Integrating the Healthcare Enterprise Overview of IHE & the 7 Profiles Kevin O’Donnell - Toshiba Corp. IHE Planning Committee Co-chair

Vendor Workshop April 8-9, IHE Mission  IHE is an initiative promoting and supporting the integration of systems in the healthcare enterprise.

Vendor Workshop April 8-9, IHE Integration Goals Improve the efficiency and effectiveness of clinical practice:  Improve Workflow  Improve Information Accuracy  Improve Information Availability  Enable Cross-System Functionality

Vendor Workshop April 8-9, IHE Annual Cycle  Identify several key healthcare workflows and integration problems  Research & select standards to specify a solution  Write, review and publish IHE Technical Framework  Hold workshops and support vendor implementation  Perform cross-testing at “Connectathon”  Demonstrate/Promote at tradeshows (RSNA/HIMSS)

Vendor Workshop April 8-9, Who Does What?  RSNA and HIMSS (Chris & Joyce):  Provide a neutral forum for working on the Big Picture  Involve users/professionals and recruit companies  Sponsor IHE and provide infrastructure/continuity  Organize demonstrations and public education  Mallinkrodt (Steve):  Manage the Connectathon process  Create and administer the MESA Test Tools  IHE Committees:  Identify and design solutions for integration problems  Vendors:  Implement profiles on products

Vendor Workshop April 8-9, IHE & DICOM / HL7 Standards are vital (HL7, DICOM, ICD, …)Standards are vital (HL7, DICOM, ICD, …) –They provide tools & technologies But Standards alone are insufficientBut Standards alone are insufficient –They are open to interpretation –There is room for optional variations –They avoid specifying how to apply them to particular real world scenarios

Vendor Workshop April 8-9, How is IHE related to Standards? Profiles are packagingProfiles are packaging IHE attacks real world radiology integration problemsIHE attacks real world radiology integration problems HL7 and DICOM provide dictionariesHL7 and DICOM provide dictionaries IHE defines a “phrasebook” that solves real world problems by assembling pieces provided by DICOM/HL7IHE defines a “phrasebook” that solves real world problems by assembling pieces provided by DICOM/HL7

Vendor Workshop April 8-9, Key IHE Concepts Generalized Systems -> ActorsGeneralized Systems -> Actors Interactions between Actors -> TransactionsInteractions between Actors -> Transactions Problem/Solution Scenarios-> Integration ProfilesProblem/Solution Scenarios-> Integration Profiles For each Integration Profile:For each Integration Profile: the context is described (which real-world problem)the context is described (which real-world problem) the actors are defined (what systems are involved)the actors are defined (what systems are involved) the transactions are defined (what must they do)the transactions are defined (what must they do)

Vendor Workshop April 8-9, IHE Transactions

Vendor Workshop April 8-9, Presentation of Grouped Procedures Subset a single acquisition IHE Year 3 Integration Profiles Patient Information Reconciliation Unknown patients and unscheduled orders Consistent Presentation of Images Hardcopy and softcopy grayscale and presentation state Access to Radiology Information Consistent access to images and reports Key Image Notes Exchange flagging significant images Simple Image and Numeric Reports Exchange simple reports with image links and, optionally, measurements Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps

Vendor Workshop April 8-9, 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

Vendor Workshop April 8-9, Patient Information Reconciliation Profile Extends Scheduled WorkflowExtends Scheduled Workflow –Handle unidentified patient (e.g. trauma) –Handle demographic information mistakes –Propagate changes to all affected systems, update all affected data Reduces incorrectly identified or “lost” studiesReduces incorrectly identified or “lost” studies

Vendor Workshop April 8-9, Standards & Mechanisms HL7HL7 ADT Messages (A01-08, A11-13, A38, A40)ADT Messages (A01-08, A11-13, A38, A40) ORM MessagesORM Messages DICOMDICOM Modality Worklist Management (MWL)Modality Worklist Management (MWL) Modality Performed Procedure Step (MPPS)Modality Performed Procedure Step (MPPS) Storage, Storage CommitmentStorage, Storage Commitment Query/RetrieveQuery/Retrieve

Vendor Workshop April 8-9, 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 Profile

Vendor Workshop April 8-9, DICOMDICOM Grayscale Standard Display Function (GSDF)Grayscale Standard Display Function (GSDF) Grayscale Softcopy Presentation State (GSPS)Grayscale Softcopy Presentation State (GSPS) Storage, Storage CommitmentStorage, Storage Commitment Query/RetrieveQuery/Retrieve Print ManagementPrint Management Presentation LUT (P-LUT)Presentation LUT (P-LUT) IHE Scheduled Workflow ProfileIHE Scheduled Workflow Profile Consistent Presentation of Images Profile

Vendor Workshop April 8-9, MODALITY Presentation of Grouped Procedures Profile Requested Procedure: CHEST Report: CHEST Report: AB/PELVIS Performs a single exam Operator groups 2 procedures Chest View RIS / PACS Requested Procedure: AB/PELVIS Chest View Ab/Pelvis View

Vendor Workshop April 8-9, IHE Scheduled Workflow ProfileIHE Scheduled Workflow Profile IHE Consistent Presentation of Images ProfileIHE Consistent Presentation of Images Profile Presentation of Grouped Procedures Profile

Vendor Workshop April 8-9, Simple Image & Numeric Reports Profile Images Retrieved Preliminary Report Verified Report Report & Images Retrieved Image Manager & Archive Report Verification Images and Exam data presented for diagnosis Reports stored for Network Access Report & Image Review for Patient Care

Vendor Workshop April 8-9, DICOMDICOM Structured Reports (SR)Structured Reports (SR) SR Template TID 2000SR Template TID 2000 Storage, Storage CommitmentStorage, Storage Commitment Query/RetrieveQuery/Retrieve HL7HL7 ORU MessagesORU Messages IHE Scheduled Workflow ProfileIHE Scheduled Workflow Profile Simple Image & Numeric Reports Profile

Vendor Workshop April 8-9, 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 Key Image Notes Profile

Vendor Workshop April 8-9, DICOMDICOM Structured Reports (SR)Structured Reports (SR) Key Object SelectionKey Object Selection Storage, Storage CommitmentStorage, Storage Commitment Query/RetrieveQuery/Retrieve IHE Scheduled Workflow ProfileIHE Scheduled Workflow Profile Key Image Note Profile

Vendor Workshop April 8-9, 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

Vendor Workshop April 8-9, DICOMDICOM Query/RetrieveQuery/Retrieve Access to Radiology Information Profile

Vendor Workshop April 8-9, Year 4 Profiles (Tomorrow)  Security (HIPAA)  General Purpose Worklist  Post-Processing Workflow  Charge Posting  (Modality Worklist Exception Handling)

Vendor Workshop April 8-9, References IHE Technical Framework - Year 3 & Year 4IHE Technical Framework - Year 3 & Year 4 Part I:The ProfilesPart I:The Profiles Part II:The TransactionsPart II:The Transactions Part III: The New TransactionsPart III: The New Transactions IHE Mailing Lists and Comment ServerIHE Mailing Lists and Comment Server Educational MaterialsEducational Materials IHE Integration Profiles; The IHE FAQ; IHE VideoIHE Integration Profiles; The IHE FAQ; IHE Video IHE Fundamentals, Purchasing Strategies, IHE PrimerIHE Fundamentals, Purchasing Strategies, IHE Primer IHE Integration Checklist, Connectathon ResultsIHE Integration Checklist, Connectathon Results

Vendor Workshop April 8-9, Questions?

Vendor Workshop April 8-9, How Established is IHE? Year 1 (1999):Proof of Concept (Basic Scheduled Workflow)Year 1 (1999):Proof of Concept (Basic Scheduled Workflow) Year 2 (2000): Introduction of the 7 Profiles (Full Featured)Year 2 (2000): Introduction of the 7 Profiles (Full Featured) Year 3 (2001): Consolidation, Catch-up (Real Products) Expansion to FranceYear 3 (2001): Consolidation, Catch-up (Real Products) Expansion to France Year 4 (2002): 3 New Profiles Expansion to Japan, GermanyYear 4 (2002): 3 New Profiles Expansion to Japan, Germany Year 5 (2003): New Profiles Expansion to Lab, Pathology, …?Year 5 (2003): New Profiles Expansion to Lab, Pathology, …?

Vendor Workshop April 8-9, How do I benefit? Clinical UsersClinical Users Greater access to more consistent informationGreater access to more consistent information Fewer errors, fewer tedious tasksFewer errors, fewer tedious tasks AdministratorsAdministrators Increased throughputIncreased throughput Better scheduling and trackingBetter scheduling and tracking BuyersBuyers Specify/purchase integration capabilities easilySpecify/purchase integration capabilities easily Freedom to acquire “Best of Breed” systemsFreedom to acquire “Best of Breed” systems IT ProfessionalsIT Professionals Faster, more predictable integration projectsFaster, more predictable integration projects