November 17, Integrating the Healthcare Enterprise An Interoperability Process for Enabling the National Agenda Joyce Sensmeier MS, RN, BC, CPHIMS Director of Professional Services Healthcare Information and Management Systems Society HIMSS

November 17, State of the Union Address “By computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care.” President George W. Bush January 20, 2004

November 17, And the beat goes on….. “ …. most Americans will have electronic health records within the next 10 years” President George W. Bush April 26, 2004 In a public address to the American Association of Community Colleges, the President outlined a plan whose goal is to assure better delivery of healthcare in the United States.

November 17, Framework for Strategic Action President Bush’s April 27th executive order called for the creation of the Office of the National Coordinator of Health Information Technology (ONCHIT). A report was required within 90 days of office creation. The Framework for Strategic Action was released by Department of Health and Human Services Secretary Tommy Thompson and newly appointed National Coordinator of Health Information Technology, David Brailer, MD at the NHII Summit in July, 2004.

November 17, Framework for Strategic Action Report includes:  12 strategies to achieve four major goals  Information from DoD, VA, and OPM on how their areas can advance the adoption of HIT  A catalog of identifiable federal HIT programs 

November 17, Four Major Goals 1. Inform Clinical Practice  Incentivize EHR adoption  Reduce risk of EHR investment  Promote EHR diffusion in rural & underserved 2. Interconnect Clinicians  Foster regional collaborations  Develop a national health information network  Coordinate federal health information systems

November 17, Four Major Goals 3. Personalize Care  Encourage use of PHRs  Enhance informed consumer choice  Promote use of telehealth systems 4. Improve Population Health  Unify public health surveillance architectures  Streamline quality and health status monitoring  Accelerate discovery and dissemination

November 17, Impact on Healthcare IT Technology trends can no longer develop in a void Systems must connect with each other  Organizational  Local  National  Global Public/Private partnerships needed

November 17, Development and Adoption of a National Health Information Network Request for Information – Interoperability  Announced in Federal Register November 15 th  HHS is seeking input on how widespread interoperability of health information technologies and health information exchange can be achieved  Encouraging collaboration and unified response  Opportunity for members to contribute  See Top Line report at and respond to surveywww.himss.org

November 17, What is IHE - Integrating the Healthcare Enterprise? A joint initiative to improve systems integration and interoperability  Process for coordinated adoption of standards  Clinicians/IT staff define needs  Vendors and IT Professionals develop solutions  Technical Framework  Professional societies supervise documentation, testing and demonstration/promotion

November 17, Understanding the IHE Initiative IHE has a clear focus IHE is a domain-based initiative IHE creates synergies for interoperability testing across domains IHE addresses the standards adoption process IHE is both regional and multi-national IHE is both user lead and vendor driven

November 17, Goals of IHE Speed up the rate and quality of integration in healthcare environments Foster communication among vendors and care providers Prove that integration is attainable based on standards Improve the efficiency and effectiveness of clinical practice Improve interoperability among care domains and build foundation for the EHR Provide integration solutions used within and across healthcare enterprises

November 17, IHE: Domain-based for a stepwise approach Cardiology Labora- tory Pharmacy,….. Radiology Patient Identifier Linkage, Registries, Security Electronic Health Record Other (e.g. Access Control, eHealthWorkflows) Patient Management Order Management

November 17, IHE 2004 – Four Active Domains 4 Technical Frameworks with 31 Integration Profiles Testing at yearly Connectathons in three continents Demonstrations at major conferences world-wide Provider-Vendor cooperation to accelerate standards adoption

November 17, A Proven Standards Adoption Process IHE Integration Profiles B IHE Integration Profile A Easy to Integrate Products IHE Connect-a-thon Product With IHE IHE Demonstration User Site RFP Standards IHE Technical Framework Product IHE Integration Statement IHE Integration Profiles at the heart of IHE :  Detailed selection of standards and options each solving a specific integration problem  A growing set of effective provider/vendor agreed solutions  Vendors can implement with ROI  Providers can deploy with stability IHE Connect-a-thon Results

November 17, IHE Technical Frameworks Detailed standards implementation guides – Cardiology – IT Infrastructure – Lab – Radiology

November 17, IHE Connectathon Open invitation to vendor community Advance testing tools (MESA) Testing organized and supervised by project management team Thousands of cross-vendor tests performed Results recorded and published

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November 17, Integration Statements

November 17, IHE Process Users identify desired functionality that require coordination and communication among multiple systems  E.g., departmental workflow, single sign-on, sharing of documents Find and document standards-based transactions among systems to achieve desired functionality  Apply necessary constraints to eliminate useless wiggle room Provide process and tools to encourage vendors to implement  MESA software test tools + Connect-a-thon interoperability testing event Provide tools and education to help users acquire and integrate systems using these solutions  Connect-a-thon results and public demonstrations  Integration statements

November 17, What IHE is NOT! A standards development organization  Uses established standards (HL7, DICOM, CCR, others) to address specific clinical needs  Activity complementary to SDOs, formal relationship with HL7, DICOM, NCCLS, etc. Simply a demonstration project  Demos only one means to the end—adoption  Backed up by documentation, tools, testing, and publication of information

November 17, IHE Organizational Structure Multi-Domain & Multi-National Participants contribute Global Development: Radiology, IT Infrastructure, Cardiology, Lab, etc. Delegates IHE Europe IHE North America IHE Asia/Oceania Regional & National Deployment supervises reports IHE (International) Strategic Development Committee Sponsors Co-Chairs Global Interoperability IHE Domain-related Planning Committee and Technical Committee National Extensions

November 17, IHE Contributors & Participants Societies Representing Healthcare Segments  RSNA, HIMSS, ACC, ACCE, AACC, Other Professional Societies…  Any Healthcare Stakeholder Organization Users  Clinicians, Medical Staff, Administrators, CIOs, … Information Systems & Equipment (e.g. imaging) Vendors Consultants In addition, active liaison with Standards Development Organizations (SDOs)  HL7, DICOM, NCCLS, ASTM, ISO, others

November 17, Participating and Contributing Vendors (America) Agfa HealthCare Allscripts Algotec Systems, Ltd. Camtronics Canon Medical Systems CapMed Carefx Cedara Software Corp. Cerner Corporation CSIST Dictaphone DR Systems Dynamic Imaging Eastern Informatics Eastman Kodak Company Emageon Eclipsys EPIC ETIAM Fujifilm Medical Systems GE Healthcare Healthramp Heartlab Novell Opentext Procom Philips Medical Systems RASNA Imaging Systems Sectra Sentillion Siemens Medical Solutions Softmedical Stentor, Inc StorCOMM, Inc Swissray International, Inc Tiani Medgraph AG Toshiba America Medical Sys. UltraVisual Medical Systems Vital Images, Inc. Voxar Limited WebMD XIMIS Hitachi Medical Corporation Hologic, Inc IDX Systems Corporation IMCO Technologies InSiteOne INFINITT InterSystems Konica Minolta Marotech, Inc. McKesson Information Soln. Medcon MedCommons Medical Manager Health Sys. Mediface Co., Ltd. MediNotes Merge eFilm MidMark Misys Mortara NextGen In yellow, companies with IHE Committees Chairs (Summer 2004)

November 17, Participating and Contributing Vendors (Europe) AGFA Healthcare Medical Solutions Algotec ARES SA aycan Digitalsysteme ConVis DEDALUS Dianoema Eastman Kodak Company Ebit Sanita EDL ELFIN s.r.l. Engineering Sanità Enti Locali ESAOTE ETIAM Ferrania Fujifilm GE Healthcare GMD GIE Convergence-Profils Rogan-Delft Sago spa Sectra Imtec AB Siemens Medical Solutions Soluzioni Informatiche srl Stentor Inc. Swissray Medical AG Symphonie On Line Synapsis TELEMIS S.A. TIANI MEDGRAPH AG TOREX GAP Medical Toshiba Medical Systems TSI groupe europMedica VEPRO AG VISUS Technology Transfer WAID XR PARTNER GWI Research IASI Srl IdeoPass Image Device-Cerner Company INFINITT INOVIT McKesson MED2RAD MEDASYS SA Medavis Medigration GmbH MEDIMON Ltd. MEDOS AG Merge eFilm METAFORA Konica Minolta Europe Omnilab Philips Medical Systems Rasna Imaging Systems RAYPAX INC. In yellow, companies with IHE Committees Chairs (Summer 2004)

November 17, Participating and Contributing Vendors (Asia) Japan AGFA Gevaert Japan EBM Japan INFINITT Japan A&T Canon Goodman Climb Medical Systems Konica Minolta MG Shimadzu SONY Toshiba Medical Systems Toyo Technica Nihon Kohden Olympus NEC Pioneer (Marotech) Hitachi Hitachi Medico Fujitsu Fuji Film Medical Yokogawa Taiwan INFINITT Shing Shian INQ GEN TEP Tah Ya Korea AGFA Korea GE Healthcare Korea INFINITT LG CNS Marotech, Inc. Medical Standard Peoplenet Communications Samsung SDS

November 17, Benefits to IHE Participants Clinicians  Improved workflow  Information when and where needed  Fewer opportunities for errors  Fewer tedious tasks/repeated work  Improved report turn around time Administrators  Improved efficiency  Best of breed opportunities  Decreased cost and complexity of interface deployment and management  Improved accuracy of charge processing/reimbursement

November 17, Benefits to IHE Participants Health Plans  Improved accuracy, completeness of billing/claims  Improved turn around time for claims processing Vendors  Align product interoperability with industry consensus  Decreased cost and complexity of interface installation and management  Focus competition on functionality/service space not information transport space SDOs  Rapid feedback to adjust standards to real-world  Establishment of critical mass and widespread adoption Plus, IHE meets fixed deadlines

November 17, IHE Organizational Structure IHE Europe IHE North America France USACanada IHE Asia-Oceania Japan KoreaTaiwan NetherlandsSpainSweden UKItalyGermany Norway Regional Deployment Radiology Planning Committee Radiology Technical Committee IT Infrastructure Planning Committee IT Infrastructure Technical Committee Pharmacy Exploratory Sub-Committee Global Development Cardiology Planning Committee Cardiology Technical Committee Laboratory Planning and Technical Committee IHE Strategic Development Committee ACC ITAC/CHITTA HIMSS CHI RSNA CAR JAHIS JIRA JRS METI-MLHW MEDIS-DC JAMI GMSIH SFR SFIL SIRM BIR EuroRec COCIR EAR-ECR DRG ESC Professional Societies / Sponsors Contributing and participating Vendors

November 17, Organization of the IHE Initiative IHE distributes its operations between a regional/national level and an international level IHE operates on overlapping yearly cycle IHE leverages dependencies and complementary interests between stakeholders IHE is an open and flexible organization A novel approach to meet these challenges

November 17, IHE Domains Milestones – 20 month cycle Development and Deployment Proposed Supplement Scope Approved Supplement Scope Public Comment Intgr-profile Sponsors announce Connectathon/Demos with set of Implementation Profiles Final Intgr-profile Trial Implementation Intgr-profile Connectathon/Demo Vendor Participant Registered Vendor Participant passed Connectathon Demo & Education Material Vendors release products with IHE Integration Statements ---

November 17, Continuity & integrity of patient information Improved patient safety and access to data Clinical workflow optimization Foster communication among diverse medical information systems Avoid repeating tasks Eliminate data redundancy Healthcare Needs Addressed by the IHE Initiative Improving the Patient Care Process

November 17, HIMSS 2005 Interoperability Showcase HIMSS leverages its sponsorship of IHE to demonstrate practical interoperability in two large Showcase Exhibits: Cross-enterprise sharing of health information in the acute care (18 vendors) and ambulatory (14 vendors). HIMSS Showcase exhibits linked with vendor booths (10 vendors) show-wide and the Health Level Seven Demo. Show-wide interactive environment demonstrating attendees “patient” record in a “HIMSS RHIO”. Uses IHE Cross- enterprise Document Sharing:  Around a central document registry  Distributed document repositories  17 EHR systems that publish/share documents (CCR, CDA, HL7-lab, PDF)

November 17, HIMSS 2005 Interoperability Showcase A national vision of a connected and interoperable healthcare infrastructure The Interoperability and Ambulatory IT Showcase exhibit areas will feature cross-enterprise sharing of health information in the acute care and ambulatory environment within the framework of a Regional Health Information Organization (RHIO) These hands-on exhibits linked with vendor booths will create a highly interactive environment to demonstrate practical interoperability featuring standards-based connectivity across the health care enterprises from acute care to ambulatory care IT. Feb , Interoperability Showcases: 2005 Annual HIMSS Conference & Exhibition Dallas, TX One of the most significant healthcare industry efforts of the 21 st century. HIMSS has taken a leadership role in making this vision a reality.

November 17, “This showcase allows multiple organizations to demonstrate cross- vendor integration and interoperability and is a prime example of the type of private-sector collaboration we are seeking to move our agenda forward. HIMSS has taken a leadership role in demonstrating the application of cross-enterprise interoperability. ” Dr. David Brailer, National Coordinator of HIT

November 17, HIMSS 2005 Interoperability Showcases Cross-enterprise Showcase  4,000 square feet on exhibit floor – located near attendee registration  Focus on cross-enterprise interoperability of an electronic health record and document sharing Ambulatory Care Showcase  4,000 square feet on exhibit floor - adjacent to Cross-enterprise Showcase  Focus on interoperability of IT applications in ambulatory care in a variety of settings

November 17, HIMSS 2005 Interoperability Showcases Ambulatory Showcase Booth Vendor Booth Cross-enterprise doc sharing (Choice of XDS,PWP,RID,PDQ) Interoperability Showcase Booth cardiology laboratory radiology IT Infrastructure laboratory radiology Pharma ? Three participation opportunities for vendors Vendors chose among 15 existing integration profiles. May participate from own vendor booth in addition to Showcase booths.

November 17, Cross-enterprise Showcase Technical demonstration  Featuring the IHE framework enabling standards-based health information exchange within and across multiple healthcare enterprises, available in products today Clinical scenarios  Focusing on clinician access and document sharing within the acute care environment and across multiple settings  Includes the Continuity of Care Record (CCR), radiology images, cardiology reports, laboratory results, etc. Connectivity with  Ambulatory Care Showcase  Health Level Seven (HL7) Demonstration  Participating vendors booths  Show-wide attendee registration and access at ‘Surf the Web’ kiosks

November 17, Cross-enterprise Showcase Interoperability Theater  Featuring learning sessions on: Outcomes of national demonstrations and industry research projects Regional health information exchange initiatives Federal agency interoperability initiatives Standards development initiatives and related activities Issues, products and insights from industry leaders

November 17, Cross-enterprise Showcase Visionary demonstrations of the future in healthcare – Organizational participants  Featuring initiatives, collaborations, and standards development activities in support of interoperability Center for Information Technology and Leadership (CITL) Continuity of Care Record (CCR) Department of Defense (DoD) – Data sharing project ISO TC 215 Health Informatics Liberty Alliance MEDecision Medical Device Interoperability – IEEE - ACCE Oregon Health Information Infrastructure Santa Barbara County Health Data Exchange Veterans Health Administration – VISTA Imaging University of Washington Personal Health Record Project

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November 17, Ambulatory Care Showcase Demonstration of interoperability across a variety of settings including a free-standing diagnostic enter, a large clinic, a small practice and the patient’s home Use cases will guide the attendee through the settings in the normal course of care Theater area for related presentations  Invited speakers and Leadership level only Product placement near demonstration

November 17, IHE, the effective bridge between information exchange standards and their practical use in healthcare

November 17, Opportunities for Participation As a User or Vendor Contributor Become a member of relevant Domains Planning or Technical Committees or HIMSS IHE SIG (Special Interest Group) Become a member of relevant Regional/National Committees Attend the HIMSS 2005 Interoperability Showcases As a Vendor Participant Respond to Public Comments of Domain Supplements Attend Yearly in September Educational/Workshops Participate in Connect-a-thons and Demonstrations As a User/Consultant Participant Respond to Public Comments of Domain Supplements Attend Yearly in September Educational/Workshops Attend Demonstrations and include IHE Integration Profiles in your RFPs and Integration Projects.

November 17, IHE expanding, more info... IHE Radiology  Chris Carr IHE Connectathon for IT January 17-21, IHE IT Infrastructure  Joyce Sensmeier HIMSS Interoperability Demonstrations February , IHE Laboratory  www. himss.org/ihe Karima Bourquard Framework in Public Comment, feedback due Nov 15 th IHE Connectathon for Lab March 2005www. himss.org/ihe IHE Cardiology  IHE Connectathon for Cardiology January 2005 First Demo ACC March 2005http://

November 17, More information…. IHE Web sites: Technical Frameworks: ITI V1.0, RAD V5.5, LAB V1.0 Technical Framework Supplements - Trial Implementation May 2004: Radiology August 2004: Cardiology, IT Infrastructure 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