RSNA 2014
IHE Profiles for Radiology Applications
Written by: David S. Mendelson, M.D.
Professor of Radiology
The Icahn School of Medicine at Mount
Sinai
Senior Associate - Clinical Informatics
The Mount Sinai Medical Center
Co-chair IHE International Board
Adapted and presented for the IHE Colombia IHE Workshop by:
Elliot B. Sloane, PhD, CCE, FHIMSS
Co-chair IHE International Board
President, Center for Healthcare Information Research and Policy
(CHIRP)
What is IHE?
IHE is International Provides for local variation
IHE includes participation from Professional organizations Vendors End users
1997: Founded in Radiology (RSNA) and IT (HIMSS)
Many professional societies (stakeholder representation) American Academy of Ophthalmology
(AAO) American College of Cardiology (ACC) American College of Physicians (ACP) American College of Clinical Engineering
(ACCE) American College of Emergency
Physicians (ACEP) American Society for Therapeutic
Radiation Oncology (ASTRO) GMSIH (IT France), JAHIS (IT Japan), SFIL
(laboratory) Healthcare Information Management
Systems Society (HIMSS) Radiological Society of North America
(RSNA) And many more….
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IHE: A Framework for Interoperability
A common framework for harmonizing and implementing multiple standards Application-to-application
System-to-system
Setting-to-setting
Enables seamless health information movement within and between enterprises, regions, nations
Promotes unbiased selection and coordinated use of established healthcare and IT standards to address specific clinical needs
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Stakeholder Benefits
Healthcare providers and health authorities Improved workflows Information whenever and wherever needed Reduced implementation costs
Vendors Align product interoperability with industry consensus Decreased cost and complexity of interface installation and management Focus competition on functionality/service not information transport
SDOs- Standards Development Organizations Rapid feedback to adjust standards to real-world Establishment of critical mass and widespread adoption
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Standards: Necessary…Not Sufficient
Foundational - to interoperability and communications
Broad - varying interpretations and implementations
Narrow - may not consider relationships between standards domains
Plentiful - often redundant or disjointed
Focused - standards implementation guides focus only on a single standard
IHE provides a process to implement an
integrated solution based upon multiple
standards
Finland
Brazil
New Zealand
Israel
Malaysia
Poland
Switzerland
Saudi Arabia Colombia
Global Adoption of IHE
Coordination of Deployment Activities3-Tier Model
Global Deployment Coordination Committee (GDC)
Continental Mirror Committees
IHE Americas IHE Europe IHE Asia
Representatives from each
Continental Mirror CommitteeMeet regularly by Tcon
Others …
IHE World Summitrotating country/continent, e.g. aligned with another global event like ISO
All Deployment Committees are
invited to an annual World Summit
Org
an
ize
s
US CDN FRA TUR JPN CN
IHE – the process
Identify Interoperability issues
Develop Integration Profiles
Actors and Transactions
Workflow
Gather relevant standards
Connectathon Testing
Publish Integration Statements
Vendors list tested profiles
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IHE terminology
Integration Profiles Describe workflow use cases, standards and the overall
relationships to achieve transparent interoperability
Integration Statements Tell customers the IHE Profiles supported by a specific
release of a specific product.
Technical Frameworks The documents for each “domain” that specify the
Integration Profiles and the associated systems (actors) and transactions.
Connectathons Testing events ? Certification
Development - IHE Domains
• Anatomic Pathology
• Cardiology
• Dental
• Eye Care
• IT Infrastructure (ITI)
• Laboratory
• Patient Care Coordination
• Patient Care Devices
• Pharmacy
• Quality, Research and Public Health
• Radiation Oncology
• Radiology• Mammography
ITI Profiles
XDS, XDS- I Cross Enterprise Document Sharing
XCA, XCA-I Cross Community Access
XDR, XDR-I Cross-Enterprise Document Reliable Interchange Document sharing in the absence of a registry and repository
XDM Cross-enterprise Document Media Interchange
XUA Cross Enterprise User Assertion Integration Profile
XDS-SD Cross-Enterprise Sharing of Scanned Documents
BPPC Basic Patient Privacy Consents
ATNA Audit Trail and Node Authentication
ITI- Trial implementation
Cross-Community Fetch (XCF) - Published 2011-08-19
Cross-Community Patient Discovery (XCPD) -Revised 2012-08-31
Cross-Enterprise Document Workflow (XDW) - Revised 2013-09-20
Interoperability Profiles-Radiology specific
PDI Portable Documents for Imaging IRWF Import Reconciliation Workflow TCE Teaching File and Clinical Trial Export
Trial Implementation IOCM Imaging Object Change Management MIMA Multiple Image Manager/Archive IID Invoke Image Display
Development Mobile Access to Health Documents - Imaging
Radiology Profiles
PDI Portable Documents for Imaging
IRWF Import Reconciliation Workflow
REM Radiation Exposure Monitoring
TCE Teaching File and Clinical Trial Export
MAWF Mamography Acquisition Workflow
IOCM Imaging Object Change Management
MIMA Multiple Image Manager/Archive
Major Radiology IT Themes-Meaningful Use for the Radiologist
Radiation Exposure- REM Aggregating and monitoring patient and population
exposure ACR DIR mapping tool
RadLex Playbook- vendors are interested in making this part of an IHE profile
Image Sharing- XDS IHE XDS; Personal Health Records as a vehicle
Reporting Teaching and Research- TCE
MIRC CTP
Meaningful Use – ONC/CMS
Radiation Exposure
Evaluating legacy dose information OCR solutions
Evaluating dose today Within the institution
Comparing multiple instruments
Patient Site comparison
IHE- REM profile ACR registry- Dose Index Registry (DIR)
Site to Site comparison as well as within an enterprise Radlex terms- RadLex Playbook mapping tool
TCE- Teaching File and Clinical Trial Export How to get images directly out of PACS as a
part of your normal workflow
MIRC compatible
Image Selector
Image Exporter
Receiver
IHE-XDS (Cross-Enterprise Document Sharing)
XDS.a
XDS- I.a
XDS.b
XDS-I.b
a vs. b
Related to web standards and transactions
NIBIB/RSNA Image Sharing Project
Consumer Control-Patient Engagement Diminishes the need for BAAs
between enterprises Imaging Site to Clearinghouse Clearinghouse to PHR
Bootstrap an IHE based network Employ IHE solutions whenever
possible IHE generally has not focused on
consumer driven solutions but rather on institutional and enterprise workflow
Can be extended to other forms of sharing HIE
Security, Security…….
5 Academic Institutions
Develop a solution for all Radiology Sites
Establish a clearinghouse
Engage PHRs Primary emphasis is Consumer
Control through PHRs
Security and Confidentiality are drivers
Replacement / Alternative to CD
A Standards Based Solution
Technical Framework
Planning Committees identify the work to be done in a yearly cycle
Technical committees develop a solution
Public Comment
Refined solution is released for “Trial Implementation”
Final Text is published as part of the Technical Framework
Technical Framework• http://www.ihe.net/Techical_Framework/index.cfm
Document Use Case
Requirements
Identify available
standards (e.g. HL7,
DICOM, IETF, OASIS)
Develop
technical
specifications
Testing at
Connectathons IHE
Demonstrations
Products
with IHE
Timely access to
information Easy to integrate
products
IHE Deployment Process
Connectathons- Testing
How does the end user know that a system is compliant?
Vendor develops a solution following the specifications of a profile
Vendors test their solutions with one another at a Connectathon
“Monitors” judge success
Modules are tested
Vendors that pass testing can then implement these modules as part of larger systems
The first Connectathon was held in 1999 in Chicago, IL, within the basement of the Radiological Society of North America's (RSNA) parking garage.
At the first Connectathon there were 23 vendors, 47 applications tested, and 1 IHE Integration Profile tested.
The IHE NA Connectathon 2012 held over 150 organizations and has grown dramatically to include over 450 participants, which is held annually at the Hyatt Regency Chicago.
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Events: Connectathon
The IHE-C Connectathon was held at April 26, 2008 in Beijing Tiantan Hospital
There are 7 companies attendedDr. Zhu, Chairman of IHE China, past vice Minister of Healthcare attended
After the Connectathon
Vendor may publish an “Integration Statement”
IHE maintains a product registry
End Users can use this information when evaluating an RFP response
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Certification- IHE Profiles
Currently Connectathon testing results in a vendor being
able to state they are compliant. IHE USA has
embarked on a formal certification process. Trial
Working Group – IHE International wished to provide
more structure for all such activities and created a
working group