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Integrating the Healthcare Enterprise

Learn about the basics of integrating healthcare systems with IHE, the significance of IT standards, challenges faced, and the process of implementing standards to enhance patient care and communication. Understand how standards enable efficiency, cost savings, and better outcomes analysis.

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Integrating the Healthcare Enterprise

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  1. Integrating the Healthcare Enterprise The Basics of IHE: Concepts and Process David Channin, MD RSNA Electronic Communications Committee IHE Strategic Development Committee IHE Radiology Planning and Technical Committees Associate Professor of Radiology Chief, Imaging Informatics Northwestern University Feinberg School of Medicine Department of Radiology

  2. Why Are Standards Important?

  3. Why Are Healthcare IT Standards Important? • Step #2 toward Crossing the Quality Chasm: “. . . making effective use of information technologies to automate clinical information and make it readily accessible to patients and all members of the care team. An improved information infrastructure is needed to establish effective and timely communication among clinicians and between patients and clinicians.” - IOM Report, 2001

  4. What IT Standards Enable • Greater efficiency and cost savings • The ability to make best of breed purchasing decisions • Better and more timely communication of medical information • Improved patient safety • Data for outcomes analysis and decision support • The potential to build a system of evidence-based medicine • The potential to develop a truly comprehensive and portable EHR So why haven’t standards solved all of healthcare’s interoperability issues?

  5. The Standards Archipelago POC Devices Mods RIS Pharm ADT/HIS PACS Lab EKG Cath Lab CIS ER OR DICOM IEEE – POCT NCPDP HL7 2.4 HL7 2.1 Billing DICOM X12/ICD9 Islands of data across the healthcare enterprise

  6. NAHIT Standards Directory “ . . . Since launching a beta version for members only in April, the Alliance has expanded the directory to include 850 voluntary and mandatory standards and electronic links to more than200 standards development organizations.” The great thing about standards is that there are so many to choose from -Old Wisecrack

  7. Standards Alone Are Not Enough • Too many standards • No clear domain boundaries • No clear mapping of information flow across boundaries • Too much generality and ambiguity • Version incompatibilities • Vendor proprietary interests • Complexity!! We need standards for how to implement standards!

  8. Connecting Standards to Care • Care providers must work with industry to coordinate the implementation of standards to meet their needs • Care providers need to identify the key interoperability problems they face • Drive industry to develop and make available standards-based solutions • Implementers need to follow common guidelines in purchasing and integrating systems that deliver these solutions

  9. ACR-NEMA Becomes DICOM: c. 1992 Demonstrations drive awareness and demand for standards-based solutions

  10. IHE Grows from DICOM Experience • Integrating the Healthcare Enterprise: • an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information • promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical needs • leads to systems that communicate better, are easier to implement, and enable care providers to use information more effectively

  11. IHE Process • Users identify desired functionalities that require coordination and communication among multiple systems • E.g., departmental workflow, single sign-on, cross-departmental sharing of documents and information • Find and document standards-based transactions among systems to achieve desired functionality • Apply necessary constraints to eliminate useless wiggle room • Provide process and tools to encourage vendors to implement • MESA software test tools • Connectathon interoperability testing event • Provide tools and education to help users acquire and integrate systems using these solutions • Connectathon results and public demonstrations • Integration statements • RFP toolkit (soon)

  12. IHE Participants • Societies Representing Healthcare Segments • RSNA, HIMSS, ACC, ACCE, … • Users • Clinicians, Medical Staff, Administrators, CIOs, … • Consultants • Information Systems Vendors • Imaging Systems Vendors • Standards Development Organizations (SDOs) • DICOM, HL7, ASTM, …

  13. IHE Deliverables • Technical Framework • Integration Profiles • Connectathon • Public Demonstrations • Tools for Acquiring Conformant Products

  14. IHE Technical Frameworks • Detailed standards implementation guides • Cardiology • IT Infra • Lab • Radiology

  15. Organization of TFs • Volume 1: Integration Profiles • Describes clinical need and use cases • Identifies the actors and transactions • Volume 2+ of Technical Framework • Provides implementation specification for each transaction

  16. Organization of TFs

  17. IHE Radiology Integration Profiles Charge Posting Presentation of Grouped Procedures Reporting Workflow KeyImageNotes Simple Image & Numeric Reports NMImage Consistent Present-ation of Images EvidenceDocs Access to Radiology Information Portable Data for Imaging Scheduled Workflow - Patient Info. Recon-ciliation Post-Processing Workflow Basic Security

  18. Example: IHE Scheduled Workflow report ADT (Registration) Film Lightbox Image Manager & Archive Order Filler Film Folder Image Display Print Server Report Repository Order Placer AcquisitionModality acquisitioncompleted acquisitionin-progress imagesprinted Modality acquisitioncompleted

  19. IHE IT Infrastructure Integration Profiles Patient Identifier Cross-referencing for MPI Patient Identifier Cross-referencing for MPI 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 presented to 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 Map patient identifiers across independent identification domains Map patient identifiers across independent identification domains Provide users a single name and centralized authentication processacross all systems Provide users a single nameandcentralized authentication processacross all systems Consistent Time Consistent Time Coordinate time across networked systems Coordinate time across networked systems

  20. IHE Connectathon • Open invitation to vendor community • Advance testing tools (MESA) • Testing organized and supervised by project management team • Thousands of cross-vendor tests performed • Results recorded and published

  21. RFPs & IHE Integration Statements • Be Brief? • “The system must support DICOM” • Be Effective? • “The system must support the following DICOM services according to the following 100 pages of specifications” • Be Both: • “The system must support IHE Scheduled Workflow as an Acquisition Modality” • IHE Integration Statements • Version 2.1 of the Jupiter 3 CT supports IHE Scheduled Workflow as an Acquisition Modality

  22. Integration Statements

  23. RFP Toolkit

  24. RFP Toolkit

  25. IHE Radiology Activities • New Supplements • Media Distribution Profile • NM Image Profile • Departmental Workflow White Paper • Report Export Extension • Instance Availability Notification Transaction • Appointment Notification Transaction • www.rsna.org/ihe/(Follow Link for Supp. & Forum)

  26. IHE IT Infrastructure Activities • Finalizing Profile Candidates • EHR (Electronic Healthcare Record) Registries • Basic Security “Profile Migration/Template” • DICOM Configuration (LDAP) • Patient Demographics Query • White Pages • www.himss.org/ihe/

  27. New IHE Domains • IHE Lab • Initiated by IHE-Europe & IHE-Japan • Lab Workflow Profile Released for Trial Implementation • www.gmsih.fr/ihe • IHE Cardiology • Sponsored by ACC, ESC, GMSIH • Finalizing Supplement Candidates • Cath Lab Workflow • Echo Workflow • ECG Report Retrieval for Display

  28. IHE expanding, more info. IHE Radiology  www.rsna.org/ihe12 Integration Profiles availableIHE Connectathon for IT January 2004 IHE IT Infrastructure www.himss.org/ihe5 Integration Profiles availableIHE Connectathon for IT January 2004 IHE Laboratory www.gmsih.fr/iheFramework in Public Comment, feedback due Nov 15thIHE Connectathon for Lab March 2004 IHE CardiologyCommitted sponsorship by ACC, ESC, HIMSS.Kick Off December 2004 – First Demo ACC March 2005

  29. What can you do? • Learn about IHE • Participate in IHE planning • Insist on IHE compliance in your RFPs and contract documents

  30. More information…. • IHE Web sites: http://www.himss.org/IHE http://www.rsna.org/IHE http://www.acc.org/quality/ihe.htm. • Technical Frameworks: • ITI V1.0, RAD V5.5, LAB V1.0 • Technical Framework Supplements - Trial Implementation • May 2004: Radiology • August 2004: Cardiology, IT Infrastructure • Non-Technical Brochures : • Calls for Participation • IHE Fact Sheet and FAQ • IHE Integration Profiles: Guidelines for Buyers • IHE Connect-a-thon Results • Vendor Products Integration Statements

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