1. Understanding IHE, BIR 20 Oct 2004 IHE Integrating the Healthcare Enterprise General Overview (again once) Scheduled Workflow Patient Information Reconciliation Patient Information Reconciliation Consistent Presentation of Images Consistent Presentation of Images Key Image Notes Key Image Notes How to deal with IHE-items Prof. Berthold B. Wein User co-chair IHE-Europe

2. Understanding IHE, BIR 20 Oct 2004 IHE : short overview and scheduled workflow and patient information reconciliation Prof. Berthold B. Wein, MD User co-chair IHE-Europe Praxisgemeinschaft Kapuzinerkarree University Hospital Aachen Germany

3. Understanding IHE, BIR 20 Oct 2004 Healthcare IT – Main Obstacles Lack of financial funding :Lack of financial funding : –IT : 2.3% of hospital budget (in other industries : 2.8%) [Gartner] Lack of national/regional guidelines & incentivesLack of national/regional guidelines & incentives Lack of access to IT infrastructureLack of access to IT infrastructure Lack of solutions that meet clinical needsLack of solutions that meet clinical needs Lack of adequate healthcare IT standards and interoperabilityLack of adequate healthcare IT standards and interoperability –Integration cost : 20% of hospital IT budget IHE scope

4. Understanding IHE, BIR 20 Oct 2004 IHE Mission Improve the quality and cost of healthcare by removing the interoperability barriersImprove the quality and cost of healthcare by removing the interoperability barriers –Continuity & Integrity of Patient Information –Clinical Workflow Optimization Provide an open interoperability framework, based on existing standardsProvide an open interoperability framework, based on existing standards Enable cross-vendor environmentEnable cross-vendor environment Make life more easy for the users and vendorsMake life more easy for the users and vendors IHE = Integrating the Healthcare Enterprise

5. Understanding IHE, BIR 20 Oct 2004 seamless information flowseamless information flow –from system to system –within and across departments –within and across hospital borders access to all vital clinical dataaccess to all vital clinical data –at the right time and at the right place workflow optimisationworkflow optimisation elimination of redundancies in data entryelimination of redundancies in data entry foster openess of productsfoster openess of products less problems in interoperability and understandingless problems in interoperability and understanding Benefits of IHE

6. Understanding IHE, BIR 20 Oct 2004 IHE is based on Technical frameworkTechnical framework –The bible for interoperability, the hope for us/vndrs Connect-a-thonConnect-a-thon –The real-life test of systems, the hell for products DemonstrationDemonstration –The show to others, how it works Integration statementsIntegration statements –The advertising to users, enabling understanding SucessSucess –The teaching by others

7. Understanding IHE, BIR 20 Oct 2004 IHE Members UsersUsers –Clinicians, Medical Staff, Administrators, CIOs, … VendorsVendors –Information Systems & Imaging Equipment (80 vendors) Societies Representing Healthcare SegmentsSocieties Representing Healthcare Segments –EAR, ECR, ESC, Other Professional Societies… Governmental agenciesGovernmental agencies –e.g. GMSIH Active liaison with Standards Development Organizations (SDOs)Active liaison with Standards Development Organizations (SDOs) –HL7, DICOM, ASTM, others …

8. Understanding IHE, BIR 20 Oct 2004 Year n Demo’s IHE TF Development Process Year n Connectathon Trial Implementation Year N Technical Framework Standards’ Assessment Year n Goals Year n-1

9. Understanding IHE, BIR 20 Oct 2004 IHE - Connect-a-thon European Application rather than protocol testing real life Paris, Aachen, Padua, Nordwijkerhout 2001200220032004 2005 –2001, Paris, F: –13 vendors > 20 sys –2002, Paris, F: –33 vendors > 60 sys –2003, Aachen, D: –47 vendors > 85 sys –2004, Padova, I: –49 vendors > 80 sys

10. Understanding IHE, BIR 20 Oct 2004 IHE - Demonstrations F D I UK EUR First experiences with IHE-compliant systems during hands-on trials on user congresses

11. Understanding IHE, BIR 20 Oct 2004 IHE Integration Statement VendorProduct NameVersionDate Huge Imaging Medical SystemsIntegrateRADV2.312 Oct 2002 Integration Profiles Implemented Actors ImplementedOptions Implemented Scheduled WorkflowImage Manager/Archiveenone Image DisplayPerformed Procedure Step Order FillerPPS Exception Management Simple Image and Numeric ReportReport Creatornone Link to vendor IHE page www.HImedicalsystems.fake/ihe Links to Standards Conformance Statements of the Implementation HL7 www.HImedicalsystems.fake/hl7 DICOM www.HImedicalsystems.fake/dicom/integrateRAD.pdf IHE Integration Statement

12. Understanding IHE, BIR 20 Oct 2004 IHE Europa National initiatives Well established F, D, I, NL, GB In organisation DK, N, E beginningS

13. Understanding IHE, BIR 20 Oct 2004 Technical Framework Integration ProfilesIntegration Profiles –Practical solutions for daily-work integration problems –Precise definitions of actors and transactions –Exact requirements for open standards Conversion tablesConversion tables –Defining correspondant fields –Describing characteristics of the fields Use casesUse cases –Depicting daily scenarios for easy understanding

14. Understanding IHE, BIR 20 Oct 2004 TF and IHE Domains RadiologyRadiology Laboratory MedicineLaboratory Medicine Information Technology InfrastructureInformation Technology Infrastructure CardiologyCardiology General practicionersGeneral practicioners PathologyPathology DermatologyDermatology

15. Understanding IHE, BIR 20 Oct 2004 Integration Profiles Solving daily life problems by standardsSolving daily life problems by standards Exactly defining solutions and parts for succeeding in interoperabilityExactly defining solutions and parts for succeeding in interoperability Reduce the problem toReduce the problem to – actors – transactions therefore making it independent from real world limitations and offering a global strategy for solution

16. Understanding IHE, BIR 20 Oct 2004 Laboratory Medicine 2004-2005 Laboratory Scheduled Workflow (LSWF) done in 2003 Tests performed by a laboratory for an identified inpatient or outpatient Laboratory Patient Information Reconciliation (LPIR) year 2004 Tests performed on an unidentified or misidentified patient Laboratory Code Set Distribution (LCSD) year 2004 Sharing the batteries and tests code sets throughout the enterprise Laboratory Device Automation (LDA) year 2004 Pre-analytic process, analysis and post-analytical treatment Laboratory Point Of Care Testing (LPOCT) year 2004 Tests performed on point of care or patient’s bedside

17. Understanding IHE, BIR 20 Oct 2004 IHE IT Infrastructure 2004-2005 Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications Consistent Time Coordinate time across networked systems Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. Patient Demographics Query Personnel White Page Access to workforce contact information Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record

18. Understanding IHE, BIR 20 Oct 2004 Radiology 2000-2005 Access to Radiology Information Patient Information Reconciliation Consistent Presentation of Images Basic Security Evidence Document Key Image Notes Simple Image and Numeric Report Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled Workflow

19. Understanding IHE, BIR 20 Oct 2004 Radiology 2000-2005 Access to Radiology Information Patient Information Reconciliation Consistent Presentation of Images Basic Security Evidence Document Key Image Notes Simple Image and Numeric Report Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled Workflow

20. Understanding IHE, BIR 20 Oct 2004 Radiology 2000-2005 Access to Radiology Information Patient Information Reconciliation Consistent Presentation of Images Basic Security Evidence Document Key Image Notes Simple Image and Numeric Report Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled Workflow

21. Understanding IHE, BIR 20 Oct 2004 Problems It is very hard to get the ball teed-up for the technologist on the modality.It is very hard to get the ball teed-up for the technologist on the modality. Paper based workflow with data re-entryPaper based workflow with data re-entry Risk of errorRisk of error InefficientInefficient Stale informationStale information Changes between time of print and time of data entryChanges between time of print and time of data entry Cancel ordersCancel orders Generic Order / Order ChangesGeneric Order / Order Changes After the tech wacks the ball, how do I let all systems know where it went.After the tech wacks the ball, how do I let all systems know where it went. When are things ready to be read (PACS)When are things ready to be read (PACS) When can things be deleted (Modality)When can things be deleted (Modality) How do I know what to bill (RIS)How do I know what to bill (RIS) When do I wake up the referring physicianWhen do I wake up the referring physician

22. Understanding IHE, BIR 20 Oct 2004 Key IHE Concepts Generalized Systems => ActorsGeneralized Systems => Actors Interactions between Actors => TransactionsInteractions between Actors => Transactions Problem/Solution Scenarios => Integration ProfilesProblem/Solution Scenarios => Integration Profiles For each Integration Profile:For each Integration Profile: the context is described (which real-world problem)the context is described (which real-world problem) the actors are defined (what systems are involved)the actors are defined (what systems are involved) the transactions are defined (what must they do)the transactions are defined (what must they do)

23. Understanding IHE, BIR 20 Oct 2004 The Product World….. Poduct XYZ from Vendor T ADT MPI HIS

24. Understanding IHE, BIR 20 Oct 2004 The IHE World…. IHE Actor Actor IHE Transaction IHE Actor

25. Understanding IHE, BIR 20 Oct 2004 HIS MPI ADT Mapping IHE to Products Poduct XYZ from Vendor T IHE Actor Actor IHE Transaction IHE Actor

26. Understanding IHE, BIR 20 Oct 2004 Integration Profiles Easy to understand practical solutions for IT integration problems in daily life. Fostering the under- standing between users and vendors  24: Report Submission Structured Report Export: 28   25: Report Issuing Report Creator  26: Query Reports  27: Retrieve Reports Report Repository Report Reader External Report Repository Access Report Manager Enterprise Report Repository

27. Understanding IHE, BIR 20 Oct 2004 Integration Profiles  24: Report Submission Structured Report Export: 28   25: Report Issuing Report Creator  26: Query Reports  27: Retrieve Reports Report Repository Report Reader External Report Repository Access Report Manager Enterprise Report Repository  24: Report Submission Structured Report Export: 28   25: Report Issuing Report Creator  26: Query Reports  27: Retrieve Reports Report Repository Report Reader External Report Repository Access Report Manager Enterprise Report Repository  24: Report Submission Structured Report Export: 28   25: Report Issuing Report Creator  26: Query Reports  27: Retrieve Reports Report Repository Report Reader External Report Repository Access Report Manager Enterprise Report Repository

28. Understanding IHE, BIR 20 Oct 2004 Workflow involves several IHE Actors ADT Patient Registration Order Placer Dept Scheduler Image Manager/Archive Modality Patient Registration (HIS): ADT Focal Point for Patient Registration Information Department Scheduler (RIS): Focal Point for Requested Procedure Management Breaks Order into Requested Procedures Schedules Steps for Each Requested Procedure Acquisition Modality: Focal Point for Performed Procedure Steps A PPS Tracks One or More Series of Images Image Manager/Archive (PACS) Focal Point for Imaging Study. Manages Images Triggers Reading when All Expected PPS Are Completed Order Placer (HIS): Focal Point for Order Management

29. Understanding IHE, BIR 20 Oct 2004 Scheduled Workflow ADT Patient Registration Image Archive Image Manager Image Display Image Creator Acquisition Modality Department System Scheduler – Order Filler – Order Placer Performed Procedure Step Manager Modality Worklist Patient Registration Procedure Scheduled Images Availability Query Procedure Update Images Stored Storage Commit Q /R Key Image Note Q /R Presentation Sates Storage Commit Images Stored PPS In-Progress / Completed PPS In-Progress / Completed PPS In-Progress / Completed Filler Order Management Placer Order Management Present. State Stored Q /R Images Key Image Note Stored Present. State Stored Key Image Note Stored

30. Understanding IHE, BIR 20 Oct 2004 Store Images Storage Commitment List of Images PACS & Archive RIS ModalityPerformed Procedure Step Performed Step: Status = Completed Performed CT Head Pat Name/ID, Dose, Accession #, Study UID Complete List of Images IHE Scheduled Workflow The Connection side Modality Worklist Worklist Procedure Scheduled Patient Registration/Update Order Management

31. Understanding IHE, BIR 20 Oct 2004 Problems John Doe Trauma Clean-UpJohn Doe Trauma Clean-Up Recovering after Systems are DownRecovering after Systems are Down Error in Manual Entry at ModalityError in Manual Entry at Modality VIP and Getting MarriedVIP and Getting Married

32. Understanding IHE, BIR 20 Oct 2004 Scheduled Workflow ADT Patient Registration Image Archive Image Manager Image Display Image Creator Acquisition Modality Department System Scheduler – Order Filler – Order Placer Performed Procedure Step Manager Modality Worklist Patient Registration Procedure Scheduled Images Availability Query Procedure Update Images Stored Storage Commit Q /R Key Image Note Q /R Presentation Sates Storage Commit Images Stored PPS In-Progress / Completed PPS In-Progress / Completed PPS In-Progress / Completed Filler Order Management Placer Order Management Present. State Stored Q /R Images Key Image Note Stored Present. State Stored Key Image Note Stored Patient Update Patient Information Reconcilication

33. Understanding IHE, BIR 20 Oct 2004 Thank you for your attention !