Strategies for Implementing the Digital Healthcare Community
Practical conditions for business adoption of standards HL7 UK, LondonOctober 26, 2005Charles ParisotCharles ParisotGE Healthcare Information TechnologiesGE Healthcare Information Technologies
HL7 UK 2006 - The future of Integration 2 25-26 October 2006
Topics
• Interoperability and digital communities
• Critical success factors for standards adoption
• Establishing a digital community framework at the international level
• Examples of successful interoperability
• Summary
HL7 UK 2006 - The future of Integration 3 25-26 October 2006
Open, standards-based interoperability critical to building a digital community •Congratulations to
standards development and implementation organizations
•Interoperability creates markets… e.g. $1B+ PACS
•More importantly… Interoperability transforms patient care
•GE interoperability at: http://www.gehealthcare.com/usen/interoperability
HL7 UK 2006 - The future of Integration 4 25-26 October 2006
Standards in the real-world
• One sort of healthcare interoperability standards… Those that are adopted !
• Multiplicity of Standards development organizations in healthcare… necessity given the breadth, complexity and technological evolution, but each one needs to be global by domain.
• Calculated risks to Introduce new standards…. require the first line stakeholders: vendors and providers to gain confidence to implement (focused use cases).
• Interoperability Standards are deployed in incremental steps.
• A Standards Implementation Process needed to orchestrate: Requires an implementation “conductor”.
HL7 UK 2006 - The future of Integration 5 25-26 October 2006
Vendors, Clinicians & CIO’s key to driving interoperability as stakeholders•Clinicians… Quality of care, safety, productivity, affordability
•CIOs… Cost effective, plug-n-play, “future-proof”
•Vendors… Reliability, ready to implement standards, speed to market
HL7 UK 2006 - The future of Integration 6 25-26 October 2006
Proven Standards Adoption Process: IHE
Document use Document use case case requirementsrequirements
Document use Document use case 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
HL7 UK 2006 - The future of Integration 7 25-26 October 2006
Sharing a Common Framework Internationally ?
•Belief that differences in health systems create insurmountable barriers and requires national customization. Over 10 countries are already rushing down this path.
Many believe that it cannot be done, it is already in progress. Loosing time ? No, results with faster and cheaper deployment
•Once one realizes that challenge is to “connect” the IT systems used in thousands of point of care. This is the primary interface to address with a globally harmonized standards-based framework
•Much energy spent creatinginternationally agreed standards
•Only partially true for clinical information. Languages, some existing codifications, and order in deployment strategies shall be accommodated.
HL7 UK 2006 - The future of Integration 8 25-26 October 2006
US EHR Vendor Association: A roadmap Phase-in of Communication Services
available
6 mos to2yrs
2yrs +
Phase 4: Active Quality Reporting
& Health SurveillancePhase 3: Advanced Clinical Support & Access Control
Phase 2: Share Diagnostic Results &
Therapeutic Information
Phase 1: Share Care Status Information
From: www.himssehrva.org
HL7 UK 2006 - The future of Integration 9 25-26 October 2006
Realizing the complementary roles of document sharing and of message
based transactionsEnd-Point System To End-Point SystemInterchange
End-Point Systems to National Infrastructure Sub-network Communication
From HIMSS EHRVA Response to ONCHIT RFI, January 2005
e.g. EMR e.g. Lab, PACSEMR, etc.
• Thin set of Health Net Services – facilitates information exchange• End-Point System services exist at two distinct levels • Net/Subnet communication level – e.g., IHE/XDS (Cross-enterprise Doc. Sharing)
• Peer-to-Peer level – transparent to infrastructure, e.g., doc content / type
Internet
Document Sharing
Dynamic Information
Mgmt
... ... Med
icat
i ons
PushNotificati
on( eRx,
eReferral )Transaction
Mgmt
Clinical Content Clinical Content
Security &Identity
Historical Documents
DynamicQueries
WorkflowTransaction
Record Locator ServicesRecord Locator Services
Patient &Provider ID Mgmt
AccessControl
CD
A
Lab
resu
lts
PD
F
Rad
iolo
gy
Allerg
ies
Med
icati
on
s
Internet
Document Sharing
Dynamic Information
Mgmt
... ... Med
icat
i ons
PushNotificati
on( eRx,
eReferral )Transaction
Mgmt
Clinical Content Clinical Content
Record Locator ServicesRecord Locator Services
Patient &Provider ID Mgmt
AccessControl
Med
Su
mm
aie
s
Lab
resu
lts
Scan
Docs
Rad
iolo
gy
Allerg
ies
Med
icati
on
s
HL7 UK 2006 - The future of Integration 10 25-26 October 2006
Community orsub-network
Clinical EncounterClinical Encounter
Clinical IT SystemClinical IT System Index of patients records(Document-level)
Aggregate Aggregate Patient InfoPatient Info
4-Patient data 4-Patient data presented to presented to
PhysicianPhysician
Sharing SystemSharing System
Clinic RecordClinic Record Specialist RecordSpecialist Record
Hospital RecordHospital Record
2-Reference2-Referenceto Records to Records for Inquiryfor Inquiry
Indexing Patient Centric Documents : IHE-XDSIndexing Patient Centric Documents : IHE-XDS
3-Records3-RecordsReturnedReturned
ReferenceReferenceto recordsto records
Repository ofDocuments
Repository ofDocuments
HL7 UK 2006 - The future of Integration 11 25-26 October 2006
Doc Exchange Integration ProfilesDoc Exchange Integration Profiles
Document Content and Modes of Document Exchange
Doc Content Profiles Doc Content Profiles (CDA R2+V3-RMIM+DICOM+PDF)(CDA R2+V3-RMIM+DICOM+PDF)
Doc SharingDoc Sharing
XDSXDS
MediaMediaInterchangeInterchange
XDMXDM
Pt-Pt DocPt-Pt DocInterchangeInterchange
XDRXDR
LaboratoryLaboratory
XD*-LabXD*-LabPatientPatientInputInput
XPHRXPHR
ConsentConsent
BPPCBPPCEmergencyEmergency
EDREDRPrePre
SurgerySurgery
PPHPPPHP
Scanned DocScanned Doc
XDS-SDXDS-SD
Discharge &Discharge &ReferralsReferrals
XDS-MSXDS-MS
ImagingImaging
XDS-IXDS-I
HL7 UK 2006 - The future of Integration 12 25-26 October 2006
IHE & Regional and National Projects Today
Canada Infoway
HITSP InteroperabilitySpecifications
Denmark (Funen)Italy (Veneto)Spain (Aragon)
Austria
THINC- New YorkNCHICA – N. Carolina
Italy (Conto CorrenteSalute)
MA-Share – MAIHIE – INMendicino - CA
FranceDMP
UK CfHRadiology
HL7 UK 2006 - The future of Integration 13 25-26 October 2006
Summary• Interoperability for national
influences local strategies… internet vs. intranet
•Modular approach allows incremental build-out of digital communities
• IHE Showcases are demo’ing profiles that will be used to build regional/national nets.
•Today… Count on GE for interoperability leadership
•Tomorrow… Count on GE to enable personalized health information exchange
HL7 UK 2006 - The future of Integration 14 25-26 October 2006