IHE Integrating the Healthcare Enterprise

1. IHEIntegrating the Healthcare Enterprise General Overview (again once) Scheduled Workflow Patient Information Reconciliation Consistent Presentation of Images Key Image Notes How to deal with IHE-items Prof. Berthold B. Wein User co-chair IHE-Europe

2. IHE: short overviewandscheduled workflow and patient information reconciliation Prof. Berthold B. Wein, MD User co-chair IHE-Europe Praxisgemeinschaft Kapuzinerkarree University Hospital Aachen Germany

3. IHE scope Healthcare IT – Main Obstacles • Lack of financial funding : • IT : 2.3% of hospital budget (in other industries : 2.8%) [Gartner] • Lack of national/regional guidelines & incentives • Lack of access to IT infrastructure • Lack of solutions that meet clinical needs • Lack of adequate healthcare IT standards and interoperability • Integration cost : 20% of hospital IT budget

4. IHE Mission • Improve the quality and cost of healthcare by removing the interoperability barriers • Continuity & Integrity of Patient Information • Clinical Workflow Optimization • Provide an open interoperability framework, based on existing standards • Enable cross-vendor environment • Make life more easy for the users and vendors IHE = Integrating the Healthcare Enterprise

5. Benefits of IHE • seamless information flow • from system to system • within and across departments • within and across hospital borders • access to all vital clinical data • at the right time and at the right place • workflow optimisation • elimination of redundancies in data entry • foster openess of products • less problems in interoperability and understanding

6. IHE is based on • Technical framework • The bible for interoperability, the hope for us/vndrs • Connect-a-thon • The real-life test of systems, the hell for products • Demonstration • The show to others, how it works • Integration statements • The advertising to users, enabling understanding • Sucess • The teaching by others

7. IHE Members • Users • Clinicians, Medical Staff, Administrators, CIOs, … • Vendors • Information Systems & Imaging Equipment (80 vendors) • Societies Representing Healthcare Segments • EAR, ECR, ESC, Other Professional Societies… • Governmental agencies • e.g. GMSIH • Active liaison with Standards Development Organizations (SDOs) • HL7, DICOM, ASTM, others …

8. Year n Demo’s Year n-1 Year n Connectathon Year n Goals Year n Trial Implementation Standards’Assessment Year N Technical Framework IHE TF Development Process

9. Paris, Aachen, Padua, Nordwijkerhout 2001 2002 2003 2004 2005 • 2001, Paris, F: • 13 vendors > 20 sys • 2002, Paris, F: • 33 vendors > 60 sys • 2003, Aachen, D: • 47 vendors > 85 sys • 2004, Padova, I: • 49 vendors > 80 sys IHE - Connect-a-thon European Application rather than protocol testing real life

10. IHE - Demonstrations First experiences with IHE-compliant systems during hands-on trials on user congresses F D I UK EUR

11. IHE Integration Statement Vendor Product Name Version Date HugeImaging Medical Systems IntegrateRAD V2.3 12 Oct 2002 Integration Profiles Implemented Actors Implemented Options Implemented Scheduled Workflow ImageManager/Archivee none Image Display Performed Procedure Step Order Filler PPS Exception Management Simple Image and Numeric Report Report Creator none Link to vendor IHE page www.HImedicalsystems.fake/ihe Links to Standards Conformance Statements of the Implementation HL7 www.HImedicalsystems.fake/hl7 DICOM www.HImedicalsystems.fake/dicom/integrateRAD.pdf IHE Integration Statement

12. IHE Europa National initiatives Well established F, D, I, NL, GB In organisation DK, N, E beginning S

13. Technical Framework • Integration Profiles • Practical solutions for daily-work integration problems • Precise definitions of actors and transactions • Exact requirements for open standards • Conversion tables • Defining correspondant fields • Describing characteristics of the fields • Use cases • Depicting daily scenarios for easy understanding

14. TF and IHE Domains • Radiology • Laboratory Medicine • Information Technology Infrastructure • Cardiology • General practicioners • Pathology • Dermatology

15. Integration Profiles • Solving daily life problems by standards • Exactly defining solutions and parts for succeeding in interoperability • Reduce the problem to • actors • transactions therefore making it independent from real world limitations and offering a global strategy for solution

16. Laboratory Scheduled Workflow (LSWF) done in 2003 Laboratory Point Of Care Testing (LPOCT) year 2004 Tests performed by a laboratory for an identified inpatient or outpatient Tests performed on point of care or patient’s bedside Laboratory Patient Information Reconciliation (LPIR) year 2004 Laboratory Device Automation (LDA) year 2004 Pre-analytic process, analysis and post-analytical treatment Tests performed on an unidentified or misidentified patient Laboratory Code Set Distribution (LCSD) year 2004 Sharing the batteries and tests code sets throughout the enterprise Laboratory Medicine 2004-2005

17. Retrieve Information for Display Retrieve Information for Display Cross-Enterprise Document Sharing Access a patient’s clinical information and documents in a format ready to be presentedto the requesting user Access a patient’s clinical information and documents in a format ready to be presentedto the requesting user Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. Consistent Time Coordinate time across networked systems IHE IT Infrastructure 2004-2005 Personnel White Page Access to workforcecontact information Patient Demographics Query Patient Synchronized Applications Synchronize multiple applications on a desktop to the same patient Patient Identifier Cross-referencing for MPI Patient Identifier Cross-referencing for MPI Enterprise User Authentication Provide users a single nameand centralized authentication processacross all systems Map patient identifiers across independent identification domains Map patient identifiers across independent identification domains

18. Radiology 2000-2005 Scheduled Workflow Charge Posting Reporting Workflow Presentation of Grouped Procedures Post- Processing Workflow Patient Information Reconciliation Consistent Presentation of Images Simple Image and Numeric Report Key Image Notes Evidence Document Access to Radiology Information Basic Security

19. Scheduled Workflow Radiology 2000-2005 Charge Posting Reporting Workflow Presentation of Grouped Procedures Post- Processing Workflow Patient Information Reconciliation Consistent Presentation of Images Simple Image and Numeric Report Key Image Notes Evidence Document Access to Radiology Information Basic Security

20. Scheduled Workflow Radiology 2000-2005 Charge Posting Reporting Workflow Presentation of Grouped Procedures Post- Processing Workflow Patient Information Reconciliation Consistent Presentation of Images Simple Image and Numeric Report Key Image Notes Evidence Document Access to Radiology Information Basic Security

21. Problems • It is very hard to get the ball teed-up for the technologist on the modality. • Paper based workflow with data re-entry • Risk of error • Inefficient • Stale information • Changes between time of print and time of data entry • Cancel orders • Generic Order / Order Changes • After the tech wacks the ball, how do I let all systems know where it went. • When are things ready to be read (PACS) • When can things be deleted (Modality) • How do I know what to bill (RIS) • When do I wake up the referring physician

22. Key IHE Concepts • Generalized Systems =>Actors • Interactions between Actors =>Transactions • Problem/Solution Scenarios =>Integration Profiles • 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)

23. The Product World….. HIS ADT Poduct XYZfrom Vendor T MPI

24. The IHE World…. Actor Actor IHETransaction IHETransaction IHE Actor Actor IHE Actor IHETransaction

25. Mapping IHE to Products Actor HIS Actor ADT Poduct XYZfrom Vendor T IHETransaction IHETransaction IHE Actor Actor IHE Actor MPI IHETransaction

26. Report Creator 24: Report Submission Structured Report Export: 28  Report Manager Enterprise Report Repository 25: Report Issuing Report Repository External Report Repository Access 26: Query Reports 27: Retrieve Reports Report Reader Integration Profiles Easy to understand practical solutions for IT integration problems in daily life. Fostering the under-standing between users and vendors

27. Report Creator Report Creator Report Creator 24: Report Submission 24: Report Submission 24: Report Submission Structured Report Export: 28  Structured Report Export: 28  Structured Report Export: 28  Report Manager Report Manager Report Manager Enterprise Report Repository Enterprise Report Repository Enterprise Report Repository 25: Report Issuing 25: Report Issuing 25: Report Issuing Report Repository Report Repository Report Repository External Report Repository Access External Report Repository Access External Report Repository Access 26: Query Reports 27: Retrieve Reports 26: Query Reports 27: Retrieve Reports 26: Query Reports 27: Retrieve Reports Report Reader Report Reader Report Reader Integration Profiles

28. ADT Patient Registration Patient Registration (HIS):ADT Focal Point for Patient Registration Information Order Placer (HIS):Focal Point for Order Management Order Placer Department Scheduler (RIS):Focal Point for Requested Procedure Management Breaks Order into Requested Procedures Schedules Steps for Each Requested Procedure Dept Scheduler Acquisition Modality:Focal Point for Performed Procedure Steps A PPS Tracks One or More Series of Images Image Manager/Archive Image Manager/Archive (PACS) Focal Point for Imaging Study. Manages Images Triggers Reading when All Expected PPS Are Completed Modality Workflow involves several IHE Actors

29. ADT Patient Registration Patient Registration Image Creator Order Placer Storage Commit Image Display Images Stored Filler Order Management Placer Order Management Q /R Key Image Note Present. State Stored Q /R Presentation Sates Q /R Images Department System Scheduler – Order Filler – Key Image Note Stored Image Archive Procedure Update Procedure Scheduled Image Manager Key Image Note Stored Images Availability Query Images Stored Storage Commit Present. State Stored PPS In-Progress / Completed Performed Procedure Step Manager PPS In-Progress / Completed Acquisition Modality PPS In-Progress / Completed Modality Worklist Scheduled Workflow

30. Patient Registration/UpdateOrder Management Worklist Modality Worklist Procedure Scheduled Store Images StorageCommitment Storage Commitment List of Images Modality Performed Procedure Step Performed Step: Status = Completed Performed CT Head Pat Name/ID, Dose, Accession #, Study UID Complete List of Images IHE Scheduled WorkflowThe Connection side RIS PACS &Archive

31. Problems • John Doe Trauma Clean-Up • Recovering after Systems are Down • Error in Manual Entry at Modality • VIP and Getting Married

32. Patient Information Reconcilication ADT Patient Registration Patient Registration Patient Update Image Creator Order Placer Storage Commit Image Display Images Stored Filler Order Management Placer Order Management Q /R Key Image Note Present. State Stored Q /R Presentation Sates Q /R Images Department System Scheduler – Order Filler – Patient Update Key Image Note Stored Image Archive Procedure Update Procedure Scheduled Image Manager Key Image Note Stored Images Availability Query Images Stored Storage Commit Present. State Stored PPS In-Progress / Completed Performed Procedure Step Manager PPS In-Progress / Completed Acquisition Modality PPS In-Progress / Completed Modality Worklist Scheduled Workflow

33. Thank you for your attention !