Integrating the Healthcare Enterprise What is IHE ? Charles Parisot, GE Healthcare IHE IT Infrastructure Technical Committee Co-chair IHE Europe Committee Copenhagen, March 17th 2005 March 17, 2005 IHE and medical Standards in Denmark

Working Together to Deliver Interoperable Health Information Systems W W W . I H E . N E T Providers and Vendors Working Together to Deliver Interoperable Health Information Systems In the Enterprise and Across Care Settings W W W . I H E – Europe. o r g March 17, 2005 IHE and medical Standards in Denmark

Connecting Standards to Care Care providers must work with industry to coordinate the implementation of standards to meet their needs Care providers need to identify the key interoperability problems they face Drive industry to develop and make available standards-based solutions Implementers need to follow common guidelines in purchasing and integrating systems that deliver these solutions What is the effective way to establish those “standards” for how to implement standards ? March 17, 2005 IHE and medical Standards in Denmark

Need for a Standards Implementation Process ? Standards Standards Standards User Projects Offer Demand March 17, 2005 IHE and medical Standards in Denmark

IHE and medical Standards in Denmark Goals of IHE Speed up the rate and quality of integration in healthcare environments Foster communication among vendors and care providers (the implementors) Prove that integration is attainable based on standards Improve the efficiency and effectiveness of clinical practice Improve interoperability among care domains and build foundation for the EHR Integration solutions within the healthcare enterprise and across healthcare enterprises March 17, 2005 IHE and medical Standards in Denmark

Understanding the IHE Initiative IHE has a clear focus IHE is a healthcare domain-based initiative IHE creates synergies for interoperability testing across domains IHE addresses the standards adoption process IHE is both regional and multi-national IHE is both user lead and vendor driven March 17, 2005 IHE and medical Standards in Denmark

IHE: Domain-based for a stepwise approach Patient Management Order Management Labora- tory Cardiology Pharmacy,….. Radiology Patient Identifier Linkage, Registries, Security Electronic Health Record Other (e.g. Access Control, eHealthWorkflows) March 17, 2005 IHE and medical Standards in Denmark

IHE 2005 – Five Active Domains 4 Technical Frameworks with 27 Integration Profiles Testing at yearly Connectathons in three continents Demonstrations at major conferences world-wide Patient Care Coordination Surgery, Pharma, Quality Provider-Vendor cooperation to accelerate standards adoption March 17, 2005 IHE and medical Standards in Denmark

A Proven Standards Adoption Process IHE Connect-a-thon Results Product IHE Integration Statement IHE Connect-a-thon Product With IHE IHE Demonstration Easy to Integrate Products IHE Technical Framework Standards IHE Integration Profiles B Profile A User Site RFP IHE Integration Profiles at the heart of IHE : Detailed selection of standards and options each solving a specific integration problem A growing set of effective provider/vendor agreed solutions Vendors can implement with ROI Providers can deploy with stability March 17, 2005 IHE and medical Standards in Denmark

IHE and medical Standards in Denmark IHE Process Users identify desired functionality that require coordination and communication among multiple systems E.g., departmental workflow, single sign-on, sharing of documents Find and document standards-based transactions among systems to achieve desired functionality Apply necessary constraints to eliminate useless wiggle room Provide process and tools to encourage vendors to implement MESA software test tools + Connect-a-thon interoperability testing event Provide tools and education to help users acquire and integrate systems using these solutions Connect-a-thon results and public demonstrations Integration statements March 17, 2005 IHE and medical Standards in Denmark

IHE Contributors & Participants Societies Representing Healthcare Segments EAR, GMSIH, ESC, RSNA, SFIL, HIMSS, ACC, Many Other Professional Societies… Any Healthcare Stakeholder Organization Users Clinicians, Medical Staff, Administrators, CIOs, … Information Systems & Equipment (e.g. imaging) Vendors Consultants In addition, active liaison with Standards Development Organizations (SDOs) HL7, DICOM, CEN, NCCLS, ISO, others … March 17, 2005 IHE and medical Standards in Denmark

IHE Organizational Structure IHE Strategic Development Committee Regional Deployment Cardiology Planning Committee Cardiology Technical Committee Radiology Planning Committee Radiology IT Infrastructure Planning Committee Pharmacy Exploratory Sub-Committee Global Development Laboratory Planning and Technical Committee IHE North America IHE Asia Japan USA Canada Taiwan Korea IHE Europe France Germany Italy UK Denmark Netherlands Spain Sweden Norway ACC ITAC/CHITTA HIMSS CHI RSNA CAR JAHIS JIRA JRS METI-MLHW MEDIS-DC JAMI GMSIH SFR SFIL SIRM BIR EuroRec COCIR EAR-ECR DRG ESC Professional Societies / Sponsors Contributing and participating Vendors March 17, 2005 IHE and medical Standards in Denmark

Organization of the IHE Initiative IHE distributes its operations between a regional/national level and an international level IHE is not a standards development organization IHE operates on overlapping yearly cycle IHE leverages dependencies and complementary interests between stakeholders IHE is an open and flexible organization A novel approach to meet these challenges March 17, 2005 IHE and medical Standards in Denmark

IHE and medical Standards in Denmark IHE Process Users and vendors work together to identify and design solutions for integration problems Intensive process with annual cycles: Identify key healthcare workflows and integration problems Research & select standards to specify a solution Write, review and publish IHE Technical Framework Perform cross-testing at “Connectathon” Demonstrations at tradeshows (HIMSS/RSNA…) **Consider making the cycle graphic Incremental approach: Can’t solve all at once Connectathon – Practical measure of progress, Validates the integration work accomplished. Refer the Scorecard. Demo – promotes standards based integration to users/purchasers March 17, 2005 IHE and medical Standards in Denmark

IHE Process – 20 month yearly cycle Development and Deployment Approved Supplement Scope Proposed Supplement Scope - 10 --- - 7 --- Public Comment Intgr-profile Trial Implementation Intgr-profile Sponsors announce Connectathon/Demos with set of Implementation Profiles Connectathon/Demo Vendor Participant Registered + 2 --- - 2 --- 0 --- Vendor Participant passed Connectathon + 5 --- + 6 --- Demo & Education Material Final Intgr-profile + 9 --- Vendors release products with IHE Integration Statements --- March 17, 2005 IHE and medical Standards in Denmark

IHE and medical Standards in Denmark What IHE is NOT! A standards development organization Uses established standards (HL7, DICOM, others) to address specific clinical needs Activity complementary to SDOs, formal relationship with HL7, ISO, DICOM, NCCLS, etc. Simply a demonstration project Demos, only one means to the end—adoption Backed up by documentation, tools, testing, and publication of information March 17, 2005 IHE and medical Standards in Denmark

IHE Technical Frameworks March 17, 2005 IHE and medical Standards in Denmark

IHE and medical Standards in Denmark Key IHE Concepts Generalized Systems -> Actors Interactions between Actors -> Transactions Problem/Solution Scenarios -> Integration Profiles For each Integration Profile: the context is described (which real-world problem) the actors are defined (what systems are involved) the transactions are defined (what must they do) Generalized the systems because there are many ways vendors can bundle products. Some PACS may include a Report Creator, others may not. Some Modalities may include a Print Composer, others may not. March 17, 2005 IHE and medical Standards in Denmark

IHE and medical Standards in Denmark 1st key concept: Actor Represents a set of application roles and responsibilities performed by a system Always supported by a real-world system A real-world system may support several IHE Actors Examples: Order Placer Order Filler Patient Admission, Discharge and Transfer (ADT) Laboratory Automation Manager Point Of Care Analyzer An IHE Actor is an abstract functional unit playing a specific set of roles and supporting a specific set of transactions to share information with other actors. A real-world system (e.g. a Laboratory Information System) is not an Actor. It may implement one or more Actors (e.g. Order Filler, Information Source). IHE leaves the definition of products to users and vendors March 17, 2005 IHE and medical Standards in Denmark

2nd key concept: Transaction A set of interactions or messages defined between two Actors for a specific task. Defines unambiguously how the Actors must cooperate to achieve this task. Using existing standards such as HL7, DICOM, NCCLS etc. Example: Transaction LAB-1 « Placer order management » Order Placer Filler → Placer order management [LAB-1] Order Placer Order Filler New order Order accepted Battery replaced Acknowledgement A transaction is a set of interactions defined between two actors to fulfill a specific task such as « placer order management ». It defines how the Actors cooperate to achieve this task. Each interaction is triggered by a real-world event (e.g. a new clinical testing order is placed for a patient by the medical staff). The interaction usually involves two messages (question and answer, event and acknowledgement). The messages are taken from an existing standard and their usage is fully described, to get rid of options and remove ambiguities. Status change Acknowledgement IHE defines transactions at a user-level workflow March 17, 2005 IHE and medical Standards in Denmark

3rd key concept: Integration Profile Solves an Integration Problem: A collection of real world information exchange capabilities supported by a set of specific Actors using Standards-based Transactions Integration Profile Actor … Transaction Examples:  Enterprise User Authentication Retrieve Information for Display Laboratory Scheduled Workflow Echo Laboratory Workflow Cross-Enterprise Document Sharing Referenced standard (e.g. HL7) Detailed messaging info -------------------------- Roles The Integration Profile is the global answer to a healthcare communication issue. For instance « Laboratory Scheduled Workflow » how the various systems of the hospital must interact with one another to establish the integrity of laboratory orders and observations throughout the hospital. March 17, 2005 IHE and medical Standards in Denmark

Product XYZ from Vendor T The Product World….. Product XYZ from Vendor T March 17, 2005 IHE and medical Standards in Denmark

IHE and medical Standards in Denmark The IHE World…. Actor Actor IHE Transaction IHE Transaction IHE Actor Actor IHE Actor IHE Transaction March 17, 2005 IHE and medical Standards in Denmark

Mapping IHE to Products Product XYZ from Vendor T Actor Actor IHE Transaction IHE Transaction IHE Actor Actor IHE Actor IHE Transaction March 17, 2005 IHE and medical Standards in Denmark

IHE and medical Standards in Denmark IHE Connectathon Open invitation to vendor community Advanced testing tools (MESA) Testing organized and supervised by project management team Thousands of cross-vendor tests performed Results recorded and published March 17, 2005 IHE and medical Standards in Denmark

IHE and medical Standards in Denmark IHE Connectathons Massive yearly events : 40-50 vendors 120-160 engineers 70-80 systems ….integrated in 5 days Vendors do not pass… until an IHE Project Manager attest it ! March 17, 2005 IHE and medical Standards in Denmark

IHE and medical Standards in Denmark March 17, 2005 IHE and medical Standards in Denmark

Integration Statements March 17, 2005 IHE and medical Standards in Denmark

Leveraging IHE Integration Statements Vendors Claim IHE Compliance in an explicit way Can rely on an objective and thorough specification (IHE Technical Framework) Willing to accept contractual commitments Willing to correct “implementation errors” Buyers Can compare product integration capabilities Simplify and strengthen their RFPs Can leverage a public and objective commitment Decreased cost and complexity of interface deployment and management March 17, 2005 IHE and medical Standards in Denmark

Participating and Contributing Vendors (Europe) AGFA Healthcare AISoftw@re Medical Solutions Algotec ARES SA aycan Digitalsysteme ConVis DEDALUS Dianoema Eastman Kodak Company Ebit Sanita EDL ELFIN s.r.l. Engineering Sanità Enti Locali ESAOTE ETIAM Ferrania Fujifilm GE Healthcare GMD GIE Convergence-Profils GWI Research IASI Srl IdeoPass Image Device-Cerner Company INFINITT INOVIT McKesson MED2RAD MEDASYS SA Medavis Medigration GmbH MEDIMON Ltd. MEDOS AG Merge eFilm METAFORA Konica Minolta Europe Omnilab Philips Medical Systems Rasna Imaging Systems RAYPAX INC. Rogan-Delft Sago spa Sectra Imtec AB Siemens Medical Solutions Soluzioni Informatiche srl Stentor Inc. Swissray Medical AG Symphonie On Line Synapsis TELEMIS S.A. TIANI MEDGRAPH AG TOREX GAP Medical Toshiba Medical Systems TSI groupe europMedica VEPRO AG VISUS Technology Transfer WAID XR PARTNER In yellow, companies with IHE Committees Chairs (Summer 2004) March 17, 2005 IHE and medical Standards in Denmark

Participating and Contributing Vendors (America) Agfa HealthCare Algotec Systems, Ltd. Berdy Camtronics Canon Medical Systems Carefx Cedara Software Corporation Cerner Corporation CSIST Dictaphone DR Systems Dynamic Imaging Eastern Informatics Eastman Kodak Company Emageon Eclipsys Fujifilm Medical Systems GE Healthcare Heartlab Hitachi Medical Corporation Hologic, Inc IDX Systems Corporation IMCO Technologies InSiteOne INFINITT Konica Minolta Marotech, Inc. McKesson Information Solutions Medcon Medical Manager Health Systems Mediface Co., Ltd. Merge eFilm Mortara Procom Philips Medical Systems RASNA Imaging Systems Sectra Sentillion Siemens Medical Solutions Softmedical Stentor, Inc StorCOMM, Inc Swissray International, Inc Tiani Medgraph AG Toshiba America Medical Systems UltraVisual Medical Systems Vital Images, Inc. Voxar Limited WebMD XIMIS In yellow, companies with IHE Committees Chairs (Summer 2004) March 17, 2005 IHE and medical Standards in Denmark

Participating and Contributing Vendors (Asia) Japan AGFA Gevaert Japan EBM Japan INFINITT Japan A&T Canon Goodman Climb Medical Systems Konica Minolta MG Shimadzu SONY Toshiba Medical Systems Toyo Technica Nihon Kohden Olympus NEC Pioneer (Marotech) Hitachi Hitachi Medico Fujitsu Fuji Film Medical Yokogawa Taiwan INFINITT Shing Shian INQ GEN TEP Tah Ya Korea AGFA Korea GE Healthcare Korea INFINITT LG CNS Marotech, Inc. Medical Standard Peoplenet Communications Samsung SDS March 17, 2005 IHE and medical Standards in Denmark

Achievements and expanding scope Over 100 vendors involved world-wide, 4 Technical Frameworks 27 Integration Profiles, Testing at yearly Connectathons, Demonstrations at major exhibitions world-wide Patient care Coordination, Quality, Pharmacy, Anatomical Pathology, Surgery, etc. To claim compliance to IHE Integration Profiles vendors shall publish for each product an IHE Integration Statement. March 17, 2005 IHE and medical Standards in Denmark

IHE Radiology Integration Profiles Charge Posting Portable Data for Imaging NM Image New Extensions Scheduled Workflow - Presentation of Grouped Procedures Reporting Workflow Patient Info. Recon-ciliation Post-Processing Workflow Consistent Present- ation of Images Evidence Docs Key Image Notes Simple Image & Numeric Reports Access to Radiology Information Basic Security March 17, 2005 IHE and medical Standards in Denmark

acquisition completed acquisition in-progress acquisition completed Scheduled Workflow Profile Report Repository Registration report Diagnostic Workstation Film Lightbox Orders Placed Image Manager & Archive Film Folder Specifies transactions that function to maintain the integrity of patient, image, and order information across systems Integrates modalities with information and imaging systems Biggest Value of IHE Smooth flow of patient, image and order information across systems Status updates of orders Orders Filled Acquisition Modality acquisition completed Film acquisition in-progress acquisition completed images printed Modality March 17, 2005 IHE and medical Standards in Denmark

“Departmental Actors” in SWF IHE Actors: DSS / Order Filler PPS Manager Image Manager / Archive Acquisition Modality Evidence Creator Image Display Acq. Modality (Primary Radiology Data Source) Evidence Creator (Auxiliary Radiology Data Source) Image Manager/Archive (Primary Radiology Data Management) March 17, 2005 IHE and medical Standards in Denmark

Example of Radiology Use Cases Local policy calls for ADT to pre-register ER patients (“John Doe”, “Jane Doe”): Case 1: Unidentified Patient registered at ADT and order is placed at Order Placer. Case 2: Unidentified Patient registered at ADT and order is placed at DSS/Order Filler. Case 3: Unidentified Patient registered at ADT but acquisition completed at Modality prior to order. March 17, 2005 IHE and medical Standards in Denmark

Unidentified Patient - Case 3 ADT Order Placer Image Manager Modality Department System Database/Scheduler/ Order Filler Filler Order Mgmt New Order [3] Procedure Scheduled [4] Patient Reconciliation J.Doe -> J.Smith Patient Update [12] Schedule Procedure Images Acquired Step Completed [7] Modality Procedure Register J.Doe Update [12] Registration [1] March 17, 2005 IHE and medical Standards in Denmark

Laboratory IHE Integration Profiles In Dev. Laboratory Scheduled Workflow (LSWF) Completed in 2003 Tests performed by a laboratory for an identified inpatient or outpatient Laboratory Point Of Care Testing (LPOCT) In Process –TI Nov 2004 Tests performed on point of care or patient’s bedside Laboratory Patient Information Reconciliation (LPIR) In Process Tests performed on an unidentified or misidentified patient Laboratory Code Set Distribution (LCSD) In Process Sharing the batteries and tests code sets throughout the enterprise Laboratory Device Automation (LDA) In Process –TI Nov 2004 Pre-analytic process, analysis and post-analytical treatment Year one (2003) brought the first integration profile « Laboratory Scheduled Workflow ». This profile supports the most common situation: The tests are placed to and performed by a clinical laboratory on specimens collected from a patient correctly identified in the hospital. Year two (2004) is expected to complete the framework with four more profiles: « Laboratory Patient Information Reconciliation » profile provides the messaging to resolve all the exceptional situations: Tests performed on an unidentified patient. Urgent tests performed before the order was generated. Merging of a misidentified patient… « Laboratory Point Of Care Testing » supports specimen testing on the point of care or on the patient’s bedside, by the care unit staff, under the overall supervision of a clinical laboratory. « Laboratory Device Automation » describes the messaging between the laboratory automation manager and all the automated devices (analyzers, robotic decappers, centrifuges, conveyors, aliquoters, …). « Laboratory Code Set Distribution » enables the various actors to rely on a common dictionary of tests and batteries. Some of these new profiles will be achieved in 2004, some others may need one more cycle. March 17, 2005 IHE and medical Standards in Denmark

IHE Cardiology 2004-2005 Retrieve ECG for Display New Retrieve ECG for Display Provide high-quality ECG and related reports to the enterprise and outside in a ready-to-display format New Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user EchoCardiography Worklflow Admit, order, schedule, acquire images, notify of completed steps, on fixed and mobile stress echo modalities. Cardiac Catheterization Workflow New Scheduled & unscheduled acquisition and management of cathlab information, notification of completed steps. March 17, 2005 IHE and medical Standards in Denmark

IHE IT Infrastructure 2004-2005 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 March 17, 2005 IHE and medical Standards in Denmark

IHE Integration Profiles for a “Regional/National Health Info Organization” Includes Integration Profiles in development in 2005 Patient Demographics Query Imaging Information Content Format of the Document Content and associated coded vocabulary Simple Document Content Format of the Document Content and associated coded vocabulary For Display Document Content Format of the Document Content Cross-Enterprise Notification Notification of a remote provider/ health enterprise Patient Identifier Cross-referencing Map patient identifiers across independent identification domains Lab Results Document Content Format of the Document Content and associated coded vocabulary Continuity of Care Document Content Format of the Document Content and associated coded vocabulary Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. Personnel White Page Access to workforce contact information User Identity, Authentication and Permissions Enable Basic Access Control Consistent Time Coordinate time across networked systems March 17, 2005 IHE and medical Standards in Denmark

IHE and medical Standards in Denmark Interoperability within the Enterprise, As well as, Interoperability Across Care Settings More on this, in this afternoon presentation…. March 17, 2005 IHE and medical Standards in Denmark

Working Together to Deliver Interoperable Health Information Systems W W W . I H E . N E T Providers and Vendors Working Together to Deliver Interoperable Health Information Systems In the Enterprise and Across Care Settings W W W . I H E – Europe. o r g March 17, 2005 IHE and medical Standards in Denmark