0. Integrating the Healthcare Enterprise
The Basics of IHE: Concepts and Process
David Channin, MD
RSNA Electronic Communications Committee
IHE Strategic Development Committee
IHE Radiology Planning and Technical Committees
Associate Professor of Radiology
Chief, Imaging Informatics
Northwestern University
Feinberg School of Medicine
Department of Radiology

1. Why Are Standards Important?
Take the case of the many various competing base connectors for a light bulb circa It’s obvious if we think it through a bit that having too many arbitrarily different and incompatible solutions to this basic problem would cause terrible inefficiencies. Think of the dilemma a manufacturer of light fixtures would face in deciding which of the competing solutions to support. Think of the confusion and trouble that a user would be put to in trying to select a replacement bulb. Think of the size of the light bulb aisle at the local hardware store! Our question for the day here might be, How many standards does it take to screw in a light bulb?

2. Why Are Healthcare IT Standards Important?
Step #2 toward Crossing the Quality Chasm: “. . . making effective use of information technologies to automate clinical information and make it readily accessible to patients and all members of the care team. An improved information infrastructure is needed to establish effective and timely communication among clinicians and between patients and clinicians.” IOM Report, 2001
It seems obvious that improved standards—and widespread, coordinated deployment of standards are necessary in order to achieve this.

3. What IT Standards Enable
Greater efficiency and cost savings
The ability to make best of breed purchasing decisions
Better and more timely communication of medical information
Improved patient safety
Data for outcomes analysis and decision support
The potential to build a system of evidence-based medicine
The potential to develop a truly comprehensive and portable EHR
So why haven’t standards solved all of healthcare’s interoperability issues?

4. The Standards Archipelago
POC Devices
Pharm
ADT/HIS
RIS
PACS
Mods
DICOM
IEEE – POCT
Lab
NCPDP
HL7 2.4
EKG
HL7 2.1
Billing ER OR
CIS
DICOM
Cath Lab
X12/ICD9
Islands of data across the healthcare enterprise

5. NAHIT Standards Directory
“ Since launching a beta version for members only in April, the Alliance has expanded the directory to include 850 voluntary and mandatory standards and electronic links to more than 200 standards development organizations.”
The great thing about standards is that there are so many to choose from -Old Wisecrack

6. Standards Alone Are Not Enough
Too many standards
No clear domain boundaries
No clear mapping of information flow across boundaries
Too much generality and ambiguity
Version incompatibilities
Vendor proprietary interests
Complexity!!
We need standards for how to implement standards!

7. Connecting Standards to Care
Care providers must work with industry to coordinate the implementation of standards to meet their needs
Care providers need to identify the key interoperability problems they face
Drive industry to develop and make available standards-based solutions
Implementers need to follow common guidelines in purchasing and integrating systems that deliver these solutions

8. IHE Grows from DICOM Experience
Integrating the Healthcare Enterprise:
an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information
promotes the coordinated use of established standards such as HL7 and DICOM to address specific clinical needs
leads to systems that communicate better, are easier to implement, and enable care providers to use information more effectively

9. IHE Process
Users identify desired functionalities that require coordination and communication among multiple systems
E.g., departmental workflow, single sign-on, cross-departmental sharing of documents and information
Find and document standards-based transactions among systems to achieve desired functionality
Apply necessary constraints to eliminate useless wiggle room
Provide process and tools to encourage vendors to implement
MESA software test tools
Connectathon interoperability testing event
Provide tools and education to help users acquire and integrate systems using these solutions
Connectathon results and public demonstrations
Integration statements
RFP toolkit (soon)

10. IHE Participants Societies Representing Healthcare Segments Users
RSNA, HIMSS, ACC, ACCE, …
Users
Clinicians, Medical Staff, Administrators, CIOs, …
Consultants
Information Systems Vendors
Imaging Systems Vendors
Standards Development Organizations (SDOs)
HL7, DICOM, ASTM, NCCLS, OASIS, IETF, ISO …

11. IHE Deliverables Technical Framework Integration Profiles Connectathon
Public Demonstrations
Tools for Acquiring Conformant Products

12. IHE Technical Frameworks
Detailed standards implementation guides
Cardiology
IT Infra
Lab
Radiology

13. Organization of TFs Volume 1: Integration Profiles
Describes clinical need and use cases
Identifies the actors and transactions
Volume 2+ of Technical Framework
Provides implementation specification for each transaction by specific reference to Standards

14. Organization of TFs

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

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

17. IHE IT Infrastructure Integration Profiles
Enterprise User Authentication
Provide users a single name and centralized authentication process across all systems
Provide users a single name and centralized authentication process across all systems
Patient Identifier Cross-referencing for MPI
Map patient identifiers across independent identification domains
Synchronize multiple applications on a desktop to the same patient
Patient Synchronized Applications
Retrieve Information for Display
Access a patient’s clinical information and documents in a format ready to be presented to the requesting user
Access a patient’s clinical information and documents in a format ready to be presented to the requesting user
Consistent Time
Coordinate time across networked systems

18. IHE Connectathon Open invitation to vendor community
Advance testing tools (MESA)
Testing organized and supervised by project management team
Dozens of vendors and systems
Thousands of cross-vendor tests performed
Results recorded and published

21. RFPs & IHE Integration Statements
Be Brief?
“The system must support DICOM”
Be Effective?
“The system must support the following DICOM services according to the following 100 pages of specifications”
Be Both:
“The system must support IHE Scheduled Workflow as an Acquisition Modality”
IHE Integration Statements
Version 2.1 of the Jupiter 3 CT supports IHE Scheduled Workflow as an Acquisition Modality

22. Integration Statements

23. RFP Toolkit

24. RFP Toolkit

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

26. More information…. IHE Web sites: Technical Frameworks:
Technical Frameworks:
ITI V1.0, RAD V5.5, LAB V1.0
Technical Framework Supplements - Trial Implementation
May 2004: Radiology
August 2004: Cardiology, IT Infrastructure
Non-Technical Brochures :
Calls for Participation
IHE Fact Sheet and FAQ
IHE Integration Profiles: Guidelines for Buyers
IHE Connect-a-thon Results
Vendor Products Integration Statements