1. IHE (Integrating the Healthcare Enterprise): A solution for Payer-Provider Interoperability? An Introduction to the “Plumbing” Mike Nusbaum, BASc, MHSA, FHIMSS President MH Nusbaum & Associates Ltd.

2. Today’s Agenda… Introduce IHE, it’s products & processes How can IHE serve the Payer community? Opportunities… Q&A 2

3. The Case for Standards 3

4. Why do we need IHE? IHE Profiles address real-world problems IHE Profiles make standards implementable Compliance to IHE Profiles maximizes opportunity for plug-compatible interoperability IHE can accelerate adoption and implementation of standards The IHE Process ensures rigor and robustness: reliance on established standards extensive engagement with stakeholders, incl. public comment profile maintenance conformance testing in a real-world environment attestation (not yet certification) 44

5. Base Standards eHealth Projects Interoperability: Highest Cause of Health IT project failures IHTSDO IETF 5

6. Profile Development Base Standards eHealth Projects From a problem to a solution Profiling Organizations Have Emerged IHTSDO IETF Specific Extensions 6

7. Standards: Necessary… but 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 focus only on a single standard IHE provides a standard process for implementing multiple standards 7

8. Connecting Standards to Care Healthcare professionals work with industry Coordinate implementation of standards to meet clinical and administrative needs Clinicians and HIT professionals identify the key interoperability problems they face Providers and industry work together to develop and make available standards- based solutions Implementers follow common guidelines in purchasing and integrating effective systems IHE: A forum for agreeing on how to implement standards and processes for making it happen 8

9. 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 9

10. Is IHE a novel idea? Has IHE been adopted? 10 What are the alternatives ? Ignore the issue Pick key standards, and hope for the best Rely on robust standards harmonization ISO Health Informatics: TR28380 Global Standards Adoption – IHE Process, Profiles and Implementation Widespread adoption of IHE Profiles by National and Regional Projects around the world: USA, Canada, Europe, Asia Home Health: CONTINUA and IHE work together. 12 Country European epSOS Project (IHE-Europe hosting Industry Team). 10

11. 1111 IHE International Organizational Structure Contributing & Participating Vendors Example Deployment Committees IHE Europe IHE North America France USA Canada IHE Asia-Oceania Japan KoreaAustralia Netherlands Spain Sweden UK Italy Germany Norway China Austria Professional Societies / Sponsors IHE International Board Global Development Domains Radiology Cardiology IT Infrastructure Patient Care Coordination Patient Care Devices Laboratory Pathology Eye CareRadiation Oncology Public Health, Quality and Research Pharmacy Endoscopy Dentistry 11

12. 12 15 Years of Steady Evolution 1998 – 2012 The IHE Development Domains 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 Endoscopy since 2010 Dentistry since 2010 Pharmacy since 2009 12

13. 13 France  Local Deployment  National Extensions  Promotional & Live Demonstration Events  Funding USAGermanyItalyJapanUKCanadaKoreaTaiwanNorway Netherlands Spain ChinaAustria 199920002001200220032004 2005200620072009 Pragmatic global standards harmonization + best practices sharing 2008 Australia International Participation in IHE 13

14. IHE Sponsors Professional societies: Healthcare Information Management Systems Society (HIMSS) American College of Physicians (ACP), American College of Emergency Physicians (ACEP) American College of Obstetricians and Gynecologists (ACOG) Many other American Professional Societies (ACCE), (AAO), (ASTRO), etc. British Institute of Radiology (BIR), British Computer Society (BCS) German Radiology Society (DRG) …ASIP (IT France), SFIL (laboratory), French National Project (DMP), European Society of Cardiology Radiological Society of North America (RSNA) JAHIS (IT Japan), JIRA, JRS,… And many more Government Agencies: French National Project (ASIP-Santé) Dutch National Project (NICTIZ) Austrian National Project (ELGA) Canada Health Infoway (CHI) Regional projects (Italy, USA, Japan) and many more….. 14

15. Document Use Case Requirements Identify available standards ( e.g. HL7, DICOM, IETF, OASIS) Develop technical specifications Testing at Connectathons Products declare IHE Timely access to information Easy to integrate products RFPs with IHE reqts IHE Standards Adoption Process 15 IHE Demonstrations

16. What is a Connectathon? Cross-vendor, live, supervised, structured testing event All participating vendors’ products tested together in the same place/time Experts from each vendor available for immediate problem resolution… fixes are done in minutes, not months!! Each vendor tests with multiple trading partners (actual product to actual product) Testing of real-world clinical scenarios using IHE Integration Profiles 16

17. IHE Product Registry A website to search IHE Integration Statements published by vendors Helps users find products that match their needs Product Registry maintains a database of actors/profiles in vendors’ integration statements Product Registry points to Integration Statement on vendor’s web site 17

18. 18 Registering IHE Integration Statements

19. Product Registry Usage 19 Approximately 410 Integration Statements in the database Over 100 companies registered Average 280 visits per month

20. IHE Integration Statement 20

21. Product Registry Links 21 IHE Integration Statement template http://tinyurl.com/62ymvtc Link to Product Registry : http://product-registry.ihe.net Documentation : http://gazelle.ihe.net/content/product -registry Support http://gazelle.ihe.net/jira/PR

22. HIMSS Interoperability Showcase 22

23. Where in the World is XDS and CDA Link 23

24. Of interest to payers… XD* family of IT infrastructure profiles XDS, XDR, XDM, XDS-SD XCA Content profiles that leverage the XD* family XDS-MS, XD-LAB, XDS-I CDA (C-CDA) harmonized templates that carry clinical data exchanged amongst healthcare stakeholders 24

25. Opportunities Is there an interest in setting up a domain to address payer needs? International or US-realm? Implications Approach Next steps 25

26. Thank you!!! Questions? Find out more at ihe.net 26