April, 2010 What IHE Delivers1

An Introduction toAn Introduction toIntegrating the Integrating the

HealthHealthEnterprise Enterprise

Dr Vincent McCauley Chair, IHE AustraliaDr Vincent McCauley Chair, IHE Australia

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IHE Organizational StructureIHE Organizational Structure

Contributing &Participating

Vendors

IHE North America

USA

Canada

IHE Asia

Japan

Korea Taiwan

China

ACCACCEACEPHISA

JAHISJIRAJRS

METI-MLHWMEDIS-DCJAMI

RSNA SFRSFILMSIA

SIRMBIREuroRecRACS

COCIREAR-ECRDRGRANZCR

ESC

Professional Societies / SponsorsACPGMSIHIMSSHL7 AUS

IHE International Board

Global Development

Radiology

Cardiology

ITInfrastructure

Patient CareCoordination

Patient CareDevices

Laboratory

Pathology

Eye CareRadiationOncology

Public Health, Quality and Research

IHE Asia-Pacific

New ZealandAustralia Malaysia

IHE Europe

France Netherlands

Spain Sweden UKItaly

Germany

Norway

Austria

Regional Deployment

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IHE Australia Organisational StructureIHE Australia Organisational Structure

IHE Australia SponsorsIHE Australia Sponsors

- Health Informatics Society of Australia (HISA)- Health Informatics Society of Australia (HISA)

- Health Level Seven (HL7) Australia- Health Level Seven (HL7) Australia

- Medical Software Industry Association (MSIA)- Medical Software Industry Association (MSIA)

- Royal Australasian College of Radiologists (RANZCR)- Royal Australasian College of Radiologists (RANZCR)

Some Australian Supporting IHE membersSome Australian Supporting IHE members

- Health Information Management Society (HIMMS)- Health Information Management Society (HIMMS)

- Royal Australian College of Surgeons (RACS)- Royal Australian College of Surgeons (RACS)

- Australian Diagnostic Imaging Association (ADIA)- Australian Diagnostic Imaging Association (ADIA)

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IHE DomainsIHE DomainsRadiologyRadiology

CardiologyCardiology

Radiation OncologyRadiation Oncology

IT InfrastructureIT Infrastructure

Patient Care CoordinationPatient Care Coordination

Patient Care devicesPatient Care devices

Laboratory, Pathology, Eye Care.Laboratory, Pathology, Eye Care.

PharmacyPharmacy

Quality Research and Public HealthQuality Research and Public Health

IHE Value PropositionIHE Value Proposition• IHE Solutions are Driven by Strategic Healthcare Lead IHE Solutions are Driven by Strategic Healthcare Lead

UsersUsers that that collaboratecollaborate with Healthcare with Healthcare VendorsVendors

• IHE Solutions are IHE Solutions are Generic, Reusable and InteroperableGeneric, Reusable and Interoperable based on Healthcare based on Healthcare StandardsStandards: : DICOM, HL7, RFCDICOM, HL7, RFC

• IHE Solutions IHE Solutions Optimize the Clinical WorkflowsOptimize the Clinical Workflows

• IHE Deployment process – Connectathon, Integration IHE Deployment process – Connectathon, Integration Statements and Users Success Stories information helps to Statements and Users Success Stories information helps to refinerefine the product “ the product “Business CaseBusiness Case””

• IHE Technical Framework specification describes the IHE Technical Framework specification describes the Global IHE solutionsGlobal IHE solutions at a High Level for Planning & at a High Level for Planning & Marketing and in details for products Architects and Marketing and in details for products Architects and Engineering developmentEngineering development

IHE BenefitsIHE Benefits • Clinical UsersClinical Users

• Greater access to consistent informationGreater access to consistent information• Fewer errors, fewer tedious tasksFewer errors, fewer tedious tasks

• AdministratorsAdministrators• Increased throughput - Better scheduling Increased throughput - Better scheduling • Reduce CostReduce Cost

• BuyersBuyers• Specify/purchase RFP’s integration capabilities Specify/purchase RFP’s integration capabilities

easily and Freedom to acquire “Best of Breed” easily and Freedom to acquire “Best of Breed” systems systems

• IT ProfessionalsIT Professionals• Faster, more predictable integration projectsFaster, more predictable integration projects• Facilitate cooperation of competing vendorsFacilitate cooperation of competing vendors

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IHE Profile Examples IHE Profile Examples (XDS/XDS-I) Cross-Enterprise Document Sharing for (XDS/XDS-I) Cross-Enterprise Document Sharing for ImagingImaging Shares clinical documents, images, diagnostic reports and related Shares clinical documents, images, diagnostic reports and related

information between healthcare enterprisesinformation between healthcare enterprises

(PIX) Patient ID Cross-referencing(PIX) Patient ID Cross-referencing Cross-index patient IDs across multiple sitesCross-index patient IDs across multiple sites

(PDQ) Patient Demographics Query(PDQ) Patient Demographics Query Query and retrieve a patient’s demographic and visit informationQuery and retrieve a patient’s demographic and visit information

(ATNA) Audit Trail and Node Authentication(ATNA) Audit Trail and Node Authentication Systems AuthenticationSystems Authentication Audit events managementAudit events management

(BPPC) Basic Patient Privacy and Consent(BPPC) Basic Patient Privacy and Consent Patient privacy consents & enforcementPatient privacy consents & enforcement

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IHE Problem Solution ProcessIHE Problem Solution ProcessUser driven, Vendor led – A standardised process User driven, Vendor led – A standardised process ISO TR28380ISO TR28380

Working with vendors, care providers and standards Working with vendors, care providers and standards

organizations, IHE:organizations, IHE:

Distills a clear description of the problem (Users)Distills a clear description of the problem (Users)

Determines the right way to solve it using standards (Vendors)Determines the right way to solve it using standards (Vendors)

(IHE Profile)(IHE Profile)

Documents the solution in an implementation guide Documents the solution in an implementation guide

(IHE Technical Framework)(IHE Technical Framework)

Coordinates cross-vendor testing of the solution Coordinates cross-vendor testing of the solution

(IHE Connectathon)(IHE Connectathon)

Demonstrates vendor implementations (IHE Showcase)Demonstrates vendor implementations (IHE Showcase)

Go see the rest of the profilesGo see the rest of the profiles

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IHE Testing ProcessIHE Testing Process

UsersUsers

Sponsors:Sponsors:ProjectProjectManagementManagementTeamTeam

VendorsVendors

Sponsors:Sponsors:ExhibitsExhibits

DevelopDevelopTesting ToolsTesting Tools

Testing ToolsTesting Tools

ImplementImplementProfile ActorsProfile Actors

In-HouseIn-HouseTestingTesting

ConnectathonConnectathon

DemonstrationDemonstration

DeployDeploySystemsSystems

Testing ResultsTesting Results

ApprovesApprovesTest LogsTest Logs

IHE Technical Framework (IHE Profile Specifications)

Product +Product +IntegrationIntegrationStatementStatement

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What is a Connectathon?What is a Connectathon?

Cross-vendor, live, supervised, structured testsCross-vendor, live, supervised, structured tests

All participating vendors’ products tested together All participating vendors’ products tested together in the same place/timein the same place/time

Experts from each vendor available for immediate Experts from each vendor available for immediate problem resolution… fixes are done in minutes, not problem resolution… fixes are done in minutes, not months!!months!!

Each vendor tests with multiple trading partners Each vendor tests with multiple trading partners (actual product to actual product)(actual product to actual product)

Testing of real-world clinical scenarios using IHE Testing of real-world clinical scenarios using IHE Integration ProfilesIntegration Profiles

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MediaCreator

Printer[Media Reader]

Image Display[Media Reader]

PACS[Media Importer]

CD

John DoeDICOM Data

Web Data(Optional)

DICOM

DICOM

DICOM

PC BrowserWeb Data

Required to cleanup Patient ID, Acc#, etc.

A “simple” IHE Profile - Portable Data A “simple” IHE Profile - Portable Data for Imagingfor Imaging

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IHE Integration Profiles for Health Info NetsIHE Integration Profiles for Health Info Nets

Emergency Referrals Format of the Document Content

and associated coded vocabulary PHR Extracts/Updates

Format of the Document Content and associated coded vocabulary

ECG Report Document

Format of the Document Content and associated coded vocabulary

Lab Results Document Content

Format of the Document Content and associated coded vocabulary

Scanned Documents Format of the Document ContentImaging Information

Format of the Document Content and associated coded vocabulary

Medical Summary (Meds, Allergies, Pbs)

Format of the Document Contentand associated coded vocabulary

Clinical and PHR ContentClinical and PHR Content

Health Data ExchangeHealth Data Exchange

Patient Demographics Query

Patient Identifier Cross-referencing

Map patient identifiers across independent identification

domains

Notification of Document Availability

Notification of a remote provider/ health enterprise

Request Formfor Data Capture

External form with custom import/export scripting

Patient ID MgmtPatient ID Mgmt

OtherOther

Final Text ApprovedFinal Text Approved

Trial Implementation-2007 Trial Implementation-2007 –– Final Txt 2008Final Txt 2008

Cross-Enterprise Document Sharing

Registration, distribution and access across health enterprises of clinical

documents forming a longitudinal record

Cross-Enterprise Document Pt-Pt Reliable InterchangeCross-Enterprise Document

Media InterchangeCross-Community Access

Security & PrivacySecurity & Privacy

Consistent TimeCoordinate time across networked

systems

Audit Trail & Node Authentication

Centralized privacy audit trail and node to node authentication to create

a secured domain.

Basic Patients Privacy Consents

Establish Consents & Enable Access Control

Document Digital Signature

Attesting “true-copy and origin

Cross-Enterprise User Attestation

User Attributes fro Access Control

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IHE, global standards-based profiles adopted by IHE, global standards-based profiles adopted by several national & regional projectsseveral national & regional projects

Quebec, Toronto,Alberta, British Columbia

Canada Infoway

Denmark (Funen)Italy (Veneto)Spain (Aragon)

NCHICA – N. Carolina

Italy (Conto Corrente

Salute)

Boston Medical

Center - MA

FranceDMP

UK CfH(Radiology WF)

Philadelphia HIE

CHINA-MoHLab results sharing

KeyHIE – Pennsylvani

a

CHINA-ShanghaiImaging Info Sharing

JAPAN-NagoyaImaging Info Sharing

South Africa

MalaysiaSingapore

VITL-Vermont

CareSpark – TN & VA

NetherlandAmsterdam

LowerAustria

Austria

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IHE Problem Solution ProcessIHE Problem Solution Process

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From Standards to Solving a Use CaseFrom Standards to Solving a Use Case

NeHTANeHTA

PIP WGPIP WG

Standards Standards AustraliaAustralia

Interoperability Specifications

+ Constructs

Standards Adoption/Profiling

Technical Use Case Driven

Base StandardsFoundations

IHEIHE

HL7, OMG, HL7, OMG,

X12, DICOM, X12, DICOM, ISO, W3C etc… ISO, W3C etc…

Business Use Case

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IHE Australia Conformance TestingIHE Australia Conformance Testing

IHE Conformance IHE Conformance Testing supervised by Testing supervised by NATA accredited Testing NATA accredited Testing Laboratory (AHML)Laboratory (AHML)

CertificationCertificationInteroperability Specifications+ Constructs

Standards Adoption/ProfilingTechnical Use Case Driven

Base StandardsFoundations

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IHE Chicago Connectathon 2010IHE Chicago Connectathon 2010

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IHE Chicago Connectathon 2010IHE Chicago Connectathon 2010

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IHE Chicago Connectathon 2010IHE Chicago Connectathon 2010

104 vendors104 vendors

150 applications150 applications

498 engineers498 engineers

Approx. $2 million in Approx. $2 million in employee costs over 5 daysemployee costs over 5 days

77 IHE Profiles77 IHE Profiles

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Australian Secure Messaging Australian Secure Messaging Specification development process Specification development processDoHA PIP GP eHealth initiative DoHA PIP GP eHealth initiative January 2009January 2009

Initial NeHTA Secure Message Initial NeHTA Secure Message Delivery (SMD) specificationDelivery (SMD) specification

Joint Vendor (MSIA) / NEHTA Joint Vendor (MSIA) / NEHTA working group refined specificationworking group refined specification

- - 25 Vendors, 6 meetings, 9 days25 Vendors, 6 meetings, 9 days

- Technical sub-committee – 6 vendors, 4 - Technical sub-committee – 6 vendors, 4 meetings 8 daysmeetings 8 days

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Australian Secure Messaging Australian Secure Messaging Specification development process Specification development process

Output of PIP Working Group Output of PIP Working Group submitted to Standards Australia Nov submitted to Standards Australia Nov 20092009

- 3 Technical Specifications + 1 - 3 Technical Specifications + 1 technical reporttechnical report

Standards Task forceStandards Task force

Rapid public comment and publication => Rapid public comment and publication => Four publications January 2010Four publications January 2010

ATS-5822:2010 – Secure messaging deliveryATS-5822:2010 – Secure messaging delivery

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Australian Secure Messaging Australian Secure Messaging Specification development process Specification development process

Continuing work by Continuing work by Conformance/Compliance Conformance/Compliance subcommiteesubcommitee

NEHTA alpha code available March NEHTA alpha code available March 20102010

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Secure Messaging ConnectathonSecure Messaging Connectathon

Funded by DoHA, contribution by Funded by DoHA, contribution by vendorsvendors

Testing single standard – Secure Testing single standard – Secure Message Delivery ATS-5822:2010Message Delivery ATS-5822:2010

Standardised content available as IHE Standardised content available as IHE Australia profiles for eResults (ATS Australia profiles for eResults (ATS 5201:2010) and eReferral5201:2010) and eReferral

Master Class and testing streamsMaster Class and testing streams

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Secure Messaging Connectathon Secure Messaging Connectathon ToolingTooling

o Test management using Gazelle (IHE Test management using Gazelle (IHE International)International)

o Java alpha code (NEHTA)Java alpha code (NEHTA)

o Pre-connectathon remote capability Pre-connectathon remote capability testing (AHML)testing (AHML)

o Connectathon Functional Test Connectathon Functional Test harness and process (AHML)harness and process (AHML)

Useful LinksUseful Links

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www.ihe.net

www.ihe.net.au

http://ihe-australia.wikispaces.com

http://wiki.ihe.net

http://motorcycleguy.blogspot.com/2010/01/where-in-world-is-xds.html

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Italy Italy (Genoa Region)(Genoa Region)

Azienda Sanitaria Locale n. 4 Chiavarese

Conto Corrente Salute

Azienda Sanitaria Locale n. 4 Chiavarese

Conto Corrente Salute

Cooperazione e condivisioneCooperazione e condivisione

Asl 4 Chiavarese; Dipartimento di Medicina

Diagnostica e Terapie Speciali dell’Università di Padova

IHE – Commissione nazionale Italia

alcune aziende ICT esperte in soluzioni “e-health” (Rasna Medical Systems, Soluzioni Informatiche);

A.S.L. 4CHIAVARESEA.S.L. 4CHIAVARESE

per la realizzazione di un prodotto open-source su J2EE che implementa il profilo IHE XDS.

E’ stato attivato un Work Group composto da:

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Italy Italy (Genoa Region)(Genoa Region)

In service since January 2006. In service since January 2006.

4 Hospitals and 500 physician offices.4 Hospitals and 500 physician offices.

EMRs import and export documents from their local EMRs import and export documents from their local records.records.

All vendor products required to pass IHE-Europe All vendor products required to pass IHE-Europe connectathon in April 2005.connectathon in April 2005.

Patients chose to join through one of their care providerPatients chose to join through one of their care provider

Infrastructure includes:Infrastructure includes: XDS RegistryXDS Registry XDS Repository shared at the regional levelXDS Repository shared at the regional level PIX for patient Id linkingPIX for patient Id linking Doc content is CDA with PDF content. Plan in place to move to CDA rel 2 with 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.structured data. IHE (XD*-Lab) CDA Lab primary candidate.

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Austria Austria (Lower Austria and (Lower Austria and National)National)

Lower Austria Region (around Vienna) Deployed Lower Austria Region (around Vienna) Deployed in 2007 - Operational. 1.5 Million patients on-line. in 2007 - Operational. 1.5 Million patients on-line. 11 hospitals connected. 11 hospitals connected.

Use IHE profiles: Use IHE profiles: XDS, PIX, XDS-SD, ATNA, XUA, BPPC.XDS, PIX, XDS-SD, ATNA, XUA, BPPC.

National project launched in 2007 (ELGA). Given National project launched in 2007 (ELGA). Given the success to deploy the first region is about the success to deploy the first region is about one year.one year.

Roll-out includes:Roll-out includes: Ministry backing of IHE conformance (IHE-Eu Connectathon)Ministry backing of IHE conformance (IHE-Eu Connectathon) Extending to Ambulatory Physicians in 2008Extending to Ambulatory Physicians in 2008 Step-wise introduction of structured and coded content with HL7 CDA Step-wise introduction of structured and coded content with HL7 CDA

based IHE Content Profiles.based IHE Content Profiles.

LowerAustria

Austria

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USA USA (Philapdelphia Region)(Philapdelphia Region)

Philadelphia Health Info Exchange in service since 2005. Philadelphia Health Info Exchange in service since 2005. Focused on images and reports sharing.Focused on images and reports sharing.

5 Hospitals + Imaging Center + Public Health5 Hospitals + Imaging Center + Public Health The Hospital of the University of Pennsylvania The Hospital of the University of Pennsylvania Thomas Jefferson University Hospital Thomas Jefferson University Hospital Children’s Hospital of Philadelphia Children’s Hospital of Philadelphia Presbyterian Medical Center Presbyterian Medical Center Pennsylvania Hospital Pennsylvania Hospital UPHS Community Radiology UPHS Community Radiology Philadelphia Department of Public HealthPhiladelphia Department of Public Health

Migration to XDS, ATNA, PIX and XDS-I completed in Migration to XDS, ATNA, PIX and XDS-I completed in 2007.2007.

Demonstrated live at RSNA-Chicago Nov 2007Demonstrated live at RSNA-Chicago Nov 2007

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USA (Other)USA (Other)HITSP (HHS sponsored) accepted 8 IHE Integration profiles HITSP (HHS sponsored) accepted 8 IHE Integration profiles for: Lab results distribution and sharing, Registration and for: Lab results distribution and sharing, Registration and Medication History for Consumers, Biosurveillance.Medication History for Consumers, Biosurveillance.

2 NHIN-1 Pilots (CSC and IBM) leveraged IHE profiles (Med 2 NHIN-1 Pilots (CSC and IBM) leveraged IHE profiles (Med Summaries and Lab).Summaries and Lab).

South Shore, MA: Operational (Inpatient and Emergency Dept)South Shore, MA: Operational (Inpatient and Emergency Dept)

NHIN-2 Trial Implementations NHIN-2 Trial Implementations (NCHICA, Virginia & CareSpark HIEs)(NCHICA, Virginia & CareSpark HIEs)

Several HIEs projects are actively planning the use of IHESeveral HIEs projects are actively planning the use of IHE Vermont StateVermont State KeyHIE (PA)KeyHIE (PA) eHealthConnecticuteHealthConnecticut Boston Medical Center and affiliated clinicsBoston Medical Center and affiliated clinics

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