Integrating the Healthcare Enterprise New Integration Profiles - Summary G. Claeys Agfa Healthcare R&D, Technology Manager Vendor co-chair IHE Europe Courtesy of IHE Committees

IHE Europe Educational Event IHE Scope 7 February 2005 IHE Europe Educational Event

IHE Radiology – Integration Profiles Patient Information Reconciliation Reconcile Worklists, Status and Data Objects For Unknown Patients and Demographics Changes Access to Radiology Information Consistent Presentation of Images Create, store, manage, retrieve & use objects for hardcopy and softcopy grayscale presentation states Key Image Notes use objects to flag significant images Simple Image and Numeric c Reports use simple diagnostic reports with optional image links & Scheduled Workflow Grouped Procedures Manage individual procedure image subsets from a multi - procedure acquisition for viewing & reporting Basic Security Charge Posting Reporting Workflow Manage worklists, track status, perform & notify diagnostic reporting steps Evidence Documents manage, retrieve & use objects to record study evidence & notify image processing & CAD steps Post Processing Create, Store, Manage, Retrieve & Use Images Admission, Order Management, Scheduling, Store, Retrieve Worklists, Track Status, Perform & Notify Acquisition Related Steps NM Image Portable Data for Imaging New New 7 February 2005 IHE Europe Educational Event

IHE Europe Educational Event IHE Radiology - new Portable Data for Imaging Profile (PDI) NM Image Profile Departmental Workflow 7 February 2005 IHE Europe Educational Event

Portable Data for Imaging (PDI) Single Media format definition must be able to support full range of viewing/ import uses For patient personal records For referral For enterprise data interchange For printing Media interoperability validation Browser compatibility 7 February 2005 IHE Europe Educational Event

IHE Europe Educational Event PDI – Key principles Three major use case categories considered: Media Export (creation of media) Media Viewing (reading & immediate viewing of media) Media Import (reading and import of media for use in other IHE workflows) Single new Transaction (Distribute Imaging Information on Media) defines the required content/ structure of the media. DICOM DIR (DICOM Part 10) “web-viewable” data derived from the DICOM data (HTML, JPEG) 7 February 2005 IHE Europe Educational Event

PDI – Actors and Transactions Distribute Imaging Information on Media Display Image Display Portable Media Creator Report Reader Print Composer Media Importer 7 February 2005 IHE Europe Educational Event

Nuclear Medicine (NM) Image Profile New “content” Profile – No new actors or transactions Profile describes how actors must create, store and retrieve NM Images Options added to Images Stored Transactions, Query Images and Retrieve Images Transactions 7 February 2005 IHE Europe Educational Event

Departmental Workflow Adds options to SWF (2 Supplements) Appointment Notification Gives the OF/DSS an option to notify Order Placer of date and time of scheduled examinations. Using HL7 SIU message Instance Availability Notification Gives the Image Manager an option to notify Order Filler and other workflow management actors of availability status of evidence objects. Alternative to Image Availability Query transaction Based on DICOM Supplement 93 7 February 2005 IHE Europe Educational Event

IHE IT Infrastructure – Integration Profiles Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. New Patient Demographics Query Personnel White Page Access to workforce contact information Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Patient Synchronized Applications Synchronize multiple applications on a desktop to the same patient Patient Identifier Cross-referencing for MPI Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Consistent Time Coordinate time across networked systems Map patient identifiers across independent identification domains 7 February 2005 IHE Europe Educational Event

IHE IT Infrastructure - new New Integration Profiles Patient Demographic Query (PDQ) Personnel White Pages (PWP) Audit Trail Node Authentication (ATNA) Cross-Enterprise Document Sharing (XDS) ITI Infrastructure has a multi-year roadmap XDS-related content profiles Security : Role based authorization LDAP based applications : e.g. PKI, Configuration management 7 February 2005 IHE Europe Educational Event

Patient Demographic Query ( PDQ) Goal: Allow quick retrieval of common patient name, identifier, and location to enable proper patient tracking Will answer common “questions”: I have a patient ID and what name, demographics, etc. go with it? I have partial demographics, e.g. name, and need to find a patient ID? Based on well established HL7 technologies, though may push the HL7 standard and require Z-queries 7 February 2005 IHE Europe Educational Event

Personnel White Pages (PWP) Goal: Electronic Staff Directory Provide access to basic information about the human workforce members (email,phone nr) Single place to store&update Technology used: LDAP directory, X500 scheme, HL7 naming scheme 7 February 2005 IHE Europe Educational Event

Audit Trail & Node Authentication (ATNA) Scope : Node authentication, using device certificates Centralized audit trails NTP Server Extends the IHE radiology oriented Basic Security profile (defined in 2002) to be applicable on enterprise level. Addition of IETF Common Audit Trail message payload Addition of Reliable Syslog transport protocol 7 February 2005 IHE Europe Educational Event

ATNA - Backward compatibility ATNA is backward compatible with Basic Security Existing applications, supporting Basic Security are ATNA compliant Basic security is deprecated No further extensions New applications are encouraged to use new message format, transport mechanism 7 February 2005 IHE Europe Educational Event

Cross Document Sharing (XDS) Focus: Support document sharing among EHRs in different care settings and organizations 7 February 2005 IHE Europe Educational Event

IHE Europe Educational Event XDS – Key principles Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (HL7-CDA, ASTM-CCR, PDF, DICOM, etc.) Document Content Neutral: Document content is processed only by source and consumer IT systems. Distributed: Each Care delivery organization “publishes” clinical information for others. Actual documents may remain in the Care delivery organization. Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain (e.g. an LHII). Standardized Registry Attributes: Queries based on meaningful attributes ensure deterministic document searches. 7 February 2005 IHE Europe Educational Event

IHE Europe Educational Event XDS – Architecture Documents Registry Document Repository Long Term Care Acute Care (Inpatient) Other Specialized Care or Diagnostics Services PCPs and Clinics (Ambulatory) EHR-CR: Care Record systems supporting care delivery Submission of Document References Retrieve of selected Documents 7 February 2005 IHE Europe Educational Event

Standards for XDS Electronic Business Standards Internet Standards No single standard addresses XDS Requirements Electronic Business Standards ebXML, SOAP … Internet Standards HTML, HTTP, ISO, PDF, JPEG … Healthcare Content Standards HL7 CDA, CEN EHRcom HL7, ASTM CCR DICOM … 7 February 2005 IHE Europe Educational Event

Other IHE Expansion Domains IHE Pathology Explorative phase in Europe (France) IHE Endoscopy Explorative phase in Japan & USA IHE Oncology IHE Dermatology Explorative phase in Europe (Spain) IHE Pharmacy / Medication Administration: Exploratory Phase in USA 7 February 2005 IHE Europe Educational Event

IHE Europe Educational Event More information…. IHE Web sites: http://www.ihe.net http://ihe-europe.org http://www.rsna.org/IHE http://www.acc.org/quality/ihe.htm http://ihe-nl.org Technical Frameworks: ITI V1.0, RAD V5.5, LAB V1.0, CARDIO V1.0 Non-Technical Brochures : IHE Europe Business Case IHE Fact Sheet and FAQ IHE Integration Profiles: Guidelines for Buyers IHE Connectathon Results Vendor Products Integration Statements 7 February 2005 IHE Europe Educational Event