September, 2005What IHE Delivers 1 IHE Essentials ePharmacy Workshop Jan. 2008 G. Claeys ([email protected] ) Co-chair IHE Europe Development Committee.

1September, 2005 What IHE Delivers

IHE Essentials IHE Essentials ePharmacy Workshop Jan. 2008ePharmacy Workshop Jan. 2008

G. Claeys ([email protected] )G. Claeys ([email protected] )

Co-chair IHE Europe Development Committee (ad interim)Co-chair IHE Europe Development Committee (ad interim)

2

IHE MissionIHE Mission

IHE = Integrating the Healthcare Enterprise

Improve the quality and cost of healthcare by

removing the real-world interoperability barriers

ondepartmental, hospital or regional level

in a pragmatic waya pragmatic way

3

IHE Global ApproachIHE Global Approach

Close Close co-operationco-operation between users and vendors between users and vendors Users identify the integration problems Users identify the integration problems Vendors provide technical solutionsVendors provide technical solutions

Profile Profile existingexisting standards (e.g. DICOM, HL7,..) standards (e.g. DICOM, HL7,..)

AgileAgile development & deployment process development & deployment process Incremental releases every yearIncremental releases every year Test drivenTest driven

4

IHE OrganisationIHE OrganisationStarted in 1999Started in 1999

Association of users, vendors and public healthcare Association of users, vendors and public healthcare authoritiesauthorities More than 100 participating vendors (major healthcare imaging&IT More than 100 participating vendors (major healthcare imaging&IT

companies)companies)

Global development committeesGlobal development committees Develop technical frameworksDevelop technical frameworks

Regional and national deployment committeesRegional and national deployment committees Present in all continents (NAFTA, Europe, Asia Pacific) Present in all continents (NAFTA, Europe, Asia Pacific) Marketing, educationMarketing, education TestingTesting

5

AGFA HealthcareAGFA Healthcare

AISoftw@re MedicalAISoftw@re Medical

Algotec Algotec

ARES SA ARES SA

aycan Digitalsysteme aycan Digitalsysteme

CEGEDIMCEGEDIM

Cerner Corp.Cerner Corp.

CHILICHILI

CMT Medical Tech.CMT Medical Tech.

Conto Corrente SaluteConto Corrente Salute

ConVisConVis

CTI Mirada SolutionsCTI Mirada Solutions

Data Processing SPAData Processing SPA

DEDALUSDEDALUS

DianoemaDianoema

Eastman Kodak Co. Eastman Kodak Co.

Ebit SanitaEbit Sanita

EDL EDL

ELFIN s.r.l. ELFIN s.r.l.

Engineering SanitàEngineering Sanità

ESAOTEESAOTE

MEDASYS SAMEDASYS SA

MedavisMedavis

Medical CommunicationsMedical Communications

Medigration GmbH Medigration GmbH MEDIMON Ltd. MEDIMON Ltd.

MEDIWAREMEDIWARE

MEDOS AG MEDOS AG

Merge eFilm Merge eFilm

METAFORA METAFORA

Mevis Diagnostics Mevis Diagnostics

Konica Minolta Konica Minolta

Omnilab Omnilab

Philips Medical SystemsPhilips Medical Systems

POLYMEDISPOLYMEDIS

Rasna Imaging SystemsRasna Imaging Systems

RAYPAX INC. RAYPAX INC.

REMREM

Rogan-DelftRogan-Delft

Sago spa Sago spa

Sectra Imtec AB Sectra Imtec AB

SeeBeyond TechnologySeeBeyond Technology

ETIAMETIAM

Ferrania Ferrania

Fujifilm Fujifilm

GE HealthcareGE Healthcare

GIE Convergence-Profils GIE Convergence-Profils

Global Imaging Online Global Imaging Online

GWI Research GWI Research

Hi. techHi. tech

IASI Srl IASI Srl

IdeoPass IdeoPass

INFINITT INFINITT

INFOPATIENTINFOPATIENT

INOVITINOVIT

INSIELINSIEL

Intersystems Corp.Intersystems Corp.

InvitaInvita

ITZ MedicomITZ Medicom

iSoftiSoft

McKesson McKesson

MED2RAD MED2RAD

MEDarchiverMEDarchiver

In yellow, companies with IHE Committees Chairs (Winter 2005)

Siemens MedicalSiemens Medical

Soluzioni Informatiche srl Soluzioni Informatiche srl

Stentor Inc. Stentor Inc.

St. JudeSt. Jude

Swissray Medical AG Swissray Medical AG

Symphonie On LineSymphonie On Line

Synapsis Synapsis

Synchro-MedSynchro-Med

TECHNIDATATECHNIDATA

TELEMIS S.A. TELEMIS S.A.

Tiani-SpritTiani-Sprit

Tomtec Imaging Tomtec Imaging

TOREX GAP MedicalTOREX GAP Medical

Toshiba Medical SystemsToshiba Medical Systems

TSI groupe europMedica TSI groupe europMedica

T-SystemsT-Systems

Uni-medicineUni-medicine

VEPRO AG VEPRO AG

VISUS Technology VISUS Technology Transfer Transfer

WAIDWAID

XR PARTNERXR PARTNER

Participating Vendors (Europe)Participating Vendors (Europe)

6

Electronic Health Record

Cardiology

Laboratory

Radiology

Oncology

Future

Domains

IHE

IT Infrastructure

19 Integration Profiles

5 Integration Profiles

8 Integration Profiles

1144 IInntteeggrraattiioonn PPrrooffiilleess

Patient Care Coordination

6 Integration Profile

Patient Care

Devices

Pathology

Eye Care

Total : 52 Integration Profiles

IHE- Expanding ScopeIHE- Expanding Scope

7

IHE Development & Deployment IHE Development & Deployment processprocess

Identify critical healthcare workflows and Identify critical healthcare workflows and integration problemsintegration problems

Research & select existing standards to Research & select existing standards to implement a solutionimplement a solution

Write, review and publish IHE Technical Write, review and publish IHE Technical FrameworkFramework

Develop trial implementationsDevelop trial implementations

Perform cross-testing at “Connectathon”Perform cross-testing at “Connectathon”

Demonstrate at tradeshows (HIMSS/RSNA…)Demonstrate at tradeshows (HIMSS/RSNA…)

8

IHE Building BlocksIHE Building Blocks

IHE Technical FrameworkIHE Technical Framework

IHE Validation ProcessIHE Validation Process

IHE Integration StatementsIHE Integration Statements

9

IHE Technical FrameworkIHE Technical Framework

Describes the different integration solutions Describes the different integration solutions (domain specific)(domain specific) Radiology, IT Infrastructure, Cardiology, Lab, ..Radiology, IT Infrastructure, Cardiology, Lab, ..

Key concepts are domain neutralKey concepts are domain neutral Integration ProfileIntegration Profile TransactionsTransactions ActorsActors Data modelData model

Country & Regional specializationCountry & Regional specialization Limited : max. 5%Limited : max. 5%

Based on existing standards Based on existing standards

IT

Standards

(http, ebxml)

Healthcare

Standards

(HL7, DICOM)

IHE

Integration Profiles

eHealth

Application

eHealth

Application

10

Integration Profiles - Integration Profiles - PrinciplesPrinciples

Solution for real-world interoperability Solution for real-world interoperability problems (bottom-up approach)problems (bottom-up approach)

Integration Profiles are orthogonalIntegration Profiles are orthogonal IPs are independent of each otherIPs are independent of each other Applications may combine multiple Integration Applications may combine multiple Integration

ProfilesProfiles• E.g. Information access + securityE.g. Information access + security

11

IHE Integration Profiles - ContentIHE Integration Profiles - Content

Set of Transactions among Set of Transactions among ActorsActors

Actor = logical entity (e.g. Actor = logical entity (e.g. modality, image manager, order modality, image manager, order filler)filler)

Transaction = Sequence of Transaction = Sequence of messages among Actors messages among Actors

Messages : e.g. HL7, DICOM, Messages : e.g. HL7, DICOM, ebXML,.ebXML,.

Profiling existing standards Profiling existing standards Map data models, message contentMap data models, message content ““Restrict the options” Restrict the options” Clarify the semantics : accession nrClarify the semantics : accession nr

Referenced standard

(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

………

12

IHE IHE ActorsActorsADT PatientRegistration

OrderPlacer

DeptScheduler

ImageManager/Archive

Modality

Patient Registration (HIS):Patient Registration (HIS):ADT focal point for patient registration informationADT focal point for patient registration information

Department Scheduler (RIS):Department Scheduler (RIS):Focal Point for Requested Procedure ManagentFocal Point for Requested Procedure ManagentBreaks Order into Requested ProceduresBreaks Order into Requested ProceduresSchedules steps for each Requested ProcedureSchedules steps for each Requested Procedure

Acquisition Modality:Acquisition Modality:Focal Point for Performed Procedure StepsFocal Point for Performed Procedure StepsA PPS tracks one or more series of ImagesA PPS tracks one or more series of Images

Image Manager/Archive (PACS)Image Manager/Archive (PACS)Focal Point For Imaging Study. Manages imagesFocal Point For Imaging Study. Manages imagesTriggers reading when all expected PPS are completedTriggers reading when all expected PPS are completed

Order Placer (HIS):Order Placer (HIS):Focal Point for Order ManagementFocal Point for Order Management

13

IHE Transactions - ExampleIHE Transactions - Example

14

imagesstored

patientinformation

RIS

examination orders

imagesretrieved

HIS

PACS

procedurescheduled

Prefetch any relevantprior studies

modalityworklist

report

report

Registration

Orders Placed

Orders Filled

Film

FilmFolder

Image Manager& Archive

FilmLightbox

report ReportRepository

DiagnosticWorkstation

Modality

acquisitionacquisitionin-progressin-progressacquisitioncompleted

acquisitioncompleted

imagesprinted

AcquisitionModality

Scheduled Workflow: Use CaseScheduled Workflow: Use Case

15

IHE Validation ProcessIHE Validation Process

Goal :Goal : Validate implementations of IHE TF in productsValidate implementations of IHE TF in products

ApproachApproach IHE is not a certification authorityIHE is not a certification authority IHE stimulates auto-validationIHE stimulates auto-validation

• Vendors are responsible for validating and documenting IHE Vendors are responsible for validating and documenting IHE implementationsimplementations

• IHE provide tools and infrastructureIHE provide tools and infrastructure

IHE Validation toolsIHE Validation tools Mesa toolkitMesa toolkit ConnectathonConnectathon IHE Integration statementIHE Integration statement

16

MESA Test ToolkitMESA Test Toolkit

Software librarySoftware library

Emulate the various actors in the different Emulate the various actors in the different implementation profilesimplementation profiles

Supports single product, single vendor Supports single product, single vendor testing testing

Pre-requisite for connectathon participationPre-requisite for connectathon participation Implementers submit test logs prior to connectathon Implementers submit test logs prior to connectathon

17

Connectathon Connectathon Connectathon = connectivity Connectathon = connectivity marathonmarathon

Validate the Integration Validate the Integration Profiles for a particular IHE Profiles for a particular IHE demodemo Pre-requisite for participating at Pre-requisite for participating at

IHE demosIHE demos1 week validation session in 1 week validation session in Europe, USA and JapanEurope, USA and Japan End-to-end scenario testingEnd-to-end scenario testing Multi-product; multi-vendor; Multi-product; multi-vendor;

multi-domainmulti-domainConnectathon 2006 : 70 Connectathon 2006 : 70 vendors, 120+ products, 200 vendors, 120+ products, 200 personspersons

Results are published on Results are published on www.ihe-europe.orgwww.ihe-europe.org

18

IHE Integration StatementsIHE Integration Statements

Document the IHE Document the IHE implementation per productimplementation per product

Content : Content :

List of supported actorsList of supported actors List of supported integration List of supported integration

profiles (per actor)profiles (per actor)

““contractual” commitmentcontractual” commitment

Published on company Published on company website; referenced from website; referenced from IHE websiteIHE website

19September, 2005 What IHE Delivers

IHE Cross-Enterprise IHE Cross-Enterprise Document SharingDocument Sharing

(XDS)(XDS)

20

IHE XDS - Use CasesIHE XDS - Use Cases

Patient referral (GP to Patient referral (GP to Hospital)Hospital)

Patient discharge (Hospital to Patient discharge (Hospital to GP)GP)

Medical summary for Medical summary for Ambulatory care and acute Ambulatory care and acute care care

Personal Health recordPersonal Health record

21

Acute Care (Inpatient)

PCPs and Clinics (Ambulatory)

Long Term Care

Other Specialized Careor Diagnostics Services

EHR-CR: EHR-CR: Care RecordCare Record systems systemssupportingsupporting care delivery care delivery

Documents Registry

DocumentRepository

EHR-LR:EHR-LR:Longitudinal RecordLongitudinal Recordas usedas usedacross-encountersacross-encounters

Submission of Document References

Retrieve of selected Documents

IHE XDS – ArchitectureIHE XDS – Architecture

22

Document Source

Document Consumer

Document Registry

Patient Identity Source

IHE XDS Actors and TransactionsIHE XDS Actors and Transactions

Document Repository

Patient Identity Feed

Query Registry

Register Document Set

Retrieve Document

Provide & Register Document Set

Affinity Domain

1-N

1

1-N

1-N

1-N

23

No single standard addresses all No single standard addresses all XDS RequirementsXDS Requirements

Healthcare Application Standards• DICOM : imaging applications (modalities, PACS)

• HL7 : adminstrative applications (e.g. clinical lab, reporting, patient admin.)

• Snomed, Loinc : medical terminology & coding

Domain focused

IT Standards

• IETF

• W3C

• Oasis

• JPEG

Technology focus

24

XDS Content modelXDS Content model

All clinical information is stored in documentsAll clinical information is stored in documents

Document format is domain specific (IHE PCC) :Document format is domain specific (IHE PCC) : Clinical Reports : PDF (plain text) -> CDA (coded text, Clinical Reports : PDF (plain text) -> CDA (coded text,

subset of HL7v3 RIM)subset of HL7v3 RIM) Images : DICOM, JPEG2000 (part 1, part 2)Images : DICOM, JPEG2000 (part 1, part 2) Video : MPEG2 -> MPEG4Video : MPEG2 -> MPEG4 Measurements (vector graphics) : SVGMeasurements (vector graphics) : SVG

25

XDS-MS Medical SummaryXDS-MS Medical Summary

SSttrruuccttuurreedd CCoonntteenntt wwiitthh ccooddeedd sseeccttiioonnss::

RReeaassoonn ffoorr RReeffeerrrraall VViittaall SSiiggnnss MMeeddiiccaattiioonn

SSttuuddiieess AAlllleerrggiieess

SSoocciiaall HHiissttoorryy PPrroobblleemmss

CCaarree PPllaann

Structured Text Section

Structured Text Section

Structured and Coded Header Patient, Author, Authenticator, Institution, etc.

Coded Section Entries

Always structured and coded

Title-coded sections with non-structured nor coded content (text, lists, tables).

Med, Problems and Allergies required as highly structured text.

Med Problems and Allergies have a required fine-grain structure with optional coding. Coding Scheme not standardized, but explicitly identified.

Coded Section Entries

Structured Text Section Coded Section

Entries

26

27

28

IHE ResourcesIHE Resources

Technical Framework Technical Framework www.ihe.net/Technical_Framework/index.cfmwww.ihe.net/Technical_Framework/index.cfm

• Volume 1 – ProfilesVolume 1 – Profiles• Volume 2 – TransactionVolume 2 – Transaction

www.ihe.net – New profiles and transactionswww.ihe.net – New profiles and transactions

Practice: Connectathon TestingPractice: Connectathon Testing www.ihe.net www.ihe.net and and www.connectathon.net www.connectathon.net

29September, 2005 What IHE Delivers

Questions?Questions?

30September, 2005 What IHE Delivers

Thank You.Thank You.