Integrating the Healthcare Enterprise

1. Integrating the Healthcare Enterprise IHE Update to DICOM • Charles Parisot, GE Healthcare • IHE IT Infrastructure Technical Committee Co-chair DICOM.Committee

2. Laboratory Integration Profiles Laboratory Scheduled Workflow (LSWF) done in 2003 Laboratory Point Of Care Testing (LPOCT) year 2004 Tests performed by a laboratory for an identified inpatient or outpatient Tests performed on point of care or patient’s bedside Laboratory Patient Information Reconciliation (LPIR) year 2004 Laboratory Device Automation (LDA) year 2004 Pre-analytic process, analysis and post-analytical treatment Tests performed on an unidentified or misidentified patient Laboratory Code Set Distribution (LCSD) year 2004 Sharing the batteries and tests code sets throughout the enterprise DICOM.Committee

3. IHE Cardiology Profiles • Cardiac Catheterization Workflow • Based on IHE Radiology Scheduled Workflow and Patient Information Reconciliation Profiles • Echocardiography Workflow • Based on IHE Radiology Scheduled Workflow and Patient Information Reconciliation Profiles • Retrieve ECG for Display • Based on IHE IT Infrastructure Retrieve Information for Display Profile DICOM.Committee

4. Cardiac Catheterization Workflow • Management of cath exams • Similar to IHE-Radiology SWF • Multi-modality, multiple procedure steps • Handle multiframe images (XA and IVUS) • Reconciliation of patient information • Similar to IHE-Radiology PIR • Unscheduled cath is the norm, not the exception • Time synchronization • Modalities must support IHE-ITI Consistent Time • Out of scope year 1 • Pre-cath and post-cath activity, Hemo waveforms and reports, Procedure logs, QCA/QVA, Final cath reports DICOM.Committee

5. Echocardiography Workflow • Management of echo exams (TTE, TEE, stress) • Similar to IHE-Radiology SWF • Handle multi-stage tests (stress echo) • Workflow management, image labeling, and display • Handle multiframe and compressed images • Reconciliation of patient information • Similar to IHE-Radiology PIR • Out of scope year 1 • Preliminary and final reports, Physician scheduling, Counter-indication/clinical decision support, Fetal and pediatric echo DICOM.Committee

6. Retrieve ECG for Display • Provide ECGs and related reports to enterprise • Extension to IHE-ITI RID • ECGs served in ready-to-display format • Requirements on displayable quality • Includes XML-based ECG/report list • Out of scope year 1 • ECG acquisition and reading workflow • ECG raw data interchange • Export of reports to external repository DICOM.Committee

7. IHE Radiology • RSNA 2004: show-wide demonstration of Portable Data for Imaging • January 2005 Connectathon - 4 new supplements: • Instance Availability Notification (SWF Option) • Appointment Notification (SWF Option) • Nuclear Imaging (New Integration Profile) • And PDI (already introduced at RSNA 2004) DICOM.Committee

8. IHE IT Infrastructure 2004-2005 Personnel White Page New Access to workforcecontact information New Retrieve Information for Display Retrieve Information for Display Cross-Enterprise Document Sharing 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 Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Patient Demographics Query New Audit Trail & Node Authentication New Centralized privacy audit trail and node to node authentication to create a secured domain. Enterprise User Authentication Enterprise User Authentication Consistent Time Provide users a single nameand centralized authentication processacross all systems Coordinate time across networked systems Patient Synchronized Applications Synchronize multiple applications on a desktop to the same patient Patient Identifier Cross-referencing for MPI Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Map patient identifiers across independent identification domains DICOM.Committee

9. IHE IT Infrastructure 2004-2005 Personnel White Page New Access to workforcecontact information New Retrieve Information for Display Retrieve Information for Display Cross-Enterprise Document Sharing 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 Patient Demographics Query New Audit Trail & Node Authentication Registration, distribution and access across health enterprises of clinical documents forming a distributed patient electronic health record New Centralized privacy audit trail and node to node authentication to create a secured domain. Enterprise User Authentication Enterprise User Authentication Consistent Time Provide users a single nameand centralized authentication processacross all systems Coordinate time across networked systems Patient Synchronized Applications Synchronize multiple applications on a desktop to the same patient Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains DICOM.Committee

10. Introduction: EHR Cross-Enterprise Document Sharing First step towards the longitudinal dimension of the EHR Focus: Support document sharing between EHRs in different care settings and organizations DICOM.Committee

11. Typically, a patient goes through a sequence of encounters in different Care Settings Long Term Care Acute Care (Inpatient) Other Specialized Care(incl. Diagnostics Services) GPs and Clinics (Ambulatory) Continuity of Care: Patient Longitudinal Record DICOM.Committee

12. community Hospital Record Laboratory Results Specialist Record Records Sent Clinical Encounter Finding the records of a patient-Manual & tedious The challenge: Finding and accessing easily documents from other care providers In the community. Clinical IT System DICOM.Committee

13. Sharing records that have been published community Hospital Record Laboratory Results Reference to records Specialist Record 4-Patient data presented to Physician Temporary Aggregate Patient History Index of patients records (Document-level) 3-Records Returned Clinical IT System Sharing System 2-Reference to Records for Inquiry 1-Patient Authorized Inquiry Clinical Encounter DICOM.Committee

14. Building and accessing Documents DocumentRepository Submission of Document References Retrieve of selected Documents Documents Registry EHR-LR:Longitudinal Recordas usedacross-encounters Long Term Care Acute Care (Inpatient) Other Specialized Careor Diagnostics Services PCPs and Clinics (Ambulatory) EHR-CR: Care Record systemssupporting care delivery DICOM.Committee

15. XDS – Value Proposition • Foundation for Health IT Infrastructures: Shared Electronic Health Record, in a community, region, etc. • Effective means to contribute and access clinical documents across health enterprises. • Scalable sharing of documents between private physicians, clinics, long term care, pharmacy, acute care with different clinical IT systems. • Easy access: Care providers are offered means to query and retrieve clinical documents of interest. DICOM.Committee

16. XDS - Value Proposition • Distributed: Each Care delivery organization “publishes” clinical information for others. Actual documents may remain in the source EHR-CR. • Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain (e.g. an LHII). • Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (HL7-CDA, ASTM-CCR, PDF, DICOM, etc.). • Document Content Neutral: Document content is processed only by source and consumer IT systems. • Standardized Registry Attributes: to ensure deterministic document searches. DICOM.Committee

17. XDS – Conclusion • Foundation for EHR & Health IT Infrastructures • Effective contribution and access to shared documents across all types of health enterprises • Scalable, Flexible and Easy access • XDS to be one of the major highlights of 2005 Annual HIMSS Conference & Exhibition. Dallas, Tex., Feb. 13-17: • used as a foundation for an on-site demonstration of interoperability in support of a National Health Information Networks. • Attendees at the conference will be able to create and share their own health records across vendor booths as well as in the ambulatory and acute care settings on the conference exhibit floor. DICOM.Committee

18. XDS Development • Specification work since Nov 2003 • Under Public Comments June-July 2004 • 600 constructive comments received, • Stable XDS specification IHE TF Aug 15th, 2004 DICOM.Committee

19. HIMSS 2005 – Three participation opportunities • Vendor Systems • Conditions: Apply before Oct 15th + system pass IHE connect-a-thon • Vendor chose among 15 existing integration profiles (out of 29, see slide 15) • May participate from own vendor booth in addition to Showcase booths Interoperability Showcase Booth laboratory ITInfrastructure Vendor Booth cardiology Vendor Booth Cross-enterprisedoc sharing (Choice of XDS,PWP,RID,PDQ) radiology Ambulatory Showcase Booth radiology laboratory Pharma ? DICOM.Committee

20. IHE Events • September 13-15th: Conference and Worshop-Oakbrook (IL-USA) • January 2005 Connectathon - 4 domains • IT Infrastructure • Cardiology • Radiology • Laboratory • HIMSS IHE Demos – February 2005 • February 7-10th: Conference and Participant Workshop (Netherland) • February 2005 IHE Japan Connectathon (Radiology) • ACC IHE Demo – March 2005 • April 25th-29th IHE Europe Connectathon DICOM.Committee

21. More information…. • Web sites: www.himss.org/ihe www.rsna.org/ihe www.ihe-europe.org DICOM.Committee