1. Integrating the Healthcare Enterprise The IHE Process: Developing Standards-based Solutions Kevin O’Donnell Co-chair, IHE Radiology Planning Committee Manager, Systems Solutions, Toshiba Medical Systems

2. April 30, 2004IHE Canada Videoconference2 Goals of IHE Increase the rate and quality of integration in healthcare environments. Foster communication among vendors. Prove that integration is attainable through the use of standards. Improve the efficiency and effectiveness of clinical practice.

3. April 30, 2004IHE Canada Videoconference3 “Improve the efficiency and effectiveness of clinical practice” Improve Workflow Improve Information Accuracy Improve Information Availability Enable Cross-System Functionality

4. April 30, 2004IHE Canada Videoconference4 How Does IHE Work? A joint initiative to improve systems integration: Clinicians define system integration needs Vendors use a well-defined process to develop standards-based solution profiles – the IHE Technical Framework. Societies (HIMSS/RSNA/ACC) supervise documentation, testing, demonstration, and promotion of the profiles.

5. April 30, 2004IHE Canada Videoconference5 “IHE drives standards-based integration in healthcare”

6. April 30, 2004IHE Canada Videoconference6 Key IHE Concepts

7. April 30, 2004IHE Canada Videoconference7 Actor A generalized system function: – Order Placer – Order Filler – Acquisition Modality – Image Manager – Report Creator Implementers choose which Actors to include in a system Systems may group several Actors

8. April 30, 2004IHE Canada Videoconference8 Transaction An interaction or exchange of data between actors Based on open standards Strictly specified to avoid incompatible implementations (retire options, clarify data model, etc.) Represents an actors interface with the rest of the world System internal functions are out of scope, e.g. – single system functions – transactions between actors inside the same system

9. April 30, 2004IHE Canada Videoconference9 Integration Profile A Problem/Solution Scenario For each Integration Profile: – the context is described (what real-world problem is addressed) – the actors are defined (what systems are involved) – the transactions are defined (what do they have to do)

10. April 30, 2004IHE Canada Videoconference10 IHE Process Identify a specific information flow between several systems Define a coherent set of actors & transactions For each transaction: – Select an existing standard (e.g. HL7, DICOM) – Detail how to use the standard to implement the transaction Bundle it up as an “Integration Profile” Do Cross-vendor testing at a “Connectathon” Use Integration Profiles as a Common Language for: – Vendors to claim in Integration Statements – Users to request in RFPs

11. April 30, 2004IHE Canada Videoconference11 What IHE is NOT! A standards development organization Uses established standards (HL7, DICOM, others) to address specific clinical needs Activity complementary to SDOs Simply a demonstration project Demos are only one means to the end: Adoption Backed up by documentation, tools, testing, and publication of information

12. April 30, 2004IHE Canada Videoconference12

13. April 30, 2004IHE Canada Videoconference13 IHE Technical Framework Volume 1: The Profiles Identifies the actors and transactions Describes the integration scenario Volume 2 (and 3): The Transactions Provides implementation specification for each transaction Volume 4: The National Appendices Documents national clarifications and extensions

14. April 30, 2004IHE Canada Videoconference14 IHE Connectathon Voluntary Participation Project Management by Mallinckrodt Pre-Validation Tools (MESA) Defined Test Protocols with Verification Engineering event – code changes are not a problem Massive Cross-vendor Testing

15. April 30, 2004IHE Canada Videoconference15 RFPs & IHE Integration Statements Be Brief? – “The system must support DICOM” Be Effective? – “The system must support the following DICOM services according to the following 100 pages of specifications” Be Both: – “The system must support IHE Scheduled Workflow as an Acquisition Modality” – IHE Integration Statements Version 2.1 of the Jupiter 3 CT supports IHE Scheduled Workflow as an Acquisition Modality

16. April 30, 2004IHE Canada Videoconference16 IHE Integration Profiles B A Proven Standards Adoption Process Standards Easy to Integrate Products IHE Integration Profile A IHE Demonstration IHE Connectathon Product With IHE User Site RFP IHE Technical Framework Product IHE Integration Statement IHE Connectathon Results

17. April 30, 2004IHE Canada Videoconference17 4 active Domains, Over 80 vendors involved, Connectathons on 3 Continents, Demonstrations at major exhibitions world-wide IHE Domains in 2004 IHE Cardiology IHE Laboratory IHE Radiology IHE Future Domain IHE Future Domain IHE IT Infrastructure Intra-Enterprise Cross-Enterprise 12 Integration Profiles 1 Integration Profile 5 Integration Profiles EHR Solutions

18. April 30, 2004IHE Canada Videoconference18 IHE Radiology Integration Profiles Patient Info. Recon- ciliation Access to Radiology Information Consistent Present- ation of Images Basic Security - Evidence Docs Key Image Notes Simple Image & Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled Workflow Media Distribution NM Image

19. April 30, 2004IHE Canada Videoconference19 IHE IT Infrastructure Integration Profiles Enterprise User Authentication Provide users a single name and centralized authentication process across all systems 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 Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications Consistent Time Coordinate time across networked systems Consistent Time Coordinate time across networked systems

20. April 30, 2004IHE Canada Videoconference20 IHE Advantages The problems are identified by the users The solutions are vendor/application neutral The profiles package relevant chunks of standards into useful real-world bundles – Where HL7 & DICOM provide Dictionaries, IHE provides a Phrasebook The connectathon enables broad cross- vendor testing of implementations The profiles simplify effective communication between vendors and users

21. April 30, 2004IHE Canada Videoconference21 Where Is More Information Available? www.rsna.org/IHE ; www.himss.org/IHE – IHE Radiology Technical Framework V5.5 – IHE IT Technical Framework V1.0 – IHE Lab Technical Framework V1.0 – IHENews Mailing List – IHE Primer and IHE FAQ – IHE Integration Profiles: Guidelines for Buyers – IHE Presentations – IHE Connectathon Results – IHE Integration Statement Links

22. April 30, 2004IHE Canada Videoconference22 Patient Identifier Cross-referencing Abstract / Scope Allow all enterprise participants to register the identifiers they use for patients in their domain Support domain systems’ queries for other systems’ identifiers for their patients Optionally, notify domain systems when other systems update identifiers for their patients

23. April 30, 2004IHE Canada Videoconference23 Patient Identifier Cross-referencing Value Proposition Maintain all systems’ identifiers for a patient in a single location Use any algorithms (encapsulated) to find matching patients across disparate identifier domains Lower cost for synchronizing data across systems – No need to force identifier and format changes onto existing systems Leverages standards and transactions already used within IHE

24. April 30, 2004IHE Canada Videoconference24 Patient Identifier Cross-referencing ID Domains & Transactions