INTEGRATING THE HEALTHCARE ENTERPISE

Critical Contribution to Interoperability Worldwide

International HL7 Interoperability Conference-10

Charles Parisot, IHE IT Infrastructure Co-Chair, GE Healthcare May, 2010

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IHE Orientation-Rio de Janeiro

Objective

Present a practical and proven process to accelerate the adoption of health information exchange standards in South America to enable the development of National and Regional eHealth Networks

eHealth and Interoperability: why is action needed ?

Interoperability: Major Cause of Health IT project failures Base Standards eHealth Projects

IETF

IHTSDO Health Interop. Standards: Ignore & Face Consequences

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Interoperability: Major Cause of Health IT project failures Base Standards eHealth Projects

IETF

IHTSDO Health Interop. Standards: Chaos with projects choice

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eHealth and Interoperability: How should we act ?

Interoperability: From a problem to a solution Profile Development eHealth Projects

IETF

IHTSDO

Project Specific Extensions

Profiling Organizations Have Emerged

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IHE Message: Standards are Necessary…Not Sufficient

Standards are

 Foundational - to interoperability and communications  Broad - varying interpretations and implementations  Narrow - may not consider relationships between standards domains  Plentiful - often redundant or disjointed  Focused - standards implementation guides focus only on a single standard

IHE provides a standard process for implementing multiple standards

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IHE: Connecting Standards to Care

Healthcare professionals work with industry Coordinate implementation of standards to meet clinical and administrative needs

 Clinicians and HIT professionals identify the key interoperability problems they face  Providers and industry work together to develop and make available standards-based solutions  Implementers follow common guidelines in purchasing and integrating effective systems

IHE: A forum for agreeing on how to implement standards and processes for making it happen

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IHE Standards Adoption Process

Adopted by International Standards Organization: TR 28380 Develop technical specifications Testing at Connectathons IHE Demonstrations Identify available standards ( e.g. HL7, DICOM, IETF, OASIS) Products with IHE Document Use Case Requirements Improve Safety, Quality and Effectiveness Easy to integrate products

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The IHE Development Domains

12 Years of Steady Evolution 1998 – 2010 Pharmacy

NEW 2009

Radiology

since 1998

Pathology

since 2006

Cardiology

since 2004

Eye Care

since 2006

Quality Research & Public Health

since 2006

(Healthcare) IT Infrastructure

since 2003

Laboratory

since 2004

Radiation Oncology

since 2004

Patient Care Devices

since 2005

Patient Care Coordination

since 2004

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Is IHE novel, how much adopted ?

IHE adopted by: The European Commission and eHealth Interop Mandate 403: endorses IHE process ISO Health Informatics: TR28380 Global Standards Adoption – IHE Process and Profiles Widespread adoption of IHE Profiles by National and Regional Projects around the world: North America, Europe, Asia Tele Health: CONTINUA and IHE work together.

12 Country European epSOS Project (IHE-Europe hosting Industry Team, performing testing).

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International Growth of IHE

  

Local Deployment, National Extensions Promotional & Live Demonstration Events Over 300 Organizational Members (all stakeholders) Switzerland Malaysia Turkey China Australia Austria UK Spain Netherlands Canada Taiwan Japan Italy France Germany USA

IHE Implementation Strategy

Leverage established standards to allow rapid deployment and plan for future

Pragmatic, Ease of Evolution

Enable architectural freedom (patient vs. provider centric, centralized vs. decentralized, scalable (from office to enterprise to IDN to Regional and National Networks)

Configuration flexibility

Support breakthrough use cases: variety of care settings, care coordination, public health, PHR, EHR

Interoperability for broad constituencies

IHE: Offers consistent, standards-based record sharing for EHRs and other information systems

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Implementing IHE today in Regional and National Health Networks:

Key Services Sharing of Patient Summaries (Incl Prescriptions)

HL7

Sharing of Laboratory Results

HL7

Sharing of Radiology Info

DICOM/HL7

Sharing of Cardiology Info Sharing of Scanned Docs

HL7/PDF DICOM HL7PDF W3C/OASIS/HL7

Sharing of Records/Documents Content Audit Trail and Secured Connection

HL7

Digital Signature

W3C/ITU

Privacy and Consent Patient Identification Mgt Provider Directory

HL7 HL7 IETF/HL7

Termi nology Services Infra structure

HL7

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Example: Patient Id Mgt Interoperability

3 IHE Profiles: Patient Identity Mgr XCPD: Cross-Community Patient Discovery Patient Identity Mgr PDQ: Patient Demographics Query PIX: Patient Identifiers Cross-referencing Based on HL7 V2 and HLV3+Web Services Widely used world-wide.

e.g. Point of care, Insurance

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IHE, Global Standards-Based Profiles Adopted in National & Regional Projects

NETHERLANDS Friesland Natn’l Mamography Lower Austria Wales

Imaging

France DMP Austria Suisse St Gallen Lausane Italy Conto Corrente Venetto - Friuli Quebec, Toronto, Alberta, British Columbia Canada Infoway VITL-Vermont France

Imaging IDF

Boston Medical Center MA Belgium Flemish-Leuven Philadelphia HIE KeyHIE Pennsylvania South Africa CHINA-Shanghai Imaging Info Sharing CHINA-MoH Lab results sharing JAPAN-Nagoya Imaging Info Sharing, Nationwide PDI guideline CareSpark – TN & VA Providence OR SHARP CA Health System THINC- New York NCHICA – N. Carolina

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eHealth and Interoperability: How to act in South America

Role of IHE for the a Country

I. Identify Interoperability Problems.

Collect requirements and promote them at the global level II. Specify Integration Profiles.

Select existing IHE profiles that match own State requirements and/or engage Country experts in the development of new IHE profiles.

Organize technical training for implementers.

III. Test Systems at the Connectathon.

Recruit implementers from own State to present systems to be tested at an existing Connectathon.

Contribute to IHE test tools development.

Evaluate possible organization of a South American Connectathon.

IV. Publish Integration Statements Drive vendors to publish their product IHE integration statements.

Organize support for national projects interoperability testing.

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Interoperability: From a problem to a policy

Base Standards Profile Development & Testing

Recognized:

Profile A Profile B Profile C …..

eHealth Projects

Interoperability Specifications IETF

Simple and Effective Profile Recognition Process & Policy

Leverage Synergies of Global Standards and Profiles Countries/Regions with such a process: Austria (ELGA) France (ASIP) Canada (Infoway), USA (HITSP) Italy (Veneto) 22

• • •

Addressing the challenge

IETF Tasks to accomplish :

Selection of specific standards Development of detailed interoperability specifications Test systems compliance.

Standards

Countries to consider:

• • Join IHE international to contribute and benefit from existing standards Ground IHE expertise in South America • Leverage the market synergies across South America 

Accelerate development of national technical interoperability strategies

IHE in SA Countries

Profiles & Tests

National Agencies & Competence Centers

Interop Specs eHealth Projects

eHealth and Interoperability

Organized as a collaborative framework Leverages IHE International Involves all key stakeholders in own Country

• • • Ministry of Health Healthcare Providers Health IT professionals • Industry, etc.

 Establishes foundation for a larger market by reducing cost and accelerating procurement of interoperable Clinical IT products

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Creation of National IHE

Step 1:

Decision on principle.

    Two/three sponsors. Agreement on governance.

Create Steering Committee. Designate Secretariat. Chair sends application to IHE International Application approved by IHE International Board. Seat on IHE Board.

Step 2:

Accept members. Approve work program and work groups.

Step 3:

For first use case (s), propose initial set of IHE Profiles for country adoption and agree on national extensions.

Step 4:

Approve initial set of IHE Profiles adopted with national extensions.

Repeat steps 3 and step 4 to broaden scope of interoperability

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Thank You!

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