september, 2005what ihe delivers 1 patient care coordination ihe europe workshop 2007 ihe patient...

1September, 2005 What IHE Delivers

Patient Patient Care Care CoordinationCoordination

IHE Europe Workshop 2007IHE Europe Workshop 2007

IHE Patient Care Coordination IHE Patient Care Coordination

Charles Parisot, GE HealthcareCharles Parisot, GE Healthcare

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Content Profile RoadmapContent Profile Roadmap

Year 2005-2006 (Trial Implementation)Year 2005-2006 (Trial Implementation) Medical Summary [MS] – Acute Care Discharge to Medical Summary [MS] – Acute Care Discharge to

PCP, PCP Referral to SpecialistPCP, PCP Referral to Specialist Unstructured Document – CDA-wrapped PDFUnstructured Document – CDA-wrapped PDF

Year 2006-2007 (Development & Testing)Year 2006-2007 (Development & Testing) Medical Summary [MS] – ED Referral [EDR]Medical Summary [MS] – ED Referral [EDR] Pre-procedure H&P [PPHP]Pre-procedure H&P [PPHP] Basic Patient Privacy Consents [BPPC]Basic Patient Privacy Consents [BPPC] Exchange Personal Health Record [XPHR] Exchange Personal Health Record [XPHR]

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PCC Content Integration ProfilesPCC Content Integration Profiles

XDS-MSXDS-MSMedicalMedical

DocumentsDocuments

ReferralReferral

BCCPBCCP

ConsentConsent

EDREDR

EmergencyEmergencyDepartmentDepartment

ReferralReferral

PPHPPPHP

PreprocedurePreprocedureHistory andHistory and

PhysicalPhysical

History andHistory andPhysicalPhysical

XPHRXPHR

PHR UpdatePHR Update

2005-20062005-20062006-20072006-20072007-20082007-2008

XD*-LABXD*-LAB

Lab ReportLab Report

PHR ExtractPHR Extract

EDNEDN


NoteNote

ACSACS

AntenatalAntenatalCareCare

SummarySummary

CACA

CareCareAssessmentsAssessments

DischargeDischargeSummarySummary

MedicalMedicalSummariesSummaries

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Content using a Specific StandardContent using a Specific Standard CDA Release 2.0CDA Release 2.0 HL7 Care Record SummaryHL7 Care Record Summary HL7/ASTM Continuity of Care DocumentHL7/ASTM Continuity of Care Document

Library of Reusable PartsLibrary of Reusable Parts Document TypesDocument Types SectionsSections EntriesEntries


Basic Patient Basic Patient PrivacyPrivacy Consents (BPPC) Consents (BPPC)

IHE Vendors Workshop 2006IHE Vendors Workshop 2006

IHE Patient Care Coordination EducationIHE Patient Care Coordination Education

John Moehrke, Robert Horn, Lori Fourquet, Keith W. BooneJohn Moehrke, Robert Horn, Lori Fourquet, Keith W. Boone

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Basic Patient Privacy ConsentsBasic Patient Privacy ConsentsAbstractAbstract

The Basic Patient Privacy Consents The Basic Patient Privacy Consents (BPPC) profile provide mechanisms to:(BPPC) profile provide mechanisms to: Record the patient privacy consent(s), Record the patient privacy consent(s), Mark documents published to XDS with the patient Mark documents published to XDS with the patient

privacy consent that was used to authorize the privacy consent that was used to authorize the publication, publication,

Enforce the privacy consent appropriate to the Enforce the privacy consent appropriate to the use.use.

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Basic Patient Privacy ConsentsBasic Patient Privacy ConsentsScopeScope

Document Sources and Document Document Sources and Document Consumers in an XDS Affinity DomainConsumers in an XDS Affinity Domain

Document Sources and Document Document Sources and Document Receivers using Cross Enterprise Point-Receivers using Cross Enterprise Point-to-Point Document Sharingto-Point Document Sharing

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Basic Patient Privacy ConsentsBasic Patient Privacy ConsentsValue PropositionValue Proposition

an Affinity Domain can an Affinity Domain can develop privacy policies, develop privacy policies, and implement them with role-based or other and implement them with role-based or other

access control mechanisms supported by EHR access control mechanisms supported by EHR systems.systems.

A patient canA patient can Be made aware of an institutions privacy policies. Be made aware of an institutions privacy policies. Have an opportunity to selectively control access Have an opportunity to selectively control access

to their healthcare information.to their healthcare information.

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Basic Patient Privacy ConsentsBasic Patient Privacy ConsentsKey Technical PropertiesKey Technical Properties

Human Readable ConsentsHuman Readable Consents

Machine ProcessableMachine Processable

Support for standards-based Role-Based Support for standards-based Role-Based Access ControlAccess Control

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Basic Patient Privacy ConsentsBasic Patient Privacy ConsentsStandards and Profiles UsedStandards and Profiles Used

CDA Release 2.0CDA Release 2.0

XDS Scanned DocumentsXDS Scanned Documents

Document Digital SignatureDocument Digital Signature

Cross Enterprise Document SharingCross Enterprise Document Sharing

Cross Enterprise Point-to-Point Document SharingCross Enterprise Point-to-Point Document Sharing

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Basic Patient Privacy ConsentsBasic Patient Privacy ConsentsExampleExample

Encounter 2Encounter 2(OK with B)(OK with B)

Encounter 1Encounter 1(Requires A)(Requires A)

Consent AConsent A

Consent BConsent B


Pre-procedure History Pre-procedure History and Physical (PPHP)and Physical (PPHP)

IHE Development Team Workshop 2006IHE Development Team Workshop 2006


Dan Russler, MD, co-chair PCC Technical CommitteeDan Russler, MD, co-chair PCC Technical Committee

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Use CaseUse Case

H&P documentation required prior to H&P documentation required prior to procedure that is designed to assess:procedure that is designed to assess: Procedure RiskProcedure Risk Anesthesia RiskAnesthesia Risk Factors influencing procedure after-care decisionsFactors influencing procedure after-care decisions

Desired outcomesDesired outcomes Minimize injury during procedureMinimize injury during procedure Optimize procedure after-careOptimize procedure after-care

Pre-procedure H&PPre-procedure H&P

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ScopeScope

To identify the required and optional PPHP To identify the required and optional PPHP document content templates including:document content templates including: CDA Document HeaderCDA Document Header CDA Document Type(s)CDA Document Type(s) CDA Section TypesCDA Section Types CDA Entry TypesCDA Entry Types


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Value PropositionValue Proposition

A procedure risk assessment A procedure risk assessment must be presentmust be present and evaluated by the operative and after-care and evaluated by the operative and after-care teams before the patient is allowed to have the teams before the patient is allowed to have the procedure. Missing information is frequently a procedure. Missing information is frequently a reason for canceling the procedure for the day, reason for canceling the procedure for the day, which leads to which leads to expensive underutilization of expensive underutilization of resources and dissatisfied patientsresources and dissatisfied patients. Further, . Further, incomplete information about the patient’s incomplete information about the patient’s clinical or home status may create a situation clinical or home status may create a situation where a procedure is performed that ultimately where a procedure is performed that ultimately results in an injury, inadequate aftercare or other results in an injury, inadequate aftercare or other undesirable outcomeundesirable outcome..


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Key Technical PropertiesKey Technical Properties

PPHP Profile inherits specifications required for PPHP Profile inherits specifications required for other IHE PCC Medical Documentsother IHE PCC Medical Documents

PPHP Profile follows documentation practices for PPHP Profile follows documentation practices for all IHE PCC Medical Documentsall IHE PCC Medical Documents

PPHP Profile emphasizes re-usability of CDA PPHP Profile emphasizes re-usability of CDA template identifiers in order to reduce un-template identifiers in order to reduce un-necessary variability in IHE Content Profilesnecessary variability in IHE Content Profiles


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Standards UsedStandards Used

IHE Medical Document Content ProfilesIHE Medical Document Content Profiles

HL7 Reference Information Model ANSI StandardHL7 Reference Information Model ANSI Standard

HL7 CDA R2 ANSI StandardHL7 CDA R2 ANSI Standard

HL7 Care Provision Domain DSTU (in process)HL7 Care Provision Domain DSTU (in process)

Implementation GuidesImplementation Guides HL7 Care Record Summary CDA R2 Implementation Guide HL7 Care Record Summary CDA R2 Implementation Guide

(in process)(in process) HL7/ASTM Continuity of Care Document Implementation HL7/ASTM Continuity of Care Document Implementation

Guide (in process)Guide (in process)



Todd Rothenhaus, MD FACEPTodd Rothenhaus, MD FACEP

American College of Emergency PhysiciansAmerican College of Emergency Physicians

Emergency Department Emergency Department ReferralReferral

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Emergency DepartmentEmergency Department ReferralReferral Value PropositionValue Proposition

Nearly 5000 EDs in US or in EuropeNearly 5000 EDs in US or in Europe

Significant percentage of ED visits are referralsSignificant percentage of ED visits are referrals

Shortage of critical health data for emergency Shortage of critical health data for emergency department patientsdepartment patients

Need to improve communication of intended patient Need to improve communication of intended patient care plans to ED providers and ensure that no care plans to ED providers and ensure that no pertinent data is lostpertinent data is lost

Streamline workflow by obviating telephone calls Streamline workflow by obviating telephone calls between busy cliniciansbetween busy clinicians

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Emergency DepartmentEmergency Department ReferralReferral ScopeScope

EHR system capable of creating a care record EHR system capable of creating a care record summary would be capable of creating a summary would be capable of creating a referral package for a receiving systemreferral package for a receiving system

The emergency department information The emergency department information systems (EDIS) will need to retrieve and read systems (EDIS) will need to retrieve and read and display this data.and display this data.

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Emergency DepartmentEmergency Department ReferralReferralUse CaseUse Case

1.1. Health care provider determines that a Health care provider determines that a patient needs to go to the EDpatient needs to go to the ED

2.2. Provider creates an ED referral package Provider creates an ED referral package using his or her EHRusing his or her EHR

3.3. Upon arrival, the ED provider identifies Upon arrival, the ED provider identifies the patient as a referralthe patient as a referral

4.4. The posted referral package is imported The posted referral package is imported into the Emergency Department into the Emergency Department Information System (EDIS)Information System (EDIS)

Provide access to critical health informationProvide access to critical health information to ED information systems in a standard manner. to ED information systems in a standard manner.


Exchange of PHR ContentExchange of PHR Content(XPHR) (XPHR)

IHE Vendors Workshop 2006IHE Vendors Workshop 2006


Keith W. Boone, GE Healthcare [co-chair PCC Technical Committee]Keith W. Boone, GE Healthcare [co-chair PCC Technical Committee]

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Exchange of PHR ContentExchange of PHR ContentXDS-MSXDS-MS

MedicalMedicalDocumentsDocuments


ReferralReferral DischargeDischargeSummarySummary

BCCPBCCP

ConsentConsent

EDREDR


ReferralReferral

PPHPPPHP


PhysicalPhysical


XPHRXPHR


XDSXDSLABLAB

CDA LabCDA Lab


XPHRXPHR



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AbstractAbstract

The Exchange of Personal Health Record The Exchange of Personal Health Record Content (XPHR) provides a standards-Content (XPHR) provides a standards-based specification for managing the based specification for managing the interchange of documents between a interchange of documents between a Personal Health Record and an EHR Personal Health Record and an EHR System to enable better interoperability System to enable better interoperability between these systems. between these systems.

Exchange of PHR Exchange of PHR ContentContent

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ScopeScope

Personal Health Record (PHR) SystemsPersonal Health Record (PHR) Systems

Electronic Health Record (EHR) SystemsElectronic Health Record (EHR) Systems

PHR System EHR System

Portable Media Creator Portable Media Importer

Distribute Document Set on Media [ITI-B]

Portable Media Creator Portable Media Importer

Distribute Document Set on Media [ITI-B]


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Value PropositionValue Proposition

Supports interchange of PHR InformationSupports interchange of PHR Information DemographicsDemographics Insurance InformationInsurance Information Medications, Problems, AllergiesMedications, Problems, Allergies Health HistoryHealth History Other InformationOther Information


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Standards UsedStandards Used

CDA Release 2.0CDA Release 2.0

ASTM Continuity of Care Data SetASTM Continuity of Care Data Set

ASTM/HL7 Continuity of Care DocumentASTM/HL7 Continuity of Care Document

HL7 Care Record SummaryHL7 Care Record Summary

AHIMA PHR Common Data ElementsAHIMA PHR Common Data Elements

XDS, XDRXDS, XDR

Document Digital SignatureDocument Digital Signature


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Key Technical PropertiesKey Technical Properties

Information is Human ReadableInformation is Human Readable

and Machine Processableand Machine Processable

Support Static and Dynamic Information Support Static and Dynamic Information Sharing Domains (XDS and XDR)Sharing Domains (XDS and XDR)

Protects Information using Digital SignatureProtects Information using Digital Signature

Update Model for EHR to PHR ChangesUpdate Model for EHR to PHR Changes


29Doc Exchange Integration ProfilesDoc Exchange Integration Profiles

Key Profiles for Document Content and ExchangeKey Profiles for Document Content and Exchange

Doc Content ProfilesDoc Content Profiles

Doc SharingDoc Sharing

XDSXDS

MediaMediaInterchangeInterchange

XDMXDM

Pt-Pt DocPt-Pt DocInterchangeInterchange

XDRXDR

ConsentConsent

BPPCBPPCEmergencyEmergency

EDREDRPrePre

SurgerySurgery

PPHPPPHP

Scanned DocScanned Doc

XDS-SDXDS-SD

LaboratoryLaboratory

XD*-LabXD*-LabPHR PHR

ExchangeExchange

XPHRXPHR

Discharge &Discharge &ReferralsReferrals

XDS-MSXDS-MS

ImagingImaging

XDS-IXDS-I

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XDS-MSXDS-MSMedicalMedical

DocumentsDocuments

ReferralReferral

BCCPBCCP

ConsentConsent

EDREDR


ReferralReferral

PPHPPPHP


PhysicalPhysical


XPHRXPHR


2005-20062005-20062006-20072006-20072007-20082007-2008

XD*-LABXD*-LAB

Lab ReportLab Report


EDNEDN


NoteNote

ACSACS

AntenatalAntenatalCareCare

SummarySummary

CACA

CareCareAssessmentsAssessments

DischargeDischargeSummarySummary


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SSttrruuccttuurreedd CCoonntteenntt wwiitthh ccooddeedd sseeccttiioonnss::

RReeaassoonn ffoorr RReeffeerrrraall VViittaall SSiiggnnss MMeeddiiccaattiioonn

SSttuuddiieess AAlllleerrggiieess

SSoocciiaall HHiissttoorryy PPrroobblleemmss

CCaarree PPllaann

Structured Text Section

Structured Text Section

Structured and Coded Header Patient, Author, Authenticator, Institution, etc.

Coded Section Entries

Coded Section Entries

Structured Text Section Coded Section

Entries

Rossi-Mori EU survey Rossi-Mori EU survey mapping tomapping to XDS-MS XDS-MSNo of No of CountriesCountries

SectionSection

allall

not not askedasked

all - BEall - BE

details about details about patientpatient

identifier, nameidentifier, name

(date of birth, gender)(date of birth, gender)

addressaddress

1212 1111

99

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historyhistorymedication historymedication historyimmunisationsimmunisationsfamily historyfamily history

1313 allergies, alerts, risks, special allergies, alerts, risks, special needsneeds

1212 ongoing medicationsongoing medications

1010 test resultstest results (lab and images) (lab and images)

1010 details about details about family doctorfamily doctor

99 active problemsactive problems

66 details about details about insuranceinsurance

66 emergency contactemergency contact (next of kin) (next of kin)

44 care planscare plansnot askednot asked ((exemptionsexemptions))

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Example of XDS-MS OptionsExample of XDS-MS Options

Actor Options Vol & Section

Content Source Discharge Summary Option(1)

Referral Option (1)

PCC TF-1: 3.4.1PCC TF-1: 3.4.2

Content Consumer

View Option (2)Document Import

Option(2)Section Import Option (2)

Discrete Data Import Option (2)

PCC TF-1: 3.4.3PCC TF-1: 3.4.4PCC TF-1: 3.4.5PCC TF-1: 3.4.6

Document Registry

No Options -

Document Repository

No Options -

Patient Identity Feed

No Options -

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IHE flexibility in leveraging standards for IHE flexibility in leveraging standards for Document FormatDocument Format

Content Format leverages Specific StandardsContent Format leverages Specific Standards HL7 CDA Release 2.0HL7 CDA Release 2.0 HL7/ASTM Continuity of Care DocumentHL7/ASTM Continuity of Care Document LOINC, SNOMED (if applicable)LOINC, SNOMED (if applicable) Others as Needed (e.g. PDF)Others as Needed (e.g. PDF)

IHE is defining a library of Reusable PartsIHE is defining a library of Reusable Parts Document TypesDocument Types Sections (only title is coded)Sections (only title is coded) Entries (clinical info semantically coded)Entries (clinical info semantically coded)

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In ConclusionIn Conclusion

IHE is experienced with patient summaries.IHE is experienced with patient summaries.

IHE ready to engage in fostering a consistent IHE ready to engage in fostering a consistent family of patient summary documents and a family of patient summary documents and a sharing infrastructure between countries and sharing infrastructure between countries and regions in Europe.regions in Europe.

september, 2005what ihe delivers 1 patient care coordination ihe europe workshop 2007 ihe patient...

Documents

patient canbe

procedureoptimize procedure

institutions privacy

privacy consent appropriate

document receivers

document consumers

preprocedure history

care teams