Strategies for Implementing the Digital Healthcare Community Practical conditions for business adoption of standards HL7 UK, London October 26, 2005 Charles Parisot GE Healthcare Information Technologies

HL7 UK The future of Integration October 2006 Topics Interoperability and digital communities Critical success factors for standards adoption Establishing a digital community framework at the international level Examples of successful interoperability Summary

HL7 UK The future of Integration October 2006 Open, standards-based interoperability critical to building a digital community Congratulations to standards development and implementation organizations Interoperability creates markets… e.g. $1B+ PACS More importantly… Interoperability transforms patient care GE interoperability at:

HL7 UK The future of Integration October 2006 Standards in the real-world One sort of healthcare interoperability standards… Those that are adopted ! Multiplicity of Standards development organizations in healthcare… necessity given the breadth, complexity and technological evolution, but each one needs to be global by domain. Calculated risks to Introduce new standards…. require the first line stakeholders: vendors and providers to gain confidence to implement (focused use cases). Interoperability Standards are deployed in incremental steps. A Standards Implementation Process needed to orchestrate: Requires an implementation “conductor”.

HL7 UK The future of Integration October 2006 Vendors, Clinicians & CIO’s key to driving interoperability as stakeholders Clinicians… Quality of care, safety, productivity, affordability CIOs… Cost effective, plug- n-play, “future-proof” Vendors… Reliability, ready to implement standards, speed to market

HL7 UK The future of Integration October 2006 Proven Standards Adoption Process: IHE Document use case requirements Identify available standards ( e.g. HL7, DICOM, IETF, OASIS) Develop technical specifications Testing at connectathons IHE demonstrations Products with IHE Timely access to information Easy to integrate products

HL7 UK The future of Integration October 2006 Sharing a Common Framework Internationally ? Belief that differences in health systems create insurmountable barriers and requires national customization. Over 10 countries are already rushing down this path. Many believe that it cannot be done, it is already in progress. Loosing time ? No, results with faster and cheaper deployment Once one realizes that challenge is to “connect” the IT systems used in thousands of point of care. This is the primary interface to address with a globally harmonized standards-based framework Much energy spent creating internationally agreed standards Only partially true for clinical information. Languages, some existing codifications, and order in deployment strategies shall be accommodated.

HL7 UK The future of Integration October 2006 US EHR Vendor Association: A roadmap Phase-in of Communication Services available 6 mos to 2yrs 2yrs + Phase 4: Active Quality Reporting & Health Surveillance Phase 3: Advanced Clinical Support & Access Control Phase 2: Share Diagnostic Results & Therapeutic Information Phase 1: Share Care Status Information From:

HL7 UK The future of Integration October 2006 Realizing the complementary roles of document sharing and of message based transactions End-Point System To End-Point System Interchange End-Point Systems to National Infrastructure Sub-network Communication From HIMSS EHRVA Response to ONCHIT RFI, January 2005 e.g. EMR e.g. Lab, PACS EMR, etc. Thin set of Health Net Services – facilitates information exchange End-Point System services exist at two distinct levels Net/Subnet communication level – e.g., IHE/XDS ( Cross-enterprise Doc. Sharing) Peer-to-Peer level – transparent to infrastructure, e.g., doc content / type Internet Document Sharing Dynamic Information Mgmt M e d i c a t i o n s Push Notificatio n ( eRx, eReferral ) Transaction Mgmt Clinical Content Clinical Content Security & Identity Historical Documents Dynamic Queries Workflow Transaction Record Locator Services Patient & Provider ID Mgmt Access Control CDA Lab results PDF Radiology Allergies Medications Internet Document Sharing Dynamic Information Mgmt M e d i c a t i o n s Push Notificatio n ( eRx, eReferral ) Transaction Mgmt Clinical Content Clinical Content Record Locator Services Patient & Provider ID Mgmt Access Control Med Summaies Lab results Scan Docs Radiology Allergies Medications

HL7 UK The future of Integration October 2006 Community or sub-network Clinical Encounter Clinical IT System Index of patients records (Document-level) Aggregate Patient Info 4-Patient data presented to Physician Sharing System Clinic Record Specialist Record Hospital Record 2-Reference to Records for Inquiry Indexing Patient Centric Documents : IHE-XDS 3-RecordsReturned Reference to records Repository of Documents

HL7 UK The future of Integration October 2006 Doc Exchange Integration Profiles Document Content and Modes of Document Exchange Doc Content Profiles (CDA R2+V3-RMIM+DICOM+PDF) Doc Sharing XDS Media Interchange XDM Pt-Pt Doc Interchange XDR LaboratoryXD*-Lab Patient Input XPHRConsentBPPCEmergencyEDR Pre Surgery PPHP Scanned Doc XDS-SD Discharge & Referrals XDS-MSImagingXDS-I

HL7 UK The future of Integration October 2006 IHE & Regional and National Projects Today Canada Infoway HITSP Interoperability Specifications Denmark (Funen) Italy (Veneto) Spain (Aragon) Austria THINC- New York NCHICA – N. Carolina Italy (Conto Corrente Salute) MA-Share – MA IHIE – IN Mendicino - CA France DMP UK CfH Radiology

HL7 UK The future of Integration October 2006 Summary Interoperability for national influences local strategies… internet vs. intranet Modular approach allows incremental build-out of digital communities IHE Showcases are demo’ing profiles that will be used to build regional/national nets. Today… Count on GE for interoperability leadership Tomorrow… Count on GE to enable personalized health information exchange

HL7 UK The future of Integration October 2006