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The IHE Technical Approach

The IHE Technical Approach. Identify the transactions required to integrate information flow between information systems For each transaction, select a single standard for use in implementing the transaction Specify in detail the use of the standard in implementing the transaction.

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The IHE Technical Approach

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  1. The IHE Technical Approach • Identify the transactions required to integrate information flow between information systems • For each transaction, select a single standard for use in implementing the transaction • Specify in detail the use of the standard in implementing the transaction RSNA 2003

  2. What is IHE? • IHE is a specification of transactions between systems. • IHE describes only integration features. • IHE is not a product itself, but… • IHE is very useful in purchasing products that integrate into workflow RSNA 2003

  3. Integration Profiles-Transactions packaged in solutions- • Coherent functional sets of transactions related to workflow • 46 Rad. + 13 IT transactions grouped into 12 + 5 Integration Profiles • Integration Profiles are the only practical way to communicate integration requirements precisely. RSNA 2003

  4. Laser Printer Level 0: Modalities connected to printer No RIS integration DICOM Basic Print Service RSNA 2003

  5. Laser Printer Level 1: Modalities connected to printer No RIS integration Post-processing workstations IHE Integration Profile: Consistent Presentation of Images Same perception?? RSNA 2003

  6. Grayscale Calibration & Presentation State Area Of Interest Area Of Interest The Technologist’s Transformations Are Saved Flip Zoom Prepared Image Annotate Original Image Original Image Window Level Original Image The Technologist’s Transformations Are Lost Consistent Presentation of Images What the Technologist Displays: What the Radiologist Sees: RSNA 2003

  7. Level 2: Modalities with RIS Connection IHE Integration Profile: Scheduled Workflow (DICOM Modality Worklist) RSNA 2003

  8. Proposed Protocols Loaded and Reviewed Worklist Modality Worklist Patient Name, ID Requested Procedure Examination Type Scheduled Date, Time Scheduled Workflow (Modality Worklist) RIS RSNA 2003

  9. Level 3: Modalities with RIS Connection PACS • IHE Integration Profiles: • Scheduled Workflow (full) • Patient Information Reconciliation • Presentation of Grouped Procedures • Access to Radiology Information RSNA 2003

  10. Patient Registration/UpdateOrder Management Proposed Protocols Loaded and Reviewed Worklist Modality Worklist Pt A, …, SPS=P1, P4 Pt C, …, SPS=P1, P5 Pt B, …, SPS=P2 Pt E, …, SPS=P4 Procedure Scheduled Order Protocol Defined Store Images StorageCommitment Storage Commitment List of Images With Performed Acquisition Protocols Performed Step: Status = Completed Modality Performed Procedure Step Performed Procedure: CT Head Performed Protocol Code=P1 Scheduled Protocol Code=P1, P5 Pat Name/ID, Dose, Accession #, Study UID Complete List of Images Scheduled Workflow RIS PACS &Archive • A Closed Loop • Update Scheduling IS • Match Procedure with Order • Support Billing Based on MPPS • Avoid Reading incomplete Procedures RSNA 2003

  11. Patient Information Reconciliation • Extends Scheduled Workflow • Handles unidentified patient (e.g. trauma) • Handles demographic information mistakes • Propagates changes to all affected systems, updates all affected data • Reduces incorrectly identified or lost studies RSNA 2003

  12. 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 Requested Procedure:CHEST RIS / PACS Requested Procedure:AB/PELVIS RSNA 2003

  13. 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 RSNA 2003

  14. Level 4: More than images: Measurements, Key images, CAD objects • IHE Integration Profiles: • Key Image Note • Evidence Documents • Post-processing workflow RSNA 2003

  15. 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 Radiologist Flags Images: Referring PhysicianSees Key Images First: RSNA 2003

  16. Measurement Templates Header: Thorax Report Type: ….. ….. ….. Mass Findings: (DICOM) SR Object ….. ….. Daim. Infiltr. ….. Image data ….. Image Refs.: (Pointer) from Modality select Coding Schemes Evidence Documents Evidence Creator application RSNA 2003

  17. Work Item Claimed Post-ProcessingWorklist Post-Processing Procedure Step STARTED Measurements CAD Reports ……....……… Post-Processing Procedure Step STARTED Post-Processing Workflowwith Post-Processing Manager Grouped with Image Manager RIS PACS &WF Mgr RetrieveImages Post-Processing Procedure Step COMPLETED Store Reports Archive Documents Post-Processing Procedure Step COMPLETED RSNA 2003

  18. Level 5: Reporting and billing HIS • IHE Integration Profiles: • Simple Image and Numeric Report • Reporting Workflow • Charge Posting RSNA 2003

  19. RIS data Header: Thorax Report Type: ….. ….. ….. Report Creator application Findings: Mass (DICOM) SR Object ….. ….. Daim. Infiltr. Conclusions: ….. Image data from PACS ….. Image Refs: (Pointer) select DICOM: Report Templates Coding Schemes Simple Image and Numeric Report RSNA 2003

  20. Work Item Claimed ReportingWorklist Reporting Procedure Step STARTED Store Report Diagnostic Reports ……....……… Issue Reports Reporting Procedure Step STARTED Reporting Workflowwith Report Manager Grouped with Image Manager RIS PACS &Rep. Mgr RetrieveImages Reporting Procedure Step COMPLETED Reporting Procedure Step COMPLETED RSNA 2003

  21. ADT Terminal CAD *Workstation 3-D *Workstation ReportRepository AcquisitionModality Charge Posting Profile Post Charges Account Management *Billing System Charge Poster Study Performed Report Generated & Signed Materials Used 3-D Performed CAD Performed … RSNA 2003

  22. IHE Integration Statement RSNA 2003

  23. Integrating the Healthcare Enterprise The 2003 Radiology Connectathon: 36 vendors & 77 products IHE is a reality, and it’s here to stay. RSNA 2003

  24. Where Is More Information Available? • www.rsna.org/IHE and www.himss.org/IHE • IHE RAD Technical framework for year 5 – V5.5 • IHE IT Technical framework for year 1 – V 1.0 • Non-Technical Brochures : • IHE Primer and IHE FAQ • IHE Integration Profiles: Guidelines for Buyers • IHE Connectathon Results RSNA 2003

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