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Integrating the Healthcare Enterprise

Learn how to address radiology workflow integration for PACS/IT administrators, discussing problems, the approach of IHE, and useful tools for testing. Explore the Institute of Medicine model for healthcare redesign and the need for a new generation of integrated healthcare IT solutions.

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Integrating the Healthcare Enterprise

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  1. Integrating the Healthcare Enterprise IHE for Administrators: Confronting Deployment Obstacles Ellie Avraham, Kodak Health Group Paul Nagy, PhD University of Maryland

  2. Learning Objectives • This is to address the Radiology Workflow Integration for the PACS/IT Administrators • We will discuss the problems you face, the approach IHE takes, and some useful tools for testing RSNA 2006

  3. Discussion Areas • The Radiology Workflow – Values required • Implementing the Radiology Workflow through the IHE Integrated Solutions • Using the IHE Testing Tools (MESA) to test your products implementation of the Radiology Workflow RSNA 2006

  4. Cardio Modern HospitalInformation Flow Complexity Lab MPI Billing ADT RIS HIS Modality PACS Display & Print RSNA 2006

  5. Institute of Medicine Model of Service and Redesign of Healthcare • Safety • Effectiveness • Patient centeredness • Timeliness • Efficiency • Equity Align to the patient Source: Insititute of Medicine, Crossing the chasm RSNA 2006

  6. To achieve these goals we need … • … a new generation of Healthcare IT solutions that have an order of magnitude greater level of integration. • … a whole new level of Complexity Management to manage these interfaces. • … we need to Decrease the time for integrating the Multi Vendors systems. • … we need the capabilities for plug and playAutomatic interoperability of systems. • … we need to lower the total cost of integration RSNA 2006

  7. Standards Exists: DICOM, HL7 • The main purpose of standards is to provide the Interoperability among systems and lower the cost of integration between systems. • The more plug and play integration the lower is the cost of the workflow implementation. • However Standards are broad and include options that reduce the interoperability • So we need to constrain the Standards “options” in order to improve the interoperability RSNA 2006

  8. What is IHE • Joint Initiative from RSNA, HIMSS and ACC since 1998 • IHE is a collaboration of Users and Vendors on Integrating the Healthcare Imaging systems and Information systems • IHE defines standardized clinical workflow solutions and a process for Development and validation implementations • Cross vendor & user discussion groups • Technical Framework for Integration Solutions: SWF, CPI, XDS-I,… • Validations testing tools - MESA • Connect-a-thons - Multi-vendor connectivity testing • Publication of success stories and integration statements • Educational materials and presentations • The IHE profiles are defined in a Technical Framework that specify the Actors / functionality and the transactions that defines the exchanging information among the actors. RSNA 2006

  9. IHE Technical Framework Components • The IHE Technical Framework (TF) defines Integrated Solutions, called “Integration Profiles”. A Profile defines a workflow or a specific problem solution. • A Profile defines a collaboration between Actors. An actor is a well defined entity, such as an Image Display, Image Manager, Image acquisition, etc. • The Actors communicate and collaborate among themselves by implementing a set of communication messages called Transactions.The Transactions defines the messages (actions) that an Actor needs to support. RSNA 2006

  10. IHE Technical Framework – Use Case Roles & Interaction Diagrams • Examples of Actors: • ADT / Patient Registration • Scheduler • Acquisition Modality • Image Display • Report Reader • Examples of Transactions: • Register Patient • Procedure Scheduled • Images Stored • Query / Retrieve Images • Query / Retrieve Reports RSNA 2006

  11. The IHE Process Standards (DICOM,HL7, etc) IHE Integration Profiles Standards (DICOM,HL7, etc) IHE Integration Profiles Standards (DICOM,HL7, etc) IHE Integration Profiles IHE Technical Framework Users Real-World Integration Problems RFP (Profiles & Actors) Select IHE Profiles IHE C-ThonResults IHE Connectathons IHE Demonstrations Vendors IHE Integration Statement (Profiles & Actors) Product with IHEProfile RSNA 2006

  12. The “Connectathon” • Voluntary Participation • Neither a Demonstration nor a Certification • Well Designed End-to-End Scenarios • Advanced Testing Tools • Unprecedented Cross-Vendor Testing • Unprecedented Pool of Technical Talent RSNA 2006

  13. IHE Connectathon Resultshttp://www.ihe.net/Events/connectathon_results.cfm • Consolidated Earlier Progress &Push for Market Adoption • More Robust Connectathon • Results Recorded and Published • Increased Industry Participation • 31 companies • 70 systems • 21 Additional Companies inIHE Europe RSNA 2006

  14. IHE Integration Statement Date 12 May 2006 Vendor Product Name Version Any Medical Systems Co. IntegrateRAD V2.3 This product implements all transactions required in the IHE Technical Framework to support the IHE Integration Profiles, Actors and Options listed below: Integration Profiles Implemented Actors Implemented Options Implemented Scheduled Workflow Image Manager/Image Archive none Image Display none Internet address for vendor’s IHE information:www.anymedicalsystemsco.com/ihe Links to Standards Conformance Statements for the Implementation HL7 www.anymedicalsystemsco.com/hl7 DICOM www.anymedicalsystemsco.com/dicom/integrateRAD.pdf Links to general information on IHE North America:www.ihe.net In Europe: www.ihe-europe.org In Japan: www.jira-net.or.jp/ihe-j RSNA 2006

  15. Store Images Today’s - Legacy Workflow RIS PACS &Archive RSNA 2006

  16. Patient Registration/UpdateOrder Management Proposed Protocols Loaded and Reviewed Worklist Modality Worklist Pt A, …, SPS=P1, P4 Pt C, …, SPS=P1, P5 Pt B, …, SPS=P2 Pt E, …, SPS=P4 Procedure Scheduled Order Protocol Defined Store Images StorageCommitment Storage Commitment List of Images With Performed Acquisition Protocols Performed Step: Status = Completed Modality Performed Procedure Step Performed Procedure: CT Head Performed Protocol Code=P1 Scheduled Protocol Code=P1, P5 Pat Name/ID, Dose, Accession #, Study UID Complete List of Images IHE Workflow RIS PACS &Archive • A Closed Loop • Update Scheduling IS • Match Procedure with Order • Support Billing Based on MPPS • Avoid Reading Incomplete Procedures RSNA 2006

  17. IHE Scheduled Workflow Profile acquisition in progress acquisition completed RSNA 2006

  18. ADT^ Scheduled Workflow • A01 Registration • A04 Admission • A05 Pre adminission • A11 Cancellation • A38 Cancellation of pre admission • DICOM C-Store • DICOM Modality Worklist • DICOM Modality Performed Procedure • DICOM Storage Commitment RSNA 2006

  19. IHE Deployment – Testing the Integrated System Solutions • For Healthcare to succeed in the digital transformation it will need much better integration between its systems. • IHE is an open based standards approach to lower the cost of integrating healthcare and exposing many more processes. • Open Source can accelerate the adoption of IHE by helping to educate administrators to learn how to test the integration RSNA 2006

  20. Open Source - Integration testing tools • There are many (dozens) of DICOM and HL7 tools. Too many to mention. • The web site “openrad.com” has a repository with all the main open source Integration testing tools RSNA 2006

  21. Open Source Toolbelt • IHE MESA Tools • DCM4JBOSS – Enterprise PACS Archive • DVTK – DICOM Validation Toolkit • HL7Browser – HL7 Message Viewer • MIND – GUI DICOM query tool • CTN – DICOM Send RSNA 2006

  22. Today’s Lesson • Build an IHE Testing Environment • Test IHE Scheduled Workflow Components • On a windows laptop RSNA 2006

  23. Standard Documentation Recommendation • IHE Radiology Technical Framework: volumes #1, 2, 3 • RAD Handbook App. H for Acceptance testing • DICOM standard • Information Object Definition Pt.3 • DICOM Services Pt.4 • Data Dictionary Pt.6 • Medical.nema.org • HL7 v2.3.1 standard RSNA 2006

  24. IHE “Medical Enterprise Simulators and Analyzers” (MESA)http://ihedoc.wustl.edu/mesasoftware/index.htm • Provides the Test Procedures and Simulation of all the IHE Profiles and Actors. Excellent Documentation. • Developed by the Mallinckrodt Institute of Radiology • MESA Tools runs on different operating systems: Windows 2000, Windows XP, Solaris 7.0, Red Hat Linux 7.0 & 9.0 from Intel. • The MESA tool is organized for particular IHE actors as defined in the IHE Technical Framework RSNA 2006

  25. Step 1. Install MESA tools • Decide What Actors/Systems you need to test • Read the Installation Guide for installing the tools you need to test your Actors/Systems • Precompiled and Source Codes are available • Recommend to Install the preferred Windows 2000 precompiled MESA s/w ready to be used RSNA 2006

  26. MESA Tools http://www.erl.wustl.edu/mesa/index.html RSNA 2006

  27. Step 2: What & How to Test • List your Products in terms of IHE Actors and Profiles that you need to test • Review the MESA Test Procedures applicable for each Profile and actor that need to be tested • Review the Test Procedures for the Workflows and Peer to Peer testing applicable actors. RSNA 2006

  28. Test Example – Scheduled Workflow Profile (SWF) This case covers both inpatient and outpatient procedures. The patient may be new or known to the current healthcare facility. The following sequence of steps describes the typical process flow when a request is made to perform an imaging procedure on a patient Figure 3.3-1. Administrative Process Flow RSNA 2006

  29. Figure 3.3-2. Procedure Performance Process Flow RSNA 2006

  30. MESA Test case #131 – Administrative & Procedure Prerform Process (SWF) Identifier Description [Transaction] Source Destination 131.102.a04.adt A04: Register BLACK as Outpatient Patient Class = ‘E’[1] ADT Ord Plc, Ord Fil 131.104.o01.orm ORM: Order P1 for BLACK [2] Ord Plc Ord Fil 131.106.o01.orm ORM: Schedule X1 [4] Ord Fil Img Mgr 131.108.dcm MWL C-FIND [5] Modality Ord Fil 131.110.dcm PPS: Begin Procedure X1 [6] Modality PPS_Mgr 131.112.dcm PPS: Begin Procedure X1 [6] PPS_Mgr Ord Fil or Img Mgr 131.114.dcm PPS: End Procedure X1 [7] Modality PPS_Mgr 131.116.dcm PPS: End Procedure X1 [7] PPS_Mgr Ord Fil or Img Mgr C-Find: Images Available Query [11] Ord Fil Img Mgr 131.118.dcm C-Store: Images [8] Modality Img Mgr 131.120.dcm C-Find: Images Available Query [11] Ord Fil Img Mgr 131.122.dcm Storage Commitment: N-Action [10] Modality Img Mgr 131.124.dcm Storage Commitment: N-Event-Report [10] Img Mgr Modality 131.117.dcm RSNA 2006

  31. MESA Testing Environment - Actors RSNA 2006

  32. Starting MESA Testcase #131Profile: Scheduled Workflow(SWF) Actor: Image Manager RSNA 2006

  33. Running Several Transactions Testcase #131 RSNA 2006

  34. Evaluating MESA Test Resultcase #131 RSNA 2006

  35. More information available…. • IHE Web site: http://www.ihe.net • Technical Frameworks and Supplements • Non-Technical Brochures : • Calls for Participation • IHE Fact Sheet and FAQ • IHE Integration Profiles: Guidelines for Buyers • IHE Connect-a-thon Results • Vendor Products Integration Statements • IHE Wiki • RSNA staff contacts: ihe@rsna.org Questions? RSNA 2006

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