Integrating the Healthcare Enterprise

1. Integratingthe Healthcare Enterprise IHE 101 Kevin O’Donnell, Toshiba Niki Wirsz, Siemens Ellie Avraham, Kodak [30 minutes]

2. IHE 101 • Who is IHE? • What is it about? • Why is it needed? • What about DICOM? • How does it work? • How do I get it? • How do I use it? • What does IHE create? • What do I get out of it? • Where can I learn more? RSNA 2002

3. What is IHE about? • IHE is an initiative promoting and supporting the integration of systems in the healthcare enterprise. • Goal: Improve the efficiency and effectiveness of clinical practice by: • Improved Information Flow • Advanced Multi-System Functions RSNA 2002

4. How do you Use IHE? • IHE “Integration Profiles” • define cross-vendor support for specific capabilities • Customer – Vendor Communication • Review the Profiles • Decide what you want • Ask vendors for that profile on the relevant systems “Which IHE Profiles do you support on System X as which actors? RSNA 2002

5. Why is IHE needed? • Serious Integration Challenges in Healthcare: • Systems need Information other systems have • But, systems communicate poorly or not at all • Result: - tedious, inefficient workflows - data that is inconsistent or unavailable • Responsibility for information flow between systems, and between departments, is often unclear. RSNA 2002

6. Who is IHE? • Participants: • Professional Societies • Radiological Society of North America (RSNA) • Healthcare Information and Management Systems Society (HIMSS) • Other societies (European, Japanese, Lab HC PartnershipACC, …) • Vendors (over 30 companies) • Standards Group Committee Members • RSNA and HIMSS sponsor IHE to provide a neutral forum for working on the Big Picture RSNA 2002

7. How Established is IHE? • Year 1 (1999): Proof of Concept (Basic Scheduled Workflow) • Year 2 (2000): Introduction of the 7 Profiles (Full Featured) • Year 3 (2001): Consolidation, Catch-up (Real Products) Expansion to France • Year 4 (2002): 3 New Profiles Expansion to Japan, Germany, Italy • Year 5 (2003): New Profiles Expansion to UK, IT Infrastructure, Cardiology, Nuclear Medicine, Lab, …? RSNA 2002

8. What does IHE cover? • [37] Vendors participated in IHE Year 4 with [71] Systems • Systems include: • HIS, RIS • CT, MR, US, CR, DX, XA, NM, … • PACS, Review Stations, Reporting Systems • Printers, Imagers RSNA 2002

9. Why Integrate? • Integrated Systems -> cooperative exchange of information • Your system receives relevant information • Patient Demographics • Order Information • Related Clinical Data >>> More efficient workflow, reduced errors, more intelligent equipment • Your system distributes relevant information • Clinical Data – test results, images, measurements, reports >>> More valuable if it’s available anywhere, anytime >>> More valuable when combined with other data (No single device has all the answers) RSNA 2002

10. Why Integrate? • Cooperative Information Flow Enables Processes • Order Workflow: Scheduling, Worklists, Status, Results • Specialist Consultation: Sharing Data, Views, Observations • Electronic Medical Records: Data Collection, Storage, Distribution • Clinical Workflow: Data Access, Review, Analysis, Recording • Research Workflow: Clinical Studies, Evidence Based Medicine • Financial Workflow: Order Authorization, Status, Billing, Collection RSNA 2002

11. How is IHE related to Standards? • Information is applied within a context • Order: Clinical View, Financial View, Dept. View • Information needs to travel widely >>> Workflows cross Standard borders • Standards provide tools & technologies • HL7 and DICOM provide dictionaries • IHE specifies how to apply them to real world scenarios & integration problems • IHE defines a “phrasebook” RSNA 2002

12. What Does IHE Do? • Users and vendors work together to identify and design solutions for integration problems • Intensive process with annual cycles: • Identify key healthcare workflows and integration problems • Research & select standards to specify a solution • Write, review and publish IHE Technical Framework • Perform cross-testing at “Connectathon” • Demonstrations at tradeshows (HIMSS/RSNA) RSNA 2002

13. What are Key IHE Concepts? • Generalized Systems -> Actors • Interactions between Actors -> Transactions • Problem/Solution Scenarios -> IntegrationProfiles • 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) RSNA 2002

14. What is the Result? • Vendors implement selected actors and profiles on their systems • IHE is not a product;it is a software feature or upgrade • Customers can request specific Integration Profiles in RFPs for clinical systems • The systems have been pre-tested at the Connectathon RSNA 2002

15. Who benefits? • Clinical Users • Greater access to more consistent information • Fewer errors, fewer tedious tasks • Buyers • Specify/purchase integration capabilities easily • Freedom to acquire “Best of Breed” systems • IT Professionals • Faster, more predictable integration projects • Administrators • Increased throughput • Better scheduling and tracking RSNA 2002

16. Scheduled Workflow Post- Processing Workflow Patient Information Reconciliation ChargePosting Admit, order, schedule, acquire & store images with notification of completed steps Schedule, perform, & notify image processing & CAD steps Collection of billable procedure details Unknown patients and unscheduled orders Consistent Presentation of Images Key ImageNotes Simple Image and Numeric Reports Simple reports with image links and measurements Hardcopy and softcopy grayscale presentation state Flag & search for significant images Presentation of Grouped Procedures Manage subsets of a single acquisition Access to Radiology Information Retrieve & view images and reports Basic Security Audit Trail Consolidation & Node Authentication IHE Integration Profiles RSNA 2002

17. Scheduled Workflow Profile report Registration Film Lightbox Image Manager & Archive Orders Filled Film Folder Diagnostic Workstation Film Report Repository Orders Placed AcquisitionModality acquisitioncompleted acquisitionin-progress imagesprinted Modality acquisitioncompleted RSNA 2002

18. Patient Information Reconciliation Profile • Extends Scheduled Workflow • Handle unidentified patient (e.g. trauma) • Handle demographic information mistakes • Propagate changes to all affected systems, update all affected data • Reduces incorrectly identified or “lost” studies RSNA 2002

19. Source Data Worklist PACS System CAD *Workstation 3-D *Workstation Workstation ReportRepository Work Status Results AcquisitionModality Post-Processing Workflow Profile Post-Proc. Workflow Manager Work Status … Results RSNA 2002

20. Images and Examdata presented fordiagnosis Verified Report Preliminary Report Image Manager & Archive ReportVerification Reports storedforNetwork Access Report & ImageReview forPatient Care Report & Images Retrieved Images Retrieved Simple Image & Numeric Reports Profile RSNA 2002

21. Account Management ADT Terminal Report Generated / Signed CAD *Workstation 3-D *Workstation ReportRepository 3-D Performed CAD Performed AcquisitionModality Charge Posting Profile Post Charges *Billing System Charge Poster Study Performed / Materials Used … RSNA 2002

22. Original Image & Presentation State Area Of Interest Area Of Interest The Radiologist’s Transformations Are Saved Flip Zoom Prepared Image Annotate Original Image Original Image Window Level Original Image The Radiologist’s Transformations Are Lost Consistent Presentation of Images Profile What the Radiologist Displays: What the Reviewing Physician Sees: RSNA 2002

23. Report:CHEST Report:AB/PELVIS Ab/Pelvis View Chest View Chest View MODALITY Performs a single exam Operator groups 2 procedures Ab/Pelvis View Presentation of Grouped Procedures Profile Requested Procedure:CHEST RIS / PACS Requested Procedure:AB/PELVIS RSNA 2002

24. Note1 Note2 For referring physician: This image shows the renal rupture. For referring physician: This image has the hematoma. Study & Key Image Notes Note2 Note1 for refering physician This image shows the renal rupture. Note1 Note2 for refering physician This image has the hematoma. for refering physician This image has the hematoma. for refering physician This image shows the renal rupture. Key Image Notes Profile Radiologist Flags Images: Referring PhysicianSees Key Images First: RSNA 2002

25. Emergency Department Referring Physician Radiology Department – Images and Reports Remote Clinics Other Departments:- Oncology- Surgery- Neurology- Pediatrics- etc. Electronic Medical Record Access to Radiology Information Profile RSNA 2002

26. Image Manager & Archive Diagnostic Workstation ReportRepository Report & ImageReview Basic Security Profile Audit Record Repository … … “Images Queried / Retrieved” “Reports Retrieved” “Reports Printed” “Images Printed” “Reports Stored” “Reports Queried / Retrieved” RSNA 2002

27. Resources • www.rsna.org/IHE • FAQs • Integration Profiles • Primer on IHE • Presentations • IHE Technical Framework RSNA 2002

28. Questions? Ask your vendors: Which IHE Profiles do they support on which systems? www.rsna.org/IHE RSNA 2002