1. Integrating the Healthcare Enterprise IHE Fundamentals Kevin O’Donnell, Toshiba Niki Wirsz, Siemens Ellie Avraham, Kodak [30 minutes]

2. RSNA 20022 IHE Fundamentals What is it about?What is it about? How do I get it?How do I get it? Why is it needed?Why is it needed? Who is IHE?Who is IHE? Where can I learn more?Where can I learn more? How does it work?How does it work? How do I use it?How do I use it? What do I get out of it?What do I get out of it? What about DICOM?What about DICOM? What does IHE create?What does IHE create?

3. RSNA 20023 What is IHE about?  IHE is an initiative promoting and supporting the integration of systems in the healthcare enterprise.  Goal: Improve the efficiency and effectiveness of clinical practice by:  Improved Information Flow  Advanced Multi-System Functions

4. RSNA 20024 How do you Use IHE? IHE “Integration Profiles”IHE “Integration Profiles” –Are Integration solutions in the Healthcare Enterprise to support specific capabilities. Customer – Vendor CommunicationCustomer – Vendor Communication –Review the Profiles –Decide what you Need –Ask vendors for that profile on the relevant systems “Which IHE Profiles do you support on System X as which actors? - The IHE Product Evaluation Worksheet.

5. RSNA 20025 Why is IHE needed? Serious Integration Challenges in Healthcare:Serious Integration Challenges in Healthcare: Systems need Information other systems haveSystems need Information other systems have But, systems communicate poorly or not at allBut, systems communicate poorly or not at all Result: - tedious, inefficient workflows - data that is inconsistent, redundant or unavailableResult: - tedious, inefficient workflows - data that is inconsistent, redundant or unavailable Responsibility for information flow between systems, and between departments, is often unclear.

6. RSNA 20026 Who is IHE?  Participants:  Professional Societies  Radiological Society of North America (RSNA)  Healthcare Information and Management Systems Society (HIMSS)  Other societies (European, Japanese, Lab HC Partnership ACC, …)  Vendors (over 30 companies)  Standards Group Committee Members of DICOM & HL7  RSNA and HIMSS sponsor IHE to provide a neutral forum for working on the Big Picture

7. RSNA 20027 How Established is IHE? Year 1 (1999):Proof of Concept (Basic Scheduled Workflow)Year 1 (1999):Proof of Concept (Basic Scheduled Workflow) Year 2 (2000): Introduction of the 7 Profiles (Full Featured)Year 2 (2000): Introduction of the 7 Profiles (Full Featured) Year 3 (2001): Consolidation, Catch-up (Real Products) Expansion to FranceYear 3 (2001): Consolidation, Catch-up (Real Products) Expansion to France Year 4 (2002): 3 New Profiles Expansion to Japan, Germany, ItalyYear 4 (2002): 3 New Profiles Expansion to Japan, Germany, Italy Year 5 (2003): New Profiles Expansion to UK, IT Infrastructure, Cardiology, Nuclear Medicine, Lab, …?Year 5 (2003): New Profiles Expansion to UK, IT Infrastructure, Cardiology, Nuclear Medicine, Lab, …?

8. RSNA 20028 What does IHE cover? [37] Vendors participated in IHE Year 4 with [71] Systems[37] Vendors participated in IHE Year 4 with [71] Systems Systems include:Systems include: HIS, RISHIS, RIS CT, MR, US, CR, DX, XA, NM, …CT, MR, US, CR, DX, XA, NM, … PACS, Review Stations, Reporting SystemsPACS, Review Stations, Reporting Systems Printers, ImagersPrinters, Imagers

9. RSNA 20029 Why Integrate? Interfacing products from different Vendors for Interoperable and effective Enterprise operation.Interfacing products from different Vendors for Interoperable and effective Enterprise operation. Integrated Systems -> cooperative exchange of informationIntegrated Systems -> cooperative exchange of information Your system receives relevant informationYour system receives relevant information –Patient Demographics –Order Information –Related Clinical Data >>> More efficient workflow, reduced errors, more intelligent equipment Your system distributes relevant informationYour system distributes relevant information –Clinical Data – test results, images, measurements, reports >>> More valuable if it’s available anywhere, anytime >>> More valuable when combined with other data (No single device has all the answers)

10. RSNA 200210 Why Integrate? Cooperative Information Flow Enables ProcessesCooperative Information Flow Enables Processes –Order Workflow: Scheduling, Worklists, Status, Results –Specialist Consultation: Sharing Data, Views, Observations –Electronic Medical Records: Data Collection, Storage, Distribution –Clinical Workflow: Data Access, Review, Analysis, Recording –Research Workflow: Clinical Studies, Evidence Based Medicine –Financial Workflow: Order Authorization, Status, Billing, Collection –Collaboration for resolving problems such as Consistent Presentation of Images or Managing Subset of single Acquisition.

11. RSNA 200211 How is IHE related to Standards? Information is applied within a contextInformation is applied within a context –Order: Clinical View, Financial View, Dept. View Information needs to travel widelyInformation needs to travel widely >>> Workflows cross Standard borders Standards provide tools & technologiesStandards provide tools & technologies –HL7 and DICOM provide dictionaries IHE specifies how to apply them to real world scenarios & integration problemsIHE specifies how to apply them to real world scenarios & integration problems –IHE defines a “phrasebook”

12. RSNA 200212 What Does IHE Do? Users and Vendors work together to identify and design solutions for integration problemsUsers and Vendors work together to identify and design solutions for integration problems Intensive process with annual cycles:Intensive process with annual cycles: –Identify key healthcare workflows and integration problems –Research & select standards to specify a solution –Write, review and publish IHE Technical Framework –Perform cross-testing at “Connectathon” –Demonstrations at tradeshows (HIMSS/RSNA)

13. RSNA 200213 What are 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)

14. RSNA 200214 What is the Result? Vendors implement selected actors and support selected profiles on their systemsVendors implement selected actors and support selected profiles on their systems IHE is not a product; it is a software feature or upgradeIHE is not a product; it is a software feature or upgrade Customers can request specific Integration Profiles in RFPs for clinical systemsCustomers can request specific Integration Profiles in RFPs for clinical systems The systems have been pre-tested at the ConnectathonThe systems have been pre-tested at the Connectathon

15. RSNA 200215 Who benefits? Clinical UsersClinical Users Greater access to more consistent informationGreater access to more consistent information Fewer errors, fewer tedious tasksFewer errors, fewer tedious tasks AdministratorsAdministrators Increased throughputIncreased throughput Better scheduling and trackingBetter scheduling and tracking BuyersBuyers Specify/purchase integration capabilities easilySpecify/purchase integration capabilities easily Freedom to acquire “Best of Breed” systemsFreedom to acquire “Best of Breed” systems IT ProfessionalsIT Professionals Faster, more predictable integration projectsFaster, more predictable integration projects

16. RSNA 200216 IHE Integration Profiles Access to Radiology Information Retrieve & view images and reports Consistent Presentation of Images Hardcopy and softcopy grayscale presentation state Key Image Notes Flag & search for significant images Simple Image and Numeric Reports Simple reports with image links and measurements Basic Security Audit Trail Consolidation & Node Authentication Presentation of Grouped Procedures Manage subsets of a single acquisition Post- Processing Workflow Schedule, perform, & notify image processing & CAD steps Charge Posting Collection of billable procedure details Scheduled Workflow Admit, order, schedule, acquire & store images with notification of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders

17. RSNA 200217 Scheduled Workflow Profile Registration Orders Placed Orders Filled Film Folder Image Manager & Archive Film Lightbox report Report Repository Diagnostic Workstation Modality acquisition in-progress acquisition completed images printed Acquisition Modality

18. RSNA 200218 Patient Information Reconciliation Profile Extends Scheduled WorkflowExtends Scheduled Workflow –Handle unidentified patient (e.g. trauma) –Handle demographic information mistakes –Propagate changes to all affected systems, update all affected data Reduces incorrectly identified or “lost” studiesReduces incorrectly identified or “lost” studies

19. RSNA 200219 Post-Processing Workflow Profile Post-Proc.WorkflowManager PACS System CAD *Workstation Report Repository Acquisition Modality 3-D *Workstation Work Status Worklist … Source Data Results Workstation Results Work Status

20. RSNA 200220 Simple Image & Numeric Reports Profile Images Retrieved Preliminary Report Verified Report Report & Images Retrieved Image Manager & Archive Report Verification Images and Exam data presented for diagnosis Reports stored for Network Access Report & Image Review for Patient Care

21. RSNA 200221 Charge Posting Profile ChargePoster *Billing System CAD *Workstation Report Repository … Report Generated / Signed CAD Performed Post Charges Acquisition Modality ADT Terminal 3-D *Workstation Account Management 3-D Performed Study Performed / Materials Used

22. RSNA 200222 What the Radiologist Displays: What the Reviewing Physician Sees: The Radiologist’s Transformations Are Saved Original Image & Presentation State Original Image Window Level Flip Zoom Area Of Interest Annotate The Radiologist’s Transformations Are Lost Original Image Area Of Interest Prepared Image Original Image Consistent Presentation of Images Profile

23. RSNA 200223 MODALITY Presentation of Grouped Procedures Profile Requested Procedure: CHEST Report: CHEST Report: AB/PELVIS Performs a single exam Operator groups 2 procedures Chest View RIS / PACS Requested Procedure: AB/PELVIS Chest View Ab/Pelvis View

24. RSNA 200224 Radiologist Flags Images: Referring Physician Sees Key Images First: for refering physician This image shows the renal rupture. Note1 for refering physician This image has the hematoma. Note2 For referring physician: This image shows the renal rupture. Note1 For referring physician: This image has the hematoma. Note2 for refering physician This image shows the renal rupture. Note1 for refering physician This image has the hematoma. Note2 Study & Key Image Notes Key Image Notes Profile

25. RSNA 200225 Access to Radiology Information Profile Radiology Department – Images and Reports Emergency Department Referring Physician Other Departments: - Oncology - Surgery - Neurology - Pediatrics - etc. Remote Clinics Electronic Medical Record

26. RSNA 200226 Basic Security Profile AuditRecordRepository … Image Manager & Archive “Images Queried / Retrieved” Diagnostic Workstation Report Repository … Report & Image Review “Reports Queried / Retrieved” “Images Printed” “Reports Stored” “Reports Retrieved” “Reports Printed”

27. RSNA 200227 Resources www.rsna.org/IHEwww.rsna.org/IHE FAQsFAQs Integration ProfilesIntegration Profiles Primer on IHEPrimer on IHE PresentationsPresentations IHE Technical FrameworkIHE Technical Framework

28. RSNA 200228 Questions? Ask your vendors: Which IHE Profiles do they support on which systems? www.rsna.org/IHE