Integrating the Healthcare Enterprise

1. Integrating the Healthcare Enterprise Transforming the Radiologic Interpretation Process (TRIP™) Using IHE™ • Sanjay Jain, Kevin O’Donnell, Dave Channin • IHE Radiology Planning Committee

2. Disclaimers • Sanjay Jain is an associate of Cerner Corporation • Kevin O’Donnell is an employee of Toshiba America Medical Systems • Dr. Channin, Northwestern Radiology, receives a portion of his research funding from GE Medical Systems RSNA 2003

3. What is TRIP™? • An initiative of the Society for Computer Applications in Radiology (SCAR) • Supported by RSNA and IHE™ • Radically change the way we think about the radiology process given the ‘digitization’ of radiology, and the role of technology in delivering healthcare RSNA 2003

4. Why is this important? Application of technology Can: • Reduce Errors and/or Delays in Treatment • Provide complete Information for Decision-making • Improve efficiencies in Utilization of Staff and Equipment RSNA 2003

5. This is healthcare This is your healthcare provider in healthcare Any Questions? RSNA 2003

6. What’s driving the Rat Race? • Volume of procedures is growing • New procedures / modalities • New uses for existing technologies • Aging population • Size and complexity of studies is growing • Implications for technology, but… • More important implications for human interpretation • Data set navigation • Timely delivery of radiologist value-add back to referring physician • Shortage of radiologists and technologists RSNA 2003

7. Why Does Anything in Radiology Matter? • Improve service to patients • Improve service to referring physicians • Improve efficiency and workflow • Enhance the academic mission • Modernize information systems RSNA 2003

8. How Can IHE™ Help? • Integrating the Healthcare Enterprise is an initiative to: • 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 • Yes, but… what does IHE™ really do to help? RSNA 2003

9. The IHE™ Process – Integration Profiles IHEConnectathon IHEDemonstration Product With IHE Easy to Integrate Products IHETechnicalFramework IHE Integration Profiles: • Detailed selection of standards and options each solving a specific integration problem • A growing set of effective provider/vendor agreed solutions • Vendors can implement with ROI • Providers can deploy with stability Standards IHEIntegration Profiles B IHEIntegration Profile A User Site RFP RSNA 2003

10. IHE™ Integration Profiles • 12 Profiles in Radiology • 5 Profiles in IT Infrastructure • 1 Profile in Lab • (Complex, problematic) workflow processes that involve cooperative manipulation of healthcare information by various information systems RSNA 2003

11. IHE™ Success – Radiology Profiles Scheduled Workflow Charge Posting Presentation of Grouped Procedures Reporting Workflow Post-Processing Workflow Patient Information Reconciliation Simple Image & Numeric Reports Consistent Presentation of Images Evidence Documents Key Image Notes Access to Radiology Information Basic Security RSNA 2003

12. Consider the ‘Workflow Profiles’ • Scheduled Workflow • Efficient, integrated acquisition • Post-Processing Workflow • Efficient, integrated 2D, 3D and CAD • Reporting Workflow • Efficient, integrated reporting RSNA 2003

13. Commonalities • Generate a work list of work to be done • Claim work list items (with pointers to inputs) • Do the work • Tell what you did and when you are done • Loop closure (for local or distributed workflow) • Positive hand-offs • Efficient, error-resistant operations RSNA 2003

14. Now Add… • Assisted Protocol Option to SWF • Decreased variance in performance of procedures • Procedure tailoring only when it makes clinical sense • Patient Information Reconciliation Profile • Manage information gaps & recovery • Unavailable computer systems (downtime) • Unknown patients (trauma, Doe, VIPs) • Operator errors RSNA 2003

15. That cover’s the basics;Now,How do we kick it up a notch?! RSNA 2003

16. IHE™ Success – Radiology Profiles Scheduled Workflow Charge Posting Presentation of Grouped Procedures Reporting Workflow Post-Processing Workflow Patient Information Reconciliation Simple Image & Numeric Reports Consistent Presentation of Images Evidence Documents Key Image Notes Access to Radiology Information Basic Security RSNA 2003

17. Make the radiologist more productive on the PACS workstation • Use Key Image Notes to ‘filter’ ‘significant images’ for referring physicians, QA, teaching, etc. • Use Evidence Documents to capture measurements, procedure logs & CAD results as structured study data and feed into reporting system. • Generate Simple Image and Numeric Reports in DICOM S/R; avoid dictation (even voice recognition) whenever possible. RSNA 2003

18. And then, Another Notch!! RSNA 2003

19. Retrieve Information for Display Retrieve Information for Display Enterprise User Authentication Enterprise User Authentication 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 Patient Synchronized Applications HL7 CDA / PDF / JPEG HL7 CCOW Synchronize multiple applications on a desktop to the same patient Provide users a single nameandcentralized authentication processacross all systems Provide users a single nameandcentralized authentication processacross all systems Patient Identifier Cross-referencing for MPI Patient Identifier Cross-referencing for MPI Consistent Time Consistent Time Coordinate time across networked systems Coordinate time across networked systems Map patient identifiers across independent identification domains Map patient identifiers across independent identification domains HL7 2.x ADT Triggers / Queries NTP (RFC 1305) Kerberos (RFC 1510) / HL7 CCOW IHE™ ITI Integration Profiles RSNA 2003

20. Use the IT Infrastructure Profiles • Use Retrieve Information for Display (RID) • Facilitate access by radiologist to EMR details • (ARI Profile facilitates access to radiology information) • Use Patient Synchronized Applications (PSA) • Share context with other applications that radiologist needs • Enterprise User Authentication (EUA) • Provides for single sign-on • Patient Identifier X-ref (PIX) • Allows radiologist to access information across multiple enterprises RSNA 2003

21. Conclusion • IHE™ provides a platform upon which to build new concepts to transform the radiologic interpretation process (TRIP™) • With integration reliably distributing relevant information, Vendors can compete on providing new features and functionalities to make radiologists much more efficient RSNA 2003

22. More information… • SCAR / TRIP™ • www.scarnet.org • IHE™ • www.rsna.org/ihe • www.himss.org/ihe • IHE Rad Technical Framework for Year 5 - V5.5 • IHE IT Technical Framework for Year 1 - V1.0 • IHE Lab Technical Framework for Year 1 (Public Comment) • Non-Technical Brochures : • IHE Fact Sheet and IHE FAQ • IHE Integration Profiles: Guidelines for Buyers • IHE Connectathon Results • Vendor Integration Statements RSNA 2003