1. Senior Director, Integrating the Healthcare Enterprise
Why IHE: The value proposition for implementing IHE Building Interoperability from the System Level to the National Level
Didi Davis, HIMSS
Senior Director, Integrating the Healthcare Enterprise

2. Connecting the Care Continuum: Interoperable Electronic Health Records

3. What is “Interoperability” Anyway?
Interoperability generally refers to "the ability of two or more systems or components to exchange information and to use the information that has been exchanged….”
“In healthcare, the ability ‘to use the information that has been exchanged’ means not only that healthcare systems must be able to communicate with one another, but also that they must employ shared terminology and definitions.”
Source: HL7 Coming to Terms Whitepaper

4. Interoperability Challenges
Lack of standards for sharing patient data
Lack of common technology infrastructures
Lack of a plan to move from “provider centric” to “patient centric” exchange of information
You really do know more about interoperability than you think. Let’s look at a new analogy: The use of phones.
I buy a phone – it’s called Mega Phone from company A. It has many features, mute, speaker, conference call etc.
Now I want to call my great grandmother from that phone. She lives in rural area, but bought a basic phone “Do the job Phone” that is rotary dial, doesn’t have any of my features and to boot was made by a different company, and she uses a different phone carrier.
Despite all these differences – I can talk with my gr. Grandmother. Why? Because each phone company builds in the connections to technically connect to a standard “plug”. I didn’t have to ask them to – its part of the phone. Then I rely on a standards based network, that identifies the location of who I’m trying to contact and based on their assignment of numbers I can reach my grandmother. Now the phone provider do provide additional services, like the routing, call services I may want or need.
Interoperability for Healthcare is similar – imagine if you will that we replace Mega phone with Health IT System A and the do the job with Health IT system B How would that work?
Patient-centered Electronic Health Record
Paper-based Disconnected Records

5. Why is Interoperability Important?
Patient Safety
Health Maintenance
Quality of Care
Cost Reduction
Transparency
Operational Efficiency

6. Cost Reduction?

7. Today’s Agenda What is IHE? How Does it Work? Who is Involved?
Who Benefits from IHE?
What Has IHE Done?
How Can We Participate?
What Value Does IHE Provide?
Does IHE Help Meet Current Market Needs?
IHE is a way to obtain the benefits of standards
It has had a remarkable track record
It has produced more value than just implementations
IHE has proven useful and, in some cases, drives market needs.
... And you can be part of it.

8. Standards: Necessary…Not Sufficient
Standards are
Foundational - to interoperability and communications
Broad - varying interpretations and implementations
Narrow - may not consider relationships between standards domains
Plentiful - often redundant or disjointed
Focused - standards implementation guides typically focus on a single standard
IHE provides a standard process for implementing multiple standards

9. What is Necessary for Harmonization?
Major improvements needed are:
Reduction/elimination of optionality in current standards
Reduction/elimination of need for point-to-point
Improved consistency of information/terminologies
Improved security and privacy of information exchange
The primary method of achieving these improvements are the development of comprehensive, standardized implementation guides.

10. What is “Integrating the Healthcare Enterprise”?
A 9-year public-private initiative
Driven by end-users, IHE improves patient care by harmonizing electronic health information exchange
Enables approved standards to seamlessly pass health information among care providers on a local, regional and national level
IHE Frameworks are freely available to all
The IHE Global Standards Adoption process as approved by the International Standards Organization (ISO) as a Technical Report in August 2007
What is IHE?
Optimal patient care requires efficient access to comprehensive electronic health records (EHRs). The Integrating the Healthcare Enterprise (IHE) initiative accelerates the adoption of the information standards needed to support EHRs. More than 300 vendors have implemented and tested products based on IHE.
IHE improves patient care by harmonizing healthcare information exchange. IHE provides a common standards-based framework for seamlessly passing health information among care providers, enabling local, regional and national health information networks.
IHE is a collaborative response to healthcare IT market requirements for system integration.
Develop standards-based implementation specifications called profiles.
Useful subsets of one or more standards
Tested at Connectathons
Demonstrated at HIMSS, and RSNA
Correct known integration problems.
Intra-enterprise and multi-enterprise scope
Satisfy emerging market needs & prevent new problems.
EHR & government driven
Regional and national scope
Build trust, collegiality, effectiveness among vendors, providers, and other stakeholders.

11. How does IHE work?
Clinicians and IT professionals identify key clinical and business workflow problems
Clinicians, IT professionals, consultants, and vendors jointly solve those problems by standardizing the way existing standards are implemented in HIT products
IT professionals follow the IHE guidelines in purchasing and integrating effective systems
IHE: A forum for agreeing on how to implement standards and processes for making it happen
Example #1: IHE provides a profile for information sharing Cross-Enterprise Document Sharing. This IHE Integration Profile facilitates the registration, distribution and access across health enterprises of patient electronic health records. Cross-Enterprise Document Sharing (XDS) is focused on providing a standards-based specification for managing the sharing of documents between any healthcare enterprise, ranging from a private physician office to a clinic to an acute care in-patient facility.
In today’s paradigm of healthcare data is documented at each patient encounter whether it be in an ER, Outpatient clinic, physician’s office, or another venue and is faxed or mailed to another venue if time is taken to copy a personal physician etc.
Example #2: IHE provides a profile for HIPAA compliance called Audit Trail and Node Authentication (ATNA) – you must comply with HIPAA regulations and must have audit trails to document compliance. Clinicians and IT professionals agree on the audit trails, the workflow, etc to enable them to maintain and document HIPAA compliance.

12. Who’s involved in IHE?
Users - Clinicians, Staff, Administrators, CIOs, Gov’t agencies (e.g. NIST, VA, DoD, CDC, CMS)
Professional Societies representing 270,000 individual members:
HIMSS, RSNA, ACC, ACP, AAO, ACCE, ASTRO, etc
Standards Development Orgs (SDOs):
HL7, DICOM, ISO, CDISC, ASTM, W3C, IEEE, IETF, etc
Vendors & consultants (e.g., imaging, EHRs, cardiology, medical devices)
VHA –
400 different models of radiology instruments interfaced
Exactly the same IHE DICOM interface to Consults for ophthalmology (eye care), dentistry, endoscopy, pathology, and cardiology.
VA will not purchase a new modality unless it supports both of these capabilities.
Associations:
1997: Founded by RSNA and HIMSS
* American Academy of Ophthalmology (AAO)
* American College of Cardiology (ACC)
* American College of Physicians (ACP)
* American College of Clinical Engineering (ACCE)
* American Society for Therapeutic Radiation Oncology (ASTRO)
* GMSIH (IT France), JAHIS (IT Japan), SFIL (laboratory)
* Healthcare Information Management Systems Society (HIMSS)
Radiological Society of North America (RSNA)
Health Level 7 (HL7)
International Organization of Standardization (ISO)
Clinical Data Interchange Standards Consortium (CDISC)
And many more….
Standards Development Orgs
HL7 – Health Level 7 standards for electronic interchange of clinical, financial, and administrative information among health care oriented computer systems
DICOM – Digital Imaging and Communications in Medicine (DICOM) standard for distributing and viewing any kind of medical image regardless of the origin
ISO - International Organization for Standardization
CDISC – Clinical Data Interchange Standards Consortium
ASTM - American Society for Testing and Materials
W3C - World Wide Web Consortium
IEEE - Institute of Electrical and Electronics Engineers
IETF - Internet Engineering Task Force

13. Who benefits from IHE’s work?
Patients
Enhance care’s quality, safety, efficiency & effectiveness
Clinicians
Improve workflow & information reporting
Fewer error opportunities; Less repeated work
Vendors & Consultants
Satisfy customers’ interoperability demands
Decreased cost & complexity of installation & better ROI
SDOs
Rapid feedback to address real-world issues
Establishment of critical mass and widespread adoption
Government
Reduced costs of implementing EHR systems
Increased patient information interoperability
Government – reducing the cost of implementing healthcare systems

14. Growth in IHE Domains Over 300 vendors involved world-wide
Veterinary
Endoscopy
Pharmacy
Over 300 vendors involved world-wide
8 Technical Frameworks
64 Integration Profiles
Testing at “Connectathons” world-wide
Demonstrations at major conferences world-wide
Quality, Research and Public Health
Pathology
Patient Care Devices (3 profiles)
Patient Care Coord. (5 profiles)
Radiation Oncology (3 profiles)
Eye Care (4 profiles)
Laboratory (6 profiles)
Cardiology (7 profiles)
IT Infrastructure for Healthcare (20 profiles)
Radiology (18 profiles)
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008

15. IHE Organizational Structure IHE International Board
Regional Deployment
Global Development
Radiology
Cardiology IT
Infrastructure
Patient Care
Coordination
Devices
Laboratory
Pathology
Eye Care
Radiation
Oncology
Quality, Research and
Public Health
IHE Europe
IHE North America
France
USA
Canada
IHE Asia-Oceania
Japan
Korea
Taiwan
Netherlands
Spain
Sweden UK
Italy
Germany
Norway
China
Austria
ACC
ACCE
ACEP
JAHIS JIRA JRS
METI-MLHW
MEDIS-DC JAMI
RSNA SFR SFIL
SIRM
BIR
EuroRec
COCIR
EAR-ECR
DRG
ESC
Professional Societies / Sponsors
ACP
GMSIHIMSS
Contributing &
Participating Vendors 15 15

16. International Adoption of IHE
Austria
Local Deployment
National Extensions
Promotional & Live Demonstration Events
Funding
China
Spain
Holland
Norway
Taiwan
Korea
Canada UK
Japan
Italy
Germany
France
USA
1999
2000
2001
2002
2003
2004
2005
2006
2007
Pragmatic global standards harmonization + best practices sharing 16 16

17. Proven Standards Adoption Process
Testing at Connectathons
Develop technical specifications
IHE
Demonstrations
Products with IHE
Identify available standards (e.g. HL7, DICOM, IETF, OASIS)
Timely access to information
Easy to integrate products
Document Use Case Requirements

18. National and Regional Projects Using IHE Profiles
Netherland
Amsterdam
Lower
Austria
Italy (Conto Corrente Salute)
UK CfH
(Radiology WF)
France DMP
Denmark (Funen)
Italy (Veneto)
Spain (Aragon)
Austria
Quebec, Ontario, Alberta, British Columbia Canada Health Infoway
VITL-Vermont
Boston Medical Center - MA
Philadelphia HIE
CPHIC – Pennsylvania
CareSpark – TN & VA
South Africa
Malaysia
CHINA-MoH
Lab results sharing
JAPAN-Nagoya
Imaging Info Sharing
THINC- New York
NCHICA – N. Carolina
CHINA-Shanghai
Imaging Info Sharing 18 18

19. IHE Integration Profiles for Health Info Nets What is available and has been added this cycle
Security & Privacy
Clinical and PHR Content
Patient ID Mgmt
Emergency Referrals
Format of the Document Content and associated coded vocabulary
PHR Extracts/Updates
ECG Report Document
Lab Results Document Content
Scanned Documents
Format of the Document Content
Imaging Information
Medical Summary
(Meds, Allergies, Pbs)
and associated coded vocabulary
Consistent Time
Coordinate time across networked systems
Audit Trail & Node Authentication
Centralized privacy audit trail and node to node authentication to create a secured domain.
Basic Patients Privacy Consents
Establish Consents & Enable Access Control
Document Digital Signature
Attesting “true-copy and origin
Cross-Enterprise User Attestation
User Attributes fro Access Control
Patient Demographics Query
Patient Identifier Cross-referencing
Map patient identifiers across independent identification domains
Notification of Document Availability
Notification of a remote provider/ health enterprise
Request Form for Data Capture
External form with custom import/export scripting
Health Data Exchange
Other
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical documents forming a longitudinal record
Cross-Enterprise Document Pt-Pt Reliable Interchange
Cross-Enterprise Document Media Interchange
Cross-Community Access

20. Alignment with Industry Drivers
Open Source Code availability
Office of the National Coordinator for HIT
Open and ongoing dialog
AHIC Priorities and Use Case Roadmap
EHR, Population Health, Consumer Empowerment, Security and Privacy, Quality
HITSP Standards
Standards hamonization leverages 18 IHE Profiles
Participation at Connectathons/Demonstrations
CCHIT Requirements
Collaborative work called project Cypress – (NIST, MITRE, CCHIT, Canada Health Infoway, and IHE USA)
Demonstration Partners – VHA, DOD, CMS, CAQH, and many others…

21. IHE and US Healthcare IT Standards Harmonization
Healthcare Information Technology Standards Panel (HITSP)
Nationwide Health Information Network Architecture Projects (NHIN)
The Health Information Security and Privacy Collaboration (HISPC)
The Certification Commission for Healthcare Information Technology (CCHIT)
American Health Information Community (AHIC)
Through the Standards Harmonization contract – the Healthcare Information Technology Standards Panel (or the HITSP) was established.
The HITSP – the Panel – currently includes over 300 different member organizations – including SDO organizations, non-SDO organizations, government bodies, and consumer groups.
As you can see from this diagram – the work of the HITSP – as well as that of the CCHIT, HISPC, and NHIN – are driven by the American Health Information Community as a federally chartered commission that provides input and recommendations to HHS. 21

22. 18 IHE Profiles adopted by HITSP Interoperability Specifications
IHE contributes to HITSP’s success 22 22

23. IHE Strategy for Implementation
Leverage established standards to allow rapid deployment and plan for future Pragmatic, Ease of Evolution
Enable architectural freedom (centralized vs. decentralized, patient vs. provider centric) Flexibility of RHIO configuration
Support breakthrough use cases: variety of care settings, care coordination, public health, PHR, EHR Interoperability for broad constituencies
IHE and the Electronic Health Record (EHR)
IHE has defined a common framework to deliver the basic interoperability needed for local and regional health information networks. It has developed a foundational set of standards-based information exchange Integration Profiles with three interrelated efforts:
Cross-Enterprise Document Sharing (XDS) support for document content interoperability. This supports a standards-based EHR across clinical encounters and care settings.
A security framework for protecting the confidentiality, authenticity and integrity of patient care data.
Cross-domain patient identification management to ensure consistent patient information and effective searches for EHRs.
Offer consistent, standards-based record sharing for EHRs and other information systems

24. 2008 HIMSS Interoperability Showcase

25. Featured this year in the Showcase…
76 connected applications, 32 IHE profiles
Secured Health Information Exchange with broad content
Clinical Scenarios, focusing on clinician and patient access and information sharing across the continuum of care
Population Health, Quality and Research
Privacy and Security
HITSP Interoperability Specifications
The 2008 Cast:
Vendors Connected 51
Supporters 22
Total 73
Health information exchange with patient care devices
Personal health record solutions
Financial and administrative systems for billing and claims attachments (CAQH/CORE)
Expanded distributed demonstration in an HIE format showing connectivity with vendor booths

26. As a Vendor Implementer
How to Use IHE
As a Vendor Implementer
Implement IHE Integration Profiles
Test systems through Connectathon process
Publish an IHE Integration Statement for products
As a User Implementer or Consultant
Use IHE Integration Profiles to develop interoperability strategy
Use Connectathon Results and Integration Statements to evaluate vendors
Demand IHE Integration Profile compliance in RFPs

27. As a User or Vendor Committee Member
How to Participate
As a User or Vendor Committee Member
Become a member of a Domain’s Planning or Technical Committees (
As a User, Consultant or Vendor Interested Observer
Provide Public Comments on Technical Framework Supplements
Attend Demonstrations, Educational Events and Workshops

28. Integrating the Healthcare Enterprise
Providers and Vendors
Working Together to Deliver
Interoperable Health Information Systems
in the Enterprise
and Across Care Settings
Integrating the Healthcare Enterprise
Health Information Technology Standards Panel
American Health Information Community
Nationwide Health Information Network
EHRVA Roadmap