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Integrating the Healthcare Enterprise

Integrating the Healthcare Enterprise. IHE 2003: Meeting Clinical Goals and Technical Challenges. Authors & Presenters. Paul Vegoda, FHIMSS Malvern Group IHE Strategic Development Committee Kevin O’Donnell Toshiba America, Inc. IHE Planning Committee Co-chair David S. Channin, MD CPHIMS

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Integrating the Healthcare Enterprise

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  1. Integratingthe Healthcare Enterprise IHE 2003:Meeting Clinical Goals and Technical Challenges

  2. Authors & Presenters Paul Vegoda, FHIMSS Malvern Group IHE Strategic Development Committee Kevin O’Donnell Toshiba America, Inc. IHE Planning Committee Co-chair David S. Channin, MD CPHIMS Northwestern University IHE Strategic Development Committee HIMSS 2003

  3. The Problem Poor Information System Support for Healthcare Delivery • Information not available when and where needed for medical, research, education or administrative decision support • Errors, both manual and electronic • Inefficient • Paper based and clogged HIMSS 2003

  4. 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 redundant, inconsistent or unavailable Responsibility for information flow between systems, and between departments, is often unclear. HIMSS 2003

  5. A CIO’s dream • A fully integrated healthcare information system • Best of breed systems working together to facilitate efficient workflow • Documented improvement of efficiency and quality of delivered care • Easy to deploy and manage • Good, fast and cheap (pick two) HIMSS 2003

  6. RIS PACS What my CIO sees: 120 Server Systems 62 point to point HL7 connections • includes 3 to PACS Dreams of ‘Best of Breed’?!  HIMSS 2003

  7. What some would like to see: Dreams of ‘Single Vendor’ ‘Mangy Mutt’  HIMSS 2003

  8. Alas…. Best of Breed vs. Integrated … “tis a consummation devoutly to be wished.” Will Shakespeare, Hamlet HIMSS 2003

  9. Then suddenly… “What light from yonder window breaks?” Will Shakespeare, Romeo and Juliet It is IHE! HIMSS 2003

  10. What is IHE? IHE is an initiative to speed the integration of information systems in the healthcareenterprise to achieve better workflow HIMSS 2003

  11. Goals of IHE • Speed up the rate and quality of integration in healthcare environments • Foster communication among vendors • Prove that integration is attainable based on standards HIMSS 2003

  12. IHE Penetration in Radiology • Now entering Year 5!! • 50+ vendors worldwide • 100+ systems in annual Connectathons • Geographic spread • U.S., France, Germany, Japan, Italy, U.K. HIMSS 2003

  13. IHE Expansion into New Areas • New IT Infrastructure Committee Formed • (EMPI, Query-Display, Synchronized Patient Views, and Advanced Security) • Cardiology Group forming in March (ACC) • Work progressing in: • Lab • Pharmacy/Medication Management HIMSS 2003

  14. IHE Participants • Societies Representing Healthcare Segments • ( RSNA, HIMSS, ACC, … ) • Users • ( Clinicians, Medical Staff, Administrators, CIOs, … ) • Information Systems Vendors • Imaging Systems Vendors • Standards Development Organizations (SDOs) • DICOM • HL7 • Others … HIMSS 2003

  15. Benefits to IHE Participants • Clinicians • Improved workflow • Information when and where needed • Fewer opportunities for errors • Fewer tedious tasks/repeated work • Administrators • Improved efficiency • Best of breed opportunities • Decreased cost and complexity of interface deployment and management HIMSS 2003

  16. Benefits to IHE Participants • Vendors • Decreased cost and complexity of interface installation and management • Validation of integration at Connectathon • Focus competition on functionality/service space not information transport space • SDOs • Rapid feedback to adjust standards to real-world HIMSS 2003

  17. IHE Process • 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/…) HIMSS 2003

  18. IHE Deliverables • Venues for discussion between users and vendors • Common vocabulary; Common view of the world based on: • HL7 and DICOM Model of the real world • Pieces of information and their meaning • Technical Framework - INTEGRATION PROFILES • ACTORS in Roles performing TRANSACTIONS to accomplish Specific Processes • Connect-a-thon • Public Demonstrations / Education Exhibits HIMSS 2003

  19. IHE Concepts and Vocabulary • Actors • Transactions • Integration Profiles HIMSS 2003

  20. Actors • Represent a role performed by a system • Collect a subset of related responsibilities  Examples: • Order Placer • Order Filler • Acquisition Modality • Image Display • Report Creator HIMSS 2003

  21. Transactions • Unambiguously defines how several actors communicate • Using existing standards such as HL7 or DICOM to accomplish a specific task. Examples:  • Procedure Scheduled • Modality Worklist Provided HIMSS 2003

  22. Integration Profiles IHE Integration Profiles define a collection of real world functionality and group together the necessary Actors and Transactions to make it work. • Examples:  • Scheduled Workflow • Patient Information Reconciliation • Presentation of Grouped Procedures HIMSS 2003

  23. IHE Technical Framework • Defines enterprise Integration Profiles • Defines <precisely> what to do to support the Integration Profiles • 3 volumes, 450+ pages • Version controlled • 5.4 is latest revision (www.rsna.org/IHE) • May be incorporated by reference into contract documents HIMSS 2003

  24. The Annual “Connectathon” • Unprecedented Cross-Vendor Testing • Voluntary Participation • Neither a Demo nor a Certification • Well Designed End-to-End Scenarios • Advanced Testing Tools • Unprecedented Pool of Technical Talent HIMSS 2003

  25. Public Demonstrations / Education Exhibits • RSNA Annual Meeting (November) • HIMSS Annual Meeting (Here and NOW!!) • Check your program books for a large number of IHE related presentations and exhibits HIMSS 2003

  26. 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 HIMSS 2003

  27. Scheduled Workflow Integration Profile • Real World Problem: • Patient-centric, service oriented care delivery • Multiple actors, multi-vendor, multi-system • Registration • Order Placer • Order Filler • Modality • Image Manager / Image Archive • Image Display • Report Creator • Etc. HIMSS 2003

  28. 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 HIMSS 2003

  29. Year 4 Enhancements to Scheduled Workflow • Reduce variance on how procedures are performed • Imaging protocols • Assisted Acquisition Protocol Setting (option) • Exception management • When errors are made on the modalities how can these be corrected • PPS Exception Management (option) HIMSS 2003

  30. Patient Information Reconciliation Integration Profile • Real World Problem: • ‘To err is human, but to really mess things up you need a computer’ 5 scenarios of patient/order/images reconciliation addressed: • Unidentified Patient registered at ADT and ordered at Order Placer • Unidentified Patient registered at ADT and ordered at Dept Scheduler/Order Filler • Unidentified Patient registered at ADT but completed at Modalityprior to Order • Unidentified Patient assigned Temporary Departmental ID andScheduled at Dept Scheduler/Order Filler • Image Acquisition Completed without Scheduling at Dept Scheduler/OrderFiller HIMSS 2003

  31. Post-Processing WorkflowIntegration Profile • Clinical Problem: • How do I know when there is post-processing (3D, CAD, etc.) to be done? • How do I know when the post-processing is done and ready to be billed, distributed, and interpreted? • How do I make sure the post-processed images / objects get associated with the correct study? HIMSS 2003

  32. Source Data Worklist PACS System CAD *Workstation 3-D *Workstation Review Workstation ReportRepository Work Status Results AcquisitionModality Post-Processing Workflow Profile Post-Proc. Workflow Manager Work Status … Results HIMSS 2003

  33. Charge Posting Integration Profile • Clinical Problem: • Can my information systems send consistent messages to a ‘charge processor’ for timely technical and professional fee billing? • Can my billing / coding process more accurately reflect what was actually done? • Can I shrink my back office? HIMSS 2003

  34. 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 … HIMSS 2003

  35. Consistent Presentation of Images Integration Profile • Real World Problems: • Is my referring clinician seeing the same picture as I am? • Can I avoid calibrating every imaging device to every display device? • Why do I have to repeat image manipulations that the technologist already performed? • Can I view the images the way Dr. X did? HIMSS 2003

  36. 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: HIMSS 2003

  37. Presentation of Grouped Procedures Integration Profile • Clinical Problem: • Single physical acquisition of images must be ‘split’ for interpretation, viewing or billing • E.g., Spiral CT of Chest, Abdomen, Pelvis • E.g., One order, two procedures, one data set, two reports • How can I optimize both patient experience (time and comfort) and throughput? • How can I make sure images are grouped and sorted correctly and ready for display HIMSS 2003

  38. 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 HIMSS 2003

  39. Key Image Note Integration Profile • Clinical Problem: • How can I flag images in a procedure for various purposes: • To clarify findings for referring physicians or teaching • QA • Technical inadequacy • Etc. HIMSS 2003

  40. 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: HIMSS 2003

  41. Simple Image & Numeric Report Integration Profile • Clinical Problem: • How can I start to use DICOM Structured Reporting for my reports? • How can I capture report information other than as blobs of text? • How can I mine my report data? • How can I disseminate reports to all downstream systems? HIMSS 2003

  42. Example: ‘Simple Image and Numeric Report’ Discussion Comparison is made to the prior study of 4/11/99. The left paratracheal lymph node (image 8, image 11) now measures 2.5x2.7x3.1 cm increasing from 2.0x2.1x2.6 previously. No other mediastinal, upper abdominal or axillary adenopathy is identified. No focal pulmonary lesions are seen. The yadda, yadda, yadda are normal. Impression Worsening L Paratracheal adenopathy. HIMSS 2003

  43. 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 HIMSS 2003

  44. Access to Radiology InformationIntegration Profile • Clinical Problem: • How can other information systems get information from me without interrupting me? • Images • Gray Scale Presentation States • Key Image Notes • Simple Image and Numeric Reports HIMSS 2003

  45. 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 HIMSS 2003

  46. Basic Security Integration Profile • Clinical Problem: • How can I begin to coordinate HIPAA / security requirements between systems? • Secure communications between nodes • Common audit repository • Common date and time across systems HIMSS 2003

  47. 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” HIMSS 2003

  48. What is Available? • IHE Integration Statements • Vendor claims of IHE Profile support on specific products • Simple format • backed up by Technical Framework • Connectathon Results • what types of systems, which companies are testing at the Connectathons See links at www.rsna.org/IHE HIMSS 2003

  49. Clinical IHE Success Progress IHE at Northwestern HIMSS 2003

  50. HIMSS 2003

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