2. September, 2005What IHE Delivers How to purchase eye care systems using IHE IHE Showcase at the AAO Conference November 2006 Andrew Casertano, Peter Kuzmak, and Dr. Ruth Dayhoff Department of Veterans Affairs VistA Imaging

3. 2 Learning Objectives How IHE can provide valuable assistance in eye care system acquisition? What tools and education are available? How the results of the connectathon can be used and how can they help in finding the right product to solve the integration problem? Example of writing a Request for Proposal (RFP) using IHE

4. 3 What is IHE? IHE is a specification of transactions between systems. IHE describes only integration features. IHE is not a product itself, but… IHE is very useful in purchasing products that integrate into workflow

5. 4 Integration Solutions Available Today from Medical Systems Vendors – BUT... Modern Healthcare Enterprises in All Countries Are Still Confronted with Problems: (In Spite of IT Standards and Advanced Technology) Lack of Access to Complete Medical Information Inconsistent Medical Information Across Departments and Institutions Inadequate Communicating of Medical Data Across Multiple Systems from Different Vendors Risky Investments in Proprietary Solutions Challenges of Integration

6. 5 Why Is Integration Hard? The Different Eye Care Systems Dont Use a Common Vocabulary The Different Eye Care Systems Dont Use Common Communication Standards Consistently The Flow of Information Through the Patient Encounter Changes With the Circumstances of Care

7. 6 IHE Eye Care Process 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

8. 7 Mapping to Real-World Products The IHE Actors and transactions are abstractions of real products in the real- world eye care information system environment. The order placer may be realized in either the practice management system or the Electronic Medical Record (EMR) products. The Performed Procedure Step Manager may be realized in either the Picture Archive and Communications System (PACS) or the Electronic Medical Record (EMR) products.

9. 8 IPs are packaged for purchasing Easy-to-understand, coherent, functional sets and a convenient way for users and vendors to communicate precisely about integration requirements and required functionality in products.

10. 9 Connectathon Interoperability testing in a public arena with peers Results are published by IHE Vendors publish Integration Statements Note that IHE is not a certification authority and does not validate product claims

11. 10 Connectathon Benefits to Users Confidence that vendor software has been tested at both detailed and interoperability levels. Reduce the costs of integration Reduce interoperability issues The end user must verify Connectathon tested software in an appropriate product release (via RFP)

12. 11 What do Connectathon results signify? That the vendor successfully performed all the particular transactions required by an actor in a IHE Integration Profile IHE is not a certification authority Connectathon testing does not certify product compliance Vendors who do not pass are not made public

13. 12 IHE Integration Statement VendorProduct NameVersionDate An Eye Care CompanyProductV2.312 Oct 2006 This product implements all transactions required in the IHE Technical Framework to support the IHE Integration Profiles, Actors and Options stated below: Integration Profiles Implemented Actors ImplementedOptions Implemented Eye Care Scheduled WorkflowImage Manager/Image Archivenone Image Displaynone Image CreatorPerformed Procedure Step Order FillerPPS Exception Management Simple Image and Numeric ReportReport Creatornone Link to the vendor IHE page www.eyecarecompany.com/ihe Links to Standards Conformance Statements for the Implementation HL7 www.amedicalsystemsco.com/hl7 DICOM www.amedicalsystemsco.com/dicom/integrateRAD.pdf For general Information on IHE In America: www.rsna.com/ihe In Europe: www.ihe-europe.org In Asia:www.rsna.com/ihewww.ihe-europe.org

14. 13 Survey of Integration Statements http://www.dclunie.com/iheintegration-survey/IntegrationStatements.html

15. 14 http://www.rsna.org/IHE/connectathon.shtml http://www.ihe-europe.org/con_result/ IHE Connectathon Results http://www.rsna.org/IHE/connectathon.shtml http://www.ihe-europe.org/con_result/

16. 15 MESA Tools http://www.erl.wustl.edu/mesa/index.html

17. 16 Users Handbook Integration rarely starts from scratch and usually, RFPs have to take into account the existing context. Integration is usually performed step wise, future steps have to be considered.

18. 17 User Success Stories Describes how IHE was used and the challenges and benefits in the real world. Identifies how to use specific IHE features and names products.

19. 18 Writing an RFP Simplify and strengthen what you ask for The system shall support DICOM. (too general! – thousands of pages of specs!) The system shall support the DICOM services related to eye care (still hundreds of pages!) The PACS shall support the IHE Eye Care Scheduled Workflow Integration Profile Image Manager/Image Archive actor.

20. 19 IHE in RFPs IHE Integration Profiles unambiguously specifies integration We have access to published information on IHE connectathon results and vendors integration statements A RFP can require IHE Integration Profiles

21. 20 Sample Requirements The vendor shall provide DICOM Conformance Statements for the DICOM components of the system. The vendor shall provide IHE Integration Statements for the system, and identify which actors and options the system implements. The vendor shall provide a timeline for the implementation of IHE Integration Profiles required but are not yet available in the proposed solution.

22. 21 Profiles Benefits IHE defines Integration Profiles to group related use cases and transactions and connects them with Real-World functions Integration Profiles allow the customer to focus on High-level Integration while IHE handles the details Profiles are used to write requirements, design a product, and purchase a system Proprietary Solutions create instant legacies

23. 22 We care! The AAO, the VA, and participating vendors have made fixing the Eye Care data integration problem a priority Use the IHE Technical Framework to purchase and deploy your eye care solution Our success is measured by your success

24. 23 More information…. IHE Showcase here at the AAO Conference IHE Web site: www.ihe.net www.ihe.net Technical Frameworks ihe_eyecare_tf_TI_vol1_2006_06_01 (Trial Implementation version) ihe_eyecare_tf_TI_vol1_2006_06_01 (Trial Implementation version) ihe_eyecare_tf_TI_vol2_2006_06_01 (Trial Implementation version) ihe_eyecare_tf_TI_vol2_2006_06_01 (Trial Implementation version) Standards used by IHE Eye Care DICOM Standard www.nema.medical.org DICOM Standard www.nema.medical.orgwww.nema.medical.org HL7 Standard www.hl7.org HL7 Standard www.hl7.orgwww.hl7.org Vendor Products Integration Statements

25. 24