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Integrating the Healthcare Enterprise

Integrating the Healthcare Enterprise. Nikolaus Wirsz, PhD Siemens Medical Solutions – IHE Radiology Planning Committee Emmanuel Cordonnier ETIAM – IHE Europe Committee Industry Co-Chairman

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Integrating the Healthcare Enterprise

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  1. Integrating the Healthcare Enterprise • Nikolaus Wirsz, PhDSiemens Medical Solutions – IHE Radiology Planning Committee • Emmanuel Cordonnier ETIAM – IHE Europe Committee Industry Co-Chairman • Minoru Hosoba, PhDKyoto College of Medical Technology – Vice-Chairman of IHE Japan Strategic Planning Committee • Prof. Hee-Joung Kim, PhDYonsei University College of Health Science/Medicine – President of IHE Korea • Prof. David Koff, MDSunnybrook and Women's College, Toronto – IHE Canada Committee • Xinrong Chen et al. Director of IHE China Steering Committee The IHE Initiative Worldwide – An Update

  2. Challenges of Integration • Integration Solutions Available Today fromMedical Systems Vendors – BUT ... • Common Problems of Modern Healthcare Enterprises – in All Countries:(In Spite of IT Standards and Advanced Technology) • Lack of Access to Complete Medical Information • Inconsistent Medical InformationAcross Departments and Institutions • Inadequate Communicating of Medical DataAcross Multiple Systems from Different Vendors • Risky Investments in Proprietary Solutions 2

  3. The IHE Initiative An Incremental Multi-Year ProjectLaunched in 1998 by RSNA & HIMSS • Enhance the Access to Clinical Information • Ensure Continuity and Integrity of Patient Information • Speed Up the Integration in Healthcare Environments • Foster Communication Between Vendors ofMedical Information Technology • Prove that Integration is Attainable Based on Standards • Participants: • Representatives of Healthcare Providers • Information Systems Vendors • Imaging Systems Vendors • Standardization Groups 3

  4. HIMSS / RSNA IHE Kick-Off Workshop October 13-14, 1998 4

  5. International Adoption Germany Holland Norway Canada Taiwan France Korea Japan China Spain Italy UK • Prove of Concept • Connectathons – Cross-Vendor Tests in North-America, Europe and Asia • Demonstrations • 24 Vendors 60+ Vendors • 35 Systems 100+ Systems • IHE Developments • Integration Profiles – Solutions to Real-World Needs & Problems: • Within clinical departments & • Across departmental / institutional boundaries Year 1 (1999) Year 2 (2000) Year 3 (2001) Year 4 (2002) Year 5 (2003) Year 6 (2004) Year 7 (2005) IHE Progress: Year 1 – 7 (1999 – 2005) Pharmacy Pathology Patient Care Devices Patient Care Coordination Radiation Oncology Laboratory Cardiology IT Infrastructure for Healthcare Radiology 5

  6. Billing Workflows Post-Processing Workflow Teaching Files & Clinical Trials Export Manage worklists, track status, perform & notify image processing & CAD steps Standardize Clinical Trial Data and Anonymization Teaching/Trials Contents & Display Common Infrastructure Reporting Workflow Manage worklists, track status, perform & notify diagnostic reporting steps NM Image Create, store, manage, retrieve & use NM image objects IHE Success: Integration ProfilesSolutions to Real-World Problems in Radiology Charge Posting Scheduled Workflow Admit, Order, Schedule Patient Information Reconciliation Collect and post timely billable procedure details Manage worklists, track status, perform & notify acquisition related step, Presentation of Grouped Procs Manage individual procedure image subsets from a multi-procedure acquisition for viewing & reporting Reconcile worklists, status, and data objects for unknown patients and demographics changes create, store, manage, retrieve & use images Consistent Presentation of Images Simple Image and Numeric Reports Evidence Documents Key Image Notes Manage, retrieve & use objects to record study evidence Create, store, manage, retrieve & use objects to flag significant images Manage simple diagnostic reports with optional images, measurements Manage, retrieve & use objects for hardcopy and softcopy grayscale presentation states XDS for Imaging - Sharing of Imaging Information across health enterprises Access to Radiology Information -Consistent access to images and reports Portable Data for Imaging - Consistent access to images and reports on CD Media ITIATNA – Radiology Option (Replaces Basic Security) 6

  7. Integration is Needed Everywhere • Integration, Interoperability and Workflow Optimization are Global Issues NOT Local Needs • IHE has had an international vision from the beginning • IHE is promoting its adoption worldwide • IHE encourages the formation of national and regional initiatives to address local healthcare needs 7

  8. International Scope of the IHE Initiative • Providing a Global Integration Framework: • Identify Common Integration Requirements • Define Generic Solutions (Integration Profiles) to Solve Real-World Problems • Specify the Details for Implementing the IHE Solutions • Selection of Established Standards for Specifying Systems Functionality and Transactions for Information Exchange (e.g. DICOM, HL7, …) • Providing a Generic Technical Framework to Address the Vast Majority of Implementation Issues 8

  9. National Scope of the IHE Initiatives inNorth America – Europe – Asia • Address Specific Needs of National Healthcare Systems According to: • Local Policies and Practices • Support for Native Languages • National Reimbursement Procedures • Manage Regional Cross-Vendor Tests (Connectathons) • Organize Demonstrations at National Venues • Promote IHE User Success Stories of Local Sites • Organize Educational Events to Raise Awareness and Acceptance of IHE 9

  10. The IHE Radiology Technical Framework Addressing Global & National Integration Needs • Common Definitions – Overall Integration in Healthcare: • High-Level Description of Integration Profiles – Volume I • Detailed Implementation Specification – Volumes II and III • National Extensions – Volume IVExamples: • Character Sets for National Languages • Extensions of Patient and Provider Information According toNational Policies (Privacy, Confidentiality, …) • Financial Information and Transactions forSpecific National Health Reimbursement System • Clinical Workflow Optimization and Information Access toSupport National Care Practices and Policies 10

  11. IHE (International) Strategic Development Committee Global Development Regional Deployment IHE North America IHE Asia-Oceania China Japan Radiology IT Infrastructure Laboratory Canada USA Korea Taiwan Cardiology Patient Care Coordination Pathology IHE Europe Radiation Oncology Patient Care Devices Pharmacy / Medication Admin Netherlands France Germany Italy Spain UK Norway Sweden Professional Societies / Sponsors Contributing and participatingVendors ACCHIMSSRSNA GMSIH SFRSFIL COCIR EAR-ECR DRG SIRM BIR EuroRec ESC JAHISJIRAJRS METI-MLHW MEDIS-DCJAMI IHE Organizational Structure 11

  12. Updates from National IHE Initiatives • IHE Asia / Oceania • IHE China • IHE Japan • IHE Korea • IHE Europe • IHE North America • IHE Canada 12

  13. IHE Activities in China Xinrong Chen – Director of IHE China Steering Committee Qiyong Fan – Director of IHE China Planning Group Guokang Zhong – Director of IHE China Project Group Tianzhen Shen – Director of IHE China Auditing Group

  14. Why IHE in China • Healthcare IT – a huge market to be activated in China • Standards are especially important for all players in this domain • IHE is very useful for end users to do benchmarking while selecting products • IHE brings standards to the market • China market needs IHE in Radiology, Cardiology, Laboratory, Patient Care, Pathology etc. now. 14

  15. IHE China Year 1 (2005) Review • Establishing IHE China • 2004.08.19 – First Meetingfor Establishing IHE China • 2004.08.31 – Second Meetingfor Establishing IHE China • 2004.09.15 – Third Meetingfor Establishing IHE China • 2005.06.28 – IHE China Inaugural Meeting 15

  16. IHE China Organization 16

  17. Planned activities in IHE China Year 2 (2006) • Education Workshop (February, 2006) • Participant Workshop • Mesa Tests • Scheduled Workflow • Connectathon 17

  18. Support from industry in IHE China 18

  19. Activity of IHE-Japan Minoru Hosoba Ph.D. Kyoto College of Medical Technology Vice-Chair, IHE-J Strategic Planning Committee

  20. IHE-J • Japanese Extension of the Technical frameworks (Radiology ) based on: • JIRA &JAHIS JJ1017 Guideline ver.3.0 • Adopted JJ1017 ver.3.0 code • Descriptive code. 32 byte-coding system. • Expantion of Technical frameworks in new domain • Scheduled workflow profiles for endoscopic and pathologic exams are being developed • Integration Profiles for Cardiology and IT infrastructure are being studied and reviewed if it might be applicable to clinical sites in Japan 20

  21. IHE-J (continued) • Connectathon 2005 • Feb. 22 and 25 • 25 companies and 48 systems participated • Demonstration 2005 • Radiological field (CyberRad at JRC) • Medical informatics field (Hospital show and JAMI) • Implementation of IHE in hospitals in Japan • Publication of guide book"Introduction to IHE" • April,2005, 245 pages 21

  22. Endoscopy Scheduled Workflow (Draft Aug. 2005) ADT Pt.Registration Pt.Registration Pt.Update Pt.Update Patho Order Placer ①Placer Order Management Order Filler Order Placer Filler Order Management Image Availability Query Patho Order Request・Patho Order No. Procedure Scheduled Pt.Update Image Creator Patho Order Filler Accept specimens PPS Creator PPS IHE Pathology Storage Commitment Creator Image Stored Query Images Image Display Image Manager Image Archive PPS Manager PPS Storage Commitment Modality Image Stored Modality Worklist Provided Blue: HL7 Messages Green: DICOM Messages Acquisition Modality Modality Worklist Provided Modality PPS Retrieve Images PPS Patho Order Request. Specimen Manager Image Display Order Manager Report Creator Patho Order No. Order of Endoscopy accepted Report Manager Check images Ready Reporting finish Report Repository Endoscopy Reporting WF Report Reader 22

  23. IHE-J Connectathon 2005 • Feb. 2004: 20 companies and 33 systems participated • Feb. 2005: 25 companies and 48 systems participated • Jan. 2006: 29 companies and 60 systems will participate 23

  24. IHE-J Demonstration Guided Tourin CyberRad2005.4.8-10 24

  25. IHE-J Implementations • Saitama Medical Center: March 2005 • Fujita Health University Hospital: April 2005 • Okazaki City Hospital: January 2006 • National Institute of Radiological Sciences (NIRS) Hospital: April 2006 25

  26. Thank You For more informationhttp://www.ihe-j.org • Dec.2005, the web site renewed • Japanese version, English version • Contents: • Schedule of the Meeting, Demonstration, Workshop etc. • Documents (Technical framework, Integration profiles, etc.) • Streaming video (The introduction to IHE) 26

  27. IHE-KR Year2 IHE Korea Hee-Joung Kim, Ph.D. (hjkim1@dragon.yonsei.ac.kr) Yonsei University

  28. IHE-KR Foundation Inaugural General Meeting LG-POSCO, Korea Univ. (06/25/04) President of IHE-KR Hee-Joung Kim President of KSOMI President of KPACS URL for IHE-KR http://www.ihekorea.org 28

  29. IHE-KR Org 총무이사Infinitt 최승욱 이사 재무이사 한국의학물리학회 총무이사 홍보이사Marotech 이진형 실장 대한의료정보학회 총무이사 대한PACS학회 총무이사 무선의료정보포럼 부회장 서울대 이경호 교수 LG CNS 손주영 수석 Samsung SDS 조성돈 수석 GE Healthcare 윤영욱 부장 Medical Standard 이원용 실장 위원장 연세대 정해조 부위원장 경북대 조 훈 경북대 김일곤 Infinitt 최승욱 LG CNS 황용돈 Samsung SDS 김도준 GE Healthcare 황용기 Marotech 이진형 중외메디칼 김한명 사이버메드 허원창 메드벤 고명자 루벤틱스 김태호 서울 C&J 권대근 현대정보기술 구전서 아그파 고희관 리스템 민진영 Technical Manager 연세대 강원석 29

  30. IHE-KR Yr2 (2005) IHE Korea 05 Workshop - 07/08/04 Submission of MESA Test Results - 11/05/05 IHE-KR 05 Connectathon - 11/11/05 IHE-KR 05 Demo at KSOMI - 11/18/05 30

  31. IHE-KR Yr2 Workshop (2005) 31

  32. IHE-KR Yr2 Connectathon SCENARIO Radiographic Room #1, 2 Patient #1: A man (Min-Soo Kim), 35 years old with no known medical problems and in good health, unfortunately, had broken his left ankle and femur due to an auto-accident at the road. He underwent orthopedic treatment at the Y hospital. After treatment, physician orders X-ray with code of “Ankle lateral” and “Femur AP” in order to follow up. Radiographic Room #3 Patient #2: A man (Kil-Dong), 48 years old with hepatitis, attended the Y hospital due to indigestion and icterus. Physician suspects the liver cirrhosis and orders an ultrasound examination with code of “Liver Ultrasound”. 32

  33. IHE-KR Yr2 Connectathon SCENARIO Radiographic Room 1 Radiographic Room 2 Radiographic Room 3 Modality (DX) Choong-Wae Medical Co. Modality (DX) Phoenix Vision Modality (US) Medison DICOM MWL DICOM MPPS DICOM Storage DICOM Storage Commitment DICOM MWL DICOM MPPS DICOM Storage DICOM Storage Commitment DICOM MWL DICOM MPPS DICOM Storage DICOM Storage Commitment PACS Room Image Mgr./Arch. MPPS Manager Order Filler (Sim.) Infinitt Technology DICOM Retrieve DICOM Query Image Display Mevisys Y Hospital Reading Room 33

  34. IHE-KR Yr2 Connectathon (2005) 34

  35. Results: IHE-KR Connectathon 2005 35

  36. ◈ Logo ◈ Homepage www.ihekorea.org 36

  37. IHE-Europe Report Emmanuel Cordonnier IHE-Europe Vendors co-chair emmanuel.cordonnier@etiam.com

  38. Expanding IHE in Europe • France, Germany, Italy, UK « running for years » • Real start of Netherlands and Spain • Norway starting • Demand from other Scandinavian countries, Portugal and European East Countries 38

  39. Official recognition of IHE in Europe • More and more national initiatives are referring to IHE: Italian Regional projects and National French projects… • Submission of an European research project « IHE Standardization of Health Care information sharing crossing borders between European clusters, region and languages » • Citation of IHE in the eHealth Forum initiative driven by the European Commission 39

  40. Evolution of organization • Creation of official organizations (associations) in Germany, Italy and Spain • Replacement of Geerd Claeys – Agfa - (thanks to him) by Emmanuel Cordonnier – Etiam (/ Peter Kuenecke – Siemens after 12 months) • Proposal made by INRIA (3,500 employees) French research organization to consolidate IHE Europe management and working force 40

  41. Participation to Technical Framework • Leadership of IHE Laboratory (4 new profiles) • Key contribution to IHE Cardiology – success of demo at ESC Stockholm • Launch of IHE Pathology (France & Spain) • Active contribution to IT Infrastructure Patient Administration Management (PAM) • Launch of European contribution to PCC • Emergence of IHE Pharmacy 41

  42. 2005 Connectathon • Well organized by IHE Netherlands in Noordwijkerhout (don’t try to pronounce it!) • 62 companies, 98 + 1 + 2 systems • 230 engineers (average of 210 per day) • 15 project managers (including Steeve & Bill) • Success of XDS (with off-line mode and Atna) • 30 workflow tests (10Radio, 7XDS-PIX, 2Lab, 4Cardio, 4UK), 1600 tests (1227 verified) 42

  43. IHE-Europe 2006 • The « Spain » year: workshop (February) and Connectathon (April) in Barcelona • Launch of cooperation with INRIA (6 months to define a cooperation agreement of stop) • Closer cooperation with European Commission and CEN (in PCC for example) • Contribution to IHE TFs (Lab, Pathology, PCC, ITI peer to peer exchange…) 43

  44. Integrating the Healthcare Enterprise IHE Canada Achievements 2005 David Koff MD

  45. IHE Canada Founding Participants Update (Feb/05): AITS (Association de l’industrie des technologies de la Santé) joins IHE Canada 45

  46. IHE Canada structure • IHE Canada activities are coordinated by a Strategic Steering Committee • Supported by several sub-committees: • Communication • Radiology • IT Infrastructure • Relies on volunteers from all healthcare sectors • Vendors • Users • Administrators • Government 46

  47. Goals of IHE Canada • Improve the efficiency and effectiveness of clinical practice • Foster collaboration among vendors, purchasers and providers • Promote and accelerate interoperability across healthcare domains and build foundation for the EHR • Demonstrate that system integration within and across healthcare enterprises is attainable when based on implementable standards • Educate stakeholders on the benefits of adopting standards-based solutions • Develop Canadian extensions to IHE integration profiles • Participate and possibly lead the definition of new IHE specifications 47

  48. National EHR • Important complement to Infoway activities and the Pan-Canadian standards initiatives by: • Ensuring completeness and eliminating ambiguities on specifications • Demonstrating applicability and usability of interoperability profiles • Promoting international awareness of requirements for a national EHR 48

  49. National Extensions • Character sets for National Languages • Extensions of patient and provider Information to support EHRS requirements (Privacy, Confidentiality, Unique Patient ID…) • The National Extensions are ready to be submitted to IHE global for inclusion in Part IV of the Technical Frameworks. 49

  50. XDS-I • All jurisdictions across Canada recognize the necessity and benefit of sharing imaging information among healthcare professionals. In addition, there is wide acceptance that DI information is seen as a core data component of the electronic health record. 50

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