DICOM and IHE, Integrating the Healthcare Enterprise

1. DICOM and IHE,Integrating the Healthcare Enterprise Cor Loef Co-chair DICOM Strategic Advisory Committee Member IHE Planning and Technical Committee Cor Loef Program Manager Interoperability Philips Medical Systems

2. Goal of IHE IHE process Integration Profiles and the role of standards in IHE DICOM’s use in the IHE Integration Profiles Current topics Questions and answers Contents

3. Different information islands: Modalities, PACS, HIS, RIS, EPR Different standards and information models : DICOM, HL7, XML Different (proprietary) interpretations and implementations Modalities PACS RIS / HIS EPR Integration Hell in the Enterprise

4. It’s an initiative promoting and supporting the integration of systems in the healthcare enterprise Integration Goal: Improve the efficiency and effectiveness of clinical practice by: Improved Information Flow Advanced Multi-System Functions With minimal “integration project pain” Goal of IHE

5. IHE process • Users and vendors work together to identify and design solutions for integration problems • Intensive process with annual cycles: • Identify key workflows and integration problems • Research & select standards to specify a solution • Write, review and publish Technical Framework • Perform cross-testing at “Connectathon” • Demonstrations at tradeshows:RSNA/HIMSS, and also JFR, DRK, JMCP

6. The (multi-vendor) Integrated Imaging Solution Modalities Connection to other Network and/or TeleRadiology Image Server Radiology Information System Diagnostic Workstation CD Exchange Web Distribution

7. Role of standards in IHE • IHE attacks real world radiology integration problems • Standards such as HL7 and DICOM provide dictionaries • IHE defines a “phrasebook” that solves real world problems by assembling pieces provided by DICOM/HL7 • IHE is also a way to promote and advance the implementaion of standards

8. Common information model Integration Solution B C DICOM HL 7 A Selection of options IHE Technical Framework IHE: Relation to Standards

9. Use Case Roles & Interaction Diagrams Actor 1 Actor 2 Actor 3 TRANSACTIONS Actor 1 Actor 2 Actor 3 Message 1 Message 2 Message 3 • Examples of Actors: • ADT / Patient Registration • Acquisition Modality • Examples of Transactions: • Register Patient • Images Stored

10. Goal of IHE IHE process Role of standards in IHE DICOM’s use in the IHE Integration Profiles Current topics Questions and answers

11. Integration solution for real-world integration problems Set of related transactions among systems Allow buyers to focus on high-level integration, cornerstone for defining requirements in RFP’s Implementation is defined by the IHE Technical Framework IHE Integration Profiles

12. Scheduled Workflow Post- Processing Workflow Patient Information Reconciliation ChargePosting Admit, order, schedule, acquire images, notify 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, optionally, measurements Hardcopy and softcopy grayscale presentation state Flag significant images Presentation of Grouped Procedures Subset of a single acquisition Access to Radiology Information Consistent access to images and reports Basic Security Audit Trail Consolidation & Node Authentication Year 4 Integration Profiles

13. 1.Scheduled Workflow acquisition in progress acquisition completed • DICOM: • Modality Worklist Query Requirements, with Acquisition Protocol Setting option • Required attribute mapping from Worklist to Images • Modality Performed Procedure Step, with Exception Management option • Store • Storage Commitment

14. Enter patient Patient later as J Doe identified - enter proper data examination orders for J Doe 2. Patient Information Reconciliation report HIS RIS

15. Area Of Interest Area Of Interest Original Image & Presentation State &Grayscale Standard Flip The Radiologist’s Transformations Are Saved Zoom Annotate Prepared Image Original Image Original Image Window Level Original Image The Radiologist’s Transformations Are Lost 3. Consistent Presentation of Images What the Radiologist Displays: What the Reviewing Physician Sees:

16. Report:HEAD Report:CHEST Chest View Head View Head View MODALITY Performs a single exam Operator groups 2 procedures Chest View 4. Presentation of Grouped Procedures Requested Procedure:HEAD RIS / PACS Requested Procedure:CHEST • DICOM: • Presentation State • Modality Performed Procedure Step

17. 5. Simple Image and NumericReport Verified Report Preliminary Report Images and Exam data presented for diagnosis Report stored for Network Access Images retrieved Report & Images retrieved Report and Image Review for Patient Care Report Verification Image Manager and Archive • DICOM: • Basic Text SR • Enhanced SR • Template TID 2000 • Codes from DCMR

18. Note1 Note2 For referring physician: This image shows the renal rupture. For referring physician: This image has the hematoma. Study & Key Image Notes Note2 Note1 for refering physician This image shows the renal rupture. Note1 Note2 for refering physician This image has the hematoma. for refering physician This image has the hematoma. for refering physician This image shows the renal rupture. 6. Key Image Notes Radiologist Flags Images: Referring PhysicianSees Key Images First: • DICOM: • Key Object Selection Document SOP Class

19. Emergency Department Referring Physician Radiology Department – Images and Reports Remote Clinics Other Departments:- Oncology- Surgery- Neurology- Pediatrics- etc. Electronic Medical Record 7. Access to Radiology Information • DICOM: • C-FIND with required matching and return keys • C-MOVE • Images and SR

20. 8. Charge Posting Acquisition Modality Report Manager ADT Account Management Charge Processor DSS/ Order Filler Charge Posted • DICOM: • required billing info in MPPS • Film consumption • Procedure Type • Supplies and devices Reporting Completed PPS In Progress/ Completed

21. Local access control (authentication of user) • Strong authentication of remote node (digital certificates) • network traffic encryption is not required • Audit trail with: • Real-time access • Time synchronization Secured System Secured System Secure network System B System A Central Audit TrailRepository 9. Basic Security • DICOM: • Basic TLS Secure Transport Connection Profile • well-known port 2762

22. 10. Post-Processing Workflow Image Creator Post-Processing Manager PP Workitem Claimed PP Workitem Completed PP PPS Started PP PPS Completed PP worklist Provided • DICOM: • General Purpose Worklist • Images • Evidence Documents: • Mammography CAD SR • Basic Text SR • Enhanced SR • Comprehensive SR

23. 10. Post-Processing Workflow: use case MPPS Complete Create Worklist Item Store Images Post-Processing WL Provided Post-Processing Task Claimed Query/ Retrieve Images Post-Processing PPS Started Creator Images Stored Post-Processing PPS Completed Post-Processing Task Completed Department Scheduler/ Post-Processing Manager Acquisition Modality Image Manager Image Creator

24. Goal of IHE IHE process Integration Profiles and the role of standards in IHE DICOM’s use in the IHE Integration Profiles Current topics Questions and answers

25. Reporting workflow Security Standard for Audit Records Extension to other clinical domains: Cardio, NM Desktop Integration Current topics

26. Back-Office Clinical Information System Clinical Information System messages Integrated Clinical Viewing at the desktop Front Office Integration: back-office and/or front-office Efficiency Improve Clinical Decisions

27. CCOW approach A Federated System of Context-Managed Applications

28. Header: Thorax Report Type: ….. ….. ….. Findings: Mass ….. ….. Radiology PACS Daim. Conclusions: Infiltr. ….. ….. (Pointer) Image Refs.: Integration:the EPR approach HIS Other Clinical System RIS Cardiology PACS VL, US, NM PACS Electronic Patient Record URL / URI? Webserver Web Viewers

29. Questions? DICOM and IHE,Integrating the Healthcare Enterprise