1 integrating the healthcare enterprise ihe for administrators: confronting deployment obstacles...
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Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise
IHE for Administrators: Confronting Deployment Obstacles
Ellie Avraham, Kodak Health Group Paul Nagy, PhD University of Maryland
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RSNA 2006 2 for Administrators Classroom Sessions
Modern HospitalModern HospitalInformation FlowInformation Flow
MPI
ADT
RIS
PACSModality Display & Print
HIS
Billing
Lab Cardio
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RSNA 2006 3 for Administrators Classroom Sessions
Institute of Medicine Model of Institute of Medicine Model of Service Redesign of HealthcareService Redesign of Healthcare
SafetyEffectiveness Patient centeredness TimelinessEfficiency Equity
Align to the patientSource: Insititute of Medicine, Crossing the chasm
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RSNA 2006 4 for Administrators Classroom Sessions
… a new generation of Healthcare IT solutions that have an order of magnitude greater level of integration.
… a whole new level of Complexity Management to manage these interfaces.
… we need to Decrease the time for integrating the Multi Vendors systems.
… we need the capabilities for plug and play interoperability of systems.
… we need to lower the total cost of integration
To achieve these goals we need To achieve these goals we need ……
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RSNA 2006 5 for Administrators Classroom Sessions
Standards Exists: DICOM, HL7Standards Exists: DICOM, HL7
The main purpose of standards is to lower the cost of integration between systems.
The more plug and play integration the lower is the cost of the implementation.
However Standards are broad and include options that reduce the interoperability
So we need to constrain the Standards in order to improve the interoperability
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RSNA 2006 6 for Administrators Classroom Sessions
What is IHEWhat is IHEJoint Initiative from HIMSS and RSNA since
1998IHE is a specification of transactions between
systems that defines integration profiles solution (SWF, PIR, RWF) based on standards
Uses a combination of standards to achieve a fully Interoperable workflow
Reinforces constrained standards to achieve fully Interoperability
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RSNA 2006 7 for Administrators Classroom Sessions
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
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RSNA 2006 8 for Administrators Classroom Sessions
IHEIHE Process Process
IHEIntegrationProfiles B
IHEIntegrationProfile A
Easy toIntegrateProducts
IHEConnectathon
ProductWith IHE
IHEDemonstration
User Site
RFPRFP
Standards
IHETechnical
Framework
Product IHE IntegrationProduct IHE IntegrationStatementStatement
IHE IHE ConnectathonConnectathonResultsResults
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
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RSNA 2006 9 for Administrators Classroom Sessions
The “Connectathon”The “Connectathon”
Voluntary Participation Neither a Demonstration nor
a Certification Well Designed End-to-End
Scenarios Advanced Testing Tools Unprecedented Cross-
Vendor Testing Unprecedented Pool of
Technical Talent
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RSNA 2006 10 for Administrators Classroom Sessions
IHE Connectathon ResultsIHE Connectathon Resultshttp://www.rsna.org/IHE/connectathon.shtml http://www.rsna.org/IHE/connectathon.shtml
http://www.ihe-europe.org/con_resulthttp://www.ihe-europe.org/con_result
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RSNA 2006 11 for Administrators Classroom Sessions
IHE Integration StatementIHE Integration Statement
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RSNA 2006 12 for Administrators Classroom Sessions
Store ImagesStore Images PACS &PACS &ArchiveArchive
RISRIS
Today’s - Legacy WorkflowToday’s - Legacy Workflow
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RSNA 2006 13 for Administrators Classroom Sessions
Patient Registration/UpdatePatient Registration/UpdateOrder ManagementOrder Management
Order Order Protocol Protocol DefinedDefinedStore ImagesStore Images
Storage CommitmentStorage CommitmentStorageStorage
CommitmentCommitment
List of ImagesList of Images
PACS &PACS &ArchiveArchive
RISRIS
A Closed LoopA Closed Loop•Update Scheduling ISUpdate Scheduling IS
•Match Procedure with OrderMatch Procedure with Order•Support Billing Based on MPPSSupport Billing Based on MPPS
•Avoid Reading Incomplete ProceduresAvoid Reading Incomplete Procedures
IHE WorkflowIHE Workflow
Modality Modality WorklistWorklist
Procedure Scheduled Procedure Scheduled
Proposed Protocols
Loaded and Reviewed
WorklistWorklistPt A, …, Pt A, …, SPS=P1, P4SPS=P1, P4
Pt C, …, Pt C, …, SPS=P1, P5SPS=P1, P5
Pt B, …, Pt B, …, SPS=P2SPS=P2
Pt E, …, Pt E, …, SPS=P4SPS=P4
ModalityModalityPerformedPerformedProcedure Procedure StepStep
With Performed With Performed Acquisition Acquisition ProtocolsProtocolsPerformed Step:Performed Step:
Status = CompletedStatus = CompletedPerformed Procedure: CT HeadPerformed Procedure: CT Head Performed Protocol Code=P1Performed Protocol Code=P1
Pat Name/ID, Dose, Pat Name/ID, Dose, Accession #, Study UIDAccession #, Study UIDComplete List of ImagesComplete List of Images
Scheduled Protocol Code=P1, PScheduled Protocol Code=P1, P55
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RSNA 2006 14 for Administrators Classroom Sessions
imagesstored
Filmimagesprinted
reportRegistration
patientinformation
Orders Placed
RISexamination orders
Orders Filled
imagesretrieved
FilmFolder
ReportRepository
HIS
Image Managerand Archive
PACS
procedurescheduled
Prefetch any relevantprior studies
modalityworklist
Patient and procedureinformation retrievedby the modality
Modality
DiagnosticWorkstation
report
report
acquisitionin progress
acquisitioncompleted
acquisitioncompleted
IHE Scheduled Workflow ProfileIHE Scheduled Workflow Profile
FilmLightbox
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RSNA 2006 15 for Administrators Classroom Sessions
ADT^ Scheduled WorkflowADT^ Scheduled Workflow
A01 Registration A04 Admission A05 Pre adminission A11 Cancellation A38 Cancellation of pre admission DICOM C-Store DICOM Modality Worklist DICOM Modality Performed Procedure DICOM Storage Commitment
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RSNA 2006 16 for Administrators Classroom Sessions
IHE Deployment – Testing the IHE Deployment – Testing the Integrated System SolutionsIntegrated System Solutions
For Healthcare to succeed in the digital transformation it will need much better integration between its systems.
IHE is an open standards approach to lower the cost of integrating healthcare and exposing many more processes.
Open Source can accelerate the adoption of IHE by helping to educate administrators to learn how to test the integration
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RSNA 2006 17 for Administrators Classroom Sessions
Open Source - Integration testing toolsOpen Source - Integration testing tools
There are many (dozens) of DICOM and HL7 tools. Too many to mention.
The web site “openrad.com” has a repository with all the main open source Integration testing tools
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RSNA 2006 18 for Administrators Classroom Sessions
Open Source ToolbeltOpen Source Toolbelt
IHE MESA ToolsDCM4JBOSS – Enterprise PACS ArchiveDVTK – Dicom Validation ToolkitHL7Browser – HL7 Message ViewerMIND – GUI DICOM query toolCTN – DICOM Send
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RSNA 2006 19 for Administrators Classroom Sessions
Today’s LessonToday’s Lesson
Build an IHE Testing EnvironmentTest IHE Scheduled Workflow ComponentsOn a windows laptop
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RSNA 2006 20 for Administrators Classroom Sessions
Standard Documentation Standard Documentation RecommendationRecommendation
IHE Technical Framework: volumes #1, 2, 3– Scheduled Workflow
DICOM standard– Information Object Definition Pt.3– Services Pt.4– Data Dictionary Pt.6– Medical.nema.org
HL7 v2.3.1 standard
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RSNA 2006 21 for Administrators Classroom Sessions
IHE “Medical Enterprise Simulators and Analyzers” (MESA)IHE “Medical Enterprise Simulators and Analyzers” (MESA) http://ihedoc.wustl.edu/mesasoftware/index.htmhttp://ihedoc.wustl.edu/mesasoftware/index.htm
Provides the Test Procedures and Simulation of all the IHE Profiles and Actors. Excellent Documentation.
Developed by the Mallinckrodt Institute of Radiology MESA Tools runs on different operating systems:
Windows 2000, Windows XP, Solaris 7.0, Red Hat Linux 7.0 & 9.0 from Intel.
The MESA tool is organized for particular IHE actors as defined in the IHE Technical Framework
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RSNA 2006 22 for Administrators Classroom Sessions
Step 1. Install MESA toolsStep 1. Install MESA tools
Decide What Actors/Systems you need to test Read the Installation Guide for installing the tools you
need to test your Actors/Systems Precompiled and Source Codes are available Recommend to Install the preferred Windows 2000
precompiled MESA s/w ready to be used
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RSNA 2006 23 for Administrators Classroom Sessions
Step 2: What & How to Test Step 2: What & How to Test
List your Actors/Profiles that you need to testReview the MESA Test Procedures applicable
for each actor that need to be testedReview the Test Procedures for the Peer to
Peer testing applicable actors.
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RSNA 2006 24 for Administrators Classroom Sessions
Query Modality Worklist [RAD-5]
ADT Order Placer
Image Manager
Acquisition Modality
Placer Order Mgmt – New [RAD-2]
Department System Scheduler/ Order Filler
Procedure Scheduled [RAD-4]
Register/Admit Patient
Create Order
Schedule Procedure and/or Assign Protocol
Continued in Figure 3.3-2
Patient Registration [RAD-1]
Test Example – Test Example – Scheduled Workflow Profile (SWF)Scheduled Workflow Profile (SWF)
Figure 3.3-1. Administrative Process FlowFigure 3.3-1. Administrative Process Flow
This case covers both inpatient and outpatient procedures. The patient may be new or known to the current healthcare facility. The following sequence of steps describes the typical process flow when a request is made to perform an imaging procedure on a patient
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RSNA 2006 25 for Administrators Classroom Sessions
Image Manager/
Image Archive
Acquisition Modality /
Department System Scheduler/ Order
Filler
Modality Procedure Step Completed [RAD-7]
Perform Acquisition
Modality Images Stored [RAD-8]
Modality Presentation State Stored [RAD-9]
Storage Commitment [RAD-10]
Modality Procedure Step In Progress [RAD-6]
Images Availability Query [RAD-11]
Modality Procedure Step Completed [RAD-7]
Modality Procedure Step In Progress [RAD-6]
Print Composer
Print Request [RAD-23*]
Print Server
Order Placer
Order Status Update [RAD-3]
Figure 3.3-2. Procedure Performance Process Flow
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RSNA 2006 26 for Administrators Classroom Sessions
Identifier Description [Transaction] Source Destination
131.102.a04.adt A04: Register BLACK as OutpatientPatient Class = ‘E’ [1]
ADT Ord Plc, Ord Fil
131.104.o01.orm ORM: Order P1 for BLACK [2] Ord Plc Ord Fil
131.106.o01.orm ORM: Schedule X1 [4] Ord Fil Img Mgr
131.108.dcm MWL C-FIND [5] Modality Ord Fil
131.110.dcm PPS: Begin Procedure X1 [6] Modality PPS_Mgr
131.112.dcm PPS: Begin Procedure X1 [6] PPS_Mgr Ord Fil or Img Mgr
131.114.dcm PPS: End Procedure X1 [7] Modality PPS_Mgr
131.116.dcm PPS: End Procedure X1 [7] PPS_Mgr Ord Fil or Img Mgr C-Find: Images Available Query [11] Ord Fil Img Mgr
131.118.dcm C-Store: Images [8] Modality Img Mgr
131.120.dcm C-Find: Images Available Query [11] Ord Fil Img Mgr
131.122.dcm Storage Commitment: N-Action [10] Modality Img Mgr
131.124.dcm Storage Commitment: N-Event-Report [10] Img Mgr Modality
131.117.dcm
MESA Test case #131MESA Test case #131 – Administrative & Procedure Prerform Process (SWF) – Administrative & Procedure Prerform Process (SWF)
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RSNA 2006 27 for Administrators Classroom Sessions
MESA Testing Environment MESA Testing Environment
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RSNA 2006 28 for Administrators Classroom Sessions
Starting MESA Test Starting MESA Test case #131case #131
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RSNA 2006 29 for Administrators Classroom Sessions
Running Several Transactions TestRunning Several Transactions Test case #131case #131
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RSNA 2006 30 for Administrators Classroom Sessions
Evaluating MESA Test Result Evaluating MESA Test Result case #131case #131
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RSNA 2006 31 for Administrators Classroom Sessions
Where Is More Information Where Is More Information Available?Available?
http://www.ihe.net
Non-Technical Brochures:– IHE Radiology Users Handbook– IHE Primer and IHE FAQ– IHE Integration Profiles: Guidelines for Buyers– IHE Connectathon Results