HIE Around the Worls Chris Lindop GE Healthcare Radiology Committee Co-chair IHE Australia Board EHRs and IHE Overview

XDS in Europe

IHE operations in Europe EU projects and IHE Notable EHR projects in Europe using IHE 3

Coordination and harmonisation of european national initiatives IHE national initiatives  Aimed at deployment of IHE at national level  Active national initiatives Austria, Denmark, Finland, France, Germany, Israel, Italy, Norway, Spain, Sweden, The Netherlands, United Kingdom  New initiatives Switzerland and Turkey will kick off in

Organisation and management of IHE CAT  CAT 2009 held in Vienna, Austria 73 companies registered 230 engineers participated 94 systems, 27 of which registered for XDS XDS and XCA witnessed the most increase in systems  CAT 2010 will be held in Bordeaux, France 10th anniversary connect-a-thon Venue will be the Cité Mondiale  CAT 2011 will be held in Pisa, Italy 5

Healthcare systems are under pressure  Citizens’ expectations for high-quality care  Demographic changes  Increased prevalence of chronic diseases  Shortage of Health Professionals  Patient safety issues  Rising healthcare costs, medical progress 6

Changes are needed in the way  healthcare is delivered  medical knowledge is managed and transferred in clinical practice EC vision for health  ICT to support the paradigm shift From “curative care ‟ to “preventive care ‟, from “hospital-based ‟ to “patient-centred ‟ throughout Europe  by Using ICT to enable collaborative and personalised care Supporting dynamic healthcare systems Aiming at sustainability of healthcare systems Interoperability 7

IHE Europe is involved in eHealth projects  epSOS  Calliope  HITCH  eHealth Interop Mandate 403  Smart PHS Smart Personal Health Systems IHE Europe is contributing to the development of eHealth in Europe 8

epSOS stands for  European Patients Smart Open Services Europe-wide project  27 beneficiaries representing twelve EU-member states IHE Ministry of Health –Germany, Denmark, Austria, The Netherlands, Spain, Sweden, UK, France Open eHealth initiative  large scale European pilot of patient summary and electronic prescription  9

The goal  to develop a practical eHealth framework  to develop ICT infrastructure Enabling  secure access to patient health information between different european healthcare systems basic patient summaries ePrescriptions 10

National entitities test services in pilot applications, which interconnect national solutions  based on advanced and distinct use cases and associated infrastructural components  Aims at delivering both a methodological process and durable implementations building blocks These building blocks will form the basis for a longer term, pan-european approach to develop interoperable service solutions 11

Calliope stands for  CALL for interOPErability Calliope is  a network of collaborating organisations  mandated with the planning and implementation of eHealth Calliope comprises  28 founding members including 17 organisations representing national governments and eHealth competence centres 11 EU-level stakeholder organisations of health professionals, patients, health insurers and industry 12

Creating an open forum  to support the implementation of interoperable eHealth infrastructures and services across Europe  to build a unique cross-stakeholder platform aspiring to governing principles supported by a communication infrastructure and knowledge management tools  to review and advance the EC interoperability recommendation  to add value to eHealth standardisation initiatives  to propose a European roadmap for eHealth interoperability 13

Mandate 403 to provide a consistent set of standards to address the needs of the rapidly-evolving field of eHealth for the benefit of future healthcare provision three European Standards Organisations (ESOs), CEN, CENELEC and ETSI, accepted this mandate from the European Commission requires active collaboration with COCIR, EHTEL, ISO/TC 215, IHE, HL7, Eurorec, IHTSDO, GS1, IEEE, DICOM 14

Mandate 403 requirements driven and collaborative primary goal is not to develop new standards  populate use cases with existing international standards when possible  collaborate with standards fora, consortia and SDOs  Reuse and encourage reuse 15

IHE Europe is also active in sustaining deployment through IHE national initiatives  stimulate regional projects at national level  provide guidance if needed  support communication if needed success stories 16

EHR Experiences - UK PACS integration project in Wales  the pilot phase involves 7 PACS in 4 organisations around Cardiff  phase 2 will include 10 more PACS in another 4 organisations this includes PACS from 6 different vendors.  the project will be providing integration WITHIN organisations (different PACS vendors) between organisations  project will be based on XDS/XDS-I 17

EHR Experiences - NL Friesland Regional Cardiogy Network  Clinical setting Sharing cardiology-related data for transfer of patients (cardiac surgery)  Data shared Cardiac images (multi-frame runs), ECGs, patient status  Setting 5 hospitals – one central site  Benefits achieved Full availability of clinical data through XDS browser Import of data to local viewing environment 18

EHR Experiences - NL Connectivity network for breast cancer screening  Clinical setting Sharing breast cancer screening results to hospitals forclinical follow-up  Data shared Mammography images, reports  Setting One central screening PACS (1m exams/year) 4% referral / retrieval rate 100 Dutch hospitals  Benefits achieved Full availability of clinical data through XDS browser Import of data to local viewing environment 19

EHR Experiences - IT Health Optimum Veneto  telemedicine project for different specialties  phase 1 duration –18 months May 2004 to January 2006 purpose –market validation of organizational models based on telemedicine services actors involved –11 healthcare Providers in Veneto Region –3 European Member States: Italy (Veneto Region), Spain(Gobierno de Aragona), Denmark (County of Funen) 20

EHR Experiences - IT Health Optimum Veneto  phase 2 duration –24 months June 2007 to May 2009 purpose –deploying organizational models based on telemedicine services actors involved –23 healthcare Providers in Veneto Region –5 European Member States: Italy, Spain, Denmark, Sweden 21

EHR Experiences - IT Health Optimum Veneto  Services Oral anti-coagulant therapy Stroke management Neuro-surgical tele-counseling –36 peripheral hospitals without neurosurgery/neuroradiology units are linked to 7 neurosurgical centres Tele-laboratory –80 peripheral sites are going to be linked to hospital LIS systems 22

EHR Experiences - IT Health Optimum Veneto  Mixing XDS and non-XDS solutions  XDS architecture adopted Treviso, Belluno, Venezia, Verona, Padova  Non-XDS architecture Rovigo, Vicenza  Central governance systems managing, including remote monitoring, all equipment involved in the interoperability platform providing the semantic interoperability allowing to perform the statistical analysis of data and proper reporting of services 23

EHR Experiences - IT Health Optimum Veneto  interoperability guidelines adhering to IHE XDS (Cross-Enterprise Document Sharing), XDS-I (XDS for Imaging) and NAV (Notification of Document Availability) profiles IHE XCA (Cross-Community Access) profile IHE PCC (Patient Care Coordination) profile authoritative ICT standards: ebXML, CDA2, DICOM, HL7, PKCS#7, etc… 24

25 Thank You for Your Attention Lapo Bertini

XDS in Japan

Network Structure of RHIE System by XDS for Stroke Care in Nagoya

Nagoya XDS project  Backed by Ministries  4 Emergency hospitals, 3 Rehab facilities(now)  Profiles and standards  Integrating XDS with PIX, PDQ and ATNA  Enhancing XUA, NAV with access control based on XACML  Excerpting XDS metadata from CDA header part  Based on ebXML ebRIM3.0/ebRS3.0 (supporting XDS storedQuery), while XDS.a was specified on ebXML2.1. (Being ahead of XDS.b.)

Updates in Japan 2009 Regional Health Network Subsidy  10 Billion JPY (100 M$) x 10  3 Billion JPY (30 M$) x 30  XDS, PIX, PDQ, ATNA,,, Online Reimbursement Claim  Mandated even to clinics  IPv6+IKE  Can be used for other destination

XDS in North America

IHE and Canada Health Infoway CHI has worked on development of IHE profiles, eg, XDS and XDS-I CHI contractors have provided testing oversight at Connectathons CHI contributed to development of testing tools CHI has specified IHE profiles as “Pan- Canadian Standards” Numerous implementation projects using IHE profiles

32 Canada Health Infoway: Standards Used in Diagnostic Imaging No single standard addresses DI Requirements Internet Standards XML, PDF, JPEG, JPIP, MIME, HTTP, FTP, UTF-8, … Electronic Business Standards ebXML, Web Services Healthcare Content, Messaging, Terminology HL7/CDA, DICOM SNOMED CT, LOINC, ICD-10CA, CCI EHRS Blueprint v2 Privacy & Security Privacy Legislation IHE Integration Profiles Rad: XDS-I, SWF, PIR, CPI, PGP, KIN, PDI IS: XDS, PIX, PDQ, ATNA, EUA, XUA, BPPC, CT

33 DI Data Sharing in the EHR Environment HL7DICOM XDSTransactions: INFOSTRUCTURE POS Registries Data & Services EHR Data & Services Business Rules EHR Index Message Structures Terminology Services Security Mgmt Data Privacy DataTerminology Longitudinal Record Services HIAL Client Registry Provider Registry Location Registry Communication Bus Common Services Shared Health Record DI Repository EHR Viewer Physician/ Provider RISPACSEMR/CPOE CTUS DI ClinicsHospitals RISPACS HIS CTMRIUS PACS DI Studies Presentation states Measurements RIS Orders Reports Imaging Modalities DI Studies Presentation states XDS Doc Registry XDS Document Repository DI Repository XDS Document Registry Registry entries Metadata XDS Document / DI Repository Manifests Document Sets Images Reports Relevant images Presentation states Measurements Other evidence docs

IHE: Supporting HHS/ONC Goals Healthcare Information Technology Standards Panel (HITSP) Nationwide Health Information Network Architecture Projects (NHIN) Health Information Security and Privacy Collaboration (HISPC) Certification Commission for Healthcare Information Technology (CCHIT) American Health Information Community  National eHealth Collaborative Standards harmonization and adoption Interoperability testing Security and privacy standards Specifications for standards- based EHR functionality to support RHIOs

HITSP Recommended Standards Biosurveillance  ICD-9CM – International Classification of Diseases v. 9 Clinical Modifications  ICD-10 CM – Diagnoses and Procedures  IHE-XDS – Integrating the Healthcare Enterprise (IHE) Cross-Enterprise Document Sharing  IHE-XDS Lab – IHE Laboratory Report Document Sharing  IHE-RFD – IHE Retrieve Form for Data Capture  IHE-PIX – IHE Patient Identification Cross-Referencing  IHE-RAD – XDS-I – IHE Cross-Enterprise Sharing of Images  IHE-NAV – IHE Notification of Document Availability  IHE-XDS-MS – IHE Medical Summary Document Sharing  ISO/TC215 -DTS Health Informatics Pseudonymisation  LOINC – Logical Observation Identifiers Names and Codes  NCCLS – National Committee for Clinical Laboratory Standards  RxNorm – National Library of Medicine RxNorm

HITSP Recommended Standards Consumer Empowerment  IHE-XDS – Integrating the Healthcare Enterprise (IHE) Cross-Enterprise Document Sharing  IHE-PIX – IHE Patient Identification Cross-Referencing  IHE-PDQ – IHE Patient Demographics Query  Health Level Seven (HL7) CDA R2 – HL7 Clinical Document Architecture Release 2  HL7 CCD – HL7 Continuity of Care Document with mappings from ASTM E Continuity of Care Record (CCR), X12 N 270/271 and NCPDP Script 8.1.  HL7 EHR Systems Functional Model Draft Standard for Trial Use (DSTU)  Logical Observation Identifiers Names and Codes (LOINC)

Electronic Health Record Exchange  IHE-XDS Lab – IHE Laboratory Report Document Sharing  IHE-PIX – IHE Patient Identification Cross-Referencing  IHE-PDQ – IHE Patient Demographics Query  Health Level Seven (HL7) CDA R2 – HL7 Clinical Document Architecture Release 2  HL7 v. 2.5  Clinical Laboratory Improvement Amendments (CLIA)  Logical Observation Identifiers Names and Codes (LOINC)  Health Insurance Portability and Accountability Act (HIPAA)  Systematized Nomenclature of Medicine – Clinical Terms (SNOMED – CT)  Unified Code for Units of Measure (UCUM) HITSP Recommended Standards IHE contributes to HITSP’s success

HITSP and Federal Procurement Former HHS Secretary Leavitt “recognized” the work product of HITSP, meaning that it will be used in for federal purchasing specifications for all affected health IT systems as of Jan. 1, 2009.

Testing – HITSP, CCHIT and NHIN HITSP interoperability pilot testing performed at IHE Connectathon CCHIT, NIST and IHE have agreement to collaborate on testing tools NIST and IHE collaborated to provide testing services for first NHIN testing event in August 2008