1. Integrating the Healthcare Enterprise
What’s New in IHE: New Profiles & New Options

2. Authors & Presenters Kevin O’Donnell John Paganini Rob Horn
Toshiba, IHE Planning Committee Co-Chair
John Paganini
IDX, IHE Planning Committee Member
Rob Horn
Agfa, IHE Planning Committee Member
RSNA 2002

3. 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
Access to Radiology Information
Retrieve & view images and reports
Basic Security
Audit Trail Consolidation & Node Authentication
RSNA 2002

4. 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
RSNA 2002

5. Post-Processing Workflow Profile
RSNA 2002

6. 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
RSNA 2002

7. IHE Post-Processing Workflow with Post-Processing Manager Grouped with Image Manager
Work Item Claimed
Post-Processing Worklist
RIS
Measurements
CAD Reports
……....………
Post-Processing
Procedure Step
STARTED
Post-Processing
Procedure Step
STARTED
PACS & Archive
Retrieve Images
Post-Processing
Procedure Step
COMPLETED
Store
Reports
Archive
Images
Post-Processing
Procedure Step
COMPLETED
RSNA 2002

8. 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
RSNA 2002

9. Charge Posting Profile
Collection of billable procedure details
RSNA 2002

10. 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
RSNA 2002

11. Charge Posting Profile
ADT Terminal
Account
Management
Post
Charges
Charge Processor
(Billing System)
DSS /
Order Filler
Study
Performed
Report Generated /
Signed
3-D
Performed
CAD
Performed
/ Materials
Used
Report Repository
Acquisition Modality
3-D
*Workstation
CAD
*Workstation …
RSNA 2002

12. Workflow HIS BILLING SYSTEM Modality RIS Patient Information
Initial Capture of Patient Demographics
Patient Information
HIS
Account Complete
BENEFITS
Procedure Information
Redundancy Eliminated
Maximum Data Integrity
Billing Available ASAP
All Systems Updated
Modality
RIS
RSNA 2002

13. 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)
RSNA 2002

14. 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
RSNA 2002

15. Basic Security Profile
RSNA 2002

16. 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
RSNA 2002

17. Secure Node Audit Repository Verifies and Authenticates the User
Failures are reported
Audit
Repository
The secure node actor provides access controls to for one individual computer. It authenticates each user, and rejects attempts to use this equipment by unauthorized users. Failures are reported to the Audit Repository.
RSNA 2002

18. Network Connection Verification
IHE Transactions
Identity Confirmed during
connection
Failures are reported
The secure node utilizes the DICOM and HL7 secure connection mechanisms to perform mutual identification during every connection setup. This ensures that data is exchanged only with other authorized secure nodes.
The Basic Security does not mandate data encryption because that extra cost and performance penalty is not always justified in environments where there is already appropriate physical and network security. Negotiation of additional encryption as part of the secure connection does not interfere with Basic Security functions, but does have a performance impact on routine IHE transactions.
Audit
Repository
Security Provides
Certificates
RSNA 2002

19. 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
IHE has defined a series of equipment, security, and Protected Healthcare Information (PHI) events. The equipment events report events like system startup and relocation. Security events like report user logins, security changes, and authentication failures. PHI events report summaries of data requests and data exchanges, such as creation, storage, and retrieval of studies. The study level was selected as providing sufficient detail to detect and analyze possible problems without generating an excess of event reports.
The event report structure is designed to be extensible because it is anticipated that experience with security systems will lead to changes in the list of events worth reporting and the level of detail that is needed.
Diagnostic
Workstation
RSNA 2002

20. Audit Records Detailed Records from many sub-systems, not just IHE
Gathers audit reports in one location
May provide analysis or detection facility (beyond the scope of IHE)
One important function of the audit record archive is to establish what is normal. All organizations have their own normal operating patterns. The bulk of the archive messages reflect normal and appropriate activity. This defines what is normal for this organization. The surveillance systems can use this information as the baseline so that the abnormal or unusual can be flagged for further investigation.
RSNA 2002

21. Audit Log Repository
RSNA 2002

22. 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.
The Basic Security profile assumes that physical security measures are in place. It assumes that the equipment is maintained in a safe environment where tampering or unauthorized connections are not a concern.
RSNA 2002

23. 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.
The basic security profile assumes that only authorized users have access to the network. This means that it is either not connected to the Internet, or protected by technologies such as firewalls and VPN facilities. The Basic Security profile is not appropriate for systems that are connected to the Internet and lack such protection.
RSNA 2002

24. 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
Every event report is time stamped by the system that generates the report. This permits the system to maintain accurate logs for mobile equipment and during network outages. The subsequent analysis and surveillance activities need these time stamps to be comparable for all the different systems that send data to the Audit Repository. The NTP protocols are used to maintain the local clock accuracy on each of the secure nodes.
NTP services are the international standard for synchronizing systems to UTC. They are readily available from a variety of equipment.
Time synchronization may support more than just security services. Other clinical and operational activities, such as cardiac catheterization laboratories, may benefit from automatic time synchronization.
RSNA 2002

25. Scheduled Workflow Profile: New Options
RSNA 2002

26. 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
RSNA 2002

27. PPS Exception Management Option
RSNA 2002

28. PPS Exception Management Option:
Defines method & codes for signaling problems, E.g.:
Technologist selects incorrect entry from Modality Worklist, images are acquired
Study is started but must be discontinued
Some behaviors are specified, most left to the discretion of the Modality / Image Manager / Order Filler.
RSNA 2002

29. 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
RSNA 2002

30. Assisted Protocol Setting Option
RSNA 2002

31. Assisted Protocol Setting Option
Allows DSS / Order Filler to provide more precise protocol codes to the Modality
Based on multiple Protocol Codes in the Scheduled Procedure Step
Provides more detailed communication
Promotes more consistent performance of procedures
RSNA 2002

32. IHE Integration Statements
RSNA 2002

33. 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
MENTION THE PRODUCT EVALUATION WORKSHEETS
RSNA 2002

34. Resources www.rsna.org/IHE FAQs Integration Profiles Document
Web Tutorials
Primer on IHE
Presentations
IHE Technical Framework
Product Evaluation Worksheet
RSNA 2002

35. Questions? www.rsna.org/IHE
Ask your vendors:
Which IHE Profiles do they support on which systems?
Questions?
RSNA 2002