1. September, 2005What IHE Delivers 1 Connecting Health Information Technology Standards to the Point-of- Care: The IHE Method Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS Vice President, Informatics, HIMSS

2. 2 Digital Age of Information In the digital age there is a fundamental difference in the generation, distribution and consumption of data, information, and knowledge

3. 3 A Framework for Interoperability Integrating the Healthcare Enterprise:  An initiative that improves patient care by harmonizing healthcare information exchange  Provides a common framework for implementing standards to seamlessly pass health information among care providers, enabling local, regional and nationwide health information networks  Promotes the coordinated use of established standards–Health Level 7, ASTM, DICOM, CDISC, W3C, IEEE, etc.—to address specific clinical needs

4. 4 Standards: Necessary…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 typically focus on a single standard IHE provides a standard process for implementing multiple standards

5. 5 Terms and Definitions HIE:Health Information Exchange IHE:Integrating the Healthcare Enterprise RHIO:Regional Health Information Organization NHIN: Nationwide Health Information Network Enterprise:Hospital System Cross-enterprise: Across all Healthcare Systems- Ambulatory or In-Patient Use Case: Scenario + Work Flow

6. 6 IHE: Connecting Standards to Care Healthcare professionals working 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 are able to 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

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8. 8 Who’s involved in IHE? Users - Clinicians, Staff, Administrators, CIOs, Gov’t agencies (e.g. NIST, VA, DoD, CDC, CMS) Professional Societies representing 270,000 individual members:  HIMSS, RSNA, ACC, ACP, AAO, ACCE, ASTRO, etc Standards Development Orgs (SDOs):  HL7, DICOM, ISO, CDISC, ASTM, W3C, IEEE, IETF, etc Vendors & consultants (e.g., imaging, EHRs, cardiology, medical devices)

9. 9 Sharing Health Information Linking Existing Sources - Interoperability Health information can stay where it is—with the doctors and others who created it Specific information is shared only when and where it is needed. Sharing does not require an all new “network” or infrastructure Sharing does not require a central database or a national ID Sharing does require a Common Framework

10. 10 The Role of IHE The Role of IHE Model for Harmonization  Mapping of standards which have different levels of granularity  Preferred standards and evolution over time  Unification Building Blocks Implementation Guides/Interoperability Specifications Architecture and Context Process Expertise  Standard v. Implementation Guide  Testing Pilots such as those in Massachusetts, New York, Tennessee, North Carolina

11. 11 Current IHE Domain (Focus) Areas Radiology Laboratory IT Infrastructure Eye Care Patient Care Devices Cardiology Radiation Oncology PathologyPatient Care Coordination Quality

12. 12 An established initiative improving the quality, safety, efficiency, and effectiveness of care by agreeing on standardized ways to implement existing standards, and inventing the processes for making it happen. http://www.ihe.net

13. September, 2005What IHE Delivers 13 Functional Status Assessment: A 2007 IHE Profile

14. 14 The Plan Goal: Move nursing data between care settings across time Year 1: Move data from ambulatory care into acute care and back to ambulatory care electronically without regard for vendor application. Year 2: Move data from ambulatory care to acute care, though all acute care, in hospital care transfers and back to ambulatory care without regard for vendor application.

15. 15 Risks Removed Decreased risk for error occurs during the transfer of care  Each time the patient data is re-entered into a computer  Increased use of staffing and acuity tools Decreased Costs associated with error probability Improved work flows with timely clinical data Allows for clinician collaboration for early intervention with physiological changes Improved accuracy of timely clinical data

16. 16 Interoperability Outcomes Early intervention minimizes complications and reduces length of stay. Ensure all pertinent data will be available immediately prior/at the time of transfer without concern about lost data. Complete clinical information promotes safety, adequate after-care, improved outcomes and patient satisfaction. Receipt of data prior to transfer allows receiving facility to plan for appropriate staffing resources based on patient acuity, and early critical thinking for admitting nurse. (Resource maximization) Continuity of interdisciplinary plan of care promotes early discharge and increased patient satisfaction.

17. 17 Scale Characteristics Qualities reviewed in scales Scales chosen are evidence-based with strong reliability and validity. Widely accepted cross-enterprise or required/recommended by accrediting agencies Content Scales Numeric Rating Scale (NRS-11) for Pain Braden Scale for Predicting Pressure Sore Risk© Geriatric Depression Scale (GDS) Minimum Data Set – Section G

18. 18 Three Use Case’s A diabetic nursing home patient is transferring from the LTC environment to an in-patient acute care hospital based on deteriorating functional status assessments. A normally active, older adult in an assisted living community has an accidental fall requiring admission to an acute care facility. A recently widowed 75 year old woman is admitted to an adult inpatient floor of a behavior health hospital for depression post suicide attempt

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20. 20 Hand Off/Transfer of Care: Use Case # 1 Daily Assessment & call to provider Hand off to Transport Assessment in the Transport Hand off Transport to Acute Care Assessment on admission to Acute care/Med-Surg Unit Daily Assessments on Unit Hand off and Assessment to Transport Hand off to LTC Daily Assessment

21. 21 MDS section G Physical Functional and Structural Problems Activities of Daily Living self performance Activities of Daily Living (ADL) support provided Test for balance Limitation for Range of Motion Modes of locomotion Modes of transfer Task Segmentation Rehabilitation potential Change in ADL function

22. 22 Geriatric Depression Scale Subjective Questions: (Examples listed)  Are you basically satisfied with life?  Do you feel that your life is empty?  Do you often get bored?  Are you hopeful about the future?  Do you often feel helpless? Yes / No answers that may have a number score Numbers are totaled Totals are used to find where the patient is in a range, Normal, Mild or Severe Depression

23. 23 Braden Scale for Predicting Pressure Sore Risk Vertical Axis:  Sensory perception  Moisture  Activity  Mobility  Nutrition  Friction and Shear Horizontal Axis  Completely, constantly, bedfast, very poor, problem  Very limited (x2), Very moist, chairfast, very probably inadequate, potential problem  Slightly limited (x2), occasionally moist, walks occasionally, adequate, no apparent problem  No impairment

24. 24 Numeric Rating Scale for Pain

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26. 26 Standards for Technical Use IHE Integration Profiles (XDS-MS) Continuity of Care Record (CCR) Continuity of Care Document (CCD) Clinical Document Architecture (CDA) HL7 Care Record Summary Logical Observation Identifiers Names and Codes (LOINC) Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT) BPPH consents In context of Continuity of Care Document, the functional status is the patient’s status at the time the document was created. Medical Summary or XPHR Extract will contain FSA if available.

27. 27 Advancing the Agenda for Patient Care Understand and embrace this initiative Get involved with Profile development Respond to public comment opportunities Attend educational workshops Attend the HIMSS08 Interoperability Showcase Include IHE Integration Profiles in your RFP’s Participate in IHE Committees

28. 28 How YOU can participate IHE Needs Nurses! Even if you could participate part of the time, IHE would be HAPPY! Please contact:  Joyce Sensmeier jsensmeier@himss.org jsensmeier@himss.org  Audrey Dickerson adickerson@himss.org adickerson@himss.org  Marcia Veenstra marciaveenstra@cpmrc.com marciaveenstra@cpmrc.com

29. September, 2005What IHE Delivers 29 Questions ??