Post on 28-Dec-2015
Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise
IHE an OverviewIHE an Overview
Eric PoiseauEric PoiseauLaboratoire IDM Faculté de MédecineLaboratoire IDM Faculté de Médecine
Université de Rennes 1Université de Rennes 1
What is IHE about? What is IHE about?
It’s an initiative promoting and It’s an initiative promoting and supporting the supporting the integrationintegration of of systemssystems in in the the healthcare enterprisehealthcare enterprise..
Integration Goal: Improve the efficiency Integration Goal: Improve the efficiency and effectiveness of clinical practice by: and effectiveness of clinical practice by: – Improved Improved Information FlowInformation Flow – Advanced Advanced Multi-System FunctionsMulti-System Functions
What is Integrating the Healthcare What is Integrating the Healthcare Enterprise ? Enterprise ?
Sponsored jointly by the Sponsored jointly by the user communityuser community::– EAR, ECR, SFR, GMSIH, SIRM, DRG, ESCEAR, ECR, SFR, GMSIH, SIRM, DRG, ESC– BIR, RCR, IPIM, CoR, NHS (joined from UK) BIR, RCR, IPIM, CoR, NHS (joined from UK) – RSNA, HIMSS, ACC, JRS (USA, Japan)RSNA, HIMSS, ACC, JRS (USA, Japan)
and by the and by the vendor communityvendor community
IHE focuses on the flow of information IHE focuses on the flow of information between between several systemsseveral systems in in several several departmentsdepartments operating operating withinwithin a healthcare a healthcare enterprise. enterprise.
In Europe:In Europe:
13 Vendors - 13 systems 13 Vendors - 13 systems in 2001in 2001
33 Vendors - 60 systems 33 Vendors - 60 systems in 2002in 2002
47 Vendors - 847 Vendors - 800 systems systems in 2003in 2003
49 Vendors - 82 systems 49 Vendors - 82 systems in 2004in 2004
How is IHE related to Standards?How is IHE related to Standards?
IHE is not a new standard !IHE is not a new standard ! Information needs to travel widely Information needs to travel widely Information is applied within a contextInformation is applied within a context
– Workflows cross Standard bordersWorkflows cross Standard borders
IHE specifies how to apply Standards IHE specifies how to apply Standards (DICOM, HL7, Web) to (DICOM, HL7, Web) to real world scenariosreal world scenarios & & integration problemsintegration problems– IHE defines a practical “IHE defines a practical “phrasebookphrasebook””
What is the Result? What is the Result?
Vendors implement well-defined subsets of Vendors implement well-defined subsets of IHE (actors & profiles) on their systems IHE (actors & profiles) on their systems
IHE is not a product;IHE is not a product;it is introduced by a software feature or it is introduced by a software feature or upgrade upgrade
Customers can request specific IHE Customers can request specific IHE Integration Profiles in a tender for clinical Integration Profiles in a tender for clinical systems systems
The systems have been pre-tested at the The systems have been pre-tested at the ConnectathonConnectathon
Unique test platform Unique test platform for vendorsfor vendors
– Peer to peer testsPeer to peer tests– Workflow tests Workflow tests
New collaboration New collaboration culture for engineersculture for engineers
– They learn to know They learn to know each othereach other
Warranty for usersWarranty for users
IHE ConnectathonIHE Connectathon
The IHE processThe IHE process
IHETechnical Framework
IHEConnectathon
IHEDemonstrations
Planning Committee
Product conform to one or more
integration profiles
We define
We test We show
We manage
Technical Framework : Document Technical Framework : Document OrganizationOrganization
Domain technical frameworks :Domain technical frameworks :– RAD, CARD, LAB, IT-IRAD, CARD, LAB, IT-I
Vol 1 : Actor and Integration ProfilesVol 1 : Actor and Integration ProfilesVol 2,3,.. : TransactionsVol 2,3,.. : TransactionsMaintenance :Maintenance :
– Change ProposalsChange Proposals– SupplementsSupplements
Technical FrameworkTechnical Framework
The IHE Technical Framework is based on The IHE Technical Framework is based on actorsactors that interact through that interact through transactionstransactions..
ActorsActors are information systems or components of are information systems or components of information systems that produce, manage, or act information systems that produce, manage, or act on information associated with operational on information associated with operational activities in the enterprise.activities in the enterprise.
TransactionsTransactions are interactions between actors that are interactions between actors that transfer the required information through transfer the required information through standards-based messages.standards-based messages.
Specific sets of actors and transactions are Specific sets of actors and transactions are specified in the specified in the Integration ProfilesIntegration Profiles
Actor descriptions examplesActor descriptions examples
Acquisition ModalityAcquisition Modality – A system that acquires – A system that acquires and creates medical images, e.g. a Computed and creates medical images, e.g. a Computed Tomography scanner or Nuclear Medicine Tomography scanner or Nuclear Medicine camera. A modality may also create Grayscale camera. A modality may also create Grayscale Softcopy Presentation States for the consistent Softcopy Presentation States for the consistent viewing of images and create Key Image Notes.viewing of images and create Key Image Notes.
ADT Patient RegistrationADT Patient Registration – A system – A system responsible for adding and/or updating patient responsible for adding and/or updating patient demographic and encounter information. In demographic and encounter information. In particular, it registers a new patient with the particular, it registers a new patient with the Order Placer and Department System Order Placer and Department System
Transaction descriptions exampleTransaction descriptions example
1.1. Patient RegistrationPatient Registration – The ADT system – The ADT system registers and/or admits a patient and forwards registers and/or admits a patient and forwards the information to other information systems.the information to other information systems.
2.2. Placer Order ManagementPlacer Order Management – The Order – The Order Placer informs the Order Filler of the initiation Placer informs the Order Filler of the initiation or cancellation of an order. The Placer/Filler or cancellation of an order. The Placer/Filler Order Management transaction will sometimes Order Management transaction will sometimes be referred to as “-New” when a new order is be referred to as “-New” when a new order is being initiated, or as “-Cancel” when an being initiated, or as “-Cancel” when an existing order is canceled.existing order is canceled.
Integration ProfilesIntegration Profiles
DescriptionDescriptionActors/Transactions interaction diagramActors/Transactions interaction diagramActors/Transactions requirementsActors/Transactions requirementsProcess flowProcess flow
Integration Profiles :DescriptionIntegration Profiles :Description
The The Scheduled Workflow Integration ProfileScheduled Workflow Integration Profile establishes the continuity and integrity of basic establishes the continuity and integrity of basic radiological data. It specifies a number of radiological data. It specifies a number of transactions that maintain the consistency of transactions that maintain the consistency of patient and ordering information as well as patient and ordering information as well as providing the scheduling and imaging acquisition providing the scheduling and imaging acquisition procedure steps. This profile also makes it procedure steps. This profile also makes it possible to determine whether images associated possible to determine whether images associated with a particular performed procedure step have with a particular performed procedure step have been stored (archived) and are available to enable been stored (archived) and are available to enable subsequent workflow steps, such as reporting.subsequent workflow steps, such as reporting.
Integration Profiles :Interactions diagramIntegration Profiles :Interactions diagram
Pt. Registration [1] 12: Patient Update [12]
Pt. Registration [1] Patient Update [12] Placer Order Management
[2] Filler Order Management [3]
ADT
Query Images [14] Retrieve Images [16]
Image Display
Storage Commitment [10]
Modality Image Stored [8] Evidence Documents Stored [43] Storage Commitment [10]
Creator Images Stored [18]
Procedure Scheduled [4] Image Availability Query [11] Patient Update [12] Performed Work Status Update [42]
Modality Worklist Provided [5]
Image Creator
Performed Procedure
Step Manager
Modality PS in Progress [6] Modality PS Completed [7] Creator PS in Progress [20] Creator PS Completed [21]
Modality PS in Progress [6] Modality PS Completed [7] Creator PS in Progress [20] Creator PS Completed [21]
Modality PS in Progress [6] Modality PS Completed [7]
Creator PS in Progress [20] Creator PS Completed [21]
Order PlacerOrder Filler
Acquisition Modality
Image Manager
Image Archive
Integration Profiles : Integration Profiles : Actors / Transactions tableActors / Transactions table
Actors Transactions Optionality Vol II / III Section
Patient Registration [1] R 4.1 ADT Patient Registration
Patient Update [12] R 4.12
Patient Registration [1] R 4.1
Patient Update [12] R 4.12
Placer Order Management [2] R 4.2
Order Placer
Filler Order Management [3] R 4.3
… … … …
Integration Profiles : Process FlowIntegration Profiles : Process Flow Image Manager/
Image Archive/ Secure Node
Image Display/ Secure Node
Audit Record Repository/ Secure Node
Time Server
Record Audit Event (User Authenticated)
Maintain Time
Query Images
Maintain Time
Retrieve Images
Record Audit Event (Query Images)
View Images
Authenticate Node
Record Audit Event (Retrieve Images)
Maintain Time
Record Audit Event (Retrieve Images)
Record Audit Event (Instances Used)
Transaction descriptionsTransaction descriptions
ScopeScopeUse case rolesUse case rolesReferences to standardsReferences to standards Interaction diagramInteraction diagram
Transaction: ScopeTransaction: Scope
Defines the scope of application of the Defines the scope of application of the transactiontransaction– « « This transaction involves the patient information, This transaction involves the patient information,
including demographics, captured at the point of including demographics, captured at the point of encounter. This may occur when the visit is encounter. This may occur when the visit is scheduled, if that precedes patient arrival at the scheduled, if that precedes patient arrival at the institution. This transaction is used for both in-institution. This transaction is used for both in-patients (i.e., those who are assigned a bed at the patients (i.e., those who are assigned a bed at the facility) and outpatients (i.e., those who are not facility) and outpatients (i.e., those who are not assigned a bed at the facility).assigned a bed at the facility). » »
Patient Registration
Order PlacerDepartment System Scheduler /
Order Filler
ADT PatientRegistration MPI
Transaction : Use case exampleTransaction : Use case example
Transaction : References to standardTransaction : References to standard
Example for transaction 32: « Authenticate Example for transaction 32: « Authenticate Node »Node »– DICOM 2001 PS 3.15: DICOM 2001 PS 3.15:
Security Profiles. Annex B1: The Basic TLS Security Profiles. Annex B1: The Basic TLS Secure Transport Connection profile.Secure Transport Connection profile.
– IETF:IETF: Transport Layer Security (TLS) 1.0 (RFC Transport Layer Security (TLS) 1.0 (RFC 2246)2246)
– ITU-T: Recommendation X.509 (03/00). ITU-T: Recommendation X.509 (03/00). “Information technology - Open Systems “Information technology - Open Systems Interconnection - The directory: Public-key and Interconnection - The directory: Public-key and attribute certificate frameworks"attribute certificate frameworks"
Transaction : Interaction diagramTransaction : Interaction diagram
ADT Patient Registration
Order Placer
HL7 ADT^*
HL7 ADT^*
HL7 ADT^*
Department System MPI
* - A01, A04, A05, A11, A38
IHE Radiology Integration ProfilesIHE Radiology Integration Profiles
Patient Info.
Recon-ciliation
Access to Radiology Information
Consistent Present-ation of Images
Basic Security
-
EvidenceDocs
KeyImageNotes
Simple Image & Numeric Reports
Presentation of Grouped Procedures
Post-
Processing Workflow
Reporting Workflow
Charge Posting
Scheduled Workflow
Portable Data for Imaging
NMImage
New
New
WorkflowWorkflow
Most critical issue in a Radiology EnvironmentMost critical issue in a Radiology Environment– Inter- or corrupted information chainInter- or corrupted information chain
Paper based information -> multiple re-entry of dataPaper based information -> multiple re-entry of data Different non adapted subsystems don‘t cooperateDifferent non adapted subsystems don‘t cooperate Error correction takes huge amount of timeError correction takes huge amount of time
– Stale information Stale information Brandnew information not known (cancellation, change)Brandnew information not known (cancellation, change)
– Status update informationStatus update information Exam registered, finished, archived, reported, deliveredExam registered, finished, archived, reported, delivered
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
A Closed LoopA Closed Loop•Update IS SchedulingUpdate IS Scheduling
•Match Procedure with OrderMatch Procedure with Order•Support Billing Based on MPPSSupport Billing Based on MPPS
•Avoid Reading Incomplete ProceduresAvoid Reading Incomplete Procedures
Modality WorklistModality Worklist
WorklistWorklist
Procedure ScheduledProcedure Scheduled
IHE Scheduled Workflow in RadiologyIHE Scheduled Workflow in Radiology
Order Placer
PerformedProcedure Step
Manager
ADTPatient Registration
Image Archive
Image Manager
Image Display
Image Creator
AcquisitionModality
DepartmentSystem Scheduler– Order Filler –
Modality Worklist
Patient Registration
Procedure Scheduled
Images Availability QueryImagesStored
StorageCommit
StorageCommit
ImagesStored
PPSIn-Progress/ Completed
Fil
ler
Ord
erM
anag
emen
t
Placer Order Management
Q /RImages
PPSIn-Progress/ Completed
PPSIn-Progress/ Completed
HL7
DICOM
Scheduled WorkflowScheduled Workflow
Patient Information ReconciliationPatient Information Reconciliation
Trauma patientTrauma patientManual wrong data entry at the modalityManual wrong data entry at the modalitySystem crashedSystem crashedVIP personVIP person
Patient Update
Patient Update
Procedure Update
Order Placer
PerformedProcedure Step
Manager
ADTPatient Registration
Image Archive
Image Manager
Image Display
Image Creator
AcquisitionModality
DepartmentSystem Scheduler– Order Filler –
Procedure Scheduled
Images Availability QueryImagesStored
StorageCommit
StorageCommit
ImagesStored
PPSIn-Progress/ Completed
Modality Worklist
Patient RegistrationF
ille
r O
rder
Man
agem
ent
Placer Order Management
Q /RImages
PPSIn-Progress/ Completed
PPSIn-Progress/ Completed
HL7
DICOM
Patient Information ReconciliationPatient Information Reconciliation
IHE-LaboratoryIHE-Laboratory
Provide users a single nameand
centralized authentication process
across all systems
Point of Care Testing(Future)
Extend laboratory testing with bedside testing devices
Retrieve Information for Display
Access a patient’s clinical information and documents in a format ready to be presented
to the requesting user
Laboratory Scheduled Workflow
Admit, Discharge, Transfer a patient, order lab tests, collect specimen, perform tests, report
results.
Synchronize multiple applications on a desktop to the same patient
Patient Synchronized Applications
Cooperation with external laboratory
Outside Healthcare Enterprise Testing (Future)
Provide users a single nameand
centralized authentication process
across all systems
Laboratory Patient Information
Reconciliation (Future)
Updates resulting from unidentified or misidentified
Patient
IHE IT InfrastructureIHE IT Infrastructure
Enterprise User AuthenticationEnterprise User Authentication
Provide users a single nameand centralized authentication
processacross all systems
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto 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 MPIMap 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
Consistent TimeCoordinate time across
networked systems
Audit Trail & Node Authentication
Centralized privacy audit trail and node to node authentication
to create a secured domain.
New
Patient Demographics Query New
Personnel White PageAccess to workforcecontact information
New
Cross-Enterprise Document Sharing
(XDS)Registration, distribution and
access across health enterprises of clinical
documents forming a patient electronic health record
New
Audit Trail & Node Authentication : ATNAAudit Trail & Node Authentication : ATNA
Protect Patient Privacy and System Security:Protect Patient Privacy and System Security:– Meet ethical and regulatory requirementsMeet ethical and regulatory requirements
Enterprise Administrative Convenience:Enterprise Administrative Convenience:– Unified and uniform auditing systemUnified and uniform auditing system– Common approach from multiple vendors simplifies definition Common approach from multiple vendors simplifies definition
of enterprise policies and protocols.of enterprise policies and protocols.– Common approach simplifies administrationCommon approach simplifies administration
Development and support cost reduction through Code Development and support cost reduction through Code Re-use:Re-use:– Allows vendors to leverage single development effort to Allows vendors to leverage single development effort to
support multiple actorssupport multiple actors– Allows a single development effort to support the needs of Allows a single development effort to support the needs of
different security policies and regulatory environments.different security policies and regulatory environments.
Patient Identifier Cross-referencing for Patient Identifier Cross-referencing for MPI : PIXMPI : PIX
Allow all enterprise participants to register the Allow all enterprise participants to register the identifiers they use for patients in their identifiers they use for patients in their domaindomain
Participants retain control over their own Participants retain control over their own domain’s patient index(es)domain’s patient index(es)
Support domain systems’ queries for other Support domain systems’ queries for other systems’ identifiers for their patientssystems’ identifiers for their patients
Optionally, notify domain systems when other Optionally, notify domain systems when other systems update identifiers for their patientssystems update identifiers for their patients
Patient Synchronized Applications : PSAPatient Synchronized Applications : PSA
Patient Synchronization of Multiple Patient Synchronization of Multiple Disparate ApplicationsDisparate Applications
Single Patient SelectionSingle Patient SelectionWhen combined with PIX Profile, allows When combined with PIX Profile, allows
patient synchronization across patient patient synchronization across patient identifier domainsidentifier domains
When combined with EUA Profile, When combined with EUA Profile, provides user Single Sign-on (SSO)provides user Single Sign-on (SSO)
Retrieve Information for Display : RIDRetrieve Information for Display : RID
SimpleSimple and and rapidrapid access to patient information access to patient information Access to existing Access to existing persistent documentspersistent documents in well- in well-
known presentation formats: CDA, PDF, JPEG.known presentation formats: CDA, PDF, JPEG. Access to Access to specific keyspecific key patient-centric information patient-centric information
for presentation to a clinician : allergies, current for presentation to a clinician : allergies, current medications, summary of reports, etc.. medications, summary of reports, etc..
Links with other IHE profiles - Enterprise User Links with other IHE profiles - Enterprise User Authentication, Patient Identifier Cross-Authentication, Patient Identifier Cross-referencing and Cross Enterprise Document referencing and Cross Enterprise Document SharingSharing
Enterprise User AuthenticationEnterprise User Authentication
Support a Support a single enterprisesingle enterprise governed by governed by a a single set of security policiessingle set of security policies and and having a having a common network domaincommon network domain. .
Establish Establish one name per userone name per user to be used to be used for all IT applications and devicesfor all IT applications and devices. .
Facilitate Facilitate centralized user authentication centralized user authentication managementmanagement. .
Provide users with Provide users with single sign-onsingle sign-on. .
Patient Demographics Query : PDQPatient Demographics Query : PDQ
Allow quick retrieval of a patient list including Allow quick retrieval of a patient list including common patient names, identifiers, contacts, common patient names, identifiers, contacts, and visit informationand visit information
Enable selection of correct patient when full Enable selection of correct patient when full identification data may not be availableidentification data may not be available
Limits access to only a subset of Limits access to only a subset of demographic and visit informationdemographic and visit information
Personnel White Pages : PWPPersonnel White Pages : PWP
Provide access to basic information Provide access to basic information about the human workforce membersabout the human workforce members– Does not include PatientsDoes not include Patients
Defines method for finding the PWPDefines method for finding the PWPDefines query/access methodDefines query/access methodDefines attributes of interestDefines attributes of interest
IHE Integration StatementIHE Integration Statement
ProductProduct U UVWVW supports the supports the
IHE IHE KK Actor Actor withwith thethe
IHE IHE XX and and YY Integration Profiles Integration Profiles
IHE IHE JJ ActorActor with the with the
IHE IHE TT Integration ProfileIntegration Profile