IHE ITI & PCC Update
to DICOM Committee
DICOM Committee–Yokohama, April 10-11, 2006
IHE IT Infrastructure Technical Committee Co-chair
Charles Parisot - GE Healthcare
September, 2005
1
What IHE Delivers
Achievements and Expanding Scope
Over 100 vendors involved world-wide, 5 Technical Frameworks
38 Integration Profiles, Testing at Connectathons
Demonstrations at major conferences world-wide
Electronic Health Record
Radiology
Cardiology
15 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
2
HIMSS 2006 Interoperability Showcase
More than 3,000 attendees visited the 2006 HIMSS Interoperability
Showcase.
37 vendors demonstrated 48 health information technology (IT)
systems.
700 attendees created and tracked their own electronic health record
(EHR).
63 educational sessions presented.
5 international delegations visited the interoperability showcase.
Three HIMSS 2006 keynote speakers toured the showcase.
16 clinical scenarios demonstrated interoperability across multiple
products, EHR and personal health record (PHR) systems, and care
delivery settings.
3
Interoperability Showcase Layout
4
What has been shown in the HIMSS showcase
Real-world implementations. Effective IHE interoperability
 36 vendor products: EHR & Ancillary IT systems, PHR systems,
Registries, Repositories, MPIs, etc.
 4 Federal entities or grantees (VA, DoD, NIST, CDC/UW)
 All implementations passed IHE Connectathon tests
Scenario focused on health information exchange:
 Within the enterprise (Cardiology, Radiology, etc.)
 Across inpatient and physician offices care settings in a RHIO for health
status information (meds, allergies, pbs, etc.), reports, images, legacy
docs
Empowered with your own health record:
 Show-wide record submission and access (11 vendor booths)
 “HIMSS RHIO” Infrastructure: secured access and communications,
distributed repositories, document registries, patient Id X-referencing
5
HIMSS IHE Interoperability Showcase
February 2006 Participants
Leadership Level
Blue Ware
Cerner
GE Healthcare +IDX
IBM
Initiate Systems
InterSystems
MiSys Healthcare
Quovadx
Siemens
Implementer Level
Allscripts
Canon
CapMed
Cardiac Science
CGI-AMS
CompassCare
CPSI
Dictaphone
DR Systems
Eastman Kodak
Eclipsys
Epic Systems
HIPAAT
Supporter Level:
Acuo
Bond
Carefx
Clearcube
HX Technologies
INFINITT Technology
Kryptiq
McKesson
MedAccess Plus
Medical Informatics
MediNotes
MNI
National Institute of Sci & Tech
NextGen Healthcare
Philips Medical
ScImage
Witt Biomedical
Organizational participant:
Dairyland
EMC
Identrus
Intel
Mediserve
Medkey
Motion Comp.
Picis
Pulse
Sentillion
American Coll. of Clinical Eng.
Catholic Healthcare West
US Dept of Defense
US Dept of Veterans Affairs
DMP–French Natl. Personal EHR
Health Level 7
HTP
IEEE
Midmark Diagostics Group
HIMSS RHIO Federation
Liberty Alliance
Univ. of Washington
HIMSS 06 IHE Interoperability Showcase
Distributed Demonstration Vendor Participants
Allscripts
CapMed
CGI-AMS
Eclipsys
GE Healthcare +IDX
InterSystems
McKesson
Medical Informatics
MediNotes
Misys Healthcare
Siemens
7
IHE Integration Profiles for Health Info Nets
What is available and has been added in 2005 and is for 2006
Emergency Referrals
Patient
Created Summaries
Format of the Document Content
and Report
associated
coded vocabulary
ECG
Document
Format
of the Document
Content
andResults
associated
coded vocabulary
Lab
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
Meds, Allergies,
Pbs)
and(associated
coded
vocabulary
Format of the Document Content
and associated coded vocabulary
Cross-Enterprise
Document Sharing
Cross-enterprise User
Authentication
Authentication & Auditing:
Enhanced Access Control
Document Digital
Signature
Audit Trail & Node
Authentication
Cross-enterprise
Document Interchange
Consistent Time
Media-CD/USB & e-mail push
Map patient identifiers across
independent identification
domains
Attesting “true-copy and origin
Centralized privacy audit trail
and node to node authentication
to create a secured domain.
Stored
Queries
Patient IdentifierV3
Cross-referencing
Option
Registration, distribution and access
across health enterprises of clinical
documents forming a patient
electronic health record
XDS/RLS
Federation
Patient Demographics
Query
Request Form
for Data Capture
External form with custom
import/export scripting
Notification of
Document Availability
Coordinate time across
networked systems
Notification of a remote
provider/ health enterprise
8
Federation of XDS and non-XDS Domains
Leverage Connecting for Health RLS – 2006-2007 Development
State RHIO
Cross-state IDN
Cancer Treatment
XDS Affinity Domain (NHIN sub-network)
A87631
Patie
M8354673993
M8354673993
nt 14355
L-716
L-716Identi
A87631
Affinity Domain Patient
ty
EHR System Identity Source
XRef
M8354673993
Mgr
A87631
Patie
M8354673993
M8354673993
nt 14355
L-716
L-716Identi
A87631
Affinity Domain Patient
ty
EHR System Identity Source
XRef
M8354673993
Mgr
A87631
Patie
M8354673993
M8354673993
nt 14355
L-716
L-716Identi
A87631
Affinity Domain Patient
ty
EHR System Identity Source
XRef
M8354673993
Mgr
Patient
L-716
Identity
Feed PIX Query
PAC
PAC
S
S
PAC
PAC
S
S
Patient
L-716
Identity
Feed PIX Query
ED
Applica
Lab
tionInfo.
PAC Sys
A87631
tem
S
A87631
Patient
L-716
Identity
Feed PIX Query
ED
Applica
tion
PAC
S
EHR
System
XDS
Affinity Domain (NHIN sub-network)
EDPAC
PAC
Applica
S
Lab
tionS
Info.
XDS Affinity DomainPAC
(NHIN sub-network)
Sys
A87631
tem
S
EHR System
A87631
Patie
M8354673993
M8354673993
nt 14355
L-716
L-716Identi
A87631
Affinity Domain Patient
ty
EHR System Identity Source
EHR System
XRef
M8354673993
Mgr
PAC
S
Patient
L-716
Identity
Feed PIX Query
A87631
Patie
M8354673993
M8354673993
nt 14355
L-716
L-716Identi
A87631
Affinity Domain Patient
ty
EHR System Identity Source
XRef
M8354673993
Mgr
A87631
EHR System
PAC
PAC
S
Lab
S
Info.
XDS Affinity DomainSys
(NHIN sub-network)
tem
XDS Affinity Domain (NHIN sub-network)
A87631
Patie
M8354673993
M8354673993
nt 14355
L-716
L-716Identi
A87631
Affinity Domain Patient
ty
EHR System Identity Source
XRef
M8354673993
Mgr
Registry
Locator service
ED
Applica
tion
PAC
PAC
S
S
XDS Affinity Domain (NHIN sub-network)
A87631
Patie
M8354673993
M8354673993
nt 14355
L-716
L-716Identi
A87631
Affinity Domain Patient
ty
EHR System Identity Source
XRef
M8354673993
Mgr
ED
Applica
tion
PAC
Patient
A87631
L-716
S
Identity
XDS Affinity Domain (NHIN sub-network)
Feed PIX Query
EHR System
Patient
L-716
Identity
Feed PIX Query
PAC
PAC
S
S
Lab
Info.
Sys
tem
Lab
Info.
Sys
tem
PAC
S
NHIN
Backbone
Registry
Locator service
EHR System
XDS Affinity Domain (NHIN sub-network)
A87631
Patie
M8354673993
M8354673993
nt 14355
L-716
L-716Identi
A87631
Affinity Domain Patient
ty
EHR System Identity Source
XRef
M8354673993
XDS Affinity Domain (NHIN sub-network) Mgr
Lab
Info.
Sys
tem
Patient
L-716
Identity
Feed PIX Query
Sub-Network
Patient Identity XRef Mgr
Patient Identity XRef Mgr
A87631
M8354673993
M8354673993
14355
A87631
M8354673993
M8354673993
14355
L-716
L-716
A87631
Affinity Domain Patient
Identity Source
A87631
XDS
Docu
ment
Repo
sitor
y
PIX Query
PACS
PIX Query
PACS
Teaching
Hospital
Community
Clinic
CT Time server
XDS Affinity Domain (NHIN sub-network)
A87631
XDS
Docu
ment
Repo
sitor
y
PACS
XDS Affinity Domain (NHIN sub-network)
PIX Query
Teaching
Hospital
Community
Clinic
CT Time server
XDS Affinity Domain (NHIN sub-network)
PACS
A87631
XDS
Docu
ment
Repo
sitor
y
PACS
PACS
Sub-Network
ED Application
Docu
ment
Regi
stry
XDS
Docu
ment
Repo
sitor
y
EHR System
Lab Info.
System
Teaching
Hospital
Community
Clinic
ATNA
Audit
record
reposito
ry
CT Time server
XDS Affinity Domain (NHIN sub-network)
A87631
EHR System
A87631
EHR System
Lab Info.
System
ATNA
Audit
record
reposito
ry
Patient
Identity
Feed
L-716
PACS
Docu
ment
Regi
stry
XDS
Docu
ment
Repo
sitor
y
L-716
M8354673993
PAC
S
Lab
Info.
Sys
tem
Affinity Domain Patient
Identity Source
EHR System
Physician
Office
ED Application
EHR System
Lab Info.
System
ATNA
Audit
record
reposito
ry
Patient
Identity
Feed
L-716
PACS
Docu
ment
Regi
stry
XDS
Docu
ment
Repo
sitor
y
L-716
A87631
M8354673993
Physician
Office
ED Application
L-716
Affinity Domain Patient
Identity Source
EHR System
M8354673993
Patient
Identity
Feed
L-716
PACS
Sub-Network
Patient Identity XRef Mgr
L-716
PAC
PAC
S
S
Registry
Locator service
A87631
M8354673993
M8354673993
14355
ED
Applica
tion
XDS Affinity Domain (NHIN sub-network)
Which regisry holds
Sub-Network
EHR System
Lab
Info.
Sys
A87631
tem
Registry
records for a patient ?
Locator service
State RHIO
Physician
Office
A87631
EHR System
PACED
PAC
S Applica
S tion
XDS Affinity Domain (NHIN sub-network)
XDS Affinity Domain (NHIN sub-network)
ED
Applica
tion
PAC
S
Patient
L-716
Identity
Feed PIX Query
Integrated
Delivery
Network
XDS Affinity Domain (NHIN sub-network)
9
Cross-Enterprise Sharing of Medical Summaries
(XDS-MS)
Patient Examination
or Discharge
Discharge or Referral
Document Created
Referred Physician
Notification
EMR
Document
Registry
EMR
Review of
Medical Summary
Report Repository
Medical
Summary
The Cross-Enterprise Sharing of Medical Summaries Integration
Profile solves the problem of transferring summary patient
information between providers in different clinical settings.
10
XDS-MS Medical Summary
Structured and Coded Header
Patient, Author, Authenticator, Institution,
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 :
 Reason for Referral
 Vital Signs
 Medication
Text Structure
Entry
Coded Section
Entry
Level 1
Level 2
Level 3
 Studies
 Allergies
Text Structure
Entry
Coded Section
Entry
 Social History
 Problems
Text Structure
Entry
 Care Plan
Coded Section
Entry
Level 3
Header always structured and coded
Title-coded sections with non-structured
nor coded content (text, lists, tables).
 Simple Viewing (XML Style sheet)
Med, Problems and Allergies
required as highly structured
text. Text easy to import/parse
Med Problems and
Allergies have a required
fine-grain structure with
optional coding. Coding
Scheme not standardized,
but explicitly identified.
XDS-MS enables both semantical
interoperability and simple viewing !
11
Use of a shared XDS infrastructure to access
Radiology Reports and Images (XDS-I)
Between Radiology and :
• Imaging specialists
• Non-imaging clinicians
Hospital
PACS Y
Radiology -toRadiology
Radiology -toPhysicians
Physician Practice
PACS Z
Imaging Center
Same XDS Infrastructure (Registry and Repositories)
for medical summaries and imaging information !
Demo at HIMSS Feb. 2006 and RSNA Dec. 2006
12
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