http://ihe.univ-rennes1.fr/data/editable/organization/PCC_WS_2005/Interoperability_Workshop_IHE%20for%20a%20RHIO-3.ppt
Leveraging IHE to build
RHIO Interoperability
Charles Parisot
GE Healthcare
IHE IT Infrastructure Technical Committee co-chair
Providers and Vendors
Working Together to Deliver
Interoperable Health Information Systems
in the Enterprise
and Across Care Settings
WWW.IHE.NET
June 28-29, 2005
2
Interoperability Strategy Workshop
Selected IHE Integration Profiles for RHIOs
What is available and is added in 2005
Lab Results Document
Content
For Display
Document
Format of the Document Content
and associated
coded vocabulary
Format
of the Document
Content
Imaging Information
Sharing
Medical
Summary
Format of the Document Content
Document
Content
and
associated coded
vocabulary
Format of the Document Content
and associated coded vocabulary
Cross-Enterprise
Document Sharing
Registration, distribution and
access across health enterprises
of clinical documents forming a
patient electronic health record
Cross-enterprise User
Authentication
Patient Demographics
Query
Authentication & Auditing:
Basis for Access Control
Patient Identifier
Cross-referencing
Document Digital
Signature
Attesting “true-copy and origin
Audit Trail & Node
Authentication
Centralized privacy audit trail
and node to node authentication
to create a secured domain.
Notification of
Document Availability
Consistent Time
Coordinate time across
networked systems
June 28-29, 2005
Map patient identifiers across
independent identification
domains
3
Notification of a remote
provider/ health enterprise
Interoperability Strategy Workshop
HIMSS 2005 – Show-Wide Interoperability
Cross-enterprise Showcase Booth
IT
Infrastructure
Radiology
Vendor System
Vendor Booth
Vendor Booth
In-Patient/Out-patient
Vendor Booth
Cardiology
Vendor Booth
HIMSS “RHIO” with
Cross-enterprise
doc sharing (17 vendors)
Vendor Booth
PCP
Vendor Booth
Diag Center
Home
Multispecialty
Clinic
Vendor Booth
Ambulatory Showcase Booth
June 28-29, 2005
HL7 Booth
4
Interoperability Strategy Workshop
HIMSS 2005 Interoperability
Show Case Vendors
Leadership Level
CapMed/SanDisk
Eclipsys
GE Healthcare
IDX
InterSystems
Kryptiq
Quovadx/CareScience
Siemens
WebMD
Participant Level
Allscripts
Cedara
Cerner
Dictaphone
Eastman Kodak
Eclipsys
Emageon
Epic
ETIAM
INFINITT Tech.
Supporter Level
AccessPt
AGFA
dbMotion
EMC
Healthvision
Healthramp
Valco Data Systems
June 28-29, 2005
5
MedcomSoft
MediNotes
MedCommons
MidMark
Mortara Instrument, Inc
National Institute of
Standards & Technology
NextGen
Novell
Open Text
Sentillion
Dinmar – Oacis
McKesson
Interoperability Strategy Workshop
IHE North America Vendors (2004-2005)
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Agfa HealthCare
Allscripts
Camtronics Medical
Systems
Cedara Software Corp.
Cerner Corporation
Dictaphone Corporation
Dynamic Imaging, LLC
Eastman Kodak Company
Eclipsys
Emageon
Epic Systems
Corporation
ETIAM
FujiFilm Medical
Systems, USA, Inc.
GE Healthcare
Heartlab, Inc
Hitachi Medical
Corporation
June 28-29, 2005
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Hologic
IDX Systems Corp.
INFINITT Technology
InSite One, Inc.
Intelerad Medical
Systems
InterSystems
Corporation
Konica-Minolta Medical
Imaging, USA, Inc.
Kryptiq
Marotech
McKesson Information
Solutions
MedCommons Inc.
MedCon, Inc.
Merge eFilm
Mortara Instrument,
Inc.
Novell, Inc.
Philips Medical
Systems6
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QRS Diagnostic
Quovadx
St. Jude Medical A.B.
Sectra Imtec A.B.
St. Jude Medical A.B.
Sectra Imtec A.B.
Sentillion
Siemens Medical
Solutions
Stentor
Swissray International,
Inc.
Tiani Medgraph A.G.
Tiani Spirit Gmbh
Toshiba Medical
Systems Company
Vital Images
WebMD Practice
Services
Interoperability Strategy Workshop
At HIMSS in 2005 : IHE-XDS
community
Clinic Record
Specialist Record
Hospital Record
Reference
to records
4-Patient data
presented to
Physician
Clinical IT System
3-Records
Returned
Index of patients records
(Document-level)
Sharing System
Temporary Aggregate
Patient History
June
28-29, 2005
Clinical
Encounter
7
2-Reference
to Records
forStrategy
Inquiry
Interoperability
Workshop
At HIMSS in 2005 : IHE-XDS
community
Laboratory Results
Specialist Record
Hospital Record
Shared prototype content:
• Medical Summaries (Pre-CCR)
• Discharge Summaries (CDA-R1)
• Lab Results (HL7)
• Other (PDF)
Clinical IT System
Reference
to records
3-Records
Returned
Index of patients records
(Document-level)
Sharing System
Temporary Aggregate
Patient History
June
28-29, 2005
Clinical
Encounter
8
2-Reference
to Records
forStrategy
Inquiry
Interoperability
Workshop
Demo a RHIO with IHE at HIMSS 2006 ?
community
Laboratory Results
Specialist Record
Hospital Record
Secured Sharing of:
• Medical Summaries
• Images & reports
• ECG Reports
• PDFs
• Lab Results ?
+ Notif of Doc Avail.
Clinical IT System
Reference
to records
3-Records
Returned
Index of patients records
(Document-level)
Sharing System
Temporary Aggregate
Patient History
June
28-29, 2005
Clinical
Encounter
1-Patient
Authorized
9
Inquiry
2-Reference
to Records
forStrategy
Inquiry
Interoperability
Workshop
Document Life Cycle Management
Addendum to a registered document
Time
Document
Addendum
A two-way relationship between
Original and Addendum
Addendum
Replacing a registered document by a new document
Time
Document 1
(Approved)
Replacement
Document 1
(Deprecated)
Replacement
Document
A two-way relationship between
Original and Replacement
Document.
Registering an alternate form or a signature for a registered document
Transform
Document 1
(Approved)
June 28-29, 2005
Document 2
(transform)
A two-way relationship between
Original and Transform (alternative
format with same scope or DSG).
10
Interoperability Strategy Workshop
Local & Regional RHIOs Infrastructure and
Interoperability
• Cross-Enterprise Document Sharing (XDS) minimizes
clinical data management by the infrastructure.
Transparency = Ease of Evolution
• XDS works with other IHE Integration Profiles: patient Id
mgt, security, etc. Flexibility of RHIO configuration
• With introduction of new Integration Profiles, IHE ready to
build regional health networks linking interoperable EHRs.
Major milestone for 2006 RHIO projects
• Goal is to offer a consistent, standards-based and
functional for EHRs and other ancillary systems.
June 28-29, 2005
11
Interoperability Strategy Workshop
Creating a Health Information Network with IHE
Tier 1 EHRs
and Ancillaries
Care
Deliver
y IT
system
Care
Deliver
y IT
system
Care
Delivery
IT
system
June 28-29, 2005
12
Interoperability Strategy Workshop
Creating a Health Information Network with IHE
Tier 2 Community HIN
What and Where ?
XDS Document
Registry
Document
Entries
Care
Deliver
y IT
system
Care
DeliverXDS
Document
y IT Repository
system
XDS
Care
Document
Delivery
Repository
IT
system
XDS
Document
Repository
June 28-29, 2005
13
Interoperability Strategy Workshop
Creating a Health Information Network with IHE
Tier 2 Community HIN
C-HIN Patient
Identity Source
Who, What and Where ?
Patient Demo
Supplier
Patient Id
X-Ref Mgr
XDS Document
Registry
PDQ
Consumer
Document
Entries
Care
DeliverXDS
Document
y IT Repository
system
Patient Id
X-Ref Mgr
XDS
Care
Document
Delivery
Repository
IT
system
XDS
Document
Repository
June 28-29, 2005
Care
Deliver
y IT
system
14
Interoperability Strategy Workshop
Creating a Health Information Network with IHE
Tier 2 Community HIN
Time
Server
C-HIN Patient
Identity Source
Patient Demo
Supplier
Patient Id
X-Ref Mgr
XDS Document
Registry
PDQ
Consumer
Document
Entries
Care
DeliverXDS
Document
y IT Repository
system
Who, What When and Where ?
Patient Id
X-Ref Mgr
XDS
Care
Document
Delivery
Repository
IT
system
XDS
Document
Repository
June 28-29, 2005
Care
Deliver
y IT
system
15
Interoperability Strategy Workshop
Creating a Health Information Network with IHE
Tier 2 Community HIN
Time
Server
C-HIN Patient
Identity Source
Patient Demo
Supplier
Patient Id
X-Ref Mgr
XDS Document
Registry
PDQ
Consumer
Document
Entries
Care
DeliverXDS
Document
y IT Repository
system
Who, What When and Where ?
Trusted !
Patient Id
X-Ref Mgr
XDS
Care
Document
Delivery
Repository
IT
system
XDS
Document
Repository
June 28-29, 2005
Care
Deliver
y IT
system
16
Interoperability Strategy Workshop
Security for XDS
Leverages IHE Audit Trail & Node Authentication
A formal Security and Privacy profile is provided for XDS
ATNA creates a secured domain:
• User Accountability (Audit trail)
• Node-to-Node Access Control
• Node-level user authentication
• User access control provided by node
Patient Identity
Source Secured
BUT Registry/repository based
Patient
User-Level Access Control and Identity
policy agreements is beyond XDS. Feed
User-level Access Control is
Node
Document
provided by XUA
Secured Registry
Node
Register
Document Set
Provide&Register
Document Set
Secured
Node
Document
Document
Repository
Source
Secured
Secured
Node
Node
June 28-29, 2005
17
Query
Documents
Secured
Node
Document
Consumer
Retrieve
Document
Interoperability Strategy Workshop
Cross-Enterprise User Authentication
Transaction Diagram
XDS
Repository
ATNA
Audit
Repository
2 Request Assertion
(of who this user is)
5 Authentication Assertion
Identity
Provider
Record
Auditable
Event
June 28-29, 2005
18
Interoperability Strategy Workshop
Is it possible to federate
multiple XDS-based HIN ?
Tier 2 Community HIN
Tier 2 Community HIN
Patient Id
X-Ref
Mgr
Care
Delivery IT
system
XDS
Document
Repository
Time
Server
C-HIN Patient
Identity Source
Patient Demo
Supplier
C-HIN Patient
Identity Source
Document
Entries
XDS and Where ?
Who, What When
Trusted ! Document
Repository
XDS
Document
Repository
June 28-29, 2005
Patient Id
X-Ref
Mgr
Care
Delivery IT
system
e.g. XDS Affinity Domain
Patient Demo
Supplier
Time
C-HIN Patient
Server
PDQIdentity Source
Consum
Patient Demo
Career
Supplier
Time
XDS DocumentTier 2 Community
HIN
Delivery
C-HIN Patient
Server
Registry
IT
PDQIdentity Source
system
Consum
Patient Demo
Career
Supplier
XDS Document
Delivery
Tier 2 Community HIN
Document
Registry
C-HIN Patient
IT
PDQ
Entries
Identity Source
system
Consum
Tier 2 Community HIN
XDS Document
Registry
Patient Id
X-Ref
Mgr
Care
Delivery IT
system
Tier2 Community-HINs
Time
Server
Patient Id
Patient Id Document
X-Ref
X-Ref
Mgr
Care
Entries
XDS
Mgr
Delivery
Care
Document
IT
Delivery IT
Repository
Patient Id
system
XDS and Where ? system
X-Ref
Who, What When
Mgr
Care
Trusted ! Document
XDS
Repository
Delivery
XDS
Document
IT
Document
Repository
system
Repository
Who, What When
XDS and Where ?
Trusted ! Document
XDS
Repository
Document
Repository
XDS Document
Registry
Patient Id Document
Entries
X-Ref
Mgr
Care
Patient Id
Delivery IT
X-Ref
system
Mgr
Care
XDS
Delivery
Document
IT
Repository
system
Who, What When
XDS and Where ?
Trusted ! Document
XDS
Repository
Document
Repository
19
Career
Delivery
IT
system
XDS Document
Registry
Time
Server
Patient Demo
Supplier
PDQ
Consum
Career
Delivery
IT
system
Document
Entries
Patient Id
X-Ref
Mgr
Care
XDS
Delivery
Document
IT
Repository
system
Who, What When and Where ?
Trusted !
XDS
Document
Repository
PDQ
Consum
Career
Delivery
IT
system
Patient Id
X-Ref
Mgr
Care
XDS
Delivery
Document
IT
Repository
system
Interoperability Strategy Workshop
Federating Tier 2 Health Information Networks
On IHE Roadmap for 2006-2007: X-Registry Federation
(Addressed by ebXML Registry 3.0)
What are the document registries where a patient has information ?
Tier 3 HIN
e.g. State Level
Patient / Registry
Locator Service
Federated Identification
RG
T2 C-HIN B
RG
e.g. XDS Affinity Domain
T2 C-HIN D
Managed Identification
e.g. XDS Affinity Domain
June 28-29, 2005
20
Interoperability Strategy Workshop
Federating Tier 2 Health Information Networks
On IHE Roadmap for 2006-2007: X-Registry Federation
Integrating existing IDNs: Adaptor + Registry
Tier 3 HIN
e.g. State Level
Patient / Registry
Locator Service
Federated Identification
RG
RG +Adapt
T2 C-HIN B
RG
e.g. XDS Affinity Domain
T2 C-HIN A
e.g. IDN
June 28-29, 2005
RG +Adapt
T2 C-HIN C
T2 C-HIN D
Managed Identification
e.g. XDS Affinity Domain
e.g. IDN
21
Interoperability Strategy Workshop
Federating Tier 3 Health Information Networks
On IHE Roadmap for 2006-2007: X-Registry Communication
Nation-Wide Health Info network (Tier 4)
Patient / Registry
Locator Service
Patient
/
e.g.
Registr
State HIN
y
Locato
RG
r
Servic
RG
RG
RGe
T1-RHIO B
e.g. XDS Affinity Domain
T1-RHIO A
T1-RHIO D
T1-RHIO C e.g. XDS Affinity Domain
e.g. IDN
e.g. IDN
Patient /
Registry
Locator Service
Patient / Registry
Locator Service
Patient /
Registry
Locator Service
e.g.
State HIN
T1-RHIO B RG
RG
RG
e.g. IDN
T1-RHIO C
e.g. IDN
June 28-29, 2005
RG
Patient
/
e.g.
Registr
State HIN
y
Locato
RG
r
Servic
RG
RG
RGe
T1-RHIO B
e.g. XDS Affinity Domain
T1-RHIO A
T1-RHIO D
T1-RHIO C e.g. XDS Affinity Domain
e.g. IDN
e.g. IDN
T1-RHIO B RG
e.g. XDS Affinity Domain
e.g. XDS Affinity Domain
T1-RHIO A
e.g.
State HIN
RG
RG
RG
Patient
/
e.g.
Registr
State HIN
y
Locato
RG
r
Servic
RG
RG
RGe
T1-RHIO B
e.g. XDS Affinity Domain
T1-RHIO A
T1-RHIO D
T1-RHIO C e.g. XDS Affinity Domain
e.g. IDN
e.g. IDN
T1-RHIO D
e.g. XDS Affinity Domain
T1-RHIO A
e.g. IDN
T1-RHIO C
T1-RHIO D
e.g. XDS Affinity Domain
e.g. IDN
22
Interoperability Strategy Workshop
IHE: RHIOs’ Interoperability Partner
• IHE offers a solid technical foundation to establish
interoperability for RHIOs.
• Standards-based, open, multi-vendor, provider-led.
• Yearly progress, validation testing built in, backed by a
proven process. Implementation by many vendors.
• IHE welcomes RHIOs’ technical architects’ active
involvement.
• The IHE Technical Framework accelerates RHIOs pilot
development (e.g. XDS Affinity Domain).
• This is being applied: Norway, Italy, then Canada, soon
USA, France, ?
June 28-29, 2005
23
Interoperability Strategy Workshop
Clinicians access XDS Services
through their clinical IT system (EHRs)
Document
Repositories
4-Patient data
presented to
Physician
3-Documents
Returned
Index of patients records
(Document-level)
Temporary Aggregate
Patient History
Clinical Encounter
June 28-29, 2005
Clinical
IT System
2- Inquiry
for Docs
3-Reference
to Docs from
Inquiry
1-Expression of a
need for additional
information
24
Interoperability Strategy Workshop
Sharing Radiology Reports and Images with XDS
in a Regional Health Information Network
Regional Health
Information
Network
Radiology Enterprise B
PACS B
Radiology-to-radiology
Radiology-toPhysicians
PACS A
Physician Office
June 28-29, 2005
25
Radiology Enterprise A
Interoperability Strategy Workshop
Sharing Radiology Reports and Images
in a Regional Health Information Network
Regional Health
Information
Network
Radiology Enterprise B
CrossEnterprise
Registry
PACS B
Patient Id= 3547F45
• Report 5/21/1998 : CT Head B
• Study 5/21/1998 : CT Head B
• Report 2/18/2005 : Chest Xray A
• Study 2/18/2005 : Chest Xray A
PACS A
Physician Office
June 28-29, 2005
26
Radiology Enterprise A
Interoperability Strategy Workshop
Physicians and Systems within a Regional Health
Network - Routine Imaging Referral
Regional Health
Information
Network
Radiology Enterprise B
Register Imaging
Information for
sharing
CrossEnterprise
Registry
Patient Id= 3547F45
• Report 5/21/1998 : CT Head B Query for
• Study 5/21/1998 : CT Head B Documents
Physician Office
June 28-29, 2005
27
Prior
imaging
Reports &
Register Imaging
Studies
Information for
sharing
Radiology Enterprise A
Interoperability Strategy Workshop
Physicians and Systems within a Regional Health
Network - Routine Imaging Referral
Regional Health
Information
Network
Radiology Enterprise B
Register Imaging
Information for
sharing
CrossEnterprise
Registry
Register Imaging
Information for
sharing
Notification of
Doc Availability
Physician Office
June 28-29, 2005
28
Radiology Enterprise A
Interoperability Strategy Workshop
Physicians and Systems within a Regional Health
Network for a Routine Imaging Referral
Regional Health
Information
Network
Prior
Imaging
Report &
Study
Radiology Enterprise B
Patient Id= 3547F45
• Report 5/21/1998 : CT Head B
Cross- • Study 5/21/1998 : CT Head B
Enterprise • Report 2/18/2005 : Chest Xray A
Registry • Study 2/18/2005 : Chest Xray A
Query for
documents
Notification of
Doc Availability
Imaging Report
& Study
Physician Office
June 28-29, 2005
29
Radiology Enterprise A
Interoperability Strategy Workshop
Regional Health Information Network
Images and reports part of a shared health record
Regional Health
Information
Network
Enterprise B
Register Documents
for sharing
Retrieve
Prior
Documents
CrossEnterprise
Registry
Query for
documents
Retrieve
Prior
Documents
Register Documents
for sharing
Query for
Documents
Notification of
Doc Availability
Retrieve
Documents
Physician Office
June 28-29, 2005
30
Enterprise A
Interoperability Strategy Workshop
Requirements for care delivery IT system in a RHIO
(e.g. EHR, Lab, Imaging, etc.)
Imaging Information
Sharing
Format of the Document Content
and associated coded vocabulary
or
Medical Summary
Document Content
Format of the Document Content
and associated coded vocabulary
Lab Results Document
Content
For
Display
Document
Format of the Document
Content
and associated
coded
vocabulary
Content
Format of the Document Content
Cross-enterprise User
Authentication
Authentication & Auditing:
Basis for Access Control
Cross-Enterprise Document
Sharing
Registration, distribution and access
across health enterprises of clinical
documents forming a patient
electronic health record
Audit Trail & Node
Authentication
or
Patient Identifier
Cross-referencing
Map patient identifiers across
independent identification
domains
Document Digital
Signature
Centralized privacy audit trail
and node to node authentication
to create a secured domain.
Attesting “true-copy and origin
Consistent Time
Notification of a remote
provider/ health enterprise
Coordinate time across
networked systems
June 28-29, 2005
Patient Demographics
Query
31
Notification of
Document Availability
Interoperability Strategy Workshop
IHE: Interoperability for RHIOs’
• By starting with a secured document sharing infrastructure, RHIOs
have a a platform on which to build clinical content (more structure
& coded terminology, specialized content).
• Solid SAML 2.0 authentication and document digital signature
(need a PKI).
• Practical HL7 V3 approach with CDA-R2 and other content (e.g.
imaging, CCR, legacy, PDF, etc.).
• Establishing a critical mass of products implementations, both in
clinical applications and infrastructure for deployment in 2006.
• An architecture that caters to various RHIOs architectures:
centralized, decentralized and mixed (operational decision).
June 28-29, 2005
32
Interoperability Strategy Workshop
More information….
• IHE Web sites: www.ihe.net
• Technical Frameworks, Supplements
– Fill in relevant supplements and frameworks
• Non-Technical Brochures :
•
•
•
•
•
Calls for Participation
IHE Fact Sheet and FAQ
IHE Integration Profiles: Guidelines for Buyers
IHE Connect-a-thon Results
Vendor Products Integration Statements
June 28-29, 2005
33
Interoperability Strategy Workshop
IHE Patient Id management
for RHIOs
Use of PIX and PDQ Integration Profiles
June 28-29, 2005
34
Interoperability Strategy Workshop
Patient Identification Management
PIX Cross Referencing (coexist with PDQ)
Patient Identity
Source
Patient Identity
Feed
Patient Identity
X-Ref Mgr
Patient
Identification
Domain C
Patient
Identification
Domain XAD
XDS Document
Source
Patient ID
Consumer
Dm=C
Pid=Pc
Dm=XAD
Pid=Px
XDS
Doc
Dm=XAD, Pid=Px
XDS Document
Registry
Document
Entry
Dm=XAD
Pid=Px
Provide&Register
Doc Set
Patient
Identification
Domain D2
XDS Document
Query Docs
Consumer
Dm=XAD
Pid=Px
Dm=D2
Patient ID Pid=Pd
Consumer
XDS
Doc
June 28-29, 2005
Patient Identity
X-Ref Mgr
XDS
Document
Repository
35
Interoperability Strategy Workshop
Patient Identification Management
PDQ Discovery + Local mapping (coexist with PIX)
Patient Identity
Patient Demographics Source
Patient Identity
Feed
Supplier
Dm=XAD, Pid=Px
Patient
Identification
Domain C
Patient
Identification
Domain XAD
XDS Document
Source
Patient
Demo
Consumer
Demo
graphics
Dm=XAD
Pid=Px
XDS
Doc
June 28-29, 2005
XDS Document
Registry
Document
Entry
Dm=XAD
Pid=Px
Provide&Register
Doc Set
Patient
Identification
Domain D2
XDS Document
Query Docs
Consumer
Dm=XAD
Pid=Px
Demo
Patient Demographics
Consumer
XDS
Doc
XDS
Document
Repository
36
Interoperability Strategy Workshop
Providers and Vendors
Working Together to Deliver
Interoperable Health Information Systems
in the Enterprise
and Across Care Settings
WWW.IHE.NET
June 28-29, 2005
37
Interoperability Strategy Workshop