Johns Hopkins SchooI of Medicine
Division of Health Sciences Informatics
March 23, 2007
Nationwide Health Information Network
Update
Anna O. Orlova, PhD
aorlova@jhsph.edu
Public Health Data Standards Consortium &
Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland, USA
Towards a Nationwide Health
Information Network (NHIN)
Where Should We Be in 2014

Building a NHIN



NHIN-2004
NHIN-2005-2006
NHIN-2007
US National HIT Strategic Plan
On July 21, 2004 the Department of Health and
Human Services (DHHS) announced the decade
of health information technology for “delivering
consumer–centric and information-rich health
care.”
The vision is to build a National* Health
Information Network (NHIN) of regional health
information exchanges formed by health care
providers who will utilize electronic health record
systems.
* Original term “National” has been changed on “Nationwide” in January 2006
Thompson TG and Brailer DJ. The Decade of Heath Information Technology to Deliver Consumer-centric
and Information-rich Health Care. Framework for Strategic Action. US DHHS, July 21, 2004.
DHHS’ Framework for Health Information Technology:
Building a NHIN
NHIN will be based on:
Electronic
Health Record Systems (EHRS) that
will enable
Regional Health Information Exchanges (RHIEs)
organized via
Regional Health Information Organizations
(RHIOs)
Thompson TG and Brailer DJ. The Decade of Heath Information Technology to Deliver Consumer-centric
and Information-rich Health Care. Framework for Strategic Action. US DHHS, July 21, 2004.
President’s Strategic Framework for HIT
US Nationwide Health Information Network
Provider Record Laboratory Results Specialist Record
Records
Returned
Requests
for Records
Another
RHIO
Authorized
RHIO
Inquiry
Patient data
to other
RHIO
Index of
where patients Temporary Aggregate
have records
Patient History
RHIO
Source: Jennie Harvell. The Decade of Health Information Technology – Framework for
Strategic Actions. MMIS Conference, September 2004
US Health Information Network - 2014
Source: Dr. Peter Elkin, Mayo Clinic, MN
Source: Dr. Peter Elkin, Mayo Clinic, MN, 2006
RHIOs as NHIN Components
Nationwide Health Information Network (NHIN)
Emerging data shows the value that
standardized health information exchange
will provide to all stakeholders:
Healthcare purchasers and payers
Hospitals and other healthcare providers
Laboratories
Practicing clinicians
Public health
Source: John Glaser, Janet Marchibroda, Jim Schuping. CCBH. Washington, D.C. December 6-7, 2004
URL: www.ehealthinitiative.com
Building a NHIN
Building a NHIN
On November 15, 2004 Office of National Coordinator for
Health Information Technology (ONC), Department of
Health and Human Services (DHHS), released
THE REQUEST FOR INFORMATION (RFI)
on the Development and Adoption of a “National”
Health Information Network
Over 500 responses from various healthcare
stakeholders has been submitted.
URL: http://www.dhhs.gov
Public Health Data Standards Consortium
PHDSC RESPONSE TO THE RFI
on the Development and Adoption of a “National”
Health Information Network
was submitted to DHHS on January 18, 2005
URL: http://phdatastandards.info or http://www.phdsc.org
PHDSC
Model:
PHDSC
Model
for Electronic Health Record-based Data Exchange
RHIO
EHR-PH
Info
Exchange
NHIN Development Process
In October 2005 DHHS Office of National
Coordinator (ONC) awarded several
NHIN contracts ($65M) as follows:




Standards Harmonization
EHR Certification
NHIN Architecture Prototypes
Health Information Security and Privacy
URL: http://www.hhs.gov/healthit/ahic.html
DHHS NHIN Contracts
Standards Harmonization - Harmonize the health care and
technology standards used in health information
interchange to address gaps and conflicts in current
standards
 EHR Certification - Set forth certification criteria for the
many electronic health care record products and
technologies currently available on the market
 NHIN Prototypes - Develop and evaluate prototypes for
the network architecture to assess the feasibility of
developing a national health information network prototype
 Privacy - Address privacy and security policy questions
affecting the exchange of health information.
Work resulting from each of these projects will be used by
HHS to develop and refine the business case for
establishing the network.

A public-private “Community” was established to
serve as the focal point for America’s health
information concerns and drive opportunities for
increasing interoperability
The
Certification
Commission
for Healthcare
Information
Technology
(CCHIT)
The Health
Information
Security and
Privacy
Collaboration
(HISPC)
Healthcare
Information
Technology
Standards
Panel (HITSP)
American
Health
Information
Community
(Community)
Nationwide
Health
Information
Network
(NHIN)
Architecture
Projects
The Community is
a federally-chartered
commission that
provides input and
recommendations
to DHHS on how to
make health records
digital and interoperable,
and assure that the
privacy and security of
those records are
protected in a smooth,
market-led way.
NHIN Development Process
The Community is chartered for two years,
with the option to renew and duration of
no more than five years.
The DHHS intends for the Community to be
succeeded within five years by a privatesector health information community
initiative that, among other things, would
set additional needed standards, certify
new health information technology, and
provide long-term governance for health
care transformation.
* AHIC URL: www.hhs.gov/healthit/ahiccharter.pdf
A public-private “Community” was established to
serve as the focal point for America’s health
information concerns and drive opportunities for
increasing interoperability
The Certification
Commission for
Healthcare
Information
Technology
(CCHIT)
The Health
Information
Security and
Privacy
Collaboration
(HISPC)
Healthcare
Information
Technology
Standards Panel
(HITSP)
American Health
Information
Community
(Community)
Nationwide
Health
Information
Network (NHIN)
Architecture
Projects
Discussion Document
Standards Harmonization Technical
Committees Update
Report to the Healthcare Information Technology
Standards Panel
Contract HHSP23320054103EC
HITSP includes 206
member organizations:
17 SDOs (8%)
161 Non-SDOs (79%)
18 Govt. bodies (8%)
10 Consumer groups (5%)
Arlington, VA
September 20, 2006
HITSP Standards Categories
1.
2.
3.
4.
5.
6.
7.
Data Standards (vocabularies and
terminologies)
Information Content Standards (RIMs)
Information Exchange Standards
Identifiers Standards
Privacy and Security Standards
Functional Standards
Other
HITSP definition
HITSP Framework for Interoperability
Specification Development

HITSP receives Use Cases and Harmonization
Requests from external sources, such as
Community and ONC.

The Use Case or Request defines scenarios,
business actors, and business and
functional/interoperability requirements.

HITSP develops Interoperability Specifications
supporting the Use Cases: technical actors,
transactions, content and terminology.
Source: HITSP Meeting, Arlington VA, September 20, 2006
HITSP Framework for Interoperability
Specification Development

HITSP identifies constructs which are logical
groupings of base standards that work
together, such as message and terminology.

These constructs can be reused like building
blocks.

While reuse is a HITSP goal, it is established
in the context of a use case and its
functional/interoperability requirements.

HITSP constructs are version controlled and, if
reused, will be uniquely identified.
Source: HITSP Meeting, Arlington VA, September 20, 2006
The standards harmonization process is a series
of steps taken by industry stakeholders
Harmonization Process Steps
Receive
Request
I
II
III
IV
V
VI
VII
VIII
Harmonization
Identification Gaps, Standards Construction
Interoperability
Requirements
Duplications
Inspection Specification
Request
of Candidate
of
Selection
Analysis
and
Standards
Interoperability Test
Release
Overlaps
Specification
and
Resolution
Dissemination
IX
Program Management
Begin
Support
Source: HITSP Meeting, Arlington VA, September 20, 2006
Policy Makers and Industry
HITSP Framework
Defines and Narrows Context
Use Case/Modification Request
Interoperability Specification
Transaction Package
1…n transactions or composite
standards
Transaction
1… n components or composite standards
Package
(Composite)
Standard
Transaction
(Composite)
Standard
Component
1... n base standards or composite standard
Component
(Composite)
Standard
s
ard s
nd tion
Sta niza
ga
Or
Base
Standard
#1
Base
Standard
#2
Base
Standard
#3
Base
Standard
#4
Base
Standard
#5
Base
Standard
#6
Base
Standard
#7
Source: HITSP Meeting, Arlington VA, September 20, 2006
Base
Standard
#8
Base
Standard
#9
Potential for Reuse in Other Context
HITSP
Standard Harmonization Process
The Community identified 3 breakthrough
areas for the NHIN development process
in 2006:



Biosurveillance
Consumer Empowerment
Electronic Health Record
* AHIC URL: www.hhs.gov/healthit/ahiccharter.pdf
Consumer Empowerment Use Case
Allow consumers to establish and manage
permissions access rights and informed
consent for authorized and secure
exchange, viewing, and querying of their
linked patient registration summaries and
medication histories between designated
caregivers and other health professionals.
Source: HITSP Meeting, Arlington VA, September 20, 2006
Electronic Health Record Use Case
Allow ordering clinicians to electronically
access laboratory results, and allow nonordering authorized clinicians to
electronically access historical and other
laboratory results for clinical care.
Source: HITSP Meeting, Arlington VA, September 20, 2006
Biosurveillance Use Case
Transmit essential ambulatory care and
emergency department visit, resource
utilization, and lab result data from
electronically enabled health care delivery
and public health systems in standardized
and anonymized format to authorized
Public Health Agencies with less than one
day lag time.
Source: HITSP Meeting, Arlington VA, September 20, 2006
Event Detection
Neighboring
Jurisdictions
EHRS
Hospital State Public Health
Surveillance System
1- Report/retrieve symptoms, diagnosis &
medication prescription data from EMRs
Ambulatory
Care
4 – Order
pathogen
test
2 – Data mining
of EMR notes
3 – Notify on
increased number
of cases &
recommend to
order pathogen test
5 – Report
test results
7 – Report on the positive case
electronically & by phone
Local
Public Health
Surveillance
System
DHHS
6 – Report
positive
test result
electronically
& by phone
Media
Laboratory
Pharmacy
Response
Team
P
U
B
L
I
C
Biosurveillance Technical Committee Recommendations
cd Bio Interoperability Specification
«component»
Resource Utilization
Message
«interoperability specification»
Bio-surv eillance
contains
+
+
«transaction»
Pseudonimize
contains
docId: = IS-02
+
docId: = ISC-47
docId: = IST-24
contains
contains
+
+
+
«transaction package»
Manage Sharing of
Documents
+
«composite standard»
IHE XDS-I
docId: = ISC-36
+
constrains
constrains
«composite standard»
IHE RFD
contains
constraints
«transaction»
Patient ID CrossReferencing
«component»
Lab Report
Document Structure
docId: = ISTP-13
docId: = ISTP-50
docId: = ISC-45
references
+
docId: = ISC-37
«base standard»
XForms
docId: = IST-22
constrains
constrains
docId: = ISTP-49
implements
+
contains
«transaction package»
Retriev e Form for Data
Capture
«component»
Acknow ledgements
docId: = ISTP-48
+
docId: = IST-25
+
«component»
Lab Report
Message
contains
docId: = ISC-41
«transaction package»
Radiology Report
Document
contains
«transaction package»
Encounter Document
docId: = ISC-39
contains
contains
«component»
Encounter Message
«component»
Radiology Message
+
+
contains
contains
«transactions»
Anonymize
contains
«composite standard»
IHE XDS
«composite standard»
IHE PIX
«composite standard»
IHE XDS-MS
-
constrains
PIX Query: ITI-9
constrains
implements
«component»
EHR Lab
Terminology
references
+
docId: = ISC-35
constrains
implements
«base standard»
DICOM 2003
«composite standard»
IHE NAV
«base standard»
ISO 15000
ebRS 2.1/3.0
«composite standard»
IHE XDS Lab
+
Provide & Register Document Set: ITI-15
constrains
constrains
constrains
constrains
constrains
constrains
«base standard»
LOINC
«base standard»
HL7 CDA r2
«base standard»
HL7 V3 Lab
«base standard»
HL7 2.5
Message
constrains
constrains
constrains
«base standard»
HL7 2.5 Code
Sets
«base standards»
HL7 3.0 Code
Sets
«base standard»
SNOMED-CT
constrains
constrains
constrains
Biosurveillance
AHIC-ONC BIO Consolidated Use Case
Patient-level data to Public Health
Message-based Submission
HITSP
Biosurveillance – Patient-level and Resource Utilization Interoperability Specification
Transaction Package
Consumer/Patient Id X-ref
Transaction
Pseudonymize
Message-based
Scenario
Component
Encounter Msg
Lab Report Message
Radiology Msg
Terminology
Standards
HCPCS HL7 V3
CPT HL7 V2.5
CCC SNOMED-CT
ICD 9/10 LOINC
NCCLS
UCUM
UB-92
URL
FIPS 5-2
HAVE
Base
Std
HL7V2.5
ADT^xxx
Base
Std
HL7V2.5
ORU^R01
IHE
XDS
IHE
PIX
PDQ
Component
Component
Component
Base
Std
HL7
QBP^Q23
RSP^K23
Anonymize
Component
Lab Terminology
Base
Std
LOINC
SNOMEDCT
Base
Std
ISO
DTS/
25237
HIPAA
DICOM
Base
Std
ISO 15000
ebRS 2.1/3.0
Base
Std
HL7 V2.5
Biosurveillance
AHIC-ONC BIO Consolidated Use Case
Patient-Level Data to Public Health
Document-based Submission
HITSP
Biosurveillance – Patient-level and Resource Utilization Interoperability Specification
Transaction Package
Consumer/Patient Id X-ref
Transaction Package
Manage Sharing of
Docs
Document-based
Scenario
Transaction
Notif of Doc Availability
IHE
XDS-I
Base
Std
HL7
QBP^Q23
RSP^K23
Transaction
Pseudonymize
IHE
NAV
IHE
XDS
IHE
PIX
PDQ
Component
Lab Report Document
Component
Anonymize
Component
Lab Terminology
Base
Std
DICOM
Base
Std
LOINC
SNOMEDCT
IHE
XDS-MS
Base
Std
HL7
CDA r2
IHE
XDS-LAB
Terminology
Standards
HCPCS HL7 V3
CPT HL7 V2.5
CCC SNOMED-CT
ICD 9/10 LOINC
NCCLS
UCUM
UB-92
URL
FIPS 5-2
HAVE
Base
Std
ISO
DTS/
25237
HIPAA
DICOM
Base
Std
ISO 15000
ebRS 2.1/3.0
Base
Std
HL7 V2.5
A public-private “Community” was established to
serve as the focal point for America’s health
information concerns and drive opportunities for
increasing interoperability
The Certification
Commission for
Healthcare
Information
Technology
(CCHIT)
The Health
Information
Security and
Privacy
Collaboration
(HISPC)
Healthcare
Information
Technology
Standards Panel
(HITSP)
American Health
Information
Community
(Community)
Nationwide
Health
Information
Network (NHIN)
Architecture
Projects
Health Information Security and Privacy
Collaborative (HISPC)
RTI International coordinates assessment of health
information exchange among states
In May 2006, RTI established the National Health
Information Security and Privacy Collaboration (HISPC)
by announcing the 34 states and U.S. territories who
signed agreements to join this project. The project is a
national collaboration created to address privacy and
security policy questions affecting the exchange of health
information.
The project is being managed by RTI in cooperation with the
National Governors Association under a contract from the
Department of Health and Human Services (HHS),
Agency for Healthcare Research and Quality. RTI's
project team includes multidisciplinary experts in privacy
and security law and in health care management together
with state and territorial governments.
URL: http://www.rti.org/page.cfm?nav=7&objectid=6D0A81F4-6A6D-44A5-BD5E14B2A7077ED6
Health Information Security and Privacy
Collaborative (HISPC)
Review of State Findings
34 states and U.S. territories signed agreements to join HISPC project
Source: Walter G. Suarez. Advancing State Approaches Towards Solutions and Implementation.
Health Information Security and Privacy Collaborative. Regional Meeting, November 17, 2006 – Boston, MA
Health Information Security and Privacy
Collaborative (HISPC) - Scenarios
Purposes of Health Information Exchange
Relevant Scenarios
Treatment
Scenarios 1-4
Payment
Scenario 5
RHIO
Scenario 6
Research
Scenario 7
Law Enforcement
Scenario 8
Prescription Drug Use/Benefit
Scenarios 9 and 10
Healthcare Operations/Marketing
Scenarios 11 and 12
Bioterrorism
Scenario 13
Employee Health
Scenario 14
Public Health
Scenarios 15-17
State Government Oversight
Scenario 18
Nine Domains of Privacy and Security
1.
2.
3.
4.
5.
6.
7.
8.
9.
User and entity authentication to verify that a person or entity seeking
access to electronic personal health information is who they claim to be.
Information authorization and access controls to allow access only to
people or software programs that have been granted access rights to
electronic personal health information.
Patient and provider identification to match identities across multiple
information systems and locate electronic personal health information
across enterprises.
Information transmission security or exchange protocols (i.e.,
encryption, etc.) for information that is being exchanged over an electronic
communications network.
Information protections so that electronic personal health information
cannot be improperly modified.
Information audits that record and monitor the activities of health
information systems.
Administrative or physical security safeguards required to implement a
comprehensive security platform for health IT.
State law restrictions about information types and classes, and the
solutions by which electronic personal health information can be viewed
and exchanged.
Information use and disclosure policies that arise as health care entities
share clinical health information electronically.
Health Information Security and Privacy
Collaborative (HISPC) – Design
Nov.- Dec. 06
March 2007
Review of State Findings: Variation Analysis
Source: Walter G. Suarez. Health Information Security and Privacy Collaborative. Regional Meeting, Nov. 17, 2006 – Boston, MA
Review of State Findings
Source: Walter G. Suarez. Health Information Security and Privacy Collaborative. Regional Meeting, Nov. 17, 2006 – Boston, MA
Review of State Findings
Source: Walter G. Suarez. Health Information Security and Privacy Collaborative. Regional Meeting, Nov. 17, 2006 – Boston, MA
Review of State Findings
Source: Walter G. Suarez. Health Information Security and Privacy Collaborative. Regional Meeting, Nov. 17, 2006 – Boston, MA
A public-private “Community” was established to
serve as the focal point for America’s health
information concerns and drive opportunities for
increasing interoperability
The Certification
Commission for
Healthcare
Information
Technology
(CCHIT)
The Health
Information
Security and
Privacy
Collaboration
(HISPC)
Healthcare
Information
Technology
Standards Panel
(HITSP)
American Health
Information
Community
(Community)
Nationwide
Health
Information
Network (NHIN)
Architecture
Projects
A public-private “Community” was established to
serve as the focal point for America’s health
information concerns and drive opportunities for
increasing interoperability
The Certification
Commission for
Healthcare
Information
Technology
(CCHIT)
The Health
Information
Security and
Privacy
Collaboration
(HISPC)
Healthcare
Information
Technology
Standards Panel
(HITSP)
American Health
Information
Community
(Community)
Nationwide
Health
Information
Network (NHIN)
Architecture
Projects
Role of Public Health in a NHIN
NEXT STEPS
Providers and Software Developers
Working Together to Deliver
Interoperable Health Information Systems
in the Enterprise
and Across Care Settings
WWW.IHE.NET
Integrating the Healthcare Enterprise (IHE)
Overview
Presented by Dan Russler, M.D., IHE
PCC Co-chair
IHE Workshop – June 19, 2006
Why IHE?



1970’s—Mainframe Era--$100,000 per interface
1990’s—HL7 2.x--$10,000 per interface
2000’s—IHE Implementation Profiles—
Cheaper than a new phone line!
How? IHE Eliminates Options Found in
Published Standards
Who is IHE?

IHE is a joint initiative among:
 American College of Cardiology (ACC)
 Radiological Society of North America (RSNA)
 Healthcare Information Management Systems Society (HIMSS)
 GMSIH, HPRIM, JAHIS (laboratory)
 American Society of Ophthalmology
 American College of Physicians (ACP)
 American



College of Clinical Engineering (ACCE)
 And many more….
Began in 1997 in Radiology (RSNA) and IT (HIMSS)
International effort: IHE- Europe and IHE-Asia
Additional sponsors for Cardiology including ASE, ESC, ASNC,
SCA&I, HRS and more
IHE 2006 – Nine Active Domains
Over 100 vendors involved world-wide, 5 Technical Frameworks
37 Integration Profiles, Testing at Connectathons
Demonstrations at major conferences world-wide
15 Active national chapters on 4 continents
Electronic Health Record
Radiology
Cardiology
14 Integration Profiles
4 Integration Profiles
IHE
IT Infrastructure
Laboratory
5 Integration Profiles
Patient Care
Coordination
1 Integration Profile
13 Integration Profiles
Future
Domains
Patient Care
Devices
Pathology
Eye Care
Oncology
IHE Standards-Based Integration Solutions
Professional Societies Sponsorship
Healthcare Providers & Software Developers
Healthcare IT Standards
General IT Standards
HL7, DICOM, etc.
Internet, ISO, etc.
IHE
Process
Interoperable Healthcare IT
Solution
Specifications
Interoperable
Healthcare IT
IHE Integration
Profile
Solution
Specifications
Interoperable
Healthcare IT
IHE Integration
Profile
Solution
Specifications
Interoperable
Healthcare IT
IHE Integration
Profile
Solution
Specifications
IHE Integration
Profile
IHE in 2006 – 18 Month Development Cycles
•
First Cycle:
•
•
•
•
•
•
•
•
•
Planning Committee Proposals:
Technical Committee Drafts:
Public Comment Due:
Trial Implementation Version:
Mesa Tool Test Results Due:
IHE Connectathon:
HIMSS Demo:
Participant Comments Due:
Final Implementation Version:
November, 2005*
June, 2006*
July 2006
August 2006
December 2006
January 2007
February 2007
March 2007
June 2007
IHE Technical Frameworks
Department System
Scheduler/
Order Filler
Order
Placer
ADT
Image
Manager/
PPS Manager
Acquisition
Modality
Register J.Doe
Patient
Registration [RAD-1]
Placer Order
Management–
New [RAD-2]
One or the
other methods
of creating an
order is used
Filler Order
Management New [RAD-3]
Schedule
Procedure
Procedure
Scheduled [RAD-4]
Query Modality Worklist [RAD-5]
Filler Order
Mgmt - Status
Update [RAD-3]
Patient Reconciliation
J.Doe ->
J.Smith
ADT
Pt. Registration [RAD-1] 
Patient Update [RAD-12] 
DSS/ Order Filler
Patient Update/
Merge [RAD-12]
 Pt. Registration [RAD-1]
 Patient Update [RAD-12]
 Placer Order Management [RAD-2]
 Filler Order Management [RAD-3]
 Modality PS in Progress [CARD-1]
 Modality PS Completed [RAD-7]
Filler Order
Mgmt - Status
Update [RAD-3]
Modality Procedure
Step In Progress
[CARD-1]
Modality Procedure
Step Completed
[RAD-7]
Modality Procedure
Step In Progress
[CARD-1]
Modality Procedure
Step Completed
[RAD-7]
Patient Update/
Merge [RAD-12]
Order Placer
 Procedure Scheduled [RAD-4]
 Patient Update [RAD-12]
 Procedure Updated [RAD-13]
 Instance Availability Notification [RAD-49]
Evidence
Creator
 Modality PS in Progress [CARD-1]
 Modality PS Completed [RAD-7]
Detailed standards implementation
guides
Performed
Procedure
Step Manager
Storage 
Commitment
[CARD-3]
Image Display
 Modality Image/Evidence
Stored [CARD-2]
Image
Manager
Image
Archive
 Modality PS in Progress [CARD-1]
 Modality PS Completed [RAD-7]
Storage
Commitment 
[CARD-3]
Modality Image/Evidence
Stored [CARD-2]
 Modality PS in Progress [CARD-1]
 Modality PS Completed [RAD-7]
 Query Modality Worklist [RAD-5]
Acquisition
Modality
 Query Images [RAD-14]
 Retrieve Images/Evidence [CARD-4]
Perform
Acquisition
HIMSS IHE Interoperability Showcase
February 2006 Participants
Leadership Level
Blue Ware
Cerner
GE Healthcare +IDX
IBM
Initiate Systems
InterSystems
MiSys Healthcare
Quovadx
Siemens
Supporter
Level:
Acuo
Bond
Carefx
Clearcube
Dairyland
EMC
Identrus
Intel
Mediserve
Implementer Level
Allscripts
Canon
CapMed
Cardiac Science
CGI-AMS
CompassCare
CPSI
Dictaphone
DR Systems
Eastman Kodak
Eclipsys
Epic Systems
HIPAAT
Medkey
Motion
Comp.
Picis
Pulse
HX Technologies
INFINITT Technology
Kryptiq
McKesson
MedAccess Plus
Medical Informatics
MediNotes
MNI
National Institute of Sci & Tech
NextGen Healthcare
Philips Medical
ScImage
Witt Biomedical
DMP–French Natl. Personal
EHR
HTP
American Coll. of Clinical Eng. Health Level 7
IEEE
Catholic Healthcare West
Midmark Diagostics Group
US Dept of Defense
HIMSS RHIO Federation
US Dept of Veterans Affairs Liberty Alliance
Organizational participant:
IHE Connectathon, January 2006
•300+ participants, 120+ systems
•60+ systems developers
•Four Domains: Cardiology, IT Infrastructure,
Patient Care Coordination, Radiology
•2800+ monitored test cases
IHE Integration Profiles for Health Info Nets
What is available and has been added in 2005 and is for 2006
Clinical and PHR
Content
Emergency Referrals
PHR Extracts/Updates
Format of the Document Content
andReport
associated
coded vocabulary
ECG
Document
Format
of the Document
Content
and
associated
coded
vocabulary
Lab
Results Document
Format of the Document Content
Content
Scanned
Documents
and associated
coded vocabulary
Format of the Document Content
Imaging
and associated
coded vocabulary
Format
of theInformation
Document
Content
Medical Summary
Format of the Document Content
Allergies,
Pbs)
and(Meds,
associated
coded
vocabulary
Format of the Document Content
and associated coded vocabulary
Health Data Exchange
Cross-Enterprise
Document Sharing
Registration, distribution and access
across health enterprises of clinical
documents forming a patient
electronic health record
Cross-enterprise Document
Point-Point Interchange
Media-CD/USB & e-mail push
Security
Basic Patients Privacy
Consents
Establish Consents & Enable
Access Control
Document Digital
Signature
Patient Id Mgt
Patient Demographics
Query
Patient Identifier
Cross-referencing
Map patient identifiers across
independent identification
domains
Attesting “true-copy and origin
Audit Trail & Node
Authentication
Centralized privacy audit trail and node
to node authentication to create a
secured domain.
Other
Request Form
for Data Capture
External form with custom
import/export scripting
Consistent Time
Coordinate time across networked
systems
Notification of
Document Availability
Notification of a remote
provider/ health enterprise
HITSP
Biosurveillance
AHIC-ONC BIO Consolidated Use Case
Patient-Level Data to Public Health
Document-based Submission
Biosurveillance – Patient-level and Resource Utilization Interoperability Specification
Transaction Package
Consumer/Patient Id X-ref
Transaction Package
Manage Sharing of
Docs
Document-based
Scenario
Transaction
Notif of Doc Availability
IHE
XDS-I
Base
Std
HL7
QBP^Q23
RSP^K23
Transaction
Pseudonymize
IHE
NAV
IHE
XDS
IHE
PIX
PDQ
Component
Lab Report Document
Component
Anonymize
Component
Lab Terminology
Base
Std
DICOM
Base
Std
LOINC
SNOMEDCT
IHE
XDS-MS
Base
Std
HL7
CDA r2
IHE
XDS-LAB
Terminology
Standards
HCPCS HL7 V3
CPT HL7 V2.5
CCC SNOMED-CT
ICD 9/10 LOINC
NCCLS
UCUM
UB-92
URL
FIPS 5-2
HAVE
Base
Std
ISO
DTS/
25237
HIPAA
DICOM
Base
Std
ISO 15000
ebRS 2.1/3.0
Base
Std
HL7 V2.5
Providers and Software Developers
Working Together to Deliver
Interoperable Health Information Systems
in the Enterprise
and Across Care Settings
PHDSC was Invited to
Sponsor Public Health
TEN: Public Health
IHE 2006 – Nine Active Domains
Over 100 vendors involved world-wide, 5 Technical Frameworks
37 Integration Profiles, Testing at Connectathons
Demonstrations at major conferences world-wide
15 Active national chapters on 4 continents
Electronic Health Record
Radiology
Cardiology
14 Integration Profiles
4 Integration Profiles
IHE
IT Infrastructure
Laboratory
5 Integration Profiles
Patient Care
Coordination
1 Integration Profile
13 Integration Profiles
Future
Domains
Patient Care
Devices
Pathology
Eye Care
Oncology
PHDSC was Invited to Sponsor
Public Health Domain at IHE
Public Health Efforts at IHE – due July 2007
White Paper on Public Health
PHDSC-sponsored

White Paper on Quality
Siemens-sponsored

White Paper on Aggregate Data Retrieval from DocumentSharing Resource
Siemens- and Oracle-sponsored

Profile Proposal on Laboratory Data Exchanges
IBM-sponsored

IHE White Paper on Public Health: Goal
To describe the organization and functions
of public health in the US in order to inform
the development of the IHE integration
profiles for interoperable clinical and public
health information systems.
Knowledge Management in Public Health
WHAT IS PUBLIC HEALTH?
State Health Department
Organizational Chart
Clinical-Public Health Paper-based Health Data Exchanges
Genetic Disorders
Provider 1
Provider 2
Communicable
Diseases
Immunization
Vital Records
Provider 3
Injury Control
Provider 4
School Health
Chronic Care
Provider X
Biosurveilance,
BT,
Preparedness
HEDIS
On average
49% of cases
got reported
(CDC, 2006).
EHR-PH System Prototype for Interoperability
Public
Health Surveillance
Clinical Care in 21st Century Health Care
System
Hospital of Birth
State Health Department
ADTBirth Record
HL7 2.4
Newborn
Screening
Test
Hearing
Screening
Test
Immunization
Administration
HL7 3.0
HL7 3.0
Newborn
Screening
Registry
HL7 3.0
EHR-PH
Info Exchange
HL7 3.0
HL7 2.4
Immunization
Registry
HL7 2.4
HL7 3.0
HL7 2.4
J2EE
External
Laboratory
Hearing
Screening
Registry
HTB
J2EE
Communicable
Disease
Registry
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flkdjghghghghghghghgh
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Healthcare
Transaction
Viewer
HTB – Health Transaction Base
Source: Orlova, et al. HIMSS 2005,Dallas TX, February 13-17, 2005 and AMIA, Washington DC, November, 2005
WHERE TO START?
WE NEED TO HARMONIZE:
DATA FORMS
WORKFLOW
POLICIES
WHERE TO START?
WE NEED TO HARMONIZE:
DATA FORMS
WORKFLOW
POLICIES
EHR-PH Data Exchange: Clinical & Public Health Systems
EHR
Forms
NBS Genetic Disorders
CDA2
Provider 1
Provider 2
IHE
LAB
TB,
STD.
……
Communicable
Diseases
IR
Immunization
VR
Vital Records
Provider 3
ECIC Injury Control
Provider 4
NCPDP
SH
CVD,
Asthma
Diabetes
Provider X
X12
BT
School Health
Chronic Care
Biosurveilance, BT,
Preparedness, Syndromic
Surveillance
HEDIS
HEDIS
WHERE TO START?
WE NEED TO HARMONIZE:
DATA FORMS
WORKFLOW
POLICIES
Event Detection
Neighboring
Jurisdictions
EHRS
Hospital State Public Health
Surveillance System
1- Report/retrieve symptoms, diagnosis &
medication prescription data from EMRs
Ambulatory
Care
4 – Order
pathogen
test
2 – Data mining
of EMR notes
3 – Notify on
increased number
of cases &
recommend to
order pathogen test
5 – Report
test results
7 – Report on the positive case
electronically & by phone
Local
Public Health
Surveillance
System
DHHS
6 – Report
positive
test result
electronically
& by phone
Media
Laboratory
Pharmacy
Response
Team
P
U
B
L
I
C
Event
Monitoring
Neighboring
Jurisdictions
EHRS
3 - Monitor ER
visits &
hospitalizations
data from EMRs
1 – Send
health alert
2 - Monitor newly
diagnosed cases
& vaccination
data from EMRs
Ambulatory
Care
4 – Order
pathogen
test
State Public Health
Surveillance System
9 – Send updates
on the event
6 – Send order to
activate emergency
vaccination
Local
Public Health
Surveillance
System
5 – Report
test results
7 – Order/
Supply
vaccine
Lab
Hospital
8 – Monitor
vaccine
supplies
Pharmacy
10 – Send
health alert
to the public
DHHS
Media
Response
Team
P
U
B
L
I
C
Event
Management
Neighboring
Jurisdictions
EHRS
3 - Monitor ER
visits,
hospitalizations
data from EMRs
& utilization data
1 – Send
Outbreak updates
2 - Monitor newly
diagnosed cases
& vaccination
data from EMRs
Ambulatory
Care
4 – Order
pathogen
test
State Public Health
Surveillance System
9 – Send outbreak
updates
6 – Send Rapid Flu
Test Kits
10 – Send
outbreak
updates
to the public
Local
Public Health
Surveillance
System
5 – Report
test results
DHHS
9 – Activate
coordinated
response
7 – Deliver
vaccine
Lab
Hospital
8 – Monitor
vaccine
supplies
Pharmacy
Media
Response
Team
P
U
B
L
I
C
Cardiovascular
Disease (CVD)
Surveillance
Payor
Hospital
EHRS
1 – Conduct
Routine Check-ups
4 – Prescribe
Medication and
Treatment Plan
Ambulatory
Care
9 - Monitor ER visits,
hospitalizations data
from EMRs &
utilization data
11 – Send reports
12– Conduct
Surveys
(BRFSS)
5 – Monitor
Treatment
2 – Order
cholesterol
test
3 – Report
test results
7 – Report
Data to
Schools
State Public Health
Surveillance System
Local CVD
Surveillance
System
10 – Conduct
Health
Education
DHHS
6 – Fill
Prescription
8– Coordinate
Care
Media
Laboratory
Pharmacy
School
P
U
B
L
I
C
Hospital
Asthma
Surveillance
Payor
EHRS
1 – Conduct
Routine Check-ups
4 – Prescribe
Medication and
Treatment Plan
Ambulatory
Care
9 - Monitor ER visits,
hospitalizations data
from EMRs &
utilization data
11 – Send reports
5 – Monitor
Treatment
2 – Order
allergen
test
3 – Report
test results
7 – Report
Data to
Schools
State Public Health
Surveillance System
12– Conduct
Surveys
(BRFSS)
Local Asthma
Surveillance
System
10 – Conduct
Health
Education
DHHS
6 – Fill
Prescription
8– Coordinate
Care
Media
Laboratory
Pharmacy
School
P
U
B
L
I
C
WHERE TO START?
WE NEED TO HARMONIZE:
DATA FORMS
WORKFLOW
POLICIES
Examples of Notifiable/Reportable
Conditions by Selected States
Notifaible/Reportable
Diseases
(in alphabetical order)
CDC
CA
FL
IN
MA
MD
MN
MD
Lab
MD
Lab
MD
Lab
MD
Lab
MD
Lab
MD
a
a
-
a
-
a
a
a
a
a
-
Alcohol Related Birth
Defects
-
-
-
-
-
-
-
-
-
-
Amebiasis
-
a
-
-
-
-
-
a
a
Anaplasmosis
-
-
-
-
-
-
-
-
Anisakiasis
-
a
-
-
-
-
-
Animal bites
-
-
-
a
-
a
Animal bites for which
rabies prophylaxis is
given,
-
-
-
a
-
Anthrax
a
a
a
a
Arboviral neuroinvasive and
neuroinvasive
diseases, all
a
-
-
California group
-
-
Eastern equine
encephalitis virus
-
-
Acquired Immunodeficiency
Syndrome (AIDS)
NC
Lab
MD
Lab
a
a
a
-
-
-
-
a
a
a
-
-
-
-
-
a
-
-
-
-
-
-
-
-
-
-
-
-
a
-
-
-
-
-
-
-
-
-
-
-
-
-
a
a
a
a
a
a
a
a
a
a
a
a
a
a
-
-
a
a
a
a
a
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
a
a
-
-
-
-
-
WHERE TO START?
SELECT PUBLIC HEALTH DOMAINS TO
BEGIN WITH
Vision for Public Health Surveillance via NHIN
Percent of Children Tested for Lead with BLL>10 µg/dL in the USA
Source: Eileen Koski. Quest Diagnostics. PHIN-2004, May, Atlanta GA