Purchasing & Integrating Radiology Systems Using IHE: A Tutorial & A Real-world Case

1. Purchasing & IntegratingRadiology SystemsUsing IHE: A Tutorial & A Real-world Case Kevin O’DonnellCoChair, IHE Radiology Planning Cmte Toshiba Medical Systems

2. Integrating the Healthcare Enterprise • facilitates integrating systems • for efficient, accurate patient care • Systems that support IHE Integration Profiles: • communicate better & integrate more easily • provide more complete and accurate information • better support care providers workflow

3. IHE = Integration Profiles • Each IHE Profile • describes a clinical information need or workflow scenario • documents how to use standards (e.g. HL7, DICOM, ...)to accomplish it • Systems that implement the same Profile address a need in a mutually compatible way • Hundreds of products support one or more IHE Radiology Profiles.

4. Your Three Step Program • Select Specific IHE Profiles • List those Profiles in your RFP • Check Vendors IHE Integration Statements

5. Selecting IHE Profiles Review the Profiles : • What they do • Benefits for your situation Some Helpful Resources: • www.ihe.net/profiles - Profile Catalog • IHE User’s Handbook - Radiology • RSNA Demonstrations • Educational Material (e.g. Workshop Presentations) • IHE Technical Framework – Radiology • Connectathon Results www.ihe.net

6. RFPs Your choice: • 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 the IHE Scheduled Workflow Profile as the Acquisition Modality actor.” • Vendor IHE Integration Statements • Version 2.1 of the CardioCT 5000 supports IHE Scheduled Workflow as an Acquisition Modality

7. IHE Integration Statements • Explicit claim by the vendorfor a specific product version • Lists IHE profiles, actors, options • Short & Sweet

9. Let’s look at an Example From the IHE Radiology User’s Handbook • Suppose you’re buying a modality (see Chapter 1) • Suppose your integration strategy has identified two key goals: • Reducing/Preventing Errors • Improving Throughput/Turnaround • Reviewing the Profile Benefits (see Section 1.1.1): • Scheduled Workflow Profile has a significant impact on both goals: • Prevents manual data entry errors & saves time at the modality console by downloading patient demographics and study details from the RIS (MWL) • Prevents lost studies & time wasted re-scanning by confirming PACS receipt of images to avoid accidental deletion (Storage Commitment); • And saves more time because confirmation is automatic and electronic • Reduces missing or irrelevantpriors by storing a full set of accurate patient and study identifiers and details in each study object (Store) • Reduces delays in the reporting process by notifying the RIS of exams in progress and ready to read (MPPS)

10. IHE Scheduled Workflow Profile report Registration Film Lightbox Image Manager & Archive Orders Filled Film Folder Diagnostic Workstation Film Report Repository Orders Placed AcquisitionModality acquisitioncompleted acquisitionin-progress imagesprinted Modality acquisitioncompleted

11. Using IHE • Present IHE as an integration priority to your vendors. A Business goal ! • Specify appropriate Profiles, Actors, Options in your RFP • “The system must support the IHE Scheduled Workflow Profile as the Acquisition Modality actor and support the Exception Management Option.” • Request Integration Statements from your vendors • Plan acceptance testing (see Section 1.2.2)

12. Dealing with Legacy • Prepare to identify and address legacy system issues (see Section 1.2.4) • Maximum benefit when all systems are IHE • Most of you will have some non-compliant devices and systems • Make best effort to bring them “up-to-date” • Incremental usage of IHE provides incremental benefit • It’s just clean DICOM and HL7; a great baseline • Get on the Yellow Brick Road... • No sense buying New legacy equipment

13. First Steps • Visit IHE Profile Demonstrations • Cross-Enterprise Document Sharing for Imaging [XDS-I] • Teaching File & Clinical Trial Export [TCE] • IHE Product Showcase and participating Vendor Booths • Interoperability Showcase at HIMSS 2008 • Visit www.ihe.net- start learning about Profiles • Talk about an IHE strategy with your CIO / IT staff, and with your vendors • Now, lets look at a Real-world Experience

14. Thames Valley Hospital Planning Partnership, London, OntarioCanada Beth Goodhew Peninsula Consulting Group

15. Thames Valley Hospital Planning Partnership • 8 Corporations • 2 in London (~75% volume) • 6 Community Facilities • 750,000 Radiology exams annually • >200 DICOM Connections • ~65 Radiologists, ~10 Residents and Fellows, ~8 NM Physicians • Canada Health Infoway sponsored project to create the South Western Ontario Image Repository

16. Project Vision Improved electronic access to Radiology images and reports to increase quality and timeliness of patient care through collaborative regional partnerships and to enhance the speed of treatment decisions.

17. Primary Read Clinical User Clinical User Technologist Radiologist Clinical Architecture Goal: Seamless Integration Community Billing GE PACS Web Clinical CERNER LAB/PHARMACY POWERCHART CPI Registration Diagnostic RADNET Dictation

18. Benefits of IHE • Improve Quality and Patient Safety • Providing for positive transfer of information using non-proprietary methods • Eliminating manual data entry • Improve the efficiency and effectiveness of clinical practice by: • Improved Information Flow • Advanced Multi-System Functions • Eliminate manual steps from common processes • Systems Integration • Enabling the sharing of health information locally, regionally and nationally

19. Alignment of IHE and Project Vision IHE Benefits Improve Quality and Patient Safety • Providing for positive transfer of information • Eliminating manual data entry Improve Efficiency • Eliminate manual steps from common processes Enable sharing of health information locally, regionally and nationally Vision Improved electronic access to Radiology images and reports to increase quality and timeliness of patient care through collaborative regional partnerships and to enhance the speed of treatment decisions.

20. Steps to IHE Implementation • Current state evaluation • Evaluate workflow challenges • Current levels of compliance • Future State Analysis • Desired workflow enhancements • Profile evaluation • Create future map of profiles and actors • Gap Analysis • Assign Actor roles to current & future systems • Plan required software upgrades/replacements • Flag remaining integration challenges • Decide on Workflow changes • Impact on Technologist/Radiologist • QC processes/exception handling • Prepare new purchase requirements

21. Non-IHE Equipment • Prepare coping strategies • Need a clear plan of action for each device • (See IHE Users Handbook – Radiology) • Users can drive compliance to IHE by asking for it often

22. Profiles Implemented • Scheduled Workflow (SWF) • Patient Information Reconciliation (PIR) • Consistent Presentation of Images (CPI) • Charge Posting (CHG)

23. Replication • After one site is properly implemented • Additional sites are configured, trained and brought live in a rapid fashion • IHE Profiles served as templates which worked well in small and large hospitals • Experience in one site was easy to repeat elsewhere

24. Rapid Roll-out of Successive Sites FAST Alliance RIS Rollout RIS Build for FAST Sites RIS Rollout Tillsonberg RIS Rollout Ingersol RIS Rollout Strathroy RIS Rollout Newbury FAST Alliance PACS Rollout June 30 Adoption DI-1 003.3 PACS Rollout Tillsonburg July 31 Adoption DI-1 003.4 PACS Rollout Strathroy DI-1 003.5 Aug 30 Adoption PACS Rollout Newbury DI-1 003.6 Sept 30 Adoption PACS Rollout Ingersoll Community Hospital RIS/PACS STEG RIS Rollout Oct 31 Adoption STEG PACS Rollout DI-1 003.7 Woodstock RIS Rollout DI-1 003.8 Woodstock PACS Rollout Dec 31 Adoption Q1’05 Q2’05 Q3’05 Q4’05

25. Take Home Tip Salvation = (SWF + PIR) Scheduled Workflow Benefits: • Serves as un-biased roadmap providing directionfor vendors and implementers alike • Paves the way for true optimization of workflow • Filmless • Rapid distribution, rapid access • Paperless • Up to the minute status, distributed access • Forms foundation for future Integration Profiles