INTEGRATING THE
HEALTHCARE ENTERPRISE
Pathway to Interoperability
IT Infrastructure Planning Committee
Michael Nusbaum – MH Nusbaum & Assoc
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Contents
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Interoperability:
Highest Cause of Health IT project failures
Base Standards
eHealth Projects
IETF
IHTSDO
Health Interoperability Standards: how can we realize the promise ?
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Interoperability: From a problem to a solution
Base Standards
Profile
Development
eHealth Projects
IETF
IHTSDO
Specific Extensions
Profiling Organizations Have Emerged
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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
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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 systems
IHE: A forum for agreeing on how to implement
standards and processes for making it happen
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IHE: A Framework for Interoperability
A common technical framework for harmonizing
and implementing multiple standards
 Application-to-application
 System-to-system
 Setting-to-setting
Enables seamless health information movement
within and between enterprises, regions, nations
Promotes unbiased selection and coordinated
use of established healthcare and IT standards
to address specific clinical needs
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Is IHE novel? Adopted?
What are the alternatives ?
 Ignore the issue
 Pick key standards, and hope for the best
 Rely on robust standards harmonization
ISO Health Informatics: TR28380 Global Standards
Adoption – IHE Process and Profiles
Widespread adoption of IHE Profiles by National and
Regional Projects around the world: USA, Canada,
Europe, Asia
Home Health: CONTINUA and IHE work together.
12 Country European epSOS Project (IHE-Europe
hosting Industry Team).
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IHE is a Proven Standards Adoption Process
Recognized by the International Standards Organization: TR 28380
Testing at
Connectathons
Develop technical
specifications
Identify available
standards (e.g. HL7,
Products
declare IHE
IHE
Demonstrations
RFPs with
IHE reqs
DICOM, IETF, OASIS)
Document Use Case
Requirements
Timely access to
information
Easy to integrate
products
IHE Organizational Structure
IHE International Board
Example Deployment Committees
IHE North America
IHE Asia-Oceania
China
Canada
USA
Korea
Global Development Domains
Radiology
IT
Infrastructure
Laboratory
Cardiology
Patient Care
Coordination
Pathology
Radiation
Oncology
Patient Care
Devices
Eye Care
Japan
Australia
IHE Europe
Austria
Italy
France
Norway
Germany
Spain
Netherlands
Sweden
Professional Societies / Sponsors
UK
Public Health, Quality
and Research
Endoscopy
Pharmacy
Dentistry
Contributing &
Participating
Vendors
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The IHE Development Domains
14 Years of Steady Evolution 1998 – 2011
Dentistry
since 2010
Radiology
since 1998
Endoscopy
since 2010
Cardiology
since 2004
Pharmacy
since 2009
Laboratory
since 2004
Pathology
since 2006
(Healthcare)
IT Infrastructure
since 2003
Eye Care
since 2006
Quality
Research & Public Health
since 2006
Radiation Oncology
since 2004
Patient Care Coordination
since 2004
Patient Care Devices
since 2005
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International Participation in IHE




Australia
Austria
Local Deployment
National Extensions
Promotional & Live Demonstration Events
Funding
Spain
China
Netherlands
Norway
Taiwan
Korea
Canada
UK
Japan
Italy
Germany
France
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
USA
Pragmatic global standards harmonization + best practices sharing
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IHE Sponsors
Professional societies:







Healthcare Information Management Systems Society (HIMSS)
American College of Physicians (ACP),
American College of Emergency Physicians (ACEP)
American College of Obstetricians and Gynecologists (ACOG)
Many other American Professional Societies (ACCE), (AAO), (ASTRO), etc.
British Institute of Radiology (BIR), British Computer Society (BCS)
German Radiology Society (DRG) …ASIP (IT France), SFIL (laboratory), French
National Project (DMP), European Society of Cardiology
 Radiological Society of North America (RSNA)
 JAHIS (IT Japan), JIRA, JRS,…
 And many more
Government Agencies:

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French National Project (ASIP-Santé)
Dutch National Project (NICTIZ)
Austrian National Project (ELGA)
Canada Health Infoway (CHI)
Regional projects (Italy, USA, Japan) and many more…..
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IHE Connectathon
Open invitation to any vendor and other implementers
Advanced IHE testing tools (MESA, GAZELLE)
Testing organized and supervised by independent
project management team
Thousands of cross-vendor tests performed
Results recorded and published
http://connectathon-results.ihe-europe.net/
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IHE N.A. Connectathon Tested Systems
EHR/PHR/Edge Systems
HIE/HIO Infrastructure
2008: 14 Systems
2009: 24 Systems
2008: 5 Systems
2009: 6 Systems
2010: 56 Systems
2010: 30 Systems
Cross-enterprise Interoperability
Intra-enterprise Interoperability
Enterprise-level: 44 Systems
Cardiology
Radiology
Devices
30 Systems
40 Systems
20 Systems
HIMSS Interoperability Showcase
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IHE, Global Standards-Based Profiles
Adopted in National & Regional Projects
http://tinyurl.com/WWXDS
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IHE, Global Standards-Based Profiles
Adopted in National & Regional Projects
http://tinyurl.com/WWXDS
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The IT Infrastructure Domain
Supplies infrastructure for sharing healthcare
information, which is independent of any
particular clinical domain.
An infrastructure interoperability component
represents a common IT function that is used as
a building block for a variety of use cases... a
necessary ingredient, but rarely visible to the end
user.
These components may be embedded in an
application, but are often deployed as a shared
resource within a health information exchange
environment.
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Categories of Healthcare Communication Services
Exchange of Health Information
Hospitals
e.g. access last 6 mo.
historical labs &
encounter summaries
e.g. order lab test, track
status and receive results
Source persisted
and attested health
records
2 or more entities
synchronize
a task
Health Record
Sharing
Workflow
Enablers
Patient and Provider Identity Management
Security/Privacy
Support Management
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ITI Strategic Focus
Category
Description
Patient and Provider Identity
Profiles in the Patient and Provider Identity category support the
management of patient, provider and healthcare organization
identity including their localization. This includes the ability to look
up, cross-reference, update, remove, merge, link and general
management of identities.
Health Record Sharing
Profiles in the Health Record Sharing category support the ability to
share patient specific healthcare information within and across
Enterprises. This includes the ability to submit, locate/list, push, pull
and retrieve patient specific healthcare information.
Security and Privacy
Profiles in the Security and Privacy category support the ability to
ensure that healthcare information is managed consistent with a
reasonable set of security and privacy policies.
Workflow Enablers
Profiles in the Workflow Enablers category support standard
sequences for performing workflow activities.
Support Management
Profiles in the support management category support the ability to
share information needed for interoperable healthcare management
such as clinical coding, technical or IT management information
http://wiki.ihe.net/index.php?title=ITI_Strategic_Planning
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More Information
IHE Web site: www.ihe.net
 IHE official material
Technical Framework documents
IHE Wiki site: wiki.ihe.net
 IHE committee pages
 Implementation Notes
 Ongoing committee work
IHE ITI technical committee mailing list
 http://www.ihe.net/IT_infra/committees
At the bottom of the page is a place to join the mailing list
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