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Image-enabled Health Records: IHE Progress and Plans

Integrating the Healthcare Enterprise. Image-enabled Health Records: IHE Progress and Plans. Christoph Dickmann – Member IHE Rad TC Glen Marshall – Co-chair IHE IT-I PC Charles Parisot – Co-chair IHE IT-I TC. Pragmatic definition of “EHR”. Integrated data and workflow functionality

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Image-enabled Health Records: IHE Progress and Plans

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  1. Integrating the Healthcare Enterprise Image-enabled Health Records:IHE Progress and Plans Christoph Dickmann – Member IHE Rad TC Glen Marshall – Co-chair IHE IT-I PC Charles Parisot – Co-chair IHEIT-I TC

  2. Pragmatic definition of “EHR” • Integrated data and workflow functionality • Multimedia data access • text, image, waveform, … • Communication among stakeholders • clinicians, caregivers, consumers, … • Support different views of data • Clinical records • Details: episode, visit, study • Longitudinal records • Summaries: episode, visit cross-department or cross-enterprise users Linking summaries and clinical details

  3. What an EHR can do for you • Combine multiple sources of patient data • Enhance functionality by • Connecting to specialized systems • Augmenting the data sources by combining them • Provide timely, relevant, comprehensive data • Surgeon preparing an operation by viewing an abdomen CT and lab values • General practitioner receiving cardiac films via CD • Neurologist reading a brain MR report and viewing an EKG

  4. EHR goals in IHE(compatible with U.S. NHII goals) • Informed Clinical Practice • Leverage existing IHE basis to ease EHR adoption • Interconnected Clinicians • Beyond the department: community or regional scope • Personalized Care • Web-based data access and summary data • Support for higher-level goals • Better outcomes • Increased patient safety • More efficient healthcare operations

  5. EHR complexity • Business dilemmas • Significant, long-term investment • Investors may not be main beneficiaries • Coordination and cooperation • Active collaboration among multiple stakeholders • Identify and work out commonalities and barriers • Integration and interoperability • Implement existing standards • Develop additional standards  Focus on selected aspects

  6. Textual data & functions Patient data Clinical data Laboratory results Surgery reports Prescriptions, meds Letters or notes Integrate with imaging data and related processes Focus: Image-enabled EHR(connect two “worlds”) • Imaging data & functions • Patient data • Images and evidence • Radiology • Cardiology • Nuclear Medicine • Integrate with clinical data and related processes

  7. Neurologist: reviewing stroke patient transfer to ward Nurse: preparing GI ward round for Dr. X Surgeon: planning gall bladder surgery GP: seeing a post-MI patient after hospital discharge Patient: preparing an obstetric visit Cardiologist: during catheter intervention Radiologist: starting an abdomen CT Physician: counseling at diabetes outpatient clinic Lab technologist: for immune-deficiency testing Ophthalmologist: during history-taking with a new patient Potential use cases of an image-enabled EHR Information need may include current or longitudinal evidence.

  8. acquire store index register Image/ ReportRepository DocumentRegistry Ultrasound reportwith images (XDS architecture) Image-enabled EHRPregnancy outpatient clinics encounter evaluate

  9. analyze acquire store index register Document/ ReportRepository DocumentRegistry Microbiology reportwith images (XDS architecture) Image-enabled EHRMicrobiology test encounter

  10. store retrieve index index query register DocumentRepository Image/ Report and DocumentRepositories Report, letters(with images) DocumentRegistry Image-enabled EHRChildbirth inpatient stay evaluate (XDS architecture)

  11. patient Acute inpatient care Long termcare Acute ambulatory care Specialized or diagnostic services Retrieve documents Query DocumentRepository Retrieve selected document references Register documents (references) Document Registry Primary existing IHE mechanismSharing documents (XDS) Care recordsystems:specific care delivery Longitudinal record system:across encounters Note: specific imaging documents are work in progress

  12. 5 Integration Profiles IHE IT Infrastructure IHE Cardiology 6 Integration Profiles 1 Integration Profile 3 Integration Profiles Existing IHE contributions for EHR implementation EHR realization IHE Radiology IHE Laboratory • Each TF can contribute to EHR scenarios with Integration Profiles for • Data access • Workflow handling

  13. Basic requirements of EHR systems • Healthcare provider systems • EHR sources and users • Document handling • Storage and retrieval of EHR documents • Infrastructure services • Basic data and application integration • Network • EHR storage, inquiry, and retrieval path

  14. IHE contributionProfiles for interoperable data and applications • Common patient identification (IT-I PIX) • Common patient demographics (IT-I PDQ) • Desktop integration (IT-I PSA)running applications work on the same patient • Single sign on (IT-I EUA) enterprise-wide user handling • Common staff data (IT-I PWP)health professionals are commonly recognized • Security and privacy (IT-I ATNA, Rad SEC)

  15. Appl. 1 Appl. 2 Appl. 3 Source 1 Source 2 Patient identifier matching Any user Samepatient selected Single sign on Patientdemographics Desktop Integration as an EHR enabler Personnel/staff data Backend integration (services, data) EHR interoperability examples Common person data or services

  16. IHE contributionProfiles for access to images and reports (1) • Radiology • Access to Radiology (Rad ARI) • Retrieve diagnostic quality images and reports • Simple Image and Numeric Reports (Rad SINR) • Access or export of reports and related images • Key Image Notes (Rad KIN) • Mark and annotate relevant imaging evidence • Portable Data for Imaging (Rad PDI) • Export/ import/ view media data • Nuclear Medicine Image (Rad NM Image) • Capture and use complex NM result screens

  17. IHE contributionProfiles for access to images and reports (2) • Cardiology • Cardiac Catheterization Workflow (Card CATH),Echo Workflow (Card ECHO) • Retrieve catheterization and echocardiography imaging evidence • Retrieve ECG for Display (Card ECG) • Retrieve ECG summaries and results • IT Infrastructure • Retrieve Information for Display (IT-I RID) • Query and retrieve documents and summaries/ lists • Cross-Enterprise Clinical Document Sharing (IT-I XDS) • store & retrieve documents and summaries with longitudinal data

  18. IHE contribution Profiles for access to clinical/ textual information (1) • Radiology • Simple Image and Numeric Reports (Rad SINR) • Access original or exported reports • IT-Infrastructure • Cross-Enterprise Clinical Document Sharing (IT-I XDS) • Store & retrieve documents or summaries with longitudinal data • Retrieve Information for Display (IT-I RID) • Access documents and summaries (e.g. imaging, lab, discharge, medications, prescriptions)

  19. IHE contribution Profiles for access to clinical/ textual information (2) • Cardiology • Retrieve ECG for Display (Card ECG) • Access ECG summaries and results or reports • Laboratory • Lab Scheduled Workflow • Notification of lab results

  20. IHE contributionProfiles for workflow / patient management support • Workflow integration • Scheduled Workflow (Rad SWF, Card CATH/ ECHO, Lab) • Ordering, scheduling and tracking of image acquisition steps • Appointment Notification (Rad SWF option): report back to the order placing system the date and time of the scheduled steps • Reporting Workflow (Rad RWF) • Scheduling and tracking of report creation tasks • Patient data integration • Patient Information Reconciliation (Rad PIR, Card CATH/ ECHO) • Modification and matching of patient data and imaging evidence • Overall concept (Rad whitepaper) • Departmental workflow and interfaces to enterprise

  21. Planned IHE development • Harmonize IHE domain-specific work • Extend XDS’ document content (Rad, Card) • Additional EHR contents • Code sets and master files • Realize overall workflow concept • Configuration support • Security details, e.g. access control

  22. Image-enabled EHR – IHE progress and plans • IHE Integration Profiles from different domains can be combined • Combinations of current profiles can cover many EHR scenarios • Information integration (imaging, textual) • Enhanced functionality beyond one department • Intra- and cross enterprise communication • Scenarios enable system evolution(organizational change management not to be forgotten) • IHE ensures integration testing and future Integration Profile development

  23. Thank you!Questions? More information: http://www.rsna.org/IHE

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