Integrating the Healthcare Enterprise - IHE

1. Integrating theHealthcare Enterprise - IHE An initiative of the ACC to improve data interoperability

2. Why IHE? • Cardiology has hardsystem anddata integration problems • Multiple locations (office, in-patient, ED …) • Multiple devices and modalities • Long term patient care by many care providers • Data integration is essential to quality patient care • Care providers must work with industry to develop solutions to meet their needs • Implementations must be based on open standards ACC Scientific Sessions

3. Goals of IHE • Advance standards-based healthcare data integration • Improve clinical and administrative workflow • Improve data flow – where it’s needed, when it’s needed • Improve the efficiency and effectiveness of clinical practice ACC Scientific Sessions

4. What is IHE? • A collaboration of clinicians and vendors • International and multi-specialty • A proven systems integration process • Refined through seven years of experience • Produces results on a yearly cycle • Problem identification, Technical specification, Vendor implementation, Test, Demonstration • Yearly cycle focuses on most important tractable problems ACC Scientific Sessions

5. Who is IHE? • IHE is a joint initiative of: • American College of Cardiology (ACC) • Radiological Society of North America (RSNA) • Healthcare Information and Management Systems Society (HIMSS) • Vendors/manufacturers in major supporting role • Local sponsorship internationally • IHE-Europe and IHE-Asia/Oceania • IHE-Cardiology additional participating societies • ASE, SCAI, ASNC, and more • IHE-Cardiology in Europe sponsored by European Society of Cardiology (ESC) ACC Scientific Sessions

6. IHE EHR - Longitudinal Record IHE Cardiology IHE Clinical Domains IHE EHR - Longitudinal Record IHE Cross - Enterprise IT Infrastructure Intra - Enterprise IHE IHE 9 Integration Profiles Radiology Cardiology 14 Integration Profiles 3 Integration Profiles IHE IHE Future Domain IHE Radiation Oncology Laboratory 5 Integration Profiles Cardiology leverages the work of the other domains Cardiology contributes to the Electronic Health Record • Being specified in IHE IT Infrastructure domain ACC Scientific Sessions

7. Cardiology and the Electronic Health Record • ACC Vision of the Electronic Health Record (1999) • “The Digital Integrated Cardiac Record” • All care areas • Across organization boundaries • EHR is a key area of IHE development • XDS – HIMSS 2005 • To play in the EHR, data must be managed and properly identified • So, this is where we started in Year 1 of IHE-Cardiology – lay the foundation ACC Scientific Sessions

8. IHE Cardiology – the Cath Lab example 5 6 7 3 4 2 1 (A) room for improvement ! ACC Scientific Sessions

9. IHE Annual Cycle – Step 1 • Cardiologists identify clinical problems to be addressed -“Integration Profiles” • Engineers from vendors collaborate to define technical specification (using standards such as DICOM and HL7) • Vendors implement the technical specification and participate in the “Connectathon” and demos • Vendors publish IHE Integration Statements, and users can buy IHE systems ACC Scientific Sessions

10. “I need to see the ECG!” Clinical Problem: • Diagnostic quality ECGs needed everywhere IHE Tasks: • Simple and fast access • Ubiquitous (Web based) communication • Integrated into other software systems Retrieve ECG for Display Integration Profile ACC Scientific Sessions

11. “Could you do a TTE on this patient right now since you are in the CCU anyway?” Clinical Problems: • Lost and unbilled echo exams because carts are constantly on the move • Patient and order info manually entered (potential for errors) or not at all • Stress echo image ID inconsistent across vendors IHE Tasks: • Accurate and automatic demographic and order reconciliation • Verify all images are securely archived • Accurate display of Stress Images Echocardiography Workflow Profile ACC Scientific Sessions

12. “There is a patient being brought up to cath from the ER…” Clinical Problems: • Need to enter patient and procedure information into multiple systems in cath lab • No order created; emergent case (unidentified patient) • Change of rooms during procedure – data scattered • Inconsistently time-stamped events IHE Tasks: • Automate download of patient info to all systems • Accurate and automatic patient demographic and order reconciliation • Verify all data is securely archived in single “folder” • All data consistently time-stamped Cardiac Catheterization Workflow Profile ACC Scientific Sessions

13. IHE Annual Process – Step 2 • Cardiologists identify clinical problems to be addressed - “Integration Profiles” • Engineers from vendors collaborate to define technical specifications (using standards such as DICOM and HL7) • Vendors implement the technical specification and participate in the “Connectathon” and demos • Vendors publish IHE Integration Statements, and users can buy IHE systems ACC Scientific Sessions

14. IHE Annual Process – Step 3 • Cardiologists identify clinical problems to be addressed - “Integration Profiles” • Engineers from vendors collaborate to define technical specification (using standards such as DICOM and HL7) • Vendors implement the technical specification and participate in the “Connectathon” and demos • Vendors publish IHE Integration Statements, and users can buy IHE systems ACC Scientific Sessions

15. IHE Joint ConnectathonJanuary, 2005Oak Brook, IL • 300 engineers • 43 companies • 110 products Working together in a collegial environment 2800 monitored test cases executed in 5 days This is integration that doesn’t take up your hospital’s resources –and no finger-pointing! ACC Scientific Sessions

16. IHE Annual Process – Step 4 • Cardiologists identify clinical problems to be addressed - “Integration Profiles” • Engineers from vendors collaborate to define technical specifications (using existing standards such as DICOM and HL7) • Vendors implement the technical specification and participate in the “Connectathon” and demos • Vendors publish IHE Integration Statements, and users can buy IHE systems ACC Scientific Sessions

17. Your Request for Proposals (RFPs) • Incorporate IHE framework into RFP documents & product selection • Much easier to specify an IHE Integration Profile than detailed technical specs • Use IHE framework to evaluate your current workflow, even if not buying now • Vendors build product functions that are requested by customers Ask for IHE Integration Loud & Often !! ACC Scientific Sessions

18. Year 1(2005) Year 2(2006) Year 3(2007) Year 4(2008) Year 5(2009) Multi-modality workflow & imaging Procedure log &reporting Hemo waveform & measures, QCA/QVA Supplies, inventory,& charge capture Precision timesynchronization Cardiology Technical Framework Cath Workflow & imaging,stress protocols Reporting workflow Measurementinteroperability Pediatric Echo Retrieve ECGfor display ECG/Stress/Holterorders ECG waveform interoperability ECG Stress testing workflow Workflow & imaging,stress protocols Reporting workflow Nuclear Multi-modality labworkflow & reporting Implantable device parameters & events Home healthmonitoring EP Workflow, reporting,& measurements MR/CT Retrieve guidelinesfor display Registry dataharvesting Retrieve structuredguidelines Quality Long Road Ahead – 5 yr Roadmap ACC Scientific Sessions

19. Commitment to EHR David J. Brailer, MD, PhD National Coordinator for Health Information Technology, US Department of Health and Human Services (HHS) Directive: Execute the Presidential Order for widespread deployment of Health Information Technology within 10 years. “The capacity to share clinical data is generally not available in the market, and I have placed a high priority on ensuring that it does come to exist before widespread EHR adoption is underway.” “IHE… is becoming the obvious thing to do. It is our goal to make it the inevitable thing to do.” HIMSS Conference, February 2005 ACC Scientific Sessions

20. This is healthcare This is the cardiologist in healthcare Why IHE? Any Questions? ACC Scientific Sessions

21. Why IHE? (for vendors) • Custom integration at customer site is a lose-lose • High cost – vendor and customer • Unpredictable and uncontrolled environment • Inefficient – solutions often must come from other locations (home office) with delays in delivery • Usually insufficiently documented – fragile and unmaintainable solutions • Resources expended on non-value-add effort • Ineffective use of available standards • Bolt-on integration is a problem • Data sharing functions don’t work well if not designed into the product • Exponential growth of pain as systems are added ACC Scientific Sessions

22. Goals of IHE (for vendors) • Effective use of standards • Reduce variability in interfaces • Controlled integration testing environment • Defined timetable • No extraneous distractions • Effective use of resources for integration testing • Coordinated deployment of cross-system functions • Avoid chicken-and-egg syndrome • Common approach creates the market in which vendors can sell and users can buy with confidence ACC Scientific Sessions

23. IHE Benefits(Vendors) • Improves onsite customer support • Reduces development cost • Standardizes interface engineering • Enables the vendors to focus on competitive features • Improves customer satisfaction ACC Scientific Sessions

24. Four Clinical Scenario Demonstrations Clinical Scenario Demonstrations: • Cath/ECG: Emergent Angioplasty • Cath/ECG: Change of Rooms • Echo/ECG: “Add on” Mobile Procedure • Echo/ECG: Stress Echo Images Watch us “connect the docs”. ACC Scientific Sessions