September, 2005What IHE Delivers 1 Didi Davis, Director of IHE, HIMSS National Committee on Vital and Health Statistics (NCVHS) July 27, 2006 IHE Testimony.

1September, 2005 What IHE Delivers

Didi Davis, Director of IHE, HIMSSDidi Davis, Director of IHE, HIMSS

National Committee on Vital and Health National Committee on Vital and Health Statistics (NCVHS) Statistics (NCVHS)

July 27, 2006July 27, 2006

IHE Testimony IHE Testimony

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Connecting standards to healthcare deliveryConnecting standards to healthcare delivery

Care providers work with vendors to Care providers work with vendors to coordinate the implementation of standards coordinate the implementation of standards to meet their needsto meet their needs Care providers identify the key interoperability Care providers identify the key interoperability

problems they faceproblems they face Drive industry to develop and make available Drive industry to develop and make available

standards-based solutionsstandards-based solutions Implementers follow common guidelines in Implementers follow common guidelines in

purchasing and integrating systems that deliver these purchasing and integrating systems that deliver these solutionssolutions

IHE, effective way to establish those IHE, effective way to establish those

“standards” for how to implement standards“standards” for how to implement standards

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What is What is Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise??

IHE provides a IHE provides a common frameworkcommon framework for passing for passing health information seamlessly:health information seamlessly: withinwithin the healthcare enterprise the healthcare enterprise acrossacross multiple healthcare enterprises multiple healthcare enterprises for local, regional & nationalfor local, regional & national health information networkshealth information networks

IHE is sponsored by IHE is sponsored by healthcare professional healthcare professional associationsassociations: HIMSS, RSNA, ACC, ACP, ACCE, : HIMSS, RSNA, ACC, ACP, ACCE, ESC, SFR, BIR, GMSIH, etc.ESC, SFR, BIR, GMSIH, etc.

IHE IHE drives standards adoptiondrives standards adoption to address specific to address specific clinical or administrative needsclinical or administrative needs

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IHE Organizational StructureIHE Organizational StructureMulti-Domain & Multi-NationalMulti-Domain & Multi-National

IHE Organizational StructureIHE Organizational StructureMulti-Domain & Multi-NationalMulti-Domain & Multi-National

Participants

contribute

Global Development:Radiology,IT Infrastructure,Cardiology,Lab, etc.

Delegates

IHE Europe

IHE North America

IHE Asia/Oceania

Regional &NationalDeployment

supervises reports

IHE (International) Strategic Development Committee

SponsorCo-Chairs

Global

Interoperability

IHE Domain-related Planning and

Technical Committees

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Proven Standards Adoption ProcessProven Standards Adoption Process

Document Use Document Use Case Case RequirementsRequirements

Document Use Document Use Case Case RequirementsRequirements

Identify available Identify available standards (standards (e.g. HL7, e.g. HL7, DICOM, IETF, OASIS)DICOM, IETF, OASIS)

Identify available Identify available standards (standards (e.g. HL7, e.g. HL7, DICOM, IETF, OASIS)DICOM, IETF, OASIS)

Develop Develop technical technical

specificationsspecifications

Develop Develop technical technical

specificationsspecifications

Testing at Testing at ConnectathonsConnectathonsTesting at Testing at ConnectathonsConnectathons

IHE IHE DemonstrationsDemonstrationsIHE IHE DemonstrationsDemonstrations

Products Products with IHEwith IHEProducts Products with IHEwith IHE

Timely access to Timely access to informationinformationTimely access to Timely access to informationinformation

Easy to integrate Easy to integrate productsproductsEasy to integrate Easy to integrate productsproducts

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Electronic Health Record

Cardiology

Laboratory

Radiology

Oncology

Future

Domains

IHE

IT Infrastructure

17 Integration Profiles

7 Integration Profiles

7 Integration Profiles

1166 IInntteeggrraattiioonn PPrrooffiilleess

Patient Care Coordination

4 Integration Profile

Patient Care

Devices

Pathology

Eye Care

IHE 2006 – Nine Active Domains IHE 2006 – Nine Active Domains Close to 200 vendors involved world-wide,Close to 200 vendors involved world-wide, 5 Technical Frameworks5 Technical Frameworks

51 Integration Profiles, Testing at Connectathons51 Integration Profiles, Testing at ConnectathonsDemonstrations at major conferences world-wideDemonstrations at major conferences world-wide

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NCVHS Discussion Template of NHIN NCVHS Discussion Template of NHIN

Draft – NCVHS - 071406

Confidentiality and SecurityC

on

fiden

tiality and

Secu

rity

Electronic health records

E-prescribing systems

Public health systems

ImmunizationRegistries

Personalhealth

records

Other edgesystems

Otheredge

systems

Policy

Edge System Examples:

Confidentiality & Security

Network Functional RequirementsExamples:

Patient Data/Record LocationTransportSecurity

(e.g., Audit Trails, Authentication)

Co

nfid

entiality &

Secu

rityPolicy

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Requirement 1: Allow “edge” systems to Requirement 1: Allow “edge” systems to retain functionality and autonomyretain functionality and autonomy

Edge HIT System

NHIN Subnetwork

Edge to Edge Communication

Edge HIT SystemC

ritica

l Bo

un

da

ry

Critic

al B

ou

nd

ary

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Requirement 2: Allow Flexibility to Requirement 2: Allow Flexibility to support multiple architecturessupport multiple architectures

A broad range of architectures are supported (centralized, distributed, federated).

Clinic

Hospital Practice

Document Registry

?Registry Locator

CentralizedRepository

Clinic

Hospital

Practice

Document Registry

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Requirement 3: Provide Incremental PhasesRequirement 3: Provide Incremental Phases

Phase 1: Share Care Status Information

Phase 2: Diagnostic Results and Therapeutic Information

Phase 3: Clinical Decision Support and Advanced Access Control

Phase 4: Active Quality Reporting and Health Surveillance

available

6 mos to1 yr

2YRs +

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Some of the BenefitsSome of the Benefits

Recognize simple hard costs Recognize simple hard costs savings: paper, fax, admin laborsavings: paper, fax, admin labor

Improve information access:Improve information access:((duplicate procedures, duplicate procedures, safety, safety, collaboration) collaboration)

Data-drivenData-drivenClinical Decision MakingClinical Decision Making

Healthcare Healthcare Information Information

TransparencyTransparency

available

6 mos to1 yr

2YRs +

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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 2006 : IHE-XDSIntroduced at HIMSS in 2006 : IHE-XDS

3-Records3-RecordsReturnedReturned

ReferenceReferenceto recordsto records

Repository ofDocuments

Repository ofDocuments

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2006 Interoperability Showcase2006 Interoperability Showcase

More than 3,000 attendees visited the ShowcaseMore than 3,000 attendees visited the Showcase

37 vendors demonstrated 48 health information 37 vendors demonstrated 48 health information technology (IT) systems in a RHIO formattechnology (IT) systems in a RHIO format

700 attendees created and tracked their own 700 attendees created and tracked their own electronic health record (EHR)electronic health record (EHR)

63 educational sessions presented63 educational sessions presented

5 international delegations visited the Showcase5 international delegations visited the Showcase

Three HIMSS 2006 keynote speakers toured the Three HIMSS 2006 keynote speakers toured the Showcase Showcase

16 clinical scenarios - EHR and personal health record 16 clinical scenarios - EHR and personal health record (PHR) systems, and multiple care delivery settings(PHR) systems, and multiple care delivery settings

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General ImpressionsGeneral Impressions

“ “I was impressed with the progress I saw in the I was impressed with the progress I saw in the Interoperability Showcase over the past year. I am Interoperability Showcase over the past year. I am encouraged by the vendor industry’s demonstration encouraged by the vendor industry’s demonstration of the real potential for interoperability. This type of of the real potential for interoperability. This type of collaboration is required for us to realize the collaboration is required for us to realize the potential for information technology in healthcare.”potential for information technology in healthcare.”

Dr. David Brailer, Dr. David Brailer, Vice Chairman, American Health Information Vice Chairman, American Health Information Community and former National Coordinator, Health Information Community and former National Coordinator, Health Information TechnologyTechnology

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HIE RequirementsHIE Requirements Considered Considered TimingTiming

Security/AuditingSecurity/Auditing Y Y Phase I - FoundationalPhase I - Foundational

Patient IdentityPatient Identity YY Phase I - FoundationalPhase I - Foundational

Definition of what is sharedDefinition of what is shared YY Ongoing thru all PhasesOngoing thru all Phases

Data location; local or centralized?Data location; local or centralized? YY Phase 1 - FoundationalPhase 1 - Foundational

Workflow ConsiderationsWorkflow Considerations YY Phases 1, 2, 3Phases 1, 2, 3

Public Health NeedsPublic Health Needs YY Phase 2Phase 2

Patient’s rolePatient’s role YY Phase 3, 4Phase 3, 4

Adaptability to future changesAdaptability to future changes YY Phase 3, 4Phase 3, 4

What’s Missing or Needs Clarity?

Nation-Wide Nation-Wide coordination of coordination of policies, resources and policies, resources and

priorities – ONC Initiatives and priorities – ONC Initiatives and Contracts for unifying regionsContracts for unifying regions

• The AHIC Community serves as The AHIC Community serves as hub for identifying breakthrough hub for identifying breakthrough opportunitiesopportunities

• CCHIT focuses on developing a CCHIT focuses on developing a mechanism for certification of mechanism for certification of health care IT productshealth care IT products

• HITSP bringing together all HITSP bringing together all relevant stakeholders to identify relevant stakeholders to identify appropriate IT standardsappropriate IT standards

• HISPC is a partnership focused HISPC is a partnership focused on addressing variations in on addressing variations in business policy and state law business policy and state law that affect privacy and security that affect privacy and security

• NHIN focuses on interoperability NHIN focuses on interoperability pilots starting in 2006pilots starting in 2006

Health Information Technology Standards

Panel (HITSP)

Nation-Wide Health

Information Network

Architecture Projects(NHIN)

The Health Information Security and

Privacy Collaboration

(HISPC)

The Certification Commission

for Health Information Technology

(CCHIT) American Health

Information Community

• Chaired by HHS Secretary Leavitt• Seven federal agency representatives• Six health industry members• One IT industry member (Intel)• One employer (Pepsi)• One state health department member (IN)

The National Health IT Effort

September, 2005 17

HITSP Harmonization ProcessHITSP Harmonization Process

II

RequirementsAnalysis

III

Standards Identification

V

Standards Selection

VII

InspectionTest

VIII

InteroperabilitySpecification

Dissemination

IXHarmonization Process Management

Begin

Support

Receive

Request

IV

Gaps/ Overlaps

Resolution

VI

InteroperabilitySpecification Construction

I

Harmonization Request

September, 2005 18

The Role of IHEThe Role of IHE

Models for HarmonizationModels for Harmonization Mapping of standards which have different levels of Mapping of standards which have different levels of

granularitygranularity Preferred standards and evolution over timePreferred standards and evolution over time UnificationUnification

Building BlocksBuilding Blocks

Implementation Guides/Interoperability SpecificationsImplementation Guides/Interoperability Specifications

Architecture and ContextArchitecture and Context

Process ExpertiseProcess Expertise Standard v. Implementation GuideStandard v. Implementation Guide TestingTesting

Pilots such as those in MassachusettsPilots such as those in Massachusetts

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More information….More information….

IHE Web site: IHE Web site: http://www.ihe.nethttp://www.ihe.net

http://www.himss.org/IHE http://www.himss.org/IHE http://www.rsna.org/IHEhttp://www.rsna.org/IHEhttp://www.acc.org/quality/ihe.htmhttp://www.acc.org/quality/ihe.htm

Technical FrameworksTechnical Frameworks

Technical Framework Supplements – Trial ImplementationTechnical Framework Supplements – Trial Implementation

Non-Technical Brochures :Non-Technical Brochures :

Calls for ParticipationCalls for Participation IHE Fact Sheet and FAQIHE Fact Sheet and FAQ IHE Integration Profiles: Guidelines for BuyersIHE Integration Profiles: Guidelines for Buyers IHE Connect-a-thon ResultsIHE Connect-a-thon Results Vendor Products Integration StatementsVendor Products Integration Statements

Questions?

Questions?

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