Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise
The Basics of IHE: Concepts and Process
Associate Professor of Radiology
Chief, Imaging Informatics
Northwestern University
Feinberg School of Medicine
Department of Radiology
David Channin, MD
RSNA Electronic Communications Committee
IHE Strategic Development Committee
IHE Radiology Planning and Technical Committees
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Why Are Standards Important?Why Are Standards Important?
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Why Are Healthcare IT Why Are Healthcare IT Standards Important?Standards Important?
Step #2 toward Crossing the Quality Chasm: “. . . making effective use of information technologies to automate clinical information and make it readily accessible to patients and all members of the care team. An improved information infrastructure is needed to establish effective and timely communication among clinicians and between patients and clinicians.”
- IOM Report, 2001
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What IT Standards EnableWhat IT Standards Enable
Greater efficiency and cost savings
The ability to make best of breed purchasing decisions
Better and more timely communication of medical information
Improved patient safety
Data for outcomes analysis and decision support
The potential to build a system of evidence-based medicine
The potential to develop a truly comprehensive and portable EHR
So why haven’t standards solved all of
healthcare’s interoperability issues?
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ER
The Standards ArchipelagoThe Standards Archipelago
ADT/HIS
CIS
EKG
Cath Lab
Lab
OR
RIS
PACS
Mods Pharm
Islands of data across the healthcare
enterprise
HL7 2.4
DICOM POC DevicesIEEE – POCT
HL7 2.1
NCPDP
Billing
X12/ICD9DICOM
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NAHIT Standards DirectoryNAHIT Standards Directory
“ . . . Since launching a beta version for members only in April, the Alliance has expanded the directory to include 850 voluntary and mandatory standards and electronic links to more than 200 standards development organizations.” The great thing about standards is that there are so many to choose from
-Old Wisecrack
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Standards Alone Are Not EnoughStandards Alone Are Not EnoughToo many standards No clear domain boundaries No clear mapping of information flow across
boundaries Too much generality and ambiguity Version incompatibilities Vendor proprietary interests Complexity!!
We need standards for how to
implement standards!
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Connecting Standards to CareConnecting Standards to Care
Care providers must work with industry to coordinate the implementation of standards to meet their needs Care providers need to identify the key
interoperability problems they face Drive industry to develop and make available
standards-based solutions Implementers need to follow common guidelines in
purchasing and integrating systems that deliver these solutions
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ACR-NEMA Becomes DICOM: ACR-NEMA Becomes DICOM: c. 1992c. 1992
Demonstrations drive awareness and
demand for standards-based solutions
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IHE Grows from DICOM ExperienceIHE Grows from DICOM Experience
Integrating the Healthcare Enterprise: an initiative by healthcare professionals and
industry to improve the way computer systems in healthcare share information
promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical needs
leads to systems that communicate better, are easier to implement, and enable care providers to use information more effectively
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IHE ProcessIHE ProcessUsers identify desired functionalities that require coordination and communication among multiple systems
E.g., departmental workflow, single sign-on, cross-departmental sharing of documents and information
Find and document standards-based transactions among systems to achieve desired functionality
Apply necessary constraints to eliminate useless wiggle room
Provide process and tools to encourage vendors to implement
MESA software test tools Connectathon interoperability testing event
Provide tools and education to help users acquire and integrate systems using these solutions
Connectathon results and public demonstrations Integration statements RFP toolkit (soon)
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IHE ParticipantsIHE ParticipantsSocieties Representing Healthcare Segments RSNA, HIMSS, ACC, ACCE, …
Users Clinicians, Medical Staff, Administrators, CIOs, …
Consultants
Information Systems Vendors
Imaging Systems Vendors
Standards Development Organizations (SDOs) DICOM, HL7, ASTM, …
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IHE DeliverablesIHE Deliverables
Technical Framework
Integration Profiles
Connectathon
Public Demonstrations
Tools for Acquiring Conformant Products
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IHE Technical FrameworksIHE Technical Frameworks
Detailed standards implementation guides
–Cardiology
–IT Infra
–Lab
–Radiology
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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
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Organization of TFsOrganization of TFs
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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
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imagesstored
patientinformation
RIS
examination orders
imagesretrieved
HIS
PACS
procedurescheduled
Prefetch any relevantprior studies
modalityworklist
report
report
ADT (Registration)
Order Placer
Order Filler
Print Server
FilmFolder
Image Manager& Archive
FilmLightbox
report ReportRepository
ImageDisplay
Modality
acquisitionacquisitionin-progressin-progressacquisitioncompleted
acquisitioncompleted
imagesprinted
AcquisitionModality
Example: IHE Scheduled WorkflowExample: IHE Scheduled Workflow
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IHE IT Infrastructure Integration ProfilesIHE IT Infrastructure Integration Profiles
Enterprise User Authentication
Provide users a single nameand
centralized authentication process
across all systems
Enterprise User Authentication
Provide users a single name and
centralized authentication process
across all systems
Retrieve Information for Display
Access a patient’s clinical information and documents in a format ready to be
presentedto the requesting
user
Retrieve Information for Display
Access a patient’s clinical information
and documents in a format ready to be presented to the
requesting user
Patient Identifier Cross-referencing
for MPI
Map patient identifiers across independent
identification domains
Patient Identifier Cross-referencing
for MPI
Map patient identifiers across independent
identification domains
Synchronize multiple applications on a
desktop to the same patient
Patient Synchronized Applications
Synchronize multiple applications on a
desktop to the same patient
Patient Synchronized Applications
Consistent Time
Coordinate time across networked systems
Consistent Time
Coordinate time across networked systems
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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
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RFPs & IHE Integration StatementsRFPs & IHE Integration Statements
Be Brief? “The system must support DICOM”
Be Effective? “The system must support the following DICOM services
according to the following 100 pages of specifications”
Be Both: “The system must support IHE Scheduled Workflow as an
Acquisition Modality”
IHE Integration Statements Version 2.1 of the Jupiter 3 CT supports IHE Scheduled
Workflow as an Acquisition Modality
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Integration StatementsIntegration Statements
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RFP ToolkitRFP Toolkit
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RFP ToolkitRFP Toolkit
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IHE Radiology ActivitiesIHE Radiology ActivitiesNew Supplements Media Distribution Profile NM Image Profile
Departmental Workflow White Paper Report Export Extension
Instance Availability Notification Transaction Appointment Notification Transaction
www.rsna.org/ihe/ (Follow Link for Supp. & Forum)
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IHE IT Infrastructure ActivitiesIHE IT Infrastructure Activities
Finalizing Profile Candidates EHR (Electronic Healthcare Record) Registries Basic Security “Profile Migration/Template” DICOM Configuration (LDAP) Patient Demographics Query White Pages
www.himss.org/ihe/
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New IHE DomainsNew IHE DomainsIHE Lab Initiated by IHE-Europe & IHE-Japan Lab Workflow Profile Released
for Trial Implementation www.gmsih.fr/ihe
IHE Cardiology Sponsored by ACC, ESC, GMSIH Finalizing Supplement Candidates
• Cath Lab Workflow• Echo Workflow• ECG Report Retrieval for Display
IHE expanding, more info.IHE expanding, more info.
• IHE Radiology www.rsna.org/ihe 12 Integration Profiles availableIHE Connectathon for IT January 2004
• IHE IT Infrastructure www.himss.org/ihe 5 Integration Profiles availableIHE Connectathon for IT January 2004
• IHE Laboratory www.gmsih.fr/ihe Framework in Public Comment, feedback due Nov 15th
IHE Connectathon for Lab March 2004
• IHE CardiologyCommitted sponsorship by ACC, ESC, HIMSS.Kick Off December 2004 – First Demo ACC March 2005
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What can you do?What can you do?
Learn about IHE
Participate in IHE planning
Insist on IHE compliance in your RFPs and contract documents
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More information….More information….IHE Web sites:
http://www.himss.org/IHEhttp://www.rsna.org/IHEhttp://www.acc.org/quality/ihe.htm.
Technical Frameworks:• ITI V1.0, RAD V5.5, LAB V1.0
Technical Framework Supplements - Trial Implementation• May 2004: Radiology• August 2004: Cardiology, IT Infrastructure
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