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What IHE Delivers Integrating the HealthEnterprise IHE Australia Introduction to IHE Dr Vincent McCauley Chair, IHE Australia Chief Medical Officer, Emerging Systems HIC 2016
What IHE Delivers
Integrating the
HealthEnterprise
IHE Australia
Introduction to IHE
Dr Vincent McCauley Chair, IHE Australia
Chief Medical Officer, Emerging Systems
HIC 2016
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IHE Organizational Structure
Contributing &
Participating
Vendors
IHE North America
USA
Canada
IHE Asia
Japan
Korea Taiwan
China
ACC
ACCE
ACEP
HISA
JAHIS
JIRA
JRS
ADIA
METI-MLHW
MEDIS-DC
JAMI
RSNA
SFR
SFIL
MSIA
SIRM
BIR
EuroRec
RACS
COCIR
EAR-ECR
DRG
RANZCR
ESC
Professional Societies / Sponsors
ACP
GMSIHIM
SS
HL7 AUS
IHE International Board
Global Development
Radiology
Cardiology
IT
Infrastructure
Patient Care
Coordination
Patient Care
Devices
Laboratory
Pathology
Eye CareRadiation
Oncology
Public Health, Quality
and Research
IHE Asia-Pacific
New ZealandAustralia Malaysia
IHE Europe
France Netherlands
Spain Sweden UKItaly
Germany
Norway
Austria
Regional Deployment
Dental
IHE International
900 plus organisational members across more than 40
countries
USA, Canada, USA, UK, 23 European nations, China,
Japan, Korea
Standards Development Organisation (SDO) 2012
Liaison A status ISO TC215 Health Informatics
MOU with HL7 International to ballot profiles at HL7
Joint Working group (WG) with HL7 International –
Healthcare Standards Integration (HSI)
Member ISO TC215 Joint International Council (JIC)
IHE Australia
IHE Australia Sponsors
- Health Informatics Society of Australia (HISA)
- Health Level Seven (HL7) Australia
- Medical Software Industry Association (MSIA)
- Royal Australasian College of Radiologists (RANZCR)
Some Australian supporting members
- Health Information Management Association (HIMAA)
- Royal Australian College of Surgeons (RACS)
- Australian Diagnostic Imaging Association (ADIA)
International
Organisation for
Standardization
(ISO) TC215
National
Representative
Bodies
International SDOs
GS1 – Identification standards
DICOM – Imaging standards
IHE – Interoperability profiles &
testing
HL7 - Clinical interoperability
standards and process models
IEC – Medical devices standards
CDISC – Health research
IHTSDO – Terminologies
CEN251 – EEC standards
IEEE – Device standards
Joint
Initiative
Council
(JIC)
International
National
Coordinates
development
between SDOs
Integration point
for all SDOs
…have specific
responsibilities to
ISO
Standards
Australia
IT-014 Technical
Subcommittees
IT-014Comprises stakeholder
representatives
Comprises independent,
content expert volunteers
HL7
Australia
IHE
Australia
GS1
Australia
License agreement
(to publish HL7 localisations with
conditions)
Health Informatics Standards Development
Environment
IHE Global Standards Context
IHE DomainsRadiology – mammography, nuclear medicine
Cardiology
Radiation Oncology
IT Infrastructure
Patient Care Coordination
Patient Care devices
Laboratory, Pathology, Eye Care, Dental
Pharmacy
Quality Research and Public Health
IHE Value Proposition
• IHE Solutions are Driven by Strategic Healthcare Lead Users that collaborate with Healthcare Vendors
• IHE Solutions are Generic, Reusable and Interoperablebased on Healthcare Standards: DICOM, HL7, RFC
• IHE Solutions Optimize the Clinical Workflows
• IHE Deployment process – Connectathon, Integration Statements and Users Success Stories information helps to refine the product “Business Case”
• IHE Technical Framework specification describes the Global IHE solutions at a High Level for Planning & Marketing and in details for products Architects and Engineering development
IHE Benefits• Clinical Users
• Greater access to consistent information
• Fewer errors, fewer tedious tasks
• Administrators
• Increased throughput - Better scheduling
• Reduce Cost
• Buyers
• Specify/purchase RFP’s integration capabilities easily and Freedom to acquire “Best of Breed” systems
• IT Professionals
• Faster, more predictable integration projects
• Facilitate cooperation of competing vendors
IHE Profile Examples
(XDS/XDS-I) Cross-Enterprise Document/Image Sharing
Shares clinical documents, images, diagnostic reports and related information between healthcare enterprises
(PIX) Patient ID Cross-referencing
Cross-index patient IDs across multiple sites
(PDQ) Patient Demographics Query
Query and retrieve a patient’s demographic and visit information
(ATNA) Audit Trail and Node Authentication
Systems Authentication
Audit events management
(BPPC) Basic Patient Privacy and Consent
Patient privacy consents & enforcement
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IHE Privacy and Security Toolkit
• Accountability Controls – includes security audit logging,
reporting, alerting and alarming
• Identification and Authentication Controls - personal
interactions, Digital Certificates, security assertions,
Kerberos
• Access Controls – Role Based Access Controls
• Confidentiality Controls – encryption or access controls
• Data Integrity Controls – digital signatures, secure hash
algorithms, CRC, and checksum
• Non-Repudiation Controls
• Patient Privacy Controls
• Availability Controls – backup, replication, fault tolerance,
RAID, trusted recovery, uninterruptible power supplies, etc.
IHE reinforces need for basic security functionalities –
through Audit Trail and Node Authentication
IHE Radiology Integration Profiles
Patient
Info.
Recon-
ciliation
Access to Radiology Information
Consistent
Presentation
of
Images
Audit Trail & Node Authentication - Radiology Option
Evidence
Docs
Key
Image
Notes
Simple
Image &
Numeric
Reports
Presentation
of
Grouped
Procedures
Post-
Processing
Workflow
Reporting
Workflow
Charge
Posting
XDS for Imaging
NM
Image
Scheduled Workflow
Teaching
Files &
Clinical Trials
Export
Portable Data for Imaging
NM
Image
Cardiac NM
Option
Image
FusionImage
Fusion
A “simple” IHE Profile - Portable Data
for Imaging
Media
Creator
Printer
[Media Reader]
Image Display
[Media Reader]
PACS
[Media Importer]
CD
John DoeDICOM Data
Web Data
(Optional)
DICOM
DICOM
DICOM
PC BrowserWeb Data
Required to
cleanup Patient
ID, Acc#, etc.
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images
stored
patient
information
RIS
examination orders
images
retrieved
HIS
PACS
procedure
scheduledPrefetch any relevant
prior studies
modality
worklist
report
report
IHE Scheduled Workflow Profile
Registration
Orders Placed
Orders Filled
Film
Film
FolderImage Manager
& Archive
Film
Lightbox
reportReport
Repository
Diagnostic
Workstation
Modality
acquisition
in-progress
acquisition
completed
acquisition
completed
images
printed
Acquisition
Modality
IHE Integration Profiles – supporting CDA
Emergency Referrals
Format of the Document Content
and associated coded vocabulary
PHR Extracts/Updates
Format of the Document Content
and associated coded vocabulary
ECG Report Document
Format of the Document Content
and associated coded vocabulary
Lab Results Document
ContentFormat of the Document Content
and associated coded vocabulary
Scanned Documents Format of the Document ContentImaging Information
Format of the Document Content
and associated coded vocabulary
Medical Summary
(Meds, Allergies, Pbs)Format of the Document Content
and associated coded vocabulary
Clinical and PHR Content
Health Data Exchange
Patient Demographics
Query
Patient Identifier
Cross-referencingMap patient identifiers across
independent identification
domains
Notification of Document Availability
Request Formfor Data Capture
External form with custom
import/export scripting
Patient ID Mgmt
OtherCross-Enterprise
Document SharingRegistration, distribution and access
across health enterprises of clinical
documents forming a longitudinal record
Cross-Enterprise Document Pt-Pt Reliable InterchangeCross-Enterprise Document
Media InterchangeCross-Community Access
Security & Privacy
Consistent Time
Coordinate time across networked
systems
Audit Trail & Node
Authentication
Centralized privacy audit trail and node
to node authentication to create a
secured domain.
Basic Patients Privacy
ConsentsEstablish Consents & Enable
Access Control
Document Digital Signature
Attesting “true-copy and origin
Cross-Enterprise User Assertion
Provides Trusted Identity
Document Metadata Subscription
Pub/sub on registered docs
CDA/CCD
Based
What IHE Delivers
Patient monitors,
vital signs monitors,
pulse oximetry,
ventilators,
Infusion pumps,
syringe pumps, PCA
pumps,
Defibrillators &
implantables
Medical Device Integration
Patient Care Devices (PCD)
Device to Enterprise Communication (DEC)
Alert Communication Management (ACM)
Point of care Infusion Verification (PIV)
Infusion Pump Event Communication (IPEC)
Implantable Device - Cardiac Observation (IDCO)
Retrospective Data Query (RDQ)
Waveform Content Module (WCM)
Location Services (MEMLS)
Device Management Communication (MEMDMC)
Rosetta Terminology Mapping (RTM)
Point of Care Identity Management (PCIM)
Optimized Messaging Syntax (OMS)
PCD Profiles:
Device to Enterprise Communication
(DEC)
TBD @ Vendors
Alert Communication Management
(ACM)
HL7 Messagesper ACM andWCM profiles
Parameters, waveforms, etc.as evidentiary data items
DeviceSpecificgraphics
Alert InformationSource, Phase, State, Priority
PatientLocationInstanceAlert textCallback
TimestampEvidentiary data
Dissemination StatusInstance
Accepted by ACUndeliverable
DeliveredRead
AcceptedRejected
CancelledCallback start/stop
AlertCommunicator
AC
AlertManagerAM
AlertReporterAR
Report AlertPCD-04 →
← PCD-05Report Alert
Status
Disseminate AlertPCD-06 →
← PCD-07DisseminateAlert Status
AlertSource
NOTE: Supports implementations per 80001-2-5 Distributed Alarm System Risk Management Guidance (headed to publication)
Point of care Infusion Verification
(PIV)
Medication
Physician’s
Order
Nurse
Review
Pharmacist
Review
Nurse confirms 6 Rights:
•Right Patient
•Right Medication
•Right Dose
•Right Time
•Right Route
•Right Device
Medication
Administered
BCMA to
Pump
(PCD-03)
Pump
may
provide
data to
EMR
(PCD-01)
Infusion Pump Event
Communication (IPEC)
Pump provides information on
infusion-related events to
BCMA/EMR (PCD-10) such as:
• Delivery Start
• Delivery Stop
• Delivery Complete
Prior to medication
administration, nurse confirms
the 6 Rights of administration
using BCMA/EMR:
• Right Patient
• Right Medication
• Right Dose
• Right Time
• Right Route
• Right Device
Infusion-related events are
displayed, validated, and/or
recorded by the clinician using
the BCMA/EMR
BCMA/EMR
Infusion Pump Event Communication enables reporting of clinical and operational events from an
infusion pump to a Bedside Computer-assisted Medication Administration (BCMA) system or EMR.
Clinicians can then view and validate this information for infusion documentation.
Infusion order sent
from BCMA/EMR
to Pump (PCD-03)
Implantable Device – Cardiac
Observation (IDCO)
IHE Australia Developed profiles
HL7 V2 Diagnostic results reporting profile
– ATS 5201-2010. An IHE profile of
AS 4700.2-2004
Secure Message Delivery – SMD –
ATS5822-2010
Development of specifications and
conformance requirements
HL7 V2 Referral Profile – AS5338 – An IHE
profile of AS4700.6-2010
Document
Consumer
Retrieve
Document
Query
Documents
Patient
Identity Source
Patient Identity
Feed
Document
Source
Document
Registry
Document
Repository
Provide & Register
Document Set
Register
Document Set
Cross-enterprise
Document Sharing - XDS
Patient Health
Identifier Service
IHI
PCEHR Architecture (XDS)
IHE Problem Solution ProcessUser driven, Vendor led – A standardised process ISO TR28380
parts 1 to 3
Working with vendors, care providers and standards
organizations, IHE:
Distills a clear description of the problem (Users)
Determines the right way to solve it using standards (Vendors)
(IHE Profile)
Documents the solution in an implementation guide
(IHE Technical Framework)
Coordinates cross-vendor testing of the solution
(IHE Connectathon)
Demonstrates vendor implementations (IHE Showcase)
Go see the rest of the profiles
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IHE Testing Process
Users
Sponsors:
Project
Management
Team
Vendors
Sponsors:
Exhibits
Develop
Testing Tools
Testing Tools
Implement
Profile Actors
In-House
Testing
Connectathon
Showcase
Deploy
Systems
Testing Results
Approves
Test Logs
IHE Technical Framework (IHE Profile Specifications)
Product +
Integration
Statement
Certification
What is an IHE Connectathon?
Cross-vendor, live, supervised, structured tests
All participating vendors’ products tested together in the same place/time
Experts from each vendor available for immediate problem resolution… fixes are done in minutes, not months!!
Each vendor tests with multiple trading partners (actual product to actual product)
Testing of real-world clinical scenarios using IHE Integration Profiles
IHE Chicago Connectathon
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IHE, Global Standards-Based Profiles Adopted in National & Regional Projects (2012)
3
3
Quebec, Toronto,
Alberta, British Columbia
Canada Infoway
THINC- New York
NCHICA – N. Carolina
Italy Conto Corrente
Salute
Venetto - Friuli
Boston Medical
Center - MA
Philadelphia HIE
CHINA-MoH
Lab results sharing
KeyHIE
Pennsylvania
CHINA-Shanghai
Imaging Info SharingJAPAN-Nagoya
Imaging Info Sharing,
Nationwide PDI guideline
South Africa
VITL-Vermont
CareSpark
– TN & VA
NETHERLANDS
Friesland
Natn’l Mamography
Lower
Austria
Austria
France
DMPWalles
(Imaging-Tender)
Belgium
Flemish-Leuven
SuisseSt GallenLausane
Providence
Health System -
OR
Australia
PCEHR
