Integrating the Healthcare Enterprise

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Integrating the Healthcare Enterprise

• Process and Influence on Radiology and Clinical
  Workflow

Charles Parisot, GE Healthcare IHE IT
Infrastructure Technical Committee Co-chair IHE
and EHR Seminar Helsinki, November 11, 2004
2
Agenda

• IHE Goals, Organization and Deliverables
• IHE Integration Profiles and Influence on
  Clinical Workflow

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Goals of IHE

• Speed up the rate and quality of integration in
  healthcare environments
• Foster communication among vendors and care
  providers
• Prove that integration is attainable based on
  standards
• Improve the efficiency and effectiveness of
  clinical practice
• Improve interoperability among care domains and
  build foundation for the EHR
• Integration solutions within the healthcare
  enterprise and across healthcare enterprises

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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 lead and vendor driven

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IHE Domain-based for a stepwise approach
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IHE 2004 Four Active Domains
4 Technical Frameworks with 31 Integration
Profiles Testing at yearly Connectathons in three
continents Demonstrations at major conferences
world-wide
Provider-Vendor cooperation to accelerate
standards adoption
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A Proven Standards Adoption Process
IHETechnicalFramework
User Site

• 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

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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 and public demonstrations
• Integration statements

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IHE Contributors Participants

• Societies Representing Healthcare Segments
• RSNA, HIMSS, ACC, CAR, CHI, ACCE, Many Other
  Professional Societies
• Any Healthcare Stakeholder Organization
• Users
• Clinicians, Medical Staff, Administrators, CIOs,
  
• Information Systems Equipment (e.g. imaging)
  Vendors
• Consultants
• In addition, active liaison with Standards
  Development Organizations (SDOs)
• HL7, DICOM, NCCLS, ASTM, ISO, others

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IHE Organizational Structure
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Organization of the IHE Initiative

• IHE distributes its operations between a
  regional/national level and an international
  level
• IHE is not a standards development organization
• IHE operates on overlapping yearly cycle
• IHE leverages dependencies and complementary
  interests between stakeholders
• IHE is an open and flexible organization

A novel approach to meet these challenges
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IHE Process

• Users and vendors work together to identify and
  design solutions for integration problems
• Intensive process with annual cycles
• Identify key healthcare workflows and integration
  problems
• Research select standards to specify a solution
• Write, review and publish IHE Technical Framework
• Perform cross-testing at Connectathon
• Demonstrations at tradeshows (HIMSS/RSNA)

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IHE Domains Milestones 20 month
cycleDevelopment and Deployment

• Proposed Supplement Scope

- 10 ---
Approved Supplement Scope
- 7 ---
Public Comment of Supplements
Sponsors announce Connectathon/Demos with set of
Implementation Profiles
- 2 ---
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How to participate to IHE?

• As a User or Vendor Contributor
• Become a member of relevant Domains Planning or
  Technical Committees
• Become a member of relevant Regional/National
  Committees
• As a Vendor Participant
• Respond to Public Comments of Domain Supplements
• Attend Yearly IHE Regional Educational/Workshops
• Participate to Regional Connect-a-thons and
  Demonstrations
• As a User/Consultant Participant
• Respond to Public Comments of Domain Supplements
• Attend Yearly Regional Educational/Workshops
• Attend Demonstrations and include IHE Integration
  Profiles in your RFPs and Integration Projects.

IHE Canada, your entry point
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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 endadoption
• Backed up by documentation, tools, testing, and
  publication of information

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Benefits to IHE Participants

• Clinicians
• Improved workflow
• Information when and where needed
• Fewer opportunities for errors
• Fewer tedious tasks/repeated work
• Administrators
• Improved efficiency
• Best of breed opportunities
• Decreased cost and complexity of interface
  deployment and management

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Benefits to IHE Participants

• Vendors
• Align product interoperability with industry
  consensus
• Decreased cost and complexity of interface
  installation and management
• Focus competition on functionality/service space
  not information transport space
• SDOs
• Rapid feedback to adjust standards to real-world
• Establishment of critical mass and widespread
  adoption

Plus, IHE meets fixed deadlines
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IHE Technical Frameworks
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Key IHE Concepts

• Generalized Systems -gt Actors
• Interactions between Actors -gt Transactions
• Problem/Solution Scenarios -gt 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)

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Key concept Integration Profile
Solves an Integration Problem A collection of
real world information exchange capabilities
supported by a set of specific Actors using
Standards-based Transactions

• Examples 
• Enterprise User Authentication
• Retrieve Information for Display
• Laboratory Scheduled Workflow
• Echo Laboratory Workflow
• Cross-Enterprise Document Sharing

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IHE Connectathon

• Open invitation to vendor community
• Advanced testing tools (MESA)
• Testing organized and supervised by project
  management team
• Thousands of cross-vendor tests performed
• Results recorded and published

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IHE Connectathons
Massive yearly events 40-50 vendors 120-160
engineers 70-80 systems .integrated in 5 days
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(No Transcript)
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Integration Statements
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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

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Participating and Contributing Vendors (America)
Novell Opentext Procom Philips Medical
Systems RASNA Imaging Systems Sectra Sentillion Si
emens Medical Solutions Softmedical Stentor,
Inc StorCOMM, Inc Swissray International,
Inc Tiani Medgraph AG Toshiba America Medical
Sys. UltraVisual Medical Systems Vital Images,
Inc. Voxar Limited WebMD XIMIS
Hitachi Medical Corporation Hologic, Inc IDX
Systems Corporation IMCO Technologies InSiteOne IN
FINITT Intersystems Konica Minolta Marotech,
Inc. McKesson Information Soln. Medcon MedCommons
Medical Manager Health Sys. Mediface Co.,
Ltd. MediNotes Merge eFilm MidMark Misys Mortara N
extGen

• Agfa HealthCare
• Allscripts
• Algotec Systems, Ltd.
• Berdy
• Camtronics
• Canon Medical Systems
• CapMed
• Carefx
• Cedara Software Corp.
• Cerner Corporation
• CSIST
• Dictaphone
• DR Systems
• Dynamic Imaging
• Eastern Informatics
• Eastman Kodak Company
• Emageon
• Eclipsys
• EPIC

In yellow, companies with IHE Committees Chairs
(Summer 2004)
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Participating and Contributing Vendors (Europe)
AGFA Healthcare AISoftw_at_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
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.
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
In yellow, companies with IHE Committees Chairs
(Summer 2004)
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Participating and Contributing Vendors (Asia)
Japan AGFA Gevaert Japan EBM Japan INFINITT
Japan AT Canon Goodman Climb Medical
Systems Konica Minolta MG Shimadzu SONY Toshiba
Medical Systems Toyo Technica Nihon
Kohden Olympus NEC Pioneer (Marotech) Hitachi Hita
chi 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
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IHE approach to standards

• IHE, starts from user defined needs and
  priorities in a domain
• Then selects the standards that
• Best address the problem
• Have the broadest practical acceptance
  (world-wide)
• Are Technically stable
• Offer potential reuse/integration with other
  existing or future integration profiles.

Problem effectiveness drives standards
selection ? On-going dialogue with HL7, ISO
TC215, DICOM, OASIS, IETF, etc.
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Healthcare Needs Addressedby the IHE Initiative

• Continuity Integrity of Patient Information
• Clinical Workflow Optimization
• Foster Communication Among Diverse Medical
  Information Systems
• Avoid Repeating Tasks
• Eliminate Data Redundancy

Improving the Patient Care Process
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Agenda

• IHE Goals, Organization and Deliverables
• IHE Integration Profiles and Influence on
  Clinical Workflow

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IHE Radiology Integration Profiles


Scheduled Workflow

-
Patient Info. Recon-ciliation
Post-Processing Workflow
Basic Security


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Example IHE Rad Scheduled Workflow
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IHE Scheduled Workflow
RIS
PACS Archive

• A Closed Loop
• Update IS Scheduling
• Match Procedure with Order
• Support Billing Based on MPPS
• Avoid Reading incomplete Procedures

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IHE Workflow Concepts
IHE identifies four fundemental workflow
information units
ORDER A request for radiologic
service
REQUESTED PROCEDURE A Unit of Reporting
Work with associated codified, billable acts

• Procedure Steps The smallest unit of work in
  the workflow SCHEDULED PROCEDURE STEP A
  unit of work to do PERFORMED PROCEDURE STEP
  A unit of work done

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Multiple Modality Steps
Radiology Department
ORDER A request for RadiologicService
Set of Codifiable, Billable, Acts
Requested Procedure 1
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IHE Presentation of Grouped Procedures
Requested ProcedureCHEST
Requested ProcedureABDOMEN
RIS / PACS
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Laboratory IHE Integration Profiles
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IHE Cardiology 2004-2005
New
Retrieve ECG for Display
Provide high-quality ECG and related reports to
the enterprise and outside in a ready-to-display
format
New
Cardiac Catheterization Workflow
New
Scheduled unscheduled acquisition and
management of cathlab information, notification
of completed steps.
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IHE IT Infrastructure 2004-2005
Patient Synchronized Applications
Synchronize multiple applications on a desktop to
the same patient
Patient Identifier Cross-referencing for MPI
Patient Identifier Cross-referencing for MPI
Map patient identifiers across independent
identification domains
Map patient identifiers across independent
identification domains
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Introduction EHR Cross-Enterprise Document
Sharing
First step towards the longitudinal dimension of
the EHR Focus Support document sharing
between EHRs in different care settings and
organizations
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Sharing and accessing Documents
Documents Registry
EHR-LRLongitudinal Recordas usedacross-encount
ers
Long Term Care
Acute Care (Inpatient)
Other Specialized Careor Diagnostics Services
PCPs and Clinics (Ambulatory)
EHR-CR Care Record systemssupporting care
delivery
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Standards selection for IHE XDS No single
standard can addressCross-enterprise Document
Sharing
Internet Standards HTML, HTTP,ISO, PDF, JPEG,
etc.
Electronic BusinessStandards ebXML Registry,
SOAP, etc.
HealthcareContent Standards HL7 CDA, CEN
EHRcomASTM CCRDICOM, etc.
Marriage of healthcare and IT standards
facilitates implementation and leverages
complementary technologies (e.g. security
privacy).
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Workshops and Connect-a-thon

• IHE Workshops
• September 13-15 2004 North America
• February 7-10 2005 Europe
• 2005 IHE Connect-a-thons
• January 17-21 North America
• February Japan
• April 25-29 Europe (week before HL7 in NL)
• To Be Announced Taiwan and Korea.

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HIMSS 2005 Interoperability Showcase

• HIMSS leverages its sponsorship of IHE to
  demonstrate practical interoperability in two
  large Showcase Exhibits
• cross-enterprise sharing of health information in
  the acute care (18 vendors) and ambulatory (14
  vendors).
• HIMSS Showcase exhibits linked with vendor booths
  (10 vendors) show-wide.
• Show-wide interactive environment demonstrating
  attendees patient record in a HIMSS RHIO.
  Uses IHE Cross-enterprise Document Sharing
• Around a central document registry
• Distributed document repositories
• 17 EHR that publish/share documents (CCR, CDA,
  HL7-lab, PDF)

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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)
• Patient Id Cross-referencing (PIX)
• Patient Demographics Query (PDQ)
• In 2005, IHE plans to complement a set of
  integration profiles to build regional Health
  networks, candidates
• Security Identity Management Info for Access
  Control
• Content Profiles DICOM, HL7-CDA, HL7-Lab, PDF
  (legacy)
• Provider Notification (with doc reference) and
  Point-to-point Transfer
• Dynamic Clinical Data Mgt (Allergy lists, Problem
  Lists)
• ? Prioritization of Candidate Integration
  Profiles November-December 2004. Technical
  development January-July 2005. Open to all.

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IHE, the effective bridgebetween information
exchange standards and their practical usein
healthcare
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IHE today, more info.
IHE Europe ? IHEEurope.org

• IHE Radiology ? www.rsna.org/ihe TF RAD
  V5.5 4 Trial Impl. Supplements
• IHE IT Infrastructure ? www.himss.org/ihe TF
  ITI V1.1 4 Trial Impl. Supplements
• IHE Laboratory ? www. himss.org/ihe TF LAB
  V1.0
• IHE Cardiology ? www.acc.org/quality/ihe.htmT
  F CARD V1.0 for Trial Implementation