2. RSNA/HIMSS Integrating the Healthcare Enterprise The IHE Initiative Worldwide Nikolaus Wirsz, PhD Siemens Medical Solutions – IHE Radiology Planning Committee Geert Claeys Agfa-Gevaert NV – IHE Europe Committee Industry Co-Chairman Hee-Joung Kim, PhD Yonsei University Medical Center – IHE Korea Committee Chairman David Koff, MD Sunnybrook and Women's College, Toronto – IHE Canada Committee Hidenori Shinoda Toshiba Medical Systems Corporation – IHE Japan Committee Co-Chairman Prof. Jenn-Lung Su, PhD Chung Yuan Christian University – IHE Taiwan Committee President Medical Image Standards Association of Taiwan

3. IHE Classroom Sessions – RSNA 2004 2 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

4. IHE Classroom Sessions – RSNA 2004 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 2004 4 HIMSS / RSNA IHE Kick-Off Workshop October 13-14, 1998

6. IHE Classroom Sessions – RSNA 2004 5 IHE Progress: Years 1 – 6 (1999 – 2004) Year 1 –Proof of Concept in 1999: – Defined General Integration Model: IHE Actors & IHE Transactions – Basic Scheduled Workflow: Admission → Ordering → Scheduling → Acquisition → Storage – Successful Demonstration: 24 Companies 35 Systems Year 2 –Integration Profiles Introduced in 2000 (Solutions to Real-World Problems): – Patient Information Reconciliation (Patient Data Updates, Patient Merge) – Access to Radiology Information (Access to Images, Reports) – Consistent Presentation of Images (Uniform Presentation on Hard/Soft Copies) – Presentation of Grouped Procedure (Manage Subsets of a Single Acquisition) – Simple Image & Numeric Reports (Exchange of Report Data) – Key Image Notes (Flag Relevant Images) – Increased Industry Participation: 30 Companies 58 Systems

7. IHE Classroom Sessions – RSNA 2004 6 IHE Progress: Years 1 – 6 (1999 – 2004) Year 3 – Consolidation in 2001: – Catching Up with Product Implementations – Growing Industry Participation: 31 Companies 70 Systems 21 Companies in Europe  Expansion to France Year 4 – New Integration Profiles in 2002: – Post-Processing Workflow (Image Processing, Reconstruction, CAD) – Charge Posting (Billing Transactions) – Basic Security (Audit Trails & Node Authentication) – Increased Industry Participation: 35 Companies 73 Systems 43 Companies in Europe – Driving Market Adoption: IHE User Success Stories  Expansion to Germany, Italy and Japan  Expansion Beyond Radiology: IHE Healthcare IT Infrastructure Launched Laboratory Integration Initiated in Europe and Japan

8. IHE Classroom Sessions – RSNA 2004 7 IHE Progress: Years 1 – 6 (1999 – 2004) Year 5 – New Integration Profiles in 2003: – Extended Archiving(Multiple PACS / Archives) – Evidence Documents(Measurements / Procedure Logs / CAD Results) – Reporting Workflow(Interpretation / Transcription Worklists) – Connectathons & Demonstrations in North America, Europe and Japan: 60+ Participating Vendors 100+ Systems  Expansion to UK  Launching IHE in Cardiology Year 6 – New Integration Profiles in 2004: – Nuclear Medicine Integration (Addressing NM Specific Needs) – Portable Data for Imaging – PDI (Exchangeability of Data on CD Media) Distributed Demonstration in Vendor Booths Sample CD Available On Site for RSNA 2004 Attendees – Interactive Hands-On Demonstration Exhibit in infoRAD (RSNA 2004)  Expansion to: Scandinavia (Norway, Denmark, Sweden) Canada Korea Taiwan

9. IHE Classroom Sessions – RSNA 2004 8 Outlook: IHE Year 7 (2005) International Development Plans Additional Global Integration Issues Teaching Files – Tools for Medical Education and Clinical Investigations Integration with Legacy Systems – Guidelines on Introducing IHE in Installed Bases Cross-Domain Cooperation – Common IHE Integration Issues in Radiology, Cardiology, IT Infrastructure Exploring Cross-Enterprise Images Sharing – Access to Radiology Information Across Systems, Departments and Institution Boundaries Publishing an IHE Deployment Handbook – Guidelines for Users and Purchasers in Acquiring IHE-Based Products Input from International IHE Initiatives is Encouraged

10. IHE Classroom Sessions – RSNA 2004 9 IHE Success: Integration Profiles Solutions to Real-World Problems in Radiology Patient Information Reconciliation Reconcile Worklists, Status and Data Objects For Unknown Patients and Demographics Changes Portable Data for Imaging Exchangeability of Clinical Data on CD Media Consistent Presentation of Images Create, store, 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 c Reports Create, store, manage, retrieve & use simple diagnostic reports with optional image links & Scheduled Workflow Presentation of Grouped Procedures Manage individual procedure image subsets from a multi-procedure acquisition for viewing & reporting Basic Security Charge Posting Collect and post timely billable procedure details Audit Trail Consolidation & Node Authentication Reporting Workflow Manage worklists, track status, perform & notify diagnostic reporting steps Evidence Documents Create, store, manage, retrieve & use objects to record study evidence Manage worklists, track status, perform & notify image processing & CAD steps Post - Processing Workflow Create, Store, Manage, Retrieve & Use Images Admission, Order Management, Scheduling, Store, Retrieve Manage Worklists, Track Status, Perform & Notify Acquisition Related Steps Access to Radiology Information Consistent access to images and reports Nuclear Medicine Image Create, store, manage, retrieve & display of NM Images & NM Results

11. IHE Classroom Sessions – RSNA 2004 10 IHE Success: Integration Profiles Solutions to Real-World Problems in IT Infrastructure 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- referenci ng for MPI Map patient identifiers across independent identification domains Patient Identifier Cross- Referencing for MPI Map patient identifiers across independent identification domains Consistent Time Coordinate time across networked systems Consistent Time Coordinate time across networked systems Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications Audit Trail and Node Authentication Cross Enterprise Document Sharing Provide a mechanism to share documents across institutions Personnel White Pages Provide access to basic information about the human workforce members Patient Demographics Query Allow quick retrieval of common patient name, identifier, contact, and visit information

12. IHE Classroom Sessions – RSNA 2004 11 IHE Success: Advancing IHE Beyond Radiology Clinical Domains with IHE Developments Radiology: – Started in 1998 – Deployment in North-America, Europe and Asia IT Infrastructure: – Started 2003 – Deployment in North-America and Europe Cardiology: – Started 2004 – Deployment in North-America and Europe Laboratory: – Started 2003 – Driven by IHE-Europe and IHE-Japan Radiotherapy: – Considers Starting in 2005

13. IHE Classroom Sessions – RSNA 2004 12 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

14. IHE Classroom Sessions – RSNA 2004 13 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

15. IHE Classroom Sessions – RSNA 2004 14 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

16. IHE Classroom Sessions – RSNA 2004 15 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

17. IHE Classroom Sessions – RSNA 2004 16 IHE Organizational Structure IHE Europe IHE North America France USACanada IHE Asia-Oceania Japan KoreaTaiwan NetherlandsSpainSweden UKItalyGermany Norway Regional Deployment Radiology Planning Committee Radiology Technical Committee IT Infrastructure Planning Committee IT Infrastructure Technical Committee Pharmacy Exploratory Sub-Committee Global Development Cardiology Planning Committee Cardiology Technical Committee Laboratory Planning and Technical Committee IHE (International) Strategic Development Committee 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

18. IHE Classroom Sessions – RSNA 2004 17 Participating and Contributing Vendors (America) Agfa HealthCare Algotec Systems, Ltd. Berdy Camtronics Canon Medical Systems Carefx Cedara Software Corp. Cerner Corp. CSIST Dictaphone DR Systems Dynamic Imaging Eastern Informatics Eastman Kodak Company Emageon Eclipsys Fujifilm Medical Systems Procom Philips Medical Systems RASNA Imaging Systems Sectra Sentillion Siemens Medical Solutions Softmedical Stentor, Inc StorCOMM, Inc Swissray International, Inc Tiani Medgraph AG Toshiba AmericaMedical Systems UltraVisual Medical Systems Vital Images, Inc. Voxar Limited WebMD XIMIS GE Healthcare Heartlab Hitachi Medical Corporation Hologic, Inc IDX Systems Corporation IMCO Technologies InSiteOne INFINITT Konica Minolta Marotech, Inc. McKessonInformation Solutions Medcon Medical ManagerHealth Systems Mediface Co., Ltd. Merge eFilm Mortara In yellow, companies with IHE Committees Chairs (Summer 2004)

19. IHE Classroom Sessions – RSNA 2004 18 Participating and Contributing Vendors (Europe) AGFA Healthcare AISoftw@re Medical Solutions Algotec ARES SA aycan Digitalsysteme ConVis DEDALUS Dianoema Eastman Kodak Company Ebit Sanita EDL ELFIN s.r.l. Engineering Sanità Enti Locali ESAOTE ETIAM Ferrania Fujifilm GE Healthcare GMD GIE Convergence-Profils Rogan-Delft Sago spa Sectra Imtec AB Siemens Medical Solutions Soluzioni Informatiche srl Stentor Inc. Swissray Medical AG Symphonie On Line Synapsis TELEMIS S.A. TIANI MEDGRAPH AG TOREX GAP Medical Toshiba Medical Systems TSI groupe europMedica VEPRO AG VISUS Technology Transfer WAID XR PARTNER GWI Research IASI Srl IdeoPass Image Device-Cerner Company INFINITT INOVIT McKesson MED2RAD MEDASYS SA Medavis Medigration GmbH MEDIMON Ltd. MEDOS AG Merge eFilm METAFORA Konica Minolta Europe Omnilab Philips Medical Systems Rasna Imaging Systems RAYPAX INC. In yellow, companies with IHE Committees Chairs (Summer 2004)

20. IHE Classroom Sessions – RSNA 2004 19 Participating and Contributing Vendors (Asia) Japan AGFA Gevaert Japan EBM Japan INFINITT Japan A&T Canon Goodman Climb Medical Systems Konica Minolta MG Shimadzu SONY Toshiba Medical Systems Toyo Technica Nihon Kohden Olympus NEC Pioneer (Marotech) Hitachi Hitachi Medico Fujitsu Fuji Film Medical Yokogawa Taiwan INFINITT Shing Shian INQ GEN TEP Tah Ya Korea AGFA Korea GE Healthcare Korea INFINITT LG CNS Marotech, Inc. Medical Standard Peoplenet Communications Samsung SDS

21. IHE Classroom Sessions – RSNA 2004 20 International IHE Initiatives IHE Asia / Oceania – IHE-JJapan – IHE-KRKorea – IHE-TWTaiwan – IHE-PRCChina(Considers Participation) IHE Europe – IHE-FFrance – IHE-DGermany – IHE-IItaly – IHE-NNorway – IHE-NLHolland – IHE-UKUnited Kingdom – IHE-DKDenmark(Starting) – IHE-SSweden(Considers Participation) – IHE-ESpain(Considers Participation) IHE North America – IHE-USAUnited States – IHE-CDNCanada

22. IHE Classroom Sessions – RSNA 2004 21 The IHE Initiative Worldwide Panel Discussion IHE – The Global Integration Solution  IHENorth America: http://www.rsna.org/IHE  IHECanada: http://www.ihe-canada.com  IHEEurope: http://www.IHE-Europe.org  IHEJapan: http://www.jira-net.or.jp/ihe-j/en/index.html  IHEKorea: http://www.ihekorea.org/  IHETaiwan: http://www.dicom.org.tw Geert Claeys Agfa-Gevaert NV IHE Europe Committee Industry Co-Chairman Hee-Joung Kim, PhD Yonsei University Medical Center IHE Korea Committee Chairman David Koff, MD Sunnybrook and Women's College, Toronto IHE Canada Committee Hidenori Shinoda Toshiba Medical Systems Corporation IHE Japan Committee Co-Chairman Prof. Jenn-Lung Su, PhD Chung Yuan Christian University IHE Taiwan Committee Nikolaus Wirsz, PhD Siemens Medical Solutions IHE Radiology Planning Committee