December 7, 2004National Health Information Summit 1 Integrating
the Healthcare Enterprise Interoperability in Pathology Charles
Parisot, GE Healthcare IHE IT Infrastructure Technical Committee
Co-chair Melbourne, Dec 8th 2004 Slide 2 December 7, 2004National
Health Information Summit 2 Connecting Standards to Care Care
providers must work with industry to coordinate the implementation
of standards to meet their needs Care providers need to identify
the key interoperability problems they face Drive industry to
develop and make available standards-based solutions Implementers
need to follow common guidelines in purchasing and integrating
systems that deliver these solutions What is the effective way to
establish those standards for how to implement standards ? Slide 3
December 7, 2004National Health Information Summit 3 Need for a
Standards Implementation Process User Projects Demand Standards ?
Offer Standards Standards Slide 4 December 7, 2004National Health
Information Summit 4 Goals of IHE Speed up the rate and quality of
integration in healthcare environments Foster communication among
vendors and care providers (the implementors) 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 Slide 5 December 7, 2004National Health Information
Summit 5 Understanding 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 Slide 6 December 7, 2004National
Health Information Summit 6 IHE: Domain-based for a stepwise
approach Cardiology Labora- tory Pharmacy,.. Radiology Patient
Identifier Linkage, Registries, Security Electronic Health Record
Other (e.g. Access Control, eHealthWorkflows) Patient Management
Order Management Slide 7 December 7, 2004National Health
Information Summit 7 IHE 2004 Four Active Domains 4 Technical
Frameworks with 31 Integration Profiles Testing at yearly
Connectathons in three continents Demonstrations at major
conferences world-wide Provider-Vendor cooperation to accelerate
standards adoption Slide 8 December 7, 2004National Health
Information Summit 8 A Proven Standards Adoption Process IHE
Integration Profiles B IHE Integration Profile A Easy to Integrate
Products IHE Connect-a-thon Product With IHE IHE Demonstration User
Site RFP Standards IHE Technical Framework Product IHE Integration
Statement 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-thon Results Slide 9 December
7, 2004National Health Information Summit 9 IHE Process Users
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 Slide 10 December 7, 2004National Health Information
Summit 10 IHE Contributors & Participants Societies
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 Slide 11
December 7, 2004National Health Information Summit 11 IHE
Organizational Structure IHE Europe IHE North America France
USACanada IHE Asia-Oceania Japan KoreaTaiwan NetherlandsSpainSweden
UKItalyGermany Norway Regional Deployment Radiology Planning
Committee Radiology Technical Committee IT Infrastructure Planning
Committee IT Infrastructure Technical Committee Pharmacy
Exploratory Sub-Committee Global Development Cardiology Planning
Committee Cardiology Technical Committee Laboratory Planning and
Technical Committee IHE Strategic Development Committee ACC
ITAC/CHITTA HIMSS CHI RSNA CAR JAHIS JIRA JRS METI-MLHW MEDIS-DC
JAMI GMSIH SFR SFIL SIRM BIR EuroRec COCIR EAR-ECR DRG ESC
Professional Societies / Sponsors Contributing and participating
Vendors Slide 12 December 7, 2004National Health Information Summit
12 Organization of the IHE Initiative IHE distributes its
operations between a regional/national level and an international
level IHE is not a standards development organization IHE operates
on overlapping yearly cycle IHE leverages dependencies and
complementary interests between stakeholders IHE is an open and
flexible organization A novel approach to meet these challenges
Slide 13 December 7, 2004National Health Information Summit 13 IHE
Process Users and vendors work together to identify and design
solutions for integration problems Intensive process with annual
cycles: 1. Identify key healthcare workflows and integration
problems 2. Research & select standards to specify a solution
3. Write, review and publish IHE Technical Framework 4. Perform
cross-testing at Connectathon 5. Demonstrations at tradeshows
(HIMSS/RSNA) Slide 14 December 7, 2004National Health Information
Summit 14 IHE Process 20 month yearly cycle Development and
Deployment - 10 --- - 7 --- - 2 --- Public Comment Intgr-profile
Trial Implementation Intgr-profile 0 --- Sponsors announce
Connectathon/Demos with set of Implementation Profiles
Connectathon/Demo Vendor Participant Registered + 2 --- Vendor
Participant passed Connectathon + 5 --- + 6 --- Demo &
Education Material Final Intgr-profile + 9 --- Vendors release
products with IHE Integration Statements --- Approved Supplement
Scope Proposed Supplement Scope Slide 15 December 7, 2004National
Health Information Summit 15 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
endadoption Backed up by documentation, tools, testing, and
publication of information Slide 16 December 7, 2004National Health
Information Summit 16 IHE Technical Frameworks Slide 17 December 7,
2004National Health Information Summit 17 Key IHE Concepts
Generalized Systems -> ActorsGeneralized Systems -> Actors
Interactions between Actors -> TransactionsInteractions between
Actors -> Transactions Problem/Solution Scenarios->
Integration ProfilesProblem/Solution Scenarios-> Integration
Profiles 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) Slide 18 December 7,
2004National Health Information Summit 18 Key concept: Integration
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 Transaction Solves an
Integration Problem: A collection of real world information
exchange capabilities supported by a set of specific Actors using
Standards-based Transactions Slide 19 December 7, 2004National
Health Information Summit 19 IHE 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 Slide 20 December 7,
2004National Health Information Summit 20 Massive yearly events :
40-50 vendors 120-160 engineers 70-80 systems .integrated in 5 days
IHE Connectathons Vendors do not pass until an IHE Project Manager
attest it ! Slide 21 December 7, 2004National Health Information
Summit 21 Slide 22 December 7, 2004National Health Information
Summit 22 Integration Statements Slide 23 December 7, 2004National
Health Information Summit 23 Leveraging IHE Integration Statements
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 Slide 24 December 7,
2004National Health Information Summit 24 Participating and
Contributing Vendors (America) Agfa HealthCare Algotec Systems,
Ltd. Berdy Camtronics Canon Medical Systems Carefx Cedara Software
Corporation Cerner Corporation CSIST Dictaphone DR Systems Dynamic
Imaging Eastern Informatics Eastman Kodak Company Emageon Eclipsys
Fujifilm Medical Systems 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 Systems UltraVisual
Medical Systems Vital Images, Inc. Voxar Limited WebMD XIMIS GE
Healthcare Heartlab Hitachi Medical Corporation Hologic, Inc IDX
Systems Corporation IMCO Technologies InSiteOne INFINITT Konica
Minolta Marotech, Inc. McKesson Information Solutions Medcon
Medical Manager Health Systems Mediface Co., Ltd. Merge eFilm
Mortara In yellow, companies with IHE Committees Chairs (Summer
2004) Slide 25 December 7, 2004National Health Information Summit
25 Participating and Contributing Vendors (Europe) AGFA Healthcare
AISoftw@re Medical Solutions Algotec ARES SA aycan Digitalsysteme
ConVis DEDALUS Dianoema Eastman Kodak Company Ebit Sanita EDL ELFIN
s.r.l. Engineering Sanit Enti Locali ESAOTE ETIAM Ferrania Fujifilm
GE Healthcare GMD 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) Slide 26 December 7, 2004National Health Information
Summit 26 Participating and Contributing Vendors (Asia) Japan AGFA
Gevaert Japan EBM Japan INFINITT Japan A&T Canon Goodman Climb
Medical Systems Konica Minolta MG Shimadzu SONY Toshiba Medical
Systems Toyo Technica Nihon Kohden Olympus NEC Pioneer (Marotech)
Hitachi Hitachi Medico Fujitsu Fuji Film Medical Yokogawa Taiwan
INFINITT Shing Shian INQ GEN TEP Tah Ya Korea AGFA Korea GE
Healthcare Korea INFINITT LG CNS Marotech, Inc. Medical Standard
Peoplenet Communications Samsung SDS Slide 27 December 7,
2004National Health Information Summit 27 IHE Radiology Integration
Profiles Patient Info. Recon- ciliation Access to Radiology
Information Consistent Present- ation of Images Basic Security -
Evidence Docs Key Image Notes Simple Image & Numeric Reports
Presentation of Grouped Procedures Post- Processing Workflow
Reporting Workflow Charge Posting Scheduled Workflow Portable Data
for Imaging NM Image New Extensions New Slide 28 December 7,
2004National Health Information Summit 28 ADT (Registration) Order
Placer Order Filler Print Server Film Folder Image Manager &
Archive Film Lightbox report Report Repository Image Display
Modality acquisition in-progress acquisition completed images
printed Acquisition Modality Example: IHE Rad Scheduled Workflow
Slide 29 December 7, 2004National Health Information Summit 29
Laboratory IHE Integration Profiles In Process TI Nov 2004
Laboratory Device Automation (LDA) In Process TI Nov 2004
Pre-analytic process, analysis and post-analytical treatment
Laboratory Scheduled Workflow (LSWF) Completed in 2003 Tests
performed by a laboratory for an identified inpatient or outpatient
In Process Laboratory Patient Information Reconciliation (LPIR) In
Process Tests performed on an unidentified or misidentified patient
In Process Laboratory Code Set Distribution (LCSD) In Process
Sharing the batteries and tests code sets throughout the enterprise
In Process TI Nov 2004 Laboratory Point Of Care Testing (LPOCT) In
Process TI Nov 2004 Tests performed on point of care or patients
bedside In Dev. Slide 30 December 7, 2004National Health
Information Summit 30 IHE Cardiology 2004-2005 Retrieve Information
for Display Access a patients clinical information and documents in
a format ready to be presented to 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 reports to the enterprise and outside in a ready-to-display
format Retrieve ECG for Display New Slide 31 December 7,
2004National Health Information Summit 31 IHE IT Infrastructure
2004-2005 Enterprise User Authentication Provide users a single
name and centralized authentication process across all systems
Retrieve Information for Display Access a patients clinical
information and documents in a format ready to be presented to the
requesting user Retrieve Information for Display Access a patients
clinical information and documents in a format ready to be
presented to the requesting user Patient Identifier
Cross-referencing for MPI Map 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 Time Coordinate 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 Page
Access to workforce contact information New Cross-Enterprise
Document Sharing Registration, distribution and access across
health enterprises of clinical documents forming a patient
electronic health record New Slide 32 December 7, 2004National
Health Information Summit 32 Introduction: EHR Cross-Enterprise
Document Sharing First step towards the longitudinal dimension of
the EHR Focus: Support document sharing between EHRs in different
care settings and organizations Slide 33 December 7, 2004National
Health Information Summit 33 community Clinical Encounter Clinical
IT System Index of patients records (Document-level) 1-Patient
Authorized Inquiry Temporary Aggregate Patient History 4-Patient
data presented to Physician Sharing System 3-RecordsReturned
Reference to records Laboratory Results Specialist Record Hospital
Record 2-Reference to Records for Inquiry Sharing records that have
been published Slide 34 December 7, 2004National Health Information
Summit 34 XDS Actors and Transactions Slide 35 December 7,
2004National Health Information Summit 35 Integration Model 1:
EHR-CR with Repository at Source An EHR-CR completes a phase of
care for a patient where it: Has these documents available as
Repository Actor. Registers documents with a Registry actor. Any
other EHR-CR may query the Registry actor, and chose to retrieve
some of these documents from any Document Repository Actor. Slide
36 December 7, 2004National Health Information Summit 36
Integration Model 2: EHR-LR with Third Party Repository An EHR-CR
completes a phase of care for a patient where it: Provides the
documents to a Repository Actor of its choice. Documents are
Registered with a Registry Actor. Any other EHR-CR may query the
Registry actor, and chose to retrieve some of these documents from
any Document Repository Actor. Slide 37 December 7, 2004National
Health Information Summit 37 Integration Model 3: EHR-CR feed a
EHR-CR/EHR-LR hub An EHR-CR completes a phase of care for a patient
where it: Provides and Registers a set of documents to a Document
Repository in an EHR-CR. The EHR-CR Consumer Actor has the
documents and may respond to queries and provide them to other
document consumers. Slide 38 December 7, 2004National Health
Information Summit 38 Integration Model 4: Repository and Registry
at Source An EHR-CR completes a phase of care for a patient where
it: Has these documents available as Repository Actor. Is it own
Registry actor. Any other EHR-CR may query the Registry actor, and
chose to retrieve some of these documents from any Document
Repository Actor. Slide 39 December 7, 2004National Health
Information Summit 39 Standards selection for IHE XDS No single
standard can address Cross-enterprise Document Sharing Marriage of
healthcare and IT standards facilitates implementation and
leverages complementary technologies (e.g. security & privacy).
Healthcare Content Standards HL7 CDA, CEN EHRcom ASTM CCR DICOM,
etc. Internet Standards HTML, HTTP, ISO, PDF, JPEG, etc. Electronic
Business Standards ebXML, SOAP, etc. Slide 40 December 7,
2004National Health Information Summit 40 Workshops and
Connect-a-thon IHE Conferences & Workshops: September 13-15
2004 North America February 7-10 2005 Europe (Netherlands) 2005 IHE
Connect-a-thons: January 17-21 North America February Japan April
25-29 Europe Slide 41 December 7, 2004National Health Information
Summit 41 HIMSS 2005 Interoperability Showcase HIMSS 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) Slide 42 December 7, 2004National Health
Information Summit 42 HIMSS 2005 Interoperability Showcases
cross-enterprise sharing of health information in the acute care,
18 vendors: CedaraGE HealthcareMortara Instruments
DictaphoneIDXNIST Eastman KodakInterSystemsNovell EclipsysInfinitt
TechnologyOpen Text EmageonKryptiqSentillion EPICMedCommonsSiemens
ambulatory sharing of health information, 14 vendors: AllscriptsGE
HealthcareMidMark CapMed/SanDiskHealthrampMisys CernerIDXNextGen
EclipsysKrytiqWebMD ETIAMMediNotes HIMSS sponsors the testing and
demonstration of IHE interoperability in two large Showcase
Exhibits: Slide 43 December 7, 2004National Health Information
Summit 43 HIMSS 2005 Show-Wide Interoperability Vendor System
Ambulatory Showcase Booth Home PCP Multispecialty Clinic Diag
Center Cross-enterprise Showcase Booth Cardiology Radiology IT
Infrastructure & Lab In-Patient/Out-patient Vendor Booth
Allscripts Eclipsys GE Healthcare Healthramp IDX Infinitt
InterSystems MedCommons Novell OpenText Siemens HIMSS RHIO with
Cross-enterprise doc sharing Slide 44 December 7, 2004National
Health Information Summit 44 XDS Actors and Transactions Slide 45
December 7, 2004National Health Information Summit 45 Secured Node
Document Consumer Retrieve Document Query Documents Patient
Identity Source Patient Identity Feed Document Source Document
Registry Document Repository Provide&Register Document Se t
Register Document Set Secured Node ATNA creates a secured domain:
User Accountability (Audit trail) Node-to-Node Access Control
Node-level user authentication User access control provided by node
BUT Registry/repository based User-Level Access Control and policy
agreements is beyond XDS.. Security for XDS Security for XDS
Leverages IHE Audit Trail & Node Authentication Slide 46
December 7, 2004National Health Information Summit 46 Push
Integration : Adding Notifications Using an unsecured e-mail
notification to turn a Pull Model into a Push Model. Pathology 4
Retrieve 3 Query Document Source Document Consumer Document
Repository Document Registry EHR-CR Notification Notification Slide
47 December 7, 2004National Health Information Summit 47 Push
Integration : Adding Notifications Using an unsecured e-mail
notification to turn a Pull Model into a Push Model. Pathology 4
Retrieve 3 Query Document Source Document Consumer Document
Repository Document Registry EHR-CR Notification Notification
Register Slide 48 December 7, 2004National Health Information
Summit 48 IHE today, more info. IHE IT Infrastructure
www.himss.org/ihe IHE Radiology www.rsna.org/ihe IHE Laboratory
www. himss.org/ihe IHE Cardiology www.acc.org/quality/ihe.htm IHE
IHE i h e. n e t Slide 49 December 7, 2004National Health
Information Summit 49 Imaging Information Content Format of the
Document Content and associated coded vocabulary Simple Document
Content Format of the Document Content and associated coded
vocabulary For Display Document Content Format of the Document
Content Lab Results Document Content Format of the Document Content
and associated coded vocabulary IHE Profiles for a Regional Health
Info Organization Integration Profiles considered for 2005 ?
Patient Identifier Cross-referencing Map patient identifiers across
independent identification domains Consistent Time Coordinate 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
Page Access to workforce contact 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 enterprise
Continuity of Care Document Content Format of the Document Content
and associated coded vocabulary Slide 50 December 7, 2004National
Health Information Summit 50 Infrastructure and Interoperability
Cross-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.
