September, 2005What IHE Delivers 1 Implementing IHE inside the Enterprise Care Settings World of Health IT October 11, :15-13:00 Harm-Jan Wessels managing director, Forcare vendor co-chair, IHE-Netherlands

2 Objective of this Presentation To provide an overview of how IHE integration profiles are applied across the care settings within an Enterprise To show the analogies across the domains To provide a structured approach to finding the right IHE integration profiles to use

3 Topics General IHE Introduction Overview of the IHE domains The building blocks  Radiology  Translating/Mapping to other care domains IHE implementations Guidance on using IHE Questions / Answers

4 Short Introduction My name: Harm-Jan Wessels Active in Healthcare IT since 1990  Applicare Medical Imaging (‘90-’99) Co-founder, Technical Director Co-founder, Technical Director  GE Healthcare – Netherlands (’99-’05) Engineering / General Manager Engineering / General Manager  Forcare – 2006 Co-founder / Managing Director Co-founder / Managing Director Involvement in IHE since ’98 Representing IHE-Netherlands as Vendor-chair since January 1 st, 2006

5 What is Integrating the Healthcare Enterprise? IHE is a global initiative, providing a common framework for passing health information seamlessly:  within the healthcare enterprise  across multiple healthcare enterprises  for local, regional & national health information networks. IHE is sponsored by healthcare professional associations: HIMSS, RSNA, ESC, ACC, BIR etc. IHE is user-led and vendor-driven IHE drives standards adoption to address specific clinical needs.

6 Document Use Case Requirements Identify available standards ( e.g. HL7, DICOM, IETF, OASIS) Develop technical specifications Testing at Connectathons IHE Demonstrations Products with IHE Timely access to information Easy to integrate products The IHE Process

7 Key IHE deliverables Techical Frameworks  Integration Profiles “A standard way to solve a standard problem using standards” Testing and Demonstrations Integration Statements Real-world Implementations

8 Benefits to IHE Participants Care Providers (Clinicians and IT staff)  Improved workflow  Information when and where needed  Decreased cost and complexity of interface installation and management Vendors  Accelerate product development  Expand your market potential by leveraging European/ International developments Standards-Developing Organizations (SDOs)  Rapid feedback to adjust standards to real-world  Establishment of critical mass and widespread adoption

9 Over 150 vendors involved world-wide, 8 Technical Frameworks 55 Integration Profiles, Testing at yearly Connectathons 55 Integration Profiles, Testing at yearly Connectathons Demonstrations at major conferences world-wide IHE 2006 – Eight Active Domains 1 Integration Profile

10 Overview IHE Domains CardiologyImplantable Device Cardiac Observations Profile (IDCO) CardiologyStress Testing Workflow Integration Profile (STRESS) CardiologyPatient Demographics Query: Urgent Implantable Device Cardiac Identification Content Profile (PDQ-IDC) CardiologyCardiac Catheterization Workflow (CATH CardiologyEchocardiography Workflow (ECHO) CardiologyRetrieve ECG for Display (ECG) CardiologyDisplayable Reports (DRPT) CardiologyEvidence Documents (ED) RadiologyScheduled Workflow (SWF) RadiologyPatient Information Reconciliation (PIR) RadiologyConsistent Presentation of Images (CPI) RadiologyPresentation of Grouped Procedures (PGP) RadiologyAccess to Radiology Information (ARI) RadiologyKey Image Note (KIN) RadiologySimple Image and Numeric Report (SINR) RadiologyCharge Posting (CHG) RadiologyPost-Processing Workflow (PWF) RadiologyReporting Workflow (RWF) RadiologyEvidence Documents (ED) RadiologyPortable Data for Imaging (PDI) RadiologyNM Image (NM) RadiologyCross-enterprise Document Sharing for Imaging (XDS-I) RadiologyTeaching File and Clinical Trial Export (TCE) RadiologyNuclear Medicine Image Integration Profile (NMI) with Cardiac Option RadiologyImage Fusion (FUS) RadiologyImport Reconciliation Workflow (IRWF) RadiologyMammography Image (MAMMO) Eye CareEye Care Workflow (EYECARE) Eye CareCharge Posting (CHG) Eye CareEye Care Evidence Documents (ECED) IT-InfraRetrieve Information for Display (RID) IT-InfraEnterprise User Authentication (EUA) IT-InfraPatient Identifier Cross-referencing (PIX) IT-InfraPatient Synchronized Applications (PSA) IT-InfraConsistent Time (CT) IT-InfraPatient Demographics Query (PDQ) IT-InfraAudit Trail and Node Authentication (ATNA) IT-InfraPersonnel White Pages (PWP) IT-InfraCross-Enterprise Document Sharing (XDS) IT-InfraDocument Digital Signature (DSG) IT-InfraNotification of Document Availability (NAV) IT-InfraPatient Administration Management (PAM) IT-InfraCross-enterprise Document Media Interchange (XDM) IT-InfraCross-enterprise Document Reliable Interchange (XDR) IT-InfraCross-enterprise Sharing of Scanned Documents (XDS-SD) IT-InfraRetrieve Form for Data Capture (RFD) IT-InfraCross-Enterprise User Authentication (XUA) LabLaboratory Scheduled Workflow LabSharing Laboratory Reports (XD*-LAB) LabLOINC Test Codes Subset (LTCS) PC CoordCross-Enterprise Sharing of Medical Summaries (XDS-MS) PC CoordBasic Patient Privacy Consents (BPPC) PC CoordEmergency Department Referral (EDR) PC CoordExchange of Personal Health Record Content (XPHR) PC CoordPre-procedure History and Physical (PPHP) PC DevicesDevice Enterprise Communication (DEC) Rad OncologyRT Objects? Can’t see the forest for the trees?

11 Back to the overview Focus: IHE inside the Enterprise Care Setting Starting with Radiology First IHE domain (1998) Wide variety in available systems, but relatively streamlined and global process

12 Main external Process Radiology order result Acquisition Reporting patient

13 report results Radiology Dept Mgt patient modality Acqui- sition radiologist Repor- ting order scheduling images patient status updat. Main Internal process

14 IHE Actors / Transactions Key terms  Actor: A system performing a particular transaction  Transaction: A single interaction between systems (actors) A system can host multiple actors Product A Product B Product C Product D IHE Transaction IHE Transaction IHE Transaction IHE Actor IHE Actor IHE Actor IHE Actor IHE Actor

15 IHE Actors / Transactions report results Radiology Dept Mgt patient modality Acqui- sition radiologist Repor- ting order scheduling images patient status updat. Department System Scheduler – Order Filler – Order Placer Acquisition Modality Performed Procedure Step Manager Image Mgr / Archive Image Display Report Creator Report Manager Enterprise Report Repository RIS HIS IMAGING PACS Workstations Modalities

16 Radiology Process Captured in Scheduled Workflow (SWF) Integration Profile Backbone of IHE Radiology Integrates Registration, Scheduling, Acquisition Workflow and Image Content Bridges HL7 and DICOM Spaces

17 Benefits of Scheduled Workflow Preserve Order Continuity / Improve Order Tracking  “Close the loop” Improve Demographic Integrity  Eliminate manual entry and correction Improve Workflow Efficiency  Worklists Reliable Storage  Storage Commitment End result: Reduce Integration Effort On site

18 So how does this apply... to other domains then Radiology? The key to understanding IHE is to see the process and the data flow Taking a few steps back...

19 Radiology Process and Data Flow Radiology Aquisition & Reporting Radiology Aquisition & Reporting Charge Capture Registration Evidence Documents Evidence Documents Report & Images Report & Images Process Flow Process Flow Data Flow Data Flow

20 Reviewing IHE Integration Profiles “Process View” and “Data View” apply across the domains The generic process chain shows a great deal of overlap for the domains IHE promotes the re-use of standards and transactions across the domain

21 Radiology Aquisition & Reporting Charge Capture Registration Evidence Documents Report & Images Data Flow Data Flow Process Flow Process Flow Constructing the Process Chain Patient Admission Patient Admission Order Placer Order Placer Order Filler Order Filler Acquisition Results Generation Results Generation Results Storage Results Storage Results Access Results Access

22 Process Flow Radiology (1) Patient Admission Patient Admission Order Placer Order Placer Order Filler Order Filler Acquisition Results Generation Results Generation Results Storage Results Storage Results Access Results Access Scheduled Workflow (SWF) Charge Posting (CHG) Post-Processing Workflow (PWF) Reporting Workflow (RWF) Import Reconciliation Workflow (IRWF) Data Flow Patient Information Reconciliation (PIR) Consistent Presentation of Images (CPI) Presentation of Grouped Procedures (PGP) Access to Radiology Information (ARI)

23 Data Flow Radiology (2) Evidence Documents (ED) Portable Data for Imaging (PDI) NM Image (NM) Cross-enterprise Document Sharing for Imaging (XDS-I) Teaching File and Clinical Trial Export (TCE) Image Fusion (FUS) Mammography Image (MAMMO) Patient Admission Patient Admission Order Placer Order Placer Order Filler Order Filler Acquisition Results Generation Results Generation Results Storage Results Storage Results Access Results Access Key Image Note (KIN) Simple Image and Numeric Report (SINR)

24 Data Flow Process Flow Cardiology Patient Admission Patient Admission Order Placer Order Placer Order Filler Order Filler Acquisition Results Generation Results Generation Results Storage Results Storage Results Access Results Access Stress Testing Workflow Integration Profile (STRESS) Cardiac Catheterization Workflow (CATH) Echocardiography Workflow (ECHO) Retrieve ECG for Display (ECG) Evidence Documents (ED)

25 Data Flow Process Flow Laboratory Patient Admission Patient Admission Order Placer Order Placer Order Filler Order Filler Acquisition Results Generation Results Generation Results Storage Results Storage Results Access Results Access Laboratory Scheduled Workflow Sharing Laboratory Reports (XD*-LAB)

26 Data Flow Process Flow Eye Care Patient Admission Patient Admission Order Placer Order Placer Order Filler Order Filler Acquisition Results Generation Results Generation Results Storage Results Storage Results Access Results Access Eye Care Workflow (EYECARE) Charge Posting (CHG) Eye Care Evidence Documents (ECED)

27 IHE Implementations IHE has been in existence since 1998 IHE Integration Profiles are key building blocks for interoperability Examples of IHE Implementations can be found at or  Success Stories

28 Guidance on using IHE Practical Guidance on using IHE can be found at To apply IHE to Radiology, consult the  Radiology User Handbook To study IHE’s approach to workflow, consult the  Departmental Workflow – white paper

29 Conclusions IHE provides a comprehensive framework for addressing interoperability challenges IHE’s process model promotes re-use across domains and stimulates similar solutions to similar problems IHE’s Integration Profiles are showing rapid adoption and application – across the Enterprise Care Settings

September, 2005What IHE Delivers 30 IHE Europe web site: Thank you for your attention Any Questions?