September, 2005What IHE Delivers 1 IHE Essentials ePharmacy Workshop Jan G. Claeys ) Co-chair IHE Europe Development Committee (ad interim)

2 IHE Mission IHE = Integrating the Healthcare Enterprise Improve the quality and cost of healthcare by removing the real-world interoperability barriers on departmental, hospital or regional level in a pragmatic way

3 IHE Global Approach Close co-operation between users and vendors  Users identify the integration problems  Vendors provide technical solutions Profile existing standards (e.g. DICOM, HL7,..) Agile development & deployment process  Incremental releases every year  Test driven

4 IHE Organisation Started in 1999 Association of users, vendors and public healthcare authorities  More than 100 participating vendors (major healthcare imaging&IT companies) Global development committees  Develop technical frameworks Regional and national deployment committees  Present in all continents (NAFTA, Europe, Asia Pacific)  Marketing, education  Testing

5 AGFA Healthcare Medical Algotec ARES SA aycan Digitalsysteme CEGEDIM Cerner Corp. CHILI CMT Medical Tech. Conto Corrente Salute ConVis CTI Mirada Solutions Data Processing SPA DEDALUSDianoema Eastman Kodak Co. Ebit Sanita EDL ELFIN s.r.l. Engineering Sanità ESAOTE MEDASYS SA Medavis Medical Communications Medigration GmbH MEDIMON Ltd. MEDIWARE MEDOS AG Merge eFilm METAFORA Mevis Diagnostics Konica Minolta Omnilab Philips Medical Systems POLYMEDIS Rasna Imaging Systems RAYPAX INC. REMRogan-Delft Sago spa Sectra Imtec AB SeeBeyond Technology ETIAMFerraniaFujifilm GE Healthcare GIE Convergence-Profils Global Imaging Online GWI Research Hi. tech IASI Srl IdeoPassINFINITTINFOPATIENTINOVITINSIEL Intersystems Corp. Invita ITZ Medicom iSoftMcKessonMED2RADMEDarchiver In yellow, companies with IHE Committees Chairs (Winter 2005) Siemens Medical Soluzioni Informatiche srl Stentor Inc. St. Jude Swissray Medical AG Symphonie On Line SynapsisSynchro-MedTECHNIDATA TELEMIS S.A. Tiani-Sprit Tomtec Imaging TOREX GAP Medical Toshiba Medical Systems TSI groupe europMedica T-SystemsUni-medicine VEPRO AG VISUS Technology Transfer WAID XR PARTNER Participating Vendors (Europe)

6 Total : 52 Integration Profiles IHE- Expanding Scope

7 IHE Development & Deployment process Identify critical healthcare workflows and integration problems Research & select existing standards to implement a solution Write, review and publish IHE Technical Framework Develop trial implementations Perform cross-testing at “Connectathon” Demonstrate at tradeshows (HIMSS/RSNA…)

8 IHE Building Blocks IHE Technical Framework IHE Validation Process IHE Integration Statements

9 IHE Technical Framework Describes the different integration solutions (domain specific)  Radiology, IT Infrastructure, Cardiology, Lab,.. Key concepts are domain neutral  Integration Profile  Transactions  Actors  Data model Country & Regional specialization  Limited : max. 5% Based on existing standards Based on existing standards IT Standards (http, ebxml) Healthcare Standards (HL7, DICOM) IHE Integration Profiles eHealth Application eHealth Application

10 Integration Profiles - Principles Solution for real-world interoperability problems (bottom-up approach) Integration Profiles are orthogonal  IPs are independent of each other  Applications may combine multiple Integration Profiles E.g. Information access + security E.g. Information access + security

11 IHE Integration Profiles - Content Set of Transactions among Actors Actor = logical entity (e.g. modality, image manager, order filler) Transaction = Sequence of messages among Actors Messages : e.g. HL7, DICOM, ebXML,. Profiling existing standards  Map data models, message content  “Restrict the options”  Clarify the semantics : accession nr Reference d standard (HL7) Detailed messagin g info Roles Integration Profile Actor … Transaction ………

12 IHE Actors ADT Patient Registration Order Placer Dept Scheduler Image Manager/Archive Modality Patient Registration (HIS): ADT focal point for patient registration information Department Scheduler (RIS): Focal Point for Requested Procedure Managent Breaks Order into Requested Procedures Schedules steps for each Requested Procedure Acquisition Modality: Focal Point for Performed Procedure Steps A PPS tracks one or more series of Images Image Manager/Archive (PACS) Focal Point For Imaging Study. Manages images Triggers reading when all expected PPS are completed Order Placer (HIS): Focal Point for Order Management

13 IHE Transactions - Example

14 Registration Orders Placed Orders Filled Film Folder Image Manager & Archive Film Lightbox report Report Repository Diagnostic Workstation Modality acquisition in-progress acquisition completed images printed Acquisition Modality Scheduled Workflow: Use Case

15 IHE Validation Process Goal :  Validate implementations of IHE TF in products Approach  IHE is not a certification authority  IHE stimulates auto-validation Vendors are responsible for validating and documenting IHE implementations Vendors are responsible for validating and documenting IHE implementations IHE provide tools and infrastructure IHE provide tools and infrastructure IHE Validation tools  Mesa toolkit  Connectathon  IHE Integration statement

16 MESA Test Toolkit Software library Emulate the various actors in the different implementation profiles Supports single product, single vendor testing Pre-requisite for connectathon participation  Implementers submit test logs prior to connectathon

17 Connectathon Connectathon = connectivity marathon Validate the Integration Profiles for a particular IHE demo  Pre-requisite for participating at IHE demos 1 week validation session in Europe, USA and Japan  End-to-end scenario testing  Multi-product; multi-vendor; multi-domain Connectathon 2006 : 70 vendors, 120+ products, 200 persons Results are published on

18 IHE Integration Statements Document the IHE implementation per product Content :  List of supported actors  List of supported integration profiles (per actor) “contractual” commitment Published on company website; referenced from IHE website IHE websiteIHE website

September, 2005What IHE Delivers 19 IHE Cross-Enterprise Document Sharing (XDS)

20 IHE XDS - Use Cases Patient referral (GP to Hospital) Patient discharge (Hospital to GP) Medical summary for Ambulatory care and acute care Personal Health record

21 Acute Care (Inpatient) PCPs and Clinics (Ambulatory) Long Term Care Other Specialized Care or Diagnostics Services EHR-CR: Care Record systems supporting care delivery Documents Registry Document Repository EHR-LR: Longitudinal Record as used across-encounters Submission of Document References Retrieve of selected Documents IHE XDS – Architecture

22 Document Source Document Consumer Document Registry Patient Identity Source IHE XDS Actors and Transactions Document Repository Patient Identity Feed Query Registry Register Document Set Retrieve Document Provide & Register Document Set Affinity Domain 1-N 1

23 No single standard addresses all XDS Requirements Healthcare Application Standards DICOM : imaging applications (modalities, PACS) HL7 : adminstrative applications (e.g. clinical lab, reporting, patient admin.) Snomed, Loinc : medical terminology & coding Domain focused IT Standards IETF W3C Oasis JPEG Technology focus

24 XDS Content model All clinical information is stored in documents Document format is domain specific (IHE PCC) :  Clinical Reports : PDF (plain text) -> CDA (coded text, subset of HL7v3 RIM)  Images : DICOM, JPEG2000 (part 1, part 2)  Video : MPEG2 -> MPEG4  Measurements (vector graphics) : SVG

25 XDS-MS Medical Summary

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28 IHE Resources Technical Framework  Volume 1 – Profiles Volume 1 – Profiles Volume 2 – Transaction Volume 2 – Transaction  – New profiles and transactions Practice: Connectathon Testing  and

September, 2005What IHE Delivers 29 Questions?

September, 2005What IHE Delivers 30 Thank You.