Laboratory to Ambulatory EHR Workflows Charles Parisot GE Healthcare IHE IT Infrastructure Technical Committee co-chair

Laboratory toAmbulatory EHR Workflows

Laboratory toAmbulatory EHR Workflows

Charles ParisotGE Healthcare

IHE IT Infrastructure Technical Committee co-chair

July 2005 Interoperability for Lab - IHE Canada2

W W W . I H E . N E TW W W . I H E . N E T

Providers and VendorsProviders and Vendors

Working Together to DeliverWorking Together to Deliver

Interoperable Health Information SystemsInteroperable Health Information Systems

in the Enterprisein the Enterprise

and Across Care Settingsand Across Care Settings


Lab to Ambulatory EHR Interoperability Lab to Ambulatory EHR Interoperability WorkflowsWorkflows

• Two primary workflows models are used around the world:

– Contract to Lab model: the ambulatory physician is the lab customer and sends the patient or specimen to selected lab.

– Collaborative Lab Model: the patient selects lab and follows physician’s lab prescription.

• Both models exist is most countries but one of the two often is the most prevalent

• Workflow contains two time segments:

– Electronic Order/Real-Time Result Communication: ordering physician, patient and laboratory. Completes when result “delivered”.

– Access to Historical Results: Same patient but in later encounters need access to previous performed lab studies.

Does IHE offers today the corresponding basic interoperability Does IHE offers today the corresponding basic interoperability ??


Patient Administration

Clinical laboratoryWard or EHR

Lab-1: Placer order

Lab-2: Filler order

Rad1, Rad-12

Patient demographics & visit

Lab-5: Results

Rad-1, Rad-12

Lab-3: Results

Lab-4: Work order

Order Result

Tracker

ADT

Automation Manager

Order Placer

Order Filler

IHE Laboratory: LSWFIHE Laboratory: LSWF

What is different in hospitals and ambulatory ?What is different in hospitals and ambulatory ?

Different

Applicable

Non Relevant



Contract toLab Model

CollaborativeLab Model

eOrder

Access HistoricalLab Results

Assessment and use case positioning (non-acute care)

Access toOther

RecordsReal-Time

ResultPaperOrder





eOrder



?

?

Access toOther

RecordsReal-Time

Result

IHE Lab ScheduledWorkflow

IHE Lab scheduled Workflow

Important ?

Real Time Result : critical for acute care and possibly ambulatory contract, not obvious for collaborative model.

PaperOrder

?


Lab to Ambulatory EHR Interoperability Lab to Ambulatory EHR Interoperability First Set of ConclusionsFirst Set of Conclusions

• IHE Lab Scheduled Workflow has a critical role to play:

– Solid and proven specification with HL7 V2.5 critical improvements

– Bring the rigor and effectiveness of IHE

– Consistent approach for laboratories in acute care and ambulatory

– Best springboard to HLV3 and Infoway strategic direction

• Remaining gaps that need to be addressed by a LSWF Integration Profile Extension (multi-jurisdiction ?):

– Results and Orders Coded Terminology

– Jurisdictions specific elements

• Need a address the historical lab results access case in a non-lab specific manner

– This is the topic of the next presentation

Sharing Laboratory Resultsin

Regional & National Networks

Sharing Laboratory Resultsin

Regional & National Networks

Charles ParisotGE Healthcare

IHE IT Infrastructure Technical Committee co-chair


Local & Regional RHIOs Infrastructure and Local & Regional RHIOs Infrastructure and InteroperabilityInteroperability

• IHE has been focusing significant efforts on cross-enterprise health information sharing for the past three years

• We will provide an update on this work and some of the major accomplishments in this area that do benefit the access to laboratory results.

• Discuss what can be implemented today.


Selected IHE Integration Profiles for RHIOsSelected IHE Integration Profiles for RHIOsWhat is available and is added in 2005What is available and is added in 2005

Consistent TimeCoordinate 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

Cross-Enterprise Document Sharing

Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record

Notification of Document Availability

Notification of a remote provider/ health enterprise

Lab Results Document Content

Format of the Document Content and associated coded vocabulary For Display Document

Format of the Document ContentImaging Information Sharing

Format of the Document Content and associated coded vocabulary

Medical Summary Document Content

Format of the Document Contentand associated coded vocabulary

Cross-enterprise User Authentication

Authentication & Auditing: Basis for Access Control

Document Digital Signature

Attesting “true-copy and origin

Patient Identifier Cross-referencing

Map patient identifiers across independent identification

domains


HIMSS 2005 – HIMSS 2005 – Show-Wide InteroperabilityShow-Wide InteroperabilityVendor System

Ambulatory Showcase BoothAmbulatory Showcase Booth

HomeHome

PCP

MultispecialtyMultispecialtyClinicClinic

Diag Center

Cross-enterprise Showcase BoothCross-enterprise Showcase Booth

Cardiology

RadiologyIT

Infrastructure

In-Patient/Out-patient

Vendor BoothVendor Booth







HL7 BoothHL7 Booth

HIMSS “RHIO” withCross-enterprise

doc sharing (17 vendors)


HIMSS 2005 InteroperabilityHIMSS 2005 InteroperabilityShow Case VendorsShow Case Vendors

Leadership LevelLeadership Level

CapMed/SanDiskCapMed/SanDiskEclipsysEclipsysGE HealthcareGE HealthcareIDXIDXInterSystemsInterSystemsKryptiqKryptiqQuovadx/CareScienceQuovadx/CareScienceSiemensSiemensWebMDWebMD

Participant LevelParticipant LevelAllscriptsAllscripts

Cedara Cedara

CernerCerner

Dictaphone Dictaphone

Eastman KodakEastman Kodak

EclipsysEclipsys

EmageonEmageon

EpicEpic

ETIAMETIAM

INFINITT Tech.INFINITT Tech.

MedcomSoft MedcomSoft

MediNotesMediNotes

MedCommonsMedCommons

MidMarkMidMark

Mortara Instrument, IncMortara Instrument, IncNational Institute National Institute ofof Standards & TechnologyStandards & Technology

NextGenNextGen

NovellNovell

Open TextOpen Text

SentillionSentillion

Supporter LevelSupporter LevelAccessPtAccessPt AGFAAGFA dbMotiondbMotion Dinmar – OacisDinmar – OacisEMCEMC HealthvisionHealthvision HealthrampHealthramp McKessonMcKesson

Valco Data SystemsValco Data Systems


IHE North America Vendors (2004-2005)IHE North America Vendors (2004-2005)

• Agfa HealthCare • Allscripts • Camtronics Medical

Systems • Cedara Software Corp. • Cerner Corporation • Dictaphone Corporation • Dynamic Imaging, LLC • Eastman Kodak Company • Eclipsys • Emageon • Epic Systems

Corporation • ETIAM • FujiFilm Medical

Systems, USA, Inc. • GE Healthcare • Heartlab, Inc • Hitachi Medical

Corporation

• Hologic • IDX Systems Corp. • INFINITT Technology • InSite One, Inc. • Intelerad Medical

Systems • InterSystems

Corporation • Konica-Minolta Medical

Imaging, USA, Inc. • Kryptiq • Marotech • McKesson Information

Solutions • MedCommons Inc. • MedCon, Inc. • Merge eFilm • Mortara Instrument,

Inc. • Novell, Inc. • Philips Medical

Systems

• QRS Diagnostic • Quovadx • St. Jude Medical A.B. • Sectra Imtec A.B. • St. Jude Medical A.B. • Sectra Imtec A.B. • Sentillion • Siemens Medical

Solutions • Stentor • Swissray International,

Inc. • Tiani Medgraph A.G. • Tiani Spirit Gmbh • Toshiba Medical

Systems Company • Vital Images • WebMD Practice

Services


community

Clinical Encounter

Clinical IT System Index of patients records(Document-level)

Temporary Aggregate Patient History

4-Patient data presented to

Physician

Sharing SystemSharing System

Clinic Record Specialist Record

Hospital Record

2-Referenceto Records for Inquiry

IHE-XDS : Cross-Enterprise Document SharingIHE-XDS : Cross-Enterprise Document Sharing

3-Records3-RecordsReturnedReturned

ReferenceReferenceto recordsto records

Shared Document Repository


community

Clinical Encounter

Clinical IT System Index of patients records(Document-level)



Physician



Hospital Record


Document Content shared by IHE-XDSDocument Content shared by IHE-XDS




Secured Sharing of:• Medical Summaries• Images & reports• ECG Reports• PDFs• Lab Results

+ Notif of Doc Avail.


community

Clinical Encounter or PHR access

Portal

Index of patients records(Document-level)



Physician or Patient



Hospital Record


Full Integration of Portals (Doc & Patients)Full Integration of Portals (Doc & Patients)





Sharing Lab Results with XDSSharing Lab Results with XDSin a Regional Health Information Networkin a Regional Health Information Network

Lab B

Physician Office

Regional Health Regional Health Information Information NetworkNetwork

Lab A

Hospital-to-Lab

Lab-to-Physicians

Hospital A



Lab B

Physician Office


Lab A

Hospital A

Cross-Cross-Enterprise Enterprise RegistryRegistry



Lab B

Physician Office


Lab A

Hospital A


Query for Query for Documents Documents

Register Lab Report Register Lab Report for sharingfor sharing

PriorLab Report

Register Lab Report Register Lab Report for sharingfor sharing



Lab B

Physician Office


Lab A

Hospital A


Prior Lab Report

Query for Query for documents documents

Lab ReportLab Report

Patient Id= 3547F45• Report 5/21/1998 : BloodWork B• Report 2/18/2005 : Glucose A

Notification of Notification of Doc AvailabilityDoc Availability


IHE: Lab Report SharingIHE: Lab Report SharingReady to be implemented ? Ready to be implemented ?

• Gap 1: What standard for a Lab Report Document ?

– Today: wrap a complete result in “HL7 V2.x” into an XDS Document. Already demonstrated at HIMSS 2005.

– Mid-Term goal: represent lab result as CDA-R2 document with HL7 V3 Lab clinical statements (same as those of the real-time result message). IHE Lab to initiate work in 2006.

• Gap 2: Jurisdiction extensions

• Gap 3: Laboratory Terminology definition. Likely a national effort initially.


IHE: Interoperability for Health Info IHE: Interoperability for Health Info NetworksNetworks

• By starting with a secured document sharing infrastructure, establish a generic platform on which to extend clinical content (more structure & coded terminology, specialized content).

• Solid SAML 2.0 authentication and document digital signature (need a PKI).

• Practical HL7 V3 approach with CDA-R2 (medical summaries) and other content (e.g. imaging, legacy content, PDF, etc.).

• Establishing a critical mass of products implementations, both in clinical applications and infrastructure for deployment in 2006.

• An architecture that caters to various regional and national architectures: centralized, decentralized and mixed.

• IHE-XDS is in use in Italy, with projects in Canada (Newfoundland), Norway and France.





InitialOrder



XDS +

XDS +

Access toOther

RecordsReal-Time

Result

IHE Lab ScheduledWorkflow

IHE Lab scheduled Workflow

Important ?

Lab regional networks need to look beyond the classical lab Lab regional networks need to look beyond the classical lab messaging approaches used in hospital where real-time result messaging approaches used in hospital where real-time result

are critical are critical Document Sharing Document Sharing

PaperOrder

XDS +

XDS +


Lab to Ambulatory EHR Interoperability Lab to Ambulatory EHR Interoperability ConclusionsConclusions

• IHE Lab Scheduled Workflow has a critical role to play:

– Solid and proven specification with HL7 V2.5 critical improvements

– Bring the rigor and effectiveness of IHE

– Consistent approach for laboratories in acute care and ambulatory

– Best springboard to HLV3 and Infoway strategic direction

• Access to historical lab results in a non-lab specific manner is critical:

– Leverage IHE Cross-enterprise Document Sharing and associated Integration profiles (e.g. security).

– Critical rationalization for ambulatory HER that will need to access other type of record than lab reports.

• Remaining gaps that need to be addressed (multi-jurisdiction ?):

– Results and Orders Coded Terminology

– Jurisdictions specific elements


More information….More information….

• IHE Web sites: www.ihe.net• Technical Frameworks, Supplements:http://www.ihe.net/Technical_Framework/index.cfm

• Non-Technical Brochures :• Calls for Participation

• IHE Fact Sheet and FAQ

• IHE Integration Profiles: Guidelines for Buyers

• IHE Connect-a-thon Results

• Vendor Products Integration Statements

http://www.ihe.net/


W W W . I H E . N E TW W W . I H E . N E T

Providers and VendorsProviders and Vendors

Working Together to DeliverWorking Together to Deliver

Interoperable Health Information SystemsInteroperable Health Information Systems

in the Enterprisein the Enterprise

and Across Care Settingsand Across Care Settings