ihe takes pacs to the next level
TRANSCRIPT
IntegratingIntegratingthe the
Healthcare EnterpriseHealthcare Enterprise
IHE takes PACS to the next IHE takes PACS to the next levellevel
Paul Nagy, PhDAssistant Professor of RadiologyMedical College of Wisconsin
Diffusion of innovation modelDiffusion of innovation model 1943 model of Iowa farmers adoption of hybrid seeds Five personality and socioeconomic categories
Time
Innovators
Early Adopters
Early Majority Late
Majority
Traditionalists
B. Reiner, E. Siegel “Psychological factors affecting the adoption of PACS” Applied Radiology Volume: 31 Number: 4 April 2002
There is PACS and then there is There is PACS and then there is PACSPACS
The difference is integrationWith the RISWith the ModalitiesWith the Dictation systemWith the Hospital Network IHE covers some of the more pressing
integration problems
Reason #1: Life expectancy of Reason #1: Life expectancy of your PACSyour PACS
If you … Want Hope Expect Need Pray
.. your PACS will last more than 3-4 years, you should be trying to use IHE where possible.
Technology Lifetime Technology Lifetime
Standards (DICOM, HL7, IHE, SNIA…) 25- 50 years
Infrastructure (IP, SAN,…) 10- 20 years
Programming Languages (PL/1, Pascal, C, C++, Java, …) 5-10 years
Software (data formats, compatibility, …)2-5 years
Hardware (Network cards, video cards, processors, …) 1-2 years
Shapiro, IBM
Reason #2: PACS alone doesn’t Reason #2: PACS alone doesn’t magically fix errorsmagically fix errors
What happens when you get rid of all the film room personnel (and your human safety net)?
Will the electronic systems protect you from making mistakes?
MalpracticeMalpractice
Smith J, Berlin L, “Malpractice Issues in Radiology: Picture Archiving and Communication Systems (PACS) and the Loss of Patient Examination Records”, AJR: 176, June (2001), pp1381-4
Failures of second generation systems without robust interfaces and integrity checking
Reason #3: PACS alone doesn’t Reason #3: PACS alone doesn’t increase productivityincrease productivity
Errors causes reworkRedesigning your workAutomating steps through interfacesIHE provides a framework for robust
interfaces
Sending safely from modality to PACSSending safely from modality to PACSBasic PACS W/ IHE SWF
1. Scanner sends CT data to PACS
2. Tech logs into PACS and confirms all the images made across by the image count on the modality.
3. Tech manually selects, deletes, and confirms the deletion on the modality.
1. Scanner sends CT data to PACS
2. Scanner requests commitment of storage
3. PACS returns a commit for every image sent
4. Modality registers commit and sets study as archived and available for deletion off of the modality.
What if the tech forgets to delete the study?What if the tech makes a mistake and deletes a study that hasn’t been archived.What if the tech misses the count?Which way is more efficient and more effective?Deming rule “Cease dependence upon inspection”
If getting one vendor to do If getting one vendor to do what you want is hard.what you want is hard.
IHE is for the relief of pains IHE is for the relief of pains that PACS can causethat PACS can cause
Reason #5: IHE is easier Reason #5: IHE is easier than DICOMthan DICOM
And more reliable IHE sits atop DICOM and HL7Is more stringent in mandatory fields to
enable workflow
Reason #6: People will think Reason #6: People will think you are really smart at workyou are really smart at work
IHE is not a standard It is really a blueprint trying to solve tricky
workflow problems. There is enormous intellectual property in IHE
and extremely thorough solutions to problems.
Tap into the experience and knowledge. In many ways IHE is the lessons learned from
all those who have tried to go soft-copy in the past decade and ran into stumbling blocks.
Vendor Integration Vendor Integration StatementsStatements
IHE Integration Statement
Vendor Product Name Version Date
Great Medical Systems IntegrateRAD V2.3 12 Oct 2002
This product implements all transactions specified in the IHE Technical Framework to support the IHE Integration Profile, Actors and Options stated below:
Integration Profiles Implemented
Actors Implemented Options Implemented
Image Manager/Image Archive none
Image Display Performed Procedure Step
Scheduled Workflow
Order Filler PPS Exception Management
Simple Image and Numeric Report
Report Creator none
Link to the vendor IHE page www.greatmedicalsystems.fake/ihe
Links to Standards Conformance Statements for the Implementation
HL7 www.greatmedicalsystems.fake/hl7
DICOM www.greatmedicalsystems.fake/dicom/integrateRAD.pdf
For general Information
on IHE
In America: www.rsna.com/ihe In Europe: www.ihe-europe.org In Asia:
Contract NegotiationContract Negotiation
“…90% payment contingent upon successful implementation and operation of … profile.”
Integration with other information systems is becoming more and more a differentiator between medical devices.
So What Now?So What Now?
Users drive the market, you have the power.
Consider including IHE in your integration planning strategies
Take a look at the IHE Technical Framework and supporting information
Use IHE Integration Profiles when writing RFPs and purchasing specifications
Information ResourcesInformation Resources
Brochures and ReprintsIHE Integration ProfilesIHE Integration ProfilesIHE At-a-GlanceIHE At-a-GlanceReprints of IHE technical papersReprints of IHE technical papersIHE Product Evaluation Worksheets IHE Product Evaluation Worksheets IHE Technical FrameworkIHE Technical FrameworkThe IHE FAQ; IHE VideoThe IHE FAQ; IHE VideoIHE Fundamentals, Purchasing Strategies, IHE PrimerIHE Fundamentals, Purchasing Strategies, IHE PrimerIHE Integration Checklist, Connectathon ResultsIHE Integration Checklist, Connectathon ResultsHIMSS MonographHIMSS Monograph
www.rsna.org/ihe