Buying IT Systems with Interoperability Built-In Fact or Fiction?? Michael H. Nusbaum HIMSS Virtual...
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Transcript of Buying IT Systems with Interoperability Built-In Fact or Fiction?? Michael H. Nusbaum HIMSS Virtual...
Buying IT Systems with Interoperability Built-In
Fact or Fiction??
Michael H. Nusbaum
HIMSS Virtual ConferenceNovember 7th, 2007
Interoperability… the holy grail!
Interoperating professionally
Interoperating with life
Interoperability…
• …is the ability of two or more systems or components to exchange information accurately, completely, securely and verifiably when and where needed. and to use the information that has been exchanged.
• Semantic health care interoperability also assures the clear and persistent communication of meaning
[Mayo Clinic, 2006]
Why is HIT Interoperability Important?
Clients/Patients
Pharmacy
Laboratory
DiagnosticHospital Emergency
Homecare
Community Care Center
Clinic Emergency Services
Specialist Clinic
Buying IT with“Under-the-covers Interoperability”
HITVendor
Product “A”
HITVendor “B”Product “B”
Buying IT with“External Interoperability”
HITVendor “A”Product “A”
Inte
rfac
e E
ng
ine
HITVendor “B”Product “B”
Buying IT with“Interoperability Built-in”
HITVendor “A”Product “A”
HITVendor “C”Product “C”
Key Criteria
• “Semantic Interoperability”
• Standards-based
• Vendor-agnostic
• Consultative process
• Vendor testing for conformance
• Opportunity to demonstrate and market
• Adoption in vendor products
Integrating theHealthcare Enterprise
IHE is a standards based, global initiative that vendors, purchasers
and implementers can use to define, test and implement
interoperable healthcare solutions
Why IHE is Different
IHE is actively involved with a realistic approach to integration
Use of IHE Integration Profiles in RFP’s means having the
information you need to get the results you want
IHE provides a standard process forimplementing multiple standards
Standards are a critical step in achieving interoperability, BUT…
They are very broad - varying interpretations andimplementations
There may be more than one standard for a given domain, sometimes even redundant or disjointed
Standards implementation guides focus on only one standard, however when building a system or application you will need to consider many, including the relationships between standards domains
IHE provides a common set of tools, and a common, dependable framework for harmonizing and then implementing multiple standards.
Benefits of this approach:Seamless sharing of health informationwithin and between organizations,regions, States, and countries
Application to applicationSystem to systemSetting-to-setting
Expert, unbiased, selection and coordination of established healthcare and IT standards to address specific clinical needs.
Interoperability: Redesigning the Office Visit
Who is involved?
IHE: A forum for agreeing on how to implement standards and processes for making it happen
The Profile development process
Timely access to informationTimely access to information
Easy to integrate productsEasy to integrate products
Products with IHEProducts with IHE
IHE DemonstrationsIHE Demonstrations
Develop technical
specifications (profiles)
Develop technical
specifications (profiles)
Document Use Case Requirements
Document Use Case Requirements
Identify available standards (e.g. HL7, DICOM, IETF, OASIS)
Identify available standards (e.g. HL7, DICOM, IETF, OASIS)
Testing at ConnectathonsTesting at Connectathons
The Use CaseA clinician would like to look at previous imaging studies of a patient. While they are available, they were taken on “ABC” System, and the Clinician has “XYZ” system
The Integration ProfileConsistent Presentation of Images Integration Profile specifies a number of transactions that maintain the consistency of presentation for grayscale images
Example of an Integration Profile
Example of an Integration Profile
Example of an Integration Profile
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical
documents forming a patient
electronic health record
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
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
SecuritySecurityClinical 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
Cross-Enterprise Document Pt-Pt Reliable Interchange
Final Text ApprovedFinal Text Approved
Trial Implementation-2006 Trial Implementation-2006 –– Final Txt 2007Final Txt 2007
Cross-Enterprise Document Media Interchange
IHE Technical Frameworks
Pt. Registration [RAD-1] Patient Update [RAD-12]
Pt. Registration [RAD-1] Patient Update [RAD-12]
Placer Order Management [RAD-2] Filler Order Management [RAD-3]
ADT
Query Images [RAD-14] Retrieve Images/Evidence [CARD-4]
Image Display
Modality Image/Evidence Stored [CARD-2]
Storage Commitment
[CARD-3]
Procedure Scheduled [RAD-4]
Procedure Updated [RAD-13]
Query Modality Worklist [RAD-5]
Performed Procedure
Step Manager
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Order Placer
Acquisition Modality
ImageManager
ImageArchive
DSS/ Order Filler
Patient Update [RAD-12]
Modality Image/Evidence Stored [CARD-2]
Storage Commitment
[CARD-3]
Evidence Creator Modality PS in Progress [CARD-1]
Modality PS Completed [RAD-7]
Instance Availability Notification [RAD-49]
Pt. Registration [RAD-1] Patient Update [RAD-12]
Pt. Registration [RAD-1] Patient Update [RAD-12]
Placer Order Management [RAD-2] Filler Order Management [RAD-3]
ADT
Query Images [RAD-14] Retrieve Images/Evidence [CARD-4]
Image Display
Modality Image/Evidence Stored [CARD-2]
Storage Commitment
[CARD-3]
Procedure Scheduled [RAD-4]
Procedure Updated [RAD-13]
Query Modality Worklist [RAD-5]
Performed Procedure
Step Manager
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Order Placer
Acquisition Modality
ImageManager
ImageArchive
DSS/ Order Filler
Patient Update [RAD-12]
Modality Image/Evidence Stored [CARD-2]
Storage Commitment
[CARD-3]
Evidence Creator Modality PS in Progress [CARD-1]
Modality PS Completed [RAD-7]
Instance Availability Notification [RAD-49]
Query Modality Worklist [RAD-5]
ADT Order Placer
Register J.Doe
AcquisitionModality
Placer OrderManagement –New [RAD-2]
Patient Reconciliation
Department System Scheduler/Order Filler
Schedule Procedure
Procedure Scheduled [RAD-4]
Modality Procedure Step Completed [RAD-7]J.Doe ->
J.Smith
Patient Update/Merge [RAD-12]
Modality Procedure Step Completed [RAD-7]
PatientRegistration [RAD-1]
Patient Update/
Merge [RAD-12]
Modality Procedure Step In Progress [CARD-1]
Modality Procedure Step In Progress [CARD-1]
Perform Acquisition
Filler Order Mgmt - Status Update [RAD-3]
Filler Order Mgmt - Status Update [RAD-3]
ImageManager/
PPS Manager
Filler Order Management -New [RAD-3]
One or the other methods of creating an order is used
Query Modality Worklist [RAD-5]
ADT Order Placer
Register J.Doe
AcquisitionModality
Placer OrderManagement –New [RAD-2]
Patient Reconciliation
Department System Scheduler/Order Filler
Schedule Procedure
Procedure Scheduled [RAD-4]
Modality Procedure Step Completed [RAD-7]J.Doe ->
J.Smith
Patient Update/Merge [RAD-12]
Modality Procedure Step Completed [RAD-7]
PatientRegistration [RAD-1]
Patient Update/
Merge [RAD-12]
Modality Procedure Step In Progress [CARD-1]
Modality Procedure Step In Progress [CARD-1]
Perform Acquisition
Filler Order Mgmt - Status Update [RAD-3]
Filler Order Mgmt - Status Update [RAD-3]
ImageManager/
PPS Manager
Filler Order Management -New [RAD-3]
One or the other methods of creating an order is used
Detailed standards implementation guides
http://www.ihe.net/Technical_Framework/index.cfm
The Connectathon in 60 seconds
2008 North America Connectathon
Date: Jan. 28 – Feb 1, 2008Place: Hyatt Regency, ChicagoIncludes a 1-day conference and tour
What happens after the Connectathon?
Successful results (specific by IHE profile/actor) are published by the sponsors
Vendors self-certify, by publishing IHE Integration Statements
Only vendors who are successful are entitled to participate in Interoperability Showcasedemonstrations
2008 HIMSS Interoperability ShowcaseFebruary 24 – 28, 2007 • Orlando, FL
• 15% of the total show conference (or more than 3,600 attendees) visited the Interoperability Showcase.
• 76 participating organizations with 51 vendors demonstrated interoperability among 74 health information technology systems including EHRs, Cardiology, Radiology, Laboratory, Infrastructure and patient care device vendors.
• Over 700 attendees created and tracked their own EHR.
• 49 educational sessions were presented. • 5international delegations (France, Germany,
Holland, China and Japan) visited the showcase.
• 4 HIMSS07 keynote speakers and Congressional leaders from six states attended the showcase.
Last year…
RFPs & Integration Statements
Requiring vendors to publish their products’ Requiring vendors to publish their products’ IHE Integration Statements IHE Integration Statements provide a very effective pressure point for market-driven interoperabilityprovide a very effective pressure point for market-driven interoperability
Be Brief?“The system must support HL7”
Be Effective?“The system must support the following HL7 V2 messages
according to the following 100 pages of specifications”
Be Both!!“The system must support IHE Patient ID Cross-reference as a Patient
Identifier Source actor”
Integration StatementVersion 2.1 of the Enterprise HIS supports IHE Patient Id Cross-
referencing as Patient Identifier Source actor
How to Participate, and use IHE
As an Interested Observer: Provide Public Comments - your knowledge and experience is critical
As a Provider: Ask for IHE integration statements in your RFPs
As a Committee Member: Become a member of relevant Domains Planning or Technical Committees and help plan or develop the profiles
As a Vendor or Implementer: Implement IHE Integration Profiles, Test sytems at the Connectathon, Publish an IHE integration statement for products
Healthcare providers and support staff
o Improved workflowso Information whenever and wherever neededo Fewer opportunities for errorso Fewer tedious tasks/repeated worko Improved report turnaround time
Benefits
Vendorso Align product interoperability with industry
consensus
o Decreased cost and complexity of interface installation and management
o Focus competition on functionality/service, not information transport
Growth in IHE Domains
Radiology (18)
IT Infrastructure for Healthcare (17)
Cardiology (7)
Laboratory (6)
Radiation Oncology (1)
Patient Care Coordination (5)
Patient Care Devices (1)
Quality
Eye Care (3)
Veterinary
Endoscopy
Pathology
Pharmacy
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Toronto, Quebec, Alberta, BCCanada Health Infoway
Austria
THINC- New YorkNCHICA – N. Carolina
Italy (Conto Corrente Salute)
MA-Share – MA
FranceDMP
Philadelphia
HIE
CHINA-MoHLab results sharing
New York HIE
IHE-based Regional and National EHR Projects (Operational and Planned)
Currently accepted by HITSP
– XDS– XDS-MS– XDS-I– XD*Lab– PIX– PDQ– NAV– RFD
Example:Example: IHE adoption in the US IHE adoption in the USUnder consideration by HITSP for 2007
• Security Profiles– CT– ATNA– BPPC– DSG– XUA
• Current Interoperability Specifications Under Review– XDM– EDES– QED– XDS.b– XCA (Pending)
Example:Example: IHE adoption in Canada IHE adoption in Canada• IHE-Canada• XDS-I Profile• PIX/PDQ/v3
Providers and Vendors
Working Together to Deliver
Interoperable Health Information Systems
in the Enterprise
and Across Care Settings
Questions?