The Essentials Integrating the Healthcare Enterprise G. Claeys Agfa Healthcare R&D, Technology Manager Vendor co-chair IHE Europe Prof. Dr. med. B. Wein Praxisgemeinschaft im Kapuzinerkarree User Co-chair IHE Europe Courtesy of IHE Committees

7 February 2005IHE Europe Educational Event 2 Healthcare IT – Main Obstacles Lack of financial funding :  IT : 2.3% of hospital budget (in other industries : 2.8%) [Gartner] Lack of national/regional guidelines & incentives Lack of access to IT infrastructure Lack of solutions that meet clinical needs Lack of adequate healthcare IT standards and interoperability  Integration cost : 20% of hospital IT budget IHE scope

7 February 2005IHE Europe Educational Event 3 IHE Mission Improve the quality and cost of healthcare by removing the interoperability barriers  Access to Patient Information  Clinical Workflow Provide an open interoperability framework, based on existing standards Enable cross-vendor environment (best-of-breed) Leverage the interoperability solutions in multiple domains (radiology, cardiology, clinical lab, enterprise) IHE = Integrating the Healthcare Enterprise

7 February 2005IHE Europe Educational Event 4 IHE Expanding Scope

7 February 2005IHE Europe Educational Event 5 IHE Approach Solve real-world integration problems Close co-operation between users and vendors  Users identify the integration problems  Vendors provide technical solutions Incremental development & deployment process with an annual heartbeat Common technical framework, based on established standards (e.g. DICOM, HL7,..)

7 February 2005IHE Europe Educational Event 6 IHE Development & Deployment process Identify critical healthcare workflows and integration problems Research & select existing standards to implement a solution Write, review and publish IHE Technical Framework Develop trial implementations Perform cross-testing at “Connectathon” Demonstrate at tradeshows (HIMSS/RSNA…)

IHE Domains Milestones – 20 month cycle Development and Deployment Proposed Scope Approved Scope Public Comment Intgr-profile Sponsors announce Connectathon/Demos with set of Implementation Profiles Final Intgr-profile Trial Implementation Intgr-profile Connectathon/Demo Vendor Participant Registered Vendor Participant passed Connectathon Demo & Education Material Vendors release products with IHE Integration Statements ---

7 February 2005IHE Europe Educational Event 8 IHE Building Blocks IHE Technical Framework IHE Validation Process IHE Integration Statements

7 February 2005IHE Europe Educational Event 9 IHE Technical Framework Describes the different integration solutions (domain specific)  Radiology, IT Infrastructure, Cardiology, Lab Key concepts are domain neutral  Integration Profile  Transactions  Actors  Data model Country & Regional specialization  Limited : max. 5% Based on existing standards IT Standards (http, ebxml) Healthcare Standards (HL7, DICOM) IHE Integration Profiles eHealth Application eHealth Application

7 February 2005IHE Europe Educational Event 10 IHE Technical Frameworks – The books One Technical Framework for each one of the IHE Domains:  Cardiology  IT Infrastructure  Lab  Radiology

7 February 2005IHE Europe Educational Event 11 IHE Integration Profile - Scope Integration solution for real-world problems Coherent set of integration functionality Allow users to focus on high-level integration

7 February 2005IHE Europe Educational Event 12 IHE Integration Profiles – Examples Streamline the workflow sub-processes  Patient ADT – Ordering – Data creation & processing– Reporting – Treatment - Billing  Cross referencing patient id’s among hospitals (MPI) Access to clinical data from workstations and browsers  Departmental reports (e.g.. Clinical lab, cardiology, radiology), measurements, images Quality control  Consistent presentation of images on displays & printers Security :  authentication, auditing Access to common longitudinal health record (EHR)  Focus on sharing of health record among healthcare institutions

7 February 2005IHE Europe Educational Event 13 IHE Integration Profiles - Content Set of Transactions among Actors Actor = logical entity (e.g. modality, image manager, order filler) Transaction = Sequence of messages among Actors Messages : e.g. HL7, DICOM, ebXML,. Profiling existing communication standards  Map data models, message content  “Restrict the options”  Clarify the semantics : accession nr ADT Patient Registration Order Placer Dept Scheduler Image Manager/Archive Modality

7 February 2005IHE Europe Educational Event 14 IHE Integration Profile - Example

7 February 2005IHE Europe Educational Event 15 IHE Transactions - Example

7 February 2005IHE Europe Educational Event 16 The IHE World…. IHE Actor Actor Actor Actor IHE Transaction IHE Actor

7 February 2005IHE Europe Educational Event 17 The Product World….. Product XYZ from Vendor T

7 February 2005IHE Europe Educational Event 18 Mapping IHE to Products IHE Actor Actor Actor Actor IHE Transaction IHE Actor Poduct XYZ from Vendor T

7 February 2005IHE Europe Educational Event 19 IHE Validation Process Goal :  Validate implementations of IHE TF in products Approach  IHE is not a certification authority  IHE stimulates auto-validation Vendors are responsible for validating and documenting IHE implementations IHE provide tools and infrastructure IHE Validation tools  Mesa toolkit  Connectathon  IHE Integration statement

7 February 2005IHE Europe Educational Event 20 MESA Test Toolkit Software library Emulate the various actors in the different implementation profiles Supports single product, single vendor testing Pre-requisite for connectathon participation  Implementers submit test logs prior to connectathon

7 February 2005IHE Europe Educational Event 21Connectathon Connectathon = connectivity marathon Validate the Integration Profiles for a particular IHE demo  Pre-requisite for participating at IHE demos 1 week validation session in Europe, USA and Japan  End-to-end scenario testing  Multi-product; multi-vendor; multi-domain Multi-vendor, multi products  2004 : 50 companies, 100 systems  2005 : 77 companies, 118 systems Multi-domain Integration Profiles  Rad, ITI, Lab, Cardio European connectathon’s :  Paris (2002), Aachen (2003), Padua (2004)  Noordwijkerhout (April 2005) Results are published on

7 February 2005IHE Europe Educational Event Aachen Connectathon at work

7 February 2005IHE Europe Educational Event 23 Connectathon results

7 February 2005IHE Europe Educational Event 24 Connectathon results (simple)

7 February 2005IHE Europe Educational Event 25 Connectathon results (simple)

7 February 2005IHE Europe Educational Event 26 Connectathon results (advanced)

7 February 2005IHE Europe Educational Event 27 IHE Integration Statements Vendors  Document the IHE implementation per product  Content : List of supported actors List of supported integration profiles (per actor)  “contractual” commitment Buyers  Uniform mechanism to compare product integration capabilities  Enables validation on paper

7 February 2005IHE Europe Educational Event 28 IHE Integration Statement VendorProduct NameVersionDate Huge Imaging Medical SystemsIntegrateRADV2.312 Oct 2002 Integration Profiles Implemented Actors ImplementedOptions Implemented Scheduled WorkflowImage Manager/Archiveenone Image DisplayPerformed Procedure Step Order FillerPPS Exception Management Simple Image and Numeric Report Report Creatornone Link to vendor IHE page Links to Standards Conformance Statements of the Implementation HL7 DICOM IHE Integration Statements - Example

7 February 2005IHE Europe Educational Event 29 IHE Integration Statements - Resources

7 February 2005IHE Europe Educational Event 30 IHE Integration Statements - List

7 February 2005IHE Europe Educational Event 31 IHE Market Adoption 40+ companies / 100+ Products with IHE Integration Statements  -> Product IS  IHE support is requested in RFPs IHE User Success Stories in North American and Europe

7 February 2005IHE Europe Educational Event 32 IHE User Success Stories – Submitted since 2002 IHE measures success on:  Compliant products availability  Provider deployed integrated systems IHE Becomes reality

7 February 2005IHE Europe Educational Event 33 IHE Europe Success Stories

7 February 2005IHE Europe Educational Event 34 IHE Organization Global Structure Why IHE Europe

7 February 2005IHE Europe Educational Event 35 IHE Europe IHE North America France USACanada IHE Asia-Ocenia Japan KoreaTaiwan NetherlandSpainSweeden UKItalyGermany Norway Regional Deployment Radiology Planning Committee Radiology Technical Committee IT Infrastructure Planning Committee IT Infrastructure Technical Committee Pharmacy Exporatory Sub-Committee Global Development Cardiology Planning Committee Cardiology Technical Committee Laboratory Planning and technical Committee IHE Strategic Development Committee ACC HIMSS RSNA JAHIS JIRA JRS METI MEDIS-DC JAMI GMSIH SFR SFIL SIRM BIR EuroRec COCIR EAR-ECR DRG ESC Professional Societies / Sponsors Contributing and participating Vendors IHE Organizational Structure

7 February 2005IHE Europe Educational Event 36 IHE Members Users  Clinicians, Medical Staff, Administrators, CIOs, … Vendors  Information Systems & Imaging Equipment (80 vendors) Societies Representing Healthcare Segments  EAR, ESC, Other Professional Societies… Governmental agencies  e.g. GMSIH Active liaison with Standards Development Organizations (SDOs)  HL7, DICOM, ASTM, others … Stakeholders of healthcare interoperability solution

7 February 2005IHE Europe Educational Event 37 AGFA Healthcare Medical Solutions Algotec ARES SA aycan Digitalsysteme ConVis DEDALUS Dianoema Eastman Kodak Company Ebit Sanita EDL ELFIN s.r.l. Engineering Sanità Enti Locali ESAOTE ETIAM Ferrania Fujifilm GE Healthcare GMD GIE Convergence-Profils Rogan-Delft Sago spa Sectra Imtec AB Siemens Medical Solutions Soluzioni Informatiche srl Stentor Inc. Swissray Medical AG Symphonie On Line Synapsis TELEMIS S.A. TIANI MEDGRAPH AG TOREX GAP Medical Toshiba Medical Systems TSI groupe europMedica VEPRO AG VISUS Technology Transfer WAID XR PARTNER GWI Research IASI Srl IdeoPass Image Device-Cerner Company INFINITT INOVIT McKesson MED2RAD MEDASYS SA Medavis Medigration GmbH MEDIMON Ltd. MEDOS AG Merge eFilm METAFORA Minolta Europe Omnilab Philips Medical Systems Rasna Imaging Systems RAYPAX INC. In yellow, companies with IHE Committees Chairs (Summer 2004) Participating and Contributing Vendors (Europe)

7 February 2005IHE Europe Educational Event 38 IHE in Europe - Why Similar integration problems ask for similar (IHE) solutions Provide European vendors (RIS/HIS) with a platform to develop and test world-class interoperability Address European specific requirements :  Multi-language aspect  Limited acceptance of HL7  Country specific RIS vendors  Country specific congresses & exhibitions Represent European needs in the different global IHE Development committees

7 February 2005IHE Europe Educational Event 39 IHE Netherlands Committee IHE Germany Committee IHE xxx Committee Demonstrations Education National TF extensions Vendor Participation IHE Europe Committee Strategic Development Connectathon New Integration Profiles Education and promotion IHE Inter- national IHE Europe vs. National IHE

7 February 2005IHE Europe Educational Event 40 IHE-Europe – Deployment Activities National IHE Committees (8)  2001 : France, Germany  2002 : Italy, UK  2003 : Norway, Denmark, Netherlands  2004 : Spain Demos :  Radiology centric demos : JFR, DRK, SIRM, UKRC, ECR  Hospital centric demos : Hopital Expo, Medica, HCC 400 visitors/demo (average) 40% local vendors; 60% international vendors

7 February 2005IHE Europe Educational Event 41 IHE Europe Development Activities Participate in global IHE Development activities  National extensions of Technical Framework Champion of IHE Clinical Lab :  Joint effort of IHE France and IHE Japan  Other countries join : USA, Germany Assess new IHE initiatives in Pathology & Surgery IHE test tool development:  Extensions of MESA Test tools for clinical lab  Web based test management tool

7 February 2005IHE Europe Educational Event 42 IHE Europe – Activities 2005 IHE Connectathon  Noordwijkerhout, April 2005  All IHE domains : Radiology, IT Infrastructure, Cardiology, Clinical Lab IHE Demos :  Radiology : UK, ECR, France, Germany  Cardiology : ESC congress (Stockholm)  Lab : France, Italy  Enterprise : Italy, France

7 February 2005IHE Europe Educational Event 43 How to participate to IHE? As a Vendor Implement IHE profiles in your products Participate to Connect-a-thons and Demonstrations Respond to Public Comments of Domain Supplements Participate in IHE development / deployment committee As a User/Consultant Include IHE Integration Profiles in your RFPs and Integration Projects Respond to Public Comments of Domain Supplements Attend Demonstrations. Participate in IHE development / deployment committee

7 February 2005IHE Europe Educational Event 44 IHE, the effective bridge between information exchange standards and their practical use in healthcare

7 February 2005IHE Europe Educational Event 45 More information…. IHE Web sites: Technical Frameworks: ITI V1.0, RAD V5.5, LAB V1.0, CARDIO V1.0 Non-Technical Brochures : IHE Europe Business Case IHE Fact Sheet and FAQ IHE Integration Profiles: Guidelines for Buyers IHE Connectathon Results Vendor Products Integration Statements