1September, 2005 What IHE Delivers

User Success Stories User Success Stories

HIMSS Interoperability Showcase February 2006HIMSS Interoperability Showcase February 2006

David Piraino, M.D.David Piraino, M.D.

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Standards are critical but alone are not enoughStandards are critical but alone are not enough

Standards offer generality, ambiguity and Standards offer generality, ambiguity and alternativesalternatives

Standard Implementation Guides are Standard Implementation Guides are focused on a single standardfocused on a single standard

Increasing complexityIncreasing complexity

IHE provides a standard process for IHE provides a standard process for

implementing multiple standards!implementing multiple standards!

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Connecting standards to careConnecting standards to care

Care providers work with vendors to Care providers work with vendors to coordinate the implementation of standards coordinate the implementation of standards to meet their needsto meet their needs Care providers identify the key interoperability Care providers identify the key interoperability

problems they faceproblems they face Drive industry to develop and make available Drive industry to develop and make available

standards-based solutionsstandards-based solutions Implementers follow common guidelines in Implementers follow common guidelines in

purchasing and integrating systems that deliver these purchasing and integrating systems that deliver these solutionssolutions

What is the effective way to establish those What is the effective way to establish those

“standards” for how to implement standards ?“standards” for how to implement standards ?

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Electronic Health Record

Cardiology

Laboratory

Radiology

Oncology

Future

Domains

IHE

IT Infrastructure

15 Integration Profiles

5 Integration Profiles

4 Integration Profiles

1133 IInntteeggrraattiioonn PPrrooffiilleess

Patient Care Coordination

1 Integration Profile

Patient Care

Devices

Pathology

Eye Care

IHE 2006 – Nine Active Domains IHE 2006 – Nine Active Domains Over 100 vendors involved world-wide,Over 100 vendors involved world-wide, 5 Technical Frameworks5 Technical Frameworks

38 Integration Profiles, Testing at Connectathons38 Integration Profiles, Testing at ConnectathonsDemonstrations at major conferences world-wideDemonstrations at major conferences world-wide

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IHE User Success StoriesIHE User Success Stories

Case studies from sites that have used IHE integration profiles to integrate systems and achieve interoperability

Identify what systems were implemented, describes the integration process and the impacts on clinical care

22 published online from institutions of all sizes from around the world

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IHE User Success Storieshttp://www.rsna.org/IHE/participation/success_stories/index.shtml

•Cleveland Clinic Foundation•Detroit Medical Center•Grossman Imaging Centers•Hôpitaux Universitaires de Genèv•IHE McKay-Dee Hospital•Johannes Gutenberg University Hospital•Magic Valley Regional Medical Center•Mayo Clinic Jacksonville•Our Lady Of The Lake Regional Medical Center (OLOL)•VA Puget Sound Health Care System•St. Vincent Hospital and Health Services•Steinberg Diagnostic Medical Imaging•University of Pisa•University of Wisconsin

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IHE ModelIHE Model

Actors in precisely defined rolesActors in precisely defined roles Abstracts a specific function of information systemAbstracts a specific function of information system

……Executing precisely defined transactionsExecuting precisely defined transactions Using existing standardsUsing existing standards

…………To solve real world interoperabilityTo solve real world interoperability problems problems Select Integration Profile for implementationSelect Integration Profile for implementation

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IHE Technical FrameworksIHE Technical FrameworksImplementation Guide for each Integration ProfileImplementation Guide for each Integration Profile

An Integration Profile :An Integration Profile : A Set of A Set of ActorsActors Exchanging Exchanging TransactionsTransactions

Query Modality Worklist [RAD-5]

ADT Order Placer

Register J.Doe

AcquisitionModality

Placer OrderManagement –New [RAD-2]

Patient Reconciliation

Department System Scheduler/Order Filler

Schedule Procedure

Procedure Scheduled [RAD-4]

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]

Modality Procedure Step In Progress [CARD-1]

Perform Acquisition

Filler Order Mgmt - Status Update [RAD-3]

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

Query Modality Worklist [RAD-5]

ADT Order Placer

Register J.Doe

AcquisitionModality

Placer OrderManagement –New [RAD-2]

Patient Reconciliation

Department System Scheduler/Order Filler

Schedule Procedure

Procedure Scheduled [RAD-4]

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]

Modality Procedure Step In Progress [CARD-1]

Perform Acquisition

Filler Order Mgmt - Status Update [RAD-3]

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

Use casesUse casesProcess FlowsProcess Flows

For each transaction:For each transaction: Std referencedStd referenced Options specifiedOptions specified Mapping requiredMapping required

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/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]

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

ImageArchive

DSS/ Order Filler

Patient Update [RAD-12]

Modality Image/Evidence Stored [CARD-2]

Storage Commitment

[CARD-3]

Evidence Creator Modality PS in Progress [CARD-1]

Modality PS Completed [RAD-7]

Instance Availability Notification [RAD-49]

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/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]

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

ImageArchive

DSS/ Order Filler

Patient Update [RAD-12]

Modality Image/Evidence Stored [CARD-2]

Storage Commitment

[CARD-3]

Evidence Creator Modality PS in Progress [CARD-1]

Modality PS Completed [RAD-7]

Instance Availability Notification [RAD-49]

ActorsActors TransactionsTransactions

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IHE Integration StatementsIHE Integration Statements document the product IHE capabilities in terms of IHE: Actors and Integration Profiles.- Promote your products with the Integration Statements - Learn from other Vendors Integration Statements the IHE Profiles and Actors supportedThe RSNA links to IHE Integration Statements published by the companies:

- Agfa HealthCare - Philips Medical Systems- Cerner Corporation - Sectra- Eastman Kodak Company - Siemens Medical Solutions - Emageon - Softmedical- Fujifilm Medical Systems USA - Stentor- GE Medical Systems - StorCOMM, Inc- INFINITT Co., Ltd. - Tiani Medgraph AG- McKesson Information Solutions - Toshiba America Medical Systems- Medcon - Voxar Limited

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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

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

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Consistent Presentation of ImagesConsistent Presentation of ImagesReporting Radiologist Referring Physician or

Reviewing Radiologist

Presentation StatePresentation LUT

Grayscale Standard

Original Image

Window Level

Flip

Zoom

Area Of

Interest

Annotate

WithoutConsistent Presentation

AchievingConsistent Presentation

Area Of

Interest

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MODALITY

Presentation of Grouped Procedures ProfilePresentation of Grouped Procedures ProfileRequested Procedure:

CHEST

Report:CHEST

Report:AB/PELVIS

Performs a single exam

Operatorgroups

2 procedures

Chest Chest ViewView

RIS / PACS

Requested Procedure:AB/PELVIS

Chest Chest ViewView

Ab/Pelvis Ab/Pelvis ViewView

Ab/Pelvis Ab/Pelvis ViewView

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Deployment of IHE Profiles – Most Used:

- Scheduled Workflow (SWF)

- Patient Information Reconciliation (PIR)

- Consistent Presentation of Images (CPI)

- Reporting Workflow (RWF)

- Basic Security for HIPAA regulations (SEC)

Clinical and Economics Accomplishments

- Improve the Patient Care – Improved data accuracy and Safety, Image Quality & Consistency and time saving due to optimized Workflows and integrated systems

- Improve the clinical practice productivity - reduced manual data entry using the ADT registration in one place and propagate it to all the other systems (PACS, RIS Modality) and reduced errors.

- Optimize the Radiological Workflow (SWF) Reduced the incorrectly or lost studies, using DICOM MWL, MPPS

IHE Success StoriesIHE Success Stories

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Want to know what new integration Want to know what new integration profiles will be developed in 2006 ?profiles will be developed in 2006 ?

Attend the IHE Domain specific Attend the IHE Domain specific sessions in these Theaters during sessions in these Theaters during HIMSS 2006 (Orange sessions)HIMSS 2006 (Orange sessions)

Contact the IHE Domain SponsorsContact the IHE Domain Sponsors

Visit the IHE Web SiteVisit the IHE Web Site

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What can you do?What can you do?

Learn about IHELearn about IHE

Insist on IHE compliance in your RFPs and Insist on IHE compliance in your RFPs and contract documents:contract documents:

Select Integration Profiles, and Appropriate Actor(s) Select Integration Profiles, and Appropriate Actor(s)

Ask vendors for their products “IHE Integration Ask vendors for their products “IHE Integration Statements”.Statements”.

Need more interoperability ? Need more interoperability ?

Contribute to IHE CommitteesContribute to IHE Committees

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IHE Web site:IHE Web site: www.IHE .netwww.IHE .net Frequently AskedFrequently Asked QuestionsQuestions

Integration Profiles in Technical Frameworks: Integration Profiles in Technical Frameworks: See Volume 1 of each TF for Use casesSee Volume 1 of each TF for Use cases

Cardiology IT Infrastructure Laboratory Patient Care Coordination Radiology

Connectathon Result: Connectathon Result: www.ihe.net/Events/connectathon_results.cfmwww.ihe.net/Events/connectathon_results.cfm

Vendor Products Integration StatementsVendor Products Integration Statements

Participation in Committees & ConnectathonsParticipation in Committees & Connectathons

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