integrating the healthcare enterprise ihe in radiology and beyond dr. nikolaus wirsz siemens medical...

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

IHE in Radiology and Beyond

Dr. Nikolaus WirszSiemens Medical Solutions

IHE Planning Committee Member

Sanjay JainCerner Corporation

IHE Planning Committee Co-Chairman

IHE Classroom Sessions – RSNA 2003

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 Medical Information

Across Departments and Institutions– Inadequate Communicating of Medical Data

Across Multiple Systems from Different Vendors– Risky Investments in Proprietary Solutions

Challenges of Integration


An Incremental Multi-Year ProjectLaunched in 1998 by RSNA & HIMSS

Enhance the Access to Clinical Information Ensure Continuity and Integrity of Patient Information Speed Up the Integration in Healthcare Environments Foster Communication Between Vendors of

Medical Information Technology Prove that Integration is Attainable Based on Standards Participants:

– Representatives of Healthcare Providers– Information Systems Vendors– Imaging Systems Vendors– Standardization Groups

The IHE Initiative


Progress: IHE Year 1 (1999)

1st Publication of the IHE Technical Framework– Defines General Integration Model:

IHE Actors & IHE Transactions– Using DICOM and HL7 Messages– Basic Scheduled Workflow - Proof of Concept

(Admission → Ordering → Scheduling → Acquisition → Storage)

Successful Demonstration– 24 companies– 35 systems



Defined 7 IHE Integration Profiles(Solutions for Real-World Problems)– Patient Information Reconciliation (Patient Data Update, Patient Merge)– Simple Image & Numeric Reports (Exchange of Report Data)– Key Image Notes (Flag Relevant Images)– Access to Radiology Information (Images, Reports)– Consistent Presentation of Images (Hard & Soft Copies)– Presentation of Grouped Procedure

(Managing Subsets of a Single Large Acquisition)

Expanded Demonstration– 30 companies– 58 systems



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


Progress: IHE Year 4 (2002) 3 Additional Radiology Integration Profiles

– Post-Processing Workflow(Image Processing, Reconstruction, CAD)

– Charge Posting Billing Transaction)– Basic Security (Audit Trails & Node Authentication)

Expansion Beyond Radiology– Healthcare IT Infrastructure Launched– Laboratory Integration Launched in Europe– Exploring Integration in Cardiology

Growing Industry Participation– 35 companies– 73 systems– 43 companies in IHE Europe!


Progress: IHE Year 4 (2002) – continued

Driving Market Adoption– First IHE User Success Stories - 13 Posted at RSNA 2002

(IHE Becomes Reality)– First Product Evaluation Worksheet

(Support for Purchasing Products with IHE Capabilities)– First IHE Integration Statements for Available Products

(Industry Commitment to IHE)


Progress: IHE Year 5 (2003) 3 New Radiology Integration Profiles

– Access to Radiology Information + Multiple Source Option(Multiple PACS / Archives)

– Evidence Documents (Measurements / Procedure Logs / CAD Results)– Reporting Workflow (Interpretation / Transcription Worklists)

IHE Radiology Well Established internationally– 12 IHE Integration Profiles– Connectathons & Demonstrations in North America, Europe, Japan:

60+ Participating Vendors 100+ Systems

– Growing Recognition by Key Players Radiologists, IT professionals

– Market Adoption 100+ Products with IHE Integration Statements Frequency of IHE Inclusion in RFPs More IHE User Success Stories in North American and Europe


Outlook: IHE Year 6 (2004) Nuclear Medicine Integration –

Addressing NM Specific Needs Media Distribution – Exchangeability of Clinical

Information on Removable Media (CD) Departmental Workflow – Linking Sub-Workflows in

Radiology:– Scheduling Workflow– Post-Processing Workflow– Reporting Workflow

Cross-Domain Cooperation on Common Integration Issues in IHE Radiology & IHE IT Infrastructure


RIS

HIS

PACS

imagesstored

Filmimagesprinted

reportRegistration

patientinformation

Orders Placed

examination orders

Orders Filled

imagesretrieved

FilmFolder

ReportRepository

Image Managerand Archive

procedurescheduled

Prefetch any relevantprior studies

modalityworklist

Patient and procedureinformation retrievedby the modality

Modality

DiagnosticWorkstation

report

report

acquisitionin progress /completed

FilmLightbox

acquisitionin progress /completed

IHE Success – Closing the Loop


IHE Success – Integration ProfilesPatient

InformationReconciliation

ReconcileWorklists,

Statusand

Data Objects For

UnknownPatients

andDemographics

Changes

Access to Radiology Information

Consistent access to images and reports

Consistent Presentation of

Images Create, store,

manage, retrieve & use objects for hardcopy and

softcopy grayscale presentation states

Key Image Notes

Create, store, manage, retrieve & use objects to flag significant images

Simple Image and Numericc

Reports Create, store,

manage, retrieve & use simple

diagnostic reports with optional image

links &

Scheduled Workflow

Presentation of Grouped

Procedures Manage individual procedure image subsets from a multi -procedure acquisition for

viewing & reporting

Basic Security

ChargePosting

Collect and post timely

billable procedure

details

Audit Trail Consolidation & Node Authentication

Reporting Workflow

Manage worklists, track status, perform

& notify diagnostic

reporting steps

Evidence Documents

Create, store, manage, retrieve & use objects to

record study evidence

Manage worklists, track status, perform & notify image processing &

CAD steps

Post-Processing Workflow

Create,Store,

Manage,Retrieve &

UseImages

Admission, Order Management, Scheduling, Store, Retrieve

ManageWorklists,

Track Status,Perform &

NotifyAcquisition

Related Steps


A Multidimensional Expansion of IntegrationIHE Vision for GrowthIHE Vision for Growth

DeptSched.

ADT

Order Mgt

ImageMgr

Modality

11stst Dimension: Dimension:Vertical Integration for RadiologyVertical Integration for RadiologyIHE Years 1 - 6 - ...IHE Years 1 - 6 - ...


22ndnd Dimension: Dimension:Growing the HorizontalGrowing the HorizontalHealthcare Enterprise IntegrationHealthcare Enterprise Integration

Master Patient Index

Electronic Health Record

Ordering Process

. . .Dept

Sched.

ADT

OrderMgt

ImageMgr

Modality

Patient Registration



33rdrd Dimension: Dimension:Increasing the Number ofIncreasing the Number ofVertically IntegratedVertically IntegratedDepartmentsDepartments

Master Patient Index

Electronic Health Record

Ordering Process

Patient RegistrationR

a d

i o

l o g

y

C a

r d

i o

l o g

y

Lab

orat

ory

/ Pat

hol

ogy

Ad

dit

ion

al C

lin

ical

Fie

lds

Nu

clea

r M

edic

ine



Lab/Path.

Radiology

Nuc. Med

IHE Vision for GrowthIHE Vision for Growth

IT Infrastructure

Cardiology

ADT/Reg.

Endoscopy

OphthalmDental

ER

1999 - 2004 - ...

2003 - ...

2004 - ...

2003 - ...

2004 - ...


Progress: IHE IT Infrastructure (ITI) IHE ITI Committees Founded End of 2002 Liaison & Cooperation with the HL7 Standards Organization Identified Initial Set of Integration Requirements

– Exchanging Relevant Medical Data Beyond Departmental Boundaries– Common Patient View Across Multiple Registration Domains– Query for Well-Known Key Patient Data: Allergies, Current Medications, Lab

Panel Results …– Viewing the same patient while moving among multiple desktop applications– User Authentication and Security Issues

IHE ITI Technical Framework V1.0 Released –5 Initial IHE ITI Integration Profiles

First IHE ITI Connectathon – Jan. 2004 First IHE ITI Demonstration – Feb. 2004 at HIMSS –

Joint Interoperability Demo with HL7 and IHE Radiology


IHE ITI Integration Profiles

Enterprise User Authentication

Provide users a single name

andcentralized

authentication process

across all systems


Provide users a single nameand

centralized authentication

processacross all systems

Retrieve Information for Display

Access a patient’s clinical information and documents

in a format ready to be presented

to the requesting user


Access a patient’s clinical information and documents in a

format ready to be presentedto the requesting user

Patient Identifier Cross-referencing

for MPI

Map patient identifiers across independent

identification domains


for MPI



Consistent Time

Coordinate time across networked

systems

Consistent Time


systems

HL7 CDA / PDF / JPEG

HL7 2.x ADT Triggers / Queries Kerberos (RFC 1510) / HL7 CCOWNTP (RFC 1305)

Synchronize multiple applications on a desktop to the same patient

Patient Synchronized Applications

HL7 CCOW


Retrieve Information For DisplayRetrieve Information For Display



andcentralized


across all systems






for MPI




for MPI



Consistent Time


systems

Consistent Time


systems




HL7 CCOW

Query for Existing Reports in Well Known Presentation Formats

– CDA, PDF, RTF, … Query for Well-Known Key Data

– Allergies, Current Medications, Lab Panel Results…

Linked to user authentication and EMPI services

Value Proposition– Simple, rapid access to patient information

for better care – Patients win!– Supports workflow from within current

workspace or application – Users win!











Patient Synchronized ApplicationsPatient Synchronized Applications



andcentralized


across all systems













for MPI




for MPI



Consistent Time


systems

Consistent Time


systems





HL7 CCOW

Viewing the same patient while moving among applications on a desktop Linked to user authentication and EMPI services Value Proposition

– Reduce the repetitive tasks of selecting same patient in multiple applications – Users win!

– Reduce likelihood of working with wrong patient – Patient safety win!



Enterprise User AuthenticationEnterprise User AuthenticationRetrieve Information

for Display








for MPI




for MPI



Consistent Time


systems

Consistent Time


systems


HL7 2.x ADT Triggers / Queries NTP (RFC 1305)



HL7 CCOW

Standards based user log-in for workstations and applications

Provisions for emergency access Value Proposition

– Facilitates centralized user access management – IT win!

– Single sign-on speed and convenience – Users win!



andcentralized


across all systems





Kerberos (RFC 1510) / HL7 CCOW



Patient Identifier Cross-Referencing for Patient Identifier Cross-Referencing for MPIMPI



andcentralized


across all systems












Consistent Time


systems

Consistent Time


systems


Kerberos (RFC 1510) / HL7 CCOWNTP (RFC 1305)



HL7 CCOW


for MPI




for MPI



HL7 2.x ADT Triggers / Queries

Mapping a patient’s multiple identities across registration domains

Enable access to data and information across independent domain boundaries

Value Proposition– Broader access to needed patient data

wherever it is – Users win!– Lower costs to use data in existing systems

anywhere in the enterprise – IT wins!



IHE Laboratory – StatusIHE Laboratory – Status Work in Progress in Europe & Japan Workflow Support for Lab Test Orders & Observation Reports Initial Scope (2003) Limited to Lab Specimens

(Chemistry, Hematology, Microbiology,…) Identified IHE Lab Integration Profiles:

– Laboratory Scheduled Workflow (LSWF)– Laboratory Patient Information Reconciliation (LPIR)– Point of Care Testing (POCT)

IHE Lab Technical Framework Released for LSWF First IHE Lab Connectathon – April 2004 in Europe First IHE Lab Demonstrations in Europe:

– May 2004 at Hôpital Expo in France– Nov. 2004 at MEDICA in Germany


Other IHE Expansion DomainsOther IHE Expansion Domains IHE Cardiology:

– Sponsoring Organizations: ACC (American College of Cardiology) ESC (European Society of Cardiology)

– Kick-Off Meeting Mar. 2003 - White Paper Issued– Planning Meeting Dec. 8-9, 2004 at ACC in Washington DC

→ Starting Activities

IHE Pharmacy / Medication Administration:– Exploratory Phase - Problems Identification & Use Cases– White Paper in Review– Recruiting Contributors


IHE Organizational StructureIHE Organizational StructureMulti-Domain & Multi-NationalMulti-Domain & Multi-National

IHE Europe

IHE North America

IHE Asia / Oceania

Participants

supervises reports

contribute

Delegates

IHE (International) Strategic Development Committee

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

Regional &NationalDeployment

IHE Domain-related Planning and Technical

Committees

SponsorCo-Chairs

Global

Interoperability


5+ Years of IHE Evolution and More to Come …

IHE Is Essential to All Aspects of Healthcare:– Radiology – Cardiology – Lab – IT Infrastructure – …

IHE - A Well Established International Program– A Global Blueprint for Integrated Solutions

IHE Is Highly Visible in the User Community– High Expectations from an Integrated Workflow– Increased Demand for IHE Support by the Industry

IHE - Critical to Successful Purchasing Decisions

ConclusionsConclusions


IHE in Radiology and BeyondQuestions?Questions?

IHE North America: http://www.rsna.org/IHE orhttp://www.himss.org/IHE

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 in radiology and beyond dr. nikolaus wirsz siemens medical...

Documents

ihe year

ihe europeprogress

europeexploring integration

radiology information

medical systems vendors

medical data

multiple systems

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