G. Claeys, C. Loef, B.B. Wein Smooth running IT systems in digital imaging The role of the radiologist and IHE

ECR 2003 How to get IHE into the Radiology Department IHE Europe2 Content: Objective: Efficient Workflow, seamless info flowObjective: Efficient Workflow, seamless info flow Approach taken by IHE to improve functionality in Radiology departmentApproach taken by IHE to improve functionality in Radiology department How to specify a tender and judge vendor offeringsHow to specify a tender and judge vendor offerings Examples of using IHE in practiceExamples of using IHE in practice Some European success storiesSome European success stories ConclusionConclusion

ECR 2003 How to get IHE into the Radiology Department IHE Europe3 The objective Seamless information flowSeamless information flow Optimal support for workflowOptimal support for workflow Improve functionality in radiology departmentImprove functionality in radiology department Integrated Information Technology (IT) solutionsIntegrated Information Technology (IT) solutions Enable the Electronic Patient Record (EPR)Enable the Electronic Patient Record (EPR)

ECR 2003 How to get IHE into the Radiology Department IHE Europe4 The IHE initiative  IHE is an initiative promoting and supporting the integration of systems in the healthcare enterprise.  Goal: Improve the efficiency and effectiveness of clinical practice by:  Improved Information Flow  Advanced Multi-System Functions

ECR 2003 How to get IHE into the Radiology Department IHE Europe5 Why is IHE needed? Serious Integration Challenges in Healthcare:Serious Integration Challenges in Healthcare: Systems need informations from other systemsSystems need informations from other systems However, systems communicate poorly or not at allHowever, systems communicate poorly or not at all Result: - tedious, inefficient workflows - redundant, inconsistent or unavailable dataResult: - tedious, inefficient workflows - redundant, inconsistent or unavailable data Responsibility for information flow between systems, and between departments, is often unclear.

ECR 2003 How to get IHE into the Radiology Department IHE Europe6 The Healthcare Information System Complex MPI ADT RIS PACS Modality Display HIS

ECR 2003 How to get IHE into the Radiology Department IHE Europe7 The approach for getting IHE focus on Operational Workflow analysis,focus on Operational Workflow analysis, require information flow details forrequire information flow details for applications, current situation of products and transactions, desired situation, gap analysis create requirements for new products and upgradescreate requirements for new products and upgrades perform an expectation managementperform an expectation management let IHE support this process with a common framework, that all involved parties can understand and commit to.let IHE support this process with a common framework, that all involved parties can understand and commit to.

ECR 2003 How to get IHE into the Radiology Department IHE Europe8 Integration Profiles Main points IHE is not a product itself.IHE is not a product itself. Functions are grouped in a set of Integration Profiles, Actors, and Transactions.Functions are grouped in a set of Integration Profiles, Actors, and Transactions. Need to map integration solution requirements on these IHE concepts.Need to map integration solution requirements on these IHE concepts.

ECR 2003 How to get IHE into the Radiology Department IHE Europe9 The Product World….. Poduct XYZ from Vendor T ADT MPI HIS

ECR 2003 How to get IHE into the Radiology Department IHE Europe10 The IHE World…. IHE Actor Actor IHE Transaction IHE Actor

ECR 2003 How to get IHE into the Radiology Department IHE Europe11 ADT MPI HIS Mapping IHE to Products Poduct XYZ from Vendor T IHE Actor Actor IHE Transaction IHE Actor

ECR 2003 How to get IHE into the Radiology Department IHE Europe12 IHE : An Integration Profile  24: Report Submission Structured Report Export: 28   25: Report Issuing Report Creator  26: Query Reports  27: Retrieve Reports Report Repository Report Reader External Report Repository Access Report Manager Enterprise Report Repository Actors Transactions A set of Actors cooperating through Transactions to perform a specific task

ECR 2003 How to get IHE into the Radiology Department IHE Europe13 Integration profiles, the easy way to deal with transactions easy-to-understand, coherent functional sets andeasy-to-understand, coherent functional sets and a convenient way for users and vendors to communicatea convenient way for users and vendors to communicate about integration requirements and needed functionality in daily life.about integration requirements and needed functionality in daily life.

ECR 2003 How to get IHE into the Radiology Department IHE Europe14 Integration Profiles Examples:Examples: –SWF (Scheduled WorkFlow) –KIN (Key Image Note) –Consistent presentation of images (CPI) –Access to Radiology Information (ARI)

ECR 2003 How to get IHE into the Radiology Department IHE Europe15 Store Images Storage Commitment List of Images PACS & Archive RIS A Closed Loop Update IS SchedulingUpdate IS Scheduling Match Procedure with OrderMatch Procedure with Order Support Billing Based on MPPSSupport Billing Based on MPPS Avoid Reading incomplete ProceduresAvoid Reading incomplete Procedures IHE 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 Patient Registration/Update Order Management Order Protocolized

ECR 2003 How to get IHE into the Radiology Department IHE Europe16 Radiologist Flags Images: Referring Physician Sees Key Images First: for refering physician This image shows the renal rupture. Note1 for refering physician This image has the hematoma. Note2 For referring physician: This image shows the renal rupture. Note1 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

ECR 2003 How to get IHE into the Radiology Department IHE Europe17 What the Radiologist Displays: What the Reviewing Physician Sees: The Radiologist’s Transformations Are Saved Original Image & Presentation State Original Image Window Level Flip Zoom Area Of Interest Annotate The Radiologist’s Transformations Are Lost Original Image Area Of Interest Prepared Image Original Image Consistent Presentation of Images

ECR 2003 How to get IHE into the Radiology Department IHE Europe18 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

ECR 2003 How to get IHE into the Radiology Department IHE Europe19 IHE Integration Profiles Access to Radiology Information Consistent access to images and reports Consistent Presentation of Images Hardcopy and softcopy grayscale presentation state Key Image Notes Flag significant images Simple Image and Numeric Reports Simple reports with image links and, optionally, measurements Basic Security Audit Trail Consolidation & Node Authentication Presentation of Grouped Procedures Subset of a single acquisition Post- Processing Workflow Schedule, perform, & notify image processing & CAD steps Charge Posting Collection of billable procedure details Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders

ECR 2003 How to get IHE into the Radiology Department IHE Europe20 General Integration Profiles Table General Integration Profiles Table Actors Integration Profiles Modality Image Creator Image Display Image Manager/ Archive DSS/Order Filler ADT Report Creator

ECR 2003 How to get IHE into the Radiology Department IHE Europe21 Vendor should provide IHE Integration Statements Product UVW supports the IHE K Actor with the IHE X and Y Integration Profiles IHE J Actor with the IHE J Actor with the IHE T Integration Profile

ECR 2003 How to get IHE into the Radiology Department IHE Europe22 IHE Integration Statement

ECR 2003 How to get IHE into the Radiology Department IHE Europe23 Example: PACS X, Vendor Y Actors Image Display Image Manager/ Archive Report Creator Secure Node

ECR 2003 How to get IHE into the Radiology Department IHE Europe24 Example: PACS Standard :Standard : –Actors: Image Manager, Image Archive, and Image Display –Integration Profiles: Scheduled Workflow and Patient Information Reconciliation Display and Printing Quality:Display and Printing Quality: –Actors: Image Display and Print Composer –Integration Profiles: Consistent Presentation of Images

ECR 2003 How to get IHE into the Radiology Department IHE Europe25 Example: PACS, part 2 Modalities with Procedure grouping:Modalities with Procedure grouping: –Actors: Image Archive –Integration Profiles: Presentation of Grouped Procedures Flagging specific images:Flagging specific images: –Actors: Image Archive and/or Image Display –Integration Profiles: Key Image Note

ECR 2003 How to get IHE into the Radiology Department IHE Europe26 Example: RIS Upgrade Standard :Standard : –Actors: Order Filler –Integration Profiles: Scheduled Workflow and Patient Information Reconciliation DICOM Structured ReportingDICOM Structured Reporting –Actors: Report Manager, Report Repository, Report Creator and Report Reader –Integration Profiles: Simple Image and Numerical Reports

ECR 2003 How to get IHE into the Radiology Department IHE Europe27 Example: New Modality Essential :Essential : –Actors: Acquisition Modality –Integration Profiles: Scheduled Workflow Complex Modalities :Complex Modalities : –Integration Profiles: Presentation of Grouped Procedures

ECR 2003 How to get IHE into the Radiology Department IHE Europe28 Example: New Modality Print Composer:Print Composer: –Integration Profiles: Consistent Presentation of Images Security:Security: –Integration Profiles: Basic Security

ECR 2003 How to get IHE into the Radiology Department IHE Europe29 Example: Modality Upgrade New Modality RequirementsNew Modality Requirements or, if not possible: Transactions:Transactions: –Modality Image Stored –Modality Worklist Provided –Storage Commitment –Procedure Step Complete –Procedure Step in Progress

ECR 2003 How to get IHE into the Radiology Department IHE Europe30 Example: other systems: - Workstations - Printers - Patient Registration - Order Entry Just think about Actors Just think about Actors and Integration Profiles and Integration Profiles

University of Pisa Department of Radiology, Pisa, ItalyUniversity of Pisa Department of Radiology, Pisa, Italy Hôpital Universitaires de Genève Department of Radiology, Genève, SwitzerlandHôpital Universitaires de Genève Department of Radiology, Genève, Switzerland Johannes Gutenberg-University Department of Radiology, Mainz, GermanyJohannes Gutenberg-University Department of Radiology, Mainz, Germany European User Success Stories

ECR 2003 How to get IHE into the Radiology Department IHE Europe32Example: Johannes Gutenberg-University Mainz, Germany

ECR 2003 How to get IHE into the Radiology Department IHE Europe33 The IHE Radiology Workflow X

ECR 2003 How to get IHE into the Radiology Department IHE Europe34 Modality Worklist / Performed Procedure Step MPPS with auto- matic transfer of: Exposure Time Total dose Exposure dose Fluoro dose Number frames Fluoro time Number series Exposure Time Total dose Exposure dose Fluoro dose Number frames Fluoro time Number series RIS gap it! GAP Acq. modality Integris Philips MWL: Name, Date of Birth Accession number UIDs et al. Name, Date of Birth Accession number UIDs et al.

ECR 2003 How to get IHE into the Radiology Department IHE Europe35 Consistency and Completeness of Image Archiving ~ images / d ~ 500 studies / d manual control takes min / modality ~ 3h / d for the complete department ~ images / d ~ 500 studies / d manual control takes min / modality ~ 3h / d for the complete department

ECR 2003 How to get IHE into the Radiology Department IHE Europe36 Storage Commitment – Push Model Please take responsibility for safekeeping of data O.k., commitment for archiving images permanently PACS (ImageDevices) P A C S Acq modality DVD

ECR 2003 How to get IHE into the Radiology Department IHE Europe37 Conclusions Mainz Standards allow a flexible implementation of different applications independant from vendorStandards allow a flexible implementation of different applications independant from vendor MWL, MPPS, StComm improve clinical workflow, data consistency, quality of documentation,...MWL, MPPS, StComm improve clinical workflow, data consistency, quality of documentation,... IHE is a pragmatic model for the clinical scenariosIHE is a pragmatic model for the clinical scenarios IHE profiles should become regular part of tendersIHE profiles should become regular part of tenders IHE Profiles could be used outside Radiology, new profiles will become necessary (Labarotory, OR)IHE Profiles could be used outside Radiology, new profiles will become necessary (Labarotory, OR) Improved interest from vendors to support institutions (e.g., pre-ß-tests for new software releases or functionality)Improved interest from vendors to support institutions (e.g., pre-ß-tests for new software releases or functionality)

ECR 2003 How to get IHE into the Radiology Department IHE Europe38 Will IHE do it all? A lot, but: Current scope is Radiology, first important step towards EPRCurrent scope is Radiology, first important step towards EPR Need to address performance requirementsNeed to address performance requirements Clinical applications requiredClinical applications required Services are neededServices are needed –Project management –Training –Implementation / transition management –Operational support

ECR 2003 How to get IHE into the Radiology Department IHE Europe39Conclusion Using IHE Integration Profiles when writing specifications will make systems integration faster, more efficient, less expensive and successful.Using IHE Integration Profiles when writing specifications will make systems integration faster, more efficient, less expensive and successful. Can go for a bigbang approach, but also for a focus on a specific smaller area.Can go for a bigbang approach, but also for a focus on a specific smaller area. Ask your vendors about the IHE Integration Statement for the IHE support in the products they offer.Ask your vendors about the IHE Integration Statement for the IHE support in the products they offer. Actual success stories show the realisation of benefits with IHE in practice.Actual success stories show the realisation of benefits with IHE in practice.