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IHE Progress and Plans for Integrating the Healthcare Enterprise Image-enabled Health Records

This article discusses the progress and plans of the Integrating the Healthcare Enterprise (IHE) initiative in implementing image-enabled health records. It covers the integration of data and workflow, communication among stakeholders, support for different views of data, and linking summaries and clinical details across departments and enterprises. The article also explores the complexities and challenges of implementing image-enabled EHRs and highlights potential use cases and contributions of IHE in EHR implementation.

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IHE Progress and Plans for Integrating the Healthcare Enterprise Image-enabled Health Records

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  1. Integrating the Healthcare Enterprise Image-enabled Health Records:IHE Progress and Plans Christoph Dickmann – Member IHE Rad TC Charles Parisot – Co-chair IHEIT-I TC

  2. Pragmatic definition of EHR • Integrated data and workflow • Multimedia data access • text, image, waveform, … • Communication among stakeholders • clinicians, caregivers, consumers, … • Support different views of data • Clinical records • Details: episode, visit, study • Longitudinal records • Summaries: episode, visit Cross-department or cross-enterprise users Linking summaries and clinical details

  3. PACS C • Within an enterprise Business need: share Radiology Reports and Images • Between Radiology and • imaging specialists • non-imaging professionals • Between enterprises Enterprise B PACS B • By network or media Radiology -to-Radiology Radiology -to-Physicians PACS A Physician Office Enterprise A

  4. EHR goals in IHE(compatible with U.S. NHII goals) • Informed Clinical Practice • IHE integrates clinical data and functions for an EHR • Interconnected Clinicians • Beyond the department: community or regional scope • Personalized Care • Web-based data access and summary data • Support for higher-level goals • Better outcomes • Increased patient safety • More efficient healthcare operations

  5. EHR complexity • Business dilemmas • Significant, long-term investment • Investors may not be main beneficiaries • Coordination and cooperation • Active collaboration among multiple stakeholders • Identify and work out commonalities and barriers • Integration and interoperability • Implement existing standards • Develop additional standards  Evolutionary system specification (system of systems)

  6. Non-imaging data Patient data Clinical data Laboratory results Surgery reports Prescriptions, meds Letters or notes Integrate with imaging data and processes Focus: Image-enabled EHR(connect two “worlds”) • Imaging data • Patient data • Images and evidence • Radiology • Cardiology • Nuclear Medicine • Integrate with non-imaging data and processes

  7. Using images Neurologist: reviewing stroke patient transfer to ward Nurse: preparing GI ward round for Dr. X GP: seeing a post-MI patient after hospital discharge Patient: preparing an obstetric visit Producing images/ evidence Cardiologist: during catheter intervention Radiologist: starting an abdomen CT Physician: counseling at diabetes outpatient clinic Oncologist: planning radiotherapy Potential use cases of an image-enabled EHR Information need may include current or longitudinal evidence

  8. acquire storenew data index register Image/ ReportRepository DocumentRegistry Ultrasound reportand images (XDS architecture) Image-enabled EHRPregnancy outpatient clinics encounter evaluate

  9. storenew data retrieve index index query register DocumentRepository Image/ Report/ DocumentRepositories Report, letters(incl. images) DocumentRegistry Image-enabled EHRChildbirth inpatient stay evaluate (XDS architecture)

  10. patient Onco-logist GP(follow-up) Radiologydepartment Documentavailability Care record sys-tems: specific care delivery report Images, report(PACS, RIS) Retrieve Query for re- ports Retrieve selected imaging report references Shared re- pository Register report & image references Longitudinal record system: across encounters Document Registry Sharing Imaging Documents (XDS-I) How does XDS-I work?  “What is new in IHE”

  11. IHE contributions to EHR implementation EHR realization IHE IT Infrastructure8 Int. Profiles IHE Radiology7 Int. Profiles IHE Laboratory1 Int. Profile IHE Cardiology4 Int. Profiles IHE Pat. Care Coord.1 Int. Profile • Each TF can contribute to EHR scenarios with Integration Profiles for • Data access • Workflow

  12. Basic requirements of EHR systems • Integrated healthcare provider systems • EHR sources/ users, user interaction • Document handling • Storage and retrieval of EHR documents • Infrastructure services • Basic data and application integration • Network • EHR storage, inquiry, and retrieval path

  13. Appl. 1 Appl. 2 Appl. 3 Source 1 Source 2 Patient identifier matching Any user Samepatient selected Single sign on Patientdemographics Desktop Integration as an EHR enabler Personnel/staff data Backend integration (services, data) EHR interoperability examples Common person data or services

  14. IHE - common interoperability services • Common patient identification (ITI PIX) • Common patient demographics (ITI PDQ) • Desktop integration (ITI PSA)Running applications work on the same patient • Single sign on (ITI EUA, XUA)Enterprise-wide or cross-enterprise user handling • Security and privacy (ITI/ RAD ATNA, DSG)Accountability, document integrity • Common staff data (ITI PWP)Health professionals are commonly recognized Fundamental enablers of cross-system health record system functions.Gradual enhancement and combination is the key.

  15. IHE – documents for general purpose EHR functions • Cross-Enterprise Document Sharing for Imaging (XDS-I)Share DICOM instances via web or DICOM connection;share imaging information via web • Cross-Enterprise Document Sharing(ITI XDS)Store & retrieve documents and summaries (focus: longitudinal data) • Notification of Document Availability (ITI NAV)Send notification/ reference to new shared documents • Retrieve Information for Display (ITI RID)Query and retrieve documents and summaries/ lists Needs common services as a basis (e.g. security, patient identification)

  16. IHE - Radiology images and reports for an EHR system • Access to Radiology (Rad ARI)Retrieve diagnostic quality images, evidence, reports • Simple Image and Numeric Reports (Rad SINR)Access or export reports and related images • Key Image Notes (Rad KIN)Mark, annotate, retrieve selected imaging evidence • Portable Data for Imaging (Rad PDI)Export/ import/ view media data • Nuclear Medicine Image (Rad NM Image)Capture and use complex NM result screens

  17. IHE – Cardiology images and reports for an EHR system • Cardiac Catheterization / Echo Workflow (CATH, ECHO)Retrieve catheterization and echocardiography imaging evidence • Retrieve ECG for Display (Card ECG)Retrieve ECG summaries and results • Displayable Reports (Card DRPT)Create and access reports for viewing

  18. IHE - clinical/ textual information for an EHR system • Simple Image and Numeric Reports (Rad SINR)Access original or exported reports • Cross-Enterprise Document Sharing (ITI XDS) Cross-Enterprise Doc. Sharing for Imaging (Rad XDS-I)Store & retrieve documents, summaries or reports with longitudinal data • Retrieve Information for Display (ITI RID) Access documents and summaries (e.g. imaging, lab, discharge, medications, prescriptions) • Lab Scheduled WorkflowNotification of laboratory results

  19. IHE - workflow / patient management support • Workflow integration (Rad, Card) • Scheduled Workflow • Ordering, scheduling and tracking of image acquisition steps • Appointment tracking to order placer • Reporting Workflow • Scheduling and tracking of report creation tasks • Patient data integration (Rad, Card, ITI) • Patient Information Reconciliation • Modification and matching of patient data and imaging evidence • Patient Administration Management • Creating and changing patient identifiers and encounter data • Overall concept (Rad whitepaper) • Departmental workflow and interfaces to the enterprise

  20. Planned IHE development • Harmonize IHE domain-specific work • Extend XDS’ document content • Code sets and master files • Realize overall workflow concept • Configuration support • Security details, e.g. access control

  21. Image-enabled EHR – IHE progress and plans • IHE Integration Profiles from different domains can be combined • Combinations of current profiles can cover many EHR scenarios • Information integration (imaging, textual) • Enhanced functionality beyond one department • Intra- and cross enterprise communication • Scenarios enable system evolution(organizational change management not to be forgotten) • IHE ensures integration testing and future Integration Profile development

  22. Thank you!Questions? More information: http://www.ihe.net

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