September, 2005What IHE Delivers Michael H. Zaroukian, MD, PhD, FACP Chief Medical Information Officer Associate Professor of Medicine Michigan State University.

September, 2005 What IHE Delivers

Michael H. Zaroukian, MD, PhD, FACP Michael H. Zaroukian, MD, PhD, FACP

Chief Medical Information OfficerChief Medical Information Officer

Associate Professor of MedicineAssociate Professor of Medicine

Michigan State University Michigan State University

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

Achieving Interoperability through Achieving Interoperability through Implementation of StandardsImplementation of Standards

January 16, 2007January 16, 2007

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Presentation ObjectivesPresentation Objectives

IHE: What? Why? Who? How organized? IHE: What? Why? Who? How organized? Healthcare provider role in developing IHE frameworkHealthcare provider role in developing IHE framework

Why standards are not enoughWhy standards are not enough

IHE process for standards adoption and IHE process for standards adoption and implementationimplementation

Benefits, growth, strategies, integrationBenefits, growth, strategies, integration

How to leverage IHE to enable interoperability inHow to leverage IHE to enable interoperability in EnterprisesEnterprises Health information exchanges (HIEs)Health information exchanges (HIEs)

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IHE: A Framework for InteroperabilityIHE: A Framework for Interoperability

A common framework for harmonizing and A common framework for harmonizing and implementing multiple standardsimplementing multiple standards Application-to-application System-to-system Setting-to-setting

Enables seamless health information movement Enables seamless health information movement within and between enterprises, regions, nationswithin and between enterprises, regions, nations

Promotes unbiased selection and coordinated use Promotes unbiased selection and coordinated use of established healthcare of established healthcare andand IT standards to IT standards to address specific clinical needsaddress specific clinical needs

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Why IHE? A Patient-centered ExampleWhy IHE? A Patient-centered Example

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Interoperability: Redesigning the Office VisitInteroperability: Redesigning the Office Visit

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IHE SponsorsIHE Sponsors1997: Founded in Radiology (RSNA) and IT (HIMSS)1997: Founded in Radiology (RSNA) and IT (HIMSS)

Many professional societies (stakeholder representation)Many professional societies (stakeholder representation) American Academy of Ophthalmology (AAO)American Academy of Ophthalmology (AAO) American College of Cardiology (ACC)American College of Cardiology (ACC) American College of Physicians (ACP)American College of Physicians (ACP)

American College of Clinical Engineering (ACCE)American College of Clinical Engineering (ACCE) American College of Emergency Physicians (ACEP) American College of Emergency Physicians (ACEP) American Society for Therapeutic Radiation Oncology (ASTRO)American Society for Therapeutic Radiation Oncology (ASTRO) GMSIH (IT France), JAHIS (IT Japan), SFIL (laboratory)GMSIH (IT France), JAHIS (IT Japan), SFIL (laboratory) Healthcare Information Management Systems Society (HIMSS)Healthcare Information Management Systems Society (HIMSS) Radiological Society of North America (RSNA)Radiological Society of North America (RSNA) And many more….And many more….

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IHE Participants and RelationshipsIHE Participants and Relationships

Participants include:Participants include: Users - Clinicians, Staff, Administrators, CIOs, Governments (e.g. Users - Clinicians, Staff, Administrators, CIOs, Governments (e.g.

NIST, VA).NIST, VA). Vendors - Information Systems and EquipmentVendors - Information Systems and Equipment

• e.g., imaging, cardiology, devicese.g., imaging, cardiology, devices ConsultantsConsultants

Maintains formal liaison with Standards Development Maintains formal liaison with Standards Development Organizations (SDOs):Organizations (SDOs): HL7, DICOM, ISO (Liaison D), othersHL7, DICOM, ISO (Liaison D), others

ISO TC215 (including ANSI) approved IHE Process and ISO TC215 (including ANSI) approved IHE Process and Profiles to be published as technical reportsProfiles to be published as technical reports Concerns expressed by some AHIC members not foundedConcerns expressed by some AHIC members not founded

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IHE Organizational StructureIHE Organizational Structure

ACCACPHIMSSRSNA

JAHISJIRAJRS

METI-MLHWMEDIS-DCJAMI

GMSIHSFRSFIL

SIRMBIREuroRec

COCIREAR-ECRDRG

ESC

Professional Societies / Sponsors Contributing &Participating

Vendors

IHE (International) Strategic Development Committee

Global Development

Radiology

Cardiology

ITInfrastructure

Patient CareCoordination

Patient CareDevices

Laboratory

Pathology

Pharmacy /Medication Admin

RadiationOncology

IHE Europe

IHE North America

France

USA

Canada

IHE Asia-Oceania

Japan

Korea Taiwan

Netherlands

Spain Sweden UK

ItalyGermany

Norway

Regional Deployment

China

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International Adoption of IHEInternational Adoption of IHE

France

Local Deployment National Extensions (Local Adaptions) Promotional & Live Demonstration Events Funding

USA

Germany

Italy

JapanUK

Canada

Korea

Taiwan

Norway

Holland

SpainChina

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Pragmatic global standards harmonization + best practices sharing Pragmatic global standards harmonization + best practices sharing

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Standards: Necessary…Not SufficientStandards: Necessary…Not Sufficient

Standards areStandards are Foundational - to interoperability and communicationsFoundational - to interoperability and communications Broad - varying interpretations and implementationsBroad - varying interpretations and implementations Narrow - may not consider relationships between Narrow - may not consider relationships between

standards domainsstandards domains Plentiful - often redundant or disjointedPlentiful - often redundant or disjointed Focused - standards implementation guides focus only Focused - standards implementation guides focus only

on a single standardon a single standard

IHE provides a standard process for IHE provides a standard process for implementing multiple standardsimplementing multiple standards

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IHE: Connecting Standards to CareIHE: Connecting Standards to Care

Healthcare professionals work with industryHealthcare professionals work with industry

Coordinate implementation of standards to Coordinate implementation of standards to meet clinical and administrative needsmeet clinical and administrative needs Clinicians and HIT professionals identify the key Clinicians and HIT professionals identify the key

interoperability problems they faceinteroperability problems they face Providers and industry work together to develop and Providers and industry work together to develop and

make available standards-based solutionsmake available standards-based solutions Implementers follow common guidelines in Implementers follow common guidelines in

purchasing and integrating effective systemspurchasing and integrating effective systems

IHE: A forum for agreeing on how to implement IHE: A forum for agreeing on how to implement standards and processes for making it happenstandards and processes for making it happen

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Standards Adoption ProcessStandards Adoption Process

Document Use Case Document Use Case RequirementsRequirementsDocument Use Case Document Use 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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Stakeholder BenefitsStakeholder BenefitsHealthcare providers and support staffHealthcare providers and support staff Improved workflowsImproved workflows Information whenever and wherever neededInformation whenever and wherever needed Fewer opportunities for errorsFewer opportunities for errors Fewer tedious tasks/repeated workFewer tedious tasks/repeated work Improved report turnaround timeImproved report turnaround time

VendorsVendors Align product interoperability with industry consensusAlign product interoperability with industry consensus Decreased cost and complexity of interface installation and Decreased cost and complexity of interface installation and

managementmanagement Focus competition on functionality/service space not information Focus competition on functionality/service space not information

transport spacetransport space

SDOsSDOs Rapid feedback to adjust standards to real-worldRapid feedback to adjust standards to real-world Establishment of critical mass and widespread adoptionEstablishment of critical mass and widespread adoption

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Growth in IHE DomainsGrowth in IHE Domains

Radiology (18)

IT Infrastructure for Healthcare (17)

Cardiology (7)

Laboratory (6)

Radiation Oncology (1)

Patient Care Coordination (5)

Patient Care Devices (1)

Quality

Eye Care (3)

Veterinary

Endoscopy

Pathology

Pharmacy

IHE Global DevelopmentsIHE Global DevelopmentsIntegration Profiles (# X) – Solutions to Real-World Interoperability Integration Profiles (# X) – Solutions to Real-World Interoperability

Needs & Problems:Needs & Problems:

Within Clinical Departments e.g.:Within Clinical Departments e.g.:RadiologyRadiologyCardiologyCardiologyLabLab ......

Across Departmental &Across Departmental &Institutional Boundaries – XDSInstitutional Boundaries – XDS

RHIOsRHIOs (Regional Healthcare Information Organizations) (Regional Healthcare Information Organizations)

EHR EnablersEHR Enablers

Yea

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IHE Implementation StrategyIHE Implementation Strategy

Leverage established standards to allow rapid deployment and Leverage established standards to allow rapid deployment and plan for futureplan for futurePragmatic, Ease of EvolutionPragmatic, Ease of Evolution

Enable architectural freedom (patient vs. provider centric, Enable architectural freedom (patient vs. provider centric, centralized vs. decentralized, scalable (from office to centralized vs. decentralized, scalable (from office to enterprise to IDN to RHIO) enterprise to IDN to RHIO) ConfigurationConfiguration flexibilityflexibility

Support breakthrough use cases: variety of care settings, care Support breakthrough use cases: variety of care settings, care coordination, public health, PHR, EHRcoordination, public health, PHR, EHRInteroperability for broad constituenciesInteroperability for broad constituencies

IHE: Offers consistent, standards-based record IHE: Offers consistent, standards-based record sharing for EHRs and other information systemssharing for EHRs and other information systems

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IHE based Regional and National EHR Projects IHE based Regional and National EHR Projects (Operational and Planned)(Operational and Planned)

Toronto, Quebec, Alberta, BCCanada Infoway

Austria

THINC- New YorkNCHICA – N. Carolina

Italy (Conto Corrente Salute)

MA-Share – MA

FranceDMP

Philadelphia

HIE

CHINA-MoHLab results sharing

New York HIE

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IHE Integration Profiles for Health Info NetsIHE Integration Profiles for Health Info NetsWhat What is availableis available and has been added and has been added in 2005in 2005 and and 20062006

Patient Demographics Query

Patient Identifier Cross-referencing

Map patient identifiers across independent identification

domains

Cross-Enterprise Document Sharing

Registration, distribution and access across health enterprises of clinical

documents forming a patient

electronic health record

Cross-enterprise Document Point-Point Interchange

Media-CD/USB & e-mail push

Emergency Referrals

Format of the Document Content and associated coded vocabulary

PHR Extracts/Updates

Format of the Document Content and associated coded vocabulary

ECG Report Document

Format of the Document Content and associated coded vocabulary

Lab Results Document Content

Format of the Document Content and associated coded vocabulary

Scanned Documents

Format of the Document ContentImaging Information

Format of the Document Content and associated coded vocabulary

Medical Summary (Meds, Allergies, Pbs)

Format of the Document Contentand associated coded vocabulary

Consistent TimeCoordinate time across networked

systems

Audit Trail & Node Authentication

Centralized privacy audit trail and node to node authentication to create

a secured domain.

Basic Patients Privacy Consents

Establish Consents & Enable Access Control

Document Digital Signature

Attesting “true-copy and origin

Notification of Document Availability

Notification of a remote provider/ health enterprise

Request Formfor Data Capture

External form with custom import/export scripting

Patient ID MgmtPatient ID MgmtSecuritySecurityClinical and PHRClinical and PHRContentContent

Health Data ExchangeHealth Data Exchange OtherOther

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IHE: Supporting HHS Goals for NHINIHE: Supporting HHS Goals for NHIN

Healthcare Information

Technology Standards Panel (HITSP)

Nationwide Health Information Network Architecture Projects

(NHIN)

Health Information Security and Privacy

Collaboration (HISPC)

Certification Commission for

Healthcare Information

Technology (CCHIT)

American Health Information Community

Standards harmonization Standards harmonization and adoptionand adoption

Interoperability testingInteroperability testing

Security and privacy standardsSecurity and privacy standardsSpecifications for standards-Specifications for standards-based EHR functionality to based EHR functionality to support RHIOssupport RHIOs

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HITSP Recommended StandardsHITSP Recommended StandardsBiosurveillanceBiosurveillance ICD-9CM – International Classification of Diseases v. 9 Clinical ICD-9CM – International Classification of Diseases v. 9 Clinical

ModificationsModifications ICD-10 CM – Diagnoses and ProceduresICD-10 CM – Diagnoses and Procedures IHE-XDS – Integrating the Healthcare Enterprise (IHE) Cross-IHE-XDS – Integrating the Healthcare Enterprise (IHE) Cross-

Enterprise Document SharingEnterprise Document Sharing IHE-XDS Lab – IHE Laboratory Report Document SharingIHE-XDS Lab – IHE Laboratory Report Document Sharing IHE-RFD – IHE Retrieve Form for Data CaptureIHE-RFD – IHE Retrieve Form for Data Capture IHE-PIX – IHE Patient Identification Cross-ReferencingIHE-PIX – IHE Patient Identification Cross-Referencing IHE-RAD – XDS-I – IHE Cross-Enterprise Sharing of ImagesIHE-RAD – XDS-I – IHE Cross-Enterprise Sharing of Images IHE-NAV – IHE Notification of Document AvailabilityIHE-NAV – IHE Notification of Document Availability IHE-XDS-MS – IHE Medical Summary Document SharingIHE-XDS-MS – IHE Medical Summary Document Sharing ISO/TC215 -DTS 25237 - Health Informatics PseudonymisationISO/TC215 -DTS 25237 - Health Informatics Pseudonymisation LOINC – Logical Observation Identifiers Names and CodesLOINC – Logical Observation Identifiers Names and Codes NCCLS – National Committee for Clinical Laboratory StandardsNCCLS – National Committee for Clinical Laboratory Standards RxNorm – National Library of Medicine RxNormRxNorm – National Library of Medicine RxNorm

IHE contributes to HITSP’s successIHE contributes to HITSP’s success

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HITSP Recommended StandardsHITSP Recommended Standards

Consumer EmpowermentConsumer Empowerment IHE-XDS – Integrating the Healthcare Enterprise (IHE) IHE-XDS – Integrating the Healthcare Enterprise (IHE)

Cross-Enterprise Document SharingCross-Enterprise Document Sharing IHE-PIX – IHE Patient Identification Cross-ReferencingIHE-PIX – IHE Patient Identification Cross-Referencing IHE-PDQ – IHE Patient Demographics QueryIHE-PDQ – IHE Patient Demographics Query Health Level Seven (HL7) CDA R2 – HL7 Clinical Document Health Level Seven (HL7) CDA R2 – HL7 Clinical Document

Architecture Release 2Architecture Release 2 HL7 CCD – HL7 Continuity of Care Document HL7 CCD – HL7 Continuity of Care Document with mappings with mappings

from ASTM E 2369-05 Continuity of Care Record (CCR), X12 N from ASTM E 2369-05 Continuity of Care Record (CCR), X12 N 270/271 and NCPDP Script 8.1.270/271 and NCPDP Script 8.1.

HL7 EHR Systems Functional Model Draft Standard for Trial HL7 EHR Systems Functional Model Draft Standard for Trial Use (DSTU)Use (DSTU)

Logical Observation Identifiers Names and Codes (LOINC)Logical Observation Identifiers Names and Codes (LOINC)

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HITSP Recommended StandardsHITSP Recommended Standards

Electronic Health Record ExchangeElectronic Health Record Exchange IHE-XDS Lab – IHE Laboratory Report Document SharingIHE-XDS Lab – IHE Laboratory Report Document Sharing IHE-PIX – IHE Patient Identification Cross-ReferencingIHE-PIX – IHE Patient Identification Cross-Referencing IHE-PDQ – IHE Patient Demographics QueryIHE-PDQ – IHE Patient Demographics Query Health Level Seven (HL7) CDA R2 – HL7 Clinical Document Health Level Seven (HL7) CDA R2 – HL7 Clinical Document

Architecture Release 2Architecture Release 2 HL7 v. 2.5HL7 v. 2.5 Clinical Laboratory Improvement Amendments (CLIA)Clinical Laboratory Improvement Amendments (CLIA) Logical Observation Identifiers Names and Codes (LOINC)Logical Observation Identifiers Names and Codes (LOINC) Health Insurance Portability and Accountability Act (HIPAA)Health Insurance Portability and Accountability Act (HIPAA) Systematized Nomenclature of Medicine – Clinical Terms Systematized Nomenclature of Medicine – Clinical Terms

(SNOMED – CT)(SNOMED – CT) Unified Code for Units of Measure (UCUM)Unified Code for Units of Measure (UCUM)

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2007 HIMSS Interoperability Showcase2007 HIMSS Interoperability ShowcaseFebruary 26 – March 1, 2007February 26 – March 1, 2007

9,000 square feet of exhibit space 9,000 square feet of exhibit space

67 Showcase participants67 Showcase participants

Secured HIExchange with broad Secured HIExchange with broad contentcontent

HIE with patient care devicesHIE with patient care devices

Personal health record solutionsPersonal health record solutions

New directions focus (Life Sciences New directions focus (Life Sciences Bio-Pharma, HL7 v3.0 PIX/PDQ, Bio-Pharma, HL7 v3.0 PIX/PDQ, ELINCS Lab)ELINCS Lab)

HITSP interoperability specificationsHITSP interoperability specifications

Financial and administrative systems Financial and administrative systems (CAQH/CORE)(CAQH/CORE)

Expanded distributed demonstration Expanded distributed demonstration in a RHIO formatin a RHIO format

Focused tours – International, VIP, Focused tours – International, VIP, CongressionalCongressional

Theater – Education sessionsTheater – Education sessions

Morial Convention Center, New Orleans, LAMorial Convention Center, New Orleans, LA

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How to ParticipateHow to Participate

As a User or Vendor Committee MemberAs a User or Vendor Committee Member

Become a member of relevant Domains Planning Become a member of relevant Domains Planning or Technical Committeesor Technical Committees

As a User, Consultant or Vendor Interested As a User, Consultant or Vendor Interested ObserverObserver

Provide Public Comments on Technical Provide Public Comments on Technical Framework SupplementsFramework Supplements

Attend Demonstrations, Educational Events and Attend Demonstrations, Educational Events and WorkshopsWorkshops

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How to Use IHEHow to Use IHE

As a Vendor ImplementerAs a Vendor ImplementerImplement IHE Integration ProfilesImplement IHE Integration Profiles

Test systems through Connectathon processTest systems through Connectathon process

Publish an IHE Integration Statement for productsPublish an IHE Integration Statement for products

As a User Implementer or ConsultantAs a User Implementer or ConsultantUse IHE Integration Profiles to develop Use IHE Integration Profiles to develop interoperability strategyinteroperability strategy

Use Connectathon Results and Integration Use Connectathon Results and Integration Statements to evaluate vendorsStatements to evaluate vendors

Demand IHE Integration Profile compliance in RFPsDemand IHE Integration Profile compliance in RFPs

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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

http://www.ihe.net

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More Resources - More Resources - www.ihe.netwww.ihe.net

Frequently Asked QuestionsFrequently Asked Questions

Integration Profiles in Technical Frameworks:Integration Profiles in Technical Frameworks: CardiologyCardiology IT InfrastructureIT Infrastructure LaboratoryLaboratory Patient Care CoordinationPatient Care Coordination Patient Care DevicesPatient Care Devices Radiation OncologyRadiation Oncology RadiologyRadiology

Connectathon ResultsConnectathon Results

Vendor Products Integration StatementsVendor Products Integration Statements

Participation in Committees and ConnectathonsParticipation in Committees and Connectathons

September, 2005 What IHE Delivers