Integrating the Healthcare Enterprise IHE for Product Planers Ellie Avraham Kodak Health Group IHE Planning and Technical Committees member.

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

IHE for Product Planers

Ellie AvrahamKodak Health Group

IHE Planning and Technical Committees member

IHE Classroom Sessions – RSNA 2005 2

Learning ObjectivesLearning Objectives Learn the Clinical and Economic benefits of

Integration for your customers – Users Handbook

Improve Product Functionality by using the IHE Technical Framework

Improve Integrated System Solutions Workflows by using IHE Integration Profiles

Learn from IHE Success stories and other information to refine the Products “Business case” evaluation

Learn the IHE Process to Synchronize it with the Product Planning & Development


Discussion AreasDiscussion Areas

The IHE Deployment Process

IHE Integration Profiles

The Value Proposition from Planning Products and Integrated Solutions using IHE


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


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


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 Annual Events for Synchronization IHE Annual Events for Synchronization with Product Planningwith Product Planning

April 2005 – IHE Supplements Profiles for Public Comment June – IHE Supplements Profiles for Trial Implementation June – IHE Participation Workshop Sept. – IHE Participation Registration: Connectathon & Demo Oct. - IHE Vendor Workshop for the Connectathon Oct. – Dec. IHE MESA Testing Validations for Connectathon Nov. - RSNA – IHE Radiology Demo Jan. 2006 – IHE Connectathon Feb. – HIMSS IHE ITI Demo Mar. – ACC IHE Cardiology Demo


Using IHE for Product Planning

IHE Aid for Global 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 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 User Success Stories 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


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 (SEC)

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 StoriesIHE User Success Stories


IHE Integration Statements 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 Integration Statement Date

12 May 2004

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 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:: 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 participants in the healthcare enterprise.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 operations.specific operations.


IHE Radiology Integration Profiles - IHE Radiology Integration Profiles - Y7, 2005Y7, 2005

Patient Info.

Recon-ciliation

Access to Radiology Information

Consistent Present-ation of Images

Audit Trial and Node Authentication (ATNA) – Radiology Option

-

EvidenceDocs

KeyImageNotes

Simple Image & Numeric Reports

Presentation of Grouped Procedures

Post-

Processing Workflow

Reporting Workflow

Charge Posting

Scheduled Workflow

Portable Data for Imaging

NMImage

Cross Enterprise DocumentSharing

For Imaging(XDS-I)

Teaching Files and

Clinical TrialExport(TCE)


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


Patient Information ReconciliationPatient Information Reconciliation


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


Radiology Option for Audit Trail and Radiology Option for Audit Trail and Node Authentication (ATNA)Node 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


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


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


Teaching File and Clinical Trial ExportTeaching File and Clinical Trial Export

Export Selector Export Manager Receiver

Export Instances [Rad 53]

Store Export Selection [Rad 51]

Store Instances [Rad 50]

Store Additional TF Info [Rad 52]

Delay for pathology

De-identify attributes

De-identify pixel data

Re-map identifiers


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


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


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


Access to Radiology InformationAccess to Radiology Information

Radiology Department – Images and

Reports

Emergency Department

Referring Physician

Other Departments:- Oncology- Surgery- Neurology- Pediatrics- etc.

Remote Clinics

Electronic Medical Record


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


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


Evidence DocumentsEvidence Documents

PACS

EvidenceDocumentsImage Manager

& Archive

Report Creator&

Image Display

Radiology

AcquisitionModality

ProcessingWorkstation

Images

Images

EvidenceDocuments

EvidenceDocuments


IHE Reporting WorkflowIHE Reporting Workflow

ReportingReportingWorklistWorklist

Work ItemWork ItemClaimedClaimed

Retrieve Images &Retrieve Images &Evidence DocumentsEvidence Documents

MeasurementsCAD Reports…………………

ReportingProcedure Step

STARTED


STARTED

StoreStoreReportsReports


COMPLETED


COMPLETED

ReportManager

RIS

ImageManager/Archive

PACS & Archive

Report Reader/Creator


IHE Value PropositionIHE Value Proposition• Product PlanningProduct Planning

• IHE Solutions are Driven by Strategic Healthcare Lead IHE Solutions are Driven by Strategic Healthcare Lead Users that collaborate with Healthcare VendorsUsers that collaborate with Healthcare Vendors

• IHE Solutions are Generic, Reusable and Interoperable IHE Solutions are Generic, Reusable and Interoperable based on Healthcare Standards: based on Healthcare Standards: DICOM, HL7, RFCDICOM, HL7, RFC

• IHE Solutions Optimize the Clinical Workflows IHE Solutions Optimize 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 refine the product “Business Case”refine the product “Business Case”

• IHE Technical Framework specification describes the IHE Technical Framework specification describes the Global IHE solutions at a High Level for Planning & Global IHE solutions 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 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 throughputIncreased throughput• Better scheduling and trackingBetter scheduling and tracking

• BuyersBuyers• Specify/purchase integration capabilities easily Specify/purchase integration capabilities easily • Freedom to acquire “Best of Breed” systems Freedom to acquire “Best of Breed” systems

• IT ProfessionalsIT Professionals• Faster, more predictable integration projectsFaster, more predictable integration projects• Facilitate cooperation of competing vendorsFacilitate cooperation of competing vendors


Picking IHE ProfilesPicking IHE Profiles

Customer RFP’s Product positioning in the market with a Good

Business Case IHE Technical Framework Volume 1 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


Consistent Presentation

of Images

Basic Security

Evidence Documents

Key Image Notes

Simple Image and Numeric

Reports


Post-Processing Workflow

Reporting Workflow

Charge Posting

Scheduled Workflow

Pat

ient

Info

rma

tion

Rec

onci

liatio

n



of Images

Basic Security

Evidence Documents

Key Image Notes


Reports



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


of Images


of Images

Basic SecurityBasic Security

Evidence DocumentsEvidence

DocumentsKey Image

NotesKey Image

Notes


Reports


Reports





Reporting WorkflowReporting Workflow

Charge PostingCharge Posting

Scheduled WorkflowScheduled Workflow

ConsiderationsConsiderations


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

Integrating the Healthcare Enterprise IHE for Product Planers Ellie Avraham Kodak Health Group IHE Planning and Technical Committees member.

Documents

ihe slide

ihe supplements profiles

ihe success stories

ihe participation workshop

healthcare enterprise

ihe annual events

ihe participation registration

ihe capabilities rfps