IHE ITI PCC Update to DICOM Committee Yokohama

IHE ITI & PCC Update to DICOM Committee–Yokohama, April 10 -11, 2006 IHE IT Infrastructure Technical Committee Co-chair Charles Parisot - GE Healthcare 3/18/2018 1

Achievements and Expanding Scope Over 100 vendors involved world-wide, 5 Technical Frameworks 38 Integration Profiles, Testing at Connectathons Demonstrations at major conferences world-wide 2

HIMSS 2006 Interoperability Showcase More than 3, 000 attendees visited the 2006 HIMSS Interoperability Showcase. 37 vendors demonstrated 48 health information technology (IT) systems. 700 attendees created and tracked their own electronic health record (EHR). 63 educational sessions presented. 5 international delegations visited the interoperability showcase. Three HIMSS 2006 keynote speakers toured the showcase. 16 clinical scenarios demonstrated interoperability across multiple products, EHR and personal health record (PHR) systems, and care delivery settings. 3

Interoperability Showcase Layout 4

What has been shown in the HIMSS showcase Real-world implementations. Effective IHE interoperability Ø 36 vendor products: EHR & Ancillary IT systems, PHR systems, Registries, Repositories, MPIs, etc. Ø 4 Federal entities or grantees (VA, Do. D, NIST, CDC/UW) Ø All implementations passed IHE Connectathon tests Scenario focused on health information exchange: Ø Within the enterprise (Cardiology, Radiology, etc. ) Ø Across inpatient and physician offices care settings in a RHIO for health status information (meds, allergies, pbs, etc. ), reports, images, legacy docs Empowered with your own health record: Ø Show-wide record submission and access (11 vendor booths) Ø “HIMSS RHIO” Infrastructure: secured access and communications, distributed repositories, document registries, patient Id X-referencing 5

HIMSS IHE Interoperability Showcase February 2006 Participants Leadership Level Blue Ware Cerner GE Healthcare +IDX IBM Initiate Systems Inter. Systems Mi. Sys Healthcare Quovadx Siemens Supporter Level: Acuo Bond Carefx Clearcube Dairyland EMC Identrus Intel Mediserve Implementer Level Allscripts Canon Cap. Med Cardiac Science CGI-AMS Compass. Care CPSI Dictaphone DR Systems Eastman Kodak Eclipsys Epic Systems HIPAAT HX Technologies INFINITT Technology Kryptiq Mc. Kesson Med. Access Plus Medical Informatics Medi. Notes MNI National Institute of Sci & Tech Next. Gen Healthcare Philips Medical Sc. Image Witt Biomedical Organizational participant: Medkey Motion Comp. Picis Pulse Sentillion American Coll. of Clinical Eng. Catholic Healthcare West US Dept of Defense US Dept of Veterans Affairs DMP–French Natl. Personal EHR Health Level 7 HTP IEEE Midmark Diagostics Group HIMSS RHIO Federation Liberty Alliance Univ. of Washington 6

HIMSS 06 IHE Interoperability Showcase Distributed Demonstration Vendor Participants Allscripts Cap. Med CGI-AMS Eclipsys GE Healthcare +IDX Inter. Systems Mc. Kesson Medical Informatics Medi. Notes Misys Healthcare Siemens 7

IHE Integration Profiles for Health Info Nets What is available and has been added in 2005 and is for 2006 Emergency Referrals Patient Created Summaries Format of the Document Content and associated coded vocabulary ECG Report Document Format of the Document Content and associated coded vocabulary Lab Results Document Format of the Document Content Scanned Documents and associated coded vocabulary Format of the Document Content Imaging Information and associated coded Content Format of the Documentvocabulary Medical Summary Format of the Document Content Meds, Allergies, Pbs) and(associated coded vocabulary Format of the Document Content and associated coded vocabulary Cross-Enterprise Document Sharing Cross-enterprise User Authentication & Auditing: Enhanced Access Control Document Digital Signature Audit Trail & Node Authentication Cross-enterprise Document Interchange Consistent Time Media-CD/USB & e-mail push Map patient identifiers across independent identification domains Attesting “true-copy and origin Centralized privacy audit trail and node to node authentication to create a secured domain. Stored Queries Patient Identifier V 3 Cross-referencing Option Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record XDS/RLS Federation Patient Demographics Query Coordinate time across networked systems Request Form for Data Capture External form with custom import/export scripting Notification of Document Availability Notification of a remote provider/ health enterprise 8

Federation of XDS and non-XDS Domains Leverage Connecting for Health RLS – 2006 -2007 Development State RHIO Cross-state IDN Cancer Treatment XDS Affinity Domain (NHIN sub-network) A 87631 Patie M 8354673993 nt 14355 L-716 Identi A 87631 Affinity Domain Patient ty EHR System Identity Source XRef M 8354673993 Mgr A 87631 Patie M 8354673993 nt 14355 L-716 Identi A 87631 Affinity Domain Patient ty EHR System Identity Source XRef M 8354673993 Mgr Patient L-716 Identity Feed PIX Query PAC PAC S S Patient L-716 Identity Feed PIX Query ED Applic Lab ation Info. PA Sys A 87631 CS tem A 87631 Patient L-716 Identity Feed PIX Query ED Applic ation PA CS EHR System XDS Affinity Domain (NHIN sub-network) EDPAC Applic S Lab S ation Info. XDS Affinity Domain (NHIN sub-network) Sys PA A 87631 tem CS EHR System A 87631 Patie M 8354673993 nt 14355 L-716 Identi A 87631 Affinity Domain Patient ty EHR System Identity Source EHR System XRef M 8354673993 Mgr PA CS Patient L-716 Identity Feed PIX Query A 87631 Patie M 8354673993 nt 14355 L-716 Identi A 87631 Affinity Domain Patient ty EHR System Identity Source XRef M 8354673993 Mgr A 87631 EHR System PAC S Lab S Info. XDS Affinity Domain (NHIN sub-network) Sys tem XDS Affinity Domain (NHIN sub-network) A 87631 Patie M 8354673993 nt 14355 L-716 Identi A 87631 Affinity Domain Patient ty EHR System Identity Source XRef M 8354673993 Mgr Registry Locator service ED Applic ation PAC S S XDS Affinity Domain (NHIN sub-network) A 87631 Patie M 8354673993 nt 14355 L-716 Identi A 87631 Affinity Domain Patient ty EHR System Identity Source XRef M 8354673993 Mgr ED Applic ation PA Patient A 87631 L-716 CS Identity XDS Feed PIX Query Affinity Domain (NHIN sub-network) EHR System Patient L-716 Identity Feed PIX Query PAC S S Lab Info. Sys tem PA CS NHIN Backbone Registry Locator service Lab Info. Sys A 87631 tem EHR System Affinity Domain (NHIN sub-network) XDS A 87631 Patie M 8354673993 nt 14355 L-716 Identi A 87631 Affinity Domain Patient ty EHR System Identity Source XRef M 8354673993 XDS Affinity Domain (NHIN sub-network) Mgr Lab Info. Sys tem Patient L-716 Identity Feed PIX Query Sub-Network A 87631 M 8354673993 Patient Identity Feed L-716 PIX Query PACS Patient Identity Feed L-716 PACS A 87631 PIX Query EHR System PACS Lab Info. System Teaching Hospital Community Clinic ATNA Audit record reposito ry CT Time server XDS Affinity Domain (NHIN sub-network) Patient Identity Feed L-716 PACS A 87631 XDS Docu ment Repo sitory XDS Affinity Domain (NHIN sub-network) A 87631 XDS Docu ment Repo sitory PIX Query Teaching Hospital CT Time server PACS Docu ment Regis try XDS Docu ment Repo sitory PACS ATNA Audit record reposito ry ED Application EHR System Lab Info. System Community Clinic A 87631 M 8354673993 Physician Office ED Application Docu ment Regis try XDS Docu ment Repo sitory Sub-Network Affinity Domain Patient Identity Source EHR System M 8354673993 Physician Office ED Application XDS Docu ment Repo sitory XDS Affinity Domain (NHIN sub-network) 14355 L-716 A 87631 Affinity Domain Patient Identity Source EHR System Docu ment Regis try XDS Docu ment Repo sitory L-716 A 87631 Affinity Domain Patient Identity Source M 8354673993 EHR System Lab Info. System Teaching Hospital Community Clinic ATNA Audit record reposito ry CT Time server XDS Affinity Domain (NHIN sub-network) A 87631 EHR System A 87631 M 8354673993 14355 PA CS Lab Info. Sys tem Patient Identity XRef Mgr A 87631 M 8354673993 14355 L-716 EHR System Sub-Network Patient Identity XRef Mgr Physician Office Registry Locator service PAC S S Which regisry holds Sub-Network ED Applic ation XDS Affinity Domain (NHIN sub-network) Registry records for a patient ? Locator service State RHIO M 8354673993 A 87631 EHR System ED PAC S Applic S ation XDS Affinity Domain (NHIN sub-network) ED Applic ation PA CS Patient L-716 Identity Feed PIX Query Integrated Delivery Network XDS Affinity Domain (NHIN sub-network) 9

Cross-Enterprise Sharing of Medical Summaries (XDS-MS) Patient Examination or Discharge or Referral Document Created Referred Physician Notification EMR Document Registry EMR Review of Medical Summary Report Repository Medical Summary The Cross-Enterprise Sharing of Medical Summaries Integration Profile solves the problem of transferring summary patient information between providers in different clinical settings. 10

XDS-MS Medical Summary Structured and Coded Header Patient, Author, Authenticator, Institution, Time of Service, etc. St r u c t u r ed Co n t en t w i t h c o d ed s ec t i o n s : · Reason for Referral · Vital Signs · Medication Text Structure Entry Coded Section Entry · Studies · Allergies Text Structure Entry Coded Section Entry · Social History · Problem s Text Structure Entry · Care Plan Coded Section Entry Level 1 Level 2 Level 3 Header always structured and coded Title-coded sections with non-structured nor coded content (text, lists, tables). Simple Viewing (XML Style sheet) Med, Problems and Allergies required as highly structured text. Text easy to import/parse Med Problems and Allergies have a required fine-grain structure with optional coding. Coding Scheme not standardized, but explicitly identified. XDS-MS enables both semantical interoperability and simple viewing ! 11

Use of a shared XDS infrastructure to access Radiology Reports and Images (XDS-I) Between Radiology and : • Imaging specialists • Non-imaging clinicians Radiology -to. Physicians Physician Practice Hospital PACS Y Radiology -to. Radiology PACS Z Imaging Center Same XDS Infrastructure (Registry and Repositories) for medical summaries and imaging information ! Demo at HIMSS Feb. 2006 and RSNA Dec. 2006 12

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