RSNA Christoph Dickmann – Member IHE Rad TC Charles Parisot – Co-chair IHE IT-I TC Image-enabled Health Records: IHE Progress and Plans Integrating the Healthcare Enterprise

RSNA Pragmatic definition of EHR Integrated data and workflow – Multimedia data access text, image, waveform, … – Communication among stakeholders clinicians, caregivers, consumers, … Support different views of data – Clinical records Details: episode, visit, study – Longitudinal records Summaries: episode, visit Cross-department or cross-enterprise users Linking summaries and clinical details

RSNA Business need: share Radiology Reports and Images Enterprise A Enterprise B Physician Office Between Radiology and Between Radiology and imaging specialists imaging specialists non-imaging professionals non-imaging professionals Between enterprises Between enterprises PACS B PACS A Radiology -to- Radiology Radiology -to- Physicians PACS C Within an enterprise Within an enterprise By network or media By network or media

RSNA EHR goals in IHE (compatible with U.S. NHII goals) Informed Clinical Practice – IHE integrates clinical data and functions for an EHR Interconnected Clinicians – Beyond the department: community or regional scope Personalized Care – Web-based data access and summary data Support for higher-level goals – Better outcomes – Increased patient safety – More efficient healthcare operations

RSNA EHR complexity Business dilemmas – Significant, long-term investment – Investors may not be main beneficiaries Coordination and cooperation – Active collaboration among multiple stakeholders – Identify and work out commonalities and barriers Integration and interoperability – Implement existing standards – Develop additional standards Evolutionary system specification (system of systems)

RSNA Focus: Image-enabled EHR (connect two worlds) Non-imaging data – Patient data – Clinical data Laboratory results Surgery reports Prescriptions, meds Letters or notes Integrate with imaging data and processes Imaging data – Patient data – Images and evidence Radiology Cardiology Nuclear Medicine Integrate with non-imaging data and processes

RSNA Potential use cases of an image-enabled EHR Using images Neurologist: reviewing stroke patient transfer to ward Nurse: preparing GI ward round for Dr. X GP: seeing a post-MI patient after hospital discharge Patient: preparing an obstetric visit Producing images/ evidence Cardiologist: during catheter intervention Radiologist: starting an abdomen CT Physician: counseling at diabetes outpatient clinic Oncologist: planning radiotherapy Information need may include current or longitudinal evidence

RSNA Image-enabled EHR Pregnancy outpatient clinics encounter acquire evaluate index Image/ Report Repository store new data Ultrasound report and images Document Registry register (XDS architecture)

RSNA Image-enabled EHR Childbirth inpatient stay register index evaluate Document Registry Image/ Report/ Document Repositories index query retrieve Document Repository store new data Report, letters (incl. images) (XDS architecture)

RSNA Sharing Imaging Documents (XDS-I) Document Registry Register report & image references Retrieve selected imaging report references Radiology department patient Query for re- ports Document availability Shared re- pository Onco- logist GP (follow-up) Images, report (PACS, RIS) report Longitudinal record system: across encounters Care record sys- tems: specific care delivery Retrieve How does XDS-I work? What is new in IHE

RSNA IHE contributions to EHR implementation IHE Laboratory 1 Int. Profile IHE Radiology 7 Int. Profiles EHR realization IHE IT Infrastructure 8 Int. Profiles Each TF can contribute to EHR scenarios with Integration Profiles for Data access Workflow IHE Cardiology 4 Int. Profiles IHE Pat. Care Coord. 1 Int. Profile

RSNA Basic requirements of EHR systems Integrated healthcare provider systems – EHR sources/ users, user interaction Document handling – Storage and retrieval of EHR documents Infrastructure services – Basic data and application integration Network – EHR storage, inquiry, and retrieval path

RSNA Desktop Integration as an EHR enabler Backend integration (services, data) EHR interoperability examples Appl. 1 Appl. 2 Appl. 3 Patient identifier matching Common person data or services Same patient selected Patient demographics Source 1 Source 2 Personnel/ staff data Any user Single sign on

RSNA IHE - common interoperability services Common patient identification (ITI PIX) Common patient demographics (ITI PDQ) Desktop integration (ITI PSA) Running applications work on the same patient Single sign on (ITI EUA, XUA) Enterprise-wide or cross-enterprise user handling Security and privacy (ITI/ RAD ATNA, DSG) Accountability, document integrity Common staff data (ITI PWP) Health professionals are commonly recognized Fundamental enablers of cross-system health record system functions. Gradual enhancement and combination is the key.

RSNA IHE – documents for general purpose EHR functions Cross-Enterprise Document Sharing for Imaging (XDS-I) Share DICOM instances via web or DICOM connection; share imaging information via web Cross-Enterprise Document Sharing (ITI XDS) Store & retrieve documents and summaries (focus: longitudinal data) Notification of Document Availability (ITI NAV) Send notification/ reference to new shared documents Retrieve Information for Display (ITI RID) Query and retrieve documents and summaries/ lists Needs common services as a basis (e.g. security, patient identification)

RSNA IHE - Radiology images and reports for an EHR system Access to Radiology (Rad ARI) Retrieve diagnostic quality images, evidence, reports Simple Image and Numeric Reports (Rad SINR) Access or export reports and related images Key Image Notes (Rad KIN) Mark, annotate, retrieve selected imaging evidence Portable Data for Imaging (Rad PDI) Export/ import/ view media data Nuclear Medicine Image (Rad NM Image) Capture and use complex NM result screens

RSNA IHE – Cardiology images and reports for an EHR system Cardiac Catheterization / Echo Workflow (CATH, ECHO) Retrieve catheterization and echocardiography imaging evidence Retrieve ECG for Display (Card ECG) Retrieve ECG summaries and results Displayable Reports (Card DRPT) Create and access reports for viewing

RSNA IHE - clinical/ textual information for an EHR system Simple Image and Numeric Reports (Rad SINR) Access original or exported reports Cross-Enterprise Document Sharing (ITI XDS) Cross-Enterprise Doc. Sharing for Imaging (Rad XDS-I) Store & retrieve documents, summaries or reports with longitudinal data Retrieve Information for Display (ITI RID) Access documents and summaries (e.g. imaging, lab, discharge, medications, prescriptions) Lab Scheduled Workflow Notification of laboratory results

RSNA IHE - workflow / patient management support Workflow integration (Rad, Card) – Scheduled Workflow Ordering, scheduling and tracking of image acquisition steps Appointment tracking to order placer – Reporting Workflow Scheduling and tracking of report creation tasks Patient data integration (Rad, Card, ITI) – Patient Information Reconciliation Modification and matching of patient data and imaging evidence – Patient Administration Management Creating and changing patient identifiers and encounter data Overall concept (Rad whitepaper) – Departmental workflow and interfaces to the enterprise

RSNA Planned IHE development Harmonize IHE domain-specific work Extend XDS document content Code sets and master files Realize overall workflow concept Configuration support Security details, e.g. access control

RSNA Image-enabled EHR – IHE progress and plans IHE Integration Profiles from different domains can be combined Combinations of current profiles can cover many EHR scenarios – Information integration (imaging, textual) – Enhanced functionality beyond one department – Intra- and cross enterprise communication Scenarios enable system evolution (organizational change management not to be forgotten) IHE ensures integration testing and future Integration Profile development

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