Integrating the Healthcare Enterprise IHE for Administrators: Confronting Deployment Obstacles Ellie Avraham, Kodak Health Group Paul Nagy, PhD University of Maryland

Learning Objectives This is to address the Radiology Workflow Integration for the PACS/IT Administrators We will discuss the problems you face, the approach IHE takes, and some useful tools for testing RSNA 2006 for Administrators Classroom Sessions

Discussion Areas The Radiology Workflow – Values required Implementing the Radiology Workflow through the IHE Integrated Solutions Using the IHE Testing Tools (MESA) to test your products implementation of the Radiology Workflow RSNA 2006 for Administrators Classroom Sessions

Modern Hospital Information Flow Complexity Cardio Lab MPI Billing ADT RIS HIS Modality PACS Display & Print RSNA 2006 for Administrators Classroom Sessions

Institute of Medicine Model of Service and Redesign of Healthcare Safety Effectiveness Patient centeredness Timeliness Efficiency Equity Align to the patient Source: Insititute of Medicine, Crossing the chasm RSNA 2006 for Administrators Classroom Sessions

To achieve these goals we need … … a new generation of Healthcare IT solutions that have an order of magnitude greater level of integration. … a whole new level of Complexity Management to manage these interfaces. … we need to Decrease the time for integrating the Multi Vendors systems. … we need the capabilities for plug and play Automatic interoperability of systems. … we need to lower the total cost of integration RSNA 2006 for Administrators Classroom Sessions

Standards Exists: DICOM, HL7 The main purpose of standards is to provide the Interoperability among systems and lower the cost of integration between systems. The more plug and play integration the lower is the cost of the workflow implementation. However Standards are broad and include options that reduce the interoperability So we need to constrain the Standards “options” in order to improve the interoperability RSNA 2006 for Administrators Classroom Sessions

What is IHE Joint Initiative from RSNA, HIMSS and ACC since 1998 IHE is a collaboration of Users and Vendors on Integrating the Healthcare Imaging systems and Information systems IHE defines standardized clinical workflow solutions and a process for Development and validation implementations Cross vendor & user discussion groups Technical Framework for Integration Solutions: SWF, CPI, XDS-I,… Validations testing tools - MESA Connect-a-thons - Multi-vendor connectivity testing Publication of success stories and integration statements Educational materials and presentations The IHE profiles are defined in a Technical Framework that specify the Actors / functionality and the transactions that defines the exchanging information among the actors. RSNA 2006 for Administrators Classroom Sessions

IHE Technical Framework Components The IHE Technical Framework (TF) defines Integrated Solutions, called “Integration Profiles”. A Profile defines a workflow or a specific problem solution. A Profile defines a collaboration between Actors. An actor is a well defined entity, such as an Image Display, Image Manager, Image acquisition, etc. The Actors communicate and collaborate among themselves by implementing a set of communication messages called Transactions. The Transactions defines the messages (actions) that an Actor needs to support. RSNA 2006 for Administrators Classroom Sessions

IHE Technical Framework – Use Case Roles & Interaction Diagrams Examples of Actors: ADT / Patient Registration Scheduler Acquisition Modality Image Display Report Reader Examples of Transactions: Register Patient Procedure Scheduled Images Stored Query / Retrieve Images Query / Retrieve Reports RSNA 2006 for Administrators Classroom Sessions

The IHE Process Users IHE Vendors Standards RFP IHE Integration Real-World Integration Problems RFP (Profiles & Actors) Select IHE Profiles IHE Standards (DICOM, HL7, etc) IHE Integration Profiles IHE Technical Framework C-Thon Results IHE Connectathons IHE Demonstrations Vendors IHE Integration Statement (Profiles & Actors) Product with IHE Profile RSNA 2006 for Administrators Classroom Sessions

The “Connectathon” Voluntary Participation Neither a Demonstration nor a Certification Well Designed End-to-End Scenarios Advanced Testing Tools Unprecedented Cross-Vendor Testing Unprecedented Pool of Technical Talent RSNA 2006 for Administrators Classroom Sessions

IHE Connectathon Results http://www. ihe Consolidated Earlier Progress & Push for Market Adoption More Robust Connectathon Results Recorded and Published Increased Industry Participation 31 companies 70 systems 21 Additional Companies in IHE Europe RSNA 2006 for Administrators Classroom Sessions

IHE Integration Statement Date 12 May 2006 Vendor Product Name Version Any Medical Systems Co. IntegrateRAD V2.3 This product implements all transactions required in the IHE Technical Framework to support the IHE Integration Profiles, Actors and Options listed below: Integration Profiles Implemented Actors Implemented Options Implemented Scheduled Workflow Image Manager/Image Archive none Image Display Internet address for vendor’s IHE information: www.anymedicalsystemsco.com/ihe Links to Standards Conformance Statements for the Implementation HL7 www.anymedicalsystemsco.com/hl7 DICOM www.anymedicalsystemsco.com/dicom/integrateRAD.pdf Links to general information on IHE North America: www.ihe.net In Europe: www.ihe-europe.org In Japan: www.jira-net.or.jp/ihe-j RSNA 2006 for Administrators Classroom Sessions

Today’s - Legacy Workflow RIS Store Images PACS & Archive RSNA 2006 for Administrators Classroom Sessions

Scheduled Protocol Code=P1, P5 IHE Workflow Patient Registration/Update Order Management Order Protocol Defined Modality Worklist Procedure Scheduled Proposed Protocols Loaded and Reviewed Worklist Pt A, …, SPS=P1, P4 Pt C, …, SPS=P1, P5 Pt B, …, SPS=P2 Pt E, …, SPS=P4 RIS Modality Performed Procedure Step With Performed Acquisition Protocols Performed Step: Status = Completed Performed Procedure: CT Head Performed Protocol Code=P1 Pat Name/ID, Dose, Accession #, Study UID Complete List of Images Scheduled Protocol Code=P1, P5 Storage Commitment List of Images Store Images PACS & Archive A Closed Loop Update Scheduling IS Match Procedure with Order Support Billing Based on MPPS Avoid Reading Incomplete Procedures RSNA 2006 for Administrators Classroom Sessions

IHE Scheduled Workflow Profile acquisition completed acquisition in progress RSNA 2006 for Administrators Classroom Sessions

ADT^ Scheduled Workflow A01 Registration A04 Admission A05 Pre adminission A11 Cancellation A38 Cancellation of pre admission DICOM C-Store DICOM Modality Worklist DICOM Modality Performed Procedure DICOM Storage Commitment RSNA 2006 for Administrators Classroom Sessions

IHE Deployment – Testing the Integrated System Solutions For Healthcare to succeed in the digital transformation it will need much better integration between its systems. IHE is an open based standards approach to lower the cost of integrating healthcare and exposing many more processes. Open Source can accelerate the adoption of IHE by helping to educate administrators to learn how to test the integration RSNA 2006 for Administrators Classroom Sessions

Open Source - Integration testing tools There are many (dozens) of DICOM and HL7 tools. Too many to mention. The web site “openrad.com” has a repository with all the main open source Integration testing tools RSNA 2006 for Administrators Classroom Sessions

Open Source Toolbelt IHE MESA Tools DCM4JBOSS – Enterprise PACS Archive DVTK – DICOM Validation Toolkit HL7Browser – HL7 Message Viewer MIND – GUI DICOM query tool CTN – DICOM Send RSNA 2006 for Administrators Classroom Sessions

Today’s Lesson Build an IHE Testing Environment Test IHE Scheduled Workflow Components On a windows laptop RSNA 2006 for Administrators Classroom Sessions

Standard Documentation Recommendation IHE Radiology Technical Framework: volumes #1, 2, 3 RAD Handbook App. H for Acceptance testing DICOM standard Information Object Definition Pt.3 DICOM Services Pt.4 Data Dictionary Pt.6 Medical.nema.org HL7 v2.3.1 standard RSNA 2006 for Administrators Classroom Sessions

Developed by the Mallinckrodt Institute of Radiology IHE “Medical Enterprise Simulators and Analyzers” (MESA) http://ihedoc.wustl.edu/mesasoftware/index.htm Provides the Test Procedures and Simulation of all the IHE Profiles and Actors. Excellent Documentation. Developed by the Mallinckrodt Institute of Radiology MESA Tools runs on different operating systems: Windows 2000, Windows XP, Solaris 7.0, Red Hat Linux 7.0 & 9.0 from Intel. The MESA tool is organized for particular IHE actors as defined in the IHE Technical Framework RSNA 2006 for Administrators Classroom Sessions

Step 1. Install MESA tools Decide What Actors/Systems you need to test Read the Installation Guide for installing the tools you need to test your Actors/Systems Precompiled and Source Codes are available Recommend to Install the preferred Windows 2000 precompiled MESA s/w ready to be used RSNA 2006 for Administrators Classroom Sessions

MESA Tools http://www.erl.wustl.edu/mesa/index.html RSNA 2006 for Administrators Classroom Sessions

Step 2: What & How to Test List your Products in terms of IHE Actors and Profiles that you need to test Review the MESA Test Procedures applicable for each Profile and actor that need to be tested Review the Test Procedures for the Workflows and Peer to Peer testing applicable actors. RSNA 2006 for Administrators Classroom Sessions

Test Example – Scheduled Workflow Profile (SWF) This case covers both inpatient and outpatient procedures. The patient may be new or known to the current healthcare facility. The following sequence of steps describes the typical process flow when a request is made to perform an imaging procedure on a patient Figure 3.3-1. Administrative Process Flow RSNA 2006 for Administrators Classroom Sessions

Figure 3.3-2. Procedure Performance Process Flow RSNA 2006 for Administrators Classroom Sessions

Description [Transaction] MESA Test case #131 – Administrative & Procedure Prerform Process (SWF) Identifier Description [Transaction] Source Destination 131.102.a04.adt A04: Register BLACK as Outpatient Patient Class = ‘E’ [1] ADT Ord Plc, Ord Fil 131.104.o01.orm ORM: Order P1 for BLACK [2] Ord Plc Ord Fil 131.106.o01.orm ORM: Schedule X1 [4] Img Mgr 131.108.dcm MWL C-FIND [5] Modality 131.110.dcm PPS: Begin Procedure X1 [6] PPS_Mgr 131.112.dcm Ord Fil or Img Mgr 131.114.dcm PPS: End Procedure X1 [7] 131.116.dcm   C-Find: Images Available Query [11] 131.118.dcm C-Store: Images [8] 131.120.dcm 131.122.dcm Storage Commitment: N-Action [10] 131.124.dcm Storage Commitment: N-Event-Report [10] 131.117.dcm RSNA 2006 for Administrators Classroom Sessions  

MESA Testing Environment - Actors RSNA 2006 for Administrators Classroom Sessions

Starting MESA Test case #131 Profile: Scheduled Workflow (SWF) Actor: Image Manager RSNA 2006 for Administrators Classroom Sessions

Running Several Transactions Test case #131 RSNA 2006 for Administrators Classroom Sessions

Evaluating MESA Test Result case #131 RSNA 2006 for Administrators Classroom Sessions

More information available…. IHE Web site: http://www.ihe.net Technical Frameworks and Supplements Non-Technical Brochures : Calls for Participation IHE Fact Sheet and FAQ IHE Integration Profiles: Guidelines for Buyers IHE Connect-a-thon Results Vendor Products Integration Statements IHE Wiki RSNA staff contacts: ihe@rsna.org Questions? RSNA 2006 for Administrators Classroom Sessions