September, 2005What IHE Delivers 1 Purchasing & Integrating Radiology Systems Using IHE: A Tutorial & A Real-world Case Kevin ODonnell CoChair, IHE Radiology Planning Cmte Toshiba Medical Systems

2 Integrating the Healthcare Enterprise facilitates integrating systems facilitates integrating systems for efficient, accurate patient care for efficient, accurate patient care Systems that support IHE Integration Profiles: communicate better & integrate more easily communicate better & integrate more easily provide more complete and accurate information provide more complete and accurate information better support care providers workflow better support care providers workflow

3 IHE = Integration Profiles Each IHE Profile describes a clinical information need or workflow scenario describes a clinical information need or workflow scenario documents how to use standards (e.g. HL7, DICOM,...) to accomplish it documents how to use standards (e.g. HL7, DICOM,...) to accomplish it Systems that implement the same Profile address a need in a mutually compatible way Hundreds of products support one or more IHE Radiology Profiles.

4 Your Three Step Program Select Specific IHE Profiles List those Profiles in your RFP Check Vendors IHE Integration Statements

5 Selecting IHE Profiles Review the Profiles : What they do Benefits for your situation Some Helpful Resources: - Profile Catalog IHE Users Handbook - Radiology RSNA Demonstrations Educational Material (e.g. Workshop Presentations) IHE Technical Framework – Radiology Connectathon Results

6 RFPs Your choice: Be Brief? The system must support DICOM The system must support DICOM Be Effective? The system must support the following DICOM services according to the following 100 pages of specifications: … The system must support the following DICOM services according to the following 100 pages of specifications: … Be Both: The system must support the IHE Scheduled Workflow Profile as the Acquisition Modality actor. The system must support the IHE Scheduled Workflow Profile as the Acquisition Modality actor. Vendor IHE Integration Statements Version 2.1 of the CardioCT 5000 supports IHE Scheduled Workflow as an Acquisition Modality Version 2.1 of the CardioCT 5000 supports IHE Scheduled Workflow as an Acquisition Modality

7 IHE Integration Statements Explicit claim by the vendor for a specific product version Lists IHE profiles, actors, options Short & Sweet

8 IHE Integration Statement Date: 03/10/2006 VendorProduct NameVersion Acme Medical SystemsPACS-o-MaticV3.9 This product implements all transactions required to support the IHE Integration Profiles, Actors and Options listed below: Integration Profiles ImplementedActors ImplementedOptions Implemented Scheduled WorkflowImage Manager / Archive. PPS Exception Management Patient Information ReconciliationImage Manager / Archive. None Consistent Presentation of ImagesImage Manager / Archive Image Display None Portable Data for Imaging Media Creator Media Importer None Audit Trail and Node AuthenticationAudit Record RepositoryNone Internet address for vendor's IHE information : Links to Standards Conformance Statements for the implementation Dicom: Health Level 7: Links to general information on IHE In North America : In Europe : In Japan :

9 Lets look at an Example From the IHE Radiology Users Handbook Suppose youre buying a modality (see Chapter 1) Suppose your integration strategy has identified two key goals: Reducing/Preventing Errors Reducing/Preventing Errors Improving Throughput/Turnaround Improving Throughput/Turnaround Reviewing the Profile Benefits (see Section 1.1.1): Scheduled Workflow Profile has a significant impact on both goals: Scheduled Workflow Profile has a significant impact on both goals: Prevents manual data entry errors & saves time at the modality console by downloading patient demographics and study details from the RIS (MWL) Prevents manual data entry errors & saves time at the modality console by downloading patient demographics and study details from the RIS (MWL) Prevents lost studies & time wasted re-scanning by confirming PACS receipt of images to avoid accidental deletion (Storage Commitment); And saves more time because confirmation is automatic and electronic Reduces missing or irrelevant priors by storing a full set of accurate patient and study identifiers and details in each study object (Store) Reduces delays in the reporting process by notifying the RIS of exams in progress and ready to read (MPPS)

10 IHE Scheduled Workflow Profile Registration Orders Placed Orders Filled Film Folder Image Manager & Archive Film Lightbox report Report Repository Diagnostic Workstation Modality acquisition in-progress acquisition completed images printed Acquisition Modality

11 Using IHE Present IHE as an integration priority to your vendors. A Business goal ! Specify appropriate Profiles, Actors, Options in your RFP The system must support the IHE Scheduled Workflow Profile as the Acquisition Modality actor and support the Exception Management Option. The system must support the IHE Scheduled Workflow Profile as the Acquisition Modality actor and support the Exception Management Option. Request Integration Statements from your vendors Plan acceptance testing (see Section 1.2.2)

12 Dealing with Legacy Prepare to identify and address legacy system issues (see Section 1.2.4) Maximum benefit when all systems are IHE Most of you will have some non-compliant devices and systems Most of you will have some non-compliant devices and systems Make best effort to bring them up-to-date Make best effort to bring them up-to-date Incremental usage of IHE provides incremental benefit Its just clean DICOM and HL7; a great baseline Its just clean DICOM and HL7; a great baseline Get on the Yellow Brick Road... No sense buying New legacy equipment No sense buying New legacy equipment

13 First Steps Visit IHE Profile Demonstrations Cross-Enterprise Document Sharing for Imaging [XDS-I] Cross-Enterprise Document Sharing for Imaging [XDS-I] Teaching File & Clinical Trial Export [TCE] Teaching File & Clinical Trial Export [TCE] IHE Product Showcase and participating Vendor Booths IHE Product Showcase and participating Vendor Booths Interoperability Showcase at HIMSS 2008 Interoperability Showcase at HIMSS 2008 Visit - start learning about Profiles Talk about an IHE strategy with your CIO / IT staff, and with your vendors Now, lets look at a Real-world Experience

September, 2005What IHE Delivers 14 Thames Valley Hospital Planning Partnership, London, Ontario Canada Beth Goodhew Peninsula Consulting Group

15 Thames Valley Hospital Planning Partnership 8 Corporations 2 in London (~75% volume) 2 in London (~75% volume) 6 Community Facilities 6 Community Facilities 750,000 Radiology exams annually >200 DICOM Connections ~65 Radiologists, ~10 Residents and Fellows, ~8 NM Physicians Canada Health Infoway sponsored project to create the South Western Ontario Image Repository

16 Project Vision Improved electronic access to Radiology images and reports to increase quality and timeliness of patient care through collaborative regional partnerships and to enhance the speed of treatment decisions.

17 Clinical Architecture GE PACS CERNER POWERCHART RADNET CPI Diagnostic ClinicalWeb Community Billing Clinical User Primary Read Clinical User Dictation RadiologistTechnologist Registration LAB/PHARMACY Goal: Seamless Integration

18 Benefits of IHE Improve Quality and Patient Safety Providing for positive transfer of information using non-proprietary methods Providing for positive transfer of information using non-proprietary methods Eliminating manual data entry Eliminating manual data entry Improve the efficiency and effectiveness of clinical practice by: Improved Information Flow Improved Information Flow Advanced Multi-System Functions Advanced Multi-System Functions Eliminate manual steps from common processes Eliminate manual steps from common processes Systems Integration Enabling the sharing of health information locally, regionally and nationally Enabling the sharing of health information locally, regionally and nationally

19 Alignment of IHE and Project Vision Vision Improved electronic access to Radiology images and reports to increase quality and timeliness of patient care through collaborative regional partnerships and to enhance the speed of treatment decisions. IHE Benefits Improve Quality and Patient Safety Providing for positive transfer of information Providing for positive transfer of information Eliminating manual data entry Eliminating manual data entry Improve Efficiency Eliminate manual steps from common processes Eliminate manual steps from common processes Enable sharing of health information locally, regionally and nationally

20 Steps to IHE Implementation Current state evaluation Evaluate workflow challenges Evaluate workflow challenges Current levels of compliance Current levels of compliance Future State Analysis Desired workflow enhancements Desired workflow enhancements Profile evaluation Profile evaluation Create future map of profiles and actors Create future map of profiles and actors Gap Analysis Assign Actor roles to current & future systems Assign Actor roles to current & future systems Plan required software upgrades/replacements Plan required software upgrades/replacements Flag remaining integration challenges Flag remaining integration challenges Decide on Workflow changes Decide on Workflow changes Impact on Technologist/RadiologistImpact on Technologist/Radiologist QC processes/exception handlingQC processes/exception handling Prepare new purchase requirements Prepare new purchase requirements

21 Non-IHE Equipment Prepare coping strategies Need a clear plan of action for each device (See IHE Users Handbook – Radiology) Users can drive compliance to IHE by asking for it often

22 Profiles Implemented Scheduled Workflow (SWF) Patient Information Reconciliation (PIR) Consistent Presentation of Images (CPI) Charge Posting (CHG)

23 Replication After one site is properly implemented Additional sites are configured, trained and brought live in a rapid fashion IHE Profiles served as templates which worked well in small and large hospitals Experience in one site was easy to repeat elsewhere

24 Rapid Roll-out of Successive Sites Q205Q105Q305Q405 FAST Alliance PACS Rollout STEG RIS Rollout PACS Rollout Strathroy PACS Rollout Ingersoll Community Hospital RIS/PACS STEG PACS Rollout Woodstock RIS Rollout Woodstock PACS Rollout PACS Rollout Tillsonburg Sept 30 Adoption Dec 31 Adoption June 30 Adoption PACS Rollout Newbury RIS Rollout Ingersol FAST Alliance RIS Rollout RIS Build for FAST Sites RIS Rollout Tillsonberg RIS Rollout Strathroy RIS Rollout Newbury July 31 Adoption Aug 30 Adoption Oct 31 Adoption DI DI DI DI DI DI

25 Take Home Tip Salvation = (SWF + PIR) Scheduled Workflow Benefits: Serves as un-biased roadmap providing direction for vendors and implementers alike Paves the way for true optimization of workflow Filmless Filmless Rapid distribution, rapid access Rapid distribution, rapid access Paperless Paperless Up to the minute status, distributed access Up to the minute status, distributed access Forms foundation for future Integration Profiles

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