INTEGRATING THE HEALTHCARE ENTERPRISE Pathway to Interoperability IT Infrastructure Planning Committee Michael Nusbaum – MH Nusbaum & Assoc 1

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Base Standards eHealth Projects Interoperability: Highest Cause of Health IT project failures Health Interoperability Standards: how can we realize the promise ? 3 IHTSDO IHTSDO IETF

Profile Development Base Standards eHealth Projects 4 Interoperability: From a problem to a solution Profiling Organizations Have Emerged IHTSDO IHTSDO IETF Specific Extensions

5 Standards: Necessary…Not Sufficient Standards 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

Connecting Standards to Care Healthcare professionals work with industry Coordinate 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 6 IHE: A forum for agreeing on how to implement standards and processes for making it happen

7 IHE: A Framework for Interoperability A common technical 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, nations Promotes unbiased selection and coordinated use of established healthcare and IT standards to address specific clinical needs

Is IHE novel? Adopted? What are the alternatives ?  Ignore the issue  Pick key standards, and hope for the best  Rely on robust standards harmonization ISO Health Informatics: TR28380 Global Standards Adoption – IHE Process and Profiles Widespread adoption of IHE Profiles by National and Regional Projects around the world: USA, Canada, Europe, Asia Home Health: CONTINUA and IHE work together. 12 Country European epSOS Project (IHE-Europe hosting Industry Team). 8

Document Use Case Requirements Identify available standards ( e.g. HL7, DICOM, IETF, OASIS) Develop technical specifications Testing at Connectathons IHE Demonstrations Products declare IHE Timely access to information Easy to integrate products RFPs with IHE reqs IHE is a Proven Standards Adoption Process Recognized by the International Standards Organization: TR 28380

1010 IHE Organizational Structure Contributing & Participating Vendors Example Deployment Committees IHE Europe IHE North America France USA Canada IHE Asia-Oceania Japan KoreaAustralia Netherlands Spain Sweden UK Italy Germany Norway China Austria Professional Societies / Sponsors IHE International Board Global Development Domains Radiology Cardiology IT Infrastructure Patient Care Coordination Patient Care Devices Laboratory Pathology Eye CareRadiation Oncology Public Health, Quality and Research Pharmacy 10 Endoscopy Dentistry

11 14 Years of Steady Evolution 1998 – 2011 The IHE Development Domains Pharmacy since 2009 Pathology since 2006 Radiation Oncology since 2004 Radiology since 1998 Cardiology since 2004 Patient Care Devices since 2005 Patient Care Coordination since 2004 Eye Care since 2006 Quality Research & Public Health since 2006 Laboratory since 2004 (Healthcare) IT Infrastructure since 2003 Endoscopy since 2010 Dentistry since 2010

12 International Participation in IHE France   Local Deployment   National Extensions   Promotional & Live Demonstration Events   Funding USAGermanyItalyJapanUKCanadaKoreaTaiwanNorway Netherlands Spain ChinaAustria Pragmatic global standards harmonization + best practices sharing 2008 Australia

13 IHE Sponsors Professional societies:  Healthcare Information Management Systems Society (HIMSS)  American College of Physicians (ACP),  American College of Emergency Physicians (ACEP)  American College of Obstetricians and Gynecologists (ACOG)  Many other American Professional Societies (ACCE), (AAO), (ASTRO), etc.  British Institute of Radiology (BIR), British Computer Society (BCS)  German Radiology Society (DRG) …ASIP (IT France), SFIL (laboratory), French National Project (DMP), European Society of Cardiology  Radiological Society of North America (RSNA)  JAHIS (IT Japan), JIRA, JRS,…  And many more Government Agencies:  French National Project (ASIP-Santé)  Dutch National Project (NICTIZ)  Austrian National Project (ELGA)  Canada Health Infoway (CHI)  Regional projects (Italy, USA, Japan) and many more…..

IHE Connectathon Open invitation to any vendor and other implementers Advanced IHE testing tools (MESA, GAZELLE) Testing organized and supervised by independent project management team Thousands of cross-vendor tests performed Results recorded and published / 14

IHE N.A. Connectathon Tested Systems Radiology 40 Systems Cardiology 30 Systems Devices 20 Systems Intra-enterprise Interoperability Enterprise-level: 44 Systems Cross-enterprise Interoperability EHR/PHR/Edge Systems 2008: 14 Systems 2009: 24 Systems 2010: 56 Systems HIE/HIO Infrastructure 2008: 5 Systems 2009: 6 Systems 2010: 30 Systems

HIMSS Interoperability Showcase 16 16

IHE, Global Standards-Based Profiles Adopted in National & Regional Projects 17

IHE, Global Standards-Based Profiles Adopted in National & Regional Projects 18

19 Supplies infrastructure for sharing healthcare information, which is independent of any particular clinical domain. An infrastructure interoperability component represents a common IT function that is used as a building block for a variety of use cases... a necessary ingredient, but rarely visible to the end user. These components may be embedded in an application, but are often deployed as a shared resource within a health information exchange environment. The IT Infrastructure Domain

20 Categories of Healthcare Communication Services Security/Privacy Health Record Sharing Patient and Provider Identity Management Workflow Enablers Source persisted and attested health records 2 or more entities synchronize a task e.g. access last 6 mo. historical labs & encounter summaries e.g. order lab test, track status and receive results Hospitals Exchange of Health Information Support Management

ITI Strategic Focus CategoryDescription Patient and Provider Identity Profiles in the Patient and Provider Identity category support the management of patient, provider and healthcare organization identity including their localization. This includes the ability to look up, cross-reference, update, remove, merge, link and general management of identities. Health Record Sharing Profiles in the Health Record Sharing category support the ability to share patient specific healthcare information within and across Enterprises. This includes the ability to submit, locate/list, push, pull and retrieve patient specific healthcare information. Security and Privacy Profiles in the Security and Privacy category support the ability to ensure that healthcare information is managed consistent with a reasonable set of security and privacy policies. Workflow Enablers Profiles in the Workflow Enablers category support standard sequences for performing workflow activities. Support Management Profiles in the support management category support the ability to share information needed for interoperable healthcare management such as clinical coding, technical or IT management information 21

22 More Information IHE Web site:   IHE official material   Technical Framework documents IHE Wiki site: wiki.ihe.net   IHE committee pages   Implementation Notes   Ongoing committee work IHE ITI technical committee mailing list     At the bottom of the page is a place to join the mailing list

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