Integrating the Healthcare Enterprise

New Integration Profiles - Summary

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

G. ClaeysAgfa Healthcare R&D, Technology Manager

Vendor co-chair

IHE Europe

Courtesy of IHE Committees

7 February 2005 IHE Europe Educational Event2

IHE

EHR- Longitudinal Record

IHE Cardiology

IHE Laboratory

IHE Radiology

IHE

Future Domain

IHE

Future Domain

IHE

IT Infrastructure Intra-Enterprise

Cross-Enterprise

1 Integration Profile

3 New Integration Profiles

5 Existing / 4 New

Integration Profiles

12 Existing / 2+2 New

Integration Profiles

IHE ScopeIHE Scope


PatientInformation

Reconciliation

ReconcileWorklists,

Statusand

Data Objects For

UnknownPatients

andDemographics

Changes

Access to Radiology Information

Consistent Presentation of

Images Create, store,

manage, retrieve & use objects for hardcopy and

softcopy grayscale presentation states

Key Image Notes

Create, store, manage, retrieve & use objects to flag significant images

Simple Image and Numericc

Reports Create, store,

manage, retrieve & use simple

diagnostic reports with optional image

links &

Scheduled Workflow

Presentation of Grouped

Procedures Manage individual procedure image subsets from a multi -procedure acquisition for

viewing & reporting

Basic Security

ChargePosting

Reporting Workflow

Manage worklists, track status, perform

& notify diagnostic

reporting steps

Evidence Documents

Create, store, manage, retrieve & use objects to

record study evidence

Manage worklists, track status, perform & notify image processing &

CAD steps

Post-Processing Workflow

Create,Store,

Manage,Retrieve &

UseImages

Admission, Order Management, Scheduling, Store, Retrieve

ManageWorklists,

Track Status,Perform &

NotifyAcquisition

Related Steps

IHE Radiology – Integration ProfilesIHE Radiology – Integration Profiles

New

NMImage

Portable Data for ImagingNew


IHE Radiology - newIHE Radiology - new

Portable Data for Imaging Profile (PDI)

NM Image Profile

Departmental Workflow


Portable Data for Imaging (PDI)Portable Data for Imaging (PDI)

Single Media format definition must be able to support full range of viewing/ import uses For patient personal records For referral For enterprise data interchange For printing

Media interoperability validation

Browser compatibility


PDI – Key principlesPDI – Key principlesThree major use case categories considered: Media Export (creation of media) Media Viewing (reading & immediate viewing of media) Media Import (reading and import of media for use in other

IHE workflows)

Single new Transaction (Distribute Imaging Information on Media) defines the required content/ structure of the media. DICOM DIR (DICOM Part 10) “web-viewable” data derived from the DICOM data (HTML,

JPEG)


PDI – Actors and TransactionsPDI – Actors and Transactions

Portable MediaCreator

Print Composer

Report Reader

Image Display

Display

Distribute ImagingInformation on Media

Media Importer


Nuclear Medicine (NM) Image ProfileNuclear Medicine (NM) Image Profile

New “content” Profile – No new actors or transactions

Profile describes how actors must create, store and retrieve NM Images

Options added to Images Stored Transactions, Query Images and Retrieve Images Transactions


Departmental WorkflowDepartmental Workflow

Adds options to SWF (2 Supplements) Appointment Notification

• Gives the OF/DSS an option to notify Order Placer of date and time of scheduled examinations.

• Using HL7 SIU message

Instance Availability Notification • Gives the Image Manager an option to notify Order Filler

and other workflow management actors of availability status of evidence objects.

• Alternative to Image Availability Query transaction• Based on DICOM Supplement 93


IHE IT Infrastructure – Integration IHE IT Infrastructure – Integration ProfilesProfiles

Enterprise User AuthenticationEnterprise 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 presented

to the requesting user

Patient Identifier Cross-referencing

for MPIMap 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

Consistent TimeCoordinate time across

networked systems

Audit Trail & Node Authentication

Centralized privacy audit trail and node to node authentication

to create a secured domain.

New

Patient Demographics Query New

Personnel White PageAccess to workforcecontact information

New

Cross-Enterprise Document Sharing

Registration, distribution and access across health enterprises of clinical

documents forming a patient electronic health record

New


IHE IT Infrastructure - newIHE IT Infrastructure - newNew Integration Profiles Patient Demographic Query (PDQ) Personnel White Pages (PWP) Audit Trail Node Authentication (ATNA) Cross-Enterprise Document Sharing (XDS)

ITI Infrastructure has a multi-year roadmap XDS-related content profiles Security : Role based authorization LDAP based applications : e.g. PKI, Configuration

management


Patient Demographic Query ( PDQ)Patient Demographic Query ( PDQ)

Goal: Allow quick retrieval of common patient name, identifier, and location to enable proper patient tracking

Will answer common “questions”: I have a patient ID and what name, demographics, etc.

go with it? I have partial demographics, e.g. name, and need to

find a patient ID?

Based on well established HL7 technologies, though may push the HL7 standard and require Z-queries


Personnel White Pages (PWP)Personnel White Pages (PWP)Goal: Electronic Staff Directory Provide access to basic information about the

human workforce members (email,phone nr) Single place to store&update

Technology used: LDAP directory, X500 scheme, HL7 naming

scheme


Audit Trail & Node Authentication (ATNA)Audit Trail & Node Authentication (ATNA)

Scope : Node authentication, using device certificates Centralized audit trails NTP Server

Extends the IHE radiology oriented Basic Security profile (defined in 2002) to be applicable on enterprise level. Addition of IETF Common Audit Trail message

payload Addition of Reliable Syslog transport protocol


ATNA - Backward compatibilityATNA - Backward compatibility

ATNA is backward compatible with Basic Security Existing applications, supporting Basic Security are

ATNA compliant

Basic security is deprecated No further extensions New applications are encouraged to use new

message format, transport mechanism


Cross Document Sharing (XDS)Cross Document Sharing (XDS)

Focus: Support document sharing among EHRs in different

care settings and organizations


Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (HL7-CDA, ASTM-CCR, PDF, DICOM, etc.)

Document Content Neutral: Document content is processed only by source and consumer IT systems.

Distributed: Each Care delivery organization “publishes” clinical information for others. Actual documents may remain in the Care delivery organization.

Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain (e.g. an LHII).

Standardized Registry Attributes: Queries based on meaningful attributes ensure deterministic document searches.

XDS – Key principlesXDS – Key principles


Acute Care (Inpatient)

PCPs and Clinics (Ambulatory)

Long Term Care

Other Specialized Careor Diagnostics Services

EHR-CR: EHR-CR: Care RecordCare Record systems systemssupportingsupporting care delivery care delivery

Documents Registry

DocumentRepository

Submission of Document References

Retrieve of selected Documents

XDS – ArchitectureXDS – Architecture


HealthcareContent Standards

HL7 CDA, CEN EHRcomHL7, ASTM CCR

DICOM …

Internet StandardsHTML, HTTP,

ISO, PDF, JPEG …

Electronic BusinessStandards

ebXML, SOAP …

Standards for XDSStandards for XDSNo single standard addresses XDS Requirements


Other IHE Expansion DomainsOther IHE Expansion DomainsIHE Pathology Explorative phase in Europe (France)

IHE Endoscopy Explorative phase in Japan & USA

IHE Oncology Explorative phase in Japan & USA

IHE Dermatology Explorative phase in Europe (Spain)

IHE Pharmacy / Medication Administration: Exploratory Phase in USA


More information….More information….

IHE Web sites: • http://www.ihe.net• http://ihe-europe.org• http://www.rsna.org/IHE• http://www.acc.org/quality/ihe.htm• http://ihe-nl.org

Technical Frameworks:• ITI V1.0, RAD V5.5, LAB V1.0, CARDIO V1.0

Non-Technical Brochures :• IHE Europe Business Case• IHE Fact Sheet and FAQ• IHE Integration Profiles: Guidelines for Buyers• IHE Connectathon Results• Vendor Products Integration Statements

Integrating the Healthcare Enterprise

Documents

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