1. Integrating the Healthcare Enterprise
What Does IHE Offer?
30 MINUTE PRESENTATION
Attendees will get a basic overview of:
- What IHE is and who is doing it
- What IHE does for you (Integration Profiles)
- How IHE relates to HL7 and DICOM
- How to get IHE functions from your Vendors
Kevin O’Donnell, Toshiba Corp. Co-chair, IHE Radiology Planning Cmte

2. What Does IHE Offer? Systems Integration To achieve clinical goals
Using non-proprietary methods
Improve the efficiency and effectiveness of clinical practice by:
Improved Information Flow
Advanced Multi-System Functions
HIMSS/RSNA
SCAR 2003

3. acquisition completed acquisition in-progress acquisition completed
Scheduled Workflow Profile
Report
Repository
Registration
report
Diagnostic
Workstation
Film
Lightbox
Orders Placed
Image Manager
& Archive
Film
Folder
Specifies transactions that function to maintain the integrity of patient, image, and order information across systems
Integrates modalities with information and imaging systems
Biggest Value of IHE
Smooth flow of patient, image and order information across systems
Status updates of orders
Orders Filled
Acquisition Modality
acquisition completed
Film
acquisition in-progress
acquisition completed
images printed
Modality
HIMSS/RSNA
SCAR 2003

4. Scheduled Workflow Benefits
Reduced Manual Data Entry
Increased efficiency, decreased error rates
Digital Scheduling, Tracking & Data
Managed workflow
Order loop closure, better billing
Paperless
Up to the minute status, distributed access
Filmless
Rapid distribution, rapid access
HIMSS/RSNA
SCAR 2003

5. Patient Information Reconciliation Profile
Extends Scheduled Workflow
Handle unidentified/emergency patient
Handle demographic information updates
Changes propagated to all affected systems, affected data updated
Specifies transactions that function to match a previously processed unidentified patient with subsequently entered or identified demographic information
Defining a systematic way to handle trauma cases eliminates one of the major reasons for incorrectly identified or “lost” patient information
HIMSS/RSNA
SCAR 2003

6. Patient Information Reconciliation Benefits
Reduction of errors
Reduces incorrectly identified or “lost” studies
More complete medical record
Supports maintenance of demographics to maintain database correspondence
Flexible Trauma Workflow
HIMSS/RSNA
SCAR 2003

7. Charge Posting Profile
ADT Terminal
Account
Management
Post
Charges
*Billing System
Charge
Poster
Study
Performed
Report Generated /
Signed
3-D
Performed
CAD
Performed
/ Materials
Used
Report Repository
Acquisition Modality
Facilitates Collection of Procedure Details for Billing
Performed Procedure Technical Fees
Materials Usage
Reporting Professional Fees
Etc.
Maintains Correspondence of Account Details in Procedure Records
3-D
*Workstation
CAD
*Workstation …
HIMSS/RSNA
SCAR 2003

8. Charge Posting Benefits
Reduces Billing Errors
less manpower required in billing cycle
More timely billing, shorter billing cycle
Detailed performed procedure information
Billing more accurately reflects what was actually done: more details, fewer errors
HIMSS/RSNA
SCAR 2003

9. Consistent Presentation of Images Profile
What the Radiologist Displays:
What the Reviewing Physician Sees:
Area Of
Interest
Annotate
The Radiologist’s Transformations
Are Saved
Original Image
& Presentation State
Area Of
Interest
Prepared Image
Zoom
Flip
Window Level
Original Image
Original Image
It helps you maintain consistent images across multiple softcopy and hardcopy devices.
Both in terms of intensity and geometry.
Note Consistency is between different softcopy devices, between hardcopy devices and between softcopy and hardcopy
Note that Original Image is there in both cases, but is supplemented by the Presentation State above
With films, image quality was the imaging department problem….
Softcopy image distribution across the healthcare enterprise
Opportunity with radiology digitalization
Avoid lost films, reduces delays
Increases utilization of staff and equipment
But quality and consistency need to be adressed
This IHE Integration Profile is the cost effective solution to ensure that image quality is maintained across different monitors and film producing devices.
The Radiologist’s Transformations
Are Lost
Original Image
HIMSS/RSNA
SCAR 2003

10. Consistent Presentation of Images Benefits
More Consistent Views
Referring sees same thing as Radiologist
Softcopy matches Hardcopy
Less Work
don’t have to repeat manipulations
don’t have to calibrate every imaging device to every display device
HIMSS/RSNA
SCAR 2003

11. Presentation of Grouped Procedures Profile
Requested Procedure: CHEST
Chest View
Ab/Pelvis View
Report: CHEST
RIS / PACS
Requested Procedure: AB/PELVIS
Report: AB/PELVIS
MODALITY
Chest View
Performs a single exam
Operator
groups
2 procedures
*** Make sure to be clear.
This profile was flagged in the pre-show materials.
Ab/Pelvis View
HIMSS/RSNA
SCAR 2003

12. Presentation of Grouped Procedures Benefits
Improved patient experience (time/comfort)
Improved acquisition throughput
Improved reporting process
images are grouped & sorted correctly and ready for display
Improved billing
multiple order/accession chains are preserved
Reduced load on Network and PACS
HIMSS/RSNA
SCAR 2003

13. Key Image Notes Profile
Radiologist
Flags Images:
Referring Physician Sees Key Images First:
for refering physician
This image shows
the renal rupture.
Note1
for refering physician
This image shows
the renal rupture.
Note1
This image has the hematoma.
Note2
For referring
physician:
This image shows
the renal rupture.
Note1
Study &
Key Image Notes
For referring
physician:
This image has
the hematoma.
Note2
for refering physician
This image has the hematoma.
Note2
The Key Image Notes are stored and managed inside the Study, together with the Images
Key Image Notes put the Postit notes back into the softcopy workflow.
Note it can also be used between the tech and the rad, etc.
HIMSS/RSNA
SCAR 2003

14. Key Image Note Benefits
Improved communication
key image display reduces clutter
note contents provide clarifications
Improved workflow
enables automatic display & routing
Improved Study & Image Handling
Key Images for Referring
Teaching Files
QA Issues
etc
HIMSS/RSNA
SCAR 2003

15. Simple Image & Numeric Reports Profile
Report Verification
Verified Report
Images and Exam data presented for diagnosis
Preliminary Report
Reports stored for Network Access
Report & Images
Retrieved
Note also the aspect of Creating, Storing, Verifying, Querying and Retrieving Reports
Accurate complete report accessible wherever the physician desires.
Images
Retrieved
Report & Image Review for Patient Care
Image Manager
& Archive
HIMSS/RSNA
SCAR 2003

16. Simple Image and Numeric Reports Benefits
Coded Values
enables data mining, decision support
Flexible Report Presentation
rich text with embed images and measurements
DICOM Management
Query/retrieve/archiving
Distribute reports through DICOM infrastructure
HIMSS/RSNA
SCAR 2003

17. Post-Processing Workflow Profile
Acquisition Modality
PACS System
Source Data
Post-Proc.
Workflow
Manager
3-D
*Workstation
Worklist
Workstation
Work Status
Work Status
CAD
*Workstation
Results
Allows for Expanding the Loop
(Move to before ARI)
Report Repository …
Results
HIMSS/RSNA
SCAR 2003

18. Post-Processing Workflow Benefits
Worklist Management
Provides todo list
Direct references to input data
Reduced Manual Data Entry
Increased efficiency, decreased error rates
Electronic Status
Status available quickly, Distributed access, Trigger interpretation, better workflow
Electronic Results
Post-processed images / objects get associated with the correct study
HIMSS/RSNA
SCAR 2003

19. Access to Radiology Information Profile
Radiology Department – Images and Reports
Emergency Department
Referring Physician
Other Departments: - Oncology - Surgery - Neurology - Pediatrics - etc.
Remote Clinics
Electronic Medical Record
HIMSS/RSNA
SCAR 2003

20. Access to Radiology Information Benefits
Improved Access to Images, Reports, etc
More complete, timely patient views
Fewer requests to radiology staff
HIMSS/RSNA
SCAR 2003

21. Basic Security Profile
Audit
Record
Repository … …
“Images Queried /
Retrieved”
“Reports Retrieved”
“Reports Printed”
Image Manager
& Archive
Report & Image Review
“Images Printed”
“Reports Stored”
“Reports Queried /
Retrieved”
Report Repository
Diagnostic
Workstation
HIMSS/RSNA
SCAR 2003

22. Basic Security Benefits
Centralized Activity Auditing
Monitor/Audit HIPAA policy conformance
Measure Departmental performance
Improved Security
HIMSS/RSNA
SCAR 2003

23. What Do You Get for All This?
Fewer errors, improved data accuracy
Greater access to information
Reduced study loss, retakes
Fewer tedious tasks
Better scheduling and tracking
Increased modality throughput
Freedom to acquire components from multiple manufacturers
HIMSS/RSNA
SCAR 2003