The IHE Initiative Mission, Process, Achievements, Plans Raymond Peter Zambuto, MS, CCE, FASHE, FHIMSS, FACCE President, Technology in Medicine, Inc. Co-Chair, IHE PCD Domain

Presentation Objectives IHE: What? Why? Who? How organized?IHE: What? Why? Who? How organized? –Healthcare provider role in developing IHE framework Why standards are not enoughWhy standards are not enough IHE process for standards adoption and implementationIHE process for standards adoption and implementation Benefits, growth, strategies, integrationBenefits, growth, strategies, integration How to leverage IHE to enable interoperability inHow to leverage IHE to enable interoperability in –Enterprises –Health information exchanges (HIEs)

IHE: A Framework for Interoperability A common framework for harmonizing and implementing multiple standardsA common framework for harmonizing and implementing multiple standards –Application-to-application –System-to-system –Setting-to-setting Enables seamless health information movement within and between enterprises, regions, nationsEnables seamless health information movement within and between enterprises, regions, nations Promotes unbiased selection and coordinated use of established healthcare and IT standards to address specific clinical needsPromotes unbiased selection and coordinated use of established healthcare and IT standards to address specific clinical needs

Why IHE? A Patient-centered Example Photo Courtesy of Philips Medical Systems

Why IHE? A Patient-centered Example Photo Courtesy of Philips Medical Systems

IHE Sponsors 1997: Founded in Radiology (RSNA) and IT (HIMSS)1997: Founded in Radiology (RSNA) and IT (HIMSS) Many professional societies (stakeholder representation)Many professional societies (stakeholder representation) –American Academy of Ophthalmology (AAO) –American College of Cardiology (ACC) –American College of Physicians (ACP) –American College of Clinical Engineering (ACCE) –American College of Emergency Physicians (ACEP) –American Society for Therapeutic Radiation Oncology (ASTRO) –GMSIH (IT France), JAHIS (IT Japan), SFIL (laboratory) –Healthcare Information Management Systems Society (HIMSS) –Radiological Society of North America (RSNA) –And many more….

IHE Participants and Relationships Participants include:Participants include: –Users - Clinicians, Staff, Administrators, CIOs, Governments (e.g. NIST, VA). –Vendors - Information Systems and Equipment e.g., imaging, cardiology, devicese.g., imaging, cardiology, devices –Consultants Maintains formal liaison with Standards Development Organizations (SDOs):Maintains formal liaison with Standards Development Organizations (SDOs): –HL7, DICOM, ISO (Liaison D), others ISO TC215 (including ANSI) approved IHE Process and Profiles to be published as technical reportsISO TC215 (including ANSI) approved IHE Process and Profiles to be published as technical reports –Concerns expressed by some AHIC members not founded

IHE Organizational Structure ACC ACP HIMSS RSNA JAHIS JIRA JRS METI-MLHW MEDIS-DC JAMI GMSIH SFR SFIL SIRM BIR EuroRec COCIR EAR-ECR DRG ESC Professional Societies / Sponsors Contributing & Participating Vendors IHE (International) Strategic Development Committee Global Development Radiology Cardiology IT Infrastructure Patient Care Coordination Patient Care Devices Laboratory Pathology Pharmacy / Medication Admin Radiation Oncology IHE Europe IHE North America France USA Canada IHE Asia-Oceania Japan KoreaTaiwan Netherlands Spain Sweden UK Italy Germany Norway Regional Deployment China

International Adoption of IHE France  Local Deployment  National Extensions (Local Adaptions)  Promotional & Live Demonstration Events  Funding USAGermanyItalyJapanUKCanadaKoreaTaiwan Norway HollandSpainChina Year 1 (1999) Year 2 (2000) Year 3 (2001) Year 4 (2002) Year 5 (2003) Year 6 (2004) Year 7 (2005) Year 8 (2006) Pragmatic global standards harmonization + best practices sharing

Standards: Necessary…Not Sufficient Standards areStandards are –Foundational - to interoperability and communications –Broad - varying interpretations and implementations –Narrow - may not consider relationships between standards domains –Plentiful - often redundant or disjointed –Focused - standards implementation guides focus only on a single standard IHE provides a standard process for implementing multiple standards

IHE: Connecting Standards to Care Healthcare professionals work with industryHealthcare professionals work with industry Coordinate implementation of standards to meet clinical and administrative needsCoordinate implementation of standards to meet clinical and administrative needs –Clinicians and HIT professionals identify the key interoperability problems they face –Providers and industry work together to develop and make available standards-based solutions –Implementers follow common guidelines in purchasing and integrating effective systems IHE: A forum for agreeing on how to implement standards and processes for making it happen

Standards Adoption Process Document Use Case Requirements Identify available standards ( e.g. HL7, DICOM, IETF, OASIS) Develop technical specifications Testing at Connectathons IHE Demonstrations Products with IHE Timely access to information Easy to integrate products

Stakeholder Benefits Healthcare providers and support staffHealthcare providers and support staff –Improved workflows –Information whenever and wherever needed –Fewer opportunities for errors –Fewer tedious tasks/repeated work –Improved report turnaround time VendorsVendors –Align product interoperability with industry consensus –Decreased cost and complexity of interface installation and management –Focus competition on functionality/service space not information transport space SDOsSDOs –Rapid feedback to adjust standards to real-world –Establishment of critical mass and widespread adoption

Growth in IHE Domains Radiology (18) IT Infrastructure for Healthcare (17) Cardiology (7) Laboratory (6) Radiation Oncology (1) Patient Care Coordination (5) Patient Care Devices (1) Quality Eye Care (3) Veterinary Endoscopy Pathology Pharmacy IHE Global Developments Integration Profiles (# X) – Solutions to Real-World Interoperability Needs & Problems:  Within Clinical Departments e.g.:  Radiology  Cardiology  Lab ...  Across Departmental & Institutional Boundaries – XDS  RHIOs (Regional Healthcare Information Organizations)  EHR Enablers Year 1 (1999)Year 2 (2000)Year 3 (2001) Year 4 (2002) Year 5 (2003)Year 6 (2004) Year 7 (2005) Year 8 (2006)Year 9 (2007)

IHE Implementation Strategy Leverage established standards to allow rapid deployment and plan for future Pragmatic, Ease of EvolutionLeverage established standards to allow rapid deployment and plan for future Pragmatic, Ease of Evolution Enable architectural freedom (patient vs. provider centric, centralized vs. decentralized, scalable (from office to enterprise to IDN to RHIO) Configuration flexibilityEnable architectural freedom (patient vs. provider centric, centralized vs. decentralized, scalable (from office to enterprise to IDN to RHIO) Configuration flexibility Support breakthrough use cases: variety of care settings, care coordination, public health, PHR, EHR Interoperability for broad constituenciesSupport breakthrough use cases: variety of care settings, care coordination, public health, PHR, EHR Interoperability for broad constituencies IHE: Offers consistent, standards-based record sharing for EHRs and other information systems

IHE based Regional and National EHR Projects (Operational and Planned) Toronto, Quebec, Alberta, BC Canada Infoway Austria THINC- New York NCHICA – N. Carolina Italy (Conto Corrente Salute) MA-Share – MA France DMP Philadelphia HIE CHINA-MoH Lab results sharing New York HIE

IHE Integration Profiles for Health Info Nets What is available and has been added in 2005 and 2006 Patient Demographics Query Patient Identifier Cross-referencing Map patient identifiers across independent identification domains Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Cross-enterprise Document Point-Point Interchange Media-CD/USB & push 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 Content Imaging Information Format of the Document Content and associated coded vocabulary Medical Summary ( Meds, Allergies, Pbs) Format of the Document Content and associated coded vocabulary Consistent Time Coordinate time across networked systems Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. Basic Patients Privacy Consents Establish Consents & Enable Access Control Document Digital Signature Attesting “true-copy and origin Notification of Document Availability Notification of a remote provider/ health enterprise Request Form for Data Capture External form with custom import/export scripting Patient ID Mgmt Security Clinical and PHR Content Health Data Exchange Other

IHE: Supporting HHS Goals for NHIN Healthcare Information Technology Standards Panel (HITSP) Nationwide Health Information Network Architecture Projects (NHIN) Health Information Security and Privacy Collaboration (HISPC) Certification Commission for Healthcare Information Technology (CCHIT) American Health Information Community Standards harmonization and adoption Interoperability testing Security and privacy standards Specifications for standards- based EHR functionality to support RHIOs

HITSP Recommended Standards BiosurveillanceBiosurveillance –ICD-9CM – International Classification of Diseases v. 9 Clinical Modifications –ICD-10 CM – Diagnoses and Procedures –IHE-XDS – Integrating the Healthcare Enterprise (IHE) Cross- Enterprise Document Sharing –IHE-XDS Lab – IHE Laboratory Report Document Sharing –IHE-RFD – IHE Retrieve Form for Data Capture –IHE-PIX – IHE Patient Identification Cross-Referencing –IHE-RAD – XDS-I – IHE Cross-Enterprise Sharing of Images –IHE-NAV – IHE Notification of Document Availability –IHE-XDS-MS – IHE Medical Summary Document Sharing –ISO/TC215 -DTS Health Informatics Pseudonymisation –LOINC – Logical Observation Identifiers Names and Codes –NCCLS – National Committee for Clinical Laboratory Standards –RxNorm – National Library of Medicine RxNorm IHE contributes to HITSP’s success

HITSP Recommended Standards Consumer EmpowermentConsumer Empowerment –IHE-XDS – Integrating the Healthcare Enterprise (IHE) Cross-Enterprise Document Sharing –IHE-PIX – IHE Patient Identification Cross-Referencing –IHE-PDQ – IHE Patient Demographics Query –Health Level Seven (HL7) CDA R2 – HL7 Clinical Document Architecture Release 2 –HL7 CCD – HL7 Continuity of Care Document with mappings from ASTM E Continuity of Care Record (CCR), X12 N 270/271 and NCPDP Script 8.1. –HL7 EHR Systems Functional Model Draft Standard for Trial Use (DSTU) –Logical Observation Identifiers Names and Codes (LOINC)

HITSP Recommended Standards Electronic Health Record ExchangeElectronic Health Record Exchange –IHE-XDS Lab – IHE Laboratory Report Document Sharing –IHE-PIX – IHE Patient Identification Cross-Referencing –IHE-PDQ – IHE Patient Demographics Query –Health Level Seven (HL7) CDA R2 – HL7 Clinical Document Architecture Release 2 –HL7 v. 2.5 –Clinical Laboratory Improvement Amendments (CLIA) –Logical Observation Identifiers Names and Codes (LOINC) –Health Insurance Portability and Accountability Act (HIPAA) –Systematized Nomenclature of Medicine – Clinical Terms (SNOMED – CT) –Unified Code for Units of Measure (UCUM)

2007 HIMSS Interoperability Showcase February 26 – March 1, ,000 square feet of exhibit space9,000 square feet of exhibit space 67 Showcase participants67 Showcase participants Secured HIExchange with broad contentSecured HIExchange with broad content HIE with patient care devicesHIE with patient care devices Personal health record solutionsPersonal health record solutions New directions focus (Life Sciences Bio-Pharma, HL7 v3.0 PIX/PDQ, ELINCS Lab)New directions focus (Life Sciences Bio-Pharma, HL7 v3.0 PIX/PDQ, ELINCS Lab) HITSP interoperability specificationsHITSP interoperability specifications Financial and administrative systems (CAQH/CORE)Financial and administrative systems (CAQH/CORE) Expanded distributed demonstration in a RHIO formatExpanded distributed demonstration in a RHIO format Focused tours – International, VIP, CongressionalFocused tours – International, VIP, Congressional Theater – Education sessionsTheater – Education sessions Morial Convention Center, New Orleans, LA

How to Participate As a User or Vendor Committee Member Become a member of relevant Domains Planning or Technical CommitteesBecome a member of relevant Domains Planning or Technical Committees As a User, Consultant or Vendor Interested Observer Provide Public Comments on Technical Framework SupplementsProvide Public Comments on Technical Framework Supplements Attend Demonstrations, Educational Events and WorkshopsAttend Demonstrations, Educational Events and Workshops

How to Use IHE As a Vendor Implementer Implement IHE Integration ProfilesImplement IHE Integration Profiles Test systems through Connectathon processTest systems through Connectathon process Publish an IHE Integration Statement for productsPublish an IHE Integration Statement for products As a User Implementer or Consultant Use IHE Integration Profiles to develop interoperability strategyUse IHE Integration Profiles to develop interoperability strategy Use Connectathon Results and Integration Statements to evaluate vendorsUse Connectathon Results and Integration Statements to evaluate vendors Demand IHE Integration Profile compliance in RFPsDemand IHE Integration Profile compliance in RFPs

Providers and Vendors Working Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings

More Resources Frequently Asked Questions Integration Profiles in Technical Frameworks: – Cardiology – IT Infrastructure – Laboratory – Patient Care Coordination – Patient Care Devices – Radiation Oncology – Radiology Connectathon Results Vendor Products Integration Statements Participation in Committees and Connectathons