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

2. 1 Why Are Standards Important?

3. 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

4. 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 havent standards solved all of healthcares interoperability issues?

5. 4 ER The Standards Archipelago ADT/ HIS CIS EKG Cath Lab Lab OR RIS PACS Mods Pharm Islands of data across the healthcare enterprise HL7 2.4 DICOM POC Devices IEEE – POCT HL7 2.1 NCPDP Billing X12/ICD9 DICOM

6. 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

7. 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!

8. 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

9. 8 ACR-NEMA Becomes DICOM: c. 1992 Demonstrations drive awareness and demand for standards-based solutions

10. 9 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 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

11. 10 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)

12. 11 IHE Participants Societies Representing Healthcare Segments RSNA, HIMSS, ACC, ACCE, … Users Clinicians, Medical Staff, Administrators, CIOs, … Consultants Information Systems Vendors Imaging Systems Vendors Standards Development Organizations (SDOs) DICOM, HL7, ASTM, …

13. 12 IHE Deliverables Technical Framework Integration Profiles Connectathon Public Demonstrations Tools for Acquiring Conformant Products

14. 13 IHE Technical Frameworks Detailed standards implementation guides – Cardiology – IT Infra – Lab – Radiology

15. 14 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

16. 15 Organization of TFs

17. 16 IHE Radiology Integration Profiles Patient Info. Recon- ciliation Access to Radiology Information Consistent Present- ation of Images Basic Security - Evidence Docs Key Image Notes Simple Image & Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled Workflow Portable Data for Imaging NM Image

18. 17 ADT (Registration) Order Placer Order Filler Print Server Film Folder Image Manager & Archive Film Lightbox report Report Repository Image Display Modality acquisition in-progress acquisition completed images printed Acquisition Modality Example: IHE Scheduled Workflow

19. 18 IHE IT Infrastructure Integration Profiles Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Retrieve Information for Display Access a patients clinical information and documents in a format ready to be presented to the requesting user Retrieve Information for Display Access a patients clinical information and documents in a format ready to be presented to the requesting user Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains 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 Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications Consistent Time Coordinate time across networked systems Consistent Time Coordinate time across networked systems

20. 19 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

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23. 22 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

24. 23 Integration Statements

25. 24 RFP Toolkit

26. 25 RFP Toolkit

27. 26 IHE Radiology Activities New Supplements Media Distribution Profile NM Image Profile Departmental Workflow White Paper Report Export Extension Instance Availability Notification Transaction Appointment Notification Transaction www.rsna.org/ihe/ (Follow Link for Supp. & Forum)

28. 27 IHE IT Infrastructure Activities Finalizing Profile Candidates EHR (Electronic Healthcare Record) Registries Basic Security Profile Migration/Template DICOM Configuration (LDAP) Patient Demographics Query White Pages www.himss.org/ihe/

29. 28 New IHE Domains IHE Lab Initiated by IHE-Europe & IHE-Japan Lab Workflow Profile Released for Trial Implementation www.gmsih.fr/ihe IHE Cardiology Sponsored by ACC, ESC, GMSIH Finalizing Supplement Candidates Cath Lab Workflow Echo Workflow ECG Report Retrieval for Display

30. IHE expanding, more info. IHE Radiology www.rsna.org/ihe 12 Integration Profiles available IHE Connectathon for IT January 2004www.rsna.org/ihe IHE IT Infrastructure www.himss.org/ihe 5 Integration Profiles available IHE Connectathon for IT January 2004www.himss.org/ihe IHE Laboratory www.gmsih.fr/ihe Framework in Public Comment, feedback due Nov 15 th IHE Connectathon for Lab March 2004www.gmsih.fr/ihe IHE Cardiology Committed sponsorship by ACC, ESC, HIMSS. Kick Off December 2004 – First Demo ACC March 2005

31. 30 What can you do? Learn about IHE Participate in IHE planning Insist on IHE compliance in your RFPs and contract documents

32. 31 More information…. IHE Web sites: http://www.himss.org/IHE http://www.rsna.org/IHE http://www.acc.org/quality/ihe.htmhttp://www.acc.org/quality/ihe.htm. 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