Integrating the Healthcare Enterprise

1. Integrating the Healthcare Enterprise The IHE Process: Developing Standards-based Solutions Kevin O’Donnell Co-chair, IHE Radiology Planning Committee Manager, Systems Solutions, Toshiba Medical Systems

2. Goals of IHE • Increase the rate and quality of integration in healthcare environments. • Foster communication among vendors. • Prove that integration is attainable through the use of standards. • Improve the efficiency and effectiveness of clinical practice. IHE Canada Videoconference

3. “Improve the efficiency and effectiveness of clinical practice” • Improve Workflow • Improve Information Accuracy • Improve Information Availability • Enable Cross-System Functionality IHE Canada Videoconference

4. How Does IHE Work? A joint initiative to improve systems integration: • Clinicians define system integration needs • Vendors use a well-defined process to develop standards-based solution profiles – the IHE Technical Framework. • Societies (HIMSS/RSNA/ACC) supervise documentation, testing, demonstration, and promotion of the profiles. IHE Canada Videoconference

5. “IHE drives standards-based integration in healthcare” IHE Canada Videoconference

6. Key IHE Concepts IHE Canada Videoconference

7. Actor • A generalized system function: • Order Placer • Order Filler • Acquisition Modality • Image Manager • Report Creator • Implementers choose which Actors to include in a system • Systems may group several Actors IHE Canada Videoconference

8. Transaction • An interaction or exchange of data between actors • Based on open standards • Strictly specified to avoid incompatible implementations (retire options, clarify data model, etc.) • Represents an actors interface with the rest of the world • System internal functions are out of scope, e.g. • single system functions • transactions between actors inside the same system IHE Canada Videoconference

9. Integration Profile • A Problem/Solution Scenario • For each Integration Profile: • the context is described (what real-world problem is addressed) • the actors are defined (what systems are involved) • the transactions are defined (what do they have to do) IHE Canada Videoconference

10. IHE Process • Identify a specific information flow between several systems • Define a coherent set of actors & transactions • For each transaction: • Select an existing standard (e.g. HL7, DICOM) • Detail how to use the standard to implement the transaction • Bundle it up as an “Integration Profile” • Do Cross-vendor testing at a “Connectathon” • Use Integration Profiles as a Common Language for: • Vendors to claim in Integration Statements • Users to request in RFPs IHE Canada Videoconference

11. IHE Canada Videoconference

12. IHE Technical Framework • Volume 1: The Profiles • Identifies the actors and transactions • Describes the integration scenario • Volume 2 (and 3): The Transactions • Provides implementation specification for each transaction • Volume 4: The National Appendices • Documents national clarifications and extensions IHE Canada Videoconference

13. IHE Connectathon • Voluntary Participation • Project Management by Mallinckrodt • Pre-Validation Tools (MESA) • Defined Test Protocols with Verification • Engineering event • code changes are not a problem • Massive Cross-vendor Testing IHE Canada Videoconference

14. 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 IHE Canada Videoconference

15. A Proven Standards Adoption Process Product IHE IntegrationStatement IHE ConnectathonResults IHEConnectathon IHEDemonstration Product With IHE Easy to Integrate Products IHETechnicalFramework Standards IHEIntegration Profiles B IHEIntegration Profile A User Site RFP IHE Canada Videoconference

16. IHE Domains in 2004 EHR Solutions IHE Cross-Enterprise IT Infrastructure Intra-Enterprise IHE IHE 5 Integration Profiles Radiology Cardiology 12 Integration Profiles IHE IHE Future Domain Laboratory IHE 1 Integration Profile Future Domain 4 active Domains, Over 80 vendors involved, Connectathons on 3 Continents, Demonstrations at major exhibitions world-wide IHE Canada Videoconference

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

18. 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 IHE IT Infrastructure Integration Profiles IHE Canada Videoconference

19. IHE Advantages • The problems are identified by the users • The solutions are vendor/application neutral • The profiles package relevant chunks of standards into useful real-world bundles • Where HL7 & DICOM provide Dictionaries, IHE provides a Phrasebook • The connectathon enables broad cross-vendor testing of implementations • The profiles simplify effective communication between vendors and users IHE Canada Videoconference

20. Where Is More Information Available? • www.rsna.org/IHE ; www.himss.org/IHE • IHE Radiology Technical Framework V5.5 • IHE IT Technical Framework V1.0 • IHE Lab Technical Framework V1.0 • IHENews Mailing List • IHE Primer and IHE FAQ • IHE Integration Profiles: Guidelines for Buyers • IHE Presentations • IHE Connectathon Results • IHE Integration Statement Links IHE Canada Videoconference