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1September, 2005 What IHE Delivers
The fundamentals of IHEThe fundamentals of IHEIntegrating Integrating EnterprisesEnterprises and building and building
standards-based standards-based regional and nationalregional and national health information networkshealth information networks
Israel Association for Medical Information Israel Association for Medical Information Tel-Aviv May 17, 2006Tel-Aviv May 17, 2006
Charles ParisotCharles ParisotGE Healthcare – IHE IT Infrastructure Technical Co-chairGE Healthcare – IHE IT Infrastructure Technical Co-chair
2
Standards are critical but alone are not enoughStandards are critical but alone are not enough
Standards offer generality, ambiguity and Standards offer generality, ambiguity and alternativesalternatives
Standard Implementation Guides are Standard Implementation Guides are focused on a single standardfocused on a single standard
Increasing complexityIncreasing complexity
IHE provides a standard process for IHE provides a standard process for
implementing multiple standards!implementing multiple standards!
3
Connecting standards to careConnecting standards to care
Care providers work with vendors to Care providers work with vendors to coordinate the implementation of standards coordinate the implementation of standards to meet their needsto meet their needs Care providers identify the key interoperability Care providers identify the key interoperability
problems they faceproblems they face Drive industry to develop and make available Drive industry to develop and make available
standards-based solutionsstandards-based solutions Implementers follow common guidelines in Implementers follow common guidelines in
purchasing and integrating systems that deliver these purchasing and integrating systems that deliver these solutionssolutions
IHE, effective way to establish those IHE, effective way to establish those
“standards” for how to implement standards“standards” for how to implement standards
4
What is What is Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise??
IHE provides a IHE provides a common frameworkcommon framework for passing for passing health information seamlessly:health information seamlessly: withinwithin the healthcare enterprise the healthcare enterprise acrossacross multiple healthcare enterprises multiple healthcare enterprises for local, regional & nationalfor local, regional & national health information networkshealth information networks
IHE is sponsored by IHE is sponsored by healthcare professional healthcare professional associationsassociations: HIMSS, RSNA, ACC, ACCE, ESC, : HIMSS, RSNA, ACC, ACCE, ESC, SFR, BIR, GMSIH, etc.SFR, BIR, GMSIH, etc.
IHE IHE drives standards adoptiondrives standards adoption to address specific to address specific clinical needsclinical needs
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More than 40 user organizations & close to 200 More than 40 user organizations & close to 200 healthcare vendors worldwide have contributed to healthcare vendors worldwide have contributed to IHEIHE
Delivery of ready-to-integrate products to benefit Delivery of ready-to-integrate products to benefit healthcare enterprises of all sizeshealthcare enterprises of all sizes
In clinical use today in enterprises and regional In clinical use today in enterprises and regional networksnetworks
IHE scope, today and in the futureIHE scope, today and in the future radiology, cardiology, laboratory, oncology, eye care, devicesradiology, cardiology, laboratory, oncology, eye care, devices enterprise healthcare IT infrastructuresenterprise healthcare IT infrastructures cross-enterprise healthcare IT infrastructurescross-enterprise healthcare IT infrastructures RHIO’s and NHINRHIO’s and NHIN
IHE Maturity and AcceptanceIHE Maturity and Acceptance
6
Proven Standards Adoption ProcessProven Standards Adoption Process
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
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IHE ConnectathonIHE Connectathon
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Electronic Health Record
Cardiology
Laboratory
Radiology
Oncology
Future Domains
IHE
IT Infrastructure
15 Integration Profiles
5 Integration Profiles
4 Integration Profiles
1133 IInntteeggrraattiioonn PPrrooffiilleess
Patient Care Coordination
1 Integration Profile
Patient Care
Devices
Pathology Eye Care
Endoscopy
Achievements and Expanding ScopeAchievements and Expanding ScopeClose to 200 vendors involved world-wide,Close to 200 vendors involved world-wide, 5 Technical Frameworks5 Technical Frameworks
48 Integration Profiles, Testing at Connectathons48 Integration Profiles, Testing at ConnectathonsDemonstrations at major conferences world-wideDemonstrations at major conferences world-wide
9
IHE Organizational StructureIHE Organizational Structure
Participants
contribute
Global Development:Radiology,IT Infrastructure,Cardiology,Lab, etc.
Delegates
IHE Europe
IHE North America
IHE Asia/Oceania
Regional &NationalDeployment
supervises reports
IHE (International) Strategic Development Committee
SponsorsCo-Chairs
Global
Interoperability
IHE Domain-related Planning Committee and
Technical Committee
National Extensions
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What is IHE NOT?What is IHE NOT?
Not a standard, Not a standard, although it leverages themalthough it leverages them
A vendor initiative, A vendor initiative, although they participatealthough they participate
Not a certifying authority, Not a certifying authority, although IHE although IHE provides compliance testingprovides compliance testing
Not simply a demonstration projectNot simply a demonstration project Demos are only one means to the end: Demos are only one means to the end: AdoptionAdoption Backed up by documentation, tools, testing, and Backed up by documentation, tools, testing, and
publication of Technical Frameworks and Product publication of Technical Frameworks and Product Integration Statements. Integration Statements.
IHE, critical for standardizing interoperabilityIHE, critical for standardizing interoperability
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IHE ModelIHE Model
Actors in precisely defined rolesActors in precisely defined roles Abstracts a specific function of information systemAbstracts a specific function of information system
……Executing precisely defined transactionsExecuting precisely defined transactions Using existing standardsUsing existing standards
…………To solve real world interoperabilityTo solve real world interoperability problems problems Specifying Integration ProfilesSpecifying Integration Profiles
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IHE Technical FrameworksIHE Technical FrameworksImplementation Guide for each Integration ProfileImplementation Guide for each Integration Profile
An Integration Profile :An Integration Profile : A Set of A Set of ActorsActors Exchanging Exchanging TransactionsTransactions
Query Modality Worklist [RAD-5]
ADT Order Placer
Register J.Doe
AcquisitionModality
Placer OrderManagement –New [RAD-2]
Patient Reconciliation
Department System Scheduler/Order Filler
Schedule Procedure
Procedure Scheduled [RAD-4]
Modality Procedure Step Completed [RAD-7]J.Doe ->
J.Smith
Patient Update/Merge [RAD-12]
Modality Procedure Step Completed [RAD-7]
PatientRegistration [RAD-1]
Patient Update/
Merge [RAD-12]
Modality Procedure Step In Progress [CARD-1]
Modality Procedure Step In Progress [CARD-1]
Perform Acquisition
Filler Order Mgmt - Status Update [RAD-3]
Filler Order Mgmt - Status Update [RAD-3]
ImageManager/
PPS Manager
Filler Order Management -New [RAD-3]
One or the other methods of creating an order is used
Query Modality Worklist [RAD-5]
ADT Order Placer
Register J.Doe
AcquisitionModality
Placer OrderManagement –New [RAD-2]
Patient Reconciliation
Department System Scheduler/Order Filler
Schedule Procedure
Procedure Scheduled [RAD-4]
Modality Procedure Step Completed [RAD-7]J.Doe ->
J.Smith
Patient Update/Merge [RAD-12]
Modality Procedure Step Completed [RAD-7]
PatientRegistration [RAD-1]
Patient Update/
Merge [RAD-12]
Modality Procedure Step In Progress [CARD-1]
Modality Procedure Step In Progress [CARD-1]
Perform Acquisition
Filler Order Mgmt - Status Update [RAD-3]
Filler Order Mgmt - Status Update [RAD-3]
ImageManager/
PPS Manager
Filler Order Management -New [RAD-3]
One or the other methods of creating an order is used
Use casesUse casesProcess FlowsProcess Flows
For each transaction:For each transaction: Std referencedStd referenced Options specifiedOptions specified Mapping requiredMapping required
Pt. Registration [RAD-1] Patient Update [RAD-12]
Pt. Registration [RAD-1] Patient Update [RAD-12]
Placer Order Management [RAD-2] Filler Order Management [RAD-3]
ADT
Query Images [RAD-14] Retrieve Images/Evidence [CARD-4]
Image Display
Modality Image/Evidence Stored [CARD-2]
Storage Commitment
[CARD-3]
Procedure Scheduled [RAD-4]
Procedure Updated [RAD-13]
Query Modality Worklist [RAD-5]
Performed Procedure
Step Manager
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Order Placer
Acquisition Modality
ImageManager
ImageArchive
DSS/ Order Filler
Patient Update [RAD-12]
Modality Image/Evidence Stored [CARD-2]
Storage Commitment
[CARD-3]
Evidence Creator Modality PS in Progress [CARD-1]
Modality PS Completed [RAD-7]
Instance Availability Notification [RAD-49]
Pt. Registration [RAD-1] Patient Update [RAD-12]
Pt. Registration [RAD-1] Patient Update [RAD-12]
Placer Order Management [RAD-2] Filler Order Management [RAD-3]
ADT
Query Images [RAD-14] Retrieve Images/Evidence [CARD-4]
Image Display
Modality Image/Evidence Stored [CARD-2]
Storage Commitment
[CARD-3]
Procedure Scheduled [RAD-4]
Procedure Updated [RAD-13]
Query Modality Worklist [RAD-5]
Performed Procedure
Step Manager
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Order Placer
Acquisition Modality
ImageManager
ImageArchive
DSS/ Order Filler
Patient Update [RAD-12]
Modality Image/Evidence Stored [CARD-2]
Storage Commitment
[CARD-3]
Evidence Creator Modality PS in Progress [CARD-1]
Modality PS Completed [RAD-7]
Instance Availability Notification [RAD-49]
ActorsActors TransactionsTransactions
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IHE Solutions within the EnterpriseIHE Solutions within the Enterprise
eMPIeMPIUser AuthUser Auth
EnterpriseEnterpriseIT InfrastructureIT Infrastructure
LaboratoryLaboratory
LISLIS
Auto MgrAuto Mgr AnalyzerAnalyzer
EMR - HISEMR - HISEMR - HISEMR - HIS
CardiologyCardiology
CISCIS
CathCath ECGECG
RadiologyRadiology
RISRIS
PACSPACSImg AcqImg Acq
-Radiation-Radiation Therapy Therapy
-Patient Care-Patient Care Devices Devices
-Pathology-Pathology
-Eye Care-Eye Care
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IHE Solutions within the Enterprise IHE Solutions within the Enterprise CardiologyCardiology
RadiologyRadiology CardiologyCardiology LaboratoryLaboratory
EnterpriseEnterpriseIT InfrastructureIT Infrastructure
EMR - HISEMR - HIS
RISRIS
PACSPACSImg AcqImg Acq
CISCIS
CathCath ECGECG
LISLIS
Auto MgrAuto Mgr AnalyzerAnalyzer
-Radiation-Radiation Therapy Therapy
-Patient Care-Patient Care Devices Devices
-Pathology-Pathology
-Eye Care-Eye Care
Cardiology Integration ProfilesCardiology Integration ProfilesCardiac Catheterization Lab WorkflowCardiac Catheterization Lab Workflow
Echocardiography Lab WorkflowEchocardiography Lab Workflow
Retrieve ECG for DisplayRetrieve ECG for Display
Displayable ReportsDisplayable Reports
Cath and Echo Evidence DocumentsCath and Echo Evidence Documents
eMPIeMPIUser AuthUser Auth
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IHE Solutions within the Enterprise IHE Solutions within the Enterprise LaboratoryLaboratory
RadiologyRadiology CardiologyCardiology LaboratoryLaboratory
EnterpriseEnterpriseIT InfrastructureIT Infrastructure
EMR - HISEMR - HIS
RISRIS
PACSPACSImg AcqImg Acq
CISCIS
CathCath ECGECG
LISLIS
Auto MgrAuto Mgr AnalyzerAnalyzer
-Radiation-Radiation Therapy Therapy
-Patient Care-Patient Care Devices Devices
-Pathology-Pathology
-Eye Care-Eye Care
Laboratory Integration ProfilesLaboratory Integration ProfilesLaboratory Scheduled WorkflowLaboratory Scheduled Workflow
Laboratory Information Reconciliation Laboratory Information Reconciliation
Laboratory Point Of Care TestingLaboratory Point Of Care Testing
Laboratory Device Automation Laboratory Device Automation
Laboratory Code Set DistributionLaboratory Code Set Distribution
eMPIeMPIUser AuthUser Auth
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IHE Solutions within the EnterpriseIHE Solutions within the EnterpriseIT Infrastructure (Enterprise)IT Infrastructure (Enterprise)
RadiologyRadiology CardiologyCardiology LaboratoryLaboratory
RISRIS
PACSPACSImg AcqImg Acq
CISCIS
CathCath ECGECG
LISLIS
Auto MgrAuto Mgr AnalyzerAnalyzer
-Radiation-Radiation Therapy Therapy
-Patient Care-Patient Care Devices Devices
-Pathology-Pathology
-Eye Care-Eye Care
eMPIeMPIUser AuthUser Auth
EMR - HISEMR - HIS
IT Infrastructure Integration ProfilesIT Infrastructure Integration Profiles
Patient Administration ManagementPatient Administration Management
Patient Demographics Query Patient Demographics Query
Patient Identifier Cross-referencingPatient Identifier Cross-referencing
Retrieve Information for DisplayRetrieve Information for Display
Enterprise User AuthenticationEnterprise User Authentication
Consistent TimeConsistent Time
Patient Synchronized ApplicationsPatient Synchronized Applications
Audit Trail and Node AuthenticationAudit Trail and Node Authentication
Personnel White PagesPersonnel White Pages
EnterpriseEnterpriseIT InfrastructureIT Infrastructure
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IHE Solutions within the Enterprise IHE Solutions within the Enterprise RadiologyRadiology
RadiologyRadiology CardiologyCardiology LaboratoryLaboratory
EnterpriseEnterpriseIT InfrastructureIT Infrastructure
EMR - HISEMR - HIS
RISRIS
PACSPACSImg AcqImg Acq
CISCIS
CathCath ECGECG
LISLIS
Auto MgrAuto Mgr AnalyzerAnalyzer
-Radiation-Radiation Therapy Therapy
-Patient Care-Patient Care Devices Devices
-Pathology-Pathology
-Eye Care-Eye Care
eMPIeMPIUser AuthUser Auth
Radiology Integration ProfilesRadiology Integration Profiles
Radiology Scheduled WorkflowRadiology Scheduled Workflow
Patient Information ReconciliationPatient Information Reconciliation
Access to Radiology InformationAccess to Radiology Information
Portable Data for ImagingPortable Data for Imaging
Consistent Presentation of ImagesConsistent Presentation of Images
Key Image NoteKey Image Note
Presentation of Grouped ProceduresPresentation of Grouped Procedures
Evidence DocumentsEvidence Documents
Audit trail and Node Authentication Audit trail and Node Authentication (Rad option)(Rad option)
Teaching Files and Clinical Trials ExportTeaching Files and Clinical Trials Export
Post-processing WorkflowPost-processing Workflow
Reporting WorkflowReporting Workflow
Charge PostingCharge Posting
Simple Image and Numeric ReportsSimple Image and Numeric Reports
How to use IHE ?How to use IHE ?
IHEIHE Radiology Radiology
HandbookHandbook
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IHE Scheduled Workflow (SWF) and IHE Scheduled Workflow (SWF) and Patient Information Reconciliation (PIR)Patient Information Reconciliation (PIR)
PIR = Fulfilling a request for imaging service PIR = Fulfilling a request for imaging service in in the absence of key informationthe absence of key information??How do I deal with trauma and “non-registered patients”?How do I deal with trauma and “non-registered patients”?
What if the ADT/ Patient Registration is down?What if the ADT/ Patient Registration is down?
What if the Order Placer is down?What if the Order Placer is down?
SWF = Fulfilling a request for imaging service SWF = Fulfilling a request for imaging service with maximum efficiencywith maximum efficiency??How do I avoid reentering information on modalities?How do I avoid reentering information on modalities?
How do I avoid entering in my RIS what my modality already How do I avoid entering in my RIS what my modality already knows ?knows ?
How do I ensure that in all cases no study is lost, remains unread, How do I ensure that in all cases no study is lost, remains unread, or read incomplete.or read incomplete.
How do I ensure that all necessary information is automatically on How do I ensure that all necessary information is automatically on my PACS and RIS?my PACS and RIS?
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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
20
IHE for Regional or National EHRIHE for Regional or National EHRSharing Health RecordsSharing Health Records
across different care settingsacross different care settings
21
Sharing and Accessing Electronic Health Sharing and Accessing Electronic Health RecordsRecords
IHE offers interoperability for local, regional, specific, IHE offers interoperability for local, regional, specific, or national health information exchangeor national health information exchange
Goal is to enable exchange between providers’s EHR Goal is to enable exchange between providers’s EHR systems and ancillary IT systems (Lab, Pharma, systems and ancillary IT systems (Lab, Pharma, Payers) and personal health record systems.Payers) and personal health record systems.
Objective is to empower the consumer in having Objective is to empower the consumer in having “shared EHR information” between all of its potential “shared EHR information” between all of its potential healthcare providers (if authorized) and self.healthcare providers (if authorized) and self.
IHE goal is not:IHE goal is not:
To create a “perfect health record”, the truth about a patient To create a “perfect health record”, the truth about a patient health.health.
To create an other “health record”, next to the one(s) To create an other “health record”, next to the one(s) managed by the provider and the consumer.managed by the provider and the consumer.
22
Community orsub-network
Clinical Encounter
Clinical IT System Index of patients records(Document-level)
Aggregate Patient Info
4-Patient data 4-Patient data presented to presented to
PhysicianPhysician
Sharing SystemSharing System
Clinic Record Specialist Record
Hospital Record
2-Reference2-Referenceto Records to Records for Inquiryfor Inquiry
Introduced at HIMSS in 2005 : IHE-XDSIntroduced at HIMSS in 2005 : IHE-XDS
3-Records3-RecordsReturnedReturned
ReferenceReferenceto recordsto records
Repository ofDocuments
Repository ofDocuments
23
Health Information Exchanges Interoperability: Health Information Exchanges Interoperability: Cross-enterprise Digital Document SharingCross-enterprise Digital Document Sharing
Cross-Enterprise Document Sharing minimizes clinical Cross-Enterprise Document Sharing minimizes clinical data management by the infrastructure. data management by the infrastructure. Transparency = Ease of EvolutionTransparency = Ease of Evolution
Patients have guaranteed portability and providers may Patients have guaranteed portability and providers may share information without concerns of aggregation errors.share information without concerns of aggregation errors.Digital Documents = Patients Digital Documents = Patients andand providers empowerment providers empowerment
Supports Supports both centralized and decentralizedboth centralized and decentralized repository repository architectures. Ease of architectures. Ease of federationfederation nationally. nationally. Flexible Flexible privacy,privacy, Flexibility of configurationsFlexibility of configurations
Workflows addressed in a second step in a much simpler Workflows addressed in a second step in a much simpler manner.manner.Point-to-Point messages best suited for workflows mgtPoint-to-Point messages best suited for workflows mgt
24
Cross-Enterprise Document Sharing (XDS) Cross-Enterprise Document Sharing (XDS) Standards UsedStandards Used
HealthcareContent Standards
HL7 CDA, CEN EHRcomHL7, DICOM …
Internet StandardsHTML, HTTP,
ISO, PDF, JPEG …
Electronic BusinessStandards
ebXML Registry, SOAP …
Implemented world-wide by more than 30 vendors/open Implemented world-wide by more than 30 vendors/open source. source. Final text published August 2005. Final text published August 2005.
Adopted in several national & regional projectsAdopted in several national & regional projects (Italy, (Italy, France, Canada, Austria, USA, etc.)France, Canada, Austria, USA, etc.)
IHE XDS, based on ISO 15000 standard:IHE XDS, based on ISO 15000 standard:15800 “Google” references (Jan’ 06) 15800 “Google” references (Jan’ 06) 38900 (April’ 06) 38900 (April’ 06)
25
Cross-Enterprise Document Sharing (XDS) Cross-Enterprise Document Sharing (XDS) Clinical Information in the Digital DocumentClinical Information in the Digital Document
Two “categories” of standards usedTwo “categories” of standards used
XDS Infrastructure(Document sources, consumers,
registries, repostories)
XDS Doc Content
• Medical Summaries Medical Summaries (HL7 CDA/CRS+V3)(HL7 CDA/CRS+V3)• Imaging Imaging (DICOM)(DICOM)• ECG Reports ECG Reports (PDF+)(PDF+)• Next lab, nursing, etc.Next lab, nursing, etc.
26
IHE-XDS is part of a family of profilesIHE-XDS is part of a family of profiles
Regional, national, local or disease centric networks need Regional, national, local or disease centric networks need a consistent set of Integration Profilesa consistent set of Integration Profiles
NineNine Integration Profiles completed and tested, plus Integration Profiles completed and tested, plus sevenseven in development = Standards-based interoperability in development = Standards-based interoperability building blocks forbuilding blocks for Rich Document Content for end-to-end application interoperability. Rich Document Content for end-to-end application interoperability.
Available is a structured medical summary (incl meds, allergies, pbs) Available is a structured medical summary (incl meds, allergies, pbs) and imaging information (incl. Images and reports).and imaging information (incl. Images and reports). More in More in development.development.
Patient identification managementPatient identification management Security and privacySecurity and privacy Basic workflow Basic workflow (Notif of doc availbility)(Notif of doc availbility)
IHE-XDS + related IHE Integration profiles provide a IHE-XDS + related IHE Integration profiles provide a complete interoperability solutioncomplete interoperability solution
27
IHE Integration Profiles for Health Info NetsIHE Integration Profiles for Health Info NetsWhat What is availableis available and and has been addedhas been added in 2005 and in 2005 and is for 2006is for 2006
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
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical
documents forming a patient electronic health record
Patient Identifier Cross-referencing
Map patient identifiers across independent identification
domains
Emergency Referrals
Format of the Document Content and associated coded vocabulary
Patient Created Summaries
Format of the Document Content and associated coded vocabulary
ECG Report Document
Format of the Document Content and associated coded vocabulary
Lab Results Document Content
Format of the Document Content and associated coded vocabulary
Scanned Documents
Format of the Document Content
Cross-enterprise User Authentication
Authentication & Auditing: Enhanced Access Control
Cross-enterpriseDocument InterchangeMedia-CD/USB & e-mail push
Notification of Document Availability
Notification of a remote provider/ health enterprise
Imaging Information
Format of the Document Content and associated coded vocabulary
Medical Summary (Meds, Allergies, Pbs)
Format of the Document Contentand associated coded vocabulary
Document Digital Signature
Attesting “true-copy and origin
28XDS Affinity Domain (NHIN sub-network)
Community Clinic
Lab Info. System
PACS
Teaching Hospital
PACS
ED Application
EHR System
Physician Office
EHR System
XDS Scenario + use of ATNA & CTXDS Scenario + use of ATNA & CT
PMS
Retrieve DocumentRetrieve Document
Register DocumentRegister DocumentQuery DocumentQuery Document
XDS Document Registry
ATNA Audit ATNA Audit record repositoryrecord repository CT Time serverCT Time server
Record AuditRecord AuditEventEvent
MaintainMaintainTimeTime
MaintainMaintainTimeTimeRecord AuditRecord Audit
EventEvent
Maintain TimeMaintain TimeProvide & Register Docs
Record AuditRecord AuditEventEvent
XDS Document Repository
XDSDocumen
t Reposito
rySecured MessagingSecured Messaging
29
SSttrruuccttuurreedd CCoonntteenntt wwii tthh ccooddeedd sseecctt iioonnss::
Reason for Referral Vital Signs
MMeeddiiccaattiioonn
Studies AAlllleerrggiieess
Social History PPrroobblleemmss
Care Plan
XDS-MS Medical Summary XDS-MS Medical Summary (HL7 CDA)(HL7 CDA)
Structured and Coded Header Patient, Author, Authenticator, Institution, Time of Service, etc.
Header always structured and coded
Title-coded sections with non-structured nor coded content (text, lists, tables). Simple Viewing (XML Style sheet)
Level 1Level 1
Level 2Level 2
Text StructureEntry
Text Structure Entry
Med, Problems and Allergies required as highly structured text. Text easy to import/parse
Text StructureEntry
Level 3Level 3
Med Problems and Allergies have a required fine-grain structure with optional coding. Procesable health data import
Coded Section Entry
Coded Section Entry
Coded Section Entry
Level 3Level 3
XDS-MS enables both semantical XDS-MS enables both semantical interoperability and simple viewing !interoperability and simple viewing !
30
Use of a shared XDS infrastructure to access Use of a shared XDS infrastructure to access Radiology Reports and Images (XDS-I)Radiology Reports and Images (XDS-I)
HospitalHospital
Imaging CenterImaging CenterPhysician PracticePhysician Practice
Between Radiology and :Between Radiology and :• IImaging specialistsmaging specialists• Non-imaging cliniciansNon-imaging clinicians PACS Y
PACS Z
Radiology -to-Radiology -to-RadiologyRadiology
Radiology -to-Radiology -to-PhysiciansPhysicians
Same XDS InfrastructureSame XDS Infrastructure (Registry and Repositories) (Registry and Repositories)
for medical summaries and imaging information !for medical summaries and imaging information !
31
HIMSS Feb 2006 Interoperability ShowcaseHIMSS Feb 2006 Interoperability Showcase
32
Successful showcase - Over 3000 visitorsSuccessful showcase - Over 3000 visitorsReal-world implementations. Effective IHE interoperabilityReal-world implementations. Effective IHE interoperability 36 vendor products:36 vendor products: EHR & Ancillary IT systems, PHR systems, EHR & Ancillary IT systems, PHR systems,
Registries, Repositories, MPIs, etc. Registries, Repositories, MPIs, etc.
4 Federal entities or grantees4 Federal entities or grantees (VA, DoD, NIST, CDC/UW) (VA, DoD, NIST, CDC/UW)
All implementations passed IHE ConnectathonAll implementations passed IHE Connectathon tests tests
Scenario focused on health information exchange:Scenario focused on health information exchange: Within the enterpriseWithin the enterprise (Cardiology, Radiology, etc.) (Cardiology, Radiology, etc.)
Across inpatient and physician offices care settingsAcross inpatient and physician offices care settings in a RHIO for in a RHIO for health status information health status information (meds, allergies, pbs, etc.),(meds, allergies, pbs, etc.), reports, reports, images, legacy docsimages, legacy docs
Empowered with your own health record:Empowered with your own health record: Show-wide record submission and accessShow-wide record submission and access (11 vendor booths) (11 vendor booths)
““HIMSS RHIO” InfrastructureHIMSS RHIO” Infrastructure: secured access & communications, : secured access & communications, distributed repositories, document registries, patient Id X-distributed repositories, document registries, patient Id X-referencingreferencing
HIMSS IHE Interoperability ShowcaseHIMSS IHE Interoperability ShowcaseFebruary 2006 ParticipantsFebruary 2006 Participants
Leadership LevelLeadership Level
Blue WareBlue Ware
CernerCerner
GE Healthcare GE Healthcare +IDX +IDX
IBMIBM
Initiate SystemsInitiate Systems
InterSystems InterSystems
MiSys Healthcare MiSys Healthcare
Quovadx Quovadx
Siemens Siemens
Implementer LevelImplementer Level
AllscriptsAllscripts
CanonCanon
CapMedCapMed
Cardiac ScienceCardiac Science
CGI-AMS CGI-AMS
CompassCareCompassCare
CPSI CPSI
DictaphoneDictaphone
DR SystemsDR Systems
Eastman KodakEastman Kodak
Eclipsys Eclipsys
Epic SystemsEpic Systems
HIPAATHIPAAT
HX TechnologiesHX Technologies
INFINITT TechnologyINFINITT Technology
KryptiqKryptiq
McKesson McKesson
MedAccess PlusMedAccess Plus
Medical Informatics Medical Informatics
MediNotes MediNotes
MNIMNI
National Institute of Sci & TechNational Institute of Sci & Tech
NextGen Healthcare NextGen Healthcare
Philips Medical Philips Medical
ScImageScImage
Witt Biomedical Witt Biomedical
Supporter Level:Supporter Level:
AcuoAcuo
BondBond
CarefxCarefx
ClearcubeClearcube
DairylandDairyland
EMCEMC
IdentrusIdentrus
IntelIntel
MediserveMediserve
Medkey Medkey
Motion Comp.Motion Comp.
PicisPicis
PulsePulse
SentillionSentillion
Organizational participant:Organizational participant:
American Coll. of Clinical Eng.American Coll. of Clinical Eng.
Catholic Healthcare WestCatholic Healthcare West
US Dept of DefenseUS Dept of Defense
US Dept of Veterans AffairsUS Dept of Veterans Affairs
DMP–French Natl. Personal EHRDMP–French Natl. Personal EHR
Health Level 7 HTP IEEEHealth Level 7 HTP IEEE
Midmark Diagostics GroupMidmark Diagostics Group
HIMSS RHIO FederationHIMSS RHIO Federation
Liberty AllianceLiberty Alliance
Univ. of WashingtonUniv. of Washington
34
EndorsementsEndorsements
National & Regional ProjectsNational & Regional Projects ItalyItaly CanadaCanada AustriaAustria FranceFrance JapanJapan USA (NHIN prototypes and RHIOs)USA (NHIN prototypes and RHIOs)
VendorsVendors US EHR Vendor Association (95% market): US EHR Vendor Association (95% market):
Interoperability Roadmap: Interoperability Roadmap: www.himssehrva.orgwww.himssehrva.org Europe: COCIREurope: COCIR
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Participating and Contributing Vendors (America)Participating and Contributing Vendors (America)
Agfa HealthCareAgfa HealthCare
AlgotecAlgotec
Allscripts HealthcareAllscripts Healthcare
BerdyBerdy
BluewareBlueware
CamtronicsCamtronics
Canon Medical SystemsCanon Medical Systems
CapMedCapMed
Cardiac Science Corp.Cardiac Science Corp.
CarefxCarefx
Cedara Software Corp.Cedara Software Corp.
Cerner CorporationCerner Corporation
CGI-AMSCGI-AMS
CSISTCSIST
DictaphoneDictaphone
DR SystemsDR Systems
Dynamic ImagingDynamic Imaging
Eastman Kodak CompanyEastman Kodak Company
EBM TechnologiesEBM Technologies
EclipsysEclipsys
EmageonEmageon
Raining DataRaining Data
RASNA Imaging Systems RASNA Imaging Systems
ScImage Inc.ScImage Inc.
Sectra ImtecSectra Imtec
SentillionSentillion
Shimadzu CorpShimadzu Corp
Siemens Medical Solutns’Siemens Medical Solutns’
SoftmedicalSoftmedical
Stentor, IncStentor, Inc
St. Jude MedicalSt. Jude Medical
StorCOMM, IncStorCOMM, Inc
Swissray International, IncSwissray International, Inc
Tiani-SpiritTiani-Spirit
Toshiba Medical SystemsToshiba Medical Systems
T-SystemsT-Systems
UltraVisual Medical Syst.UltraVisual Medical Syst.
Vital Images, Inc.Vital Images, Inc.
Voxar LimitedVoxar Limited
WebMD Practice ServicesWebMD Practice Services
Witt Biomedical Corp.Witt Biomedical Corp.
XIMISXIMIS
Epic Systems Corp.Epic Systems Corp.
ETIAMETIAM
FujifilmFujifilm
GE HealthcareGE Healthcare
HeartlabHeartlab
HIPAAT Inc.HIPAAT Inc.
Hitachi Medical Corp.Hitachi Medical Corp.
HologicHologic
Hx TechnologiesHx Technologies
IDX Systems CorporationIDX Systems Corporation
Imco TechnologiesImco Technologies
INFINITTINFINITT
Initiate Systems Inc.Initiate Systems Inc.
InSiteOneInSiteOne
Intelerad Medical SystemsIntelerad Medical Systems
IBMIBM
Intersystems CorporationIntersystems Corporation
Konica Minolta Konica Minolta
KrypticKryptic
Marotech, Inc.Marotech, Inc.
McKessonMcKesson
In yellow, companies with IHE Committees Chairs (Spring 2006)
MedAccessPlus HealthMedAccessPlus Health
MedCommons IncMedCommons Inc
MedconMedcon
Medical Informatics Eng.Medical Informatics Eng.
Medical Manager Health Medical Manager Health
Mediface Co.Mediface Co.
MedinotesMedinotes
Medis Medical ImagingMedis Medical Imaging
Merge eFilmMerge eFilm
MisysMisys
MNI MedicosMNI Medicos
Mortara Mortara
NextGenNextGen
NovellNovell
Open Text Corp.Open Text Corp.
Philips Medical SystemsPhilips Medical Systems
Procom TechnologyProcom Technology
Prosolv CardiovascularProsolv Cardiovascular
QRS DiagnosticsQRS Diagnostics
QuovadxQuovadx
RADinfo SystemsRADinfo Systems
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Participating and Contributing Vendors (Europe)Participating and Contributing Vendors (Europe)
AGFA HealthcareAGFA Healthcare
AISoftw@re MedicalAISoftw@re Medical
Algotec Algotec
ARES SA ARES SA
aycan Digitalsysteme aycan Digitalsysteme
CEGEDIMCEGEDIM
Cerner Corp.Cerner Corp.
CHILICHILI
CMT Medical Tech.CMT Medical Tech.
Conto Corrente SaluteConto Corrente Salute
ConVisConVis
CTI Mirada SolutionsCTI Mirada Solutions
Data Processing SPAData Processing SPA
DEDALUSDEDALUS
DianoemaDianoema
Eastman Kodak Co. Eastman Kodak Co.
Ebit SanitaEbit Sanita
EDL EDL
ELFIN s.r.l. ELFIN s.r.l.
Engineering SanitàEngineering Sanità
ESAOTEESAOTE
MEDASYS SAMEDASYS SA
MedavisMedavis
Medical CommunicationsMedical Communications
Medigration GmbH Medigration GmbH MEDIMON Ltd. MEDIMON Ltd.
MEDIWAREMEDIWARE
MEDOS AG MEDOS AG
Merge eFilm Merge eFilm
METAFORA METAFORA
Mevis Diagnostics Mevis Diagnostics
Konica Minolta Konica Minolta
Omnilab Omnilab
Philips Medical SystemsPhilips Medical Systems
POLYMEDISPOLYMEDIS
Rasna Imaging SystemsRasna Imaging Systems
RAYPAX INC. RAYPAX INC.
REMREM
Rogan-DelftRogan-Delft
Sago spa Sago spa
Sectra Imtec AB Sectra Imtec AB
SeeBeyond TechnologySeeBeyond Technology
ETIAMETIAM
Ferrania Ferrania
Fujifilm Fujifilm
GE HealthcareGE Healthcare
GIE Convergence-Profils GIE Convergence-Profils
Global Imaging Online Global Imaging Online
GWI Research GWI Research
Hi. techHi. tech
IASI Srl IASI Srl
IdeoPass IdeoPass
INFINITT INFINITT
INFOPATIENTINFOPATIENT
INOVITINOVIT
INSIELINSIEL
Intersystems Corp.Intersystems Corp.
InvitaInvita
ITZ MedicomITZ Medicom
iSoftiSoft
McKesson McKesson
MED2RAD MED2RAD
MEDarchiverMEDarchiver
In yellow, companies with IHE Committees Chairs (Winter 2005)
Siemens MedicalSiemens Medical
Soluzioni Informatiche srl Soluzioni Informatiche srl
Stentor Inc. Stentor Inc.
St. JudeSt. Jude
Swissray Medical AG Swissray Medical AG
Symphonie On LineSymphonie On Line
Synapsis Synapsis
Synchro-MedSynchro-Med
TECHNIDATATECHNIDATA
TELEMIS S.A. TELEMIS S.A.
Tiani-SpritTiani-Sprit
Tomtec Imaging Tomtec Imaging
TOREX GAP MedicalTOREX GAP Medical
Toshiba Medical SystemsToshiba Medical Systems
TSI groupe europMedica TSI groupe europMedica
T-SystemsT-Systems
Uni-medicineUni-medicine
VEPRO AG VEPRO AG
VISUS Technology VISUS Technology Transfer Transfer
WAIDWAID
XR PARTNERXR PARTNER
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Participating and Contributing Vendors (Asia)Participating and Contributing Vendors (Asia)
JapanJapanEBMJEBMJPSPPSPPANASONICPANASONICALOKAALOKAKONICA MINOLTAKONICA MINOLTAHitachi Medical Co.Hitachi Medical Co.KODAKKODAKHITACHIHITACHISBSSBSINFOCOMINFOCOMCLIMBMSCLIMBMSTECHMATRIXTECHMATRIXCANONCANONVIEWSENDVIEWSEND
TaiwanTaiwanINFINITTINFINITTShing ShianShing ShianINQ GENINQ GENTEPTEPTah YaTah Ya
KoreaKoreaAGFA KoreaAGFA Korea GE Healthcare GE Healthcare KoreaKoreaINFINITTINFINITTLG CNS LG CNS Marotech, Inc.Marotech, Inc.Medical StandardMedical StandardPeoplenet CommunicationsPeoplenet CommunicationsSamsung SDSSamsung SDS
JapanJapanITECITECWINTCSWINTCSNECNECAGFAAGFAJMACJMACGEYMSGEYMSAJSAJSTOSHIBATOSHIBAYOKOGAWAYOKOGAWAGOODMANGOODMANFUJITSUFUJITSUAANDTAANDTFUJIFILMFUJIFILM
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What can you do?What can you do?
Learn about IHELearn about IHE
Insist on IHE compliance in your RFPs and Insist on IHE compliance in your RFPs and contract documents:contract documents:
Select Integration Profiles, and Appropriate Actor(s) Select Integration Profiles, and Appropriate Actor(s)
Ask vendors for their products “IHE Integration Ask vendors for their products “IHE Integration Statements”.Statements”.
Need more interoperability ? Need more interoperability ?
Join Join IHE IsraelIHE Israel
Contribute to Global IHE CommitteesContribute to Global IHE Committees
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Call for TendersCall for TendersBe Brief (but ineffective) ?Be Brief (but ineffective) ? ““The system must support DICOM” The system must support DICOM” ““The system must support HL7”The system must support HL7”
Be Effective (but lengthy) ?Be Effective (but lengthy) ? ““The system must support the following DICOM or HL7 services The system must support the following DICOM or HL7 services
according to the following 100 pages of specifications: …”according to the following 100 pages of specifications: …”
Be Both brief and effective:Be Both brief and effective: Quote IHE profiles and actors: “The system must support the Quote IHE profiles and actors: “The system must support the
IHE Scheduled Workflow as the Order Filler actor.”IHE Scheduled Workflow as the Order Filler actor.”
Request IHE Integration StatementsRequest IHE Integration Statements Version 2.1 of the SuperX CT supports IHE Scheduled Version 2.1 of the SuperX CT supports IHE Scheduled
Workflow, Patient Information Reconciliation and Key Image Workflow, Patient Information Reconciliation and Key Image Note as an Acquisition ModalityNote as an Acquisition Modality
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IHE Integration StatementsIHE Integration Statements
Explicit claim by the vendor,Explicit claim by the vendor, for for a specific product versiona specific product version
Lists profiles, actors, optionsLists profiles, actors, options
Short (1 page) & SweetShort (1 page) & Sweet
Compare apples with apples. Compare apples with apples. e.g.: The number of IHE Integration Profiles actually delivered on e.g.: The number of IHE Integration Profiles actually delivered on different PACS products varies greatly:different PACS products varies greatly:
http://http://www.ihe.netwww.ihe.net/resources//resources/
ihe_integration_statements.cfmihe_integration_statements.cfm
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As a Provider or Vendor ContributorAs a Provider or Vendor Contributor
Offer Clinical Use Case Input to Drive IHE Profile DevelopmentOffer Clinical Use Case Input to Drive IHE Profile Development
Become a member of relevant domain’s Planning or Technical Become a member of relevant domain’s Planning or Technical CommitteesCommittees
Become a member of relevant Regional/National Committees Become a member of relevant Regional/National Committees IHE Israel IHE Israel
Help to shape IHE’s future directionHelp to shape IHE’s future direction
As a Vendor ParticipantAs a Vendor Participant
Respond to Public Comments of Domain SupplementsRespond to Public Comments of Domain Supplements
Attend Educational WorkshopsAttend Educational Workshops
Participate in Connect-a-thons and DemonstrationsParticipate in Connect-a-thons and Demonstrations
As a Provider/Consultant ParticipantAs a Provider/Consultant Participant
Respond to Public Comments of Domain SupplementsRespond to Public Comments of Domain Supplements
Attend Educational Workshops Attend Educational Workshops
Include IHE Integration Profiles in your RFPs and Integration Projects.Include IHE Integration Profiles in your RFPs and Integration Projects.
How can I participate?How can I participate?
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IHE Web site:IHE Web site: www.IHE .netwww.IHE .net Frequently AskedFrequently Asked QuestionsQuestions
Integration Profiles in Technical Frameworks: Integration Profiles in Technical Frameworks: See Volume 1 of each TF for Use casesSee Volume 1 of each TF for Use cases
CardiologyCardiology IT InfrastructureIT Infrastructure LaboratoryLaboratory Patient Care CoordinationPatient Care Coordination RadiologyRadiology
Connectathon Result: Connectathon Result: www.ihe.net/Events/connectathon_results.cfmwww.ihe.net/Events/connectathon_results.cfm
Vendor Products Integration StatementsVendor Products Integration Statements
Participation in Committees & ConnectathonsParticipation in Committees & Connectathons
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