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Continuity of Carevirtual tour
HL7-IHE DemonstrationHIMSS 2004
Presented by
• John Madden, MD, PhD, Duke University Medical Center, Department of Pathology
• Liora Alschuler, HL7/the-word-electric
Continuity of CarePatient scenario
• John is a 70-year old man with a 100-pack-year smoking history
• He recently developed persistent cough with blood-streaked sputum
• He visits Dr. Sullivan, his Primary Care Provider (PCP)
• Dr. Sullivan sends John to a nearby radiology practice for a chest x-ray
AdobeBerdyCarefxCommerceNetDCRIDictaphoneDigital InfuzionEclipsysEpicGEHeartlabIBMINFINITTKodakKryptiqMicrosoftMisysMortaraNISTPhilipsRaining DataSentillionSiemensSNOMEDXIMIS Outpatient encounter and chest xray
Scheduled workflow; report stored as CDA
PCP
Continuity of CareImaging Integration, Tumor Reporting, Claims Processing
Repository
RIS
ServerWorkstation
Registry
ImagingHL7
StandardsaECG ArdenCCOW
CDA ODMLDMRIM
SDMSPLV2V3
IHE ProfilesCT
EUAPIX
PSARID
SWFPCP sends order to
radiology office
Radiology information systemqueries scheduling server
Imaging modality queries schedulingserver for demographics
Imaging system uploads completedimage to server
Server relays copy of imageto repository.
Repository forwards document information to registry.
Continuity of CarePatient scenario
• Chest x-ray shows a 3 cm right upper lobe mass
• Radiologists communicate result to Dr. Sullivan the same day
• She refers John to Dr. Blade, a chest surgeon at the South Hospital Medical Center
Patient referred for surgeryEMR & eForms CCR sent through brokers to hospital, surgery
PCP
Continuity of CareImaging Integration, Tumor Reporting, Claims Processing
EMRBroker
Hospital
Repository
eForms
Surgery
RIS
Server
Imaging
Workstation
Registry
Server/WSEMR
EMR
AdobeBerdyCarefxCommerceNetDCRIDictaphoneDigital InfuzionEclipsysEpicGEHeartlabIBMINFINITTKodakKryptiqMicrosoftMisysMortaraNISTPhilipsRaining DataSentillionSiemensSNOMEDXIMIS
HL7 Standards
aECG ArdenCCOW
CDA ODMLDMRIM
SDMSPLV2V3
IHE ProfilesCT
EUAPIX
PSARID
SWF
PCP enters referral requestvia eForms application
Broker forwards referral to South
Med Center and torepository/registry
Hospital EMR distributes referral
request and schedules patient
visit
Clinic queries community
radiology server for availability
of x-rays
Continuity of CarePatient scenario
• Medical center radiology obtains outside chest x-ray on behalf of Dr. Blade and reviews it for the South Hospital medical record
• Dr. Blade meets with John and personally reviews the outside x-ray
• He determines that John will require surgery
Surgeon reviews imaging reportsRID query, CDA link to PACS, reg/rep for consulting report
PCP
Continuity of CareImaging Integration, Tumor Reporting, Claims Processing
Surgery
Registry
EMR
eForms
Hospital
Identity server
Dictation ServerWorkstation
ImagingRIS
AdobeBerdyCarefxCommerceNetDCRIDictaphoneDigital InfuzionEclipsysEpicGEHeartlabIBMINFINITTKodakKryptiqMicrosoftMisysMortaraNISTPhilipsRaining DataSentillionSiemensSNOMEDXIMIS
HL7 Standards
aECG ArdenCCOW
CDA ODMLDMRIM
SDMSPLV2V3
IHE ProfilesCT
EUAPIX
PSARID
SWF
Med Ctr radiology reviews
community images and
issues report
During consultation, Dr. Blade requests a low-resolution
version of x-ray to review on
office computer with John’s family
Medical dictation service
delivers radiology review
note to repository
Identity server verifies outside patient record number
Outside image and report
delivered to surgeon’s
consultation room
Continuity of CarePatient scenario
• Dr. Blade admits John
• He orders a preoperative chest CT
Patient admitted; Pre-op CT, consultEMR sends admit message; orders imaging; report converted from V2 to CDA
PCP
Continuity of CareImaging Integration, Tumor Reporting, Claims Processing
Surgery
Registry
Server
EMR
Hospital
eForms
Repository
Broker
DictationWorkstation
Imaging
ImagingRIS
HL7 Standards
aECG ArdenCCOW
CDA ODMLDMRIM
SDMSPLV2V3
IHE ProfilesCT
EUAPIX
PSARID
SWF
CT scheduled…
AdobeBerdyCarefxCommerceNetDCRIDictaphoneDigital InfuzionEclipsysEpicGEHeartlabIBMINFINITTKodakKryptiqMicrosoftMisysMortaraNISTPhilipsRaining DataSentillionSiemensSNOMEDXIMIS
John is admitted,
preoperative CT
ordered
…performed…and reported
Continuity of CarePatient scenario
• Dr. Blade performs wedge resection of RUL with node sampling
• Specimen is examined by pathology; the diagnosis is large cell carcinoma with negative nodes
• Pathology report is sent to Dr. Blade, hospital Tumor Registry
• A copy is sent to the PCP, Dr. Sullivan
Pathology Report; Surgical Report; ReferralFor patient chart and Tumor Registry; CCR back to PCP
PCP
Continuity of CareImaging Integration, Tumor Reporting, Claims Processing
Server
EMR
Hospital
Dictation
Tumor Registry
Broker
eFormsBroker
Pathology
Surgery
Repository
Registry
Workstation
ImagingRIS
AdobeBerdyCarefxCommerceNetDCRIDictaphoneDigital InfuzionEclipsysEpicGEHeartlabIBMINFINITTKodakKryptiqMicrosoftMisysMortaraNISTPhilipsRaining DataSentillionSiemensSNOMEDXIMIS
HL7 Standards
aECG ArdenCCOW
CDA ODMLDMRIM
SDMSPLV2V3
IHE ProfilesCT
EUAPIX
PSARID
SWF
Pathology report
ordered……and reported
Coded format auto-
generated for tumor
registry from CDA data
Dr. Blade composes discharge summary, dictation service queries
registry for location of referenced documents
Discharge summary
posted, copy forwarded to PCP’s broker
PCP requests copy of discharge summary in
encrypted email from broker
South Hospital
Repository view:Repository view:HL7-CDA standard XML HL7-CDA standard XML
with XQuery-ready, with XQuery-ready, context-linked SNOMED context-linked SNOMED
encodingsencodings
Pathologist view:Pathologist view:CAP/ACoS standards CAP/ACoS standards compliant, template-compliant, template-
driven data entrydriven data entry
Clinician view:Clinician view:Traditional format, Traditional format,
print/electronic print/electronic deliverydelivery
Tumor registrar view:Tumor registrar view:Irrelevant items Irrelevant items filtered, stage filtered, stage
computed computed automaticallyautomatically
A singleA singledata data
REPRESENTATIONREPRESENTATION standard standard
facilitates multiplefacilitates multiple document document
PRESENTATIONPRESENTATION standards !standards !
Continuity of CarePatient scenario
• Dr. Sullivan submits a claim to payer
• Payer requests more information
Brokered Claim; Registry DiscoveryFor patient chart and Tumor Registry; CCR back to PCP
PCP
Continuity of CareImaging Integration, Tumor Reporting, Claims Processing
Surgery
Server
EMR
Hospital
Repository
Pathology
Dictation
Tumor Registry
Registry
eForms
Broker
Broker
Payer
Workstation
ImagingRIS
AdobeBerdyCarefxCommerceNetDCRIDictaphoneDigital InfuzionEclipsysEpicGEHeartlabIBMINFINITTKodakKryptiqMicrosoftMisysMortaraNISTPhilipsRaining DataSentillionSiemensSNOMEDXIMIS
HL7 Standards
aECG ArdenCCOW
CDA ODMLDMRIM
SDMSPLV2V3
IHE ProfilesCT
EUAPIX
PSARID
SWF
Virtual EHRUbiquitous Access to Distributed Information
PCP
Continuity of CareImaging Integration, Tumor Reporting, Claims Processing
Imaging
EMR
Dictation
Tumor Registry
Broker
vEHR
Payer
Pathology
RepositoryeForms
Workstation
Registry
Server
Imaging
Hospital
RIS
AdobeBerdyCarefxCommerceNetDCRIDictaphoneDigital InfuzionEclipsysEpicGEHeartlabIBMINFINITTKodakKryptiqMicrosoftMisysMortaraNISTPhilipsRaining DataSentillionSiemensSNOMEDXIMIS
HL7 Standards
aECG ArdenCCOW
CDA ODMLDMRIM
SDMSPLV2V3
IHE ProfilesCT
EUAPIX
PSARID
SWF
AdobeBerdyCarefxCommerceNetDCRIDictaphoneDigital InfuzionEclipsysEpicGE HeartlabIBMINFINITTKodakKryptiqMicrosoftMisysMortaraNISTPhilipsRaining DataSentillionSiemensSNOMEDXIMIS
HL7 aECG ArdenCCOW
CDA ODMLDMRIM
SDMSPLV2V3
IHECT
EUAPIX
PSARID
SWF
Continuity of CareMini-tours
• Tour 1: Referrals & Repository
• Tour 2: Pictures & Words
• Tour 3: Putting it all together
AdobeBerdyCarefxCommerceNetDCRIDictaphoneDigital InfuzionEclipsysEpicGE HeartlabIBMINFINITTKodakKryptiqMicrosoftMisysMortaraNISTPhilipsRaining DataSentillionSiemensSNOMEDXIMIS
HL7 aECG ArdenCCOW
CDA ODMLDMRIM
SDMSPLV2V3
IHECT
EUAPIX
PSARID
SWF
Continuity of CareMini-tour 1
Referrals & Repository
• Order origination
• CDA export/import
• Report creation
• Referrals
• Discharge summary
AdobeBerdyCarefxCommerceNetDCRIDictaphoneDigital InfuzionEclipsysEpicGE HeartlabIBMINFINITTKodakKryptiqMicrosoftMisysMortaraNISTPhilipsRaining DataSentillionSiemensSNOMEDXIMIS
HL7 aECG ArdenCCOW
CDA ODMLDMRIM
SDMSPLV2V3
IHECT
EUAPIX
PSARID
SWF
Continuity of CareMini-tour 2
Pictures & Words
• Radiology workflow & standards
• Dictation
• CCOW
AdobeBerdyCarefxCommerceNetDCRIDictaphoneDigital InfuzionEclipsysEpicGE HeartlabIBMINFINITTKodakKryptiqMicrosoftMisysMortaraNISTPhilipsRaining DataSentillionSiemensSNOMEDXIMIS
HL7 aECG ArdenCCOW
CDA ODMLDMRIM
SDMSPLV2V3
IHECT
EUAPIX
PSARID
SWF
Continuity of CareMini-tour 3
Putting it all together
• Message routing
• Repository & registry
• Virtual EHR
• Financials
AdobeBerdyCarefxCommerceNetDCRIDictaphoneDigital InfuzionEclipsysEpicGE HeartlabIBMINFINITTKodakKryptiqMicrosoftMisysMortaraNISTPhilipsRaining DataSentillionSiemensSNOMEDXIMIS
HL7 aECG ArdenCCOW
CDA ODMLDMRIM
SDMSPLV2V3
IHECT
EUAPIX
PSARID
SWF
Thank you!
• Questions?
• Tours starting now