Planning Committee Focus Group

1. Planning CommitteeFocus Group 8:00 - 17:00, Friday, September 24, 2010 8:00 - 10:00, Saturday, September 25, 2010 ASTRO HQ, Fairfax, VA

2. 1) Welcome and Introductions Regrets: May Wahab (PC Co-chair), Mika Miettinen (PC co-chair, Varian), Ramesh Rengen, Christopher Rose

3. 2) Meeting Goals • Quick overview of IHE and IHE-RO • Establish directions & goals for IHE-RO PC • Have brief joint TC and PC meeting • Changes to Agenda ?

4. 3a) Overview of IHE • Integrating the Healthcare Enterprise, formed in 1998 • Global initiative to facilitate sharing of health information • from application to application • system to system • across multiple healthcare enterprises • Brings together health information technology stakeholders to implement standards for communicating patient information efficiently throughout and among healthcare enterprises by developing a framework of interoperability • Because of its proven process of collaboration, demonstration and real world implementation of interoperable solutions, IHE is in a unique position to significantly accelerate the process for defining, testing, and implementing standards-based interoperability among electronic health record systems (from http://www.ihe.net/News/ihe_intl_expands_incorporates_2009-12-31.cfm )

5. IHE Organizational Structure Anatomic Pathology Pharmacy Quality, Research & Public Health ASTRO AAPM ACR AROI CARO CSRO ESTRO JASTRO

6. About IHE-RO • 2004: Prabhakar Tripuraneni and Jatinder Palta formed IHE-RO at RSNA • 2004: Bruce Curran and Stuart Swerdloff spear-headed the TC • 2006: First IHE-RO Domain Pre-testing • 2007: First Connectathon (Aug) • 2007: PC became more active • 2007: First Public demonstration (Oct)

7. How Does This All Happen ? • ASTRO Significant Support • Since 2006, spent well over US$ 1.0M • Test Tools and Administrative support • RT Vendors Significant Resources • Domain Pre-testing • Connectathons • Product Development and Documentation • End Users • Volunteer time and energy • Florida grant (Jatinder and May)

8. IHE-RO Connectathon Vendors Accuray (2009/10) BrainLAB (2007/8/9/10) Candelis (2010) Elekta(2007/8/9/10) GE Healthcare (2009) MIMVista(2008/9) Nucletron(2007/8/9/10) Philips (2007/8/9/10) Siemens (2008/9/10) Third Way Software (2010) Tomotherapy(2007/8/9/10) Varian (2007/8/9/10) Numerous Volunteers Other IHE-RO Members ASTRO AAPM ATC Bogardus Medical Systems Brigham & Women’s Hospital Cogent Health Solutions Inc. Cross Cancer Institute ESTRO IBA Particle Therapy Loyala University Medical Centre Radion, Inc SEFM SJS Targeted Solutions Sun Nuclear TSG Integrations University of Florida VisionRT VisionTree Software, Inc Wake Forest Acknowledgements

9. Links to more info • Wiki.ihe.net • www.ihe.net • http://www.astro.org/Research/ResearchHighlights/IHERO/index.aspx

10. 3b) PC Membership • Google docs Roster • Governance document • http://www.ihe.net/governance/index.cfm • Join IHE • Process is easy, and it is free ! • Institutional politics may not be as easy • Link to on-line application

11. 4) ASTRO IHE-RO and Research Committee • EMR and Registry • CCHIT and IHE-RO • Patient Safety

12. ASTRO safety initiative named to 25 Most Influential list ASTRO has been named as one of RT Image's 25 Most Influential people, institutions or events that shaped radiology in 2010. ASTRO ranked sixth for its Target Safely initiative, a six-point patient protection plan that will improve safety and quality and reduce the chances of medical errors. To learn more about Target Safely, visit www.astro.org/targetsafely, or ASTRO Chairman Williams’s article.

13. 5) Use Cases • Process • Review • old, in development, on hold, new • http://wiki.ihe.net/index.php?title=Radiation_Oncology#Use_Case_Selection

14. Steps of IHE Process • Identify Inter-operability problems (Use Cases) • describe how end-users will • accomplish a goal by performing a task or a series of tasks using systems (or software) • includes the responses of the systems (or software) to user actions • Select Use Cases to develop (process) • Specify Integration Profiles, Develop Test Tools • Domain Pre-testing • Test Integration Profiles at Connectathon • Public Demonstration ? • Publish Integration Profiles for use in RFPs

15. Successfully Completed Use Cases • Basic RT Treatment Planning (2007) • Multimodality Registration (2008) • Advanced RT Objects (2009) • Treatment Delivery Workflow (2010?)

16. Use Cases in Development (2010) • Treatment Delivery Workflow • Public comment (07-Mar-2010) • Domain pre-testing (June 2-11, 2010) • 2010 connectathon(Sept 20-26, 2010) • Dose Compositing • Public comment (26-Feb-2010) • Domain pre-testing (2011 ?) • 2011 connectathon (2011 ?) • Enterprise Schedule Integration • Japan IHE-RO

17. Use Cases requiring more support • Prescription Automation • Needs DICOM WG 7 extension of standards • Structure Templates: Creation, Export and Import • User Authentication and Authorization • IHE-ITI XUA++ (Cross-Enterprise User Assertion – Attribute Extension)

18. 2010 Use Case Selection • http://www.doodle.com/k62626a552iy6y6r • Flesh out top 3 details for ASTRO AGM • Ensure problem is well defined • Suggest how things should work • Sell TC on necessity to support the Use Case • Let’s review each Use Case in ranked order • Very brief summary by Champion • Questions, comments, discussion • Currently 15 others Use Cases on the list • http://wiki.ihe.net/index.php?title=Radiation_Oncology#Use_Case_Wish_List

19. Radiation Oncology Workflow Exchange • Data dictionary needed

20. Closed Loop Patient Safety • Categories: • Handshaking check of data transfer • Feedback loop, plan, deliver, cf plan • Imaging closed loop • Population of a Registry • End to end check - phantom

21. Anonymization • Anonymize specific dicom tags • Template for data to send • reader to ensure all links are preserved between related items

22. Radiation Oncology Patient Portal • Data dictionary required • Source: RT data; Destination: secured web browser • Interactive record of patient data • Updating of followup data • 2015 requirement for meaningful use

23. Deformable Registration

24. Instance-level Query Retrieve

25. 6) Current Issues • Clinical Release of Connectathon software- what are IHE rules? 1 year, special rules for IHE-RO?- PC communicate rules to TC- PC/TC cross compare passed actors with released software, vendors and users check • Use of integration profiles in RFP • Wiki pages • Rishabh volunteered to help with updating of Wiki • Vote using Survey Monkey instead of Doodle • Consensus was that Doodle was adequate

26. 7) Open Forum • Future of IHE-RO • Funding for IHE-RO • IHE-RO initiative should become cost neutral to ASTRO • PC members were encourage to obtain grants in support of IHE-RO activities • Volunteer effort • Election of Co-chairs • Dr. May Wahab will be stepping down as PC Chair, and Dr. Ramesh Rengan will be assuming this role • Some thought may need to be given to transitioning Mika’s and Colin’s PC co-chair roles, and Bruce’s and Stuart’s TC co-chair roles • Other ?

27. Lunch (Connectathon, LL)

28. 8) Technical and Planning committee Joint meeting

29. IHE-RO Co-ChairsPrabhakar Tripuraneni, MDJatinder Palta, PhD Planning Committee May Abdel-Wahab, MD, PhD Colin Field, MSc Mika Miettinen Recruit vendors of relevant information systems and users with clinical and operational experience Prioritize & coordinate domain activities Identify, gather, review and prioritize integration and information inter-operability problems (Use Cases) Approve proposals selected by the TC for Profile development Develop educational materials for the domain and profiles Technical Committee Bruce Curran, MS, ME Stuart Swerdloff, PhD Recruit vendors of relevant information systems and users with technical experience Assess the feasibility and estimated effort for PC selected Use Cases Build consensus on the appropriate standards-based solutions Develop Integration Profiles for Use Case solutions Maintain Technical Framework for domain Integration Profiles, describes solutions to inter-operability problems

30. 8) Technical and Planning committee Joint meeting • Is more support from PC required at pre-testing and at connectathon ? Yes, clinicians with practical experience, Wednesday thru Friday. • Is PC input needed at TC meeting after ASTRO ? No, but questioned will need to be answered soon after TC meeting. • Can PC help with linac configuration gold standard? NEMA MITA working on (Stuart Swerdloff). Stuart will let us know. • Is a public demonstration needed ? No. • What else can PC do to help TC ? Chase small companies that should be participating to get involved.

31. A big “Thank You” to the Technical Committee for all their efforts !!

32. 9) Budget Planning • Make test tools free. Charge for evaluation. • Make per Actor cost for evaluation the same for all Actors (categorized as simpleor complex) • How is re-testing charged ? After failed test, charge at 100%. For voluntary re-testing, at a discounted rate of 50%. • Retest every year? Ask TC. • With new versions of test tools, vendor can decide whether they wish to re-test and be evaluated. They can use the new version of test tools in-house for their own evaluation.

33. 10) Publicity and Promotion • Publish success stories from IHE-RO

34. 11) Plan of Action for the future • Develop a list of items for the participants to mull overnight • Should this meeting occur next year ? Yes. Preferably on Sunday/Monday to facilitate TC attendance ? • ASTRO has asked for a single presentation in ASTRO booth during ASTRO AGM. Bruce nominated. Ramesh Rengen tag team. • Create webinar with CME credits for IHE-RO (MD, Physics, RTT, CMD). Tony to investigate. Interoperability and patient safety. • Create annual report showing passed actors with product releases. Verified by vendors and users • Standardize information on www.ihe.net and wiki.ihe.net. Rishabh

35. Use Cases • Prioritize new Use Cases with prior ‘tabled’ Use Cases • How do we close the loop from Use Case to Integration profile to RFP to Clinical Use ? Test tool versions. Poll users, allowing reporting of failures. Contact initial customers. Mini complaint system ? • Take Use cases to ASTRO Corporate Advisory Board for support. Jatinder. Prepared after TC has vetted. Needed by <date>

36. Tasks • Develop Data Dictionary. PC role? Provided data needed to support user cases. Todd and Walter • Develop Standard Testing facility (or resource centre) for all vendors (outside scope of IHE-RO). Jatinder to ask ASTRO Executive • Develop scope of facility • FDA implications • Create ASTRO IHE-RO Task force to provide recommendations to RO community. Evidence based info needed. Interoperability Errors • Publications subcommittee: • Publish success stories • Continue to obtain funding in support of TC. Everyone • Correct Nucletron representative on PC. Colin, Harold. • Every issue of ASTRO news to have IHE-RO content. Barbara • Document Budget cycle for each IHE-RO vendor. Sidrah • Use PLUNC as IHE-RO test platform ? • Update PC and TC membership roster in consistent manner. Sidrah

38. Planning CommitteeFocus Group 8:00 - 10:00am, Saturday, September 25, 2010 ASTRO HQ, Fairfax, VA

39. Finalize the plan of action for the future • Identify tasks and create timelines • Identify outstanding unresolved Issues • Set deliverables for ASTRO meeting

40. Closed Loop Patient Safety Other patient safety use cases: Compare what was treated with what was planned (dynalog, gantry, etc). MU currently checked. Handshaking check of data transfer from OIS to treatment workstation 3 MITA propositions Feedback loop, plan, deliver, cf plan Imaging closed loop Population of a Registry End to end check - phantom Focus on one aspect Working group consisting of: Kevin, May, Stephen, Nick, Akkamma, Adam When: 15-Oct fully fleshed out; poll posted on 18-Oct, voting completed 28-Oct

41. Prioritize new Use Cases with prior ‘tabled’ Use Cases TC provides status on ‘tabled’ Use Cases Information distributed to PC Rank vote on 3 new and 3 ‘tabled’ Use Cases Results for ASTRO AGM When: 10-Oct info received from TC 15-Oct info distributed to PC 18-Oct poll posted 28-Oct voting completed

42. Create annual report showing passed actors with product releases • Verified by vendors and users • ask users for confirmation • Survey tool for test • Who: • Colin to ask Bruce for passed actors and software versions from previous connectathons • Colin, Jacob to create table • When: draft table to be shown at ASTRO AGM

43. How do we close the loop from Use Case to Integration profile to RFP to Clinical Use ? Add Test tool version number Poll users, allowing reporting of failures. Contact initial customers to validate clinical release. Establish Mini complaint system for tracking issues? Aside: End to end ‘scripting’ test to verify RT process Who? When? Table to AGM after matrix is available

44. Publicity and Promotions Success Stories • Wait for use case / software version matrix, talk to vendors to get users to approach • Set timelines for ASTROnews publications and AAPM newsletter, PRO

45. Create webinar with CME credits for IHE-RO (MD, Physics, RTT, CMD Interoperability and patient safety Who: Tony to investigate/create (Lynn Brown ASTRO) With assistance from Publications and Promotions ? Everyone to bombard Tony with facts. Dick Fraass 1 hour presentation ? When: update at ASTRO AGM

46. Create a ASTRO IHE-RO Task force to provide recommendations to RO community Evidence based info needed Errors resulting from interoperability Cost of not having interoperability Who ? Akkamma, Kevin, Jacob, Charles When ? Table (tie to webinar)

47. Develop Standard Testing facility (or resource centre) for all vendors Develop scope of facility FDA implications Jatinder to ask ASTRO Executive Who? Jatinder, Adam, Nick, Tony, Todd, Sha, Martin When? Create a separate working group outside of IHE-RO.

48. 2) ASTRO PC & TC Meetings • PC • 7:00-10:00am, Tues, 02-Nov-2010 • Where: TBD • TC • Potentially noon-1:00pm, Tues, 02-Nov-2010in room used for NEMA meeting 7:30am-noon • Where: TBD

49. 3) Meeting Wrap Up

50. Comments, Questions