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Harm-Jan Wessels managing director, Forcare vendor co-chair, IHE-Netherlands

Implementing IHE inside the Enterprise Care Settings World of Health IT October 11, 2006 12:15-13:00. Harm-Jan Wessels managing director, Forcare vendor co-chair, IHE-Netherlands. Objective of this Presentation.

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Harm-Jan Wessels managing director, Forcare vendor co-chair, IHE-Netherlands

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  1. Implementing IHE insidethe Enterprise Care SettingsWorld of Health ITOctober 11, 2006 12:15-13:00 Harm-Jan Wesselsmanaging director, Forcarevendor co-chair, IHE-Netherlands

  2. Objective of this Presentation • To provide an overview of how IHE integration profiles are applied across the care settings within an Enterprise • To show the analogies across the domains • To provide a structured approach to finding the right IHE integration profiles to use

  3. Topics • General IHE Introduction • Overview of the IHE domains • The building blocks • Radiology • Translating/Mapping to other care domains • IHE implementations • Guidance on using IHE • Questions / Answers

  4. Short Introduction • My name: Harm-Jan Wessels • Active in Healthcare IT since 1990 • Applicare Medical Imaging (‘90-’99) • Co-founder, Technical Director • GE Healthcare – Netherlands (’99-’05) • Engineering / General Manager • Forcare – 2006 • Co-founder / Managing Director • Involvement in IHE since ’98 • Representing IHE-Netherlands as Vendor-chairsince January 1st, 2006

  5. What is Integrating the Healthcare Enterprise? • IHE is a global initiative, providing a common framework for passing health information seamlessly: • within the healthcare enterprise • across multiple healthcare enterprises • for local, regional & nationalhealth information networks. • IHE is sponsored by healthcare professional associations: HIMSS, RSNA, ESC, ACC, BIR etc. • IHE is user-led and vendor-driven • IHE drives standards adoption to address specific clinical needs.

  6. Testing at Connectathons IHE Demonstrations Develop technical specifications Products with IHE Identify available standards (e.g. HL7, DICOM, IETF, OASIS) Timely access to information Document Use Case Requirements Easy to integrate products The IHE Process

  7. Key IHE deliverables • Techical Frameworks • Integration Profiles“A standard way to solve a standard problem using standards” • Testing and Demonstrations • Integration Statements • Real-world Implementations

  8. Benefits to IHE Participants • Care Providers (Clinicians and IT staff) • Improved workflow • Information when and where needed • Decreased cost and complexity of interface installation and management • Vendors • Decreased cost and complexity of interface installation and management • Accelerate product development • Expand your market potential by leveraging European/ International developments • Standards-Developing Organizations (SDOs) • Rapid feedback to adjust standards to real-world • Establishment of critical mass and widespread adoption

  9. IHE 2006 – Eight Active Domains Over 150 vendors involved world-wide,8 Technical Frameworks 55 Integration Profiles, Testing at yearly Connectathons Demonstrations at major conferences world-wide 1 Integration Profile 1 Integration Profile

  10. ? Can’t see the forest for the trees? Overview IHE Domains Eye Care Eye Care Workflow (EYECARE) Eye Care Charge Posting (CHG) Eye Care Eye Care Evidence Documents (ECED) Cardiology Implantable Device Cardiac Observations Profile (IDCO) Cardiology Stress Testing Workflow Integration Profile (STRESS) Cardiology Patient Demographics Query: Urgent Implantable Device Cardiac Identification Content Profile (PDQ-IDC) Cardiology Cardiac Catheterization Workflow (CATH Cardiology Echocardiography Workflow (ECHO) Cardiology Retrieve ECG for Display (ECG) Cardiology Displayable Reports (DRPT) Cardiology Evidence Documents (ED) Lab Laboratory Scheduled Workflow Lab Sharing Laboratory Reports (XD*-LAB) Lab LOINC Test Codes Subset (LTCS) Radiology Scheduled Workflow (SWF) Radiology Patient Information Reconciliation (PIR) Radiology Consistent Presentation of Images (CPI) Radiology Presentation of Grouped Procedures (PGP) Radiology Access to Radiology Information (ARI) Radiology Key Image Note (KIN) Radiology Simple Image and Numeric Report (SINR) Radiology Charge Posting (CHG) Radiology Post-Processing Workflow (PWF) Radiology Reporting Workflow (RWF) Radiology Evidence Documents (ED) Radiology Portable Data for Imaging (PDI) Radiology NM Image (NM) Radiology Cross-enterprise Document Sharing for Imaging (XDS-I) Radiology Teaching File and Clinical Trial Export (TCE) Radiology Nuclear Medicine Image Integration Profile (NMI) with Cardiac Option Radiology Image Fusion (FUS) Radiology Import Reconciliation Workflow (IRWF) Radiology Mammography Image (MAMMO) PC Devices Device Enterprise Communication (DEC) Rad Oncology RT Objects PC Coord Cross-Enterprise Sharing of Medical Summaries (XDS-MS) PC Coord Basic Patient Privacy Consents (BPPC) PC Coord Emergency Department Referral (EDR) PC Coord Exchange of Personal Health Record Content (XPHR) PC Coord Pre-procedure History and Physical (PPHP) IT-Infra Retrieve Information for Display (RID) IT-Infra Enterprise User Authentication (EUA) IT-Infra Patient Identifier Cross-referencing (PIX) IT-Infra Patient Synchronized Applications (PSA) IT-Infra Consistent Time (CT) IT-Infra Patient Demographics Query (PDQ) IT-Infra Audit Trail and Node Authentication (ATNA) IT-Infra Personnel White Pages (PWP) IT-Infra Cross-Enterprise Document Sharing (XDS) IT-Infra Document Digital Signature (DSG) IT-Infra Notification of Document Availability (NAV) IT-Infra Patient Administration Management (PAM) IT-Infra Cross-enterprise Document Media Interchange (XDM) IT-Infra Cross-enterprise Document Reliable Interchange (XDR) IT-Infra Cross-enterprise Sharing of Scanned Documents (XDS-SD) IT-Infra Retrieve Form for Data Capture (RFD) IT-Infra Cross-Enterprise User Authentication (XUA)

  11. Back to the overview • Focus: IHE inside the Enterprise Care Setting • Starting with Radiology • First IHE domain (1998) • Wide variety in available systems, but relatively streamlined and global process

  12. patient patient order result Main external Process Radiology Acquisition Reporting

  13. modality radiologist Acqui-sition Repor-ting patient patient status updat. scheduling report order results images Main Internal process Radiology Dept Mgt

  14. IHE Actor IHE Actor IHE Actor IHE Actor IHE Actor IHE Transaction Product C IHE Transaction Product A IHE Transaction Product B Product D IHE Actors / Transactions • Key terms • Actor: A system performing a particular transaction • Transaction: A single interaction between systems (actors) • A system can host multiple actors

  15. Enterprise Report Repository modality Order Placer radiologist Report Manager Report Creator Image Display IMAGING • PACS • Workstations • Modalities Acqui-sition Repor-ting Department System Scheduler – Order Filler – patient patient Image Mgr / Archive status updat. HIS HIS scheduling Performed Procedure Step Manager report Acquisition Modality order Radiology Dept Mgt RIS results images IHE Actors / Transactions

  16. Radiology Process • Captured in Scheduled Workflow (SWF) Integration Profile • Backbone of IHE Radiology • Integrates Registration, Scheduling, Acquisition Workflow and Image Content • Bridges HL7 and DICOM Spaces

  17. Benefits of Scheduled Workflow • Preserve Order Continuity / Improve Order Tracking • “Close the loop” • Improve Demographic Integrity • Eliminate manual entry and correction • Improve Workflow Efficiency • Worklists • Reliable Storage • Storage Commitment • End result: Reduce Integration Effort On site

  18. So how does this apply... • to other domains then Radiology? • The key to understanding IHE is to see the process and the data flow • Taking a few steps back...

  19. Radiology Process and Data Flow Data Flow Registration Process Flow Evidence Documents Radiology Aquisition & Reporting Report & Images Charge Capture

  20. Reviewing IHE Integration Profiles • “Process View” and “Data View” apply across the domains • The generic process chain shows a great deal of overlap for the domains • IHE promotes the re-use of standards and transactions across the domain

  21. Registration Evidence Documents Radiology Aquisition & Reporting Report & Images Charge Capture Constructing the Process Chain Data Flow Process Flow Patient Admission Order Placer Order Filler Acquisition Results Generation Results Storage Results Access

  22. Radiology (1) Patient Admission Order Placer Order Filler Acquisition Results Generation Results Storage Results Access Process Flow Scheduled Workflow (SWF) Charge Posting (CHG) Post-Processing Workflow (PWF) Reporting Workflow (RWF) Import Reconciliation Workflow (IRWF) DataFlow Patient Information Reconciliation (PIR) Consistent Presentation of Images (CPI) Presentation of Grouped Procedures (PGP) Access to Radiology Information (ARI)

  23. Radiology (2) Patient Admission Order Placer Order Filler Acquisition Results Generation Results Storage Results Access Data Flow Key Image Note (KIN) Simple Image and Numeric Report (SINR) Evidence Documents (ED) Portable Data for Imaging (PDI) NM Image (NM) Cross-enterprise Document Sharing for Imaging (XDS-I) Teaching File and Clinical Trial Export (TCE) Image Fusion (FUS) Mammography Image (MAMMO)

  24. Cardiology Patient Admission Order Placer Order Filler Acquisition Results Generation Results Storage Results Access Process Flow Cardiac Catheterization Workflow (CATH) Echocardiography Workflow (ECHO) Stress Testing Workflow Integration Profile (STRESS) DataFlow Retrieve ECG for Display (ECG) Evidence Documents (ED)

  25. Laboratory Patient Admission Order Placer Order Filler Acquisition Results Generation Results Storage Results Access Process Flow Laboratory Scheduled Workflow DataFlow Sharing Laboratory Reports (XD*-LAB)

  26. Eye Care Patient Admission Order Placer Order Filler Acquisition Results Generation Results Storage Results Access Process Flow Eye Care Workflow (EYECARE) Charge Posting (CHG) DataFlow Eye Care Evidence Documents (ECED)

  27. IHE Implementations • IHE has been in existence since 1998 • IHE Integration Profiles are key building blocks for interoperability • Examples of IHE Implementations can be found at www.ihe.net or www.ihe-europe.org • Success Stories

  28. Guidance on using IHE • Practical Guidance on using IHE can be found at www.ihe.net • To apply IHE to Radiology, consult the • Radiology User Handbook • To study IHE’s approach to workflow, consult the • Departmental Workflow – white paper

  29. Conclusions • IHE provides a comprehensive framework for addressing interoperability challenges • IHE’s process model promotes re-use across domains and stimulates similar solutions to similar problems • IHE’s Integration Profiles are showing rapid adoption and application – across the Enterprise Care Settings

  30. Thank you for your attention Any Questions? IHE Europe web site: www.ihe-europe.org

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