Integrating the Healthcare Enterprise The Basics of IHE: Concepts and Process David Channin, MD RSNA Electronic Communications Committee IHE Strategic Development Committee IHE Radiology Planning and Technical Committees Associate Professor of Radiology Chief, Imaging Informatics Northwestern University Feinberg School of Medicine Department of Radiology

Why Are Standards Important? Take the case of the many various competing base connectors for a light bulb circa 1905. It’s obvious if we think it through a bit that having too many arbitrarily different and incompatible solutions to this basic problem would cause terrible inefficiencies. Think of the dilemma a manufacturer of light fixtures would face in deciding which of the competing solutions to support. Think of the confusion and trouble that a user would be put to in trying to select a replacement bulb. Think of the size of the light bulb aisle at the local hardware store! Our question for the day here might be, How many standards does it take to screw in a light bulb?

Why Are Healthcare IT Standards Important? Step #2 toward Crossing the Quality Chasm: “. . . making effective use of information technologies to automate clinical information and make it readily accessible to patients and all members of the care team. An improved information infrastructure is needed to establish effective and timely communication among clinicians and between patients and clinicians.” - IOM Report, 2001 It seems obvious that improved standards—and widespread, coordinated deployment of standards are necessary in order to achieve this.

What IT Standards Enable Greater efficiency and cost savings The ability to make best of breed purchasing decisions Better and more timely communication of medical information Improved patient safety Data for outcomes analysis and decision support The potential to build a system of evidence-based medicine The potential to develop a truly comprehensive and portable EHR So why haven’t standards solved all of healthcare’s interoperability issues?

The Standards Archipelago POC Devices Pharm ADT/HIS RIS PACS Mods DICOM IEEE – POCT Lab NCPDP HL7 2.4 EKG HL7 2.1 Billing ER OR CIS DICOM Cath Lab X12/ICD9 Islands of data across the healthcare enterprise

NAHIT Standards Directory “ . . . Since launching a beta version for members only in April, the Alliance has expanded the directory to include 850 voluntary and mandatory standards and electronic links to more than 200 standards development organizations.” The great thing about standards is that there are so many to choose from -Old Wisecrack

Standards Alone Are Not Enough Too many standards No clear domain boundaries No clear mapping of information flow across boundaries Too much generality and ambiguity Version incompatibilities Vendor proprietary interests Complexity!! We need standards for how to implement standards!

Connecting Standards to Care Care providers must work with industry to coordinate the implementation of standards to meet their needs Care providers need to identify the key interoperability problems they face Drive industry to develop and make available standards-based solutions Implementers need to follow common guidelines in purchasing and integrating systems that deliver these solutions

IHE Grows from DICOM Experience Integrating the Healthcare Enterprise: an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information promotes the coordinated use of established standards such as HL7 and DICOM to address specific clinical needs leads to systems that communicate better, are easier to implement, and enable care providers to use information more effectively

IHE Process Users identify desired functionalities that require coordination and communication among multiple systems E.g., departmental workflow, single sign-on, cross-departmental sharing of documents and information Find and document standards-based transactions among systems to achieve desired functionality Apply necessary constraints to eliminate useless wiggle room Provide process and tools to encourage vendors to implement MESA software test tools Connectathon interoperability testing event Provide tools and education to help users acquire and integrate systems using these solutions Connectathon results and public demonstrations Integration statements RFP toolkit (soon)

IHE Participants Societies Representing Healthcare Segments Users RSNA, HIMSS, ACC, ACCE, … Users Clinicians, Medical Staff, Administrators, CIOs, … Consultants Information Systems Vendors Imaging Systems Vendors Standards Development Organizations (SDOs) HL7, DICOM, ASTM, NCCLS, OASIS, IETF, ISO …

IHE Deliverables Technical Framework Integration Profiles Connectathon Public Demonstrations Tools for Acquiring Conformant Products

IHE Technical Frameworks Detailed standards implementation guides Cardiology IT Infra Lab Radiology

Organization of TFs Volume 1: Integration Profiles Describes clinical need and use cases Identifies the actors and transactions Volume 2+ of Technical Framework Provides implementation specification for each transaction by specific reference to Standards

Organization of TFs

IHE Radiology Integration Profiles Charge Posting Scheduled Workflow - Presentation of Grouped Procedures Reporting Workflow Patient Info. Recon-ciliation Post-Processing Workflow NM Image Consistent Present- ation of Images Evidence Docs Key Image Notes Simple Image & Numeric Reports Access to Radiology Information Portable Data for Imaging Basic Security

acquisition completed acquisition in-progress acquisition completed Example: IHE Scheduled Workflow Report Repository ADT (Registration) report Image Display Film Lightbox Order Placer Image Manager & Archive Film Folder Specifies transactions that function to maintain the integrity of patient, image, and order information across systems Integrates modalities with information and imaging systems Biggest Value of IHE Smooth flow of patient, image and order information across systems Status updates of orders Order Filler Acquisition Modality acquisition completed Print Server acquisition in-progress acquisition completed images printed Modality

IHE IT Infrastructure Integration Profiles Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Provide users a single name and centralized authentication process across all systems Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Consistent Time Coordinate time across networked systems

IHE Connectathon Open invitation to vendor community Advance testing tools (MESA) Testing organized and supervised by project management team Dozens of vendors and systems Thousands of cross-vendor tests performed Results recorded and published

RFPs & IHE Integration Statements Be Brief? “The system must support DICOM” Be Effective? “The system must support the following DICOM services according to the following 100 pages of specifications” Be Both: “The system must support IHE Scheduled Workflow as an Acquisition Modality” IHE Integration Statements Version 2.1 of the Jupiter 3 CT supports IHE Scheduled Workflow as an Acquisition Modality

Integration Statements

RFP Toolkit

RFP Toolkit

What can you do? Learn about IHE Participate in IHE planning Insist on IHE compliance in your RFPs and contract documents

More information…. IHE Web sites: Technical Frameworks: http://www.himss.org/IHE http://www.rsna.org/IHE http://www.acc.org/quality/ihe.htm. Technical Frameworks: ITI V1.0, RAD V5.5, LAB V1.0 Technical Framework Supplements - Trial Implementation May 2004: Radiology August 2004: Cardiology, IT Infrastructure Non-Technical Brochures : Calls for Participation IHE Fact Sheet and FAQ IHE Integration Profiles: Guidelines for Buyers IHE Connect-a-thon Results Vendor Products Integration Statements