ihe radiology kevin o’donnell toshiba medical systems co-chair, ihe radiology planning cmte

IHE RadiologyIHE Radiology

Kevin O’DonnellToshiba Medical Systems

Co-chair, IHE Radiology Planning Cmte.

June 28-29, 2005 Interoperability Strategy Workshop2

IHE RadiologyIHE RadiologyAchievementsAchievements

Status:• Now finishing 7th year

– Robust Vendor Participation at Connectathons– IHE Profiles appearing in User Purchasing Processes

• Have addressed basic workflows– Acquisition, Post-Processing, Reporting, Routing Teaching Files/Clinical

Trials

• Have addressed imaging content handling– Measurements, CAD Results, NM, Presentation States, Reports,

Key Image Notes

• Have addressed distribution of imaging info– on CDs, to EHRs, keeping Audit Trails


IHE RadiologyIHE RadiologyCurrent Activities/DirectionCurrent Activities/Direction

• Facilitate deployment of IHE Profiles in the Market– Users Handbook (2005 Edition)– Considering more depth to Connectathon tests

• Start addressing integration and workflow spanning departments/enterprises/regions– XDS-I

• Expand support for specialties– Address Mammography– Support Radiation Oncology Domain

Bruce Curran

University of Michigan

Co-chair, IHE-RO Technical Committee

IHE Radiation OncologyIHE Radiation Oncology


IHE-ROIHE-RO


IHE-ROIHE-RO

• Planning Committee– Jay Cooper, Co-chair

NYU

– Keith LaPlain, Co-chairVarian Medical Systems

• Technical Committee– Bruce Curran, Co-chair

U Michigan

– Stuart Swerdloff, Co-chairIMPAC

• ASTRO Leadership– Prabhakar Tripuranemi, IHE Co-chair

Scripps Clinic– Jatindar Palta, IHE Co-chair

U Florida– Jennifer Padberg, Staff Liaison

ASTRO


IHE-ROIHE-ROBasic InteroperabilityBasic Interoperability

Imaging Study

Imaging Study

Imaging Study

ContouringSystem

SimulationSystem

PlanningWorkstation

Rad OncIMS

TreatmentDelivery

TreatmentVerification


IHE-ROIHE-ROStandards UsedStandards Used

• DICOM– Significant interoperability issues

• Un-equally spaced Image Sets• 3D Contouring

– Bifurcations– Auto-segmentation ‘leftovers’

• Limits on Size of Structure Set / Dose Objects

– Workflow issues to be addressed in 2007• Query/Retrieve for RT Objects• General Purpose / Modality Worklists


IHE-ROIHE-ROActorsActors

• Proposals circulating between Planning Committee and Technical Committee– Many applications combine actors

ImageArchive

RTArchive

Patient RegistrarMulti-Media Registration

ContouringReference Point Generation

Prescription EntryBeam Placer / Shaper

Dose CalculatorPlan Evaluator

FractionatorReference Image Creator

Planning Application

RT SSet

RT Plan G

RT SSet RT Plan

RT Dose Reference Images

RT Dose

DICOM


More information….More information….

• IHE Web site: http://www.ihe.nethttp://www.himss.org/IHEhttp://www.rsna.org/IHEhttp://www.acc.org/quality/ihe.htm

• Technical Frameworks• Technical Framework Supplements – Trial Implementation

• 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

Questions?

Questions?

http://www.ihe.net/

http://www.rsna.org/IHE

http://www.acc.org/quality/ihe.htm

http://www.acc.org/quality/ihe.htm

IHE CardiologyIHE Cardiology

Harry SolomonGE Medical Systems

Co-chair, IHE Cardiology Technical Cmte.


IHE Cardiology RoadmapIHE Cardiology Roadmap• 2004-5 – three profiles with “success path”, addressing

broad range of integration problems – Cath Lab Workflow management, including angio, hemo, and

IVUS, especially for emergent cases– Echocardiography Workflow management, including mobile echo– Ability to view an ECG from any location - quickly and easily

integrated into other applications

• 2005-6 – focus on reporting– Evidence Documents specialized for cardiology logs and

measurements– Displayable Reports for PDF-based clinical reports, RID and XDS

for report distribution

• 2006-9 – additional subspecialties, focus on quality initiatives


Cardiology – 5 Year RoadmapCardiology – 5 Year Roadmap

Year 1(2005)

Year 2(2006)

Year 3(2007)

Year 4(2008)

Year 5(2009)

Cath

Echo

ECG

Nuclear

EP

Ca

rdio

log

y T

ec

hn

ica

l Fra

me

wo

rk

Quality

General

Multi-modality workflow & imaging

Measurements &evidence

Procedure log,coded reports

Supplies, inventory,& charge capture

Workflow & imaging,stress protocols

Measurements

Retrieve ECGfor display

ECG/Stress/Holterorders

Workflow & stress protocols

Multi-modality labworkflow & reporting

Home healthmonitoring

Retrieve guidelinesfor display

Retrieve structuredguidelines

Registry dataharvesting

Reporting & reportdistribution

Precision timesynchronization

Implantable device parameters & events

PediatricCoded reports

ECG waveform interoperability

Stress testing workflow

Clinical Laboratory DomainClinical Laboratory Domain

Charles ParisotCharles ParisotGE HealthcareGE Healthcare

IHE IT Technical Committee Co-chairIHE IT Technical Committee Co-chair

François MacaryFrançois MacaryAGFA Healthcare ITAGFA Healthcare IT

IHE Laboratory Committee Co-chairIHE Laboratory Committee Co-chair


The IHE Laboratory CommitteeThe IHE Laboratory Committee

Contributing countries– France

– Japan

– Germany

– Italy

– The Netherlands

– UK

– US (CLSI - ex NCCLS)

• Development started in 2003

• First profile published in November 2003

• 10 systems validated in 2004

• 12 systems validated in 2005

• Four new profiles currently published for public comment

Cochairs: Francois Macary - Agfa Healthcare IT

Yoshimitsu Takagi - Hitachi


IHE Lab today and to-morrowIHE Lab today and to-morrow

• Five profiles:– Laboratory Scheduled Workflow (LSWF)– Laboratory Point Of Care Testing (LPOCT)– Laboratory Device Automation (LDA)– Laboratory Code Set Distribution (LCSD)– Laboratory Information Reconciliation (LIR)

• Future plans– Incorporate analyzer images in the result workflow– Cross-enterprise sharing of lab reports, using CDA-R2– Specimen labels workflow

• Ordering, placing, scheduling and performing clinical laboratory tests both for Hospital and Ambulatory.

• Microbiology included. Anatomic pathology and blood bank excluded

IT InfrastructureIT Infrastructure

Glen MarshallSiemens Health Solutions

IHE IT Infrastructure Committee Co-chair


IHE IT Infrastructure RoadmapIHE IT Infrastructure RoadmapStage 0 – 2003 profile development for 2004 ConnectathonStage 0 – 2003 profile development for 2004 Connectathon

EHR Security

Profiles Retrieve Information for Display (RID) Patient Identifier Cross-Referencing

(PIX) Patient Synchronized Applications

(PSA)

Profiles Enterprise User Authentication (EUA) Consistent Time (CT)

Standards & Prerequisites CCOW v1.4 Patient Context HL7 v2.3.1 HL7 v2.4 HTTP WSDL 1.1 XHTML 1.0 XML 1.0

Standards & Prerequisites CCOW v 1.4 User Context Kerberos NTP SNTP



EHR Support Security

ProfilesCross-enterprise Document Sharing (XDS)Patient Demographics Query (PDQ)

ProfilesAudit Trail and Node Authentication (ATNA)Personnel White Pages (PWP)

Standards & PrerequisitesStage 0 IHE ITI profilesCDA r1HL7 v2.5ebXML RegistryHTTP

Standards & PrerequisitesIHE Radiology Basic SecurityStage 0 IHE ITI security profilesRFC 3881 (Audit record schema)LDAP (RFC 2251-2256)RFC 2798 (inetOrgPerson schema)



EHR Support Security

ProfilesNotification of Document Availability (NAV)Patient Management (PAM

ProfilesCross-Enterprise User Authentication (XUA)Document Digital Signature (DSG)

Standards & PrerequisitesStage 1 IHE ITI profiles IETF SMTP / MIME HL7 v2.5

Standards & PrerequisitesStage 1 IHE ITI security profilesOASIS SAML 2.0HL7 v2.6 UAC segmentW3C XML Digital SignatureITU X.509ISO/TS 17090


IHE IT Infrastructure RoadmapIHE IT Infrastructure RoadmapStage 3 – 2006 profile candidates for 2007 ConnectathonStage 3 – 2006 profile candidates for 2007 Connectathon

EHR Security Common Data

Profiles – to be decided in Nov. 2005Templates registry Patient Demographics Query - multi-enterprise Federated XDS registries Harmonize XDS and RID document retrieval capabilities

Referred to IHE PCC domainScheduling – enterprise scopeDynamic data for EHR

Profiles – to be decided in Nov. 2005RBAC – enterprise scope

Referred to IHE PCC domainPatient consents

Profiles – to be decided in Nov. 2005LDAP information sourcesTransaction Failure Management (TFM)RID configurability directoryService discovery

Depends on other IHE domains’ needsMasterfile MaintenanceReference code set maintenance

Standards & PrerequisitesStage 2 IHE ITI profilesHL7 templates standardsW3 standards for XML schemas and XSLHL7 scheduling messagesW3C Semantic Web (interoperability and clinical vocabulary standards for assembling dynamic data sources into documents)

Standards & PrerequisitesStage 2 IHE ITI security profilesISO/TS 21547-1 for certificate archivingISO/TS 22600 parts 1 & 2ISO/TS 21298 for function & structural rolesASTM E31.20 Privilege Management InfrastructureStable HL7 standards for communicating patient consents

Standards & PrerequisitesStage 2 IHE ITI Patient Management profileHL7 v2 Masterfile maintenanceMature/stable standards for selected masterfile information sourcesSuitable LDAP schema definitionsWeb services standardsIETF infrastructureW3C infrastructure


IHE IT Infrastructure RoadmapIHE IT Infrastructure RoadmapStage 4 – 2007 profile candidates for 2008 ConnectathonStage 4 – 2007 profile candidates for 2008 Connectathon


ProfilesScheduling Respond to national/regional EHR mandates and initiatives, TBD

ProfilesRBAC – multi-enterprise scopeWide-area patient accessMobile applicationsPatient identification based security

ProfilesWorkflow management preferencesSNMP MIBSLDAP equipment directory support

Standards & PrerequisitesHL7 scheduling messagesEHR-related standards, TBD

Standards & PrerequisitesStage 3 IHE ITI security profilesStable standards for cross-enterprise RBACStable standards for mobile access securityStable standards for patient identification

Standards & PrerequisitesStable workflow management standards for healthcare use cases Suitable LDAP schema definitionsIETF MIB standards


IHE IT Infrastructure RoadmapIHE IT Infrastructure RoadmapStage 5 – 2008+ profile candidates for 2009+ ConnectathonStage 5 – 2008+ profile candidates for 2009+ Connectathon


ProfilesXDS composite documents from multiple clinical domains.

ProfilesRemote service accessAnonymizationPseudoanonymizationPatient-controlled access

ProfilesEquipment discovery and automatic provisioningRID and XDS configurability

Standards & PrerequisitesStage 3 IHE ITI profilesClinical domains’ XDS document profiles

Standards & PrerequisitesStage 4 IHE ITI security profilesStable healthcare data model standardsStable standards for labeled data access rules

Standards & PrerequisitesStage 3 IHE ITI common data profilesStable standards for user interface optimization, e.g., DICOM “hanging protocols”XDS clinical application domains’ content profiles

Patient Care CoordinationPatient Care Coordination

John DonnellyIntePro Solutions, Inc.

IHE IT Infrastructure Committee and Co-chair, IHE Patient Care Coordination Committee


Patient Care CoordinationPatient Care Coordination Domain ScopeDomain Scope

• Facilitate the use of EHR content standards for the transferring or sharing of patient care services via the development of medical summary (MS) content profiles

• Specify appropriate “transfer packages” of clinical information for specific transfer of care use cases via the development of integration profiles.

• Optimize the use of the IHE ITI profiles (e.g. XDS) in delivering healthcare in “communities” of patient care settings


Patient Care CoordinationPatient Care Coordination Current AccomplishmentsCurrent Accomplishments

• Issued Call for Participation to vendor community and medical societies for Planning and Technical Committee formation – 2 t-cons and 1 FtoF meeting

• Finalized a Medical Summary Content Proposal highlighting two key transfer of care use cases

• Conducted high-level content standards evaluation exercise

• Promoted content standard education initiative

ihe radiology kevin o’donnell toshiba medical systems co-chair, ihe radiology planning cmte

Documents

therapeutic radiology

ihe radiology planning

cochair nyukeith laplain

connectathonsihe profiles

key image noteshave

presentation states

cad results

connectathon testsstart