1September, 2005 What IHE Delivers
Chris Lindop Chris Lindop , GE Healthcare GE Healthcare Co-chair, IHE Radiology Planning CommitteeCo-chair, IHE Radiology Planning Committee
RadiologyRadiology
2008 Update2008 Update
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An Incremental Multi-Year ProjectAn Incremental Multi-Year ProjectLaunched in 1998Launched in 1998
Goal:Goal:
Enhance the Access to Clinical InformationEnhance the Access to Clinical Information Ensure Continuity and Integrity of Patient InformationEnsure Continuity and Integrity of Patient Information Speed Up the Integration in Healthcare EnvironmentsSpeed Up the Integration in Healthcare Environments Fosters Communication Between Vendors ofFosters Communication Between Vendors of
Medical Information TechnologyMedical Information Technology
ProveProve that that IntegrationIntegration is Attainable is Attainable Based on StandardsBased on Standards
Participants:Participants:
Representatives of Healthcare Providers Representatives of Healthcare Providers Information Systems VendorsInformation Systems Vendors Imaging Systems VendorsImaging Systems Vendors Standardization GroupsStandardization Groups
The IHE Initiative
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IHE RadiologyIHE Radiology
Scope: Scope: Radiology including Nuclear Medicine, MammographyRadiology including Nuclear Medicine, Mammography
VendorsVendors Acquisition Modalities, RIS, PACS, Workstations, Displays, PrintersAcquisition Modalities, RIS, PACS, Workstations, Displays, Printers
Established 1998 (first IHE domain)Established 1998 (first IHE domain)
Sponsor: RSNASponsor: RSNA
Supporters: COCIR, DRG, EAR, ECR, EuroPACS, Supporters: COCIR, DRG, EAR, ECR, EuroPACS, GMSIH, JIRA, JAHIS, JRS, JSRT, METI, MEDIS-DC, GMSIH, JIRA, JAHIS, JRS, JSRT, METI, MEDIS-DC, SFR, SIRM SFR, SIRM
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IHE Radiology - AchievementsIHE Radiology - AchievementsNow entering 10th yearNow entering 10th year Robust Vendor Participation at ConnectathonsRobust Vendor Participation at Connectathons Over 200 IHE Integration Statements published Over 200 IHE Integration Statements published Over 1000 Actors in Radiology implementedOver 1000 Actors in Radiology implemented IHE Profiles appearing in User Purchasing ProcessesIHE Profiles appearing in User Purchasing Processes
Have addressed basic radiology workflowsHave addressed basic radiology workflows Acquisition, Post-Processing, Reporting, Teaching Files/Clinical TrialsAcquisition, Post-Processing, Reporting, Teaching Files/Clinical Trials
Have addressed imaging content handlingHave addressed imaging content handling Measurements, CAD Results, NM, Mammo, Presentation States, Reports, Measurements, CAD Results, NM, Mammo, Presentation States, Reports,
Key Image NotesKey Image Notes
Have addressed distribution of imaging informationHave addressed distribution of imaging information on CDs, to enterprise, to EHRs, keeping Audit Trails on CDs, to enterprise, to EHRs, keeping Audit Trails
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IHE Radiology – Recent Development ActivitiesIHE Radiology – Recent Development ActivitiesExpand focus to integration and workflow Expand focus to integration and workflow spanningspanning departments/enterprises/regionsdepartments/enterprises/regions Teaching Files and Clinical Export***Teaching Files and Clinical Export*** Scheduled Workflow II****Scheduled Workflow II**** PDI-large image set option****PDI-large image set option****
Expand focus to Quality Initiatives in RadiologyExpand focus to Quality Initiatives in Radiology Radiation Emission Monitoring (REM) *Radiation Emission Monitoring (REM) *
Focused support for specialtiesFocused support for specialties Modality Acquisition Workflow *Modality Acquisition Workflow * NM Image Cardiology Option **NM Image Cardiology Option ** Image Fusion **Image Fusion **
** Approved for Trial Implementation 2008/09 Approved for Trial Implementation 2008/09
**** Carried over for Trial Implementation in 2008/09 Carried over for Trial Implementation in 2008/09
*** *** Approved for release in Technical Framework V9.0 Approved for release in Technical Framework V9.0
**** Strategic - to be carried over in next Development cycle**** Strategic - to be carried over in next Development cycle
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Connectathon StatusConnectathon StatusNorth AmericanNorth American Jan 28 – Feb 1, Chicago, ILJan 28 – Feb 1, Chicago, IL 70 Vendors, 136 products70 Vendors, 136 products
JapanJapan February, Tokyo, JapanFebruary, Tokyo, Japan 36 Vendors, 60 systems36 Vendors, 60 systems
EuropeEurope 20-26 April, Oxford, England20-26 April, Oxford, England 72 Vendors, 120 products72 Vendors, 120 products
ChinaChina May, BeijingMay, Beijing
AustraliaAustralia July, SydneyJuly, Sydney
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Radiology ProfilesRadiology Profiles
Access to Radiology Information
-
ConsistentPresentation
of Images
EvidenceDocument
KeyImageNotes
Simple Image & Numeric Reports
Presentation of
Grouped Procedures
Post-Processing Workflow
Reporting Workflow
Charge Posting
Patien
t Info
. Reco
nciliatio
n
Scheduled Workflow
Portable Data for Imaging
Mammo-graphy
Image
Audit Trail & Node Authentication – Radiology Option
Image Fusion
Teaching Files & Clinical Export
Import Reconcil-
iation Workflow
Cross-Enterprise Document Sharing for Imaging
NMImageCard
Option
Radiation Emission
Monitoring
Mammo-graphy
Acquisition Workflow
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IHE Radiology – Integration ProfilesIHE Radiology – Integration ProfilesWorkflow
Scheduled Workflow
Patient Information Reconciliation
Post-Processing Workflow
Reporting Workflow
Import Reconciliation Workflow
Mammography Acquisition Workflow**
Infrastructure
Access to Radiology Information
Portable Data for Imaging
Cross-Enterprise Data Sharing for Images
Security: Audit Trails & Node Authentication
Charge Posting
Teaching Files & Clinical Trials Export
Presentation & ContentConsistent Presentation of Images
Key Image Notes
Image Fusion **
Presentation of Grouped Procedure
Evidence Documents
Simple Image & Numeric Reports
NM Image*
Mammography Image
Radiation Emission Monitoring**
* Cardiology Option – in Trial Implementation* Cardiology Option – in Trial Implementation** in Trial Implementation** in Trial Implementation
Publications
Radiology Users Guide
Mammography Users Guide
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2008 Trial Implementation Profiles2008 Trial Implementation Profiles
Radiation Emmission MonitoringRadiation Emmission Monitoring
Mammography Acquisition WorkflowMammography Acquisition Workflow
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Dose ReportingDose Reporting
Facilitates the collection and distribution of reports detailing patient radiation exposure resulting from imaging procedures.
Retrieve Dose Information
Query Dose Information
PerformStudy
Submit Dose Information
Prepare Monthly Submission
Store Dose Information (CT)
Store Dose Information (XR)
Retrieve Dose Information
Query Dose Information
Generate Weekly Reports
. . .
Acquisition Modality 1
(XR)
Image Archive
Dose Information
Monitor
Dose Registry
Acquisition Modality 2
(CT)
. . .
Initiate Weekly Report Task
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Mammography Acquisition Workflow (MAWF)Mammography Acquisition Workflow (MAWF)
MAWF addresses specific Digital XR MAWF addresses specific Digital XR Mammo Workflow issues:Mammo Workflow issues:
• High ThroughputHigh Throughput• Screening vs. diagnostic acquisition contextScreening vs. diagnostic acquisition context• Procedure conversion done at acquisition Procedure conversion done at acquisition
– screening -> diagnostic, self referralscreening -> diagnostic, self referral
MAWF leverages existing profiles and options of IHE MAWF leverages existing profiles and options of IHE (SWF, KIN)(SWF, KIN)
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MAWF – Use cases overviewMAWF – Use cases overview
3 main uses:3 main uses:• Procedure error or modificationProcedure error or modification• Finish an exam with supplemental viewsFinish an exam with supplemental views• Correct / Remove images at modality or workstationCorrect / Remove images at modality or workstation
Each use case drives new requirements for each Each use case drives new requirements for each actor of the radiology department: actor of the radiology department:
• Acquisition modalities, Acquisition modalities, • DSS/OFs (RIS) DSS/OFs (RIS) • Image managers/archives (PACS)Image managers/archives (PACS)• Image displays (Workstations)Image displays (Workstations)
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Use of coded valuesUse of coded values
IHE provides baseline ofIHE provides baseline of codes codes
MAWF uses cases rely onMAWF uses cases rely on extensive use of codes (incl. extensive use of codes (incl. Assisted protocol setting and Assisted protocol setting and exception management)exception management)
Codes are configurable on a enterprise basisCodes are configurable on a enterprise basis
Codes allow for a better workflow integration and exception Codes allow for a better workflow integration and exception cases (see previous uses cases)cases (see previous uses cases)
Coding Scheme Designator (0008,0102)
Code Value (0008,0100)
Code Meaning (0008,0104)
IHERADTF MAWF0001 Screening Mammography, bilateral
IHERADTF MAWF0002 Screening Mammography, left
IHERADTF MAWF0003 Screening Mammography, right
IHERADTF MAWF0004 Diagnostic Mammography, bilateral
IHERADTF MAWF0005 Diagnostic Mammography, left
IHERADTF MAWF0006 Diagnostic Mammography, right
IHERADTF MAWF0007 Mammary Ductogram, Single Duct
IHERADTF MAWF0008 Mammary Ductogram, Multiple Ducts
IHERADTF MAWF0009 Mammogram for clip placement, bilateral
IHERADTF MAWF0010 Mammogram for clip placement, left
IHERADTF MAWF0011 Mammogram for clip placement, right
IHERADTF MAWF0012 Needle Localization, Image Guided, Mammography, bilateral
IHERADTF MAWF0013 Needle Localization, Image Guided, Mammography, left
IHERADTF MAWF0014 Needle Localization, Image Guided, Mammography, right
IHERADTF MAWF0015 Stereotactic Biopsy, Image Guidance, bilateral
IHERADTF MAWF0016 Stereotactic Biopsy, Image Guidance, left
IHERADTF MAWF0017 Stereotactic Biopsy, Image Guidance, right
IHERADTF MAWF0018 Breast Specimen Mammography, bilateral
IHERADTF MAWF0019 Breast Specimen Mammography, left
IHERADTF MAWF0020 Breast Specimen Mammography, right
IHERADTF MAWF0021 Quality Control, Mammography
IHERADTF MAWF0022 Additional Mammography Views
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2008 Development Schedule2008 Development ScheduleTimeframe Activity Scheduled Location
2007
Aug. Submit Brief Profile Proposals to Planning Committee (PC) by Aug 31 E-mail
Sept. PC Selects "Short List" of Proposals Sept 4 T-Con
Sept. PC Drafts Detailed Profile Proposals for "Short Listed" Proposals by Sept 14 E-mail
Oct. TC Completes technical review of Detailed Proposals T-Con
Oct. PC makes Final Selection of Proposals for this year Oct 24 T-Con
Nov. TC Profile development kickoff meeting Nov. 5-7 Chicago
2008
Jan. TC Finalizes profile supplements for public comment Feb 4-7 Chicago
Feb. Publication of Public Comment Supplements approx. Feb 27 www.ihe.net
Mar. Deadline for submission of public comments on profile supplements approx. Mar 27 www.ihe.net
Mar. TC reconciles public comments Mar 31-Apr 2 Chicago
Jun. Publication of Trial Implementation Supplements www.ihe.net
Jun. Publication of Final Text Technical Framework www.ihe.net
2009
Jan. First Test implementations at Connectathon Chicago
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Strategic Profile Development for 2008Strategic Profile Development for 2008
PDI – Large Data Sets (DVD/USB media)PDI – Large Data Sets (DVD/USB media)
Scheduled Workflow II (Volume 1 only)Scheduled Workflow II (Volume 1 only)
Profiles not yet released!Profiles not yet released!
Development is still in progressDevelopment is still in progress
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MediaCreator
Printer[Media Reader]
Image Display[Media Reader]
PACS[Media Importer]
CD DVD*USB*
John DoeDICOM Data
Web Data(Optional)
DICOM
DICOM
DICOM
PC BrowserWeb Data
Required to cleanup Patient ID, Acc#, etc.
Portable Data for ImagingPortable Data for Imaging
* New Option
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Scheduled Workflow IIScheduled Workflow II
Scheduled Workflow ScopeScheduled Workflow Scope Volume 1 onlyVolume 1 only PAM AdoptionPAM Adoption Use of Current HL-7 Version (v 2.5)Use of Current HL-7 Version (v 2.5) Options ReviewOptions Review
• Incorporate, remove or maintain statusIncorporate, remove or maintain status Actor EvaluationActor Evaluation
• ExamplesExamples– MPPS Mgr – is it neededMPPS Mgr – is it needed– Image Archive/Manager should they be grouped?Image Archive/Manager should they be grouped?
TransactionsTransactions• ExamplesExamples
– Image availability QueryImage availability Query
Profile Grouping Profile Grouping • Incorporate PIRIncorporate PIR
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Strategic Profile Deployment for 2008Strategic Profile Deployment for 2008
Global Deployment priorityGlobal Deployment priority PDIPDI XDS-IXDS-I
for North America for North America TCETCE
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PDI Use Case for External AcquisitionPDI Use Case for External Acquisition
Radiology Enterprise A
Radiology Enterprise B
Provider A
Radiology Site B
PACS A
Portable Data Creator Patient Data
2. Radiology Site B creates portable media with patient images
1. Provider A orders External Radiology Procedure
3. Portable Media is sent to Reading Site A via CD. Patient Data is imported and read.
4. Study Results sent to Provider
Radiologist
PDI Disk
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Radiology Enterprise B
Radiology Enterprise A
PACS B
Portable Data Creator
Patient Data
2.Relevant Data (including film) is collected and Enterprise A creates portable media with patient’s radiology information.
1. Request for Patient’s case data to be transferred from Enterprise A to B.
3.Data is transported to Site B via CD. Patient Demographics are reconciled and data is imported into archive.
4. Patient Data is now associated with B’s electronic health record system.
PDI Use Case for Patient ReferralPDI Use Case for Patient Referral
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XDS-I Actors and TransactionsXDS-I Actors and Transactions
Document Consumer
Retrieve Document
Query Documents
Patient Identity Source
Patient Identity Feed
Imaging Document Source
Document Registry
Document Repository
Provide & RegisterDocument Set
RegisterDocument Set
Imaging Document Consumer
Retrieve Images
Retrieve Presentation StatesRetrieve Key Image NoteRetrieve Evidence DocumentsWADO Retrieve
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Teaching File & Clinical Trail ExportTeaching File & Clinical Trail Export
Priority Profile for IHE USA
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ParticipatingParticipatingVendorsVendors Implement IHE Profiles in your productsImplement IHE Profiles in your products Test your products at the IHE ConnectathonTest your products at the IHE Connectathon Publish IHE Integration StatementsPublish IHE Integration Statements
UsersUsers Learn about the IHE ProfilesLearn about the IHE Profiles Include specific IHE Profiles in your RFPsInclude specific IHE Profiles in your RFPs
IHE ProcessIHE Process Review Draft Profiles during Public Comment phaseReview Draft Profiles during Public Comment phase Participate on CommitteesParticipate on Committees
• Radiology Planning Committee: Radiology Planning Committee: – Kevin O’Donnell (Toshiba) & Chris Lindop (GE Healthcare)Kevin O’Donnell (Toshiba) & Chris Lindop (GE Healthcare)
• Radiology Technical Committee: Radiology Technical Committee: – Cindy Levy ( Cedara)Cindy Levy ( Cedara)
• Chris Carr (RSNA) – [email protected] Carr (RSNA) – [email protected]
24September, 2005 What IHE Delivers
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