DICOM and Integrating the Healthcare Enterprise: Five years of cooperation and mutual influence Charles Parisot Chair, NEMA Committee for advancement of DICOM GE Medical Systems-IT Andrei Leontiev Chair, DICOM WG6 IDX

IHE Mission  IHE is an initiative promoting and supporting the integration of systems in the healthcare enterprise.

IHE Integration Goals Improve the efficiency and effectiveness of clinical practice:  Improve Workflow  Improve Information Accuracy  Improve Information Availability  Enable Cross-System Functionality

IHE Integration Profiles B A Proven Standards Adoption Process IHE Integration Profiles: – Detailled selection of standards and options each solving a specific integration problem – A growing set of effective provider/vendor agreed solutions – Vendors can implement with ROI – Providers can deploy with stability Standards Easy to Integrate Products IHE Integration Profile A IHE Demonstration IHE Connectathon Product With IHE User Site RFP IHE Technical Framework

IHE Integration profiles Access to Radiology Information Basic Security Consistent Presentation of Images Evidence Documents Key Image Notes Simple Image and Numeric Reports - Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Patient Informa- tion Reconci- liation, Scheduled Workflow

IHE IT Infrastructure 5 Integration Profiles Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains 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 Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications Consistent Time Coordinate time across networked systems Consistent Time Coordinate time across networked systems

IHE Growth Radiology –5 years – Extensive integration with IT IT Infrastructure –1 Year – Strong start with critical infrastructure issues addressed: authentication, linking patient ids, CCOW, retrieve info for display. HIMSS Feb 2004 HL7-IHE Joint Demo. Laboratory –1 year – Lab Scheduled Workflow goes to public comment Oct 15th for demos mid Cardiology –ACC and ESC have solid plans – launch imminent. Strong influence from the DICOM Efficiency Culture

IHE & DICOM / HL7 Standards are vital (HL7, DICOM, ICD, …) – They provide tools & technologies But Standards alone are insufficient – They are open to interpretation – There is room for optional variations – They avoid specifying how to apply them to particular real world scenarios

IHE Stimulated adoption of DICOM features By 1998, DICOM Storage and Query Retrieve SOP Classes have been implemented and actively used by dozens of vendors However, some features were interpreted differently (scout lines, query keys) IHE established common interpretation

Use of DICOM in Workflow Management DICOM MWL and MPPS were defined but not well implemented because their use without correlation with overall information flow in Radiology Department was limited IHE defined use cases and established mechanisms to use these DICOM SOP Classes via Scheduled Workflow Integration Profiles

IHE researched DICOM data model Patient Imaging Serv. Req. (Order) Requested Procedure Scheduled Procedure Step 1:n 0:nScheduling Image Study Series Image 1:n Work Products Study Mgt Performed Procedure Step Work Tracking n:m

IHE Integration Profiles based on DICOM Most IHE Radiology Integration Profiles are based on one or more DICOM SOP Classes IHE spearheaded implementations of several recently defined DICOM capabilities spending time and effort to build practical implementation framework for them

IHE Profiles vs. DICOM SOPs Consistent Presentation of Images Simple Image and Numeric Report Key Image Note Grayscale Presentation State Structured Reporting Key Object Selection Document

IHE Profiles vs. DICOM SOPs Post-Processing Workflow and Reporting Workflow Evidence Documents General Purpose Worklist and PPS Mammo CAD, Chest CAD, etc.

IHE initiated development of DICOM features IHE actively influenced development of DICOM: – Correction proposals for better consistency of MWL/MPPS – Development of Key Object Selection Documents – Development of common audit messaging

Operational influences DICOM influenced development process of IHE Technical Framework: – Supplements, Correction Proposals DICOM adopted IHE approach to definitions of use cases: – Actors, transactions…

Summary The development of DICOM has influenced the development of IHE Technical Framework, and in turn, was influenced by user needs that are advocated for by the framework developers. Cooperative effort of two bodies have proved very effective and will continue in the future, allowing for further advancement of DICOM and its acceptance in user and vendor communities.

Where Is More Information Available? IHE: DICOM : –