Improving Healthcare IT Systems Through Interoperability .

AchievingInteroperabilityImproved OutcomesPatient SafetyImproving Healthcare ITSystems throughInteroperabilityIHE can help manage“the medical devices mismatch”Lisa Spellman, MBA, CPHIMSSenior Director, InformaticsSecretary, IHE InternationalHIMSS Sponsored Domainslspellman@himss.org

Presentation OverviewOverview: Given the brief time for the sessions, will be unable to cover inextensive detail, so please contact me as we would be delighted to provideadditional information.Primary goal for today’s session: That you are intrigued and wish to learn more Who is talking about global health interoperability?What is IHE? What does IHE Do or Produce? Who recognizes IHE?IHE and Medical Devices OverviewIHE interoperability Success StoriesIHE Patient Care Devices [PCD] OverviewNext Steps Join us – get involved with IHE Q&A

Why interoperability? What’s the value?Does this look familiar?It’s not justinterfacing infusionpumps, for exampleMany clinicalsystems must beintegrated – frommany vendors –using manytechnologies!Use of IHE-basedproducts helpsreduce costs andspeedimplementation

Who is talking about interoperability?WHO, UN and many others – connection to MDGGlobal Meeting on GovernmentInteroperability Frameworks 2010 Representativesof 26 developingcountries agreed, through adeclaration the urgency forgovernments, civil society and theprivate sector to work together todevelop and implementgovernment interoperabilityframeworks for acceleratingprogress in MillenniumDevelopment Goals. IHE can helphttp://www.gif4dev.net/?page id 60

Who is talking about interoperability?Margaret Chan, Director-General of the WHO, continued“Developing a global health indicator registry withstandards for data, indicators, metadata, and referencesto analytic methods that builds upon work done inhealth and disease programs, promotes theimplementation of the standards.”Developing and promoting interoperabilitystandards for the health sector at both thelevel of individual and aggregate records.The eight agencies commit themselves to acting upon thisgoal immediately by: Working together and enhancinginvestments in developing a common standardfor health information, including a commonindicator and metadata registry and e/info%3Adoi%2F10.1371%2Fjournal.pmed.1000223

Isn’t interoperability largely a technology challenge?No, it is more than just technology.“ When implementing an e-Health system a systemic approachis necessary to account for all factors impacting on the successof the system. These impacting factors include policy andlegal frameworks, workflows and processesand financial and human resources.Technical interoperability is not always just atechnical issue, it can also be a political one. Ifthere is no interest in collaboration then therewill be little support for te/bib/gtz2010-0158en-e-health-conference.pdf

IntroducingIntegrating the Healthcare EnterpriseIHE IHE is an organization with a process to helpmake the important goals of health ITinteroperability happen in high and lowresourced countries IHE - Changing the Way Healthcare Connects

IHE – a brief overview Global non-profit organization 400 members from 30 nationsworldwide and still growing Over a decade of experience Led by IHE volunteers and sponsororganizations Over 100 IHE Profiles [IHE’s workproduct] published & in useworldwide IHE’s work is open source and freelyavailable to all

Who are IHE Members?Members lead IHE and represent a wide range of health and ITstakeholders including Clinicians – physicians & nurses Executive clinical leaders such as CMIOs, CNOs Academic medicine faculty Non-profit membership associations such as HIMSS, EuropeanAssociation of Hospital Pharmacists, AAMI and many more Standards developers & SDO entities HL7, ISO. IEEE, DICOM, etc Health professionals such as public health administrators &biomedical and clinical engineers and many others Consultants, product developers and vendors

What Does IHE Do or Produce, continued The official description IHE creates paths to seamless movement ofclinical patient data within & betweenenterprises, regions, nations IHE has created a common technicalframework for harmonizing andimplementing multiple health & IT standards Reduction of interfaces between health ITsystems reduced costs

Improving patient safety,ability to conduct clinical research and moreFrom the official description to a story to helpillustrate via a common use case Over 100,000 people per year estimated todie from preventable medical errors in justthe U.S. – how many more worldwide?

About those recognized base standardsWho recognizes IHE?Using accepted basestandards such as CreatesProfilesIHTSDOREPEATABLE

IHE annual cycleHigh level overview xX

IHE Domains & Structure1.2.3.4.5.6.7.Anatomic PathologyCardiologyEye CareIT InfrastructureLaboratoryMammographyNursing – PCCsubcommittee8. Patient Care Coordination9. Patient Care Devices /Medical Devices10. Pharmacy11. Quality, Research & PublicHealth12. Radiology13. Radiation OncologyFuture Domains may include: Dentistry [In process] Surgery [In process] And others

The larger vision & goalSemantic interoperability1st Level Goal: Interoperability with two or more computer systemsto exchange informationNext Level Goal: Semantic interoperability is the ability toautomatically interpret the information accurately exchangedin order to produce useful results as defined by the end users ofboth systems.What’s Needed to reach this goal? To achieve semanticinteroperability, both sides must defer to a common informationexchange reference model. The content of the informationexchange requests are unambiguously defined: what is sent isthe same as what is understood.www.ieee.org

Why not just use standards?Why is IHE Needed?Standards are important and needed, but standardsalone are not enough Sometimes they are too broad resulting invarying interpretations and implementations Sometimes there are too many & sometimes too few As a result, many times purchasers, end users, governments,agencies / ministries and product developers are forced tochoose one standard over another and lose potential to reachan interoperable state

Benefits of medical device connectivity forhospitals & other connected entities With today’s often high staff-to-patient-ratio, staff must spend more timecharting and less time on direct patient care Medical Devices able to transmit data directly to the EHR Eliminates transcription errors Increase staff productivity Example: One of IHE’ s vendor members has a device interface library with400 different types of medical devices supported, including patientmonitors, ventilators, infusion pumps, and anesthesia machines. This solution automatically converts the medical device data to HL7 or XMLformat and integrates it with any Electronic Medical Record, (EMR), ClinicalInformation System (CIS), or Alarm and Event Management systemimproving clinical documentation, enhancing workflow and savingthousands of nursing hours.

IHE Success StoriesJust showing twoexamples today due totime limitations, thereare many more successstories available uponrequest

Sample of IHE Implementations WorldwideNetherlandAmsterdamUK CfH(Radiology WF)Italy(Conto Corrente Salute)FranceDMPDenmark (Funen)Italy (Veneto)Spain (Aragon)Quebec, Ontario,Alberta, British ColumbiaCanada Health InfowayVITL-VermontBoston MedicalCenter - MAAustraliaPhiladelphia HIECPHIC –PennsylvaniaCareSpark – TN & VASouth AfricaCHINA-ShanghaiImaging Info SharingMalaysiaCHINA-MoHLab results sharingJAPAN-NagoyaImaging Info SharingTHINC- New YorkNCHICA – N. Carolina

Go to Google Maps & enter“Where in the World is XDS & CDA?”IHE Success Stories – XDSWhere in the world is Xx

IHE Success Stories – XDSInSite One: Largest managed HIE includes medical imaging with 650 sites w/ability toshare data through their enterprise archive using IHE actors and profilesWhere in the worldis www.insiteone.com/why-dicom.phpXx

IHE Success Stories: InterSystemsOne of 200 vendors worldwideXx

IHE Success Stories: epSOS Project – EuropeSmart Open Services for European Patients Who: 30 European entities from 12 EUmembers Goal: To develop a practical eHealthframework and infrastructure that will enablesecure access to patient health information,particularly with respect to a basic patientsummary and e-prescription, betweenEuropean healthcare systems. epSOS Critical Principles include – Not to alter any Member State’s current healthinformation system– Instead create a technical interface allowingdifferent systems to work togetherwww.epsos.eu/epsos-home.html

IHE Patient Care Devices [PCD] DomainThe PCD Domain is concerned withuse cases in which at least oneactor is a patient-centric point-ofcare medical device.PCD coordinates with other IHEclinical specialty based domainssuch as medical imaging and labto ensure consistency of medicaldevice integration solutionsacross all IHE technicalframeworks

IHE PCD Work Product Current IHE PCD Profiles: Enterprise sharing of Patient Care Data (DEC)Subscribe to Patient Data (SPD)Rosetta Stone Terminology Project (RTM)PCD Alarm Communication Management (ACM)Point-of-care Infusion Verification (PIV) IHE PCD Work in Process: Device Point-of-care Integration (DPI)Waveform Communication Management (WCM)Event Communication (EVT)Medical Equipment Management (MEM)Patient – Device Association (PDA) Initial device classes Vital signs / physiological monitors, infusion pumps and ventilators

IHE PCD Work Product IHE PCD Users Handbook How to assess PCD profile support System verification & validation testing considerationsPlease contact me and I can email link and/or document uponrequest lspellman@himss.org

IHE Technical DemonstrationsHeld in locationsworldwide for six years,including: Australia,Canada, China, Korea,France, Spain, USUS2010 -Atlanta 25K Sq Ft & 4K visitors 80 participants & 70 systemsUpcoming ShowcasesOct 2010: KoreaMay 2011: BudapestAugust 2011: Australia

PCD area of an Interoperability Showcase

Suggested Next StepsJoin IHE and help make interoperability happenHow to Apply? IHE Membership is free Complete on-line applicationat www.ihe.net/apply Submit declaration page Applications reviewed by IHEInternational Board Reviewed monthly Join IHE Clinical orOperational Domains andsub-committeesBenefits of IHEMembership Leadership in HIT industry Direct work of IHECommittees Learn from industry’s topprofessionals Participation in IHE Domain

IHE Supports WHA resolution 60.29WHA resolution WHA 60.29 of May 2007"Health technologies" - in particular medical devicesUrges Member States: "to draw up national or regionalguidelines for good manufacturing and regulatory practices,to establish surveillance systems and other measures toensure the quality, safety and efficacy of medical devices andwhere appropriate participate in international harmonization

Why choose IHE?For End Users For End Users Simplify tender & RFPprocesses Reduces cost Need fewer interfaces Open source Improve patient safety –Spend time innovating ratherthan supportinginfrastucture work – again &again & . Improve patient safety -

A Wealth of Resources,learn more & please join us!IHE Main Websitewww.ihe.netIHE Europewww.ihe-europe.netGreat resource for standards,interoperability, and IHEprimarily U.S focused, thoughnot exclusively: Keith Boone: GE& Co-Chair Patient CareCoordination Domainhttp://motorcycleguy.blogspot.com/IHE Development Wiki Workspacehttp://wiki.ihe.net/index.php?title Main PageInteroperability ShowcaseInformation, videos, examples,and morewww.interoperabilityshowcase@himss.orgPlease feel free to contact meLisa Spellmanlspellman@himss.org

Questions & Discussion

Thank you!Changing the Way Healthcare Connectslspellman@himss.org

Holding Slides These are holding slides in case we havemore time

IHE maximizes connections IHE works Application-to-Applicationo UNIX Oracle IHE works System-to-Systemo Medical Device EHR PHR IHE works Setting-to-Settingo ER Cardiology ICU Lab EHR