2. Integrating the Healthcare Enterprise IHE for Product Planers Ellie Avraham Kodak Health Group IHE Planning and Technical Committees member Co-Editor IHE Technical Framework

3. IHE Classroom Sessions – RSNA 2006 2 Learning Objectives Clinical and Economic benefits of Integration for your customers – IHE Radiology Users Handbook Improve Product Functionality by using the IHE Technical Framework Improve Integrated System Solutions Workflows by using IHE Integration Profiles IHE Success stories and other information to refine the Products Business case evaluation IHE Process to Synchronize it with the Product Planning & Development

4. IHE Classroom Sessions – RSNA 2006 3 Discussion Areas IHE Deployment Process IHE Integration Profiles The Value Proposition from Planning Products and Integrated Solutions using IHE

5. IHE Classroom Sessions – RSNA 2006 4 Integration Solutions Available Today from Several Medical Systems Vendors – BUT... Modern Healthcare Enterprises Are Still Confronted with Problems: (In Spite of IT Standards and Advanced Technology) – Lack of Access to Complete Medical Information – Inconsistent or Redundant Medical Information Across Departments and Institutions – Inadequate Communicating of Medical Data Across Multiple Systems from Different Vendors – Risky Investments in Proprietary Solutions – Clinical Workflows are not Optimized Challenges of Integration

6. IHE Classroom Sessions – RSNA 2006 5 IHE drives healthcare standards based-integration

7. IHE Classroom Sessions – RSNA 2006 6 IHE Process - Annual Cycle IHE Integration Profiles B IHE Integration Profile A Easy to Integrate Products IHE Connectathon Product With IHE IHE Demonstration User Site RFP Standards IHE Technical Framework Product IHE Integration Statement IHE Connectathon Results IHE Technical Framework – Define Standard Integration Solutions IHE Connectathon Results – Most implemented and tested IHE Solutions IHE Integration Statements – Most Comertialized IHE Solutions IHE Success Story – Most Successful Used IHE Solutions IHE Users Handbook – IHE Solutions, Economical and Clinical benefits

8. IHE Classroom Sessions – RSNA 2006 7 IHE Calendar Annual Events for Synchronization with Product Planning Feb. 2006 – IHE Supplements Profiles for Public Comment May – IHE Supplements Profiles for Trial Implementation Aug. – IHE Participation Workshop Sept. – IHE Participation Registration: Connectathon & Demos Oct. - IHE Vendor Workshop for the Connectathon Oct. – Nov. IHE MESA Testing Validations for Connectathon Nov. - RSNA – IHE Radiology Demo Jan. 2007 – IHE Connectathon Feb. 2007 – HIMSS IHE ITI Demo Mar. 2007– ACC IHE Cardiology Demo

9. IHE Classroom Sessions – RSNA 2006 8 Using IHE for Product Planning IHE Aid for Global / International Product Planning – IHE Technical Framework (TF) > Vol 1: Defines Global Integration Profiles > Vol 2,3: Defines the TF Transactions details for Development > Vol 4: Defines the Local National specialization details – IHE Connectathon Results – Learn what IHE solutions are developed – IHE User Success Stories & IHE Users Handbook – Learn the Clinical and Economic benefits of using products with IHE capabilities – IHE Integration Statements – The Commercialized products with IHE capabilities – RFPs from customers

10. IHE Classroom Sessions – RSNA 2006 9 IHE Connectathon Results http://www.ihe.net/Events/connectathon_results.cfm Consolidated Earlier Progress & Push for Market Adoption More Robust Connectathon – Results Recorded and Published Increased Industry Participation – 31 companies – 70 systems – 21 Additional Companies in IHE Europe

11. IHE Classroom Sessions – RSNA 2006 10 IHE User Success Story http://www.ihe.net/resources/user_success_stories.cfm Cleveland Clinic Foundation Detroit Medical Center Grossman Imaging Centers Hôpitaux Universitaires de Genèv IHE McKay-Dee Hospital Johannes Gutenberg University Hospital Magic Valley Regional Medical Center Mayo Clinic Jacksonville Our Lady Of The Lake Regional Medical Center (OLOL) VA Puget Sound Health Care System St. Vincent Hospital and Health Services Steinberg Diagnostic Medical Imaging University of Pisa University of Wisconsin

12. IHE Classroom Sessions – RSNA 2006 11 Deployment of IHE Profiles – Most Used: - Scheduled Workflow (SWF) - Patient Information Reconciliation (PIR) - Consistent Presentation of Images (CPI) - Reporting Workflow (RWF) - Basic Security for HIPAA regulations (ATNA) Clinical and Economics Accomplishments - Improve the Patient Care – Improved data accuracy and Safety, Image Quality & Consistency and time saving due to optimized Workflows and integrated systems - Improve the clinical practice productivity - reduced manual data entry using the ADT registration in one place and propagate it to all the other systems (PACS, RIS Modality) and reduced errors. - Optimize the Radiological Workflow (SWF) Reduced the incorrectly or lost studies, using DICOM MWL, MPPS IHE User Success Story & Handbook IHE User Success Story & Handbook

13. IHE Classroom Sessions – RSNA 2006 12 IHE Integration Statement http://www.ihe.net/resources/ihe_integration_statements.cfm IHE Integration Statements document the product IHE capabilities in terms of IHE: Actors and Integration Profiles. - Promote your products with the Integration Statements - Learn from other Vendors Integration Statements the IHE Profiles and Actors supported The RSNA links to IHE Integration Statements published by the companies: - Agfa HealthCare- Philips Medical Systems - Cerner Corporation- Sectra - Eastman Kodak Company- Siemens Medical Solutions - Emageon- Softmedical - Fujifilm Medical Systems USA- Stentor - GE Medical Systems- StorCOMM, Inc - INFINITT Co., Ltd.- Tiani Medgraph AG - McKesson Information Solutions- Toshiba America Medical Systems - Medcon- Voxar Limited

14. IHE Classroom Sessions – RSNA 2006 13 IHE Integration Statement Date 12 May 2006 VendorProduct NameVersion Any Medical Systems Co. IntegrateRADV2.3 This product implements all transactions required in the IHE Technical Framework to support the IHE Integration Profiles, Actors and Options listed below: Integration Profiles Implemented Actors ImplementedOptions Implemented Scheduled Workflow Image Manager/Image Archivenone Image Displaynone Internet address for vendors IHE information: www.anymedicalsystemsco.com/ihe Links to Standards Conformance Statements for the Implementation HL7 www.anymedicalsystemsco.com/hl7 DICOM www.anymedicalsystemsco.com/dicom/integrateRAD.pdf Links to general information on IHE North America: www.ihe.net In Europe: www.ihe-europe.orgIn Japan: www.jira- net.or.jp/ihe-j

15. IHE Classroom Sessions – RSNA 2006 14 IHE Technical Framework Organized in sections that provide an increasing level of detail Integration Profiles: in terms of Actors and communication transactions Actors: Identify specific kinds of operational participants in the healthcare enterprise. Integration Profiles: Defines a Problem and the Solution in terms of Actors and communication transactions Actors: Identify specific kinds of operational participants in the healthcare enterprise. IHE Foundation http://www.ihe.net/Technical_Framework/index.cfm Transactions: Describe particular interactions between actors to perform specific operations.

16. IHE Classroom Sessions – RSNA 2006 15 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 NM Image Cardiac NM Option Image Fusion

17. IHE Classroom Sessions – RSNA 2006 16 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 Scheduled Workflow Profile

18. IHE Classroom Sessions – RSNA 2006 17 Patient Information Reconciliation

19. IHE Classroom Sessions – RSNA 2006 18 Consistent Presentation of Images Reporting Radiologist Referring Physician or Reviewing Radiologist Presentation State Presentation LUT Grayscale Standard Original ImageWindow LevelFlip Zoom Area Of Interest Annotate Without Consistent Presentation Achieving Consistent Presentation Area Of Interest

20. IHE Classroom Sessions – RSNA 2006 19 Radiology Option for Audit Trail and Node Authentication (ATNA) Radiology Option for Audit Trail and Node Authentication (ATNA) System A System B Secured System Secure network TLS authentication of remote node (digital certificates) with/without encryption Secured System Audit PHI trail with: Real-time access Time synchronization Central Audit Trail Repository

21. IHE Classroom Sessions – RSNA 2006 20 MODALITY Presentation of Grouped Procedures Profile Requested Procedure: CHEST Report: CHEST Report: AB/PELVIS Performs a single exam Operator groups 2 procedures Chest View RIS / PACS Requested Procedure: AB/PELVIS Chest View Ab/Pelvis View

22. IHE Classroom Sessions – RSNA 2006 21 Portable Data for Imaging (PDI) Distribute Imaging Information on Media CD Creator Printer Image/ Report Display Media Importer John Doe CD

23. IHE Classroom Sessions – RSNA 2006 22 Document Consumer Retrieve Document Query Documents Patient Identity Source Patient Identity Feed Document Source Document Registry Document Repository Provide & Register Document Set Register Document Set Cross-enterprise Document Sharing for Imaging (XDS- I) Image Manager Image Archive Retrieve Images Retrieve Presentation States Retrieve Key Image Note Retrieve Evidence Documents WADO Retrieve

24. IHE Classroom Sessions – RSNA 2006 23 Simple Image & Numeric Reports Profile Simple Image & Numeric Reports Profile Images Retrieved Preliminary Report Verified Report Report & Images Retrieved Image Manager & Archive Report Verification Images and Exam data presented for diagnosis Reports stored for Network Access Report & Image Review for Patient Care

25. IHE Classroom Sessions – RSNA 2006 24 Radiologist Flags Images: Referring Physician Sees Key Images First: for refering physician This image shows the renal rupture. Note1 for refering physician This image has the hematoma. Note2 For referring physician: This image shows the renal rupture. Note1 For referring physician: This image has the hematoma. Note2 for refering physician This image shows the renal rupture. Note1 for refering physician This image has the hematoma. Note2 Study & Key Image Notes Key Image Notes Profile

26. IHE Classroom Sessions – RSNA 2006 25 Post-Processing Workflow Profile Post-Proc.WorkflowManager PACS System CAD *Workstation Report Repository Acquisition Modality 3-D *Workstation Work Status Worklist … Source Data Results Workstation Results Work Status

27. IHE Classroom Sessions – RSNA 2006 26 Charge Posting Profile ChargePoster *Billing System CAD *Workstation Report Repository … Report Generated / Signed CAD Performed Post Charges Acquisition Modality ADT Terminal 3-D *Workstation Account Management 3-D Performed Study Performed / Materials Used

28. IHE Classroom Sessions – RSNA 2006 27 IHE Reporting Workflow ReportingWorklist Work Item Claimed Retrieve Images & Evidence Documents Measurements CAD Reports ………………… Reporting Procedure Step STARTED Reporting Procedure Step STARTED StoreReports Reporting Procedure Step COMPLETED Reporting Procedure Step COMPLETED Report Manager RIS Image Manager/ Archive PACS & Archive Report Reader/Creator

29. IHE Classroom Sessions – RSNA 2006 28 IHE Value Proposition Product PlanningProduct Planning IHE Solutions are Driven by Strategic Healthcare Lead Users that collaborate with Healthcare VendorsIHE Solutions are Driven by Strategic Healthcare Lead Users that collaborate with Healthcare Vendors IHE Solutions are Generic, Reusable and Interoperable based on Healthcare Standards: DICOM, HL7, RFCIHE Solutions are Generic, Reusable and Interoperable based on Healthcare Standards: DICOM, HL7, RFC IHE Solutions Optimize the Clinical WorkflowsIHE Solutions Optimize the Clinical Workflows IHE Deployment process – Connectathon, Integration Statements and Users Success Stories information helps to refine the product Business CaseIHE Deployment process – Connectathon, Integration Statements and Users Success Stories information helps to refine the product Business Case IHE Technical Framework specification describes the Global IHE solutions at a High Level for Planning & Marketing and in details for products Architects and Engineering developmentIHE Technical Framework specification describes the Global IHE solutions at a High Level for Planning & Marketing and in details for products Architects and Engineering development

30. IHE Classroom Sessions – RSNA 2006 29 IHE Benefits Clinical UsersClinical Users Greater access to consistent informationGreater access to consistent information Fewer errors, fewer tedious tasksFewer errors, fewer tedious tasks AdministratorsAdministrators Increased throughput - Better schedulingIncreased throughput - Better scheduling Reduce CostReduce Cost BuyersBuyers Specify/purchase RFPs integration capabilities easily and Freedom to acquire Best of Breed systemsSpecify/purchase RFPs integration capabilities easily and Freedom to acquire Best of Breed systems IT ProfessionalsIT Professionals Faster, more predictable integration projectsFaster, more predictable integration projects Facilitate cooperation of competing vendorsFacilitate cooperation of competing vendors

31. IHE Classroom Sessions – RSNA 2006 30 Picking IHE Profiles Customer RFPs Product positioning in the market with a Good Business Case IHE Technical Framework Volume 1, Users Handbook Healthcare Institution Needs: > Optimized Clinical Workflow : SWF, PIR, RWF > Improve the Patient Health Care: SWF, PIR, CPI, PGP,KIN > Economy - Reduce Healthcare cost: SWF, CHG > Protect the Patient Health Information: SEC Considerations Considerations

32. IHE Classroom Sessions – RSNA 2006 31 IHE for Product Planers Questions? IHE North America:RSNA - http:// www.ihe.net HIMSS - http://www.himss.org/IHE ACC - http://www.acc.org/quality/ihe/ihe.htm IHE Europe:http://www.IHE-Europe.org IHE France:http://www.gmsih.fr/fr/som_comm.htm IHE Germany:http://www.IHE-D.org IHE Italy:http://www.rad.unipd.it/IHE IHE UK:http://www.IHE-UK-org IHE Japan:http://www.jira-net.or.jp/ihe-j/en/index.html