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INTEGRATING THE HEALTHCARE ENTERPISEINTEGRATING THE HEALTHCARE ENTERPISE

Contribution to the Meaningful Use of Contribution to the Meaningful Use of Interoperability World-wideInteroperability World-wide

International HL7 Interoperability ConferenceInternational HL7 Interoperability ConferenceOrlando, May 2011Orlando, May 2011

John Moehrke, John Moehrke, IHE IT Infrastructure, GE HealthcareIHE IT Infrastructure, GE Healthcare

Base Standards eHealth Projects

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The Health IT Interoperability ChallengeThe Health IT Interoperability Challenge

IHTSDO

IETFIETF

How can we realize the promise of HIT Standards?How can we realize the promise of HIT Standards?

Profile Development

Base Standards eHealth Projects

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Interoperability: From a problem to a solutionInteroperability: From a problem to a solution

IHTSDO

IETFIETF

Profiling Organizations Have EmergedProfiling Organizations Have Emerged

Specific ExtensionsSpecific Extensions

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IHE: A Framework for InteroperabilityIHE: A Framework for Interoperability

A common technical framework for harmonizing A common technical framework for harmonizing and implementing multiple standardsand implementing multiple standards Application-to-applicationApplication-to-application System-to-systemSystem-to-system Setting-to-settingSetting-to-setting

Enables seamless health information movement Enables seamless health information movement within and between enterprises, regions, nationswithin and between enterprises, regions, nations

Promotes unbiased selection and coordinated use Promotes unbiased selection and coordinated use of established healthcare of established healthcare andand IT standards to IT standards to address specific clinical needsaddress specific clinical needs

How much is IHE adopted ?How much is IHE adopted ?ISO Health Informatics: TR28380 Global Standards Adoption – IHE Process and Profiles

Worldwide IHE Adoption by National and Regional Projects

23 Country European epSOS Project US Nationwide Health Information Network Exchange Over 60 regional communities operational worldwide Large scale (5-30 Million) national projects (Austria, France) on-line &

ramping up Products broadly available

• US: over 40 EHRs • More than 10 HIE infrastructure products in clinical use• Multiple Open Source Offerings

http://tinyurl.com/wwxds Home Health CONTINUA and IHE are work together

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IHE Standards Adoption ProcessIHE Standards Adoption ProcessAdopted by International Standards Organization: TR 28380Adopted by International Standards Organization: TR 28380

Document Use Case Document Use Case RequirementsRequirementsDocument Use Case Document Use Case RequirementsRequirements

Identify available Identify available standards (standards (e.g. HL7, e.g. HL7, DICOM, IETF, OASIS)DICOM, IETF, OASIS)

Identify available Identify available standards (standards (e.g. HL7, e.g. HL7, DICOM, IETF, OASIS)DICOM, IETF, OASIS)

Develop Develop technical technical

specificationsspecifications

Develop Develop technical technical

specificationsspecifications

Testing at Testing at ConnectathonsConnectathonsTesting at Testing at ConnectathonsConnectathons IHE IHE

DemonstrationsDemonstrationsIHE IHE DemonstrationsDemonstrations

Products Products with IHEwith IHEProducts Products with IHEwith IHE

Timely access to Timely access to informationinformationTimely access to Timely access to informationinformation Easy to integrate Easy to integrate

productsproductsEasy to integrate Easy to integrate productsproducts 6

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13 Years of Steady Evolution 1998 – 201113 Years of Steady Evolution 1998 – 2011

The IHE Development DomainsThe IHE Development Domains

PharmacySince 2009

Pathologysince 2006

Radiation Oncologysince 2004

Radiologysince 1998

Cardiologysince 2004

Patient Care Devicessince 2005

Patient Care Coordinationsince 2004

Eye Caresince 2006

QualityResearch & Public Health

since 2006

Laboratorysince 2004

(Healthcare)IT Infrastructure

since 2003

since 2008

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International Growth of IHEInternational Growth of IHE

FranceFrance

Local Deployment, National Extensions Promotional & Live Demonstration Events Over 400 Organizational Members

USAUSA

GermanyGermany

ItalyItaly

JapanJapanUKUK

CanadaCanadaTaiwanTaiwan

NetherlandsNetherlandsSpainSpain

AustriaAustria

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99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

09

Pragmatic global standards harmonization + best practices sharing Pragmatic global standards harmonization + best practices sharing

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08

AustraliaAustralia

20

10

ChinaChina

TurkeyTurkey

MalaysiaMalaysia

SwitzerlandSwitzerland

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Massive events :Massive events :70-80 vendors, 120-150 products70-80 vendors, 120-150 products250-300 engineers250-300 engineers100-120 systems100-120 systems…….integrated in 5 days.integrated in 5 days

IHE ConnectathonsIHE Connectathons

Vendors do not pass…Vendors do not pass…until attested by an independent IHE Monitoruntil attested by an independent IHE Monitor

North America: January 17-21, 2011North America: January 17-21, 2011EU Connectathon: April 10-14, 2011EU Connectathon: April 10-14, 2011Korea: July 2011 Korea: July 2011 China: September 2011 China: September 2011 Japan: October 2011Japan: October 2011

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Interoperability ShowcasesInteroperability Showcases

Recent DemonstrationsRecent Demonstrations

HIMSS, Orlando - February 2011HIMSS, Orlando - February 2011

WoHIT – Budapest – May 2011WoHIT – Budapest – May 2011

Coming:Coming:Medica, Germany, November 2011Medica, Germany, November 2011

Japan, Korea, Australia, etc.Japan, Korea, Australia, etc.10

Leveraging IHE Leveraging IHE for a Meaningful Use of for a Meaningful Use of

InteroperabilityInteroperability

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MU Stage 1 – Clinical ContentMU Stage 1 – Clinical Content

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MU Stage 1Criteria

Interoperability Standards

Implement.Specification

IHE Profile

Exchange clinical info and summary record.

CDA R2 and CCD(or CCR)

HITSP C32 XPHR

Clinical Summaries CDA R2 and CCD(or CCR)

HITSP C32 XPHR

Diagnosis Terminology ICD-9-CM or SNOMED(ICD-10-CM soon)

None XPHR

Medications Terminology RXNORM or any source terminology

None XPHRXDS-MS

Vaccine Terminology HL7 VXQ None XPHRXDS-MS

Discharge Summaries None None XDS-MSXDS-SD

MU Stage 1 – Public Health & QualityMU Stage 1 – Public Health & Quality

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MU Stage 1Criteria

Interoperability Standards

Implementation Specification

IHE Profile

Syndromic Surveillance HL7V2.3.1 or V2.5.1

CDC/PHIN (new) PIX and/or PAM

Reportable Lab Results HL7V2.5.1 Electronic Lab Reporting to PH

Lab Testing Workflow XD*Lab Document

Report Quality Measures PQRI 2009 None Work in Progress

MU Stage 1 – Security & PrivacyMU Stage 1 – Security & Privacy

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MU Stage 1Criteria

Interoperability Standards

Implementation Specification

IHE Profile

Encryption AES (FIPS) None ATNA uses AES with TLS or WSXDM – e-Mail uses S/MIME

Integrity SHA-1 (FIPS) None ATNA and XDS use SHA-1XDM – e-Mail uses S/MIME

Audit Log None None ATNA requires Security Audit

Health Information Exchange MechanismsHealth Information Exchange Mechanisms

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Exchange Method Interoperability Standards

Implementation Specification

IHE Profile

Point-to-point Blind Push SMTP+MIME Direct Project

Point-to-point send with labeling

SMTP+MIME Direct Project XDM

Point-to-point send WS-I, SOAP, ebRS NwHIN CONNECT

XDR+PIX

Community Sharing HIE WS-I, SOAP, ebRS None XDS+PIX

Nation-wide Health Info Network Exchange

WS-I, SOAP, epRS NwHIN CONNECT

XCA+XCPD

Source EHRA

MU Stage 1 – Transport Gaps (2)MU Stage 1 – Transport Gaps (2)

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Publish & Share

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Point-to-Point

Information Exchange Transport Use Cases

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TransportTransport

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PCAST

Publish & Share

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Point-to-Point

IHE XCA (cross-HIE)

IHE XDS (intra-HIE)

IHE XDR (web services)

SMTP + IHE XDM (secure e-mail)

Information Exchange Transport Use Cases

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Direct

SM

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Bridge

SMTP Only(secure e-mail)

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HIN

IHE

Source EHRA

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To learn about IHE, what can you do?To learn about IHE, what can you do?

Go to: Go to: www.ihe.net

Insist on relevant IHE profiles compliance in your Insist on relevant IHE profiles compliance in your RFPs and contract documents:RFPs and contract documents:

Select Integration and Content Profiles, and Select Integration and Content Profiles, and Appropriate Actor(s) Appropriate Actor(s)

Ask vendors for their products “IHE Integration Ask vendors for their products “IHE Integration Statements”.Statements”.

Need more interoperability ? Need more interoperability ?

Contribute to IHE CommitteesContribute to IHE Committees

Support or create your national IHE (IHE Support or create your national IHE (IHE International and IHE- Europe will help)International and IHE- Europe will help)

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Providers and VendorsProviders and Vendors

Working Together to DeliverWorking Together to Deliver

Interoperable Health Information SystemsInteroperable Health Information Systems

in the Enterprisein the Enterprise

and Across Care Settingsand Across Care Settings

http://www.ihe.net

www.iheusa.net