Continuity of Care virtual tour HL7-IHE Demonstration HIMSS 2004.

Continuity of Carevirtual tour

HL7-IHE DemonstrationHIMSS 2004

Presented by

• John Madden, MD, PhD, Duke University Medical Center, Department of Pathology

• Liora Alschuler, HL7/the-word-electric

Continuity of CarePatient scenario

• John is a 70-year old man with a 100-pack-year smoking history

• He recently developed persistent cough with blood-streaked sputum

• He visits Dr. Sullivan, his Primary Care Provider (PCP)

• Dr. Sullivan sends John to a nearby radiology practice for a chest x-ray

AdobeBerdyCarefxCommerceNetDCRIDictaphoneDigital InfuzionEclipsysEpicGEHeartlabIBMINFINITTKodakKryptiqMicrosoftMisysMortaraNISTPhilipsRaining DataSentillionSiemensSNOMEDXIMIS Outpatient encounter and chest xray

Scheduled workflow; report stored as CDA

PCP

Continuity of CareImaging Integration, Tumor Reporting, Claims Processing

Repository

RIS

ServerWorkstation

Registry

ImagingHL7

StandardsaECG ArdenCCOW

CDA ODMLDMRIM

SDMSPLV2V3

IHE ProfilesCT

EUAPIX

PSARID

SWFPCP sends order to

radiology office

Radiology information systemqueries scheduling server

Imaging modality queries schedulingserver for demographics

Imaging system uploads completedimage to server

Server relays copy of imageto repository.

Repository forwards document information to registry.


• Chest x-ray shows a 3 cm right upper lobe mass

• Radiologists communicate result to Dr. Sullivan the same day

• She refers John to Dr. Blade, a chest surgeon at the South Hospital Medical Center

Patient referred for surgeryEMR & eForms CCR sent through brokers to hospital, surgery

PCP


EMRBroker

Hospital

Repository

eForms

Surgery

RIS

Server

Imaging

Workstation

Registry

Server/WSEMR

EMR

AdobeBerdyCarefxCommerceNetDCRIDictaphoneDigital InfuzionEclipsysEpicGEHeartlabIBMINFINITTKodakKryptiqMicrosoftMisysMortaraNISTPhilipsRaining DataSentillionSiemensSNOMEDXIMIS

HL7 Standards

aECG ArdenCCOW

CDA ODMLDMRIM

SDMSPLV2V3

IHE ProfilesCT

EUAPIX

PSARID

SWF

PCP enters referral requestvia eForms application

Broker forwards referral to South

Med Center and torepository/registry

Hospital EMR distributes referral

request and schedules patient

visit

Clinic queries community

radiology server for availability

of x-rays


• Medical center radiology obtains outside chest x-ray on behalf of Dr. Blade and reviews it for the South Hospital medical record

• Dr. Blade meets with John and personally reviews the outside x-ray

• He determines that John will require surgery

Surgeon reviews imaging reportsRID query, CDA link to PACS, reg/rep for consulting report

PCP


Surgery

Registry

EMR

eForms

Hospital

Identity server

Dictation ServerWorkstation

ImagingRIS


HL7 Standards

aECG ArdenCCOW

CDA ODMLDMRIM

SDMSPLV2V3

IHE ProfilesCT

EUAPIX

PSARID

SWF

Med Ctr radiology reviews

community images and

issues report

During consultation, Dr. Blade requests a low-resolution

version of x-ray to review on

office computer with John’s family

Medical dictation service

delivers radiology review

note to repository

Identity server verifies outside patient record number

Outside image and report

delivered to surgeon’s

consultation room


• Dr. Blade admits John

• He orders a preoperative chest CT

Patient admitted; Pre-op CT, consultEMR sends admit message; orders imaging; report converted from V2 to CDA

PCP


Surgery

Registry

Server

EMR

Hospital

eForms

Repository

Broker

DictationWorkstation

Imaging

ImagingRIS

HL7 Standards

aECG ArdenCCOW

CDA ODMLDMRIM

SDMSPLV2V3

IHE ProfilesCT

EUAPIX

PSARID

SWF

CT scheduled…


John is admitted,

preoperative CT

ordered

…performed…and reported


• Dr. Blade performs wedge resection of RUL with node sampling

• Specimen is examined by pathology; the diagnosis is large cell carcinoma with negative nodes

• Pathology report is sent to Dr. Blade, hospital Tumor Registry

• A copy is sent to the PCP, Dr. Sullivan

Pathology Report; Surgical Report; ReferralFor patient chart and Tumor Registry; CCR back to PCP

PCP


Server

EMR

Hospital

Dictation

Tumor Registry

Broker

eFormsBroker

Pathology

Surgery

Repository

Registry

Workstation

ImagingRIS


HL7 Standards

aECG ArdenCCOW

CDA ODMLDMRIM

SDMSPLV2V3

IHE ProfilesCT

EUAPIX

PSARID

SWF

Pathology report

ordered……and reported

Coded format auto-

generated for tumor

registry from CDA data

Dr. Blade composes discharge summary, dictation service queries

registry for location of referenced documents

Discharge summary

posted, copy forwarded to PCP’s broker

PCP requests copy of discharge summary in

encrypted email from broker

South Hospital

Repository view:Repository view:HL7-CDA standard XML HL7-CDA standard XML

with XQuery-ready, with XQuery-ready, context-linked SNOMED context-linked SNOMED

encodingsencodings

Pathologist view:Pathologist view:CAP/ACoS standards CAP/ACoS standards compliant, template-compliant, template-

driven data entrydriven data entry

Clinician view:Clinician view:Traditional format, Traditional format,

print/electronic print/electronic deliverydelivery

Tumor registrar view:Tumor registrar view:Irrelevant items Irrelevant items filtered, stage filtered, stage

computed computed automaticallyautomatically

A singleA singledata data

REPRESENTATIONREPRESENTATION standard standard

facilitates multiplefacilitates multiple document document

PRESENTATIONPRESENTATION standards !standards !


• Dr. Sullivan submits a claim to payer

• Payer requests more information

Brokered Claim; Registry DiscoveryFor patient chart and Tumor Registry; CCR back to PCP

PCP


Surgery

Server

EMR

Hospital

Repository

Pathology

Dictation

Tumor Registry

Registry

eForms

Broker

Broker

Payer

Workstation

ImagingRIS


HL7 Standards

aECG ArdenCCOW

CDA ODMLDMRIM

SDMSPLV2V3

IHE ProfilesCT

EUAPIX

PSARID

SWF

Virtual EHRUbiquitous Access to Distributed Information

PCP


Imaging

EMR

Dictation

Tumor Registry

Broker

vEHR

Payer

Pathology

RepositoryeForms

Workstation

Registry

Server

Imaging

Hospital

RIS


HL7 Standards

aECG ArdenCCOW

CDA ODMLDMRIM

SDMSPLV2V3

IHE ProfilesCT

EUAPIX

PSARID

SWF

AdobeBerdyCarefxCommerceNetDCRIDictaphoneDigital InfuzionEclipsysEpicGE HeartlabIBMINFINITTKodakKryptiqMicrosoftMisysMortaraNISTPhilipsRaining DataSentillionSiemensSNOMEDXIMIS

HL7 aECG ArdenCCOW

CDA ODMLDMRIM

SDMSPLV2V3

IHECT

EUAPIX

PSARID

SWF

Continuity of CareMini-tours

• Tour 1: Referrals & Repository

• Tour 2: Pictures & Words

• Tour 3: Putting it all together


HL7 aECG ArdenCCOW

CDA ODMLDMRIM

SDMSPLV2V3

IHECT

EUAPIX

PSARID

SWF

Continuity of CareMini-tour 1

Referrals & Repository

• Order origination

• CDA export/import

• Report creation

• Referrals

• Discharge summary


HL7 aECG ArdenCCOW

CDA ODMLDMRIM

SDMSPLV2V3

IHECT

EUAPIX

PSARID

SWF


Pictures & Words

• Radiology workflow & standards

• Dictation

• CCOW


HL7 aECG ArdenCCOW

CDA ODMLDMRIM

SDMSPLV2V3

IHECT

EUAPIX

PSARID

SWF


Putting it all together

• Message routing

• Repository & registry

• Virtual EHR

• Financials


HL7 aECG ArdenCCOW

CDA ODMLDMRIM

SDMSPLV2V3

IHECT

EUAPIX

PSARID

SWF

Thank you!

• Questions?

• Tours starting now

Continuity of Care virtual tour HL7-IHE Demonstration HIMSS 2004.

Documents

surgery slide

hospital tumor registry

server server relays

sullivan slide

chest xray slide

repository identity

preoperative chest ct

tumor reporting