Integrating the Healthcare Enterprise IHE Update Charles Parisot

Integrating the Healthcare Enterprise IHE Update Charles Parisot, GE Healthcare IHE IT Infrastructure Technical Committee Co-chair Nov 30, 2004 1 IT International Update

IHE IT Infrastructure 2004 -2005 New Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record New Retrieve Information for Display Access a a patient’s clinical Access patient’s clinical information and documents in in information and documents a format ready to be presented a format ready to be to the requesting user presented to the requesting user New Audit Trail & Node Authentication Patient Identifier Cross-referencing for Cross-referencing MPI for MPI Map patient identifiers across independent identification domains Nov 30, 2004 Centralized privacy audit trail and node to node authentication to create a secured domain. Consistent Time Coordinate time across networked systems 2 Personnel White Page Access to workforce contact information Patient Demographics Query New Patient Synchronized Applications Synchronize multiple applications on a desktop to the same patient Enterprise User Authentication Provide users a single name and centralized authentication process across all systems IT International Update

Sharing and accessing Documents EHR-LR: 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 EHR-CR: Care Record systems supporting care delivery Submission of Document References Retrieve of selected Documents Nov 30, 2004 3 IT International Update

Standards selection for IHE XDS No single standard can address Cross-enterprise Document Sharing Electronic Business Standards eb. XML Registry, SOAP, etc. Internet Standards HTML, HTTP, ISO, PDF, JPEG, etc. Healthcare Content Standards HL 7 CDA, CEN EHRcom ASTM CCR DICOM, etc. Marriage of healthcare standards facilitates implementation and leverages complementary technologies (e. g. security & privacy). Nov 30, 2004 4 IT International Update

HIMSS 2005 Interoperability Showcases HIMSS leverages its sponsorship of IHE to demonstrate practical interoperability in two large Showcase Exhibits: cross-enterprise sharing of health information in the acute care (18 vendors) and ambulatory (14 vendors). HIMSS Showcase exhibits linked with vendor booths (10 vendors) show-wide. Show-wide interactive environment demonstrating attendees “patient” record in a “HIMSS RHIO”. Uses IHE Cross-enterprise Document Sharing: Ø Around a central document registry Ø Distributed document repositories Ø 17 EHR that publish/share documents (CCR, CDA, HL 7 -lab, PDF) Nov 30, 2004 5 IT International Update

HIMSS 2005 Interoperability Showcases HIMSS sponsors the testing and demonstration of IHE interoperability in two large Showcase Exhibits: cross-enterprise sharing of health information in the acute care, 18 vendors: Cedara Dictaphone Eastman Kodak Eclipsys Emageon EPIC GE Healthcare IDX Inter. Systems Infinitt Technology Kryptiq Med. Commons Mortara Instruments NIST Novell Open Text Sentillion Siemens ambulatory sharing of health information, 14 vendors: Allscripts Cap. Med/San. Disk Cerner Eclipsys ETIAM Nov 30, 2004 GE Healthcare Healthramp IDX Krytiq Medi. Notes 6 Mid. Mark Misys Next. Gen Web. MD IT International Update

HIMSS 2005 – Show-Wide Interoperability Cross-enterprise Showcase Booth Radiology IT Infrastructure & Lab Vendor System Vendor Booth Allscripts In-Patient/Out-patient Eclipsys GE Healthcare Vendor Booth Healthramp Cardiology IDX Radiology HIMSS “RHIO” with Infinitt Vendor Booth Cross-enterprise Inter. Systems Vendor Booth doc sharing Med. Commons PCP Novell Open. Text. Vendor Booth Diag Center Siemens Home Multispecialty Clinic Vendor Booth Ambulatory Showcase Booth Nov 30, 2004 Vendor Booth 7 IT International Update

IHE Profiles for a “Regional Health Info Organization” What are the gaps to be filled in 2005 ? Patient Demographics Query Imaging Information Simple. Content Document Format of the Document Content and associated coded vocabulary For Display. Document Content Format of the Document Content and associated coded vocabulary Lab Results Document Format of the Document Content Continuity of Care Format of the Document Content and associated coded vocabulary Cross-Enterprise Notification Patient Identifier Cross-referencing Notification of a remote provider/ health enterprise Map patient identifiers across independent identification domains Audit Trail & Node Authentication Personnel White Page 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 electronic health record Centralized privacy audit trail and node to node authentication to create a secured domain. Consistent Time Coordinate time across networked systems Nov 30, 2004 8 Access to workforce contact information User Identity, Authentication and Permissions Enable Basic Access Control IT International Update

Infrastructure and Interoperability Cross-Enterprise Document Sharing (XDS) minimizes clinical data management by the infrastructure. Transparency = Ease of Evolution, increase efficiencies. XDS needs other IHE Integration Profiles: Ø Audit Trail and Node Authentication (ATNA) Ø Patient Id Cross-referencing (PIX) Ø Patient Demographics Query (PDQ) In 2005, IHE plans to complement a set of integration profiles to build a RHIO, candidates: Ø Ø Security: Identity Management + Info for Access Control Content Profiles: Core CCR, HL 7 -CDA, HL 7 -Lab, PDF (legacy) Provider Notification (with doc reference) and Point-to-point Transfer Dynamic Clinical Data Mgt (Allergy lists, Problem Lists) Prioritization of Candidate Integration Profiles November-December 2004. Technical development January-July 2005. Open to all. Nov 30, 2004 IT International Update 9

IHE Radiology Integration Profiles Charge Posting Extensions Scheduled Workflow - Patient Info. Reconciliation Presentation of Grouped Procedures Post. Processing Workflow Reporting Workflow New NM Image Consistent Presentation of Images Evidence Docs Key Image Notes Simple Image & Numeric Reports Access to Radiology Information New Portable Data for Imaging Basic Security Nov 30, 2004 10 IT International Update

Laboratory IHE Integration Profiles Laboratory Scheduled Workflow (LSWF) Laboratory Point Of Care Testing (LPOCT) Completed in 2003 In Process –TI Nov 2004 Tests performed by a laboratory for an identified inpatient or outpatient In Dev. Tests performed on point of care or patient’s bedside In Dev. Laboratory Patient Information Reconciliation (LPIR) In Process Tests performed on an unidentified or misidentified patient Laboratory Device Automation (LDA) In Process –TI Nov 2004 Laboratory Code Set Distribution (LCSD) In Process In Dev. Sharing the batteries and tests code sets throughout the enterprise Nov 30, 2004 In Dev. 11 Pre-analytic process, analysis and post-analytical treatment IT International Update

IHE Cardiology 2004 -2005 Retrieve ECG for Display New Provide high-quality ECG and related reports to the enterprise and outside in a ready-to-display format New Retrieve Information Echo. Cardiography for Display Worklflow Cardiac Catheterization Workflow Access a patient’s clinical information and Admit, order, schedule, acquire documents in a format ready to be images, presented completed notify of steps, on fixed and mobile stress to the requesting user Scheduled & unscheduled acquisition and management of cathlab information, notification of completed steps. Nov 30, 2004 New echo modalities. 12 IT International Update

ACC 2005 IHE Demonstration ACC sponsors the testing and demonstration of IHE interoperability in their exhibit – March 2005 11 vendors: Agfa Camtronics Cerner Emageon GE Healthcare Heartlab IDX Medcon Schiller Philips Toshiba Scenario: Ø Emergency Cath, Change of Lab mid-procedure Ø Scheduled Echo+Mobile Modality, Stress Echo demo planned for ASE (Boston June 2005) Full demonstration planned for ESC (August 2005) Nov 30, 2004 13 IT International Update