Chris Lindop GE Healthcare, IHE-International, IHE-Radiology Co-Chair (Wednesday, Interoperability Reference Architecture Workshop)

1. INTEGRATING THE
HEALTHCARE
ENTERPISE (IHE)
HINZ Conference 2011
Chris Lindop, GE healthcare, IHE-International, IHE-Radiology Co-Chair
1

2. Agenda
IHE and the Standards Adoption Process:
achieving practical interoperability
2

3. Why are standards important?
Selecting a single industry-wide Standard
Reduces
 Production costs
 Deployment/Installation costs
 Deployment/Installation schedule
 Project risks
Enables
 Vendors to focus on features
 Clinicians to focus on Patient Care
4

4. 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
5

5. What does IHE do?
Enables Standards-based Interoperability:
Harmonizes Standards:
 Into implementable specifications called IHE Profiles
Public Forum:
 All work output developed through a broad, consensus-based
committee process and subjected to public review
Publish and Promote:
 IHE applies existing standards such as HL7, IEEE, DICOM
and others to specific healthcare interoperability needs
 IHE Technical Frameworks freely available to all, promoted
through public demonstrations and education events
Implement and Test:
 Rigorous testing process and extensive tool set for
implementers

6. Interoperability: From a problem to a solution
Profile
Development eHealth Projects
IETF
IHTSDO
Project Specific Extensions
Profiling Organizations Have Emerged
To provide major support and sustainability 8

7. The IHE Initiative
An Incremental Multi-Year Project
Launched in 1998
Goal:
 Enhance the Access to Clinical Information
 Ensure Continuity and Integrity of Patient Information
 Speed Up the Integration in Healthcare Environments
 Fosters Communication Between Vendors of
Medical Information Technology
Prove that Integration is Attainable Based on Standards
Participants:
 Representatives of Healthcare Providers
 Information & Imaging Systems Vendors
 Standardization Groups

8. IHE: 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
10

9. Stakeholder Benefits
Healthcare providers and support staff
 Improved workflows
 Information whenever and wherever needed
 Fewer opportunities for errors
 Fewer tedious tasks/repeated work
 Improved report turnaround time
Vendors
 Align product interoperability with industry consensus
 Decreased cost and complexity of interface installation and
management
 Focus competition on functionality/service space not information
transport space
SDOs
 Rapid feedback to adjust standards to real-world
 Establishment of critical mass and widespread adoption
12

10. IHE Organizational Structure
IHE International Board
Regional Deployment Global Development
IHE North America IHE Asia-Oceania
China Japan Radiology IT Laboratory
Canada
Infrastructure
USA Australia Taiwan
Malaysia Korea
Cardiology Patient Care Pathology
Coordination
IHE Europe
Radiation Patient Care Eye Care
Oncology Devices
Austria France Germany Netherlands
Italy Norway Spain Sweden UK Public Health, Quality
and Research
Professional Societies / Sponsors Contributing &
ACC ACP RSNA COCIR SIRM ESC JAHIS METI-MLHW Jun
Participating
ACCE GMSI SFR EAR-ECR BIR MSC JIRA MEDIS-DC
ACEP HIMSS DRG EuroRec MDEC
Vendors e-
SFIL JRS JAMI
Sep
13
13 tem

11. The IHE Development Domains
13 Years of Steady Evolution 1998 – 2011
Today over
100 Radiology
Profiles since 1998
Pharmacy
for Interop. Since 2009 Cardiology
since 2004
within the
Pathology
Enterprise since 2006
Laboratory
since 2004
& National Eye Care
-Regional since 2006 (Healthcare)
IT Infrastructure
Health Info since 2003
Exchange Quality Radiation Oncology
Research & Public Health since 2004
since 2006
At Home
Patient Care Coordination
since 2008 Patient Care Devices since 2004
since 2005

12. International Growth of IHE
Switzerland
 Local Deployment, National Extensions Malaysia
 Promotional & Live Demonstration Events
Turkey
 Over 300 Organizational Members (all stakeholders)
China
Australia
Austria
Spain
Netherlands
Taiwan
Canada
UK
Japan
Italy
Germany
France
USA
2008
2005
2006
2007
2000
2001
2002
2003
2004
2009
2010
1999
Pragmatic global standards harmonization + best practices sharing
15

13. IHE Implementation Strategy
Leverage established standards to allow rapid deployment and
plan for future
Pragmatic, Ease of Evolution
Enable architectural freedom (patient vs. provider centric,
centralized vs. decentralized, scalable (from office to
enterprise to IDN to Regional and National Networks)
Configuration flexibility
Support breakthrough use cases: variety of care settings, care
coordination, public health, PHR, EHR
Interoperability for broad constituencies
IHE: Offers consistent, standards-based record
sharing for EHRs and other information systems
16

14. Standards Adoption Process
Testing at
Connectathons IHE
Develop Demonstrations
technical
specifications
Products
Identify available with IHE
standards (e.g. HL7,
DICOM, IETF, OASIS)
Timely access to
Document Use Case information Easy to integrate
17
Requirements products

15. Key IHE Concepts
• Generalized Systems -> Actors
• Interactions between Actors -> Transactions
• Problem/Solution Scenarios -> Integration
Profiles
• For each Integration Profile:
• the context is described (which real-world problem)
• the actors are defined (what systems are involved)
• the transactions are defined (what must they do)
18

16. IHE Integration Profiles - Model
Actors in precisely defined roles
 Abstracts a specific function of information system
…Executing precisely defined transactions
 Using existing standards
……To solve real world interoperability
problems
 Specifying Integration Profiles
19

17. The Product World…..
Product XYZ
from Vendor T
20

18. The IHE World….
Actor
Actor
IHE
IHE Transaction
IHE Actor
Transaction
IHE Actor
IHE Actor
Transaction
21

19. Mapping IHE to Products
Actor
Actor
IHE
IHE Transaction
IHE Actor
Transaction Product XYZ
from Vendor T
IHE Actor
IHE Actor
Transaction
22

20. IHE Technical Frameworks
Implementation Guide for each Integration Profile
Order Department System Image
ADT Acquisition
An Integration Profile : Placer Scheduler/ Manager/
Order Filler PPS Manager Modality
Use cases Register J.Doe
 A Set of Actors
Patient
Registration [RAD-1]
Process Flows
Placer Order
Management–
One or the New [RAD-2]
 Exchanging Transactions
other methods
of creating an
order is used Filler Order
Management - Schedule
New [RAD-3] Procedure
Procedure
Scheduled [RAD-4]
Actors Transactions Filler Order
Mgmt - Status
Query Modality Worklist [RAD-5]
Modality Procedure
Step In Progress
[CARD-1]
Modality Procedure
Step In Progress
[CARD-1]
Perform
Acquisition
Update [RAD-3]
Modality Procedure Modality Procedure
Patient Reconciliation Filler Order Step Completed Step Completed
J.Doe -> Mgmt - Status [RAD-7] [RAD-7]
Update [RAD-3]
J.Smith
ADT Patient Update/
Patient Update/
Pt. Registration [RAD-1] Merge [RAD-12]
Merge [RAD-12]
Patient Update [RAD-12] Pt. Registration [RAD-1]
Patient Update [RAD-12]
Placer Order Management [RAD-2]
Filler Order Management [RAD-3]
DSS/ Order Filler
Modality PS in Progress [CARD-1] Procedure Scheduled [RAD-4]
Order Placer
For each transaction:
Modality PS Completed [RAD-7] Patient Update [RAD-12]
Procedure Updated [RAD-13]
Instance Availability Notification [RAD-49]
 Std referenced
Evidence
Creator
Image Display
 Options specified
 Mapping required
Modality PS in Progress [CARD-1]
Modality PS Completed [RAD-7]
Query Images [RAD-14]
Storage Modality Image/Evidence Retrieve Images/Evidence [CARD-4]
Performed Commitment Stored [CARD-2]
Procedure [CARD-3]
Step Manager
Image Image
Manager Archive
Modality PS in Progress [CARD-1]
Modality PS Completed [RAD-7]
Storage Modality Image/Evidence
Commitment Stored [CARD-2]
[CARD-3]
Modality PS in Progress [CARD-1]
Modality PS Completed [RAD-7]
Acquisition
Modality
Query Modality Worklist [RAD-5]
23

21. Organization of Technical Frameworks
Volume 1: Integration and content
Profiles
 Describes clinical need and use cases
 Identifies :
• the actors and transactions or,
• content modules
Volume 2+ of Technical Framework
 Provides implementation specification for
transactions or content modules
24

22. Standards Adoption Process
Testing at
Connectathons IHE
Develop Demonstrations
technical
specifications
Products
Identify available with IHE
standards (e.g.
HL7, DICOM, IETF, OASIS)
Timely access to
Document Use Case information Easy to integrate
25
Requirements products

23. IHE Demonstrations: NOT an IHE Connectathon
IHE Connectathon is about qualifying “real-world
implementations”. Strict process and controlled
technical testing activity.
 It is the stick !
IHE demonstration is about education and promotion
about what some “connectathon tested
implementations” can achieve.
 It is the carrot !
Implementations participating to an IHE
Demonstration are required to have passed an IHE
Connectahon. Not all vendors and products are
demonstrated.
26

24. IHE Connectathon
Open invitation to vendor and other
implementors community
Advanced testing tools (GAZELLE)
Testing organized and supervised by
project management team
Thousands of cross-vendor tests performed
Results recorded and published
27

25. IHE Connectathons
2011 Connectathons:
Chicago, USA, January 17-21, 2011
Pisa, Italy, April 11-15, 2011
Australia, July 2011
Japan, October 2011
Massive yearly events :
70-80 vendors
250-300 engineers
100-150 systems
………tested in 5 days
Next EU Connectathons:
Bern, Switzerland, May 2012
Istanbul, April 2013
28

26. http://www.ihe.net/Connectathon/index.cfm
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27. HIMSS Interoperability Showcase
30

28. Example: 2010 HIMSS Interoperability Showcase
31

29. Leveraging IHE Integration Statements
Vendors
 Claim IHE Compliance in an explicit way
 Can rely on an objective and thorough specification
(IHE Technical Framework)
 Willing to accept contractual commitments
 Willing to correct “implementation errors”
Buyers
 Can compare product integration capabilities
 Simplify and strengthen their RFPs
 Can leverage a public and objective commitment
 Decreased cost and complexity of interface deployment and
management
32

30. IHE Integration Statement
Product vendors take the next step
33

31. Providers and Vendors
Working Together to Deliver
Interoperable Health Information Systems
in the Enterprise
And Across Care Settings
 Intra Hospital Workflows and Information Access
http://www.ihe.net
34

32. IHE Solutions within the Enterprise
Enterprise EMR - HIS
IT Infrastructure
eMPI
User Auth
RIS CIS LIS Eye Care
Pathology
Img Acq PACS Cath ECG Auto Mgr Analyzer
Radiology Cardiology Laboratory
Home
Therapy Plan Nursing Station Hub
Established
Img Acq Feb 2009
Treatment Devices
Devices Devices
Radiation Therapy Pharmacy Intensive Care Unit
35

33. IHE Solutions within the Enterprise
Example: IT Infrastructure
Enterprise EMR - HIS
IT Infrastructure
eMPI
User Auth
RIS IT Infrastructure Integration Profiles
CIS
Patient Administration Management LIS Eye Care
Patient Demographics Query
Patient Identifier Cross-referencing Pathology
Img Acq Retrieve Information Cath
PACS for Display ECG Auto Mgr Analyzer
Enterprise User Authentication
Radiology Consistent Time Cardiology Laboratory
Patient Synchronized Applications
Audit Trail and Node Authentication
Personnel White Pages
Shared Value Sets
Home
Therapy Plan Nursing Station Hub
Established
Img Acq Feb 2009
Treatment Devices
Devices Devices
Radiation Therapy Pharmacy Intensive Care Unit
36

34. IHE Solutions within the Enterprise
Example: Patient Care Devices
Enterprise EMR - HIS
IT Infrastructure
eMPI
User Auth
Patient Care Devices Profiles
Device Enterprise Communication (DEC)
RIS CIS
Alarm Communication Mgt (ACM) LIS
Subscribe to Patient Data (SPD) Eye Care
Patient Identity Binding (PIB) Pathology
Rosetta Terminology Mapping (RTM)
Img Acq PACS Cath ECG Auto Mgr Analyzer
Radiology Cardiology Laboratory
Home
Therapy Plan Nursing Station Hub
Established
Img Acq Feb 2009
Treatment Devices Personal
Devices
Devices
Radiation Therapy Pharmacy Intensive Care Unit
37

35. IHE Solutions within the Enterprise
Example: Cardiology
Enterprise EMR - HIS
IT Infrastructure
eMPI
User Auth
RIS CIS LIS Eye Care
Pathology
Img Acq PACS Cath ECG Auto Mgr Analyzer
Radiology Cardiology Laboratory
Cardiology Integration Profiles
Cardiac Catheterization Lab Workflow Home
Therapy Plan Echocardiography Lab Workflow Nursing Station Hub
Established
Retrieve ECG for Display
Img Acq Feb 2009
Displayable Reports
Treatment Cath and Echo Evidence Documents Devices
Devices Devices
Radiation Therapy Pharmacy Intensive Care Unit
38

36. IHE Solutions within the Enterprise
Example: Radiology
Enterprise EMR - HIS
IT Infrastructure Radiology Integration Profiles
eMPI Radiology Scheduled Workflow
Patient Information Reconciliation User Auth
Access to Radiology Information
Portable Data for Imaging
RIS Consistent CIS
Presentation of Images LIS Eye Care
Key Image Note
Presentation of Grouped Procedures Pathology
Img Acq PACS Cath
Evidence Documents ECG Auto Mgr Analyzer
Radiology Audit trail and Node AuthenticationLaboratory
Cardiology (Rad option)
Teaching Files and Clinical Trials Export
Post-processing Workflow
Reporting Workflow Home
Therapy Plan Charge Posting Nursing Station Hub
Established
Img Acq Simple Image and Numeric Reports
Feb 2009
Treatment Devices
Devices Devices
Radiation Therapy Pharmacy Intensive Care Unit
41

37. Scheduled Workflow Profile
report
report
Registration Report
report
Repository
HIS patient Diagnostic Film
information Workstation Lightbox
images
PACS retrieved
Orders Placed
procedure
scheduled Film
Prefetch any relevant Image Manager
Folder
examination orders prior studies & Archive
modality Acquisition
images
worklist Modality
Orders Filled stored
RIS acquisition
completed
acquisition Film
in-progress
completed images
printed
Modality 42

38. Requirements for an open HIE/EHR
Bring trust and ease of use for healthcare professionals:
 Care delivery organizations choose information to
share:
• Based on patient health status
• When they see fit (discharge, end of encounter, etc.)
• What information to share (pick relevant documents, and content elements).
 Care delivery organizations access patient info through:
• Their own local EMR (if they have one)
• Through a shared portal/service otherwise.
 When accessing patient info:
• Find quickly if relevant information is available or not (single query)
• May select among relevant records (may be done in background)
• Among them chose to import whole or part in local patient record
43

39. Requirements for an open HIE/EHR(2)
Bring trust and privacy to patients:
 Only authorized organizations and authenticated
healthcare providers may transact in the HIE:
• Each node or IT system interfaced is strongly authenticated
• Each user shall be authenticated on the edge system
• All traffic trough the infrastructure is encrypted
 Patient consent needs multiple choices or levels
• Unless opt-in, no data about a specific patient may be shared
• Several data sharing policies offered to the patient consent
• Each shared record/document is assigned to specific policies
(or not shared) at encounter time.
• Healthcare providers may only access records/documents
compatible with their role.
44

40. Categories of Healthcare Communication Services
HIEs and Shared EHRs Hospitals
e.g. access to last 6 e.g. get a current list e.g. order a lab
months historical of allergies or med test, track status and
labs and encounter list from a source receive results
summaries
Source-persisted Specific info 2 or more entities
and attested health snapshot synchronize
records provided on demand a task
Dynamic
Document Workflow
Information
Sharing Management
Access
Patient and Provider ID Mgt
Security
45

41. Registering Health Records:IHE-XDS
Community
Clinic Record Specialist Record
Hospital Record
Repository of
1-Reference
Documents
to records
Repository of
Documents
Clinical IT System Index of
patients records
Health Info Exchange
46
Clinical Encounter

42. Access to Shared Records : IHE-XDS
Community
Clinic Record Specialist Record
Hospital Record
Repository of
Documents
Repository of
Documents
3-Records
4-Patient data Returned
presented to
Physician
Clinical IT System Index of
patients records
Aggregate HIE
Patient Info 2-Reference
to Records
for Inquiry 47
Clinical Encounter

43. XDS – Value Proposition
Foundation for Health IT Infrastructures: Shared
Electronic Health Record, in a community, region, etc.
Effective means to contribute and access clinical
documents across health enterprises.
Scalable sharing of documents between private
physicians, clinics, long term care, pharmacy, acute
care with different clinical IT systems.
Easy access: Care providers are offered means to
query and retrieve clinical documents of interest.
48

44. XDS - Value Proposition
Distributed: Each Care delivery organization “publishes” clinical
information for others. Actual documents may remain in the
source EHR
Cross-Enterprise: A Registry provides an index for published
information to authorized care delivery organizations belonging
to the same clinical affinity domain (e.g. a region).
Document Centric: Published clinical data is organized into
“clinical documents”. using agreed standard document types
(HL7-CDA, PDF, DICOM, etc.)
Document Content Neutral: Document content is processed only
by source and consumer IT systems.
Standardized Registry Attributes: Queries based on meaningful
attributes ensure deterministic document searches.
49

45. Cross-Enterprise Document Sharing (XDS)
Standards Used
Healthcare
Content Standards
HL7 CDA header extract
HL7 data types
Electronic Business
Standards Internet Standards
ebXML Registry, SOAP, HTTP, IETF, W3C, …
Web Services …
Implemented world-wide by over 150 vendors/open
source.
Adopted in several national & regional projects:
Italy, Austria, Canada, USA, Japan, South Africa, France, Netherlands,
etc.)
50

46. Cross-Enterprise Document Sharing (XDS.b)
Actor/Transaction Diagram
Patient
Identity Source
Patient Identity
Feed
Query
Document Documents Document
Registry Consumer
Register
Document Set
Provide&Register Retrieve
Document Set Document Set
Document Document
Source Repository
51

47. IHE-XDS is part of a family of profiles
Regional, national, local or disease centric networks need
a consistent set of Integration Profiles
Fifthteen Integration Profiles completed and tested, plus
five ready to implement = Standards-based
interoperability building blocks for
 Rich Document Content for end-to-end application interoperability.
 Patient identification management
 Security and privacy
 Notification and data capture
IHE-XDS + related IHE Integration profiles provide a
complete interoperability solution
52

48. Combining IHE Profiles
Document Content & Modes of Document Exchange
Doc Content Profiles (Semantics content)
Scanned Doc Emergency Pre- Functional Status
Consent Surgery Assesment
XDS-SD BPPC EDR PPHP FSA
Imaging Laboratory Discharge & PHR
Referrals Exchange
XDS-I XD*-Lab XDS-MS XPHR
Document Reliable Pt-Pt Media
Sharing Interchange Interchange
XDS / XCA XDR XDM
Document Exchange Integration Profiles
53

49. IHE Integration Profiles for Health Info Nets
What is available and in trial implementation
Clinical and PHR Content Security & Privacy
Basic Patients Privacy Patient ID Mgmt
Emergency Referrals
PHR Extracts/Updates
Format of the Document Content
Consents
Establish Consents & Enable
and associated coded vocabulary
ObGyn Documents
Format of the Document Content Access Control Patient Demographics
Lab ResultsDocumentvocabulary
and associated coded
Document Query
Format of the Content
Content
Scanned Documents
and associated coded vocabulary Cross-Enterprise User
Format of the Document Content Patient Identifier
Imaging Information
Formatassociated coded Content
and of the Document vocabulary
Assertion
Provides Trusted Identity Cross-referencing
Format of theSummary
Medical Document Content Map patient identifiers across
and(associated coded vocabulary
Meds, Allergies, Pbs) independent identification
Format of the Document Content Document Digital
domains
and associated coded vocabulary Signature
Attesting “true-copy and origin
Health Data Exchange
Cross-Enterprise Audit Trail & Node
Other
Document Sharing Authentication Request Form
Registration, distribution and access
across health enterprises of clinical Centralized privacy audit trail and node for Data Capture
to node authentication to create a External form with custom
documents forming a longitudinal record
secured domain. import/export scripting
Cross-Enterprise Document
Pt-Pt Reliable Interchange Document
Cross-Enterprise Document Consistent Time Subscription and
Media Interchange Coordinate time across networked Notification
Cross-Community Access systems
Final Text Approved
54
Trial Implementation-2009– Final Txt 2010

50. XDS-MS Medical Summary or PHR Extract Exchange
Profile based on HL7 CDA Rel 2 and HL7 CCD IG
Structured and Coded Header
Patient, Author, Authenticator, Institution,
Level 1 Header always structured and coded
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 :
Level 2 Title-coded sections with non-structured
Reason for Referral
nor coded content (text, lists, tables).
Vital Signs  Simple Viewing (XML Style sheet)
Medication
Text Structure Coded Section Level 3 Med, Problems and Allergies
Entry Entry as highly structured text.
Text easy to import/parse
Studies
Allergies
Level 3 Med Problems and
Text Structure Coded Section Allergies have a
Entry Entry
fine-grain structure with
Social History optional coding. Coding
Scheme explicitly identified.
Problems
Text Structure Coded Section
Entry Entry
XDS-MS and XPHR enable both semantic
Care Plan interoperability & simple viewing ! 55

51. Use of a shared XDS infrastructure to access
Radiology Reports and Images (XDS-I)
Between Radiology and :
• Imaging specialists Hospital
• Non-imaging clinicians PACS B
Radiology -to-
Radiology
Radiology -to-
Physicians
PACS A
Imaging Center
Physician Practice
Same XDS Infrastructure (Registry and Repositories)
for medical summaries and imaging information !
56

52. Cross-Enterprise Document Workflow (XDW)
The Cross-Enterprise Document Workflow (XDW)
profile enables participants in a multi-organizational
environment to manage and track the tasks related to
patient-centric workflows as they coordinate their
activities:
No central controller
No central scheduler
Decisions are made by the “edges” (providers,
doctors, nurses, etc)
XDW coordinates these activities
Approved for Trial Implementation in September 2011

53. XDW - Key Elements
Workflow Document in XDW:
• Specified by XDW is generic across specific workflow content
• Manages workflow specific status with relationship to input/output documents
• Tracking the current/past steps of the workflow and engaged health care entities
• Workflow driven/enforced by the XDW actors, infrastructure provides transparency

54. How real is XDS ?
Stable specification IHE Technical Framework Published
XDS.b Supplement that offers:
 Use most recent Web Services stds (MTOM/XOP)
 Allow Retrieve sets of Documents in one transaction
 Same services
First implementation in clinical use in region of Genoa -
Italy) since early 2006.
Several since: Lower Austria region, State of Vermont,
Nagoya city, South Africa region, Dutch regions, etc.
Adopted by several national programs world-wide
4 open source toolkits available, numerous product
implementations in EMRs and Infrastructure offerings.
59

55. Implementation Tools
Open source implementations are available for
XDS, XCA, XCPD, PIX, PDQ, ATNA, CT, and more:
 Microsoft under codeplex http://ihe.codeplex.com/
 NIST under Source Forge http://sourceforge.net/projects/iheos/
 HIE-OS under Source Forge http://sourceforge.net/projects/hieos/
 FHA CONNECT http://www.connectopensource.org
 OHT – IHE Profiles Charter https://iheprofiles.projects.openhealthtools.org
 OHT – Open Exchange Forge https://openexchange.projects.openhealthtools.org
 OHT – Model Driven Health Tools-Charter
https://mdht.projects.openhealthtools.org
60

56. IHE, Global Standards-Based Profiles
Adopted in National & Regional Projects (sample)
Lower
NETHERLANDS Italy
Austria
Friesland Conto Corrente
Natn’l Mamography Venetto - Friuli
France Suisse
VITL-Vermont
Quebec, Toronto,
Wales DMP St Gallen Alberta, British Columbia
Imaging Austria Lausane
Canada Infoway
France
Imaging
Boston Medical
IDF
Center - MA
For more complete list see: tinyurl.com/wwXDS Philadelphia HIE
Belgium
Flemish-Leuven KeyHIE
Pennsylvania
CareSpark
– TN & VA
SHARP
CA
South Africa THINC- New York
Providence NCHICA – N. Carolina
CHINA-Shanghai CHINA-MoH JAPAN-Nagoya
Health System -
Imaging Info Sharing Lab results sharing Imaging Info Sharing,
OR
Nationwide PDI guideline
6
61

57. National Image Sharing:
Canada's IHE Success Story

58. Canada
Overview
• Canada Health Infoway, a federally funded organization (over CDN$2
billion to date) with an annual operating budget of ~CDN$24M and 162
employees, has established a national EHR Blueprint.
• EHR implementation is governed at the jurisdiction (sub-province) level
and driven by local priorities, funding, etc.
• There is a dedicated Standards Collaborative chartered to develop
standards (including nomenclature and messaging) for use by the EHR
program.
• In spring of 2011, Canada Health Infoway's Standards Collaborative
assumed the role of IHE National Deployment Committee in Canada.
• IHE Integration Profile, XDS-I.b is the national standard for image
exchange
63

59. IHE Canada Constituency
The IHE Canadian Constituency, hosted by the
Standards Collaborative, supports the mandate of
IHE International by:
– Representing Canada on the IHE International Board;
– Supporting domestic and international IHE work items;
– Supporting domestic input on annual IHE planning and publishing
cycles;
– Participating in the organization and promotion of the North American
Connectathon.
– The willingness to be collaborative with other countries and adopt the
best of what is available.
64

60. Major Accomplishments
• A major contributor in XDS-I Integration Profile development
• Adopted as the Pan-Canadian Standard for Image Exchange
• Full XDS-I.b infrastructure deployed in Quebec and other
Jurisdictions throughout Canada
• Ontario has four DIRs in various stages of XDS-I.b deployment
• Continue to be a major contributor in IHE Development
65

61. XDS-I.b Actors

62. Regional Image Exchange
XDS –I
XDS Image Document
Document Consumer
Registry (Community
Radiologists Prior Viewer)
Studies
PIX/PDQ Mgr (Client Registry)
General
Practitioners
Images & Images &
Hospitals DIR - Jurisdiction Reports
Reports DIR - Jurisdiction
DIR - Jurisdiction
XDS-I
XDS-I
XDS XDS-I
XDS-I
Image
Image
XDS-I
XDS-I
XDS
Repository Image
Image
XDS Document
Document
Image
Image
Repository Document
Document
Imaging Repository Consumer
Consumer
Document
Document Specialists
Consumer
Consumer
Centers Consumer
Consumer
standards-based solution connects heterogeneous systems

63. Provence of Quebec – case study
Fully deployed XDS-I.b Infrastructure
• 200 hospitals
• 100 private clinics
• 10 million procedures a year
• Population of 8 million patients
• 550 radiologists and 20,000 Md’s
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64. Quebec Image Exchange Architecture
No IHE Patient Identity Services
Uses provincial health
User insurance identifier as pseudo-
GPI
Registry
DIR/Image Repository 1
Document
Document Registry DIR/Image Repository 1
Repository Document
Community Image Repository
Image Document Viewer
Source Image Document
Source
McGill/Montréal DIR
Sherbrooke DIR
DIR/Image Repository 1
Document
Repository
RIS/PACS RIS/PACS
Image Document
DICOM Image
and XDS-I.b Source
Report Source
Image Document Laval DIR Image Document
Care Team Consumer
Consumer
(Zero footprint
viewer)
RIS/PACS

65. Canada
Quebec Status
Deployment of PACS and DIR connectivity
– Public (75% of exam volume)
• >95% PACS/RIS deployment
• >75% DIR connectivity
Private (25% of exam volume)
• 30-40% PACS/RIS deployment
• No DIR connectivity
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66. Key XDS-I.b Metadata
–for Retrieval of Priors
Anatomical Region
 Mapped from Image Set using DCMR Context Group
CID4
Modality
 Mapped from Image Set using DCMR Context Group
CID29
Requested Procedure Code
 Designated by the XDS Affinity Domain
Study Date & Time
 Mapped from Image Set
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67. SCWG10-DI Terminology Project
Ontario: Develop a DI Terminology Reference Set:
• Consistent representation of information in PACS
within and across the four DI repositories
Intended use:
• XDS-I.b Metadata model
– reliably find and retrieve reports and images
• Information Display
– consistent information display to clinicians at the point of service
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68. Project Goals
Define Ontario DI terminology reference set based on the current
knowledge the reference set is to include the following areas/concepts:
 Modality
 Procedure Description
 SNOMED CT Concept ID
 Body site
 Speciality (TBD)
 Laterality (TBD)
Develop the mapping rules/guidelines to map the GTA West reference set,
SWODIN and HDIRS local codes to Ontario DI terminology reference set.
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69. Ontario Project Data Mapping Flow
SNOMED CT
Ontario Terminology Project
MAPPED TO NOMED CT
Requests for new Terms from On Term Project Team
Ontario Ref Set
Terms are in the On Ref Set During course of project all
simple 1 to 1 mapping new terms are to be reviewed
by On Term Project Team
HDIRS Hospitals
Becomes basis of
ON Ref Set No Ref set exists Agfa
Mapped to SNOMED CT- new terms added as required through governance structure
DIR
GTA West Ref Set
NEODIN Ref Set Start with NEODIN Ref
New terms added Set SWO/LHIN 3-4 Hospitals
here and also to the New terms added here
On Ref Set and also to the On Ref
No Ref set exists
Mapped to SNOMED CT- new terms added as required through governance structure
GE
Set
DIR
GE
DIR
GTA West Hospitals
NEODIN Hospitals
local terms from 3 GTA West Hospitals
Local terms are
currently mapped to
Organizations to be local terms remainder to be mapped during integration to GTA West DI-r CGI
mapped to GTA W Ref
the NEODIN Ref Set
Set in a pilot DIR
Progression over time. Ontario Reference set is complete and passed to eHO for maintenance once GTA West and SNOMED CT mapping is complete
5/11 6/11 7/11 8/11 9/11 10/11 11/11 12/11 1/12 2/12 3/12 4/12 5/12 6/12 7/12 8/12 9/12 10/12 11/12 12/12 1/13 2/13 3/13
4/1/2011 3/31/2013

70. IHE Radiology - New Development supporting
Canada
IHE 2011-12 Trial Implementation Profiles
include:
– Cross-Community Access for Images (XCA-I)
– Image Object Change Management (IOCM)
IHE 2011-12 New Work-items:
– Import Reconciliation Workflow Enhancement and
Foreign Exam Management
– XDR/XDS-I Registry Metadata Extensions
– Cross Enterprise Document Reliable Interchange
for Imaging (XDR-I)
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71. Providers and Vendors
Working Together to Deliver
Interoperable Health Information Systems
in the Enterprise
and Across Care Settings
http://www.ihe.net
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72. See you for Part 2, this afternoon
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