1. 1 INTEGRATING THE HEALTHCARE ENTERPISE Contribution to the Meaningful Use of Interoperability World-wide International HL7 Interoperability Conference Orlando, May 2011 John Moehrke, IHE IT Infrastructure, GE Healthcare

2. Base Standards eHealth Projects 2 The Health IT Interoperability Challenge IHTSDO IETF How can we realize the promise of HIT Standards?

3. Profile Development Base Standards eHealth Projects 3 Interoperability: From a problem to a solution IHTSDO IETF Profiling Organizations Have Emerged Specific Extensions

4. 4 IHE: A Framework for Interoperability A common technical framework for harmonizing and implementing multiple standards  Application-to-application  System-to-system  Setting-to-setting Enables seamless health information movement within and between enterprises, regions, nations Promotes unbiased selection and coordinated use of established healthcare and IT standards to address specific clinical needs

5. How much is IHE adopted ? ISO Health Informatics:   TR28380 Global Standards Adoption – IHE Process and Profiles Worldwide IHE Adoption by National and Regional Projects   23 Country European epSOS Project   US Nationwide Health Information Network Exchange   Over 60 regional communities operational worldwide   Large scale (5-30 Million) national projects (Austria, France) on-line & ramping up   Products broadly available US: over 40 EHRs More than 10 HIE infrastructure products in clinical use Multiple Open Source Offerings   http://tinyurl.com/wwxds http://tinyurl.com/wwxds Home Health   CONTINUA and IHE are work together 5

6. 6 IHE Standards Adoption Process Adopted by International Standards Organization: TR 28380 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 6

7. 7 13 Years of Steady Evolution 1998 – 2011 The IHE Development Domains Pharmacy Since 2009 Pathology since 2006 Radiation Oncology since 2004 Radiology since 1998 Cardiology since 2004 Patient Care Devices since 2005 Patient Care Coordination since 2004 Eye Care since 2006 Quality Research & Public Health since 2006 Laboratory since 2004 (Healthcare) IT Infrastructure since 2003 since 2008

8. 8 International Growth of IHE France  Local Deployment, National Extensions  Promotional & Live Demonstration Events  Over 400 Organizational Members USA Germany Italy Japan UK Canada Taiwan Netherlands Spain Austria 199920002001200220032004 2005200620072009 Pragmatic global standards harmonization + best practices sharing 2008 Australia 2010 China Turkey Malaysia Switzerland

9. 9 Massive events : 70-80 vendors, 120-150 products 250-300 engineers 100-120 systems ….integrated in 5 days IHE Connectathons Vendors do not pass… until attested by an independent IHE Monitor North America: January 17-21, 2011 EU Connectathon: April 10-14, 2011 Korea: July 2011 China: September 2011 Japan: October 2011

10. 10 Interoperability Showcases Recent Demonstrations HIMSS, Orlando - February 2011 WoHIT – Budapest – May 2011 Coming: Medica, Germany, November 2011 Japan, Korea, Australia, etc. 10

11. Leveraging IHE for a Meaningful Use of Interoperability 11

12. MU Stage 1 – Clinical Content 12 MU Stage 1 Criteria Interoperability Standards Implement. Specification IHE Profile Exchange clinical info and summary record. CDA R2 and CCD (or CCR) HITSP C32XPHR Clinical SummariesCDA R2 and CCD (or CCR) HITSP C32XPHR Diagnosis TerminologyICD-9-CM or SNOMED (ICD-10-CM soon) NoneXPHR Medications TerminologyRXNORM or any source terminology NoneXPHR XDS-MS Vaccine TerminologyHL7 VXQNoneXPHR XDS-MS Discharge SummariesNone XDS-MS XDS-SD

13. MU Stage 1 – Public Health & Quality 13 MU Stage 1 Criteria Interoperability Standards Implementation Specification IHE Profile Syndromic SurveillanceHL7V2.3.1 or V2.5.1 CDC/PHIN (new)PIX and/or PAM Reportable Lab ResultsHL7V2.5.1Electronic Lab Reporting to PH Lab Testing Workflow  XD*Lab Document Report Quality MeasuresPQRI 2009NoneWork in Progress

14. MU Stage 1 – Security & Privacy 14 MU Stage 1 Criteria Interoperability Standards Implementation Specification IHE Profile EncryptionAES (FIPS)NoneATNA uses AES with TLS or WS XDM – e-Mail uses S/MIME IntegritySHA-1 (FIPS)NoneATNA and XDS use SHA-1 XDM – e-Mail uses S/MIME Audit LogNone ATNA requires Security Audit

15. Health Information Exchange Mechanisms 15 Exchange MethodInteroperability Standards Implementation Specification IHE Profile Point-to-point Blind PushSMTP+MIMEDirect Project Point-to-point send with labeling SMTP+MIMEDirect ProjectXDM Point-to-point sendWS-I, SOAP, ebRSNwHIN CONNECT XDR+PIX Community Sharing HIEWS-I, SOAP, ebRSNoneXDS+PIX Nation-wide Health Info Network Exchange WS-I, SOAP, epRSNwHIN CONNECT XCA+XCPD Source EHRA

16. MU Stage 1 – Transport Gaps (2) 16

17. Transport 17

18. 18 To learn about IHE, what can you do? Go to: www.ihe.net www.ihe.net Insist on relevant IHE profiles compliance in your RFPs and contract documents:  Select Integration and Content Profiles, and Appropriate Actor(s)  Ask vendors for their products “IHE Integration Statements”. Need more interoperability ?  Contribute to IHE Committees  Support or create your national IHE (IHE International and IHE- Europe will help)

19. 19 Providers and Vendors Working Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings http://www.ihe.net www.iheusa.net