Integrating the Integrating the Healthcare Healthcare Enterprise Enterprise Understanding, Optimizing and Implementing Workflow with IHE Charles Parisot GE Medical Systems-IT John Paganini IDX Systems
Apr 01, 2015
Integrating the Integrating the Healthcare EnterpriseHealthcare Enterprise
Understanding, Optimizingand ImplementingWorkflow with IHE
Charles Parisot
GE Medical Systems-IT
John Paganini
IDX Systems
Learning ObjectivesLearning Objectives
Understand how the IHE Scheduled Workflow Integration Profile streamlines radiology data workflow
Learn how to practically apply IHE in solving some of the typical workflow cases
Discussion Areas Discussion Areas
Workflow Defined What Are The Benefits? How Do I Get It? What Systems Should Be Considered
For Integration? What Is The Sequence To Follow?
““Enter the data one time Enter the data one time and then pass it from and then pass it from system to system.”system to system.”
On Brookwood Medical Center, Birmngham, ALOn Brookwood Medical Center, Birmngham, AL
IHE Integration Profiles – 2004IHE Integration Profiles – 2004P
atie
nt In
form
atio
n R
eco
ncili
atio
n
Access to Radiology Information
Consistent Presentation
of Images
Basic Security
Evidence Documents
Key Image Notes
Simple Image and Numeric
Reports
Presentation of Grouped Procedures
Post-Processing Workflow
Reporting Workflow
Charge Posting
Scheduled Workflow
Workflow DefinitionWorkflow Definition
Focus Is On Processes– Tasks– Procedural Steps– Organizations Or People – Data: Required Input And Output Information– Tools
Benefits 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
What’s in it for Me?What’s in it for Me?
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.
What is backing IHE ?What is backing IHE ?www.rsna.org/ihe
TransactionsTransactions: Describe particular interactions : Describe particular interactions between actors to perform between actors to perform specific operations.specific operations.
Picking IHE Profiles ?Picking IHE Profiles ?
Potential Efficiency Gains Cost-Effectiveness Vendor Readiness End-User Pain Clinical Priorities Available Resources / Skillsets Improvements in Department Performance Administrative Guidelines / Vision
Pat
ient
Info
rma
tion
Rec
onci
liatio
n
Access to Radiology Information
Consistent Presentation
of Images
Basic Security
Evidence Documents
Key Image Notes
Simple Image and Numeric
Reports
Presentation of Grouped Procedures
Post-Processing Workflow
Reporting Workflow
Charge Posting
Scheduled Workflow
Pat
ient
Info
rma
tion
Rec
onci
liatio
n
Access to Radiology Information
Consistent Presentation
of Images
Basic Security
Evidence Documents
Key Image Notes
Simple Image and Numeric
Reports
Presentation of Grouped Procedures
Post-Processing Workflow
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
Consistent Presentation
of Images
Consistent Presentation
of Images
Basic SecurityBasic Security
Evidence DocumentsEvidence
DocumentsKey Image
NotesKey Image
Notes
Simple Image and Numeric
Reports
Simple Image and Numeric
Reports
Presentation of Grouped Procedures
Presentation of Grouped Procedures
Post-Processing Workflow
Post-Processing Workflow
Reporting WorkflowReporting Workflow
Charge PostingCharge Posting
Scheduled WorkflowScheduled Workflow
ConsiderationsConsiderations
Workflow Reengineering AnalysisWorkflow Reengineering Analysis
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 Simplify the complex Still need all that paper?
Shorten the start-to-finish cycle time
Expect innovation
QuestionsQuestions Defines one actor that controls
every major piece of shared data
Remove ambiguities from standards
Improves access to information Ensures synchronizing data in
multiple systems Mechanisms for correcting
incorrect data Eliminates “Vendor Lock-in”
associated with proprietary data flows.
Keep healthy competition on applications ease of use.
IHE AnswersIHE Answers
Classic Project Lifecyclewith IHE IHE Added Added ValueValue
Definition of Client Requirements – Site Analysis, Operational Workflow
IHE Contribution – Use Cases ((Technical Framework Vol I)
Generation of Proposal - Review and Modify as Needed IHE Integration Statements Integration Profiles and Actors.
Review vendors capabilities (Connectathon results)
Solution Development and Implementation Leverage Use Case Section in each Profile
Testing, QA and More Testing Connectathon Profile/Transaction Based-Testing SCAR Paper – QA and Acceptance Testing of PACS Project
Go-Live and Signoff Succeed with less Surprises
Post Implementation Review Evaluate benefits and …….
Submit your IHE User Success Story
Leveraging IHE in your RIS/PACS projectsLeveraging IHE in your RIS/PACS projects
Start building the integrated Start building the integrated healthcare enterprisehealthcare enterprise
IHE-Based Solution IHE-Based Solution Development Development
Where to start...Where to start...
First, recognize what systems you need to integrate
See what Actors they implement and what Profiles they support
Ensure you have the Actors based on the Profiles you want to implement
By leveraging IHE, the first part can be done easily
Note: You still have to include additional integration needs not covered by IHE.
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
Example: RIS to Modality ConnectionExample: RIS to Modality Connection
Order Filler RIS
AcquisitionModality
Requires the Requires the Scheduled Workflow ProfileScheduled Workflow ProfileTwo Actors and Two Actors and two Transactions: Modality Worklist and PPStwo Transactions: Modality Worklist and PPS
modalityworklist
PPSmodality PerformedProcedure Step (PPS)
Understand Capabilities of ActorsUnderstand Capabilities of Actors
DICOM: MWL Capable PPS Capable
DICOM: MWL Capable PPS Capable
Order Filler RIS
AcquisitionModality
The IHE way:The IHE way:1-Get the vendors to commit to the support of the same IHE 1-Get the vendors to commit to the support of the same IHE Integration profile: Scheduled Workflow.Integration profile: Scheduled Workflow.2-Confirm with their IHE Integration Statements:2-Confirm with their IHE Integration Statements:Claim the right actors for the desired Integration Profile ? Claim the right actors for the desired Integration Profile ?
modalityworklist
PPSmodality PerformedProcedure Step (PPS)
The Classical way:The Classical way:Try, issues ?Try, issues ?
Read the DICOM CSsRead the DICOM CSsTry again. Try again.
Look at what was used from the Look at what was used from the IHE Technical FrameworkIHE Technical Framework
TRIGGER EVENTSThe patient arrives at the Acquisition Modality for a procedure.
MESSAGE SEMANTICSThe Acquisition Modality uses the C-FIND Request of the DICOM Modality Worklist SOP Class to query for the worklist from the DSS/Order Filler. The Acquisition Modality performs the SCU role, and the DSS/Order Filler the SCP role.
Query Keys Matching Query Keys Return Attribute Name Tag
SCU SCP SCU SCP
Scheduled Procedure Step
Scheduled Procedure Step Sequence
(0040,0100) R+* R R+* [IHE-1] R [IHE-2]
>Scheduled Station AE Title (0040,0001) R+ R R+* R
>Scheduled Procedure Step Start Date
(0040,0002) R+ R R+ R
>Scheduled Procedure Step Start Time
(0040,0003) O R R+ R
> Scheduled Procedure Step Location
(0040,0011) O O O O
>Modality (0008,0060) R+ R R+ R
>Scheduled Performing Physician's Name
(0040,0006) O O O R
>Scheduled Procedure Step ID (0040,0009) O O R+* R
>Scheduled Protocol Code Sequence
(0040,0008) O O R+* R
>>Code Value (0008,0100) O O R+* R
>>Coding Scheme Version (0008,0103) O O O O
>>Coding Scheme Designator (0080,0102) O O R+* R
>>Code Meaning (0080,0104) O O R+* R+
>Scheduled Procedure Step Description
(0040,0007) O O R+ R
Requested Procedure
Requested Procedure Comments (0040,1400) O O O O
Requested Procedure Description
(0032,1060) O O R+ R
Requested Procedure Code Sequence
(0032,1064) O O R+* R
>Code Value (0008,0100) O O R+* R
>Coding Scheme Version (0008,0103) O O O O
>Coding Scheme Designator (0008,0102) O O R+* R
>Code Meaning (0008,0104) O O R+* R+
Requested Procedure ID (0040,1001) R+ R+ R+ R
Names of Intended recipients of results
(0040,1010) O O O O
Study Instance UID (0020,000D) O O R+* R
Referenced Study Sequence (0008,1110) O O R+* R
>Referenced SOP Class UID (0008,1150) O O R+* R
>Referenced SOP Instance UID (0008,1155) O O R+* R
Imaging Service Request
Imaging Service Request Comments
(0040,2400) O O O O
Accession Number (0008,0050) R+ R+ R+ R
Requesting Physician (0032,1032) O O O R
Dealing with LegacyDealing with Legacy Understand that you may have to deal
with non-compliant devices and systems
Make best effort to bring them “up-to-date”
Initial implementations may provide partial support
Incremental usage of IHE is fine– It’s DICOM and HL7 anyway
Follow IHE’s yellow brick road...
Communication Your Plans to the Communication Your Plans to the VendorVendor
Present IHE as integration priority to Vendors. A Business goal !
Use as a checklist for dealing w/vendors Ensure you specify Actors, Profiles etc, Ask for Integration Statements in RFP Ensure Project Manager and team are
knowledgeable at implementing IHE
Putting the Pieces TogetherPutting the Pieces Together
1. IHE compliant products exist
2. Review Products IHE Integration Statements
1. IHE Booth has dedicated workstation
2. Website – www.rsna.org/ihe
3. Make sure the IHE Integration Statements are for the correct versions of the software
4. Check the vendors’ results of IHE Connectathon
5. Ask your vendors to commit to deliver operational IHE Integration Profiles
IHE Integration StatementIHE Integration StatementIHE Integration Statement Date 12 Oct
2002Vendor 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
Image Creator Performed Procedure Step
Order Filler PPS Exception Management
Simple Image and Numeric Report
Report Creator 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
In North America: www.rsna.org/IHE
In Europe: www.ihe-europe.org In Japan: www.jira-net.or.jp/ihe-j
Find them at:Find them at: www.rsna.org www.rsna.org//IHEIHE//integration_statements integration_statements
Additional InformationAdditional Information
Brochures and Reprints– IHE Integration Profiles OverviewIHE Integration Profiles Overview– IHE At-a-GlanceIHE At-a-Glance– Reprints of IHE technical papersReprints of IHE technical papers– IHE Technical FrameworkIHE Technical Framework– The IHE FAQ; IHE VideoThe IHE FAQ; IHE Video– IHE Fundamentals, Purchasing Strategies, IHE IHE Fundamentals, Purchasing Strategies, IHE
PrimerPrimer– List of Vendors Product IHE Integration StatementsList of Vendors Product IHE Integration Statements– Connectathon ResultsConnectathon Results– HIMSS MonographHIMSS Monograph
www.himss.orgwww.rsna.org/ihe