September, 2005What IHE Delivers 1 Implementing IHE in Regional Health Information Networks IHE Europe 2006 - Changing the Way Healthcare Connects IHE

1September, 2005 What IHE Delivers

Implementing IHE in Regional Implementing IHE in Regional Health Information NetworksHealth Information Networks

IHE Europe 2006 - Changing the Way Healthcare ConnectsIHE Europe 2006 - Changing the Way Healthcare Connects

IHE Presentation at the World of Health IT show, IHE Presentation at the World of Health IT show,

October 2006October 2006

Alexander Ihls, Stakeholder PCC, IHE GermanyAlexander Ihls, Stakeholder PCC, IHE Germany

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Actors in Regional HealtcareActors in Regional Healtcare

General Practitioners (GPs)General Practitioners (GPs) Family DoctorsFamily Doctors Medical SpecialistMedical Specialist

HospitalsHospitals Emergency Department (ED)Emergency Department (ED) Inpatient care, surgeriesInpatient care, surgeries

HomecareHomecare Patient self-carePatient self-care NursesNurses

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IHE DomainsIHE Domains

CardiologyCardiology

Eye CareEye Care

IT InfrastructureIT Infrastructure e.g. Cross-Enterprise Document Sharing (XDS)e.g. Cross-Enterprise Document Sharing (XDS)

LaboratoryLaboratory

Patient Care CoordinationPatient Care Coordination

Patient Care DevicesPatient Care Devices

RadiologyRadiology MammographyMammography Nuclear MedicineNuclear Medicine

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Patient Care CoordinationPatient Care Coordination

The Patient Care Coordination (PCC) The Patient Care Coordination (PCC) domain was established in July 2005 to domain was established in July 2005 to deal with integration issues that cross deal with integration issues that cross providers, patient problems or time. providers, patient problems or time.

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Profile RoadmapProfile Roadmap

Year 2005-2006 (Trial Implementation)Year 2005-2006 (Trial Implementation) Medical Summary [MS] – Acute Care Discharge to PCP, PCP Medical Summary [MS] – Acute Care Discharge to PCP, PCP

Referral to SpecialistReferral to Specialist Unstructured Document – CDA-wrapped PDFUnstructured Document – CDA-wrapped PDF

Year 2006-2007 (Development & Testing)Year 2006-2007 (Development & Testing) Medical Summary [MS] – ED Referral [EDR]Medical Summary [MS] – ED Referral [EDR] Pre-procedure H&P [PPHP]Pre-procedure H&P [PPHP] Basic Patient Privacy Consents [BPPC]Basic Patient Privacy Consents [BPPC] Exchange Personal Health Record [XPHR] Exchange Personal Health Record [XPHR] Coordination with Laboratory Domain [XDS-LAB] Coordination with Laboratory Domain [XDS-LAB]

Future (Profile Document / White Paper) Future (Profile Document / White Paper) Medical Summary [MS] – Discharge to LTCMedical Summary [MS] – Discharge to LTC Forms Display for Data Capture (e.g. clinical research)Forms Display for Data Capture (e.g. clinical research)

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PCC ProfilesPCC Profiles

PCC DomainPCC Domain

Medical SummaryMedical SummaryXDS-MSXDS-MS

Exchange of Patient Health Exchange of Patient Health Record Data (XPHR)Record Data (XPHR)

Emergency Department ReferralEmergency Department Referral(EDR) (EDR)

Basic Patient Privacy ConsentBasic Patient Privacy Consent(BPPC) (BPPC)

Preprocedural History Preprocedural History and Physical (PPHP)and Physical (PPHP)

Sharing Laboratory Reports Sharing Laboratory Reports (XDS-LAB) (XDS-LAB)


Medical Summary Profiles Medical Summary Profiles

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AbstractAbstract

Define a medical summary Define a medical summary format for clinical documents format for clinical documents containing at a minimum:containing at a minimum:

ProblemsProblems

AllergiesAllergies

MedicationsMedications

Pointers to other materialPointers to other material

Medical Medical SummariesSummaries

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Value PropositionValue Proposition

Leverage Clinical Documents ontologyLeverage Clinical Documents ontology A common mechanism for transfer of encoded clinical A common mechanism for transfer of encoded clinical

data embedded in documentsdata embedded in documents Basis for ongoing harmonization of CCR/CCDBasis for ongoing harmonization of CCR/CCDEnhances Clinical Documents criteria for key Enhances Clinical Documents criteria for key use cases:use cases: Inpatient to Primary Care ProviderInpatient to Primary Care Provider Primary Care Provider to SpecialistPrimary Care Provider to SpecialistTo be enhanced in future years to support:To be enhanced in future years to support: Home Care Home Care Long Term CareLong Term Care


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Key Technical PropertiesKey Technical Properties

Document Transfer (Integration Profile)Document Transfer (Integration Profile) XDS/XDP for document sharing.XDS/XDP for document sharing. NAV for notification.NAV for notification. XDS Folders to support organization.XDS Folders to support organization. XDS Submission Sets to support packaging.XDS Submission Sets to support packaging. Identification of “Master” document or ManifestIdentification of “Master” document or Manifest

Document Content (Content Profile)Document Content (Content Profile) CDA Release 2.0CDA Release 2.0 Care Record Summaries Implementation GuideCare Record Summaries Implementation Guide


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Use CaseUse Case

1.1. Health care provider determines that a Health care provider determines that a patient needs to go to the EDpatient needs to go to the ED

2.2. Provider creates an ED referral package Provider creates an ED referral package using his or her EHRusing his or her EHR

3.3. Upon arrival, the ED provider identifies Upon arrival, the ED provider identifies the patient as a referralthe patient as a referral

4.4. The posted referral package is imported The posted referral package is imported into the Emergency Department into the Emergency Department Information System (EDIS)Information System (EDIS)

Provide access to critical health informationProvide access to critical health information in ED information systems in a standard manner\ in ED information systems in a standard manner\ED ReferralED Referral

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Nearly 5000 EDs in USNearly 5000 EDs in US

Significant percentage of ED visits are referralsSignificant percentage of ED visits are referrals

Shortage of critical health data for emergency Shortage of critical health data for emergency department patientsdepartment patients

Need to improve communication of intended patient Need to improve communication of intended patient care plans to ED providers and ensure that no care plans to ED providers and ensure that no pertinent data is lostpertinent data is lost

Streamline workflow by obviating telephone calls Streamline workflow by obviating telephone calls between busy cliniciansbetween busy clinicians

ED ReferralED Referral

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ScopeScope

EHR system capable of creating a care record EHR system capable of creating a care record summary would be capable of creating a summary would be capable of creating a referral package for a receiving systemreferral package for a receiving system

The emergency department information The emergency department information systems (EDIS) will need to retrieve and read systems (EDIS) will need to retrieve and read and display this data.and display this data.

ED ReferralED Referral

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AbstractAbstract

The Basic Patient Privacy Consents The Basic Patient Privacy Consents (BPPC) profile provide mechanisms to:(BPPC) profile provide mechanisms to: Record the patient privacy consent(s), Record the patient privacy consent(s), Mark documents published to XDS with the patient Mark documents published to XDS with the patient

privacy consent that was used to authorize the privacy consent that was used to authorize the publication, publication,

Enforce the privacy consent appropriate to the Enforce the privacy consent appropriate to the use.use.

Basic Patient Privacy Basic Patient Privacy Consents Consents

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ScopeScope

Document Sources and Document Document Sources and Document Consumers in an XDS Affinity DomainConsumers in an XDS Affinity Domain

Document Sources and Document Document Sources and Document Receivers using Cross Enterprise Point-Receivers using Cross Enterprise Point-to-Point Document Sharingto-Point Document Sharing


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An Affinity Domain can An Affinity Domain can develop privacy policies, develop privacy policies, and implement them with role-based or other and implement them with role-based or other

access control mechanisms supported by EHR access control mechanisms supported by EHR systems.systems.

A patient canA patient can Be made aware of an institutions privacy policies. Be made aware of an institutions privacy policies. Have an opportunity to selectively control access Have an opportunity to selectively control access

to their healthcare information.to their healthcare information.


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Human Readable ConsentsHuman Readable Consents

Machine ProcessableMachine Processable

Support for standards-based Role-Based Support for standards-based Role-Based Access ControlAccess Control


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Standards and Profiles UsedStandards and Profiles Used

CDA Release 2.0CDA Release 2.0

XDS Scanned DocumentsXDS Scanned Documents

Document Digital SignatureDocument Digital Signature

Cross Enterprise Document SharingCross Enterprise Document Sharing

Cross Enterprise Point-to-Point Document Cross Enterprise Point-to-Point Document SharingSharing


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Use CaseUse Case

H&P documentation required prior to H&P documentation required prior to procedure that is designed to assess:procedure that is designed to assess: Procedure RiskProcedure Risk Anesthesia RiskAnesthesia Risk Factors influencing procedure after-care decisionsFactors influencing procedure after-care decisions

Desired outcomesDesired outcomes Minimize injury during procedureMinimize injury during procedure Optimize procedure after-careOptimize procedure after-care

Pre-procedure H&PPre-procedure H&P

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ScopeScope

To identify the required and optional PPHP To identify the required and optional PPHP document content templates including:document content templates including: CDA Document HeaderCDA Document Header CDA Document Type(s)CDA Document Type(s) CDA Section TypesCDA Section Types CDA Entry TypesCDA Entry Types


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A procedure risk assessment A procedure risk assessment must be presentmust be present and evaluated by the operative and after-care and evaluated by the operative and after-care teams before the patient is allowed to have the teams before the patient is allowed to have the procedure. Missing information is frequently a procedure. Missing information is frequently a reason for canceling the procedure for the day, reason for canceling the procedure for the day, which leads to which leads to expensive underutilization of expensive underutilization of resources and dissatisfied patientsresources and dissatisfied patients. Further, . Further, incomplete information about the patient’s incomplete information about the patient’s clinical or home status may create a situation clinical or home status may create a situation where a procedure is performed that ultimately where a procedure is performed that ultimately results in an injury, inadequate aftercare or other results in an injury, inadequate aftercare or other undesirable outcomeundesirable outcome..


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PPHP Profile inherits specifications required for PPHP Profile inherits specifications required for other IHE PCC Medical Documentsother IHE PCC Medical Documents

PPHP Profile follows documentation practices for PPHP Profile follows documentation practices for all IHE PCC Medical Documentsall IHE PCC Medical Documents

PPHP Profile emphasizes re-usability of CDA PPHP Profile emphasizes re-usability of CDA template identifiers in order to reduce un-template identifiers in order to reduce un-necessary variability in IHE Content Profilesnecessary variability in IHE Content Profiles


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Standards UsedStandards Used

IHE Medical Document Content ProfilesIHE Medical Document Content Profiles

HL7 Reference Information Model ANSI StandardHL7 Reference Information Model ANSI Standard

HL7 CDA R2 ANSI StandardHL7 CDA R2 ANSI Standard

HL7 Care Provision Domain DSTU (in process)HL7 Care Provision Domain DSTU (in process)

Implementation GuidesImplementation Guides

HL7 Care Record Summary CDA R2 HL7 Care Record Summary CDA R2 Implementation Guide (in process)Implementation Guide (in process)

HL7/ASTM Continuity of Care Document HL7/ASTM Continuity of Care Document Implementation Guide (in process)Implementation Guide (in process)

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AbstractAbstract

The Exchange of Personal Health Record The Exchange of Personal Health Record Content (XPHR) provides a standards-Content (XPHR) provides a standards-based specification for managing the based specification for managing the interchange of documents between a interchange of documents between a Personal Health Record and an EHR Personal Health Record and an EHR System to enable better interoperability System to enable better interoperability between these systems. between these systems.

Exchange of PHR Exchange of PHR ContentContent

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ScopeScope

Personal Health Record (PHR) SystemsPersonal Health Record (PHR) Systems

Electronic Health Record (EHR) SystemsElectronic Health Record (EHR) Systems PHR System EHR System

Portable Media Creator Portable Media Importer

Distribute Document Set on Media [ITI-B]

Portable Media Creator Portable Media Importer

Distribute Document Set on Media [ITI-B]


PHR System EHR System

Document Source Document Recipient

Send Document Set [ITI-A]

Document Source Document Recipient

Send Document Set [ITI-A]

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Supports interchange of PHR InformationSupports interchange of PHR Information DemographicsDemographics Insurance InformationInsurance Information Medications, Problems, AllergiesMedications, Problems, Allergies Health HistoryHealth History Other InformationOther Information


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ASTM Continuity of Care (CCR) Data SetASTM Continuity of Care (CCR) Data Set

ASTM/HL7 Continuity of Care Document (CCD)ASTM/HL7 Continuity of Care Document (CCD)

HL7 Care Record SummaryHL7 Care Record Summary

AHIMA PHR Common Data ElementsAHIMA PHR Common Data Elements

XDS, XDPXDS, XDP



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Information is Human ReadableInformation is Human Readable

and Machine Processableand Machine Processable

Support Static and Dynamic Information Support Static and Dynamic Information Sharing Domains (XDS and XDP)Sharing Domains (XDS and XDP)

Protects Information using Digital SignatureProtects Information using Digital Signature

Update Model for EHR to PHR ChangesUpdate Model for EHR to PHR Changes


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ScopeScope

The clinical laboratory report is: The clinical laboratory report is: A report of A report of a set of final resultsa set of final results (the fulfillment process being (the fulfillment process being

completed) to be shared as “historical information”.completed) to be shared as “historical information”. Human-readableHuman-readable, shared between care providers of various , shared between care providers of various

specialties and patients (e.g. through a PHR)specialties and patients (e.g. through a PHR) May contain May contain machine readable coded entries machine readable coded entries (decision support, bio-(decision support, bio-

surveillance)surveillance)

All clinical laboratory specialties in scope, except:All clinical laboratory specialties in scope, except: Blood banks (blood products out of scope, but blood tests in scope) Blood banks (blood products out of scope, but blood tests in scope) Pathology (has its dedicated domain in IHE)Pathology (has its dedicated domain in IHE)

Sharing of Lab Sharing of Lab ReportsReports

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Sharing of Lab ReportsSharing of Lab Reports

Use case 1: Hospital lab report Use case 1: Hospital lab report RHIO RHIO EHRs EHRs At discharge time, a hospital physician selects the most significant laboratory reports At discharge time, a hospital physician selects the most significant laboratory reports produced during patient stay, and issues these reports individually to a health information produced during patient stay, and issues these reports individually to a health information exchange (e.g. XDS Affinity Domain) shared by a number of healthcare enterprises and exchange (e.g. XDS Affinity Domain) shared by a number of healthcare enterprises and primary care providers.primary care providers.

Use case 2: Ambulatory lab report Use case 2: Ambulatory lab report RHIO RHIO PHR PHRA private laboratory having signed a final report for a patient, sends this report in an electronic A private laboratory having signed a final report for a patient, sends this report in an electronic format to the patient record in the national EHR.format to the patient record in the national EHR.

Use case 3: Lab report Use case 3: Lab report PHR PHRA physician reviews the results received from a reference laboratory for his patient. The A physician reviews the results received from a reference laboratory for his patient. The doctor, as requested by the patient, sends this laboratory report in the patient’s personal doctor, as requested by the patient, sends this laboratory report in the patient’s personal health record in an electronic format.health record in an electronic format.

Use case 4: Lab report automatically shared Use case 4: Lab report automatically shared RHIO RHIOA community or hospital laboratory, systematically (with some degree of automatism) shares A community or hospital laboratory, systematically (with some degree of automatism) shares its final reports with a regional healthcare network.its final reports with a regional healthcare network.

Use case 5: Hospital’s EHR Lab report Use case 5: Hospital’s EHR Lab report RHIO RHIOAt discharge time of an inpatient, a hospital physician selects the most significant lab results, At discharge time of an inpatient, a hospital physician selects the most significant lab results, produced by one or more laboratories of the healthcare enterprise during patient stay, and produced by one or more laboratories of the healthcare enterprise during patient stay, and builds a cumulative report sent to an health info exchange shared by a number of healthcare builds a cumulative report sent to an health info exchange shared by a number of healthcare enterprises and primary care providers.enterprises and primary care providers.

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ASTM/HL7 Continuity of Care Document (CCD)ASTM/HL7 Continuity of Care Document (CCD)

HL7 V3 Laboratory DMIM HL7 V3 Laboratory DMIM

HL7 Care Record SummaryHL7 Care Record Summary

LOINC & SNOMEDLOINC & SNOMED

HIPAA Lab Claim Attachment NPRMHIPAA Lab Claim Attachment NPRM

IHE XDS (registry/repository) & XDP (pt-pt)IHE XDS (registry/repository) & XDP (pt-pt)



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Information is Human Readable (two levels of Information is Human Readable (two levels of sections) and machine processablesections) and machine processable

Full alignments with HL7 V3 lab messagesFull alignments with HL7 V3 lab messages

Supports custom report organizations and results Supports custom report organizations and results rendering regulations (e.g. CLIA in the USA).rendering regulations (e.g. CLIA in the USA).

Complements the real-time result return to ordering Complements the real-time result return to ordering provider (e.g. ELINCS).provider (e.g. ELINCS).

Used both in sharing (XDS) & pt-pt interchange (XDP)Used both in sharing (XDS) & pt-pt interchange (XDP)

May protect Information using Digital SignatureMay protect Information using Digital Signature



PCC Wrap-up PCC Wrap-up

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PCC RoadMapPCC RoadMapCare TransfersCare Transfers Medical SummaryMedical Summary 20052005 EDR, PPHPEDR, PPHP 20062006 LabsLabs 2006-72006-7 Growth ChartsGrowth Charts

Consumer EmpowermentConsumer Empowerment PHRPHR 20062006 ConsentsConsents 20062006

Provider OrderingProvider Ordering Ambulatory Ordering Ambulatory Ordering 20062006 Medication ListsMedication Lists 20072007

Clinical Data ReuseClinical Data Reuse Clinical Trials (RFD)Clinical Trials (RFD) 2006-72006-7 Biosurveillance Biosurveillance 2007-82007-8

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As a Provider or Vendor ContributorAs a Provider or Vendor Contributor

Offer Clinical Use Case Input to Drive IHE Profile DevelopmentOffer Clinical Use Case Input to Drive IHE Profile Development

Become a member of relevant domain’s Planning or Technical Become a member of relevant domain’s Planning or Technical CommitteesCommittees

Become a member of relevant Regional/National CommitteesBecome a member of relevant Regional/National Committees

Help to shape IHE’s future directionHelp to shape IHE’s future direction

As a Vendor ParticipantAs a Vendor Participant

Respond to Public Comments of Domain SupplementsRespond to Public Comments of Domain Supplements

Attend the Educational WorkshopsAttend the Educational Workshops

Participate in Connect-a-thons and DemonstrationsParticipate in Connect-a-thons and Demonstrations

As a Provider/Consultant ParticipantAs a Provider/Consultant Participant

Respond to Public Comments of Domain SupplementsRespond to Public Comments of Domain Supplements

Attend the Educational Workshops Attend the Educational Workshops

Attend Demonstrations and include IHE Integration Profiles in your RFPs Attend Demonstrations and include IHE Integration Profiles in your RFPs and Integration Projects.and Integration Projects.

How to Get Involved?How to Get Involved?

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IHE Web Site - http://www.ihe-europe.netIHE Web Site - http://www.ihe-europe.net Technical FrameworksTechnical Frameworks Technical Framework Supplements – Trial ImplementationTechnical Framework Supplements – Trial Implementation Calls for ParticipationCalls for Participation IHE Fact Sheet and FAQIHE Fact Sheet and FAQ IHE Integration Profiles: Guidelines for BuyersIHE Integration Profiles: Guidelines for Buyers IHE Connectathon ResultsIHE Connectathon Results Vendors’ Product Integration StatementsVendors’ Product Integration Statements

Sponsors’ IHE sitesSponsors’ IHE sites http://www.himss.org/IHE http://www.himss.org/IHE http://www.rsna.org/IHEhttp://www.rsna.org/IHE http://www.acc.org/quality/ihe.htmhttp://www.acc.org/quality/ihe.htm

More InformationMore Information

Questions?Questions?