Implementing IHE in Regional Health Information Networks

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Implementing IHE in Regional Health Information
Networks

• IHE Europe 2006 - Changing the Way Healthcare
  Connects
• IHE Presentation at the World of Health IT show,
• October 2006
• Alexander Ihls, Stakeholder PCC, IHE Germany

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Actors in Regional Healtcare

• General Practitioners (GPs)
• Family Doctors
• Medical Specialist
• Hospitals
• Emergency Department (ED)
• Inpatient care, surgeries
• Homecare
• Patient self-care
• Nurses

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IHE Domains

• Cardiology
• Eye Care
• IT Infrastructure
• e.g. Cross-Enterprise Document Sharing (XDS)
• Laboratory
• Patient Care Coordination
• Patient Care Devices
• Radiology
• Mammography
• Nuclear Medicine

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Patient Care Coordination

• The Patient Care Coordination (PCC) domain was
  established in July 2005 to deal with integration
  issues that cross providers, patient problems or
  time.

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Profile Roadmap

• Year 2005-2006 (Trial Implementation)
• Medical Summary MS Acute Care Discharge to
  PCP, PCP Referral to Specialist
• Unstructured Document CDA-wrapped PDF
• Year 2006-2007 (Development Testing)
• Medical Summary MS ED Referral EDR
• Pre-procedure HP PPHP
• Basic Patient Privacy Consents BPPC
• Exchange Personal Health Record XPHR
• Coordination with Laboratory Domain XDS-LAB
  
• Future (Profile Document / White Paper)
  
• Medical Summary MS Discharge to LTC
• Forms Display for Data Capture (e.g. clinical
  research)

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PCC Profiles
PCC Domain
Medical Summary XDS-MS
Exchange of Patient Health Record Data (XPHR)
Basic Patient Privacy Consent (BPPC)
Emergency Department Referral (EDR)
Preprocedural History and Physical (PPHP)
Sharing Laboratory Reports (XDS-LAB)
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Medical Summary Profiles
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Abstract

• Define a medical summary format for clinical
  documents containing at a minimum
• Problems
• Allergies
• Medications
• Pointers to other material

Medical Summaries
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Value Proposition

• Leverage Clinical Documents ontology
• A common mechanism for transfer of encoded
  clinical data embedded in documents
• Basis for ongoing harmonization of CCR/CCD
• Enhances Clinical Documents criteria for key use
  cases
• Inpatient to Primary Care Provider
• Primary Care Provider to Specialist
• To be enhanced in future years to support
• Home Care
• Long Term Care

Medical Summaries
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Key Technical Properties

• Document Transfer (Integration Profile)
• XDS/XDP for document sharing.
• NAV for notification.
• XDS Folders to support organization.
• XDS Submission Sets to support packaging.
• Identification of Master document or Manifest
• Document Content (Content Profile)
• CDA Release 2.0
• Care Record Summaries Implementation Guide

Medical Summaries
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PCC Profiles
PCC Domain
Medical Summary XDS-MS
Exchange of Patient Health Record Data (XPHR)
Basic Patient Privacy Consent (BPPC)
Preprocedural History and Physical (PPHP)
Emergency Department Referral (EDR)
Sharing Laboratory Reports (XDS-LAB)
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Use Case

• Health care provider determines that a patient
  needs to go to the ED
• Provider creates an ED referral package using his
  or her EHR
• Upon arrival, the ED provider identifies the
  patient as a referral
• The posted referral package is imported into the
  Emergency Department Information System (EDIS)

Provide access to critical health information
in ED information systems in a standard manner\
ED Referral
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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

ED Referral
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Scope

• EHR system capable of creating a care record
  summary would be capable of creating a referral
  package for a receiving system
• The emergency department information systems
  (EDIS) will need to retrieve and read and display
  this data.

ED Referral
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PCC Profiles
PCC Domain
Medical Summary XDS-MS
Exchange of Patient Health Record Data (XPHR)
Basic Patient Privacy Consent (BPPC)
Emergency Department Referral (EDR)
Preprocedural History and Physical (PPHP)
Sharing Laboratory Reports (XDS-LAB)
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Abstract

• The Basic Patient Privacy Consents (BPPC) profile
  provide mechanisms to
• Record the patient privacy consent(s),
• Mark documents published to XDS with the patient
  privacy consent that was used to authorize the
  publication,
• Enforce the privacy consent appropriate to the
  use.

Basic Patient Privacy Consents
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Scope

• Document Sources and Document Consumers in an XDS
  Affinity Domain
• Document Sources and Document Receivers using
  Cross Enterprise Point-to-Point Document Sharing

Basic Patient Privacy Consents
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Value Proposition

• An Affinity Domain can
• develop privacy policies,
• and implement them with role-based or other
  access control mechanisms supported by EHR
  systems.
• A patient can
• Be made aware of an institutions privacy
  policies.
• Have an opportunity to selectively control access
  to their healthcare information.

Basic Patient Privacy Consents
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Key Technical Properties

• Human Readable Consents
• Machine Processable
• Support for standards-based Role-Based Access
  Control

Basic Patient Privacy Consents
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Standards and Profiles Used

• CDA Release 2.0
• XDS Scanned Documents
• Document Digital Signature
• Cross Enterprise Document Sharing
• Cross Enterprise Point-to-Point Document Sharing

Basic Patient Privacy Consents
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PCC Profiles
PCC Domain
Medical Summary XDS-MS
Exchange of Patient Health Record Data (XPHR)
Basic Patient Privacy Consent (BPPC)
Emergency Department Referral (EDR)
Preprocedural History and Physical (PPHP)
Sharing Laboratory Reports (XDS-LAB)
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Use Case

• HP documentation required prior to procedure
  that is designed to assess
• Procedure Risk
• Anesthesia Risk
• Factors influencing procedure after-care
  decisions
• Desired outcomes
• Minimize injury during procedure
• Optimize procedure after-care

Pre-procedure HP
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Scope

• To identify the required and optional PPHP
  document content templates including
• CDA Document Header
• CDA Document Type(s)
• CDA Section Types
• CDA Entry Types

Pre-procedure HP
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Value Proposition

• A procedure risk assessment must be present and
  evaluated by the operative and after-care teams
  before the patient is allowed to have the
  procedure. Missing information is frequently a
  reason for canceling the procedure for the day,
  which leads to expensive underutilization of
  resources and dissatisfied patients. Further,
  incomplete information about the patients
  clinical or home status may create a situation
  where a procedure is performed that ultimately
  results in an injury, inadequate aftercare or
  other undesirable outcome.

Pre-procedure HP
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Key Technical Properties

• PPHP Profile inherits specifications required for
  other IHE PCC Medical Documents
• PPHP Profile follows documentation practices for
  all IHE PCC Medical Documents
• PPHP Profile emphasizes re-usability of CDA
  template identifiers in order to reduce
  un-necessary variability in IHE Content Profiles

Pre-procedure HP
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Standards Used

• IHE Medical Document Content Profiles
• HL7 Reference Information Model ANSI Standard
• HL7 CDA R2 ANSI Standard
• HL7 Care Provision Domain DSTU (in process)
• Implementation Guides
• HL7 Care Record Summary CDA R2 Implementation
  Guide (in process)
• HL7/ASTM Continuity of Care Document
  Implementation Guide (in process)

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PCC Profiles
PCC Domain
Medical Summary XDS-MS
Exchange of Patient Health Record Data (XPHR)
Basic Patient Privacy Consent (BPPC)
Emergency Department Referral (EDR)
Preprocedural History and Physical (PPHP)
Sharing Laboratory Reports (XDS-LAB)
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Abstract

• The Exchange of Personal Health Record Content
  (XPHR) 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.

Exchange of PHR Content
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Scope

• Personal Health Record (PHR) Systems
• Electronic Health Record (EHR) Systems

Exchange of PHR Content
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Value Proposition

• Supports interchange of PHR Information
• Demographics
• Insurance Information
• Medications, Problems, Allergies
• Health History
• Other Information

Exchange of PHR Content
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Standards Used

• CDA Release 2.0
• ASTM Continuity of Care (CCR) Data Set
• ASTM/HL7 Continuity of Care Document (CCD)
• HL7 Care Record Summary
• AHIMA PHR Common Data Elements
• XDS, XDP
• Document Digital Signature

Exchange of PHR Content
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Key Technical Properties

• Information is Human Readable
• and Machine Processable
• Support Static and Dynamic Information Sharing
  Domains (XDS and XDP)
• Protects Information using Digital Signature
• Update Model for EHR to PHR Changes

Exchange of PHR Content
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PCC Profiles
PCC Domain
Medical Summary XDS-MS
Exchange of Patient Health Record Data (XPHR)
Basic Patient Privacy Consent (BPPC)
Emergency Department Referral (EDR)
Preprocedural History and Physical (PPHP)
Sharing Laboratory Reports (XDS-LAB)
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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)

Sharing of Lab Reports
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Value Proposition

• Use case 1 Hospital lab report ? RHIO ? EHRs At
  discharge time, a hospital physician selects the
  most significant laboratory reports produced
  during patient stay, and issues these reports
  individually to a health information exchange
  (e.g. XDS Affinity Domain) shared by a number of
  healthcare enterprises and primary care
  providers.
• Use case 2 Ambulatory lab report ? RHIO ? PHRA
  private laboratory having signed a final report
  for a patient, sends this report in an electronic
  format to the patient record in the national EHR.
• Use case 3 Lab report ? PHRA physician reviews
  the results received from a reference laboratory
  for his patient. The doctor, as requested by the
  patient, sends this laboratory report in the
  patients personal health record in an electronic
  format.
• Use case 4 Lab report automatically shared ?
  RHIOA community or hospital laboratory,
  systematically (with some degree of automatism)
  shares its final reports with a regional
  healthcare network.
• Use case 5 Hospitals EHR Lab report ? RHIOAt
  discharge time of an inpatient, a hospital
  physician selects the most significant lab
  results, produced by one or more laboratories of
  the healthcare enterprise during patient stay,
  and builds a cumulative report sent to an health
  info exchange shared by a number of healthcare
  enterprises and primary care providers.

Sharing of Lab Reports
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Standards Used

• CDA Release 2.0
• ASTM/HL7 Continuity of Care Document (CCD)
• HL7 V3 Laboratory DMIM
• HL7 Care Record Summary
• LOINC SNOMED
• HIPAA Lab Claim Attachment NPRM
• IHE XDS (registry/repository) XDP (pt-pt)
• Document Digital Signature

Sharing of Lab Reports
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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 (e.g. ELINCS).
• Used both in sharing (XDS) pt-pt interchange
  (XDP)
• May protect Information using Digital Signature

Sharing of Lab Reports
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PCC Wrap-up
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PCC RoadMap

• Care Transfers
• Medical Summary 2005
• EDR, PPHP 2006
• Labs 2006-7
• Growth Charts
• Consumer Empowerment
• PHR 2006
• Consents 2006
• Provider Ordering
• Ambulatory Ordering 2006
• Medication Lists 2007
• Clinical Data Reuse
• Clinical Trials (RFD) 2006-7
• Biosurveillance 2007-8

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How to Get Involved?

• As a Provider or Vendor Contributor
• Offer Clinical Use Case Input to Drive IHE
  Profile Development
• Become a member of relevant domains Planning or
  Technical Committees
• Become a member of relevant Regional/National
  Committees
• Help to shape IHEs future direction
• As a Vendor Participant
• Respond to Public Comments of Domain Supplements
• Attend the Educational Workshops
• Participate in Connect-a-thons and Demonstrations
• As a Provider/Consultant Participant
• Respond to Public Comments of Domain Supplements
• Attend the Educational Workshops
• Attend Demonstrations and include IHE Integration
  Profiles in your RFPs and Integration Projects.

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More Information

• IHE Web Site - http//www.ihe-europe.net
• Technical Frameworks
• Technical Framework Supplements Trial
  Implementation
• Calls for Participation
• IHE Fact Sheet and FAQ
• IHE Integration Profiles Guidelines for Buyers
• IHE Connectathon Results
• Vendors Product Integration Statements
• Sponsors IHE sites
• http//www.himss.org/IHE
• http//www.rsna.org/IHE
• http//www.acc.org/quality/ihe.htm

Questions?