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Joyce Sensmeier MS, RN, FHIMSS, HIMSSJoyce Sensmeier MS, RN, FHIMSS, HIMSS

Glen Marshall, Siemens Healthcare Glen Marshall, Siemens Healthcare

Charles Parisot, GE Healthcare Charles Parisot, GE Healthcare

IHE's contribution to IHE's contribution to standards harmonization for standards harmonization for

the Nationwide Health the Nationwide Health Information NetworkInformation Network

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What is Standards Harmonization?What is Standards Harmonization?

Healthcare is a complex multi-specialty multi-stakeholder Healthcare is a complex multi-specialty multi-stakeholder system. Multiple standard development organizations are system. Multiple standard development organizations are necessary.necessary.

Challenge is to achieve “interoperability” while implementing Challenge is to achieve “interoperability” while implementing multiple standards to meet a broad range of information multiple standards to meet a broad range of information exchange needs:exchange needs: Application-to-application System-to-system Setting-to-setting

Coordinate adoption of standards to meet clinical and Coordinate adoption of standards to meet clinical and administrative Use Casesadministrative Use Cases Identify the key interoperability problems they faceIdentify the key interoperability problems they face Providers and industry work together to develop and make available Providers and industry work together to develop and make available

standards-based solutionstandards-based solution

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Standards: Necessary…Not SufficientStandards: Necessary…Not Sufficient

Standards areStandards are Foundational - interoperability and communicationsFoundational - interoperability and communications Broad - varying interpretations and implementationsBroad - varying interpretations and implementations Narrow - may not consider relationships between Narrow - may not consider relationships between

standards domainsstandards domains Plentiful - often redundant or disjointedPlentiful - often redundant or disjointed Focused - standards implementation guides typically Focused - standards implementation guides typically

focus on a single standardfocus on a single standard

Need a standard process for implementing multiple Need a standard process for implementing multiple standardsstandards

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US Federal Initiative for Health IT and US Federal Initiative for Health IT and Nationwide Health Information NetworkNationwide Health Information Network

The U.S. healthcare system is managed both at the federal level and the state-level.

Over 200 Health Information Exchange projects in the U.S. at the state level or regional communities within the states.

At the federal level, HHS has set-up a policy-level setting board (AHIC), a coordination office (ONC) and 4 supporting initiatives for standards harmonization, certification, privacy and implementation prototyping.

IHE-USA has been engaged in the organization of one of these supporting initiatives: HITSP. IHE and its sponsors (e.g. HIMSS, RSNA, ACCE, etc.) and participants contribute to those initiatives.

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The Community is the Hub that Drives The Community is the Hub that Drives InteroperabilityInteroperability

AHIC, chaired by HHS Secretary provides strategic coordination.

CCHIT focuses on developing a mechanism for certification of health care IT products

HITSP brings together all relevant stakeholders to identify & harmonize appropriate standards

HISPC addresses variations in business policy and state law that affect privacy and security

NHIN is focused on interoperability pilots and implementation

Healthcare Information Technology

Standards Panel (HITSP)

Nationwide Health Information

Network (NHIN) Architecture

Projects

The Health Information Security and

Privacy Collaboration

(HISPC)

The Certification Commission for

Healthcare Information Technology

(CCHIT)

American Health Information

Community (AHIC)

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HITSP Delivers Interoperability Specs to AHICHITSP Delivers Interoperability Specs to AHIC

The Healthcare Information Technology Standards Panel (HITSP) has addressed 7 business use cases for interoperability.

HITSP has nearly 400 member organizations representing all U.S. stakeholders including Standards Development Organizations (incl. X12, DICOM, HL7, etc.).

HITSP, through its standards-based interoperability specifications, is leveraging standard-based implementation guides such as those from Integrating the Healthcare Enterprise (IHE).

The IHE Connectathon and the HIMSS Interoperability Showcase play a visible role demonstrating the HITSP/IHE synergy.

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From Standards to Solving a Use CaseFrom Standards to Solving a Use Case

AHIC/ONC

HITSPInteroperability Specifications

+ Constructs

Standards Adoption/Profiling

Technical Use Case Driven

Base StandardsFoundations

IHE

HL7, NCPDP,

X12, DICOM, ISO, etc…

Business Use Case

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18 IHE Profiles 18 IHE Profiles used by HITSP used by HITSP Interoperability Interoperability SpecificationsSpecifications

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IHE Profiles/HITSP Constructs IHE Profiles/HITSP Constructs reused across ISs for consistencyreused across ISs for consistency

Elect

ronic

Hea

lth R

ecord

Biosu

rvei

llence

Consum

er E

mpower

men

t

CE and A

cces

s to

clin

ical

info

Emer

gency

Res

ponder

CE and A

cces

s to

info

via

Med

ia

Quality

Med

icat

ion M

anag

emen

t HITSP In t ero p era b i l i t y Sp ecifi ca t io n s

Wit h 18 Sup p o r t in g IHE P ro fi les IS-01 IS-02

IS-03 v2.1

IS-03 v3

IS-04 IS-05 IS-06 IS-07

Expected Accepted in

APRIL 08

HITSP Construct

#IHE

Profile

Interoperability Specification Constructs (Components (C), Transactions (T), and Transaction Packages (TP))

l l l l l l13

XDSXCA Manage Sharing of Documents Transaction Package (HITSP V2.2 2007 TP13)

l 14 Send Lab Result Message Transaction Package (HITSP V2.1 2007 TP14) l l l l l 15 ATNA Security Audit Trail (HITSP_v1.1_2007_T15)l l l l l 16 CT Consistent Time (HITSP_v1.1_2007_T16)l l l 17 ATNA Secured Communication Channel (HITSP_v1.1_2007_T17)

l 18 View Lab Result From Web App Transaction (HITSP V2.0 2007 T18) l l l l l 19 XUA Entity Identity Assertion (HITSP_v1.1_2007_C19)l l l l 20 Access Control (HITSP_v1.1_2007_TP20)

l 21 QED Query for Existing Data (HITSP_v1.0_2007_TP21)l l l l l l l 22 PIX Patient ID Cross-Referencing Transaction Package (HITSP V2.0 2007 TP22) l l l l l l 23 PDQ Patient Demographics Query Transaction (HITSP V2.0 2007 T23)

l 24 PIX Pseudonymize Transaction (HITSP V2.1 2007 T24) l 25 Anonymize Component (HITSP V2.1 2007 C25)

l l 26 DSG Nonrepudiation of Origin (HITSP_v1.1_2007_C26)l 28 EDES Emergency Care Summary Document (HITSP_v1.1_2007_C28

l l 29 NAV Notification of Document Availability Transaction (HITSP V2.0 2007 T29) l l 30 BPPC Manage Consent Directives (HITSP_V1.1_2007_TP30)

l l l l l 32 Summary Documents Using CCD Component (HITSP V2.1 2007 C32) l 33 XDM Transfer of Documents on Media (HITSP_v1.0_2007_T33)

l 34 Patient Level Quality Data Message (HITSP_v1.0_2007_C34)l l l l 35 Lab Result Terminology Component (HITSP V2.0 2007 C35) l l l l 37 XD*Lab Lab Report Document Component (HITSP V2.0 2007 C37)

l 38 XDS-MS Patient Level Quality Data Document (HITSP_v1.0_2007_C38)l l 39 Encounter Message Component (HITSP V2.0 2007 C39)

l 40 Patient Eligibility Verification (HITSP_v.0.0.1_2007_T40)l 41 Radiology Result Message Component (HITSP V2.0 2007 C41)

l 42 Medication Dispensing Status (HITSP_v.0.0.1_2007_T42)l 43 Medication Orders (HITSP_v.0.0.1_2007_TP43)

l 44 Secure Web Connection Component (HITSP V2.0 2007 C44) l 46 Medication Formulary and Benefits Information (HITSP_v.0.0.1_2007_TP46)

l l 48 XDS-MS Encounter Document Component (HITSP V2.1 2007 C48) l 49 XDS-I Sharing Radiology Results Transaction Package (HITSP V2.0 2007 TP49) l 50 RFD Retrieve Form for Data Capture Transaction Package (HITSP V2.1 2007 TP50)

rraiford/v4/022208

Round One Use CasesRecognized January 2008

Round Two Use CasesAccepted January 2008

HITSP In t ero p era b i l i t y Sp ecifi ca t io n s

Wit h 18 Sup p o r t in g IHE P ro fi les

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Conformance Testing & CertificationConformance Testing & Certification

IHE Conformance Testing

CCHIT Certification

Interoperability Specifications+ Constructs

Standards Adoption/ProfilingTechnical Use Case Driven

Base StandardsFoundations

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HITSP GOALS and IHEHITSP GOALS and IHE

HITSP goals with respect to testing activities Ensure 'fitness for use' of HITSP Interoperability Specifications Has leveraged the IHE testing process to support overall collaborative

testing activities

HITSP collaboration with IHE 18 IHE Profiles are used as constructs in HITSP ISs IHE Profiles provide globally accepted standards to HITSP IHE Connectathon/HIMSS Showcase provide opportunity for

collaboration to meet mutual goals

To access HITSP Interoperability Specifications:www.HITSP.org

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HIMSS08 Interoperability ShowcaseHIMSS08 Interoperability Showcase40 out of 51 implementers demonstrated HITSP40 out of 51 implementers demonstrated HITSP