1. September, 2005What IHE Delivers 1 Purchasing & Integrating Radiology Systems Using IHE: A Tutorial & A Real-world Case Kevin ODonnell, Toshiba Medical Systems Co-chair, IHE Radiology Planning Cmte

2. 2 Integrating the Healthcare Enterprise IHE facilitates integrating systems for efficient, accurate patient care Systems that support IHE Integration Profiles: communicate better & integrate more easily communicate better & integrate more easily provide more complete and accurate information provide more complete and accurate information better support care providers workflow better support care providers workflow Each IHE Profile describes a clinical information need or workflow scenario describes a clinical information need or workflow scenario documents how to use standards (e.g. HL7, DICOM,...) to accomplish it documents how to use standards (e.g. HL7, DICOM,...) to accomplish it Systems that implement the same Profile address a need in a mutually compatible way Hundreds of products support one or more IHE Radiology Profiles.

3. 3 Your Three Step Program Select Specific IHE Profiles List those Profiles in your RFP Check Vendors IHE Integration Statements

4. 4 Selecting IHE Profiles Review the Profiles : What they do Benefits for your situation Some Helpful Resources: IHE Users Handbook - Radiology RSNA Demonstrations Educational Material (e.g. Workshop Presentations) IHE Technical Framework – Radiology Connectathon Results www.ihe.net

5. 5 RFPs Be Brief? The system must support DICOM The system must support DICOM Be Effective? The system must support the following DICOM services according to the following 100 pages of specifications: … The system must support the following DICOM services according to the following 100 pages of specifications: … Be Both: The system must support the IHE Scheduled Workflow Profile as the Acquisition Modality actor. The system must support the IHE Scheduled Workflow Profile as the Acquisition Modality actor. Vendor IHE Integration Statements Version 2.1 of the CardioCT 5000 supports IHE Scheduled Workflow as an Acquisition Modality Version 2.1 of the CardioCT 5000 supports IHE Scheduled Workflow as an Acquisition Modality

6. 6 IHE Integration Statements Explicit claim by the vendor, for a specific product version Lists profiles, actors, options Short & Sweet

7. 7 IHE Integration Statement Date: 03/10/2006 VendorProduct NameVersion Acme Medical SystemsPACS-o-MaticV3.9 This product implements all transactions required to support the IHE Integration Profiles, Actors and Options listed below: Integration Profiles ImplementedActors ImplementedOptions Implemented Scheduled WorkflowImage Manager / Archive. PPS Exception Management Patient Information ReconciliationImage Manager / Archive. None Consistent Presentation of ImagesImage Manager / Archive Image Display None Portable Data for Imaging Media Creator Media Importer None Audit Trail and Node AuthenticationAudit Record RepositoryNone Internet address for vendor's IHE information : http://www.acme-medical.com/IHE Links to Standards Conformance Statements for the implementation Dicom: http://www.acme-medical.com/DICOM Health Level 7: http://www.acme-medical.com/HL7 Links to general information on IHE In North America : http://www.ihe.net In Europe : http://www.ihe-europe.org In Japan : http://www.jira-net.or.jp/ihe-j

8. 8 Lets look at an Example From the IHE Radiology Users Handbook Suppose youre buying a modality (Chapter 1) Suppose your integration plan has identified two key targets: Reducing/Preventing Errors Reducing/Preventing Errors Improving Throughput/Turnaround Improving Throughput/Turnaround Reviewing the Profile Benefits (Section 1.1.1): Scheduled Workflow Profile has a significant impact on both targets: Scheduled Workflow Profile has a significant impact on both targets: Prevents manual data entry errors & also saves time at the modality console by downloading patient demographics and study details from the RIS (MWL) Prevents manual data entry errors & also saves time at the modality console by downloading patient demographics and study details from the RIS (MWL) Prevents lost studies and time wasted re-scanning by confirming PACS receipt of images to avoid accidental deletion; And saves time spent doing it manually by doing it automatically and electronically (Storage Commitment) Reduces missing or irrelevant priors by storing a full set of accurate patient and study identifiers and details in each study object (Store) Reduces delays in the review/reporting process by notifying the RIS of exams in progress and completed (MPPS)

9. 9 IHE 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

10. 10 Using IHE You present IHE as an integration priority to your vendors. A Business goal ! You specify appropriate Profiles, Actors, Options in your RFP The system must support the IHE Scheduled Workflow Profile as the Acquisition Modality actor and support the Exception Management Option. The system must support the IHE Scheduled Workflow Profile as the Acquisition Modality actor and support the Exception Management Option. You request Integration Statements from your vendors You plan acceptance testing (Section 1.2.2)

11. 11 Dealing with Legacy Prepare to identify and address any legacy system issues (Section 1.2.4) Maximum benefit when all systems are IHE Most of you will have some non-compliant devices and systems Most of you will have some non-compliant devices and systems Make best effort to bring them up-to-date Make best effort to bring them up-to-date Incremental usage of IHE provides incremental benefit Its just clean DICOM and HL7 Its just clean DICOM and HL7 Get on the Yellow Brick Road... No sense buying New legacy equipment No sense buying New legacy equipment

12. 12 First Steps Visit IHE Profile Demonstrations Cross-Enterprise Document Sharing for Imaging [XDS-I] Cross-Enterprise Document Sharing for Imaging [XDS-I] Teaching File & Clinical Trial Export [TCE] Teaching File & Clinical Trial Export [TCE] Here in Inforad and in participating Vendor Booths Here in Inforad and in participating Vendor Booths Interoperability Showcase at HIMSS 2007 Interoperability Showcase at HIMSS 2007 Visit www.ihe.net - start learning about Profiles www.ihe.net Talk about an IHE strategy with your CIO / IT staff, and with your vendors Now, lets look at a Real-world Experience

13. September, 2005What IHE Delivers 13 Thames Valley Hospital Planning Partnership, London, Ontario Beth Goodhew Peninsula Consulting Group

14. 14 Thames Valley Hospital Planning Partnership 8 Corporations 2 in London (~75% volume) 2 in London (~75% volume) 6 Community Facilities 6 Community Facilities 750,000 Radiology exams annually >200 DICOM Connections ~65 Radiologists, ~10 Residents and Fellows, ~8 NucMed Physicians Infoway Sponsored Project to create the South Western Ontario Image Repository

15. 15 Project Vision Improved electronic access to Radiology images and reports to increase quality and timeliness of patient care through collaborative regional partnerships and to enhance the speed of treatment decisions.

16. 16 Clinical Architecture GE PACS CERNER POWERCHART RADNET CPI Diagnostic ClinicalWeb Community Billing Clinical User Primary Read Clinical User Dictation RadiologistTechnologist Registration LAB/PHARMACY Goal: Seamless Integration

17. 17 Benefits of IHE Improve Quality and Patient Safety Providing for positive transfer of information using non-proprietary methods Providing for positive transfer of information using non-proprietary methods Eliminating manual data entry Eliminating manual data entry Improve the efficiency and effectiveness of clinical practice by: Improved Information Flow Improved Information Flow Advanced Multi-System Functions Advanced Multi-System Functions Eliminate manual steps from common processes Eliminate manual steps from common processes Systems Integration Enabling the sharing of health information locally, regionally and nationally Enabling the sharing of health information locally, regionally and nationally

18. 18 Alignment of IHE and Project Vision Vision Improved electronic access to Radiology images and reports to increase quality and timeliness of patient care through collaborative regional partnerships and to enhance the speed of treatment decisions. IHE Benefits Improve Quality and Patient Safety Providing for positive transfer of information Providing for positive transfer of information Eliminating manual data entry Eliminating manual data entry Improve Efficiency Eliminate manual steps from common processes Eliminate manual steps from common processes Enable sharing of health information locally, regionally and nationally

19. 19 Drivers behind IHE Implementation StandardsConsistency Vendor Uniformity Patient Safety Quality Productivity

20. 20 Replication After one site is properly implemented Additional sites are configured, trained and brought live in a rapid fashion. IHE functionality is very scalable

21. 21 Rapid Roll-out of Successive Sites Q205Q105Q305Q405 FAST Alliance PACS Rollout STEG RIS Rollout PACS Rollout Strathroy PACS Rollout Ingersoll Community Hospital RIS/PACS STEG PACS Rollout Woodstock RIS Rollout Woodstock PACS Rollout PACS Rollout Tillsonburg Sept 30 Adoption Dec 31 Adoption June 30 Adoption PACS Rollout Newbury RIS Rollout Ingersol FAST Alliance RIS Rollout RIS Build for FAST Sites RIS Rollout Tillsonberg RIS Rollout Strathroy RIS Rollout Newbury July 31 Adoption Aug 30 Adoption Oct 31 Adoption DI-1 003.3 DI-1 003.4 DI-1 003.5 DI-1 003.6 DI-1 003.7 DI-1 003.8

22. 22 Profiles Implemented Scheduled Workflow (SWF) Patient Information Reconciliation (PIR) Consistent Presentation of Images (CPI) Charge Posting (CHG)

23. September, 2005What IHE Delivers 23 The more effort invested in examining, optimizing and streamlining workflow for IHE, The better the final result ActorsTransactions Expected Workflow Who owns it?

24. 24 Non-IHE Equipment Need coping strategies Need a clear plan of action for each device

25. September, 2005What IHE Delivers 25 Take Home Tip Salvation = (SWF + PIR)

26. 26