Integrating the Healthcare Enterprise

1. Integrating the Healthcare Enterprise Key Image Notes Simple Image & Numeric Report Evidence Documents Sanjay Jain Co-Chair, Radiology Planning Committee IHE Interoperability Workshop

2. Value Proposition • Share diagnosis, reports and images • Standard mechanism to communicate with the referring physicians • Enable Automated handling based on coded data • E.g. Routing • Mammo Follow-up and checking • Clinical trials • Avoid dependence only on memory • Paper, audio .. • Data mining IHE Interoperability Workshop

3. Don’t Call Us, We’ll Call You • “Dave, you read that 3000 slice MR study last night. Can you highlight the 5 most important images for me” • Thinking… “#$@%!%# You”, says “Sure” • “Dr. Channin, I just reviewed 40 cases and marked my questions on yellow stickies. Can you review those” • Tech to radiologist: “The patient wouldn’t hold still” The solution is…… IHE Interoperability Workshop

4. IHE Radiology Integration Profiles Charge Posting Presentation of Grouped Procedures Reporting Workflow KeyImageNotes Simple Image & Numeric Reports NMImage Consistent Present-ation of Images EvidenceDocs Access to Radiology Information Portable Data for Imaging Scheduled Workflow - Patient Info. Recon-ciliation Post-Processing Workflow Basic Security IHE Interoperability Workshop

5. for referring physician Here you can see the renal osteopathy. For teaching Fibroosteoclasia IHE Interoperability Workshop

6. Note3 Note1 Note2 for referring physician Here you can see the renal rupture. for referring physician This is the hematoma. for referring physician Hematoma everywhere Note1 Note2 for refering physician This is the hematoma. for refering physician Here you can see the renal rupture. Note3 Note3 Note3 Note3 for refering physician Hematoma everywhere for refering physician Hematoma everywhere for refering physician Hematoma everywhere for refering physician Hematoma everywhere Different notes on different images Same note on different images IHE Interoperability Workshop

7. Key Image Notes Titles are Coded Codes Of Interest Rejected for Quality Reasons For Referring Provider For Surgery For Teaching For Conference For Therapy For Patient For Peer Review For Research Reporting (CP in ballot) Quality Issue Defined by DICOM Supplement 59. May be extended The note title defines the semantics of the reason of significance. Key Image Notes can be queried by code. The user comments are meant to be informal. IHE Interoperability Workshop

8. Key Image Notes • There is more to teamwork than images and reports • With IHE, it is possible to attach « electronic post-it™ » to images to increase informal but critical communication between: • The Technologist and the Radiologist about specific examination events • The Radiologist and the Technologist about image quality issues • The Radiologist and other department clinicians (surgeon, orthopedist,..) • The Radiologist and collegues about selecting images for conferences • The Radiologist to the Referring Provider, …..etc. • Query for the Images/Studies using the codes • This IHE Integration Profile is the cost effective solution (increases radiology and overall efficiency) IHE Interoperability Workshop

9. Evidence Documents Header: Report Type: OB / Gyn ….. BPD Findings: ... ….. Query / Retrieve Image Refs.: Evidence Document Stored Storage Commitment IHE Interoperability Workshop

10. Evidence Documents • Measurements and coded data • DICOM SR document • Created by either Acquisition Modality or Evidence Creator • Produced during acquisition or post-processing workflows • Interpreted along with the images IHE Interoperability Workshop

11. Evidence Documents Examples • Mammography CAD • Chest CAD • OB-Gyn Ultrasound Measurements • Vascular Ultrasound Measurements • Vascular Intervention Results • Echocardiography Measurements IHE Interoperability Workshop

12. Header: Report Type: OB / Gyn Radiology Report Header: ….. BPD BPD Report Type: OB / Gyn Findings: ... ... ….. ….. ….. Findings: Gestational Impressions: Age ... Image Refs.: Image Refs.: Evidence Documents Simple Image & Numeric Report Interpretation Key Image Notes IHE Interoperability Workshop

13. Can You Make A Report Like This? Institution Identification Patient Identification Study Identification Technique Identification Discussion The liver is normal. There is a focal area of decreased attenuation adjacent to the falciform ligt., likely representing focal fat (image 22). The spleen, both kidneys, the … are normal. Impression CT of the abdomen within normal limits Signature The solution is…… IHE Interoperability Workshop

14. (We can’t either). What about? Discussion Comparison is made to the prior study of 4/11/99. The left paratracheal lymph node (image 8, image 11) now measures 2.5x2.7x3.1 cm increasing from 2.0x2.1x2.6 previously. No other mediastinal, upper abdominal or axillary adenopathy is identified. No focal pulmonary lesions are seen. The yadda, yadda, yadda are normal. Impression Worsening L Paratracheal adenopathy. Signature IHE Interoperability Workshop

15. IHE Radiology Integration Profiles Charge Posting Presentation of Grouped Procedures Reporting Workflow KeyImageNotes Simple Image & Numeric Reports NMImage Consistent Present-ation of Images EvidenceDocs Access to Radiology Information Portable Data for Imaging Scheduled Workflow - Patient Info. Recon-ciliation Post-Processing Workflow Basic Security IHE Interoperability Workshop

16. Simple ImageandNumeric Reports IHE Interoperability Workshop

17. Simple Image& NumericReports • Based on DICOM SR • Allows to include without transcription:- measurements- image links- structured content • Integrated with the imaging workflow • Friendly to XML implementations • Easy to export to the EPR (HL7) IHE Interoperability Workshop

18. Pattern – Simple Image Report • Minimal Structure : Coded Title and Headings • Full image links from specific sections of report • Observation Context (who, what, when) may be section specific IHE Interoperability Workshop

19. Pattern – Simple Image & Numeric Report Simply adds Measurements to Simple Image Reports IHE Interoperability Workshop

20. An Illustration Chest, PA & Lateral (GCS,T78) Dr Andrew Smith……. George Jones…... Procedure PA and Lateral radiographs were ……. Findings The PA demonstrates ... A small opacity is visible in the base of lung in lateral view. Image 32 CT recommended. Conclusions Possible Mass (ICD,XXX) IHE Interoperability Workshop

21. Simple Image and Numeric Report • Reports’ content is more than words….. • SINR is the Output of Interpretation, while Evidence documents are Input for Interpretation • With IHE, it is possible to add value to reports/preliminary reports by organizing content • This IHE Integration Profile is the cost effective solution to sharing reports and enabling content processing applications (increases radiology efficiency) IHE Interoperability Workshop

22. More information…. • IHE Web sites: http://www.himss.org/IHE http://www.rsna.org/IHE http://www.acc.org/quality/ihe.htm. • Technical Frameworks: • ITI V1.0, RAD V5.5, LAB V1.0 • Technical Framework Supplements - Trial Implementation • May 2004: Radiology • August 2004: Cardiology, IT Infrastructure • Non-Technical Brochures : • Calls for Participation • IHE Fact Sheet and FAQ • IHE Integration Profiles: Guidelines for Buyers • IHE Connect-a-thon Results • Vendor Products Integration Statements Questions? IHE Interoperability Workshop