1. Integrating the Healthcare Enterprise - IHE An initiative of the ACC to improve data interoperability with the cooperation of the ASE

2. June 2005ASE Scientific Sessions2 Why IHE? Cardiology has hard system and data integration problems - Multiple locations (office, in-patient, ED …) - Multiple devices and modalities - Long term patient care by many care providers Data integration is essential to quality patient care and efficient clinical practice Care providers must work with industry to develop solutions to meet their needs - Implementations must be based on open standards

3. June 2005ASE Scientific Sessions3 “I feel your pain” –Bill Clinton “Ease his pain” –the voice in “Field of Dreams” “We are addressing your pain” –IHE Quotes

4. June 2005ASE Scientific Sessions4 What is IHE? A collaboration of clinicians and vendors - International and multi-specialty - Sponsored by ACC, HIMSS, RSNA A proven systems integration process - Refined through seven years of experience Produces results on a yearly cycle - Problem identification, Technical specification, Vendor implementation, Test, Demonstration - Yearly cycle focuses on most important tractable problems

5. June 2005ASE Scientific Sessions5 You are here IHE is international - North America, Europe, Asia/Oceania IHE is multi-domain - Radiology, Cardiology, IT Infrastructure, Lab, Oncology, Patient Care, Eyecare … IHE Cardiology is multi-specialty - Cath/Angio, Echo, Nuc, EP, CT/MR … IHE is multi-year - Cardiology Year 1 (2004-5)

6. June 2005ASE Scientific Sessions6 IHE Cardiology Year 1 Three initial clinical problems to be addressed: 1. The ability to view an ECG from many locations - quickly and easily integrated into other applications 2. Effective integration of patient, order, and procedure information in an Echo Lab, including mobile echo 3. Effective integration of patient, order, and procedure information in a Cath Lab, including angio, hemo, and IVUS, especially for emergent cases ► “Retrieve ECG for Display” ► “Echocardiography Workflow” ► “Cardiac Catheterization Workflow”

7. June 2005ASE Scientific Sessions7 Echo Workflow

8. June 2005ASE Scientific Sessions8 Echocardiography pain Intermittently connected modality - Lost and unbilled echo exams because carts are constantly on the move - Patient and order info manually entered (potential for errors) or not at all Stress echo - Stress echo image ID inconsistent across vendors – pain setting up workstations for consistent quad display Patient information reconciliation - Change of patient demographics not tracked into images

9. June 2005ASE Scientific Sessions9 IHE Annual Cycle – Step 1 1. Cardiologists identify clinical problems to be addressed - “Integration Profiles” 2. Engineers from vendors collaborate to define technical specification (using standards such as DICOM and HL7) 3. Vendors implement the technical specification and participate in the “Connectathon” and demos 4. Vendors publish IHE Integration Statements, and users can buy IHE systems

10. June 2005ASE Scientific Sessions10 Echo – 6 use cases Case E1: Patient Registered at ADT and Procedure Ordered Case E2: Intermittently Connected Modality Case E3: Intermittently Connected Modality with Ad Hoc Procedure, Patient Registered, Scheduled Procedure Case E4: Intermittently Connected Modality with Ad Hoc Procedure, Patient Registered, Unscheduled Procedure Case E5: Intermittently Connected Modality with Ad Hoc Procedure, Patient Unregistered, Unscheduled Procedure Case E6: Stress Echo Staged Protocol

11. June 2005ASE Scientific Sessions11 “Could you do a TTE on this patient right now since you are in the CCU anyway?” Case E4, a.k.a. “Drive-by echo” - Demo scenario 1

12. June 2005ASE Scientific Sessions12 IHE Annual Process – Step 2 1. Cardiologists identify clinical problems to be addressed - “Integration Profiles” 2. Engineers from vendors collaborate to define technical specifications (using standards such as DICOM and HL7) 3. Vendors implement the technical specification and participate in the “Connectathon” and demos 4. Vendors publish IHE Integration Statements, and users can buy IHE systems

13. June 2005ASE Scientific Sessions13 Technical Framework

14. June 2005ASE Scientific Sessions14 IHE Annual Process – Step 3 1. Cardiologists identify clinical problems to be addressed - “Integration Profiles” 2. Engineers from vendors collaborate to define technical specification (using standards such as DICOM and HL7) 3. Vendors implement the technical specification and participate in the “Connectathon” and demos 4. Vendors publish IHE Integration Statements, and users can buy IHE systems

15. June 2005ASE Scientific Sessions15 IHE Joint Connectathon January, 2005 Oak Brook, IL 300 engineers 43 companies 110 products – Working together in a collegial environment – 2800 monitored test cases executed in 5 days This is integration that doesn’t take up your hospital’s resources – and no finger-pointing!

16. June 2005ASE Scientific Sessions16 Echo Profile Connectathon Results North America and Europe 2005

17. June 2005ASE Scientific Sessions17 IHE Annual Process – Step 4 1. Cardiologists identify clinical problems to be addressed - “Integration Profiles” 2. Engineers from vendors collaborate to define technical specifications (using existing standards such as DICOM and HL7) 3. Vendors implement the technical specification and participate in the “Connectathon” and demos 4. Vendors publish IHE Integration Statements, and users can buy IHE systems

18. June 2005ASE Scientific Sessions18 Your Request for Proposals (RFPs) Incorporate IHE framework into RFP documents & product selection Much easier to specify an IHE Integration Profile than detailed technical specs - “Device must support IHE Echo Integration Profile, and vendor must supply an IHE Integration Statement.” Use IHE framework to evaluate your current workflow, even if not buying now Vendors build product functions that are requested by customers Ask for IHE Integration Loud & Often !!

19. June 2005ASE Scientific Sessions19 Long Road Ahead – 5 yr Roadmap Year 1 (2005) Year 2 (2006) Year 3 (2007) Year 4 (2008) Year 5 (2009) Cath Echo ECG Nuclear EP Cardiology Technical Framework Quality General Multi-modality workflow & imaging Measurements & evidence Procedure log, coded reports Supplies, inventory, & charge capture Workflow & imaging, stress protocols Measurements Retrieve ECG for display ECG/Stress/Holter orders Workflow & stress protocols Multi-modality lab workflow & reporting Home health monitoring Retrieve guidelines for display Retrieve structured guidelines Registry data harvesting Reporting & report distribution Precision time synchronization Implantable device parameters & events PediatricCoded reports ECG waveform interoperability Stress testing workflow

20. June 2005ASE Scientific Sessions20 IHE Cardiology Year 2 2005-6 Measurements - Standard measurement exchange using DICOM Structured Reporting Clinical reports - PDF-based report creation, signature, and archive - Distribution using HL7 v2, HTTP, and ebXML

21. June 2005ASE Scientific Sessions21 Why IHE? This is the cardiologist in healthcare Any Questions? This is healthcare

22. June 2005ASE Scientific Sessions22 Custom integration at customer site is a lose-lose - High cost – vendor and customer - Unpredictable and uncontrolled environment - Inefficient – solutions often must come from other locations (home office) with delays in delivery - Usually insufficiently documented – fragile and unmaintainable solutions - Resources expended on non-value-add effort - Ineffective use of available standards Bolt-on integration is a problem - Data sharing functions don’t work well if not designed into the product Exponential growth of pain as systems are added Why IHE? (for vendors)

23. June 2005ASE Scientific Sessions23 Goals of IHE (for vendors) Effective use of standards Reduce variability in interfaces Controlled integration testing environment - Defined timetable - No extraneous distractions Effective use of resources for integration testing Coordinated deployment of cross-system functions - Avoid chicken-and-egg syndrome Common approach creates the market in which vendors can sell and users can buy with confidence

24. June 2005ASE Scientific Sessions24 IHE Benefits (Vendors) Improves onsite customer support Reduces development cost Standardizes interface engineering Enables the vendors to focus on competitive features Improves customer satisfaction

25. June 2005ASE Scientific Sessions25 IHE Benefits (Consultants & Providers) IHE Profiles facilitate interaction of multiple providers & services to improve quality of patient care IHE provides a consistent view of the entire end-to-end clinical workflow Improves cost effectiveness of system implementation and operations

26. June 2005ASE Scientific Sessions26 More Information Information Available On the Web at: http://www.acc.org/quality/ihe.htm Home Page of IHE Europe: www.IHE-Europe.org Home Page of IHE Japan: www.jira-net.or.jp/ihe-j/en/index.html http://www.ihe.net

27. June 2005ASE Scientific Sessions27 Two Clinical Scenario Demonstrations “Add on” Mobile Procedure Stress Echo Images Join a 10 minute demonstration – Watch us “connect the docs”.