Understanding IHE, BIR20 Oct 2004
IHEIHEIntegrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise
General Overview (again once)General Overview (again once)
Scheduled WorkflowScheduled Workflow
Patient Information ReconciliationPatient Information Reconciliation
Consistent Presentation of ImagesConsistent Presentation of Images
Key Image NotesKey Image Notes
How to deal with IHE-itemsHow to deal with IHE-items
Prof. Berthold B. WeinProf. Berthold B. Wein
User co-chair IHE-EuropeUser co-chair IHE-Europe
Understanding IHE, BIR20 Oct 2004
IHEIHE: : short overviewshort overview andand
scheduled workflow and scheduled workflow and patient information reconciliationpatient information reconciliation
Prof. Berthold B. Wein, MDProf. Berthold B. Wein, MD
User co-chair IHE-EuropeUser co-chair IHE-EuropePraxisgemeinschaft Praxisgemeinschaft
KapuzinerkarreeKapuzinerkarreeUniversity Hospital Aachen University Hospital Aachen
GermanyGermany
Understanding IHE, BIR20 Oct 2004
Healthcare IT – Main ObstaclesHealthcare IT – Main Obstacles
• Lack of financial funding :Lack of financial funding :– IT : 2.3% of hospital budget (in other industries : 2.8%) IT : 2.3% of hospital budget (in other industries : 2.8%)
[Gartner][Gartner]
• Lack of national/regional guidelines & incentivesLack of national/regional guidelines & incentives
• Lack of access to IT infrastructureLack of access to IT infrastructure
• Lack of solutions that meet clinical needsLack of solutions that meet clinical needs
• Lack of adequate healthcare IT standards and Lack of adequate healthcare IT standards and interoperabilityinteroperability– Integration cost : 20% of hospital IT budgetIntegration cost : 20% of hospital IT budget
IHE scope
Understanding IHE, BIR20 Oct 2004
IHE MissionIHE Mission
• Improve the quality and cost of healthcare by Improve the quality and cost of healthcare by removing the interoperability barriersremoving the interoperability barriers– Continuity & Integrity of Patient InformationContinuity & Integrity of Patient Information
– Clinical Workflow OptimizationClinical Workflow Optimization
• Provide an open interoperability framework, Provide an open interoperability framework, based on existing standardsbased on existing standards
• Enable cross-vendor environmentEnable cross-vendor environment
• Make life more easy for the users and vendorsMake life more easy for the users and vendors
IHE = Integrating the Healthcare EnterpriseIHE = Integrating the Healthcare Enterprise
Understanding IHE, BIR20 Oct 2004
• seamless information flowseamless information flow– from system to systemfrom system to system– within and across departmentswithin and across departments– within and across hospital borderswithin and across hospital borders
• access to all vital clinical data access to all vital clinical data – at the right time and at the right placeat the right time and at the right place
• workflow optimisationworkflow optimisation• elimination of redundancies in data entryelimination of redundancies in data entry• foster openess of productsfoster openess of products• less problems in interoperability and less problems in interoperability and
understandingunderstanding
Benefits of IHEBenefits of IHE
Understanding IHE, BIR20 Oct 2004
IHE is based onIHE is based on• Technical frameworkTechnical framework
– The bible for interoperability, the hope for us/vndrsThe bible for interoperability, the hope for us/vndrs
• Connect-a-thonConnect-a-thon– The real-life test of systems, the hell for productsThe real-life test of systems, the hell for products
• DemonstrationDemonstration– The show to others, how it worksThe show to others, how it works
• Integration statementsIntegration statements– The advertising to users, enabling understandingThe advertising to users, enabling understanding
• SucessSucess– The teaching by othersThe teaching by others
Understanding IHE, BIR20 Oct 2004
IHE MembersIHE Members• UsersUsers
– Clinicians, Medical Staff, Administrators, CIOs, …Clinicians, Medical Staff, Administrators, CIOs, …
• Vendors Vendors – Information Systems & Imaging Equipment (80 vendors)Information Systems & Imaging Equipment (80 vendors)
• Societies Representing Healthcare SegmentsSocieties Representing Healthcare Segments– EAR, ECR, ESC, Other Professional Societies…EAR, ECR, ESC, Other Professional Societies…
• Governmental agencies Governmental agencies – e.g. GMSIHe.g. GMSIH
• Active liaison with Standards Development Active liaison with Standards Development Organizations (SDOs)Organizations (SDOs)– HL7, DICOM, ASTM, others …HL7, DICOM, ASTM, others …
Understanding IHE, BIR20 Oct 2004
Year nYear n
Demo’sDemo’s
IHE TF Development ProcessIHE TF Development Process
Year nYear nConnectathonConnectathon
Year nYear nTrial ImplementationTrial Implementation
Year N Year N Technical FrameworkTechnical Framework
Standards’Standards’AssessmentAssessment
Year nYear nGoalsGoals
Year n-1Year n-1
Understanding IHE, BIR20 Oct 2004
IHE - Connect-a-thonIHE - Connect-a-thon
EuropeanEuropean
Application rather than protocol testing real lifeApplication rather than protocol testing real life
Paris, Aachen, Padua, NordwijkerhoutParis, Aachen, Padua, Nordwijkerhout2001 2002 2003 2004 2005
–2001, Paris, F: –13 vendors > 20 sys
–2002, Paris, F: –33 vendors > 60 sys
–2003, Aachen, D:–47 vendors > 85 sys
–2004, Padova, I: –49 vendors > 80 sys
Understanding IHE, BIR20 Oct 2004
IHE - DemonstrationsIHE - Demonstrations
F D I UK F D I UK EUREUR
First experiences with IHE-compliant systemsFirst experiences with IHE-compliant systemsduring hands-on trials on user congressesduring hands-on trials on user congresses
Understanding IHE, BIR20 Oct 2004
IHE Integration Statement
Vendor Product Name Version Date
Huge Imaging Medical Systems IntegrateRAD V2.3 12 Oct 2002
Integration Profiles Implemented
Actors Implemented Options Implemented
Scheduled Workflow Image Manager/Archivee none
Image Display Performed Procedure Step
Order Filler PPS Exception Management
Simple Image and Numeric Report Report Creator none
Link to vendor IHE page www.HImedicalsystems.fake/ihe
Links to Standards Conformance Statements of the Implementation
HL7 www.HImedicalsystems.fake/hl7
DICOM www.HImedicalsystems.fake/dicom/integrateRAD.pdf
IHE Integration StatementIHE Integration Statement
Understanding IHE, BIR20 Oct 2004
IHE EuropaIHE Europa
National initiativesNational initiatives
Well establishedWell established
F, D, I, NL, GBF, D, I, NL, GB
In organisationIn organisation
DK, N, EDK, N, E
beginningbeginning
SS
Understanding IHE, BIR20 Oct 2004
Technical FrameworkTechnical Framework
• Integration ProfilesIntegration Profiles– Practical solutions for daily-work integration Practical solutions for daily-work integration
problemsproblems
– Precise definitions of actors and transactionsPrecise definitions of actors and transactions
– Exact requirements for open standardsExact requirements for open standards
• Conversion tablesConversion tables– Defining correspondant fieldsDefining correspondant fields
– Describing characteristics of the fieldsDescribing characteristics of the fields
• Use casesUse cases– Depicting daily scenarios for easy understandingDepicting daily scenarios for easy understanding
Understanding IHE, BIR20 Oct 2004
TF and IHE DomainsTF and IHE Domains
• RadiologyRadiology
• Laboratory MedicineLaboratory Medicine
• Information Technology InfrastructureInformation Technology Infrastructure
• CardiologyCardiology
• General practicionersGeneral practicioners
• PathologyPathology
• DermatologyDermatology
Understanding IHE, BIR20 Oct 2004
Integration ProfilesIntegration Profiles
• Solving daily life problems by standardsSolving daily life problems by standards
• Exactly defining solutions and parts for Exactly defining solutions and parts for succeeding in interoperabilitysucceeding in interoperability
• Reduce the problem to Reduce the problem to – actorsactors
– transactionstransactions
therefore making it independent from real world therefore making it independent from real world limitations and offering a global strategy for limitations and offering a global strategy for solutionsolution
Understanding IHE, BIR20 Oct 2004
Laboratory Medicine 2004-2005Laboratory Medicine 2004-2005
Laboratory Scheduled Workflow (LSWF) done in 2003
Tests performed by a laboratory for an identified inpatient or outpatient
Laboratory Patient Information Reconciliation
(LPIR) year 2004Tests performed on an unidentified
or misidentified patient
Laboratory Code Set Distribution (LCSD) year 2004
Sharing the batteries and tests code sets throughout the enterprise
Laboratory Device Automation (LDA) year 2004
Pre-analytic process, analysis and post-analytical treatment
Laboratory Point Of Care Testing (LPOCT) year 2004
Tests performed on point of care or patient’s bedside
Understanding IHE, BIR20 Oct 2004
IHE IT Infrastructure 2004-2005IHE IT Infrastructure 2004-2005
Enterprise 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.
Patient Demographics Query
Personnel White PageAccess to workforcecontact information
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical
documents forming a patient electronic health record
Understanding IHE, BIR20 Oct 2004
Radiology 2000-2005Radiology 2000-2005
Access to Radiology Information
Pat
ient
Inf
orm
atio
n R
econ
cilia
tion
Consistent Presentation of Images
Basic Security
Evidence Document
Key Image Notes
Simple Image and
Numeric Report
Presentation of Grouped Procedures
Post-Processing Workflow
Reporting Workflow
Charge Posting
Scheduled Workflow
Understanding IHE, BIR20 Oct 2004
Radiology 2000-2005Radiology 2000-2005
Access to Radiology Information
Pat
ient
Inf
orm
atio
n R
econ
cilia
tion
Consistent Presentation of Images
Basic Security
Evidence Document
Key Image Notes
Simple Image and
Numeric Report
Presentation of Grouped Procedures
Post-Processing Workflow
Reporting Workflow
Charge Posting
Scheduled Workflow
Understanding IHE, BIR20 Oct 2004
Radiology 2000-2005Radiology 2000-2005
Access to Radiology Information
Pat
ient
Inf
orm
atio
n R
econ
cilia
tion
Consistent Presentation of Images
Basic Security
Evidence Document
Key Image Notes
Simple Image and
Numeric Report
Presentation of Grouped Procedures
Post-Processing Workflow
Reporting Workflow
Charge Posting
Scheduled Workflow
Understanding IHE, BIR20 Oct 2004
ProblemsProblems• It is very hard to get the ball teed-up for the It is very hard to get the ball teed-up for the
technologist on the modality.technologist on the modality.• PaperPaper based workflow with based workflow with data redata re--entryentry
• RRisk of errorisk of error
• InefficientInefficient • Stale informationStale information
• CChanges between time of print and time of data entryhanges between time of print and time of data entry• Cancel ordersCancel orders• GGenericeneric Order Order / / OOrder rder CChangeshanges
• After the tech wacks the ball, how do I let all After the tech wacks the ball, how do I let all systems know where it went.systems know where it went.• When are things ready to be read (PACS)When are things ready to be read (PACS)• When can things be deleted (Modality)When can things be deleted (Modality)• How do I know what to bill (RIS)How do I know what to bill (RIS)• When do I wake up the referring physicianWhen do I wake up the referring physician
Understanding IHE, BIR20 Oct 2004
Key IHE ConceptsKey IHE Concepts
• Generalized SystemsGeneralized Systems =>=> ActorsActors
• Interactions between ActorsInteractions between Actors =>=> TransactionsTransactions
• Problem/Solution ScenariosProblem/Solution Scenarios =>=> Integration Integration ProfilesProfiles • For each Integration Profile:For each Integration Profile:
• the context is described (which real-world problem)the context is described (which real-world problem)
• the actors are defined (what systems are involved)the actors are defined (what systems are involved)
• the transactions are defined (what must they do)the transactions are defined (what must they do)
Understanding IHE, BIR20 Oct 2004
The Product World…..The Product World…..
Poduct XYZfrom Vendor T
ADT
MPI
HIS
Understanding IHE, BIR20 Oct 2004
The IHE The IHE WWorld….orld….
IHE Actor
ActorActor
Actor
IHEIHETransactionTransactionIHEIHE
TransactionTransaction
IHEIHETransactionTransaction
IHE Actor
Understanding IHE, BIR20 Oct 2004
HIS
MPI
ADT
Mapping IHE to ProductsMapping IHE to Products
Poduct XYZfrom Vendor T
IHE Actor
ActorActor
Actor
IHEIHETransactionTransactionIHEIHE
TransactionTransaction
IHEIHETransactionTransaction
IHE Actor
Understanding IHE, BIR20 Oct 2004
Integration ProfilesIntegration Profiles
Easy to understand Easy to understand practical solutions for practical solutions for IT integration problems IT integration problems in daily life.in daily life.
Fostering the under-Fostering the under-standing between standing between users and vendorsusers and vendors
24: Report Submission
Structured Report Export: 28
25: Report Issuing
Report Creator
26: Query Reports27: Retrieve Reports
Report Repository
Report Reader
External Report Repository Access
Report Manager
Enterprise Report Repository
Understanding IHE, BIR20 Oct 2004
Integration ProfilesIntegration Profiles
24: Report Submission
Structured Report Export: 28
25: Report Issuing
Report Creator
26: Query Reports27: Retrieve Reports
Report Repository
Report Reader
External Report Repository Access
Report Manager
Enterprise Report Repository
24: Report Submission
Structured Report Export: 28
25: Report Issuing
Report Creator
26: Query Reports27: Retrieve Reports
Report Repository
Report Reader
External Report Repository Access
Report Manager
Enterprise Report Repository
24: Report Submission
Structured Report Export: 28
25: Report Issuing
Report Creator
26: Query Reports27: Retrieve Reports
Report Repository
Report Reader
External Report Repository Access
Report Manager
Enterprise Report Repository
Understanding IHE, BIR20 Oct 2004
Workflow involves several Workflow involves several IHE IHE ActorsActors
ADT PatientRegistration
OrderPlacer
DeptScheduler
ImageManager/Archive
Modality
Patient Registration (HIS):Patient Registration (HIS):ADT Focal Point for Patient Registration InformationADT Focal Point for Patient Registration Information
Department Scheduler (RIS):Department Scheduler (RIS):Focal Point for Requested Procedure ManagementFocal Point for Requested Procedure ManagementBreaks Order into Requested ProceduresBreaks Order into Requested ProceduresSchedules Steps for Each Requested ProcedureSchedules Steps for Each Requested Procedure
Acquisition Modality:Acquisition Modality:Focal Point for Performed Procedure StepsFocal Point for Performed Procedure StepsA PPS Tracks One or More Series of ImagesA PPS Tracks One or More Series of Images
Image Manager/Archive (PACS)Image Manager/Archive (PACS)Focal Point for Imaging Study. Manages ImagesFocal Point for Imaging Study. Manages ImagesTriggers Reading when All Expected PPS Are CompletedTriggers Reading when All Expected PPS Are Completed
Order Placer (HIS):Order Placer (HIS):Focal Point for Order ManagementFocal Point for Order Management
Understanding IHE, BIR20 Oct 2004
Scheduled WorkflowScheduled WorkflowADT
Patient Registration
Image Archive
Image Manager
Image Display
Image Creator
AcquisitionModality
DepartmentSystem Scheduler– Order Filler –
Order Placer
PerformedProcedure Step
ManagerModality Worklist
Patient Registration
Procedure Scheduled
Images Availability Query
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
Understanding IHE, BIR20 Oct 2004
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 WorkflowThe Connection sideThe Connection side
Modality WorklistModality Worklist
WorklistWorklist
Procedure ScheduledProcedure Scheduled
Patient Registration/UpdatePatient Registration/UpdateOrder ManagementOrder Management
Understanding IHE, BIR20 Oct 2004
ProblemsProblems
• John Doe John Doe TraumaTrauma Clean-Up Clean-Up
• Recovering after Recovering after Systems Systems are Dare Downown
• Error in Manual Entry at Modality Error in Manual Entry at Modality
• VIP and Getting MarriedVIP and Getting Married
Understanding IHE, BIR20 Oct 2004
Scheduled WorkflowScheduled WorkflowADT
Patient Registration
Image Archive
Image Manager
Image Display
Image Creator
AcquisitionModality
DepartmentSystem Scheduler– Order Filler –
Order Placer
PerformedProcedure Step
ManagerModality Worklist
Patient Registration
Procedure Scheduled
Images Availability Query
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
Patient Update
Patient Update
Patient Information ReconcilicationPatient Information Reconcilication
Understanding IHE, BIR20 Oct 2004
Thank you for your attention !Thank you for your attention !
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