IHE Radiology Kevin O’Donnell Toshiba Medical Systems Co-chair, IHE Radiology Planning Cmte.

June 28-29, 2005Interoperability Strategy Workshop2 IHE Radiology Achievements Status: Now finishing 7th year –Robust Vendor Participation at Connectathons –IHE Profiles appearing in User Purchasing Processes Have addressed basic workflows –Acquisition, Post-Processing, Reporting, Routing Teaching Files/Clinical Trials Have addressed imaging content handling –Measurements, CAD Results, NM, Presentation States, Reports, Key Image Notes Have addressed distribution of imaging info –on CDs, to EHRs, keeping Audit Trails

June 28-29, 2005Interoperability Strategy Workshop3 IHE Radiology Current Activities/Direction Facilitate deployment of IHE Profiles in the Market –Users Handbook (2005 Edition) –Considering more depth to Connectathon tests Start addressing integration and workflow spanning departments/enterprises/regions –XDS-I Expand support for specialties –Address Mammography –Support Radiation Oncology Domain

Bruce Curran University of Michigan Co-chair, IHE-RO Technical Committee IHE Radiation Oncology

June 28-29, 2005Interoperability Strategy Workshop5 IHE-RO

June 28-29, 2005Interoperability Strategy Workshop6 IHE-RO

June 28-29, 2005Interoperability Strategy Workshop7 IHE-RO Planning Committee –Jay Cooper, Co-chair NYU –Keith LaPlain, Co-chair Varian Medical Systems Technical Committee –Bruce Curran, Co-chair U Michigan –Stuart Swerdloff, Co- chair IMPAC ASTRO Leadership –Prabhakar Tripuranemi, IHE Co-chair Scripps Clinic –Jatindar Palta, IHE Co-chair U Florida –Jennifer Padberg, Staff Liaison ASTRO

June 28-29, 2005Interoperability Strategy Workshop8 IHE-RO Basic Interoperability Imaging Study Contouring System Simulation System Planning Workstation Rad Onc IMS Treatment Delivery Treatment Verification

June 28-29, 2005Interoperability Strategy Workshop9 IHE-RO Standards Used DICOM –Significant interoperability issues Un-equally spaced Image Sets 3D Contouring –Bifurcations –Auto-segmentation ‘leftovers’ Limits on Size of Structure Set / Dose Objects –Workflow issues to be addressed in 2007 Query/Retrieve for RT Objects General Purpose / Modality Worklists

June 28-29, 2005Interoperability Strategy Workshop10 IHE-RO Actors Proposals circulating between Planning Committee and Technical Committee –Many applications combine actors Image Archive RT Archive Patient Registrar Multi-Media Registration Contouring Reference Point Generation Prescription Entry Beam Placer / Shaper Dose Calculator Plan Evaluator Fractionator Reference Image Creator Planning Application RT SSet RT Plan G RT SSet RT Plan RT Dose Reference Images RT Dose DICOM

June 28-29, 2005Interoperability Strategy Workshop11 More information…. IHE Web site: Technical Frameworks Technical Framework Supplements – Trial Implementation Non-Technical Brochures : –Calls for Participation –IHE Fact Sheet and FAQ –IHE Integration Profiles: Guidelines for Buyers –IHE Connect-a-thon Results –Vendor Products Integration Statements Questions?

IHE Cardiology Harry Solomon GE Medical Systems Co-chair, IHE Cardiology Technical Cmte.

June 28-29, 2005Interoperability Strategy Workshop13 IHE Cardiology Roadmap – three profiles with “success path”, addressing broad range of integration problems –Cath Lab Workflow management, including angio, hemo, and IVUS, especially for emergent cases –Echocardiography Workflow management, including mobile echo –Ability to view an ECG from any location - quickly and easily integrated into other applications – focus on reporting –Evidence Documents specialized for cardiology logs and measurements –Displayable Reports for PDF-based clinical reports, RID and XDS for report distribution – additional subspecialties, focus on quality initiatives

June 28-29, 2005Interoperability Strategy Workshop14 Cardiology – 5 Year Roadmap Year 1 (2005) Year 2 (2006) Year 3 (2007) Year 4 (2008) Year 5 (2009) Cath Echo ECG Nuclear EP Cardiology Technical Framework Quality General Multi-modality workflow & imaging Measurements & evidence Procedure log, coded reports Supplies, inventory, & charge capture Workflow & imaging, stress protocols Measurements Retrieve ECG for display ECG/Stress/Holter orders Workflow & stress protocols Multi-modality lab workflow & reporting Home health monitoring Retrieve guidelines for display Retrieve structured guidelines Registry data harvesting Reporting & report distribution Precision time synchronization Implantable device parameters & events PediatricCoded reports ECG waveform interoperability Stress testing workflow

Clinical Laboratory Domain Charles Parisot GE Healthcare IHE IT Technical Committee Co-chair François Macary AGFA Healthcare IT IHE Laboratory Committee Co-chair

June 28-29, 2005Interoperability Strategy Workshop16 The IHE Laboratory Committee Contributing countries –France –Japan –Germany –Italy –The Netherlands –UK –US (CLSI - ex NCCLS) Development started in 2003 First profile published in November systems validated in systems validated in 2005 Four new profiles currently published for public comment Cochairs: Francois Macary - Agfa Healthcare IT Yoshimitsu Takagi - Hitachi

June 28-29, 2005Interoperability Strategy Workshop17 IHE Lab today and to-morrow Five profiles: –Laboratory Scheduled Workflow (LSWF) –Laboratory Point Of Care Testing (LPOCT) –Laboratory Device Automation (LDA) –Laboratory Code Set Distribution (LCSD) –Laboratory Information Reconciliation (LIR) Future plans –Incorporate analyzer images in the result workflow –Cross-enterprise sharing of lab reports, using CDA-R2 –Specimen labels workflow Ordering, placing, scheduling and performing clinical laboratory tests both for Hospital and Ambulatory. Microbiology included. Anatomic pathology and blood bank excluded

IT Infrastructure Glen Marshall Siemens Health Solutions IHE IT Infrastructure Committee Co-chair

June 28-29, 2005Interoperability Strategy Workshop19 IHE IT Infrastructure Roadmap Stage 0 – 2003 profile development for 2004 Connectathon EHRSecurity Profiles  Retrieve Information for Display (RID)  Patient Identifier Cross-Referencing (PIX)  Patient Synchronized Applications (PSA) Profiles  Enterprise User Authentication (EUA)  Consistent Time (CT) Standards & Prerequisites  CCOW v1.4 Patient Context  HL7 v2.3.1  HL7 v2.4  HTTP  WSDL 1.1  XHTML 1.0  XML 1.0 Standards & Prerequisites  CCOW v 1.4 User Context  Kerberos  NTP  SNTP

June 28-29, 2005Interoperability Strategy Workshop20 IHE IT Infrastructure Roadmap Stage 1 – 2004 profile development for 2005 Connectathon EHR SupportSecurity Profiles  Cross-enterprise Document Sharing (XDS)  Patient Demographics Query (PDQ) Profiles  Audit Trail and Node Authentication (ATNA)  Personnel White Pages (PWP) Standards & Prerequisites  Stage 0 IHE ITI profiles  CDA r1  HL7 v2.5  ebXML Registry  HTTP Standards & Prerequisites  IHE Radiology Basic Security  Stage 0 IHE ITI security profiles  RFC 3881 (Audit record schema)  LDAP (RFC )  RFC 2798 (inetOrgPerson schema)

June 28-29, 2005Interoperability Strategy Workshop21 IHE IT Infrastructure Roadmap Stage 2 – 2005 profile development for 2006 Connectathon EHR SupportSecurity Profiles  Notification of Document Availability (NAV)  Patient Management (PAM Profiles  Cross-Enterprise User Authentication (XUA)  Document Digital Signature (DSG) Standards & Prerequisites  Stage 1 IHE ITI profiles  IETF SMTP / MIME  HL7 v2.5 Standards & Prerequisites  Stage 1 IHE ITI security profiles  OASIS SAML 2.0  HL7 v2.6 UAC segment  W3C XML Digital Signature  ITU X.509  ISO/TS 17090

June 28-29, 2005Interoperability Strategy Workshop22 IHE IT Infrastructure Roadmap Stage 3 – 2006 profile candidates for 2007 Connectathon EHRSecurityCommon Data Profiles – to be decided in Nov  Templates registry  Patient Demographics Query - multi- enterprise  Federated XDS registries  Harmonize XDS and RID document retrieval capabilities Referred to IHE PCC domain  Scheduling – enterprise scope  Dynamic data for EHR Profiles – to be decided in Nov  RBAC – enterprise scope Referred to IHE PCC domain  Patient consents Profiles – to be decided in Nov  LDAP information sources  Transaction Failure Management (TFM)  RID configurability directory  Service discovery Depends on other IHE domains’ needs  Masterfile Maintenance  Reference code set maintenance Standards & Prerequisites  Stage 2 IHE ITI profiles  HL7 templates standards  W3 standards for XML schemas and XSL  HL7 scheduling messages  W3C Semantic Web (interoperability and clinical vocabulary standards for assembling dynamic data sources into documents) Standards & Prerequisites  Stage 2 IHE ITI security profiles  ISO/TS for certificate archiving  ISO/TS parts 1 & 2  ISO/TS for function & structural roles  ASTM E31.20 Privilege Management Infrastructure  Stable HL7 standards for communicating patient consents Standards & Prerequisites  Stage 2 IHE ITI Patient Management profile  HL7 v2 Masterfile maintenance  Mature/stable standards for selected masterfile information sources  Suitable LDAP schema definitions  Web services standards  IETF infrastructure  W3C infrastructure

June 28-29, 2005Interoperability Strategy Workshop23 IHE IT Infrastructure Roadmap Stage 4 – 2007 profile candidates for 2008 Connectathon EHRSecurityCommon Data Profiles  Scheduling  Respond to national/regional EHR mandates and initiatives, TBD Profiles  RBAC – multi-enterprise scope  Wide-area patient access  Mobile applications  Patient identification based security Profiles  Workflow management preferences  SNMP MIBS  LDAP equipment directory support Standards & Prerequisites  HL7 scheduling messages  EHR-related standards, TBD Standards & Prerequisites  Stage 3 IHE ITI security profiles  Stable standards for cross- enterprise RBAC  Stable standards for mobile access security  Stable standards for patient identification Standards & Prerequisites  Stable workflow management standards for healthcare use cases  Suitable LDAP schema definitions  IETF MIB standards

June 28-29, 2005Interoperability Strategy Workshop24 IHE IT Infrastructure Roadmap Stage 5 – profile candidates for Connectathon EHRSecurityCommon Data Profiles  XDS composite documents from multiple clinical domains. Profiles  Remote service access  Anonymization  Pseudoanonymization  Patient-controlled access Profiles  Equipment discovery and automatic provisioning  RID and XDS configurability Standards & Prerequisites  Stage 3 IHE ITI profiles  Clinical domains’ XDS document profiles Standards & Prerequisites  Stage 4 IHE ITI security profiles  Stable healthcare data model standards  Stable standards for labeled data access rules Standards & Prerequisites  Stage 3 IHE ITI common data profiles  Stable standards for user interface optimization, e.g., DICOM “hanging protocols”  XDS clinical application domains’ content profiles

Patient Care Coordination John Donnelly IntePro Solutions, Inc. IHE IT Infrastructure Committee and Co-chair, IHE Patient Care Coordination Committee

June 28-29, 2005Interoperability Strategy Workshop26 Patient Care Coordination Domain Scope Facilitate the use of EHR content standards for the transferring or sharing of patient care services via the development of medical summary (MS) content profiles Specify appropriate “transfer packages” of clinical information for specific transfer of care use cases via the development of integration profiles. Optimize the use of the IHE ITI profiles (e.g. XDS) in delivering healthcare in “communities” of patient care settings

June 28-29, 2005Interoperability Strategy Workshop27 Patient Care Coordination Current Accomplishments Issued Call for Participation to vendor community and medical societies for Planning and Technical Committee formation – 2 t-cons and 1 FtoF meeting Finalized a Medical Summary Content Proposal highlighting two key transfer of care use cases Conducted high-level content standards evaluation exercise Promoted content standard education initiative