IHE Update to DICOM Committee
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Transcript of IHE Update to DICOM Committee
IHE Update to DICOM CommitteeIHE Update to DICOM Committee
Charles Parisot, GE Healthcare ITIHE IT Infrastructure Technical Committee co-chair
IHE IT Infrastructure – March 2004 2
More Info on IHEMore Info on IHE
To learn more about IHEIntegrating the Healthcare Enterprise:
www.himss.org/iheRead the IHE Fact Sheet
www.rsna.org/ihe
IHE IT Infrastructure – March 2004 3
IHE IT InfrastructureIHE IT Infrastructure5 Current Integration Profiles5 Current Integration Profiles
Enterprise User Authentication
Provide users a single nameand
centralized authentication process
across all systems
Enterprise User Authentication
Provide users a single nameand
centralized authentication process
across 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 presentedto the requesting user
Patient Identifier Cross-referencing
for MPI
Map patient identifiers across independent
identification domains
Patient Identifier Cross-referencing
for MPI
Map patient identifiers across independent
identification domains
Synchronize multiple applications on a desktop to the same patient
Patient Synchronized Applications
Synchronize multiple applications on a desktop to the same patient
Patient Synchronized Applications
Consistent Time
Coordinate time across networked
systems
Consistent Time
Coordinate time across networked
systems
IHE IT Infrastructure – March 2004 4
IHE IT Infrastructure ProgressIHE IT Infrastructure ProgressIHE IT Connect-a-thons held in the USA
(January 2004) and Europe (March 2004).
Successful HL7-IHE joint demonstration at HIMSS (Orlando). 2 IHE Radiology and 5 IT Infrastructure Integration were demonstrated by 12 vendors with 30 actors.
Overview of Supplements to be Overview of Supplements to be specified in 2004specified in 2004
IHE IT Infrastructure – March 2004 6
Prof. Societies Sponsorship
Healthcare Providers & Vendors
Healthcare IT Standards HL7, DICOM, etc.
General IT Standards Internet, ISO, etc.
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
IHE Process
IHE drives healthcare standards based-integration IHE drives healthcare standards based-integration
IHE IT Infrastructure – March 2004 7
IHE
EHR- Longitudinal Record
IHE Cardiology
IHE Laboratory
IHE Radiology
IHE
Future Domain
IHE
Future Domain
IHE
IT Infrastructure Intra-Enterprise
Cross-Enterprise
12 Integration Profiles
1 Integration Profile
6 Integration Profiles
5 Integration Profiles
IHE 2003 achievements and expanding scope IHE 2003 achievements and expanding scope
Over 80 vendors involved world-wide, 4 Technical Frameworks24 Integration Profiles, Testing at yearly Connectathons,
Demonstrations at major exhibitions world-wide
Provider-Vendor cooperation to accelerate standards adoption
IHE IT Infrastructure – March 2004 8
IHE ProcessIHE Process Users and vendors work together to identify
and design solutions for integration problems
Intensive process with annual cycles:– Identify key healthcare workflows and integration
problems– Research & select standards to specify a solution– Write, review and publish IHE Technical Framework– Perform cross-testing at “Connectathon”– Demonstrations at tradeshows (HIMSS/RSNA…)
IHE IT Infrastructure – March 2004 9
A Proven Standards Adoption ProcessA Proven Standards Adoption Process
IHEIntegrationProfiles B
IHEIntegrationProfile A
Easy toIntegrateProducts
IHEConnectathon
ProductWith IHE
IHEDemonstration
User Site
RFPRFP
Standards
IHETechnical
Framework
Product IHE IntegrationProduct IHE IntegrationStatementStatement
IHE IHE ConnectathonConnectathonResultsResults
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 IT Infrastructure – March 2004 10
IHE IT Infrastructure – Plan for 2004-2005
• IT Infrastructure Development Plan:• IHE ITI Planning Committee decision:IHE ITI Planning Committee decision: mid-Februarymid-February• Issue Public Comment version: June 2004• Public Comment Due: July 2004• Issue Trial Implementation version: Issue Trial Implementation version: August 2004August 2004• IHE Connectathon: January 2005• HIMSS Demo: HIMSS Demo: February 2005February 2005
• Profiles under development are:• Audit Trail and Node AuthenticationAudit Trail and Node Authentication• Personnel White Page Directory Personnel White Page Directory • Patient Demographics QueryPatient Demographics Query• EHR-Cross-Enterprise Clinical Document SharingEHR-Cross-Enterprise Clinical Document Sharing
IHE IT Infrastructure – March 2004 11
IHE IT Cardiology – Plan for 2004-2005 • IT Cardiology Development Plan:
• IHE Card Planning Committee decision:IHE Card Planning Committee decision: mid-Februarymid-February• Issue Public Comment version: July 2004• Public Comment Due: August 2004• Issue Trial Implementation version: Issue Trial Implementation version: September 2004September 2004• IHE Connectathon (USA): January 2005• IHE Connectathon (EU): March 2005• ACC Demo: ACC Demo: March 2005March 2005• ESC Demo: ESC Demo: August 2005August 2005
• Profiles under development :• CathLab WorkflowCathLab Workflow• EchoLab WorkflowEchoLab Workflow• Enterprise ECG Reports AccessEnterprise ECG Reports Access• Retrieve Info for Display (in Cardio - extension)Retrieve Info for Display (in Cardio - extension)• Audit Trail and Node AuthenticationAudit Trail and Node Authentication• Patient Id Cross-ReferencingPatient Id Cross-Referencing
2004 IHE Integration Profiles2004 IHE Integration Profiles
Enterprise User Authentication
Provide users a single nameand
centralized authentication
processacross all systems
Enterprise 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 presentedto the requesting user
Patient Identifier Cross-referencing
for MPI
Map patient identifiers across independent
identification domains
Patient Identifier Cross-referencing
for MPI
Map patient identifiers across independent
identification domains
Synchronize multiple applications on a desktop to the same patient
Patient Synchronized Applications
Synchronize multiple applications on a desktop to the same patient
Patient Synchronized Applications
Consistent Time
Coordinate time across networked
systems
Consistent Time
Coordinate time across networked
systems
Patient Infor-
mation Reconci-
liation
,
Access to Radiology Information
Consistent Presentation
of Images
Basic Security
-
Evidence
Documents
Key Image
Notes
Simple Image and Numeric Reports
Presentation of
Grouped Procedure
s
Post-
Processing Workflow
Reporting Workflow
Charge
Posting
Scheduled Workflow
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Laboratory Scheduled WorkflowAdmit, Discharge, Transfer a patient, order lab tests,
collect specimen, perform tests, report results.
IT InfrastructureIT InfrastructureRadiology,Radiology, LaboratoryLaboratory
IHE IT Infrastructure – March 2004 13
IHE Radiology – Plan for 2004-2005
• Radiology Development Plan:• IHE Rad Planning Committee decision:IHE Rad Planning Committee decision: mid-Octobermid-October• Issue Public Comment version: February 2004• Public Comment Due: March 2, 2004• Issue Trial Implementation version: Issue Trial Implementation version: April 2004April 2004• IHE Connectathon (USA): January 2005• IHE Connectathon (EU): March 2005
• Supplements under development:• Imaging Patient Record on MediaImaging Patient Record on Media• Appointment Notification (SWF Option)Appointment Notification (SWF Option)• Report Report (HL7 V2-OBX) (SINR Option)Report Report (HL7 V2-OBX) (SINR Option)• Instance Availability NotificationInstance Availability Notification• White Paper on Departmental WorkflowWhite Paper on Departmental Workflow
IHE IT Infrastructure – March 2004 14
IHE Laboratory – Plan for 2004-2005
• Laboratory Development Plan:• IHE Lab Planning Committee decision:IHE Lab Planning Committee decision: May 2004May 2004• Issue Public Comment version: August 2004• Public Comment Due: September, 2004• Issue Trial Implementation version: Issue Trial Implementation version: October 2004October 2004• IHE Connectathon (USA): January 2005• IHE Connectathon (EU): March 2005
• Supplements Under Discussion:• Lab Patient Info ReconciliationLab Patient Info Reconciliation• Point of Care TestingPoint of Care Testing• Lab Analyzer ManagementLab Analyzer Management• Lab Report AccessLab Report Access
IHE IT Infrastructure – March 2004 15
IHE Authentication Audit TrailIHE Authentication Audit TrailScope
– Ensures that only permitted system/devices connect to network
Authentication is node-to-node Note: User authentication covered by the EUA profile or local
procedures.
– Support for a central repository of audit information. Facilitates audit review and includes:
General security events such as logins, file access, and detection of unauthorized activity
Healthcare privacy events such as access to patient data and applications.
Imaging privacy/security events such as access to patient images.
IHE IT Infrastructure – March 2004 16
IHE Authentication and AuditIHE Authentication and Audit
Key technical properties– Node-to-node authentication uses X.509
certificates, but PKI is not specified by IHE yet.– Audit messages use a standardized XML format
(IETF RFC Pending)– Transport for audit messages may use syslog or
reliable syslog– Backwards compatibility with IHE Radiology (year
2002) is preserved.
IHE IT Infrastructure – March 2004 17
Personnel White Pages DirectoryPersonnel White Pages DirectoryScopeScope
WhitePagesServer
Healthcare Staff Info
Provide access to healthcare staff informationProvide access to healthcare staff information to systems in a standard manner. to systems in a standard manner.
Lab Reporting
ElectronicElectronicMedicalMedicalRecordsRecords
Pharma
Healthcare Staff Info
Healthcare Staff Info
IHE IT Infrastructure – March 2004 18
Personnel White Pages DirectoryPersonnel White Pages DirectoryTechnical PropertiesTechnical Properties
LDAP based directory location service
LDAP based requests of person info leveraging inetOrgPerson.
Specializes for Healthcare: Contact Info (Phone Numbers, email address, etc), and user interface friendly info (Salutation, First name, Last name, office building, user certificate list-no PKI).
Access certificate revocation list (no use rule defined).
IHE IT Infrastructure – March 2004 19
Patient Demographics QueryPatient Demographics QueryAbstract/ScopeAbstract/Scope
Allow quick retrieval of common patient name, identifier, and location in a standard manner at the point of care.
Enable selection of correct patient when full identification data may not be available
Protect patient- and enterprise-sensitive clinical information
IHE IT Infrastructure – March 2004 20
Patient Demographics QueryPatient Demographics QueryKey Technical PropertiesKey Technical Properties
Employs HL7 Conformance Based Queries– Defined in HL7 Version 2.5, Chapter 5– Query by Parameter (QBP) with Segment Pattern
Response (RSP)
User enters identifiers for patients of interest Server returns information in HL7 V2.5 patient
data segments.
IHE IT Infrastructure – March 2004 21
Introduction:EHR Cross-EnterpriseEHR Cross-EnterpriseClinical Document SharingClinical Document Sharing
First step towards the First step towards the longitudinal dimension of the EHRlongitudinal dimension of the EHR::
Focus:Focus: Clinical Information Exchange between EHRs in Clinical Information Exchange between EHRs in care settings to communicate with a distributed care settings to communicate with a distributed longitudinal EHR.longitudinal EHR.
Goal:Goal: Meet a broad range of EHR-LR (Longitudinal Record) Meet a broad range of EHR-LR (Longitudinal Record) needs with a needs with a distributed, distributed, cross-enterprise, cross-enterprise, document centric document centric
document content generic document content generic
IHE IT Infrastructure – March 2004 22
Acute Care (Inpatient)
GPs and Clinics (Outpatient)
Nursing Homes
Other Specialized Care(incl. Diagnostics Services)
Continuity of Care: Patient Longitudinal RecordPatient Longitudinal Record
Typically, a patient goes through a sequence of encounters in different Care Setting
IHE IT Infrastructure – March 2004 23
Acute Care (Inpatient)
GPs and Clinics (Outpatient)
Nursing Homes
Other Specialized Careor Diagnostics Services
EHR-LR Integration Profiles: Publishing & Accessing the EHR-LRPublishing & Accessing the EHR-LR
EHR-LR
The EHR-LR (Longitudinal Record) brings together patient encounter information managed by multiple care delivery systems
IHE IT Infrastructure – March 2004 24
Key Statements:EHR-LR FundamentalsEHR-LR Fundamentals
• Brings together patient encounter information managed by all types of care delivery systems.
• Cross-enterprise, possibly across large geographical regions, and may include many clinical domains.
• Typically collected and retained over a large period of time, providing a deep historic record for the patient.
• Supported by multiple repositories that contribute to the patient’s longitudinal healthcare record.
• Encounter data will very likely include some clinical documents, state and workflow information that will not be stored in the EHR-LR.
IHE IT Infrastructure – March 2004 25
Key Statements: What is in the EHR-LR?What is in the EHR-LR?
• The EHR-LR data is made of discrete, persistent, clinical documents accessed by an unique identifier.
• It may also contain other dynamic objects which are not being addressed by IHE at this time.
• Metadata will be provided with each document by the EHR-CR and will be stored in the EHR-LR.
• EHR-LR data formats will follow relevant clinical domain standards defined by field experts. EHR-CR is responsible for converting its internal data formats to the standard EHR-LR documents.
• EHR-LR documents will kept in the EHR-CR or pushed to a separate EHR-LR repository.
IHE IT Infrastructure – March 2004 26
Key Statements: IHE EHR Profiles ConstraintsIHE EHR Profiles Constraints
• Although the EHR-LR data domains are primarily clinical, other information and services are needed to provide a complete view of the patient longitudinal record. These include patient demographics, access security, consent policies and others – some have already been addressed by IHE integration profiles.
• The EHR-LR and EHR-CR repositories may be using different Patient Identification numbers. The longitudinal view is made possible by using standard cross-patient identification services (IHE PIX Integration Profile).
• The way data is stored and managed internally by the EHR-CR is out of scope for the EHR-LR IHE Integration Profiles.
IHE IT Infrastructure – March 2004 27
Key Statements: Accessing the EHR-LRAccessing the EHR-LR
• EHR-LR shall make available a list of all published documents for a given patient/selection parameters.
• The selection of documents is the responsibility of the EHR-LR and not of the consumer applications. This is possible because of the document metadata kept in the EHR-LR.
• The EHR-LR must ensure full content fidelity for all clinical documents that have been published.
• The actual location of any particular document shall be transparent to the consumer application.
• EHR-CR may provide clinical data by processing, extracting, or combining multiple documents.
IHE IT Infrastructure – March 2004 28
Key Statements: Deploying IHE EHR-LR ProfilesDeploying IHE EHR-LR Profiles
• The deployment of EHR-LR integration profiles will initially be focused on a small number of specialties (cardiology, oncology, etc), disease, and/or on key information for continuity of care (e.g. CCR summaries).
• The scope of the EHR-LR profiles will expand progressively as other specialties are included in the use cases.
• The IHE Cross-Enterprise Document Sharing (XDS) Profile provides the document management infrastructure to be used in conjunction with future IHE Clinical Document Content-Oriented Integration Profiles.
• A set of Care Delivery Organizations (EHR-CR) sharing Clinical Documents per the XDS Integration Profile form a “ Clinical Affinity Domain”. An EHR-CR may belong to multiple Clinical Affinity Domains (a community network, a research team, etc.)
IHE IT Infrastructure – March 2004 29
EHR-CR Document Source– Healthcare point of service system where clinical
information is first collected
EHR-LR Document Registry– Index and metadata database for all published clinical
documents
EHR-LR Documents Repository– Maintains and stores published EHR-LR documents
EHR-CR Document Consumer– Application system that needs access to EHR-LR
documents and information
EHR-LR Integration Profile: Key Actors (Application Roles)Key Actors (Application Roles)
IHE IT Infrastructure – March 2004 30
Integration Model 1: EHR-LR with Source RepositoryEHR-LR with Source Repository
1. An EHR-CR completes a phase of care for a patient where it:
1. Registers documents with an EHR-LR Registry actor.
2. Keeps these documents in an EHR-LR Repository actor.
2. Any other EHR-CR may query an EHR-LR Registry actor, find out about documents related to all phases of care for the patient and chose to retrieve some of these documents from any EHR-LR Repository Actor (Used in model 1 & 2).
EHR-CRSource
EHR-LRRegistry
EHR-LRRepository
EHR-CRConsumer
Register
Retrieve
Query
IHE IT Infrastructure – March 2004 31
Integration Model 2:EHR-LR with Third Party RepositoryEHR-LR with Third Party Repository
1. An EHR-CR completes a phase of care for a patient where it:
1. Registers documents with an EHR-LR Registry Actor.
2. Provides these documents to an EHR-LR Repository Actor.
2. Any other EHR-CR may query an EHR-LR Registry Actor, find out about documents related to all phases of care for the patient and chose to retrieve some of these documents from any EHR-LR Repository Actor (Used in model 1 & 2).
EHR-CREHR-CRSourceSource
EHR-LREHR-LRRegistryRegistry
EHR-LREHR-LRRepositoryRepository
EHR-CR EHR-CR ConsumerConsumer
Register
Retrieve
Query
Provide-Transfer
IHE IT Infrastructure – March 2004 32
EHR-CR EHR-CR ConsumerConsumer
Integration Model 3: Direct Patient Transfer-Referral Direct Patient Transfer-Referral
1. An EHR-CR completes a phase of care for a patient where it:
• Registers and Provides an EHR-CR Consumer Actor that a specific set of documents (newly created and priors of interest documents) are available from an EHR-LR Repository
2. The EHR-CR Consumer Actor receives both the registration and the documents.
EHR-CREHR-CRSourceSource
Register
Provide-Transfer
EHR-LREHR-LRDirectoryDirectory
EHR-LREHR-LRRepositoryRepository
IHE IT Infrastructure – March 2004 33
Conclusion:Conclusion:EHR Cross-Enterprise Document SharingEHR Cross-Enterprise Document Sharing
• Leverages HL7 CDA (Clinical Document Architecture).
• Leverages content from ASTM CCR (Continuity of Care Record), DICOM Objects, EHRCOM Compositions and others.
• The proposed strategy addresses one of the key integration problems in the realization of the EHR vision. IHE does not claim to master and address the definition and all aspects of a complete and interoperable EHR System.
• In collaboration with well established standards bodies and other EHR related initiatives world-wide (EuroREC, CCR, etc.), IHE expects to contribute at a more cost-effective and rapid deployment.