Andrew M. Keller, MD, FACC, FASE, FACP Chief of Cardiology, Danbury Hospital Danbury, CT, USA

1. Integrating the Healthcare EnterpriseIHE: Meeting Global needs for Integrated HealthcareJapanese Circulation Society (JCS)Kobe, JapanMarch 16th, 2007 Andrew M. Keller, MD, FACC, FASE, FACP Chief of Cardiology, Danbury Hospital Danbury, CT, USA

2. Thank you for the opportunity to be at the Japanese Circulation Society Scientific Sessions. IHE Cardiology:

3. Integrate Clinical Information • Goal: optimal patient care • To attain optimal patient care, we need clinical information • When we need it • Wherever we need it • In a meaningful manner • Without repeating tests (time and money) • Originating from many different locations • Cardiology data is especially complex Proper integration of clinical information means better patient care.

4. Integrated Clinical Information

5. Information from many places Hospital Home Doctor’s office Data pointers Extended Care

6. Information is difficult to integrate!

7. How can we integrate these system? • Today, at least in U.S. and Europe, each two systems that are connected are an “IT integration project”. • Very expensive • Very time consuming • Very resource intensive • Never works quite right • Usually involves third party • Do not attempt to upgrade software on either system

8. How to integrate? • Instead, use standards: • DICOM • HL7 • XML • Define use of standards in Technical Framework • Have common testing plan • Vendors implement Technical Framework in products • Allow vendors to work together, before it gets to our hospitals An integrated product…

9. IHE is formed • IHE is a consortium of professional societies and vendors working together to facilitate the integration of healthcare information • 1997: IHE Radiology established; sponsored by RSNA • 2000: First European Connectathon • 2003: IHE Cardiology established; sponsored by ACC • 2004: ESC joins IHE Cardiology • 2007: IHE International formalized • 2007: We are excited to have JCS join IHE Cardiology in expanding support to Asia

10. Global Support “I am convinced that IHE is the best possible pathway to the true integrated patient record and all of the benefits that are associated with it.” -Ruediger Simon, MD, FESC, FACC Chief of Cardiology University of Kiel Kiel, Germany IHE-Europe Co-Chair

11. Veterinary Endoscopy Pathology Pharmacy Growth in IHE Domains IHE Global Developments Integration Profiles (# X) – Solutions to Real-World Interoperability Needs & Problems: • Within Clinical Departments e.g.: • Radiology • Cardiology • Lab • ... • Across Departmental &Institutional Boundaries – XDS • RHIOs (Regional Healthcare Information Organizations) • EHR Enablers Quality Patient Care Devices (1) Patient Care Coordination (5) Radiation Oncology (1) Eye Care (3) Laboratory (6) Cardiology (7) IT Infrastructure for Healthcare (17) Radiology (18) Year 5 (2003) Year 6 (2004) Year 8 (2006) Year 9 (2007) Year 4 (2002) Year 7 (2005) Year 1 (1999) Year 2 (2000) Year 3 (2001)

12. Testing at Connectathons IHE Demonstrations Develop technical specifications Products with IHE Identify available standards (e.g. HL7, DICOM, IETF, OASIS) Document Use Case Requirements Timely access to information Proven Standards Adoption Process Easy to integrate products

13. IHE Cardiology Profiles (9) Cath Lab Workflow Echocardiography Workflow Retrieve ECG for Display Echocardiography Measurement Patient: Doe, John Technologist: der Payd, N Measurements: Mitral valve diameter 3.1cm - shown in image at [ ] Ventricular length, diastolic 5.97 cm - shown in image at [ ] Ventricular volume, diastolic 14.1 ml - inferred from [ ] - inferred from VLZ algorithm Cross-Enterprise Document Sharing (EHR to EHR) Evidence Documents (Measurements) Implantable Cardiac Device Observation Displayable Reports Stress Testing Workflow Nuclear Medicine

14. Cath Lab Integration Procedure Log One patient; one order; one procedure; consistent time stamps

15. Stress Echo Integration Goodman PACS (or 5 other vendors) views stages Toshiba Aplio (or Philips or GE) Views defined; stages defined Consistent display of different vendor stress exams

16. Stress testing integration One patient; one order; one procedure across systems; Consistently defined Protocols and stages

17. Brigham and Women’s Hospital Cath Workflow Profile: Patient info and orders Philips Allura x6 Secure Storage Patient info, Order, schedule, and procedure status Witt hemo x6

18. Brigham and Women’s Hospital • Realized Benefits at Brigham: • Accurate and automated patient demographics • Happier technologists (less busy work –typing) • Fewer interruptions for Cath Lab Flow Manager (procedure status and cancellations) • Faster room turn around time • Better communication between cath lab teams • Improved efficiency of billing • Providing data to be able to optimize resource utilization • It works!

19. Integration benefits • For users across the healthcare enterprise, IHE: • allows faster access to information, • reduces errors, • streamlines workflow, • simplifies interface projects, • optimizes resource utilization. Spend time with patients; not chasing information.

20. Working together with JCS How can IHE Cardiology and IHE-Japan work together more closely: • Visit the IHE Interoperability Workshop at ACC.07 if you are attending (booth #2251) • Understand differences in clinical workflow in Japan • Encourage additional direct involvement in the Planning Committee • Web-ex/tcon in May, 2007, to explain new Year 4 Profiles and gain direct feedback • Direct involvement in annual IHE Cardiology prioritization process for new Profiles (usually August/September timeframe) • Bi-annual joint tcons at mutually agreed upon times

21. More Resources - www.ihe.net • www.ihe-j.org • Frequently Asked Questions • Integration Profiles in Technical Frameworks: • Cardiology • IT Infrastructure • Laboratory • Patient Care Coordination • Patient Care Devices • Radiation Oncology • Radiology • Connectathon Results • Vendor Products Integration Statements • Participation in Committees and Connectathons