September, 2005What IHE Delivers 1 Patient Care Coordination IHE Europe Workshop 2007 IHE Patient Care Coordination Charles Parisot, GE Healthcare

2 Content Profile Roadmap Year (Trial Implementation)  Medical Summary [MS] – Acute Care Discharge to PCP, PCP Referral to Specialist  Unstructured Document – CDA-wrapped PDF Year (Development & Testing)  Medical Summary [MS] – ED Referral [EDR]  Pre-procedure H&P [PPHP]  Basic Patient Privacy Consents [BPPC]  Exchange Personal Health Record [XPHR]

3 PCC Content Integration Profiles XDS-MS Medical Documents Referral BCCP Consent EDR Emergency Department Referral PPHP Preprocedure History and Physical History and Physical XPHR PHR Update XD*-LAB Lab Report PHR Extract EDN Emergency Department Note ACS Antenatal Care Summary CA Care Assessments Discharge Summary Medical Summaries

4 PCC Content Integration Profiles Content using a Specific Standard  CDA Release 2.0  HL7 Care Record Summary  HL7/ASTM Continuity of Care Document Library of Reusable Parts  Document Types  Sections  Entries

September, 2005What IHE Delivers 5 Basic Patient Privacy Consents (BPPC) IHE Vendors Workshop 2006 IHE Patient Care Coordination Education John Moehrke, Robert Horn, Lori Fourquet, Keith W. Boone

6 Basic Patient Privacy Consents Abstract The Basic Patient Privacy Consents (BPPC) profile provide mechanisms to:  Record the patient privacy consent(s),  Mark documents published to XDS with the patient privacy consent that was used to authorize the publication,  Enforce the privacy consent appropriate to the use.

7 Basic Patient Privacy Consents Scope Document Sources and Document Consumers in an XDS Affinity Domain Document Sources and Document Receivers using Cross Enterprise Point- to-Point Document Sharing

8 Basic Patient Privacy Consents Value Proposition an Affinity Domain can  develop privacy policies,  and implement them with role-based or other access control mechanisms supported by EHR systems. A patient can  Be made aware of an institutions privacy policies.  Have an opportunity to selectively control access to their healthcare information.

9 Basic Patient Privacy Consents Key Technical Properties Human Readable Consents Machine Processable Support for standards-based Role-Based Access Control

10 Basic Patient Privacy Consents Standards and Profiles Used CDA Release 2.0 XDS Scanned Documents Document Digital Signature Cross Enterprise Document Sharing Cross Enterprise Point-to-Point Document Sharing

11 Basic Patient Privacy Consents Example Encounter 2 (OK with B) Encounter 1 (Requires A) Consent A Consent B

September, 2005What IHE Delivers 12 Pre-procedure History and Physical (PPHP) IHE Development Team Workshop 2006 IHE Patient Care Coordination Education Dan Russler, MD, co-chair PCC Technical Committee

13 Use Case H&P documentation required prior to procedure that is designed to assess:  Procedure Risk  Anesthesia Risk  Factors influencing procedure after-care decisions Desired outcomes  Minimize injury during procedure  Optimize procedure after-care Pre-procedure H&P

14 Scope To identify the required and optional PPHP document content templates including:  CDA Document Header  CDA Document Type(s)  CDA Section Types  CDA Entry Types Pre-procedure H&P

15 Value Proposition A procedure risk assessment must be present and evaluated by the operative and after-care teams before the patient is allowed to have the procedure. Missing information is frequently a reason for canceling the procedure for the day, which leads to expensive underutilization of resources and dissatisfied patients. Further, incomplete information about the patient’s clinical or home status may create a situation where a procedure is performed that ultimately results in an injury, inadequate aftercare or other undesirable outcome. Pre-procedure H&P

16 Key Technical Properties PPHP Profile inherits specifications required for other IHE PCC Medical Documents PPHP Profile follows documentation practices for all IHE PCC Medical Documents PPHP Profile emphasizes re-usability of CDA template identifiers in order to reduce un- necessary variability in IHE Content Profiles Pre-procedure H&P

17 Standards Used IHE Medical Document Content Profiles HL7 Reference Information Model ANSI Standard HL7 CDA R2 ANSI Standard HL7 Care Provision Domain DSTU (in process) Implementation Guides  HL7 Care Record Summary CDA R2 Implementation Guide (in process)  HL7/ASTM Continuity of Care Document Implementation Guide (in process) Pre-procedure H&P

September, 2005What IHE Delivers 18 Todd Rothenhaus, MD FACEP American College of Emergency Physicians Emergency Department Referral

19 Emergency Department Referral Value Proposition Nearly 5000 EDs in US or in Europe Significant percentage of ED visits are referrals Shortage of critical health data for emergency department patients Need to improve communication of intended patient care plans to ED providers and ensure that no pertinent data is lost Streamline workflow by obviating telephone calls between busy clinicians

20 Emergency Department Referral Scope EHR system capable of creating a care record summary would be capable of creating a referral package for a receiving system The emergency department information systems (EDIS) will need to retrieve and read and display this data.

21 Emergency Department Referral Use Case 1. Health care provider determines that a patient needs to go to the ED 2. Provider creates an ED referral package using his or her EHR 3. Upon arrival, the ED provider identifies the patient as a referral 4. The posted referral package is imported into the Emergency Department Information System (EDIS) Provide access to critical health information to ED information systems in a standard manner.

September, 2005What IHE Delivers 22 Exchange of PHR Content (XPHR) IHE Vendors Workshop 2006 IHE Patient Care Coordination Education Keith W. Boone, GE Healthcare [co-chair PCC Technical Committee]

23 Exchange of PHR Content XDS-MS Medical Documents Medical Summaries Referral Discharge Summary BCCP Consent EDR Emergency Department Referral PPHP Preprocedure History and Physical History and Physical XPHR PHR Update XDS LAB CDA Lab PHR Extract XPHR PHR Update PHR Extract

24 Abstract The Exchange of Personal Health Record Content (XPHR) provides a standards- based specification for managing the interchange of documents between a Personal Health Record and an EHR System to enable better interoperability between these systems. Exchange of PHR Content

25 Scope Personal Health Record (PHR) Systems Electronic Health Record (EHR) Systems Exchange of PHR Content

26 Value Proposition Supports interchange of PHR Information  Demographics  Insurance Information  Medications, Problems, Allergies  Health History  Other Information Exchange of PHR Content

27 Standards Used CDA Release 2.0 ASTM Continuity of Care Data Set ASTM/HL7 Continuity of Care Document HL7 Care Record Summary AHIMA PHR Common Data Elements XDS, XDR Document Digital Signature Exchange of PHR Content

28 Key Technical Properties Information is Human Readable and Machine Processable Support Static and Dynamic Information Sharing Domains (XDS and XDR) Protects Information using Digital Signature Update Model for EHR to PHR Changes Exchange of PHR Content

29 Doc Exchange Integration Profiles Key Profiles for Document Content and Exchange Doc Content Profiles Doc Sharing XDS Media Interchange XDM Pt-Pt Doc Interchange XDR ConsentBPPCEmergencyEDR Pre Surgery PPHP Scanned Doc XDS-SD LaboratoryXD*-Lab PHR Exchange XPHR Discharge & Referrals XDS-MSImagingXDS-I

30 PCC Content Integration Profiles XDS-MS Medical Documents Referral BCCP Consent EDR Emergency Department Referral PPHP Preprocedure History and Physical History and Physical XPHR PHR Update XD*-LAB Lab Report PHR Extract EDN Emergency Department Note ACS Antenatal Care Summary CA Care Assessments Discharge Summary Medical Summaries

31 Rossi-Mori EU survey mapping to XDS-MS No of Countries Sectionall not asked all - BE details about patient identifier, name (date of birth, gender) address history medication history immunisations family history 13 allergies, alerts, risks, special needs 12 ongoing medications 10 test results (lab and images) 10 details about family doctor 9 active problems 6 details about insurance 6 emergency contact (next of kin) 4 care plans not asked (exemptions)

32 Example of XDS-MS Options ActorOptionsVol & Section Content SourceDischarge Summary Option(1) Referral Option (1) PCC TF-1: PCC TF-1: Content Consumer View Option (2) Document Import Option(2) Section Import Option (2) Discrete Data Import Option (2) PCC TF-1: PCC TF-1: PCC TF-1: PCC TF-1: Document Registry No Options- Document Repository No Options- Patient Identity Feed No Options-

33 IHE flexibility in leveraging standards for Document Format Content Format leverages Specific Standards  HL7 CDA Release 2.0  HL7/ASTM Continuity of Care Document  LOINC, SNOMED (if applicable)  Others as Needed (e.g. PDF) IHE is defining a library of Reusable Parts  Document Types  Sections (only title is coded)  Entries (clinical info semantically coded)

34 In Conclusion IHE is experienced with patient summaries.  IHE ready to engage in fostering a consistent family of patient summary documents and a sharing infrastructure between countries and regions in Europe.