IHE – Radiation Oncology

2 2 What is IHE? Standards-based,Standards-based, Global InitiativeGlobal Initiativegenerating Real-world ImplementationsReal-world Implementations in patient care “Defining, testing, and implementing standards-based interoperability for EHR’s”

3 3 IHE brings reality to workflow

4 IHE Organizational Structure Contributing & Participating Vendors IHE International Board Global Development Radiology Cardiology IT Infrastructure Patient Care Coordination Patient Care Devices Laboratory Eye Care QualityRadiation Oncology IHE Europe IHE Americas France USA Canada IHE Asia-Oceania Japan KoreaTaiwan Netherlands Spain Sweden UK Italy Germany Norway Regional Deployment China ACC ACP HIMSS RSNA JAHIS JIRA JRS METI-MLHW MEDIS-DC JAMI GMSIH SFR SFIL SIRM BIR EuroRec COCIR EAR-ECR DRG ESC Professional Societies / Sponsors AAO ASTRO

5 IHE – Standards-Based Integration Solutions Professional Societies Sponsorship Healthcare Providers & Software Developers Healthcare IT Standards HL7, DICOM, etc. General IT Standards Internet, ISO, etc. Interoperable Healthcare IT Solution Specifications IHE Integration Profile Interoperable Healthcare IT Solution Specifications IHE Integration Profile Interoperable Healthcare IT Solution Specifications IHE Integration Profile Interoperable Healthcare IT Solution Specifications IHE Integration Profile IHE Process

6 What are these Standards? DICOM (Digital Imaging and Communications in Medicine)DICOM (Digital Imaging and Communications in Medicine) –DICOM is a standard for handling, storing, printing, and transmitting information in medical imaging. medical imagingmedical imaging –DICOM enables the integration of scanners, servers, workstations, printers, and network hardware from multiple manufacturers – HL7 (Health Level 7)HL7 (Health Level 7) –HL7 is an international community of healthcare subject matter experts and information scientists collaborating to create standards for the exchange, management and integration of electronic healthcare information. –HL7 promotes the use of such standards within and among healthcare organizations to increase the effectiveness and efficiency of healthcare delivery for the benefit of all. – Parts from

7 IHE – Domain Sponsors Domain Sponsors shall be Member Organizations in the User Category with no direct or indirect responsibilities in the acquisition decision of systems implementing IHE specified capabilities. Domain Sponsors generally come from Healthcare Professional Organizations (clinical, IT, administrative, public health, etc.) or Governmental Agencies. In supporting development activities of IHE International in the domain (or domains) relevant to their membership and mission, they shall adhere to the principles of IHE and promote the broad success of the initiative worldwide.Domain Sponsors shall be Member Organizations in the User Category with no direct or indirect responsibilities in the acquisition decision of systems implementing IHE specified capabilities. Domain Sponsors generally come from Healthcare Professional Organizations (clinical, IT, administrative, public health, etc.) or Governmental Agencies. In supporting development activities of IHE International in the domain (or domains) relevant to their membership and mission, they shall adhere to the principles of IHE and promote the broad success of the initiative worldwide. Domain Sponsors take responsibility for development of IHE Technical Frameworks and associated documents in the domain (or domains) relevant to their membership and mission.Domain Sponsors take responsibility for development of IHE Technical Frameworks and associated documents in the domain (or domains) relevant to their membership and mission.

8 IHE – Domain Secretary Organizing and hosting domain planning and technical committees composed of volunteer domain experts and IHE Member representatives.Organizing and hosting domain planning and technical committees composed of volunteer domain experts and IHE Member representatives. Coordinating with the IHE International Sponsors and Domain Coordination Committee to publish the work of their domain committees under IHE International Copyright;Coordinating with the IHE International Sponsors and Domain Coordination Committee to publish the work of their domain committees under IHE International Copyright; Providing information for publication about their membership, plans, process and work product (e.g., via the Website).Providing information for publication about their membership, plans, process and work product (e.g., via the Website).

9 Why is IHE-RO Important? ASTRO’s 6-point patient protection planASTRO’s 6-point patient protection plan –5) Further developing our Integrating the Healthcare Enterprise – Radiation Oncology (IHE-RO) connectivity compliance program to ensure that medical technologies from different manufacturers can safely transfer information to reduce the chance of a medical error. Promotes discussion and correction of protocols / standards for data communication to improve the reliability and safety of data exchange in radiation oncologyPromotes discussion and correction of protocols / standards for data communication to improve the reliability and safety of data exchange in radiation oncology Provides a mechanism for inter-manufacturer testing of radiation oncology products prior to deliveryProvides a mechanism for inter-manufacturer testing of radiation oncology products prior to delivery –Domain Pre-testing –Connectathon

The Connectathon: IHE’s Conformance Testing Process

11 Timely access to information Easy to integrate products Products with IHE IHE Demonstrations Develop technical specifications Proven Standards Adoption Process Document Use Case Requirements Identify available standards ( e.g. HL7, DICOM, IETF, OASIS) Testing at Connectathons

12 What is a Connectathon? Cross-vendor, live, supervised, structured tests All participating vendors’ products tested together in the same place/timeAll participating vendors’ products tested together in the same place/time Experts from each vendor available for immediate problem resolution… fixes are done in minutes, not months!!Experts from each vendor available for immediate problem resolution… fixes are done in minutes, not months!! Each vendor tests with multiple trading partners (actual product to product)Each vendor tests with multiple trading partners (actual product to product) Testing of real-world clinical scenarios with IHE Integration ProfilesTesting of real-world clinical scenarios with IHE Integration Profiles

13 Connectathon Testing is based on specifications laid out in the Technical Framework Technical Framework Part 1: Integration Profiles model the business process problem (use case) and its solution. Part 2: Transactions define in how current standards are used to solve the business problem defined in the Integration Profiles. Connectathon: Vendors register to test their product as an actor(s) within an Integration Profile

14 What happens after the Connectathon? Successful results (specific by IHE profile/actor) are published by the sponsors ( results (specific by IHE profile/actor) are published by the sponsors ( Vendors self-certify, by publishing IHE Integration Statements: Precise and explicit public interoperability commitment fro a specific commercial product.Vendors self-certify, by publishing IHE Integration Statements: Precise and explicit public interoperability commitment fro a specific commercial product. Only vendors who are successful are entitled to participate in Interoperability Showcase demonstrations:Only vendors who are successful are entitled to participate in Interoperability Showcase demonstrations: –HIMSS Annual Conference (February 26 th – March 1 st, New Orleans) –ACC Annual Conference (March 24 th – 27 th, New Orleans) –Canada e-Health 2007 Conference (May 27 th – 30 th, Quebec City) –RSNA Annual Conference (November 25 th – 30 th, Chicago) –others…

15 IHE Integration Statement

16 RFPs & Integration Statements Be Brief ?Be Brief ? –“The system must support HL7” Be Effective ?Be Effective ? –“The system must support the following HL7 V2 messages according to the following 100 pages of specifications” Be Both:Be Both: –“The system must support IHE Patient Id Cross-reference as a Patient Identifier Source actor” Integration StatementIntegration Statement –Version 2.1 of the Enterprise HIS supports IHE Patient Id Cross-referencing as Patient Identifier Source actor Requiring vendors to publish their products IHE Integration Statements provide a very effective pressure point for market-driven interoperability

17 RFP Language (actual example)

18 How Does IHE-RO Function? Planning CommitteePlanning Committee –Identifies information systems or components of information systems that produce, manage, or act on information associated with clinical and operational activities that require integration. Technical CommitteeTechnical Committee –Identifies and implements standards for interactions between actors that communicate the required information through standards-based messages. The PC and TC work together to Prioritize Efforts, Propose Solutions, and Eventually Demonstrate Connectivity

19 IHE-RO Progress ProfilesProfiles –2007 Basic InteroperabilityBasic Interoperability –2008 Multi-Modality Image RegistrationMulti-Modality Image Registration –2009 Basic Worklist / Workflow IntegrationBasic Worklist / Workflow Integration Advanced InteroperabilityAdvanced Interoperability –2010 Dose CompositingDose Compositing Treatment Delivery WorkflowTreatment Delivery Workflow

20 Domain Pre-Testing participants, 9 Vendors, 10+ systems25+ participants, 9 Vendors, 10+ systems 95+ monitored test cases95+ monitored test cases

21 IHE-RO 2007 Formal Connect-a-thon ASTRO HQ NucletronVarian Philips Tomotherapy Impac CMS Brainlab Elekta Courtesy of ASTRO HQ

22 Imaging Study Contouring System Simulation System Planning Workstation Rad Onc IMS Treatment Delivery Treatment Verification IHE-RO 2007 (Basic Interoperability)

23 Imaging Studies Contouring System Simulation System Planning Workstation Rad Onc IMS Treatment Delivery Treatment Verification IHE-RO 2008 (Image Registration)

24 Imaging Study Contouring System Simulation System Planning Workstation Rad Onc IMS Treatment Delivery Treatment Verification IHE-RO 2009 (Modality Worklist)

25 Where can you learn more?

26 Where can you learn more?