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1September, 2005 What IHE Delivers
IHE 2006 Workshop, June 2006IHE 2006 Workshop, June 2006Charles Parisot, GE HealthcareCharles Parisot, GE HealthcareIT Infrastructure co-chair Technical CommitteeIT Infrastructure co-chair Technical Committee
IHE support for RHIOs, IHE support for RHIOs, and community Health and community Health Information ExchangeInformation Exchange
http://www.ihe.net/Events/upload/IHE%20Support%20for%20RHIOs-V5-Charles.ppthttp://www.ihe.net/Events/upload/IHE%20Support%20for%20RHIOs-V5-Charles.ppt
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1 - Distinguish “edge” HIT systems from 1 - Distinguish “edge” HIT systems from information exchange infrastructureinformation exchange infrastructure
Edge HIT System
NHIN Subnetwork
Edge to Edge Communication
Edge HIT System
Critic
al B
ou
nd
ary
Critic
al B
ou
nd
ary
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2 - Support multiple architectures2 - Support multiple architectures
Centralized, distributed, federated, etc.Centralized, distributed, federated, etc.
Clinic
Hospital Practice
Document Registry
?Registry Locator
CentralizedRepository
Clinic
Hospital
Practice
Document Registry
Different business models, cost, legacy systems, etc.Different business models, cost, legacy systems, etc.
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3 - Enrich Incrementally, no rip and replace3 - Enrich Incrementally, no rip and replace
Has been the hallmark of IHE for many yearsHas been the hallmark of IHE for many years
Think long-term, but specify & implement what is Think long-term, but specify & implement what is needed todayneeded today
Steal good ideas, learn form others’ mistakesSteal good ideas, learn form others’ mistakes
Listen and collaborateListen and collaborate
Reuse, reuse previous Integration ProfilesReuse, reuse previous Integration Profiles
If a clear use case cannot be specified in 6 months, If a clear use case cannot be specified in 6 months, and implemented for testing in the next 6 month, and implemented for testing in the next 6 month, rethink.rethink.
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Step-wise IHE RHIO strategyStep-wise IHE RHIO strategy1.1. Start with “Document Sharing” with patient identifiers managementStart with “Document Sharing” with patient identifiers management
2.2. Establish basic security Establish basic security (pipe encryption and node authentication)(pipe encryption and node authentication)
3.3. Grow document sharing content to deliver multi-level interoperability Grow document sharing content to deliver multi-level interoperability (enabling coded information) (enabling coded information) with medical summaries & imaging infowith medical summaries & imaging info
20052005
20062006
20072007
What is introduced in 2006-2007 ?What is introduced in 2006-2007 ?
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Step-wise IHE RHIO strategyStep-wise IHE RHIO strategy1.1. Start with “Document Sharing” with patient identifiers managementStart with “Document Sharing” with patient identifiers management
2.2. Establish basic security Establish basic security (pipe encryption and node authentication)(pipe encryption and node authentication)
3.3. Grow document sharing content to deliver multi-level interoperability Grow document sharing content to deliver multi-level interoperability (enabling coded information) (enabling coded information) with medical summaries & imaging infowith medical summaries & imaging info
4.4. Introduce point-point interchange by disfeaturing “document sharing” to Introduce point-point interchange by disfeaturing “document sharing” to enable upward evolutionenable upward evolution
5.5. Grown content to cover info exchange to support common care Grown content to cover info exchange to support common care coordination use cases, basic diagnostics/therapeutic information, and coordination use cases, basic diagnostics/therapeutic information, and simple patient input.simple patient input.
6.6. Extend security by leveraging existing edge system security capabilities to Extend security by leveraging existing edge system security capabilities to enable basic RHIO policiesenable basic RHIO policies
20052005
20062006
20072007
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Step-wise IHE RHIO strategyStep-wise IHE RHIO strategy1.1. Start with “Document Sharing” with patient identifiers managementStart with “Document Sharing” with patient identifiers management
2.2. Establish basic security Establish basic security (pipe encryption and node authentication)(pipe encryption and node authentication)
3.3. Grow document sharing content to deliver multi-level interoperability Grow document sharing content to deliver multi-level interoperability (enabling coded information) (enabling coded information) with medical summaries & imaging infowith medical summaries & imaging info
4.4. Introduce point-point interchange by disfeaturing “document sharing” to Introduce point-point interchange by disfeaturing “document sharing” to enable upward evolutionenable upward evolution
5.5. Grown content to cover info exchange to support common care coordination Grown content to cover info exchange to support common care coordination use cases, basic diagnostics/therapeutic information, and simple patient use cases, basic diagnostics/therapeutic information, and simple patient input.input.
6.6. Extend security by leveraging existing edge system security capabilities to Extend security by leveraging existing edge system security capabilities to enable basic RHIO policiesenable basic RHIO policies
7.7. Progressive introduction of consistent of coded terminologies…..Progressive introduction of consistent of coded terminologies…..
8.8. Cross-enterprise workflows (e.g. lab & radiology orders …….Cross-enterprise workflows (e.g. lab & radiology orders …….
9.9. Federation of XDS domains ……Federation of XDS domains ……
10.10. X-Enterprise User Authentication-Federated identity ……X-Enterprise User Authentication-Federated identity ……
20052005
20062006
20072007
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Sharing, Sending, Interchanging and TransactingSharing, Sending, Interchanging and Transacting
Health Information Exchange or RHIOHealth Information Exchange or RHIO
PublishPublish
PullPullStructuredStructuredobjectsobjects
PullPull
Send toSend to
WriteWrite ReadRead
SwitchSwitch
InterchangeInterchangeMediaMedia
Send toSend to
TransactionsTransactionsWorkflowWorkflow
MgrMgrWorkflowWorkflow
MgrMgr
Info Info RequestorRequestor
Data Data RepositoryRepositoryQuery / ResponseQuery / Response
XDSXDS
XDPXDP
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IHE Integration Profiles for Health Info NetsIHE Integration Profiles for Health Info NetsWhat What is availableis available and and has been addedhas been added in 2005 and in 2005 and is for 2006is for 2006
Patient Demographics Query
Patient Identifier Cross-referencing
Map patient identifiers across independent identification
domains
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical
documents forming a patient
electronic health record
Cross-enterprise Document Point-Point Interchange
Media-CD/USB & e-mail push
Emergency Referrals
Format of the Document Content and associated coded vocabulary
PHR Extracts/Updates
Format of the Document Content and associated coded vocabulary
ECG Report Document
Format of the Document Content and associated coded vocabulary
Lab Results Document Content
Format of the Document Content and associated coded vocabulary
Scanned Documents
Format of the Document ContentImaging Information
Format of the Document Content and associated coded vocabulary
Medical Summary (Meds, Allergies, Pbs)
Format of the Document Contentand associated coded vocabulary
Consistent TimeCoordinate time across networked
systems
Audit Trail & Node Authentication
Centralized privacy audit trail and node to node authentication to create
a secured domain.
Basic Patients Privacy Consents
Establish Consents & Enable Access Control
Document Digital Signature
Attesting “true-copy and origin
Notification of Document Availability
Notification of a remote provider/ health enterprise
Request Formfor Data Capture
External form with custom import/export scripting
Patient Id MgtPatient Id MgtSecuritySecurityClinical and PHRClinical and PHRContentContent
Health Data ExchangeHealth Data Exchange OtherOther
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Health Information Exchanges Interoperability: Health Information Exchanges Interoperability: Cross-enterprise Document SharingCross-enterprise Document Sharing
Cross-Enterprise Document Sharing minimizes Cross-Enterprise Document Sharing minimizes clinical/admin data management by the infrastructure. clinical/admin data management by the infrastructure. Transparency = Ease of EvolutionTransparency = Ease of Evolution
Patients/consumers have guaranteed portability and Patients/consumers have guaranteed portability and providers may share information without concerns of providers may share information without concerns of aggregation errors.aggregation errors.Digital Documents = Patients Digital Documents = Patients andand providers empowerment providers empowerment
Supports Supports both centralized and decentralizedboth centralized and decentralized repository repository architectures. Ease of architectures. Ease of federationfederation nationally. nationally. Flexible Flexible privacy,privacy, Flexibility of configurationsFlexibility of configurations
Has received major support world-wide: Has received major support world-wide: National & regional projects, NHIN contractors, US EHR National & regional projects, NHIN contractors, US EHR Vendor Assoc., complements Vendor Assoc., complements Connecting for Health RLSConnecting for Health RLS..
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Exchange of EHR & PHR Content, Exchange of EHR & PHR Content, Array of document content with many common modulesArray of document content with many common modules
XDS-MSXDS-MSMedicalMedical
DocumentsDocuments
MedicalMedicalSummariesSummaries
ReferralReferral DischargeDischargeSummarySummary
BCCPBCCP
ConsentConsent
EDREDR
EmergencyEmergencyDepartmentDepartment
ReferralReferral
PPHPPPHP
PreprocedurePreprocedureHistory andHistory and
PhysicalPhysical
History andHistory andPhysicalPhysical
XPHRXPHR
PHR UpdatePHR Update
XDS-LABXDS-LAB
Lab ReportLab Report
PHR ExtractPHR Extract
XPHRXPHR
PHR UpdatePHR Update
PHR ExtractPHR Extract
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e.g. Exchange of PHR Contente.g. Exchange of PHR Content
The Exchange of Personal Health Record The Exchange of Personal Health Record Content (XPHR) provides a standards-based Content (XPHR) provides a standards-based specification for enabling interoperability of specification for enabling interoperability of core personal health information between:core personal health information between: a Personal Health Record and a Personal Health Record and either an EHR or another PHR System either an EHR or another PHR System
Supports interchange of PHR Information:Supports interchange of PHR Information: DemographicsDemographics Insurance InformationInsurance Information Medications, Problems, AllergiesMedications, Problems, Allergies Health HistoryHealth History Other InformationOther Information
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PHR System
Internet
Community
Index of patients records(Document-level)
Aggregate Patient Info
Sharing SystemSharing System
Health PayerRecord
Specialist RecordHospital Record
2-Reference2-Referenceto Records to Records for Inquiryfor Inquiry
PHR Systems another edge systemPHR Systems another edge systemNeeds sharing records/documents: IHE-XDSNeeds sharing records/documents: IHE-XDS
4 - Health data 4 - Health data presented to presented to
PatientPatient
SharedRepository of
Documents
Repository ofDocuments
3-Records3-RecordsReturnedReturned
ReferenceReferenceto recordsto records
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IHE Integration StatementsIHE Integration Statements
Explicit claim by the implementor/vendor,Explicit claim by the implementor/vendor, for for a specific product versiona specific product version
Lists IHE Integration Profiles, Actors & OptionsLists IHE Integration Profiles, Actors & Options
Short (1 page) & SweetShort (1 page) & Sweet
Compare apples with apples. Compare apples with apples.
http://http://www.ihe.netwww.ihe.net/resources//resources/ihe_integration_statements.cfmihe_integration_statements.cfm
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Building a RHIO with IHEBuilding a RHIO with IHELeverage a large body of international contributions Leverage a large body of international contributions and experiences. Submit your gaps.and experiences. Submit your gaps.
Suggested ApproachSuggested Approach Define Use Cases of interestDefine Use Cases of interest Match against existing IHE Integration ProfilesMatch against existing IHE Integration Profiles For each use case selected, develop a “RHIO interoperability For each use case selected, develop a “RHIO interoperability
specification” that builds by reference upon the selected set of specification” that builds by reference upon the selected set of IHE Integration Profiles. Include in RFP.IHE Integration Profiles. Include in RFP.
Request vendors (infrastructure and edge systems) to submit Request vendors (infrastructure and edge systems) to submit proposed product IHE Integration Statementsproposed product IHE Integration Statements
Verify vendor participation in IHE ConnectathonVerify vendor participation in IHE Connectathon
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IHE Integration Profiles for Health Info NetsIHE Integration Profiles for Health Info NetsWhat What is availableis available and and has been addedhas been added in 2005 and in 2005 and is for 2006is for 2006
Patient Demographics Query
Patient Identifier Cross-referencing
Map patient identifiers across independent identification
domains
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical
documents forming a patient
electronic health record
Cross-enterprise Document Point-Point Interchange
Media-CD/USB & e-mail push
Emergency Referrals
Format of the Document Content and associated coded vocabulary
PHR Extracts/Updates
Format of the Document Content and associated coded vocabulary
ECG Report Document
Format of the Document Content and associated coded vocabulary
Lab Results Document Content
Format of the Document Content and associated coded vocabulary
Scanned Documents
Format of the Document ContentImaging Information
Format of the Document Content and associated coded vocabulary
Medical Summary (Meds, Allergies, Pbs)
Format of the Document Contentand associated coded vocabulary
Consistent TimeCoordinate time across networked
systems
Audit Trail & Node Authentication
Centralized privacy audit trail and node to node authentication to create
a secured domain.
Basic Patients Privacy Consents
Establish Consents & Enable Access Control
Document Digital Signature
Attesting “true-copy and origin
Notification of Document Availability
Notification of a remote provider/ health enterprise
Request Formfor Data Capture
External form with custom import/export scripting
Patient Id MgtPatient Id MgtSecuritySecurityClinical and PHRClinical and PHRContentContent
Health Data ExchangeHealth Data Exchange OtherOther
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