integrating the healthcare enterprise ihe fundamentals kevin o’donnell, toshiba niki wirsz,...
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IntegratingIntegratingthe the
Healthcare EnterpriseHealthcare Enterprise
IHE IHE FundamentalsFundamentals
Kevin O’Donnell, ToshibaKevin O’Donnell, ToshibaNiki Wirsz, SiemensNiki Wirsz, Siemens
Ellie Avraham, KodakEllie Avraham, Kodak[30 minutes][30 minutes]
RSNA 20022
IHE IHE FundamentalsFundamentals• 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?
RSNA 20023
What is IHE about?What is IHE about?
IHE is an initiative promoting and IHE is an initiative promoting and supporting the supporting the integrationintegration of of systemssystems in in the the healthcare enterprisehealthcare enterprise..
Goal: Improve the efficiency and Goal: Improve the efficiency and effectiveness of clinical practice by:effectiveness of clinical practice by: Improved Improved Information FlowInformation Flow Advanced Advanced Multi-System FunctionsMulti-System Functions
RSNA 20024
How do you Use IHE?How do you Use IHE?
• IHE “Integration Profiles”IHE “Integration Profiles”– Are Are Integration solutions in the Healthcare EnterpriseIntegration solutions in the Healthcare Enterprise to to
support specific capabilities.support specific capabilities.
• Customer – Vendor CommunicationCustomer – Vendor Communication– Review the ProfilesReview the Profiles– Decide what you Decide what you NeedNeed– Ask vendors for that profile on the relevant systemsAsk vendors for that profile on the relevant systems
““Which IHE Profiles do you support on System X as Which IHE Profiles do you support on System X as which actors? - which actors? - The IHE Product Evaluation The IHE Product Evaluation Worksheet.Worksheet.
RSNA 20025
Why is IHE needed?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 all But, systems communicate poorly or not at all
• Result: - tedious, inefficient workflows Result: - tedious, inefficient workflows - data that is inconsistent, - data that is inconsistent, redundant redundant or or unavailable unavailable
Responsibility for information flow between systems, Responsibility for information flow between systems, and between departments, is often unclear.and between departments, is often unclear.
RSNA 20026
Who is IHE?Who is IHE? Participants:Participants:
Professional Societies Professional Societies Radiological Society of North America (RSNA)Radiological Society of North America (RSNA) Healthcare Information and Management Systems Society Healthcare Information and Management Systems Society
(HIMSS) (HIMSS) Other societies (European, Japanese, Lab HC PartnershipOther societies (European, Japanese, Lab HC Partnership
ACC, …)ACC, …) Vendors (over 30 companies)Vendors (over 30 companies) Standards Group Committee Members Standards Group Committee Members of DICOM & HL7of DICOM & HL7
RSNA and HIMSS sponsor IHE to provide a RSNA and HIMSS sponsor IHE to provide a neutral forumneutral forum for working on the for working on the Big PictureBig Picture
RSNA 20027
How Established is IHE?How Established is IHE?• Year 1 (1999):Year 1 (1999): Proof of ConceptProof of Concept
(Basic Scheduled Workflow)(Basic Scheduled Workflow)
• Year 2 (2000): Year 2 (2000): Introduction of the 7 ProfilesIntroduction of the 7 Profiles(Full Featured)(Full Featured)
• Year 3 (2001): Year 3 (2001): Consolidation, Catch-up (Real Consolidation, Catch-up (Real Products)Products) Expansion to FranceExpansion to France
• Year 4 (2002): Year 4 (2002): 3 New Profiles3 New ProfilesExpansion to Japan, Germany, ItalyExpansion to Japan, Germany, Italy
• Year 5 (2003): Year 5 (2003): New ProfilesNew ProfilesExpansion to UK, IT Infrastructure, Expansion to UK, IT Infrastructure,
Cardiology, Nuclear Medicine, Cardiology, Nuclear Medicine, Lab, …?Lab, …?
RSNA 20028
What does IHE cover?What does IHE cover?• [37] Vendors participated in IHE Year 4 with [71] [37] Vendors participated in IHE Year 4 with [71]
Systems 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, Imagers Printers, Imagers
RSNA 20029
Why Integrate?Why Integrate?• Interfacing products from different Vendors for Interfacing products from different Vendors for
Interoperable and effective Enterprise operation.Interoperable and effective Enterprise operation.• Integrated Systems -> cooperative exchange of Integrated Systems -> cooperative exchange of
informationinformation
• Your system receives relevant informationYour system receives relevant information– Patient DemographicsPatient Demographics– Order InformationOrder Information– Related Clinical DataRelated Clinical Data>>> More efficient workflow, reduced errors, more intelligent >>> More efficient workflow, reduced errors, more intelligent
equipment equipment
• Your system distributes relevant informationYour system distributes relevant information– Clinical Data – test results, images, measurements, reportsClinical Data – test results, images, measurements, reports>>> More valuable if it’s available anywhere, anytime>>> More valuable if it’s available anywhere, anytime>>> More valuable when combined with other data>>> More valuable when combined with other data
(No single device has all the answers) (No single device has all the answers)
RSNA 200210
Why Integrate?Why Integrate?• Cooperative Information Flow Enables ProcessesCooperative Information Flow Enables Processes
– Order Workflow: Scheduling, Worklists, Status, ResultsOrder Workflow: Scheduling, Worklists, Status, Results
– Specialist Consultation: Sharing Data, Views, ObservationsSpecialist Consultation: Sharing Data, Views, Observations
– Electronic Medical Records: Data Collection, Storage, DistributionElectronic Medical Records: Data Collection, Storage, Distribution
– Clinical Workflow: Data Access, Review, Analysis, RecordingClinical Workflow: Data Access, Review, Analysis, Recording
– Research Workflow: Clinical Studies, Evidence Based MedicineResearch Workflow: Clinical Studies, Evidence Based Medicine
– Financial Workflow: Order Authorization, Status, Billing, CollectionFinancial Workflow: Order Authorization, Status, Billing, Collection
– Collaboration for resolving problems such as Consistent Collaboration for resolving problems such as Consistent Presentation of Images or Managing Subset of single Acquisition.Presentation of Images or Managing Subset of single Acquisition.
RSNA 200211
How is IHE related to Standards?How is IHE related to Standards?• Information is applied within a contextInformation is applied within a context
– Order: Clinical View, Financial View, Dept. ViewOrder: Clinical View, Financial View, Dept. View
• Information needs to travel widelyInformation needs to travel widely>>> Workflows cross Standard borders>>> Workflows cross Standard borders
• Standards provide tools & technologiesStandards provide tools & technologies– HL7 and DICOM provide dictionariesHL7 and DICOM provide dictionaries
• IHE specifies how to apply them to real world IHE specifies how to apply them to real world scenarios & integration problemsscenarios & integration problems– IHE defines a “phrasebook”IHE defines a “phrasebook”
RSNA 200212
What Does IHE Do?What Does IHE Do?• Users and Vendors work together to identify Users and Vendors work together to identify
and design solutions for integration problemsand design solutions for integration problems
• Intensive process with Intensive process with annual cyclesannual cycles::– Identify key healthcare workflows and integration Identify key healthcare workflows and integration
problemsproblems– Research & select standards to specify a solutionResearch & select standards to specify a solution– Write, review and publish IHE Technical FrameworkWrite, review and publish IHE Technical Framework– Perform cross-testing at “Connectathon”Perform cross-testing at “Connectathon”– Demonstrations at tradeshows (HIMSS/RSNA)Demonstrations at tradeshows (HIMSS/RSNA)
RSNA 200213
What are What are Key IHE ConceptsKey IHE Concepts??• Generalized Systems Generalized Systems -> -> ActorsActors
• Interactions between Actors Interactions between Actors -> -> TransactionsTransactions
• Problem/Solution ScenariosProblem/Solution Scenarios -> -> IntegrationIntegration ProfilesProfiles
• 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)
RSNA 200214
What is the Result?What is the Result?• Vendors implement selected actors and Vendors implement selected actors and
support selectedsupport selected profiles on their systems profiles on their systems
• IHE is IHE is not a productnot a product;;it is it is a software feature or upgradea software feature or upgrade
• Customers can request specific Integration Customers can request specific Integration Profiles in RFPs for clinical systemsProfiles in RFPs for clinical systems
• The systems have been pre-tested at the The systems have been pre-tested at the ConnectathonConnectathon
RSNA 200215
Who benefits?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 easily Specify/purchase integration capabilities easily • Freedom to acquire “Best of Breed” systems Freedom to acquire “Best of Breed” systems
• IT ProfessionalsIT Professionals• Faster, more predictable integration projectsFaster, more predictable integration projects
RSNA 200216
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
RSNA 200217
imagesstored
patientinformation
RIS
examination orders
imagesretrieved
HIS
PACS
procedurescheduled
Prefetch any relevantprior studies
modalityworklist
report
report
Scheduled Workflow ProfileScheduled Workflow Profile
Registration
Orders Placed
Orders Filled
Film
FilmFolder
Image Manager& Archive
FilmLightbox
report ReportRepository
DiagnosticWorkstation
Modality
acquisitionacquisitionin-progressin-progressacquisitioncompleted
acquisitioncompleted
imagesprinted
AcquisitionModality
RSNA 200218
Patient Information Reconciliation ProfilePatient Information Reconciliation Profile
• Extends Scheduled WorkflowExtends Scheduled Workflow– Handle unidentified patient (e.g. trauma)Handle unidentified patient (e.g. trauma)– Handle demographic information mistakesHandle demographic information mistakes– Propagate changes to all affected systems, update Propagate changes to all affected systems, update
all affected dataall affected data
• Reduces incorrectly identified or “lost” studiesReduces incorrectly identified or “lost” studies
RSNA 200219
Post-Processing Workflow ProfilePost-Processing Workflow Profile
Post-Proc.Post-Proc.WorkflowWorkflowManagerManager
PACS System
CAD*Workstation
ReportRepository
AcquisitionModality
3-D*Workstation
Work Status
WorklistWorklist
…
Source Data
Results
Workstation
Results
Work StatusWork Status
RSNA 200220
Simple Image & Numeric Reports ProfileSimple Image & Numeric Reports Profile
PACS
Images Retrieved
Preliminary Report
Verified Report
Report & Images Retrieved
Image Manager& Archive
ReportVerification
Images and Examdata presented for
diagnosis
Reports storedfor
Network Access
Report & ImageReview for
Patient Care
RSNA 200221
Charge Posting ProfileCharge Posting Profile
ChargeChargePosterPoster
*Billing System
CAD*Workstation
ReportRepository……
Report Generated / Signed
CADPerformed
PostCharges
AcquisitionModality
ADT Terminal
3-D*Workstation
Account Management
3-DPerformed
StudyPerformed
/ MaterialsUsed
RSNA 200222
What the Radiologist What the Radiologist Displays:Displays:
What the Reviewing What the Reviewing Physician Sees: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 ProfileConsistent Presentation of Images Profile
RSNA 200223
MODALITY
Presentation of Grouped Procedures ProfilePresentation of Grouped Procedures ProfileRequested Procedure:
CHEST
Report:CHEST
Report:AB/PELVIS
Performs a single exam
Operatorgroups
2 procedures
Chest Chest ViewView
RIS / PACS
Requested Procedure:AB/PELVIS
Chest Chest ViewView
Ab/Pelvis Ab/Pelvis ViewView
Ab/Pelvis Ab/Pelvis ViewView
RSNA 200224
RadiologistRadiologistFlags Images:Flags Images:
Referring PhysicianReferring PhysicianSees Key Images First:Sees Key Images First:
for refering physicianThis image showsthe renal rupture.
Note1
for refering physicianThis image has the hematoma.
Note2
For referringphysician:This image showsthe renal rupture.
Note1
For referring physician:This image hasthe hematoma.
Note2
for refering physicianThis image showsthe renal rupture.
Note1
for refering physicianThis image has the hematoma.
Note2
Study & Key Image Notes
Key Image Notes ProfileKey Image Notes Profile
RSNA 200225
Access to Radiology Information ProfileAccess 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
RSNA 200226
Basic Security ProfileBasic Security Profile
AuditAuditRecordRecord
RepositoryRepository
……
Image Manager& Archive
“Images Queried / Retrieved”
DiagnosticWorkstation
ReportRepository
……
Report & ImageReview
“Reports Queried / Retrieved”
“Images Printed”“Reports Stored”
“Reports Retrieved” “Reports Printed”
RSNA 200227
ResourcesResources
• www.rsna.org/IHEwww.rsna.org/IHE
• FAQsFAQs
• Integration ProfilesIntegration Profiles
• Primer on IHEPrimer on IHE
• PresentationsPresentations
• IHE Technical FrameworkIHE Technical Framework
RSNA 200228
Questions?Questions?
Ask your vendorsAsk your vendors: :
Which IHE Profiles do they support on which systems?Which IHE Profiles do they support on which systems?
www.rsna.org/IHE