2. RSNA/HIMSS Integrating the Healthcare Enterprise The IHE Initiative Worldwide – An Update Nikolaus Wirsz, PhD Siemens Medical Solutions – IHE Radiology Planning Committee Emmanuel Cordonnier ETIAM – IHE Europe Committee Industry Co-Chairman Minoru Hosoba, PhD Kyoto College of Medical Technology – Vice-Chairman of IHE Japan Strategic Planning Committee Prof. Hee-Joung Kim, PhD Yonsei University College of Health Science/Medicine – President of IHE Korea Prof. David Koff, MD Sunnybrook and Women's College, Toronto – IHE Canada Committee Xinrong Chen et al. Director of IHE China Steering Committee

3. IHE Classroom Sessions – RSNA 2005 2 Integration Solutions Available Today from Medical Systems Vendors – BUT... Common Problems of Modern Healthcare Enterprises – in All Countries: (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

4. IHE Classroom Sessions – RSNA 2005 3 An Incremental Multi-Year Project Launched in 1998 by RSNA & HIMSS Enhance the Access to Clinical Information Ensure Continuity and Integrity of Patient Information Speed Up the Integration in Healthcare Environments Foster Communication Between Vendors of Medical Information Technology Prove that Integration is Attainable Based on Standards Participants: – Representatives of Healthcare Providers – Information Systems Vendors – Imaging Systems Vendors – Standardization Groups The IHE Initiative

5. IHE Classroom Sessions – RSNA 2005 4 HIMSS / RSNA IHE Kick-Off Workshop October 13-14, 1998

6. IHE Classroom Sessions – RSNA 2005 5 IHE Progress: Year 1 – 7 (1999 – 2005) Year 1 (1999)Year 2 (2000)Year 3 (2001)Year 4 (2002)Year 5 (2003)Year 6 (2004)Year 7 (2005) Radiology IT Infrastructure for Healthcare Cardiology Laboratory Radiation Oncology Patient Care Coordination Patient Care Devices Pathology Pharmacy IHE Developments Integration Profiles – Solutions to Real-World Needs & Problems: Within clinical departments & Across departmental / institutional boundaries Prove of Concept Connectathons – Cross-Vendor Tests in North-America, Europe and Asia Demonstrations 24 Vendors60+Vendors 35 Systems100+Systems FranceGermanyItalyJapanUKCanadaKoreaTaiwanNorwayHollandSpainChina International Adoption

7. IHE Classroom Sessions – RSNA 2005 6 Patient Information Reconciliat ion Reconcile worklists, status, and data objects for unknown patients and demographics changes Access to Radiology Information - Consistent access to images and reports Consistent Presentation of Images Manage, retrieve & use objects for hardcopy and softcopy grayscale presentation states Key Image Notes Create, store, manage, retrieve & use objects to flag significant images Simple Image and Numeric Reports Manage simple diagnostic reports with optional images, measurements Scheduled Workflow Presentation of Grouped Procs Manage individual procedure image subsets from a multi-procedure acquisition for viewing & reporting Charge Posting Collect and post timely billable procedure details ITI ATNA – Radiology Option (Replaces Basic Security) Reporting Workflow Manage worklists, track status, perform & notify diagnostic reporting steps Evidence Documents Manage, retrieve & use objects to record study evidence Manage worklists, track status, perform & notify image processing & CAD steps Post- Processing Workflow Manage worklists, track status, perform & notify acquisition related step, create, store, manage, retrieve & use images NM Image Create, store, manage, retrieve & use NM image objects Portable Data for Imaging - Consistent access to images and reports on CD Media Admit, Order, Schedule Teaching Files & Clinical Trials Export Standardize Clinical Trial Data and Anonymization XDS for Imaging - Sharing of Imaging Information across health enterprises IHE Success: Integration Profiles Solutions to Real-World Problems in Radiology WorkflowsBilling Teaching/ Trials Contents & DisplayCommon Infrastructure

8. IHE Classroom Sessions – RSNA 2005 7 Integration is Needed Everywhere Integration, Interoperability and Workflow Optimization are Global Issues NOT Local Needs IHE has had an international vision from the beginning IHE is promoting its adoption worldwide IHE encourages the formation of national and regional initiatives to address local healthcare needs

9. IHE Classroom Sessions – RSNA 2005 8 International Scope of the IHE Initiative Providing a Global Integration Framework: – Identify Common Integration Requirements – Define Generic Solutions (Integration Profiles) to Solve Real-World Problems – Specify the Details for Implementing the IHE Solutions Selection of Established Standards for Specifying Systems Functionality and Transactions for Information Exchange (e.g. DICOM, HL7, …) Providing a Generic Technical Framework to Address the Vast Majority of Implementation Issues

10. IHE Classroom Sessions – RSNA 2005 9 National Scope of the IHE Initiatives in North America – Europe – Asia Address Specific Needs of National Healthcare Systems According to: – Local Policies and Practices – Support for Native Languages – National Reimbursement Procedures Manage Regional Cross-Vendor Tests (Connectathons) Organize Demonstrations at National Venues Promote IHE User Success Stories of Local Sites Organize Educational Events to Raise Awareness and Acceptance of IHE

11. IHE Classroom Sessions – RSNA 2005 10 The IHE Radiology Technical Framework Common Definitions– Overall Integration in Healthcare: – High-Level Description of Integration Profiles– Volume I – Detailed Implementation Specification– Volumes II and III National Extensions– Volume IV Examples: – Character Sets for National Languages – Extensions of Patient and Provider Information According to National Policies (Privacy, Confidentiality, …) – Financial Information and Transactions for Specific National Health Reimbursement System – Clinical Workflow Optimization and Information Access to Support National Care Practices and Policies Addressing Global & National Integration Needs

12. IHE Classroom Sessions – RSNA 2005 11 Global Development Radiology Cardiology IT Infrastructure Patient Care Coordination Patient Care Devices Laboratory Pathology Pharmacy / Medication Admin Radiation Oncology IHE Organizational Structure ACC 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 and participating Vendors IHE Europe IHE North America France USA Canada IHE Asia-Oceania Japan KoreaTaiwan Netherlands Spain Sweden UK ItalyGermany Norway Regional Deployment China IHE (International) Strategic Development Committee

13. IHE Classroom Sessions – RSNA 2005 12 Updates from National IHE Initiatives IHE Asia / Oceania  IHEChina  IHEJapan  IHEKorea IHE Europe IHE North America  IHECanada

14. RSNA/HIMSS IHE Activities in China Xinrong Chen– Director of IHE China Steering Committee Qiyong Fan– Director of IHE China Planning Group Guokang Zhong– Director of IHE China Project Group Tianzhen Shen– Director of IHE China Auditing Group

15. IHE Classroom Sessions – RSNA 2005 14 Why IHE in China Healthcare IT – a huge market to be activated in China Standards are especially important for all players in this domain – IHE is very useful for end users to do benchmarking while selecting products – IHE brings standards to the market – China market needs IHE in Radiology, Cardiology, Laboratory, Patient Care, Pathology etc. now.

16. IHE Classroom Sessions – RSNA 2005 15 IHE China Year 1 (2005) Review Establishing IHE China – 2004.08.19 – First Meeting for Establishing IHE China – 2004.08.31 – Second Meeting for Establishing IHE China – 2004.09.15 – Third Meeting for Establishing IHE China 2005.06.28 – IHE China Inaugural Meeting

17. IHE Classroom Sessions – RSNA 2005 16 IHE China Organization IHE China Steering Committee Technical Group Project Group Auditing Group

18. IHE Classroom Sessions – RSNA 2005 17 Planned activities in IHE China Year 2 (2006) Education Workshop (February, 2006) Participant Workshop Mesa Tests – Scheduled Workflow Connectathon

19. IHE Classroom Sessions – RSNA 2005 18 Support from industry in IHE China

20. RSNA/HIMSS Minoru Hosoba Ph.D. Kyoto College of Medical Technology Vice-Chair, IHE-J Strategic Planning Committee Activity of IHE-Japan

21. IHE Classroom Sessions – RSNA 2005 20 IHE-J Japanese Extension of the Technical frameworks (Radiology ) based on: – JIRA &JAHIS JJ1017 Guideline ver.3.0 Adopted JJ1017 ver.3.0 code Descriptive code. 32 byte-coding system. Expantion of Technical frameworks in new domain – Scheduled workflow profiles for endoscopic and pathologic exams are being developed Integration Profiles for Cardiology and IT infrastructure are being studied and reviewed if it might be applicable to clinical sites in Japan

22. IHE Classroom Sessions – RSNA 2005 21 IHE-J (continued) Connectathon 2005 – Feb. 22 and 25 – 25 companies and 48 systems participated Demonstration 2005 – Radiological field (CyberRad at JRC) – Medical informatics field (Hospital show and JAMI) Implementation of IHE in hospitals in Japan Publication of guide book "Introduction to IHE" – April,2005, 245 pages

23. IHE Classroom Sessions – RSNA 2005 22 Endoscopy Scheduled Workflow (Draft Aug. 2005) ADT Order Placer Order Filler Acquisition Modality Image Manager Image Archive Image Creator Image Display Pt.Registration Filler Order Management Modality Worklist Provided Procedure Scheduled Modality PPS PPS Modality Image Stored Storage Commitment Creator PPS Storage CommitmentCreator Image Stored Query Images ① Placer Order Management Pt.Update Image Availability Query Retrieve Images Report Manager Report Creator Report Reader Report Repository Order Manager Patho Order Placer Patho Order Filler IHE Pathology Accept specimens Check images Ready Image Display Order of Endoscopy accepted Reporting finish Patho Order Request ・ Patho Order No. Specimen Manager Modality Worklist Provided PPS Manager Blue: HL7 Messages Green: DICOM Messages Endoscopy Reporting WF Patho Order Request. Patho Order No.

24. IHE Classroom Sessions – RSNA 2005 23 IHE-J Connectathon 2005 Feb. 2004: 20 companies and 33 systems participated Feb. 2004: 20 companies and 33 systems participated Feb. 2005: 25 companies and 48 systems participated Feb. 2005: 25 companies and 48 systems participated Jan. 2006: 29 companies and 60 systems will participate Jan. 2006: 29 companies and 60 systems will participate

25. IHE Classroom Sessions – RSNA 2005 24 Guided Tour in CyberRad 2005.4.8-10 IHE-J Demonstration

26. IHE Classroom Sessions – RSNA 2005 25 IHE-J Implementations Saitama Medical Center: March 2005 Saitama Medical Center: March 2005 Fujita Health University Hospital: April 2005 Fujita Health University Hospital: April 2005 Okazaki City Hospital: January 2006 Okazaki City Hospital: January 2006 National Institute of Radiological Sciences (NIRS) Hospital: April 2006 National Institute of Radiological Sciences (NIRS) Hospital: April 2006

27. IHE Classroom Sessions – RSNA 2005 26 For more information http://www.ihe-j.org Dec.2005, the web site renewed – Japanese version, English version Contents: – Schedule of the Meeting, Demonstration, Workshop etc. – Documents (Technical framework, Integration profiles, etc.) – Streaming video (The introduction to IHE) Thank You

28. RSNA/HIMSS IHE-KR Year2 IHE Korea Hee-Joung Kim, Ph.D. (hjkim1@dragon.yonsei.ac.kr) Yonsei University

29. IHE Classroom Sessions – RSNA 2005 28 IHE-KR Foundation Inaugural General Meeting LG-POSCO, Korea Univ. (06/25/04) President of IHE-KR Hee-Joung Kim President of KSOMI President of KPACS URL for IHE-KR http://www.ihekorea.org

30. IHE Classroom Sessions – RSNA 2005 29 President Vice-President Steering Committee Technical Committee OfficeAudit 총무이사 Infinitt 최승욱 이사 재무이사 한국의학물리학회 총무이사 홍보이사 Marotech 이진형 실장 대한의료정보학회 총무이사 대한 PACS 학회 총무이사 무선의료정보포럼 부회장 서울대 이경호 교수 LG CNS 손주영 수석 Samsung SDS 조성돈 수석 GE Healthcare 윤영욱 부장 Medical Standard 이원용 실장 위원장 연세대 정해조 부위원장 경북대 조 훈 경북대 김일곤 Infinitt 최승욱 LG CNS 황용돈 Samsung SDS 김도준 GE Healthcare 황용기 Marotech 이진형 중외메디칼 김한명 사이버메드 허원창 메드벤 고명자 루벤틱스 김태호 서울 C&J 권대근 현대정보기술 구전서 아그파 고희관 리스템 민진영 Technical Manager 연세대 강원석 IHE-KR Org

31. IHE Classroom Sessions – RSNA 2005 30 IHE-KR Yr2 (2005) Submission of MESA Test Results - 11/05/05 IHE-KR 05 Connectathon - 11/11/05 IHE Korea 05 Workshop - 07/08/04 IHE-KR 05 Demo at KSOMI - 11/18/05

32. IHE Classroom Sessions – RSNA 2005 31 IHE-KR Yr2 Workshop (2005)

33. IHE Classroom Sessions – RSNA 2005 32 IHE-KR Yr2 Connectathon SCENARIO Patient #2: A man (Kil-Dong), 48 years old with hepatitis, attended the Y hospital due to indigestion and icterus. Physician suspects the liver cirrhosis and orders an ultrasound examination with code of “Liver Ultrasound”. Patient #1: A man (Min-Soo Kim), 35 years old with no known medical problems and in good health, unfortunately, had broken his left ankle and femur due to an auto-accident at the road. He underwent orthopedic treatment at the Y hospital. After treatment, physician orders X-ray with code of “Ankle lateral” and “Femur AP” in order to follow up. Radiographic Room #1, 2 Radiographic Room #3

34. IHE Classroom Sessions – RSNA 2005 33 Modality (DX) Choong-Wae Medical Co. DICOM MPPS DICOM Storage DICOM Storage Commitment DICOM MPPS DICOM Storage DICOM Storage Commitment DICOM MWL DICOM Query DICOM Retrieve Radiographic Room 1 Modality (DX) Phoenix Vision Radiographic Room 2 Modality (US) Medison Radiographic Room 3 PACS Room Image Mgr./Arch. MPPS Manager Order Filler (Sim.) Infinitt Technology DICOM MWL DICOM MPPS DICOM Storage DICOM Storage Commitment Reading Room Image Display Mevisys Y Hospital IHE-KR Yr2 Connectathon SCENARIO

35. IHE Classroom Sessions – RSNA 2005 34 IHE-KR Yr2 Connectathon (2005)

36. IHE Classroom Sessions – RSNA 2005 35 SWF Acquisition Modality ImageArch./Manager PPS Manager Image Display MEDISON ● Choong-Wae Medical ● Phoenix Vision ● MEVISYS ● INFINITT Technology ●● Results: IHE-KR Connectathon 2005

37. IHE Classroom Sessions – RSNA 2005 36 www.ihekorea.org ◈ Logo ◈ Homepage

38. RSNA/HIMSS IHE-Europe Report Emmanuel Cordonnier IHE-Europe Vendors co-chair emmanuel.cordonnier@etiam.com

39. IHE Classroom Sessions – RSNA 2005 38 Expanding IHE in Europe France, Germany, Italy, UK « running for years » Real start of Netherlands and Spain Norway starting Demand from other Scandinavian countries, Portugal and European East Countries

40. IHE Classroom Sessions – RSNA 2005 39 Official recognition of IHE in Europe More and more national initiatives are referring to IHE: Italian Regional projects and National French projects… Submission of an European research project « IHE Standardization of Health Care information sharing crossing borders between European clusters, region and languages » Citation of IHE in the eHealth Forum initiative driven by the European Commission

41. IHE Classroom Sessions – RSNA 2005 40 Evolution of organization Creation of official organizations (associations) in Germany, Italy and Spain Replacement of Geerd Claeys – Agfa - (thanks to him) by Emmanuel Cordonnier – Etiam (/ Peter Kuenecke – Siemens after 12 months) Proposal made by INRIA (3,500 employees) French research organization to consolidate IHE Europe management and working force

42. IHE Classroom Sessions – RSNA 2005 41 Participation to Technical Framework Leadership of IHE Laboratory (4 new profiles) Key contribution to IHE Cardiology – success of demo at ESC Stockholm Launch of IHE Pathology (France & Spain) Active contribution to IT Infrastructure Patient Administration Management (PAM) Launch of European contribution to PCC Emergence of IHE Pharmacy

43. IHE Classroom Sessions – RSNA 2005 42 2005 Connectathon Well organized by IHE Netherlands in Noordwijkerhout (don’t try to pronounce it!) 62 companies, 98 + 1 + 2 systems 230 engineers (average of 210 per day) 15 project managers (including Steeve & Bill) Success of XDS (with off-line mode and Atna) 30 workflow tests (10Radio, 7XDS-PIX, 2Lab, 4Cardio, 4UK), 1600 tests (1227 verified)

44. IHE Classroom Sessions – RSNA 2005 43 IHE-Europe 2006 The « Spain » year: workshop (February) and Connectathon (April) in Barcelona Launch of cooperation with INRIA (6 months to define a cooperation agreement of stop) Closer cooperation with European Commission and CEN (in PCC for example) Contribution to IHE TFs (Lab, Pathology, PCC, ITI peer to peer exchange…)

45. RSNA/HIMSS Integrating the Healthcare Enterprise IHE Canada Achievements 2005 David Koff MD

46. IHE Classroom Sessions – RSNA 2005 45 IHE Canada Founding Participants Update (Feb/05): AITS (Association de l’industrie des technologies de la Santé) joins IHE Canada

47. IHE Classroom Sessions – RSNA 2005 46 IHE Canada structure IHE Canada activities are coordinated by a Strategic Steering Committee Supported by several sub-committees: – Communication – Radiology – IT Infrastructure Relies on volunteers from all healthcare sectors – Vendors – Users – Administrators – Government

48. IHE Classroom Sessions – RSNA 2005 47 Goals of IHE Canada Improve the efficiency and effectiveness of clinical practice Foster collaboration among vendors, purchasers and providers Promote and accelerate interoperability across healthcare domains and build foundation for the EHR Demonstrate that system integration within and across healthcare enterprises is attainable when based on implementable standards Educate stakeholders on the benefits of adopting standards-based solutions Develop Canadian extensions to IHE integration profiles Participate and possibly lead the definition of new IHE specifications

49. IHE Classroom Sessions – RSNA 2005 48 National EHR  Important complement to Infoway activities and the Pan-Canadian standards initiatives by: – Ensuring completeness and eliminating ambiguities on specifications – Demonstrating applicability and usability of interoperability profiles – Promoting international awareness of requirements for a national EHR

50. IHE Classroom Sessions – RSNA 2005 49 National Extensions  Character sets for National Languages  Extensions of patient and provider Information to support EHRS requirements (Privacy, Confidentiality, Unique Patient ID…)  The National Extensions are ready to be submitted to IHE global for inclusion in Part IV of the Technical Frameworks.

51. IHE Classroom Sessions – RSNA 2005 50 XDS-I  All jurisdictions across Canada recognize the necessity and benefit of sharing imaging information among healthcare professionals. In addition, there is wide acceptance that DI information is seen as a core data component of the electronic health record.

52. IHE Classroom Sessions – RSNA 2005 51 XDS-I Development of the profile was based on a common set of “process flows” that reflect use case scenarios encountered in the Canadian healthcare setting. These scenarios address the DI information sharing between all health professionals and geographic locations. The process flows and use case scenarios were developed by the IHE Radiology Technical Committee and vetted by the pCSG for DI/Teleradiology. As such, the interoperability profile is clinically relevant.

53. IHE Classroom Sessions – RSNA 2005 52 XDS-I  Definition of DI document types to be supported  Development of x-enterprise (EHR) use cases  Selection of registration and retrieval protocols (DICOM-WADO, ebXML)  Extension to XDS registry metadata

54. IHE Classroom Sessions – RSNA 2005 53 XDS-I  In complement of XDS-I, have been developed:  An up-date of the toolkit to enable testing of XDS-I at the next Connectathon.  XDS-I use cases which have been submitted to IHE global.

55. IHE Classroom Sessions – RSNA 2005 54 Future developments  The IT infrastructure planning committee has submitted to IHE Global a proposal for a new profile : Client Registry using HL7 V3.  Imagination: a new Canadian forum to promote the sharing of information and knowledge.

56. IHE Classroom Sessions – RSNA 2005 55 The IHE Initiative Worldwide – An Update Questions ?  IHEMain Web Site: http://www.IHE.net  IHECanada: http://www.ihe-canada.com  IHEEurope: http://www.IHE-Europe.org  IHEJapan: http://www. ihe-j.org  IHEKorea: http://www.ihekorea.org/  IHETaiwan: http://www.dicom.org.tw Emmanuel Cordonnier ETIAM IHE Europe Committee Industry Co-Chairman Minoru Hosoba, PhD Kyoto College of Medical Technology Vice-Chairman of IHE Japan Strategic Committee Prof. Hee-Joung Kim, PhD Yonsei University College of Health Science President of IHE Korea David Koff, MD Sunnybrook and Women's College, Toronto IHE Canada Committee Xinrong Chen et al. Director of IHE China Steering Committee Nikolaus Wirsz, PhD Siemens Medical Solutions IHE Radiology Planning Committee IHE International Meeting Tuesday – November 29, 2005 9:00AM – 3:00PM Room E271A IHE Asia-Oceania Meeting Tuesday – November 29, 2005 4:00PM – 6:00PM Room E257