Health Information Exchange One size does not fit all. Dr Peter MacIsaac, Secretary IHE Australia, eHealth Consultant – Hewlett Packard Enterprise Services

18/07/ Blair Butterfield – eHealth Initiative

Australian PC-EHR concept 18/07/2011 3

Australian PC-EHR concept 18/07/2011 4

Health Information Exchange -HIE Health information exchange (HIE) is the transmission of healthcare-related data among facilities, health information organizations (HIO) and government agencies according to national standards. (US Office National Coordinator) 18/07/2011 5

Health Information Exchange Health information exchange (HIE) is the transmission of healthcare-related data among facilities, health information organizations (HIO) and government agencies according to national standards. (US Office National Coordinator) 18/07/ This is a very broad and inclusive definition

Types of HIE Messaging Data Synchronisation Data aggregation Portals Common health record Shared healthcare record  Centralised  Federated 18/07/ There was the PAS then came: RadiologyLabED Operating theatre… GP systems…..

One Size does not fit all 18/07/2011 8

Types of HIE Messaging  Point to point  Essentially two models Application to application (point to point) Application to application (point to point) Using a messaging intermediary or service Using a messaging intermediary or service Messaging transport  HL7, DICOM, Webservices, File Transfer etc. Messaging payloads  Data synchronisation eg. Patient identity/ADT  Information delivery e.g. reports, discharge summary  Electronic test ordering  Electronic transfer of prescriptions 18/07/2011 9

Types of HIE Application synchronisation or linkage across multiple sites  Shared applications across sites  Same software e.g. GP software running in different locations or mobile and home-base  Same software running in different organisations  Issues of data compatibility due to local build or customisation 18/07/

Types of HIE Access to common data – data aggregation  Central operational data store for health transactions from multiple applications Use for point of care – record aggregation or single patient view Use for point of care – record aggregation or single patient view Management dashboards Management dashboards  Central data warehouse used for reporting/analytics/research  Many organisations have multiple duplicated data stores 18/07/

Types of HIE Portals  External access point to another system  Does not required pre-existing clinical information systems – may use web browser  Patient, staff or external healthcare providers  May access single organisations EMR  May access a composite record drawn from many applications (single or multiple organisations)  May access third party systems e.g. health insurance, Medicare. 18/07/

Types of HIE Share healthcare records  Support information sharing as patients move through healthcare system  Support consumer engagement with their healthcare Models  Centralisation  Federation – index and retrieve 18/07/

Types of HIE Common electronic health records  Usually Internet delivered  Used by all participants  Specialist care record, care planning or coordinated care  Access to consolidated view of patient/client  Usually secondary to main records system 18/07/

Type of HIE Centralised Shared Healthcare Record  Record or summary data sent from source to a centralised common EHR  e.g. UK NHS Spine  e.g. Canada HealthInfoway  Australia’s HealthConnect Mark 1 – /07/

One size does not fit all Index and retrieve  Within or between organisations  Information is placed in a secure accessible repository or specific secure access systems used to access primary data May be a copy (static data) May be a copy (static data) May be a link to extract information or report (dynamic data) May be a link to extract information or report (dynamic data)  Basic description of content (metadata) stored in a common index – no or limited patient data 18/07/

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Important characteristics of HIE Cross organisation communication Patient consent and privacy Multivendor systems Focus on single patient view over time: aggregation and longitudinal E.H.R Use of a common architecture  Standards approach  Scalable – local to national  Extensible in function 18/07/

Growth in al models of HIE - USA 18/07/ KLAS Enterprises 2011

IHE based HIEs 18/07/ Where in the world is XDS? Where in the world is XDS?

Customer Successes

A private, not for profit, 626 licensed bed, academic medical center emphasizing community based care. Boston HealthNet 1995, includes BMC, Boston Univ School of Medicine, 15 Community health centers Boston HealthNet 1995, includes BMC, Boston Univ School of Medicine, 15 Community health centers Community Information Exchange (CIE) focus on sharing medications, problems, allergies, and lab results Community Information Exchange (CIE) focus on sharing medications, problems, allergies, and lab results Access directly from physician’s EMR Access directly from physician’s EMR eReferral portal utilizes the CIE base infrastructure eReferral portal utilizes the CIE base infrastructure Supports the IHE framework Supports the IHE framework HIE Snapshot GE/IHE – U.S. Addressing critical needs across Vermont Medication history to clinicians in the ER Medication history to clinicians in the ER Chronic disease management - patient data from EMRs to data center Chronic disease management - patient data from EMRs to data center Lab results electronically delivered to physician EMRs Lab results electronically delivered to physician EMRs Supports the IHE framework Supports the IHE framework Connecting physicians and healthcare professionals in a 31-county region 13 member organizations 13 member organizations Data from 8 hospitals and 31 clinics Data from 8 hospitals and 31 clinics Used in 3 emergency departments and 3 primary care clinics Used in 3 emergency departments and 3 primary care clinics 2.6 million patient records 2.6 million patient records 345,000 patient authorizations 345,000 patient authorizations Supports the IHE framework Supports the IHE framework

23 USA (Philapdelphia Region) Philadelphia Health Info Exchange in service since Focused on images and reports sharing. 5 Hospitals + Imaging Center + Public Health  The Hospital of the University of Pennsylvania  Thomas Jefferson University Hospital  Children’s Hospital of Philadelphia  Presbyterian Medical Center  Pennsylvania Hospital  UPHS Community Radiology  Philadelphia Department of Public Health Migration to XDS, ATNA, PIX and XDS-I completed in Demonstrated live at RSNA-Chicago Nov /07/2011

24 Diagnostic Imaging Exchange

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27 Italy (Genoa Region) 18/07/2011

28 Italy (Genoa Region) In service since January Hospitals and 500 physician offices. EMRs import and export documents from their local records. All vendor products required to pass IHE-Europe connectathon in April Patients chose to join through one of their care provider Infrastructure includes:  XDS Registry  XDS Repository shared at the regional level  PIX for patient Id linking  Doc content is CDA with PDF content. Plan in place to move to CDA rel 2 with structured data. IHE (XD*-Lab) CDA Lab primary candidate. 18/07/2011

29 Austria (Lower Austria and National) Lower Austria Region (around Vienna) Deployed in Operational. 1.5 Million patients on-line. 11 hospitals connected. Use IHE profiles: XDS, PIX, XDS-SD, ATNA, XUA, BPPC. National project launched in 2007 (ELGA). Given the success to deploy the first region is about one year. Roll-out includes:  Ministry backing of IHE conformance (IHE-Eu Connectathon)  Extending to Ambulatory Physicians in 2008  Step-wise introduction of structured and coded content with HL7 CDA based IHE Content Profiles. Lower Austria 18/07/2011

Support for PC-EHR Community 18/07/ Link to site Link to sitehttp://ihe-australia.wikispaces.com/PCEHR

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32 Reference and Resources US State Health Information Exchange Cooperative Agreement Program US State Health Information Exchange Cooperative Agreement Program Where in the world is XDS? Where in the world is XDS? -w -w 18/07/2011

Useful Links in-world-is-xds.html -in-world-is-xds.html 18/07/2011