March 17, 2005 IHE and medical Standards in De nmark 1 Integrating the Healthcare Enterprise Enterprise IHE for interoperability within the enterprise - Overview Charles Parisot, GE Healthcare IHE IT Infrastructure Technical Committee Co-chair IHE Europe Committee Copenhagen, March 17th 2005 Copenhagen, March 17th 2005
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March 17, 2005 IHE and medical Standards in Denmark1
Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise
IHE for interoperability within the enterprise - Overview
Charles Parisot, GE Healthcare
IHE IT Infrastructure Technical Committee Co-chair
IHE Europe Committee
Copenhagen, March 17th 2005Copenhagen, March 17th 2005
March 17, 2005 IHE and medical Standards in Denmark2
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
W W W . I H E – Europe. o r gW W W . I H E – Europe. o r g
March 17, 2005 IHE and medical Standards in Denmark3
27 Integration Profiles, Testing at yearly Connectathons,Demonstrations at major exhibitions world-wide
To claim compliance to IHE Integration Profiles vendors shall publish for each product an IHE Integration Statement.
Patient care Coordination, Quality, Pharmacy, Anatomical Pathology, Surgery, etc.
March 17, 2005 IHE and medical Standards in Denmark4
IHE Radiology Integration ProfilesIHE Radiology Integration Profiles
Patient Info.
Recon-ciliation
Access to Radiology Information
Consistent Present-ation of Images
Basic Security
-
EvidenceDocs
KeyImageNotes
Simple Image & Numeric Reports
Presentation of Grouped Procedures
Post-
Processing Workflow
Reporting Workflow
Charge Posting
Scheduled Workflow
Portable Data for Imaging
NMImage
New
Extensions
New
March 17, 2005 IHE and medical Standards in Denmark5
““Departmental Actors” in SWFDepartmental Actors” in SWF
Query Images [14] Retrieve Images [16]
Image Display
Storage Commitment [10]
Modality Image Stored [8] Storage Commitment [10]
Creator Images Stored [18]
Procedure Scheduled [4] Image Availability Query [11] Procedure Updated [13] Performed Work Status Update [42] Performed Work Status Update [42]
Modality Worklist Provided [5]
Evidence Creator
Performed Procedure
Step Manager
Modality PS in Progress [6] Modality PS Completed [7] Creator PS in Progress [20] Creator PS Completed [21]
Modality PS in Progress [6] Modality PS Completed [7] Creator PS in Progress [20] Creator PS Completed [21]
Modality PS in Progress [6] Modality PS Completed [7]
Creator PS in Progress [20] Creator PS Completed [21]
Acquisition Modality
Image Manager
Image Archive
DSS/ Order Filler
IHE Actors:DSS / Order Filler
PPS Manager
Image Manager /Archive
Acquisition Modality
Evidence Creator
Image Display
March 17, 2005 IHE and medical Standards in Denmark6
Example of Radiology Use CasesExample of Radiology Use CasesLocal policy calls for ADT to pre-register ER patients (“John Doe”, “Jane Doe”): Case 1: Unidentified Patient registered at ADT
and order is placed at Order Placer. Case 2: Unidentified Patient registered at ADT
and order is placed at DSS/Order Filler. Case 3: Unidentified Patient registered at ADT but
acquisition completed at Modality prior to order.
March 17, 2005 IHE and medical Standards in Denmark7
Unidentified Patient - Case 3Unidentified Patient - Case 3ADT
Order
Placer
Image
ManagerModality
Department SystemDatabase/Scheduler/
Order Filler
Filler Order Mgmt
New Order [3]
Procedure
Scheduled [4]
Patient Reconciliation
J.Doe -> J.Smith
Patient
Update [12]
Schedule Procedure
Images
Acquired
Modality Procedure
Step Completed [7]
Modality Procedure
Step Completed [7]
Register J.Doe
Patient
Update [12]
Patient
Registration [1]
March 17, 2005 IHE and medical Standards in Denmark8
PDI – Value PropositionPDI – Value Proposition
Removable media that contains DICOM and may contain browser viewable data. For patient personal records For referral For enterprise data interchange For use in other departments, e.g. surgery For printing
Media interoperability validation
Browser compatibility
Get CDs that you can create and read anywhere
March 17, 2005 IHE and medical Standards in Denmark9
PDI –Value PropositionPDI –Value Proposition
Interoperability validation is especially important for media Network Interoperability Problems
• Immediate, Unambiguous• Rapidly resolved
Media Interoperability Problems• Long delays in detection and recognition• Ambiguous or unknown source vendor/version• Long delays in resolution• Large volume of non-interoperable media created due to delays
IHE Virtual Connectathon for PDI solves the media validation problem
• Provides rapid, unambiguous detection of problems• Enabling rapid resolution of problems
March 17, 2005 IHE and medical Standards in Denmark10
PDI – Actors and TransactionsPDI – Actors and Transactions
Portable MediaCreator
Print Composer
Report Reader
Image Display
Display
Distribute ImagingInformation on Media
Media Importer
March 17, 2005 IHE and medical Standards in Denmark11
CDROM StructureCDROM Structure
DICOMDIR
INDEX.HTM
README.TXT
Directory of DICOM files
IHE_PDIDirectory of web files
Other optional content
Web content (optional)
March 17, 2005 IHE and medical Standards in Denmark12
IHE Cardiology 2004-2005IHE Cardiology 2004-2005
Retrieve Information for Display
Access a patient’s clinical information and documents in a format ready to be
presentedto the requesting user
EchoCardiography Worklflow
Admit, order, schedule, acquire images, notify of completed
steps, on fixed and mobile stress echo modalities.
Provide high-quality ECG and related reportsto the enterprise and outside in a ready-to-display format
Retrieve ECG for Display
Cardiac Catheterization Workflow
Scheduled & unscheduled acquisition and management of cathlab information,
notification of completed steps.
March 17, 2005 IHE and medical Standards in Denmark13
Management of cath exams Similar to IHE-Radiology SWF Multi-modality, multiple procedure steps Handle multiframe images (XA and IVUS)
Reconciliation of patient information Similar to IHE-Radiology PIR Unscheduled cath is the norm, not the exception
Time synchronization Modalities must support IHE-ITI Consistent Time
Out of scope for 2004-2005 Pre-cath and post-cath activity, Hemo waveforms and reports, Procedure
March 17, 2005 IHE and medical Standards in Denmark14
Cath actors and transactionsCath actors and transactions
Pt. Registration [Rad-1] Patient Update [Rad-12]
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 [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]
Modality PS in Progress [Card-1] Modality PS Completed [Rad-7]
Modality PS in Progress [Card-1] Modality PS Completed [Rad-7]
Order Placer
Acquisition Modality
ImageManager
Image Archive
DSS/ Order Filler
Patient Update [Rad-12]
March 17, 2005 IHE and medical Standards in Denmark15
Cath actors and transactionsCath actors and transactions
Pt. Registration [Rad-1] Patient Update [Rad-12]
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 [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]
Modality PS in Progress [Card-1] Modality PS Completed [Rad-7]
Modality PS in Progress [Card-1] Modality PS Completed [Rad-7]
Order Placer
Acquisition Modality
ImageManager
Image Archive
DSS/ Order Filler
Patient Update [Rad-12]
Many actors cooperating in a complete end-to-end Many actors cooperating in a complete end-to-end workflowworkflow
Documented in the IHE CARD Technical Framework Documented in the IHE CARD Technical Framework Vol 1 & Vol 2 with reference to RAD TF-Vol 2Vol 1 & Vol 2 with reference to RAD TF-Vol 2
March 17, 2005 IHE and medical Standards in Denmark16
IHE Cardiology 2004-2005IHE Cardiology 2004-2005
Cardiac Catheterization Workflow
Scheduled & unscheduled acquisition and management of cathlab information, notification
of completed steps.
Provide high-quality ECG and related reportsto the enterprise and outside in a ready-to-display format
Retrieve ECG for Display
Retrieve Information for Display
Access a patient’s clinical information and documents in a format ready to be presented
to the requesting user
EchoCardiography Worklflow
Admit, order, schedule, acquire images, notify of completed steps, on fixed and
mobile stress echo modalities.
March 17, 2005 IHE and medical Standards in Denmark17
Reuse of similar IHE-Radiology Profiles Scheduled Workflow (IHE-R SWF) Patient Information Reconciliation (IHE-R PIR)
Placer Order Management [Rad-2] Filler Order Management [Rad-3]
ADT
Query Images [Rad-14] Retrieve Images [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]
Modality PS in Progress [Card-1] Modality PS Completed [Rad-7]
Modality PS in Progress [Card-1] Modality PS Completed [Rad-7]
Order Placer
Acquisition Modality
ImageManager
Image Archive
DSS/ Order Filler
Patient Update [Rad-12]
March 17, 2005 IHE and medical Standards in Denmark19
IHE Cardiology 2004-2005IHE Cardiology 2004-2005
Retrieve Information for Display
Access a patient’s clinical information and documents in a format ready to be
presentedto the requesting user
EchoCardiography Worklflow
Admit, order, schedule, acquire images, notify of completed
steps, on fixed and mobile stress echo modalities.
Cardiac Catheterization Workflow
Scheduled & unscheduled acquisition and management of cathlab information, notification
of completed steps.
Provide high-quality ECG and related reportsto the enterprise and outside in a ready-to-display format
Retrieve ECG for Display
March 17, 2005 IHE and medical Standards in Denmark20
Retrieve ECG for DisplayRetrieve ECG for DisplayProvide ECGs and related reports to enterpriseExtension to IHE-ITI RID ECGs served in ready-to-display format
• Requirements on PDF displayable quality
Includes XML-based ECG/report listOut of scope 2004-2005
ECG acquisition and reading workflow ECG raw data interchange Export of reports to external repository
March 17, 2005 IHE and medical Standards in Denmark21
Example ECG in PDF FormatExample ECG in PDF Format
March 17, 2005 IHE and medical Standards in Denmark22
PDFPDFECG Source required to support PDF so it is compatible with existing IHE ITI RID clients.
PDF is a common document type and most computers already have a viewer.
ECG Source required to use vector graphics for waveforms in PDF. Gives high quality line drawings at any screen resolution and
zoom factor. Rasterized (e.g. scanned, bitmapped) ECG “images” not
allowed.
March 17, 2005 IHE and medical Standards in Denmark23
Transaction Diagram
Retrieve ECG for DisplayRetrieve ECG for Display
Display InformationSource
Retrieve Specific Info for Display [ITI-11]Retrieve Specific Info for Display [ITI-11]
Retrieve Document for Display [ITI-12]Retrieve Document for Display [ITI-12]
Retrieve ECG List [Retrieve ECG List [CARD-5CARD-5]]
Retrieve ECG Doc for Display [Retrieve ECG Doc for Display [CARD-6CARD-6]]
March 17, 2005 IHE and medical Standards in Denmark24
Laboratory IHE Integration ProfilesLaboratory IHE Integration Profiles
Laboratory Device Automation (LDA)
In Process –TI Nov 2004In Process –TI Nov 2004
Pre-analytic process, analysis and post-analytical treatment
Laboratory Scheduled Workflow (LSWF)Completed in 2003Completed in 2003
Tests performed by a laboratory for an identified
inpatient or outpatient
Laboratory Patient Information Reconciliation (LPIR) In ProcessIn Process
Tests performed on an unidentified or misidentified patient
Laboratory Code Set Distribution (LCSD) In ProcessIn Process
Sharing the batteries and tests code sets throughout the enterprise
Laboratory Point Of Care Testing (LPOCT) In Process –TI Nov 2004In Process –TI Nov 2004
Tests performed on point of care or patient’s bedside
In Dev.
In Dev.
In Dev.
In Dev.
March 17, 2005 IHE and medical Standards in Denmark25
LSWF: Three major use casesLSWF: Three major use casesExternally placed order with identified specimens The ordering provider collects the specimens and uniquely identifies them
(in the order sent in the message as well as on the container with a barcode label)
Externally placed order with specimens unidentified or to be collected by the laboratory
Filler order with specimens identified by the laboratory
Breakthrough: All three workflows are required and have been designed consistently.
March 17, 2005 IHE and medical Standards in Denmark26
LSWF:LSWF: Workflow Workflow
ADT
Order FillerOrder Placer
RAD-1. Pt registrationRAD-12. Pt Update
LAB-1. Placer Order Mgmt
Automation Manager
LAB-4. Work Order Mgmt
Order Result Tracker
LAB-2. Filler Order Mgmt
LAB-3. Order Results Mgmt
LAB-5. Test Results Mgmt
Laboratory
RAD-1. Pt registrationRAD-12. Pt Update
RAD-1. Pt registrationRAD-12. Pt Update
Technicalvalidation
Clinicalvalidation
Selected standard: HL7 version 2.5
March 17, 2005 IHE and medical Standards in Denmark27
Example 1: Microbiology with two Example 1: Microbiology with two specimens and three germsspecimens and three germs
Day 1 at 8:10: Order placed
Day 1 at 8:20: Specimens checked, order scheduled
Day 1 at 14:46: Partial urin results not validated
Day 2 at 09:40: Antibiogram order generated / urin
Day 2 at 09:45: Antibiogram order generated / pus
Day 3 at 11:30: Final validated results
March 17, 2005 IHE and medical Standards in Denmark28
Example 2: Glucose tolerance Example 2: Glucose tolerance study on a series of specimensstudy on a series of specimens
Step 1: Order placed with first specimens
Step 2: order scheduled and started, one broken tube
Step 3: Partial results not validated
Step 4: Last specimens provided
Step 5: Last specimens accepted
Step 7: Final validated results
Step 6: Last results from AM
Order Placer Order Filler Automation Manager
Order Result Tracker
Order entered
OML^O21 (NW) 9.3.3.1
First 3 specimens
sent to laboratory Specimens checked.
Order started
OML^O21 (NW) 9.3.3.2
OML^O21 (SC) 9.3.3.3
OUL^R24 (NW) 9.3.3.4
first technical validationOUL^R21 (SC)
9.3.3.5OML^O21 (SC)
9.3.3.6 OUL^R24 (SC) 9.3.3.7
OML^O21 (XO) 9.3.3.8
Last 2specimens
sent to laboratory
Last specimens checked.
OML^O21 (NW) 9.3.3.9 OUL^R24 (SC)
9.3.3.11
OML^O21 (SC) 9.3.3.10
last technical validationOUL^R21 (SC) 9.3.3.12
OML^O21 (SC) 9.3.3.13
OUL^R24 (SC) 9.3.3.14
Clinical validation
March 17, 2005 IHE and medical Standards in Denmark29
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
W W W . I H E – Europe. o r gW W W . I H E – Europe. o r g