September, 2005What IHE Delivers IHE Eye Care Integration Profiles Andrew Casertano Department of Veterans Affairs

2 Learning Objectives How to read the IHE Eye Care Technical Framework What is an Integration Profile? They are a practical way to communicate integration problems and solution requirements precisely. How IHE Eye Care Integration Profiles simplify the integration process.

3 The Goal of IHE Eye Care Any Eye Care Image, Anywhere, Intact, Anytime Seamless integration from check-in to acquisition through archive and billing Standardization and guidelines for Quality Assurance & Patient Safety Protection of the integrity of the data

4 What is IHE Eye Care? IHE is a proven systems integration process – eight years of experience A collaboration of clinicians and vendors  Promote integrated solutions based on open standards  International and multi-specialty Produces results on a yearly cycle 1.Clinicians identify and prioritize clinical problems (Use Cases) 2.Engineers from industry define solutions (Technical Framework) 3.Participating vendors implement and test at “Connectathon” (Test) 4.Vendors publish “Integration Statements” for products; users request in RFPs (Products)

5 Why IHE Eye Care? Multiple devices and systems from multiple vendors  Need to integrate data sources for comprehensive view of patient  List of Different Equipment  Multiple specialists cooperating on single patient Multiple locations  Individual patient is seen in multiple locations – distributed patient record  Individual clinician practices in multiple locations – across organizational boundaries  Office, small and large clinics, linking to hospitals Chronic Disease  Long term patient care – persistent and evolving patient record Lots of hard data integration problems

6 Costs of non-integration Quality - Less accurate care due to lack of relevant patient records at point of care Time - Delay in treatment due to unavailability of critical information Money - Higher costs needed to support manual rather than automated record keeping processes Emotional - Patient dissatisfaction with provider; clinician frustration with data environment

7 Why Is Integration Hard? The Different Systems Don’t Use a Common Vocabulary The Different Systems Don’t Use Common Communication Standards Consistently The Flow of Information Through the Enterprise Changes With the Circumstances of the Case

8 Benefits of Integration Reading efficiency: user-friendly, intuitive, multi-modality, universal workstation that will display and lay-out images from an eye care acquisition device as needed for the complete integrated imaging evaluation. Quality: preservation of rendered image quality on multiple displays. Quality/Safety: patient and image identifiers are available and properly located.

9 IHE 2006 – Integrated EHR Over 100 vendors involved world-wide, 6 Technical Frameworks 39 Integration Profiles, Testing at Connectathons, Result in an Integrated Electronic Health Record

10 Use Cases ➨ IHE Profiles IHE develops incrementally Use cases are developed for specific data sharing problems with practical solutions in 1-2 year timeframe Use case becomes an IHE Profile with a technical solution in the Technical Framework IHE Eye Care Profiles:  Scheduled Workflow  Charge Posting  Evidence Documents  More coming next year, and next …

11 What is the Big Picture? IHE Defines Integration Profiles to Group Related Transactions and Connects Them With Real- world Functions Integration Profiles Allow the Customer to Focus on High-level Integration While IHE handles the details Proprietary Solutions create instant legacies

12 IHE Technical Framework Components IHE defines a set of Integration Profiles which describe a problem and provide a packaged Solution containing Integration requirements and functionality IHE defines a set of Actors which represent the roles systems can play in a Profile IHE defines a set of Transactions precisely define interactions between Actors

13 TF Vol. I – Integration Profiles Integration Profiles are a clinical problem defined and a description of its solution. Each problem’s use case and process flow consists of IHE Actors and Transactions.

14 The Integration Profile Transactions Actors cooperating through Transactions to solve the problem

15 The Vocabulary Foundation IHE Defines a Common Vocabulary for Patient and Administrative Information Order Requested Procedure Accession Number Procedure Step Others

16 Identifying Transactions from patient check-in to acquisition through archive and billing … IHE Defines the Eye Care workflow from patient check-in to acquisition through archive and billing … IHE identifies the transactions required to make integration work

17 The Right Selection IHE Selects an Existing Industry Standard for each Transaction and Specifies the Transaction Unambiguously HL7 Patient Registration and Order DICOM Modality Worklist DICOM Objects

18 Mapping to Real-World Products The IHE Actors and transactions are abstractions of real products in the real- world eye care information system environment.  The order placer may be realized in either the practice management system or the Electronic Medical Record (EMR) products.  The Performed Procedure Step Manager may be realized in either the Picture Archive and Communications System (PACS) or the Electronic Medical Record (EMR) products.

19 Six Key Actors A Patient registration system (also known as Admit, Discharge and Transfer (ADT) system is responsible patient demographic and encounter information. An Order Placer generates eye care orders and distributes those orders. This may be hospital level system. A Department System Scheduler/Order Filler provides worklists and monitors progress. An Acquisition Modality acquires and creates DICOM objects. An Image Manager/ Image Archive provides long-term storage. An Image Display offers browsing of patients’ studies.

20 Dependencies between Integration Profiles

21 Process Flow Diagrams

22 TF Vol. II - Transactions Vol. II defines eye care transactions in detail, specifying the roles for each actor, the standards employed, the information exchanged. The appendices provide clarification of technical details of the IHE data model and transactions.

23 We care! The AAO and the VA have made fixing the Eye Care data integration problem a priority The IHE participating vendors have responded to cooperatively develop data interoperability Our success is measured by your success

24 To find out more … Join and participate in IHE Eye Care IHE Technical Frameworks leveraged by Eye Care  Cardiology  IT Infrastructure  Radiology Standards used by IHE Eye Care Standards used by IHE Eye Care  DICOM Standard  HL7 Standard IHE Connectathon 2006 at RSNA HQ IHE Showcase at 2006 AAO Conference Vendor Products Integration Statements

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