Integrating the Healthcare Enterprise (IHE)


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Chris Lindop
GE Healthcare,
IHE-International, IHE-Radiology Co-Chair
(Wednesday, Interoperability Reference Architecture Workshop)

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  • [Briefly explain the key components of a standards-based HIE, and explain Centralized and Federated models, pointing out that the “igloos” are federated repositories that can be located at the customer site in their own data center if desired.] The Document Registry keeps track of all the documents in each Document Repository, and the MPI maps all those disparate MRNs from different provider organizations. Community Connections provide a standards-based way to integrate system using IHE profiles.
  • Integrating the Healthcare Enterprise (IHE)

    1. 1. INTEGRATING THE HEALTHCARE ENTERPISE (IHE)HINZ Conference 2011Chris Lindop, GE healthcare, IHE-International, IHE-Radiology Co-Chair 1
    2. 2. AgendaIHE and the Standards Adoption Process: achieving practical interoperability 2
    3. 3. Why are standards important?Selecting a single industry-wide StandardReduces Production costs Deployment/Installation costs Deployment/Installation schedule Project risksEnables Vendors to focus on features Clinicians to focus on Patient Care 4
    4. 4. Standards: 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 5
    5. 5. What does IHE do?Enables Standards-based Interoperability:Harmonizes Standards: Into implementable specifications called IHE ProfilesPublic Forum: All work output developed through a broad, consensus-based committee process and subjected to public reviewPublish and Promote: IHE applies existing standards such as HL7, IEEE, DICOM and others to specific healthcare interoperability needs IHE Technical Frameworks freely available to all, promoted through public demonstrations and education eventsImplement and Test: Rigorous testing process and extensive tool set for implementers
    6. 6. Interoperability: From a problem to a solution Profile Development eHealth Projects IETF IHTSDO Project Specific Extensions Profiling Organizations Have Emerged To provide major support and sustainability 8
    7. 7. The IHE Initiative An Incremental Multi-Year Project Launched in 1998Goal: Enhance the Access to Clinical Information Ensure Continuity and Integrity of Patient Information Speed Up the Integration in Healthcare Environments Fosters Communication Between Vendors of Medical Information TechnologyProve that Integration is Attainable Based on StandardsParticipants: Representatives of Healthcare Providers Information & Imaging Systems Vendors Standardization Groups
    8. 8. 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 systemsIHE: A forum for agreeing on how to implementstandards and processes for making it happen 10
    9. 9. Stakeholder BenefitsHealthcare providers and support staff Improved workflows Information whenever and wherever needed Fewer opportunities for errors Fewer tedious tasks/repeated work Improved report turnaround timeVendors Align product interoperability with industry consensus Decreased cost and complexity of interface installation and management Focus competition on functionality/service space not information transport spaceSDOs Rapid feedback to adjust standards to real-world Establishment of critical mass and widespread adoption 12
    10. 10. IHE Organizational Structure IHE International Board Regional Deployment Global Development IHE North America IHE Asia-Oceania China Japan Radiology IT Laboratory Canada Infrastructure USA Australia Taiwan Malaysia Korea Cardiology Patient Care Pathology Coordination IHE Europe Radiation Patient Care Eye Care Oncology Devices Austria France Germany Netherlands Italy Norway Spain Sweden UK Public Health, Quality and ResearchProfessional Societies / Sponsors Contributing & ACC ACP RSNA COCIR SIRM ESC JAHIS METI-MLHW Jun Participating ACCE GMSI SFR EAR-ECR BIR MSC JIRA MEDIS-DC ACEP HIMSS DRG EuroRec MDEC Vendors e- SFIL JRS JAMI Sep 13 13 tem
    11. 11. The IHE Development Domains 13 Years of Steady Evolution 1998 – 2011Today over100 Radiology Profiles since 1998 Pharmacyfor Interop. Since 2009 Cardiology since 2004within the PathologyEnterprise since 2006 Laboratory since 2004& National Eye Care-Regional since 2006 (Healthcare) IT InfrastructureHealth Info since 2003Exchange Quality Radiation Oncology Research & Public Health since 2004 since 2006At Home Patient Care Coordination since 2008 Patient Care Devices since 2004 since 2005
    12. 12. International Growth of IHE Switzerland  Local Deployment, National Extensions Malaysia  Promotional & Live Demonstration Events Turkey  Over 300 Organizational Members (all stakeholders) China Australia Austria Spain Netherlands Taiwan Canada UK Japan Italy Germany France USA 2008 2005 2006 2007 2000 2001 2002 2003 2004 2009 20101999Pragmatic global standards harmonization + best practices sharing 15
    13. 13. IHE Implementation StrategyLeverage established standards to allow rapid deployment andplan for futurePragmatic, Ease of EvolutionEnable architectural freedom (patient vs. provider centric,centralized vs. decentralized, scalable (from office toenterprise to IDN to Regional and National Networks) Configuration flexibilitySupport breakthrough use cases: variety of care settings, carecoordination, public health, PHR, EHRInteroperability for broad constituencies IHE: Offers consistent, standards-based recordsharing for EHRs and other information systems 16
    14. 14. Standards Adoption Process Testing at Connectathons IHE Develop Demonstrations technical specifications ProductsIdentify available with IHEstandards (e.g. HL7,DICOM, IETF, OASIS) Timely access toDocument Use Case information Easy to integrate 17Requirements products
    15. 15. Key IHE Concepts• Generalized Systems -> Actors• Interactions between Actors -> Transactions• Problem/Solution Scenarios -> Integration Profiles• For each Integration Profile: • the context is described (which real-world problem) • the actors are defined (what systems are involved) • the transactions are defined (what must they do) 18
    16. 16. IHE Integration Profiles - Model Actors in precisely defined roles  Abstracts a specific function of information system …Executing precisely defined transactions  Using existing standards ……To solve real world interoperability problems  Specifying Integration Profiles 19
    17. 17. The Product World….. Product XYZ from Vendor T 20
    18. 18. The IHE World…. ActorActor IHE IHE Transaction IHE Actor Transaction IHE Actor IHE Actor Transaction 21
    19. 19. Mapping IHE to Products ActorActor IHE IHE Transaction IHE Actor Transaction Product XYZ from Vendor T IHE Actor IHE Actor Transaction 22
    20. 20. IHE Technical Frameworks Implementation Guide for each Integration Profile Order Department System Image ADT AcquisitionAn Integration Profile : Placer Scheduler/ Manager/ Order Filler PPS Manager Modality Use cases Register J.Doe A Set of Actors Patient Registration [RAD-1] Process Flows Placer Order Management– One or the New [RAD-2] Exchanging Transactions other methods of creating an order is used Filler Order Management - Schedule New [RAD-3] Procedure Procedure Scheduled [RAD-4] Actors Transactions Filler Order Mgmt - Status Query Modality Worklist [RAD-5] Modality Procedure Step In Progress [CARD-1] Modality Procedure Step In Progress [CARD-1] Perform Acquisition Update [RAD-3] Modality Procedure Modality Procedure Patient Reconciliation Filler Order Step Completed Step Completed J.Doe -> Mgmt - Status [RAD-7] [RAD-7] Update [RAD-3] J.Smith ADT Patient Update/ Patient Update/ Pt. Registration [RAD-1] Merge [RAD-12] Merge [RAD-12] Patient Update [RAD-12] Pt. Registration [RAD-1] Patient Update [RAD-12] Placer Order Management [RAD-2] Filler Order Management [RAD-3] DSS/ Order Filler Modality PS in Progress [CARD-1] Procedure Scheduled [RAD-4] Order Placer For each transaction: Modality PS Completed [RAD-7] Patient Update [RAD-12] Procedure Updated [RAD-13] Instance Availability Notification [RAD-49]  Std referenced Evidence Creator Image Display  Options specified  Mapping required Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7] Query Images [RAD-14] Storage Modality Image/Evidence Retrieve Images/Evidence [CARD-4] Performed Commitment Stored [CARD-2] Procedure [CARD-3] Step Manager Image Image Manager Archive Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7] Storage Modality Image/Evidence Commitment Stored [CARD-2] [CARD-3] Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7] Acquisition Modality Query Modality Worklist [RAD-5] 23
    21. 21. Organization of Technical Frameworks Volume 1: Integration and content Profiles  Describes clinical need and use cases  Identifies : • the actors and transactions or, • content modules Volume 2+ of Technical Framework  Provides implementation specification for transactions or content modules 24
    22. 22. Standards Adoption Process Testing at Connectathons IHE Develop Demonstrations technical specifications ProductsIdentify available with IHEstandards (e.g.HL7, DICOM, IETF, OASIS) Timely access toDocument Use Case information Easy to integrate 25Requirements products
    23. 23. IHE Demonstrations: NOT an IHE Connectathon IHE Connectathon is about qualifying “real-world implementations”. Strict process and controlled technical testing activity.  It is the stick ! IHE demonstration is about education and promotion about what some “connectathon tested implementations” can achieve.  It is the carrot ! Implementations participating to an IHE Demonstration are required to have passed an IHE Connectahon. Not all vendors and products are demonstrated. 26
    24. 24. IHE ConnectathonOpen invitation to vendor and otherimplementors communityAdvanced testing tools (GAZELLE)Testing organized and supervised byproject management teamThousands of cross-vendor tests performedResults recorded and published 27
    25. 25. IHE Connectathons2011 Connectathons: Chicago, USA, January 17-21, 2011 Pisa, Italy, April 11-15, 2011 Australia, July 2011 Japan, October 2011 Massive yearly events : 70-80 vendors 250-300 engineers 100-150 systems ………tested in 5 daysNext EU Connectathons:Bern, Switzerland, May 2012Istanbul, April 2013 28
    26. 26. 29
    27. 27. HIMSS Interoperability Showcase 30
    28. 28. Example: 2010 HIMSS Interoperability Showcase 31
    29. 29. Leveraging IHE Integration Statements Vendors  Claim IHE Compliance in an explicit way  Can rely on an objective and thorough specification (IHE Technical Framework)  Willing to accept contractual commitments  Willing to correct “implementation errors” Buyers  Can compare product integration capabilities  Simplify and strengthen their RFPs  Can leverage a public and objective commitment  Decreased cost and complexity of interface deployment and management 32
    30. 30. IHE Integration Statement Product vendors take the next step 33
    31. 31. Providers and Vendors Working Together to Deliver Interoperable Health Information Systems in the Enterprise And Across Care Settings Intra Hospital Workflows and Information Access 34
    32. 32. IHE Solutions within the Enterprise Enterprise EMR - HISIT Infrastructure eMPI User Auth RIS CIS LIS Eye Care Pathology Img Acq PACS Cath ECG Auto Mgr AnalyzerRadiology Cardiology Laboratory HomeTherapy Plan Nursing Station Hub Established Img Acq Feb 2009Treatment Devices Devices DevicesRadiation Therapy Pharmacy Intensive Care Unit 35
    33. 33. IHE Solutions within the Enterprise Example: IT Infrastructure Enterprise EMR - HISIT Infrastructure eMPI User Auth RIS IT Infrastructure Integration Profiles CIS Patient Administration Management LIS Eye Care Patient Demographics Query Patient Identifier Cross-referencing Pathology Img Acq Retrieve Information Cath PACS for Display ECG Auto Mgr Analyzer Enterprise User AuthenticationRadiology Consistent Time Cardiology Laboratory Patient Synchronized Applications Audit Trail and Node Authentication Personnel White Pages Shared Value Sets HomeTherapy Plan Nursing Station Hub Established Img Acq Feb 2009Treatment Devices Devices DevicesRadiation Therapy Pharmacy Intensive Care Unit 36
    34. 34. IHE Solutions within the Enterprise Example: Patient Care Devices Enterprise EMR - HISIT Infrastructure eMPI User Auth Patient Care Devices Profiles Device Enterprise Communication (DEC) RIS CIS Alarm Communication Mgt (ACM) LIS Subscribe to Patient Data (SPD) Eye Care Patient Identity Binding (PIB) Pathology Rosetta Terminology Mapping (RTM) Img Acq PACS Cath ECG Auto Mgr AnalyzerRadiology Cardiology Laboratory HomeTherapy Plan Nursing Station Hub Established Img Acq Feb 2009Treatment Devices Personal Devices DevicesRadiation Therapy Pharmacy Intensive Care Unit 37
    35. 35. IHE Solutions within the Enterprise Example: Cardiology Enterprise EMR - HISIT Infrastructure eMPI User Auth RIS CIS LIS Eye Care Pathology Img Acq PACS Cath ECG Auto Mgr AnalyzerRadiology Cardiology Laboratory Cardiology Integration Profiles Cardiac Catheterization Lab Workflow HomeTherapy Plan Echocardiography Lab Workflow Nursing Station Hub Established Retrieve ECG for Display Img Acq Feb 2009 Displayable ReportsTreatment Cath and Echo Evidence Documents Devices Devices DevicesRadiation Therapy Pharmacy Intensive Care Unit 38
    36. 36. IHE Solutions within the Enterprise Example: Radiology Enterprise EMR - HISIT Infrastructure Radiology Integration Profiles eMPI Radiology Scheduled Workflow Patient Information Reconciliation User Auth Access to Radiology Information Portable Data for Imaging RIS Consistent CIS Presentation of Images LIS Eye Care Key Image Note Presentation of Grouped Procedures Pathology Img Acq PACS Cath Evidence Documents ECG Auto Mgr AnalyzerRadiology Audit trail and Node AuthenticationLaboratory Cardiology (Rad option) Teaching Files and Clinical Trials Export Post-processing Workflow Reporting Workflow HomeTherapy Plan Charge Posting Nursing Station Hub Established Img Acq Simple Image and Numeric Reports Feb 2009Treatment Devices Devices DevicesRadiation Therapy Pharmacy Intensive Care Unit 41
    37. 37. Scheduled Workflow Profile report report Registration Report report RepositoryHIS patient Diagnostic Film information Workstation Lightbox images PACS retrieved Orders Placed procedure scheduled Film Prefetch any relevant Image Manager Folderexamination orders prior studies & Archive modality Acquisition images worklist Modality Orders Filled stored RIS acquisition completed acquisition Film in-progress completed images printed Modality 42
    38. 38. Requirements for an open HIE/EHRBring trust and ease of use for healthcare professionals: Care delivery organizations choose information to share: • Based on patient health status • When they see fit (discharge, end of encounter, etc.) • What information to share (pick relevant documents, and content elements). Care delivery organizations access patient info through: • Their own local EMR (if they have one) • Through a shared portal/service otherwise. When accessing patient info: • Find quickly if relevant information is available or not (single query) • May select among relevant records (may be done in background) • Among them chose to import whole or part in local patient record 43
    39. 39. Requirements for an open HIE/EHR(2)Bring trust and privacy to patients: Only authorized organizations and authenticated healthcare providers may transact in the HIE: • Each node or IT system interfaced is strongly authenticated • Each user shall be authenticated on the edge system • All traffic trough the infrastructure is encrypted Patient consent needs multiple choices or levels • Unless opt-in, no data about a specific patient may be shared • Several data sharing policies offered to the patient consent • Each shared record/document is assigned to specific policies (or not shared) at encounter time. • Healthcare providers may only access records/documents compatible with their role. 44
    40. 40. Categories of Healthcare Communication Services HIEs and Shared EHRs Hospitalse.g. access to last 6 e.g. get a current list e.g. order a lab months historical of allergies or med test, track status andlabs and encounter list from a source receive results summaries Source-persisted Specific info 2 or more entities and attested health snapshot synchronize records provided on demand a task Dynamic Document Workflow Information Sharing Management Access Patient and Provider ID Mgt Security 45
    41. 41. Registering Health Records:IHE-XDSCommunity Clinic Record Specialist Record Hospital Record Repository of 1-Reference Documents to records Repository of Documents Clinical IT System Index of patients records Health Info Exchange 46Clinical Encounter
    42. 42. Access to Shared Records : IHE-XDSCommunity Clinic Record Specialist Record Hospital Record Repository of Documents Repository of Documents 3-Records 4-Patient data Returned presented to Physician Clinical IT System Index of patients records Aggregate HIE Patient Info 2-Reference to Records for Inquiry 47Clinical Encounter
    43. 43. XDS – Value PropositionFoundation for Health IT Infrastructures: SharedElectronic Health Record, in a community, region, etc.Effective means to contribute and access clinicaldocuments across health enterprises.Scalable sharing of documents between privatephysicians, clinics, long term care, pharmacy, acutecare with different clinical IT systems.Easy access: Care providers are offered means toquery and retrieve clinical documents of interest. 48
    44. 44. XDS - Value PropositionDistributed: Each Care delivery organization “publishes” clinicalinformation for others. Actual documents may remain in thesource EHRCross-Enterprise: A Registry provides an index for publishedinformation to authorized care delivery organizations belongingto the same clinical affinity domain (e.g. a region).Document Centric: Published clinical data is organized into“clinical documents”. using agreed standard document types(HL7-CDA, PDF, DICOM, etc.)Document Content Neutral: Document content is processed onlyby source and consumer IT systems.Standardized Registry Attributes: Queries based on meaningfulattributes ensure deterministic document searches. 49
    45. 45. Cross-Enterprise Document Sharing (XDS) Standards Used Healthcare Content Standards HL7 CDA header extract HL7 data types Electronic Business Standards Internet Standards ebXML Registry, SOAP, HTTP, IETF, W3C, … Web Services …Implemented world-wide by over 150 vendors/opensource.Adopted in several national & regional projects:Italy, Austria, Canada, USA, Japan, South Africa, France, Netherlands,etc.) 50
    46. 46. Cross-Enterprise Document Sharing (XDS.b) Actor/Transaction Diagram Patient Identity Source Patient Identity Feed Query Document Documents Document Registry Consumer Register Document Set Provide&Register Retrieve Document Set Document Set Document Document Source Repository 51
    47. 47. IHE-XDS is part of a family of profiles Regional, national, local or disease centric networks need a consistent set of Integration Profiles Fifthteen Integration Profiles completed and tested, plus five ready to implement = Standards-based interoperability building blocks for  Rich Document Content for end-to-end application interoperability.  Patient identification management  Security and privacy  Notification and data captureIHE-XDS + related IHE Integration profiles provide a complete interoperability solution 52
    48. 48. Combining IHE ProfilesDocument Content & Modes of Document Exchange Doc Content Profiles (Semantics content) Scanned Doc Emergency Pre- Functional Status Consent Surgery Assesment XDS-SD BPPC EDR PPHP FSA Imaging Laboratory Discharge & PHR Referrals Exchange XDS-I XD*-Lab XDS-MS XPHR Document Reliable Pt-Pt Media Sharing Interchange Interchange XDS / XCA XDR XDM Document Exchange Integration Profiles 53
    49. 49. IHE Integration Profiles for Health Info Nets What is available and in trial implementationClinical and PHR Content Security & Privacy Basic Patients Privacy Patient ID Mgmt Emergency Referrals PHR Extracts/Updates Format of the Document Content Consents Establish Consents & Enable and associated coded vocabulary ObGyn Documents Format of the Document Content Access Control Patient Demographics Lab ResultsDocumentvocabulary and associated coded Document Query Format of the Content Content Scanned Documents and associated coded vocabulary Cross-Enterprise User Format of the Document Content Patient Identifier Imaging Information Formatassociated coded Content and of the Document vocabulary Assertion Provides Trusted Identity Cross-referencing Format of theSummary Medical Document Content Map patient identifiers across and(associated coded vocabulary Meds, Allergies, Pbs) independent identification Format of the Document Content Document Digital domains and associated coded vocabulary Signature Attesting “true-copy and originHealth Data Exchange Cross-Enterprise Audit Trail & Node Other Document Sharing Authentication Request Form Registration, distribution and access across health enterprises of clinical Centralized privacy audit trail and node for Data Capture to node authentication to create a External form with customdocuments forming a longitudinal record secured domain. import/export scripting Cross-Enterprise Document Pt-Pt Reliable Interchange Document Cross-Enterprise Document Consistent Time Subscription and Media Interchange Coordinate time across networked Notification Cross-Community Access systems Final Text Approved 54 Trial Implementation-2009– Final Txt 2010
    50. 50. XDS-MS Medical Summary or PHR Extract Exchange Profile based on HL7 CDA Rel 2 and HL7 CCD IG Structured and Coded Header Patient, Author, Authenticator, Institution, Level 1 Header always structured and coded Time of Service, etc.St r u c t u r ed Co n t en t w i t h c o d ed s ec t i o n s : Level 2 Title-coded sections with non-structured Reason for Referral nor coded content (text, lists, tables). Vital Signs  Simple Viewing (XML Style sheet) Medication Text Structure Coded Section Level 3 Med, Problems and Allergies Entry Entry as highly structured text. Text easy to import/parse Studies Allergies Level 3 Med Problems and Text Structure Coded Section Allergies have a Entry Entry fine-grain structure with Social History optional coding. Coding Scheme explicitly identified. Problems Text Structure Coded Section Entry Entry XDS-MS and XPHR enable both semantic Care Plan interoperability & simple viewing ! 55
    51. 51. Use of a shared XDS infrastructure to access Radiology Reports and Images (XDS-I)Between Radiology and :• Imaging specialists Hospital• Non-imaging clinicians PACS B Radiology -to- Radiology Radiology -to- Physicians PACS A Imaging Center Physician PracticeSame XDS Infrastructure (Registry and Repositories)for medical summaries and imaging information ! 56
    52. 52. Cross-Enterprise Document Workflow (XDW)The Cross-Enterprise Document Workflow (XDW)profile enables participants in a multi-organizationalenvironment to manage and track the tasks related topatient-centric workflows as they coordinate theiractivities: No central controller No central scheduler Decisions are made by the “edges” (providers, doctors, nurses, etc) XDW coordinates these activitiesApproved for Trial Implementation in September 2011
    53. 53. XDW - Key ElementsWorkflow Document in XDW:• Specified by XDW is generic across specific workflow content• Manages workflow specific status with relationship to input/output documents• Tracking the current/past steps of the workflow and engaged health care entities• Workflow driven/enforced by the XDW actors, infrastructure provides transparency
    54. 54. How real is XDS ?Stable specification IHE Technical Framework PublishedXDS.b Supplement that offers:  Use most recent Web Services stds (MTOM/XOP)  Allow Retrieve sets of Documents in one transaction  Same servicesFirst implementation in clinical use in region of Genoa -Italy) since early 2006.Several since: Lower Austria region, State of Vermont,Nagoya city, South Africa region, Dutch regions, etc.Adopted by several national programs world-wide4 open source toolkits available, numerous productimplementations in EMRs and Infrastructure offerings. 59
    55. 55. Implementation ToolsOpen source implementations are available forXDS, XCA, XCPD, PIX, PDQ, ATNA, CT, and more:  Microsoft under codeplex  NIST under Source Forge  HIE-OS under Source Forge  FHA CONNECT  OHT – IHE Profiles Charter  OHT – Open Exchange Forge  OHT – Model Driven Health Tools-Charter 60
    56. 56. IHE, Global Standards-Based ProfilesAdopted in National & Regional Projects (sample) Lower NETHERLANDS Italy Austria Friesland Conto CorrenteNatn’l Mamography Venetto - Friuli France Suisse VITL-Vermont Quebec, Toronto, Wales DMP St Gallen Alberta, British ColumbiaImaging Austria Lausane Canada Infoway France Imaging Boston Medical IDF Center - MA For more complete list see: Philadelphia HIE BelgiumFlemish-Leuven KeyHIE Pennsylvania CareSpark – TN & VA SHARP CASouth Africa THINC- New York Providence NCHICA – N. Carolina CHINA-Shanghai CHINA-MoH JAPAN-Nagoya Health System - Imaging Info Sharing Lab results sharing Imaging Info Sharing, OR Nationwide PDI guideline 6 61
    57. 57. National Image Sharing:Canadas IHE Success Story
    58. 58. CanadaOverview• Canada Health Infoway, a federally funded organization (over CDN$2 billion to date) with an annual operating budget of ~CDN$24M and 162 employees, has established a national EHR Blueprint.• EHR implementation is governed at the jurisdiction (sub-province) level and driven by local priorities, funding, etc.• There is a dedicated Standards Collaborative chartered to develop standards (including nomenclature and messaging) for use by the EHR program.• In spring of 2011, Canada Health Infoways Standards Collaborative assumed the role of IHE National Deployment Committee in Canada.• IHE Integration Profile, XDS-I.b is the national standard for image exchange 63
    59. 59. IHE Canada ConstituencyThe IHE Canadian Constituency, hosted by theStandards Collaborative, supports the mandate ofIHE International by: – Representing Canada on the IHE International Board; – Supporting domestic and international IHE work items; – Supporting domestic input on annual IHE planning and publishing cycles; – Participating in the organization and promotion of the North American Connectathon. – The willingness to be collaborative with other countries and adopt the best of what is available. 64
    60. 60. Major Accomplishments• A major contributor in XDS-I Integration Profile development• Adopted as the Pan-Canadian Standard for Image Exchange• Full XDS-I.b infrastructure deployed in Quebec and other Jurisdictions throughout Canada• Ontario has four DIRs in various stages of XDS-I.b deployment• Continue to be a major contributor in IHE Development 65
    61. 61. XDS-I.b Actors
    62. 62. Regional Image Exchange XDS –I XDS Image Document Document Consumer Registry (CommunityRadiologists Prior Viewer) Studies PIX/PDQ Mgr (Client Registry) General Practitioners Images & Images & Hospitals DIR - Jurisdiction Reports Reports DIR - Jurisdiction DIR - Jurisdiction XDS-I XDS-I XDS XDS-I XDS-I Image Image XDS-I XDS-I XDS Repository Image Image XDS Document Document Image Image Repository Document Document Imaging Repository Consumer Consumer Document Document Specialists Consumer Consumer Centers Consumer Consumer standards-based solution connects heterogeneous systems
    63. 63. Provence of Quebec – case studyFully deployed XDS-I.b Infrastructure• 200 hospitals• 100 private clinics• 10 million procedures a year• Population of 8 million patients• 550 radiologists and 20,000 Md’s 68
    64. 64. Quebec Image Exchange Architecture No IHE Patient Identity Services Uses provincial health User insurance identifier as pseudo- GPI Registry DIR/Image Repository 1 Document Document Registry DIR/Image Repository 1 Repository Document Community Image Repository Image Document Viewer Source Image Document Source McGill/Montréal DIR Sherbrooke DIR DIR/Image Repository 1 Document RepositoryRIS/PACS RIS/PACS Image Document DICOM Image and XDS-I.b Source Report Source Image Document Laval DIR Image Document Care Team Consumer Consumer (Zero footprint viewer) RIS/PACS
    65. 65. CanadaQuebec StatusDeployment of PACS and DIR connectivity – Public (75% of exam volume) • >95% PACS/RIS deployment • >75% DIR connectivity Private (25% of exam volume) • 30-40% PACS/RIS deployment • No DIR connectivity 70
    66. 66. Key XDS-I.b Metadata –for Retrieval of PriorsAnatomical Region Mapped from Image Set using DCMR Context Group CID4Modality Mapped from Image Set using DCMR Context Group CID29Requested Procedure Code Designated by the XDS Affinity DomainStudy Date & Time Mapped from Image Set 71
    67. 67. SCWG10-DI Terminology ProjectOntario: Develop a DI Terminology Reference Set:• Consistent representation of information in PACS within and across the four DI repositoriesIntended use:• XDS-I.b Metadata model – reliably find and retrieve reports and images• Information Display – consistent information display to clinicians at the point of service 72
    68. 68. Project GoalsDefine Ontario DI terminology reference set based on the currentknowledge the reference set is to include the following areas/concepts:  Modality  Procedure Description  SNOMED CT Concept ID  Body site  Speciality (TBD)  Laterality (TBD)Develop the mapping rules/guidelines to map the GTA West reference set,SWODIN and HDIRS local codes to Ontario DI terminology reference set. 73
    69. 69. Ontario Project Data Mapping Flow SNOMED CT Ontario Terminology Project MAPPED TO NOMED CT Requests for new Terms from On Term Project Team Ontario Ref Set Terms are in the On Ref Set During course of project all simple 1 to 1 mapping new terms are to be reviewed by On Term Project Team HDIRS Hospitals Becomes basis of ON Ref Set No Ref set exists Agfa Mapped to SNOMED CT- new terms added as required through governance structure DIR GTA West Ref Set NEODIN Ref Set Start with NEODIN Ref New terms added Set SWO/LHIN 3-4 Hospitals here and also to the New terms added here On Ref Set and also to the On Ref No Ref set exists Mapped to SNOMED CT- new terms added as required through governance structure GE Set DIRGEDIR GTA West Hospitals NEODIN Hospitals local terms from 3 GTA West Hospitals Local terms are currently mapped to Organizations to be local terms remainder to be mapped during integration to GTA West DI-r CGI mapped to GTA W Ref the NEODIN Ref Set Set in a pilot DIR Progression over time. Ontario Reference set is complete and passed to eHO for maintenance once GTA West and SNOMED CT mapping is complete 5/11 6/11 7/11 8/11 9/11 10/11 11/11 12/11 1/12 2/12 3/12 4/12 5/12 6/12 7/12 8/12 9/12 10/12 11/12 12/12 1/13 2/13 3/13 4/1/2011 3/31/2013
    70. 70. IHE Radiology - New Development supporting Canada IHE 2011-12 Trial Implementation Profiles include: – Cross-Community Access for Images (XCA-I) – Image Object Change Management (IOCM) IHE 2011-12 New Work-items: – Import Reconciliation Workflow Enhancement and Foreign Exam Management – XDR/XDS-I Registry Metadata Extensions – Cross Enterprise Document Reliable Interchange for Imaging (XDR-I) 75
    71. 71. Providers and Vendors Working Together to DeliverInteroperable Health Information Systems in the Enterprise and Across Care Settings 76
    72. 72. See you for Part 2, this afternoon 77