Leveraging IHE forLeveraging IHE forInteroperability in the Enterprise Interoperability in the Enterprise

Michael H. NusbaumMH Nusbaum & Associatesmichael@mhnusbaum.com

John T. DonnellyIntePro Solutionsjtdonnelly@intepro.biz

IHE IT Infrastructure Planning Committee

Healthcare in America is Broken

1. Not Enough Time

2. Not Enough Money

3. Not Enough Courage

4. Not Enough Brain

5. Anecdotal versus Evidence Based Medicine

6. Quality / Safety concerns

7. Inefficient Processes

8. No UNIVERSAL PATIENT Identification

9. No Standards for the Use of Standards

Healthcare IT is Broken

• Dis-Integrated Workflow • Dis-Integrated Information Flow• Dis-Integrated Systems

Dis-Integrated Patient Care

What is IHE?

• A process, with an intensive annual cycle– Define problems– Define technical solutions

• Common information model• Common vocabulary• Use existing standards

– Test product solutions between vendors– Deploy these solutions in products– Educate the public

What is IHE NOT?

• Not a standard

• Not a standards development organization

• Not a certifying authority

• Not simply a demonstration project– Demos are only one means to the end: Adoption– Backed up by documentation, tools, testing, and

publication of information

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.

• 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.

• IHE scope, today and in the future– radiology, cardiology, laboratory– enterprise healthcare IT infrastructures– cross-enterprise healthcare IT infrastructures– RHIO’s– NHIN

IHE Maturity and Acceptance

Leadership LevelLeadership Level

CapMed/SanDiskCapMed/SanDiskEclipsysEclipsysGE HealthcareGE HealthcareIDXIDXInterSystemsInterSystemsKryptiqKryptiqQuovadx/CareScienceQuovadx/CareScienceSiemensSiemensWebMDWebMD

Participant LevelAllscriptsAllscripts

Cedara Cedara

CernerCerner

Dictaphone Dictaphone

Eastman KodakEastman Kodak

EclipsysEclipsys

EmageonEmageon

EpicEpic

ETIAMETIAM

INFINITT Tech.INFINITT Tech.

MedcomSoft MedcomSoft

MediNotesMediNotes

MedCommonsMedCommons

MidMarkMidMark

Mortara Instrument, IncMortara Instrument, IncNational Institute National Institute ofof Standards and TechnologyStandards and Technology

NextGenNextGen

NovellNovell

Open TextOpen Text

SentillionSentillion

Supporter LevelSupporter LevelAccessPtAccessPt AGFAAGFA dbMotiondbMotion Dinmar – OacisDinmar – OacisEMCEMC HealthvisionHealthvision HealthrampHealthramp McKessonMcKesson

Valco Data SystemsValco Data Systems

Vendors demonstrating at theInteroperability Showcases

Prof. Societies Sponsorship

Healthcare Providers & Vendors

Healthcare IT Standards HL7, DICOM, etc.

General IT Standards Internet, ISO, etc.

IHE Process

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

Driving healthcarethrough standards-based integration

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 scope14 Active national chapters on 3 continents, 4 Technical Frameworks

27 Integration Profiles, Testing at yearly Connectathons,Demonstrations at major exhibitions world-wide

Vendors claim compliance to IHE Integration Profiles by publishing an IHE Integration Statement for each product.

IHE Organizational StructureMulti-Domain & Multi-National

Participants

contribute

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

Goals of IHE

• Speed up the rate and quality of integration in healthcare environments

• Foster communication among vendors and care providers

• Prove that integration is attainable based on standards

• Improve the efficiency and effectiveness of clinical practice

• Improve interoperability among care domains and build a foundation for the EHR

• Provide integration solutions used within and across healthcare enterprises

IHE Deliverables

• Venue(s) for communication

• Integration Profiles

• Technical Framework

• Connect-a-thon

• Public Demonstrations

Vendorexpertise

Integration Profile

Proposed solutionUsing existing standards

IHE Technical Frameworkdetails solution

Vendor implements solutioninto

REAL product

Vendor tests solutionat

Connect-a-thon

Professional SocietiesDemonstrate/EducateThat solution exists

Healthcare SiteIncludes IHE

in RFP

The IHE ProcessProviderexpertise

IHEIntegrationProfiles B

IHEIntegrationProfile A

Easy toIntegrateProducts

IHEIHEConnect-a-thonConnect-a-thon

ProductWith IHE

IHEIHEDemonstrationDemonstration

User Site

RFPRFP

StandardsStandards

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

IHE Facilitates Standards Adoption

Connect-a-thon

• 300 people• 100 different products• 50 vendors• 5 days

Connect-a-thon Results (on ihe.net)

Vendors

IntegrationProfiles

Actors

Integration Statements

IHE Model

• Actors in precisely defined roles– Abstract the notion of information system

• Executing precisely defined transactions– Using existing standards

• Solve real world process problem

Integration Profiles for 2005

Workflow

Security

Identity Management

EHR

NEW for 2005

Cross-Enterprise Document Sharing (XDS)Transaction Overview

Document Source

Document Consumer

Document

Registry

DocumentRepository

Provide & Register

Document Set[ITI-15]

Register Document Set [ITI-14]

Retrieve Document

[ITI-17]

Query Documents

[ITI-16]

Patient Ident. Source

Patient Identity Feed

[ITI – 18]

An Affinity Domain is made up of a well defined set of Document Repositories, Document Sources and Consumers that have agreed to share clinical documents registered into a single Document Registry.

IHE Technical Specifications

• Continuity & Integrity of Patient Information

• Improved Patient Safety Through Ubiquitous Access to Data

• Clinical Workflow Optimization• Efficient Integration of Clinical Events to

Administrative/ Billing Requirements

Enterprise Healthcare Needs Addressed by IHE

Improving the Patient Care Process

Benefits of IHE

• Clinicians– Timely access to complete and consistent

patient information– Improved workflow

• Less paper, less sneakernet

• Fewer redundant steps

– Fewer manual processes, fewer opportunities for error

Benefits of IHE™

• Purchasers of Systems– True interoperability– Cheaper, less complicated deployments– Easier management of interfaces– Improved workflow

Benefits of IHE

• Vendors– Synergistic development across products– Cheaper, less complicated deployments

• Fewer site specific customizations

– Support of common workflow and information models

– Better use of standards– Focus competition on features and

functionality, rather than on interoperability

IHE Works!

• 22 user success stories deploying IHE (www.ihe.net)• Complex problematic processes involving heterogeneous

information systems• Step-wise pragmatic process that yields real-world product

solutions• Uses existing standards• First, within the Enterprise

– patient centric, bottom-up approach

• Now, address longitudinal dimension of the EHR with an inter-enterprise, patient centric, top-down approach

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

doc sharingdoc sharing

AttendeeRegistration

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

AllscriptsCapMedCerner

EclipsysGE Healthcare

IDXInfinitt

InterSystemsKryptiq

MedCommonsMediNotesNextGenOpenTextSiemensWebMD

• Technical demonstration– Featuring the IHE framework enabling standards-based

health information exchange within and across multiple healthcare enterprises, available in products today

• Clinical scenarios– Focusing on clinician access and document sharing

within the acute care environment and across multiple settings

– Includes the Continuity of Care Record (CCR), radiology images, cardiology reports, laboratory results, etc.

Cross-Enterprise Showcase

Ambulatory Care Showcase

• Demonstration of interoperability across a variety of settings, including a multi-specialty clinic and diagnostic center, a small “primary care” practice and the patient’s home

• Use cases will guide the attendee through the settings in the normal course of care

• Vendors display IHE and other interoperability solutions for effective continuity of care

• Theater area for related presentations

**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%

What can you do?

• Learn about IHE

• Participate on IHE Committees

• Insist on IHE compliance in your RFPs and contract documents

As a Provider or Vendor Contributor• Offer Clinical Use Case Input to Drive IHE Profile Development• Become a member of relevant domain’s Planning or Technical Committees or

HIMSS IHE SIG (Special Interest Group)• Become a member of relevant Regional/National Committees• Help to shape IHE’s future direction

As a Vendor Participant• Respond to Public Comments of Domain Supplements• Attend the September Educational/Workshops• Participate in Connect-a-thons and Demonstrations

As a Provider/Consultant Participant• Respond to Public Comments of Domain Supplements• Attend the September Educational/Workshops • Attend Demonstrations and include IHE Integration Profiles in your RFPs and

Integration Projects.

How can I participate?

the effective bridge betweeninformation exchange standards

and theirpractical use in healthcare

Providers and VendorsWorking Together to Deliver

Interoperable Health Information Systemsin the Enterprise and across Care Settings

Let’s hear from the users!!

Thank You!Questions ?

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

www.ihe.net