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IHE Implementation Hurdles

IHE Implementation Hurdles. Paul Nagy, PhD Director, Informatics Research Department of Radiology University of Maryland School of Medicine. What other industries call IHE. Understanding the role of diffusion of innovation Obstacles when implementing IHE Getting over the hump.

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IHE Implementation Hurdles

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  1. IHE Implementation Hurdles Paul Nagy, PhD Director, Informatics Research Department of Radiology University of Maryland School of Medicine

  2. What other industries call IHE. • Understanding the role of diffusion of innovation • Obstacles when implementing IHE • Getting over the hump

  3. What does your technology strategy look like? • Each department solving its own internal problems. • To get data from the department you need to go down to it.

  4. What other industries call it. • EAI (Enterprise Application Integration) • SOA (Service Oriented Architecture) • ESB (Enterprise Service Bus) • BPM (Business Process Management) • EDI (Electronic Data Interchange) • A Rose by any other name • $6.3 Billion dollar market 2005 (Aberdeen) • http://www.eaiindustry.org/docs/member%20docs/Fall%202003%20Enterprise%20Integration%20Software%20Piece%20-%20BCF.pdf

  5. EAI Enables • Supply chain management • Just in time inventory • B2B Business to business • CRM Customer relations management • The internet economy • Nobody does it all anywhere.

  6. Goal is the same • Loosely coupled systems where the end user doesn’t know where they are being run. • Make process transparent to end users (customers) • Fedex package tracking • Buying goods through Amazon

  7. In medicine we call it IHE • Integrating the Healthcare Enterprise • A standard way to use the standards

  8. Institute of Medicine Model of Service • Safety • Effectiveness • Patient centeredness • Timeliness • Efficiency • Equity Align to the patient Source: Insititute of Medicine, Crossing the chasm

  9. 10 points of system redesign by IOM • 4. Share knowledge and let information flow freely • 6. Safety is a system property not a function of vigilance • 7. Become transparent • 10 Foster cooperation among clinicians Berwick D. Escape Fire. Jossey-Bass, San Francisco 2004

  10. Chain of Effect Patient Patient Focus Provider Referring Physicians Clinicians Radiologists Process Work Product Data, Images, Results Infra- structure Single Sign-on, Directory Services, Communication

  11. Gartner Group • Predicted that by 2005, 90% of basic functionality between PACS vendors would be converged (window/level/pan/zoom). • The major differentiator between vendors would be in their ability to integrate with other vendors.

  12. Diffusion of innovation model • 1943 model of Iowa farmers adoption of hybrid seeds • Five personality and socioeconomic categories Early Majority Early Adopters Late Majority Traditionalists Innovators Time B. Reiner, E. Siegel “Psychological factors affecting the adoption of PACS” Applied Radiology Volume: 31 Number: 4 April 2002

  13. Technology Lifetime Standards (DICOM, HL7, IHE, SNIA…) 25- 50 years Infrastructure (IP, SAN,…) 10- 20 years Programming Languages (PL/1, Pascal, C, C++, Java, …) 5-10 years Software (data formats, compatibility, …)2-5 years Hardware (Network cards, video cards, processors, …) 1-2 years Shapiro, IBM

  14. Obstacles you will need to hurdle • Top ten excuses for not doing IHE from hospitals

  15. #1. Modality Integration Study • 101 Modalities • C-Store 100% • Modality worklist was above 90%, • MPPS and storage commitment 30% • The simultaneous support of all of Q/R SCU/SCP, MPPS, print SCU, verification SCU/SCP, Worklist SCU, and Storage commitment on 3 modalities A Gavain, SCAR 2004, To be published (University of Montreal)

  16. #2. Asking for “none of the above” from the vendors • Proprietary vendor integration • Vendor provided API • Customized DICOM Interfacing • Custom HL7 Interfacing • None of the above X Write in: IHE Integration

  17. Results of PACS interviewing (2001) • 19 PACS vendors interviewed • Everyone loves and supports IHE • About half thought they participated in the connectathon. • No one knew what profiles they supported. • Responses included: • I don’t know. • Can I get back to you? • Frankly, I’m new here. • What is a profile? • ITE? IHC? I will have to check on that. • I don’t know off the top of my head. • Yeah we’re compliant on that. • Absolutely, we support NT/2000/ and Unix. • No one has ever asked me that before.

  18. #3. Internalizing IHE • IHE describes the interface only • You can comply with IHE and do little or nothing with the messages. • (MPPS completed message on a RIS) • Internalizing the message is the real value to the end user. • When a vendor says they conform to IHE they at the very least set the expectation with the end user about internalization. • Its not good business to say you do it but don’t do anything with it.

  19. #4 Lifecycle of RIS is longer than the PACS • RIS has a 10 year life span • Legacy systems • PACS has 5 year life span • Higher churn rate as computer industry moves forward. • Unidirectional RIS interfaces

  20. #5. Price per interface • How many interfaces is scheduled workflow(Only the first integration profile)? • Dicom C-Store • Dicom Storage Commitment • Dicom Modality Worklist • Dicom Modality Performed Procedure Step (In Progress) • Dicom Modality Performed Procedure Step (Completed) • If you pay 20k per interface. Do you have to pay 100k per modality to get IHE? • The cost of interfaces to the vendor is for the very reason that DICOM or HL7 were not plug and play. • The whole point of IHE is to bring down that complexity integration by having the connectathon.

  21. #6. 1st step is the hardest • Scheduled workflow and Patient Information Reconciliation are the biggest steps • Involves (RIS, PACS, & Modalities) • Involves the most number of transactions

  22. #7. Planning goes against the medical ideology • Organic evolution and responding to clinical drivers instead of systematic approach towards a technology vision. “People don’t plan to fail, they fail to plan”

  23. Technical Leadership • CTO is focused on the use of technology in products developed by the company and technology delivered to external customers. CTOs are typically more technical than CIOs. • A CIO is more concerned with keeping systems running day-to-day and uptime. CIOs are typically more managerial than CTOs. • http://www.monster-isp.com/glossary/CTO.html

  24. Defining the complementary job roles of the CTO and CIO • As the right hand of the CIO, the CTO is responsible for designing and recommending the appropriate technology solutions to support the policies and directives issued by the CIO. In so doing, the CIO is able to marry the recommended technologies to the strategic business objectives of the company. This approach establishes the CTO as the technology specialist. • http://techrepublic.com.com/5100-6299-5030390.html

  25. #8. Educated users • I’ve got DICOM, why do I need IHE • DICOM 3.0 is 12 years old. Become very flexible. Not plug and play. • Too technocratic, hard to directly address business needs of an organization. It’s the building blocks. • IHE is how you need to use those blocks • DICOM gets you lost in the trees • DICOM is point to point IHE is about workflow

  26. #9 IHE doesn’t always go far enough • PSA – Patient Synchronized Applications • Keeps app synched to patient • But doesn’t synch to Study ID • A RIS can’t drive the PACS without adding extra functionality.

  27. IHE is still evolving • New profiles are coming out each year. • IHE is now 7 years old • The first profiles are just as valid now as they were 7 years ago. • Very close to the tipping point if we haven’t crossed it already.

  28. #10 Don’t want to be an early adopter • Subsidize the development cost of IHE with the vendors. • A. You pay for it one way or another • Vendors have already done it • 5 years from now you will be kicking yourself • Migration costs • Not achieve the workflow benefits of PACS that everyone assumes will magically happen.

  29. Getting over the hump IHE is a marriage between business objectives and technical architectural policies. Making all the domains of healthcare transparent to the patient and the bedside.

  30. Conclusions • IHE is now a reality. • Yes, but some assembly is required • IHE is a critical indicator of when PACS hits the majority phase of technology maturity and cost effectiveness. • Vendors need to internalize IHE to get full value • Need more CTO’s (leadership) in healthcare

  31. Before signing the US constitution most of the delegates did not believe that the document could possibly last more than 5 to 10 years. • Ben Franklin – “ I am not sure that this isn’t the best document that man can create” • IHE might not be perfect • But is evolving and an open process • And certainly much better than any alternative Walter Isaacson, Ben Franklin. Simon & Schuster 2003.

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