1. Buying IT Systems with Interoperability Built-In Fact or Fiction?? Michael H. Nusbaum HIMSS Virtual Conference November 7 th, 2007

2. Interoperability… the holy grail! Interoperating professionally Interoperating with life

3. Interoperability… …is the ability of two or more systems or components to exchange information accurately, completely, securely and verifiably when and where needed. and to use the information that has been exchanged. Semantic health care interoperability also assures the clear and persistent communication of meaning [Mayo Clinic, 2006]

4. Why is HIT Interoperability Important? Clients/Patients Pharmacy Laboratory Diagnostic Hospital Emergency Homecare Community Care Center Clinic Emergency Services Specialist Clinic

5. Buying IT with Under-the-covers Interoperability HIT Vendor Product A

6. HIT Vendor B Product B Buying IT with External Interoperability HIT Vendor A Product A Interface Engine

7. HIT Vendor B Product B Buying IT with Interoperability Built-in HIT Vendor A Product A HIT Vendor C Product C

8. Key Criteria Semantic Interoperability Standards-based Vendor-agnostic Consultative process Vendor testing for conformance Opportunity to demonstrate and market Adoption in vendor products

9. Integrating the Healthcare Enterprise IHE is a standards based, global initiative that vendors, purchasers and implementers can use to define, test and implement interoperable healthcare solutions

10. Why IHE is Different IHE is actively involved with a realistic approach to integration Use of IHE Integration Profiles in RFPs means having the information you need to get the results you want

11. IHE provides a standard process for implementing multiple standards Standards are a critical step in achieving interoperability, BUT… They are very broad - varying interpretations and implementations There may be more than one standard for a given domain, sometimes even redundant or disjointed Standards implementation guides focus on only one standard, however when building a system or application you will need to consider many, including the relationships between standards domains

12. IHE provides a common set of tools, and a common, dependable framework for harmonizing and then implementing multiple standards. Benefits of this approach: Seamless sharing of health information within and between organizations, regions, States, and countries Application to application System to system Setting-to-setting Expert, unbiased, selection and coordination of established healthcare and IT standards to address specific clinical needs.

13. Interoperability: Redesigning the Office Visit

14. Who is involved? IHE: A forum for agreeing on how to implement standards and processes for making it happen

15. The Profile development process Timely access to information Easy to integrate products Products with IHE IHE Demonstrations Develop technical specifications (profiles) Document Use Case Requirements Identify available standards ( e.g. HL7, DICOM, IETF, OASIS) Testing at Connectathons

16. The Use Case A clinician would like to look at previous imaging studies of a patient. While they are available, they were taken on ABC System, and the Clinician has XYZ system The Integration Profile Consistent Presentation of Images Integration Profile specifies a number of transactions that maintain the consistency of presentation for grayscale images Example of an Integration Profile

19. Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Emergency Referrals Format of the Document Content and associated coded vocabulary PHR Extracts/Updates Format of the Document Content and associated coded vocabulary ECG Report Document Format of the Document Content and associated coded vocabulary Lab Results Document Content Format of the Document Content and associated coded vocabulary Scanned Documents Format of the Document Content Imaging Information Format of the Document Content and associated coded vocabulary Medical Summary ( Meds, Allergies, Pbs) Format of the Document Content 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 originSecurity Clinical and PHR Content Health Data Exchange 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 Patient ID Mgmt Other Cross-Enterprise Document Pt-Pt Reliable Interchange Final Text Approved Trial Implementation-2006 – Final Txt 2007 Cross-Enterprise Document Media Interchange

20. IHE Technical Frameworks Detailed standards implementation guides http://www.ihe.net/Technical_Framework/index.cfm

21. The Connectathon in 60 seconds 2008 North America Connectathon Date: Jan. 28 – Feb 1, 2008 Place: Hyatt Regency, Chicago Includes a 1-day conference and tour

22. What happens after the Connectathon? Successful results (specific by IHE profile/actor) are published by the sponsors Vendors self-certify, by publishing IHE Integration Statements Only vendors who are successful are entitled to participate in Interoperability Showcase demonstrations

23. 2008 HIMSS Interoperability Showcase February 24 – 28, 2007 Orlando, FL 15% of the total show conference (or more than 3,600 attendees) visited the Interoperability Showcase. 76 participating organizations with 51 vendors demonstrated interoperability among 74 health information technology systems including EHRs, Cardiology, Radiology, Laboratory, Infrastructure and patient care device vendors. Over 700 attendees created and tracked their own EHR. 49 educational sessions were presented. 5international delegations (France, Germany, Holland, China and Japan) visited the showcase. 4 HIMSS07 keynote speakers and Congressional leaders from six states attended the showcase. Last year…

24. RFPs & Integration Statements Requiring vendors to publish their products IHE Integration Statements provide a very effective pressure point for market-driven interoperability Be Brief? The system must support HL7 Be Effective? The system must support the following HL7 V2 messages according to the following 100 pages of specifications Be Both!! The system must support IHE Patient ID Cross-reference as a Patient Identifier Source actor Integration Statement Version 2.1 of the Enterprise HIS supports IHE Patient Id Cross- referencing as Patient Identifier Source actor

25. How to Participate, and use IHE As an Interested Observer: Provide Public Comments - your knowledge and experience is critical As a Provider: Ask for IHE integration statements in your RFPs As a Committee Member: Become a member of relevant Domains Planning or Technical Committees and help plan or develop the profiles As a Vendor or Implementer: Implement IHE Integration Profiles, Test sytems at the Connectathon, Publish an IHE integration statement for products

26. Healthcare providers and support staff oImproved workflows oInformation whenever and wherever needed oFewer opportunities for errors oFewer tedious tasks/repeated work oImproved report turnaround time Benefits Vendors oAlign product interoperability with industry consensus oDecreased cost and complexity of interface installation and management oFocus competition on functionality/service, not information transport

27. Growth in IHE Domains Radiology (18) IT Infrastructure for Healthcare (17) Cardiology (7) Laboratory (6) Radiation Oncology (1) Patient Care Coordination (5) Patient Care Devices (1) Quality Eye Care (3) Veterinary Endoscopy Pathology Pharmacy Year 1 (1999)Year 2 (2000)Year 3 (2001) Year 4 (2002) Year 5 (2003)Year 6 (2004) Year 7 (2005) Year 8 (2006)Year 9 (2007)

28. Toronto, Quebec, Alberta, BC Canada Health Infoway Austria THINC- New York NCHICA – N. Carolina Italy (Conto Corrente Salute) MA-Share – MA France DMP Philadelphia HIE CHINA-MoH Lab results sharing New York HIE IHE-based Regional and National EHR Projects (Operational and Planned)

29. Currently accepted by HITSP –XDS –XDS-MS –XDS-I –XD*Lab –PIX –PDQ –NAV –RFD Example: IHE adoption in the US Under consideration by HITSP for 2007 Security Profiles –CT –ATNA –BPPC –DSG –XUA Current Interoperability Specifications Under Review –XDM –EDES –QED –XDS.b –XCA (Pending)

30. Example: IHE adoption in Canada IHE-Canada XDS-I Profile PIX/PDQ/v3

31. Providers and Vendors Working Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings Providers and Vendors Working Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings

32. Questions? michael@mhnusbaum.com