2. RSNA/HIMSS Integrating the Healthcare Enterprise What’s New in IHE: Charge Posting Security Post Processing

3. HIMSS 2003 Authors & Presenters Ellie Avraham – IHE Planning and Technical Committees – KODAK Sanjay Jain – Co-Chair, IHE Planning Committee – Cerner Corporation, Radiology and Clinical Imaging

4. HIMSS 2003 IHE Integration Profiles Access to Radiology Information Retrieve & view images and reports Consistent Presentation of Images Hardcopy and softcopy grayscale presentation state Key Image Notes Flag & search for significant images Simple Image and Numeric Reports Simple reports with image links and measurements Basic Security Audit Trail Consolidation & Node Authentication Presentation of Grouped Procedures Manage subsets 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 & store images with notification of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders

5. HIMSS 2003 Year 4 Additions to IHE Technical Framework 3 New Integration Profiles  Post-Processing Workflow  Charge Posting  Basic Security 2 New Options for Scheduled Workflow  PPS Exception Management  Assisted Protocol Setting IHE Integration Statements

6. HIMSS 2003 IHE Expands Scope Recruiting Participants in new CommitteesRecruiting Participants in new Committees Enterprise Master Patient IndexEnterprise Master Patient Index Advanced SecurityAdvanced Security Query/Display and Synchronized Patient ViewQuery/Display and Synchronized Patient View Special Panel Session in IHE TheatreSpecial Panel Session in IHE Theatre Overview of new IHE enterprise initiativesOverview of new IHE enterprise initiatives Learn how to participateLearn how to participate –Tuesday, February 11, 9:15 – 10:00 a.m. –Wednesday, February 12, 12:15 – 1:00 p.m

7. HIMSS 2003 Post-Processing Workflow Profile

8. HIMSS 2003 Post-Processing Workflow: Features Supports Workflow for Post-Processing Tasks: Computer Aided Detection Image Processing Image Reconstruction etc... Task Scheduling, Worklists & Status Tracking Worklist Entries Reference Input Data Status Messages support Workflow Metrics and Billing Associate Post-Processing Output with Acquired Images and other Order Results for easier review

9. HIMSS 2003 PACS & Archive RIS IHE Post-Processing Workflow with Post-Processing Manager Grouped with Image Manager Post-Processing Worklist Retrieve Images StoreReports Measurements CAD Reports ……....……… ArchiveImages Post-Processing Procedure Step STARTED Work Item Claimed Post-Processing Procedure Step STARTED Post-Processing Procedure Step COMPLETED Post-Processing Procedure Step COMPLETED

10. HIMSS 2003 Post-Processing Workflow: Technical Details Based on DICOM – General Purpose Worklist – General Purpose Scheduled Procedure Step – General Purpose Performed Procedure Step Dept. System Scheduler/Order Filler Actor Schedules Post-Processing New Post-Processing Manager Actor Image Creator/Report Creator Actors Perform Post-Processing

11. HIMSS 2003 Charge Posting Profile

12. HIMSS 2003 Charge Posting Profile: Features  Facilitates Collection of Procedure Details for Billing  Performed Procedure Technical Fees  Materials Usage  Reporting Professional Fees  Etc.  Facilitates Management of Account Details in Multiple Systems and Procedure Records

13. HIMSS 2003 Charge Posting Profile DSS / Order Filler Charge Processor (Billing System) CAD *Workstation Report Repository … Report Generated / Signed CAD Performed Post Charges Acquisition Modality ADT Terminal 3-D *Workstation Account Management 3-D Performed Study Performed / Materials Used

14. HIMSS 2003 Workflow BENEFITS Initial Capture of Patient Demographics HIS BILLING SYSTEM Modality Patient Information Account Complete Procedure Information RIS Redundancy Eliminated All Systems Updated Maximum Data Integrity Billing Available ASAP

15. HIMSS 2003 Charge Posting Profile: Technical Details HL7 Messages manage account details between systems – Open, Update, Close Account DICOM Performed Procedure Step Messages (MPPS, GP-PPS) provide optional details to Order Filler : – Performed (Billable) Technical Activities – Performed (Billable) Professional Activities – Usage of Materials HL7 Messages allow Order Filler to post charges to the Charge Processor New Charge Processor Actor (financial system)

16. HIMSS 2003 Charge Posting Profile: Benefits Billing System receives more complete, timely and accurate data Eliminates Redundant Data Entry Reduces Billing Errors Reduces Billing Resource Requirements Reduces System Interface Installation Time Reduces Need for Billing System to Know Radiology Details

17. HIMSS 2003 Basic Security Profile

18. HIMSS 2003 Basic Security Profile: Features  Verifies that only secure nodes exchange data.  Provides audit facility to:  Verify compliance with procedures  Permit detection of inappropriate behavior  Avoid interfering with time critical activities

19. HIMSS 2003 Secure Node Verifies and Authenticates the User AuditRepository Failures are reported

20. HIMSS 2003 Network Connection Verification AuditRepository Security Provides Certificates Identity Confirmed during connection IHE Transactions Failures are reported

21. HIMSS 2003 Basic Security Profile AuditRecordRepository … Image Manager & Archive “Images Queried / Retrieved” Diagnostic Workstation Report Repository … Report & Image Review “Reports Queried / Retrieved” “Images Printed” “Reports Stored” “Reports Retrieved” “Reports Printed”

22. HIMSS 2003 Audit Records Detailed Records from many sub-systems, not just IHE Detailed Records from many sub-systems, not just IHE Gathers audit reports in one location Gathers audit reports in one location May provide analysis or detection facility (beyond the scope of IHE) May provide analysis or detection facility (beyond the scope of IHE)

23. HIMSS 2003 Audit Log Repository

24. HIMSS 2003 Basic Security Environment Required Physical Security Doors, key access, etc. restrict access Communications and Equipment are kept in restricted access areas Access to equipment is controlled Cabinets, wiring, etc. are protected.

25. HIMSS 2003 Basic Security Environment Required Network Security Firewalls, VPN, and other access controls. Unauthorized external access is denied. Additional security facilities may be in place if warranted by local conditions.

26. HIMSS 2003 Basic Security Profile: Technical Details Certificates used to authenticate Secure Nodes Syslog Protocol used to transmit and store audit messages Network Time Protocol (NTP) used to synchronize / stamp audit messages

27. HIMSS 2003 Scheduled Workflow Profile: New Options

28. HIMSS 2003 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

29. HIMSS 2003 PPS Exception Management Option

30. HIMSS 2003 PPS Exception Management Option: Defines method & codes for signaling problems, E.g.:Defines method & codes for signaling problems, E.g.: Technologist selects incorrect entry from Modality Worklist, images are acquiredTechnologist selects incorrect entry from Modality Worklist, images are acquired Study is started but must be discontinuedStudy is started but must be discontinued Some behaviors are specified, most left to the discretion of the Modality / Image Manager / Order Filler.Some behaviors are specified, most left to the discretion of the Modality / Image Manager / Order Filler.

31. HIMSS 2003 Discontinue Reason Codes Code Meaning (0008,0104) Doctor cancelled procedure Equipment failure Incorrect procedure ordered Patient allergic to media/contrast Patient died Patient refused to continue procedure Patient taken for treatment or surgery Patient did not arrive Patient pregnant Change of procedure for correct charging Duplicate order Nursing unit cancel Incorrect side ordered Discontinued for unspecified reason Incorrect worklist entry selected Patient condition

32. HIMSS 2003 Assisted Protocol Setting Option

33. HIMSS 2003 Assisted Protocol Setting Option Allows DSS / Order Filler to provide more precise protocol codes to the ModalityAllows DSS / Order Filler to provide more precise protocol codes to the Modality Based on multiple Protocol Codes in the Scheduled Procedure StepBased on multiple Protocol Codes in the Scheduled Procedure Step Provides more detailed communicationProvides more detailed communication Promotes more consistent performance of proceduresPromotes more consistent performance of procedures

34. HIMSS 2003 IHE Integration Statements

35. HIMSS 2003 IHE Integration Statements Provides a Clear, Simple, but Precise, statement of the integration capabilities of a vendor system “Integration for people who aren’t DICOM engineers” For a Vendor System it States: – the product name, version – which IHE Actors the system implements in each IHE Profile www.rsna.org/IHE/

36. HIMSS 2003 Special IHE Panel Session IHE - IT Infrastructure: The Value PropositionIHE - IT Infrastructure: The Value Proposition –Find out how you can benefit from participating in IHE committees and Connectathons –Learn how IHE fills the interoperability gap –Hear the status of new enterprise initiatives Software vendors, developers and interested parties invited to attend special panel sessionSoftware vendors, developers and interested parties invited to attend special panel session

37. HIMSS 2003 Resources www.rsna.org/IHE FAQs Integration Profiles Document Web Tutorials Primer on IHE Presentations IHE Technical Framework Product Evaluation Worksheet

38. HIMSS 2003 Questions? Ask your vendors: Which IHE Profiles do they support on which systems? www.rsna.org/IHE