1. HIMSS 20051 Interoperability in the Real World, Testing, Success Stories and International Didi Davis, Eclipsys Glen Marshall, Siemens IHE IT Planning Committee Co-Chairs

2. HIMSS 20052 W W W. I H E. N E T Providers and Vendors Working Together to Deliver Interoperable Health Information Systems in the Enterprise and across Care Settings

3. HIMSS 20053 Standards Alone Are Not Enough Standards offer generality, ambiguity and alternatives. We need to manage domain boundaries, with mapping of information flow across those boundaries. Vendors always have proprietary interests. The result: Complexity!! We need uniform guidance for how to implement standards!

4. HIMSS 20054 Connecting Standards to Care Care providers must work with vendors to coordinate the implementation of standards to meet their needs –Care providers need to identify the key interoperability problems they face –Drive industry to develop and make available standards-based solutions –Implementers need to follow common guidelines in purchasing and integrating systems that deliver these solutions What is an effective way to establish uniform guidance for how to implement standards ?

5. HIMSS 20055 Need for a Standards Implementation Process Standards Demand ?Offer Standards Standards User Projects

6. HIMSS 20056 What is Integrating the Healthcare Enterprise ? IHE provides a common framework for passing health information seamlessly: –within the healthcare enterprise –across multiple healthcare enterprises –for local, regional & national health information networks. IHE is sponsored by healthcare professional associations (ACC, HIMSS, RSNA, etc.). IHE drives standards adoption to address specific clinical needs.

7. HIMSS 20057 IHE Maturity and Acceptance More than 100 healthcare vendors worldwide have contributed to IHE and the delivery of ready-to-integrate products to benefit healthcare enterprises of all sizes. IT professionals & clinicians appreciate IHE’s positive impact now expanded to address: –radiology, cardiology, laboratory –enterprise healthcare IT infrastructures –cross-enterprise healthcare IT infrastructures

8. HIMSS 20058 Understanding the IHE Initiative IHE has a clear focus IHE is a healthcare domain-based initiative IHE creates synergies for interoperability testing across domains IHE addresses the standards adoption process IHE is both regional and multi-national IHE is both user led and vendor driven

9. HIMSS 20059 A Proven Standards Adoption Process IHE Integration Profiles B IHE Integration Profile A Easy to Integrate Products IHE Connect-a-thon Product With IHE IHE Demonstration User Site RFP Standards Standards Standards IHE Technical Framework Product IHE Integration Statement IHE Integration Profiles at the heart of IHE : –Detailed selection of standards and options each solving a specific integration problem –A growing set of effective provider/vendor agreed solutions –Vendors can implement with ROI –Providers can deploy with stability IHE Connect-a-thon Results

10. HIMSS 200510 IHE Drives Healthcare Standards-based Integration IHE Integration Profile: A well-defined and tested solution to a specific information exchange problem

11. HIMSS 200511 Achievements and expanding scope Over 100 vendors involved world-wide, 4 Technical Frameworks 27 Integration Profiles, Testing at yearly Connectathons, Demonstrations at major exhibitions world-wide To claim compliance to IHE Integration Profiles vendors shall publish for each product an IHE Integration Statement.

12. HIMSS 200512 **HIMSS web-based survey in November 2004 – 163 participants IHE Survey Results –92% of respondents were aware of IHE –Potential benefits of IHE  Improved clinical workflow + access of data = 63% –Benefits of IHE products  Reduce deployment costs = 56%

13. HIMSS 200513 IHE: Domain-based for a stepwise approach Cardiology Labora- tory Pharmacy,….. Radiology Patient Identifier Linkage, Registries, Security Electronic Health Record Other (e.g. Access Control, eHealthWorkflows) Patient Management Order Management

14. HIMSS 200514 IHE Organizational Structure Multi-Domain & Multi-National Participants contribute Global Development: Radiology, IT Infrastructure, Cardiology, Lab, etc. Delegates IHE Europe IHE North America IHE Asia/Oceania Regional & National Deployment supervises reports IHE (International) Strategic Development Committee Sponsors Co-Chairs Global Interoperability IHE Domain-related Planning Committee and Technical Committee National Extensions

15. HIMSS 200515 IHE Process Users identify desired functionality that require coordination and communication among multiple systems –E.g., departmental workflow, single sign-on, sharing of documents Find and document standards-based transactions among systems to achieve desired functionality –Apply necessary constraints to eliminate useless wiggle room Provide process and tools to encourage vendors to implement –MESA software test tools + Connect-a-thon interoperability testing event Provide tools and education to help users acquire and integrate systems using these solutions –Connect-a-thon results, public demo & Vendor Integration statements

16. HIMSS 200516 IHE Process – 20 month yearly cycle Development and Deployment - 10 --- - 7 --- - 2 --- 0 --- Public Comment Intgr-profile Trial Implementation Intgr-profile Sponsors announce Connectathon/Demos with set of Implementation Profiles + 2 --- + 5 --- + 6 --- Vendor Participant Registered Vendor Participants pass Connectathon + 9 --- Demo & Education Material Final Integration profile --- Vendors release products with IHE Integration Statements Approved Supplement Scope Proposed Supplement Scope

17. HIMSS 200517 What IHE is NOT! A standards development organization –Uses established standards (HL7, DICOM, others) to address specific clinical needs –Activity complementary to SDOs, formal relationship with HL7, ISO, DICOM, NCCLS, etc. Simply a demonstration project –Demos, only one means to the end—adoption –Backed up by documentation, tools, testing, and publication of information

18. HIMSS 200518 Continuity & Integrity of Patient Information Improved Patient Safety Through Ubiquitous Access to Data Clinical Workflow Optimization Avoidance of Repeating Tasks Reduction of Data Redundancy Enterprise-wide Healthcare Needs Addressed by IHE Improving the Patient Care Process

19. HIMSS 200519 IHE IT Infrastructure Profiles Level / Function WorkstationIntra- enterprise Cross- enterprise Security, Directories EUA (single sign-on) ATNA, CT (log & sec. Nodes, date/time) PWP (personnel directory) Patient Identity PSA (patient synch.) PDQ (patient query) PIX (cross- referencing Ids) EHR RID (document access) XDS (documents sharing)

20. HIMSS 200520 Key IHE Concepts Generalized Systems -> Actors Interactions between Actors -> Transactions Problem/Solution Scenarios-> Integration Profiles For each Integration Profile: the context is described (which real-world problem) the actors are defined (what systems are involved) the transactions are defined (what must they do)

21. HIMSS 200521 The Product World….. Product XYZ from Vendor T

22. HIMSS 200522 The IHE World…. IHE Actor Actor Actor Actor IHE Transaction IHE Actor

23. HIMSS 200523 Mapping IHE to Products Product XYZ from Vendor T IHE Actor Actor Actor Actor IHE Transaction IHE Actor

24. HIMSS 200524 IHE Connectathon Open invitation to all implementers Advanced testing tools (MESA) Testing organized and supervised by project management team Thousands of cross-vendor tests performed Results recorded and published

25. HIMSS 200525 Massive yearly events : 40-50 vendors >300 engineers >100 systems ….integrated in 5 days IHE Connectathons Vendors do not pass… until an IHE Project Manager attest it !

26. HIMSS 200526 Integration Statements

27. HIMSS 200527 Leveraging IHE Integration Statements Vendors –Claim IHE Compliance in an explicit way –Can rely on an objective and thorough specification (IHE Technical Framework) –Willing to accept contractual commitments –Willing to correct “implementation errors” Buyers –Can compare product integration capabilities –Simplify and strengthen their RFPs –Can leverage a public and objective commitment –Decreased cost and complexity of interface deployment and management

28. HIMSS 200528 Participating and Contributing Vendors America Agfa HealthCare Algotec Systems, Ltd. Berdy Camtronics Canon Medical Systems Carefx Cedara Software Corporation Cerner Corporation CSIST Dictaphone DR Systems Dynamic Imaging Eastern Informatics Eastman Kodak Company Emageon Eclipsys Fujifilm Medical Systems Procom Philips Medical Systems RASNA Imaging Systems Sectra Sentillion Siemens Medical Solutions Softmedical Stentor, Inc StorCOMM, Inc Swissray International, Inc Tiani Medgraph AG Toshiba America Medical Systems UltraVisual Medical Systems Vital Images, Inc. Voxar Limited WebMD XIMIS GE Healthcare Heartlab Hitachi Medical Corporation Hologic, Inc IDX Systems Corporation IMCO Technologies InSiteOne INFINITT Konica Minolta Marotech, Inc. McKesson Information Solutions Medcon Medical Manager Health Systems Mediface Co., Ltd. Merge eFilm Mortara In white, companies with IHE Committees Chairs (Summer 2004)

29. HIMSS 200529 Participating and Contributing Vendors Europe AGFA Healthcare AISoftw@re Medical Solutions Algotec ARES SA aycan Digitalsysteme ConVis DEDALUS Dianoema Eastman Kodak Company Ebit Sanita EDL ELFIN s.r.l. Engineering Sanità Enti Locali ESAOTE ETIAM Ferrania Fujifilm GE Healthcare GMD GIE Convergence-Profils Rogan-Delft Sago spa Sectra Imtec AB Siemens Medical Solutions Soluzioni Informatiche srl Stentor Inc. Swissray Medical AG Symphonie On Line Synapsis TELEMIS S.A. TIANI MEDGRAPH AG TOREX GAP Medical Toshiba Medical Systems TSI groupe europMedica VEPRO AG VISUS Technology Transfer WAID XR PARTNER GWI Research IASI Srl IdeoPass Image Device-Cerner Company INFINITT INOVIT McKesson MED2RAD MEDASYS SA Medavis Medigration GmbH MEDIMON Ltd. MEDOS AG Merge eFilm METAFORA Konica Minolta Europe Omnilab Philips Medical Systems Rasna Imaging Systems RAYPAX INC. In white, companies with IHE Committees Chairs (Summer 2004)

30. HIMSS 200530 Participating and Contributing Vendors Asia Japan AGFA Gevaert Japan EBM Japan INFINITT Japan A&T Canon Goodman Climb Medical Systems Konica Minolta MG Shimadzu SONY Toshiba Medical Systems Toyo Technica Nihon Kohden Olympus NEC Pioneer (Marotech) Hitachi Hitachi Medico Fujitsu Fuji Film Medical Yokogawa Taiwan INFINITT Shing Shian INQ GEN TEP Tah Ya Korea AGFA Korea GE Healthcare Korea INFINITT LG CNS Marotech, Inc. Medical Standard Peoplenet Communications Samsung SDS

31. HIMSS 200531 Bethesda Healthcare Systems Cleveland Clinic Foundation Detroit Medical Center Grossman Imaging Centers Hôpitaux Universitaires de Genève Johannes Gutenberg University Hospital Klinikum Nürnberg, Magic Valley Regional Medical Center Mayo Clinic Jacksonville McKay-Dee Hospital MeritCare Medical System Montefiore Medical Center Our Lady Of The Lake Regional Medical Center (OLOL) US Dept. of Veterans Affairs VA Puget Sound Health Care System St. Vincent Hospital and Health Services Sinlau Hospital Staedtisches Klinikum Goerlitz Steinberg Diagnostic Medical University of Pisa University of Wisconsin Warren Hospital IHE Success Stories highlighting benefits

32. HIMSS 200532 IHE Radiology Integration Profiles Patient Info. Recon- ciliation Access to Radiology Information Consistent Present- ation of Images Basic Security - Evidence Docs Key Image Notes Simple Image & Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled Workflow Portable Data for Imaging NM Image New Extensions New

33. HIMSS 200533 Laboratory IHE Integration Profiles In Process –TI Nov 2004 Laboratory Device Automation (LDA) In Process –TI Nov 2004 Pre-analytic process, analysis and post-analytical treatment Laboratory Scheduled Workflow (LSWF) Completed in 2003 Tests performed by a laboratory for an identified inpatient or outpatient In Process Laboratory Patient Information Reconciliation (LPIR) In Process Tests performed on an unidentified or misidentified patient In Process Laboratory Code Set Distribution (LCSD) In Process Sharing the batteries and tests code sets throughout the enterprise In Process –TI Nov 2004 Laboratory Point Of Care Testing (LPOCT) In Process –TI Nov 2004 Tests performed on point of care or patient’s bedside In Dev.

34. HIMSS 200534 IHE Cardiology 2004-2005 Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user EchoCardiography Worklflow Admit, order, schedule, acquire images, notify of completed steps, on fixed and mobile stress echo modalities. Cardiac Catheterization Workflow Scheduled & unscheduled acquisition and management of cathlab information, notification of completed steps. Provide high-quality ECG and related reports to the enterprise and outside in a ready-to-display format Retrieve ECG for Display New

35. HIMSS 200535 IHE IT Infrastructure 2004-2005 Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications 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. New Patient Demographics Query New Personnel White Page Access to workforce contact information New Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record New

36. HIMSS 200536 IHE Profiles for RHIOs What is available and what will be added in 2005 Patient Identifier Cross-referencing Map patient identifiers across independent identification domains 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. Patient Demographics Query Personnel White Page Access to workforce contact information Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Notification of Document Availability Notification of a remote provider/ health enterprise Cross-enterprise User Identity and Accountability Authentication & Auditing: Basis for Access Control Imaging Information Content Format of the Document Content and associated coded vocabulary For Display Document Content Format of the Document Content Lab Results Document Content Format of the Document Content and associated coded vocabulary Continuity of Care Document Content Format of the Document Content and associated coded vocabulary

37. HIMSS 200537 Local & Regional RHIOs Infrastructure and Interoperability Cross-Enterprise Document Sharing (XDS) minimizes clinical data management by the infrastructure. Transparency = Ease of Evolution XDS works with other IHE Integration Profiles: –Audit Trail and Node Authentication (ATNA) and Consistent Time (CT) –Patient Id Cross-referencing (PIX) –Patient Demographics Query (PDQ) In 2005, IHE plans to finish base set of integration profiles to build regional health networks and interoperable EHRs: –Security: Identity Management+ Accountability –Content Profiles: DICOM, HL7-CDA-R2/CCR, HL7-Lab, PDF. –Notification of Document Availability (with XDS document reference)

38. HIMSS 200538 IHE: RHIOs’ Interoperability Partner IHE offers a solid technical foundation to establish interoperability for RHIOs. Standards-based, open, multi-vendor, provider-led. Yearly progress, validation testing built in, backed by a proven process. Implementation by many vendors. RHIOs’ technical architects’ needs direct IHE involvement. Policies easier to establish when based on solid IHE Technical Framework, but are beyond IHE’s scope. They remains RHIOs’ responsibility.

39. HIMSS 200539 HIMSS “RHIO” with IHE-XDS Cross-enterprise doc sharing Experience your HIMSS-Wide Electronic Health Record Ambulatory Showcase Booth Home PCP Multispecialty Clinic Diag Center Cross-enterprise Showcase Booth Cardiology Workup Comprehensive Patient Care Radiology Coordinated Patient Evaluation IT Infrastructure Vendor Booth HL7 Demonstration 15 Vendor Booths

40. HIMSS 200540 W W W. I H E. N E T Thank You Questions ?

41. HIMSS 200541 W W W. I H E. N E T Providers and Vendors Working Together to Deliver Interoperable Health Information Systems in the Enterprise and across Care Settings