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
March 17, 2005 IHE and medical Standards in Denmark2
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, 2005 IHE and medical Standards in Denmark3
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 ?
March 17, 2005 IHE and medical Standards in Denmark4
Need for a Standards Implementation ProcessNeed for a Standards Implementation Process
UserProjects
DemandDemand
StandardsStandards ?OfferOfferStandardsStandardsStandardsStandards
March 17, 2005 IHE and medical Standards in Denmark5
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
March 17, 2005 IHE and medical Standards in Denmark6
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
March 17, 2005 IHE and medical Standards in Denmark7
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
March 17, 2005 IHE and medical Standards in Denmark8
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
1 Integration Profiles
3 Integration Profiles
9 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
March 17, 2005 IHE and medical Standards in Denmark9
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
March 17, 2005 IHE and medical Standards in Denmark10
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
March 17, 2005 IHE and medical Standards in Denmark11
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 …
March 17, 2005 IHE and medical Standards in Denmark12
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
March 17, 2005 IHE and medical Standards in Denmark15
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
March 17, 2005 IHE and medical Standards in Denmark16
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
March 17, 2005 IHE and medical Standards in Denmark17
IHE Technical FrameworksIHE Technical Frameworks
March 17, 2005 IHE and medical Standards in Denmark18
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)
March 17, 2005 IHE and medical Standards in Denmark19
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
March 17, 2005 IHE and medical Standards in Denmark20
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
March 17, 2005 IHE and medical Standards in Denmark21
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
March 17, 2005 IHE and medical Standards in Denmark22
The Product World…..The Product World…..
Product XYZfrom Vendor T
March 17, 2005 IHE and medical Standards in Denmark23
The IHE World….The IHE World….
IHE ActorIHE Actor
ActorActorActorActor
ActorActor
IHEIHETransactionTransactionIHEIHE
TransactionTransaction
IHEIHETransactionTransaction
IHE ActorIHE Actor
March 17, 2005 IHE and medical Standards in Denmark24
Mapping IHE to ProductsMapping IHE to Products
Product XYZfrom Vendor T
IHE ActorIHE Actor
ActorActorActorActor
ActorActor
IHEIHETransactionTransactionIHEIHE
TransactionTransaction
IHEIHETransactionTransaction
IHE ActorIHE Actor
March 17, 2005 IHE and medical Standards in Denmark25
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
March 17, 2005 IHE and medical Standards in Denmark26
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 !
March 17, 2005 IHE and medical Standards in Denmark27
March 17, 2005 IHE and medical Standards in Denmark28
Integration StatementsIntegration Statements
March 17, 2005 IHE and medical Standards in Denmark29
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
March 17, 2005 IHE and medical Standards in Denmark30
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)
March 17, 2005 IHE and medical Standards in Denmark31
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)
March 17, 2005 IHE and medical Standards in Denmark32
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
March 17, 2005 IHE and medical Standards in Denmark33
IHE
EHR- Longitudinal Record
IHE Cardiology
IHE Laboratory
IHE Radiology
IHE
Oncology
IHE
Future Domain
IHE
IT Infrastructure Intra-Enterprise
Cross-Enterprise
14 Integration Profiles
1 Integration Profile
3 Integration Profiles
9 Integration Profiles
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.
March 17, 2005 IHE and medical Standards in Denmark34
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
March 17, 2005 IHE and medical Standards in Denmark35
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
March 17, 2005 IHE and medical Standards in Denmark36
““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
March 17, 2005 IHE and medical Standards in Denmark37
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.
March 17, 2005 IHE and medical Standards in Denmark38
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]
March 17, 2005 IHE and medical Standards in Denmark39
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.
March 17, 2005 IHE and medical Standards in Denmark40
IHE Cardiology 2004-2005IHE Cardiology 2004-2005
Retrieve Information for Display
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
March 17, 2005 IHE and medical Standards in Denmark41
IHE IT Infrastructure 2004-2005IHE IT Infrastructure 2004-2005
Enterprise User AuthenticationEnterprise User Authentication
Provide users a single nameand centralized authentication
processacross all systems
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Retrieve Information for Display
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
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical
documents forming a patient electronic health record
New
March 17, 2005 IHE and medical Standards in Denmark42
Imaging Information Content
Format of the Document Content and associated coded vocabulary
Simple Document Content
Format of the Document Content and associated coded vocabulary
For Display Document Content
Format of the Document ContentLab Results Document Content
Format of the Document Content and associated coded vocabulary
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
Cross-Enterprise Document Sharing
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
March 17, 2005 IHE and medical Standards in Denmark43
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….
March 17, 2005 IHE and medical Standards in Denmark44
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