VA Success Story – Image Acquisition using IHE Scheduled Workflow June 6~7, 2006 Peter Kuzmak, Andrew Casertano, and Dr. Ruth Dayhoff Department of Veterans Affairs

VA Healthcare Enterprise 157 Medical Centers & 850+ Outpatient Clinics Serves an active patient population of 5 million veterans All sites acquire DICOM images ½ billion images online ½ million images acquired each day

VistA & Computerized Patient Record System

Multimedia Patient Record Computerized Patient Record and VistA Imaging Chart Data Textual chart data Computable data Handwritten and non-electronic chart data Multimedia Data Images, graphics, waveforms, audio, etc.

Wide Variety of Images Integrated with the Online Patient Record Cardiology Bronchoscopy Gastrointestinal Endoscopy Hematology Pathology Surgery Nuclear Medicine Dental Radiology Dermatology Ophthalmology Podiatry Vascular Urology Nursing Electrocardiography Scanned Documents

VA IHE Success Story All VA DICOM image acquisition uses IHE Radiology Transactions to interface modalities to PACS:  #5 - Modality Worklist Provided - download patient and study #8 - Modality Images Stored - send images to the PACS. One interface for 250 different models of instruments! Radiology, ophthalmology, dentistry, endoscopy, pathology, and cardiology. VA/DoD DICOM Modality requirements documents: www.va.gov\imaging The VA will not purchase a new modality unless it supports these capabilities.

Using Consults for Clinical Specialties (Simplified Workflow) Consult Ordered Schedule Appointment Patient Arrives Images Acquired Patient Leaves Diagnostic Reporting Follow up Visits

Workflow Transactions P A C S VA Hospital Information System Worklist Query Worklist Response DICOM offers a great many services. We will look at the core services by considering the case of scheduled acquisition workflow in an integrated, digital department. The outside world is HL7 where the order is typically placed. This is outside the scope of DICOM. Starting at the RIS… RIS - Mod MWL Query Mod - RIS MPPS (In-Prog, Complete) note time free [Mod - PACS Store (note the different image classes)] Mod - PACS Store Commit PACS-Other Instance Availability Notification [PACS - WS Query / Retrieve] Mod/PACS - Prt Print Management [presume that Association Negotiation is covered] Mention PIR issue and flavor of solution and point to IHE. Really it's more of a policy thing than a service thing. Acquisition Modality

Workflow Transactions Image Retrieval P A C S VA Hospital Information System Worklist Query Storage Worklist Response DICOM offers a great many services. We will look at the core services by considering the case of scheduled acquisition workflow in an integrated, digital department. The outside world is HL7 where the order is typically placed. This is outside the scope of DICOM. Starting at the RIS… RIS - Mod MWL Query Mod - RIS MPPS (In-Prog, Complete) note time free [Mod - PACS Store (note the different image classes)] Mod - PACS Store Commit PACS-Other Instance Availability Notification [PACS - WS Query / Retrieve] Mod/PACS - Prt Print Management [presume that Association Negotiation is covered] Mention PIR issue and flavor of solution and point to IHE. Really it's more of a policy thing than a service thing. Acquisition Modality

VA’s Role in Advancement of DICOM in Ophthalmology Initially no Ophthalmology specification in DICOM Could not even tell left from right 2002 - VA encouraged AAO develop new specification 2004 - Ophthalmic Photography Image DICOM Supplement 91 2005 – Organized the IHE Eye Care Showcase 2006 – VA national Diabetic Retinopathy Surveillance program Fundus Image 3072 x 2048 24-bit

2005 IHE Eye Care Showcase

VA National Diabetic Retinopathy Surveillance Network

IHE Value to Vendors IHE Technical Framework defines implementation specifications in detail Resources needed to developed, test, and maintain just a single interface IHE provides interface testing tools and vendor-to-vendor interoperability Connectathon. IHE saves vendors money

Conclusion: Follow IHE for Success IHE enables interoperability and saves money Using industry standards avoids having to develop custom interface methodologies Provides smoother integration Accelerates acceptance testing Cost-effective for all participants

More information…. IHE Web site: www.ihe.net Technical Frameworks ihe_eyecare_tf_TI_vol1_2006_06_01 (Trial Implementation version) ihe_eyecare_tf_TI_vol2_2006_06_01 (Trial Implementation version) ihe_tf_rev6.0ft_vol1_2005-05-18-FINAL (Radiology) ihe_tf_rev6.0ft_vol2_2005-05-18-FINAL (Radiology) ihe_CARD_tf_vol2_2.1_FT (Cardiology) Standards used by IHE Eye Care DICOM Standard www.nema.medical.org HL7 Standard www.hl7.org IHE Connectathon Oct. 2006 at RSNA HQ IHE Showcase at Nov. 2006 AAO Conference Vendor Products Integration Statements

Thank You!