Laboratory to

Ambulatory EHR Workflows

CharlesParisot
GEHealthcare
IHEITInfrastructureTechnicalCommitteecochair
 Providers and Vendors
Working Together to Deliver
Interoperable Health Information Systems
in the Enterprise
and Across Care Settings

WWW.IHE.NET
July2005 2 InteroperabilityforLabIHE
Canada
 LabtoAmbulatoryEHRInteroperability
Workflows
Twoprimaryworkflowsmodelsareusedaroundtheworld:
ContracttoLabmodel:theambulatoryphysicianisthelabcustomerandsendsthe
patientorspecimentoselectedlab.
CollaborativeLabModel:thepatientselectslabandfollowsphysicianslab
prescription.
Bothmodelsexistismostcountriesbutoneofthetwooftenisthemost
prevalent
Workflowcontainstwotimesegments:
ElectronicOrder/RealTimeResultCommunication:orderingphysician,patientand
laboratory.Completeswhenresultdelivered.
AccesstoHistoricalResults:Samepatientbutinlaterencountersneedaccessto
previousperformedlabstudies.

DoesIHEofferstodaythecorrespondingbasicinteroperability?

July2005 3 InteroperabilityforLabIHE
Canada
 IHELaboratory:LSWF
Whatisdifferentinhospitalsandambulatory?
Patient
Administration
Different
Rad-1, Rad-12 Rad1, Rad-12
ADT
Patient demographics
& visit
Lab-1: Placer order
Order Order Filler
Placer Lab-2: Filler order
Lab-4: Lab-5:
Work order Results
Order Lab-3: Results Automation
Result
Tracker
NonRelevant
Manager
Clinical
Ward or EHR Applicable laboratory

July2005 4 InteroperabilityforLabIHE
Canada
 LabtoAmbulatoryEHRInteroperability
Workflows
Assessmentandusecasepositioning(nonacutecare)
Accessto
Paper e RealTime AccessHistorical Other
Order Order Result LabResults Records
Contractto
LabModel

Collaborative
LabModel

July2005 5 InteroperabilityforLabIHE
Canada
 LabtoAmbulatoryEHRInteroperability
Workflows
Assessmentandusecasepositioning(nonacutecare)
Accessto
Paper e RealTime AccessHistorical Other
Order Order Result LabResults Records
Contractto IHELabScheduled
LabModel Workflow
?

Collaborative IHELabscheduled
?
LabModel Workflow
?
Important?

RealTimeResult:criticalforacutecareandpossibly
ambulatorycontract,notobviousforcollaborativemodel.
July2005 6 InteroperabilityforLabIHE
Canada
 LabtoAmbulatoryEHRInteroperability
FirstSetofConclusions
IHELabScheduledWorkflowhasacriticalroletoplay:
SolidandprovenspecificationwithHL7V2.5criticalimprovements
BringtherigorandeffectivenessofIHE
Consistentapproachforlaboratoriesinacutecareandambulatory
BestspringboardtoHLV3andInfowaystrategicdirection
RemaininggapsthatneedtobeaddressedbyaLSWFIntegration
ProfileExtension(multijurisdiction?):
ResultsandOrdersCodedTerminology
Jurisdictionsspecificelements
Needaaddressthehistoricallabresultsaccesscaseinanonlab
specificmanner
Thisisthetopicofthenextpresentation

July2005 7 InteroperabilityforLabIHE
Canada
 Sharing Laboratory Results
in
Regional & National Networks

CharlesParisot
GEHealthcare
IHEITInfrastructureTechnicalCommitteecochair
Local&RegionalRHIOsInfrastructureand
Interoperability

IHEhasbeenfocusingsignificanteffortsoncross
enterprisehealthinformationsharingforthepast
threeyears
Wewillprovideanupdateonthisworkandsome
ofthemajoraccomplishmentsinthisareathatdo
benefittheaccesstolaboratoryresults.
Discusswhatcanbeimplementedtoday.

July2005 9 InteroperabilityforLabIHE
Canada
 SelectedIHEIntegrationProfilesforRHIOs
Whatisavailableandisaddedin2005

Cross-enterprise User Patient Demographics

Lab Results Document Authentication Query
Content
Format of the Document Content
For
and Display
associatedDocument
coded vocabulary Authentication & Auditing:
Patient Identifier
Basis for Access Control
Imaging Information
Format of the Document Content Cross-referencing
Medical Sharing
Summary Map patient identifiers across
Format of the Document Content Document Digital independent identification
Document
and Content
associated coded vocabulary domains
Format of the Document Content Signature
Attesting true-copy and origin
and associated coded vocabulary

Audit Trail & Node

Cross-Enterprise Authentication
Document Sharing Centralized privacy audit trail
and node to node authentication
Registration, distribution and to create a secured domain.
access across health enterprises Notification of
of clinical documents forming a Document Availability
patient electronic health record Consistent Time Notification of a remote
Coordinate time across provider/ health enterprise
networked systems

July2005 10 InteroperabilityforLabIHE
Canada
 HIMSS2005ShowWideInteroperability
Vendor System
Cross-enterprise Showcase Booth
IT Vendor Booth
Radiology Infrastructure
Vendor Booth
In-Patient/Out-patient
Vendor Booth
Cardiology
HIMSS RHIO with Vendor Booth
Cross-enterprise
doc sharing (17 vendors) Vendor Booth
PCP
Diag Center Vendor Booth

Multispecialty
Home Clinic Vendor Booth

Ambulatory Showcase Booth HL7 Booth

July2005 11 InteroperabilityforLabIHE
Canada
 HIMSS2005Interoperability
ShowCaseVendors
Leadership Level Participant Level MedcomSoft
CapMed/SanDisk Allscripts MediNotes
Eclipsys Cedara MedCommons
GE Healthcare Cerner MidMark
IDX Dictaphone Mortara Instrument, Inc
InterSystems Eastman Kodak National Institute of
Eclipsys Standards & Technology
Kryptiq NextGen
Emageon
Quovadx/CareScience Novell
Epic
Siemens ETIAM Open Text
WebMD INFINITT Tech. Sentillion

Supporter Level
AccessPt AGFA dbMotion Dinmar Oacis
EMC Healthvision Healthramp McKesson
Valco Data Systems
July2005 12 InteroperabilityforLabIHE
Canada
 IHENorthAmericaVendors(20042005)
Hologic
Agfa HealthCare QRS Diagnostic
IDX Systems Corp.
Allscripts Quovadx
INFINITT Technology
Camtronics Medical St. Jude Medical A.B.
InSite One, Inc.
Systems Sectra Imtec A.B.
Intelerad Medical
Cedara Software Corp. St. Jude Medical A.B.
Systems
Cerner Corporation Sectra Imtec A.B.
InterSystems
Dictaphone Corporation Corporation Sentillion
Dynamic Imaging, LLC Konica-Minolta Medical Siemens Medical
Eastman Kodak Company Imaging, USA, Inc. Solutions
Eclipsys Kryptiq Stentor
Emageon Marotech Swissray International,
Epic Systems Inc.
McKesson Information
Corporation Solutions Tiani Medgraph A.G.
ETIAM MedCommons Inc. Tiani Spirit Gmbh
FujiFilm Medical MedCon, Inc. Toshiba Medical
Systems, USA, Inc. Systems Company
Merge eFilm
GE Healthcare Vital Images
Mortara Instrument,
Heartlab, Inc Inc. WebMD Practice
Services
Hitachi Medical Novell, Inc.
Corporation Philips Medical
July2005 13 InteroperabilityforLabIHE
Systems Canada
IHE-XDS : Cross-Enterprise Document Sharing
community

Clinic Record Specialist Record

Hospital Record

Shared Document
Repository
Reference
to records
4-Patient data
presented to 3-Records
Physician
Returned

Clinical IT System Index of patients records

(Document-level)
Sharing System
Temporary Aggregate
Patient History 2-Reference
to Records
July2005
Clinical Encounter 14 for Inquiry
InteroperabilityforLabIHE
Canada
 Document Content shared by IHE-XDS
community

Clinic Record Specialist Record

Hospital Record
Secured Sharing of: Shared Document
Medical Summaries Repository
Images & reports Reference
ECG Reports to records
PDFs
4-Patient data
Labpresented
Results to 3-Records
Physician
+ Notif of Doc Avail. Returned

Clinical IT System Index of patients records

(Document-level)
Sharing System
Temporary Aggregate
Patient History 2-Reference
to Records
July2005
Clinical Encounter 15 for Inquiry
InteroperabilityforLabIHE
Canada
Full Integration of Portals (Doc & Patients)
community

Clinic Record Specialist Record

Hospital Record

Shared Document
Repository
Reference
to records
4-Patient data
presented to 3-Records
Physician or Patient
Returned

Index of patients records

(Document-level)
Sharing System
Temporary Aggregate
Patient History 2-Reference
Clinical Encounter
or PHR access
July2005
Portal16 to Records
for Inquiry
InteroperabilityforLabIHE
Canada
 SharingLabResultswithXDS
inaRegionalHealthInformationNetwork
Regional Health
Information
Network
Lab B

Hospital-to-Lab

Lab-to-
Physicians
Lab A

Physician Office Hospital A

July2005 17 InteroperabilityforLabIHE
Canada
 SharingLabResultswithXDS
inaRegionalHealthInformationNetwork
Regional Health
Information
Network
Lab B

Cross-
Enterprise
Registry

Lab A

Physician Office Hospital A

July2005 18 InteroperabilityforLabIHE
Canada
 SharingLabResultswithXDS
inaRegionalHealthInformationNetwork
Regional Health
Information Lab B
Network
Register Lab Report
for sharing

Prior
Cross- Lab Report
Enterprise Register Lab Report
Registry for sharing
Query for
Documents

Lab A

Physician Office Hospital A

July2005 19 InteroperabilityforLabIHE
Canada
 SharingLabResultswithXDS
inaRegionalHealthInformationNetwork
Regional Health
Information Lab B
Network
Patient Id= 3547F45
Prior Lab
Report 5/21/1998 : BloodWork B
Report Cross- Report 2/18/2005 : Glucose A
Enterprise
Registry

Query for
documents
Notification of
Doc Availability

Lab Report Lab A

Physician Office Hospital A

July2005 20 InteroperabilityforLabIHE
Canada
 IHE:LabReportSharing
Readytobeimplemented?
Gap1:WhatstandardforaLabReportDocument?
Today:wrapacompleteresultinHL7V2.xintoanXDS
Document.AlreadydemonstratedatHIMSS2005.
MidTermgoal:representlabresultasCDAR2documentwith
HL7V3Labclinicalstatements(sameasthoseoftherealtime
resultmessage).IHELabtoinitiateworkin2006.

Gap2:Jurisdictionextensions
Gap3:LaboratoryTerminologydefinition.Likelya
nationaleffortinitially.
July2005 21 InteroperabilityforLabIHE
Canada
 IHE:InteroperabilityforHealthInfo
Networks
Bystartingwithasecureddocumentsharinginfrastructure,establish
agenericplatformonwhichtoextendclinicalcontent(more
structure&codedterminology,specializedcontent).
SolidSAML2.0authenticationanddocumentdigitalsignature(need
aPKI).
PracticalHL7V3approachwithCDAR2(medicalsummaries)and
othercontent(e.g.imaging,legacycontent,PDF,etc.).
Establishingacriticalmassofproductsimplementations,bothin
clinicalapplicationsandinfrastructurefordeploymentin2006.
Anarchitecturethatcaterstovariousregionalandnational
architectures:centralized,decentralizedandmixed.
IHEXDSisinuseinItaly,withprojectsinCanada(Newfoundland),
NorwayandFrance.
July2005 22 InteroperabilityforLabIHE
Canada
 LabtoAmbulatoryEHRInteroperability
Workflows
Assessmentandusecasepositioning(nonacutecare)
Accessto
Paper Initial RealTime AccessHistorical Other
Order Order Result LabResults Records
Contractto IHELabScheduled
LabModel Workflow
XDS+ XDS+

Collaborative IHELabscheduled
XDS+
LabModel Workflow XDS+

Important?
Labregionalnetworksneedtolookbeyondtheclassicallab
messagingapproachesusedinhospitalwhererealtimeresult
arecriticalDocumentSharing
July2005 23 InteroperabilityforLabIHE
Canada
 LabtoAmbulatoryEHRInteroperability
Conclusions
IHELabScheduledWorkflowhasacriticalroletoplay:
SolidandprovenspecificationwithHL7V2.5criticalimprovements
BringtherigorandeffectivenessofIHE
Consistentapproachforlaboratoriesinacutecareandambulatory
BestspringboardtoHLV3andInfowaystrategicdirection

Accesstohistoricallabresultsinanonlabspecificmanneriscritical:
LeverageIHECrossenterpriseDocumentSharingandassociatedIntegration
profiles(e.g.security).
CriticalrationalizationforambulatoryHERthatwillneedtoaccessothertypeof
recordthanlabreports.
Remaininggapsthatneedtobeaddressed(multijurisdiction?):
ResultsandOrdersCodedTerminology
Jurisdictionsspecificelements
July2005 24 InteroperabilityforLabIHE
Canada
 Moreinformation.
IHEWebsites:www.ihe.net
TechnicalFrameworks,Supplements:
http://www.ihe.net/Technical_Framework/index.cfm
NonTechnicalBrochures:
CallsforParticipation
IHEFactSheetandFAQ
IHEIntegrationProfiles:GuidelinesforBuyers
IHEConnectathonResults
VendorProductsIntegrationStatements

July2005 25 InteroperabilityforLabIHE
Canada
 Providers and Vendors
Working Together to Deliver
Interoperable Health Information Systems
in the Enterprise
and Across Care Settings

WWW.IHE.NET
July2005 26 InteroperabilityforLabIHE
Canada