Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

IHE ’s Potential for CardiologyIHE ’s Potential for CardiologyJoseph BiegelJoseph Biegel

MitraMitraIHE Planning CommitteeIHE Planning Committee

ACC 20022

What is IHE?What is IHE?

• An industry-clinical partnership to An industry-clinical partnership to integrate clinical information systems integrate clinical information systems throughout healthcarethroughout healthcare– Demographics, images, waveforms, reports Demographics, images, waveforms, reports

• Goal: Improve the efficiency and Goal: Improve the efficiency and effectiveness of clinical practice by:effectiveness of clinical practice by:– Providing an implementation framework for Providing an implementation framework for

open connectivity using open connectivity using existing standardsexisting standards– Improving clinical information flowImproving clinical information flow

ACC 20023

Who participates in IHE?Who participates in IHE?• Industry sponsors: Radiological Society of North Industry sponsors: Radiological Society of North

American (RSNA) and Health Information and American (RSNA) and Health Information and Management Systems Society (HIMSS)Management Systems Society (HIMSS)

• A neutral forum open to all vendors: Participants A neutral forum open to all vendors: Participants include GE, Phillips, Siemens, IDX, Cerner, Mitra, include GE, Phillips, Siemens, IDX, Cerner, Mitra, and some 30 othersand some 30 others

• Standards committee members: DICOM, HL7 Standards committee members: DICOM, HL7

• Clinicians, hospital information technology staff, Clinicians, hospital information technology staff, healthcare administratorshealthcare administrators

ACC 20024

Why is IHE needed?Why is IHE needed?• Serious Integration Challenges:Serious Integration Challenges:

• Systems need information from other systems: patient Systems need information from other systems: patient demographics, referring physicians, echo/angio demographics, referring physicians, echo/angio images, ECG waveforms, hemodynamics, clinical images, ECG waveforms, hemodynamics, clinical reports, etc.reports, etc.

• 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 or unavailable - data that is inconsistent or 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.

ACC 20025

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 annual cycles:Intensive process with annual cycles:

– Identify key specific healthcare workflows and Identify key specific healthcare workflows and integration problemsintegration problems

– 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 meetings (RSNA/HIMSS/ACC)Demonstrations at meetings (RSNA/HIMSS/ACC)

ACC 20026

What does IHE cover?What does IHE cover?• Currently focused in RadiologyCurrently focused in Radiology

• 30 Vendors tested 70 systems at the Year 3 30 Vendors tested 70 systems at the Year 3 ConnectathonConnectathon

• Systems include:Systems include:

• HIS, RISHIS, RIS

• MR, CT, US, CR, DX, …MR, CT, US, CR, DX, …

• PACS, Review Stations, Reporting SystemsPACS, Review Stations, Reporting Systems

• Printers, Imagers Printers, Imagers

ACC 20027

Why aren’t existing industry Why aren’t existing industry standards sufficient?standards sufficient?

• Standards are vital (HL7, DICOM, ICD, …)Standards are vital (HL7, DICOM, ICD, …)– They provide consensus, tools & technologiesThey provide consensus, tools & technologies– IHE is entirely standards-basedIHE is entirely standards-based

• But standards alone are insufficientBut standards alone are insufficient– Varying interpretationsVarying interpretations– Optional variationsOptional variations– No real-world specifications or scenariosNo real-world specifications or scenarios– No assurance of portability or connectivityNo assurance of portability or connectivity

ACC 20028

How is IHE related to standards?How is IHE related to standards?

• IHE focuses on specific, practical integration IHE focuses on specific, practical integration problemsproblems

• Standards such as HL7 and DICOM provide Standards such as HL7 and DICOM provide “dictionaries”“dictionaries”

• IHE defines a “phrasebook” and/or “grammar” IHE defines a “phrasebook” and/or “grammar” that solves real world problems by assembling that solves real world problems by assembling pieces provided by DICOM/HL7pieces provided by DICOM/HL7

ACC 20029

Key IHE conceptsKey IHE concepts• Technical Framework: detailed, Technical Framework: detailed,

structured document delineating structured document delineating standards-based standards-based transactionstransactions among among systems (“systems (“IHE actorsIHE actors”) to support ”) to support specific workflow and integration specific workflow and integration capabilitiescapabilities

• Integration Profiles: Documents Integration Profiles: Documents specifying integration capabilities for specifying integration capabilities for specific patient-care problemsspecific patient-care problems

ACC 200210

IHE’s track recordIHE’s track record• 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 7 Integration Profiles Introduction of 7 Integration Profiles for for RadiologyRadiology

• 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, GermanyExpansion to Japan, Germany

• Year 5 (2003): Year 5 (2003): New ProfilesNew ProfilesExpansion to Cardiology, Lab,Expansion to Cardiology, Lab,

Pathology, …?Pathology, …?

ACC 200211

Integration Profile examplesIntegration Profile examples

• Scheduled Imaging-Encounter WorkflowScheduled Imaging-Encounter Workflow• Registration, ordering, scheduling, acquisition, Registration, ordering, scheduling, acquisition,

distribution, storagedistribution, storage

• Patient Information ReconciliationPatient Information Reconciliation

• Consistent Presentation of ImagesConsistent Presentation of Images• Across various devices, mediaAcross various devices, media

• Key Image NoteKey Image Note• Adding text notes and pointers to imagesAdding text notes and pointers to images

ACC 200212

Why IHE in cardiology (1)?Why IHE in cardiology (1)?• Cardiology workflow involves multiple Cardiology workflow involves multiple

diagnostic tests, images and reportsdiagnostic tests, images and reports

• Cardiology clinical systems/devices Cardiology clinical systems/devices typically are unintegratedtypically are unintegrated– Separate systems for ECG/Holter, EP, Separate systems for ECG/Holter, EP,

PPM/ICD, echo, angiographic images, PPM/ICD, echo, angiographic images, hemodynamics, documents/reportshemodynamics, documents/reports

– Each system typically requires redundant Each system typically requires redundant manual data entry, with inevitable errorsmanual data entry, with inevitable errors

ACC 200213

Why IHE in cardiology (2)?Why IHE in cardiology (2)?• Systems typically do not share dataSystems typically do not share data

– Patient demographics, directories of Patient demographics, directories of referring physicians or of images/documents referring physicians or of images/documents

• Image formats often not portableImage formats often not portable– Encrypted formats, proprietary readers, Encrypted formats, proprietary readers,

variable headers variable headers

• Fragmentation causes inefficiency, Fragmentation causes inefficiency, invalid or inaccessible clinical data, and invalid or inaccessible clinical data, and compromises the quality of carecompromises the quality of care

ACC 200214

Why IHE in cardiology (2) ?Why IHE in cardiology (2) ?

• Some of the concepts of the IHE TF have Some of the concepts of the IHE TF have broad general applicability and many can be broad general applicability and many can be applied or adapted to Cardiologyapplied or adapted to Cardiology

• The imaging vendors are largely the sameThe imaging vendors are largely the same• DICOM and HL7 are used in Cardiology DICOM and HL7 are used in Cardiology

todaytoday– Other Cardiology specific standards could easily Other Cardiology specific standards could easily

be leveraged in a Cardiology specific version of be leveraged in a Cardiology specific version of the TFthe TF

ACC 200215

Common characteristicsCommon characteristics• Cardiology is similar in some vital respects to Cardiology is similar in some vital respects to

radiologyradiology– Driven by imaging modalitiesDriven by imaging modalities– Managing distributed departmental resourcesManaging distributed departmental resources– Need for an integrated patient-centered view and Need for an integrated patient-centered view and

for administrative reportingfor administrative reporting– Need to improve lab efficiency via workflow Need to improve lab efficiency via workflow

managementmanagement– Legacy installed base technology issuesLegacy installed base technology issues

ACC 200216

Cardiology workflow elementsCardiology workflow elements

• Workflow often similar to radiology:Workflow often similar to radiology:– Patients are admittedPatients are admitted– Demographics entered (often multiple Demographics entered (often multiple

times for the same patient)times for the same patient)– Imaging studies are performed and readImaging studies are performed and read– Reports generatedReports generated

ACC 200217

Distinct cardiology needsDistinct cardiology needs

• Clinical data content is more complexClinical data content is more complex– Therapeutic as well as diagnostic procedure Therapeutic as well as diagnostic procedure

reports, with richer report contentreports, with richer report content– Richer graphical content: moving images, colorRicher graphical content: moving images, color– Clinical encounter dataClinical encounter data– Outcome reportingOutcome reporting

• Cardiology focuses on an integrated patient Cardiology focuses on an integrated patient view rather than on procedures, images and view rather than on procedures, images and reports in isolationreports in isolation

ACC 200218

IHE/cardiology possibilities (1)IHE/cardiology possibilities (1)– Image exchange/portabilityImage exchange/portability

– Even with DICOM, image transfer and Even with DICOM, image transfer and display often don’t workdisplay often don’t work

– Difficulty importing outside images into Difficulty importing outside images into local archiveslocal archives

+ As part of a cardiology Technical Framework, As part of a cardiology Technical Framework, IHE could specify unambiguous, vendor-IHE could specify unambiguous, vendor-supported, compatible DICOM supported, compatible DICOM implementationsimplementations

ACC 200219

IHE/cardiology possibilities (2)IHE/cardiology possibilities (2)

– Redundant, manual patient demographic data Redundant, manual patient demographic data entry is slow and error prone entry is slow and error prone • DICOM and HL7 can help, but the standards DICOM and HL7 can help, but the standards

themselves are not enoughthemselves are not enough

+ IHE could leverage or adapt its Scheduled IHE could leverage or adapt its Scheduled Workflow Integration Profile and Patient Workflow Integration Profile and Patient Information Reconciliation Profile for Information Reconciliation Profile for cardiology, resulting in a single entry point for cardiology, resulting in a single entry point for patient demographics, accessible to all patient demographics, accessible to all cardiology systems and devicescardiology systems and devices

ACC 200220

IHE/cardiology possibilities (3)IHE/cardiology possibilities (3)

• IHE can develop generic, standards-based IHE can develop generic, standards-based interfaces between cardiology interfaces between cardiology devices/systems and enterprise systems for devices/systems and enterprise systems for scheduling, ordering and results reportingscheduling, ordering and results reporting

• Cardiology makes large capital purchases of Cardiology makes large capital purchases of imaging and information systems without imaging and information systems without assurance that systems can co-exist or assurance that systems can co-exist or interface: The “fear at power on” factorinterface: The “fear at power on” factor

+ The IHE TF can define vendor-neutral The IHE TF can define vendor-neutral requirements that assure interoperabilityrequirements that assure interoperability

ACC 200221

IHE/cardiology possibilities (4)IHE/cardiology possibilities (4)

• Structured reporting: In partnership with ACC Structured reporting: In partnership with ACC and clinicians, IHE could develop standards-and clinicians, IHE could develop standards-based cardiology reports, including diagrams based cardiology reports, including diagrams and graphics for anatomy, function and and graphics for anatomy, function and viability viability

• Beyond static, black-and-white DICOM: IHE Beyond static, black-and-white DICOM: IHE could develop Implementation Profiles for could develop Implementation Profiles for motion images, color images, waveforms, motion images, color images, waveforms, Doppler, pediatric echo Doppler, pediatric echo

ACC 200222

IHE and industry will do the heavy lifting IHE and industry will do the heavy lifting at the technical levelat the technical level

BUT BUT IHE needs ACC involvementIHE needs ACC involvement To ensure that IHE focuses on clinical needs To ensure that IHE focuses on clinical needs

and provides clinically relevant solutionsand provides clinically relevant solutions To act as impartial, patient-centered To act as impartial, patient-centered

observers (rarely referees), so that IHE observers (rarely referees), so that IHE remains truly vendor-neutral remains truly vendor-neutral

An IHE/ACC partnershipAn IHE/ACC partnership

ACC 200223

ConclusionsConclusions

• IHE can dramatically improve the care of IHE can dramatically improve the care of cardiology patients and life for cardiologists.cardiology patients and life for cardiologists.

• To succeed--and to do justice to its goals--To succeed--and to do justice to its goals--IHE needs both expert cardiology input and IHE needs both expert cardiology input and ACC involvement ACC involvement