May 2011 HIT Standards & Seamless 1
How Healthcare IT
Standards Help to Achieve
Seamless Data Flows
Terveydenhuollon Atk-päivät 2011
Charles Parisot, Mgr Architecture & Standards, GE Healthcare
IHE International Board
Interoperability: From a problem to a solution
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Profile Development
& testing eHealth Projects
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Project Specific Extensions IHTSDO
IETF
Profiling Organizations are well established
Base Standards
IHE Europe & IHE National
IHE
International
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Standards Adoption Process
Document Use Case
Requirements
Identify available
standards (e.g. HL7,
DICOM, IETF, OASIS)
Develop
technical
specifications
Testing at
Connectathons IHE
Demonstrations
Products
with IHE
Timely access to
information Easy to integrate
products
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13 Years of Steady Evolution 1998 – 2011
The IHE Development Domains
Pharmacy Since 2009
Pathology since 2006
Radiation Oncology since 2004
Radiology since 1998
Cardiology since 2004
Patient Care Devices since 2005
Patient Care Coordination since 2004
Eye Care since 2006
Quality Research & Public Health
since 2006
Laboratory since 2004
(Healthcare) IT Infrastructure
since 2003
since 2008
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International Growth of IHE
France
Local Deployment, National Extensions
Promotional & Live Demonstration Events
Over 400 Organizational Members
(see www.ihe.net/governance)
USA
Germany
Italy
Japan UK
Canada Taiwan
Netherlands
Spain
Austria
1999
2000
2001
2002
2003
2004
2005
2006
2007
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09
Pragmatic global standards harmonization + best practices sharing
2008
Australia
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10
China
Turkey
Malaysia
Switzerland
What is IHE, how much adopted ?
ISO Health Informatics: TR28380 Global Standards Adoption – IHE Process and Profiles
Home Health: CONTINUA and IHE work together.
Widespread adoption of IHE Profiles by National and Regional Projects around the world:
US Nationwide Health Information Network (NwHIN) leverages IHE profiles (XCA, XDR, XCPD, BPPC, ATNA)
23 Country European epSOS Project: IHE-Europe hosting Industry Team, support project interoperability conformance testing (XCA, XCPD, ATNA, XUA, BPPC, CDA Content Modules from PCC).
In use in several national and regional projects: Austria, France, South Africa, Italy, Netherlands, USA, Japan, Switzerland, Canada
EU Commission eHealth Interop Mandate 403 leverages IHE process
European HITCH project to roadmap conformance testing and certification leverages the IHE testing experience
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eHealth and Interoperability:
What’s new in IHE Profiles ? Patient Care Devices
Patient Care Coordination
Radiology
IT Infrastructure
And more: Pharmacy, Eye Care, Endoscopy, Dentistry
Domains
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eHealth and Interoperability:
What’s new in IHE Profiles ?
Patient Care Devices
Patient Care Coordination, Radiology
IT Infrastructure
Testing, Tools and Connectathons
And more: Pharmacy, Eye Care, Endoscopy, Dentistry
Domains
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9 Courtesy: Continua Alliance
General Device - Communication Architecture
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Single data interface architecture: all Continua Personal Health
Devices, all IHE-PCD Medical Devices, and all IHE EMRs!
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DEC Profile: PCD-01 Transaction
It profiles HL7 V2.6 + IEEE Device Data Terminology
IHE DEC Profile: PCD-01 transaction
Two transport: TCP/IP+MLLP or WS (ITI TF App V)
One profiled message format (HL7 V2.6): compact, common
One simple data model for all devices (data levels, values, units, etc.)
IHE RTM Profile: Rosetta Terminology Mapping
For each specific home and care device (over 300):
Consistent „containment hierarchy‟ and value sets for coded data
Consistent use of units-of-measure for enumerated values
A consistent approach
to importing device data in a medical record
eHealth and Interoperability:
What’s new in IHE Profiles ? Patient Care Devices
Patient Care Coordination
Radiology
IT Infrastructure
Testing, Tools and Connectathons
And more: Pharmacy, Eye Care, Endoscopy, Dentistry
Domains
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Road to semantic interoperability: a huge step
A consistent approach
to standardized modular definition of clinical content
Terminology
Value Sets: • Snomed
• ICD
• LOINC
• IEEE
• Etc.
Templates
Modules
Data Elements
Archetypes
CDA Rel2
Header
Section A
Section B
Section L
Section K
Result in a Flexible but Consistent
set of Document Types
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Patient Care Coordination
Maternal and Baby Care now supported with a complete
set of CDA documents:
Antepartum Education (APE)
Antepartum Laboratory (APL)
Antepartum History and Physical (APHP)
Antepartum Summary (APS)
Labor and Delivery History and Physical (LDHP)
Labor and Delivery Summary (LDS)
Maternal Discharge Summary (MDS)
Newborn Discharge Summary (NDS)
Postpartum Visit Summary (PPVS)
All relying on the standardized modular definition of
clinical content
eHealth and Interoperability:
What’s new in IHE Profiles ? Patient Care Devices
Patient Care Coordination
Radiology
IT Infrastructure
Testing, Tools and Connectathons
And more: Pharmacy, Eye Care, Endoscopy, Dentistry
Domains
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Radiology
XDS-I continues to receive much attention
Sharing of Imaging Information (based on XDS)
Multi-Community Clarifications with XCA-I
Implementation is now widespread and feedback is positive
Radiation Exposure Monitoring ready for prime
time
At the Modality level, now moving to PACS/RIS, next to
national registries
eHealth and Interoperability:
What’s new in IHE Profiles ? Patient Care Devices
Patient Care Coordination
Radiology
IT Infrastructure
Testing, Tools and Connectathons
And more: Pharmacy, Eye Care, Endoscopy, Dentistry
Domains
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IT Infrastructure
Growing understanding of the strength and breadth
of the “XD*” family of profiles
XDM on e-mail for ubiquitous pt-to-pt send or CD/USB for media
XDR on SOAP/WS for point-to-point exchange
XDS for registry-centric exchange in a “community”*
XCA for peer to peer federation of “communities”*
* Most suited for Finland
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IT Infrastructure
Growing understanding of the strength and breadth
of the “XD*” family of profiles
XDM on e-mail for ubiquitous pt-to-pt send or CD/USB for media
XDR on SOAP/WS for point-to-point exchange
XDS for registry-centric exchange in a “community”*
XCA for peer to peer federation of “communities”*
To be combined with different patient identification strategies:
PDQ Shared stable source of Identities*
PIX for “MPI” centric patient Id linkage
XCPD for discovery & ID linkage across communities
XCPD for location discovery with a shared source of
identities* * Most likely suited for Finland
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IT Infrastructure
XDS and related Profiles extend deployment:
Off-the shelf sharing of records/documents (Finns
invention !). All type of clinical content.
Robust service: submission sets, replace/amend, etc.
Open source and support by well over 100 products
(infrastructure & EPRs).
Projects range from communities (a few
hospitals/clinics) to regions and nations. Now a few
registries/repositories with more than 1 million patients.
Implementation feedback is positive: moving beyond
interfacing to user experience.
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IHE, Global Standards-Based Profiles Adopted in National & Regional Projects (sample)
Quebec, Toronto,
Alberta, British Columbia
Canada Infoway
THINC- New York
NCHICA – N. Carolina
Italy Conto Corrente
Venetto - Friuli
Boston Medical
Center - MA
Philadelphia HIE
CHINA-MoH
Lab results sharing
CHINA-Shanghai
Imaging Info Sharing JAPAN-Nagoya
Imaging Info Sharing,
Nationwide PDI guideline
South Africa
VITL-Vermont
CareSpark
– TN & VA
NETHERLANDS
Friesland
Natn’l Mamography
Lower
Austria
Austria
France
DMP Wales
Imaging
Belgium
Flemish-Leuven
Suisse St Gallen Lausane
Providence
Health System -
OR
KeyHIE
Pennsylvania
SHARP
CA
France
Imaging
IDF
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For more complete list see: tinyurl.com/wwXDS
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IT Infrastructure
Completed the regional & national infrastructure needs:
Terminology Value Set distribution/updates with extended
SVS profile:
• Retrieve value Sets by unique identifier
• Queries to search and access value set descriptions
Healthcare Provider Directory (HPD)
• Based on LDAP
• Support Provider Persons or Provider Organizations or both (with
optional relationships)
Security and Privacy increasingly better understood:
• Encryption and Audit Trail (ATNA)
• Basic Patient Privacy Consent (BPPC)
• User Assertion (XUA) now enriched with explicit attributes
XDW - Necessity
Many different worldwide projects have as goals
to paperless/digitizing of clinical processes.
The management of workflows across multiple
organizations is the next frontier:
For example various eReferral, chronic care workflows
Flexible nature and processes for these workflows
Clinical, economic, social and organizational impact
value
XDW – Key Elements
Key assumption: Data/records are shared (use XDS)
Build key elements on top of XDS:
Managing multi-organizational workflows. Any entities to join
Workflow associated information in referenced documents
Tracking the past steps of the workflow related to specific
clinical events that triggered it
Generic workflow infrastructure: federation of point of care
workflows
Public Comment opens May 27, 2011 for one
month. Trial implementation starts August 2011
eHealth and Interoperability:
What’s new in IHE Profiles ? Patient Care Devices
Patient Care Coordination
Radiology
IT Infrastructure
Testing, Tools and Connectathons
And more: Pharmacy, Eye Care, Endoscopy, Dentistry
Domains
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Implementation Tools
Open source implementations are available for XDS, XCA, XCPD, PIX, PDQ, ATNA, CT, and more:
HIE-OS under Source Forge http://sourceforge.net/projects/hieos/
Microsoft under codeplex http://ihe.codeplex.com/
NIST under Source Forge http://sourceforge.net/projects/iheos/
OHT – IHE Profiles Charter https://iheprofiles.projects.openhealthtools.org
OHT – Model Driven Health Tools-Charter https://mdht.projects.openhealthtools.org
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Interoperability Testing Needs an Ecosystem
Document Use Case
Requirements
Identify available
standards (e.g. HL7,
DICOM, IETF, OASIS)
Develop
technical
specifications
Testing at
Connectathons IHE
Demonstrations
Products
with IHE
Timely access to
information Easy to integrate
products
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IHE Connectathon
Open invitation to vendor and other
implementers community
Advanced testing tools (GAZELLE)
Testing organized and supervised by
project management team
Thousands of cross-vendor tests performed
Results recorded and published
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IHE Connectathons
2011 Connectathon:
Chicago, USA, January 17-21, 2011
Pisa, ITALY, April 11-15, 2011
Australia, July 2011
Japan, October 2011
Massive yearly events :
70-80 vendors
250-300 engineers
100-150 systems
….integrated in 5 days
Profile
Development
& Testing
Base
Standards
eHealth Projects Interoperability
Specifications
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Interoperability: From a problem to a policy
IETF
Countries/Regions with such a process: Austria (ELGA, Regions) France (ASIP) USA (NwHIN) Italy (Venetto, etc.) China (MoH) Switzerland (ehealth suisse) Canada (Infoway)
Simple and
Effective
Profile
Recognition
Process &
Policy
Leverage Synergies of
Global Standards and Profiles
Recognized:
Profile A
Profile B
Profile C
…..
IHE- Roles of Different levels
Regional Profile Deployment
IHE Europe
France Netherlands
Spain Turkey UK Italy
Germany
Switzerland
Austria
Radiology
Cardiology
IT
Infrastructure
Patient Care
Coordination
Patient Care
Devices
Laboratory
Pathology
Eye Care Radiation
Oncology
Public Health, Quality
and Research
Pharmacy
IHE
Finland National Engagement
Projects
European Coordination
Testing & Education
International
Use Cases & Profiles
International Governance IHE International Board
Global Profile Development
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Open
to
all
Stakeholders
IHE based “Interoperability”
experience has demonstrated
significant benefits to national
and regional programs:
Reduce specification consensus time
Simplify implementation efforts
Reuse of testing tools and processes
Shared implementation experience
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HL7 Finland IHE SIG meeting next week
• Theme: national and regional interoperability using IHE profiles
– update on national imaging architecture project
– status updates on regional projects
– special focus on privacy issues (BPPC), requirements for healthcare law and updated KanTa law
• Date and time: tuesday 31.5.2011 at 13-16
• Place: National institute for health and welfare, lintulahdenkuja 4, Helsinki
• Details and registration www.uef.fi/ihe (program)
– Please register during this week!
25.4.2010 Jari Porrasmaa 33
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Providers and Vendors
Working Together to Deliver
Interoperable Health Information Systems
in the Enterprise
and Across Care Settings
http://www.ihe.net
May 2011 HIT Standards & Seamless 35
