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Integrating the Healthcare Enterprise

This article discusses the new profiles and options introduced in the Integration of the Healthcare Enterprise (IHE) framework, such as Post-Processing Workflow, Charge Posting, Basic Security, and more.

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Integrating the Healthcare Enterprise

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  1. Integrating the Healthcare Enterprise What’s New in IHE:New Profiles & New Options

  2. Authors & Presenters • Kevin O’Donnell • Toshiba, IHE Planning Committee Co-Chair • John Paganini • IDX, IHE Planning Committee Member • Rob Horn • Agfa, IHE Planning Committee Member RSNA 2002

  3. Scheduled Workflow Post- Processing Workflow Patient Information Reconciliation ChargePosting Admit, order, schedule, acquire & store images with notification of completed steps Schedule, perform, & notify image processing & CAD steps Collection of billable procedure details Unknown patients and unscheduled orders Consistent Presentation of Images Key ImageNotes Simple Image and Numeric Reports Simple reports with image links and measurements Hardcopy and softcopy grayscale presentation state Flag & search for significant images Presentation of Grouped Procedures Manage subsets of a single acquisition Access to Radiology Information Retrieve & view images and reports Basic Security Audit Trail Consolidation & Node Authentication IHE Integration Profiles RSNA 2002

  4. Year 4 Additions toIHE Technical Framework • 3 New Integration Profiles • Post-Processing Workflow • Charge Posting • Basic Security • 2 New Options for Scheduled Workflow • PPS Exception Management • Assisted Protocol Setting • IHE Integration Statements RSNA 2002

  5. Post-Processing Workflow Profile RSNA 2002

  6. Post-Processing Workflow:Features • Supports Workflow for Post-Processing Tasks: • Computer Aided Detection • Image Processing • Image Reconstruction • etc . . . • Task Scheduling, Worklists & Status Tracking • Worklist Entries Reference Input Data • Status Messages support Workflow Metrics and Billing • Associate Post-Processing Output with Acquired Images and other Order Results for easier review RSNA 2002

  7. Work Item Claimed Post-ProcessingWorklist Post-Processing Procedure Step STARTED Measurements CAD Reports ……....……… Post-Processing Procedure Step STARTED IHE Post-Processing Workflowwith Post-Processing Manager Grouped with Image Manager RIS PACS &Archive RetrieveImages Post-Processing Procedure Step COMPLETED Store Reports Archive Images Post-Processing Procedure Step COMPLETED RSNA 2002

  8. Post-Processing Workflow:Technical Details • Based on DICOM • General Purpose Worklist • General Purpose Scheduled Procedure Step • General Purpose Performed Procedure Step • Dept. System Scheduler/Order Filler Actor Schedules Post-Processing • New Post-Processing Manager Actor • Image Creator/Report Creator Actors Perform Post-Processing RSNA 2002

  9. Charge Posting Profile RSNA 2002

  10. Charge Posting Profile:Features • Facilitates Collection of Procedure Details for Billing • Performed Procedure Technical Fees • Materials Usage • Reporting Professional Fees • Etc. • Facilitates Management of Account Details in Multiple Systems and Procedure Records RSNA 2002

  11. Account Management ADT Terminal Report Generated / Signed CAD *Workstation 3-D *Workstation ReportRepository 3-D Performed CAD Performed AcquisitionModality Charge Posting Profile Post Charges Charge Processor (Billing System) DSS / Order Filler Study Performed / Materials Used … RSNA 2002

  12. Patient Information Account Complete BILLINGSYSTEM RIS Procedure Information Modality Workflow Initial Capture of Patient Demographics HIS BENEFITS Redundancy Eliminated Maximum Data Integrity Billing Available ASAP All Systems Updated RSNA 2002

  13. Charge Posting Profile:Technical Details • HL7 Messages manage account details between systems • Open, Update, Close Account • DICOM Performed Procedure Step Messages (MPPS, GP-PPS) provide optional details to Order Filler : • Performed (Billable) Technical Activities • Performed (Billable) Professional Activities • Usage of Materials • HL7 Messages allow Order Filler to post charges to the Charge Processor • New Charge Processor Actor (financial system) RSNA 2002

  14. Charge Posting Profile: Benefits • Billing System receives more complete, timely and accurate data • Eliminates Redundant Data Entry • Reduces Billing Errors • Reduces Billing Resource Requirements • Reduces System Interface Installation Time • Reduces Need for Billing System to Know Radiology Details RSNA 2002

  15. Basic Security Profile RSNA 2002

  16. Basic Security Profile:Features • Verifies that only secure nodes exchange data. • Provides audit facility to: • Verify compliance with procedures • Permit detection of inappropriate behavior • Avoid interfering with time critical activities RSNA 2002

  17. Secure Node Verifies and Authenticates the User Failures are reported Audit Repository RSNA 2002

  18. Network Connection Verification IHETransactions Identity Confirmed during connection Failures are reported Audit Repository Security Provides Certificates RSNA 2002

  19. Image Manager & Archive Diagnostic Workstation ReportRepository Report & ImageReview Basic Security Profile Audit Record Repository … … “Images Queried / Retrieved” “Reports Retrieved” “Reports Printed” “Images Printed” “Reports Stored” “Reports Queried / Retrieved” RSNA 2002

  20. Audit Records • Detailed Records from many sub-systems, not just IHE • Gathers audit reports in one location • May provide analysis or detection facility (beyond the scope of IHE) RSNA 2002

  21. Audit Log Repository RSNA 2002

  22. Basic Security EnvironmentRequired Physical Security Doors, key access, etc. restrict access Communications and Equipment are kept in restricted access areas Access to equipment is controlled Cabinets, wiring, etc. are protected. RSNA 2002

  23. Basic Security EnvironmentRequired Network Security Firewalls, VPN, and other access controls. Unauthorized external access is denied. Additional security facilities may be in place if warranted by local conditions. RSNA 2002

  24. Basic Security Profile:Technical Details • Certificates used to authenticate Secure Nodes • Syslog Protocol used to transmit and store audit messages • Network Time Protocol (NTP) used to synchronize / stamp audit messages RSNA 2002

  25. Scheduled Workflow Profile: New Options RSNA 2002

  26. Scheduled Workflow Profile report Registration Film Lightbox Image Manager & Archive Orders Filled Film Folder Diagnostic Workstation Film Report Repository Orders Placed AcquisitionModality acquisitioncompleted acquisitionin-progress imagesprinted Modality acquisitioncompleted RSNA 2002

  27. PPS Exception Management Option RSNA 2002

  28. PPS Exception Management Option: • Defines method & codes for signaling problems, E.g.: • Technologist selects incorrect entry from Modality Worklist, images are acquired • Study is started but must be discontinued • Some behaviors are specified, most left to the discretion of the Modality / Image Manager / Order Filler. RSNA 2002

  29. Code Meaning (0008,0104) Doctor cancelled procedure Equipment failure Incorrect procedure ordered Patient allergic to media/contrast Patient died Patient refused to continue procedure Patient taken for treatment or surgery Patient did not arrive Patient pregnant Change of procedure for correct charging Duplicate order Nursing unit cancel Incorrect side ordered Discontinued for unspecified reason Incorrect worklist entry selected Patient condition Discontinue Reason Codes RSNA 2002

  30. Assisted Protocol Setting Option RSNA 2002

  31. Assisted Protocol Setting Option • Allows DSS / Order Filler to provide more precise protocol codes to the Modality • Based on multiple Protocol Codes in the Scheduled Procedure Step • Provides more detailed communication • Promotes more consistent performance of procedures RSNA 2002

  32. IHE Integration Statements RSNA 2002

  33. IHE Integration Statements • Provides a Clear, Simple, but Precise, statement of the integration capabilities of a vendor system • “Integration for people who aren’t DICOM engineers” • For a Vendor System it States: • the product name, version • which IHE Actors the system implements in each IHE Profile • www.rsna.org/IHE/ RSNA 2002

  34. Resources • www.rsna.org/IHE • FAQs • Integration Profiles Document • Web Tutorials • Primer on IHE • Presentations • IHE Technical Framework • Product Evaluation Worksheet RSNA 2002

  35. Questions? Ask your vendors: Which IHE Profiles do they support on which systems? www.rsna.org/IHE RSNA 2002

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