March 17, 2005 IHE and medical Standards in De nmark 1 Integrating the Healthcare Enterprise Enterprise IHE for cross- enterprise interoperability Charles Parisot, GE Healthcare IHE IT Infrastructure Technical Committee Co-chair IHE Europe Committee Copenhagen, March 17th 2005 Copenhagen, March 17th 2005
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March 17, 2005IHE and medical Standards in Denmark 1 Integrating the Healthcare Enterprise IHE for cross-enterprise interoperability Charles Parisot, GE.
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March 17, 2005 IHE and medical Standards in Denmark1
Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise
IHE for cross-enterprise interoperability
Charles Parisot, GE Healthcare
IHE IT Infrastructure Technical Committee Co-chair
IHE Europe Committee
Copenhagen, March 17th 2005Copenhagen, March 17th 2005
March 17, 2005 IHE and medical Standards in Denmark2
W W W . I H E . N E TW W W . I H E . N E T
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
W W W . I H E – Europe. o r gW W W . I H E – Europe. o r g
March 17, 2005 IHE and medical Standards in Denmark3
Prof. Societies Sponsorship
Healthcare Providers & Vendors
Healthcare IT Standards HL7, DICOM, etc.
General IT Standards Internet, ISO, etc.
Interoperable Healthcare IT Solution Specifications
IHE Integration Profile Interoperable Healthcare IT
Solution Specifications IHE Integration Profile
Interoperable Healthcare IT Solution Specifications
IHE Integration Profile Interoperable Healthcare IT
Solution Specifications IHE Integration Profile
IHE Process
IHE drives healthcare standards based-integration IHE drives healthcare standards based-integration
March 17, 2005 IHE and medical Standards in Denmark4
A Proven Standards Adoption ProcessA Proven Standards Adoption Process
IHEIntegrationProfiles B
IHEIntegrationProfile A
Easy toIntegrateProducts
IHEIHEConnect-a-thonConnect-a-thon
ProductWith IHE
IHEIHEDemonstrationDemonstration
User Site
RFPRFP
StandardsStandards
IHETechnical
Framework
Product IHE IntegrationStatement
IHE Connect-a-thonResults
IHE Integration Profiles at the heart of IHE : Detailed selection of standards and options each solving a specific integration problem A growing set of effective provider/vendor agreed solutions Vendors can implement with ROI Providers can deploy with stability Process started in1998 with continuous improvements
March 17, 2005 IHE and medical Standards in Denmark5
Enables the seamless information sharing Enables the seamless information sharing between healthcare IT systems (e.g. EHRs) between healthcare IT systems (e.g. EHRs)
servingserving all types of care delivery all types of care delivery organizations in a region or nation.organizations in a region or nation.
March 17, 2005 IHE and medical Standards in Denmark8
community
Clinical Encounter
Clinical IT System Index of patients records(Document-level)
1-Patient Authorized
Inquiry
Temporary Aggregate Patient History
4-Patient data presented to
Physician
Sharing SystemSharing System
3-Records3-RecordsReturnedReturned
Referenceto records
Laboratory Results Specialist Record
Hospital Record
2-Referenceto Records for Inquiry
Sharing records that have been publishedSharing records that have been published
March 17, 2005 IHE and medical Standards in Denmark9
Acute Care (Inpatient)
PCPs and Clinics (Ambulatory)
Long Term Care
Other Specialized Careor Diagnostics Services
Building and accessing DocumentsBuilding and accessing Documents
EHR-CR: EHR-CR: Care RecordCare Record systems systemssupportingsupporting care delivery care delivery
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XDS – Value PropositionXDS – Value PropositionFoundation for Health IT Infrastructures: Shared Electronic Health Record, in a community, region, etc.
Effective means to contribute and access clinical documents across health enterprises.
Scalable sharing of documents between private physicians, clinics, long term care, pharmacy, acute care with different clinical IT systems.
Easy access: Care providers are offered means to query and retrieve clinical documents of interest.
March 17, 2005 IHE and medical Standards in Denmark11
XDS - Value PropositionXDS - Value PropositionDistributed: Each Care delivery organization “publishes” clinical information for others. Actual documents may remain in the source EHR-CR.
Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain (e.g. an RHIO).
Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (HL7-CDA, PDF, DICOM, etc.)
Document Content Neutral: Document content is processed only by source and consumer IT systems.
Standardized Registry Attributes: Queries based on meaningful attributes ensure deterministic document searches.
March 17, 2005 IHE and medical Standards in Denmark12
XDS DocumentXDS Document
A set of attested clinical information (structured or not) which A set of attested clinical information (structured or not) which form an element of a patient record to be shared. It may form an element of a patient record to be shared. It may already exist within the source IT system.already exist within the source IT system.
XDS Submission SetXDS Submission Set
A set of documents related to a patient that a (team of) A set of documents related to a patient that a (team of) clinician(s) in the same source system have decided to make clinician(s) in the same source system have decided to make available to potential consumers.available to potential consumers.
XDS FolderXDS FolderA means to group documents for a number of other reasons:A means to group documents for a number of other reasons:
Team work across several physicians,Team work across several physicians,
Episode of care, Episode of care,
Emergency information for a patient, etc.Emergency information for a patient, etc.
XDS leaves open the use of folders to affinity domain clinicians.XDS leaves open the use of folders to affinity domain clinicians.
IHE XDS Integration Profile: Key ConceptsKey Concepts
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Document Consumer
Retrieve Document
Query Documents
Patient Identity Source
Patient Identity Feed
Document Source
Document Registry
Document Repository
Provide & Register Document Set
Register Document Set
XDS Actors and TransactionsXDS Actors and Transactions
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Secured Node
Document Consumer
Retrieve Document
Query Documents
Patient Identity Source
Patient Identity
Feed
Document Source
Document Registry
Document Repository
Provide&RegisterDocument Set
RegisterDocument Set
Secured Node
Secured Node
Secured Node
Secured Node
Secured Node
ATNA creates a secured domain:• User Accountability (Audit trail)
• Node-to-Node Access Control
• Node-level user authentication
• User access control provided by node BUT Registry/repository based User-Level Access Control and policy agreements is beyond XDS..
Security for XDSSecurity for XDSLeverages IHE Audit Trail & Node Authentication
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Integration Model 1: EHR-CR with Repository at SourceEHR-CR with Repository at Source An EHR-CR completes a phase of care for a patient where it:
Has these documents available as Repository Actor.
Registers documents with a Registry actor.
Any other EHR-CR may query the Registry actor, and chose to retrieve some of these documents from any Document Repository Actor.
EHR-CR
Register
4 Retrieve
3 Query
2
Document Source Document Consumer
Document Repository
Document Registry
EHR-CR
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Integration Model 2:EHR-LR with Third Party RepositoryEHR-LR with Third Party Repository An EHR-CR completes a phase of care for a patient where it:
Provides the documents to a Repository Actor of its choice.
Documents are Registered with a Registry Actor.
Any other EHR-CR may query the Registry actor, and chose to retrieve some of these documents from any Document Repository Actor.
EHR-CR
2 Register
4 Retrieve
3 Query
Document Source
Document Consumer
Document Repository
Document Registry
EHR-CR
1 Provide & Register
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Integration Model 3: EHR-CR feed a EHR-CR/EHR-LR hubEHR-CR feed a EHR-CR/EHR-LR hubAn EHR-CR completes a phase of care for a patient where it:
Provides and Registers a set of documents to a Document Repository in an EHR-CR.
The EHR-CR Consumer Actor has the documents and may respond to queries and provide them to other document consumers.
Document Source
Document Consumer
Document Repository
Document Registry
EHR-CR
1 Provide & Register
EHR-CR
March 17, 2005 IHE and medical Standards in Denmark19
Patient Access also possiblePatient Access also possible
A patient accesses own record:
Query and Retrieve a set of documents using for example a portal application that offers the ability to display documents’ content.
This is a particular case of an EHR-CR, where the patient is interested her/his own care. Patient may also register and provide documents.
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Standards selection for IHE XDSStandards selection for IHE XDSNo single standard can address
Cross-enterprise Document Sharing
Marriage of healthcare standards facilitates implementation and leverages complementary
technologies (e.g. security & privacy).
HealthcareContent Standards
HL7 CDA, CEN EHRcomHL7, ASTM CCR
DICOM, etc.
Internet StandardsXML, HTTP,
ISO, etc.
Electronic BusinessStandards
ebXML Registry, ebMS, SOAP, etc.
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How real is XDS ?How real is XDS ?Specification work since Nov 2003Specification work since Nov 2003
Under Public Comments June-July 2004Under Public Comments June-July 2004
Stable specification IHE Technical Framework Published Aug 15Stable specification IHE Technical Framework Published Aug 15 thth, , 2004 (TI Supplement)2004 (TI Supplement)
IHE Connectathon - January 2005 (USA)IHE Connectathon - January 2005 (USA) 14 Vendors passed14 Vendors passed
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IHE Profiles for a RHIOIHE Profiles for a RHIOAvailable Integration Profiles completedAvailable Integration Profiles completed
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical
documents forming a patient electronic health record
New
Patient Identifier Cross-referencing
Map patient identifiers across independent identification
domains
Patient Demographics QueryNew
2004
Consistent TimeCoordinate time across
networked systems
Audit Trail & Node Authentication
Centralized privacy audit trail and node to node authentication
to create a secured domain.
New
2004
Personnel White PageAccess to workforcecontact information
New
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IHE Profiles for RHIOsIHE Profiles for RHIOs What is available and what will be added in 2005What is available and what will be added in 2005
Patient Identifier Cross-referencing
Map patient identifiers across independent identification
domains
Consistent TimeCoordinate time across
networked systems
Audit Trail & Node Authentication
Centralized privacy audit trail and node to node authentication
to create a secured domain.
Patient Demographics Query
Personnel White PageAccess to workforcecontact information
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical
documents forming a patient electronic health record
Notification of Document Availability
Notification of a remote provider/ health enterprise
Cross-enterprise User Identity and
Accountability
Authentication & Auditing: Basis for Access Control
Imaging Information Content
Format of the Document Content and associated coded vocabulary
For Display Document Content
Format of the Document ContentLab Results Document Content
Format of the Document Content and associated coded vocabulary
Continuity of Care Document Content
Format of the Document Contentand associated coded vocabulary
March 17, 2005 IHE and medical Standards in Denmark27
IHE and HL7 V3IHE and HL7 V3Continuity of Care Document Content
Format of the Document Contentand associated coded vocabulary
IHE relies only on approved standards.
HL7 V2 is widely used. Official relation with HL7, effective cooperation with HL7 affiliate world-wide.
Early 2005, foundations elements of HL7 V3 have been approved, but only a few “application level” are.
One of this element based on HL7 V3 based on the RIM has been approved in January 2005: CDA Release 2 (nothing to do with HL7V2).
IHE considers that HL7 CDA based on HL7-V3-RIM as the strategic means to introduce HL7V3 in the real world.
In 2005, IHE is developing in cooperation with HL7 an integration profile for “care record summary”. It will allow the sharing with XDS of the basic care information in a form both structured and human displayable in a consistent manner.
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Using « an e-mail notification that need not be secured» to turn a Pull Model into a like Push Model.
4 Retrieve
3 QueryDocument
Source DocumentConsumerDocument
Repository
Document Registry
NotificationNotification
Register
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Local & Regional RHIOs Infrastructure Local & Regional RHIOs Infrastructure and Interoperabilityand Interoperability
Cross-Enterprise Document Sharing (XDS) minimizes clinical data management by the infrastructure. Transparency = Ease of Evolution
XDS works with other IHE Integration Profiles: Audit Trail and Node Authentication (ATNA) and Consistent Time (CT) Patient Id Cross-referencing (PIX) Patient Demographics Query (PDQ)
In 2005, IHE plans to finish base set of integration profiles to build regional health networks and interoperable EHRs: Security: Identity Management+ Accountability Content Profiles: DICOM, HL7-CDA-r2/CCR, HL7-Lab, PDF. Notification of Document Availability (with XDS document reference)
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