisite for participating at Pre-requisite for participating at
IHE demosIHE demos1 week validation session in 1 week validation session in Europe, USA and JapanEurope, USA and Japan End-to-end scenario testingEnd-to-end scenario testing Multi-product; multi-vendor; Multi-product; multi-vendor;
multi-domainmulti-domainConnectathon 2006 : 70 Connectathon 2006 : 70 vendors, 120+ products, 200 vendors, 120+ products, 200 personspersons
Results are published on Results are published on www.ihe-europe.orgwww.ihe-europe.org
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IHE Integration StatementsIHE Integration Statements
Document the IHE Document the IHE implementation per productimplementation per product
Content : Content :
List of supported actorsList of supported actors List of supported integration List of supported integration
profiles (per actor)profiles (per actor)
““contractual” commitmentcontractual” commitment
Published on company Published on company website; referenced from website; referenced from IHE websiteIHE website
19September, 2005 What IHE Delivers
IHE Cross-Enterprise IHE Cross-Enterprise Document SharingDocument Sharing
(XDS)(XDS)
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IHE XDS - Use CasesIHE XDS - Use Cases
Patient referral (GP to Patient referral (GP to Hospital)Hospital)
Patient discharge (Hospital to Patient discharge (Hospital to GP)GP)
Medical summary for Medical summary for Ambulatory care and acute Ambulatory care and acute care care
Personal Health recordPersonal Health record
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Acute Care (Inpatient)
PCPs and Clinics (Ambulatory)
Long Term Care
Other Specialized Careor Diagnostics Services
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
IHE XDS – ArchitectureIHE XDS – Architecture
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Document Source
Document Consumer
Document Registry
Patient Identity Source
IHE XDS Actors and TransactionsIHE XDS Actors and Transactions
Document Repository
Patient Identity Feed
Query Registry
Register Document Set
Retrieve Document
Provide & Register Document Set
Affinity Domain
1-N
1
1-N
1-N
1-N
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No single standard addresses all No single standard addresses all XDS RequirementsXDS Requirements
Healthcare Application Standards• DICOM : imaging applications (modalities, PACS)
• HL7 : adminstrative applications (e.g. clinical lab, reporting, patient admin.)
• Snomed, Loinc : medical terminology & coding
Domain focused
IT Standards
• IETF
• W3C
• Oasis
• JPEG
Technology focus
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XDS Content modelXDS Content model
All clinical information is stored in documentsAll clinical information is stored in documents
Document format is domain specific (IHE PCC) :Document format is domain specific (IHE PCC) : Clinical Reports : PDF (plain text) -> CDA (coded text, Clinical Reports : PDF (plain text) -> CDA (coded text,
subset of HL7v3 RIM)subset of HL7v3 RIM) Images : DICOM, JPEG2000 (part 1, part 2)Images : DICOM, JPEG2000 (part 1, part 2) Video : MPEG2 -> MPEG4Video : MPEG2 -> MPEG4 Measurements (vector graphics) : SVGMeasurements (vector graphics) : SVG
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XDS-MS Medical SummaryXDS-MS Medical Summary
SSttrruuccttuurreedd CCoonntteenntt wwiitthh ccooddeedd sseeccttiioonnss::
RReeaassoonn ffoorr RReeffeerrrraall VViittaall SSiiggnnss MMeeddiiccaattiioonn
SSttuuddiieess AAlllleerrggiieess
SSoocciiaall HHiissttoorryy PPrroobblleemmss
CCaarree PPllaann
Structured Text Section
Structured Text Section
Structured and Coded Header Patient, Author, Authenticator, Institution, etc.
Coded Section Entries
Always structured and coded
Title-coded sections with non-structured nor coded content (text, lists, tables).
Med, Problems and Allergies required as highly structured text.
Med Problems and Allergies have a required fine-grain structure with optional coding. Coding Scheme not standardized, but explicitly identified.
Coded Section Entries
Structured Text Section Coded Section
Entries
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IHE ResourcesIHE Resources
Technical Framework Technical Framework www.ihe.net/Technical_Framework/index.cfmwww.ihe.net/Technical_Framework/index.cfm
• Volume 1 – ProfilesVolume 1 – Profiles• Volume 2 – TransactionVolume 2 – Transaction
www.ihe.net – New profiles and transactionswww.ihe.net – New profiles and transactions
Practice: Connectathon TestingPractice: Connectathon Testing www.ihe.net www.ihe.net and and www.connectathon.net www.connectathon.net
29September, 2005 What IHE Delivers
Questions?Questions?
30September, 2005 What IHE Delivers
Thank You.Thank You.