Integrating the Healthcare Enterprise

August 31, 2004 IHE European Cardiology1

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

IHE, beyond cardiology and radiologyAn interoperability strategy for the enterprise

Charles Parisot, GE Healthcare

IHE IT Infrastructure Co-chair


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

5 Integration Profile



IHE 2004 achievements and expanding scope IHE 2004 achievements and expanding scope

Over 80 vendors involved world-wide, 4 Technical Frameworks31 Integration Profiles, Testing at yearly Connectathons,

Demonstrations at major exhibitions world-wide

Provider-Vendor cooperation to accelerate standards adoption


IHE: A stepwise approachIHE: A stepwise approach

CardiologyCardiologyLabora-Labora-ttoryory

Pharmacy,…..Pharmacy,…..RadiologRadiologyy

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

Electronic Health RecordElectronic Health Record

Enterprise SchedulingEnterprise Scheduling

Patient ManagementPatient Management

Order ManagementOrder Management


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)


IHE Radiology Integration profilesIHE Radiology Integration profiles

-

Pa

tient

Info

rma

tion

Rec

onc

ilia

tion

Access to Radiology Information

Consistent Presentation

of Images

Basic Security

Evidence Documents

Key Image Notes

Simple Image and Numeric

Reports

Presentation of Grouped Procedures

Post-Processing Workflow

Reporting Workflow

Charge Posting

Scheduled Workflow


IHE Penetration in RadiologyIHE Penetration in Radiology

Now entering Year 6 !!

50+ vendors worldwide

100+ systems in annual Connectathons

Geographic spread U.S., France, Germany, Japan, Italy, Korea, Taiwan, U.K,

Norway, Netherlands, Spain, etc.

Well over 100 commercial products available


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

Retrieve Information for Display

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


IHE Penetration in IT Infrastructure IHE Penetration in IT Infrastructure and Laboratoryand Laboratory

Has just completed Year 1 !!

About 20 vendors worldwide

40+ systems in annual Connectathons

Geographic spread U.S., France, Italy, Japan, Germany, etc.

Commercial products appearing


IHE Laboratory Integration ProfilesIHE Laboratory Integration Profiles

Laboratory Scheduled Workflow (LSWF) done in 2003

Tests performed by a laboratory for an identified inpatient or outpatient

Laboratory Patient Information Reconciliation

(LPIR) year 2004Tests performed on an unidentified

or misidentified patient

Laboratory Code Set Distribution (LCSD) year 2004

Sharing the batteries and tests code sets throughout the enterprise

Laboratory Device Automation (LDA) year 2004

Pre-analytic process, analysis and post-analytical treatment

Laboratory Point Of Care Testing (LPOCT) year 2004

Tests performed on point of care or patient’s bedside


An Example ofAn Example ofIHE IT InfrastructureIHE IT Infrastructure

Integration ProfileIntegration Profile


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)

GPs and Clinics (Ambulatory)

Long Term Care

Other Specialized Care(incl. Diagnostics Services)

Continuity of Care: Patient Longitudinal RecordPatient Longitudinal Record

Typically, a patient goes through a sequence of encounters in different Care Settings


community

Clinical Encounter

Clinical IT System

RecordsRecordsSentSent

Laboratory Results Specialist Record

Hospital Record

Finding the records of a patient-Manual & tediousFinding the records of a patient-Manual & tedious

The challenge: Finding and accessing easilydocuments from other care providers In the community.


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 SystemSharing System

3-Records3-RecordsReturnedReturned

Referenceto records

Laboratory Results Specialist Record

Hospital Record

2-Referenceto Records for Inquiry

Sharing records that have been publishedSharing records that have been published


Acute Care (Inpatient)

PCPs and Clinics (Ambulatory)

Long Term Care

Other Specialized Careor Diagnostics Services

Building and accessing DocumentsBuilding 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


XDS – Value PropositionXDS – Value PropositionFoundation for Health IT Infrastructures: Shared Electronic Health Record, in a community, region, etc.

Effective means to contribute and access clinical documents across health enterprises.

Scalable sharing of documents between private physicians, clinics, long term care, pharmacy, acute care with different clinical IT systems.

Easy access: Care providers are offered means to query and retrieve clinical documents of interest.


XDS - Value PropositionXDS - Value PropositionDistributed: Each Care delivery organization “publishes” clinical information for others. Actual documents may remain in the source EHR-CR.

Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain (e.g. an LHII).

Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (HL7-CDA, ASTM-CCR, PDF, DICOM, etc.).

Document Content Neutral: Document content is processed only by source and consumer IT systems.

Standardized Registry Attributes: to ensure deterministic document searches.


XDS – ConclusionXDS – Conclusion• Foundation for EHR & Health IT Infrastructures

• Effective contribution and access to shared documents across all types of health enterprises

• Scalable, Flexible and Easy access

XDS to be one of the major highlights of 2005 Annual HIMSS Conference & Exhibition. Dallas, Tex., Feb. 13-17:

used as a foundation for an on-site demonstration of interoperability in support of a National Health Information Networks.

Attendees at the conference will be able to create and share their own health records across vendor booths as well as in the ambulatory and acute care settings on the conference exhibit floor.


How real is XDS ?How real is XDS ?

Specification work since Nov 2003Specification work since Nov 2003

Under Public Comments June-July 2004Under Public Comments June-July 2004 600 constructive comments received, 600 constructive comments received,

Stable specification IHE TF Aug 15Stable specification IHE TF Aug 15thth, 2004, 2004

IHE Connectathon January 2005 (USA)IHE Connectathon January 2005 (USA)

HIMSS Feb 2005 show-wide demonstrationHIMSS Feb 2005 show-wide demonstration

IHE Connectathon April 2005 (Europe)IHE Connectathon April 2005 (Europe)


IHE, IHE,

The practical solutions to the The practical solutions to the effective useeffective use

of information exchange of information exchange standards in healthcarestandards in healthcare


IHEIHE

Thank You !


More information….More information….IHE Web sites:

http://www.ihe-europe.orghttp://www.himss.org/IHEhttp://www.rsna.org/IHEhttp://www.acc.org/quality/ihe.htm.

Technical Frameworks:• ITI V1.0, RAD V5.5, LAB V1.0, CARD V1.0

Technical Framework Supplements - Trial Implementation• May 2004: Radiology• August 2004: Cardiology, IT Infrastructure• December 2004: Laboratory

Non-Technical Brochures :• IHE Fact Sheet and FAQ• IHE Integration Profiles: Guidelines for Buyers• IHE Connect-a-thon Results• Vendor Products Integration Statements