RSNA 2003 The IHE Technical Approach Identify the transactions required to integrate information flow between information systems For each transaction, select a single standard for use in implementing the transaction Specify in detail the use of the standard in implementing the transaction

RSNA 2003 What is IHE? IHE is a specification of transactions between systems. IHE describes only integration features. IHE is not a product itself, but… IHE is very useful in purchasing products that integrate into workflow

RSNA 2003 Integration Profiles - Transactions packaged in solutions- Coherent functional sets of transactions related to workflow 46 Rad IT transactions grouped into Integration Profiles Integration Profiles are the only practical way to communicate integration requirements precisely.

RSNA 2003 Level 0: Modalities connected to printer No RIS integration Laser Printer DICOM Basic Print Service

RSNA 2003 Level 1: Modalities connected to printer No RIS integration Post-processing workstations Laser Printer IHE Integration Profile: Consistent Presentation of Images Same perception??

RSNA 2003 What the Technologist Displays: What the Radiologist Sees: The Technologists Transformations Are Saved Grayscale Calibration & Presentation State Original Image Window Level Flip Zoom Area Of Interest Annotate The Technologists Transformations Are Lost Original Image Area Of Interest Prepared Image Original Image Consistent Presentation of Images

RSNA 2003 Level 2: Modalities with RIS Connection IHE Integration Profile: Scheduled Workflow (DICOM Modality Worklist)

RSNA 2003 RIS Scheduled Workflow (Modality Worklist) Modality Worklist Proposed Protocols Loaded and ReviewedWorklist Patient Name, ID Requested Procedure Examination Type Scheduled Date, Time

RSNA 2003 Level 3:Modalities with RIS Connection PACS IHE Integration Profiles: Scheduled Workflow (full) Patient Information Reconciliation Presentation of Grouped Procedures Access to Radiology Information

RSNA 2003 Patient Registration/Update Order Management Order Protocol Defined Store Images Storage Commitment List of Images PACS & Archive RIS A Closed Loop Update Scheduling ISUpdate Scheduling IS Match Procedure with OrderMatch Procedure with Order Support Billing Based on MPPSSupport Billing Based on MPPS Avoid Reading incomplete ProceduresAvoid Reading incomplete Procedures Scheduled Workflow Modality Worklist Procedure Scheduled Proposed Protocols Loaded and ReviewedWorklist Pt A, …, SPS=P1, P4 Pt C, …, SPS=P1, P5 Pt B, …, SPS=P2 Pt E, …, SPS=P4 ModalityPerformed Procedure Step With Performed Acquisition Protocols Performed Step: Status = Completed Performed Procedure: CT Head Performed Protocol Code=P1 Performed Protocol Code=P1 Pat Name/ID, Dose, Accession #, Study UID Complete List of Images Scheduled Protocol Code=P1, P5

RSNA 2003 Patient Information Reconciliation Extends Scheduled Workflow – Handles unidentified patient (e.g. trauma) – Handles demographic information mistakes – Propagates changes to all affected systems, updates all affected data Reduces incorrectly identified or lost studies

RSNA 2003 MODALITY Presentation of Grouped Procedures Requested Procedure: CHEST Report: CHEST Report: AB/PELVIS Performs a single exam Operator groups 2 procedures Chest View RIS / PACS Requested Procedure: AB/PELVIS Chest View Ab/Pelvis View

RSNA 2003 Access to Radiology Information Radiology Department – Images and Reports Emergency Department Referring Physician Other Departments: - Oncology - Surgery - Neurology - Pediatrics - etc. Remote Clinics Electronic Medical Record

RSNA 2003 Level 4:More than images: Measurements, Key images, CAD objects IHE Integration Profiles: Key Image Note Evidence Documents Post-processing workflow

RSNA 2003 Radiologist Flags Images: Referring Physician Sees Key Images First: for refering physician This image shows the renal rupture. Note1 For referring physician: This image shows the renal rupture. Note1 for refering physician This image has the hematoma. Note2 For referring physician: This image has the hematoma. Note2 for refering physician This image shows the renal rupture. Note1 for refering physician This image has the hematoma. Note2 Study & Key Image Notes

RSNA 2003 Findings: Image Refs.: Header : Report Type: Evidence Documents Image data from Modality Coding Schemes Thorax ….. Mass ….. Daim. Infiltr. ….. (Pointer) select Evidence Creator application (DICOM) SR Object Measurement Templates

RSNA 2003 PACS & WF Mgr RIS Post-Processing Workflow with Post-Processing Manager Grouped with Image Manager Post-Processing Worklist Retrieve Images StoreReports Measurements CAD Reports ……....……… ArchiveDocuments Post-Processing Procedure Step STARTED Work Item Claimed Post-Processing Procedure Step STARTED Post-Processing Procedure Step COMPLETED Post-Processing Procedure Step COMPLETED

RSNA 2003 Level 5: Reporting and billing IHE Integration Profiles: Simple Image and Numeric Report Reporting Workflow Charge Posting HIS

RSNA 2003 Findings: Conclusions: Image Refs: Header : Report Type: Simple Image and Numeric Report Image data from PACS Coding Schemes Thorax ….. Mass ….. Daim. Infiltr. ….. (Pointer) select Report Creator application RIS data DICOM: Report Templates (DICOM) SR Object

RSNA 2003 PACS & Rep. Mgr RIS Reporting Workflow with Report Manager Grouped with Image Manager Reporting Worklist Retrieve Images Reporting Procedure Step STARTED Work Item Claimed Reporting Procedure Step STARTED Reporting Procedure Step COMPLETED Reporting Procedure Step COMPLETED IssueReports StoreReport Diagnostic Reports ……....………

RSNA 2003 Charge Posting Profile Charge Poster *Billing System CAD *Workstation Report Repository … Report Generated & Signed CAD Performed Post Charges Acquisition Modality ADT Terminal 3-D *Workstation Account Management 3-D Performed Study Performed Materials Used

RSNA 2003 IHE Integration Statement

RSNA 2003 Integrating the Healthcare Enterprise The 2003 Radiology Connectathon: 36 vendors & 77 products IHE is a reality, and its here to stay.

RSNA 2003 Where Is More Information Available? and – IHE RAD Technical framework for year 5 – V5.5 – IHE IT Technical framework for year 1 – V 1.0 Non-Technical Brochures : – IHE Primer and IHE FAQ – IHE Integration Profiles: Guidelines for Buyers – IHE Connectathon Results