1. September, 2005What IHE Delivers Introduction to IHE ACCA IHE Workshop 2007 Jon Elion MD, FACC Associate Professor of Medicine, Brown University Co-Chair, IHE-Cardiology Planning Committee

2. 2 Overview of Today’s Workshop Introduction to IHE Review of Profiles Part 1:  Cardiology Workflows: Cath, Echo Stress  Content Display Requirements: Stress Echo, Stress Break Review of Profiles Part 2:  ECG for Display  Nuclear Cardiology  Implantable Device Cardiac Observations  Displayable reports (status updates)  XDS and related profiles  IHE’s Relationship to government initiatives. Interactive RFP Session

3. 3 Why Standards Are Important Bernstein Heisler Thomson-Houston (arc current) Municipal EdisonMunicipal Bernstein Thomson-Houston (alternating current)

4. 4IHE … is 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 DICOM and HL7 to address specific clinical needs … leads to systems that communicate better, are easier to implement, and enable care providers to use information more effectively

5. 5 Goals of IHE Speed up the rate and quality of integration in healthcare environments Foster communication among vendors and care providers Improve the efficiency and effectiveness of clinical practice Improve interoperability among care domains and build foundation for the EHR Integration solutions within the healthcare enterprise and across healthcare enterprises

6. 6 Who is IHE? IHE is a joint initiative among:  American College of Cardiology (ACC), Echocardiography (ASE)  American College of Physicians  Radiological Society of North America (RSNA)  Healthcare Information Management Systems Society (HIMSS)  GMSIH, HPRIM, JAHIS (laboratory)  American Society of Ophthalmology  And many more…. Began in 1997 in Radiology (RSNA) and IT (HIMSS) International effort: IHE- Europe and IHE-Japan Additional sponsors for Cardiology including ASE, ESC, ASNC, SCA&I, HRS and more

7. 7 IHE Participants Societies Representing Healthcare Segments: RSNA, HIMSS, ACC, ASE, ACP… Users: Clinicians, Medical Staff, Administrators, CIOs, … Consultants Imaging and Information Systems Vendors Standards Development Organizations: DICOM, HL7, ASTM, …

8. 8 IHE Deliverables Venue for communication (committees) Integration Profiles (what needs to be done) Technical Framework (how to do it) Connect-a-thon (actually do it!) Public Demonstrations (example: ACC ’07 for Cardiology) Tools for Acquiring Conformant Products (RFP’s)

9. 9 Standards-Based Integration Professional Societies Sponsorship Healthcare Providers & Vendors Healthcare IT Standards HL7, DICOM, etc. General IT Standards Internet, ISO, etc. Interoperable Healthcare IT Solution Specifications IHE Integration Profile Interoperable Healthcare IT Solution Specifications IHE Integration Profile Interoperable Healthcare IT Solution Specifications IHE Integration Profile Interoperable Healthcare IT Solution Specifications IHE Integration Profile IHE Process

10. 10 IHE Organizational Structure Participants contribute Global Development: Radiology, IT Infrastructure, Cardiology, Laboratory, Eye Care, Patient Care Coordination Patient Care Devices Delegates IHE Europe IHE North America IHE Asia/Oceania Regional & National Deployment supervises reports IHE (International) Strategic Development Committee Sponsor Co-Chairs Global Interoperability IHE Domain-related Planning and Technical Committees

11. 11 Standards Adoption Process IHE Integration Profiles Easy to Integrate Products IHE Demonstration User Site RFP Standards IHE Technical Framework Product IHE Integration Statement IHE Integration Profiles at the heart of IHE :  Detailed selection of standards and options each solving a specific integration problem  A growing set of effective provider/vendor agreed solutions  Vendors can implement with ROI  Providers can deploy with stability  Process started in 1998; continuously improved IHE Connect-a-thon Product With IHE IHE Connect-a-thon Results

12. 12 What is IHE NOT IHE is not a standard You conform to a standard You conform to a standard You comply with IHE Technical Framework You comply with IHE Technical Framework IHE is not a standards development organization IHE is not a certifying authority IHE is not simply a demonstration project Demos are only one means to the end: Adoption Demos are only one means to the end: Adoption Backed up by documentation, tools, testing, and publication of information Backed up by documentation, tools, testing, and publication of information IHE is not just for radiology any more!

13. 13 IHE Annual Cycle 1.Clinicians identify clinical problems to be addressed -“Integration Profiles” 2.Engineers from vendors collaborate to define technical specification (using existing standards such as DICOM and HL7) 3.Vendors implement the technical specification and participate in the “Connectathon” 4.Demonstrations at trade shows (ACC, HIMSS, etc.) 5.Vendors publish IHE Integration Statements 6.Customers reference IHE profiles in RFP’s

14. 14 Cardiology Example (Year 1) The Planning Committee identified three initial clinical problems to be addressed: 1. The ability to view an ECG from many locations - quickly and easily 2. Lab systems integration of patient, order, and procedure information in an Echo Lab, including mobile echo 3. Lab systems integration of patient, order, and procedure information in a Cath Lab, including angio, hemo, and IVUS ► “Retrieve ECG for Display” ► “Echocardiography Workflow” ► “Cardiac Catheterization Workflow”

15. 15 IHE Annual Cycle 1.Clinicians identify clinical problems to be addressed -“Integration Profiles” 2.Engineers from vendors collaborate to define technical specification (using existing standards such as DICOM and HL7) 3.Vendors implement the technical specification and participate in the “Connectathon” 4.Demonstrations at trade shows (ACC, HIMSS, etc.) 5.Vendors publish IHE Integration Statements 6.Customers reference IHE profiles in RFP’s

16. 16 IHE Technical Frameworks Detailed standards implementation guides:   Cardiology   IT Infrastructure   Lab   Radiology   Eye Care   Patient Care Coordination   Patient Care Devices

17. 17 Organization of Frameworks 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

18. 18 Transactions & Actors: Example Encapsulated Report Retrieve [CARD-11] Encapsulated Report Report Repository Report Manager Enterprise Report Repository Encapsulated Report Query Encapsulated Report Retrieve Report Reader Report Creator Encapsulated Report Storage Commitment Retrieve Document for Display Information Source Report Reference Web Display Patient Demographics Source Patient Identity Feed Patient Demographics Consumer Dept Scheduler / Order Filler Encapsulated Report or Report Completion Notify

19. 19 IHE Annual Cycle 1.Clinicians identify clinical problems to be addressed -“Integration Profiles” 2.Engineers from vendors collaborate to define technical specification (using existing standards such as DICOM and HL7) 3.Vendors implement the technical specification and participate in the “Connectathon” 4.Demonstrations at trade shows (ACC, HIMSS, etc.) 5.Vendors publish IHE Integration Statements 6.Customers reference IHE profiles in RFP’s

20. 20 IHE Connectathon Open invitation to vendor community Advance testing tools (MESA) Testing organized and supervised by project management team Thousands of cross-vendor tests performed Results recorded and published

21. 21 IHE Connectathon, January 2007 165 systems from 79 vendors, 3500 monitored test cases Workflow: Cath (22) and Echo (20) Evidence Documents (measurement interchange): 13 Nuclear Cardiology: 12 Stress Testing Workflow: 15 Retrieve ECG for Display: 5 Cross Enterprise Document Sharing (XDS): 45

22. 22 IHE Connectathon

23. 23 Looks like it’s working just fine! Egad! They’ve totally misunderstood the Technical Framework! Ohmagawd – we’re next!

24. 24 IHE Annual Cycle 1.Clinicians identify clinical problems to be addressed -“Integration Profiles” 2.Engineers from vendors collaborate to define technical specification (using existing standards such as DICOM and HL7) 3.Vendors implement the technical specification and participate in the “Connectathon” 4.Demonstrations at trade shows (ACC, HIMSS, etc.) 5.Vendors publish IHE Integration Statements 6.Customers reference IHE profiles in RFP’s

25. 25 Total ACC attendance is typically over 28,000.

26. 26 2005: Over 1,000 visitors from 47 countries attended the IHE presentations and demonstrations.

27. 27 IHE Annual Cycle 1.Clinicians identify clinical problems to be addressed -“Integration Profiles” 2.Engineers from vendors collaborate to define technical specification (using existing standards such as DICOM and HL7) 3.Vendors implement the technical specification and participate in the “Connectathon” 4.Demonstrations at trade shows (ACC, HIMSS, etc.) 5.Vendors publish IHE Integration Statements 6.Customers reference IHE profiles in RFP’s

28. 28 IHE Integration Statement

29. 29 IHE Annual Cycle 1.Clinicians identify clinical problems to be addressed -“Integration Profiles” 2.Engineers from vendors collaborate to define technical specification (using existing standards such as DICOM and HL7) 3.Vendors implement the technical specification and participate in the “Connectathon” 4.Demonstrations at trade shows (ACC, HIMSS, etc.) 5.Vendors publish IHE Integration Statements 6.Customers reference IHE profiles in RFP’s

30. 30 RFPs & IHE Integration Be Brief: “The system must support DICOM” “The system must support DICOM” Be Effective: “The system must support the following DICOM services (see following 100 pages of specs)” “The system must support the following DICOM services (see following 100 pages of specs)” Be Both: “The system must support IHE Scheduled Workflow as an Acquisition Modality” “The system must support IHE Scheduled Workflow as an Acquisition Modality” IHE Integration Statements: “Version 2.1 of the Acme RoadRunner Trap supports IHE Scheduled Workflow as an Acquisition Modality” “Version 2.1 of the Acme RoadRunner Trap supports IHE Scheduled Workflow as an Acquisition Modality”

31. 31 Request for Proposals (RFPs) Incorporate IHE framework into RFP documents & product selection Much easier to specify an IHE Integration Profile than detailed technical specs  “Device must support IHE Echo Integration Profile, and vendor must supply an IHE Integration Statement.” Use IHE framework to evaluate your current workflow, even if not buying now Vendors build product functions that are requested by customers Ask for IHE Integration Loud & Often !!

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