1. Continuity of Care virtual tour HL7-IHE Demonstration HIMSS 2004

2. Presented by John Madden, MD, PhD, Duke University Medical Center, Department of Pathology Liora Alschuler, HL7/the-word-electric

3. Continuity of Care Patient scenario John is a 70-year old man with a 100- pack-year smoking history He recently developed persistent cough with blood-streaked sputum He visits Dr. Sullivan, his Primary Care Provider (PCP) Dr. Sullivan sends John to a nearby radiology practice for a chest x-ray

4. Adobe Berdy Carefx CommerceNet DCRI Dictaphone Digital Infuzion Eclipsys Epic GE Heartlab IBM INFINITT Kodak Kryptiq Microsoft Misys Mortara NIST Philips Raining Data Sentillion Siemens SNOMED XIMIS Outpatient encounter and chest xray Scheduled workflow; report stored as CDA PCP Continuity of Care Imaging Integration, Tumor Reporting, Claims Processing Repository RIS Server Workstation Registry Imaging HL7 Standards aECG Arden CCOW CDA ODM LDM RIM SDM SPL V2 V3 IHE Profiles CT EUA PIX PSA RID SWF PCP sends order to radiology office Radiology information system queries scheduling server Imaging modality queries scheduling server for demographics Imaging system uploads completed image to server Server relays copy of image to repository. Repository forwards document information to registry.

5. Continuity of Care Patient scenario Chest x-ray shows a 3 cm right upper lobe mass Radiologists communicate result to Dr. Sullivan the same day She refers John to Dr. Blade, a chest surgeon at the South Hospital Medical Center

6. Patient referred for surgery EMR & eForms CCR sent through brokers to hospital, surgery PCP Continuity of Care Imaging Integration, Tumor Reporting, Claims Processing EMR Broker Hospital Repository eForms Surgery RIS Server Imaging Workstation Registry Server/WS EMR Adobe Berdy Carefx CommerceNet DCRI Dictaphone Digital Infuzion Eclipsys Epic GE Heartlab IBM INFINITT Kodak Kryptiq Microsoft Misys Mortara NIST Philips Raining Data Sentillion Siemens SNOMED XIMIS HL7 Standards aECG Arden CCOW CDA ODM LDM RIM SDM SPL V2 V3 IHE Profiles CT EUA PIX PSA RID SWF PCP enters referral request via eForms application Broker forwards referral to South Med Center and to repository/registry Hospital EMR distributes referral request and schedules patient visit Clinic queries community radiology server for availability of x-rays

7. Continuity of Care Patient scenario Medical center radiology obtains outside chest x-ray on behalf of Dr. Blade and reviews it for the South Hospital medical record Dr. Blade meets with John and personally reviews the outside x-ray He determines that John will require surgery

8. Surgeon reviews imaging reports RID query, CDA link to PACS, reg/rep for consulting report PCP Continuity of Care Imaging Integration, Tumor Reporting, Claims Processing Surgery Registry EMR eForms Hospital Identity server Dictation Server Workstation Imaging RIS Adobe Berdy Carefx CommerceNet DCRI Dictaphone Digital Infuzion Eclipsys Epic GE Heartlab IBM INFINITT Kodak Kryptiq Microsoft Misys Mortara NIST Philips Raining Data Sentillion Siemens SNOMED XIMIS HL7 Standards aECG Arden CCOW CDA ODM LDM RIM SDM SPL V2 V3 IHE Profiles CT EUA PIX PSA RID SWF Med Ctr radiology reviews community images and issues report During consultation, Dr. Blade requests a low-resolution version of x-ray to review on office computer with Johns family Medical dictation service delivers radiology review note to repository Identity server verifies outside patient record number Outside image and report delivered to surgeons consultation room

9. Continuity of Care Patient scenario Dr. Blade admits John He orders a preoperative chest CT

10. Patient admitted; Pre-op CT, consult EMR sends admit message; orders imaging; report converted from V2 to CDA PCP Continuity of Care Imaging Integration, Tumor Reporting, Claims Processing Surgery Registry Server EMR Hospital eForms Repository Broker Dictation Workstation Imaging RIS HL7 Standards aECG Arden CCOW CDA ODM LDM RIM SDM SPL V2 V3 IHE Profiles CT EUA PIX PSA RID SWF CT scheduled… Adobe Berdy Carefx CommerceNet DCRI Dictaphone Digital Infuzion Eclipsys Epic GE Heartlab IBM INFINITT Kodak Kryptiq Microsoft Misys Mortara NIST Philips Raining Data Sentillion Siemens SNOMED XIMIS John is admitted, preoperative CT ordered …performed …and reported

11. Continuity of Care Patient scenario Dr. Blade performs wedge resection of RUL with node sampling Specimen is examined by pathology; the diagnosis is large cell carcinoma with negative nodes Pathology report is sent to Dr. Blade, hospital Tumor Registry A copy is sent to the PCP, Dr. Sullivan

12. Pathology Report; Surgical Report; Referral For patient chart and Tumor Registry; CCR back to PCP PCP Continuity of Care Imaging Integration, Tumor Reporting, Claims Processing Server EMR Hospital Dictation Tumor Registry Broker eForms Broker Pathology Surgery Repository Registry Workstation Imaging RIS Adobe Berdy Carefx CommerceNet DCRI Dictaphone Digital Infuzion Eclipsys Epic GE Heartlab IBM INFINITT Kodak Kryptiq Microsoft Misys Mortara NIST Philips Raining Data Sentillion Siemens SNOMED XIMIS HL7 Standards aECG Arden CCOW CDA ODM LDM RIM SDM SPL V2 V3 IHE Profiles CT EUA PIX PSA RID SWF Pathology report ordered… …and reported Coded format auto-generated for tumor registry from CDA data Dr. Blade composes discharge summary, dictation service queries registry for location of referenced documents Discharge summary posted, copy forwarded to PCPs broker PCP requests copy of discharge summary in encrypted email from broker

13. South Hospital Repository view: HL7-CDA standard XML with XQuery-ready, context-linked SNOMED encodings Pathologist view: CAP/ACoS standards compliant, template- driven data entry Clinician view: Traditional format, print/electronic delivery Tumor registrar view: Irrelevant items filtered, stage computed automatically A single data REPRESENTATION standard facilitates multiple document PRESENTATION standards !

14. Continuity of Care Patient scenario Dr. Sullivan submits a claim to payer Payer requests more information

15. Brokered Claim; Registry Discovery For patient chart and Tumor Registry; CCR back to PCP PCP Continuity of Care Imaging Integration, Tumor Reporting, Claims Processing Surgery Server EMR Hospital Repository Pathology Dictation Tumor Registry Registry eForms Broker Payer Workstation Imaging RIS Adobe Berdy Carefx CommerceNet DCRI Dictaphone Digital Infuzion Eclipsys Epic GE Heartlab IBM INFINITT Kodak Kryptiq Microsoft Misys Mortara NIST Philips Raining Data Sentillion Siemens SNOMED XIMIS HL7 Standards aECG Arden CCOW CDA ODM LDM RIM SDM SPL V2 V3 IHE Profiles CT EUA PIX PSA RID SWF

16. Virtual EHR Ubiquitous Access to Distributed Information PCP Continuity of Care Imaging Integration, Tumor Reporting, Claims Processing Imaging EMR Dictation Tumor Registry Broker vEHR Payer Pathology Repository eForms Workstation Registry Server Imaging Hospital RIS Adobe Berdy Carefx CommerceNet DCRI Dictaphone Digital Infuzion Eclipsys Epic GE Heartlab IBM INFINITT Kodak Kryptiq Microsoft Misys Mortara NIST Philips Raining Data Sentillion Siemens SNOMED XIMIS HL7 Standards aECG Arden CCOW CDA ODM LDM RIM SDM SPL V2 V3 IHE Profiles CT EUA PIX PSA RID SWF

17. Adobe Berdy Carefx CommerceNet DCRI Dictaphone Digital Infuzion Eclipsys Epic GE Heartlab IBM INFINITT Kodak Kryptiq Microsoft Misys Mortara NIST Philips Raining Data Sentillion Siemens SNOMED XIMIS HL7 aECG Arden CCOW CDA ODM LDM RIM SDM SPL V2 V3 IHE CT EUA PIX PSA RID SWF Continuity of Care Mini-tours Tour 1: Referrals & Repository Tour 2: Pictures & Words Tour 3: Putting it all together

18. Adobe Berdy Carefx CommerceNet DCRI Dictaphone Digital Infuzion Eclipsys Epic GE Heartlab IBM INFINITT Kodak Kryptiq Microsoft Misys Mortara NIST Philips Raining Data Sentillion Siemens SNOMED XIMIS HL7 aECG Arden CCOW CDA ODM LDM RIM SDM SPL V2 V3 IHE CT EUA PIX PSA RID SWF Continuity of Care Mini-tour 1 Referrals & Repository Order origination CDA export/import Report creation Referrals Discharge summary

19. Adobe Berdy Carefx CommerceNet DCRI Dictaphone Digital Infuzion Eclipsys Epic GE Heartlab IBM INFINITT Kodak Kryptiq Microsoft Misys Mortara NIST Philips Raining Data Sentillion Siemens SNOMED XIMIS HL7 aECG Arden CCOW CDA ODM LDM RIM SDM SPL V2 V3 IHE CT EUA PIX PSA RID SWF Continuity of Care Mini-tour 2 Pictures & Words Radiology workflow & standards Dictation CCOW

20. Adobe Berdy Carefx CommerceNet DCRI Dictaphone Digital Infuzion Eclipsys Epic GE Heartlab IBM INFINITT Kodak Kryptiq Microsoft Misys Mortara NIST Philips Raining Data Sentillion Siemens SNOMED XIMIS HL7 aECG Arden CCOW CDA ODM LDM RIM SDM SPL V2 V3 IHE CT EUA PIX PSA RID SWF Continuity of Care Mini-tour 3 Putting it all together Message routing Repository & registry Virtual EHR Financials

21. Adobe Berdy Carefx CommerceNet DCRI Dictaphone Digital Infuzion Eclipsys Epic GE Heartlab IBM INFINITT Kodak Kryptiq Microsoft Misys Mortara NIST Philips Raining Data Sentillion Siemens SNOMED XIMIS HL7 aECG Arden CCOW CDA ODM LDM RIM SDM SPL V2 V3 IHE CT EUA PIX PSA RID SWF Thank you! Questions? Tours starting now