HIMSS 2005 1

Interoperability in the Real World, Testing, Success Stories and International

Didi Davis, Didi Davis, EclipsysEclipsysGlen Marshall, Glen Marshall, SiemensSiemens

IHE IT Planning Committee Co-ChairsIHE IT Planning Committee Co-Chairs

HIMSS 2005 2

W W W . I H E . N E TW W W . I H E . N E T

Providers and VendorsWorking Together to Deliver

Interoperable Health Information Systemsin the Enterprise

and across Care Settings

HIMSS 2005 3

Standards Alone Are Not Enough

• Standards offer generality, ambiguity and alternatives.

• We need to manage domain boundaries, with mapping of information flow across those boundaries.

• Vendors always have proprietary interests.• The result: Complexity!!

We need uniform guidance for We need uniform guidance for how to implement standards!how to implement standards!

HIMSS 2005 4

Connecting Standards to Care

• Care providers must work with vendors to coordinate the implementation of standards to meet their needs– Care providers need to identify the key interoperability

problems they face– Drive industry to develop and make available

standards-based solutions– Implementers need to follow common guidelines in

purchasing and integrating systems that deliver these solutions

What is an effective way to establish uniform What is an effective way to establish uniform guidance for how to implement standards ?guidance for how to implement standards ?

HIMSS 2005 5

Need for a Standards Implementation Process

StandardsStandards

DemandDemand

?OfferOfferStandardsStandardsStandardsStandards

UserProjects

HIMSS 2005 6

What is Integrating the Healthcare Enterprise ?

• IHE provides a common framework for passing health information seamlessly:– within the healthcare enterprise– across multiple healthcare enterprises– for local, regional & national health information networks.

• IHE is sponsored by healthcare professional associations (ACC, HIMSS, RSNA, etc.).

• IHE drives standards adoption to address specific clinical needs.

HIMSS 2005 7

IHE Maturity and Acceptance

• More than 100 healthcare vendors worldwide have contributed to IHE and the delivery of ready-to-integrate products to benefit healthcare enterprises of all sizes.

• IT professionals & clinicians appreciate IHE’s positive impact now expanded to address:– radiology, cardiology, laboratory– enterprise healthcare IT infrastructures– cross-enterprise healthcare IT infrastructures

HIMSS 2005 8

Understanding the IHE Initiative

• IHE has a clear focus

• IHE is a healthcare domain-based initiative

• IHE creates synergies for interoperability testing across domains

• IHE addresses the standards adoption process

• IHE is both regional and multi-national

• IHE is both user led and vendor driven

HIMSS 2005 9

A Proven Standards Adoption Process

IHEIntegrationProfiles B

IHEIntegrationProfile A

Easy toIntegrateProducts

IHEConnect-a-thon

ProductWith IHE

IHEDemonstration

User Site

RFPRFP

StandardsStandardsStandardsStandardsStandardsStandards

IHETechnical

Framework

Product IHE IntegrationStatement

IHE Integration Profiles at the heart of IHE :– Detailed selection of standards and options each solving a specific integration problem– A growing set of effective provider/vendor agreed solutions– Vendors can implement with ROI– Providers can deploy with stability

IHE Connect-a-thonResults

HIMSS 2005 10

Prof. Societies Sponsorship

Healthcare Providers & Vendors Healthcare IT Standards

HL7, DICOM, etc. General IT Standards

Internet, ISO, etc.

IHE Process

IHE Drives HealthcareStandards-based Integration

IHE Integration Profile: A well-defined and tested solution to a specific information exchange problem

Interoperable Healthcare IT Solution Specifications

IHE Integration Profile Interoperable Healthcare IT

Solution Specifications IHE Integration Profile

Interoperable Healthcare IT Solution Specifications

IHE Integration Profile Interoperable Healthcare IT

Solution Specifications IHE Integration Profile

HIMSS 2005 11

IHE

EHR- Longitudinal Record

IHE Cardiology

IHE Laboratory

IHE Radiology

IHE

Oncology

IHE

Future Domain

IHE

IT Infrastructure Intra-Enterprise

Cross-Enterprise

14 Integration Profiles

1 Integration Profile

3 Integration Profiles

9 Integration Profiles

Achievements and expanding scope

Over 100 vendors involved world-wide, 4 Technical Frameworks27 Integration Profiles, Testing at yearly Connectathons,

Demonstrations at major exhibitions world-wide

To claim compliance to IHE Integration Profiles vendors shall publish for each product an IHE Integration Statement.

HIMSS 2005 12

**HIMSS web-based survey in November 2004 – 163 participants

6%

14%

18%

28%

35%

Fewer Point-to-PointInterfaces

Improved Use of Data

Enhanced PatientSafety

Improved Access toData

Improved ClincalWorkflow

22%

30%

52%

56%

Other

Increased Sales

Technical Framework ProvidesInformation to Marketing Staff

Reduced Deployment Costs

IHE Survey Results

– 92% of respondents were aware of IHE

– Potential benefits of IHE Improved clinical workflow + access of data = 63%

– Benefits of IHE products Reduce deployment costs

= 56%

HIMSS 2005 13

IHE: Domain-based for a stepwise approach

CardiologyLabora-tory

Pharmacy,…..Radiology

Patient Identifier Linkage, Registries, SecurityPatient Identifier Linkage, Registries, Security

Electronic Health RecordElectronic Health Record

Other (e.g. Access Control, eHealthWorkflows)Other (e.g. Access Control, eHealthWorkflows)

Patient ManagementPatient Management

Order ManagementOrder Management

HIMSS 2005 14

IHE Organizational StructureMulti-Domain & Multi-National

Participantscontribute

Global Development:Radiology,IT Infrastructure,Cardiology,Lab, etc.

Delegates

IHE Europe

IHE North America

IHE Asia/Oceania

Regional &NationalDeployment

supervises reports

IHE (International) Strategic Development Committee

SponsorsCo-Chairs Global

Interoperability

IHE Domain-related Planning Committee and

Technical Committee

National Extensions

HIMSS 2005 15

IHE Process• Users identify desired functionality that require

coordination and communication among multiple systems– E.g., departmental workflow, single sign-on, sharing of documents

• Find and document standards-based transactions among systems to achieve desired functionality– Apply necessary constraints to eliminate useless wiggle room

• Provide process and tools to encourage vendors to implement– MESA software test tools + Connect-a-thon interoperability testing event

• Provide tools and education to help users acquire and integrate systems using these solutions– Connect-a-thon results, public demo & Vendor Integration statements

HIMSS 2005 16

IHE Process – 20 month yearly cycleDevelopment and Deployment

- 10 ---

- 7 ---

- 2 ---

0 ---

Public Comment Intgr-profile

Trial Implementation Intgr-profile

Sponsors announce Connectathon/Demos with set of Implementation Profiles

+ 2 ---

+ 5 ---

+ 6 ---

Vendor Participant Registered

Vendor Participants pass Connectathon

+ 9 ---

Demo &Education Material

Final Integration profile

--- Vendors release products with IHE Integration Statements

Approved Supplement Scope

Proposed Supplement Scope

HIMSS 2005 17

What IHE is NOT!

• A standards development organization– Uses established standards (HL7, DICOM, others) to

address specific clinical needs– Activity complementary to SDOs, formal relationship

with HL7, ISO, DICOM, NCCLS, etc.

• Simply a demonstration project– Demos, only one means to the end—adoption– Backed up by documentation, tools, testing, and

publication of information

HIMSS 2005 18

• Continuity & Integrity of Patient Information• Improved Patient Safety Through Ubiquitous

Access to Data• Clinical Workflow Optimization• Avoidance of Repeating Tasks• Reduction of Data Redundancy

Enterprise-wide Healthcare Needs Addressed by IHE

Improving the Patient Care Process

HIMSS 2005 19

IHE IT Infrastructure Profiles

Level / Function

Workstation Intra- enterprise

Cross- enterprise

Security, Directories

EUA(single sign-on)

ATNA, CT(log & sec. Nodes,

date/time)

PWP(personnel directory)

Patient Identity

PSA(patient synch.)

PDQ(patient query)

PIX (cross- referencing

Ids)

EHR RID(document access)

XDS(documents

sharing)

HIMSS 2005 20

Key IHE Concepts• Generalized Systems -> Actors

• Interactions between Actors -> Transactions

• Problem/Solution Scenarios -> Integration Profiles

• For each Integration Profile:

• the context is described (which real-world problem)

• the actors are defined (what systems are involved)

• the transactions are defined (what must they do)

HIMSS 2005 21

The Product World…..

Product XYZfrom Vendor T

HIMSS 2005 22

The IHE World….

IHE ActorIHE Actor

ActorActorActorActor

ActorActor

IHEIHETransactionTransactionIHEIHE

TransactionTransaction

IHEIHETransactionTransaction

IHE ActorIHE Actor

HIMSS 2005 23

Mapping IHE to Products

Product XYZfrom Vendor T

IHE ActorIHE Actor

ActorActorActorActor

ActorActor

IHEIHETransactionTransactionIHEIHE

TransactionTransaction

IHEIHETransactionTransaction

IHE ActorIHE Actor

HIMSS 2005 24

IHE Connectathon

• Open invitation to all implementers

• Advanced testing tools (MESA)

• Testing organized and supervised by project management team

• Thousands of cross-vendor tests performed

• Results recorded and published

HIMSS 2005 25

Massive yearly events :Massive yearly events :40-50 vendors40-50 vendors>300 engineers>300 engineers>100 systems>100 systems…….integrated in 5 days.integrated in 5 days

IHE Connectathons

Vendors do not pass…Vendors do not pass…until an IHE Project Manager attest it !until an IHE Project Manager attest it !

HIMSS 2005 26

Integration Statements

HIMSS 2005 27

Leveraging IHE Integration Statements

• Vendors– Claim IHE Compliance in an explicit way– Can rely on an objective and thorough specification

(IHE Technical Framework)– Willing to accept contractual commitments – Willing to correct “implementation errors”

• Buyers– Can compare product integration capabilities– Simplify and strengthen their RFPs– Can leverage a public and objective commitment– Decreased cost and complexity of interface deployment and

management

HIMSS 2005 28

Participating and Contributing VendorsAmerica

Agfa HealthCareAlgotec Systems, Ltd.BerdyCamtronicsCanon Medical SystemsCarefxCedara Software

CorporationCerner CorporationCSISTDictaphoneDR SystemsDynamic ImagingEastern InformaticsEastman Kodak CompanyEmageonEclipsysFujifilm Medical Systems

ProcomPhilips Medical SystemsRASNA Imaging SystemsSectraSentillionSiemens Medical SolutionsSoftmedicalStentor, IncStorCOMM, IncSwissray International, IncTiani Medgraph AGToshiba America Medical

SystemsUltraVisual Medical SystemsVital Images, Inc.Voxar LimitedWebMDXIMIS

GE HealthcareHeartlabHitachi Medical CorporationHologic, IncIDX Systems CorporationIMCO TechnologiesInSiteOneINFINITTKonica Minolta Marotech, Inc.McKesson Information

SolutionsMedconMedical Manager Health

SystemsMediface Co., Ltd.Merge eFilmMortara

In white, companies with IHE Committees Chairs (Summer 2004)

HIMSS 2005 29

Participating and Contributing VendorsEurope

AGFA HealthcareAISoftw@re Medical SolutionsAlgotec ARES SA aycan Digitalsysteme ConVisDEDALUSDianoemaEastman Kodak Company Ebit SanitaEDL ELFIN s.r.l. Engineering Sanità Enti LocaliESAOTEETIAM Ferrania Fujifilm GE HealthcareGMD GIE Convergence-Profils

Rogan-DelftSago spa Sectra Imtec AB Siemens Medical Solutions Soluzioni Informatiche srl Stentor Inc. Swissray Medical AG Symphonie On Line Synapsis TELEMIS S.A. TIANI MEDGRAPH AG TOREX GAP MedicalToshiba Medical Systems TSI groupe europMedica VEPRO AG VISUS Technology Transfer WAIDXR PARTNER

GWI Research IASI Srl IdeoPass Image Device-Cerner

Company INFINITT INOVITMcKesson MED2RAD MEDASYS SAMedavisMedigration GmbH MEDIMON Ltd. MEDOS AG Merge eFilm METAFORA Konica Minolta Europe Omnilab Philips Medical SystemsRasna Imaging SystemsRAYPAX INC.

In white, companies with IHE Committees Chairs (Summer 2004)

HIMSS 2005 30

Participating and Contributing VendorsAsia

JapanAGFA Gevaert JapanEBM JapanINFINITT JapanA&TCanonGoodmanClimb Medical SystemsKonica Minolta MGShimadzuSONYToshiba Medical SystemsToyo TechnicaNihon KohdenOlympusNECPioneer (Marotech)HitachiHitachi MedicoFujitsuFuji Film MedicalYokogawa

TaiwanINFINITTShing ShianINQ GENTEPTah Ya

KoreaAGFA Korea GE Healthcare KoreaINFINITTLG CNS Marotech, Inc.Medical StandardPeoplenet CommunicationsSamsung SDS

HIMSS 2005 31

Bethesda Healthcare SystemsCleveland Clinic FoundationDetroit Medical CenterGrossman Imaging CentersHôpitaux Universitaires de GenèveJohannes Gutenberg University HospitalKlinikum Nürnberg, Magic Valley Regional Medical CenterMayo Clinic JacksonvilleMcKay-Dee HospitalMeritCare Medical SystemMontefiore Medical CenterOur Lady Of The Lake Regional Medical Center (OLOL)US Dept. of Veterans AffairsVA Puget Sound Health Care SystemSt. Vincent Hospital and Health ServicesSinlau HospitalStaedtisches Klinikum GoerlitzSteinberg Diagnostic MedicalUniversity of PisaUniversity of WisconsinWarren Hospital

IHE Success Stories highlighting benefits

HIMSS 2005 32

IHE Radiology Integration Profiles

Patient Info.

Recon-ciliation

Access to Radiology Information

Consistent Present-ation of Images

Basic Security

-

EvidenceDocs

KeyImageNotes

Simple Image & Numeric Reports

Presentation of Grouped Procedures

Post-

Processing Workflow

Reporting Workflow

Charge Posting

Scheduled Workflow

Portable Data for Imaging

NMImage

New

Extensions

New

HIMSS 2005 33

Laboratory IHE Integration Profiles

Laboratory Device Automation (LDA)

In Process –TI Nov 2004In Process –TI Nov 2004

Pre-analytic process, analysis and post-analytical treatment

Laboratory Scheduled Workflow (LSWF)Completed in 2003Completed in 2003

Tests performed by a laboratory for an identified

inpatient or outpatient

Laboratory Patient Information Reconciliation (LPIR) In ProcessIn Process

Tests performed on an unidentified or misidentified patient

Laboratory Code Set Distribution (LCSD) In ProcessIn Process

Sharing the batteries and tests code sets throughout the enterprise

Laboratory Point Of Care Testing (LPOCT) In Process –TI Nov 2004In Process –TI Nov 2004

Tests performed on point of care or patient’s bedside

In Dev.

In Dev.

In Dev.

In Dev.

HIMSS 2005 34

IHE Cardiology 2004-2005

Retrieve Information for Display

Access a patient’s clinical information and documents in a format ready to be

presentedto the requesting user

EchoCardiography Worklflow

Admit, order, schedule, acquire images, notify of completed

steps, on fixed and mobile stress echo modalities.

Cardiac Catheterization Workflow

Scheduled & unscheduled acquisition and management of cathlab information, notification

of completed steps.

Provide high-quality ECG and related reportsto the enterprise and outside in a ready-to-display format

Retrieve ECG for Display

New

New

New

HIMSS 2005 35

IHE IT Infrastructure 2004-2005

Enterprise User AuthenticationEnterprise User Authentication

Provide users a single nameand centralized authentication

processacross all systems

Retrieve Information for Display

Access a patient’s clinical information and documents in a

format ready to be presentedto the requesting user

Retrieve Information for Display

Access a patient’s clinical information and documents in

a format ready to be presented

to the requesting user

Patient Identifier Cross-referencing

for MPIMap patient identifiers

across independent identification domains

Patient Identifier Cross-referencing for

MPIMap patient identifiers

across independent identification domains

Synchronize multiple applications on a desktop to the

same patient

Patient Synchronized Applications

Consistent TimeCoordinate time across

networked systems

Audit Trail & Node Authentication

Centralized privacy audit trail and node to node authentication

to create a secured domain.

New

Patient Demographics Query New

Personnel White PageAccess to workforcecontact information

NewCross-Enterprise

Document Sharing

Registration, distribution and access across health enterprises of clinical

documents forming a patient electronic health record

New

HIMSS 2005 36

IHE Profiles for RHIOs What is available and what will be added in 2005

Patient Identifier Cross-referencing

Map patient identifiers across independent identification

domains

Consistent TimeCoordinate time across

networked systems

Audit Trail & Node Authentication

Centralized privacy audit trail and node to node authentication

to create a secured domain.

Patient Demographics Query

Personnel White PageAccess to workforcecontact information

Cross-Enterprise Document Sharing

Registration, distribution and access across health enterprises of clinical

documents forming a patient electronic health record

Notification of Document Availability

Notification of a remote provider/ health enterprise

Cross-enterprise User Identity and

AccountabilityAuthentication & Auditing: Basis for Access Control

Imaging Information Content

Format of the Document Content and associated coded vocabulary

For Display Document Content

Format of the Document ContentLab Results Document Content

Format of the Document Content and associated coded vocabulary

Continuity of Care Document Content

Format of the Document Contentand associated coded vocabulary

HIMSS 2005 37

Local & Regional RHIOs Infrastructure and Interoperability

• Cross-Enterprise Document Sharing (XDS) minimizes clinical data management by the infrastructure. Transparency = Ease of Evolution

• XDS works with other IHE Integration Profiles:– Audit Trail and Node Authentication (ATNA) and Consistent Time (CT)– Patient Id Cross-referencing (PIX)– Patient Demographics Query (PDQ)

• In 2005, IHE plans to finish base set of integration profiles to build regional health networks and interoperable EHRs:– Security: Identity Management+ Accountability– Content Profiles: DICOM, HL7-CDA-R2/CCR, HL7-Lab, PDF.– Notification of Document Availability (with XDS document reference)

HIMSS 2005 38

IHE: RHIOs’ Interoperability Partner

• IHE offers a solid technical foundation to establish interoperability for RHIOs.

• Standards-based, open, multi-vendor, provider-led.

• Yearly progress, validation testing built in, backed by a proven process. Implementation by many vendors.

• RHIOs’ technical architects’ needs direct IHE involvement. Policies easier to establish when based on solid IHE Technical Framework, but are beyond IHE’s scope. They remains RHIOs’ responsibility.

HIMSS 2005 39

HIMSS “RHIO” withHIMSS “RHIO” withIHE-XDS Cross-enterpriseIHE-XDS Cross-enterprise

doc sharingdoc sharing

Experience your HIMSS-WideElectronic Health Record

Ambulatory Showcase BoothAmbulatory Showcase Booth

HomeHome

PCP

MultispecialtyMultispecialtyClinicClinic

Diag CenterDiag Center

Cross-enterprise Showcase Booth

Cardiology Workup

ComprehensivePatient Care

RadiologyRadiology CoordinatedCoordinatedPatient EvaluationPatient Evaluation

ITInfrastructure

Vendor BoothVendor Booth

Vendor BoothVendor Booth

Vendor BoothVendor Booth

Vendor BoothVendor Booth

Vendor BoothVendor Booth

Vendor BoothVendor Booth

HL7 Demonstration HL7 Demonstration

15 Vendor Booths

HIMSS 2005 40

W W W . I H E . N E TW W W . I H E . N E T

Thank YouThank YouQuestions ?Questions ?

HIMSS 2005 41

W W W . I H E . N E TW W W . I H E . N E T

Providers and VendorsWorking Together to Deliver

Interoperable Health Information Systemsin the Enterprise

and across Care Settings