IHE in regional and national Health Information Exchanges

IHE in regional and national Health Information Exchanges around the WORLD HIMSS Interoperability Showcase February 2008 Charles Parisot (GE) 3/16/2018 1

International Growth of IHE q q Australia Local Deployment National Extensions Promotional & Live Demonstration Events Funding Austria Spain China Netherlands Norway Taiwan Korea UK Canada Japan Italy Germany France 2088 2007 2006 2005 2004 2003 2002 2001 2000 1999 USA Pragmatic global standards harmonization + best practices sharing 2

IHE Organizational Structure IHE International Board Global Development Regional Deployment IHE North America IHE Asia-Oceania Radiology Taiwan IHE Europe Austria Italy France Norway Germany Spain Cardiology Patient Care Coordination Pathology Patient Care Devices Eye Care Japan Korea USA Laboratory Radiation Oncology China Canada IT Infrastructure Netherlands Sweden Public Health, Quality and Research UK Professional Societies / Sponsors ACCE ACEP ACP GMSI HIMSS RSNA SFR SFIL COCIR SIRM ESC EAR-ECR BIR DRG Euro. Rec JAHIS JIRA JRS METI-MLHW MEDIS-DC JAMI Contributing & Participating Vendors 3

National and Regional projects It is difficult to provide a simple summary view of these projects: These slides reflect information publicly available and current based on author’s knowledge. IHE offers 24 Integration & Content profiles applicable in health information exchange for communities, regions or nations. Each project discussed here uses different subsets of these profiles (IHE Modularity). These projects are multi-year and projects with complex decision making processes. 4

Categories of Healthcare Communication Services Most HIEs in the World chose to start with Document Sharing HIEs and RHIOs e. g. access to last 6 months historical labs and encounter summaries Source persisted and attested health records Document Sharing Hospitals e. g. get a current list of allergies or med list from a source Specific info snapshot provided on demand Dynamic Information Access e. g. order a lab test, track status and receive results 2 or more entities synchronize a task Workflow Management Patient and Provider ID Mgt Security 5

Sharing and Accessing Electronic Health Records IHE offers interoperability for local, regional, specific, or national health information exchange Goal is to enable exchange between providers’ clinical and administrative systems and ancillary IT systems (EHRs, Lab, Pharma, Payers, etc. ) and personal health record systems. Objective is to empower the consumers in having “shared EHR information” between all of its potential healthcare providers (if authorized) and self. Objective is to empower the providers in choosing when and what information to share, and to trust the information they may use in the care of their patients. 6

Introduced at HIMSS in 2005 : IHE-XDS Community or sub-network Hospital Record Repository of Documents Clinical IT System Clinic Record 1 -Reference to records Specialist Record Repository of Documents Index of patients records Sharing System Clinical Encounter 7

Introduced at HIMSS in 2005 : IHE-XDS Community or sub-network Clinic Record Hospital Record Repository of Documents 3 -Records Returned 4 -Patient data presented to Physician Clinical IT System Aggregate Patient Info Clinical Encounter 1 -Reference to records Specialist Record Index of patients records Sharing System 2 -Reference to Records for Inquiry 8

IHE Integration Profiles for Health Info Nets What is available and has been added in 2007 Clinical and PHR Content Emergency Referrals Format of the Document Content PHR Extracts/Updates and associated coded vocabulary ECG Report. Document Content Format of the Document and associated coded Lab Results. Document vocabulary Document Format of the Content Scanned Documents and associated coded vocabulary Format of the Document Content Formatassociated coded Content Imaging Information and of the Document vocabulary Medical Document Content Format of the. Summary and(associated coded vocabulary Meds, Allergies, Pbs) Format of the Document Content and associated coded vocabulary Security & Privacy Basic Patients Privacy Consents Establish Consents & Enable Access Control Cross-Enterprise User Attestation User Attributes fro Access Control Document Digital Signature Patient ID Mgmt Patient Demographics Query Patient Identifier Cross-referencing Map patient identifiers across independent identification domains Attesting “true-copy and origin Health Data Exchange Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a longitudinal record Cross-Enterprise Document Pt-Pt Reliable Interchange Cross-Enterprise Document Media Interchange Cross-Community Access Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. Other Request Form for Data Capture External form with custom import/export scripting Consistent Time Notification of Document Availability Coordinate time across networked systems Notification of a remote provider/ health enterprise Final Text Approved 9 Trial Implementation-2007 – Final Txt 2008

IHE, global standards-based profiles adopted by several national & regional projects Lower Austria Netherland Amsterdam UK Cf. H (Radiology WF) France DMP Denmark (Funen) Italy (Veneto) Spain (Aragon) Italy (Conto Corrente Salute) Austria Quebec, Toronto, Alberta, British Columbia Canada Infoway VITL-Vermont Boston Medical Center - MA Philadelphia HIE Key. HIE – Pennsylvania Care. Spark – TN & VA South Africa CHINA-Shanghai Imaging Info Sharing Malaysia Singapore CHINA-Mo. H Lab results sharing JAPAN-Nagoya Imaging Info Sharing NCHICA – N. Carolina 10

Italy (Genoa Region) 11

Italy (Genoa Region) In service since January 2006. 4 Hospitals and 500 physician offices. EMRs import and export documents from their local records. All vendor products required to pass IHE-Europe connectathon in April 2005. Patients chose to join through one of their care provider Infrastructure includes: Ø Ø XDS Registry XDS Repository shared at the regional level PIX for patient Id linking Doc content is CDA with PDF content. Plan in place to move to CDA rel 2 with structured data. IHE (XD*-Lab) CDA Lab primary candidate. 12

Austria (Lower Austria and National) Lower Austria Region (around Vienna) Deployed in 2007 - Operational. 1. 5 Million patients on-line. 11 hospitals connected. Use IHE profiles: XDS, PIX, XDS-SD, ATNA, XUA, BPPC. Austria National project launched in 2007 (ELGA). Given the success to deploy the first region is about one year. Roll-out includes: Ø Ministry backing of IHE conformance (IHE-Eu Connectathon) Ø Extending to Ambulatory Physicians in 2008 Ø Step-wise introduction of structured and coded content with HL 7 CDA based IHE Content Profiles. 13

USA (Philapdelphia Region) Philadelphia Health Info Exchange in service since 2005. Focused on images and reports sharing. 5 Hospitals + Imaging Center + Public Health Ø Ø Ø Ø The Hospital of the University of Pennsylvania Thomas Jefferson University Hospital Children’s Hospital of Philadelphia Presbyterian Medical Center Pennsylvania Hospital UPHS Community Radiology Philadelphia Department of Public Health Migration to XDS, ATNA, PIX and XDS-I completed in 2007. Demonstrated live at RSNA-Chicago Nov 2007 14

USA (Other) HITSP (HHS sponsored) accepted 8 IHE Integration profiles for: Lab results distribution and sharing, Registration and Medication History for Consumers, Biosurveillance. 2 NHIN-1 Pilots (CSC and IBM) leveraged IHE profiles (Med Summaries and Lab). South Shore, MA: Operational (Inpatient and Emergency Dept) NHIN-2 Trial Implementations (NCHICA, Virginia & Care. Spark HIEs) Several HIEs projects are actively planning the use of IHE Ø Vermont State Ø Key. HIE (PA) Ø e. Health. Connecticut Ø Boston Medical Center and affiliated clinics 15

Canada Health Infoway: national Commitment to XDS/XDSI for imaging sharing 3 infrastructure tenders awarded in 2007 and 1 more to come early 2008 resulting in over 1/3 of Canadian patients covered: Ø Ø Toronto East Network - Ontario Montreal Mc. Gill - Quebec Alberta British Columbia Includes XDS, ATNA, PIX and XDS-I. Planned to become live 2008 in Quebec, Ontario, Alberta, British Columbia. 16

France (National DMP) Prototype RFP call for tender mid-2005. Confirmed requirement to use to IHE profiles: XDS, ATNA, XUA, BPPC, etc. Encourage vendors to submit their products to the IHEEurope Connectathon (April 2007 -Berlin). Implementation plan under revision. Infrastructure to include: Ø Ø XUA from User Authentication Portal and BPPC for privacy XDS Registry/XDS Repositories ATNA for audit trail and node authentication. Doc content to be: CDA rel 2 patient summary (close to XDS-MS), Hprim with migration to IHE XD*-Lab for Lab, Scanned Doc (PDF) and imaging (XDS-I). 17

Other Commitments China Ø Mo. H selected XDS and XD*-Lab (CDA) for lab info sharing. Ø XDS-I in Shanghai. Israel, Jordan, Palestinian Authority Ø Public Health Info Affinity Domain (XDS, ATNA, XD*Lab) Ø Middle east Consortium for infectious Disease Surveillance Netherlands Ø Amsterdam region network project launched 2007. XDS-I. Japan Ø Nagoya region network project operational late 2007. XDS, XDS-I Ø Kobe with imaging info sharing South Africa Ø National project launched in 2007. Tender awarded. Operational in 2008. 18

IHE, global standards-based profiles adopted by several national & regional projects Lower Austria Netherland Amsterdam UK Cf. H (Radiology WF) France DMP Denmark (Funen) Italy (Veneto) Spain (Aragon) Italy (Conto Corrente Salute) Austria Quebec, Toronto, Alberta, British Columbia Canada Infoway VITL-Vermont Boston Medical Center - MA Philadelphia HIE Key. HIE – Pennsylvania Care. Spark – TN & VA South Africa CHINA-Shanghai Imaging Info Sharing Malaysia Singapore CHINA-Mo. H Lab results sharing JAPAN-Nagoya Imaging Info Sharing NCHICA – N. Carolina 19

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