1. Integrating the Healthcare Enterprise Practical Tools for the CIO: Using IHE to Leverage Standards Nogah Haramati, MD Chief of Radiology, Professor, Radiology & Surgery Jack D. Weiler Hospital Albert Einstein College of Medicine Bronx, NY USA

2. ITAC IHE Canada April 30, 2004 Agenda Is the IHE ready for prime time? How do I get it & use it? Provocative discussion…

3. ITAC IHE Canada April 30, 2004 Why Should You Care? Single Vendor Solutions are a Myth Integration and Interfaces are Difficult Your Clients Want Integration, Sometimes IHE isn’t a Standard

4. ITAC IHE Canada April 30, 2004 PACS-RIS Integration Do Vendors Really Want this? Most RIS vendors are now offering PACS products The largest PACS vendors are now offering RIS products Every vendor wants “their” system to be the “Seamlessly” integrated environment

5. ITAC IHE Canada April 30, 2004 Integrating the Healthcare Enterprise (IHE) Every vendor can create their part of an IHE integrated environment in isolation Technical Framework sufficiently detailed for each vendor’s piece to be created in isolation One size fits all The customer can replace IHE vendors without requiring massive integration projects Vendors do this ONLY because customers want it!

6. ITAC IHE Canada April 30, 2004 IHE Workflows Each IHE Profile is composed of the architectural workflows related to that profile IHE compliance can be verified by following the workflow in the profile and assuring the following: Each actor’s role is fulfilled by the appropriate vendor Every transaction is successfully executed

7. ITAC IHE Canada April 30, 2004 Advantages to using IHE Profiles for Acceptance Testing Testing procedures cannot be “rigged” or “fixed” by the vendor Testing procedures mirror the exact functionality that was purchased Testing procedures assure that ALL the actors (regardless of vendor source) are working together

8. ITAC IHE Canada April 30, 2004

9. ITAC IHE Canada April 30, 2004 Figure 3.2-9. Exception Management Workflow (Wrong Worklist Entry Selected)

10. ITAC IHE Canada April 30, 2004

11. ITAC IHE Canada April 30, 2004 Case 1: Unidentified Patient Registered at ADT and Ordered at the Order Placer Any unidentified patient is assigned a permanent Patient ID and a temporary name (e.g., “John Doe”) When the real patient identity is known, the ADT is responsible for reconciliation of its own records The ADT sends a Patient Update message to both the Order Placer and Department System Scheduler/Order Filler The Department System Scheduler/Order Filler sends the Patient Update message to the Image Manager.

12. ITAC IHE Canada April 30, 2004 Case 1: Unidentified Patient Registered at ADT and Ordered at the Order Placer

13. ITAC IHE Canada April 30, 2004 Case 5: Image Acquisition Completed Without Scheduling at Department System Scheduler/Order Filler In this case, no valid Patient ID is available to the Department System Scheduler/Order Filler No scheduling is done before the procedure is performed. A temporary ID and name are entered by the technologist at the Modality and conveyed to the Department System Scheduler/Order Filler and to the Image Manager. The Patient ID and name are selected by the technologist according to the locally defined rules

14. ITAC IHE Canada April 30, 2004 Case 5: Image Acquisition Completed Without Scheduling at Department System Scheduler/Order Filler When patient information is known, ADT sends new patient information to both the Order Placer and Department System Scheduler/Order Filler. The Department System Scheduler/Order Filler performs a merge of the permanent patient record with the temporary one and sends a Patient Update to the Image Manager. At the same time, Department System Scheduler/Order Filler generates and submits an order to the Order Placer using a valid Patient ID.

15. ITAC IHE Canada April 30, 2004 Case 5: Image Acquisition Completed Without Scheduling at Department System Scheduler/Order Filler

16. How do to leverage the IHE to your advantage? The “How To” Piece…

17. ITAC IHE Canada April 30, 2004 Current RFPs and Contracts Do not purchase any system or modality without a vendor commitment to present or future IHE compliance! Stipulate the level of IHE compliance – Specific integration profiles – Actors supported (present and/or future) – Deadline for compliance – Process for requiring additional IHE profiles

18. ITAC IHE Canada April 30, 2004 The Contractual Approach Initially use a multiparty agreement including your organization and two vendors The IHE integration profiles to be included initially are… Vendor assignment of ACTOR roles for each profile should be included Penalties for non-performance must be included for ALL parties Acceptance testing parameters must be based on the same IHE profiles

19. ITAC IHE Canada April 30, 2004 Maintaining the Integration at the State-of-the-Art Integration Steering CMTE – one per party Knowledgeable reps from all parties Decide on new or modified profiles Unanimous CMTE vote includes the profile in the integration agreement and is legally binding on all parties Interval after profile is incorporated until delivery of actual product - We have used the longer of 18 months following the incorporation or the first IHE connectathon where that profile is demonstrated (or agree on a time)

20. ITAC IHE Canada April 30, 2004 What if one or both vendors do not agree to add a needed profile? IHE is a customer driven initiative Vendors do not want to create custom products for idiosyncratic customers Customer has ONLY one recourse! Customer must obtain a written expression of interest in the profile from X number of the vendor’s existing customers When the customer gets the written letters, the profile is legally binding on that vendor! IHE is a customer driven initiative!

21. ITAC IHE Canada April 30, 2004 What if the go-live date arrives A transaction does not work & all vendors blame the others? The IHE transactions are excruciatingly described that by inspecting the actual transaction, fault is easily determined If the transaction is properly formatted and constructed, then the recipient is at fault If the transaction is improperly formatted, then the sender is at fault Errors occur Build a window of tolerance to allow the vendors to fix bugs

22. ITAC IHE Canada April 30, 2004 Use a lawyer/law firm that has experience in IHE issues and concepts When do physicians ever have nice things to say about lawyers? Put in language for binding arbitration of disputes Specify from where an IHE ‘expert’ is to be found to resolve issues concerning transactions and non-performance if this becomes necessary Specify the penalties and give them teeth!

23. ITAC IHE Canada April 30, 2004 Traditional RIS & PACS Acceptance Testing Traditional PACS acceptance testing criteria focused on image transmission, retrieval, display & manipulation criteria RIS Acceptance criteria focused on ability to perform certain procedures

24. ITAC IHE Canada April 30, 2004 CIO Take Home Today, vendors need motivation to create an IHE integrated environment The customers are driving this effort Long term benefits of an IHE environment are easier integration and replacement for future vendors IHE is moving to the enterprise Require it now in your contracts so that you don’t have to pay more later…

25. Provocative Discussion Should I install IHE now or wait?

26. Provocative Discussion Is the IHE just another fad?

27. Provocative Discussion Is this only something big, academic centers should do?

28. Provocative Discussion I don’t have IHE trained staff and have a lot of other priorities, why should I need this now?

29. ITAC IHE Canada April 30, 2004 Summary What is the IHE Is the IHE ready for prime time? How do I get it & use it? Provocative discussion…

30. ITAC IHE Canada April 30, 2004 More information…. Web sites: www.himss.org/ihe www.rsna.org/ihe – IHE Rad Technical framework for year 5 – V5.5 – IHE IT Technical framework for year 1 – V 1.0 Non-Technical Brochures : – IHE Fact Sheet and IHE FAQ – IHE Integration Profiles: Guidelines for Buyers – IHE Connectathon Results