1 September, 2005 What IHE Delivers INTEGRATING THE INTEGRATING THE HEALTHCARE HEALTHCARE ENTERPISE (IHE) ENTERPISE (IHE) Orientation Workshop Orientation Workshop International HL7 Interoperability International HL7 Interoperability Conference-08 Conference-08 Charles Parisot, Charles Parisot, IHE Europe, GE Healthcare, Buc, France IHE Europe, GE Healthcare, Buc, France Eric Poiseau, Eric Poiseau, IHE Europe Technical Project Manager, INRIA Rennes IHE Europe Technical Project Manager, INRIA Rennes
Transcript
1September, 2005 What IHE Delivers
INTEGRATING THE INTEGRATING THE HEALTHCARE HEALTHCARE
International HL7 Interoperability Conference-08International HL7 Interoperability Conference-08Charles Parisot, Charles Parisot, IHE Europe, GE Healthcare, Buc, FranceIHE Europe, GE Healthcare, Buc, France
Eric Poiseau, Eric Poiseau, IHE Europe Technical Project Manager, INRIA RennesIHE Europe Technical Project Manager, INRIA Rennes
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AgendaAgenda
08:30-10:30 THE IHE STANDARDS ADOPTION PROCESS: 08:30-10:30 THE IHE STANDARDS ADOPTION PROCESS: achieving practical interoperability achieving practical interoperability - - Charles ParisotCharles Parisot
Coffee BreakCoffee Break
11:00-12:30 USERS AND VENDORS WORKING TOGETHER: 11:00-12:30 USERS AND VENDORS WORKING TOGETHER: how can I contribute & benefit from IHE how can I contribute & benefit from IHE – Charles Parisot– Charles Parisot
Lunch BreakLunch Break
13:30-15:00 HOW TO USE IHE RESOURCES: hands on 13:30-15:00 HOW TO USE IHE RESOURCES: hands on experienceexperience – Eric Poiseau– Eric Poiseau
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AgendaAgenda
08:30-10:30 THE IHE STANDARDS ADOPTION 08:30-10:30 THE IHE STANDARDS ADOPTION PROCESS: achieving practical interoperabilityPROCESS: achieving practical interoperability
Coffee BreakCoffee Break
11:00-12:30 USERS AND VENDORS WORKING TOGETHER: 11:00-12:30 USERS AND VENDORS WORKING TOGETHER: how can I contribute & benefit from IHE how can I contribute & benefit from IHE – Charles Parisot– Charles Parisot
Lunch BreakLunch Break
13:30-15:00 HOW TO USE IHE RESOURCES: hands on 13:30-15:00 HOW TO USE IHE RESOURCES: hands on experience experience – Eric Poiseau– Eric Poiseau
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IHE: A Framework for InteroperabilityIHE: A Framework for Interoperability
A common framework for harmonizing and A common framework for harmonizing and implementing multiple standardsimplementing multiple standards Application-to-applicationApplication-to-application System-to-systemSystem-to-system Setting-to-settingSetting-to-setting
Enables seamless health information movement Enables seamless health information movement within and between enterprises, regions, nationswithin and between enterprises, regions, nations
Promotes unbiased selection and coordinated use Promotes unbiased selection and coordinated use of established healthcare of established healthcare andand IT standards to IT standards to address specific clinical needsaddress specific clinical needs
Standards areStandards are Foundational - to interoperability and communicationsFoundational - to interoperability and communications Broad - varying interpretations and implementationsBroad - varying interpretations and implementations Narrow - may not consider relationships between Narrow - may not consider relationships between
standards domainsstandards domains Plentiful - often redundant or disjointedPlentiful - often redundant or disjointed Focused - standards implementation guides focus only Focused - standards implementation guides focus only
on a single standardon a single standard
IHE provides a standard process for IHE provides a standard process for implementing multiple standardsimplementing multiple standards
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IHE: Connecting Standards to CareIHE: Connecting Standards to Care
Healthcare professionals work with industryHealthcare professionals work with industry
Coordinate implementation of standards to Coordinate implementation of standards to meet clinical and administrative needsmeet clinical and administrative needs Clinicians and HIT professionals identify the key Clinicians and HIT professionals identify the key
interoperability problems they faceinteroperability problems they face Providers and industry work together to develop and Providers and industry work together to develop and
make available standards-based solutionsmake available standards-based solutions Implementers follow common guidelines in Implementers follow common guidelines in
purchasing and integrating effective systemspurchasing and integrating effective systems
IHE: A forum for agreeing on how to implement IHE: A forum for agreeing on how to implement standards and processes for making it happenstandards and processes for making it happen
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Standards Adoption ProcessStandards Adoption Process
Document Use Case Document Use Case RequirementsRequirementsDocument Use Case Document Use 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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Stakeholder BenefitsStakeholder BenefitsHealthcare providers and support staffHealthcare providers and support staff Improved workflowsImproved workflows Information whenever and wherever neededInformation whenever and wherever needed Fewer opportunities for errorsFewer opportunities for errors Fewer tedious tasks/repeated workFewer tedious tasks/repeated work Improved report turnaround timeImproved report turnaround time
VendorsVendors Align product interoperability with industry consensusAlign product interoperability with industry consensus Decreased cost and complexity of interface installation and Decreased cost and complexity of interface installation and
managementmanagement Focus competition on functionality/service space not information Focus competition on functionality/service space not information
transport spacetransport space
SDOsSDOs Rapid feedback to adjust standards to real-worldRapid feedback to adjust standards to real-world Establishment of critical mass and widespread adoptionEstablishment of critical mass and widespread adoption
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IHE Implementation StrategyIHE Implementation Strategy
Leverage established standards to allow rapid deployment and Leverage established standards to allow rapid deployment and plan for futureplan for futurePragmatic, Ease of EvolutionPragmatic, Ease of Evolution
Enable architectural freedom (patient vs. provider centric, Enable architectural freedom (patient vs. provider centric, centralized vs. decentralized, scalable (from office to centralized vs. decentralized, scalable (from office to enterprise to IDN to RHIO) enterprise to IDN to RHIO) ConfigurationConfiguration flexibilityflexibility
Support breakthrough use cases: variety of care settings, care Support breakthrough use cases: variety of care settings, care coordination, public health, PHR, EHRcoordination, public health, PHR, EHRInteroperability for broad constituenciesInteroperability for broad constituencies
IHE: Offers consistent, standards-based record IHE: Offers consistent, standards-based record sharing for EHRs and other information systemssharing for EHRs and other information systems
• Testing at “Connectathons” world-wideTesting at “Connectathons” world-wide• Demonstrations at major conferences Demonstrations at major conferences
world-wideworld-wide
VeterinaryEndoscopyPharmacy
Public Health, Quality and Research
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International Growth of IHEInternational Growth of IHE
France
Local Deployment National Extensions Promotional & Live Demonstration Events Funding
USA
Germany
Italy
JapanUK
Canada
Korea
Taiwan
Norway
Netherlands
SpainChina
Austria
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Pragmatic global standards harmonization + best practices sharing Pragmatic global standards harmonization + best practices sharing
Australia
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IHE Integration Profiles - ModelIHE Integration Profiles - 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]
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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Organization of Technical FrameworksOrganization of Technical Frameworks
Volume 1: Integration and content Volume 1: Integration and content ProfilesProfilesDescribes clinical need and use casesDescribes clinical need and use cases Identifies :Identifies :
• the actors and transactions or,the actors and transactions or,• content modulescontent modules
Volume 2+ of Technical FrameworkVolume 2+ of Technical FrameworkProvides implementation specification for Provides implementation specification for
transactions or content modulestransactions or content modules
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Key IHE ConceptsKey IHE Concepts
• Generalized Systems Generalized Systems -> -> ActorsActors
• Interactions between Actors Interactions between Actors -> -> TransactionsTransactions
• For each Integration Profile:For each Integration Profile:
• the context is described (which real-world problem)the context is described (which real-world problem)
• the actors are defined (what systems are involved)the actors are defined (what systems are involved)
• the transactions are defined (what must they do)the transactions are defined (what must they do)
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11stst key concept: key concept: ActorActorRepresents a set of application roles and Represents a set of application roles and responsibilities performed by a systemresponsibilities performed by a system
Always supported by a real-world systemAlways supported by a real-world system
A real-world system may support several IHE A real-world system may support several IHE ActorsActors
Examples:Examples: Order PlacerOrder Placer Order FillerOrder Filler Patient Admission, Discharge and Transfer (ADT)Patient Admission, Discharge and Transfer (ADT) Laboratory Automation ManagerLaboratory Automation Manager Point Of Care AnalyzerPoint Of Care Analyzer
IHE leaves the definition of products to users and vendors
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22ndnd key concept: key concept: TransactionTransactionA set of interactions or A set of interactions or
messages defined between messages defined between
two Actors for a specific two Actors for a specific
task. task.
Defines unambiguously how Defines unambiguously how
the Actors must cooperate the Actors must cooperate
to achieve this task.to achieve this task.
Using existing standards Using existing standards
such as HL7, DICOM, NCCLS such as HL7, DICOM, NCCLS
(e.g. HL7)Detailed messaging info --------------------------Roles
Integration Profile
Actor Actor Actor…
Tra
nsac
tion
Tra
nsac
tion
Tra
nsac
tion
Tra
nsac
tion
Tra
nsac
tion
………
Solves an Integration Problem: A collection of real world information exchange capabilities supported by a set of specific Actors using Standards-based Transactions
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The Product World…..The Product World…..
Product XYZfrom Vendor T
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The IHE World….The IHE World….
IHE ActorIHE Actor
ActorActorActorActor
ActorActor
IHEIHETransactionTransactionIHEIHE
TransactionTransaction
IHEIHETransactionTransaction
IHE ActorIHE Actor
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Mapping IHE to ProductsMapping IHE to Products
Product XYZfrom Vendor T
IHE ActorIHE Actor
ActorActorActorActor
ActorActor
IHEIHETransactionTransactionIHEIHE
TransactionTransaction
IHEIHETransactionTransaction
IHE ActorIHE Actor
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IHE and Service Oriented ArchitecturesIHE and Service Oriented Architectures
SOA is a powerful business driven design methodologySOA is a powerful business driven design methodology
SOA “wraps” interoperability in “services”, but does not SOA “wraps” interoperability in “services”, but does not solve interoperability:solve interoperability:
E.g. Web Services may or may not be used in SOA. IHE Profiles are E.g. Web Services may or may not be used in SOA. IHE Profiles are largely (not always) based on Web Services.largely (not always) based on Web Services.
Standardizing Services “offered” along with the “protocols” is 20 Standardizing Services “offered” along with the “protocols” is 20 years old (Open System Interconnect). Good, but a precise Service years old (Open System Interconnect). Good, but a precise Service definition does not result in compatibility “on the wire”.definition does not result in compatibility “on the wire”.
IHE Integration profiles are supportive of Service Oriented IHE Integration profiles are supportive of Service Oriented Architecture, but do not “require” them. Service Aware !Architecture, but do not “require” them. Service Aware !
Bits have to be compatible on the wire: Bits have to be compatible on the wire: No way to avoid specifying transaction & No way to avoid specifying transaction &
contentcontent
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Standards Adoption ProcessStandards Adoption Process
Document Use Case Document Use Case RequirementsRequirementsDocument Use Case Document Use 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
Open invitation to vendor and other Open invitation to vendor and other implementors communityimplementors community
Leveraging IHE Integration StatementsLeveraging IHE Integration Statements
VendorsVendors Claim IHE Compliance in an explicit wayClaim IHE Compliance in an explicit way Can rely on an objective and thorough specificationCan rely on an objective and thorough specification
(IHE Technical Framework)(IHE Technical Framework) Willing to accept contractual commitments Willing to accept contractual commitments Willing to correct “implementation errors”Willing to correct “implementation errors”
BuyersBuyers Can compare product integration capabilitiesCan compare product integration capabilities Simplify and strengthen their RFPsSimplify and strengthen their RFPs Can leverage a public and objective commitmentCan leverage a public and objective commitment Decreased cost and complexity of interface deployment and Decreased cost and complexity of interface deployment and
Next Demonstration at WoHIT, Next Demonstration at WoHIT, Copenhagen, Nov 4-6, 2008Copenhagen, Nov 4-6, 2008
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Feb 2008 HIMSS Interoperability ShowcaseFeb 2008 HIMSS Interoperability Showcase
Next Demonstration at WoHIT, Next Demonstration at WoHIT, Copenhagen, Nov 4-6, 2008Copenhagen, Nov 4-6, 2008
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Featured this year in the HIMSS Showcase…Featured this year in the HIMSS Showcase…
76 connected applications, 32 IHE profiles76 connected applications, 32 IHE profiles
Secured Health Information Exchange with Secured Health Information Exchange with broad contentbroad content
Clinical Scenarios, focusing on clinician and Clinical Scenarios, focusing on clinician and patient access and information sharing patient access and information sharing across the continuum of careacross the continuum of care
Population Health, Quality and ResearchPopulation Health, Quality and Research
Health information exchange with patient care devicesHealth information exchange with patient care devices
Personal health record solutionsPersonal health record solutions
Financial and administrative systems for billing and claims attachments Financial and administrative systems for billing and claims attachments (CAQH/CORE)(CAQH/CORE)
Expanded distributed demonstration in an HIE format showing connectivity Expanded distributed demonstration in an HIE format showing connectivity with vendor boothswith vendor booths
The 2008 Cast:The 2008 Cast:
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Providers and VendorsProviders and Vendors
Working Together to DeliverWorking Together to Deliver
Interoperable Health Information Systems Interoperable Health Information Systems
in the Enterprise andin the Enterprise and
Across Care SettingsAcross Care Settings
Health Information Exchange (HIE)Health Information Exchange (HIE)or shared EHRor shared EHR
Requirements for an open HIE/EHRRequirements for an open HIE/EHR
Bring trust and ease of use for healthcare professionals:Bring trust and ease of use for healthcare professionals:
Care delivery organizations choose information to share:Care delivery organizations choose information to share:• Based on patient health statusBased on patient health status
• When they see fit (discharge, end of encounter, etc.)When they see fit (discharge, end of encounter, etc.)
• What information to share (pick relevant types of documents, and content elements).What information to share (pick relevant types of documents, and content elements).
Care delivery organizations access patient information through:Care delivery organizations access patient information through:• their own local EMR (if they have one), or their own local EMR (if they have one), or
• through a shared portal/service otherwise.through a shared portal/service otherwise.
When accessing patient info:When accessing patient info:• Find quickly if relevant information is available or not (single query).Find quickly if relevant information is available or not (single query).
• May select among relevant records, which ones to see (may be done in background)May select among relevant records, which ones to see (may be done in background)
• Among those of interest, chose to import in whole or part in its own EMR patient record Among those of interest, chose to import in whole or part in its own EMR patient record (responsibility).(responsibility).
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Requirements for an open HIE/EHR(2)Requirements for an open HIE/EHR(2)
Bring trust and privacy to patients:Bring trust and privacy to patients:
Only authorized organizations and authenticated healthcare Only authorized organizations and authenticated healthcare providers may transact in the HIE:providers may transact in the HIE:
• Each node or IT system interfaced is strongly authenticatedEach node or IT system interfaced is strongly authenticated
• Each user shall be authenticated on the edge system (where context is best known)Each user shall be authenticated on the edge system (where context is best known)
• All traffic trough the infrastructure is encryptedAll traffic trough the infrastructure is encrypted
Patient consent needs multiple choices or levelsPatient consent needs multiple choices or levels
• Unless opt-in, no data about a specific patient may be sharedUnless opt-in, no data about a specific patient may be shared
• Several data sharing policies offered to the patient consentSeveral data sharing policies offered to the patient consent
• Each shared record/document is assigned to specific policies (or not shared) Each shared record/document is assigned to specific policies (or not shared) at encounter time.at encounter time.
• Healthcare providers may only access records/documents compatible with Healthcare providers may only access records/documents compatible with their role.their role.
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Categories of Healthcare Communication ServicesCategories of Healthcare Communication Services
Security
DocumentSharing
Patient and Provider ID Mgt
DynamicInformation
Access
WorkflowManagement
Source-persisted and attested health
records
Specific info snapshot
provided on demand
2 or more entitiessynchronize
a task
e.g. access to last 6 months historical
labs and encounter summaries
e.g. order a lab test, track status and receive results
e.g. get a current list of allergies or med list from a source
HospitalsHIEs and Shared EHRs
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Categories of Healthcare Communication ServicesCategories of Healthcare Communication Services
Security
DocumentSharing
Patient and Provider ID Mgt
DynamicInformation
Access
WorkflowManagement
Source-persisted and attested health
records
Specific info snapshot
provided on demand
2 or more entitiessynchronize
a task
e.g. access to last 6 months historical
labs and encounter summaries
e.g. order a lab test, track status and receive results
e.g. get a current list of allergies or med list from a source
Patient Id Cross-Patient Id Cross-Referencing (PIX)Referencing (PIX)
Medical Summary Medical Summary (XDS-MS)(XDS-MS)
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IHE Profiles SpecificationsIHE Profiles Specifications
Go to: Go to: www.www.iheihe.net/Technical_frameworks.net/Technical_frameworks
For XDS:Under IT InfrastructureFor XDS:Under IT Infrastructure IT Infrastructure Technical Framework 5.0 (XDS.b)IT Infrastructure Technical Framework 5.0 (XDS.b) Until 5.0 published: use XDS.b+XDS Stored Query Until 5.0 published: use XDS.b+XDS Stored Query
supplements.supplements.
For PIX:Under IT InfrastructureFor PIX:Under IT Infrastructure IT Infrastructure Technical Framework 4.0 or 5.0 (PIX, IT Infrastructure Technical Framework 4.0 or 5.0 (PIX,
Patient Identifier Cross-referencing for MPIPatient Identifier Cross-referencing for MPIServicesServices
Allow all enterprise participants to register the Allow all enterprise participants to register the identifiers they use for patients in their domainidentifiers they use for patients in their domain
Participants retain control over their own Participants retain control over their own domain’s patient index(es)domain’s patient index(es)
Support domain systems’ queries for other Support domain systems’ queries for other systems’ identifiers for their patientssystems’ identifiers for their patients
Optionally, notify domain systems when other Optionally, notify domain systems when other systems update identifiers for their patientssystems update identifiers for their patients
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Patient Identifier Cross-referencing for MPIPatient Identifier Cross-referencing for MPIValue PropositionValue Proposition
Maintain all systems’ identifiers for a patient in a Maintain all systems’ identifiers for a patient in a single locationsingle location
Use any algorithms (encapsulated) to find matching Use any algorithms (encapsulated) to find matching patients across disparate identifier domainspatients across disparate identifier domains
Lower cost for synchronizing data across systemsLower cost for synchronizing data across systems No need to force identifier and format changes onto existing No need to force identifier and format changes onto existing
systemssystems
Leverages standards and transactions already used Leverages standards and transactions already used within IHE within IHE
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Patient Identifier Cross-referencing for MPIPatient Identifier Cross-referencing for MPITransaction DiagramTransaction Diagram
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Patient Identifier Cross-referencing for MPIPatient Identifier Cross-referencing for MPIProcess Flow Showing ID Domains & TransactionsProcess Flow Showing ID Domains & Transactions
• Assigns patient identities within its own domainAssigns patient identities within its own domain• Notifies Patient Identifier Cross-reference Manager of all events Notifies Patient Identifier Cross-reference Manager of all events
related to patient identification (creation, merge, etc.)related to patient identification (creation, merge, etc.)• Example: Registration (ADT) Actor in IHE Radiology Scheduled Example: Registration (ADT) Actor in IHE Radiology Scheduled
• Requires information about patient identifiers in other domainsRequires information about patient identifiers in other domains• Requests patient identifier information from Patient Identifier Requests patient identifier information from Patient Identifier
• Serves a well-defined set of Patient Identifier DomainsServes a well-defined set of Patient Identifier Domains• Receives patient identifier information from Patient Identity Source Receives patient identifier information from Patient Identity Source
ActorsActors• Manages cross-referencing of identifiers across domainsManages cross-referencing of identifiers across domains
Queries for Corresponding Identifiers Queries for Corresponding Identifiers (ADT^Q23/K23)(ADT^Q23/K23) Notification of Identifiers Lists Updates Notification of Identifiers Lists Updates (ADT^A31)(ADT^A31)
PIX V3: HL7 V3PIX V3: HL7 V3 Leverage Web Services (harmonized WS by IHE Leverage Web Services (harmonized WS by IHE
PIX Integration Profile & MPIPIX Integration Profile & MPI The Equivalent IHE ModelThe Equivalent IHE Model
Patient Identification Domain C
Patient Identity Cross-reference Manager
Patient Identification Domain A(Master Domain)
Patient Identification Domain B
Master (A) PatientIdentity Source
Linking PIX Server
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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
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Health Information Exchanges Interoperability: Health Information Exchanges Interoperability: Cross-enterprise Document SharingCross-enterprise Document Sharing
Cross-Enterprise Document Sharing simplifies clinical Cross-Enterprise Document Sharing simplifies clinical data management by defining interoperable infrastructure. data management by defining interoperable 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
Addresses the need for a longitudinal healthcare data Addresses the need for a longitudinal healthcare data (health records). Complements to interactive workflow or (health records). Complements to interactive workflow or dynamic access to data. dynamic access to data.
Implemented world-wide by close to 100 vendors/open Implemented world-wide by close to 100 vendors/open source.source.
Adopted in several national & regional projects:Adopted in several national & regional projects:Italy, Austria, Canada, USA, Japan, South Africa, France, etc.)Italy, Austria, Canada, USA, Japan, South Africa, France, etc.)
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Why is IHE-XDS a breakthrough ?Why is IHE-XDS a breakthrough ?
It based on an International Standards; ebXML registry: OASIS and It based on an International Standards; ebXML registry: OASIS and ISO standard, Web Service/Soap/XML.ISO standard, Web Service/Soap/XML.
Sharing of digital documents as “attested by the source”, meets the Sharing of digital documents as “attested by the source”, meets the most urgent needs. A most urgent needs. A provenproven healthcare community healthcare community data-sharingdata-sharing paradigm (paradigm (Message feeding a central web server hinders use of EHRsMessage feeding a central web server hinders use of EHRs).).
Efficient to support Efficient to support all types of Health IT Systemsall types of Health IT Systems (IDNs, Hospitals, (IDNs, Hospitals, Ambulatory, Pharmacy, Diagnostics Centers, etc.) and Ambulatory, Pharmacy, Diagnostics Centers, etc.) and all types of all types of informationinformation (summaries, meds, images, lab reports, ECGs, etc.), (summaries, meds, images, lab reports, ECGs, etc.), structured and unstructuredstructured and unstructured..
Meets both the needs of push communication by info sources and on-Meets both the needs of push communication by info sources and on-demand pull in a variety of centralized or distributed architectures.demand pull in a variety of centralized or distributed architectures.
Offer a consistent, standards-based and functional Offer a consistent, standards-based and functional record sharing for EHRs, PHRs & other IT Systemsrecord sharing for EHRs, PHRs & other IT Systems
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Combining IHE ProfilesCombining IHE ProfilesDocument Content & Modes of Document ExchangeDocument Content & Modes of Document Exchange
XDS – Value PropositionXDS – Value PropositionFoundation for Health IT Infrastructures: Shared Electronic Health Record, in a community, region, etc.
Effective means to contribute and access clinical documents across health enterprises.
Scalable sharing of documents between private physicians, clinics, long term care, pharmacy, acute care with different clinical IT systems.
Easy access: Care providers are offered means to query and retrieve clinical documents of interest.
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XDS - Value PropositionXDS - Value Proposition
Distributed: Each Care delivery organization “publishes” clinical information for others. Actual documents may remain in the source EHR
Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain (e.g. a region).
Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (HL7-CDA, PDF, DICOM, etc.)
Document Content Neutral: Document content is processed only by source and consumer IT systems.
Standardized Registry Attributes: Queries based on meaningful attributes ensure deterministic document searches.
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XDS DocumentXDS Document
XDS Submission SetXDS Submission Set
XDS FolderXDS Folder
IHE XDS Integration Profile: Key ConceptsKey Concepts
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Document Repository and RegistryDocument Repository and RegistryExample of Submission RequestExample of Submission Request
A set of attested clinical information (structured or not) which A set of attested clinical information (structured or not) which form an element of a patient recordform an element of a patient record to be shared. It may to be shared. It may already exist within the source IT system.already exist within the source IT system.
XDS Submission SetXDS Submission Set
A set of documents related to a patient that a (team of) A set of documents related to a patient that a (team of) clinician(s) in clinician(s) in the same source systemthe same source system have decided to make have decided to make available at available at one point in timeone point in time to potential consumers. to potential consumers.
XDS FolderXDS FolderA means to group documents for a number of other reasons:A means to group documents for a number of other reasons:
Team work across several physicians,Team work across several physicians,
Episode of care, Episode of care,
Emergency information for a patient, etc.Emergency information for a patient, etc.
XDS leaves open the use of folders to affinity domain clinicians.XDS leaves open the use of folders to affinity domain clinicians.
IHE XDS Integration Profile: Key ConceptsKey Concepts
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How real is XDS ?How real is XDS ?Stable specification IHE Technical Framework Published Stable specification IHE Technical Framework Published Aug 15Aug 15thth, 2004 (TI Supplement), 2004 (TI Supplement)
XDS.b Supplement that offers:XDS.b Supplement that offers: Use most recent Web Services stds (MTOM/XOP)Use most recent Web Services stds (MTOM/XOP) Allow Retrieve sets of Documents in one transactionAllow Retrieve sets of Documents in one transaction Same servicesSame services
First implementation in clinical use in region of Genoa - First implementation in clinical use in region of Genoa - Italy) since early 2006.Italy) since early 2006.
Several since: Lower Austria region, State of Vermont, Several since: Lower Austria region, State of Vermont, Nagoya city, South Africa region, 2 Dutch regions, etc.Nagoya city, South Africa region, 2 Dutch regions, etc.
Adopted by several national programs world-wideAdopted by several national programs world-wide
4 open source toolkits available, numerous product 4 open source toolkits available, numerous product implementations in EHRs and Infrastructure offerings.implementations in EHRs and Infrastructure offerings.
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IHE, global standards-based profiles adopted by IHE, global standards-based profiles adopted by several national & regional projectsseveral national & regional projects
Quebec, Toronto,Alberta, British Columbia
Canada Infoway
Denmark (Funen)Italy (Veneto)Spain (Aragon)
THINC- New YorkNCHICA – N. Carolina
Italy (Conto Corrente
Salute)
Boston Medical
Center - MA
FranceDMP
UK CfH(Radiology WF)
Philadelphia HIE
CHINA-MoHLab results sharing
CPHIC – Pennsylvani
a
CHINA-ShanghaiImaging Info Sharing
JAPAN-NagayaImaging Info Sharing
South Africa
Malaysia
VITL-Vermont
CareSpark – TN & VA
NetherlandAmsterdam
LowerAustria
Austria
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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
EightEight Integration Profiles completed and tested, plus Integration Profiles completed and tested, plus tenten ready to implement = Standards-based interoperability ready to implement = 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. Patient identification managementPatient identification management Security and privacySecurity and privacy Notification and data captureNotification and data capture
IHE-XDS + related IHE Integration profiles provide a IHE-XDS + related IHE Integration profiles provide a complete interoperability solutioncomplete interoperability solution
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IHE Integration Profiles for Health Info NetsIHE Integration Profiles for Health Info Nets What What is availableis available and and has been added in 2007has been added in 2007
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 Content
Format 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 Contentand associated coded vocabulary
Clinical and PHR ContentClinical and PHR Content
Health Data ExchangeHealth Data Exchange
Patient Demographics Query
Patient Identifier Cross-referencing
Map patient identifiers across independent identification
domains
Notification of Document Availability
Notification of a remote provider/ health enterprise
Request Formfor Data Capture
External form with custom import/export scripting
Patient ID MgmtPatient ID Mgmt
OtherOther
Final Text ApprovedFinal Text Approved
Final Txt 2008Final Txt 2008
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical
XDS-MS Medical Summary or PHR Extract ExchangeXDS-MS Medical Summary or PHR Extract ExchangeProfile based on HL7 CDA Rel 2 and HL7 CCD IGProfile based on HL7 CDA Rel 2 and HL7 CCD IG
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 as highly structured text. Text easy to import/parse
Text StructureEntry
Level 3Level 3
Med Problems and Allergies have afine-grain structure with optional coding. Coding Scheme explicitly identified.
Coded Section Entry
Coded Section Entry
Coded Section Entry
Level 3Level 3
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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 :• Imaging specialistsImaging 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 !
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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
Laboratory Testing Workflow (LTW)Laboratory Device Automation (LDA)Laboratory Point Of Care Testing (LPOCT)Laboratory Code Sets Distribution (LCSD)Laboratory Barcode Labeling (LBL)
Sharing Laboratory Reports (XD-LAB)V3:V3:
CDA CDA
V2.5V2.5
HL7HL7
Subset of LO
INC
test S
ubset of LOIN
C test
codescodes
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Dependencies toward IHE IT InfrastructureDependencies toward IHE IT Infrastructure
Laboratory Testing Workflow (LTW)Laboratory Device Automation (LDA)Laboratory Point Of Care Testing (LPOCT)Laboratory Code Sets Distribution (LCSD)Laboratory Barcode Labeling (LBL)
08:30-10:30 THE IHE STANDARDS ADOPTION PROCESS: 08:30-10:30 THE IHE STANDARDS ADOPTION PROCESS: achieving practical interoperability achieving practical interoperability - - Charles ParisotCharles Parisot
Coffee BreakCoffee Break
11:00-12:30 USERS AND VENDORS WORKING 11:00-12:30 USERS AND VENDORS WORKING TOGETHER: how can I contribute & benefit from TOGETHER: how can I contribute & benefit from IHE IHE – Charles Parisot– Charles Parisot
Lunch BreakLunch Break
13:30-15:00 HOW TO USE IHE RESOURCES: hands on 13:30-15:00 HOW TO USE IHE RESOURCES: hands on experience experience – Eric Poiseau– Eric Poiseau
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Understanding the IHE InitiativeUnderstanding the IHE Initiative
IHE has a clear focusIHE has a clear focus
IHE is a healthcare domain-based initiativeIHE is a healthcare domain-based initiative
IHE creates synergies for interoperability testing IHE creates synergies for interoperability testing across domainsacross domains
IHE addresses the standards adoption processIHE addresses the standards adoption process
IHE is both regional and multi-nationalIHE is both regional and multi-national
IHE is both user lead and vendor drivenIHE is both user lead and vendor driven
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Standards Adoption ProcessStandards Adoption Process
Document Use Case Document Use Case RequirementsRequirementsDocument Use Case Document Use 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
878787
IHE Organizational StructureIHE Organizational Structure
Contributing &Participating
Vendors
Regional Deployment
IHE Europe
IHE North America
France
USA
Canada
IHE Asia-Oceania
Japan
Korea Taiwan
Netherlands
Spain Sweden UKItaly
Germany
Norway
China
Austria
ACCACCEACEP
JAHISJIRAJRS
METI-MLHWMEDIS-DCJAMI
RSNA SFRSFIL
SIRMBIREuroRec
COCIREAR-ECRDRG
ESC
Professional Societies / SponsorsACPGMSIHIMSS
Global Development
Radiology
Cardiology
ITInfrastructure
Patient CareCoordination
Patient CareDevices
Laboratory
Pathology
Eye CareRadiationOncology
Public Health, Quality and Research
IHE International Board
888888
IHE SponsorsIHE SponsorsProfessional societies (stakeholder representation)Professional societies (stakeholder representation)
Healthcare Information Management Systems Society (HIMSS)Healthcare Information Management Systems Society (HIMSS) Radiological Society of North America (RSNA)Radiological Society of North America (RSNA) British Institute of Radiology (BIR), British Computer Society (BCSBritish Institute of Radiology (BIR), British Computer Society (BCS German Radiology Society (DRG)German Radiology Society (DRG) GMSIH (IT France), SFIL (laboratory), French National Project (DMP)GMSIH (IT France), SFIL (laboratory), French National Project (DMP) European Society of CardiologyEuropean Society of Cardiology …………Many other European SocietiesMany other European Societies American College of Physicians (ACP), American College of American College of Physicians (ACP), American College of
Emergency Physicians (ACEP) Emergency Physicians (ACEP) ……Many other American healthcare societies (ACCE), (AAO), Many other American healthcare societies (ACCE), (AAO),
(ASTRO), etc.(ASTRO), etc. JAHIS (IT Japan), and many other Japanese SocietiesJAHIS (IT Japan), and many other Japanese Societies And many more….And many more….
89
IHE Participants and RelationshipsIHE Participants and RelationshipsParticipants include:Participants include: Users - Clinicians, Staff, Administrators, CIOs, GovernmentsUsers - Clinicians, Staff, Administrators, CIOs, Governments Vendors of Information Systems and EquipmentVendors of Information Systems and Equipment ConsultantsConsultants
Relationship with Standards Development Organizations Relationship with Standards Development Organizations (SDOs):(SDOs): HL7, DICOM, ISO, CDISC, ASTM, W3C, IEEE, IETF, and many othersHL7, DICOM, ISO, CDISC, ASTM, W3C, IEEE, IETF, and many others Approved via ISO/TC 215 allowing for IHE profiles to be published as Approved via ISO/TC 215 allowing for IHE profiles to be published as
ISO deliverablesISO deliverables
National Adoption of Healthcare IT Standards and IHE ProfilesNational Adoption of Healthcare IT Standards and IHE Profiles DMP(France), ELGA(Austria), HITSP (USA), Infoway (Canada), many DMP(France), ELGA(Austria), HITSP (USA), Infoway (Canada), many
others worldwide…..others worldwide…..
909090
IHE Organizational StructureIHE Organizational Structure
Contributing &Participating
Vendors
Regional Deployment
IHE Europe
IHE North America
France
USA
Canada
IHE Asia-Oceania
Japan
Korea Taiwan
Netherlands
Spain Sweden UKItaly
Germany
Norway
China
Austria
ACCACCEACEP
JAHISJIRAJRS
METI-MLHWMEDIS-DCJAMI
RSNA SFRSFIL
SIRMBIREuroRec
COCIREAR-ECRDRG
ESC
Professional Societies / SponsorsACPGMSIHIMSS
Global Development
Radiology
Cardiology
ITInfrastructure
Patient CareCoordination
Patient CareDevices
Laboratory
Pathology
Eye CareRadiationOncology
Public Health, Quality and Research
IHE International Board
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IHE International Governance - MembershipIHE International Governance - Membership
Membership: Membership: www.ihe.net/governancewww.ihe.net/governance Members are Organizations–Sign Governance & IP once.Members are Organizations–Sign Governance & IP once. Three Organizational Categories: User, Developer, General Three Organizational Categories: User, Developer, General
InterestInterest Member designates a primary/alternate representatives to Member designates a primary/alternate representatives to
one of more Committees (Domains, Test& Tools, MarCom).one of more Committees (Domains, Test& Tools, MarCom). Voting rights lost after three missed meetings, regained at Voting rights lost after three missed meetings, regained at
second meetingsecond meeting Elect Committee (or sub-Committee) co-chairs. One User Elect Committee (or sub-Committee) co-chairs. One User
& one vendor recommended for Planning Committees& one vendor recommended for Planning Committees Regional and National IHE Committee members required to Regional and National IHE Committee members required to
become members of IHE International.become members of IHE International.
IHE International Governance – Others CommitteesIHE International Governance – Others Committees
IHE Regional or National Deployment Committees are IHE Regional or National Deployment Committees are independent entities with their own governance but close independent entities with their own governance but close collaborative relationship with IHE International. collaborative relationship with IHE International.
IHE International Board empowers “Regional and IHE International Board empowers “Regional and National Committee”. 3 year commitment, renewable. National Committee”. 3 year commitment, renewable.
Oversees Testing and Tools CommitteeOversees Testing and Tools Committee
Coordinates the various Regional and National Committees.Coordinates the various Regional and National Committees.
Oversees Marketing & Communication CommitteeOversees Marketing & Communication Committee
Consistency of communication among Domains within IHE Consistency of communication among Domains within IHE International and various Regional and National Committees.International and various Regional and National Committees.
93
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 CommitteesBecome a member of relevant Regional/National Committees
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 the June Educational WorkshopAttend the June Educational Workshop
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 the June Educational Workshop Attend the June Educational Workshop
Attend Demonstrations and include IHE Integration Profiles in your RFPs Attend Demonstrations and include IHE Integration Profiles in your RFPs and Integration Projects.and Integration Projects.
How can I participate?How can I participate?
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What can you do?What can you do?
Learn about IHE, Learn about IHE, www.ihe.netwww.ihe.net
Insist on relevant IHE profiles compliance in Insist on relevant IHE profiles compliance in your RFPs and contract documents:your RFPs and contract documents:
Select Integration Profiles, and Appropriate Select Integration Profiles, and Appropriate Actor(s) Actor(s)
Ask vendors for their products “IHE Ask vendors for their products “IHE Integration Statements”.Integration Statements”.
Need more interoperability ? Need more interoperability ?
Contribute to IHE CommitteesContribute to IHE Committees
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 Eye CareEye Care IT InfrastructureIT Infrastructure LaboratoryLaboratory Patient Care CoordinationPatient Care Coordination Patient Care DevicesPatient Care Devices PathologyPathology QualityQuality Radiation Oncology Radiation Oncology RadiologyRadiology
Integration Profiles in Technical Frameworks:Integration Profiles in Technical Frameworks: CardiologyCardiology IT InfrastructureIT Infrastructure LaboratoryLaboratory Patient Care CoordinationPatient Care Coordination Patient Care DevicesPatient Care Devices Radiation OncologyRadiation Oncology RadiologyRadiology
