Integrating the Integrating the Healthcare EnterpriseHealthcare Enterprise
IHE for Consultants and IHE for Consultants and System IntegratorsSystem Integrators
Andrei Leontiev
John PaganiniIDX Systems Corporation
HIMSS/RSNA HIMSS 2003
• The IHE Technical Framework presentsThe IHE Technical Framework presentsthe technical details for system integrators the technical details for system integrators implementing an IHE networkimplementing an IHE network
• It includes guidelines for defining dependency It includes guidelines for defining dependency relationships, system validation and verification. relationships, system validation and verification.
• These guidelines and tools will simplify the These guidelines and tools will simplify the process, identify potential problems, and make process, identify potential problems, and make systems integration faster, more efficient, less systems integration faster, more efficient, less expensive and more successful.expensive and more successful.
IHE as an IHE as an Integration ToolIntegration Tool
HIMSS/RSNA HIMSS 2003
IHE Technical FrameworkIHE Technical FrameworkOrganized in three sections that Organized in three sections that
provide an increasing level of detail:provide an increasing level of detail:
Integration ProfilesIntegration Profiles: Establish broad categories of : Establish broad categories of compatible function.compatible function.
ActorsActors: Identify specific kinds of operational : Identify specific kinds of operational participants in the healthcare enterprise.participants in the healthcare enterprise.
TransactionsTransactions: Describe particular interactions : Describe particular interactions between actors to perform specific operations.between actors to perform specific operations.
HIMSS/RSNA HIMSS 2003
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
HIMSS/RSNA HIMSS 2003
Technical Framework: Technical Framework: ActorsActors
• Actors identify specific kinds of operational Actors identify specific kinds of operational participants in the healthcare enterprise.participants in the healthcare enterprise.
• An individual actor often corresponds to a device An individual actor often corresponds to a device or software productor software product
However, actors only reflect integration However, actors only reflect integration capabilities of such device or productcapabilities of such device or product
• Real-life products often implement multiple actorsReal-life products often implement multiple actors• Actors may implement more than one IHE profile.Actors may implement more than one IHE profile.• 17 types of actors IHE Year 417 types of actors IHE Year 4
HIMSS/RSNA HIMSS 2003
Technical Framework:Technical Framework:TransactionsTransactions
• Transactions specify how actors communicate Transactions specify how actors communicate to each other in the integration profileto each other in the integration profile
• Transactions define standard protocols Transactions define standard protocols • (DICOM, HL7, etc.)(DICOM, HL7, etc.)
• If protocol allows for multiple options, certain If protocol allows for multiple options, certain choice of options is often dictatedchoice of options is often dictated
• May be required in multiple profiles; some May be required in multiple profiles; some transactions are optionaltransactions are optional
• Over 30 types of transactions in Year 4Over 30 types of transactions in Year 4
HIMSS/RSNA HIMSS 2003
Generic Integration Solution Implementation Guide Based on Standards Choice of Useful Standards Definitions Select Options Defined by Standards Strict Conformance to Standards:
– Health Level 7 ( HL7 )– DICOM 3.0– ...
IHE - Relationship to StandardsIHE - Relationship to Standards
HIMSS/RSNA HIMSS 2003
Use Case Roles Use Case Roles & Interaction Diagrams& Interaction Diagrams
Actor 1 Actor 2
TRANSACTIONS
Actor 3
Actor 1 Actor 2 Actor 3
Message 1Message 2
Message 3
• Examples of Actors:Examples of Actors:- ADT / Patient RegistrationADT / Patient Registration- SchedulerScheduler- Acquisition ModalityAcquisition Modality- Image DisplayImage Display- Report ReaderReport Reader
• Examples of Transactions:Examples of Transactions:- Register PatientRegister Patient- Procedure ScheduledProcedure Scheduled- Images StoredImages Stored- Query / Retrieve ImagesQuery / Retrieve Images- Query / Retrieve ReportsQuery / Retrieve Reports
HIMSS/RSNA HIMSS 2003
Use Case Roles &Use Case Roles & Interaction Diagrams Examples Interaction Diagrams Examples
Interaction Diagram:Interaction Diagram: Retrieve ReportsRetrieve Reports
Retrieve Reports ( C-MOVE )
Store Reports ( C-STORE )
View Reports
ReportReader
ReportRepository
External Report
Repository
Retrieve Reports ( C-MOVE )
Store Reports ( C-STORE )
View Reports
HIMSS/RSNA HIMSS 2003
System Transactions OverviewSystem Transactions Overview
Order Placer
PerformedProcedure Step
Manager
ADTPatient Registration
Image Archive
Image Manager
Image Display
Image Creator
AcquisitionModality
DepartmentSystem Scheduler– Order Filler –
Modality Worklist
Patient Registration
Patient Update
Procedure Scheduled
Images Availability Query
Patient Update
Procedure Update
ImagesStored
StorageCommit
Q /R KeyImage Note
Q /RPresentation
Sates
StorageCommit
ImagesStored
PPSIn-Progress/ Completed
PPSIn-Progress/ Completed
PPSIn-Progress/ Completed
Fil
ler
Ord
erM
anag
emen
t
Placer Order Management Present.
StateStored
Q /RImages
Key Image Note
StoredPresent.State
Stored
Key Image Note
Stored
HIMSS/RSNA HIMSS 2003
Order Placer
PerformedProcedure Step
Manager
ADTPatient Registration
Image Archive
Image Manager
Image Display
Image Creator
AcquisitionModality
DepartmentSystem Scheduler– Order Filler –
Modality Worklist
Patient Registration
Patient Update
Procedure Scheduled
Images Availability Query
Patient Update
Procedure Update
ImagesStored
StorageCommit
Q /R KeyImage Note
Q /RPresentation
Sates
StorageCommit
ImagesStored
PPSIn-Progress/ Completed
PPSIn-Progress/ Completed
PPSIn-Progress/ Completed
Fil
ler
Ord
erM
anag
emen
t
Placer Order Management Present.
StateStored
Q /RImages
Key Image Note
StoredPresent.State
Stored
Key Image Note
Stored
System Transactions OverviewSystem Transactions OverviewPRINTING
Print Server
Print Request withPresentation LUT
Print Composer
ExternalReport
Repository
Report Reader
Report Creator
Report Manager
Report Repository
Report Submission
Report Issuing
Query Report
Retrieve Report
Enterprise Result
Repository
Structured ReportExport
HIMSS/RSNA HIMSS 2003
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
IHE Scheduled WorkflowIHE Scheduled Workflow
Modality WorklistModality Worklist
WorklistWorklist
Procedure ScheduledProcedure Scheduled
Patient Registration/UpdatePatient Registration/UpdateOrder ManagementOrder Management
HIMSS/RSNA HIMSS 2003
Scheduled WorkflowScheduled Workflow
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
Patient Update
Q /RImages
PPSIn-Progress/ Completed
PPSIn-Progress/ Completed
HIMSS/RSNA HIMSS 2003
Example: Image Manager/ Image Archive ActorTransaction Optionality Section in TF
Procedure Scheduled R 6.4Modality Procedure Step In Progress R 6.6Modality Procedure Step Completed R 6.7Modality Images Stored R 6.8Storage Commitment R 6.10Image Availability Query R 6.11Query Images R 6.14Retrieve Images R 6.16Creator Images Stored R6.18Creator Procedure Step in Progress R 6.20Creator Procedure Step Completed R 6.21
Integration Profiles Actors and Integration Profiles Actors and Transactions Scheduled WorkflowTransactions Scheduled Workflow
HIMSS/RSNA HIMSS 2003
Where to start...Where to start...
First, recognize what systems you need to integrate
See what Actors they implement and in what Profiles are supported.
Make sure Actors and Profiles match properly and fit into the Framework.
… Otherwise it won’t work!
HIMSS/RSNA HIMSS 2003
Next StepsNext Steps Just matching of Actors and profiles
is not enough Most systems have much more
complex functionality than that defined in framework
They need more data to function properly
Identify what data systems need besides elements defined in the IHE transactions.
HIMSS/RSNA HIMSS 2003
Check Optional Check Optional TransactionsTransactions
IHE Integration Profiles may contain optional transactions - make sure both sender and receiver treat such transactions similarly– if receiver requires transaction, sender must be able to
always generate it– If receiver does not utilize transaction, make sure it is
gracefully handled when it “shows up”
HIMSS/RSNA HIMSS 2003
Check the Options Check the Options
in Transactionsin Transactions Many data elements in the transactions are optional or conditional
Make sure that sender generates conditional information when conditions are met
Make sure that receiver may operate without optional data or the sender must be able to always generate it
HIMSS/RSNA HIMSS 2003
Is it going to work now?Is it going to work now?
Make sure the conformance statements are for correct versions of the software
Check HL7 interface specs Review DICOM Conformance Statements Check the results of IHE Connect-a-thon Ask vendors to provide output from the
MESA test tools
HIMSS/RSNA HIMSS 2003
MESA ToolsMESA Tools
Test tools that are developed by the IHE Technical Project Management Team
Used in preparation for IHE Connect-a-thon. MESA tools are in public domain. Test outputs are fairly informative and may
provide the extra information on how transactions are implemented
HIMSS/RSNA HIMSS 2003
Are we there yet?Are we there yet?
One yet have to find the healthcare enterprise equipped so that all the systems are “IHE aware”
Understand that you may have to deal with non-compliant devices and systems
Make best effort to bring them “up-to-date” Follow yellow brick road...
HIMSS/RSNA HIMSS 2003
Implementing Integration Implementing Integration Projects with IHEProjects with IHE
HIMSS/RSNA HIMSS 2003
Project ConsiderationsProject Considerations
A working knowledge of rapidly changing technology An unbiased insight into the business strategies of
potential suppliers Incorporating existing equipment Considering changes to current operations Accounting for the various skills and apprehensions of a
multitude of potential users Accommodating complex practice patterns of
radiologists and referring physicians Impact of organization changes within the enterprise Impact of changes in the health care industry
HIMSS/RSNA HIMSS 2003
Classic Consulting Classic Consulting ProcessProcess
1. Definition of Client Requirements – Site Analysis, Operational Workflow
2. Generation of Proposal - Review with Client, Modify as Needed
3. Solution Development and Implementation
4. Client Testing QA / Test
5. Client Signoff
6. Post Implementation Review
HIMSS/RSNA HIMSS 2003
Solution and DevelopmentSolution and Development
• Current State AnalysisCurrent State Analysis • Impact StudyImpact Study • Current State AnalysisCurrent State Analysis • Impact StudyImpact Study • System Design and System Design and
Implementation StrategyImplementation Strategy
• Current State AnalysisCurrent State Analysis • Impact StudyImpact Study • System Design and System Design and
Implementation StrategyImplementation Strategy • Cost EstimateCost Estimate
• Current State AnalysisCurrent State Analysis • Impact StudyImpact Study • System Design and System Design and
Implementation StrategyImplementation Strategy • Cost EstimateCost Estimate • Pay Back AnalysisPay Back Analysis
• Current State AnalysisCurrent State Analysis Department Layout
Imaging Asset Analysis
Room Utilization
Hardcopy Utilization
Digital Image Equivalents
Workflow Analysis Cost Analysis
Develop assumptions about system performance and specify performance requirements.
Interviews with the radiologists and clinicians
Questionnaires
Short and long term outcomes.
System design includes block diagrams and component lists.
Physical network
Acquisition devices
Display systemsArchives Interfaces
Determine the pricing of the required products and services.
•Applications.
•Professional Services.
•Integrations.
•Training.
Material costs and labor savings are combined with other potential savings
HIMSS/RSNA HIMSS 2003
Vendor Vendor ConsiderationsConsiderations
Cost - Look at whole pictureFlexibility - Integratable, ScalableFunctionality - Standard, customizableImplementability - Mature, ComplexityStability - Revenue, Market SegmentUsability - Hides complexity,Productive
HIMSS/RSNA HIMSS 2003
Reengineering Reengineering AnalysisAnalysis
What works well now? What does not work well
now? What is a "relic from the
past"? Search for redundancies Search for important,
missing data Check workload peaks &
valleys
Challenge traditions Expect innovation Document every detail Simplify the complex Still need all that paper? Shorten the start-to-
finish cycle time Verify computations
HIMSS/RSNA HIMSS 2003
User AnalysisUser AnalysisIHE brings users
together in new waysEach user vital to
patient careEach user has
different perspectiveEach user needs to
see how IHE can benefit them
HIMSS/RSNA HIMSS 2003
Departmental ChiefDepartmental Chief
ROLE Responsible for
prompt, reliable, cost-effective patient care
Analyzes workflow, visionary, road map
IHE INTEREST Purchase best of
breed while conforming to IHE
Seamless integration Deliver on unique
requirements of Staff Ensure optimized
workflow
HIMSS/RSNA HIMSS 2003
Chief Information OfficerChief Information Officer
ROLE Protector and Provider of
Patient Data Manages dozens of
information systems
PROBLEMS Increasing policies,
procedures, regulations Tight budgets Changing technologies Tight technical labor market
IHE INTEREST Workflow defined Deploy best of breed
systems with standards Technical Framework will
enable application consolidation
Promotes healthy competition to vendors –improve performance and service
HIMSS/RSNA HIMSS 2003
ConclusionConclusion
IHE should be part of theproposed solution
IHE benefits users, providers and vendorsYear 5 - Key year for expansion into other
domains while radiology continuesSupport and involvement building across
disciplines and internationally
HIMSS/RSNA HIMSS 2003
IHE Expands ScopeIHE Expands Scope Recruiting Participants in new Committees
Enterprise Master Patient Index Advanced Security Query/Display and Synchronized Patient View
Special Panel Session in IHE Theatre Overview of new IHE enterprise initiatives Learn how to participate
– Tuesday, February 11, 9:15 – 10:00 a.m.– Wednesday, February 12, 12:15 – 1:00 p.m
HIMSS/RSNA HIMSS 2003
Special IHE Panel SessionSpecial IHE Panel Session IHE - IT Infrastructure: The Value Proposition
– Find out how you can benefit from participating in IHE committees and Connectathons
– Learn how IHE fills the interoperability gap – Hear the status of new enterprise initiatives
Software vendors, developers and interested parties invited to attend special panel session
Top Related