1September, 2005 What IHE Delivers
Patient Patient Care Care CoordinationCoordination
IHE Europe Workshop 2007IHE Europe Workshop 2007
IHE Patient Care Coordination IHE Patient Care Coordination
Charles Parisot, GE HealthcareCharles Parisot, GE Healthcare
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Content Profile RoadmapContent Profile Roadmap
Year 2005-2006 (Trial Implementation)Year 2005-2006 (Trial Implementation) Medical Summary [MS] – Acute Care Discharge to Medical Summary [MS] – Acute Care Discharge to
PCP, PCP Referral to SpecialistPCP, PCP Referral to Specialist Unstructured Document – CDA-wrapped PDFUnstructured Document – CDA-wrapped PDF
Year 2006-2007 (Development & Testing)Year 2006-2007 (Development & Testing) Medical Summary [MS] – ED Referral [EDR]Medical Summary [MS] – ED Referral [EDR] Pre-procedure H&P [PPHP]Pre-procedure H&P [PPHP] Basic Patient Privacy Consents [BPPC]Basic Patient Privacy Consents [BPPC] Exchange Personal Health Record [XPHR] Exchange Personal Health Record [XPHR]
3
PCC Content Integration ProfilesPCC Content Integration Profiles
XDS-MSXDS-MSMedicalMedical
DocumentsDocuments
ReferralReferral
BCCPBCCP
ConsentConsent
EDREDR
EmergencyEmergencyDepartmentDepartment
ReferralReferral
PPHPPPHP
PreprocedurePreprocedureHistory andHistory and
PhysicalPhysical
History andHistory andPhysicalPhysical
XPHRXPHR
PHR UpdatePHR Update
2005-20062005-20062006-20072006-20072007-20082007-2008
XD*-LABXD*-LAB
Lab ReportLab Report
PHR ExtractPHR Extract
EDNEDN
EmergencyEmergencyDepartmentDepartment
NoteNote
ACSACS
AntenatalAntenatalCareCare
SummarySummary
CACA
CareCareAssessmentsAssessments
DischargeDischargeSummarySummary
MedicalMedicalSummariesSummaries
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PCC Content Integration ProfilesPCC Content Integration Profiles
Content using a Specific StandardContent using a Specific Standard CDA Release 2.0CDA Release 2.0 HL7 Care Record SummaryHL7 Care Record Summary HL7/ASTM Continuity of Care DocumentHL7/ASTM Continuity of Care Document
Library of Reusable PartsLibrary of Reusable Parts Document TypesDocument Types SectionsSections EntriesEntries
5September, 2005 What IHE Delivers
Basic Patient Basic Patient PrivacyPrivacy Consents (BPPC) Consents (BPPC)
IHE Vendors Workshop 2006IHE Vendors Workshop 2006
IHE Patient Care Coordination EducationIHE Patient Care Coordination Education
John Moehrke, Robert Horn, Lori Fourquet, Keith W. BooneJohn Moehrke, Robert Horn, Lori Fourquet, Keith W. Boone
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Basic Patient Privacy ConsentsBasic Patient Privacy ConsentsAbstractAbstract
The Basic Patient Privacy Consents The Basic Patient Privacy Consents (BPPC) profile provide mechanisms to:(BPPC) profile provide mechanisms to: Record the patient privacy consent(s), Record the patient privacy consent(s), Mark documents published to XDS with the patient Mark documents published to XDS with the patient
privacy consent that was used to authorize the privacy consent that was used to authorize the publication, publication,
Enforce the privacy consent appropriate to the Enforce the privacy consent appropriate to the use.use.
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Basic Patient Privacy ConsentsBasic Patient Privacy ConsentsScopeScope
Document Sources and Document Document Sources and Document Consumers in an XDS Affinity DomainConsumers in an XDS Affinity Domain
Document Sources and Document Document Sources and Document Receivers using Cross Enterprise Point-Receivers using Cross Enterprise Point-to-Point Document Sharingto-Point Document Sharing
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Basic Patient Privacy ConsentsBasic Patient Privacy ConsentsValue PropositionValue Proposition
an Affinity Domain can an Affinity Domain can develop privacy policies, develop privacy policies, and implement them with role-based or other and implement them with role-based or other
access control mechanisms supported by EHR access control mechanisms supported by EHR systems.systems.
A patient canA patient can Be made aware of an institutions privacy policies. Be made aware of an institutions privacy policies. Have an opportunity to selectively control access Have an opportunity to selectively control access
to their healthcare information.to their healthcare information.
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Basic Patient Privacy ConsentsBasic Patient Privacy ConsentsKey Technical PropertiesKey Technical Properties
Human Readable ConsentsHuman Readable Consents
Machine ProcessableMachine Processable
Support for standards-based Role-Based Support for standards-based Role-Based Access ControlAccess Control
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Basic Patient Privacy ConsentsBasic Patient Privacy ConsentsStandards and Profiles UsedStandards and Profiles Used
CDA Release 2.0CDA Release 2.0
XDS Scanned DocumentsXDS Scanned Documents
Document Digital SignatureDocument Digital Signature
Cross Enterprise Document SharingCross Enterprise Document Sharing
Cross Enterprise Point-to-Point Document SharingCross Enterprise Point-to-Point Document Sharing
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Basic Patient Privacy ConsentsBasic Patient Privacy ConsentsExampleExample
Encounter 2Encounter 2(OK with B)(OK with B)
Encounter 1Encounter 1(Requires A)(Requires A)
Consent AConsent A
Consent BConsent B
12September, 2005 What IHE Delivers
Pre-procedure History Pre-procedure History and Physical (PPHP)and Physical (PPHP)
IHE Development Team Workshop 2006IHE Development Team Workshop 2006
IHE Patient Care Coordination EducationIHE Patient Care Coordination Education
Dan Russler, MD, co-chair PCC Technical CommitteeDan Russler, MD, co-chair PCC Technical Committee
13
Use CaseUse Case
H&P documentation required prior to H&P documentation required prior to procedure that is designed to assess:procedure that is designed to assess: Procedure RiskProcedure Risk Anesthesia RiskAnesthesia Risk Factors influencing procedure after-care decisionsFactors influencing procedure after-care decisions
Desired outcomesDesired outcomes Minimize injury during procedureMinimize injury during procedure Optimize procedure after-careOptimize procedure after-care
Pre-procedure H&PPre-procedure H&P
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ScopeScope
To identify the required and optional PPHP To identify the required and optional PPHP document content templates including:document content templates including: CDA Document HeaderCDA Document Header CDA Document Type(s)CDA Document Type(s) CDA Section TypesCDA Section Types CDA Entry TypesCDA Entry Types
Pre-procedure H&PPre-procedure H&P
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Value PropositionValue Proposition
A procedure risk assessment A procedure risk assessment must be presentmust be present and evaluated by the operative and after-care and evaluated by the operative and after-care teams before the patient is allowed to have the teams before the patient is allowed to have the procedure. Missing information is frequently a procedure. Missing information is frequently a reason for canceling the procedure for the day, reason for canceling the procedure for the day, which leads to which leads to expensive underutilization of expensive underutilization of resources and dissatisfied patientsresources and dissatisfied patients. Further, . Further, incomplete information about the patient’s incomplete information about the patient’s clinical or home status may create a situation clinical or home status may create a situation where a procedure is performed that ultimately where a procedure is performed that ultimately results in an injury, inadequate aftercare or other results in an injury, inadequate aftercare or other undesirable outcomeundesirable outcome..
Pre-procedure H&PPre-procedure H&P
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Key Technical PropertiesKey Technical Properties
PPHP Profile inherits specifications required for PPHP Profile inherits specifications required for other IHE PCC Medical Documentsother IHE PCC Medical Documents
PPHP Profile follows documentation practices for PPHP Profile follows documentation practices for all IHE PCC Medical Documentsall IHE PCC Medical Documents
PPHP Profile emphasizes re-usability of CDA PPHP Profile emphasizes re-usability of CDA template identifiers in order to reduce un-template identifiers in order to reduce un-necessary variability in IHE Content Profilesnecessary variability in IHE Content Profiles
Pre-procedure H&PPre-procedure H&P
17
Standards UsedStandards Used
IHE Medical Document Content ProfilesIHE Medical Document Content Profiles
HL7 Reference Information Model ANSI StandardHL7 Reference Information Model ANSI Standard
HL7 CDA R2 ANSI StandardHL7 CDA R2 ANSI Standard
HL7 Care Provision Domain DSTU (in process)HL7 Care Provision Domain DSTU (in process)
Implementation GuidesImplementation Guides HL7 Care Record Summary CDA R2 Implementation Guide HL7 Care Record Summary CDA R2 Implementation Guide
(in process)(in process) HL7/ASTM Continuity of Care Document Implementation HL7/ASTM Continuity of Care Document Implementation
Guide (in process)Guide (in process)
Pre-procedure H&PPre-procedure H&P
18September, 2005 What IHE Delivers
Todd Rothenhaus, MD FACEPTodd Rothenhaus, MD FACEP
American College of Emergency PhysiciansAmerican College of Emergency Physicians
Emergency Department Emergency Department ReferralReferral
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Emergency DepartmentEmergency Department ReferralReferral Value PropositionValue Proposition
Nearly 5000 EDs in US or in EuropeNearly 5000 EDs in US or in Europe
Significant percentage of ED visits are referralsSignificant percentage of ED visits are referrals
Shortage of critical health data for emergency Shortage of critical health data for emergency department patientsdepartment patients
Need to improve communication of intended patient Need to improve communication of intended patient care plans to ED providers and ensure that no care plans to ED providers and ensure that no pertinent data is lostpertinent data is lost
Streamline workflow by obviating telephone calls Streamline workflow by obviating telephone calls between busy cliniciansbetween busy clinicians
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Emergency DepartmentEmergency Department ReferralReferral ScopeScope
EHR system capable of creating a care record EHR system capable of creating a care record summary would be capable of creating a summary would be capable of creating a referral package for a receiving systemreferral package for a receiving system
The emergency department information The emergency department information systems (EDIS) will need to retrieve and read systems (EDIS) will need to retrieve and read and display this data.and display this data.
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Emergency DepartmentEmergency Department ReferralReferralUse CaseUse Case
1.1. Health care provider determines that a Health care provider determines that a patient needs to go to the EDpatient needs to go to the ED
2.2. Provider creates an ED referral package Provider creates an ED referral package using his or her EHRusing his or her EHR
3.3. Upon arrival, the ED provider identifies Upon arrival, the ED provider identifies the patient as a referralthe patient as a referral
4.4. The posted referral package is imported The posted referral package is imported into the Emergency Department into the Emergency Department Information System (EDIS)Information System (EDIS)
Provide access to critical health informationProvide access to critical health information to ED information systems in a standard manner. to ED information systems in a standard manner.
22September, 2005 What IHE Delivers
Exchange of PHR ContentExchange of PHR Content(XPHR) (XPHR)
IHE Vendors Workshop 2006IHE Vendors Workshop 2006
IHE Patient Care Coordination EducationIHE Patient Care Coordination Education
Keith W. Boone, GE Healthcare [co-chair PCC Technical Committee]Keith W. Boone, GE Healthcare [co-chair PCC Technical Committee]
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Exchange of PHR ContentExchange of PHR ContentXDS-MSXDS-MS
MedicalMedicalDocumentsDocuments
MedicalMedicalSummariesSummaries
ReferralReferral DischargeDischargeSummarySummary
BCCPBCCP
ConsentConsent
EDREDR
EmergencyEmergencyDepartmentDepartment
ReferralReferral
PPHPPPHP
PreprocedurePreprocedureHistory andHistory and
PhysicalPhysical
History andHistory andPhysicalPhysical
XPHRXPHR
PHR UpdatePHR Update
XDSXDSLABLAB
CDA LabCDA Lab
PHR ExtractPHR Extract
XPHRXPHR
PHR UpdatePHR Update
PHR ExtractPHR Extract
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AbstractAbstract
The Exchange of Personal Health Record The Exchange of Personal Health Record Content (XPHR) provides a standards-Content (XPHR) provides a standards-based specification for managing the based specification for managing the interchange of documents between a interchange of documents between a Personal Health Record and an EHR Personal Health Record and an EHR System to enable better interoperability System to enable better interoperability between these systems. between these systems.
Exchange of PHR Exchange of PHR ContentContent
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ScopeScope
Personal Health Record (PHR) SystemsPersonal Health Record (PHR) Systems
Electronic Health Record (EHR) SystemsElectronic Health Record (EHR) Systems
PHR System EHR System
Portable Media Creator Portable Media Importer
Distribute Document Set on Media [ITI-B]
Portable Media Creator Portable Media Importer
Distribute Document Set on Media [ITI-B]
Exchange of PHR Exchange of PHR ContentContent
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Value PropositionValue Proposition
Supports interchange of PHR InformationSupports interchange of PHR Information DemographicsDemographics Insurance InformationInsurance Information Medications, Problems, AllergiesMedications, Problems, Allergies Health HistoryHealth History Other InformationOther Information
Exchange of PHR Exchange of PHR ContentContent
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Standards UsedStandards Used
CDA Release 2.0CDA Release 2.0
ASTM Continuity of Care Data SetASTM Continuity of Care Data Set
ASTM/HL7 Continuity of Care DocumentASTM/HL7 Continuity of Care Document
HL7 Care Record SummaryHL7 Care Record Summary
AHIMA PHR Common Data ElementsAHIMA PHR Common Data Elements
XDS, XDRXDS, XDR
Document Digital SignatureDocument Digital Signature
Exchange of PHR Exchange of PHR ContentContent
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Key Technical PropertiesKey Technical Properties
Information is Human ReadableInformation is Human Readable
and Machine Processableand Machine Processable
Support Static and Dynamic Information Support Static and Dynamic Information Sharing Domains (XDS and XDR)Sharing Domains (XDS and XDR)
Protects Information using Digital SignatureProtects Information using Digital Signature
Update Model for EHR to PHR ChangesUpdate Model for EHR to PHR Changes
Exchange of PHR Exchange of PHR ContentContent
29Doc Exchange Integration ProfilesDoc Exchange Integration Profiles
Key Profiles for Document Content and ExchangeKey Profiles for Document Content and Exchange
Doc Content ProfilesDoc Content Profiles
Doc SharingDoc Sharing
XDSXDS
MediaMediaInterchangeInterchange
XDMXDM
Pt-Pt DocPt-Pt DocInterchangeInterchange
XDRXDR
ConsentConsent
BPPCBPPCEmergencyEmergency
EDREDRPrePre
SurgerySurgery
PPHPPPHP
Scanned DocScanned Doc
XDS-SDXDS-SD
LaboratoryLaboratory
XD*-LabXD*-LabPHR PHR
ExchangeExchange
XPHRXPHR
Discharge &Discharge &ReferralsReferrals
XDS-MSXDS-MS
ImagingImaging
XDS-IXDS-I
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PCC Content Integration ProfilesPCC Content Integration Profiles
XDS-MSXDS-MSMedicalMedical
DocumentsDocuments
ReferralReferral
BCCPBCCP
ConsentConsent
EDREDR
EmergencyEmergencyDepartmentDepartment
ReferralReferral
PPHPPPHP
PreprocedurePreprocedureHistory andHistory and
PhysicalPhysical
History andHistory andPhysicalPhysical
XPHRXPHR
PHR UpdatePHR Update
2005-20062005-20062006-20072006-20072007-20082007-2008
XD*-LABXD*-LAB
Lab ReportLab Report
PHR ExtractPHR Extract
EDNEDN
EmergencyEmergencyDepartmentDepartment
NoteNote
ACSACS
AntenatalAntenatalCareCare
SummarySummary
CACA
CareCareAssessmentsAssessments
DischargeDischargeSummarySummary
MedicalMedicalSummariesSummaries
31
SSttrruuccttuurreedd CCoonntteenntt wwiitthh ccooddeedd sseeccttiioonnss::
RReeaassoonn ffoorr RReeffeerrrraall VViittaall SSiiggnnss MMeeddiiccaattiioonn
SSttuuddiieess AAlllleerrggiieess
SSoocciiaall HHiissttoorryy PPrroobblleemmss
CCaarree PPllaann
Structured Text Section
Structured Text Section
Structured and Coded Header Patient, Author, Authenticator, Institution, etc.
Coded Section Entries
Coded Section Entries
Structured Text Section Coded Section
Entries
Rossi-Mori EU survey Rossi-Mori EU survey mapping tomapping to XDS-MS XDS-MSNo of No of CountriesCountries
SectionSection
allall
not not askedasked
all - BEall - BE
details about details about patientpatient
identifier, nameidentifier, name
(date of birth, gender)(date of birth, gender)
addressaddress
1212 1111
99
55
historyhistorymedication historymedication historyimmunisationsimmunisationsfamily historyfamily history
1313 allergies, alerts, risks, special allergies, alerts, risks, special needsneeds
1212 ongoing medicationsongoing medications
1010 test resultstest results (lab and images) (lab and images)
1010 details about details about family doctorfamily doctor
99 active problemsactive problems
66 details about details about insuranceinsurance
66 emergency contactemergency contact (next of kin) (next of kin)
44 care planscare plansnot askednot asked ((exemptionsexemptions))
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Example of XDS-MS OptionsExample of XDS-MS Options
Actor Options Vol & Section
Content Source Discharge Summary Option(1)
Referral Option (1)
PCC TF-1: 3.4.1PCC TF-1: 3.4.2
Content Consumer
View Option (2)Document Import
Option(2)Section Import Option (2)
Discrete Data Import Option (2)
PCC TF-1: 3.4.3PCC TF-1: 3.4.4PCC TF-1: 3.4.5PCC TF-1: 3.4.6
Document Registry
No Options -
Document Repository
No Options -
Patient Identity Feed
No Options -
33
IHE flexibility in leveraging standards for IHE flexibility in leveraging standards for Document FormatDocument Format
Content Format leverages Specific StandardsContent Format leverages Specific Standards HL7 CDA Release 2.0HL7 CDA Release 2.0 HL7/ASTM Continuity of Care DocumentHL7/ASTM Continuity of Care Document LOINC, SNOMED (if applicable)LOINC, SNOMED (if applicable) Others as Needed (e.g. PDF)Others as Needed (e.g. PDF)
IHE is defining a library of Reusable PartsIHE is defining a library of Reusable Parts Document TypesDocument Types Sections (only title is coded)Sections (only title is coded) Entries (clinical info semantically coded)Entries (clinical info semantically coded)
34
In ConclusionIn Conclusion
IHE is experienced with patient summaries.IHE is experienced with patient summaries.
IHE ready to engage in fostering a consistent IHE ready to engage in fostering a consistent family of patient summary documents and a family of patient summary documents and a sharing infrastructure between countries and sharing infrastructure between countries and regions in Europe.regions in Europe.