Integrating the Healthcare Enterprise - IHE

1. Integrating the Healthcare Enterprise - IHE

2. Who is IHE? • IHE is a joint initiative between: • American College of Cardiology (ACC) • Radiological Society of North America (RSNA) • Healthcare Information Management Systems Society (HIMSS) • GMSIH, HPRIM, JAHIS (laboratory) • American Society of Opthamology • And many more…. • Began in 1997 in Radiology and IT • International effort: IHE- Europe and IHE-Japan • Within IHE-Cardiology additional sponsors including ASE, ESC, SCAI, ASNC, and more ACC meeting

3. What is IHE? • IHE is a systems integration process • Develops a detailed document called the “Technical Framework” • Incorporates and refines existing standards such as DICOM and HL7 • Consists of a Planning Committee and a Technical Committee of cardiologists and vendors • Goal: Effective inter-vendor communication ACC meeting

4. IHE shares technology IHE Cardiology inherits technology from IHE Radiology and IHE IT: • Network and Node Security • User Authentication • Scheduled Workflow • Image Display and Archiving • Procedure status • Much, much more • Ask about IHE Success Stories from Radiology and IT ACC meeting

5. The ACC and IHE share a vision… ACC meeting

6. ACC and IHE Shared Vision The “Digital Integrated Cardiac Record” as part of the greater Electronic Health Record (EHR) • Cross Enterprise physician access (in/out of hospital) • Access all department’s information • Populations outcomes • Secure (IHE IT) • Filtered Patient access ACC meeting

7. However….we must walk before we can run. Patient identification and medical information must be: • Automated and integrated • Accurate • Coded/identifiable So, this is where we started in IHE-Cardiology Year 1. ACC meeting

8. IHE Annual Cycle – Step 1 • Cardiologists identify clinical problems to be addressed -“Integration Profiles” • Engineers from vendors collaborate to define technical specification (using existing standards such as DICOM and HL7) • Vendors implement the technical specification and participate in the “Connectathon” • Vendors publish IHE Integration Statements ACC meeting

9. IHE Cardiology Year 1 The Planning Committee identified three initial clinical problems to be addressed: • The ability to view an ECG from many locations - quickly and easily • Lab systems integration of patient, order, and procedure information in an Echo Lab, including mobile echo • Lab systems integration of patient, order, and procedure information in a Cath Lab, including angio, hemo, and IVUS ► “Retrieve ECG for Display” ► “Echocardiography Workflow” ► “Cardiac Catheterization Workflow” ACC meeting

10. “Retrieve ECG for Display” “I need to see the ECG!” Clinical Use Cases: • Diagnostic quality ECGs • Display for Review (not analysis) • Web based tool Benefits: • Simple and fast access • Integrated into other software systems • Real-time remote conferencing • Compare ECGs ACC meeting

11. “Retrieve ECG for Display” ACC meeting

12. “Echocardiography Workflow” “Could you scan this patient right now since you have a cart in CCU anyway?” Clinical Use Cases: • 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 identification across vendors Benefits: • Accurate and automatic demographic and order reconciliation • Verify all images are securely archived • Accurate display of Stress Images ACC meeting

13. “Echocardiography Workflow” ACC meeting

14. “Cardiac Catheterization Workflow” “There is a patient being brought up from ER…” Clinical Use Cases: • Manually enter patient and procedure information into multiple systems in a cath lab • No order created • Emergent case (unidentified patient) • Change of rooms during procedure Benefits: • Automate download of patient info to all systems • Accurate and automatic patient demographic and order reconciliation • Verify all images are securely archived ACC meeting

15. “Cardiac Catheterization Workflow” ACC meeting

16. IHE Annual Process – Step 2 • 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” • Vendors publish IHE Integration Statements ACC meeting

17. IHE Annual Process – Step 3 • Cardiologists identify clinical problems to be addressed - “Integration Profiles” • Engineers from vendors collaborate to define technical specification (using existing standards such as DICOM and HL7) • Vendors implement the technical specification and participate in the “Connectathon” • Vendors publish IHE Integration Statements ACC meeting

18. 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 ACC meeting

19. 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” • Vendors publish IHE Integration Statements ACC meeting

20. 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 • IHE Cardio solutions in early product Development stage – future mandated deliverable • Vendors build product functions that are requested by providers Ask for IHE Integration Loud & Often !! ACC meeting

21. 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 Registry dataharvesting Retrieve guidelinesfor display Retrieve structuredguidelines Quality Long Road Ahead – 5 yr Roadmap ACC meeting

22. 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 meeting

23. 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 meeting