September, 2005 What IHE Delivers

Andrew M. Keller, MD, FACC, FASEAndrew M. Keller, MD, FACC, FASE

Chief of Cardiology, Danbury HospitalChief of Cardiology, Danbury Hospital

Danbury, CT, USADanbury, CT, USA

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

IIHE: Meeting Global needs HE: Meeting Global needs for Integrated Healthcarefor Integrated HealthcareJapanese Circulation Society (JCS)Japanese Circulation Society (JCS)

Kobe, JapanKobe, JapanMarch 16March 16thth, 2007, 2007

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Thank you for the opportunity to beThank you for the opportunity to beat the Japanese Circulation Societyat the Japanese Circulation Society

Scientific Sessions.Scientific Sessions.

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IHE’s vision and purposeIHE’s vision and purpose

To apply the knowledge of physician, hospital, and office workflow in order to link and integrate modalities (actors) passing information from application to application seamlessly across the entire health care system.

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Workflow that must be IntegratedWorkflow that must be Integrated

Order entry

Pre-authorization

Patient Scheduling

Transportation

Registration and payer verification

Reconciliation of patient demographics

Coordination with physicians

Study acquisition

Notification study completed

Study archiving and storage

Image retrieval system

Preliminary reporting

Professional review

Transcription, reporting, and electronic signature

Report dissemination

Quality assurance

Statistical analysis

Billing and auditing

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Integrate Clinical InformationIntegrate Clinical Information

Goal: optimal patient careGoal: optimal patient care

To attain optimal patient care, we need clinical To attain optimal patient care, we need clinical informationinformation When we need it Wherever we need it In a meaningful manner Without repeating tests (time and money) Originating from many different locations Cardiology data is especially complex

Proper integration of clinical information means Proper integration of clinical information means better patient care.better patient care.

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Information from many placesInformation from many places

HospitalHospital

HomeHome

Doctor’s officeDoctor’s office

Extended CareExtended Care

Data pointersData pointers

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Information is difficult to integrate!Information is difficult to integrate!

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How can we integrate these system?How can we integrate these system?

Today, at least in U.S. and Europe, each two Today, at least in U.S. and Europe, each two systems that are connected are an “IT integration systems that are connected are an “IT integration project”.project”. Very expensive Very time consuming Very resource intensive Never works quite right Usually involves third party May break if software is upgraded on either system

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How to integrate?How to integrate?

Instead, use standards: DICOM HL7 XML

Define use of standards in Technical Framework

Have common testing plan in order to have vendors work together

Vendors implement Technical Framework in products

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IHE comes inIHE comes in

A consortium of professional societies and vendors to facilitate the integration of healthcare information 1997: IHE founded by RSNA 1998: Becomes global project in radiology 1999: Moves beyond radiology 2003: IHE Cardiology formed with ACC/ESC 2007: IHE Cardiology is excited to join with JCS and

become a truly global organization

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Proven Standards Adoption ProcessProven Standards Adoption Process

Document Use Document Use Case Case RequirementsRequirements

Document Use Document Use Case Case RequirementsRequirements

Identify available Identify available standards (standards (e.g. HL7, e.g. HL7, DICOM, IETF, OASIS)DICOM, IETF, OASIS)

Identify available Identify available standards (standards (e.g. HL7, e.g. HL7, DICOM, IETF, OASIS)DICOM, IETF, OASIS)

Develop Develop technical technical

specificationsspecifications

Develop Develop technical technical

specificationsspecifications

Testing at Testing at ConnectathonsConnectathonsTesting at Testing at ConnectathonsConnectathons

IHE IHE DemonstrationsDemonstrationsIHE IHE DemonstrationsDemonstrations

Products Products with IHEwith IHEProducts Products with IHEwith IHE

Timely access to Timely access to informationinformationTimely access to Timely access to informationinformation

Easy to integrate Easy to integrate productsproductsEasy to integrate Easy to integrate productsproducts

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Growth in IHE DomainsGrowth in IHE Domains

Radiology (18)

IT Infrastructure for Healthcare (17)

Cardiology (7)

Laboratory (6)

Radiation Oncology (1)

Patient Care Coordination (5)

Patient Care Devices (1)

Quality

Eye Care (3)

Veterinary

Endoscopy

Pathology

Pharmacy

IHE Global DevelopmentsIHE Global DevelopmentsIntegration Profiles (# X) – Solutions to Real-World Interoperability Integration Profiles (# X) – Solutions to Real-World Interoperability

Needs & Problems:Needs & Problems:

Within Clinical Departments e.g.:Within Clinical Departments e.g.:RadiologyRadiologyCardiologyCardiologyLabLab ......

Across Departmental &Across Departmental &Institutional Boundaries – XDSInstitutional Boundaries – XDS

RHIOsRHIOs (Regional Healthcare Information Organizations) (Regional Healthcare Information Organizations)

EHR EnablersEHR Enablers

Yea

r 1

(199

9)

Yea

r 2

(200

0)

Yea

r 3

(200

1)

Yea

r 4

(200

2)

Yea

r 5

(200

3)

Yea

r 6

(200

4)

Yea

r 7

(200

5)

Yea

r 8

(200

6)

Yea

r 9

(200

7)

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IHE Cardiology Profiles (9)IHE Cardiology Profiles (9)

Cath Lab WorkflowCath Lab Workflow Echocardiography WorkflowEchocardiography Workflow Retrieve ECG for DisplayRetrieve ECG for Display

Echocardiography Measurement

Patient: Doe, John Technologist: der Payd, N

Measurements:

Mitral valve diameter 3.1cm

- shown in image at [ ]

Ventricular length, diastolic 5.97 cm

- shown in image at [ ]

Ventricular volume, diastolic 14.1 ml

- inferred from [ ]

- inferred from VLZ algorithm

Evidence Documents (Measurements)Evidence Documents (Measurements)

Displayable ReportsDisplayable Reports

Cross-Enterprise Document Cross-Enterprise Document Sharing (EHR to EHR)Sharing (EHR to EHR)

Stress Testing WorkflowStress Testing Workflow Nuclear MedicineNuclear MedicineImplantable CardiacImplantable CardiacDevice ObservationDevice Observation

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Cath Lab Integration Cath Lab Integration

One patient; one order; one procedure; consistent time stampsOne patient; one order; one procedure; consistent time stamps

Procedure LogProcedure Log

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Stress Echo IntegrationStress Echo Integration

Views defined; stages definedViews defined; stages definedConsistent display of different vendor stress examsConsistent display of different vendor stress exams

Toshiba AplioToshiba Aplio(or Philips or GE)(or Philips or GE)

Goodman Goodman PACS (or 5PACS (or 5other vendors)other vendors)

viewsviewsstagesstages

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Stress testing integrationStress testing integration

One patient; one order; one procedure across systems;One patient; one order; one procedure across systems;Consistently defined Protocols and stagesConsistently defined Protocols and stages

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Integration benefitsIntegration benefits

For users across the healthcare enterprise, IHE: allows faster access to information, reduces errors, streamlines workflow, simplifies interface projects, optimizes resource utilization.

2020

Working together with JCSWorking together with JCS

How can IHE Cardiology North America, Europe, and Japan work together more closely: Understand differences in clinical workflow Japan Encourage additional direct involvement in the Planning

Committee Web-ex/tcon in May, 2007, to explain new Year 4 Profiles

and gain direct feedback Direct involvement in annual voting process for new Profiles

(usually August/September timeframe) Bi-annual joint tcons at mutually agreed upon times

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More Resources - More Resources - www.ihe.netwww.ihe.net

Frequently Asked QuestionsFrequently Asked Questions

Integration Profiles in Technical Frameworks:Integration Profiles in Technical Frameworks: CardiologyCardiology IT InfrastructureIT Infrastructure LaboratoryLaboratory Patient Care CoordinationPatient Care Coordination Patient Care DevicesPatient Care Devices Radiation OncologyRadiation Oncology RadiologyRadiology

Connectathon ResultsConnectathon Results

Vendor Products Integration StatementsVendor Products Integration Statements

Participation in Committees and ConnectathonsParticipation in Committees and Connectathons

September, 2005 What IHE Delivers