IHE CDA Templates HL7 UK 2007 HL7 UK 2007 Keith W. Boone Keith W. Boone Interoperability Architect, GE Healthcare Interoperability Architect, GE Healthcare Co-chair, IHE Patient Care Coordination TC Co-chair, IHE Patient Care Coordination TC Co-chair, HL7 Structured Documents Co-chair, HL7 Structured Documents Member, ANSI/HITSP CE, CD and PH TCs Member, ANSI/HITSP CE, CD and PH TCs Member, ASTM Member, ASTM
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IHE CDA Templates
HL7 UK 2007HL7 UK 2007Keith W. BooneKeith W. BooneInteroperability Architect, GE HealthcareInteroperability Architect, GE Healthcare
Co-chair, IHE Patient Care Coordination TC Co-chair, IHE Patient Care Coordination TC
Co-chair, HL7 Structured DocumentsCo-chair, HL7 Structured Documents
Member, ANSI/HITSP CE, CD and PH TCsMember, ANSI/HITSP CE, CD and PH TCs
Member, ASTMMember, ASTM
Integrating the Healthcare Enterprise
Electronic Health Record
Cardiology
Laboratory
Radiology
Oncology
Future
Domains
IHE
IT Infrastructure
Patient Care Coordination
Patient Care
Devices
Pathology
Eye Care
1999
2003
2002
2002
2004
2005
2005
20052005
Over 100 vendors and 20 professional societies involved worldwideOver 100 vendors and 20 professional societies involved worldwide6 Technical Frameworks and 70+ integration profiles6 Technical Frameworks and 70+ integration profiles
Testing at Connectathons and Demonstrations at Major Conferences WorldwideTesting at Connectathons and Demonstrations at Major Conferences Worldwide
Patient Care Coordination
• Support profiles addressing integration issues that cross providers, patient problems or time.
• Deals with general clinical care aspects rather than technology infrastructure.
• Addresses workflows and information sharing needs that are common to multiple specialty areas.
• Professional Input from ACP, ACEP, ACOG, HIMSS
A content profile is…
• A sharable information component that can be exchanged…– within an HIE or RHIO (XDS)– via Media or USB Device (XDM)– via Reliable Messages (XDR)
• Document content using standards– CDA Release 2.0– HL7 Care Record Summary– ASTM/HL7 Continuity of Care Document
• Library of Reusable Parts• A Template!
PCC Content ProfilesStandards and Profiles Used
• Standards– ASTM/HL7 Continuity of Care Document– HL7 Care Record Summary– HL7 CDA Release 2.0– XHTML 1.0– XSLT 1.0– LOINC– SNOMED
• IHE Profiles– XDS/XDR/XDM– NAV - Notification of Document Availability– DSG - Document Digital Signature
PCC Content ProfilesKey Technical Properties
• Human Readable
• Machine processable
• Digital Signature Enabled
• Can be shared multiple ways– RHIO or HIE (XDS)– CD or USB Media (XDM)– Point to Point (XDR)
IHE Profiles of HL7 V3
Medical Summaries
ED Referral
ExchangingPHR
Content
AntepartumCare
Summary
EmergencyDepartmentEncounter Summary
BasicPatientPrivacyConsent
LabReport
FunctionalStatus
Assessments
PCCPCC2005-062005-062006-072006-072007-082007-08In
teg
rati
on
Co
nte
nt
(V
3)
(CD
A)
Query for Existing Data
PIX/PDQ V3
ITIITILABLAB
Medical SummariesValue Proposition
• Supports key use cases for transfer of care:– Inpatient to PCP– PCP to Specialist
• Supports Transfer of Encoded– Problems– Medications– Allergies
Emergency Department ReferralValue Proposition
• Nearly 5000 EDs in US• Significant percentage of ED visits are referrals• Shortage of critical health data for emergency
department patients• Need to improve communication of intended
patient care plans to ED providers and ensure that no pertinent data is lost
• Streamline workflow by obviating telephone calls between busy clinicians
Exchange of Personal Health RecordsValue Proposition
• Provides a standards-based specification for managing the interchange of documents between a Personal Health Record and an EHR System to enable better interoperability between these systems.
Antepartum Summary ProfileValue Proposition
• Over 4 million live births per year in US • Obstetric patients must have a complete
summary of antepartum care available for all care providers and at admission for labor and delivery.
• Incomplete information can be a danger to the mother and child and result in injury, inadequate treatment or undesirable outcome.
Functional Status Assessment
Value Proposition• The Institute of Medicine has determined that a high risk
for errors occurs during the transfer of care.• The Functional Status Assessment Profile (FSA)
supports the handoff of assessment information between practitioners during transfers of care, cross-enterprise or intra-enterprise.
• Transfer of physician documentation provides medical assessment, diagnosis and treatment information.
• Transfer of nursing documentation provides assessment and treatment of human response (psychosocial, physiologic, emotional and spiritual) of patient/family to changing conditions.
Emergency Department Encounter SummaryValue Proposition
• The Centers for Disease Control and Prevention (CDC) estimates that there were over 110 million emergency department visits in 2004 in the US
• ED visits account for as much as 40% of hospital admissions
• The ED Chart is the most common medical summary in use today
• This profile supports sharing of the clinical information in the ED chart with inpatient care providers and the patient's primary care physician.
Query for Existing Data Value Proposition
Typical institutions have a large number of interfaces (30 – 60 or more) to manage, at a cost of $10,000 to $20,000 per year per interface. Few HL7 Version 2.X interfaces provide any query capabilities.
Supporting a single standard to query clinical information is expected to reduce the overall costs of hooking together discrete clinical information systems.
Use Cases
Exchange of information between Data Repositories and Clinical Data Consumers for:
1. Drug Safety2. Public Health, Biosurveillance and Disease
Registries3. Identifying Qualifying Patients
1. Clinical Trials2. Disease Management
4. Quality Reporting5. Claims Submission
⋮
[PCC-5]Query Problems and
Allergies
[PCC-2]Query Medications
[PCC-1]Query Vital Signs
[PCC-3]Query Immunizations
[PCC-4]Query Diagnostic Data
Scope• Problems and Allergies
– Disease Registries, EHR Systems
• Vital Signs– Monitoring Systems, EHR Systems
• Diagnostic Results– Laboratory and Radiology
Information Systems, EHR Systems
• Medications– Pharmacy, EHR Systems
• Immunizations– Immunization Registries,
EHR Systems
• Decision Support Systems
Key Technical Properties
• Support for Web Services and SOA Architecture
• HL7 Care Record Query for all queries
• Reuse of PCC Templates
• Compatibility with ASTM/HL7 CCD
Standards Used
HL7 Version 3.0 Care Record DSTU
HL7 Version 3.0 Care Record Query DSTU
ASTM/HL7 Continuity of Care Document (CCD)
Web Services Description Language (WSDL)
Simple Object Access Protocol (SOAP)
Extensible Markup Language (XML)
LOINC
SNOMED
Proposed for 2008
• Focused Care Management– Chronic Disease– Public Health Registries
• Clinical Trials and Adverse Event Reporting• Antepartum Record • Cancer and Immunization Registries• Nursing Note• Pre-hospital (Emergency) Care Report
More information….
• IHE Wiki: http://wiki.ihe.net• IHE Web site: http://www.ihe.net
http://www.himss.org/IHE http://www.rsna.org/IHEhttp://www.acc.org/quality/ihe.htm
• Technical Frameworks• Technical Framework Supplements – Trial Implementation• Non-Technical Brochures :
– Calls for Participation– IHE Fact Sheet and FAQ– IHE Integration Profiles: Guidelines for Buyers– IHE Connect-a-thon Results– Vendor Products Integration Statements
Questions?
Questions?
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