content integration profiles
DESCRIPTION
Content Integration Profiles. Ana ESTELRICH, GIP-DMP, FRANCE Charles PARISOT, GE. - PowerPoint PPT PresentationTRANSCRIPT
September, 2005 What IHE Delivers
Content Integration Content Integration ProfilesProfiles
Ana ESTELRICH, GIP-DMP, FRANCEAna ESTELRICH, GIP-DMP, FRANCE
Charles PARISOT, GECharles PARISOT, GE
Grateful thanks to Charles Parisot, Keith Boone, Lori Forquet, Liora Alschuler, Larry McKnight, René Spronk, Thom Kuhn, Todd Rothenhaus, John Donnelly whose work contributed to the creation of this presentation
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Content Integration ProfileContent Integration Profile
IHE-XDS is neutral regarding contentIHE-XDS is neutral regarding content
Will exchange any type of document as an Will exchange any type of document as an opaque octet of informationopaque octet of information
Content Profiles address clinical informationContent Profiles address clinical information
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Content Integration ProfilesSupport profiles addressing integration issues that combine providers, patient problems or time.
Deal with general clinical care aspects rather than technology infrastructure.
Address workflows and information sharing needs that are common to multiple specialty areas.
Started in 2005 and now supports 9 Content Profiles
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A content profile is…A sharable information component that can be exchanged… within an HIE or RHIO (XDS) via Media or USB Device (XDM) via Reliable Messages Point to Point (XDR)
Document content using standards CDA Release 2.0 HL7 Care Record Summary ASTM/HL7 Continuity of Care Document
More complex documents have a library of reusable parts
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Content profiles – full picture
BPPCBPPC
XDS-XDS-SDSD
September, 2005 What IHE Delivers
Cross-sharing of scanned Cross-sharing of scanned documentsdocumentsXDS-SD XDS-SD
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XDS-SDXDS-SD
Most basic exchangeMost basic exchange of documents of documents
CDA headerCDA header
pdfpdf or or texttext content content
CDA (Clinical Document Architecture) header needed CDA (Clinical Document Architecture) header needed to preserve the document’s integrity and its context of to preserve the document’s integrity and its context of creationcreation
The XDS-SD profile specifies the minimum The XDS-SD profile specifies the minimum requirements needed as a CDA header, but it is not requirements needed as a CDA header, but it is not restricted only to that.restricted only to that.
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Creation of a Creation of a pdfpdf or or texttext document document within the XDS-SD within the XDS-SD contextcontext
A PDF/A or text document is created by the application or by scanning a paper document (pdf ou txt)
The application will also generate a CDA R2 for the document pdf ou text created
The document is stable on its own, and it is able to be queried and imported by a Document Consumer
The document is wrapped by the CDA header, keeping its authentic context of creation. It can be used
clinically
The XDS metadata are generated based on the data present in the CDA header
The document thus created is sent to the Respository via transaction ITI-15 - Provide and Register
Document Set
The document is complete
The Repository saves the document and registers the XDS metadata with the Registry
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The specification for the XDS-SDThe specification for the XDS-SD
The specification for the construction of XDS-SD type of The specification for the construction of XDS-SD type of documents are found on:documents are found on:
http://www.ihe.net/Technical_Framework/upload/http://www.ihe.net/Technical_Framework/upload/IHE_ITI_TF_Supplement_XDS_Scanned_Docs_TI_2007_08_20.pdfIHE_ITI_TF_Supplement_XDS_Scanned_Docs_TI_2007_08_20.pdf
September, 2005 What IHE Delivers
Patient Care Patient Care Coordination Coordination
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PCC Content Profiles - ReminderKey Technical Properties
Human readableHuman readable
Machine processableMachine processable
Digital Signature enabledDigital Signature enabled
Can be shared multiple waysCan be shared multiple ways RHIO or HIE (XDS)RHIO or HIE (XDS) CD or USB Media (XDM)CD or USB Media (XDM) Point to Point (XDR)Point to Point (XDR)
September, 2005 What IHE Delivers
Medical Summary Profiles Medical Summary Profiles
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What's in a Medical Summary?What's in a Medical Summary?
Intended AudienceIntended Audience
Pro
blem
Sco
peP
robl
em S
cope
Broad
Focused
Focused
Broad
EpisodeCareCollaborative
Care
PermanentCare
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Medical Summary – Use CaseMedical Summary – Use CaseEpisode CareEpisode Care Purpose: summarize an Purpose: summarize an episodeepisode Author participation in care continues (generally)Author participation in care continues (generally) Scope: Scope: problems involved in episodeproblems involved in episode ExEx: Admit H&P (History and Physical), : Admit H&P (History and Physical), Discharge SummaryDischarge Summary, ,
Procedure NoteProcedure Note
Collaborative CareCollaborative Care Purpose: Purpose: request helprequest help in Patient Management in Patient Management Broad Audience is a side effectBroad Audience is a side effect Scope: focus on a problemScope: focus on a problem ExEx: : ReferralReferral, admit to long term care, admit to long term care
Permanent Care:Permanent Care: Purpose is Transfer CarePurpose is Transfer Care Author participation in care does not continueAuthor participation in care does not continue Scope: all aspects of careScope: all aspects of care ExEx: discharge from military, patient relocation: discharge from military, patient relocation
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Medical Summary - ScopeMedical Summary - Scope
Define a medical summary format for clinical Define a medical summary format for clinical documents containing at a minimum that documents containing at a minimum that provides essential information to the HCP:provides essential information to the HCP:
ProblemsProblems AllergiesAllergies MedicationsMedications Pointers to other materialPointers to other material
Medical Medical SummariesSummaries
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Value PropositionValue Proposition
A common mechanism for transfer of encoded A common mechanism for transfer of encoded clinical data embedded in documentsclinical data embedded in documents
To be used in millions of care coordination To be used in millions of care coordination across settings everydayacross settings everyday Inpatient to Primary Care Provider (Discharge)Inpatient to Primary Care Provider (Discharge) Primary Care Provider to Specialist (Referral)Primary Care Provider to Specialist (Referral)
Medical Medical SummariesSummaries
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Key Technical PropertiesKey Technical PropertiesDocument Transfer (Integration Profile)Document Transfer (Integration Profile) XDS/XDM/XDR for document sharing.XDS/XDM/XDR for document sharing. NAV for notification.NAV for notification. XDS Folders to support organization.XDS Folders to support organization. XDS Submission Sets to support packaging.XDS Submission Sets to support packaging.
Document Content (Content Profile) - StandardsDocument Content (Content Profile) - Standards CDA Release 2.0CDA Release 2.0 Continuity of Care Document Implementation (CCD) GuideContinuity of Care Document Implementation (CCD) Guide Key Medical Terminologies subject to national extensions Key Medical Terminologies subject to national extensions
• Medication, Problems, Allergies, etc. Medication, Problems, Allergies, etc.
Medical Medical SummariesSummaries
September, 2005 What IHE Delivers
EmergencyDepartment Encounter
Summary
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Use CaseThe patient undergoes assessments by a triage nurse, is assigned a triage category (i.e. emergent, urgent, nonurgent) –
* may or may not happen like that in all countries
The patient is then registered and demographic data is obtained.
The patient undergoes additional assessments by a primary RN*
The patient is seen by an ED physician who performs a history and physical, orders various diagnostic tests, determines a course of therapy, orders medications to be administered in the ED and performs procedures on the patient.
Upon completion of ED care, the patient is either admitted to the hospital, discharged from the ED, or transferred to another facility.
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ScopeScope
Emergency Department Information Systems (EDIS)
Inpatient EHR Systems
Ambulatory EHR Systems
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Value Proposition
In US alone there were 110 million emergency department visits in 2004
ED visits account for as much as 40% of hospital admissions
The ED Chart is the most common medical summary in use today
This profile supports sharing of the clinical information in the ED chart with inpatient care providers and the patient's primary care physician.
September, 2005 What IHE Delivers
Emergency Department Emergency Department ReferralReferral
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Use CaseUse Case
Health care provider determines that a patient needs to go to the ED
Provider creates an ED referral package using his or her HER
Upon arrival, the ED provider identifies the patient as a referral
The posted referral package is imported into the Emergency Department Information System (EDIS)
ED ReferralED Referral
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Value PropositionValue PropositionProvide access to critical health information in ED information Provide access to critical health information in ED information systems in a standard mannersystems in a standard manner
Nearly 5000 EDs in USNearly 5000 EDs in US
Significant percentage of ED visits are referralsSignificant percentage of ED visits are referrals
Shortage of critical health data for emergency department patientsShortage of critical health data for emergency department patients
Need to improve communication of intended patient care plans to ED Need to improve communication of intended patient care plans to ED providers and ensure that no pertinent data is lostproviders and ensure that no pertinent data is lost
Streamline workflow by obviating telephone calls between busy Streamline workflow by obviating telephone calls between busy cliniciansclinicians
ED ReferralED Referral
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ScopeScope
EHR system capable of creating a care record EHR system capable of creating a care record summary would be capable of creating a referral summary would be capable of creating a referral package for a receiving systempackage for a receiving system
The emergency department information systems The emergency department information systems (EDIS) will need to retrieve and read and display (EDIS) will need to retrieve and read and display this data.this data.
ED ReferralED Referral
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Profile contents based on CDAProfile contents based on CDA
Interoperability Human
• The “paper world” with documents, forms...
Application• Storage, management of clinical data• Context driven analysis• Reusability
Stepwise approach to application interoperabilityapplication interoperability Immediate human interoperability (compliant users) Incremental interoperability between machines – very much
sought-after by clinicians
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12 steps to semantic interoperability
Liora Alschuler 2007
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Clinical Document ArchitectureClinical Document Architecture
René SpronkRené Spronk
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CDA StructureCDA Structure
René SpronkRené Spronk
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Section LevelsSection Levels
René SpronkRené Spronk
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CDA - Three LevelsCDA - Three Levels
René SpronkRené Spronk
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Why CDA? Why CDA? Content integration profiles and templatesContent integration profiles and templates
What is a template?What is a template?
How can it be expressed?How can it be expressed?
What can I do with it?What can I do with it?
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WhatWhat is a Template?is a Template?
A template is an expression of a set of A template is an expression of a set of constraints on the RIM that is used to constraints on the RIM that is used to apply additional constraints to a portion apply additional constraints to a portion of an instance of data which is of an instance of data which is expressed in terms of some other Static expressed in terms of some other Static Model.Model.
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IHE Content Integration TemplatesIHE Content Integration Templates
Are Content Profiles or ModulesAre Content Profiles or Modules
Have a formal written definitionHave a formal written definition
Result in an Implicit HL7 Static ModelResult in an Implicit HL7 Static Model
Use ISO Schematron for ImplementationUse ISO Schematron for Implementation
Inherit from ASTM/HL7 CCD when possibleInherit from ASTM/HL7 CCD when possible
Provide Constraints onProvide Constraints on DocumentsDocuments SectionsSections EntriesEntries
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Features of a TemplateFeatures of a Template
Has an IdentityHas an Identity
Can Require, Prohibit, or Suggest Can Require, Prohibit, or Suggest (constrain)(constrain) RIM AttributesRIM Attributes RelationshipsRelationships Other TemplatesOther Templates Specify CardinalitySpecify Cardinality Conditional and Co-relationshipsConditional and Co-relationships
Can Inherit from other TemplatesCan Inherit from other Templates
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Document Level TemplatesDocument Level Templates
Template IDTemplate ID
Summary DescriptionSummary Description
Format Code for use with XDSFormat Code for use with XDS
Standards UsedStandards Used
Data Element Table (needs Definitions)Data Element Table (needs Definitions)
SpecificationSpecification SectionsSections (Header) Entries(Header) Entries
ConformanceConformance
Sample XML (abbreviated)Sample XML (abbreviated)
SchematronSchematron
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Document Template SpecificationDocument Template Specification
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IHE PCC Document TemplatesIHE PCC Document Templates
Medical Summary Specification Medical Summary Specification
XDS-SD Scanned DocumentsXDS-SD Scanned Documents
Referral Summary Specification Referral Summary Specification
Discharge Summary Specification Discharge Summary Specification
PHR Extract Specification PHR Extract Specification
PHR Update Specification PHR Update Specification
Emergency Department Referral Specification Emergency Department Referral Specification
Emergency Department Encounter SummaryEmergency Department Encounter Summary
Antepartum Summary Antepartum Summary
Triage Note Triage Note
Nursing Note Nursing Note
Composite Triage and Nursing Note Composite Triage and Nursing Note
ED Physician NoteED Physician Note
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Section Level TemplateSection Level Template
Template IDTemplate ID
Parent Template(s)Parent Template(s)
Summary DescriptionSummary Description
LOINC CodeLOINC Code
Required and Optional Sub-sectionsRequired and Optional Sub-sections
Required and Optional Entry Templates Required and Optional Entry Templates
Sample XML (abbreviated)Sample XML (abbreviated)
SchematronSchematron
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Section Level TemplateSection Level Template
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Section TemplatesSection Templates
Reasons for Care Reasons for Care
Other Condition Histories Other Condition Histories
Medications Medications
Physical Exams Physical Exams
Relevant Studies Relevant Studies
Plans of Care Plans of Care
Procedures Performed Procedures Performed
Impressions Impressions
Administrative and Other InformationAdministrative and Other Information
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Entry Level TemplateEntry Level Template
Template IDTemplate ID
Summary DescriptionSummary Description
StandardsStandards
Parent Template(s)Parent Template(s)
SpecificationSpecification Example XML (abbreviated)Example XML (abbreviated) Line by Line SpecificationLine by Line Specification Code TablesCode Tables References to Other TemplatesReferences to Other Templates (Schematron coming)(Schematron coming)
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Entry Template ExampleEntry Template Example
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Entry Level TemplatesEntry Level TemplatesLanguage Communication Language Communication
Employer and School Contacts Employer and School Contacts
Healthcare Providers and Pharmacies Healthcare Providers and Pharmacies
Patient Contacts Patient Contacts
Authorization Authorization
Consent Service EventsConsent Service Events
Authors and Informants Authors and Informants
Linking Narrative and Coded Entries Linking Narrative and Coded Entries
Severity Severity
Problem Status Observation Problem Status Observation
Health Status Health Status
Comments Comments
Patient Medication Instructions Patient Medication Instructions
Medication Fulfillment Instructions Medication Fulfillment Instructions
External References External References
Internal References Internal References
Language Communication Language Communication
Employer and School Contacts Employer and School Contacts
Healthcare Providers and Pharmacies Healthcare Providers and Pharmacies
Patient Contacts Patient Contacts
Authorization Authorization
Consent Service EventsConsent Service Events
Authors and Informants Authors and Informants
Linking Narrative and Coded Entries Linking Narrative and Coded Entries
Severity Severity
Problem Status Observation Problem Status Observation
Health Status Health Status
Comments Comments
Patient Medication Instructions Patient Medication Instructions
Medication Fulfillment Instructions Medication Fulfillment Instructions
External References External References
Internal ReferencesInternal References
Language Communication Language Communication
Employer and School Contacts Employer and School Contacts
Healthcare Providers and Pharmacies Healthcare Providers and Pharmacies
Patient Contacts Patient Contacts
Authorization Authorization
Consent Service EventsConsent Service Events
Authors and Informants Authors and Informants
Linking Narrative and Coded Entries Linking Narrative and Coded Entries
Severity Severity
Problem Status Observation Problem Status Observation
Health Status Health Status
Comments Comments
Patient Medication Instructions Patient Medication Instructions
Medication Fulfillment Instructions Medication Fulfillment Instructions
External References External References
Internal References Internal References
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Navigating the wikiNavigating the wiki
http://wiki.ihe.net/index.php?title=Main_Pagehttp://wiki.ihe.net/index.php?title=Main_Page
Or type in Google “IHE wiki” – demonstration Or type in Google “IHE wiki” – demonstration by Charles Parisot, GEby Charles Parisot, GE
Schematrons for the ConnectathonSchematrons for the Connectathon
[email protected]@[email protected]@med.ge.com