IHE Progress at Northwestern: The Promise and the Peril David S. Channin M.D. Chief, Imaging Informatics And The Northwestern IHE Collaborative (The Northwestern IHE Collaborative consists of teams from Northwestern University’s Feinberg School of Medicine Department of Radiology, Northwestern Memorial Hospital Department of Radiology, Siemens Medical Solutions MRI, GE Medical Systems CT, and GE Medical Systems Information Technologies)

Goals Define the PACS / modality environment: –Northwestern Memorial Hospital Measure a specific PACS / modality workflow metric in the absence of IHE transactions Deploy core IHE Scheduled Workflow Integration Profile transactions (MPPS) between modalities and PACS Re-measure the metric in the presence of the IHE transactions

NMH Environment Patient Reg. Actor (ADT) –Plus 2000 (McKesson) Order Placer Actor (CIS) – PowerChart (Cerner) Order Filler Actor (RIS) –Classic RadNet (Cerner) Image Manager / Image Archive –Centricity 1.0 PACS (GEMS) Acquisition Modality: MR –Syngo MR (Siemens) Acquisition Modality: CT –LightSpeed CT (GEMS) Non-IHE Compliant Systems Systems Supporting IHE Transactions

Process to be measured Order received by PACS: –Procedure is in ‘Ordered’ status Images received by PACS: –Procedure transitions to ‘Arrived’ status  Procedure closed for acquisition: –Procedure transitions to ‘Verified’ status Procedure dictated: –Procedure transitions to ‘Dictated’ status Dictation transcribed: –Procedure transitions to ‘Transcribed’ status Electronically signed report received: –Procedure transitions to ‘Complete’ status

The Problem (I) ‘Verification’ as defined above can occur: –Manually –By dictation (jumps over ‘verified’ status) –Automatically at 5 hours –On receipt of complete message from RIS Not used due to unreliable usage by technologists Time to ‘Verification’ is variable and inconsistent

The Problem (II) Timely verification is critical because it triggers: –Closing a procedure for further acquisition signifying procedure is done. –Writing of the images to permanent long-term storage Which triggers DICOM Storage Commitment back to the Modality –Procedure is ready to be interpreted

Time to verify (or dictate) a Study before IHE

The Promise Use of DICOM Modality Performed Procedure Step Transaction as defined by IHE Framework can automatically trigger ‘Verification’

Time to verify (or dictate) a Study after IHE

The Peril (Lessons Learned) (I) IHE functionality can be purchased / deployed in select commercial products IHE functions at the ‘least common denominator’ level Connect-a-thon success does not guarantee clinical success: –test, test, then test some more Upgrading legacy equipment to support IHE may be expensive and take a long time (and involve forklifts and other heavy machinery)

The Peril (Lessons Learned) (II) Modalities need to better integrate IHE transactions into: –Technologist workflow and technologist user interfaces Does MPPS get sent automatically? How many ‘button’ clicks? –Don’t forget tech training: You are modifying their workflow too! –What if I delete some images on the modality, how does PPS react?! –What if the technologist makes a mistake? –What if I do reconstructions / post-processing on the modality? When do I send MPPS? PACS needs to integrate IHE transactions into core operations

Conclusion The promise of efficiencies from implementation of IHE Integration Profiles is so great that it merits continued dedication and commitment from the user community. The perils of IHE deployment indicate that vendors must continue their dedication and commitment to improving implementations and understanding details of clinical operations