DICOM and Integrating the Healthcare Enterprise:

1. DICOM andIntegrating the Healthcare Enterprise: Five years of cooperation and mutual influence Andrei Leontiev Chair, DICOM WG6 IDX Charles Parisot Chair, NEMA Committee for advancement of DICOM GE Medical Systems-IT

2. IHE Mission • IHE is an initiative promoting and supporting the integration of systems in the healthcare enterprise.

3. IHE Integration Goals Improve the efficiency and effectiveness of clinical practice: • Improve Workflow • Improve Information Accuracy • Improve Information Availability • Enable Cross-System Functionality

4. A Proven Standards Adoption Process IHEConnectathon IHEDemonstration Product With IHE Easy to Integrate Products IHETechnicalFramework Standards • IHE Integration Profiles: • Detailled 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 IHEIntegration Profiles B IHEIntegration Profile A User Site RFP

5. Scheduled Workflow Patient Informa-tion Reconci-liation Charge Posting - Presentation of Grouped Procedures Reporting Workflow Post-Processing Workflow , Simple Image and Numeric Reports Consistent Presentation of Images Evidence Documents Key Image Notes Access to Radiology Information Basic Security IHE Integration profiles

6. Retrieve Information for Display Retrieve Information for Display Enterprise User Authentication Enterprise User Authentication Patient Synchronized Applications Patient Synchronized Applications 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 Synchronize multiple applications on a desktop to the same patient 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 IHE IT Infrastructure5 Integration Profiles

7. IHE Growth • Radiology • 5 years – Extensive integration with IT • IT Infrastructure • 1 Year – Strong start with critical infrastructure issues addressed: authentication, linking patient ids, CCOW, retrieve info for display. HIMSS Feb 2004 HL7-IHE Joint Demo. • Laboratory • 1 year – Lab Scheduled Workflow goes to public comment Oct 15th for demos mid 2004. • Cardiology • ACC and ESC have solid plans – launch imminent. Strong influence from the DICOM Efficiency Culture

8. IHE & DICOM / HL7 • Standards are vital (HL7, DICOM, ICD, …) • They provide tools & technologies • But Standards alone are insufficient • They are open to interpretation • There is room for optional variations • They avoid specifying how to apply them to particular real world scenarios

9. IHE Stimulated adoption of DICOM features • By 1998, DICOM Storage and Query Retrieve SOP Classes have been implemented and actively used by dozens of vendors • However, some features were interpreted differently (scout lines, query keys) • IHE established common interpretation

10. Use of DICOM in Workflow Management • DICOM MWL and MPPS were defined but not well implemented because their use without correlation with overall information flow in Radiology Department was limited • IHE defined use cases and established mechanisms to use these DICOM SOP Classes via Scheduled Workflow Integration Profiles

11. 0:n Imaging Serv. Req. (Order) 1:n RequestedProcedure Study Study Mgt 1:n ScheduledProcedure Step PerformedProcedure Step n:m 1:n 1:n Series Scheduling Series 1:n Work Tracking Image Image Image Image Work Products Image IHE researched DICOM data model Patient

12. IHE Integration Profiles based on DICOM • Most IHE Radiology Integration Profiles are based on one or more DICOM SOP Classes • IHE spearheaded implementations of several recently defined DICOM capabilities spending time and effort to build practical implementation framework for them

13. Consistent Presentation of Images Simple Image and Numeric Report Key Image Note Grayscale Presentation State Structured Reporting Key Object Selection Document IHE Profiles vs. DICOM SOPs

14. Post-Processing Workflow and Reporting Workflow Evidence Documents General Purpose Worklist and PPS Mammo CAD, Chest CAD, etc. IHE Profilesvs. DICOM SOPs

15. IHE initiated development of DICOM features • IHE actively influenced development of DICOM: • Correction proposals for better consistency of MWL/MPPS • Development of Key Object Selection Documents • Development of common audit messaging

16. Operational influences • DICOM influenced development process of IHE Technical Framework: • Supplements, Correction Proposals • DICOM adopted IHE approach to definitions of use cases: • Actors, transactions…

17. Summary • The development of DICOM has influenced the development of IHE Technical Framework, and in turn, was influenced by user needs that are advocated for by the framework developers. • Cooperative effort of two bodies have proved very effective and will continue in the future, allowing for further advancement of DICOM and its acceptance in user and vendor communities.

18. Where Is More Information Available? • IHE: • http://www.himss.org/IHE • http://www.rsna.org/IHE • DICOM : • http://dicom.nema.org