The IHE InitiativeMission, Process, Achievements, Plans

Raymond Peter Zambuto,Raymond Peter Zambuto,MS, CCE, FASHE, FHIMSS, FACCE

President, Technology in Medicine, Inc.

Co-Chair, IHE PCD Domain

Presentation Objectives

• IHE: What? Why? Who? How organized? IHE: What? Why? Who? How organized? – Healthcare provider role in developing IHE Healthcare provider role in developing IHE

frameworkframework

• Why standards are not enoughWhy standards are not enough• IHE process for standards adoption and IHE process for standards adoption and

implementationimplementation• Benefits, growth, strategies, integrationBenefits, growth, strategies, integration• How to leverage IHE to enable interoperability inHow to leverage IHE to enable interoperability in

– EnterprisesEnterprises– Health information exchanges (HIEs)Health information exchanges (HIEs)

IHE: A Framework for Interoperability

• A common framework for harmonizing and A common framework for harmonizing and implementing multiple standardsimplementing multiple standards– Application-to-application– System-to-system– Setting-to-setting

• Enables seamless health information movement Enables seamless health information movement within and between enterprises, regions, nationswithin and between enterprises, regions, nations

• Promotes unbiased selection and coordinated use Promotes unbiased selection and coordinated use of established healthcare of established healthcare andand IT standards to IT standards to address specific clinical needsaddress specific clinical needs

Why IHE? A Patient-centered ExampleWhy IHE? A Patient-centered Example

Photo Courtesy of Philips Medical Systems

Why IHE? A Patient-centered ExampleWhy IHE? A Patient-centered Example

Photo Courtesy of Philips Medical Systems

IHE Sponsors

• 1997: Founded in Radiology (RSNA) and IT (HIMSS)1997: Founded in Radiology (RSNA) and IT (HIMSS)• Many professional societies (stakeholder representation)Many professional societies (stakeholder representation)

– American Academy of Ophthalmology (AAO)American Academy of Ophthalmology (AAO)– American College of Cardiology (ACC)American College of Cardiology (ACC)– American College of Physicians (ACP)American College of Physicians (ACP)

– American College of Clinical Engineering (ACCE)American College of Clinical Engineering (ACCE) – American College of Emergency Physicians (ACEP) American College of Emergency Physicians (ACEP) – American Society for Therapeutic Radiation Oncology American Society for Therapeutic Radiation Oncology

(ASTRO)(ASTRO)– GMSIH (IT France), JAHIS (IT Japan), SFIL (laboratory)GMSIH (IT France), JAHIS (IT Japan), SFIL (laboratory)– Healthcare Information Management Systems Society (HIMSS)Healthcare Information Management Systems Society (HIMSS)– Radiological Society of North America (RSNA)Radiological Society of North America (RSNA)– And many more….And many more….

IHE Participants and Relationships

• Participants include:Participants include:– Users - Clinicians, Staff, Administrators, CIOs, Governments (e.g. Users - Clinicians, Staff, Administrators, CIOs, Governments (e.g.

NIST, VA).NIST, VA).– Vendors - Information Systems and EquipmentVendors - Information Systems and Equipment

• e.g., imaging, cardiology, devicese.g., imaging, cardiology, devices

– ConsultantsConsultants

• Maintains formal liaison with Standards Development Maintains formal liaison with Standards Development Organizations (SDOs):Organizations (SDOs):– HL7, DICOM, ISO (Liaison D), othersHL7, DICOM, ISO (Liaison D), others

• ISO TC215 (including ANSI) approved IHE Process and ISO TC215 (including ANSI) approved IHE Process and Profiles to be published as technical reportsProfiles to be published as technical reports– Concerns expressed by some AHIC members not foundedConcerns expressed by some AHIC members not founded

IHE Organizational StructureIHE Organizational Structure

ACCACPHIMSSRSNA

JAHISJIRAJRS

METI-MLHWMEDIS-DCJAMI

GMSIHSFRSFIL

SIRMBIREuroRec

COCIREAR-ECRDRG

ESC

Professional Societies / Sponsors Contributing &Participating

Vendors

IHE (International) Strategic Development Committee

Global Development

Radiology

Cardiology

ITInfrastructure

Patient CareCoordination

Patient CareDevices

Laboratory

Pathology

Pharmacy /Medication Admin

RadiationOncology

IHE Europe

IHE North America

France

USA

Canada

IHE Asia-Oceania

Japan

Korea Taiwan

Netherlands

Spain Sweden UK

ItalyGermany

Norway

Regional Deployment

China

International Adoption of IHE

France

Local Deployment National Extensions (Local Adaptions) Promotional & Live Demonstration Events Funding

USA

Germany

Italy

JapanUK

Canada

Korea

Taiwan

Norway

Holland

SpainChina

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Pragmatic global standards harmonization + best practices sharing Pragmatic global standards harmonization + best practices sharing

Standards: Necessary…Not Sufficient

• Standards areStandards are– Foundational - to interoperability and Foundational - to interoperability and

communicationscommunications– Broad - varying interpretations and Broad - varying interpretations and

implementationsimplementations– Narrow - may not consider relationships between Narrow - may not consider relationships between

standards domainsstandards domains– Plentiful - often redundant or disjointedPlentiful - often redundant or disjointed– Focused - standards implementation guides focus Focused - standards implementation guides focus

only on a single standardonly on a single standardIHE provides a standard process for implementing IHE provides a standard process for implementing multiple standardsmultiple standards

IHE: Connecting Standards to Care

• Healthcare professionals work with industryHealthcare professionals work with industry• Coordinate implementation of standards to Coordinate implementation of standards to

meet clinical and administrative needsmeet clinical and administrative needs– Clinicians and HIT professionals identify the key Clinicians and HIT professionals identify the key

interoperability problems they faceinteroperability problems they face– Providers and industry work together to develop Providers and industry work together to develop

and make available standards-based solutionsand make available standards-based solutions– Implementers follow common guidelines in Implementers follow common guidelines in

purchasing and integrating effective systemspurchasing and integrating effective systems

IHE: A forum for agreeing on how to implement IHE: A forum for agreeing on how to implement standards and processes for making it happenstandards and processes for making it happen

Standards Adoption Process

Document Use Case Document Use Case RequirementsRequirementsDocument Use Case Document Use Case RequirementsRequirements

Identify available Identify available standards (standards (e.g. HL7, e.g. HL7, DICOM, IETF, OASIS)DICOM, IETF, OASIS)

Identify available Identify available standards (standards (e.g. HL7, e.g. HL7, DICOM, IETF, OASIS)DICOM, IETF, OASIS)

Develop Develop technical technical

specificationsspecifications

Develop Develop technical technical

specificationsspecifications

Testing at Testing at ConnectathonsConnectathonsTesting at Testing at ConnectathonsConnectathons IHE IHE

DemonstrationsDemonstrationsIHE IHE DemonstrationsDemonstrations

Products Products with IHEwith IHEProducts Products with IHEwith IHE

Timely access to Timely access to informationinformationTimely access to Timely access to informationinformation Easy to integrate Easy to integrate

productsproductsEasy to integrate Easy to integrate productsproducts

Stakeholder Benefits

• Healthcare providers and support staffHealthcare providers and support staff– Improved workflowsImproved workflows– Information whenever and wherever neededInformation whenever and wherever needed– Fewer opportunities for errorsFewer opportunities for errors– Fewer tedious tasks/repeated workFewer tedious tasks/repeated work– Improved report turnaround timeImproved report turnaround time

• VendorsVendors– Align product interoperability with industry consensusAlign product interoperability with industry consensus– Decreased cost and complexity of interface installation and Decreased cost and complexity of interface installation and

managementmanagement– Focus competition on functionality/service space not Focus competition on functionality/service space not

information transport spaceinformation transport space• SDOsSDOs

– Rapid feedback to adjust standards to real-worldRapid feedback to adjust standards to real-world– Establishment of critical mass and widespread adoptionEstablishment of critical mass and widespread adoption

Growth in IHE Domains

Radiology (18)

IT Infrastructure for Healthcare (17)

Cardiology (7)

Laboratory (6)

Radiation Oncology (1)

Patient Care Coordination (5)

Patient Care Devices (1)

Quality

Eye Care (3)

Veterinary

Endoscopy

Pathology

Pharmacy

IHE Global DevelopmentsIHE Global DevelopmentsIntegration Profiles (# X) – Solutions to Real-World Interoperability Integration Profiles (# X) – Solutions to Real-World Interoperability

Needs & Problems:Needs & Problems:

Within Clinical Departments e.g.:Within Clinical Departments e.g.:RadiologyRadiologyCardiologyCardiologyLabLab ......

Across Departmental &Across Departmental &Institutional Boundaries – XDSInstitutional Boundaries – XDS

RHIOsRHIOs (Regional Healthcare Information Organizations) (Regional Healthcare Information Organizations)

EHR EnablersEHR Enablers

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IHE Implementation Strategy

• Leverage established standards to allow rapid deployment and Leverage established standards to allow rapid deployment and plan for futureplan for futurePragmatic, Ease of EvolutionPragmatic, Ease of Evolution

• Enable architectural freedom (patient vs. provider centric, Enable architectural freedom (patient vs. provider centric, centralized vs. decentralized, scalable (from office to centralized vs. decentralized, scalable (from office to enterprise to IDN to RHIO) enterprise to IDN to RHIO) ConfigurationConfiguration flexibilityflexibility

• Support breakthrough use cases: variety of care settings, care Support breakthrough use cases: variety of care settings, care coordination, public health, PHR, EHRcoordination, public health, PHR, EHRInteroperability for broad constituenciesInteroperability for broad constituencies

IHE: Offers consistent, standards-based record sharing for IHE: Offers consistent, standards-based record sharing for EHRs and other information systemsEHRs and other information systems

IHE based Regional and National EHR Projects (Operational and Planned)

Toronto, Quebec, Alberta, BCCanada Infoway

Austria

THINC- New YorkNCHICA – N. Carolina

Italy (Conto Corrente Salute)

MA-Share – MA

FranceDMP

Philadelphia

HIE

CHINA-MoHLab results sharing

New York HIE

IHE Integration Profiles for Health Info NetsWhat is available and has been added in 2005 and 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 MgmtPatient ID MgmtSecuritySecurityClinical and PHRClinical and PHRContentContent

Health Data ExchangeHealth Data Exchange OtherOther

IHE: Supporting HHS Goals for NHIN

Healthcare Information

Technology Standards Panel (HITSP)

Nationwide Health Information Network Architecture Projects

(NHIN)

Health Information Security and Privacy

Collaboration (HISPC)

Certification Commission for

Healthcare Information

Technology (CCHIT)

American Health Information Community

Standards harmonization Standards harmonization and adoptionand adoption

Interoperability testingInteroperability testing

Security and privacy standardsSecurity and privacy standardsSpecifications for standards-Specifications for standards-based EHR functionality to based EHR functionality to support RHIOssupport RHIOs

HITSP Recommended Standards

• BiosurveillanceBiosurveillance– ICD-9CM – International Classification of Diseases v. 9 Clinical ICD-9CM – International Classification of Diseases v. 9 Clinical

ModificationsModifications– ICD-10 CM – Diagnoses and ProceduresICD-10 CM – Diagnoses and Procedures– IHE-XDS – Integrating the Healthcare Enterprise (IHE) Cross-IHE-XDS – Integrating the Healthcare Enterprise (IHE) Cross-

Enterprise Document SharingEnterprise Document Sharing– IHE-XDS Lab – IHE Laboratory Report Document SharingIHE-XDS Lab – IHE Laboratory Report Document Sharing– IHE-RFD – IHE Retrieve Form for Data CaptureIHE-RFD – IHE Retrieve Form for Data Capture– IHE-PIX – IHE Patient Identification Cross-ReferencingIHE-PIX – IHE Patient Identification Cross-Referencing– IHE-RAD – XDS-I – IHE Cross-Enterprise Sharing of ImagesIHE-RAD – XDS-I – IHE Cross-Enterprise Sharing of Images– IHE-NAV – IHE Notification of Document AvailabilityIHE-NAV – IHE Notification of Document Availability– IHE-XDS-MS – IHE Medical Summary Document SharingIHE-XDS-MS – IHE Medical Summary Document Sharing– ISO/TC215 -DTS 25237 - Health Informatics PseudonymisationISO/TC215 -DTS 25237 - Health Informatics Pseudonymisation– LOINC – Logical Observation Identifiers Names and CodesLOINC – Logical Observation Identifiers Names and Codes– NCCLS – National Committee for Clinical Laboratory NCCLS – National Committee for Clinical Laboratory

StandardsStandards– RxNorm – National Library of Medicine RxNormRxNorm – National Library of Medicine RxNorm

IHE contributes to HITSP’s successIHE contributes to HITSP’s success

HITSP Recommended Standards

• Consumer EmpowermentConsumer Empowerment– IHE-XDS – Integrating the Healthcare Enterprise (IHE) IHE-XDS – Integrating the Healthcare Enterprise (IHE)

Cross-Enterprise Document SharingCross-Enterprise Document Sharing– IHE-PIX – IHE Patient Identification Cross-ReferencingIHE-PIX – IHE Patient Identification Cross-Referencing– IHE-PDQ – IHE Patient Demographics QueryIHE-PDQ – IHE Patient Demographics Query– Health Level Seven (HL7) CDA R2 – HL7 Clinical Health Level Seven (HL7) CDA R2 – HL7 Clinical

Document Architecture Release 2Document Architecture Release 2– HL7 CCD – HL7 Continuity of Care Document HL7 CCD – HL7 Continuity of Care Document with with

mappings from ASTM E 2369-05 Continuity of Care Record mappings from ASTM E 2369-05 Continuity of Care Record (CCR), X12 N 270/271 and NCPDP Script 8.1.(CCR), X12 N 270/271 and NCPDP Script 8.1.

– HL7 EHR Systems Functional Model Draft Standard for HL7 EHR Systems Functional Model Draft Standard for Trial Use (DSTU)Trial Use (DSTU)

– Logical Observation Identifiers Names and Codes Logical Observation Identifiers Names and Codes (LOINC)(LOINC)

HITSP Recommended Standards

• Electronic Health Record ExchangeElectronic Health Record Exchange– IHE-XDS Lab – IHE Laboratory Report Document SharingIHE-XDS Lab – IHE Laboratory Report Document Sharing

– IHE-PIX – IHE Patient Identification Cross-ReferencingIHE-PIX – IHE Patient Identification Cross-Referencing

– IHE-PDQ – IHE Patient Demographics QueryIHE-PDQ – IHE Patient Demographics Query

– Health Level Seven (HL7) CDA R2 – HL7 Clinical Document Health Level Seven (HL7) CDA R2 – HL7 Clinical Document Architecture Release 2Architecture Release 2

– HL7 v. 2.5HL7 v. 2.5

– Clinical Laboratory Improvement Amendments (CLIA)Clinical Laboratory Improvement Amendments (CLIA)

– Logical Observation Identifiers Names and Codes (LOINC)Logical Observation Identifiers Names and Codes (LOINC)

– Health Insurance Portability and Accountability Act (HIPAA)Health Insurance Portability and Accountability Act (HIPAA)

– Systematized Nomenclature of Medicine – Clinical Terms Systematized Nomenclature of Medicine – Clinical Terms (SNOMED – CT)(SNOMED – CT)

– Unified Code for Units of Measure (UCUM)Unified Code for Units of Measure (UCUM)

2007 HIMSS Interoperability ShowcaseFebruary 26 – March 1, 2007

• 9,000 square feet of exhibit space 9,000 square feet of exhibit space • 67 Showcase participants67 Showcase participants• Secured HIExchange with broad Secured HIExchange with broad

contentcontent• HIE with patient care devicesHIE with patient care devices• Personal health record solutionsPersonal health record solutions• New directions focus (Life Sciences New directions focus (Life Sciences

Bio-Pharma, HL7 v3.0 PIX/PDQ, Bio-Pharma, HL7 v3.0 PIX/PDQ, ELINCS Lab)ELINCS Lab)

• HITSP interoperability specificationsHITSP interoperability specifications• Financial and administrative systems Financial and administrative systems

(CAQH/CORE)(CAQH/CORE)• Expanded distributed demonstration Expanded distributed demonstration

in a RHIO formatin a RHIO format• Focused tours – International, VIP, Focused tours – International, VIP,

CongressionalCongressional• Theater – Education sessionsTheater – Education sessions

Morial Convention Center, New Orleans, LAMorial Convention Center, New Orleans, LA

How to Participate

As a User or Vendor Committee MemberAs a User or Vendor Committee Member• Become a member of relevant Domains Planning Become a member of relevant Domains Planning

or Technical Committeesor Technical Committees

As a User, Consultant or Vendor Interested As a User, Consultant or Vendor Interested ObserverObserver

• Provide Public Comments on Technical Provide Public Comments on Technical Framework SupplementsFramework Supplements

• Attend Demonstrations, Educational Events and Attend Demonstrations, Educational Events and WorkshopsWorkshops

How to Use IHE

As a Vendor ImplementerAs a Vendor Implementer• Implement IHE Integration ProfilesImplement IHE Integration Profiles• Test systems through Connectathon processTest systems through Connectathon process• Publish an IHE Integration Statement for productsPublish an IHE Integration Statement for products

As a User Implementer or ConsultantAs a User Implementer or Consultant• Use IHE Integration Profiles to develop Use IHE Integration Profiles to develop

interoperability strategyinteroperability strategy• Use Connectathon Results and Integration Use Connectathon Results and Integration

Statements to evaluate vendorsStatements to evaluate vendors• Demand IHE Integration Profile compliance in RFPsDemand IHE Integration Profile compliance in RFPs

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

http://www.ihe.net

More Resources - www.ihe.net

• Frequently Asked Questions• Integration Profiles in Technical Frameworks:– CardiologyCardiology– IT InfrastructureIT Infrastructure– LaboratoryLaboratory– Patient Care CoordinationPatient Care Coordination– Patient Care DevicesPatient Care Devices– Radiation OncologyRadiation Oncology– RadiologyRadiology

• Connectathon Results• Vendor Products Integration Statements

• Participation in Committees and Connectathons