IHE Takes PACS to the Next Level

IntegratingIntegratingthe the

Healthcare EnterpriseHealthcare Enterprise

IHE takes PACS to the next IHE takes PACS to the next levellevel

Paul Nagy, PhDAssistant Professor of RadiologyMedical College of Wisconsin

IHE takes PACS to the next IHE takes PACS to the next levellevel

Six reasons to use IHE today

Diffusion of innovation modelDiffusion of innovation model 1943 model of Iowa farmers adoption of hybrid seeds Five personality and socioeconomic categories

Time

Innovators

Early Adopters

Early Majority Late

Majority

Traditionalists

B. Reiner, E. Siegel “Psychological factors affecting the adoption of PACS” Applied Radiology Volume: 31 Number: 4 April 2002

There is PACS and then there is There is PACS and then there is PACSPACS

The difference is integrationWith the RISWith the ModalitiesWith the Dictation systemWith the Hospital Network IHE covers some of the more pressing

integration problems

Reason #1: Life expectancy of Reason #1: Life expectancy of your PACSyour PACS

If you … Want Hope Expect Need Pray

.. your PACS will last more than 3-4 years, you should be trying to use IHE where possible.

Technology Lifetime Technology Lifetime

Standards (DICOM, HL7, IHE, SNIA…) 25- 50 years

Infrastructure (IP, SAN,…) 10- 20 years

Programming Languages (PL/1, Pascal, C, C++, Java, …) 5-10 years

Software (data formats, compatibility, …)2-5 years

Hardware (Network cards, video cards, processors, …) 1-2 years

Shapiro, IBM

Reason #2: PACS alone doesn’t Reason #2: PACS alone doesn’t magically fix errorsmagically fix errors

What happens when you get rid of all the film room personnel (and your human safety net)?

Will the electronic systems protect you from making mistakes?

MalpracticeMalpractice

Smith J, Berlin L, “Malpractice Issues in Radiology: Picture Archiving and Communication Systems (PACS) and the Loss of Patient Examination Records”, AJR: 176, June (2001), pp1381-4

Failures of second generation systems without robust interfaces and integrity checking

Reason #3: PACS alone doesn’t Reason #3: PACS alone doesn’t increase productivityincrease productivity

Errors causes reworkRedesigning your workAutomating steps through interfacesIHE provides a framework for robust

interfaces

Sending safely from modality to PACSSending safely from modality to PACSBasic PACS W/ IHE SWF

1. Scanner sends CT data to PACS

2. Tech logs into PACS and confirms all the images made across by the image count on the modality.

3. Tech manually selects, deletes, and confirms the deletion on the modality.

1. Scanner sends CT data to PACS

2. Scanner requests commitment of storage

3. PACS returns a commit for every image sent

4. Modality registers commit and sets study as archived and available for deletion off of the modality.

What if the tech forgets to delete the study?What if the tech makes a mistake and deletes a study that hasn’t been archived.What if the tech misses the count?Which way is more efficient and more effective?Deming rule “Cease dependence upon inspection”

Reason #4: Getting vendors to Reason #4: Getting vendors to work togetherwork together

If getting one vendor to do If getting one vendor to do what you want is hard.what you want is hard.

How do you get two to work How do you get two to work together?together?

IHE is for the relief of pains IHE is for the relief of pains that PACS can causethat PACS can cause

Reason #5: IHE is easier Reason #5: IHE is easier than DICOMthan DICOM

And more reliable IHE sits atop DICOM and HL7Is more stringent in mandatory fields to

enable workflow

Reason #6: People will think Reason #6: People will think you are really smart at workyou are really smart at work

IHE is not a standard It is really a blueprint trying to solve tricky

workflow problems. There is enormous intellectual property in IHE

and extremely thorough solutions to problems.

Tap into the experience and knowledge. In many ways IHE is the lessons learned from

all those who have tried to go soft-copy in the past decade and ran into stumbling blocks.

Product Evaluation WorksheetProduct Evaluation Worksheet

Vendor Integration Vendor Integration StatementsStatements

IHE Integration Statement

Vendor Product Name Version Date

Great Medical Systems IntegrateRAD V2.3 12 Oct 2002

This product implements all transactions specified in the IHE Technical Framework to support the IHE Integration Profile, Actors and Options stated below:

Integration Profiles Implemented

Actors Implemented Options Implemented

Image Manager/Image Archive none

Image Display Performed Procedure Step

Scheduled Workflow

Order Filler PPS Exception Management

Simple Image and Numeric Report

Report Creator none

Link to the vendor IHE page www.greatmedicalsystems.fake/ihe

Links to Standards Conformance Statements for the Implementation

HL7 www.greatmedicalsystems.fake/hl7

DICOM www.greatmedicalsystems.fake/dicom/integrateRAD.pdf

For general Information

on IHE

In America: www.rsna.com/ihe In Europe: www.ihe-europe.org In Asia:

Contract NegotiationContract Negotiation

“…90% payment contingent upon successful implementation and operation of … profile.”

Integration with other information systems is becoming more and more a differentiator between medical devices.

So What Now?So What Now?

Users drive the market, you have the power.

Consider including IHE in your integration planning strategies

Take a look at the IHE Technical Framework and supporting information

Use IHE Integration Profiles when writing RFPs and purchasing specifications

Information ResourcesInformation Resources

Brochures and ReprintsIHE Integration ProfilesIHE Integration ProfilesIHE At-a-GlanceIHE At-a-GlanceReprints of IHE technical papersReprints of IHE technical papersIHE Product Evaluation Worksheets IHE Product Evaluation Worksheets IHE Technical FrameworkIHE Technical FrameworkThe IHE FAQ; IHE VideoThe IHE FAQ; IHE VideoIHE Fundamentals, Purchasing Strategies, IHE PrimerIHE Fundamentals, Purchasing Strategies, IHE PrimerIHE Integration Checklist, Connectathon ResultsIHE Integration Checklist, Connectathon ResultsHIMSS MonographHIMSS Monograph

www.rsna.org/ihe