integrating the healthcare enterprise ihe for consultants and system integrators andrei leontiev...

Integrating the Integrating the Healthcare EnterpriseHealthcare Enterprise

IHE for Consultants and IHE for Consultants and System IntegratorsSystem Integrators

Andrei Leontiev

John PaganiniIDX Systems Corporation

HIMSS/RSNA HIMSS 2003

• The IHE Technical Framework presentsThe IHE Technical Framework presentsthe technical details for system integrators the technical details for system integrators implementing an IHE networkimplementing an IHE network

• It includes guidelines for defining dependency It includes guidelines for defining dependency relationships, system validation and verification. relationships, system validation and verification.

• These guidelines and tools will simplify the These guidelines and tools will simplify the process, identify potential problems, and make process, identify potential problems, and make systems integration faster, more efficient, less systems integration faster, more efficient, less expensive and more successful.expensive and more successful.

IHE as an IHE as an Integration ToolIntegration Tool


IHE Technical FrameworkIHE Technical FrameworkOrganized in three sections that Organized in three sections that

provide an increasing level of detail:provide an increasing level of detail:

Integration ProfilesIntegration Profiles: Establish broad categories of : Establish broad categories of compatible function.compatible function.

ActorsActors: Identify specific kinds of operational : Identify specific kinds of operational participants in the healthcare enterprise.participants in the healthcare enterprise.

TransactionsTransactions: Describe particular interactions : Describe particular interactions between actors to perform specific operations.between actors to perform specific operations.


IHE Integration ProfilesIHE Integration Profiles

Access to Radiology InformationRetrieve & view images and reports

Consistent Presentation of Images

Hardcopy and softcopy grayscale presentation state

Key ImageNotes

Flag & search for significant images

Simple Image and Numeric Reports

Simple reports with image links and measurements

Basic SecurityAudit 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


Technical Framework: Technical Framework: ActorsActors

• Actors identify specific kinds of operational Actors identify specific kinds of operational participants in the healthcare enterprise.participants in the healthcare enterprise.

• An individual actor often corresponds to a device An individual actor often corresponds to a device or software productor software product

However, actors only reflect integration However, actors only reflect integration capabilities of such device or productcapabilities of such device or product

• Real-life products often implement multiple actorsReal-life products often implement multiple actors• Actors may implement more than one IHE profile.Actors may implement more than one IHE profile.• 17 types of actors IHE Year 417 types of actors IHE Year 4


Technical Framework:Technical Framework:TransactionsTransactions

• Transactions specify how actors communicate Transactions specify how actors communicate to each other in the integration profileto each other in the integration profile

• Transactions define standard protocols Transactions define standard protocols • (DICOM, HL7, etc.)(DICOM, HL7, etc.)

• If protocol allows for multiple options, certain If protocol allows for multiple options, certain choice of options is often dictatedchoice of options is often dictated

• May be required in multiple profiles; some May be required in multiple profiles; some transactions are optionaltransactions are optional

• Over 30 types of transactions in Year 4Over 30 types of transactions in Year 4


Generic Integration Solution Implementation Guide Based on Standards Choice of Useful Standards Definitions Select Options Defined by Standards Strict Conformance to Standards:

– Health Level 7 ( HL7 )– DICOM 3.0– ...

IHE - Relationship to StandardsIHE - Relationship to Standards


Use Case Roles Use Case Roles & Interaction Diagrams& Interaction Diagrams

Actor 1 Actor 2

TRANSACTIONS

Actor 3

Actor 1 Actor 2 Actor 3

Message 1Message 2

Message 3

• Examples of Actors:Examples of Actors:- ADT / Patient RegistrationADT / Patient Registration- SchedulerScheduler- Acquisition ModalityAcquisition Modality- Image DisplayImage Display- Report ReaderReport Reader

• Examples of Transactions:Examples of Transactions:- Register PatientRegister Patient- Procedure ScheduledProcedure Scheduled- Images StoredImages Stored- Query / Retrieve ImagesQuery / Retrieve Images- Query / Retrieve ReportsQuery / Retrieve Reports


Use Case Roles &Use Case Roles & Interaction Diagrams Examples Interaction Diagrams Examples

Interaction Diagram:Interaction Diagram: Retrieve ReportsRetrieve Reports

Retrieve Reports ( C-MOVE )

Store Reports ( C-STORE )

View Reports

ReportReader

ReportRepository

External Report

Repository

Retrieve Reports ( C-MOVE )

Store Reports ( C-STORE )

View Reports


System Transactions OverviewSystem Transactions Overview

Order Placer

PerformedProcedure Step

Manager

ADTPatient Registration

Image Archive

Image Manager

Image Display

Image Creator

AcquisitionModality

DepartmentSystem Scheduler– Order Filler –

Modality Worklist

Patient Registration

Patient Update

Procedure Scheduled

Images Availability Query

Patient Update

Procedure Update

ImagesStored

StorageCommit

Q /R KeyImage Note

Q /RPresentation

Sates

StorageCommit

ImagesStored

PPSIn-Progress/ Completed



Fil

ler

Ord

erM

anag

emen

t

Placer Order Management Present.

StateStored

Q /RImages

Key Image Note

StoredPresent.State

Stored

Key Image Note

Stored


Order Placer


Manager


Image Archive

Image Manager

Image Display

Image Creator

AcquisitionModality


Modality Worklist


Patient Update

Procedure Scheduled

Images Availability Query

Patient Update

Procedure Update

ImagesStored

StorageCommit

Q /R KeyImage Note

Q /RPresentation

Sates

StorageCommit

ImagesStored




Fil

ler

Ord

erM

anag

emen

t

Placer Order Management Present.

StateStored

Q /RImages

Key Image Note

StoredPresent.State

Stored

Key Image Note

Stored

System Transactions OverviewSystem Transactions OverviewPRINTING

Print Server

Print Request withPresentation LUT

Print Composer

ExternalReport

Repository

Report Reader

Report Creator

Report Manager

Report Repository

Report Submission

Report Issuing

Query Report

Retrieve Report

Enterprise Result

Repository

Structured ReportExport


Store ImagesStore Images

Storage CommitmentStorage CommitmentStorageStorage

CommitmentCommitment

List of ImagesList of Images

PACS &PACS &ArchiveArchive

RISRIS

ModalityModalityPerformedPerformedProcedure Procedure StepStep

Performed Step:Performed Step:

Status = CompletedStatus = CompletedPerformed CT HeadPerformed CT HeadPat Name/ID, Dose, Pat Name/ID, Dose,

Accession #, Study UIDAccession #, Study UIDComplete List of ImagesComplete List of Images

IHE Scheduled WorkflowIHE Scheduled Workflow

Modality WorklistModality Worklist

WorklistWorklist

Procedure ScheduledProcedure Scheduled

Patient Registration/UpdatePatient Registration/UpdateOrder ManagementOrder Management


Scheduled WorkflowScheduled Workflow

Order Placer


Manager


Image Archive

Image Manager

Image Display

Image Creator

AcquisitionModality


Modality Worklist


Procedure Scheduled

Images Availability QueryImagesStored

StorageCommit

StorageCommit

ImagesStored


Fil

ler

Ord

erM

anag

emen

t

Placer Order Management

Patient Update

Q /RImages




Example: Image Manager/ Image Archive ActorTransaction Optionality Section in TF

Procedure Scheduled R 6.4Modality Procedure Step In Progress R 6.6Modality Procedure Step Completed R 6.7Modality Images Stored R 6.8Storage Commitment R 6.10Image Availability Query R 6.11Query Images R 6.14Retrieve Images R 6.16Creator Images Stored R6.18Creator Procedure Step in Progress R 6.20Creator Procedure Step Completed R 6.21

Integration Profiles Actors and Integration Profiles Actors and Transactions Scheduled WorkflowTransactions Scheduled Workflow

How to build the integrated How to build the integrated healthcare enterprisehealthcare enterprise


Where to start...Where to start...

First, recognize what systems you need to integrate

See what Actors they implement and in what Profiles are supported.

Make sure Actors and Profiles match properly and fit into the Framework.

… Otherwise it won’t work!


Next StepsNext Steps Just matching of Actors and profiles

is not enough Most systems have much more

complex functionality than that defined in framework

They need more data to function properly

Identify what data systems need besides elements defined in the IHE transactions.


Check Optional Check Optional TransactionsTransactions

IHE Integration Profiles may contain optional transactions - make sure both sender and receiver treat such transactions similarly– if receiver requires transaction, sender must be able to

always generate it– If receiver does not utilize transaction, make sure it is

gracefully handled when it “shows up”


Check the Options Check the Options

in Transactionsin Transactions Many data elements in the transactions are optional or conditional

Make sure that sender generates conditional information when conditions are met

Make sure that receiver may operate without optional data or the sender must be able to always generate it


Is it going to work now?Is it going to work now?

Make sure the conformance statements are for correct versions of the software

Check HL7 interface specs Review DICOM Conformance Statements Check the results of IHE Connect-a-thon Ask vendors to provide output from the

MESA test tools


MESA ToolsMESA Tools

Test tools that are developed by the IHE Technical Project Management Team

Used in preparation for IHE Connect-a-thon. MESA tools are in public domain. Test outputs are fairly informative and may

provide the extra information on how transactions are implemented


Are we there yet?Are we there yet?

One yet have to find the healthcare enterprise equipped so that all the systems are “IHE aware”

Understand that you may have to deal with non-compliant devices and systems

Make best effort to bring them “up-to-date” Follow yellow brick road...


Implementing Integration Implementing Integration Projects with IHEProjects with IHE


Project ConsiderationsProject Considerations

A working knowledge of rapidly changing technology An unbiased insight into the business strategies of

potential suppliers Incorporating existing equipment Considering changes to current operations Accounting for the various skills and apprehensions of a

multitude of potential users Accommodating complex practice patterns of

radiologists and referring physicians Impact of organization changes within the enterprise Impact of changes in the health care industry


Classic Consulting Classic Consulting ProcessProcess

1. Definition of Client Requirements – Site Analysis, Operational Workflow

2. Generation of Proposal - Review with Client, Modify as Needed

3. Solution Development and Implementation

4. Client Testing QA / Test

5. Client Signoff

6. Post Implementation Review


Solution and DevelopmentSolution and Development

• Current State AnalysisCurrent State Analysis • Impact StudyImpact Study • Current State AnalysisCurrent State Analysis • Impact StudyImpact Study • System Design and System Design and

Implementation StrategyImplementation Strategy

• Current State AnalysisCurrent State Analysis • Impact StudyImpact Study • System Design and System Design and

Implementation StrategyImplementation Strategy • Cost EstimateCost Estimate

• Current State AnalysisCurrent State Analysis • Impact StudyImpact Study • System Design and System Design and

Implementation StrategyImplementation Strategy • Cost EstimateCost Estimate • Pay Back AnalysisPay Back Analysis

• Current State AnalysisCurrent State Analysis Department Layout

Imaging Asset Analysis

Room Utilization

Hardcopy Utilization

Digital Image Equivalents

Workflow Analysis Cost Analysis

Develop assumptions about system performance and specify performance requirements.

Interviews with the radiologists and clinicians

Questionnaires

Short and long term outcomes.

System design includes block diagrams and component lists.

Physical network

Acquisition devices

Display systemsArchives Interfaces

Determine the pricing of the required products and services.

•Applications.

•Professional Services.

•Integrations.

•Training.

Material costs and labor savings are combined with other potential savings


Vendor Vendor ConsiderationsConsiderations

Cost - Look at whole pictureFlexibility - Integratable, ScalableFunctionality - Standard, customizableImplementability - Mature, ComplexityStability - Revenue, Market SegmentUsability - Hides complexity,Productive


Reengineering Reengineering AnalysisAnalysis

What works well now? What does not work well

now? What is a "relic from the

past"? Search for redundancies Search for important,

missing data Check workload peaks &

valleys

Challenge traditions Expect innovation Document every detail Simplify the complex Still need all that paper? Shorten the start-to-

finish cycle time Verify computations


User AnalysisUser AnalysisIHE brings users

together in new waysEach user vital to

patient careEach user has

different perspectiveEach user needs to

see how IHE can benefit them


Departmental ChiefDepartmental Chief

ROLE Responsible for

prompt, reliable, cost-effective patient care

Analyzes workflow, visionary, road map

IHE INTEREST Purchase best of

breed while conforming to IHE

Seamless integration Deliver on unique

requirements of Staff Ensure optimized

workflow


Chief Information OfficerChief Information Officer

ROLE Protector and Provider of

Patient Data Manages dozens of

information systems

PROBLEMS Increasing policies,

procedures, regulations Tight budgets Changing technologies Tight technical labor market

IHE INTEREST Workflow defined Deploy best of breed

systems with standards Technical Framework will

enable application consolidation

Promotes healthy competition to vendors –improve performance and service


ConclusionConclusion

IHE should be part of theproposed solution

IHE benefits users, providers and vendorsYear 5 - Key year for expansion into other

domains while radiology continuesSupport and involvement building across

disciplines and internationally


IHE Expands ScopeIHE Expands Scope Recruiting Participants in new Committees

Enterprise Master Patient Index Advanced Security Query/Display and Synchronized Patient View

Special Panel Session in IHE Theatre Overview of new IHE enterprise initiatives Learn how to participate

– Tuesday, February 11, 9:15 – 10:00 a.m.– Wednesday, February 12, 12:15 – 1:00 p.m


Special IHE Panel SessionSpecial IHE Panel Session IHE - IT Infrastructure: The Value Proposition

– Find out how you can benefit from participating in IHE committees and Connectathons

– Learn how IHE fills the interoperability gap – Hear the status of new enterprise initiatives

Software vendors, developers and interested parties invited to attend special panel session


Where is More Information Where is More Information Available?Available?

www.rsna.org/IHEIHE Technical framework for year 5 – V5.5

Non-Technical Brochures :IHE Primer and IHE FAQIHE Integration Profiles: Guidelines for BuyersIHE Connectathon Results

integrating the healthcare enterprise ihe for consultants and system integrators andrei leontiev...

Documents

multiple actors actors

ihe profile

types of actors ihe

healthcare enterprise

systems integration

integration tool slide

technical details

integration capabilities