IHE Around the World

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IHE Around the World
EHRs and IHEOverview

• Chris Lindop
• GE Healthcare
• Radiology Committee Co-chair
• IHE Australia Board

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XDS in Europe
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Agenda

• IHE operations in Europe
• EU projects and IHE
• Notable EHR projects in Europe using IHE

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IHE-Europe

• Coordination and harmonisation of european
  national initiatives
• IHE national initiatives
• Aimed at deployment of IHE at national level
• Active national initiatives
• Austria, Denmark, Finland, France, Germany,
  Israel, Italy, Norway, Spain, Sweden, The
  Netherlands, United Kingdom
• New initiatives
• Switzerland and Turkey will kick off in 2010

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IHE-Europe

• Organisation and management of IHE CAT
• CAT 2009 held in Vienna, Austria
• 73 companies registered
• 230 engineers participated
• 94 systems, 27 of which registered for XDS
• XDS and XCA witnessed the most increase in
  systems
• CAT 2010 will be held in Bordeaux, France
• 10th anniversary connect-a-thon
• Venue will be the Cité Mondiale
• CAT 2011 will be held in Pisa, Italy

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Challenges

• Healthcare systems are under pressure
• Citizens expectations for high-quality care
• Demographic changes
• Increased prevalence of chronic diseases
• Shortage of Health Professionals
• Patient safety issues
• Rising healthcare costs, medical progress

Source EC
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Challenges

• Changes are needed in the way
• healthcare is delivered
• medical knowledge is managed and transferred in
  clinical practice
• EC vision for health
• ICT to support the paradigm shift
• From curative care? to preventive care?, from
  hospital-based? to patient-centred? throughout
  Europe
• by
• Using ICT to enable collaborative and
  personalised care
• Supporting dynamic healthcare systems
• Aiming at sustainability of healthcare systems
• Interoperability

Source EC
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Projects

• IHE Europe is involved in eHealth projects
• epSOS
• Calliope
• HITCH
• eHealth Interop Mandate 403
• Smart PHS
• Smart Personal Health Systems
• IHE Europe is contributing to the development of
  eHealth in Europe

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epSOS

• epSOS stands for
• European Patients Smart Open Services
• Europe-wide project
• 27 beneficiaries representing twelve EU-member
  states
• IHE
• Ministry of Health
• Germany, Denmark, Austria, The Netherlands,
  Spain, Sweden, UK, France
• Open eHealth initiative
• large scale European pilot of patient summary and
  electronic prescription
• www.epsos.eu

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epSOS

• The goal
• to develop a practical eHealth framework
• to develop ICT infrastructure
• Enabling
• secure access to patient health information
  between different european healthcare systems
• basic patient summaries
• ePrescriptions

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epSOS

• National entitities test services in pilot
  applications, which interconnect national
  solutions
• based on advanced and distinct use cases and
  associated infrastructural components
• Aims at delivering both a methodological process
  and durable implementations
• building blocks
• These building blocks will form the basis for a
  longer term, pan-european approach to develop
  interoperable service solutions

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Calliope

• Calliope stands for
• CALL for interOPErability
• Calliope is
• a network of collaborating organisations
• mandated with the planning and implementation of
  eHealth
• Calliope comprises
• 28 founding members including
• 17 organisations representing national
  governments and eHealth competence centres
• 11 EU-level stakeholder organisations of health
  professionals, patients, health insurers and
  industry

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Calliope

• Creating an open forum
• to support the implementation of interoperable
  eHealth infrastructures and services across
  Europe
• to build a unique cross-stakeholder platform
• aspiring to governing principles
• supported by a communication infrastructure and
  knowledge management tools
• to review and advance the EC interoperability
  recommendation
• to add value to eHealth standardisation
  initiatives
• to propose a European roadmap for eHealth
  interoperability
• www.calliope-network.eu/

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Mandate 403

• to provide a consistent set of standards to
  address the needs of the rapidly-evolving field
  of eHealth for the benefit of future healthcare
  provision
• three European Standards Organisations (ESOs),
  CEN, CENELEC and ETSI, accepted this mandate from
  the European Commission
• requires active collaboration with COCIR, EHTEL,
  ISO/TC 215, IHE, HL7, Eurorec, IHTSDO, GS1, IEEE,
  DICOM

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Mandate 403

• requirements driven and collaborative
• primary goal is not to develop new standards
• populate use cases with existing international
  standards when possible
• collaborate with standards fora, consortia and
  SDOs
• Reuse and encourage reuse

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Deployment

• IHE Europe is also active in sustaining
  deployment through IHE national initiatives
• stimulate regional projects at national level
• provide guidance if needed
• support communication if needed
• success stories

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EHR Experiences - UK

• PACS integration project in Wales
• the pilot phase involves 7 PACS in 4
  organisations around Cardiff
• phase 2 will include 10 more PACS in another 4
  organisations
• this includes PACS from 6 different vendors.
• the project will be providing
• integration WITHIN organisations (different PACS
  vendors)
• between organisations
• project will be based on XDS/XDS-I

Data courtesy of IHE-UK
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EHR Experiences - NL

• Friesland Regional Cardiogy Network
• Clinical setting
• Sharing cardiology-related data for transfer of
  patients (cardiac surgery)
• Data shared
• Cardiac images (multi-frame runs), ECGs, patient
  status
• Setting
• 5 hospitals one central site
• Benefits achieved
• Full availability of clinical data through XDS
  browser
• Import of data to local viewing environment

Data courtesy of Forcare/IHE-NL
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EHR Experiences - NL

• Connectivity network for breast cancer screening
• Clinical setting
• Sharing breast cancer screening results to
  hospitals forclinical follow-up
• Data shared
• Mammography images, reports
• Setting
• One central screening PACS (1m exams/year)
• 4 referral / retrieval rate
• 100 Dutch hospitals
• Benefits achieved
• Full availability of clinical data through XDS
  browser
• Import of data to local viewing environment

Data courtesy of Forcare/IHE-NL
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EHR Experiences - IT

• Health Optimum Veneto
• telemedicine project for different specialties
• phase 1
• duration
• 18 months May 2004 to January 2006
• purpose
• market validation of organizational models based
  on telemedicine services
• actors involved
• 11 healthcare Providers in Veneto Region
• 3 European Member States Italy (Veneto Region),
  Spain(Gobierno de Aragona), Denmark (County of
  Funen)

Data courtesy of Arsenal.it/IHE-I
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EHR Experiences - IT

• Health Optimum Veneto
• phase 2
• duration
• 24 months June 2007 to May 2009
• purpose
• deploying organizational models based on
  telemedicine services
• actors involved
• 23 healthcare Providers in Veneto Region
• 5 European Member States Italy, Spain, Denmark,
  Sweden

Data courtesy of Arsenal.it/IHE-I
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EHR Experiences - IT

• Health Optimum Veneto
• Services
• Oral anti-coagulant therapy
• Stroke management
• Neuro-surgical tele-counseling
• 36 peripheral hospitals without
  neurosurgery/neuroradiology units are linked to 7
  neurosurgical centres
• Tele-laboratory
• 80 peripheral sites are going to be linked to
  hospital LIS systems

Data courtesy of Arsenal.it/IHE-I
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EHR Experiences - IT

• Health Optimum Veneto
• Mixing XDS and non-XDS solutions
• XDS architecture adopted
• Treviso, Belluno, Venezia, Verona, Padova
• Non-XDS architecture
• Rovigo, Vicenza
• Central governance systems
• managing, including remote monitoring, all
  equipment involved in the interoperability
  platform
• providing the semantic interoperability
• allowing to perform the statistical analysis of
  data and proper reporting of services

Data courtesy of Arsenal.it/IHE-I
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EHR Experiences - IT

• Health Optimum Veneto
• interoperability guidelines adhering to
• IHE XDS (Cross-Enterprise Document Sharing),
  XDS-I (XDS for Imaging) and NAV (Notification of
  Document Availability) profiles
• IHE XCA (Cross-Community Access) profile
• IHE PCC (Patient Care Coordination) profile
• authoritative ICT standards ebXML, CDA2, DICOM,
  HL7, PKCS7, etc

Data courtesy of Arsenal.it/IHE-I
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XDS in Japan
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Network Structure of RHIE System by XDS for
Stroke Care in Nagoya
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Nagoya XDS project

• Backed by Ministries
• 4 Emergency hospitals, 3 Rehab facilities(now)
• Profiles and standards
• Integrating XDS with PIX, PDQ and ATNA
• Enhancing XUA, NAV with access control based on
  XACML
• Excerpting XDS metadata from CDA header part
• Based on ebXML ebRIM3.0/ebRS3.0 (supporting XDS
  storedQuery), while XDS.a was specified on
  ebXML2.1. (Being ahead of XDS.b.)

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Updates in Japan

• 2009 Regional Health Network Subsidy
• 10 Billion JPY (100 M) x 10
• 3 Billion JPY (30 M) x 30
• XDS, PIX, PDQ, ATNA,,,
• Online Reimbursement Claim
• Mandated even to 90000 clinics
• IPv6IKE
• Can be used for other destination

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XDS in North America
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IHE and Canada Health Infoway

• CHI has worked on development of IHE profiles,
  eg, XDS and XDS-I
• CHI contractors have provided testing oversight
  at Connectathons
• CHI contributed to development of testing tools
• CHI has specified IHE profiles as Pan-Canadian
  Standards
• Numerous implementation projects using IHE
  profiles

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Canada Health Infoway Standards Used in
Diagnostic Imaging

• No single standard addresses DI Requirements

IHE Integration Profiles Rad XDS-I, SWF, PIR,
CPI, PGP, KIN, PDI IS XDS, PIX, PDQ, ATNA, EUA
, XUA, BPPC, CT
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DI Data Sharing in the EHR Environment
INFOSTRUCTURE
POS
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IHE Supporting HHS/ONC Goals
Certification Commission for Healthcare
Information Technology (CCHIT)
Healthcare Information Technology Standards
Panel (HITSP)
American Health Information Community? National
eHealth Collaborative
Standards harmonization and adoption
Interoperability testing
Nationwide Health Information Network
Architecture Projects (NHIN)
Health Information Security and Privacy
Collaboration (HISPC)
Specifications for standards-based EHR
functionality to support RHIOs
Security and privacy standards
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HITSP Recommended Standards

• Biosurveillance
• ICD-9CM International Classification of
  Diseases v. 9 Clinical Modifications
• ICD-10 CM Diagnoses and Procedures
• IHE-XDS Integrating the Healthcare Enterprise
  (IHE) Cross-Enterprise Document Sharing
• IHE-XDS Lab IHE Laboratory Report Document
  Sharing
• IHE-RFD IHE Retrieve Form for Data Capture
• IHE-PIX IHE Patient Identification
  Cross-Referencing
• IHE-RAD XDS-I IHE Cross-Enterprise Sharing of
  Images
• IHE-NAV IHE Notification of Document
  Availability
• IHE-XDS-MS IHE Medical Summary Document Sharing
• ISO/TC215 -DTS 25237 - Health Informatics
  Pseudonymisation
• LOINC Logical Observation Identifiers Names and
  Codes
• NCCLS National Committee for Clinical
  Laboratory Standards
• RxNorm National Library of Medicine RxNorm

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HITSP Recommended Standards

• Consumer Empowerment
• IHE-XDS Integrating the Healthcare Enterprise
  (IHE) Cross-Enterprise Document Sharing
• IHE-PIX IHE Patient Identification
  Cross-Referencing
• IHE-PDQ IHE Patient Demographics Query
• Health Level Seven (HL7) CDA R2 HL7 Clinical
  Document Architecture Release 2
• HL7 CCD HL7 Continuity of Care Document with
  mappings from ASTM E 2369-05 Continuity of Care
  Record (CCR), X12 N 270/271 and NCPDP Script 8.1.
• HL7 EHR Systems Functional Model Draft Standard
  for Trial Use (DSTU)
• Logical Observation Identifiers Names and Codes
  (LOINC)

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HITSP Recommended Standards

• Electronic Health Record Exchange
• IHE-XDS Lab IHE Laboratory Report Document
  Sharing
• IHE-PIX IHE Patient Identification
  Cross-Referencing
• IHE-PDQ IHE Patient Demographics Query
• Health Level Seven (HL7) CDA R2 HL7 Clinical
  Document Architecture Release 2
• HL7 v. 2.5
• Clinical Laboratory Improvement Amendments (CLIA)
• Logical Observation Identifiers Names and Codes
  (LOINC)
• Health Insurance Portability and Accountability
  Act (HIPAA)
• Systematized Nomenclature of Medicine Clinical
  Terms (SNOMED CT)
• Unified Code for Units of Measure (UCUM)

IHE contributes to HITSPs success
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HITSP and Federal Procurement

• Former HHS Secretary Leavitt recognized the
  work product of HITSP, meaning that it will be
  used in for federal purchasing specifications for
  all affected health IT systems as of Jan. 1, 2009.

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Testing HITSP, CCHIT and NHIN

• HITSP interoperability pilot testing performed at
  IHE Connectathon
• CCHIT, NIST and IHE have agreement to collaborate
  on testing tools
• NIST and IHE collaborated to provide testing
  services for first NHIN testing event in August
  2008

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Thank You for Your Attention
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