1. IHE CDA Templates HL7 UK 2007 Keith W. Boone Interoperability Architect, GE Healthcare Co-chair, IHE Patient Care Coordination TC Co-chair, HL7 Structured Documents Member, ANSI/HITSP CE, CD and PH TCs Member, ASTM

2. Integrating the Healthcare Enterprise Electronic Health Record Cardiology Laboratory Radiology Oncology Future Domains IHE IT Infrastructure Patient Care Coordination Patient Care Devices Pathology Eye Care 1999 2003 2002 2004 2005 Over 100 vendors and 20 professional societies involved worldwide 6 Technical Frameworks and 70+ integration profiles Testing at Connectathons and Demonstrations at Major Conferences Worldwide

3. Patient Care Coordination Support profiles addressing integration issues that cross providers, patient problems or time. Deals with general clinical care aspects rather than technology infrastructure. Addresses workflows and information sharing needs that are common to multiple specialty areas. Professional Input from ACP, ACEP, ACOG, HIMSS

4. A content profile is… A sharable information component that can be exchanged… –within an HIE or RHIO (XDS) –via Media or USB Device (XDM) –via Reliable Messages (XDR) Document content using standards –CDA Release 2.0 –HL7 Care Record Summary –ASTM/HL7 Continuity of Care Document Library of Reusable Parts A Template!

5. PCC Content Profiles Standards and Profiles Used Standards –ASTM/HL7 Continuity of Care Document –HL7 Care Record Summary –HL7 CDA Release 2.0 –XHTML 1.0 –XSLT 1.0 –LOINC –SNOMED IHE Profiles –XDS/XDR/XDM –NAV - Notification of Document Availability –DSG - Document Digital Signature

6. PCC Content Profiles Key Technical Properties Human Readable Machine processable Digital Signature Enabled Can be shared multiple ways –RHIO or HIE (XDS) –CD or USB Media (XDM) –Point to Point (XDR)

7. IHE Profiles of HL7 V3 Medical Summaries ED Referral Exchanging PHR Content Antepartum Care Summary Emergency Department Encounter Summary Basic Patient Privacy Consent Lab Report Functional Status Assessments PCC 2005-06 2006-07 2007-08 IntegrationContent (V3) (CDA) Query for Existing Data PIX/PDQ V3 ITI LAB

8. PCC TF as a Library of Templates LAB Problems Vitals Result Problem Obs Severity Referral DocumentsSectionsEntriesParts XPHR Vital

9. Medical Summaries Value Proposition Supports key use cases for transfer of care: –Inpatient to PCP –PCP to Specialist Supports Transfer of Encoded –Problems –Medications –Allergies

10. Emergency Department Referral Value Proposition Nearly 5000 EDs in US Significant percentage of ED visits are referrals Shortage of critical health data for emergency department patients Need to improve communication of intended patient care plans to ED providers and ensure that no pertinent data is lost Streamline workflow by obviating telephone calls between busy clinicians

11. Exchange of Personal Health Records Value Proposition Provides a standards-based specification for managing the interchange of documents between a Personal Health Record and an EHR System to enable better interoperability between these systems.

12. Antepartum Summary Profile Value Proposition Over 4 million live births per year in US Obstetric patients must have a complete summary of antepartum care available for all care providers and at admission for labor and delivery. Incomplete information can be a danger to the mother and child and result in injury, inadequate treatment or undesirable outcome.

13. Functional Status Assessment Value Proposition The Institute of Medicine has determined that a high risk for errors occurs during the transfer of care. The Functional Status Assessment Profile (FSA) supports the handoff of assessment information between practitioners during transfers of care, cross- enterprise or intra-enterprise. Transfer of physician documentation provides medical assessment, diagnosis and treatment information. Transfer of nursing documentation provides assessment and treatment of human response (psychosocial, physiologic, emotional and spiritual) of patient/family to changing conditions.

14. Emergency Department Encounter Summary Value Proposition The Centers for Disease Control and Prevention (CDC) estimates that there were over 110 million emergency department visits in 2004 in the US ED visits account for as much as 40% of hospital admissions The ED Chart is the most common medical summary in use today This profile supports sharing of the clinical information in the ED chart with inpatient care providers and the patient's primary care physician.

15. Query for Existing Data Value Proposition Typical institutions have a large number of interfaces (30 – 60 or more) to manage, at a cost of $10,000 to $20,000 per year per interface. Few HL7 Version 2.X interfaces provide any query capabilities. Supporting a single standard to query clinical information is expected to reduce the overall costs of hooking together discrete clinical information systems.

16. Use Cases Exchange of information between Data Repositories and Clinical Data Consumers for: 1.Drug Safety 2.Public Health, Biosurveillance and Disease Registries 3.Identifying Qualifying Patients 1.Clinical Trials 2.Disease Management 4.Quality Reporting 5.Claims Submission ⋮

17. [PCC-5] Query Problems and Allergies [PCC-2] Query Medications [PCC-1] Query Vital Signs [PCC-3] Query Immunizations [PCC-4] Query Diagnostic Data Scope Problems and Allergies –Disease Registries, EHR Systems Vital Signs –Monitoring Systems, EHR Systems Diagnostic Results –Laboratory and Radiology Information Systems, EHR Systems Medications –Pharmacy, EHR Systems Immunizations –Immunization Registries, EHR Systems Decision Support Systems

18. Key Technical Properties Support for Web Services and SOA Architecture HL7 Care Record Query for all queries Reuse of PCC Templates Compatibility with ASTM/HL7 CCD

19. Standards Used HL7 Version 3.0 Care Record DSTU HL7 Version 3.0 Care Record Query DSTU ASTM/HL7 Continuity of Care Document (CCD) Web Services Description Language (WSDL) Simple Object Access Protocol (SOAP) Extensible Markup Language (XML) LOINC SNOMED

20. Proposed for 2008 Focused Care Management –Chronic Disease –Public Health Registries Clinical Trials and Adverse Event Reporting Antepartum Record Cancer and Immunization Registries Nursing Note Pre-hospital (Emergency) Care Report

21. More information…. IHE Wiki: http://wiki.ihe.net IHE Web site: http://www.ihe.net http://www.himss.org/IHE http://www.rsna.org/IHE http://www.acc.org/quality/ihe.htm Technical Frameworks Technical Framework Supplements – Trial Implementation Non-Technical Brochures : –Calls for Participation –IHE Fact Sheet and FAQ –IHE Integration Profiles: Guidelines for Buyers –IHE Connect-a-thon Results –Vendor Products Integration Statements Questions?