1. September, 2005What IHE Delivers Charles Parisot, GE healthcare International HL7 Interoperability Conference, Auckland, New Zealand Overview of Integrating the Healthcare Enterprise (IHE) and Cross-Enterprise Document Sharing (XDS)

2. 1 Presentation Objectives Standards adoption and implementation – The IHE process Application to a hospital project Application to regional and national Health Information Exchange World-wide deployment of IHE IT Infrastructure Profiles

3. 2 IHE: A Framework for Interoperability A common framework for harmonizing the use, implementing and testing multiple standards Enables seamless health information movement within and between enterprises, regions, nations Promotes unbiased selection and coordinated use of established healthcare and IT standards to address specific clinical and administrative needs at the international and country levels: HL7, DICOM, W3C, ISO, IEEE, SNOMED, LOINC, ASTM, OASIS, IETF, CDISC, CEN, ECMA, WHO, ETSI, and many more, etc. HL7, DICOM, W3C, ISO, IEEE, SNOMED, LOINC, ASTM, OASIS, IETF, CDISC, CEN, ECMA, WHO, ETSI, and many more, etc.

4. 3 Standards Adoption Process Document Use Case Requirements Identify available standards ( e.g. HL7, DICOM, IETF, OASIS) Develop technical specifications Testing at Connectathons IHE Demonstrations Products with IHE Timely access to information Easy to integrate products

5. 4 IHE Participants and Relationships Sponsorship: Healthcare Professional Organizations Open World-wide - Participants include: Users - Clinicians, Staff, Administrators, CIOs, Governments. Users - Clinicians, Staff, Administrators, CIOs, Governments. Vendors - Information Systems and Equipment Vendors - Information Systems and Equipment e.g., EMR/EHR, imaging, cardiology, devices e.g., EMR/EHR, imaging, cardiology, devices Consultants Consultants Maintains formal liaison with Standards Development Organizations (SDOs): HL7, DICOM, ISO (Liaison D), others HL7, DICOM, ISO (Liaison D), others ISO TC215 approved IHE Process and Profiles to be published as technical reports

6. 5 IHE Organizational Structure ACC ACP HIMSS RSNA JAHIS JIRA JRS METI-MLHW MEDIS-DC JAMI GMSIH SFR SFIL SIRM BIR EuroRec COCIR EAR-ECR DRG ESC Professional Societies / Sponsors Contributing & Participating Vendors IHE (International) Strategic Development Committee Global Development Radiology Cardiology IT Infrastructure Patient Care Coordination Patient Care Devices Laboratory Pathology Eye care, Quality, etc. Radiation Oncology IHE Europe IHE North America France USA Canada IHE Asia Japan KoreaTaiwan Netherlands Spain Sweden UK Italy Germany Norway Regional Deployment China IHE Pacific ? New Zealand ?Australia ?

7. 6 International Adoption of IHE France Local Deployment National Extensions (Local Adaptions) Promotional & Live Demonstration Events Conformance Testing USAGermanyItalyJapanUKCanadaKoreaTaiwan Norway HollandSpainChina Year 1 (1999) Year 2 (2000) Year 3 (2001) Year 4 (2002) Year 5 (2003) Year 6 (2004) Year 7 (2005) Year 8 (2006) Pragmatic global standards harmonization + best practices sharing

8. 7 Standards: Necessary…Not Sufficient Standards are Foundational - to interoperability and communications Foundational - to interoperability and communications Broad - varying interpretations and implementations Broad - varying interpretations and implementations Narrow - may not consider relationships between standards domains Narrow - may not consider relationships between standards domains Plentiful - often redundant or disjointed Plentiful - often redundant or disjointed Focused - standards implementation guides focus only on a single standard Focused - standards implementation guides focus only on a single standard IHE provides a standard process for implementing multiple standards

9. 8 IHE: Connecting Standards to Care Healthcare professionals work with industry Coordinate implementation of standards to meet clinical and administrative needs Clinicians and HIT professionals identify the key interoperability problems they face Clinicians and HIT professionals identify the key interoperability problems they face Providers and industry work together to develop and make available standards-based solutions Providers and industry work together to develop and make available standards-based solutions Implementers follow common guidelines in purchasing and integrating effective systems Implementers follow common guidelines in purchasing and integrating effective systems IHE: A forum for agreeing on how to implement standards and processes for making it happen

10. 9 IHE Connectathons Connectathons 2007: 430 engineers, 80+ organizations, 160+ systems and applications ….integrated in 5 days Vendors do not pass… until an IHE Project Manager attest it !

11. 10 Stakeholder Benefits Healthcare providers and support staff Improved workflows Improved workflows Information whenever and wherever needed Information whenever and wherever needed Fewer opportunities for errors Fewer opportunities for errors Fewer tedious tasks/repeated work Fewer tedious tasks/repeated work Improved report turnaround time Improved report turnaround timeVendors Align product interoperability with industry consensus Align product interoperability with industry consensus Decreased cost and complexity of interface installation and management Decreased cost and complexity of interface installation and management Focus competition on functionality/service space not information transport space Focus competition on functionality/service space not information transport spaceSDOs Rapid feedback to adjust standards to real-world Rapid feedback to adjust standards to real-world Establishment of critical mass and widespread adoption Establishment of critical mass and widespread adoption

12. 11 Growth in IHE Domains Radiology (18) IT Infrastructure for Healthcare (17) Cardiology (7) Laboratory (6) Radiation Oncology (1) Patient Care Coordination (5) Patient Care Devices (1) Quality Eye Care (3) Veterinary Endoscopy Pharmacy IHE Global Developments Integration Profiles (# X) – Solutions to Real-World Interoperability Needs & Problems: Within Clinical Departments e.g.: Within Clinical Departments e.g.: Radiology Radiology Cardiology Cardiology Lab Lab...... Across Departmental & Institutional Boundaries – XDS Across Departmental & Institutional Boundaries – XDS RHIOs (Regional Healthcare Information Organizations) RHIOs (Regional Healthcare Information Organizations) EHR Enablers EHR Enablers Year 1 (1999)Year 2 (2000)Year 3 (2001) Year 4 (2002) Year 5 (2003)Year 6 (2004) Year 7 (2005) Year 8 (2006)Year 9 (2007) Pathology (1)

13. 12 Presentation Objectives Standards adoption and implementation – The IHE process Application to a hospital project: Two examples,: devices and radiology Two examples,: devices and radiology Application to regional and national Health Information Exchange World-wide deployment of IHE IT Infrastructure Profiles

14. 13 IHE PCD Technical Framework Volume1 Integration Profiles

15. 14 IHE PCD Technical Framework Volume 2 Transactions

16. 15 Device Enterprise Communication (DEC) Profile

17. 16 DEC Profile Mapping Model Periodic physiologic data (heart rate, invasive blood pressure, respiration rate, etc.), A-periodic physiologic data (non-invasive blood pressure, patient weight, cardiac output, etc.) Point-of-care laboratory tests (i.e. home blood glucose, etc.) May include contextual data such as the patient ID, caregiver identification, and patient care device configuration information

18. 17 DEC Profile Mapping Model ISO/IEEE 11073 Domain Information Model and Nomenclature mapped to HL7 Observation Report ISO/IEEE 11073 Data Types mapped to HL7 Data Types Mapping preserves measurement context for complex devices.

19. 18 Measurement Context is Dynamic

20. 19 IEEE 11073 Domain Information Model Defines Device Context 1 0..n0..n

21. 20 Mapping preserves measurement context

22. 21 Example PCD-01 Message MSH|^~\&|INFO_SRC_PHILIPS^ACDE48234567ABCD^EUI-64||||20061215153500||ORU^R01^ORU_R01|PMS116621490051| P|2.5|||NE|AL||8859/1 PID|||AB60001^^^Philips Medical^PI||Brooks^Albert^^^^^L||19610101|M PV1||I|UNIT_1^^Bed1 OBR|1|PMS116621490051^INFO_SRC_PHILIPS^ACDE48234567ABCD^EUI-64| PMS116621490051^INFO_SRC_PHILIPS^ACDE48234567ABCD^EUI-64| 69837^MDC_DEV_METER_PHYSIO_MULTI_PARAM_MDS^MDC|||20061215153500 OBX|1|ST|184326^MDC_ECG_STAT_ECT^MDC|1.5130.1.184326|""||||||F OBX|2|ST|184327^MDC_ECG_STAT_RHY^MDC|1.5130.1.184327|Sinus Rhythm||||||F OBX|3|NM|150456^MDC_PULS_OXIM_SAT_O2^MDC|1.5238.1.150456|99|262688^MDC_DIM_PERCENT^MDC|||||F OBX|4|NM|147842^MDC_ECG_HEART_RATE^MDC|1.5130.1.147842|81|264864^MDC_DIM_BEAT_PER_MIN^MDC|||||F OBX|5|NM|150037^MDC_PRESS_BLD_ART_ABP_SYS^MDC|1.5190.1.150036|126|266016^MDC_DIM_MMHG^MDC|||||F OBX|6|NM|150038^MDC_PRESS_BLD_ART_ABP_DIA^MDC|1.5190.1.150036|76|266016^MDC_DIM_MMHG^MDC|||||F OBX|7|NM|150039^MDC_PRESS_BLD_ART_ABP_MEAN^MDC|1.5190.1.150036|92|266016^MDC_DIM_MMHG^MDC|||||F OBX|8|NM|148065^MDC_ECG_V_P_C_CNT^MDC|1.5130.1.148065|0|264864^MDC_DIM_BEAT_PER_MIN^MDC|||||F OBX|9|NM|150045^MDC_PRESS_BLD_ART_PULM_SYS^MDC|1.5190.1.150044|26|266016^MDC_DIM_MMHG^MDC|||||F OBX|10|NM|150046^MDC_PRESS_BLD_ART_PULM_DIA^MDC|1.5190.1.150044|9|266016^MDC_DIM_MMHG^MDC|||||F OBX|11|NM|150047^MDC_PRESS_BLD_ART_PULM_MEAN^MDC|1.5190.1.150044|14|266016^MDC_DIM_MMHG^MDC|||||F OBX|12|NM|149538^MDC_PLETH_PULS_RATE^MDC|1.5238.1.149538|55|264864^MDC_DIM_BEAT_PER_MIN^MDC|||||F OBX|13|NM|150067^MDC_PRESS_BLD_ATR_LEFT_MEAN^MDC|1.5190.1.150064|4|266016^MDC_DIM_MMHG^MDC|||||F OBX|14|NM|150087^MDC_PRESS_BLD_VEN_CENT_MEAN^MDC|1.5190.1.150084|12|266016^MDC_DIM_MMHG^MDC|||||F

23. 22 IHE PCD - US 2007 Connectathon Systems LiveData OR Mgr GE Centricity Periop CIS Philips CareVue CIS DOR DOC ADT A04 Feed MWB Draeger Innovian CIS GE Aware GW Philips IIC GW B. Braun DoseTrac GW Welch Allyn Connex CIS Validated VS, Vent, Anesth & Med Export, max every 3 minutes Validated Vitals export, Batch Unvalidated VS, Vent, Anesth. Data export every 1 minute VS Mon Pt Mon, Vent, Anesthesia Pt Mon, Vent, Anesthesia Pt Mon, Vent, Anesthesia Infusion Devices CT (Time) Feed Philips CareVue CIS Pt Mon, Vent, Anesthesia Validated VS, Vent, Anesth & Med Export, max every 5 minutes Unvalidated Med (Infusion System) exported every 1 minute

24. 23 Radiology Scheduled Workflow: Use Case 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

25. 24 To find IHE Profiles: www.ihe.net /technical_frameworks Radiology (18) IT Infrastructure for Healthcare (17) Cardiology (7) Laboratory (6) Radiation Oncology (1) Patient Care Coordination (5) Patient Care Devices (1) Quality Eye Care (3) Veterinary Endoscopy Pharmacy IHE Global Developments Over 60 Integration and content Profiles (# X) Solutions to Real-World Interoperability Needs & Problems: Within Clinical Departments e.g.: Within Clinical Departments e.g.: Radiology Radiology Cardiology Cardiology Lab Lab...... Across Departmental & Institutional Boundaries – XDS Across Departmental & Institutional Boundaries – XDS RHIOs (Regional Healthcare Information Organizations) RHIOs (Regional Healthcare Information Organizations) EHR Enablers EHR Enablers Year 1 (1999)Year 2 (2000)Year 3 (2001) Year 4 (2002) Year 5 (2003)Year 6 (2004) Year 7 (2005) Year 8 (2006)Year 9 (2007) Pathology (1)

26. 25 Presentation Objectives Standards adoption and implementation – The IHE process Application to a hospital project Application to regional and national Health Information Exchange World-wide deployment of IHE IT Infrastructure Profiles

27. 26 Health Information Exchanges: Linking diverse Care Delivery and Personal Health Records Health Information Exchange Hospital Group Integrated Care Delivery EMRs Hospital Group Hospital Multi- Practitioner Clinics Physician Offices Lab/pathology Radiology Pharmacy Personal Health Record Specific Registries

28. 27 Roles of Integrated Care Delivery EMRs and Health Information Exchanges Integrated Care Delivery EMR: Serves one care delivery organization or a set of closely integrated organizations. Cohesive practice and IT strategy Strong emphasis on advanced clinical decision support and tight care delivery workflows Typical: in-patient, hospital groups, affiliated clinics, a GP/PCP office. Health Information Exchange (HIE): Serves multiple independent care delivery organizations Loosely coordinated IT strategy Strong emphasis on care coordination, longitudinal health information, access to specific services (referral, diagnosis, etc.), personal health management. Typical: from the small community (hospitals+nearby GPs and clinics) to the specialized, regional and national health information network

29. 28 Integrated Care Delivery EHR: A centralized Clinical Data Repository with a fine grained health information data model shared over the entire organization. A rich set of applications delivering the value of the CDR, with: clinical decision support consistent with CDR data models. Proactive workflows, care plans. Applications and CDR must evolve together. Health Information Exchange (HIE): Shared clinical data should be managed both centralized and distributed to account for organizations with different operational constraints. Level of structure and coding in the shared data will lag some of the Care Delivery EHRs (span of standardization, installed base). Longitudinal record consistency and depth, trust by source attestation drives encapsulation of encounter/service clinical data into documents. Cost, ease of evolution and robustness of shared infrastructure best served with Document Repository/Registry. Integrated Care Delivery EHRs and HIEs Why different but synergistic IT architecture approaches ?

30. 29 Interoperability Dimensions for Health Info Nets Interoperability Dimensions for Health Info NetsSecurityPrivacy Id Mgt Health Records Sharing WorkflowTransactionsDynamicQueries Content Infrastructure From EHR Vendor Association Interop Roadmap: www.ehrva.org Immunization History Medication History Examples:ePrescription Laboratory Order/Results Examples: Care Record Service Examples: Immunization Queries Medication History

31. 30 Interoperability Dimensions for Health Info Nets Interoperability Dimensions for Health Info NetsSecurityPrivacy Id Mgt Health Records Sharing WorkflowTransactionsDynamicQueries Content Infrastructure IT HC From EHR Vendor Association Interop Roadmap: www.ehrva.org

32. 31 DocumentSource DocumentSource Document Registry/Repository Model: Document Repository Submit Doc Meta-data + References Submit Documents Document Repository Submit Doc Meta-data + ReferencesDocumentRegistry Retrieve Documents Query for Docs References DocumentConsumer Retrieve Documents

33. 32 Health Information Exchanges Interoperability: Cross-enterprise Document Sharing Performance, Scalability and Cost: Registry and Repository are simple Content Evolution: Registry and Repositories support any document content (e.g. enable use of HL7 CDA, DICOM, PDF, etc.). Real end-to-end structured data: not a portal view, easy to integrate in applications Supports centralized and distributed approaches. XDS Domains may be federated. Real Interoperability: Standards and profiles in place and in use Products are available: over 100 vendors world-wide. Tested at IHE Connectathons. Selected by a significant number of regional and national programs

34. 33 Example: Providing Access to Prior Health Information Acute Care (Inpatient) PCPs and Clinics (Ambulatory) Long Term Care Other Specialized Care or Diagnostics Services Shared Document Repository Longitudinal Record as used across-encounters Encounter Medical Summary (med-prescribed & dispensed, allergies, pbs, etc) Lab Report (structured & coded tests results) Radiology Report and Images Links EKG Report Public Health

35. 34 IHE Profiles for Health Info Nets Leverages HL7 V2 and V3 SecurityPrivacy Id Mgt RecordSharingWorkflowTransactionsDynamicQueries Doc Sharing Doc Sharing X-Community X-Community Pt-Pt Doc Trf Pt-Pt Doc Trf Media Interchange Media Interchange Query Existing Data (med, allegies, immunizations, etc.) Query Existing Data (med, allegies, immunizations, etc.) Patient Id X-ref Patient Id X-ref Patient Demogra phics Query Patient Demogra phics Query Consent Mgt Consent Mgt Digit Sign Docs Digit Sign Docs Audit Trail-Node Authentic ation Audit Trail-Node Authentic ation User Authentic ation User Authentic ation Scanned Doc Scanned Doc Imaging Imaging Lab Reports Lab Reports Med Summary Med Summary Personal Record Extract Personal Record Extract Emergency Record Emergency Record Etc… Etc… Content Infrastructure Request Form for Data capture Request Form for Data capture HL7 V3 CDA HL7 V3 (and V2) Messages

36. 35 Doc Exchange Integration Profiles Key Profiles for Document Content and Exchange Doc Content Profiles Doc Sharing XDS Media Interchange XDM Pt-Pt Doc Interchange XDR ConsentBPPCEmergencyEDER Pre Surgery PPHP Scanned Doc XDS-SD LaboratoryXD*-Lab PHR Exchange XPHR Discharge & Referrals XDS-MSImagingXDS-I

37. 36 IHE Patient Care Coordination A family of HL7 V3 CDA-based documents content profiles Referral Summary Specification

38. 37 IHE Patient Care Coordination A family of HL7 V3 CDA-based documents content profiles Current Meds

39. 38 IHE Patient Care Coordination A family of HL7 V3 CDA-based documents content profiles

40. 39 IHE Patient Care Coordination A family of HL7 V3 CDA-based documents content profiles

41. 40 IHE Patient Care Coordination A family of HL7 V3 CDA-based documents content profiles Medications

42. 41 IHE Patient Care Coordination A family of HL7 V3 CDA-based documents content profiles

43. 42 IHE Profiles for Health Info Nets Common use of SOA & Web Services SecurityPrivacy Id Mgt RecordSharingWorkflowTransactionsDynamicQueries Doc Sharing Doc Sharing X-Community X-Community Pt-Pt Doc Trf Pt-Pt Doc Trf Media Interchange Media Interchange Query Existing Data (med, allegies, immunizations, etc.) Query Existing Data (med, allegies, immunizations, etc.) PIX PIX PDQ PDQ Consent Mgt Consent Mgt Digit Sign Docs Digit Sign Docs Audit Trail-Node Authentic ation Audit Trail-Node Authentic ation User Authentic ation User Authentic ation Scanned Doc Scanned Doc Imaging Imaging Lab Reports Lab Reports Med Summary Med Summary Personal Record Extract Personal Record Extract Emergency Record Emergency Record Etc… Etc… Content Infrastructure Request Form for Data capture Request Form for Data capture Web Services - SOA Introduced in 2007: XDS.b, XCA, XDR, PIX/PDQ V3, QED, RFP, XUA

44. 43 IHE-XDS The Legs of HL7 CDA The semantic power of CDA runs on top of XDS Doc content independent Evolution A web service/SOA approach (improved with XDS.b) Either distributed or centralized High performance and scales upward Account fot the healthcare specifics sharing workflow Support records sharing and shared records

45. 44 IHE-XDS Infrastructure Components Audit Record Repository (ATNA) – Receive audit records from other actors and securely store for audit purposes. ATNA also authenticates peer-nodes and encrypt communications. Time Server (CT) – Provides consistent definition of date/time enabling time synchronization across multiple systems. Enables events associated with patients to be sorted reliably in chronological order. Document Registry (XDS) – Queryable index of metadata and references to all documents shared within a connected community (XDS Affinity Domain) Document Repository (XDS) – Supports storage and retrieval of clinical information (as documents). May be centralized or distributed. Patient Identifier Cross Reference Manager (PIX) – Reconciles information on patients from multiple domains to a single, cross referenced set of IDs for each given patient. Patient Demographics Supplier (PDQ) – Returns demographic information and identifiers for patients based on specified demographic criteria.

46. 45 Community Clinic Lab Info. System PACS Teaching Hospital PACS ED Application EHR System Physician Office EHR System XDS Scenario + use of ATNA & CT PMS Retrieve Document Register Document Query Document XDS Document Registry ATNA Audit record repository CT Time server Record Audit Event MaintainTime MaintainTime Event Maintain Time Provide & Register Docs Record Audit Event XDS Document Repository Secured Messaging

47. 46 Community Clinic Lab Info. System PACS Teaching Hospital PACS ED Application EHR System Physician Office EHR System XDS Scenario + use of PIX & PDQ A87631 PACS L-716 Affinity Domain Patient Identity Source M8354673993 Retrieve Document Provide & Register Docs Register (using Pt ID)Query Document (using Pt Id) Patient Identity Feed Document Registry 14355 M8354673993 L-716 A87631 Patient Identity Feed PIX Query PIX Query Patient Identity Feed Patient Identity XRef Mgr Patient Identity Feed PDQ Query to Acquire Affinity Domain Patient ID M8354673993 A87631 L-716 M8354673993 XDS Document Repository XDS Document Repository ATNA Audit record repository CT Time server

48. 47 Regional Network B Acute Care (Inpatient) PCPs and Clinics (Ambulatory) Long Term Care Other Specialized Care or Diagnostics Services Document Registry Document Repository Longitudinal Record as used across-encounters Regional Network C Acute Care (Inpatient) PCPs and Clinics (Ambulatory) Long Term Care Other Specialized Care or Diagnostics Services Document Registry Document Repository Longitudinal Record as used across-encounters Regional Network A Acute Care (Inpatient) PCPs and Clinics (Ambulatory) Long Term Care Other Specialized Care or Diagnostics Services Document Registry Document Repository Longitudinal Record as used across-encounters Hierarchical Exchange From Cross Community Information Exchange White Paper Cross Community Bridge Which community holds records for a patient ? Cross Community Bridge Bridge Community Locator service Each region notifies Community Location Service when new patient is registered or first data is stored. Each region notifies Community Location Service when new patient is registered or first data is stored. Cross Community Bridges query Community Locator Service (future) Cross Community Bridges query Community Locator Service (future) Cross-Community Bridges query and retrieve records (2007 & future) Cross-Community Bridges query and retrieve records (2007 & future) IHE XCA Transactions

49. 48 Presentation Objectives Standards adoption and implementation – The IHE process Application to a hospital project: Application to regional and national Health Information Exchange World-wide deployment of IHE IT Infrastructure Profiles

50. 49 IHE, the only sets of harmonized global standards already adopted by several national & regional projects Quebec, Toronto, Alberta, British Columbia Canada Infoway Denmark (Funen) Italy (Veneto) Spain (Aragon) Austria THINC- New York NCHICA – N. Carolina Italy (Conto Corrente Salute) MA-Share – MA France DMP UK CfH (Radiology WF) Philadelphia HIE CHINA-MoH Lab results sharing State Project – NY CHINA-Shangai Imaging Info Sharing JAPAN-Nogaya Imaging Info Sharing

51. 50 Committed National Programs: IHE XDS, PIX, PDQ, ATNA, CT, etc. Austria Lower Austria Region: live since end of 2006, 1.5 Million Patients, Entire Country by 2008. Italy 4 regional projects. Genoa region, live since early 2006. National deployment planned. Canada 7 regional projects coordinated by Infoway. Scheduled to go on-line in 2008. France Implementation tender to be awarded in September 2007. USA IHE Profiles adopted formally.Several regional projects: VT, NC, CareSpark, Geisinger, Philiadelphia HIE, CT, etc. Netherlands Amsterdam region network project launched with NICTIZ. Implementation early 2008. Japan One implemented project. One pilot to be launched in 2007. China: MoH selected XDS and XD*-Lab (CDA) for two large pilots. XDS-I in Shangai. Sweden Gotteborg region network project launched in 2006

52. 51 Broad Industry Adoption: HIMSS 2007 Over 200 vendors world-wide

53. 52 Stakeholders Working Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings http://www.ihe.net

54. 53 More Resources - www.ihe.net www.ihe.net Frequently Asked Questions Integration Profiles in Technical Frameworks: Cardiology Cardiology IT Infrastructure IT Infrastructure Laboratory Laboratory Patient Care Coordination Patient Care Coordination Patient Care Devices Patient Care Devices Radiation Oncology Radiation Oncology Radiology Radiology Connectathon Results Vendor Products Integration Statements Participation in Committees and Connectathons

55. September, 2005What IHE Delivers