March 17, 2005IHE and medical Standards in Denmark 1 Integrating the Healthcare Enterprise IHE for interoperability within the enterprise - Overview Charles Parisot, GE Healthcare IHE IT Infrastructure Technical Committee Co-chair IHE Europe Committee Copenhagen, March 17th 2005

March 17, 2005IHE and medical Standards in Denmark 2 W W W. I H E. N E T Providers and Vendors Working Together to Deliver Interoperable Health Information Systems In the Enterprise and Across Care Settings W W W. I H E – Europe. o r g

March 17, 2005IHE and medical Standards in Denmark 3 Achievements and expanding scope Over 100 vendors involved world-wide, 4 Technical Frameworks 27 Integration Profiles, Testing at yearly Connectathons, Demonstrations at major exhibitions world-wide To claim compliance to IHE Integration Profiles vendors shall publish for each product an IHE Integration Statement. Patient care Coordination, Quality, Pharmacy, Anatomical Pathology, Surgery, etc.

March 17, 2005IHE and medical Standards in Denmark 4 IHE Radiology Integration Profiles Patient Info. Recon- ciliation Access to Radiology Information Consistent Present- ation of Images Basic Security - Evidence Docs Key Image Notes Simple Image & Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled Workflow Portable Data for Imaging NM Image New Extensions New

March 17, 2005IHE and medical Standards in Denmark 5 Departmental Actors in SWF IHE Actors: DSS / Order Filler PPS Manager Image Manager / Archive Acquisition Modality Evidence Creator Image Display

March 17, 2005IHE and medical Standards in Denmark 6 Example of Radiology Use Cases Local policy calls for ADT to pre-register ER patients (John Doe, Jane Doe): Case 1: Unidentified Patient registered at ADT and order is placed at Order Placer. Case 2: Unidentified Patient registered at ADT and order is placed at DSS/Order Filler. Case 3: Unidentified Patient registered at ADT but acquisition completed at Modality prior to order.

March 17, 2005IHE and medical Standards in Denmark 7 Unidentified Patient - Case 3 ADT Order Placer Image Manager Modality Department System Database/Scheduler/ Order Filler Filler Order Mgmt New Order [3] Procedure Scheduled [4] Patient Reconciliation J.Doe ->J.Smith Patient Update [12] Schedule Procedure Images Acquired ModalityProcedure Step Completed [7] Modality Procedure Step Completed [7] RegisterJ.Doe Patient Update [12] Patient Registration [1]

March 17, 2005IHE and medical Standards in Denmark 8 PDI – Value Proposition Removable media that contains DICOM and may contain browser viewable data. For patient personal records For referral For enterprise data interchange For use in other departments, e.g. surgery For printing Media interoperability validation Browser compatibility Get CDs that you can create and read anywhere

March 17, 2005IHE and medical Standards in Denmark 9 PDI –Value Proposition Interoperability validation is especially important for media Network Interoperability Problems Immediate, Unambiguous Rapidly resolved Media Interoperability Problems Long delays in detection and recognition Ambiguous or unknown source vendor/version Long delays in resolution Large volume of non-interoperable media created due to delays IHE Virtual Connectathon for PDI solves the media validation problem Provides rapid, unambiguous detection of problems Enabling rapid resolution of problems

March 17, 2005IHE and medical Standards in Denmark 10 PDI – Actors and Transactions Portable Media Creator Print Composer Report Reader Image Display Display Distribute Imaging Information on Media Media Importer

March 17, 2005IHE and medical Standards in Denmark 11 CDROM Structure DICOMDIR INDEX.HTM README.TXT Directory of DICOM files IHE_PDI Directory of web files Other optional content Web content (optional)

March 17, 2005IHE and medical Standards in Denmark 12 IHE Cardiology Retrieve Information for Display Access a patients clinical information and documents in a format ready to be presented to the requesting user EchoCardiography Worklflow Admit, order, schedule, acquire images, notify of completed steps, on fixed and mobile stress echo modalities. Provide high-quality ECG and related reports to the enterprise and outside in a ready-to-display format Retrieve ECG for Display Cardiac Catheterization Workflow Scheduled & unscheduled acquisition and management of cathlab information, notification of completed steps.

March 17, 2005IHE and medical Standards in Denmark 13 Management of cath exams Similar to IHE-Radiology SWF Multi-modality, multiple procedure steps Handle multiframe images (XA and IVUS) Reconciliation of patient information Similar to IHE-Radiology PIR Unscheduled cath is the norm, not the exception Time synchronization Modalities must support IHE-ITI Consistent Time Out of scope for Pre-cath and post-cath activity, Hemo waveforms and reports, Procedure logs, QCA/QVA, Final cath reports Cardiac Catheterization Workflow

March 17, 2005IHE and medical Standards in Denmark 14 Cath actors and transactions Pt. Registration [Rad-1] Patient Update [Rad-12] Pt. Registration [Rad-1] Patient Update [Rad-12] Placer Order Management [Rad-2] Filler Order Management [Rad-3] ADT Query Images [Rad-14] Retrieve Images [Card-4] Image Display Modality Image/Evidence Stored [Card-2] Storage Commitment [Card-3] Procedure Scheduled [Rad-4] Procedure Updated [Rad-13] Query Modality Worklist [Rad-5] Performed Procedure Step Manager Modality PS in Progress [Card-1] Modality PS Completed [Rad-7] Modality PS in Progress [Card-1] Modality PS Completed [Rad-7] Modality PS in Progress [Card-1] Modality PS Completed [Rad-7] Order Placer Acquisition Modality Image Manager Image Archive DSS/ Order Filler Patient Update [Rad-12]

March 17, 2005IHE and medical Standards in Denmark 15 Cath actors and transactions Pt. Registration [Rad-1] Patient Update [Rad-12] Pt. Registration [Rad-1] Patient Update [Rad-12] Placer Order Management [Rad-2] Filler Order Management [Rad-3] ADT Query Images [Rad-14] Retrieve Images [Card-4] Image Display Modality Image/Evidence Stored [Card-2] Storage Commitment [Card-3] Procedure Scheduled [Rad-4] Procedure Updated [Rad-13] Query Modality Worklist [Rad-5] Performed Procedure Step Manager Modality PS in Progress [Card-1] Modality PS Completed [Rad-7] Modality PS in Progress [Card-1] Modality PS Completed [Rad-7] Modality PS in Progress [Card-1] Modality PS Completed [Rad-7] Order Placer Acquisition Modality Image Manager Image Archive DSS/ Order Filler Patient Update [Rad-12] Many actors cooperating in a complete end-to-end workflow Documented in the IHE CARD Technical Framework Vol 1 & Vol 2 with reference to RAD TF-Vol 2

March 17, 2005IHE and medical Standards in Denmark 16 IHE Cardiology Cardiac Catheterization Workflow Scheduled & unscheduled acquisition and management of cathlab information, notification of completed steps. Provide high-quality ECG and related reports to the enterprise and outside in a ready-to-display format Retrieve ECG for Display Retrieve Information for Display Access a patients clinical information and documents in a format ready to be presented to the requesting user EchoCardiography Worklflow Admit, order, schedule, acquire images, notify of completed steps, on fixed and mobile stress echo modalities.

March 17, 2005IHE and medical Standards in Denmark 17 Reuse of similar IHE-Radiology Profiles Scheduled Workflow (IHE-R SWF) Patient Information Reconciliation (IHE-R PIR) Intermittently Connected Modality Workflow Acquisition Modality storage Stress Echo Workflow Staged Protocol Acquisition Modality (optional) Image Display (required) Digital vs. Videotape Scope: Imaging Workflow

March 17, 2005IHE and medical Standards in Denmark 18 Echo Actors & Transactions Pt. Registration [Rad-1] Patient Update [Rad-12] Pt. Registration [Rad-1] Patient Update [Rad-12] Placer Order Management [Rad-2] Filler Order Management [Rad-3] ADT Query Images [Rad-14] Retrieve Images [Card-4] Image Display Modality Image/Evidence Stored [Card-2] Storage Commitment [Card-3] Procedure Scheduled [Rad-4] Procedure Updated [Rad-13] Query Modality Worklist [Rad-5] Performed Procedure Step Manager Modality PS in Progress [Card-1] Modality PS Completed [Rad-7] Modality PS in Progress [Card-1] Modality PS Completed [Rad-7] Modality PS in Progress [Card-1] Modality PS Completed [Rad-7] Order Placer Acquisition Modality Image Manager Image Archive DSS/ Order Filler Patient Update [Rad-12]

March 17, 2005IHE and medical Standards in Denmark 19 IHE Cardiology Retrieve Information for Display Access a patients clinical information and documents in a format ready to be presented to the requesting user EchoCardiography Worklflow Admit, order, schedule, acquire images, notify of completed steps, on fixed and mobile stress echo modalities. Cardiac Catheterization Workflow Scheduled & unscheduled acquisition and management of cathlab information, notification of completed steps. Provide high-quality ECG and related reports to the enterprise and outside in a ready-to-display format Retrieve ECG for Display

March 17, 2005IHE and medical Standards in Denmark 20 Retrieve ECG for Display Provide ECGs and related reports to enterprise Extension to IHE-ITI RID ECGs served in ready-to-display format Requirements on PDF displayable quality Includes XML-based ECG/report list Out of scope ECG acquisition and reading workflow ECG raw data interchange Export of reports to external repository

March 17, 2005IHE and medical Standards in Denmark 21 Example ECG in PDF Format

March 17, 2005IHE and medical Standards in Denmark 22PDF ECG Source required to support PDF so it is compatible with existing IHE ITI RID clients. PDF is a common document type and most computers already have a viewer. ECG Source required to use vector graphics for waveforms in PDF. Gives high quality line drawings at any screen resolution and zoom factor. Rasterized (e.g. scanned, bitmapped) ECG images not allowed.

March 17, 2005IHE and medical Standards in Denmark 23 Transaction Diagram Retrieve ECG for Display Display Information Source Retrieve Specific Info for Display [ITI-11] Retrieve Document for Display [ITI-12] Retrieve ECG List [CARD-5] Retrieve ECG Doc for Display [CARD-6]

March 17, 2005IHE and medical Standards in Denmark 24 Laboratory IHE Integration Profiles In Process –TI Nov 2004 Laboratory Device Automation (LDA) In Process –TI Nov 2004 Pre-analytic process, analysis and post-analytical treatment Laboratory Scheduled Workflow (LSWF) Completed in 2003 Tests performed by a laboratory for an identified inpatient or outpatient In Process Laboratory Patient Information Reconciliation (LPIR) In Process Tests performed on an unidentified or misidentified patient In Process Laboratory Code Set Distribution (LCSD) In Process Sharing the batteries and tests code sets throughout the enterprise In Process –TI Nov 2004 Laboratory Point Of Care Testing (LPOCT) In Process –TI Nov 2004 Tests performed on point of care or patients bedside In Dev.

March 17, 2005IHE and medical Standards in Denmark 25 LSWF: Three major use cases Externally placed order with identified specimens The ordering provider collects the specimens and uniquely identifies them (in the order sent in the message as well as on the container with a barcode label) Externally placed order with specimens unidentified or to be collected by the laboratory Filler order with specimens identified by the laboratory Breakthrough: All three workflows are required and have been designed consistently.

March 17, 2005IHE and medical Standards in Denmark 26 LSWF: Workflow Technical validation Clinical validation Selected standard: HL7 version 2.5

March 17, 2005IHE and medical Standards in Denmark 27 Example 1: Microbiology with two specimens and three germs Day 1 at 8:10: Order placed Day 1 at 8:20: Specimens checked, order scheduled Day 1 at 14:46: Partial urin results not validated Day 2 at 09:40: Antibiogram order generated / urin Day 2 at 09:45: Antibiogram order generated / pus Day 3 at 11:30: Final validated results

March 17, 2005IHE and medical Standards in Denmark 28 Example 2: Glucose tolerance study on a series of specimens Step 1: Order placed with first specimens Step 2: order scheduled and started, one broken tube Step 3: Partial results not validated Step 4: Last specimens provided Step 5: Last specimens accepted Step 7: Final validated results Step 6: Last results from AM

March 17, 2005IHE and medical Standards in Denmark 29 W W W. I H E. N E T Providers and Vendors Working Together to Deliver Interoperable Health Information Systems In the Enterprise and Across Care Settings W W W. I H E – Europe. o r g