1. IHE for PACS administrators Paul Nagy, PhD Medical College of Wisconsin

2. Outline State of the PACS industry Benefits of PACS What and Why of IHE –Business perspective –User perspective –Technical perspective How to use IHE in an RFP

3. Diffusion of innovation model 1943 model of Iowa farmers adoption of hybrid seeds Five personality and socioeconomic categories Time Innovators Early Adopters Early Majority Late Majority Traditionalists B. Reiner, E. Siegel “Psychological factors affecting the adoption of PACS” Applied Radiology Volume: 31 Number: 4 April 2002

4. First Generation 1988-1993 Screen grabbing Innovator phase Second Generation 1993-2000 DICOM emerges Medical Device Manufacturers Hardware based pricing model Early adopter phase Third Generation 2001- IHE focuses on workflow IT companies drive innovation Pricing models based on usage not boxes Early majority phase Clear cost effectiveness Life cycle of the PACS industry

5. Radiologist productivity USRP predicts drought of radiologists to continue for at least another 10 years. –Even if current radiologists stay until they are over 70 PACS can boost radiologist productivity 50% * 8-15% less time to read studies –8% muscoskeletal –15% cross-sectional (CT) –10-20% general radiology –Hanging protocols –Large study image scrolling 44%-82% less consultations * AJR AM J Roentegenol, 2001: 176:861-864

6. Technologist Productivity Shortage in radiology technologists 15.3% –Highest vacancy rate of hospital staffing –The Healthcare Workforce Shortage and Its Implications for America's Hospitals. First Consulting Group Productivity due to PACS increases 40% –40% General Radiology –60% Computed Tomography –Reduced steps handling film B. Reiner, Changes in Technologist Productivity with Implementation of an Enterprisewide PACS, Journal of Digital Imaging, DOI: 10.1007/s10278-002-0999-y

7. Clinician Productivity Clinicians can save 50 minutes per day –Transit times to radiology –Time spent chasing down films –Not have to wait 24 hours to retrieve studies Multiple access to images –Not having to wait until everyone else is done with the films. Report turnaround time is decreased 60% *PACS: A Guide to the Digital Revolution, Springer, New York 2002 pp 183

8. Reduced Errors Naming errors on the modality –15% to 1.5% Film lost rate from –8% to <1% Film retake rates –5% to <0.3%

9. Benefits of PACS Radiologist productivity Technologist productivity Clinician productivity Reduction in naming errors Reduction in lost studies Reduction in retakes PACS = Workflow Redesign

10. Presentation of Grouped Procedures Subset a single acquisition IHE Integration Profiles Patient Information Reconciliation Unknown patients and unscheduled orders Consistent Presentation of Images Hardcopy and softcopy grayscale and presentation state Access to Radiology Information Consistent access to images and reports Key Image Notes Exchange flagging significant images Simple Image and Numeric Reports Exchange simple reports with image links and, optionally, measurements Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps

11. Why IHE? Workflow is not point to point PACS alone does not improve workflow The lessons learned from those who have gone before IHE is an open methodology Connectathon has vendors solve your problems offsite UC Davis study in 2000 (Skip Kennedy)

12. IHE is not a standard Reinforces DICOM Reinforces HL7 It’s a commonly agreed upon methodology

13. How to use IHE Learn the new language (why a new language?) Assign profiles and actors to your players Ask which profiles on which product versions were tested at the connectathon

14. How much does IHE cost? Modality dependent Upfront competitive pressure Modality Worklist 5-10K Storage Commitment Free (if you ask for it) MPPS 5-10K DICOM/IHE Box 20K RIS customization Its all about leverage

15. Don’t buy another piece of equipment without IHE C-Store Modality Worklist Storage Commitment Modality Performed Procedure Step Scheduled Workflow Presentation of Grouped Procedures

16. What profiles affect what area? 1.Scheduled workflow 2.Patient info reconciliation 3.Consistent presentation of images 4.Presentation of grouped procedures 5.Access to radiology information 6.Key image note 7.Simple image and numeric reporting HISRISPACSModality The key to IHE is that it spans islands of information.

17. Conclusions Don’t think you are the only one who doesn’t understand IHE. Vendors listen to the voice of the customer. Start talking IHE with vendors. IHE is treated like DICOM was 4-5 years ago. Show me the compliance. Would like to see a web site showing everyone’s capabilities. Cost of IHE minimal during purchasing

18. Special Thanks Jay Gaeta –Ultravisual Christopher Lindop –General Electric Medical Systems Christopher Carr –RSNA