Integrating the Healthcare Enterprise IHE Technical Committee Status IHE ITI Plan Committee - February 2004.

Integrating the Healthcare EnterpriseIHE Technical Committee Status

IHE ITI Plan Committee - February 2004

IHE IT Infrastructure-2004IHE IT Infrastructure-20045 Integration Profiles5 Integration Profiles

Enterprise User Authentication

Provide users a single nameand

centralized authentication process

across all systems

Enterprise User Authentication

Provide users a single nameand

centralized authentication process

across all systems

Retrieve Information for Display

Access a patient’s clinical information and documents in a

format ready to be presentedto the requesting user

Retrieve Information for Display

Access a patient’s clinical information and documents in a

format ready to be presentedto the requesting user

Patient Identifier Cross-referencing

for MPI

Map patient identifiers across independent

identification domains

Patient Identifier Cross-referencing

for MPI

Map patient identifiers across independent

identification domains

Synchronize multiple applications on a desktop to the same patient

Patient Synchronized Applications

Synchronize multiple applications on a desktop to the same patient

Patient Synchronized Applications

Consistent Time

Coordinate time across networked

systems

Consistent Time

Coordinate time across networked

systems

IHE IT Infrastructure – Plan for 2004-2005

• IT Infrastructure Development Plan:• IHE ITI Planning Committee decision:IHE ITI Planning Committee decision: mid-Februarymid-February• Issue Public Comment version: June 2004• Public Comment Due: July 2004• Issue Trial Implementation version: Issue Trial Implementation version: August 2004August 2004• IHE Connectathon: January 2005• HIMSS Demo: HIMSS Demo: February 2005February 2005

• Profiles discussed this week are:• Audit Trail and Node AuthenticationAudit Trail and Node Authentication• Personnel White Page Directory Personnel White Page Directory • Patient Demographics QueryPatient Demographics Query• EHR-Cross-Enterprise Clinical Document SharingEHR-Cross-Enterprise Clinical Document Sharing

IHE Authentication Audit TrailIHE Authentication Audit TrailScope

– Ensures that only permitted system/devices connect to network

Authentication is node-to-node Note: User authentication covered by the EUA profile or local

procedures.

– Support for a central repository of audit information. Facilitates audit review and includes:

General security events such as logins, file access, and detection of unauthorized activity

Healthcare privacy events such as access to patient data and applications.

Imaging privacy/security events such as access to patient images.

IHE Authentication and AuditIHE Authentication and Audit

Key technical properties– Node-to-node authentication uses X.509

certificates, but PKI is not specified by IHE yet.– Audit messages use a standardized XML format

(IETF RFC Pending)– Transport for audit messages may use syslog or

reliable syslog– Backwards compatibility with IHE Radiology (year

2002) is preserved.

Personnel White Pages DirectoryPersonnel White Pages DirectoryScopeScope

WhitePagesServer

Healthcare Staff Info

Provide access to healthcare staff informationProvide access to healthcare staff information to systems in a standard manner. to systems in a standard manner.

Lab Reporting

ElectronicElectronicMedicalMedicalRecordsRecords

Pharma

Healthcare Staff Info

Healthcare Staff Info

Personnel White Pages DirectoryPersonnel White Pages DirectoryTechnical PropertiesTechnical Properties

LDAP based directory location service

LDAP based requests of person info leveraging inetOrgPerson.

Specializes for Healthcare: Contact Info (Phone Numbers, email address, etc), and user interface friendly info (Salutation, First name, Last name, office building, user certificate list-no PKI).

Access certificate revocation list (no use rule defined).

Patient Demographics QueryPatient Demographics QueryAbstract/ScopeAbstract/Scope

Allow quick retrieval of common patient name, identifier, and location in a standard manner at the point of care.

Enable selection of correct patient when full identification data may not be available

Protect patient- and enterprise-sensitive clinical information

Patient Demographics QueryPatient Demographics QueryKey Technical PropertiesKey Technical Properties

Employs HL7 Conformance Based Queries– Defined in HL7 Version 2.5, Chapter 5– Query by Parameter (QBP) with Segment Pattern

Response (RSP)

User enters identifiers for patients of interest Server returns information in HL7 V2.5 patient

data segments.

Introduction:EHR Cross-EnterpriseEHR Cross-EnterpriseClinical Document SharingClinical Document Sharing

First step towards the First step towards the longitudinal dimension of the EHRlongitudinal dimension of the EHR::

Focus:Focus: Clinical Information Exchange between EHRs in Clinical Information Exchange between EHRs in care settings to communicate with a distributed care settings to communicate with a distributed longitudinal EHR.longitudinal EHR.

Goal:Goal: Meet a broad range of EHR-LR (Longitudinal Record) Meet a broad range of EHR-LR (Longitudinal Record) needs with a needs with a distributed, distributed, cross-enterprise, cross-enterprise, document centric document centric

document content generic document content generic

Acute Care (Inpatient)

GPs and Clinics (Outpatient)

Nursing Homes

Other Specialized Care(incl. Diagnostics Services)

Continuity of Care: Patient Longitudinal RecordPatient Longitudinal Record

Typically, a patient goes through a sequence of encounters in different Care Setting

Acute Care (Inpatient)

GPs and Clinics (Outpatient)

Nursing Homes

Other Specialized Careor Diagnostics Services

EHR-LR Integration Profiles: Publishing & Accessing the EHR-LRPublishing & Accessing the EHR-LR

EHR-LR

The EHR-LR (Longitudinal Record) brings together patient encounter information managed by multiple care delivery systems

Care Delivery Process

Selection of informations

Decide toAssess demand For care

Actions to order

Define an action plan

Identification End ofEncounter

Define healthcareObjective

EHR-Solution = EHR-LR (Longitudinal Record) + EHR-CR (Care Delivery Record)

Two types of Integration : EHR-CR: Health Record as used during care deliveryEHR-LR: Health Record as used across-encounters

EHR-CR

Read

EHR-LR EHR-LR

Read

EHR-LR

CreateUpdate

Key Statements:EHR-LR FundamentalsEHR-LR Fundamentals

• Brings together patient encounter information managed by all types of care delivery systems.

• Cross-enterprise, possibly across large geographical regions, and may include many clinical domains.

• Typically collected and retained over a large period of time, providing a deep historic record for the patient.

• Supported by multiple repositories that contribute to the patient’s longitudinal healthcare record.

• Encounter data will very likely include some clinical documents, state and workflow information that will not be stored in the EHR-LR.

Key Statements: What is in the EHR-LR?What is in the EHR-LR?

• The EHR-LR data is made of discrete, persistent, clinical documents accessed by an unique identifier.

• It may also contain other dynamic objects which are not being addressed by IHE at this time.

• Metadata will be provided with each document by the EHR-CR and will be stored in the EHR-LR.

• EHR-LR data formats will follow relevant clinical domain standards defined by field experts. EHR-CR is responsible for converting its internal data formats to the standard EHR-LR documents.

• EHR-LR documents will kept in the EHR-CR or pushed to a separate EHR-LR repository.

Key Statements: IHE EHR Profiles ConstraintsIHE EHR Profiles Constraints

• Although the EHR-LR data domains are primarily clinical, other information and services are needed to provide a complete view of the patient longitudinal record. These include patient demographics, access security, consent policies and others – some have already been addressed by IHE integration profiles.

• The EHR-LR and EHR-CR repositories may be using different Patient Identification numbers. The longitudinal view is made possible by using standard cross-patient identification services (IHE PIX Integration Profile).

• The way data is stored and managed internally by the EHR-CR is out of scope for the EHR-LR IHE Integration Profiles.

Key Statements: Accessing the EHR-LRAccessing the EHR-LR

• EHR-LR shall make available a list of all published documents for a given patient/selection parameters.

• The selection of documents is the responsibility of the EHR-LR and not of the consumer applications. This is possible because of the document metadata kept in the EHR-LR.

• The EHR-LR must ensure full content fidelity for all clinical documents that have been published.

• The actual location of any particular document shall be transparent to the consumer application.

• EHR-CR may provide clinical data by processing, extracting, or combining multiple documents.

Key Statements: Deploying IHE EHR-LR ProfilesDeploying IHE EHR-LR Profiles

• The deployment of EHR-LR integration profiles will initially be focused on a small number of specialties (cardiology, oncology, etc), disease, and/or on key information for continuity of care (e.g. CCR summaries).

• The scope of the EHR-LR profiles will expand progressively as other specialties are included in the use cases.

EHR-CR Source– Healthcare point of service system where clinical

information is first collected EHR-LR Directory

– Index and metadata database for all published clinical documents

EHR-LR Documents Repository– Maintains and stores published EHR-LR documents

EHR-CR Consumer– Application system that needs access to EHR-LR

documents and information

EHR-LR Integration Profile: Key Actors (Application Roles)Key Actors (Application Roles)

Integration Model 1: EHR-LR with Source RepositoryEHR-LR with Source Repository

1. An EHR-CR completes a phase of care for a patient where it:

1. Registers documents with an EHR-LR Directory actor.

2. Keeps these documents in an EHR-LR Repository actor.

2. Any other EHR-CR may query an EHR-LR Directory actor, find out about documents related to all phases of care for the patient and chose to retrieve some of these documents from any EHR-LR Repository Actor (Used in use Case 1 & 2).

EHR-CRSource

EHR-LRDirectory

EHR-LRRepository

EHR-LRConsumer

Register

Retrieve

Query

Integration Model 2:EHR-LR with Third Party RepositoryEHR-LR with Third Party Repository

1. An EHR-CR completes a phase of care for a patient where it:

1. Registers documents with an EHR-LR Directory Actor.

2. Provides these documents to an EHR-LR Repository Actor.

2. Any other EHR-CR may query an EHR-LR Directory Actor, find out about documents related to all phases of care for the patient and chose to retrieve some of these documents from any EHR-LR Repository Actor (Used in use Case 1 & 2).

EHR-CREHR-CRSourceSource

EHR-LREHR-LRDirectoryDirectory

EHR-LREHR-LRRepositoryRepository

EHR-LR EHR-LR ConsumerConsumer

Register

Retrieve

Query

Provide-Transfer

EHR-CR EHR-CR ConsumerConsumer

Integration Model 3: Direct Patient Transfer-Referral Direct Patient Transfer-Referral

1. An EHR-CR completes a phase of care for a patient where it:

• Registers and Provides an EHR-CR Recipient Actor that a specific set of documents (newly created and priors of interest documents) are available from an EHR-LR Repository

2. The EHR-CR Recipient Actor receive both the registration and the documents.

EHR-CREHR-CRSourceSource

Register

Provide-Transfer

EHR-LREHR-LRDirectoryDirectory

EHR-LREHR-LRRepositoryRepository

Conclusion:Conclusion:EHR Cross-Enterprise Document SharingEHR Cross-Enterprise Document Sharing

• Leverages HL7 CDA (Clinical Document Architecture) and ASTM CCR (Continuity of Care Record).

• The proposed strategy addresses one of the key integration problems in the realization of the EHR vision. IHE does not claim to master and address the definition and all aspects of a complete and interoperable EHR System.

• In collaboration with well established standards bodies and other EHR related initiatives world-wide (EHRCOM, CCR, HL7, etc.), IHE expects to contribute at a more cost-effective and rapid deployment.

IHE IT Infrastructure

• To join IT Infrastructure planning or technical committee:

• Contact Joyce Sensmeier, HIMSS. [email protected]

• Suggest new profiles to IHE IT Infrastructure Planning

• Produce new profiles in IHE IT Infrastructure Technical Committee