Webinar Series 2013 Integrating the Healthcare Enterprise International.

Webinar Series 2013

• Integrating the Healthcare EnterpriseInternational

• Cardiology Domain Update

• Tom Dolan, Philips Healthcare• Chris Melo, Philips Healthcare• Harry Solomon, GE

Cardiology Domain Update Agenda

• Domain & Committee Overview• Domain Profiles & Technical Frameworks

• New and existing profiles highlights for 2014 connectathon• Profiles in development• Overview of other Profiles developed

• How to Participate? • IHE International Membership• Planning & Technical Committees

• Q&A Session

Cardiology Domain Overview

• Scope: interoperability in the in-patient and ambulatory cardiology practice

• Sponsors: American College of Cardiology, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society

• Established 2003• Close working relationship with other IHE domains

• Radiology• Patient Care Coordination• IT Infrastructure• Patient Care Devices• Quality, Research and Public Health

Cardiology Domain – Key Trends

• Co-ordination across transitions of care • Consistent use of HL7 Clinical Document Architecture across all

clinical domains• Registries and quality-improvement programs

• Profiling of standard data elements for both clinical and secondary use

• Proliferation of Electronic Health Record Systems in both the in-patient and ambulatory environments

• Need better bi-directional integration with imaging

Cardiology Domain - Current Focus

Discrete data capture and codification profiles leveraging clinical guidelines and C-CDA:• 2013/14 Registry Submission Content (RSC) • 2012 Cath Report Content (CRC)• 2011 Cardiac Imaging Report Content (CIRC)

• 2013/14 Electrophysiology Report Content (EPRC)

Align cardiology workflow with best practice in general imaging:• Cath/Echo/Nuclear-Medicine/ECG specializations to existing imaging workflow

and evidence gathering profiles.• Displayable Reports (DRPT) • Image Enabled Office (IEO)

Profiles highlighted for 2014 connectathon

Profiles & Technical FrameworksWorkflow in the ambulatory environment

• Image-Enabled Office– Bi-directional integration of medical

imaging equipment and office EHR

– Not limited to cardiology – applies to orthopedics, women’s health, gastroenterology, even primary care

– Ambulatory office EHRs, mini-PACS (or cloud PACS), imaging modalities

– Supports the 2014 Meaningful Use criteria for EHR with imaging

TRIAL

Image-Enabled Office (IEO) Workflow

EHR-S

Acquisition Modality

Query Images Evidence […]Retrieve Images/Evidence [CARD-4] Image

Display

Modality Images /Evidence Stored [CARD-2]

Query Modality

Worklist [RAD-5]

Procedure Step in Progress […]

Procedure Step Completed […]

Report Creator

Encapsulated Report Submission [CARD-7]

Procedure Scheduled [RAD-4]

Procedure Updated [RAD-13] Outpatient Update [CARD-16]

Notify Study Access [CARD-14]

Evidence Creator

Invoke Image Display Service [CARD-15]

Storage Commitment [CARD-3]

Integrated EHR-S

Image Manager / Image Archive

Patient Registration [RAD-1]

Outpatient Update [CARD-16] Placer Order Management [RAD-2]

InformationSource

Display

Encapsulated Report Storage [CARD-9]

DSS / OF PPSManager

Filler Order Management [RAD-3]

Image-Enabled Office

• Leverages in-patient workflow concepts to minimize impact on imaging devices, but adapted to use with office EHR (EHR-S)

• EHR – PACS image display integration using Web technologies

• Integrated EHR-System is an optional integration of an EHR with the image “order filler” (scheduling and management) function• Can be implemented with 3rd party software components

without having to expose internal order transactions• Agnostic to EHR and PACS deployment technology (on-

site, hosted, SaaS, cloud, etc.)

TRIAL

Profiles & Technical FrameworksCath Procedure Reporting

TRIAL

<ClinicalDocument xmlns=“urn:hl7-org:v3”> <typeId extension=”POCD_HD000040” root=”2.16.840.1.113883.1.3”/> <templateId root=“1.3.6.1.4.1.19376.1.4.1.1.2”/> <id root=“” extension=“”/> <code code=“18745-0” displayName=“Cardiac catheterization study report” codeSystem=“2.16.840.1.113883.6.1” codeSystemName=“LOINC”/> <title>Cardiac Catheterization Report</title> <effectiveTime value=“201207231245”/> <confidentialityCode code=“N” displayName=“Normal” codeSystem=“2.16.840.1.113883.5.25” codeSystemName=“Confidentiality”/> <componentOf> <encompassingEncounter> <id extension=“IHE-CardtemplateId” root=“1.3.6.1.4.1.19376.1.4.1.3.1”/> <effectiveTime value=”20120723”/> <code code=“1234097013” codeSystem=“2.16.840.1.113883.6.96” codeSystemName="SNOMED CT" displayName="Diagnostic Coronary Angiography“>

– “Cath Report Content” profile defines an HL7 CDA structured report (XML) to facilitate consistency, accuracy, and semantic interoperability of Diagnostic Cath, Angiography, and PCI procedure reports and findings

– Based on “ACC/AHA 2008 Cardiac Catheterization Report Prototype” and “ACC-NCDR CathPCI Registry v4.4 Coder’s Data Dictionary”

– Affected systems include: Cardiovascular Information Systems, EHR systems, cardiac cath lab analysis and reporting workstations

– Aligned with HL7 Implementation Guide for CDA Release 2: IHE Health Story Consolidation, Release 1.1 DSTU

– Related links:• http://

wiki.ihe.net/index.php?title=Cath_Report_Content • http://

www.ihe.net/Technical_Framework/upload/IHE_CARD_Suppl_CRC.pdf

• http://www.ihe.net/Technical_Framework/index.cfm#cardiology

Cath Report Content (CRC)

TRIAL

• Based on >100 discrete cath & PCI procedure data elements, fully modeled using non-proprietary SNOMED, LOINC, and DICOM terminologies

• Is not a direct specialization of any existing HL7 CDA document template ID. However, some parts were based on:

– IHE Cardiology CIRC content profile– HL7 Implementation Guide for CDA Release 2: IHE Health Story Consolidation,

Release 1.1 DSTU -July 2012 (C-CDA) Procedure Note.

• Allows structured representation of lesions, coronary anatomy and devices

• Supports data import into longitudinal patient tracking databases• First step to wider secondary use of report data (outcomes research,

quality metrics and quality improvement)• Leverages HL7 CDA capability for both human readable narrative and

robust XML-encoded data elements.

• CDA is the schema for those documents

• The HL7 Clinical Document Architecture (CDA) is a document markup standard that specifies the structure and semantics of “clinical documents” for the purpose of exchange.

• HL7 Clinical Document Architecture Release 2 is a HL7 V3 normative standard.

• C-CDA defines a set of CDA documents

• The HL7 Consolidated CDA is an Implementation Guide which specifies a library of templates and details their use for a set of specific clinical document types.

• HL7 C-CDA Release 1.1 is an HL7 DSTU.

HL7 CDA and C-CDA

HL7 Consolidated CDA (C-CDA)

• HL7 Implementation Guides for CDA Release 2: IHE Health Story Consolidation, DTSU Release 1.1 – US Realm

• It contains a library of CDA templates incorporating and harmonizing previous

efforts from HL7, IHE, and HITSP• Consolidates previous document templates into a single library and resolves conflicts and

ambiguities.

• It includes 9 CDA document types• Continuity of Care Document (CCD) / HITSP C32

• History and Physical Note

• Discharge Summary

• Consultation Note

• Diagnostic Imaging Report

• Procedure Note

• Operative Note

• Progress Note

• Unstructured Document (non-XML body)

• It includes all required CDA templates in the Final Rules for Meaningful Use Stage 1 and can support Meaningful Use Stage 2 requirements.

Cath Report Content (CRC)

• General – context, use cases, and actors

• Header elements

• Section content modules

• Entry content modules

• Vocabulary constraints and value sets

CRC - Context• Clinical Reports for cardiology procedures recorded in a Cardiac

Catheterization Laboratory, including:

• Diagnostic Catheterization

• Angiography

• PCI

• Does not include imaging studies, EP procedures, and non-cardiology procedures (e.g. peripheral angiography).

• It is assumed that there is a DICOM Study associated with the exam. If there is not a DICOM Study, this report content may not be appropriate.

• There are no constraints on the narrative text and figures that the cardiologist could include in the report document, although there are requirements on minimum data elements reflecting expert consensus (ACC-NCDR Cath PCI data elements).

Cath Report - Summary• Narrative form of the summary

information including the major highlights from each section:

• Patient demographics

• History and Physical

• Procedures and Interventions

• Findings and Results

• Equipment

• Complications

• Notes

• Key images and graphics

Cath Report – Pre-procedure• Documents the key elements from

the information gathered prior to the cath procedure being performed, including:

• Patient demographics

• Medical, family, and social history

• Allergies

• Known problems and symptoms

• Current medications

• Physical exam and vital signs

• Prior procedures and interventions

• Pre-procedure results

Cath Report - Procedure• Documents the key elements from

the information gathered during the cath procedure including:

• Procedures performed

• Equipment used

• Medications administered

• Anatomical locations addressed

• Specimens obtained

• Complications

Cath Report – Results and Interpretations

• Documents the key results, including measurements, findings, and observations, for the cath procedure performed, including:

• Anatomical measurements

• Cardiac functional measurements

• Device related measurements

• Diagnoses

• Additional notes

CRC – Use Cases• Compile and Transfer Report of Cardiac Cath Lab Procedure with Use of

ACC-NCDR Cath/PCI Data Elements

• This use case addresses the generation and transfer of a cardiac cath lab report based on the NCDR CathPCI Registry v4.4 Coder’s Data Dictionary data elements.

• Perform Discrete Data-analysis on Procedure Report Content

• The goal of this use case is to assist data collection for comparative and research purposes. Based on a report generated in the previous use case an advanced medical data analysis system collects discrete data from multiple patients and their procedure, e.g., for cardiac Clinical Decision Support or for advanced lifetime patient records.

• Review Procedure Report

• This is a secondary use-case addressed by this profile involves the direct human use of the procedure report. In most practical cases this will be:

• The referring physician who instigated/ordered the procedure, and other healthcare providers who manage subsequent patient care activities.

• Another person involved in downstream clinical or administrative data processing e.g., someone validating/source-checking for QA the original report as part of JCAHO audits, or pre-submission checking on the original reporting data against the case-data imported in the ACC-NCDR Cath/PCI registry-

submission application.

CRC – Actors and Options• Actors: Content Creator and Content Consumer

• Content Creator• Create a CRC document populating the required header elements, sections, and entry content

modules

• Group with a Time Client actor to synchronize its clock

• Content Consumer• Receive and process a CRC document, parsing

the relevant header elements, sections, and entries

• Implement the View option, the Discrete Data Import option, or both

• If implements the Document Import or Section Import options, must also implement the View option

• Options:Actor Option Name Optionality Description

Content Consumer View O Demonstrate rendering; print; display with original style sheet; support traversal of any links in document

Document Import O Store the document; access document from storage

Section Import O Import one or more sections as free textDiscrete Data Import O Import structured data from one or more sections

Content Creator No options defined  

CRC – Relationship with other Profiles

• Other Content Profiles• Cardiac Imaging Report Content (CIRC) Profile – in Trial Implementation

• Electrophysiology Report Content (EPRC) Profile – currently under development

• Registry Submission Content (RSC) Profile – Cath/PCI - currently under development

• Actor Required Grouping• Consistent Time (CT) – for Legal Authentication timestamp to be accurate

• Cross Profile Considerations – grouping of Content Creator/Content Consumer with actors of workflow profiles that manage interchange of clinical data

• Displayable Reports (DRPT) - to exchange the CRC content between Report Creator and Report Manager

• Cross-enterprise Document Sharing (XDS), Cross-enterprise Document Media Interchange (XDM), Cross-enterprise Reliable Interchange (XDR), Cross-enterprise Document Sharing for Imaging (XDS-I), and Cross-enterprise Reliable Document Interchange for Imaging (XDR-I) - to exchange the CRC content Cross Enterprise

• Portable Data for Imaging (PDI) - to exchange the CRC content via removable media.

• Retrieve Form for Data Capture (RFD) - to use the CRC content for pre-population of data entry

• Document Digital Signature (DSG) – to allow digital signing of the CRC content

CRC – Relationship to C-CDA • CRC is realm agnostic – so it can be specialized for deployments

• Deviates from C-CDA (US Realm) by not specifying format of addresses, telcoms, names, NPI

• Utilizes documentation style of C-CDA for defining constraints

• Where constraints defined in C-CDA were not modified, the constraint remains as the C-CDA constraint identifier (e.g., CONF:5361). If only the value set was modified, then the constraint is considered unchanged.

• Where constraints defined in C-CDA were modified, the original constraint ID is also modified by appending “-CRC” (e.g., CONF:5253-CRC). Modifications could include changes in the cardinality.

• Where new constraints were introduced, a new constraint identifier was defined (e.g., CONF:CRC-xxx)

• Use of C-CDA Sections and Entries

• If there are no new or modified constraints for a section or entry or if only the value sets are constrained, then the definition of the section or entry is considered unchanged from the C-CDA definition and the C-CDA template ID will be used. These unchanged sections/entries are referenced directly from the C-CDA specification and are not included in this specification.

• If there are new or modified constraints for a section or entry, then that section or entry is assigned a new IHE Card specific template ID.

CRC – Header Elements • code - is selected from a value set specific for Cath lab reporting.

• recordTarget – identifies the patient whose health information is described in this clinical document for the procedure.

• author – represents the creator(s) of the clinical document content.

• custodian – represents the organization that is in charge of maintaining the clinical document.

• legalAuthenticator – identifies the single person legally responsible for the document. This profile does not support the exchange of preliminary unapproved procedure reports.

• authenticator – identifies participants that attest to the accuracy of the information in the clinical document. There may be one for each cath procedure performed (e.g. diagnostic cath and PCI).

• inFulfillmentOf – represents orders that are fulfilled by this clinical document. For CRC, the order/id is the Accession Number used in the DICOM imaging data.

• authorization – contains information about patient consents for the procedure(s) and for the anesthesia.

• componentOf – contains information about the encompassing encounter for the clinical procedures documented in this report. This includes the clinical setting (location and organization). It also allows for the referring provider(s), an attending physician and a responsible physician to be identified.

• documentationOf/serviceEvent – represents the main cath procedure that is being documented. This also documents the primary performer (potentially one for the diagnostic cath and one for the PCI) and any assistants involved in the procedures.

CRC – Section Content Modules (21 total)

• New sections (2)• Document Summary

• Includes a summary of most significant aspects of the procedures in a narrative form. It is a condensed form of the full narrative report whose structure has no constraint.

• Key Images – Cardiac• Contains narrative description of and references

to DICOM Image Information Objects that illustrate the findings of the procedure reported.

• Specialized sections (5)• Medical History – Cardiac

• Adds support for coded problem observation and procedures.

• Pre-Procedure Results – Cardiac• Adds support for results in external documents.

• Procedure Description – Cardiac• Adds support for device specific observations

and identification of lesions.

• Procedure Results – Cardiac• Adds support for lesions.

• Plan of Care – Cardiac• Includes specialized Plan of Care Activity Act

with elements.

• Unchanged sections (14)• Allergies• Family History• Social History• Physical Exam• Vital Signs• Planned Procedure• Procedure Indications• Anesthesia• Medications Administered• Procedure Specimens Taken• Procedure Disposition• Complications• Postprocedure Diagnosis• DICOM Object Catalog

CRC – Entry Content Modules

• Unchanged entry content modules (~35)

• New entry content modules (3)• Lesion Observation – identifies a lesion of interest, identified by a global ID and one or

more target sites

• Procedure Device Organizer – Cardiac – contains a set of observations related to a device used during a procedure

• Device Observation – represents observations made of devices used during a procedure

• Specialized entry content modules (6)• Problem Observation – Cardiac

• Extends the Problem Observation Entry with an entryRelationship for a Severity Observation

• Result Organizer – Cardiac• Extends to support references to external documents for results

• Result Observation – Cardiac• Extends to support an entryRelationship to a Severity Observation

• Plan of Care Activity Act – Cardiac• Extends to support code, statusCode, and effectiveTime elements

• Procedure Results Organizer – Cardiac• Extends to include entryRelationship to a Lesion Observation

• Procedure Activity Procedure – Cardiac• Extends to support entryRelationship to a Procedure Device Organizer and a Lesion Observation

CRC – Vocabulary Constraints

• Result observation constraints – defines complete sets of elements for observations, including codes and allowed values

• Value sets provided for Cath specific concept domains

• Cardiac Problems/Concerns

• Body Site

• Cardiovascular Family History

• Contrast Agents Classes for Adverse Reactions

• Cardiac Lab Results

• Vital Sign Results

• Procedure Indications

• Contrast Agents

• Cardiac Activity Procedures

• Drug Classes and Specific Cardiac Drugs

• Rx Recommendations

• Procedure Findings Types

• Postprocedure Diagnoses

• Supported File Types

• Complications

Intravascular Imaging

• Intravascular Imaging Option to CATH Workflow • Addresses use case to workflow to change a modality during the

procedure• Requires support for Intravascular Optical Coherence Tomography (OCT)

SOP classes• Option for Image Manager/Archive and Image Display Actors

– Image Manager/Archive actors must store the following SOP Classes• Intravascular Optical Coherence Tomography Image Storage –

For Presentation• Intravascular Optical Coherence Tomography Image Storage –

For Processing− Image Displays have to provide the functionality to display

Intravascular Optical Coherence Tomography Image Storage – For Presentation objects

• http://www.ihe.net/Technical_Framework/upload/IHE_CARD_Suppl_IVI_Option_for_Cath_Workflow.pdf

TRIAL

New Supplement in 2013 – target for Japan connectathon

Current work in progress

Electrophysiology Report Content (EPRC)

• This proposal is targeted at the completion of the original 2011-2012 proposal for a cardiac electrophysiology report content profile.

• Leverages the Cardiac EP Key Data Elements white paper published in 2011:

http://www.ihe.net/Technical_Framework/upload/IHE_CARD_WP_Cardiac_EP_Key_Data_Elements_Rev1-0_PC_2011-08-05.pdf

• A CDA implementation guide for an EP procedure report will bring the benefits of structured reports to the EP lab.

• This is a critical first step to a profile that uses the EP procedure clinical report as pre-population data for submission to a registry.

• This new profile will leverage the existing CIRC and CRC content profiles.

TRIAL

New Supplement target for 2015 connectathon

Registry Submission Content (RSC)

• Develop a CDA implementation guide for data elements to be submitted to registries, including NCDR Cath/PCI registry.

• Leverages the C-CDA codification and structuring done in CRC profile, expanded to capture the additional information needed for NCDR Registry submission.

• Authoring of profile led by the ACC-NCDR organization.• Aims to make the rich registry data collection needs from

multiple clinical/administrative sources more efficient for Registry participants.

• Aligns data content for Registry collection with emerging best-practice in wider clinical data exploitation initiatives.

TRIAL

New Supplement target for 2015 connectathon

Technical Framework Overview

Profiles & Technical Frameworks

• IHE Technical Frameworks• Final Text: Current version 5.0• Trial Implementation: Supplements• http://www.ihe.net/Technical_Framework/index.cfm#cardiology

• Brief descriptions of Profiles developed by Cardiology Domain

• http://wiki.ihe.net/index.php?title=Profiles#IHE_Cardiology_Profiles

Overview

FINAL

TRIAL

Profiles & Technical FrameworksWorkflow in the in-patient environment

• Profiles aligned with IHE Radiology workflow

– Scheduled and unscheduled cardiac

imaging exams, including multimodality

– Management of data, demographic and

procedure identifiers

– Cardiovascular Information Systems,

PACS, imaging and waveform

modalities: X-ray and hemo (cath lab),

Echo, Nuclear imaging analysis and

reporting workstations– Consistent, robust workflow

minimizes manual procedure management tasks

• Cardiac Catheterization Workflow

• Echocardiography Workflow

• Stress (ECG + imaging) Workflow

• Evidence Documents (cardiology specialization)

• Displayable Reports Workflow

• Intravascular Imaging Option for Cardiac Catheterization Workflow

FINAL

TRIAL

Profiles & Technical FrameworksWorkflow in the ambulatory environment

• Image-Enabled Office– Bi-directional integration of medical

imaging equipment and office EHR

– Not limited to cardiology – applies to orthopedics, women’s health, gastroenterology, even primary care

– Ambulatory office EHRs, mini-PACS (or cloud PACS), imaging modalities

– Supports the 2014 USA Meaningful Use criteria for EHR with imaging

TRIAL

Displayable Report Workflow (DRPT)• Cardiology reports typically

include lots of graphics • Addresses workflow between a

reporting application and the departmental info system and/or the EMR

− Possible report archiving to PACS

• Report format may be PDF or HL7 CDA

• Applicable to other clinical domains!

TRIAL

Profiles & Technical FrameworksReporting

Report Content• Cardiac Imaging Report Content

(CIRC)− CDA structured report (XML) to facilitate

consistency, accuracy, and semantic interoperability of imaging findings

− Based on ACC/AHA 2008 Key Data

Elements for Cardiac Imaging

• Cath Report Content (CRC)− CDA structured report (XML) to facilitate

consistency, accuracy, and semantic interoperability of cardiac cath and PCI procedure reports and findings

− Based on ACC/AHA 2008 Cardiac Catheterization Report Prototype and ACC-NCDR CathPCI Registry v4.4 Coder’s Data Dictionary

Profiles & Technical FrameworksECG Workflow

• Retrieve ECG for Display

– Access to ECGs from everywhere in the hospital

– Resting ECGs, Holter ECGs

– ECG Management Systems, EMRs, workstations

– Simplified and standardized Web-based access to ECGs; No need for ‘printed ECGs’

• Resting ECG Workflow

– Multi-system workflow for the most common cardiology exam

– Scheduled/unscheduled, post-exam reconciliation

– Cardiovascular Information Systems, ECG Management Systems, ECG devices and workstations, PACS and imaging workstations, EMRs

– Components and workflow shared with imaging

TRIALFINAL

Profiles & Technical Frameworks

• Radiology– Scheduled Workflow (CT/MR/NM)– Nuclear Medicine Image (cardiac)– Evidence Documents, Key Image

Note– Portable Data for Imaging, XDS-I,

Import Reconciliation•Patient Care Devices– Implantable Device - Cardiac -

Observations– Device Enterprise Communication– Waveform Content Message

•Patient Care Coordination– Medical Summary – ED Referral

• IT Infrastructure– XDS, ATNA, Consistent Time– PIX, PDQ, PAM– Retrieve Form for Data Capture

Cardiology Relevant Profiles in Other Domains

Domain organization

IHE Cardiology Planning Committee

Contact Information• Secretary Paul Dow

[email protected] • Co-Chair Alan Katz, MD

[email protected] • Co-Chair David Slotwiner, MD

[email protected] • Committee’s wiki page http://

wiki.ihe.net/index.php?title=Cardiology_Planning_Committee

Responsibilities • Identifying priority issues for the

cardiology community− Liaison to sponsor

organizations• Soliciting and developing IHE

Profile Proposals− Now soliciting proposals!

• Evaluation of Technical Committee work

• Marketing IHE Cardiology profiles to user community

IHE Cardiology Technical Committee

Contact Information• Secretary Paul Dow

[email protected] • Co-Chair Tom Dolan

[email protected] • Co-Chair Antje Schroeder

[email protected] • Committee’s wiki page http://

wiki.ihe.net/index.php?title=Cardiology_Technical_Committee

Responsibilities • Development of IHE Profiles

and white papers• Maintenance of IHE Cardiology

Technical Frameworks• Liaison with other IHE domains• Support for Planning

Committee marketing

How to Participate in IHE Cardiology?

• Apply for IHE International Organizational Membership• Visit: www.ihe.net/apply • Approved monthly by IHE International Board • Review IHE's 400+ Organizational Members

• Participate in IHE Domains & Committees• IHE Organizational Members only• 12 Clinical and Operational Domains • Each Domain has one planning and one technical committee

• Non-members participate in comment periods and implement IHE Technical Frameworks

IHE International Membership is Free.

How to Participate in IHE Cardiology?

• Committee work typically follows the IHE Profile Cycle Annual cycle• ~18 months from profile proposal to Connectathon• Each IHE domain has its own independent schedule• Opportunities for IHE members and non-members to participate in

cycle

IHE’s Profile Development Cycle

IHE Profiles Drafted & Revised

months 5-11

Trial Implementation PostedPublished

For PublicComment

IHE Technical Framework

Supplement Developed

Install Interoperable products in

Clinical Settings

worldwide

Install Interoperable products in

Clinical Settings

worldwide

Demonstrate at a

or ACC / HRS / ESC …

Demonstrate at a

or ACC / HRS / ESC …

IHE Improves, Safety, Quality and Efficiency

inClinical

Settings

IHE Call for Proposals Opens IHE Call for Proposals Opens

Profile Selection by Committees

months 1-4

months 12-18

Publish in IHE’s Product Registry

Test at IHE Connectathons

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