1. September, 2005What IHE Delivers 1 Panel Session: Development in the IHE Domains IHE Workshop 2007 IHE Domain Co-chairs

2. September, 2005What IHE Delivers 2 IT Infrastructure IHE Workshop 2007 Charles Parisot, GE Co-chair ITI Planning Committee

3. 3 What is IHE IT Infrastructure? IHE IT Infrastructure domain produces...  Profiles that serve the purposes of clinical workflows, regardless of IHE clinical domain Examples: Security, Records Storage, Patient Identifiers  Basic implementation-specification foundations to be extended by other IHE clinical domains Examples: Retrieve Forms for Data Capture; Cross-Enterprise Document Sharing  White Papers for current work items Examples: HIE Security and Privacy; Health Data Re-use Infrastructure; Risk Management

4. 4 ITI Provides Foundation for Document Exchange Doc Exchange Integration Profiles Doc Content Profiles Doc Sharing XDS Media Interchange XDM Pt-Pt Doc Interchange XDR Scanned Doc XDS-SDConsentBPPCEmergencyEDR Pre Surgery PPHPLaboratoryXD*-Lab PHR Exchange XPHR Discharge & Referrals XDS-MS ImagingXDS-I

5. 5 IHE IT Infrastructure Composable Integration Profiles Doc Exchange Integration Profiles Doc Sharing XDS Media Interchange XDM Pt-Pt Doc Interchange XDR Patient Demographics Query Patient Identifier Cross-referencing Map patient identifiers across independent identification domains Notice of Document Availability Know about new information Patient Administration Management Patient Synchronized Applications Retrieve Information for Display Cross-Enterprise User Assertion User Attributes for Access Cntrl Cross-Community Access Querying and Retrieving Documents across multiple communities Remotely Manage Information Capture Request Form for Data Capture Scanned Doc XDS-SD 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. Document Digital Signature Attesting “true-copy and origin Personal White Pages Enterprise User Authentication (Intra-Enterprise only) * * * * * * Adopted by HITSP

6. 6 IHE IT Infrastructure- What is new?  New Profiles that serve the purposes of clinical workflows, regardless of IHE clinical domain Cross-Enterprise User Assertion* Cross-Community Access* Patient Id X-Ref (V3)* Patient Demographics Query(V3)* Supplements: SOA-Web Services extension for XDS (XDS.b)* Appendix L : Affinity Domain Checklist* Appendix L : Affinity Domain Checklist* XDS patient Merge* XDS patient Merge*  Basic implementation-specification foundations to be extended by other IHE clinical domains Request Form for Data Capture*  White Papers for current work items Health Info Exchange Security and Privacy Risk Management Configuration Managemnt Health Data Reuse * Public Comment June 10 th -July 10th

7. 7 IHE, the only sets of harmonized global standards already adopted by several national & regional projects Quebec, Toronto, Alberta, British Columbia Canada Infoway Denmark (Funen) Italy (Veneto) Spain (Aragon) Austria ELGA THINC- New York NCHICA – N. Carolina Italy (Conto Corrente Salute) MA-Share – MA France DMP UK CfH (Radiology WF) Philadelphia HIE CHINA-MoH Lab results sharing State Project – NY CHINA-Shanghai Imaging Info Sharing JAPAN-Nogaya Imaging Info Sharing

8. September, 2005What IHE Delivers 8 Laboratory IHE Workshop 2007 Charles Parisot, GE Co-chair ITI Planning Committee

9. 9 XDS Laboratory Report XDS-MS Medical Documents Medical Summaries Referral Discharge Summary BCCP Consent EDR Emergency Department Referral PPHP Preprocedure History and Physical History and Physical XPHR PHR Update XDS LAB CDA Lab PHR Extract XDS-LAB Lab Report

10. 10 Scope The clinical laboratory report is:  A report of a set of final results (the fulfillment process being completed) to be shared as “historical information”.  Human-readable, shared between care providers of various specialties and patients (e.g. through a PHR)  May contain machine readable coded entries (decision support, bio- surveillance) All clinical laboratory specialties in scope, except:  Blood banks (blood products out of scope, but blood tests in scope)  Pathology (has its dedicated domain in IHE)

11. 11 Key Technical Properties Information is Human Readable (two levels of sections) and machine processable Full alignments with HL7 V3 lab messages Supports custom report organizations and results rendering regulations (e.g. CLIA in the USA). Complements the real-time result return to ordering provider. Used both in sharing (XDS) & pt-pt interchange (XDP) May protect Information using Digital Signature

12. September, 2005What IHE Delivers 12 Patient Care Coordination IHE Workshop 2007 IHE Patient Care Coordination John Donnelly, Co-Chair Planning Committee

13. 13 Primary Membership Sponsors Physician and Nursing Associations & Colleges  ACP, AAP, AAFP, FACEP, ANA/ANIA EMR Vendors  Ambulatory, Inpatient PHR Vendors  Tethered solutions, Independent PC-based systems, Independent Web-based solutions Other Stakeholders in HIT  HIMSS, CAST/AHIMA, TIGER/ANI, Clinical research initiatives, Public health agencies

14. 14 Profile Roadmap Years 2005-2007 (Trial Implementation)  Medical Summary [MS] – Acute Care Discharge to PCP, PCP Referral to Specialist  Unstructured Document – CDA-wrapped pdf  Medical Summary [MS] – ED Referral [EDR], Pre- procedure H&P [PHP]  Consents for H/C Information Sharing [BPPC]  Exchange Personal Health Record [XPHR]

15. 15 Profile Roadmap Year 2007-2008 (Development & Testing)  Functional Status Assessments  Query for Existing Data (QED)  Emergency Department Encounter Record (EDER)  Public Health Lab Reporting Content (PHLab)  Antepartum Summary (APS)  PCC Technical Framework Updates Future (White Paper)  Case Management (Clinical research, Quality, Public Health)

16. 16 PCC Profiles Medical Summaries ED Referral Exchanging PHR Content Antepartum Care Summary Emergency Department Encounter Record Preprocedure History and Physical Basic Patient Privacy Consent Lab Report Functional Status Assessments 2005-06 2006-07 2007-08 IntegrationContent Query for Existing Data - Among 30 Consensus Standards Recommended by HITSP and accepted by HHS Secretary Leavitt.

17. 17 Domain Visibility & Support HIMSS Annual Conference  2007 HIMSS ‘RHIO’ Showcase – 50+ vendors exchanged XDS-MS, XDS-pdf documents  Informational Presentations from Providers & HIT Vendors ACC Annual Conference  2007 ACC Interoperability Showcase – 20+ vendors exchanged XDS-MS, XDS-pdf documents  Informational Presentations from HIT Vendors Physician Association Annual Meetings  Informational Presentations Planned RHIO and Inteoperability Initiatives Participation  Multiple NHIIN “Pilot” RHIO’s Deploy IHE profiles  HITSP Interoperability Specification Constructs v2.0 Mandate Numerous IHE Profiles

18. September, 2005What IHE Delivers 18 Cardiology IHE Workshop 2007 Keith Klassy, Emageon Co-chair, IHE Cardiology Technical Committee

19. 19 Primary Membership Sponsors Physician Associations & Colleges  Primary: ACC, ESC  Specialty: ASE, ASNC, HRS, SCAI Vendor Participation– ACC Demonstrators 2006:  Leadership Level: GE Healthcare GE Healthcare Heartlab, An Agfa Company Heartlab, An Agfa Company McKesson McKesson  Implementer Level: Camtronics – An Emageon Company Camtronics – An Emageon Company Cardiac Science Corporation Cardiac Science Corporation Medical Informatics Engineering, Inc Medical Informatics Engineering, Inc MediNotes Corporation MediNotes Corporation Medis medical imaging systems, bv Medis medical imaging systems, bv Philips Medical Systems Philips Medical Systems  Implementer Level: (cont) ProSolv CardioVascular ProSolv CardioVascular Siemens Medical Solutions Siemens Medical Solutions Toshiba Medical Solutions Toshiba Medical Solutions Witt Biomedical Corporation Witt Biomedical Corporation  Supporter Level: Cerner Corporation Cerner Corporation GOODMAN Healthcare IT Solutions GOODMAN Healthcare IT Solutions LUMEDX LUMEDX St. Jude Medical St. Jude Medical

20. 20 IHE Cardiology Profiles: Workflow Foundation Managing cardiology procedure workflow to ensure consistently identified and integrated data 1. Cardiac Catheterization Workflow Profile 2. Echocardiography Workflow Profile 3. Stress Testing Workflow Profile 4. Nuclear Medicine Image Profile (Cardiology option)

21. 21 IHE Cardiology Profiles: Getting Results Consistent electronic methods for reporting on cardiology findings 5. Evidence Documents Profile (measurements) Cath, Echo, Stress, CTA/MRA options Cath, Echo, Stress, CTA/MRA options 6. Implantable Cardiac Device Observations Profile 7. Displayable Reports Profile 8. Retrieve Information for Display Profile A. Retrieve ECG for Display Profile

22. 22 Domain Visibility & Support ACC Annual Conference  2005, 2006, 2007 ACC Interoperability Showcase  Educational Workshops and Session ESC Annual Conference  2005, 2006, 2007 ACC Interoperability Showcase  Educational Workshops and Session Specialty Hands-On Demonstrations  ASE 2006  ASNC 2007  HRS 2007 Additional Conference Representation  CT Angiography  SCAI  Computers in Cardiology  American College of Cardiology Administrators (ACCA)

23. September, 2005What IHE Delivers 23 Eye Care IHE Workshop 2007

24. 24 IHE Eye Care Targeting all eye care providersTargeting all eye care providers Ophthalmology and OptometryOphthalmology and Optometry Roots in DICOM WG9 (Ophthalmology)Roots in DICOM WG9 (Ophthalmology) OP and Stereo modules approvedOP and Stereo modules approved OTM and Refractive SR work items in progressOTM and Refractive SR work items in progress AAO is the sponsoring organizationAAO is the sponsoring organization Dr. Flora Lum, AAO, coordinatorDr. Flora Lum, AAO, coordinator Don Van Syckle, DVS Consulting, Project ManagerDon Van Syckle, DVS Consulting, Project Manager Planning CommitteePlanning Committee Mike Schmidt, Carl Zeiss MeditecMike Schmidt, Carl Zeiss Meditec Dr. Mark Horton, U.S. Indian Health ServicesDr. Mark Horton, U.S. Indian Health Services Technical Committee co-chairsTechnical Committee co-chairs Jim Riggi, MedflowJim Riggi, Medflow Peter Kuzmak, U.S. Dept. of Veteran AffairsPeter Kuzmak, U.S. Dept. of Veteran Affairs

25. 25 IHE Eye Care – Plan for 2007 Informal Efforts 2005Informal Efforts 2005 AAO Showcase: October 2005AAO Showcase: October 2005 First AAO IHE Demonstration AAO 2006 Annual Meeting, Las VegasFirst AAO IHE Demonstration AAO 2006 Annual Meeting, Las Vegas Development ScheduleDevelopment Schedule Technical Framework Updated to Trial Implementation: May 2007Technical Framework Updated to Trial Implementation: May 2007 Mini-connectathon/Demo Rehearsal:October 2007Mini-connectathon/Demo Rehearsal:October 2007 AAO Showcase: November 2007 New Orleans, LAAAO Showcase: November 2007 New Orleans, LA Available ProfilesAvailable Profiles Eye Care Scheduled Workflow (EYECARE)Eye Care Scheduled Workflow (EYECARE) Charge Posting (CHG)Charge Posting (CHG) Eye Care Evidence Documents [ECED]Eye Care Evidence Documents [ECED] New: Eye Care Displayable Report (ECDR)New: Eye Care Displayable Report (ECDR)

26. 26 IHE Eye Care Connectathon Open invitation to vendor community October Timeframe, Location TBD Prerequisite to participate in the AAO Annual Meeting Interoperability Showcase Application: Contact Flora Lum, flum@aao.org, (415) 561-8592 flum@aao.org

27. September, 2005What IHE Delivers 27 Patient Care Devices IHE Workshop 2006 Ray Zambuto Co-chair PCD Planning Committee

28. 28 Primary Membership Sponsors Co Sponsors  ACCE and HIMSS Medical Device Vendors  Physio Monitors, ventilators, pumps, clinical dashboards, home health Purchasers / Providers  Acute care – ED, ICU, OR Other Stakeholders in HIT  Regulatory & Public health agencies

29. 29 Profile Roadmap Year 1: (2006-2007)  Enterprise communication of PCD data (DEC) Passed connectathon, demonstrated at HIMSS with 6 vendors. Patient Identification Association [PIDA] Year 2: (3 Profiles)  3 Profiles Plug-n-Play Medical Device Real Time Interoperability Plug-n-Play Medical Device Real Time Interoperability Patient ID Binding Patient ID Binding Query – Publish Subscribe Filtering of DEC data Query – Publish Subscribe Filtering of DEC data  Public comment July 2006

30. 30 Future Developments

31. 31 Domain Visibility & Support HIMSS Annual Conference  2005 & 2006: Booth in IHE Showcase  2006: Showcase presentation … “standing room only”  2007: PCD “POD” – Demonstration – Significant Interest generated Industry Survey  2005: Survey within HIMSS / IHE re. PCD priorities  2006: Survey widened to include many other groups Presentations at Conferences  IHE PCD Presentations at conferences such as AAMI & APSF

32. September, 2005What IHE Delivers 32 Quality IHE Workshop 2007 Floyd Eisenberg, MD, MPH Co-chair, Quality Technical Committee

33. 33 Primary Membership Sponsors Physician Associations & Colleges  ACC, AHA, HIMSS, RSNA EHR and General HIT Vendors Other Stakeholders  Regulatory & Public health agencies  Quality monitoring and accreditation organizations Technical Committee Co-chair  Floyd Eisenberg, MD, MPH – Siemens Medical Systems  Recruiting committee leadership

34. 34 Profile Roadmap Year 1: 2007-2008 (Development & Testing)  Patient-level Export of Quality Data (PEQD)  ACEI-ARB Content Profile  Public comment starts June 15 Future…  Other data measures  Data registries  Peer review  Outcomes analysis  Real-time CME  Adverse event reporting, etc.

35. September, 2005What IHE Delivers 35 Kevin O’Donnell, Toshiba Medical Systems Co-chair, IHE Radiology Planning Cmte Radiology

36. 36 IHE Radiology Scope:  Radiology including Nuclear Medicine, Mammography Vendors  Acquisition Modalities, RIS, PACS, Workstations, Displays, Printers Established 1998 (first IHE domain) Sponsor: RSNA Supporters: COCIR, DRG, EAR, ECR, EuroPACS, GMSIH, JIRA, JAHIS, JRS, JSRT, METI, MEDIS-DC, SFR, SIRM

37. 37 IHE Radiology - Deployment In active use:  Robust Vendor Participation at Connectathons (78 of 150 Systems in Chicago)  Over 200 IHE Integration Statements published  IHE Profiles appearing in User Purchasing Processes Most implemented Profiles  Scheduled Workflow  Patient Information Reconciliation  Consistent Presentation of Images  Portable Data for Imaging  XDS for Imaging

38. 38 IHE Radiology - Achievements Year 1998-2006 Basic radiology workflows  Acquisition, Post-Processing, Reporting, Teaching Files/Clinical Trials, CD/Hardcopy Import Handling imaging content  Measurements, CAD Results, NM, Mammo, Fusion, Presentation States, Reports, Key Image Notes Distribution of imaging information  on CDs, to EHRs, keeping Audit Trails

39. 39 IHE Radiology – Recent Direction Support National Extensions to Technical Framework  IHE Canada  IHE Spain  (IHE Japan) Expand support for specialties  Refactored NM Image Profile for Cardiology  Mammography Users Handbook  Mammography Workflow – Use Cases Reporting 2.0  Drafting Strawman Whitepaper – Use Cases, Workflow Model  Cross-domain Reporting Task Force

40. September, 2005What IHE Delivers 40 Radiation Oncology Bruce Curran, MD Associate Prof/Univ of Michigan

41. 41 Primary Membership Sponsors Radiation Oncology Vendors  Delivery Devices – Linear Accelerators, Brachytherapy  Simulators  Treatment Planning Systems  Oncology Information Systems Physician Associations & Colleges  ASTRO (American Society for Therapeutic Radiation Oncology)  AAPM (American Association of Physicists in Medicine)  ATC (Advanced Technology Consortium)

42. 42 Profile Roadmap Initial Implementation (2005-2007)  RO General Integration Profile CT Image Retrieval / Storage CT Image Retrieval / Storage Image Set Contouring Image Set Contouring Geometric Plan Definition Geometric Plan Definition Dosimetric Plan Definition Dosimetric Plan Definition 3D Dose Matrix Viewer 3D Dose Matrix Viewer  Reduce Multiplicity of Implementation Paths  Test Tools Contract in place  Connectathon Scheduled (8/25/2007) 2008 Profiles  RO Multimodality Registration  Treatment Delivery Workflow

43. 43 Domain Visibility & Support ASTRO Annual Conference  2006 eASTRO IHE-RO Showcase  2007 Public Demonstration Other Potential Conferences  AAPM  ESTRO  JASTRO

44. 44 Questions?