Healthcare IT Standards for EHR and the Role of · PDF fileHealthcare IT Standards for EHR ......
Transcript of Healthcare IT Standards for EHR and the Role of · PDF fileHealthcare IT Standards for EHR ......
Healthcare IT Standards for EHR
and the Role of IHE
Herman Oosterwijk, OTech
Harshad Puppalwar, ST Electronics
© 2010 OTech Inc.
© 2010 OTech Inc.
Big Picture
HIS: (enterprise)
Admission Billing
Operations
RIS: (department)
Scheduling Ordering
Operations Reports
PACS: (department)
Acquisition Image management
Display and Archiving
EMR: (enterprise)
Results/Reports Patient longitudinal record
Images (or references)
HL7
DICOM
EHR:
Regional
PHR:
Personal
Other
© 2010 OTech Inc.
Standards 1. Workflow
Combo study
2. Data model
Patient ID
3. Profiles
IHE
4. Presentation
GSDF
5. Vocabularies
Body part, proc codes
6. Data formats
DICOM/HL7/propr
7. Protocols
DICOM/HL7/propr
8. Transport
TCP/IP
9. Link
Ethernet/Fibre channel
10. Physical
CAT 5, fiber
Plug
and play
© 2010 OTech Inc.
DICOM vs HL7
Scope is Imaging Scope beyond Imaging
Protocol is mainly Client/
Server
Based on object oriented
principles
Attributes encoded
Conformance specified in
Conformance statements
Conformance varies; site
dependent; requires on-site
modifications and validation (I/F
engine)
Protocol is event driven, i.e.
unsolicited events using “triggers”
Object oriented in v 3.0
Attributes are text strings
Encoding uses tags No tags
“standard” “guideline”
© 2010 OTech Inc.
Example Patient Registration Message
MSH|^~\&|MegaReg|UABHospC|ImgOrdMgr|UABImgCtr|20010529090131-0500||ADT^A01|01052901|P|2.3.1
EVN||200105290901||||200105290900
PID|||56782445^^^UAReg^PI~999855750^^^USSSA^SS||KLEINSAMPLE^BARRY^Q^JR||19620910|M||2028-9^^HL70005^RA99113^^XYZ|260 GOODWIN CREST DRIVE^^BIRMINGHAM^AL^35209^^H|||||||0105I30001^^^99DEF^AN
PV1||I|W^389^1^UABH^^^^3||||12345^MORGAN^REX^J^^^MD^0010^UAMC^L||67890^GRAINGER^LUCY^X^^^MD^0010^UAMC^L|MED|||||A0||13579^POTTER^SHERMAN^T^^^MD^0010^UAMC^L
OBX|1|NM|^Body Height||1.80|m^Meter^ISO+|||||F
OBX|2|NM|^Body Weight||79|kg^Kilogram^ISO+|||||F
AL1|1||^ASPIRIN
© 2010 OTech Inc.
DICOM Example Message
0008,0005-10-ISO_IR 100 (char set)
0008,0008-22-ORIGINAL\PRIMARY\AXIAL (image Type)
0008,0016-26-1.2.840.10008.5.1.4.1.1.2 (SOP Class)
0008,0018-46-1.2.840.1936523.4.5.1.198745.. (SOP Instance)
0008,0020-8-19990702 (study date)
0008,0030-6-113004 (study time)
0008,0050-10-046-73-303 (accession #)
0008,0060-2-CT (modality)
0008,0070-8-otechinc (manufacturer)
…….
7FE0,0010-64000-82368390288994988.. (pixel data)
Tag-Length-Value:
© 2010 OTech Inc.
How does IHE fit in?
• ADT in HL7: 60 messages, 20 segments each, 30
fields each = 600 data elements
• ADT in IHE: 4 messages, 3 segments each, 10
fields each = 30 data elements
• MWL in DICOM: 120 Attributes
• MWL in IHE: 42 Attributes
• MWL Keys for query; matching key attributes:
• Patient's Name(0010,0010)
• Patient ID(0010,0020)
• Accession Number(0008,0050)
• Requested Procedure ID(0040,1001)
© 2010 OTech Inc.
Relevant HL7 Messages
Broker
PACS
Modality Worklist Mgt
RadViewing/reporting
RIS
Order (1)
Admission (2)
Modality Result
(3)
© 2010 OTech Inc.
DICOM has 2 Components
1. Communication Protocol:
• Addressing (AE Title, Port, IP address)
• Negotiation
• Roles
• Services (“commands”):
• Store, Print, Find (worklist-images)
© 2010 OTech Inc.
DICOM has 2 Components (cont.)
2. Data formats
• Object/image format:
• Header: related to patient and to image
• Encoding of pixel data (JPEG, MPEG, Wavelet)
© 2010 OTech Inc.
Use of Vocabularies
• Many objects make extensive use of Coded data
entries using standard vocabulary:
• Instead of specifying “Sagittal” for View Code, one
specifies:
• Code Value : R-112300
• Coding Scheme : SNOMED
• Scheme Version : Version 1.0
• Meaning : Sagittal
© 2010 OTech Inc.
IHE
• What is IHE?
• Role of IHE in the context of EHR’s
© 2010 OTech Inc.
The IHE Initiative
• The need for IHE
• A very simple example – SWF Profile
• IHE Profiles and Domains
• Benefits
• Latest developments
© 2010 OTech Inc.
Standards Alone Are Not Enough
• Focused on a single domain
• Mostly provide interoperability and communications
not workflows
• No clear mapping of information flow
• Narrow - may not consider relationships between
standards domains
• Don’t define the choreography among actors
• Some have issues, too many, too complex, version
problems, vendor interests
Need standards on how to implement standards
© 2010 OTech Inc.
RIS
Modality
PACS
ADT
Registration
Patient
Information
Order
Place
r
Server
Film
Folder
Image
Display
Film
Lightbox
Report
Repository
Order
Filler
Examination
Orders
Acquisitio
n Modality
Image
Manager
& Archive
Procedure
Scheduled
Modality
Worklist
Acquisition
Completed
Images
Stored
Images
Printed
Images
Retrieve
d
Report
Report
Report
Acquisition
Completed H
L7
D
IC
OM
Scheduled Workflow (SWF) Overview
© 2010 OTech Inc.
Integrating the Healthcare Enterprise (IHE)
Use of established standards to address specific
clinical need in support of optimal patient care
• It is not a standard but an agreement on how to use
established standards between systems.
• IHE is organized by clinical and operational domains Cardiology, Eye Care, IT Infrastructure, Laboratory, Patient Care
Coordination, Patient Care Devices, Quality, Research and Public Health, Radiation Oncology, Radiology
• Each domain develops and maintains its own set of
Technical Framework documents
© 2010 OTech Inc.
IHE Domains
Cardiology (CARD)
Eye Care (EYECARE)
IT Infrastructure (ITI)
Laboratory (LAB)
Anatomic Pathology (ANAPATH)
Patient Care Coordination (PCC)
Patient Care Device (PCD)
Pharmacy (PHARM)
Quality, Research and Public Health (QRPH)
Radiation Oncology (RO)
Radiology (RAD)
IHE Domains
IHE Domains are responsible
for the development and
maintenance of the IHE
Technical Frameworks
Each domain has two
Committees.
• The Planning Committee
• The Technical Committee
Each domain is sponsored by a
professional society.
© 2010 OTech Inc.
SWF
Actor: Acquisition Modality Transactions: RAD-5, RAD-6,
RAD-7, RAD-8, RAD-10
Describe the solution to a specific integration problem
Typically contain:
• The system roles (Actors)
• Their transactions
• Standards
• Design details
Integration Profiles
© 2010 OTech Inc.
Cross-enterprise Document Sharing for Imaging Consistent sharing of images and radiology reports across enterprise boundaries
Presentation of
Grouped
Procedures Manage individual
procedure image
subsets from a multi-procedure
acquisition for
viewing & reporting
Post-Processing
Workflow Manage worklists,
track status, perform
& notify image processing & CAD
steps
Reporting
Workflow Manage worklists,
track status, perform
& notify diagnostic reporting steps
Import
Reconciliation
Workflow Reconcile imported
data objects
Patient Information
Reconciliation Reconcile worklists,
status, and data
objects for unknown patients and
demographics
changes
Consistent
Presentation of
Images Create, store,
manage, retrieve
& use objects for hardcopy and
softcopy
grayscale
presentation
state
Evidence
Documents Create, store,
manage, retrieve
& use objects to record study
evidence
Key Image
Notes Create, store,
manage, retrieve
& use objects to flag significant
images
Simple Image
and Numeric
Reports Create, store,
manage, retrieve
& use simple diagnostic
reports with
optional image
NM Image Create, store,
manage, retrieve
& use NM image objects
Mammo Image Create, store,
manage, retrieve
& use Mammo image objects
Charge Posting Collect and post timely billable procedure
details
Access to Radiology Information Consistent access to images and reports
Portable Data for Imaging Consistent access to images and reports on CD Media
Other Radiology Relevant Profiles: ITI ATNA – Radiology Audit Trail Option, ITI RID, ITI PIX
create,
store,
manage, retrieve &
use images
manage
worklists, track
status, perform & notify
acquisition
related steps,
Scheduled Workflow Admit, order, schedule,
create,
store,
manage, retrieve &
use images
manage
worklists, track
status, perform & notify
acquisition
related steps,
Scheduled Workflow Admit, order, schedule,
IHE Integration Profiles - Radiology
© 2010 OTech Inc.
IHE brings together users and developers of healthcare information
technology (HIT) in an annually recurring four-step process
Define critical use cases
for information sharing
Specifications for communication
among systems to address these use cases, selecting established standards.
implements these
specifications called IHE Profiles
Tests systems at events
called Connectathons.
How Is It Organized?
© 2010 OTech Inc.
Connectathon Overview
Primary purpose: foster adoption of standards based
solutions in products
• Face-to-face interoperability testing event
• Tests implementation of Integration Profiles
capabilities defined in IHE Technical Frameworks
• Testing structured and supervised by Technical
Project Management Team
• Successful results recorded and published
• Used as preparation for demonstrations events
© 2010 OTech Inc.
Connectathon Scale
• 11th IHE North America Connectathon (Jan 11-15,
2010, Chicago)
• HIT industry's largest interoperability testing event
• Featured more than 150 systems from over 100
participating organizations - 500 systems engineers
• More than 3500 successful tests of IHE Integration
Profiles
Image Source: ihe.net
© 2010 OTech Inc.
Healthcare providers & staff
• Improved workflows
• Information whenever and
wherever needed
• Fewer opportunities for errors
• Fewer tedious tasks/repeated
work
• Improved report turnaround time
Vendors
• Align product interoperability with
industry consensus
• Decreased cost and complexity of
interface installation and
management
• Focus competition on functionality/
service space not information
transport space
Systems developed in accordance with IHE communicate with one
another better, are easier to implement, and enable care providers to
use information more effectively
Stakeholder Benefits
© 2010 OTech Inc.
Cross-Enterprise Document Sharing (XDS)
• Facilitates the registration, distribution and access across health
enterprises of patient electronic health records
• Managed through federated document repositories and a document
registry to create a longitudinal record of information about a patient
within a given clinical Affinity Domain
Benefits
• Management of the Electronic Health Record
• Registration, distribution and access across health enterprises of
patient electronic health records.
• Focused on providing a standards-based specification for managing
the sharing of documents between any healthcare enterprise,
ranging from a private physician office to a clinic to an acute care in-
patient facility.
© 2010 OTech Inc.
IHE Around the World
Source: ihe.net
© 2010 OTech Inc.
IHE in Asia
• HIMSS Asia Pacific IHE Showcases
• 2009, Kuala Lumpur, Malaysia
• Connectathon events
• 2009 in Kuala Lumpur, Malaysia
• 2010 scheduled in Korea
© 2010 OTech Inc.
When should you worry about IHE?
• Enterprise level Health IT initiatives
• Procuring equipment / systems
• Bringing disparate healthcare facilities together
• Federate & distribute Health Information systems
Remember, IHE can be incrementally implemented
© 2010 OTech Inc.
Thank You
• Harshad Puppalwar - [email protected]
• Fiona Loke – [email protected]
© 2010 OTech Inc.
Summary
• Electronic Health Record implementations require
standards to interoperate
• Standards range from physical to protocols and from
data formats to coding and from workflow to good
practices
• IHE plays a critical role in the implementation to take
away optionality and specify profiles.