Clinical Document Sharing and Integrating the Healthcare Enterprise

Clinical Document Sharing and Integrating the Healthcare Enterprise (IHE) Dr Nick Brown IHE-UK Steering Committee User Co-chair Mark Simmons IHE-UK Steering Committee Supplier Co-chair Use of slides supplied by IHE-Europe and Ed Conley, Cardiff University, is acknowledged Handouts sponsored by British Computer Society IHE-UK IT Infrastructure Technical Committee British Institute of Radiology IHE-UK Medical Imaging and Radiation Oncology TC HL 7 Roadshow 2009 London

An IHE cross enterprise document sharing task scenario Data document(s) + descriptive search keywords ‘Pull’ 2

An IHE cross enterprise document sharing task scenario Data Notify document(s) + descriptive search keywords ‘Pull’ 3

Why do we need Integrating the Healthcare Enterprise (IHE) ? • Healthcare data communication standards are written to support a wide range of healthcare situations and include many optional features. • Different suppliers implement different features – hence interoperability problems • IHE is a not-for-profit organisation that enables healthcare IT system users and IT suppliers to work together to obtain clinical interoperability by selecting existing standard features to fit the IT requirements for specific clinical tasks • The home of IHE-UK is the British Computer Society) 4

Who is IHE? IHE (International) Strategic Development Committee Sponsors Co-Chairs supervises reports Global IHE North America IHE Europe IHE Domain-related Planning and Technical Committees IHE Asia/Oceania Regional & National Deployment Global Development: IT Infrastructure, Radiology, Cardiology, Lab, etc. Delegates Interoperability contribute Participants 5

Standards Adoption Process Develop technical specifications Testing at Connectathons Identify available standards (e. g. HL 7, IHE Demonstrations Products with IHE DICOM, IETF, OASIS) Timely access to Document Use Case information Requirements Easy to integrate products 6

• Connectathon Barcelona 2006 • 300+ participants, 120+ systems • 60+ systems developers • 2800+ monitored test cases 7

IHE integration profiles • An IHE integration profile includes definitions of – A specific clinical task (use case) – Which data items in existing standards are to be used to exchange essential task information - overriding optionality – Essential application entity task processes • Supplier web sites show products that support IHE profiles • Purchasers can buy products from different suppliers that will work properly as specified by IHE profiles 8

Evolution of IHE Domains IHE Global Developments Veterinarian Integration Profiles – Solutions to Real-World Interoperability Needs & Problems: Endoscopy (1) Eye Care / (3) Ophthalmology q Within Clinical Departments e. g. : Pharmacy Ø Radiology Ø Cardiology Ø Lab Ø. . . Pathology (1) Patient Care Devices (1) Patient Care Coordination (5) q Across Departmental & Radiation Oncology (1) Institutional Boundaries – XDS Laboratory (6) Ø Regional/national Healthcare Information Exchange Ø HIT Enablers Cardiology (7) IT Infrastructure for Healthcare (17) Year 8 (2006) Year 7 (2005) Year 6 (2004) Year 5 (2003) Year 4 (2002) Year 3 (2001) Year 2 (2000) Year 1 (1999) Radiology (18) 9

IHE-EUR countries and participants • • • Denmark France Germany Israel Italy • • • Netherlands Norway Spain Sweden United Kingdom Users, HC Authorities, Vendors: 40% single country vendors 60% multi-countries vendors Example: IHE-Netherlands Users Amphia Antonius Mesos Amsterdam MC AZ Maastricht Ned. Ver. Radiologie Ned. Ver. Leeuwarden UMC Nijmegen UMC Groningen. Kl. Chemie Ned. Ver. Microbiologie MC Vumc Agfa Forcare Chipsoft D&A Medical GE Healthcare Getronics H 2 W IBM ICT Healthcare Initiate Systems i. SOFT Leones Government / Associations Vendors Medical Phit Nucletron Oldelft Benelux Philips RVC Sectra Siemens Verdonk, Klooster & Verdonk, Associates Welch Allyn Cardio Control APC Platform NICTIZ HL 7 Nederland OIZ TNO 10

IHE Regional and National EHR Projects Today France DMP Austria NÖmed. WAN Canada Infoway MA-Share – MA IHIE – IN Mendicino - CA HITSP Interoperability Specifications Denmark (Funen) Italy (Veneto) Spain (Aragon) THINC- New York NCHICA – N. Carolina Italy (Conto Corrente Salute) 11

IHE-XDS components Community or sub-network Clinic Record (Affinity domain) Local document repository Hospital Record pointers to documents Centralized document repository 3 -Documents returned 4 -Patient data presented to clinician Clinical IT System Aggregate Patient Info Clinical Encounter Specialist Record eb. XML Document registry/ Patients IDs Manager 1 -Search for certain documents 2 -pointers to documents found 12

IHE Document sharing IHE Clinical document sharing • Any format PDF, JPEG (Images), DICOM Images, CDA, etc • Proven specifications • Multiple suppliers REPOSITORY • • Support for multiple patient identifiers Email notification of availability of documents Security metadata item Registry can point to hardcopy and/or electronic documents 13

IHE-UK Current Key Projects • Support for Humber XDS project Multi Disciplinary Team support in planning stage – XDS UK search data spec for Doc Class and Sub-class – XDS UK user guides • Support for image sharing between institutions: IHE XDS-I, ISO WADO-WS, ISO WARM • Work with Pro. Rec UK on step by step implementation of improved EHRs 14

IHE Benefits to users • Users benefit because they can know exactly what functionality will be implemented in purchased products for which conformance to IHE specifications is stated • Easy resolution of any interoperability problems that do arise at commissioning • Easy replacement of systems • Easy extension of networked systems • Future proofing of investment 15

IHE Benefits to suppliers 1 • Clear requirement specifications from users • Easy implementation of systems that interoperate • Connectathon: testing their software with a number of different suppliers. They can learn more in one week at the connectathon than several months at base • Reduced costs of commissioning on site • If IHE is specified then you know what to do to get paid • IHE specifications can shorten product development time 16

IHE Benefits to suppliers 2 • Work with users and other suppliers to create applications that work well in the real world • Support development – IHE-UK Specific extensions to the core IHE Integration Profiles – IHE-UK Guidance notes regarding use of IHER specs in the UK • Collaborate with other suppliers in creating solutions for large multi enterprise (or multi-department) facilities • Obtain a deep understanding of the benefits of the IHE methodology 17