Post on 27-Mar-2015
Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise
IHE for Product Planers Ellie Avraham
Kodak Health Group
IHE Planning and Technical Committees member
Co-Editor IHE Technical Framework
IHE Classroom Sessions – RSNA 2006 2
Learning ObjectivesLearning Objectives Clinical and Economic benefits of Integration for
your customers – IHE Radiology Users Handbook
Improve Product Functionality by using the IHE Technical Framework
Improve Integrated System Solutions Workflows by using IHE Integration Profiles
IHE Success stories and other information to refine the Products “Business case” evaluation
IHE Process to Synchronize it with the Product Planning & Development
IHE Classroom Sessions – RSNA 2006 3
Discussion AreasDiscussion Areas
IHE Deployment Process
IHE Integration Profiles
The Value Proposition from Planning Products and Integrated Solutions using IHE
IHE Classroom Sessions – RSNA 2006 4
Integration Solutions Available Today fromSeveral Medical Systems Vendors – BUT ...
Modern Healthcare Enterprises AreStill Confronted with Problems:(In Spite of IT Standards and Advanced Technology)– Lack of Access to Complete Medical Information– Inconsistent or Redundant Medical Information
Across Departments and Institutions– Inadequate Communicating of Medical Data
Across Multiple Systems from Different Vendors– Risky Investments in Proprietary Solutions– Clinical Workflows are not Optimized
Challenges of Integration
IHE Classroom Sessions – RSNA 2006 5
Prof. Societies Sponsorship
Healthcare Providers & Vendors
Healthcare IT Standards HL7, DICOM, etc.
General IT Standards Internet, ISO, etc.
Interoperable Healthcare IT Solution Specifications
IHE Integration Profile Interoperable Healthcare IT
Solution Specifications IHE Integration Profile
Interoperable Healthcare IT Solution Specifications
IHE Integration Profile Interoperable Healthcare IT
Solution Specifications IHE Integration Profile
IHE Process
IHE drives healthcare standards based-integrationIHE drives healthcare standards based-integration
IHE Classroom Sessions – RSNA 2006 6
IHEIHE Process Process - Annual Cycle- Annual Cycle
IHEIntegrationProfiles B
IHEIntegrationProfile A
Easy toIntegrateProducts
IHEConnectathon
ProductWith IHE
IHEDemonstration
User Site
RFPRFP
Standards
IHETechnical
Framework
Product IHE IntegrationProduct IHE IntegrationStatementStatement
IHE IHE ConnectathonConnectathonResultsResults
IHE Technical Framework – Define Standard Integration Solutions
IHE Connectathon Results – Most implemented and tested IHE Solutions
IHE Integration Statements – Most Comertialized IHE Solutions
IHE Success Story – Most Successful Used IHE Solutions
IHE Users Handbook – IHE Solutions, Economical and Clinical benefits
IHE Classroom Sessions – RSNA 2006 7
IHE Calendar Annual Events for IHE Calendar Annual Events for Synchronization with Product PlanningSynchronization with Product Planning
Feb. 2006 – IHE Supplements Profiles for Public Comment May – IHE Supplements Profiles for Trial Implementation Aug. – IHE Participation Workshop Sept. – IHE Participation Registration: Connectathon & Demos Oct. - IHE Vendor Workshop for the Connectathon Oct. – Nov. IHE MESA Testing Validations for Connectathon Nov. - RSNA – IHE Radiology Demo Jan. 2007 – IHE Connectathon Feb. 2007 – HIMSS IHE ITI Demo Mar. 2007– ACC IHE Cardiology Demo
IHE Classroom Sessions – RSNA 2006 8
Using IHE for Product Planning
IHE Aid for Global / International Product Planning– IHE Technical Framework (TF)
> Vol 1: Defines Global Integration Profiles
> Vol 2,3: Defines the TF Transactions details for Development
> Vol 4: Defines the Local National specialization details
– IHE Connectathon Results – Learn what IHE solutions are developed
– IHE User Success Stories & IHE Users Handbook – Learn the Clinical and Economic benefits of using products with IHE capabilities
– IHE Integration Statements – The Commercialized products with IHE capabilities
– RFP’s from customers
IHE Classroom Sessions – RSNA 2006 9
IHE Connectathon Results http://www.ihe.net/Events/connectathon_results.cfm
Consolidated Earlier Progress &Push for Market Adoption
More Robust Connectathon– Results Recorded and Published
Increased Industry Participation– 31 companies– 70 systems– 21 Additional Companies in
IHE Europe
IHE Classroom Sessions – RSNA 2006 10
IHE User Success Story http://www.ihe.net/resources/user_success_stories.cfm
•Cleveland Clinic Foundation•Detroit Medical Center•Grossman Imaging Centers•Hôpitaux Universitaires de Genèv•IHE McKay-Dee Hospital•Johannes Gutenberg University Hospital•Magic Valley Regional Medical Center•Mayo Clinic Jacksonville•Our Lady Of The Lake Regional Medical Center (OLOL)•VA Puget Sound Health Care System•St. Vincent Hospital and Health Services•Steinberg Diagnostic Medical Imaging•University of Pisa•University of Wisconsin
IHE Classroom Sessions – RSNA 2006 11
Deployment of IHE Profiles – Most Used:- Scheduled Workflow (SWF)
- Patient Information Reconciliation (PIR)- Consistent Presentation of Images (CPI)- Reporting Workflow (RWF)- Basic Security for HIPAA regulations (ATNA)
Clinical and Economics Accomplishments- Improve the Patient Care – Improved data accuracy and Safety, Image Quality & Consistency and time saving due to optimized Workflows and integrated systems
- Improve the clinical practice productivity - reduced manual data entry using the ADT registration in one place and propagate it to all the other systems (PACS, RIS Modality) and reduced errors.
- Optimize the Radiological Workflow (SWF) Reduced the incorrectly or lost studies, using DICOM MWL, MPPS
IHE User Success Story & HandbookIHE User Success Story & Handbook
IHE Classroom Sessions – RSNA 2006 12
IHE Integration Statement http://www.ihe.net/resources/ihe_integration_statements.cfmIHE Integration Statements document the product IHE capabilities in terms of IHE: Actors and Integration Profiles.- Promote your products with the Integration Statements - Learn from other Vendors Integration Statements the IHE Profiles and Actors supportedThe RSNA links to IHE Integration Statements published by the companies:
- Agfa HealthCare - Philips Medical Systems- Cerner Corporation - Sectra- Eastman Kodak Company - Siemens Medical Solutions - Emageon - Softmedical- Fujifilm Medical Systems USA - Stentor- GE Medical Systems - StorCOMM, Inc- INFINITT Co., Ltd. - Tiani Medgraph AG- McKesson Information Solutions - Toshiba America Medical Systems- Medcon - Voxar Limited
IHE Classroom Sessions – RSNA 2006 13
IHE Integration Statement Date
12 May 2006
Vendor Product Name Version
Any Medical Systems Co.
IntegrateRAD V2.3
This product implements all transactions required in the IHE Technical Framework to support the IHE Integration Profiles, Actors and Options listed below:
Integration Profiles
Implemented
Actors Implemented Options Implemented
Scheduled Workflow
Image Manager/Image Archive none
Image Display none
Internet address for vendor’s IHE information: www.anymedicalsystemsco.com/ihe
Links to Standards Conformance Statements for the Implementation
HL7 www.anymedicalsystemsco.com/hl7
DICOM www.anymedicalsystemsco.com/dicom/integrateRAD.pdf
Links to general information on IHE
North America: www.ihe.net
In Europe: www.ihe-europe.org In Japan: www.jira-net.or.jp/ihe-j
IHE Classroom Sessions – RSNA 2006 14
IHE Technical FrameworkIHE Technical FrameworkOrganized in sections that provide an Organized in sections that provide an
increasing level of detailincreasing level of detail
Integration ProfilesIntegration Profiles:: Defines a Problem and the Solution in terms of Actors and communication in terms of Actors and communication transactionstransactionsActorsActors:: Identify specific kinds of operational Identify specific kinds of operational participants in the healthcare enterprise.participants in the healthcare enterprise.
IHE FoundationIHE Foundationhttp://www.ihe.net/Technical_Framework/index.cfm
TransactionsTransactions: : Describe particular interactions Describe particular interactions between actors to perform between actors to perform specific operationsspecific operations..
IHE Classroom Sessions – RSNA 2006 15
IHE Radiology Integration ProfilesIHE Radiology Integration Profiles
Patient Info.
Recon-ciliation
Access to Radiology Information
Consistent Presentation
ofImages
Audit Trail & Node Authentication - Radiology Option
EvidenceDocs
KeyImageNotes
Simple Image & Numeric Reports
Presentation of
Grouped Procedures
Post-
Processing Workflow
Reporting Workflow
Charge Posting
XDS for Imaging
NMImage
Scheduled Workflow
Teaching Files &
Clinical Trials Export
Portable Data for Imaging
NMImage
Cardiac NM Option
ImageFusion
ImageFusion
IHE Classroom Sessions – RSNA 2006 16
imagesstored
patientinformation
RIS
examination orders
imagesretrieved
HIS
PACS
procedurescheduled
Prefetch any relevantprior studies
modalityworklist
report
report
Registration
Orders Placed
Orders Filled
Film
FilmFolder
Image Manager& Archive
FilmLightbox
report ReportRepository
DiagnosticWorkstation
Modality
acquisitionacquisitionin-progressin-progressacquisitioncompleted
acquisitioncompleted
imagesprinted
AcquisitionModality
Scheduled Workflow ProfileScheduled Workflow Profile
IHE Classroom Sessions – RSNA 2006 17
Patient Information ReconciliationPatient Information Reconciliation
IHE Classroom Sessions – RSNA 2006 18
Consistent Presentation of ImagesConsistent Presentation of ImagesReporting Radiologist Referring Physician or
Reviewing Radiologist
Presentation StatePresentation LUT
Grayscale Standard
Original Image
Window Level
Flip
Zoom
Area Of
Interest
Annotate
WithoutConsistent Presentation
AchievingConsistent Presentation
Area Of
Interest
IHE Classroom Sessions – RSNA 2006 19
Radiology Option for Audit Trail and Node Radiology Option for Audit Trail and Node Authentication (ATNA)Authentication (ATNA)
System A System B
Secured SystemSecure network
• TLS authentication of remote node (digital certificates)• with/without encryption
Secured System
• Audit PHI trail with:• Real-time access • Time synchronization
Central Audit TrailRepository
IHE Classroom Sessions – RSNA 2006 20
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
IHE Classroom Sessions – RSNA 2006 21
Portable Data for Imaging Portable Data for Imaging (PDI)(PDI)
Distribute Imaging Information Distribute Imaging Information on Mediaon Media
CDCreator
Printer
Image/ Report Display
Media Importer
John Doe
CD
IHE Classroom Sessions – RSNA 2006 22
Document Consumer
Retrieve Document
Query Documents
Patient Identity Source
Patient Identity Feed
Document Source
Document Registry
Document Repository
Provide & Register Document Set
Register Document Set
Cross-enterprise Document Cross-enterprise Document Sharing for Imaging (XDS- I)Sharing for Imaging (XDS- I)
Image ManagerImage Archive
Retrieve Images
Retrieve Presentation StatesRetrieve Key Image NoteRetrieve Evidence DocumentsWADO Retrieve
IHE Classroom Sessions – RSNA 2006 23
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
IHE Classroom Sessions – RSNA 2006 24
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
IHE Classroom Sessions – RSNA 2006 25
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
IHE Classroom Sessions – RSNA 2006 26
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
IHE Classroom Sessions – RSNA 2006 27
IHE Reporting WorkflowIHE Reporting Workflow
ReportingReportingWorklistWorklist
Work ItemWork ItemClaimedClaimed
Retrieve Images &Retrieve Images &Evidence DocumentsEvidence Documents
MeasurementsCAD Reports…………………
ReportingProcedure Step
STARTED
ReportingProcedure Step
STARTED
StoreStoreReportsReports
ReportingProcedure Step
COMPLETED
ReportingProcedure Step
COMPLETED
ReportManager
RIS
ImageManager/Archive
PACS & Archive
Report Reader/Creator
IHE Classroom Sessions – RSNA 2006 28
IHE Value PropositionIHE Value Proposition• Product PlanningProduct Planning
• IHE Solutions are Driven by Strategic Healthcare Lead IHE Solutions are Driven by Strategic Healthcare Lead UsersUsers that that collaboratecollaborate with Healthcare with Healthcare VendorsVendors
• IHE Solutions are IHE Solutions are Generic, Reusable and InteroperableGeneric, Reusable and Interoperable based on Healthcare based on Healthcare StandardsStandards: : DICOM, HL7, RFCDICOM, HL7, RFC
• IHE Solutions IHE Solutions Optimize the Clinical WorkflowsOptimize the Clinical Workflows
• IHE Deployment process – Connectathon, Integration IHE Deployment process – Connectathon, Integration Statements and Users Success Stories information helps to Statements and Users Success Stories information helps to refinerefine the product “ the product “Business CaseBusiness Case””
• IHE Technical Framework specification describes the IHE Technical Framework specification describes the Global IHE solutionsGlobal IHE solutions at a High Level for Planning & at a High Level for Planning & Marketing and in details for products Architects and Marketing and in details for products Architects and Engineering developmentEngineering development
IHE Classroom Sessions – RSNA 2006 29
IHE BenefitsIHE Benefits • Clinical UsersClinical Users
• Greater access to consistent informationGreater access to consistent information• Fewer errors, fewer tedious tasksFewer errors, fewer tedious tasks
• AdministratorsAdministrators• Increased throughput - Better scheduling Increased throughput - Better scheduling • Reduce CostReduce Cost
• BuyersBuyers• Specify/purchase RFP’s integration capabilities Specify/purchase RFP’s integration capabilities
easily and Freedom to acquire “Best of Breed” easily and Freedom to acquire “Best of Breed” systems systems
• IT ProfessionalsIT Professionals• Faster, more predictable integration projectsFaster, more predictable integration projects• Facilitate cooperation of competing vendorsFacilitate cooperation of competing vendors
IHE Classroom Sessions – RSNA 2006 30
Picking IHE ProfilesPicking IHE Profiles
Customer RFP’s Product positioning in the market with a Good
Business Case IHE Technical Framework Volume 1, Users Handbook Healthcare Institution Needs:
> Optimized Clinical Workflow : SWF, PIR, RWF
> Improve the Patient Health Care: SWF, PIR, CPI, PGP,KIN
> Economy - Reduce Healthcare cost: SWF, CHG
> Protect the Patient Health Information: SECP
atie
nt In
form
atio
n R
econ
cilia
tion
Access to Radiology Information
Consistent Presentation
of Images
Basic Security
Evidence Documents
Key Image Notes
Simple Image and Numeric
Reports
Presentation of Grouped Procedures
Post-Processing Workflow
Reporting Workflow
Charge Posting
Scheduled Workflow
Pat
ient
Info
rma
tion
Rec
onci
liatio
n
Access to Radiology Information
Consistent Presentation
of Images
Basic Security
Evidence Documents
Key Image Notes
Simple Image and Numeric
Reports
Presentation of Grouped Procedures
Post-Processing Workflow
Reporting Workflow
Charge Posting
Scheduled Workflow
Pat
ient
Info
rma
tion
Rec
onci
liatio
n P
atie
nt In
form
atio
n R
econ
cilia
tion
Access to Radiology InformationAccess to Radiology Information
Consistent Presentation
of Images
Consistent Presentation
of Images
Basic SecurityBasic Security
Evidence DocumentsEvidence
DocumentsKey Image
NotesKey Image
Notes
Simple Image and Numeric
Reports
Simple Image and Numeric
Reports
Presentation of Grouped Procedures
Presentation of Grouped Procedures
Post-Processing Workflow
Post-Processing Workflow
Reporting WorkflowReporting Workflow
Charge PostingCharge Posting
Scheduled WorkflowScheduled Workflow
ConsiderationsConsiderations
IHE Classroom Sessions – RSNA 2006 31
IHE for Product PlanersQuestions?Questions?
IHE North America: RSNA - http:// www.ihe.net
HIMSS - http://www.himss.org/IHE
ACC - http://www.acc.org/quality/ihe/ihe.htm
IHE Europe: http://www.IHE-Europe.org
IHE France: http://www.gmsih.fr/fr/som_comm.htm
IHE Germany: http://www.IHE-D.org
IHE Italy: http://www.rad.unipd.it/IHE
IHE UK: http://www.IHE-UK-org
IHE Japan: http://www.jira-net.or.jp/ihe-j/en/index.html