Didi Davis, HIMSS Didi Davis, HIMSS Senior Director, Informatics/IHE International Senior Director, Informatics/IHE International Introduction to Introduction to Integrating the Healthcare Integrating the Healthcare Enterprise (IHE) Enterprise (IHE) and IHE’s contribution to standards and IHE’s contribution to standards harmonization for the Nationwide harmonization for the Nationwide Health Information Network Health Information Network
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Didi Davis, HIMSS Senior Director, Informatics/IHE International Introduction to Integrating the Healthcare Enterprise (IHE) and IHEs contribution to standards.
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Introduction to Introduction to Integrating the Healthcare Enterprise (IHE)Integrating the Healthcare Enterprise (IHE)
and IHE’s contribution to standards and IHE’s contribution to standards harmonization for the Nationwide Health harmonization for the Nationwide Health
Information NetworkInformation Network
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What is Standards Harmonization?
• Healthcare is a complex multi-specialty multi-stakeholder Healthcare is a complex multi-specialty multi-stakeholder system. Multiple standard development organizations are system. Multiple standard development organizations are necessary.necessary.
• Challenge is to achieve “interoperability” while implementing Challenge is to achieve “interoperability” while implementing multiple standards to meet a broad range of information multiple standards to meet a broad range of information exchange needs:exchange needs:– Application-to-application– System-to-system– Setting-to-setting
• Coordinate adoption of standards to meet clinical and Coordinate adoption of standards to meet clinical and administrative Use Casesadministrative Use Cases– Identify the key interoperability problems they faceIdentify the key interoperability problems they face– Providers and industry work together to develop and make Providers and industry work together to develop and make
available standards-based solutionavailable standards-based solution
Standards: Necessary…Not Sufficient
• Standards areStandards are– Foundational - interoperability and communicationsFoundational - interoperability and communications– 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 Focused - standards implementation guides
typically focus on a single standardtypically focus on a single standard
Need a standard process for implementing Need a standard process for implementing multiple standardsmultiple standards
What is “Integrating the Healthcare Enterprise”?
• A 9-year public-private initiative • Driven by end-users, IHE improves patient care by
harmonizing electronic health information exchange • Enables approved standards to seamlessly pass
health information among care providers on a local, regional and national level
• IHE Frameworks are freely available to all• The IHE Global Standards Adoption process as
approved by the International Standards Organization (ISO) as a Technical Report 28380 in August 2007
How does IHE work?
• Clinicians and IT professionals identify key Clinicians and IT professionals identify key clinical and business workflow problemsclinical and business workflow problems
• Clinicians, IT professionals, consultants, and Clinicians, IT professionals, consultants, and vendors jointly solve those problems by vendors jointly solve those problems by standardizing the way existing standards are standardizing the way existing standards are implemented in HIT productsimplemented in HIT products
• IT professionals follow the IHE guidelines in IT professionals follow the IHE guidelines in purchasing and integrating effective systemspurchasing and integrating effective systems
• Vendors & consultants (e.g., imaging, EHRs, Vendors & consultants (e.g., imaging, EHRs, cardiology, medical devices)cardiology, medical devices)
Integrating the Healthcare Enterprise
““Achieving Interoperability through Implementation of Standards”Achieving Interoperability through Implementation of Standards”
1997: Founded in Radiology (RSNA) and IT (HIMSS)1997: Founded in Radiology (RSNA) and IT (HIMSS)• Many professional societies (stakeholder Many professional societies (stakeholder
representation)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 (ASTRO)American Society for Therapeutic Radiation Oncology (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….
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
Cross-Enterprise User Attestation
User Attributes fro Access Control
IHE Integration Profiles for Health Info Nets What is available and has been added this cycle
Clinical and PHR ContentClinical and PHR Content
The Community is the Hub that Drives Interoperability
• AHIC, chaired by HHS Secretary provides strategic coordination.
• CCHIT focuses on developing a mechanism for certification of health care IT products
• HITSP brings together all relevant stakeholders to identify & harmonize appropriate standards
• HISPC addresses variations in business policy and state law that affect privacy and security
• NHIN is focused on interoperability pilots and implementation
Healthcare Information Technology
Standards Panel (HITSP)
Nationwide Health Information
Network (NHIN) Architecture
Projects
The Health Information Security and
Privacy Collaboration
(HISPC)
The Certification Commission for
Healthcare Information Technology
(CCHIT)
American Health Information
Community (AHIC)
Standards Harmonization
HITSP (Healthcare Information Standards Panel)
US Federal Initiative for Health IT and Nationwide Health Information Network
• The U.S. healthcare system is managed both at the federal level and the state-level.
• Over 200 Health Information Exchange projects in the U.S. at the state level or regional communities within the states.
• At the federal level, HHS has set-up a policy-level setting board (AHIC), a coordination office (ONC) and 4 supporting initiatives for standards harmonization, certification, privacy and implementation prototyping.
• IHE-USA has been engaged in the organization of one of these supporting initiatives: HITSP. IHE and its sponsors (e.g. HIMSS, RSNA, ACCE, etc.) and participants contribute to those initiatives.
HITSP Delivers Interoperability Specs to AHIC
• The Healthcare Information Technology Standards Panel (HITSP) has addressed 7 business use cases for interoperability.
• HITSP has nearly 400 member organizations representing all U.S. stakeholders including Standards Development Organizations (incl. X12, DICOM, HL7, etc.).
• HITSP, through its standards-based interoperability specifications, is leveraging standard-based implementation guides such as those from Integrating the Healthcare Enterprise (IHE).
• The IHE Connectathon and the HIMSS Interoperability Showcase play a visible role demonstrating the HITSP/IHE synergy.
From Standards to Solving a Use Case
• AHIC/ONC
• HITSPInteroperability Specifications
+ Constructs
Standards Adoption/Profiling
Technical Use Case Driven
Base StandardsFoundations
• IHE
• HL7, NCPDP, • X12, DICOM,
ISO, etc…
Business Use Case
2020
IHE contributes to
HITSP’s success
IHE contributes to
HITSP’s success18 IHE Profiles adopted
byHITSP Interoperability
Specifications
Conformance Testing & Certification
• IHE Conformance Testing
• CCHIT Certification
Interoperability Specifications+ Constructs
Standards Adoption/ProfilingTechnical Use Case Driven
Base StandardsFoundations
HITSP GOALS and IHE
• HITSP goals with respect to testing activities– Ensure 'fitness for use' of HITSP Interoperability Specifications– Has leveraged the IHE testing process to support overall
collaborative testing activities
• HITSP collaboration with IHE– 18 IHE Profiles are used as constructs in HITSP ISs– IHE Profiles provide globally accepted standards to HITSP – IHE Connectathon/HIMSS Showcase provide opportunity for
collaboration to meet mutual goals
• To access HITSP Interoperability Specifications:www.HITSP.org
HIMSS08 Interoperability Showcase40 out of 51 implementers demonstrated HITSP
Requirements for an open RHIO/HIE(1)• Bring trust and ease of use for healthcare professionals:
– Care delivery organizations choose information to share:• Based on patient situation
• When they see fit (discharge, end of encounter, etc.)
• What information to share (pick relevant types of documents, and content elements).
– Care delivery organizations access patient information through:• their own EMR (if they have one), or
• through a shared portal otherwise.
– When accessing patient info:• Find quickly if relevant information is available or not (single query).
• May select among relevant documents, which ones to see (may be done in background)
• Among those of interest, chose to import in whole or part in its own EMR Chart (responsibility).
Requirements for an open RHIO/HIE(2)
• Bring trust and privacy to patients:– Only authorized organizations and authenticated healthcare providers
may transact in the HIE:• Each node or IT system interfaced is strongly authenticated
• Each user shall be authenticated on the edge system (where context is best known)
• All traffic trough the infrastructure is encrypted
– Patient consent needs multiple choices or levels• Unless opt-in, no data about a specific patient may be shared
• Several data sharing policies offered to the patient consent
• Each shared document is assigned to specific policies (or not shared) at encounter time.
• Healthcare providers may only access documents compatible with their role.
– Shared Document Registry does not contain patient clinical data only generic information (minimum metadata + repository reference)
Categories of Healthcare Communication Services
Security
DocumentSharing
Patient and Provider ID Mgt
DynamicInformation
Access
WorkflowManagement
Source persisted and attested health
records
Specific info snapshot
provided on demand
2 or more entitiessynchronize
a task
e.g. access to last 6 months historical
labs and encounter summaries
e.g. order a lab test, track status and receive results
e.g. get a current list of allergies or med list from a source
HospitalsHIEs and RHIOs
IT Infrastructure
What is IHE IT Infrastructure?
• IHE IT Infrastructure domain produces...– Profiles that serve the purposes of clinical
workflows, regardless of IHE clinical domainExamples: Security, Records Storage, Patient Identifiers
– Basic implementation-specification foundations to be extended by other IHE clinical domains
Examples: Retrieve Forms for Data Capture; Cross-Enterprise Document Sharing
– White Papers for current work itemsExamples: HIE Security and Privacy; Health Data Re-use
Infrastructure; Risk Management
Community orsub-network
Clinical Encounter
Clinical IT System Index of patients records(Document-level)
Aggregate Patient Info
4-Patient data 4-Patient data presented to presented to
PhysicianPhysician
Sharing SystemSharing System
Clinic Record Specialist Record
Hospital Record
2-Reference2-Referenceto Records to Records for Inquiryfor Inquiry
Introduced at HIMSS in 2005 : IHE-XDSIntroduced at HIMSS in 2005 : IHE-XDS
3-Records3-RecordsReturnedReturned
ReferenceReferenceto recordsto records Repository of
Documents
Repository ofDocuments
IHE-XDS Infrastructure Components
• Audit Record Repository (ATNA) – Receive audit records from other actors and securely store for audit purposes. ATNA also authenticates peer-nodes and encrypt communications.
• Time Server (CT) – Provides consistent definition of date/time enabling time synchronization across multiple systems. Enables events associated with patients to be sorted reliably in chronological order.
• Document Registry (XDS) – Queryable index of metadata and references to all documents shared within a connected community (XDS Affinity Domain)
• Document Repository (XDS) – Supports storage and retrieval of clinical information (as documents). May be centralized or distributed.
• Patient Identifier Cross Reference Manager (PIX) – Reconciles information on patients from multiple domains to a single, cross referenced set of ids for each given patient.
• Patient Demographics Supplier (PDQ) – Returns demographic information and identifiers for patients based on specified demographic criteria.
IHE IT InfrastructureComposable Integration Profiles
Functional Status Functional Status AssesmentAssesment
FSAFSA
Use of a shared XDS infrastructure to access Radiology Reports and Images (XDS-I)
HospitalHospital
Imaging CenterImaging CenterPhysician PracticePhysician Practice
Between Radiology and :Between Radiology and :• IImaging specialistsmaging specialists• Non-imaging cliniciansNon-imaging clinicians PACS Y
PACS Z
Radiology -to-Radiology -to-RadiologyRadiology
Radiology -to-Radiology -to-PhysiciansPhysicians
Same XDS InfrastructureSame XDS Infrastructure (Registry and Repositories) (Registry and Repositories)
for medical summaries and imaging information !for medical summaries and imaging information !
2008 HIMSS Interoperability Showcase
Featured this year in the Showcase…
• 76 connected applications, 32 IHE profiles76 connected applications, 32 IHE profiles• Secured Health Information Exchange with Secured Health Information Exchange with
broad contentbroad content• Clinical Scenarios, focusing on clinician and Clinical Scenarios, focusing on clinician and
patient access and information sharing patient access and information sharing across the continuum of careacross the continuum of care
• Population Health, Quality and ResearchPopulation Health, Quality and Research• Privacy and SecurityPrivacy and Security• HITSP Interoperability SpecificationsHITSP Interoperability Specifications
Vendors Vendors ConnectedConnected 5151
SupportersSupporters 2222
TotalTotal 7373
• Health information exchange with patient care devicesHealth information exchange with patient care devices• Personal health record solutionsPersonal health record solutions• Financial and administrative systems for billing and claims attachments Financial and administrative systems for billing and claims attachments
(CAQH/CORE)(CAQH/CORE)• Expanded distributed demonstration in an HIE format showing connectivity Expanded distributed demonstration in an HIE format showing connectivity
with vendor boothswith vendor booths
The 2008 Cast:The 2008 Cast:
Visit the Virtual Conference April 23 – 24, 2008
IHE: Proof of Concept – Promotion – Participation
Live Public Demonstrations Walk-Through healthcare scenarios Simulated multi-vendor clinical
Connectathons Proof of concept Annual multi-vendor interoperability tests North America, Europe, Asia
Health Information Exchanges Interoperability: Cross-enterprise Document Sharing
• Cross-Enterprise Document Sharing simplifies clinical data management by defining interoperable infrastructure.
Transparency = Ease of Evolution
• Patients have guaranteed portability and providers may share information without concerns of aggregation errors.Digital Documents = Patients and providers empowerment
• Supports both centralized and decentralized repository architectures. Ease of federation nationally. Flexible privacy, Flexibility of configurations
• Addresses the need for a longitudinal healthcare data (health records). Complements to interactive workflow or dynamic access to data.
How to Use IHE
As a Vendor ImplementerAs a Vendor Implementer• Participate and Implement IHE Integration ProfilesParticipate and Implement 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• Require IHE Integration Profile compliance in RFPsRequire 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