1. Integrating the Healthcare Enterprise
IHE 2003: Meeting Clinical Goals and Technical Challenges
60 MINUTE PRESENTATION followed by 15 minute question period
Describe the recent accomplishments of the IHE initiative and it’s relevance to clinicians and
administrators. User success stories emphasize the value of integrating the Healthcare Enterprise
for users and healthcare organizations.

2. Authors & Presenters Dr. Paul Vegoda Kevin O’Donnell Dr. David Channin
Malvern Group, FHIMSS, IHE Strategic Dev. Committee
Kevin O’Donnell
Toshiba, IHE Planning Committee Co-chair
Dr. David Channin
Northwestern University, Assistant Professor of Radiology, Chief of Imaging Informatics
HIMSS 2003

3. What is IHE about?
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
Systems means HIS, RIS, modalities, PACS, review stations, printers, etc.
HIMSS 2003

4. Goals of IHE
Speed up the rate and quality of integration in healthcare environments
Foster communication between vendors
Prove that integration is attainable based on standards
HIMSS 2003

5. IHE Participants Representatives of Healthcare Providers Users
( RSNA, HIMSS, … )
Users
( Radiologists, Medical Staff, Administrators, CIOs, … )
Information Systems Vendors
( RIS & HIS Vendors )
Imaging Systems Vendors
( Modality & PACS Vendors )
Standards Committee Members
( DICOM, HL7 )
HIMSS 2003

6. Why is IHE needed? Serious Integration Challenges in Healthcare:
Systems need Information other systems have
But, systems communicate poorly or not at all
Result: - tedious, inefficient workflows data that is redundant, inconsistent or unavailable
E.G. too much data re-entry, too many manual steps
“Who owns the problem?”
The hospital can’t solve the problem with insufficient tools (although there have been impressive efforts)
The integration problem was generally outside the scope of a single vendor/product
Responsibility for information flow between systems, and between departments, is often unclear.
HIMSS 2003

7. How it Benefits Clinicians and Administrators
How is it relevant to their jobs
What do they get
HIMSS 2003

8. Clinician Benefits Clinical Users
More convenient access to more information
Preservation of continuity and integrity of Patient Record
Fewer opportunities for errors
Fewer tedious tasks/repeated work
Buyers
Specify/purchase integration capabilities easily
Freedom to acquire “Best of Breed” systems
HIMSS 2003

9. Administrator Benefits
Administrators
Increased throughput
Better scheduling and tracking
IT Professionals
Faster, more predictable integration projects
Buyers
Specify/purchase integration capabilities easily
Freedom to acquire “Best of Breed” systems
HIMSS 2003

10. IHE Penetration in Radiology
# of years (entering 5th)
# of vendors (over 50 worldwide)
# systems at Connectathon (over 100 worldwide)
kinds of capabilities (one or two easily grasped examples)
Geographic spread (U.S., France, Germany, Japan, Italy, U.K., …)
HIMSS 2003

11. Expansion into New Areas
New IT Infrastructure Committee Formed (MPI, Query/Display, Security, …)
Cardiology Group forming in March
Work progressing in Lab, Pharmacy/Medication, …
HIMSS 2003

12. IHE Accomplishments
Users and vendors work together to identify and design solutions for integration problems
Intensive process with annual cycles:
Identify key healthcare workflows and integration problems
Research & select standards to specify a solution
Write, review and publish IHE Technical Framework
Perform cross-testing at “Connectathon”
Demonstrations at tradeshows (HIMSS/RSNA)
**Consider making the cycle graphic
Incremental approach: Can’t solve all at once
Connectathon – Practical measure of progress, Validates the integration work accomplished. Refer the Scorecard.
Demo – promotes standards based integration to users/purchasers
HIMSS 2003

13. IHE Integration Profiles
Scheduled Workflow
Admit, order, schedule, acquire & store images with notification of completed steps
Patient Information Reconciliation
Unknown patients and unscheduled orders
Post- Processing Workflow
Schedule, perform, & notify image processing & CAD steps
Charge Posting
Collection of billable procedure details
Presentation of Grouped Procedures
Manage subsets of a single acquisition
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
DON’T GO INTO DETAILS ON PROFILES, JUST GIVE THEM A TASTE AND RECOMMEND THE DOCS AND DETAILED PRESENTATION FOR MORE INFO
Access to Radiology Information
Retrieve & view images and reports
Basic Security
Audit Trail Consolidation & Node Authentication
HIMSS 2003

14. acquisition completed acquisition in-progress acquisition completed
Scheduled Workflow Profile
Report
Repository
Registration
report
Diagnostic
Workstation
Film
Lightbox
Orders Placed
Image Manager
& Archive
Film
Folder
Specifies transactions that function to maintain the integrity of patient, image, and order information across systems
Integrates modalities with information and imaging systems
Biggest Value of IHE
Smooth flow of patient, image and order information across systems
Status updates of orders
Orders Filled
Acquisition Modality
acquisition completed
Film
acquisition in-progress
acquisition completed
images printed
Modality
HIMSS 2003

15. Patient Information Reconciliation Profile
Extends 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” studies
Specifies transactions that function to match a previously processed unidentified patient with subsequently entered or identified demographic information
Defining a systematic way to handle trauma cases eliminates one of the major reasons for incorrectly identified or “lost” patient information
HIMSS 2003

16. Post-Processing Workflow Profile
Acquisition Modality
PACS System
Source Data
Post-Proc.
Workflow
Manager
3-D
*Workstation
Worklist
Workstation
Work Status
Work Status
CAD
*Workstation
Results
Report Repository …
Results
HIMSS 2003

17. Simple Image & Numeric Reports Profile
Report Verification
Verified Report
Images and Exam data presented for diagnosis
Preliminary Report
Reports stored for Network Access
Report & Images
Retrieved
Note also the aspect of Creating, Storing, Verifying, Querying and Retrieving Reports
Accurate complete report accessible wherever the physician desires.
Images
Retrieved
Report & Image Review for Patient Care
Image Manager
& Archive
HIMSS 2003

18. Charge Posting Profile
ADT Terminal
Account
Management
Post
Charges
*Billing System
Charge
Poster
Study
Performed
Report Generated /
Signed
3-D
Performed
CAD
Performed
/ Materials
Used
Report Repository
Acquisition Modality
Facilitates Collection of Procedure Details for Billing
Performed Procedure Technical Fees
Materials Usage
Reporting Professional Fees
Etc.
Maintains Correspondence of Account Details in Procedure Records
3-D
*Workstation
CAD
*Workstation …
HIMSS 2003

19. Consistent Presentation of Images Profile
What the Radiologist Displays:
What the Reviewing Physician Sees:
Area Of
Interest
Annotate
The Radiologist’s Transformations Are Saved
Original Image
& Presentation State
Area Of
Interest
Prepared Image
Zoom
Flip
Window Level
Original Image
Original Image
It helps you maintain consistent images across multiple softcopy and hardcopy devices.
Both in terms of intensity and geometry.
Note Consistency is between different softcopy devices, between hardcopy devices and between softcopy and hardcopy
Note that Original Image is there in both cases, but is supplemented by the Presentation State above
With films, image quality was the imaging department problem….
Softcopy image distribution across the healthcare enterprise
Opportunity with radiology digitalization
Avoid lost films, reduces delays
Increases utilization of staff and equipment
But quality and consistency need to be adressed
This IHE Integration Profile is the cost effective solution to ensure that image quality is maintained across different monitors and film producing devices.
The Radiologist’s Transformations Are Lost
Original Image
HIMSS 2003

20. Presentation of Grouped Procedures Profile
Requested Procedure: CHEST
Chest View
Ab/Pelvis View
Report: CHEST
RIS / PACS
Requested Procedure: AB/PELVIS
Report: AB/PELVIS
MODALITY
Chest View
Performs a single exam
Operator
groups
2 procedures
Ab/Pelvis View
HIMSS 2003

21. Key Image Notes Profile
Radiologist
Flags Images:
Referring Physician Sees Key Images First:
for refering physician
This image shows
the renal rupture.
Note1
for refering physician
This image shows
the renal rupture.
Note1
This image has the hematoma.
Note2
For referring
physician:
This image shows
the renal rupture.
Note1
Study &
Key Image Notes
For referring
physician:
This image has
the hematoma.
Note2
for refering physician
This image has the hematoma.
Note2
The Key Image Notes are stored and managed inside the Study, together with the Images
Key Image Notes put the Postit notes back into the softcopy workflow.
Note it can also be used between the tech and the rad, etc.
HIMSS 2003

22. Access to Radiology Information Profile
Radiology Department – Images and Reports
Emergency Department
Referring Physician
Other Departments: - Oncology - Surgery - Neurology - Pediatrics - etc.
Remote Clinics
Electronic Medical Record
HIMSS 2003

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

24. The Annual “Connectathon”
Voluntary Participation
Neither a Demo nor a Certification
Well Designed End-to-End Scenarios
Advanced Testing Tools
Unprecedented Cross-Vendor Testing
Unprecedented Pool of Technical Talent
HIMSS 2003

25. Connectathon Results
# of systems available (Check
IHE Integration Statements
what they are, what they include
where to find them
HIMSS 2003

26. User Success Stories Examples from the 13 Success Stories
Personal purchase experience?
HIMSS 2003

27. How Did They Benefit Types of benefits observed
“The water’s not too bad, come on in”
HIMSS 2003

28. Start Checking It Out Get informed Get involved Get on board
HIMSS 2003

29. Resources www.rsna.org/IHE FAQs Integration Profiles Primer on IHE
Presentations
IHE Technical Framework
HIMSS 2003

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