HIMSS IHE, Interoperability for Regional Health Information Organizations Charles Parisot, GE Healthcare Mike Henderson, Eastern Informatics IHE IT Technical Committee Co-Chairs

HIMSS 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

HIMSS State of the Union Addresses By computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care. President George W. Bush January 20, 2004

HIMSS And the beat goes on….. …. most Americans will have electronic health records within the next 10 years President George W. Bush April 26, 2004 In a public address to the American Association of Community Colleges, the President outlined a plan whose goal is to assure better delivery of healthcare in the United States.

HIMSS Framework for Strategic Action President Bushs April 27th executive order called for the creation of the Office of the National Coordinator of Health Information Technology (ONCHIT). A report was required within 90 days of office creation. The Framework for Strategic Action was released by Department of Health and Human Services Secretary Tommy Thompson and newly appointed National Coordinator of Health Information Technology, David Brailer, MD, at the NHII Summit in July, 2004.

HIMSS Four Major Goals 1.Inform Clinical Practice –Incentivize EHR adoption –Reduce risk of EHR investment –Promote EHR diffusion in rural & underserved 2.Interconnect Clinicians –Foster regional collaborations –Develop a national health information network –Coordinate federal health information systems

HIMSS Four Major Goals 3.Personalize Care –Encourage use of PHRs –Enhance informed consumer choice –Promote use of telehealth systems 4.Improve Population Health –Unify public health surveillance architectures –Streamline quality and health status monitoring –Accelerate discovery and dissemination Thousands of EHRs to interconnect, Through a thin National Health Information Network. Make connectivity open, consistent, step-wise and evolutionary ! IHE can accelerate and simplify the process. See: 13 Organization Collaborative NHIN RFI Response Plus IHE Response to the NHIN RFI.

HIMSS Standards Alone Are Not Enough Managing the domain boundaries with mapping of information flow across boundaries Standards offer generality, ambiguity and alternatives. Vendor proprietary interests Complexity!! We need standards for how to implement standards!

HIMSS Connecting Standards to Care Care providers must work with vendors 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 ?

HIMSS Need for a Standards Implementation Process Standards Demand ?Offer Standards Standards User Projects

HIMSS What is Integrating the Healthcare Enterprise ? IHE provides a common framework for passing health information seamlessly: –within the healthcare enterprise –across multiple healthcare enterprises –for local, regional & national health information networks. IHE is sponsored by healthcare professional associations (ACC, HIMSS, RSNA, etc.). IHE drives standards adoption to address specific clinical needs.

HIMSS IHE Maturity and Acceptance More than 100 healthcare vendors worldwide have contributed to IHE and the delivery of ready-to-integrate products to benefit healthcare enterprises of all sizes. IT professionals & clinicians appreciate IHEs positive impact now expanded to address: –radiology, cardiology, laboratory –enterprise healthcare IT infrastructures –cross-enterprise healthcare IT infrastructures

HIMSS 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-led and vendor-driven

HIMSS A Proven Standards Adoption Process IHE Integration Profiles B IHE Integration Profile A Easy to Integrate Products IHE Connect-a-thon Product With IHE IHE Demonstration User Site RFP Standards Standards Standards IHE Technical Framework Product IHE Integration Statement 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 IHE Connect-a-thon Results

HIMSS 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 To claim compliance to IHE Integration Profiles vendors shall publish for each product an IHE Integration Statement.

HIMSS **HIMSS web-based survey in November 2004 – 163 participants IHE Survey Results –92% of respondents were aware of IHE –Potential benefits of IHE Improved clinical workflow + access of data = 63% –Benefits of IHE products Reduce deployment costs = 56%

HIMSS HIMSS RHIO with IHE-XDS Cross-enterprise doc sharing Experience your HIMSS-Wide Electronic Health Record Ambulatory Showcase Booth Home PCP Multispecialty Clinic Diag Center Vendor Booth Cross-enterprise Showcase Booth Cardiology Workup Comprehensive Patient Care Radiology Coordinated Patient Evaluation IT Infrastructure

HIMSS community Clinical Encounter Clinical IT System Index of patient records (Document-level) 1-Patient Authorized Inquiry Temporary Aggregate Patient History 4-Patient data presented to Physician Sharing System 3-RecordsReturned Reference to records Laboratory Results Specialist Record Hospital Record 2-Reference to Records for Inquiry Sharing records that have been published

HIMSS Standards selection for IHE XDS No single standard can address Cross-enterprise Document Sharing Marriage of healthcare standards facilitates implementation and leverages complementary technologies (e.g. security & privacy). Healthcare Content Standards HL7 CDA, CEN EHRcom HL7, ASTM CCR DICOM, etc. Internet Standards HTML, HTTP, ISO, PDF, JPEG, etc. Electronic Business Standards ebXML Registry, SOAP, etc.

HIMSS Acute Care (Inpatient) PCPs and Clinics (Ambulatory) Long Term Care Other Specialized Care or Diagnostics Services Registering and accessing Documents EHR-CR: Care Record systems supporting care delivery Document Registry Document Repository EHR-LR: Longitudinal Record as used across encounters Submission of Document References Retrieval of selected Documents

HIMSS XDS Actors and Transactions

HIMSS IHE Profiles for a RHIO Integration Profiles completed by HIMSS 2005 Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record New Patient Identifier Cross-referencing Map patient identifiers across independent identification domains Patient Demographics Query New 2004 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. New 2004 Personnel White Page Access to workforce contact information New Patient Identifier Cross-referencing Map patient identifiers across independent identification domains

HIMSS Patient Identification Management Enterprises using PIX Cross Referencing with XDS XDS Document Registry XDS Document Repository Patient Identity Source Patient Identification Domain C Patient Identification Domain XAD Patient Identification Domain D2 Document Entry Dm=XAD Pid=Px Patient Identifier X-Ref Mgr Patient Identity Feed Dm=XAD, Pid=Px Patient ID Consumer Dm=C Pid=Pc XDS Document Source XDS Doc Dm=XAD Pid=Px XDS Doc Provide&Register Doc Set Patient ID Consumer XDS Document Consumer Dm=D2 Pid=Pd Dm=XAD Pid=Px Query Docs

HIMSS IHE Profiles for RHIOs What is available and what will be added in 2005 Patient Identifier Cross-referencing Map patient identifiers across independent identification domains 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. 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 Notification of Document Availability Notification of a remote provider/ health enterprise Cross-enterprise User Identity and Accountability Authentication & Auditing: Basis for Access Control Imaging Information Content Format of the Document Content and associated coded vocabulary For Display Document Content Format of the Document Content 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

HIMSS Local & Regional RHIOs Infrastructure and Interoperability Cross-Enterprise Document Sharing (XDS) minimizes clinical data management by the infrastructure. Transparency = Ease of Evolution XDS works with other IHE Integration Profiles: –Audit Trail and Node Authentication (ATNA) and Consistent Time (CT) –Patient Id Cross-referencing (PIX) –Patient Demographics Query (PDQ) In 2005, IHE plans to finish base set of integration profiles to build regional health networks and interoperable EHRs: –Security: Identity Management+ Accountability –Content Profiles: DICOM, HL7-CDA/CCR, HL7-Lab, PDF. –Notification of Document Availability (with XDS document reference)

HIMSS IHE: RHIOs Interoperability Partner IHE offers a solid technical foundation to establish interoperability for RHIOs. Standards-based, open, multi-vendor, provider-led. Yearly progress, validation testing built in, backed by a proven process. Implementation by many vendors. RHIOs technical architects needs direct IHE involvement. Policies easier to establish when based on solid IHE Technical Framework, but are beyond IHEs scope. They remains RHIOs responsibility. IHE IT Infrastructure Committee: Tuesday 15 th 1:00-3:00 pm HIMSS Room A134

HIMSS W W W. I H E. N E T Thank You Questions ?