Transcript macisaac_Introduction to HIE - MacIsaac

Health Information Exchange
One size does not fit all.
Dr Peter MacIsaac,
Secretary IHE Australia,
eHealth Consultant – Hewlett Packard Enterprise Services
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Blair Butterfield – eHealth Initiative
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Australian PC-EHR concept
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Australian PC-EHR concept
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Health Information Exchange -HIE
Health information exchange (HIE) is the
transmission of healthcare-related data
among facilities, health information
organizations (HIO) and government
agencies according to national standards.
(US Office National Coordinator)
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Health Information Exchange
Health information exchange (HIE) is the
transmission of healthcare-related data
among facilities, health information
organizations (HIO) and government
agencies according to national standards.
(US Office National Coordinator)
This is a very broad and inclusive definition
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Types of HIE
Messaging
Data Synchronisation
Data aggregation
Portals
There was the PAS
then came:
Common health record
 Centralised
Radiology
Lab
ED
Operating theatre…
 Federated
GP systems…..
Shared healthcare record
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One Size does not fit all
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Types of HIE
Messaging
 Point to point
 Essentially two models
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Application to application (point to point)
Using a messaging intermediary or service
Messaging transport
 HL7, DICOM, Webservices, File Transfer etc.
Messaging payloads
 Data synchronisation eg. Patient identity/ADT
 Information delivery e.g. reports, discharge summary
 Electronic test ordering
 Electronic transfer of prescriptions
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Types of HIE
Application synchronisation or linkage across
multiple sites
 Shared applications across sites
 Same software e.g. GP software running in different
locations or mobile and home-base
 Same software running in different organisations
 Issues of data compatibility due to local build or
customisation
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Types of HIE
Access to common data – data aggregation
 Central operational data store for health transactions
from multiple applications
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Use for point of care – record aggregation or single patient
view
Management dashboards
 Central data warehouse used for
reporting/analytics/research
 Many organisations have
multiple duplicated data
stores
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Types of HIE
Portals
 External access point to another system
 Does not required pre-existing clinical information
systems – may use web browser
 Patient, staff or external healthcare providers
 May access single organisations EMR
 May access a composite record drawn from many
applications (single or multiple organisations)
 May access third party systems
e.g. health insurance, Medicare.
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Types of HIE
Share healthcare records
 Support information sharing as patients move
through healthcare system
 Support consumer engagement with their
healthcare
Models
 Centralisation
 Federation – index and retrieve
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Types of HIE
Common electronic health records
 Usually Internet delivered
 Used by all participants
 Specialist care record, care planning or
coordinated care
 Access to consolidated view of patient/client
 Usually secondary to main records system
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Type of HIE
Centralised Shared Healthcare Record
 Record or summary data sent from source to a
centralised common EHR
 e.g. UK NHS Spine
 e.g. Canada HealthInfoway
 Australia’s HealthConnect Mark 1 – 2003
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One size does not fit all
Index and retrieve
 Within or between organisations
 Information is placed in a secure accessible
repository or specific secure access systems used to
access primary data
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•
May be a copy (static data)
May be a link to extract
information or report
(dynamic data)
 Basic description of content
(metadata) stored in a
common index –
no or limited patient data
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Important characteristics of HIE
Cross organisation communication
Patient consent and privacy
Multivendor systems
Focus on single patient view over time:
aggregation and longitudinal E.H.R
Use of a common architecture
 Standards approach
 Scalable – local to national
 Extensible in function
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Growth in al models of HIE - USA
KLAS Enterprises 2011
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IHE based HIEs
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Where in the world is XDS? 20
Customer Successes
HIE Snapshot GE/IHE – U.S.
Connecting physicians and
healthcare professionals in
a 31-county region
13 member organizations
Data from 8 hospitals and 31
clinics
Used in 3 emergency
departments and 3 primary care
clinics
2.6 million patient records
345,000 patient
authorizations
Supports the IHE framework
Addressing critical needs
across Vermont
Medication history to
clinicians in the ER
Chronic disease
management - patient data
from EMRs to data center
Lab results electronically
delivered to physician EMRs
Supports the IHE framework
A private, not for profit, 626
licensed bed, academic
medical center
emphasizing community
based care.
Boston HealthNet 1995,
includes BMC, Boston Univ
School of Medicine, 15
Community health centers
Community Information
Exchange (CIE) focus on
sharing medications, problems,
allergies, and lab results
Access directly from
physician’s EMR
eReferral portal utilizes the
CIE base infrastructure
Supports the IHE framework
USA (Philapdelphia Region)
Philadelphia Health Info Exchange in service since 2005.
Focused on images and reports sharing.
5 Hospitals + Imaging Center + Public Health
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The Hospital of the University of Pennsylvania
Thomas Jefferson University Hospital
Children’s Hospital of Philadelphia
Presbyterian Medical Center
Pennsylvania Hospital
UPHS Community Radiology
Philadelphia Department of Public Health
Migration to XDS, ATNA, PIX and XDS-I completed in
2007.
Demonstrated live at RSNA-Chicago Nov 2007
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Diagnostic Imaging Exchange
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Italy (Genoa Region)
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Italy (Genoa Region)
In service since January 2006.
4 Hospitals and 500 physician offices.
EMRs import and export documents from their local
records.
All vendor products required to pass IHE-Europe
connectathon in April 2005.
Patients chose to join through one of their care provider
Infrastructure includes:
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XDS Registry
XDS Repository shared at the regional level
PIX for patient Id linking
Doc content is CDA with PDF content. Plan in place to move to CDA rel 2 with
structured data. IHE (XD*-Lab) CDA Lab primary candidate.
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Austria (Lower Austria and National)
Lower
Austria
Lower Austria Region (around Vienna) Deployed
in 2007 - Operational. 1.5 Million patients on-line.
11 hospitals connected.
Use IHE profiles: XDS, PIX, XDS-SD, ATNA, XUA, BPPC.
National project launched in 2007 (ELGA). Given
the success to deploy the first region is about
one year.
Austria
Roll-out includes:
 Ministry backing of IHE conformance (IHE-Eu Connectathon)
 Extending to Ambulatory Physicians in 2008
 Step-wise introduction of structured and coded content with HL7 CDA
based IHE Content Profiles.
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Support for PC-EHR Community
http://ihe-australia.wikispaces.com/PCEHR
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Link to site
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Reference and Resources
US State Health Information Exchange Cooperative
Agreement Program
Where in the world is XDS?
http://www.youtube.com/watch?v=JwngzRPaw
-w
http://www.nationalehealth.org/NHIN-U/
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Useful Links
www.ihe.net
www.ihe.net.au
http://ihe-australia.wikispaces.com
http://wiki.ihe.net
http://motorcycleguy.blogspot.com/2010/01/where
-in-world-is-xds.html
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