Integrating the Healthcare Enterprise What Does IHE Offer? 30 MINUTE PRESENTATION Attendees will get a basic overview of: - What IHE is and who is doing it - What IHE does for you (Integration Profiles) - How IHE relates to HL7 and DICOM - How to get IHE functions from your Vendors Kevin O’Donnell, Toshiba Corp. Co-chair, IHE Radiology Planning Cmte

What Does IHE Offer? Systems Integration To achieve clinical goals Using non-proprietary methods Improve the efficiency and effectiveness of clinical practice by: Improved Information Flow Advanced Multi-System Functions HIMSS/RSNA SCAR 2003

acquisition completed acquisition in-progress acquisition completed Scheduled Workflow Profile Report Repository Registration report Diagnostic Workstation Film Lightbox Orders Placed Image Manager & Archive Film Folder Specifies transactions that function to maintain the integrity of patient, image, and order information across systems Integrates modalities with information and imaging systems Biggest Value of IHE Smooth flow of patient, image and order information across systems Status updates of orders Orders Filled Acquisition Modality acquisition completed Film acquisition in-progress acquisition completed images printed Modality HIMSS/RSNA SCAR 2003

Scheduled Workflow Benefits Reduced Manual Data Entry Increased efficiency, decreased error rates Digital Scheduling, Tracking & Data Managed workflow Order loop closure, better billing Paperless Up to the minute status, distributed access Filmless Rapid distribution, rapid access HIMSS/RSNA SCAR 2003

Patient Information Reconciliation Profile Extends Scheduled Workflow Handle unidentified/emergency patient Handle demographic information updates Changes propagated to all affected systems, affected data updated Specifies transactions that function to match a previously processed unidentified patient with subsequently entered or identified demographic information Defining a systematic way to handle trauma cases eliminates one of the major reasons for incorrectly identified or “lost” patient information HIMSS/RSNA SCAR 2003

Patient Information Reconciliation Benefits Reduction of errors Reduces incorrectly identified or “lost” studies More complete medical record Supports maintenance of demographics to maintain database correspondence Flexible Trauma Workflow HIMSS/RSNA SCAR 2003

Charge Posting Profile ADT Terminal Account Management Post Charges *Billing System Charge Poster Study Performed Report Generated / Signed 3-D Performed CAD Performed / Materials Used Report Repository Acquisition Modality Facilitates Collection of Procedure Details for Billing Performed Procedure Technical Fees Materials Usage Reporting Professional Fees Etc. Maintains Correspondence of Account Details in Procedure Records 3-D *Workstation CAD *Workstation … HIMSS/RSNA SCAR 2003

Charge Posting Benefits Reduces Billing Errors less manpower required in billing cycle More timely billing, shorter billing cycle Detailed performed procedure information Billing more accurately reflects what was actually done: more details, fewer errors HIMSS/RSNA SCAR 2003

Consistent Presentation of Images Profile What the Radiologist Displays: What the Reviewing Physician Sees: Area Of Interest Annotate The Radiologist’s Transformations Are Saved Original Image & Presentation State Area Of Interest Prepared Image Zoom Flip Window Level Original Image Original Image It helps you maintain consistent images across multiple softcopy and hardcopy devices. Both in terms of intensity and geometry. Note Consistency is between different softcopy devices, between hardcopy devices and between softcopy and hardcopy Note that Original Image is there in both cases, but is supplemented by the Presentation State above With films, image quality was the imaging department problem…. Softcopy image distribution across the healthcare enterprise Opportunity with radiology digitalization Avoid lost films, reduces delays Increases utilization of staff and equipment But quality and consistency need to be adressed This IHE Integration Profile is the cost effective solution to ensure that image quality is maintained across different monitors and film producing devices. The Radiologist’s Transformations Are Lost Original Image HIMSS/RSNA SCAR 2003

Consistent Presentation of Images Benefits More Consistent Views Referring sees same thing as Radiologist Softcopy matches Hardcopy Less Work don’t have to repeat manipulations don’t have to calibrate every imaging device to every display device HIMSS/RSNA SCAR 2003

Presentation of Grouped Procedures Profile Requested Procedure: CHEST Chest View Ab/Pelvis View Report: CHEST RIS / PACS Requested Procedure: AB/PELVIS Report: AB/PELVIS MODALITY Chest View Performs a single exam Operator groups 2 procedures *** Make sure to be clear. This profile was flagged in the pre-show materials. Ab/Pelvis View HIMSS/RSNA SCAR 2003

Presentation of Grouped Procedures Benefits Improved patient experience (time/comfort) Improved acquisition throughput Improved reporting process images are grouped & sorted correctly and ready for display Improved billing multiple order/accession chains are preserved Reduced load on Network and PACS HIMSS/RSNA SCAR 2003

Key Image Notes Profile Radiologist Flags Images: Referring Physician Sees Key Images First: for refering physician This image shows the renal rupture. Note1 for refering physician This image shows the renal rupture. Note1 This image has the hematoma. Note2 For referring physician: This image shows the renal rupture. Note1 Study & Key Image Notes For referring physician: This image has the hematoma. Note2 for refering physician This image has the hematoma. Note2 The Key Image Notes are stored and managed inside the Study, together with the Images Key Image Notes put the Postit notes back into the softcopy workflow. Note it can also be used between the tech and the rad, etc. HIMSS/RSNA SCAR 2003

Key Image Note Benefits Improved communication key image display reduces clutter note contents provide clarifications Improved workflow enables automatic display & routing Improved Study & Image Handling Key Images for Referring Teaching Files QA Issues etc HIMSS/RSNA SCAR 2003

Simple Image & Numeric Reports Profile Report Verification Verified Report Images and Exam data presented for diagnosis Preliminary Report Reports stored for Network Access Report & Images Retrieved Note also the aspect of Creating, Storing, Verifying, Querying and Retrieving Reports Accurate complete report accessible wherever the physician desires. Images Retrieved Report & Image Review for Patient Care Image Manager & Archive HIMSS/RSNA SCAR 2003

Simple Image and Numeric Reports Benefits Coded Values enables data mining, decision support Flexible Report Presentation rich text with embed images and measurements DICOM Management Query/retrieve/archiving Distribute reports through DICOM infrastructure HIMSS/RSNA SCAR 2003

Post-Processing Workflow Profile Acquisition Modality PACS System Source Data Post-Proc. Workflow Manager 3-D *Workstation Worklist Workstation Work Status Work Status CAD *Workstation Results Allows for Expanding the Loop (Move to before ARI) Report Repository … Results HIMSS/RSNA SCAR 2003

Post-Processing Workflow Benefits Worklist Management Provides todo list Direct references to input data Reduced Manual Data Entry Increased efficiency, decreased error rates Electronic Status Status available quickly, Distributed access, Trigger interpretation, better workflow Electronic Results Post-processed images / objects get associated with the correct study HIMSS/RSNA SCAR 2003

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

Access to Radiology Information Benefits Improved Access to Images, Reports, etc More complete, timely patient views Fewer requests to radiology staff HIMSS/RSNA SCAR 2003

Basic Security Profile Audit Record Repository … … “Images Queried / Retrieved” “Reports Retrieved” “Reports Printed” Image Manager & Archive Report & Image Review “Images Printed” “Reports Stored” “Reports Queried / Retrieved” Report Repository Diagnostic Workstation HIMSS/RSNA SCAR 2003

Basic Security Benefits Centralized Activity Auditing Monitor/Audit HIPAA policy conformance Measure Departmental performance Improved Security HIMSS/RSNA SCAR 2003

What Do You Get for All This? Fewer errors, improved data accuracy Greater access to information Reduced study loss, retakes Fewer tedious tasks Better scheduling and tracking Increased modality throughput Freedom to acquire components from multiple manufacturers HIMSS/RSNA SCAR 2003