Jonathan L. Elion MD, FACC Co-Chair, IHE Cardiology Planning Committee The Basics of IHE: Concepts and Process EyeEh?Chi.

Jonathan L. Elion MD, FACC

Co-Chair, IHE Cardiology Planning Committee

The Basics of IHE:The Basics of IHE:Concepts and ProcessConcepts and Process

EyeEye Eh?Eh? ChiChi

August 12, 2005 IHE EP Subcommittee2

Professional 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

Standards-Based Integration Standards-Based Integration Standards-Based Integration Standards-Based Integration


IHE Organizational StructureIHE Organizational StructureMulti-Domain & Multi-NationalMulti-Domain & Multi-NationalIHE Organizational StructureIHE Organizational Structure

Multi-Domain & Multi-NationalMulti-Domain & Multi-National

Participants

contribute

Global Development:Radiology,IT Infrastructure,Cardiology,Lab, etc.

Delegates

IHE Europe

IHE North America

IHE Asia/Oceania

Regional &NationalDeployment

supervises reports

IHE (International) Strategic Development Committee

SponsorCo-Chairs

Global

Interoperability

IHE Domain-related Planning and

Technical Committees


Achievements and expanding scopeAchievements and expanding scope15 Active national chapters on 4 continents15 Active national chapters on 4 continents

4 Technical Frameworks4 Technical Frameworks39 Integration Profiles, Testing at yearly Connectathons,39 Integration Profiles, Testing at yearly Connectathons,

Demonstrations at major exhibitions world-wideDemonstrations at major exhibitions world-wide

Vendors claim compliance to IHE Integration Profiles by publishing an IHE Integration Statement for each product.

IHE

EHR- Longitudinal Record

IHE Cardiology

IHE Laboratory

IHE Radiology

New IHE Domains

Patient Care Coordination

IHE

IT Infrastructure

16 Integration Profiles




1 Integration Profile Oncology, Eye care, Intensive care devices, Pathology, etc.


Proven Standards Adoption ProcessProven Standards Adoption Process

IHEIntegrationProfiles B

IHEIntegrationProfile A

Easy toIntegrateProducts

IHEIHEDemonstrationDemonstration

User Site

RFPRFP

StandardsStandards

IHETechnical

Framework

Product IHE IntegrationStatement

IHE Integration Profiles at the heart of IHE :– Detailed selection of standards and options each solving a specific integration problem– A growing set of effective provider/vendor agreed solutions– Vendors can implement with ROI– Providers can deploy with stability– Process started in 1998; continuously improved

IHEIHEConnect-a-thonConnect-a-thon

ProductWith IHE

IHE Connect-a-thonResults


Who is IHE?Who is IHE?

• IHE is a joint initiative among:

– American College of Cardiology (ACC)

– Radiological Society of North America (RSNA)

– Healthcare Information Management Systems Society (HIMSS)

– GMSIH, HPRIM, JAHIS (laboratory)

– American Society of Ophthalmology

– And many more….

• Began in 1997 in Radiology (RSNA) and IT (HIMSS)

• International effort: IHE- Europe and IHE-Japan

• Additional sponsors for Cardiology including ASE, ESC, ASNC, SCA&I, HRS and more


IHE DeliverablesIHE Deliverables

• Venue(s) for communication (committees)

• Integration Profiles (what needs to be done)

• Technical Framework (how to do it)

• Maintenance of Integration Profiles (sustainability)

• Connect-a-thon (actually do it!)

• Public Demonstrations (ACC ’05 for Cardiology)

• Tools for Acquiring Conformant Products (RFP’s)


What is IHE NOTWhat is IHE NOT

• IHE is not a standard• You conform to a standard• You comply with IHE integration profile and actors

• IHE is not a standards development organization• IHE is not a certifying authority• IHE is not simply a demonstration project

• Demos are only one means to the end: Adoption• Backed up by documentation, tools, testing, and publication of

information• IHE is not just for radiology and more!


IHE Domains Milestones: 20 month cycleIHE Domains Milestones: 20 month cycleDevelopmentDevelopment and and DeploymentDeployment

Proposed Supplement Scope

Approved Supplement Scope

Public Comment Int. profile Sponsors announce Connectathon/Demos with set

of Implementation Profiles

• Final Int. profile + 9 ---

- 10 ---

- 7 ---

- 2 ---

Trial Implementation int. profile 0 ---

Connectathon/Demo Vendor Participant Registered+ 2 ---

Vendor Participant passed Connectathon+ 5 ---

+ 6 --- Demo &Education Material

Vendors release products with IHE Integration Statements

---


IHE Annual Cycle IHE Annual Cycle

1. Clinicians identify clinical problems to be addressed -“Integration Profiles”

2. Engineers from vendors collaborate to define technical specification (using existing standards such as DICOM and HL7)

3. Vendors implement the technical specification and participate in the “Connectathon”

4. Demonstrations at trade shows (ACC, HIMSS, etc.)

5. Vendors publish IHE Integration Statements

6. Customers reference IHE profiles in RFP’s


Cardiology Example (Year 1)Cardiology Example (Year 1)

The Planning Committee identified three initial clinical problems to be addressed:

1. The ability to view an ECG from many locations - quickly and easily

2. Lab systems integration of patient, order, and procedure information in an Echo Lab, including mobile echo

3. Lab systems integration of patient, order, and procedure information in a Cath Lab, including angio, hemo, and IVUS

► “Retrieve ECG for Display”

► “Echocardiography Workflow”

► “Cardiac Catheterization Workflow”










IHE Technical FrameworksIHE Technical Frameworks

Pt. Registration [RAD-1] Patient Update [RAD-12]


Placer Order Management [RAD-2] Filler Order Management [RAD-3]

ADT

Query Images [RAD-14] Retrieve Images/Evidence [CARD-4]

Image Display

Modality Image/Evidence Stored [CARD-2]

Storage Commitment

[CARD-3]

Procedure Scheduled [RAD-4]

Procedure Updated [RAD-13]

Query Modality Worklist [RAD-5]

Performed Procedure

Step Manager

Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]



Order Placer

Acquisition Modality

ImageManager

ImageArchive

DSS/ Order Filler

Patient Update [RAD-12]


Storage Commitment

[CARD-3]

Evidence Creator Modality PS in Progress [CARD-1]

Modality PS Completed [RAD-7]

Instance Availability Notification [RAD-49]



Placer Order Management [RAD-2] Filler Order Management [RAD-3]

ADT

Query Images [RAD-14] Retrieve Images/Evidence [CARD-4]

Image Display


Storage Commitment

[CARD-3]


Procedure Updated [RAD-13]


Performed Procedure

Step Manager




Order Placer

Acquisition Modality

ImageManager

ImageArchive

DSS/ Order Filler

Patient Update [RAD-12]


Storage Commitment

[CARD-3]

Evidence Creator Modality PS in Progress [CARD-1]

Modality PS Completed [RAD-7]

Instance Availability Notification [RAD-49]


ADT Order Placer

Register J.Doe

AcquisitionModality

Placer OrderManagement –New [RAD-2]

Patient Reconciliation

Department System Scheduler/Order Filler

Schedule Procedure


Modality Procedure Step Completed [RAD-7]J.Doe ->

J.Smith

Patient Update/Merge [RAD-12]

Modality Procedure Step Completed [RAD-7]

PatientRegistration [RAD-1]

Patient Update/

Merge [RAD-12]

Modality Procedure Step In Progress [CARD-1]


Perform Acquisition

Filler Order Mgmt - Status Update [RAD-3]


ImageManager/

PPS Manager

Filler Order Management -New [RAD-3]

One or the other methods of creating an order is used


ADT Order Placer

Register J.Doe

AcquisitionModality

Placer OrderManagement –New [RAD-2]

Patient Reconciliation

Department System Scheduler/Order Filler

Schedule Procedure


Modality Procedure Step Completed [RAD-7]J.Doe ->

J.Smith

Patient Update/Merge [RAD-12]

Modality Procedure Step Completed [RAD-7]

PatientRegistration [RAD-1]

Patient Update/

Merge [RAD-12]



Perform Acquisition



ImageManager/

PPS Manager

Filler Order Management -New [RAD-3]

One or the other methods of creating an order is used

Detailed standards implementation guides

–Cardiology

–IT Infra

–Lab

–Radiology


Organization of TFsOrganization of TFs

• Volume 1: Integration Profiles

– Describes clinical need and use cases

– Identifies the actors and transactions

• Volume 2+ of Technical Framework

– Provides implementation specification for each transaction by specific reference to Standards


Transactions & Actors:Transactions & Actors:Displayable Reports ExampleDisplayable Reports Example

Encapsulated Report Storage [CARD-9]

Report Repository

ReportManager

Enterprise Report

Repository

Encapsulated Report Query [CARD-10]Encapsulated Report Retrieve [CARD-11]

Report Reader

Report Creator

Encapsulated Report Submission [CARD-7]

Storage Commitment [RAD-10]

Encapsulated Report Submission [CARD-7]

Display

Retrieve Specific Info for Display [ITI-11] Retrieve Document for Display [ITI-12]

InformationSource

Report Reference Submission [CARD-8]

Retrieve Information for Display (RID) Profile Retrieve Information for Display (RID) Profile










IHE ConnectathonIHE Connectathon

• Open invitation to vendor community

• Advance testing tools (MESA)

• Testing organized and supervised by project management team

• Thousands of cross-vendor tests performed

• Results recorded and published


IHE Connectathon, January 2005IHE Connectathon, January 2005

300 participants, 110 systems (31 Cardiology)300 participants, 110 systems (31 Cardiology)43 vendors (14 Cardiology)43 vendors (14 Cardiology)2800 monitored test cases2800 monitored test cases


Looks like it’s working

just fine!

Egad! They’ve totally misunderstood the

Technical Framework!

Ohmagawd – we’re next!










Total ACC’05 attendance was over 28,000.Total ACC’05 attendance was over 28,000.


Over 1,000 visitors from 47 countries attended theOver 1,000 visitors from 47 countries attended theIHE presentations and demonstrations.IHE presentations and demonstrations.










IHE Integration StatementIHE Integration Statement










Your Request for Proposals (RFPs)Your Request for Proposals (RFPs)

• Incorporate IHE framework into RFP documents & product selection

• Much easier to specify an IHE Integration Profile than detailed technical specs

– “Device must support IHE Echo Integration Profile, and vendor must supply an IHE Integration Statement.”

• Use IHE framework to evaluate your current workflow, even if not buying now

• Vendors build product functions that are requested by customers

Ask for IHE Integration Loud & Often !!


More information….More information….

• IHE Web site: http://www.ihe.nethttp://www.himss.org/IHE http://www.rsna.org/IHEhttp://www.acc.org/quality/ihe.htm

• Technical Frameworks• Technical Framework Supplements – Trial Implementation• Non-Technical Brochures :

– Calls for Participation– IHE Fact Sheet and FAQ– IHE Integration Profiles: Guidelines for Buyers– IHE Connect-a-thon Results– Vendor Products Integration Statements

Questions?

Questions?


W W W . I H E . N E TW W W . I H E . N E T

Providers and VendorsProviders and Vendors

Working Together to DeliverWorking Together to Deliver

Interoperable Health Information SystemsInteroperable Health Information Systems

in the Enterprisein the Enterprise

and Across Care Settingsand Across Care Settings

Jonathan L. Elion MD, FACC Co-Chair, IHE Cardiology Planning Committee The Basics of IHE: Concepts and Process EyeEh?Chi.

Documents

ihe ihe

ihe europe

basics of ihe

heart of ihe

actors ihe

improved ihe

ihe integration statements

ihe ep subcommittee7