Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

Integrating the Healthcare EnterpriseContribution to an EHR Strategy

José Mussi – Director of Architecture, Canada Health Infoway

Goals of IHEGoals of IHE

Increase the rate and quality of integration in healthcare environments.

Foster communication among vendors.

Prove that integration is attainable through the use of standards.

Improve the efficiency and effectiveness of clinical practice.

Introduction:EHR ChallengesEHR Challenges

• One of the key integration challenges in healthcare today is achieving longitudinal electronic health records (EHR-LR)

• Developing EHR solutions requires many integration profiles, some of which IHE has already addressed:

• The Patient Cross-Referencing (PIX) profile provides methods for linking patient ID across multiple enterprises

• The Retrieve Information Display (RID) profile defines a simple method for accessing clinical data

• The Audit Trail (ATNA) profile addresses the need to have centralized logs of activities for privacy related requirements

• IHE is now addressing one of the core profiles for the EHR:

• The sharing and exchange of clinical documents across multiple healthcare settings

Introduction:EHR Cross-Enterprise Document SharingEHR Cross-Enterprise Document Sharing

First step towards the First step towards the longitudinal dimension of the EHRlongitudinal dimension of the EHR::

Focus:Focus: Clinical Information Exchange between EHRs in Clinical Information Exchange between EHRs in care settings to communicate with a distributed care settings to communicate with a distributed longitudinal EHR.longitudinal EHR.

Goal:Goal: Meet a broad range of EHR-LR (Longitudinal Record) Meet a broad range of EHR-LR (Longitudinal Record) needs with a needs with a distributed, distributed, cross-enterprise, cross-enterprise, document centric document centric

document content generic document content generic

Acute Care (Inpatient)

GPs and Clinics (Outpatient)

Nursing Homes

Other Specialized Care(incl. Diagnostics Services)

Continuity of Care: Patient Longitudinal RecordPatient Longitudinal Record

Typically, a patient goes through a sequence of encounters in different Care Setting

Acute Care (Inpatient)

GPs and Clinics (Outpatient)

Nursing Homes

Other Specialized Careor Diagnostics Services

EHR-LR Integration Profiles: Publishing & Accessing the EHR-LRPublishing & Accessing the EHR-LR

EHR-LR

The EHR-LR (Longitudinal Record) brings together patient encounter information managed by multiple care delivery systems

Care Delivery Process

Selection of informations

Decide toAssess demand For care

Actions to order

Define an action plan

Identification End ofEncounter

Define healthcareObjective

EHR-Solution = EHR-LR (Longitudinal Record) + EHR-CR (Care Delivery Record)

Two types of Integration : EHR-CR: Health Record as used during care deliveryEHR-LR: Health Record as used across-encounters

EHR-CR

Read

EHR-LR EHR-LR

Read

EHR-LR

CreateUpdate

Key Statements:EHR-LR FundamentalsEHR-LR Fundamentals

• Brings together patient encounter information managed by all types of care delivery systems.

• Cross-enterprise, possibly across large geographical regions, and may include many clinical domains.

• Typically collected and retained over a large period of time, providing a deep historic record for the patient.

• Supported by multiple repositories that contribute to the patient’s longitudinal healthcare record.

• Encounter data will very likely include some clinical documents, state and workflow information that will not be stored in the EHR-LR.

Key Statements: What is in the EHR-LR?What is in the EHR-LR?

• The EHR-LR data is made of discrete, persistent, clinical documents accessed by an unique identifier.

• It may also contain other dynamic objects which are not being addressed by IHE at this time.

• Metadata will be provided with each document by the EHR-CR and will be stored in the EHR-LR.

• EHR-LR data formats will follow relevant clinical domain standards defined by field experts. EHR-CR is responsible for converting its internal data formats to the standard EHR-LR documents.

• EHR-LR documents will kept in the EHR-CR or pushed to a separate EHR-LR repository.

Key Statements: Accessing the EHR-LRAccessing the EHR-LR

• EHR-LR shall make available a list of all published documents for a given patient/selection parameters.

• The selection of documents is the responsibility of the EHR-LR and not of the consumer applications. This is possible because of the document metadata kept in the EHR-LR.

• The EHR-LR must ensure full content fidelity for all clinical documents that have been published.

• The actual location of any particular document shall be transparent to the consumer application.

• EHR-CR may provide clinical data by processing, extracting, or combining multiple documents.

Key Statements: Deploying IHE EHR-LR ProfilesDeploying IHE EHR-LR Profiles

• The deployment of EHR-LR integration profiles will initially be focused on a small number of specialties (cardiology, oncology, etc), disease, and/or on key information for continuity of care (e.g. CCR summaries).

• The scope of the EHR-LR profiles will expand progressively as other specialties are included in the use cases.

EHR-CR Source– Healthcare point of service system where clinical

information is first collected EHR-LR Directory

– Index and metadata database for all published clinical documents

EHR-LR Documents Repository– Maintains and stores published EHR-LR documents

EHR-LR Consumer– Application system that needs access to EHR-LR

documents and information EHR-CR Recipient

– Healthcare point of service system that receives clinical documents as part of a continuity of care transfer

EHR-LR Integration Profile: Key Actors (Application Roles)Key Actors (Application Roles)

Integration Model 1: EHR-LR with Source RepositoryEHR-LR with Source Repository

1. An EHR-CR completes a phase of care for a patient where it:

1. Registers documents with an EHR-LR Directory actor.

2. Keeps these documents in an EHR-LR Repository actor.

2. Any other EHR-CR may query an EHR-LR Directory actor, find out about documents related to all phases of care for the patient and chose to retrieve some of these documents from any EHR-LR Repository Actor (Used in use Case 1 & 2).

EHR-CRSource

EHR-LRDirectory

EHR-LRRepository

EHR-LRConsumer

Register

Retrieve

Query

Integration Model 2:EHR-LR with Third Party RepositoryEHR-LR with Third Party Repository

1. An EHR-CR completes a phase of care for a patient where it:

1. Registers documents with an EHR-LR Directory Actor.

2. Provides these documents to an EHR-LR Repository Actor.

2. Any other EHR-CR may query an EHR-LR Directory Actor, find out about documents related to all phases of care for the patient and chose to retrieve some of these documents from any EHR-LR Repository Actor (Used in use Case 1 & 2).

EHR-CREHR-CRSourceSource

EHR-LREHR-LRDirectoryDirectory

EHR-LREHR-LRRepositoryRepository

EHR-LR EHR-LR ConsumerConsumer

Register

Retrieve

Query

Provide-Transfer

EHR-CR EHR-CR RecipientRecipient

Integration Model 3: Direct Patient Transfer-Referral Direct Patient Transfer-Referral

1. An EHR-CR completes a phase of care for a patient where it:

• Registers and Provides an EHR-CR Recipient Actor that a specific set of documents (newly created and priors of interest documents) are available from an EHR-LR Repository

2. The EHR-CR Recipient Actor receive both the registration and the documents.

EHR-CREHR-CRSourceSource

Register

Provide-Transfer

EHR-LREHR-LRDirectoryDirectory

EHR-LREHR-LRRepositoryRepository

Conclusion:Conclusion:EHR Cross-Enterprise Document SharingEHR Cross-Enterprise Document Sharing

• Leverages HL7 CDA (Clinical Document Architecture) and ASTM CCR (Continuity of Care Record).

• The proposed strategy addresses one of the key integration problems in the realization of the EHR vision. IHE does not claim to master and address the definition and all aspects of a complete and interoperable EHR System.

• In collaboration with well established standards bodies and other EHR related initiatives world-wide (EHRCOM, CCR, HL7, etc.), IHE expects to contribute at a more cost-effective and rapid deployment.

IHE IT Infrastructure An open process for everyone!An open process for everyone!

• To join IT Infrastructure planning or technical committee:

• Contact Joyce Sensmeier, HIMSS. jsensmeier@himss.org

• Suggest new profiles in IHE IT Infrastructure PlanningPlan IHE at HIMSS 2005

• Produce new profiles in IHE IT Infrastructure Technical Committee

For more information….For more information….

Web sites: www . himss . org / ihewww . rsna . org / ihe

Technical Documentation (www.rsna.org/ihe/tf/ihe_tf_index.shtml)

– IHE IT Technical Framework 2004 – V 1.0 – IHE Rad Technical Framework 2003 – V 5.5– IHE Laboratory Technical Framework 2004 – V 1.0

Non-Technical Brochures (www.rsna.org/ihe/ihe_faq.shtml)

– IHE Fact Sheet and IHE FAQ– IHE Integration Profiles: Guidelines for Buyers– IHE Connectathon Results

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

Thank You