1. SCAR University Section 10 Integrating the Healthcare Enterprise 110 What is IHE™ and Why does IT matter ?! David S. Channin MD Associate Professor of Radiology Chief, Imaging Informatics Northwestern University Feinberg School of Medicine Department of Radiology On behalf of and with acknowledgement of: RSNA Electronic Communications Committee IHE Strategic Development Committee IHE Radiology Planning and Technical Committees

2. SCAR 2004 Objectives Understand what is IHE™ Understand why IHE™ is important Understand how to purchase IHE™ functionality Know where to go for more information

3. SCAR 2004 Channin’s First Axiom No single company nor any single information system can meet all of the information management needs of a healthcare enterprise much less all the requirements for truly complete, distributed, national and international electronic medical records.

4. SCAR 2004 Therefore… Information systems must communicate with each other to successfully accomplish complex healthcare processes This can be accomplished in proprietary ways or using standards. Two dominant standards in healthcare: DICOM and HL7

5. SCAR 2004 Are we done yet? No. DICOM and HL7 are necessary but not sufficient Designed for point-to-point communications Too much wiggle room Need coordination between systems Need agreed upon FLOW Healthcare processes are complex and involve many different information systems

6. SCAR 2004 Goals of IHE Improve the efficiency and effectiveness of clinical practice Speed up the rate and quality of integration in healthcare environments Foster communication among vendors Prove that integration is attainable based on standards

7. SCAR 2004 What is IHE™? A process, with an intensive annual cycle – Define problems – Define technical solutions Common information model Common vocabulary Use existing standards – Test product solutions between vendors – Deploy these solutions in products – Educate the public

8. SCAR 2004 Healthcare Site with Complex Problematic Process involving heterogeneous information system Vendor expertise Integration Profile Proposed solution Using existing standards IHE Technical Framework details solution Vendor implements solution into REAL product Vendor tests solution at Connect-a-thon Professional Societies Demonstrate/Educate That solution exists Healthcare Site Includes IHE in RFP

9. SCAR 2004 Healthcare Site with 1 Solution and NEXT PROBLEM Vendor expertise Integration Profile Proposed solution Using existing standards IHE Technical Framework details solution Vendor implements solution Into Real product Vendor tests solution At Connect-a-thon Professional Societies Demonstrate/Educate That solution exists Healthcare Site Includes IHE In RFP

10. SCAR 2004 What is IHE™ NOT? Not a standard – You conform to a standard – You comply with IHE Technical Framework Not a standards development organization Not a certifying authority Not simply a demonstration project – Demos are only one means to the end: Adoption – Backed up by documentation, tools, testing, and publication of information Not just for radiology

11. SCAR 2004 IHE™ Deliverables Venue(s) for communication Integration Profiles Technical Framework Connect-a-thon Public Demonstrations Marketing Tools for Conformant Products

12. SCAR 2004 IHE™ Deliverables Venue(s) for communication Integration Profiles Technical Framework Connect-a-thon Public Demonstrations Marketing Tools for Conformant Products

13. ADT PR OP IM IA AM DSS OF PPM IDRC RM RR EC PC PPSM ARR CP PC ERR PS EC

14. SCAR 2004 IHE Radiology Integration Profiles Patient Info. Recon- ciliation Access to Radiology Information Consistent Present- ation of Images Basic Security - Evidence Docs Key Image Notes Simple Image & Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled Workflow Portable Data for Imaging NM Image

15. SCAR 2004 Thought Questions How do you order and fulfill a request for imaging service? – How many steps are involved? – How much paper? – How do you know when a procedure is finished? – How do you know what was actually done (versus what was planned to be done)? – What happens when someone makes a mistake?

16. SCAR 2004 ADT (Registration) Order Placer Order Filler Print Server Film Folder Image Manager & Archive Film Lightbox report Report Repository Image Display Modality acquisition in-progress acquisition completed images printed Acquisition Modality Example: IHE Scheduled Workflow

17. SCAR 2004 Now Add (to SWF)… Assisted Acquisition Protocol Setting Option – Decreased variance in performance of procedures – Procedure tailoring only when it makes clinical sense PPS Exception Management Option – Correct mistakes during acquisition

18. SCAR 2004 IHE Radiology Integration Profiles Patient Info. Recon- ciliation Access to Radiology Information Consistent Present- ation of Images Basic Security - Evidence Docs Key Image Notes Simple Image & Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled Workflow Portable Data for Imaging NM Image

19. SCAR 2004 Commonalities Make a worklist Query for the worklist Claim a workitem Tell when you start Tell when you finish Automatic handoffs – no fumbles

21. SCAR 2004 IHE Radiology Integration Profiles Patient Info. Recon- ciliation Access to Radiology Information Consistent Present- ation of Images Basic Security - Evidence Docs Key Image Notes Simple Image & Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled Workflow Portable Data for Imaging NM Image

22. SCAR 2004 IHE ITI Integration Profiles Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Consistent Time Coordinate time across networked systems Consistent Time Coordinate time across networked systems HL7 CDA / PDF / JPEGHL7 2.x ADT Triggers / QueriesKerberos (RFC 1510) / HL7 CCOWNTP (RFC 1305) Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications HL7 CCOW

23. SCAR 2004 IHE™ Deliverables Venue(s) for communication Integration Profiles Technical Framework Connect-a-thon Public Demonstrations Marketing Tools for Conformant Products

24. SCAR 2004

25. IHE™ Deliverables Venue(s) for communication Integration Profiles Technical Framework Connect-a-thon Public Demonstrations Marketing Tools for Conformant Products

26. SCAR 2004

29. IHE™ Deliverables Venue(s) for communication Integration Profiles Technical Framework Connect-a-thon Public Demonstrations Marketing Tools for Conformant Products

30. SCAR 2004 IHE™ Deliverables Venue(s) for communication Integration Profiles Technical Framework Connect-a-thon Public Demonstrations Marketing Tools for Conformant Products

31. SCAR 2004

34. What can you do? Learn about IHE Participate in IHE planning Insist on IHE compliance in your RFPs and contract documents

35. SCAR 2004 Remember With integration reliably distributing relevant information, Vendors can compete on providing new features and functionalities to advance the art and science of medicine

36. SCAR 2004 Where Is More Information Available? www.rsna.org/IHE – IHE Radiology Technical Framework V5.5 – IHE IT Technical Framework V1.0 – IHE Lab Technical Framework V1.0 – IHENews Mailing List – IHE Primer and IHE FAQ – IHE Integration Profiles: Guidelines for Buyers – IHE Presentations – IHE Connectathon Results – IHE Integration Statement Links