IHE Radiology – Overview

1. IHE Radiology – Overview Peter Künecke / Dr. Nikolaus Wirsz SIEMENS Medical Solutions

2. Challenges of Integration • Integration Solutions Available Today fromMedical Systems Vendors – BUT ... • Common Problems of Modern Healthcare Enterprises:(In Spite of IT Standards and Advanced Technology) • Lack of Access to Complete Medical Information • Inconsistent Medical InformationAcross Departments and Institutions • Inadequate Communicating of Medical DataAcross Multiple Systems from Different Vendors • Risky Investments in Proprietary Solutions

3. The IHE Initiative An Incremental Multi-Year ProjectLaunched in 1998 by RSNA & HIMSS • Enhance the Access to Clinical Information • Ensure Continuity and Integrity of Patient Information • Speed Up the Integration in Healthcare Environments • Foster Communication Between Vendors ofMedical Information Technology • Prove that Integration is Attainable Based on Standards • Participants: • Representatives of Healthcare Providers • Information Systems Vendors • Imaging Systems Vendors • Standardization Groups

4. IHE Global Developments Integration Profiles – Solutions to Real-World Needs & Problems: • Within Clinical Departments e.g.: • Radiology • Cardiology • Lab • ... • Across Departmental &Institutional Boundaries – XDS • RHIOs (Regional Healthcare Information Organizations) • EHR Enablers Veterinarian Endoscopy Eye Care / Ophthalmology Year 1 (1999) Year 2 (2000) Year 3 (2001) Year 4 (2002) Year 5 (2003) Year 6 (2004) Year 7 (2005) Year 8 (2006) Evolution of IHE Domains Pharmacy Pathology Patient Care Devices Patient Care Coordination Radiation Oncology Laboratory Cardiology IT Infrastructure for Healthcare Radiology

5. Report Repository Light Box Workstation Film Folder Printer IHE & the Radiology Workflow Diagnostic image and demographic info for radiologist Patient Registration report initial capture of patient demographic information report Radiologist report stored for network access HIS Patient Information Orders Placed query/ retrieve images acquisition completed Image Manager and Archive physician orders desired procedure Diagnostic image and demographic info stored for network access PACS Examination Ordered procedure scheduled Orders Filled Prefetch any relevant prior studies Break down entered order: specific radiology procedure steps to be performed modality worklist Modality storage Patient and procedure information retrieved by the modality commitment RIS print images acquisition completed Position patient and acquire images * IHE = Integrating the Healthcare Enterprise

6. ADT Patient Registration Patient Registration Image Creator Order Placer Patient Update Storage Commit Image Display Images Stored Filler Order Management Placer Order Management Present. State Stored Q /R Key Image Note Q /R Presentation Sates Department System Scheduler – Order Filler – Q /R Images Image Archive Patient Update Key Image Note Stored Image Manager Procedure Update Procedure Scheduled Key Image Note Stored Images Availability Query Images Stored Performed Procedure Step Manager Storage Commit Present. State Stored PPS In-Progress / Completed Acquisition Modality PPS In-Progress / Completed PPS In-Progress / Completed Modality Worklist IHE Systems Transactions Overview

7. ADT Patient Registration HIS Patient Registration Image Creator Order Placer Patient Update Storage Commit Image Display Images Stored Filler Order Management Placer Order Management IMAGING: • PACS • Workstations • Modalities Present. State Stored Q /R Key Image Note Q /R Presentation Sates Department System Scheduler – Order Filler – Q /R Images Image Archive Patient Update Key Image Note Stored RIS Image Manager Procedure Update Procedure Scheduled Key Image Note Stored Images Availability Query Images Stored Performed Procedure Step Manager Storage Commit Present. State Stored PPS In-Progress / Completed Acquisition Modality PPS In-Progress / Completed PPS In-Progress / Completed Modality Worklist IHE Systems Transactions Overview

8. IHE = A Standards Harmonization Approach IHE Goes Beyond Standards IHE = + Multi-Vendor + Workflow-Driven + INTEGRATION based on established medical IT Standards

9. Integration Profiles Q Actors Q Transactions Q Standards User Focus: Solutions to Clinical Problems Implementation: Technical Details (Standards) Transaction Transaction Transaction Transaction Transaction Transaction Transaction Transaction Transaction

10. Integration Profiles - Group related transactionsand associate them with real-world functions • Integration Profiles allow the customer to focus onhigh-level integration while vendor products handle the details • Reduce Ambiguities • Manage Customer Expectations IHE Integration Profiles: http://www.ihe.net/resources/ihe_integration_profiles.cfm IHE FAQ: http://www.ihe.net/About/ihe_faq.cfm IHE User’s Handbook: http://www.ihe.net/Resources/upload/ihe_radiology_users_handbook_2005edition.pdf

11. IHE Radiology Integration Profiles – Solutions to Real-World Problems in Radiology Billing Workflows Post-Processing Workflow Teaching Files & Clinical Trials Export Manage worklists, track status, perform & notify image processing & CAD steps Standardize Clinical Trial Data and Anonymization Teaching/Research Contents & Display Common Infrastructure Reporting Workflow Manage worklists, track status, perform & notify diagnostic reporting steps NM Image Create, store, manage, retrieve & use NM image objects Charge Posting Scheduled Workflow Admit, Order, Schedule Patient Information Reconciliation Collect and post timely billable procedure details Manage worklists, track status, perform & notify acquisition related step, Presentation of Grouped Procs Manage individual procedure image subsets from a multi-procedure acquisition for viewing & reporting Reconcile worklists, status, and data objects for unknown patients and demographics changes create, store, manage, retrieve & use images Consistent Presentation of Images Simple Image and Numeric Reports Evidence Documents Key Image Notes Manage, retrieve & use objects to record study evidence Create, store, manage, retrieve & use objects to flag significant images Manage simple diagnostic reports with optional images, measurements Manage, retrieve & use objects for hardcopy and softcopy grayscale presentation states XDS for Imaging - Sharing of Imaging Information across health enterprises Access to Radiology Information -Consistent access to images and reports Portable Data for Imaging - Consistent access to images and reports on CD Media ITIATNA – Radiology Option (Replaces Basic Security)

12. IHE Radiology – Integration Profiles Workflow Support: • Scheduled Workflow • Patient Information Reconciliation • Post-Processing Workflow • Reporting Workflow • Presentation of Grouped Procedure Common IT Infrastructure & Data Sharing • Access to Radiology Information • Portable Data for Imaging • Cross-Enterprise Data & Image Sharing • Security: Audit Trails & Node Authentication Contents – Consistency – Presentation • Consistent Presentation of Images • Evidence Documents • Key Image Notes • Simple Image & Numeric Reports • NM Image Others: • Billing / Charge Posting • Teaching Files & Clinical Trials

13. Scheduled Workflow (SWF) Charge Posting Scheduled Workflow Admit, Order, Schedule Manage worklists, track status, perform & notify acquisition related step, Post-Processing Workflow Teaching Files & Clinical Trials Export Manage worklists, track status, perform & notify image processing & CAD steps Standardize Clinical Trial Data and Anonymization create, store, manage, retrieve & use images Consistent Presentation of Images Manage, retrieve & use objects for hardcopy and softcopy grayscale presentation states Reporting Workflow Manage worklists, track status, perform & notify diagnostic reporting steps NM Image Create, store, manage, retrieve & use NM image objects Charge Posting Patient Information Reconciliation Collect and post timely billable procedure details Presentation of Grouped Procs Manage individual procedure image subsets from a multi-procedure acquisition for viewing & reporting Reconcile worklists, status, and data objects for unknown patients and demographics changes Simple Image and Numeric Reports Evidence Documents Key Image Notes Manage, retrieve & use objects to record study evidence Create, store, manage, retrieve & use objects to flag significant images Manage simple diagnostic reports with optional images, measurements XDS for Imaging - Sharing of Imaging Information across health enterprises Access to Radiology Information -Consistent access to images and reports Portable Data for Imaging - Consistent access to images and reports on CD Media ITIATNA – Radiology Option (Replaces Basic Security)

14. Scheduled Workflow (SWF) ADT Patient Registration Patient Registration Image Creator Order Placer Storage Commit Image Display Images Stored Filler Order Management Placer Order Management Present. State Stored Q /R Key Image Note Q /R Presentation Sates Department System Scheduler – Order Filler – Q /R Images Image Archive Patient Update Key Image Note Stored Image Manager Procedure Update Procedure Scheduled Key Image Note Stored Images Availability Query Images Stored Performed Procedure Step Manager Storage Commit Present. State Stored PPS In-Progress / Completed Acquisition Modality PPS In-Progress / Completed PPS In-Progress / Completed Modality Worklist The IHE Benefits: Data Consistency & Process Optimization Patient Update

15. Reporting Workflow (RWF) Charge Posting Scheduled Workflow Admit, Order, Schedule Manage worklists, track status, perform & notify acquisition related step, Post-Processing Workflow Teaching Files & Clinical Trials Export Manage worklists, track status, perform & notify image processing & CAD steps Standardize Clinical Trial Data and Anonymization create, store, manage, retrieve & use images Consistent Presentation of Images Manage, retrieve & use objects for hardcopy and softcopy grayscale presentation states Reporting Workflow Manage worklists, track status, perform & notify diagnostic reporting steps NM Image Create, store, manage, retrieve & use NM image objects Charge Posting Patient Information Reconciliation Collect and post timely billable procedure details Presentation of Grouped Procs Manage individual procedure image subsets from a multi-procedure acquisition for viewing & reporting Reconcile worklists, status, and data objects for unknown patients and demographics changes Simple Image and Numeric Reports Evidence Documents Key Image Notes Manage, retrieve & use objects to record study evidence Create, store, manage, retrieve & use objects to flag significant images Manage simple diagnostic reports with optional images, measurements XDS for Imaging - Sharing of Imaging Information across health enterprises Access to Radiology Information -Consistent access to images and reports Portable Data for Imaging - Consistent access to images and reports on CD Media ITIATNA – Radiology Option (Replaces Basic Security)

16. Reporting Workflow (RWF) Work Item Claimed Released (Completed) Reporting Worklist Store Reports Reporting Procedure Step STARTED Measurements CAD Reports ………………… Retrieve Images &Evidence Documents Reporting Procedure Step STARTED The IHE Benefits: Manage Reporting Tasks & Improve Workflow Efficiency RIS Report Manager Report Reader/Creator Reporting Procedure Step COMPLETED PACS & Archive Image Manager/ Archive Reporting Procedure Step COMPLETED

17. Consistent Presentation of Images (CPI) Charge Posting Scheduled Workflow Admit, Order, Schedule Manage worklists, track status, perform & notify acquisition related step, Post-Processing Workflow Teaching Files & Clinical Trials Export Manage worklists, track status, perform & notify image processing & CAD steps Standardize Clinical Trial Data and Anonymization create, store, manage, retrieve & use images Consistent Presentation of Images Manage, retrieve & use objects for hardcopy and softcopy grayscale presentation states Reporting Workflow Manage worklists, track status, perform & notify diagnostic reporting steps NM Image Create, store, manage, retrieve & use NM image objects Charge Posting Patient Information Reconciliation Collect and post timely billable procedure details Presentation of Grouped Procs Manage individual procedure image subsets from a multi-procedure acquisition for viewing & reporting Reconcile worklists, status, and data objects for unknown patients and demographics changes Simple Image and Numeric Reports Evidence Documents Key Image Notes Manage, retrieve & use objects to record study evidence Create, store, manage, retrieve & use objects to flag significant images Manage simple diagnostic reports with optional images, measurements XDS for Imaging - Sharing of Imaging Information across health enterprises Access to Radiology Information -Consistent access to images and reports Portable Data for Imaging - Consistent access to images and reports on CD Media ITIATNA – Radiology Option (Replaces Basic Security)

18. Consistent Presentation of Images (CPI) Achieving Consistent Presentation Original Image Window Level Flip Zoom Without Consistent Presentation Area Of Interest Area Of Interest Annotate The IHE Benefits: Enhancing & Preserving Image Quality Referring Physician or Reviewing Radiologist Reporting Radiologist Presentation State Presentation LUT Grayscale Standard

19. Key Image Notes (KIN) Charge Posting Scheduled Workflow Admit, Order, Schedule Manage worklists, track status, perform & notify acquisition related step, Post-Processing Workflow Teaching Files & Clinical Trials Export Manage worklists, track status, perform & notify image processing & CAD steps Standardize Clinical Trial Data and Anonymization create, store, manage, retrieve & use images Consistent Presentation of Images Manage, retrieve & use objects for hardcopy and softcopy grayscale presentation states Reporting Workflow Manage worklists, track status, perform & notify diagnostic reporting steps NM Image Create, store, manage, retrieve & use NM image objects Charge Posting Patient Information Reconciliation Collect and post timely billable procedure details Presentation of Grouped Procs Manage individual procedure image subsets from a multi-procedure acquisition for viewing & reporting Reconcile worklists, status, and data objects for unknown patients and demographics changes Simple Image and Numeric Reports Evidence Documents Key Image Notes Manage, retrieve & use objects to record study evidence Create, store, manage, retrieve & use objects to flag significant images Manage simple diagnostic reports with optional images, measurements XDS for Imaging - Sharing of Imaging Information across health enterprises Access to Radiology Information -Consistent access to images and reports Portable Data for Imaging - Consistent access to images and reports on CD Media ITIATNA – Radiology Option (Replaces Basic Security)

20. Key Image Notes (KIN) The IHE Benefits: Enhancing Communication Among Medical Specialties Radiologist Flags Images: Referring PhysicianSees Key Images First: Note 1 For referring physician: This image shows the renal rupture. Note 1 For referring physician: This image shows the renal rupture. Note 1 For referring physician: This image shows the renal rupture. Study Including Key Image Notes Note 2 For referring physician: This image has the hematoma. Note 2 For referring physician: This image has the hematoma. Note 2 For referring physician: This image has the hematoma.

21. Portable Data for Imaging (PDI) Charge Posting Scheduled Workflow Admit, Order, Schedule Manage worklists, track status, perform & notify acquisition related step, Post-Processing Workflow Teaching Files & Clinical Trials Export Manage worklists, track status, perform & notify image processing & CAD steps Standardize Clinical Trial Data and Anonymization create, store, manage, retrieve & use images Consistent Presentation of Images Manage, retrieve & use objects for hardcopy and softcopy grayscale presentation states Reporting Workflow Manage worklists, track status, perform & notify diagnostic reporting steps NM Image Create, store, manage, retrieve & use NM image objects Charge Posting Patient Information Reconciliation Collect and post timely billable procedure details Presentation of Grouped Procs Manage individual procedure image subsets from a multi-procedure acquisition for viewing & reporting Reconcile worklists, status, and data objects for unknown patients and demographics changes Simple Image and Numeric Reports Evidence Documents Key Image Notes Manage, retrieve & use objects to record study evidence Create, store, manage, retrieve & use objects to flag significant images Manage simple diagnostic reports with optional images, measurements XDS for Imaging - Sharing of Imaging Information across health enterprises Access to Radiology Information -Consistent access to images and reports Portable Data for Imaging - Consistent access to images and reports on CD Media ITIATNA – Radiology Option (Replaces Basic Security)

22. What Is the IHE PDI Integration Profile? Enables the Reliable Interchange ofPatient Records on CD including: • Images • Evidence Objects • Diagnostic Reports for: • Import • Storage • Display • Printing CDs that Work !

23. Media Importer Image / Report Display Printer John Doe Distribution of Imaging Information on CD Media • For use in other departments, e.g. surgery • For enterprise data interchange • For referral • For printing • For patient personal records CD Creator CD

24. CDROM Structure: DICOMDIR Directory of DICOM files README.TXT INDEX.HTM Web content (optional) IHE_PDI Directory of web files Other optional content IHE PDI – Media Creator • Create DICOM Compliant CDROM media • Create web content (optional)

25. IHE PDI – Value Proposition • Get CDs that can be Created and Read Anywhere • Media Interoperability Validation:– Eliminate Sources of Problems & Incompatibilities • Support for Exchange of DICOM Data • Optional Support for Web Data: – View of Images and Reports in a Browser • Allow Import of Patient Data into theLocal Information Base

26. Cross-Enterprise Image & Data Sharing (XDS-I) Charge Posting Scheduled Workflow Admit, Order, Schedule Manage worklists, track status, perform & notify acquisition related step, Post-Processing Workflow Teaching Files & Clinical Trials Export Manage worklists, track status, perform & notify image processing & CAD steps Standardize Clinical Trial Data and Anonymization create, store, manage, retrieve & use images Consistent Presentation of Images Manage, retrieve & use objects for hardcopy and softcopy grayscale presentation states Reporting Workflow Manage worklists, track status, perform & notify diagnostic reporting steps NM Image Create, store, manage, retrieve & use NM image objects Charge Posting Patient Information Reconciliation Collect and post timely billable procedure details Presentation of Grouped Procs Manage individual procedure image subsets from a multi-procedure acquisition for viewing & reporting Reconcile worklists, status, and data objects for unknown patients and demographics changes Simple Image and Numeric Reports Evidence Documents Key Image Notes Manage, retrieve & use objects to record study evidence Create, store, manage, retrieve & use objects to flag significant images Manage simple diagnostic reports with optional images, measurements XDS for Imaging - Sharing of Imaging Information across health enterprises Access to Radiology Information -Consistent access to images and reports Portable Data for Imaging - Consistent access to images and reports on CD Media ITIATNA – Radiology Option (Replaces Basic Security)

27. Cross-Enterprise Image & Data Sharing (XDS-I) PACS C • Within an Enterprise Business Need: Share Radiology Reports & Image • Between Radiology and • Imaging Specialists • Non-imaging Professionals • Between Enterprises Enterprise B PACS B Radiology -to-Physicians Radiology -to-Radiology PACS A Physician Office Enterprise A

28. acquire storenew data index register Image/ ReportRepository DocumentRegistry Ultrasound reportand images (XDS architecture) Image-Enabled EHRPregnancy Outpatient Clinics Encounter evaluate

29. Image-Enabled EHR Childbirth Inpatient Stay storenew data retrieve index index query register DocumentRepository Image/ Report/ DocumentRepositories Report, letters(incl. images) DocumentRegistry evaluate (XDS architecture)

30. IHE Radiology – Integration ProfilesNewest Additions in 2006 Workflow Extensions • Import Reconciliation Workflow (IRWF) • Describes workflow details for the import of “external” data: • Evidence Objects e.g. DICOM images (on a CD) and • Non-Digital Data e.g. scanned films, documents into the Enterprise • Extends the PDI profile (interchange of CDs) withworkflow integration capabilities Content Profiles • Nuclear Medicine Image with Cardiac Option • Addition of a Cardiac NM option to the existing NM Image Profile –improve functionality for nuclear medicine cardiac image viewing • synchronous viewing of gated images or projections of tomographic images • ability to display myocardial perfusion data

31. IHE Radiology – Integration ProfilesNewest Additions in 2006 (continued) Content Profiles (continued) • Image Fusion (FUS) • Specifies communications between systems creating and registeringimage sets and systems displaying fused images • Defines how DICOM objects for spatial registration, blended presentation and the images themselves are created, stored, queried, retrieved, processed and displayed • Mammography Image (MAMMO) • Specifies how DICOM Mammography images & evidence objectsare created, exchanged & used • Full Field Digital Mammography (FFDM) Images on Acquisition Modalities • CAD Systems acting as Evidence Creators • Attributes & Capabilities for Image Displays IHE Brochure “Going Digital: An IHE Guide for Mammography”http://www.ihe.net/Mammo/going_digital_mammography.cfm

32. IHE Radiology – Integration ProfilesAn Outlook for 2007 (Year 9) Incremental Developments ~2 New Integration Profiles / Year Work Item Proposals for 2007 • Mammography Workflow • Enhanced CT / MR Image • Reporting Strategy / Improvements / Workflow Considerations • DICOM SR • HL7 CDA • PDF • Multi-Study Acquisition • Local „hard split“ on Acquisition Modalitiesan „easy entry“ alternative to PGP (Presentation of Grouped Procedures) • … others … Selection / priorities to be determined in October 2006

33. Germany Holland Norway Canada Taiwan France Korea Japan China Spain Italy USA UK Year 1 (1999) Year 2 (2000) Year 3 (2001) Year 4 (2002) Year 5 (2003) Year 6 (2004) Year 7 (2005) International Adoption of IHE • Local Deployment • National Extensions (Local Adaptions) • Promotional & Live Demonstration Events • Funding

34. IHE (International) Strategic Development Committee Global Development Regional Deployment IHE North America IHE Asia-Oceania China Japan Radiology IT Infrastructure Laboratory Canada USA Korea Taiwan New New New New New Cardiology Patient Care Coordination Pathology IHE Europe Radiation Oncology Patient Care Devices Pharmacy / Medication Admin Netherlands France Germany Italy Spain UK Norway Sweden Professional Societies / Sponsors Contributing & ParticipatingVendors ACCHIMSSRSNA GMSIH SFRSFIL COCIR EAR-ECR DRG SIRM BIR EuroRec ESC JAHISJIRAJRS METI-MLHW MEDIS-DCJAMI IHE Organizational Structure

35. Questions ? IHE Europe: http://www.IHE-Europe.org IHE Main Web Site: http://www.IHE.net