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HIE Around the Worls

Chris LindopChris LindopGE HealthcareGE HealthcareRadiology Committee Co-chairRadiology Committee Co-chairIHE Australia BoardIHE Australia Board

EHRs and IHEOverview

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XDS in Europe

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AgendaAgenda

IHE operations in Europe

EU projects and IHE

Notable EHR projects in Europe using IHE

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IHE-EuropeIHE-Europe

Coordination and harmonisation of european national initiatives

IHE national initiatives Aimed at deployment of IHE at national level Active national initiatives

• Austria, Denmark, Finland, France, Germany, Israel, Italy, Norway, Spain, Sweden, The Netherlands, United Kingdom

New initiatives• Switzerland and Turkey will kick off in 2010

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IHE-EuropeIHE-Europe

Organisation and management of IHE CAT CAT 2009 held in Vienna, Austria

• 73 companies registered• 230 engineers participated• 94 systems, 27 of which registered for XDS• XDS and XCA witnessed the most increase in systems

CAT 2010 will be held in Bordeaux, France• 10th anniversary connect-a-thon• Venue will be the Cité Mondiale

CAT 2011 will be held in Pisa, Italy

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ChallengesChallenges

Healthcare systems are under pressure Citizens’ expectations for high-quality care Demographic changes Increased prevalence of chronic diseases Shortage of Health Professionals Patient safety issues Rising healthcare costs, medical progress

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ChallengesChallenges

Changes are needed in the way healthcare is delivered medical knowledge is managed and transferred in clinical practice

EC vision for health ICT to support the paradigm shift

• From “curative care‟ to “preventive care‟, from “hospital-based‟ to “patient-centred‟ throughout Europe

by• Using ICT to enable collaborative and personalised care• Supporting dynamic healthcare systems• Aiming at sustainability of healthcare systems• Interoperability

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ProjectsProjects

IHE Europe is involved in eHealth projects epSOS Calliope HITCH eHealth Interop Mandate 403 Smart PHS

• Smart Personal Health Systems

IHE Europe is contributing to the development of eHealth in Europe

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epSOSepSOS

epSOS stands for European Patients Smart Open Services

Europe-wide project 27 beneficiaries representing twelve EU-member states

• IHE• Ministry of Health

– Germany, Denmark, Austria, The Netherlands, Spain, Sweden, UK, France

Open eHealth initiative large scale European pilot of patient summary and electronic

prescription www.epsos.eu

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epSOSepSOS

The goal to develop a practical eHealth framework to develop ICT infrastructure

Enabling secure access to patient health information between

different european healthcare systems• basic patient summaries• ePrescriptions

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epSOSepSOS

National entitities test services in pilot applications, which interconnect national solutions based on advanced and distinct use cases and associated

infrastructural components Aims at delivering both a methodological process and

durable implementations• building blocks

These building blocks will form the basis for a longer term, pan-european approach to develop interoperable service solutions

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CalliopeCalliope

Calliope stands for CALL for interOPErability

Calliope is a network of collaborating organisations mandated with the planning and implementation of eHealth

Calliope comprises 28 founding members including

• 17 organisations representing national governments and eHealth competence centres

• 11 EU-level stakeholder organisations of health professionals, patients, health insurers and industry

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CalliopeCalliope

Creating an open forum to support the implementation of interoperable eHealth

infrastructures and services across Europe to build a unique cross-stakeholder platform

• aspiring to governing principles• supported by a communication infrastructure and knowledge

management tools to review and advance the EC interoperability recommendation to add value to eHealth standardisation initiatives to propose a European roadmap for eHealth interoperability

www.calliope-network.eu/

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Mandate 403Mandate 403

to provide a consistent set of standards to address the needs of the rapidly-evolving field of eHealth for the benefit of future healthcare provision

three European Standards Organisations (ESOs), CEN, CENELEC and ETSI, accepted this mandate from the European Commission

requires active collaboration with COCIR, EHTEL, ISO/TC 215, IHE, HL7, Eurorec, IHTSDO, GS1, IEEE, DICOM

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Mandate 403Mandate 403

requirements driven and collaborative

primary goal is not to develop new standards populate use cases with existing international

standards when possible collaborate with standards fora, consortia and SDOs Reuse and encourage reuse

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DeploymentDeployment

IHE Europe is also active in sustaining deployment through IHE national initiatives stimulate regional projects at national level provide guidance if needed support communication if needed

• success stories

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EHR Experiences - UKEHR Experiences - UK

PACS integration project in Wales the pilot phase involves 7 PACS in 4 organisations

around Cardiff phase 2 will include 10 more PACS in another 4

organisations• this includes PACS from 6 different vendors.

the project will be providing • integration WITHIN organisations (different PACS vendors)• between organisations

project will be based on XDS/XDS-I

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EHR Experiences - NLEHR Experiences - NL

Friesland Regional Cardiogy Network Clinical setting

• Sharing cardiology-related data for transfer of patients (cardiac surgery)

Data shared • Cardiac images (multi-frame runs), ECGs, patient status

Setting• 5 hospitals – one central site

Benefits achieved• Full availability of clinical data through XDS browser• Import of data to local viewing environment

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EHR Experiences - NLEHR Experiences - NL

Connectivity network for breast cancer screening Clinical setting

• Sharing breast cancer screening results to hospitals forclinical follow-up Data shared

• Mammography images, reports Setting

• One central screening PACS (1m exams/year)• 4% referral / retrieval rate• 100 Dutch hospitals

Benefits achieved• Full availability of clinical data through XDS browser• Import of data to local viewing environment

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EHR Experiences - ITEHR Experiences - IT

Health Optimum Veneto telemedicine project for different specialties phase 1

• duration– 18 months May 2004 to January 2006

• purpose– market validation of organizational models based on telemedicine

services• actors involved

– 11 healthcare Providers in Veneto Region– 3 European Member States: Italy (Veneto Region),

Spain(Gobierno de Aragona), Denmark (County of Funen)

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EHR Experiences - ITEHR Experiences - IT

Health Optimum Veneto phase 2

• duration– 24 months June 2007 to May 2009

• purpose– deploying organizational models based on telemedicine services

• actors involved– 23 healthcare Providers in Veneto Region

– 5 European Member States: Italy, Spain, Denmark, Sweden

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EHR Experiences - ITEHR Experiences - IT

Health Optimum Veneto Services

• Oral anti-coagulant therapy• Stroke management• Neuro-surgical tele-counseling

– 36 peripheral hospitals without neurosurgery/neuroradiology units are linked to 7 neurosurgical centres

• Tele-laboratory– 80 peripheral sites are going to be linked to hospital LIS systems

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EHR Experiences - ITEHR Experiences - IT

Health Optimum Veneto Mixing XDS and non-XDS solutions XDS architecture adopted

• Treviso, Belluno, Venezia, Verona, Padova Non-XDS architecture

• Rovigo, Vicenza Central governance systems

• managing, including remote monitoring, all equipment involved in the interoperability platform

• providing the semantic interoperability• allowing to perform the statistical analysis of data and proper

reporting of services

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EHR Experiences - ITEHR Experiences - IT

Health Optimum Veneto interoperability guidelines adhering to

• IHE XDS (Cross-Enterprise Document Sharing), XDS-I (XDS for Imaging) and NAV (Notification of Document Availability) profiles

• IHE XCA (Cross-Community Access) profile• IHE PCC (Patient Care Coordination) profile• authoritative ICT standards: ebXML, CDA2, DICOM, HL7,

PKCS#7, etc…

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Thank You for Your AttentionThank You for Your AttentionLapo Bertini

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XDS in Japan

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Network Structure of RHIE System by XDS for Stroke Care in Nagoya

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Nagoya XDS project

Backed by Ministries

4 Emergency hospitals, 3 Rehab facilities(now)

Profiles and standards Integrating XDS with PIX, PDQ and ATNA Enhancing XUA, NAV with access control based on

XACML Excerpting XDS metadata from CDA header part Based on ebXML ebRIM3.0/ebRS3.0 (supporting XDS

storedQuery), while XDS.a was specified on ebXML2.1. (Being ahead of XDS.b.)

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Updates in Japan

2009 Regional Health Network Subsidy 10 Billion JPY (100 M$) x 10 3 Billion JPY (30 M$) x 30 XDS, PIX, PDQ, ATNA,,,

Online Reimbursement Claim Mandated even to 90000 clinics IPv6+IKE Can be used for other destination

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XDS in North America

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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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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

www.ihe.net

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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

www.ihe.net

2009-04-05 HIMSS 2009 17 17

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

Commun ication Bus

Common Serv ices

SharedHealth Record

DIRepository

EHR Viewer

Physic ian /Provider

RISPACS EMR/C PO E

CT US

DI ClinicsHospitals

RIS PACSHIS

CT MRI US

PACS• DI Studies• Presentati on states• Meas ureme nts

RIS• Orders• Repor ts

Imagi ng Modali ties• DI Studies• Presentati on states

XDS Doc

Registry

XDS DocumentRepository

DI Repository

XDS Doc ume nt Regis try

• Registr y e ntries

• Me tada ta

XDS Doc ume nt / DI Repositor y

• Ma nifes ts

• Docume nt Sets• Images• Repor ts• Relev ant ima ges• Presentati on states• Meas ureme nts• Other ev idence docs

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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 HITSP Recommended StandardsStandards

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-Enterprise IHE-XDS – Integrating the Healthcare Enterprise (IHE) Cross-Enterprise

Document SharingDocument 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 StandardsNCCLS – National Committee for Clinical Laboratory Standards 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 Document Health Level Seven (HL7) CDA R2 – HL7 Clinical Document

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

from ASTM E 2369-05 Continuity of Care Record (CCR), X12 N from ASTM E 2369-05 Continuity of Care Record (CCR), X12 N 270/271 and NCPDP Script 8.1.270/271 and NCPDP Script 8.1.

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

Logical Observation Identifiers Names and Codes (LOINC)Logical Observation Identifiers Names and Codes (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 HITSP Recommended StandardsStandards

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

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HITSP and Federal HITSP and Federal ProcurementProcurement

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 NHINTesting – HITSP, CCHIT and NHIN

HITSP interoperability pilot testing performed at HITSP interoperability pilot testing performed at IHE ConnectathonIHE Connectathon

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

NIST and IHE collaborated to provide testing NIST and IHE collaborated to provide testing services for first NHIN testing event in August services for first NHIN testing event in August 20082008