March 17, 2005IHE and medical Standards in Denmark 1 Integrating the Healthcare Enterprise What is IHE ? Charles Parisot, GE Healthcare IHE IT Infrastructure.

March 17, 2005 IHE and medical Standards in Denmark1

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

What is IHE ?

Charles Parisot, GE Healthcare

IHE IT Infrastructure Technical Committee Co-chair

IHE Europe Committee

Copenhagen, March 17th 2005Copenhagen, March 17th 2005


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


Connecting Standards to CareConnecting Standards to Care

Care providers must work with industry to coordinate the implementation of standards to meet their needs Care providers need to identify the key

interoperability problems they face Drive industry to develop and make available

standards-based solutions Implementers need to follow common guidelines in

purchasing and integrating systems that deliver these solutions

What is the effective way to establish those

“standards” for how to implement standards ?


Need for a Standards Implementation ProcessNeed for a Standards Implementation Process

UserProjects

DemandDemand

StandardsStandards ?OfferOfferStandardsStandardsStandardsStandards


Goals of IHEGoals of IHESpeed up the rate and quality of integration in healthcare environments

Foster communication among vendors and care providers (the implementors)

Prove that integration is attainable based on standards

Improve the efficiency and effectiveness of clinical practice

Improve interoperability among care domains and build foundation for the EHR

Integration solutions within the healthcare enterprise and across healthcare enterprises


Understanding the IHE InitiativeUnderstanding the IHE Initiative

IHE has a clear focus

IHE is a healthcare domain-based initiative

IHE creates synergies for interoperability testing across domains

IHE addresses the standards adoption process

IHE is both regional and multi-national

IHE is both user lead and vendor driven


IHE: Domain-based for a stepwise approachIHE: Domain-based for a stepwise approach

CardiologyCardiologyLabora-Labora-ttoryory

Pharmacy,…..Pharmacy,…..RadiologRadiologyy

Patient Identifier Linkage, Registries, SecurityPatient Identifier Linkage, Registries, Security

Electronic Health RecordElectronic Health Record

Other (e.g. Access Control, eHealthWorkflows)Other (e.g. Access Control, eHealthWorkflows)

Patient ManagementPatient Management

Order ManagementOrder Management


IHE

EHR- Longitudinal Record

IHE Cardiology

IHE Laboratory

IHE Radiology

IHE

Oncology

IHE

Future Domains

IHE

IT Infrastructure Intra-Enterprise

Cross-Enterprise

14 Integration Profiles




IHE 2005 – Five Active Domains IHE 2005 – Five Active Domains

4 Technical Frameworks with 27 Integration ProfilesTesting at yearly Connectathons in three continents

Demonstrations at major conferences world-wide

Provider-Vendor cooperation to accelerate standards adoption

Patient Care CoordinationSurgery, Pharma, Quality


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 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

IHE Connect-a-thonResults


IHE ProcessIHE ProcessUsers identify desired functionality that require coordination and communication among multiple systems E.g., departmental workflow, single sign-on, sharing of documents

Find and document standards-based transactions among systems to achieve desired functionality Apply necessary constraints to eliminate useless wiggle room

Provide process and tools to encourage vendors to implement MESA software test tools + Connect-a-thon interoperability testing event

Provide tools and education to help users acquire and integrate systems using these solutions Connect-a-thon results and public demonstrations Integration statements


IHE Contributors & ParticipantsIHE Contributors & ParticipantsSocieties Representing Healthcare Segments EAR, GMSIH, ESC, RSNA, SFIL, HIMSS, ACC, Many Other

Professional Societies… Any Healthcare Stakeholder Organization

Users Clinicians, Medical Staff, Administrators, CIOs, …

Information Systems & Equipment (e.g. imaging) Vendors

Consultants

In addition, active liaison with Standards Development Organizations (SDOs) HL7, DICOM, CEN, NCCLS, ISO, others …


IHE Organizational StructureIHE Organizational Structure

IHE Europe

IHE North America

France

USA Canada

IHE Asia

Japan

KoreaTaiwan

Netherlands Spain Sweden

UKItalyGermany

Norway

Regional Deployment

CardiologyPlanning Committee

CardiologyTechnical Committee

RadiologyPlanning Committee

RadiologyTechnical Committee

IT InfrastructurePlanning Committee

IT InfrastructureTechnical Committee

Pharmacy ExploratorySub-Committee

Global Development

CardiologyPlanning Committee

CardiologyTechnical Committee

LaboratoryPlanning and Technical

Committee

IHE Strategic Development Committee

ACC ITAC/CHITTAHIMSS CHIRSNA CAR

JAHISJIRAJRS

METI-MLHWMEDIS-DCJAMI

GMSIHSFRSFIL

SIRMBIREuroRec

COCIREAR-ECRDRG

ESCProfessional Societies / SponsorsProfessional Societies / Sponsors Contributing and participatingContributing and participating

VendorsVendors

Denmark


IHE Process – 20 month yearly cycleIHE Process – 20 month yearly cycleDevelopmentDevelopment and and DeploymentDeployment

- 10 ---

- 7 ---

- 2 ---Public Comment Intgr-profile

Trial Implementation Intgr-profile 0 ---

Sponsors announce Connectathon/Demos with set of

Implementation Profiles

Connectathon/Demo Vendor Participant Registered

+ 2 ---

Vendor Participant passed Connectathon

+ 5 ---

+ 6 --- Demo &Education Material

Final Intgr-profile + 9 ---Vendors release products

with IHE Integration Statements

---

Approved Supplement Scope

Proposed Supplement Scope


What IHE is NOT!What IHE is NOT!

A standards development organization Uses established standards (HL7, DICOM, others)

to address specific clinical needs Activity complementary to SDOs, formal

relationship with HL7, ISO, DICOM, NCCLS, etc.

Simply a demonstration project Demos, only one means to the end—adoption Backed up by documentation, tools, testing, and

publication of information


IHE Technical FrameworksIHE Technical Frameworks


Key IHE ConceptsKey IHE Concepts• Generalized Systems Generalized Systems -> -> ActorsActors

• Interactions between Actors Interactions between Actors -> -> TransactionsTransactions

• Problem/Solution ScenariosProblem/Solution Scenarios -> -> IntegrationIntegration ProfilesProfiles

• For each Integration Profile:For each Integration Profile:

• the context is described (which real-world problem)the context is described (which real-world problem)

• the actors are defined (what systems are involved)the actors are defined (what systems are involved)

• the transactions are defined (what must they do)the transactions are defined (what must they do)


11stst key concept: key concept: ActorActorRepresents a set of application roles and responsibilities performed by a system

Always supported by a real-world system

A real-world system may support several IHE Actors

Examples: Order Placer Order Filler Patient Admission, Discharge and Transfer (ADT) Laboratory Automation Manager Point Of Care Analyzer

IHE leaves the definition of products to users and vendors


22ndnd key concept: key concept: TransactionTransactionA set of interactions or

messages defined between

two Actors for a specific

task.

Defines unambiguously how

the Actors must cooperate

to achieve this task.

Using existing standards

such as HL7, DICOM, NCCLS

etc.

Order Placer

Order Filler

New order

Order accepted

Battery replaced

Acknowledgement

Status change

Acknowledgement

Example: Transaction LAB-1

« Placer order management »

Order Placer

Order Filler

→ Placer order management [LAB-1]

IHE defines transactions at a user-level workflow


33rdrd key concept: key concept: Integration ProfileIntegration Profile

Examples:

Enterprise User Authentication

Retrieve Information for Display

Laboratory Scheduled Workflow

Echo Laboratory Workflow

Cross-Enterprise Document Sharing

Referenced standard

(e.g. HL7)Detailed messaging info --------------------------Roles

Integration Profile

Actor Actor Actor…

Tra

nsac

tion

Tra

nsac

tion

Tra

nsac

tion

Tra

nsac

tion

Tra

nsac

tion

………

Solves an Integration Problem: A collection of real world information exchange capabilities supported by a set of specific Actors using Standards-based Transactions


The Product World…..The Product World…..

Product XYZfrom Vendor T


The IHE World….The IHE World….

IHE ActorIHE Actor

ActorActorActorActor

ActorActor

IHEIHETransactionTransactionIHEIHE

TransactionTransaction

IHEIHETransactionTransaction

IHE ActorIHE Actor


Mapping IHE to ProductsMapping IHE to Products

Product XYZfrom Vendor T

IHE ActorIHE Actor

ActorActorActorActor

ActorActor

IHEIHETransactionTransactionIHEIHE

TransactionTransaction

IHEIHETransactionTransaction

IHE ActorIHE Actor


IHE ConnectathonIHE Connectathon

Open invitation to vendor community

Advanced testing tools (MESA)

Testing organized and supervised by project management team

Thousands of cross-vendor tests performed

Results recorded and published


Massive yearly events :Massive yearly events :40-50 vendors40-50 vendors120-160 engineers120-160 engineers70-80 systems70-80 systems…….integrated in 5 days.integrated in 5 days

IHE ConnectathonsIHE Connectathons

Vendors do not pass…Vendors do not pass…until an IHE Project Manager attest it !until an IHE Project Manager attest it !



Integration StatementsIntegration Statements


Leveraging IHE Integration Leveraging IHE Integration StatementsStatements

Vendors Claim IHE Compliance in an explicit way Can rely on an objective and thorough specification

(IHE Technical Framework) Willing to accept contractual commitments Willing to correct “implementation errors”

Buyers Can compare product integration capabilities Simplify and strengthen their RFPs Can leverage a public and objective commitment Decreased cost and complexity of interface deployment and

management


Participating and Contributing Vendors (Europe)Participating and Contributing Vendors (Europe)AGFA HealthcareAISoftw@re Medical SolutionsAlgotec ARES SA aycan Digitalsysteme ConVisDEDALUSDianoemaEastman Kodak Company Ebit SanitaEDL ELFIN s.r.l. Engineering Sanità Enti LocaliESAOTEETIAM Ferrania Fujifilm GE HealthcareGMD GIE Convergence-Profils

Rogan-Delft

Sago spa

Sectra Imtec AB

Siemens Medical Solutions

Soluzioni Informatiche srl

Stentor Inc.

Swissray Medical AG

Symphonie On Line

Synapsis

TELEMIS S.A.

TIANI MEDGRAPH AG

TOREX GAP Medical

Toshiba Medical Systems

TSI groupe europMedica

VEPRO AG

VISUS Technology Transfer

WAID

XR PARTNER

GWI Research

IASI Srl

IdeoPass

Image Device-Cerner Company

INFINITT

INOVIT

McKesson

MED2RAD

MEDASYS SA

Medavis

Medigration GmbH

MEDIMON Ltd.

MEDOS AG

Merge eFilm

METAFORA

Konica Minolta Europe

Omnilab

Philips Medical Systems

Rasna Imaging Systems

RAYPAX INC.

In yellow, companies with IHE Committees Chairs (Summer 2004)


Participating and Contributing Vendors (America)Participating and Contributing Vendors (America)Agfa HealthCare

Algotec Systems, Ltd.

Berdy

Camtronics

Canon Medical Systems

Carefx

Cedara Software Corporation

Cerner Corporation

CSIST

Dictaphone

DR Systems

Dynamic Imaging

Eastern Informatics

Eastman Kodak Company

Emageon

Eclipsys

Fujifilm Medical Systems

Procom

Philips Medical Systems

RASNA Imaging Systems

Sectra

Sentillion

Siemens Medical Solutions

Softmedical

Stentor, Inc

StorCOMM, Inc

Swissray International, Inc

Tiani Medgraph AG

Toshiba America Medical Systems

UltraVisual Medical Systems

Vital Images, Inc.

Voxar Limited

WebMD

XIMIS

GE Healthcare

Heartlab

Hitachi Medical Corporation

Hologic, Inc

IDX Systems Corporation

IMCO Technologies

InSiteOne

INFINITT

Konica Minolta

Marotech, Inc.

McKesson Information Solutions

Medcon

Medical Manager Health Systems

Mediface Co., Ltd.

Merge eFilm

Mortara

In yellow, companies with IHE Committees Chairs (Summer 2004)


Participating and Contributing Vendors (Asia)Participating and Contributing Vendors (Asia)Japan

AGFA Gevaert JapanEBM JapanINFINITT JapanA&TCanonGoodmanClimb Medical SystemsKonica Minolta MGShimadzuSONYToshiba Medical SystemsToyo TechnicaNihon KohdenOlympusNECPioneer (Marotech)HitachiHitachi MedicoFujitsuFuji Film MedicalYokogawa

TaiwanINFINITTShing ShianINQ GENTEPTah Ya

KoreaAGFA Korea GE Healthcare KoreaINFINITTLG CNS Marotech, Inc.Medical StandardPeoplenet CommunicationsSamsung SDS


IHE

EHR- Longitudinal Record

IHE Cardiology

IHE Laboratory

IHE Radiology

IHE

Oncology

IHE

Future Domain

IHE

IT Infrastructure Intra-Enterprise

Cross-Enterprise


1 Integration Profile



Achievements and expanding scopeOver 100 vendors involved world-wide, 4 Technical Frameworks

27 Integration Profiles, Testing at yearly Connectathons,Demonstrations at major exhibitions world-wide

To claim compliance to IHE Integration Profiles vendors shall publish for each product an IHE Integration Statement.

Patient care Coordination, Quality, Pharmacy, Anatomical Pathology, Surgery, etc.


IHE Radiology Integration ProfilesIHE Radiology Integration Profiles

Patient Info.

Recon-ciliation

Access to Radiology Information

Consistent Present-ation of Images

Basic Security

-

EvidenceDocs

KeyImageNotes

Simple Image & Numeric Reports

Presentation of Grouped Procedures

Post-

Processing Workflow

Reporting Workflow

Charge Posting

Scheduled Workflow

Portable Data for Imaging

NMImage

New

Extensions

New


imagesstored

patientinformation

RIS

examination orders

imagesretrieved

HIS

PACS

procedurescheduled

Prefetch any relevantprior studies

modalityworklist

report

report

Scheduled Workflow ProfileScheduled Workflow Profile

Registration

Orders Placed

Orders Filled

Film

FilmFolder

Image Manager& Archive

FilmLightbox

report ReportRepository

DiagnosticWorkstation

Modality

acquisitionacquisitionin-progressin-progressacquisitioncompleted

acquisitioncompleted

imagesprinted

AcquisitionModality


““Departmental Actors” in SWFDepartmental Actors” in SWF

Query Images [14] Retrieve Images [16]

Image Display

Storage Commitment [10]

Modality Image Stored [8] Storage Commitment [10]

Creator Images Stored [18]

Procedure Scheduled [4] Image Availability Query [11] Procedure Updated [13] Performed Work Status Update [42] Performed Work Status Update [42]

Modality Worklist Provided [5]

Evidence Creator

Performed Procedure

Step Manager

Modality PS in Progress [6] Modality PS Completed [7] Creator PS in Progress [20] Creator PS Completed [21]

Modality PS in Progress [6] Modality PS Completed [7] Creator PS in Progress [20] Creator PS Completed [21]

Modality PS in Progress [6] Modality PS Completed [7]

Creator PS in Progress [20] Creator PS Completed [21]

Acquisition Modality

Image Manager

Image Archive

DSS/ Order Filler

IHE Actors:DSS / Order Filler

PPS Manager

Image Manager /Archive

Acquisition Modality

Evidence Creator

Image Display


Example of Radiology Use CasesExample of Radiology Use CasesLocal policy calls for ADT to pre-register ER patients (“John Doe”, “Jane Doe”): Case 1: Unidentified Patient registered at ADT

and order is placed at Order Placer. Case 2: Unidentified Patient registered at ADT

and order is placed at DSS/Order Filler. Case 3: Unidentified Patient registered at ADT but

acquisition completed at Modality prior to order.


Unidentified Patient - Case 3Unidentified Patient - Case 3ADT

Order

Placer

Image

ManagerModality

Department SystemDatabase/Scheduler/

Order Filler

Filler Order Mgmt

New Order [3]

Procedure

Scheduled [4]

Patient Reconciliation

J.Doe -> J.Smith

Patient

Update [12]

Schedule Procedure

Images

Acquired

Modality Procedure

Step Completed [7]

Modality Procedure

Step Completed [7]

Register J.Doe

Patient

Update [12]

Patient

Registration [1]


Laboratory IHE Integration ProfilesLaboratory IHE Integration Profiles

Laboratory Device Automation (LDA)

In Process –TI Nov 2004In Process –TI Nov 2004

Pre-analytic process, analysis and post-analytical treatment

Laboratory Scheduled Workflow (LSWF)Completed in 2003Completed in 2003

Tests performed by a laboratory for an identified

inpatient or outpatient

Laboratory Patient Information Reconciliation (LPIR) In ProcessIn Process

Tests performed on an unidentified or misidentified patient

Laboratory Code Set Distribution (LCSD) In ProcessIn Process

Sharing the batteries and tests code sets throughout the enterprise

Laboratory Point Of Care Testing (LPOCT) In Process –TI Nov 2004In Process –TI Nov 2004

Tests performed on point of care or patient’s bedside

In Dev.

In Dev.

In Dev.

In Dev.


IHE Cardiology 2004-2005IHE Cardiology 2004-2005


Access a patient’s clinical information and documents in a format ready to be

presentedto the requesting user

EchoCardiography Worklflow

Admit, order, schedule, acquire images, notify of completed

steps, on fixed and mobile stress echo modalities.

Cardiac Catheterization Workflow

Scheduled & unscheduled acquisition and management of cathlab information, notification

of completed steps.

Provide high-quality ECG and related reportsto the enterprise and outside in a ready-to-display format

Retrieve ECG for Display

New

New

New


IHE IT Infrastructure 2004-2005IHE IT Infrastructure 2004-2005

Enterprise User AuthenticationEnterprise User Authentication

Provide users a single nameand centralized authentication

processacross all systems


Access a patient’s clinical information and documents in a

format ready to be presentedto the requesting user


Access a patient’s clinical information and documents in

a format ready to be presented

to the requesting user

Patient Identifier Cross-referencing

for MPIMap 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

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

Patient Demographics Query New

Personnel White PageAccess to workforcecontact information

New


Registration, distribution and access across health enterprises of clinical

documents forming a patient electronic health record

New


Imaging Information Content

Format of the Document Content and associated coded vocabulary

Simple Document Content


For Display Document Content

Format of the Document ContentLab Results Document Content


IHE Integration Profiles for a IHE Integration Profiles for a “Regional/National Health Info Organization”“Regional/National Health Info Organization”

Includes Integration Profiles in development in 2005Includes Integration Profiles in development 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


Registration, distribution and access across health enterprises of clinical

documents forming a patient electronic health record

User Identity, Authentication and

Permissions

Enable Basic Access Control

Cross-Enterprise Notification

Notification of a remote provider/ health enterpriseContinuity of Care

Document ContentFormat of the Document Contentand associated coded vocabulary


Interoperability within the Enterprise,Interoperability within the Enterprise,

As well as,As well as,

Interoperability Across Care SettingsInteroperability Across Care Settings More on this, in this afternoon presentation….


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, 2005IHE and medical Standards in Denmark 1 Integrating the Healthcare Enterprise What is IHE ? Charles Parisot, GE Healthcare IHE IT Infrastructure.

Documents

standards standards

ihe initiative ihe

domains ihe

heart of ihe

products ihe

stability ihe

medical standards

ge healthcare ihe