1 Integrating the Healthcare Enterprise Using the IHE User’s Handbook to Purchase & Integrate Radiology Systems Sanjay Jain, Cerner Andrei Leontiev, Dynamic Imaging Kevin O’Donnell, Toshiba John Perry, Fuji

RSNA Classroom Sessions Modern Hospital Information Flow MPI ADT RIS PACSModalityDisplay HIS Billing Lab Surgery Cardio

RSNA Classroom Sessions The Integration Problem You need to: Streamline workflow; improve turnaround time; improve throughput “Go digital” Get information quickly & reliably to where it is needed Maintain completeness & accuracy of the medical record; reduce errors … Identifying your needs/goals is your important first task.

RSNA Classroom SessionsFurthermore… Now that you know what you want… How do you make it happen? How do you – clearly tell vendors your needs? – get them to agree? – get multiple vendor products to support the same architecture – know if it will work? How do you “buy integration”?

RSNA Classroom Sessions IHE: A powerful tool The “Integrating the Healthcare Enterprise” Initiative: Identifies common integration problems Documents a standards-based solution Oversees cross-vendor testing of implementations Provides a common reference for users & vendors IHE Integration Profiles

RSNA Classroom Sessions - Solutions packaged for purchasing - IHE Integration Profiles - Solutions packaged for purchasing - coherent bundle of functionality addressing a specific integration problem a convenient way for users and vendors to communicate precisely about integration requirements and required functionality in products.

RSNA Classroom Sessions What is IHE? IHE is professional societies supervising vendors developing collaborative solutions IHE is a specification of transactions between systems IHE describes only integration features IHE is not a product itself, but… IHE is very useful for purchasing products that integrate

RSNA Classroom Sessions OK, … Now What? IHE Radiology User’s Handbook - Organized by Purchase Scenarios: – a new Modality, a new PACS, a new RIS Guidance for Key Purchasing Steps: – Selecting appropriate Profiles and Actors – Putting Profile requirements in RFPs – Identifying suitable products Guidance for Key Installation Steps: – Aligning your workflow and configuring IHE – Confirming the integration is working – Identifying and addressing legacy issues

RSNA Classroom Sessions Using IHE in the Purchasing Process

RSNA Classroom Sessions Step 1: Pick a Chapter First edition has 3 chapters: – RIS, Modality & PACS

RSNA Classroom Sessions Step 2: Select Profiles Handbook outlines specific benefits for several Profiles – Benefits are grouped by Organizational Goals e.g. Reduce Errors, Improve Throughput, etc. – Relevancy of profile – Business case – Handbook summarizes relevant Profiles and Actors – Actors are roles a system can play in a Profile – In the Handbook, mostly defined by the Scenario If more details desired: – IHE Presentations – IHE Technical Framework, Vol. 1

RSNA Classroom Sessions Considerations Potential Efficiency Gains Cost-Effectiveness Vendor Readiness End-User Pain Clinical Priorities Available Resources / Skillsets Improvements in Department Performance Administrative Guidelines / Vision Patient Info. Recon- ciliation Access to Radiology Information Consistent Presentation of Images Audit Trail & Node Authentication - Radiology Option Evidence Docs Key Image Notes Simple Image & Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting XDS for Imaging NM Image Scheduled Workflow Teaching Files & Clinical Trials Export Portable Data for Imaging

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

RSNA Classroom Sessions IHE Scheduled Workflow Profile – The backbone of integrating Radiology – Touches most systems in Radiology (HIS - RIS – Modality – PACS – Display) Is there a less ambitious way to start…?

RSNA Classroom Sessions What the Technologist Displays: What the Radiologist Sees: The Technologist’s Transformations Are Saved Grayscale Calibration & Presentation State Original Image Window Level Flip Zoom Area Of Interest Annotate The Technologist’s Transformations Are Lost Original Image Area Of Interest Prepared Image Original Image IHE Consistent Presentation of Images

RSNA Classroom Sessions IHE Patient Information Reconciliation Extends Scheduled Workflow – Handles unidentified patient (e.g. trauma) – Handles demographic information mistakes – Propagates changes to all affected systems, updates all affected data Reduces incorrectly identified or lost studies

RSNA Classroom Sessions Radiologist Flags Images: Referring Physician Sees Key Images First: for refering physician This image shows the renal rupture. Note1 For referring physician: This image shows the renal rupture. Note1 for refering physician This image has the hematoma. Note2 For referring physician: This image has the hematoma. Note2 for refering physician This image shows the renal rupture. Note1 for refering physician This image has the hematoma. Note2 Study & Key Image Notes IHE Key Image Notes

RSNA Classroom Sessions IHE Portable Data for Imaging IHE Portable Data for Imaging

RSNA Classroom Sessions Step 3: Write RFP Text Handbook provides suggestions and sample language “The modality system shall support the IHE Scheduled Workflow Integration Profile as the Acquisition Modality and Image Display Actors.” Brief & Effective RFPs Leverages the IHE Technical Framework

RSNA Classroom Sessions Step 4: Identify Suitable Products IHE Integration Statements – Direct product claim by the vendor – Lists Profiles, Actors, Options – Short & Sweet Link Page at

RSNA Classroom Sessions

RSNA Classroom Sessions Vendor Activity Recent Connectathons – IHE-North America in January 2005 (Chicago, IL) 45 Vendors, 110 Systems, 300 Engineers, 22 Profiles – IHE-Europe in April 2005 (Noordwijkerhout, Netherlands) 62 Vendors, 98 Systems, 230 Engineers, 23 Profiles – IHE-Asia Connectathon in Feb 2005 (Yokohama, Japan) 30 Vendors, 70 Systems, 8 Profiles Demonstrations – RSNA, HIMSS, ACC, ASE, ECR, Hopital Expo, JRS, …

RSNA Classroom Sessions Using IHE in the Installation Process

RSNA Classroom Sessions Step 5: Configure your Workflow Adapting your Workflow – Some IHE Profiles depend on certain practices – Handbook highlights important behaviors – e.g. Use of Accession #’s, Registration on HIS Configuring IHE – Some things are local decisions – Handbook describes codes and settings to be chosen/defined by the Site

RSNA Classroom Sessions Step 6: Making it Work Testing – Organized by Profile – Handbook describes key cases to test & key data to check Legacy Issues – IHE is based on DICOM and HL7 –

RSNA Classroom Sessions Handbook Caveats Profiles – … are not the only way to integrate, (just the easiest) – can also consider IHE Transactions – next level down – Profiles are synergistic not exclusive – You can walk before you run 2005 Edition: – addresses the most widely implemented profiles – addresses three common purchases – the same principles apply, refer to the TF – stay tuned for future editions

RSNA Classroom Sessions Useful in their own right: Developing an Integration Strategy Understanding IHE Integration Profiles How to read a DCS How to read an Integration Statement …

RSNA Classroom Sessions Where Is More Information Available? – Links to web-sites with IHE Integration Statements of all participating vendors – IHE Technical Frameworks: Radiology, Cardiology, IT, Lab – IHE User’s Handbooks: Radiology, Cardiology (coming soon) – Connectathon Results – IHE FAQs, Integration Profile Primers, Presentations

RSNA Classroom Sessions Integration Profiles Fundamental Building Blocks of IHE A bundle of Integration: – Defines a clinical integration need – Documents use cases – Defines the Actors and Transactions involved – Selects appropriate standards – Works out tricky details – Guides vendor implementation Basic Units of User-Vendor Communication …

RSNA Classroom Sessions IHE Connectathon Massive Cross-vendor Testing – One week; dozens of vendors; thousands of tests – Opportunity to find/resolve issues Participation is Voluntary – Litmus test not a pre-requisite or certification Engineering event – Huge Congregation of Engineering Talent – Project Management by Mallinckrodt – Pre-Validation Tools (MESA) – Defined Test Protocols with Verification