1. Integrating the Healthcare Enterprise Margarita Zuley, M.D. Elizabeth Wende Breast Clinic Rochester, NY

2. What is IHE? Integrating the Healthcare Enterprise™ “A process that drives the use of existing standards to solve complex healthcare information processes that span multiple, heterogeneous information systems.”

3. Goal of IHE To ensure that all required information is correct and available to the medical professional for optimal patient care.

4. IHE Domain Sponsors Laboratory Domain Sponsors: GMSIH, JAHIS, SFIL Cardiology Domain Sponsor: ACC Assoc. Domain Sponsor: ASE IT Infrastructure Domain Sponsor: HIMSS Eye Care Domain Sponsor: AAO Patient Care Coordination Domain Sponsor: HIMSS Patient Care Devices Domain Sponsors: IEEE, ACCE Radiology Domain Sponsor: RSNA Associate Domain Sponsors: ASTRO, SNM

5. How Does IHE Work?  Defines components of the healthcare enterprise called ACTORS  Describes coordinated, standards based transactions that each actor has with all other actors  Integration Profiles are functional groups of these transactions that solve specific clinical needs

6. IHE Radiology Integration Profiles Patient Info. Recon- ciliation Access to Radiology Information Consistent Presentation of Images Audit Trail & Node Authentication - Radiology Option Evidence Docs Key Image Notes Simple Image & Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting XDS for Imaging NM Image Scheduled Workflow Teaching Files & Clinical Trials Export Portable Data for Imaging

7. Scheduled Workflow Profile Registration Orders Placed Orders Filled Film Folder Image Manager & Archive Film Lightbox report Report Repository Diagnostic Workstation Modality acquisition in-progress acquisition completed images printed Acquisition Modality

8. How do you use IHE?  Vendors implement Actors and Integration Profiles in their systems and test them at the annual Connectathon  Users specify Actors and Integration Profiles in RFPs when acquiring, upgrading or integrating systems

9. IHE Connectathon  Massive Cross-vendor Testing  One week; dozens of vendors; thousands of tests  Opportunity to find/resolve issues  Participation is Voluntary  Litmus test not a pre-requisite or certification  Engineering event  Huge Congregation of Engineering Talent  Project Management by Mallinckrodt  Pre-Validation Tools (MESA)  Defined Test Protocols with Verification

10. IHE Connectathon Managed by the IHE Sponsors

11. Connectathon Results  Published at www.ihe.net and www.ihe-europe.org www.ihe.netwww.ihe-europe.orgwww.ihe.netwww.ihe-europe.org  NOT Product Certification  Demonstration of Engineering Competence  Recent Connectathons  IHE-North America in January 2006 (Chicago, IL)  59 Vendors, 140 Systems, 300+ Engineers  IHE-Europe in April 2005 (Noordwijkerhout, Netherlands)  62 Vendors, 98 Systems, 230 Engineers  IHE-Japan Connectathon in January 2006 (Tokyo, Japan)  28 Vendors, 60 Systems

12. 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

13. IHE Web site: www.IHE.net  Frequently Asked Questions  Integration Profiles in Technical Frameworks:  Cardiology  IT Infrastructure  Laboratory  Patient Care Coordination  Radiology  Connectathon Results  Vendor Products Integration Statements  Participation in Committees & Connectathons

14. Vendor A FFDM Vendor A FFDM Breast MRI U/S Multi Modality Diagnostic Workstation Vendor A Diagnostic Workstation Vendor A Diagnostic Workstation Vendor B Diagnostic Workstation Vendor B Diagnostic Workstation Vendor C Diagnostic Workstation Vendor C Diagnostic Workstation Vendor C FFDM Vendor C FFDM Vendor B FFDM Vendor B FFDM System wide PACS System wide PACS Vendor A Mini PACS Vendor A Mini PACS Vendor B Mini PACS Vendor B Mini PACS Vendor C Mini PACS Vendor C Mini PACS

15. Ideal Configuration: Maintain Integrity

16. FFDM Problems  Content/Display Incompatibilities  Workflow Constraints

17. Content/Display Issues  Image Size  Image Orientation and Justification  Image Contrast Adjustment  Background Blackness Maintenance  Annotation of Identification and Technical Factor Information  Display of CAD Marks

18. Image Size

19. Image orientation

20. Annotations

21. Mammo IHE Timeline  June ’05 (SCAR) forum to discuss problems  July ‘05 IHE mammo group formed  Oct ‘05 1 st Draft of profile  RSNA ’05 Discuss time frame and most critical limitations  Jan ’06 Prelim testing at connect-a-thon  Jan ’06 Mammo Image Profile completed  Today 1 st display of components of the profile

22. Planned Timetable  Spring 06-Jan ’07  Vendors implement Mammography Image profile  Jan ’07  Official testing at connect-a-thon  April ’07 (SBI)  Public display of implementation

23. Mammography Workflow Profile  Spring ’06 White paper drafted  June ’06 –Jan ’07 Integration Profile written  Spring ’07 Profile finalized  Spring’07-Jan ’08 Vendors implement Profile  Jan ’08 Testing at connect-a-thon  Spring ’08 Public display

24. Why Does this take so Long?  Problems must be clearly defined  Many vendors must be willing to participate  Solutions can be complicated  Solutions need to work for everyone  The implementation is very labor intensive, time consuming, and costly for the vendors

25. RFPs  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 the IHE Echocardiography Workflow Profile as the Acquisition Modality actor.”  Request IHE Integration Statements  Version 2.1 of the SuperSono XT supports IHE Echocardiography Workflow as an Acquisition Modality

26. RFP  Itemize which options in each profile that you specifically want, or wish to exclude  Ask your vendor to commit to all of the IHE requirements agreed upon

27. RFP  Look at the user’s handbook prior to purchases  Do your homework and understand what each profile is giving you  Specify for each piece of equipment (actor) that you purchase, all IHE profiles you require  If the profiles are not yet implemented by the vendor, get a date of conformance

28. IHE Integration Statements  Explicit claim by the vendor, for a specific product version  Lists profiles, actors, options  Short & Sweet

29. User’s Handbook  Information to help in purchasing of digital equipment  Diagnostic Workstation  Modality  Understanding the IHE profiles and specifically what each offers for each piece of equipment  RFP template

30. FFDM Paradise   Any Image, anywhere intact, anytime.   Seamless integration from check-in to acquisition through archive   Standardization and guidelines for Quality Assurance   Protection of the integrity of the data