Politische Entwicklungen und IHE

Transkript

1 Integrating the Healthcare Enterprise IHE - Integrationsprofil XDS.b - Andreas Kassner VHitG e.v. IHE-Deutschland vendor co-chairchair

2 Agenda IHE Organisation und Prozess XDS als Baustein einer EPA Politische Entwicklungen und IHE Ausblick neue IHE Profile

3 IHE Organizational Structure Multi-Domain & Multi-National IHE (International) ti Strategic t Development Committee Sponsor Co-Chairs supervises reports Global IHE North America IHE Europe IHE Asia/Oceania Regional & National Deployment Delegates IHE Domain-related Planning and Technical Committees contribute Participants Global l Development: Radiology, IT Infrastructure, Cardiology, Lab, etc. Interoperability

4 IHE : Integrating the Healthcare Enterprise Professional Societies Sponsorship p Healthcare Providers & Vendors Healthcare IT Standards HL7, DICOM, etc. Allgemeine IT Standards Internet, ISO, etc. IHE Prozess Interoperable Healthcare IT Solution Specifications Interoperable Healthcare IT IHE Integration Solution Profile Specifications Interoperable Healthcare IT IHE Integration Solution Profile Specifications Interoperable Healthcare IT IHE Integration Solution Profile Specifications IHE Integration Profile

5 Wer ist IHE? IHE ist eine gemeinsame Initiative von: Radiological i l Society of North America (RSNA) Healthcare Information Management Systems Society (HIMSS) American College of Cardiology (ACC) GMSIH, HL7-France-HPRIM, JAHIS (laboratory) Deutsche Röntgen Gesellschaft American Society of Ophthalmology Und viele mehr. Begann in 1997 in der Radiologie (RSNA) und IT (HIMSS) Internationale Verbreitung: IHE- Europe und IHE-Asia

6 IHE-EUR EUR Länder und Teilnehmer Denmark France Germany Israel Italy Netherlands Norway Spain Sweden United Kingdom Users, HC Authorities, Vendors: 40% nationale Lösungsanbieter 60% multi-nationale Hersteller Beispiel: IHE-Netherlands Users Vendors Government / Associations Amphia Antonius Mesos Amsterdam MC AZ Maastricht Ned. Ver. Radiologie Ned. VerLeeuwarden UMC Nijmegen UMC Groningen. Kl. Chemie Ned. Ver. Microbiologie MC Vumc Agfa Forcare Chipsoft D&A Medical GE Healthcare Getronics H2W IBM ICT Healthcare Initiate Systems isoft Leones Medical Phit Nucletron Oldelft Benelux Philips RVC Sectra Siemens Verdonk, Klooster & Associates Welch Allyn Cardio Control APC Platform NICTIZ HL7 Nederland OIZ TNO

7

8 Der IHE Prozess IHE IHE Integration Profile Profiles A B IHE Connect-a-thon Results Product IHE Integration Statement User needs Product With IHE Easy to Integrate Products Standards IHE Technical Framework IHE Connect-a-thon IHE Demonstration User Site IHE Integrationsprofile: RFP Bestehende Standards werden anhand von Use Cases beschreiben und anwendbar gemacht Hersteller können sicher entwickeln mit ROI Prozess in 1998 gestartet; kontinuierlich verbessert; Mittlerweile ISO

9 IHE Connectathon, Berlin Teilnehmer 120+ Systeme geprüfte Testfälle

10 Evolution der IHE Domänen IHE Globale Entwicklung Integrationsprofile Lösung für die Praxis: Innerhalb Medizinischer Einrichtungen: o Radiologie o Kardiologie i o Labor o... Über Abteilungen & Institutionen XDS o RHIOs (Regional Healthcare Information Organizations) o EHR Enablers Veterinarian Endoscopy Eye Care / Ophthalmology Pharmacy Pathology Patient Care Devices Patient Care Coordination Radiation Oncology Laboratory Cardiology IT Infrastructure for Healthcare Radiology

11 Herangehensweisen Elektronische Patientenakten Quelle: Kees Smedema

12 Was ist IHE IT Infrastructure? Electronic Health Record Radiology Cardiology 14 Integration Profiles Laboratory 5 Integration Profiles Future Domains Pathology IHE IT Infrastructure 13 Integration Profiles Eye Care Oncology 4 Integration Profiles Patient Care Coordination 1 Integration Profile Patient Care Devices

13 Building and accessing s EHR-LR: Longitudinal Record as used across-encounters s Registry Long Term Care Repository Acute Care (Inpatient) Other Specialized Care or Diagnostics Services PCPs and Clinics (Ambulatory) EHR-CR: Care Record systems supporting care delivery Submission of References Retrieve of selected s

14 Akteure und Transaktionen - XDS Patient Identity Feed Patient Identity Source Registry Query s Consumer Provide&Register Set Source Repository Register Set Retrieve

15 XDS Scenario + use of ATNA & CT EHR System PMS PACS Physician Office Lab Info. System Community Clinic XDS Repository Query Retrieve XDS Registry XDS Repository Register Secured Messaging Record Audit Event Record Audit Event ATNA Audit record repository Maintain Time Maintain Time CT Time server Maintain Time Record Audit Event PACS ED Application EHR System Provide & Register Docs Teaching Hospital XDS Affinity Domain (NHIN sub-network)

16 Co ontent IHE Integration Profiles for Health Info Nets What is available and has been added in 2005 and is for 2006 Info Exchange Security Id Mgt Emergency Referrals PHR Extracts Format of the Content ECG Format and Report associated of the coded vocabulary Content Lab and Results associated coded vocabulary Format of the Content Scanned and associated Content s coded vocabulary Format of the Content Format Imaging and associated of the Information coded vocabulary Content Medical Summary Format of the Content and (Meds, associated Allergies, coded Pbs) vocabulary Format of the Content and associated coded vocabulary Cross-enterprise User Authentication Authentication & Auditing: Enhanced Access Control Digital Signature Attesting true-copy and origin Patient Demographics Query Patient Identifier Cross-referencing V3 Option Map patient identifiers across independent identification domains Cross-Enterprise Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Stored Cross-enterprise Interchange Media-CD/USB & push Queries Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. Consistent Time Coordinate time across networked systems Request Form for Data Capture External form with custom import/export t scripting Notification of Availability Notification of a remote provider/ health enterprise

17 IHE-XDS Zentralisierte Architektur Patient Identity Source Source Source Source Provide&Register Set Patient Identity Feed Registry Repository Query s Retrieve Consumer Consumer Consumer Consumer

18 IHE-XDS Dezentralisierte Architektur Patient Identity Source Patient Identity Feed Register Set Registry Query s Consumer Consumer Consumer Consumer Source Source Source Source Repository Repository Repository Repository Retrieve

19 IHE-XDS Gemischte Architektur Source Source Source Source Source Source Source Source Provide & Register Set Repository Repository Repository Repository Register Set Patient Identity Feed Patient Identity Source Registry Repository Query s Retrieve Consumer Consumer Consumer Consumer

20 Cross Community Discovery Build an index of patient data locations Several identifying i communities Community Attribute Search Engine Controlled by attributes (1) (1) XDS Community A XDS Community B RLS/PIX+ XDS Registry (7) Cross Community Bridge (3) (4) Cross Community Bridge (5) PDQ Server XDS Repository (2) (8) Cross Community Searcher (6) XDS Registry XDS Repository

21 IHE XDS Integration Profile Key Concepts XDS XDS Submission Set XDS Folder

22 Repository and Registry Example of Submission Request Registry Submission Request Folder A Submission Set 1 Entry Entry Repositories

23 IHE XDS Integration Profile: Key Concepts XDS Medizinischen Informationen in einem Dokument (strukturiert oder nicht), das Teil eines verteilten Patienten Records sein soll. Es existiert ggf. bereits im Quell IT System. XDS Submission Set Set von Dokumenten zu einem Patienten, für die ein (Team von) Arzt/(Ärzten) im selben Quell System entscheidet, potentiellen Empfängern verfügbar zu machen (zeitlich zusammenhängend). Bsp.: Radiologischer Befund und Entlassbrief in einem Submission Set XDS Folder Gruppierung von Dokumenten(sets) zu unterschiedlichen Zwecken: Team work über mehrere Ärzte, Episode of care, Notfalldaten eines Patienten, etc. XDS läßt die Nutzung der Folder in speziellen medizinischen i i Domänen offen

24 IHE - Cross Enterprise Sharing Metadata in der Registry ebxml basierend auf HL7 CDA R2; EHR ENV (CEN) Wer Was Wo Wann Submission Set Patient Identifier, Name, Address, Gender, Date of Birth Author Institution, Person, Role, Specialty Legal Authenticator Patient Identifier Author Institution, Person, Role, Specialty Service Event Confidentiality Class Format Type Language Title URI Healthcare Facility Practice Setting Service start Service end Creation Content Source Submitted Folder Owner Code(s) Description Searchable Metadata, Stored Metadata Update

25 RegistryPackage Klassendiagramm ExtrinsicObject XDSSubmissionSet authorinstitution authorperson authorrole authorspecialty comments contenttypecode patientid sourceid submissiontime uniqueid + XDSFolder codelist comments lastupdatetime patientid uniqueid * XDSEntry authorinstitution authorperson authorrole authorspecialty availabilitystatus classcode confidentialitycode creationtime entryuuid eventcodelist formatcode hash healthcarefacilitytypecode languagecode legalauthenticator mimetype parentid patientid practicesettingcode servicestarttime servicestoptime size sourcepatientid sourcepatientinfo title + typecode uniqueid URI Einige allgemeine Attribute: author + patient document source encounter Andere enthalten logische / technische Informationen title type of document eventcodelist d t classcode availabilitycode confidentialitycode formatcode languageg g MIME Type size vgl. HL7 CDA

26 Dokumentennetzwerk Verteilte Ablage, Repositories Einheitliche itli h Dokumentation ti einer Beobachtung / Maßnahme (event) Kurze Informationen (Diagnose) Umfassende Dokumente (OP Bericht, Pflegebericht, Entlassbrief) Eigenschaften im Sinne des Dokumentenmgmts. Datum, Autor, Vertraulichkeit, Sprache, Typ, Klasse, Versionierung, u.v.m. Gruppierung von Dokumenten in einen Kontext t Referenzierung untereinander Zugriff, Policies i Zugriffsmuster, Patientenzustimmung, Signatur

27 Relationships von HL7 APND (append) Aktuelles Dokument ist eine Erweiterung des Elterndokuments RPLC (replace) Aktuelles Dokument ersetzt das Elterndokument XFRM (transform) Aktuelles Dokument ist eine Transformation des Elterndokuments XFRM_RPLC RPLC (transform with replace) Aktuelles Dokument ist beides, Transformation und Ersatz eines Elterndokuments 1 parent * parentid tid current

28 XDS - Availability Management Submitted Registration in progress Verfügbarkeitsstatus sichtbar für Source Approved Available for Patient Care Deprecated Obsolete Deleted Verfügbarkeitsstatus sichtbar für Consumer Änderung des Verfügbarkeitsstatus ist unter Kontrolle der Original Source und dem Patient ( Profil BPPC, sofern erlaubt in der Affinity Domain)

29 Life Cycle Management Addendum to a registered document Time Addendum Addendum A two-way relationship between Original and Addendum Replacing a registered document by a new document Time 1 (Approved) 1 (Deprecated) Replacement Replacement A two-way relationship between Original and Replacement. Registering an alternate form of a registered document 1 (Approved) Transform 2 (transform) A two-way relationship between Original and Transform (alternative format with same scope).

30 Cross-Enterprise Sharing (XDS) Standards XDS Infrastructure Standards OASIS/ebXML Registry Information Model v2.0 Basis of XDS Registry Information Model Registry Services Specifications v2.0 Registry Services Messaging Services Specifications v2.0 Offline protocols ISO/IEC 9075 Database Language SQL Registry Query Language SOAP with Attachments Protocol for communication with XDS Registries and Repositories SHA-1 [FIPS 180-1] Hashes

31 Internet Standards HTTP Protocol for Retrieve Online SOAP bindings SMTP Offline ebms bindings MIME Type codes PDF, JPEG, HTML XDS Content IETF Language Identifiers UTF-8 Encoding of Registry Attributes

32 Cross-Enterprise Sharing (XDS) Standards XDS Infrastructure Standards (cont) HL7 Version Messages for Patient t Identity Management HL7 Version 2.5 Datatypes for XDS Registry Attribute values HL7 CDA Release 1 XDS concept definition Source of XDS Entry Attributes DICOM, ASTM CCR, HL7 CDA Release 2, CEN EHRcom Sources of XDS Entry Attributes

33 Use Cases in Diskussion Use Case: Multiple primary residences Use Case: Between two XDS Affinity Domains Use Case: Patient Move Use Case: Vacationer Vacationer: A patient Use Case: Mergers, aquisitions, divestitures. A large healthcare corporation, Bigco, acquires a small local hospital, Smallco. Divestitures A healthcare facility splits into two new organizations: Newco1 and Newco2. Use Case: Transitory Alliances A medical facility and a research facility form a short term alliance for a research project. Use Case: Surveillance, CDC pseudonimized Use Case: PHR Services Use Case: Remote Consulting.

34 IHE XDS in nationalen und regionalen Projekten UK CfH (Radiology WF) France DMP Denmark (Funen) Italy (Veneto) Spain (Aragon) Austria ELGA Italy (Conto Corrente Salute) Quebec, Toronto, Alberta, British Columbia Canada Infoway MA-Share MA State Project NY JAPAN-Nogaya Imaging Info Sharing Philadelphia HIE CHINA-Shanghai Imaging Info Sharing CHINA-MoH Lab results sharing THINC- New York NCHICA N. Carolina

35 Members of The open ehealth Initiative 1. Austria 2. Belgium 3. Bulgaria 4. Czech Republic 5. Denmark 6. Finland 7. France 8. Germany 9. Greece 10. Italy 11. Lithuania 12. Norway 13. Netherlands 14. Slovakia 15. Slovenia 16. Spain 17. Sweden 18. UK eprescription, Patient Summary IHE als Dach für Industriekonsortium LSP S.O.S epsos mit 13 Ländern

36 ehealth Interoperability Mandate M403 Personal care and healthcare not contained in EU Treaty, responsibility of Member States (MS) MS have asked EC to think and act regarding patient mobility and patient safety related to travelling DG ENTR asked ESOs to plan for ehealth stds ESOs received ehealth Mandate (Q4 2007) M403 The three European Standards Organisations (ESOs), CEN, CENELEC and ETSI, accepted a mandate from the European Commission ESO ehealth-interop Quelle: ehealth-interop Project Team

37

38

39

40

41 Federation of XDS and non-xds Domains National or Regional Network B Longitudinal Record as used across-encounters s Registry Feverage Cross-CommunityCommunity Sharing Architecture Which registry holds records for a patient? Long Term Care Registry Locator service IHE Transactions Cross- Domain Bridge Cross- Domain Bridge National Network A Non-IHE National EHR Repository Acute Care (Inpatient) Other Specialized Care or Diagnostics Services XDS Affinity Domain (NHIN sub-network) PCPs and Clinics (Ambulatory) National Network C IHE based Sub-Networks Longitudinal Record as used across-encounters Repository Acute Care (Inpatient) Long Term Care Other Specialized Care or Diagnostics Services Repository Acute Care (Inpatient) Registry Locator service Long Term Care Other Specialized Care or Diagnostics Services Cross-Domain Bridge Non-IHE Sub-Net Integrated Delivery Network National or Regional Networks not required to be IHE-based Mapping to & from IHE Transactions performed by X-Domain bridges Mapping practical as most European projects use variants of structured document sharing s Registry s Registry g Longitudinal Record as used across-encounters PCPs and Clinics (Ambulatory) PCPs and Clinics (Ambulatory) XDS Affinity Domain (NHIN sub-network)

42 IHE D Profile in Entwicklung Implementing e Purpose Specific c Records using IHE XDS.b Fallakte-Konzept als White Paper Cross-Enterprise Privacy Policy (XPP) Policy exchange Policy based access Federated [Organization] Registry Pseudonymization, TMF-Konzept als White Paper?

43 Herausforderungen elektronischer Akten Kein Nutzen von blob-akten Business Modell, Finanzierung Usability, Akzeptanz Semantik Datenschutz, Patientenzustimmung Standards Zeit Migrationskonzept Technische Anbindung, Rollout Sir Derek Wanless (CfH, NHS): Die Nation wird nie den heiligen Gral eines voll integrierten Systems mit detaillierten Patientenakten erreichen.

44 Vielen Dank für Ihre Aufmerksamkeit Andreas Kassner

45 Was ist IHE IT Infrastructure? Electronic Health Record Radiology Cardiology 14 Integration Profiles Laboratory 5 Integration Profiles Future Domains Pathology IHE IT Infrastructure 13 Integration Profiles Eye Care Oncology 4 Integration Profiles Patient Care Coordination 1 Integration Profile Patient Care Devices

46 Was ist IHE IT Infrastructure? Profiles - Medical Information Sharing XDS Cross-Enterprise Sharing XDS Stored Query XDS-SD XDS Scanned s XDP Cross-Enterprise Interchange NAV Notification of Availability RID Retrieve Information for Display Patient t Management PAM Patient Administration Management PDQ Patient Demographics Query PIX Patient Identifier Cross-referencing PSA Patient Synchronized Applications RFD Retrieve Form for Data Capture

47 Was ist IHE IT Infrastructure? Profiles - Security ATNA Audit Trial and Node Authentication CT Consistent t Time DSG Digital Signature EUA Enterprise Use Authentication ti ti PWP Personnel White Pages

48 Organisation der TFs Volume 1: Integrationsprofil ti Beschreibt medizinischen Bedarf und reale Use Cases Identifiziert Akteure und Transaktionen Volume 2+ des Technical Framework Liefert die Implementierungs-Spezifikation Liefert die Implementierungs Spezifikation für jede Transaktion mit spezifischer Referenz auf die Standards

49 Integrationsprofile (2) Akteur Transaktion Report Creator Report Manager 24: Report Submission 25: Report Issuing Report Repository Report Reader 26: Query Reports 27: Retrieve Reports Structured Report Export: 28 Enterprise Report Repository External Report Repository Access

50 Integration Profile (2) Produkt I Produkt II Report Creator Report Manager 24: Report Submission 25: Report Issuing Structured Report Export: 28 Enterprise Report Repository Report Repository 26: Query Reports 27: Retrieve Reports External Report Repository Access Report Reader Alle Produkte decken den Anwenderbedarf d im realen Leben und sind auf technischer h und workflow Ebene interoperabel.

51 Integrationsprofile (3) Lösungen existieren bereits in verschiedenen Domänen: Anzahl der Integrationsprofile RAD Radiology: 17 ITI Information Technology Integration: 9 LAB Laboratory Medicine: i 6 CARD Cardiology: 6 PCC Patient Care Coordination: 1... und weitere folgen

52 XDS Szenario (mit PIX) Patient Identity Feed Patient Identity XRef Mgr A87631 M M Patient Identity Feed Patient Identity Feed L L-716 A87631 A87631 Physician Office PMS Patient Identity Feed M XAD Patient Identity Source Patient Identity Feed ED Application L-716 Repository Registry PIX Query PACS PACS PIX Query Query Register EHR System Repository Lab Info. System Retrieve Provide & Register Community Clinic XDS Clinical Affinity Domain Teaching Hospital