Integrating the Healthcare Enterprise IHE Approach and Patient

Integrating the Healthcare Enterprise (IHE) Approach and Patient Summary Presented by Charles Parisot, IHE Europe IT Infrastructure Planning Committee co-Chair e. Health interoperability ad hoc group January 17, 2007 3/18/2018 1

Agenda IHE, a proven multi-stakeholder process IHE, what can be leveraged IHE Medical Summaries, a solid base, potential for European national extensions 2

What is Integrating the Healthcare Enterprise? It implements a methodology which enables users and suppliers to work together to obtain clinical interoperability IHE tailors existing standards to fit the IT requirements for specific clinical tasks The IHE Technical Framework document specifies clinical tasks and how to use profiles of existing standards to support them Annual test sessions enable suppliers to test their application software for conformance with the IHE Technical Framework Purchasers can buy systems that are known to interoperate 3

What is IHE? 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

IHE-EUR countries and participants • • • Denmark France Germany Israel Italy • • • Netherlands Norway Spain Sweden United Kingdom Users, HC Authorities 40% local vendors 60% international vendors Example: IHE-Netherlands Government / Associations Users Vendors Amphia Agfa Medical Phit Antonius Mesos Forcare Nucletron Chipsoft Oldelft Benelux D&A Medical Philips HL 7 Nederland GE Healthcare RVC Ned. Ver. Radiologie Ver. Getronics Sectra OIZ Ned. Ver. Kl. Chemie H 2 W Siemens Ned. Ver. Microbiologie Ver. IBM Verdonk, Klooster & Verdonk, Associates Amsterdam MC AZ Maastricht MC Leeuwarden UMC Nijmegen UMC Groningen ICT Healthcare Initiate Systems i. SOFT APC Platform NICTIZ TNO Welch Allyn Cardio Control Leones VUmc 6

Evolution of IHE Domains IHE Global Developments Veterinarian Integration Profiles – Solutions to Real-World Interoperability Needs & Problems: q Within Endoscopy (1) Eye Care / (3) Ophthalmology 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 & Institutional Boundaries – XDS Radiation Oncology (1) 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) 7

IHE, Annual Cycle Proven Standards Adoption Process Demonstration (National shows) Multi-vendors test at the annual Connect-a-thon Installation on site Clinicians identify clinical problems to be addressed Vendors implement Choice of relevant the profile in their standards (HL 7, CEN, DICOM, products Engineers from vendors W 3 C, Oasis…) collaborate to define technical specification 8

IHE Technical Framework Detailed standards implementation guides Ø Ø Ø Cardiology IT Infrastructure Laboratory Radiology …. . 9

IHE Connectathon Open invitation to the Software Developer Community • Advance testing tools (MESA) applied • Compliance Testing organized and supervised by the sponsors of IHE-EUR • Thousands Connectathon of cross-system tests performed • 10

IHE Connectathon, Barcelona April 2006 • 300+ participants, 120+ systems • 60+ systems developers • 2006 Focus: Cardiology, IT Infrastructure, Patient Care Coordination, Laboratory, Radiology • 2800+ monitored test cases 11

Regional and National EHR Projects Many EHR projects world-wide, Some country-wide, some regional, Different stages of implementation, … 12

IHE based Regional and National EHR Projects Operational and planned Toronto, Quebec, Alberta, BC Canada Infoway MA-Share – MA New York HIE Philadelphia HIE THINC- New York NCHICA – N. Carolina Austria France DMP Italy (Conto Corrente Salute) CHINA-Mo. H Lab results sharing 13

Agenda IHE, a proven multi-stakeholder process IHE, what can be leveraged IHE Medical Summaries, a solid base, potential for European national extensions 14

IHE Integration Profiles for Health Info Nets What is available and has been added in 2005 and is for 2006 Info Exchange Security Id Mgt Content Emergency Referrals PHR Extracts 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 Registration, distribution and access across health enterprises of clinical documents forming a patient Stored electronic health record Cross-enterprise User Authentication & Auditing: Enhanced Access Control Document Digital Signature Media-CD/USB & e-mail push V 3 Option Patient Identifier Cross-referencing Map patient identifiers across independent identification domains Attesting “true-copy and origin Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. Queries Cross-enterprise Document Interchange Patient Demographics Query Consistent Time 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 15

Cross Enterprise Document Sharing Prototyped in 2003, matured in 2004 -2005 Ø HL 7 and IHE Joint Demonstration at HIMSS 2004 Ø ISO 15000 (eb. RS) and tracks Web Services & SOA. Further step with WS-I in 2007. Implemented by 20+ Vendors Available Commercially in US, Europe and now in Asia Open Source Communities Ø Ø O 3 (Univ Trieste & Padova) RIDE EU Project IHEOS Eclipse Open Healthcare Framework Named in Specifications by more than 5 countries Appears in more than 10 regional and national projects underway. 16

Profile example in a region: XDS (Document Sharing) Longitudinal Record as used across-encounters Documents Registry Long Term Care Document Repository Acute Care (Inpatient) PCPs and Clinics (Ambulatory) Other Specialized Care or Diagnostics Services Submission of Document References Query for Document References Retrieve of selected Documents 17

Federation of XDS and non-XDS Domains Leverage Cross-Community Sharing Architecture Which registry holds records for a patient ? National or Regional Network B Longitudinal Record as used across-encounters Documents Registry Long Term Care Document Repository Acute Care (Inpatient) Cross. Domain Bridge Registry Locator service IHE Transactions XDS Affinity Domain (NHIN sub-network) Cross-Domain Bridge Registry Locator service National Network C IHE based Sub-Networks Documents Registry Longitudinal Record as used across-encounters Acute Care (Inpatient) PCPs and Clinics (Ambulatory) Cross. Domain Bridge Non-IHE National EHR Other Specialized Care or Diagnostics Services PCPs and Clinics (Ambulatory) Document Repository National Network A Non-IHE Sub-Net Documents Registry Longitudinal Record as used across-encounters Long Term Care Other Specialized Care or Diagnostics Services Document Repository Acute Care (Inpatient) PCPs and Clinics (Ambulatory) Long Term Care Other Specialized Care or Diagnostics Services Integrated Delivery Network XDS Affinity Domain (NHIN sub-network) Ø National or Regional Networks not required to be IHE-based Ø Mapping to & from IHE Transactions performed by X -Domain bridges Ø Mapping practical as most European projects use variants of structured document sharing 18

Agenda IHE, a proven multi-stakeholder process IHE, what can be leveraged IHE Medical Summaries, a solid base, potential for European national extensions 19

Medical Summaries EU Stakeholder group study (Rossi Mori) has confirmed Ø There is a significant variety of “medical summaries” (in use or in plan) across the European countries. Some of the differences are: • • • scope/use case driven due to national specificities from the technical standard used IHE Patient Care Coordination: Ø Is well engaged with the scope/use case driven differences Ø Plan to address national specificities based on the stakeholder WG analysis, and the interest of the countries 2007 is the year IHE-Europe has set to finalize a “family” of patient summaries for several European countries with a common core. 20

Care Coordination Content Profiles XDS-MS Consent Lab Report Medical Documents History and Physical Antenatal Care Summary Preprocedure History and Physical 2005 -2006 -2007 -2008 Medical Summaries Referral Care Assessments Discharge Summary PHR Extract Emergency Department Note Emergency Department Referral PHR Update Includes data needed to support emergency data set and prescription/medication history 21

Rossi-Mori EU survey mapping to XDS-MS No of Countries all not asked all - BE 12 11 9 5 13 Section details about patient identifier, name (date of birth, gender) address history medication history immunisations family history allergies, alerts, risks, special needs 12 ongoing medications 10 test results (lab and images) 10 details about family doctor 9 active problems 6 details about insurance 6 emergency contact (next of kin) 4 care plans not asked (exemptions) Structured and Coded Header Patient, Author, Authenticator, Institution, etc. Structured Content with coded sections: · Reason for Referral · Vital Signs · Medication Structured Text Section · Studies · Allergies Structured Text Section · Social History · Problem s Structured Text Section · Care Plan Coded Section Entries 22

IHE flexibility in leveraging standards for Document Format Content Format leverages Specific Standards Ø HL 7 CDA Release 2. 0 Ø HL 7/ASTM Continuity of Care Document Ø CEN 13606 Ø LOINC, SNOMED (if applicable) Ø Others as Needed (e. g. PDF) IHE is defining a library of Reusable Parts Ø Document Types Ø Sections (only title is coded) Ø Entries (clinical info semantically coded) 23

In Conclusion IHE is a user & vendor driven initiative. IHE is dedicated to interoperability of IT systems in healthcare with proven methodology. IHE Integration and Content Profiles are already used in Europe and world-wide. IHE is experienced with patient summaries. IHE ready to engage in fostering a consistent family of patient summary documents and a sharing infrastructure between countries and regions in Europe. 24

WWW. IHE-EUROPE. ORG 25