Image Sharing- the NIBIB/RSNA image sharing project employing

IHE solutions

David S. Mendelson, M.D.

Professor of Radiology

Chief of Clinical Informatics

The Mount Sinai Medical Center

Co-chair IHE International Board

IHE-Providing the Foundation for Interoperability

Fourth China-U.S. Roundtable Meeting on Scientific Data Cooperation:

Presentation Objectives

Integrating the Healthcare Enterprise (IHE)Overview- How is IHE organized?

Healthcare Interoperability in the United StatesChallengesARRA (American Recovery and

Reinvestment Act)Image Sharing

Via HIEImage Sharing Project- Personal Health

Records (PHRs)

Integrating the Healthcare Integrating the Healthcare EnterpriseEnterprise

The state of IHE - 2010The state of IHE - 2010

David S. Mendelson, M.D.David S. Mendelson, M.D.

Chief of Clinical InformaticsChief of Clinical Informatics

The Mount Sinai Medical CenterThe Mount Sinai Medical Center

Co-chair IHE BoardCo-chair IHE Board

International Adoption of IHE

4

France

Local Deployment National Extensions (Local

Adaptions) Promotional & Live Demonstration

Events Funding

USA

Germany

Italy

JapanUK

Canada

Korea

Taiwan

Norway

Holland

SpainChina

Year

1

(19

99

)

Year

2

(20

00

)

Year

3

(20

01

)

Year

4

(20

02

)

Year

5

(20

03

)

Year

6

(20

04

)

Year

7

(20

05

)

Year

8

(20

06

)

Pragmatic global standards harmonization + best practices sharing Pragmatic global standards harmonization + best practices sharing

Austria

National and Regional Projects Using IHE Profiles

5

Quebec, Toronto,Alberta, British Columbia

Canada Infoway

Denmark (Funen)Italy (Veneto)Spain (Aragon)

THINC- New YorkNCHICA – N. Carolina

Italy (Conto Corrente

Salute)

Boston Medical

Center - MA

FranceDMP

UK CfH(Radiology WF)

Philadelphia HIE

CHINA-MoHLab results sharing

CPHIC – Pennsylvani

a

CHINA-ShanghaiImaging Info Sharing

JAPAN-NagoyaImaging Info Sharing

South Africa

Malaysia

VITL-Vermont

CareSpark – TN & VA

NetherlandAmsterdam

LowerAustria

Austria

66

IHE Organizational StructureIHE Organizational Structure

Contributing &Participating

Vendors

IHE International Board

Global Development

Radiology

Cardiology

ITInfrastructure

Patient CareCoordination

Patient CareDevices

Laboratory

Pathology

Eye CareRadiationOncology

Regional Deployment

IHE Europe

IHE North America

France

USA

Canada

IHE Asia-Oceania

Japan

Korea Taiwan

Netherlands

Spain Sweden UKItaly

Germany

Norway

China

Austria

ACCACCEACEP

JAHISJIRAJRS

METI-MLHWMEDIS-DCJAMI

RSNA SFRSFIL

SIRMBIREuroRec

COCIREAR-ECRDRG

ESC

Professional Societies / SponsorsACPGMSIHIMSS

77

Thank You for Your AttentionThank You for Your AttentionProf. Jianping Dai, MD

IHE China: IHE China: http://www.ihe-c.orghttp://www.ihe-c.org

8

Events: PromotionEvents: Promotion

Education and Promotion by Journals Education and Promotion by Workshop

9

Events: ConnectathonEvents: 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

10

The IHE-C Connectathon was held at April 26, 2008 in Beijing Tiantan Hospital

Events: ConnectathonEvents: Connectathon

IHE – the processIdentify Interoperability issuesDevelop Integration Profiles

Actors and TransactionsWorkflowGather relevant standards

Connectathon TestingPublish Integration Statements

Vendors list tested profiles

11

Problem to ProfileProblem Domain Integratio

n ProfileTransaction

Actors

Patient Identity across multiple settings

IT Infrastructure

Patient Identifier Cross-Referencing (PIX)

Patient Identity feed

Patient Identity Source

Patient Identity Cross Reference Manager

Make CAD results available with images

Radiology Evidence Documents

Evidence Document Stored

Evidence Creator (Post Processing Workstation

Image Manager/Image Archive

12

Interoperability in the US-ChallengesPrivacy rightsHIPAANo Single identifier

Office of the National Coordinator for Healthcare IT (ONC)Health Information Technology Standards Panel

(HITSP)Certification Commission for HIT (CCHIT)

American Recovery and Reinvestment Act (ARRA)Includes financial incentives for adoption of the

Electronic Health Record throughout the USInteroperability is a cornerstone

Funding for related research- NIHQuality -Comparative EffectivenessEHR

XDS (Cross-Enterprise Document Sharing)XDS.aXDS- I.aXDS.b

?? XDS-I.b

a vs. bRelated to web standards and transactions

XDS

XDS-I

NIBIB contract summaryConsumer ControlEmploy IHE

solutions whenever possibleIHE generally has

not focused on consumer driven solutions but rather on institutional and enterprise workflow

5 Academic InstitutionsMayo ClinicMount Sinai Medical

CenterUniversity of California

San FranciscoUniversity of ChicagoUniversity of Maryland

Establish a clearinghouse

Engage PHRs300,000 patients over 2

years

Elements of SolutionEdge Server

Register a patientListens to a Radiology Information System (RIS)-

looking for a complete examRetrieves Image set from PACS and Report from RISSend both to clearinghouse

Clearinghouse – functions as a secure routerTransiently hold encrypted patient data

PHRConsumer controls upload and future accessDevelop web based viewersDownload full DICOM data set

XDS (Cross-Enterprise Document Sharing)XDS.aXDS- I.aXDS.b

?? XDS-I.b

Protocol Flow

Web/JavaSrv

MIRTHHL7

DICOM

From RIS

Dbase

OS

PACS Qry/Rtrv

Firewall

Clearing House

XDS.b &

token

Edge Appliance

ADMIN

RSRCH

Software architecture

Prepare content Poll database, get report, get exam,prepare big fat file

Background java srvlet 25 days

Transfer content Poll database for transfer out, package content into xds.b

Background java srvlet 35 days

HL7 receiver Receive HL7 A04 messages, extract reports and store them in database

Mirth HL7 Channel. Let Mirth create its default database, all script work-but may have to customize per site

65 days for 5 sites

Token App Create new tokens based on two parts, associate token with accession numbers, update database, user interface with login, get patient info,create job

Ajax based web front-end ,JavaServlet for CFIND using dcm4che, creating job in the RSNA database, creating tokens using kerberos – tokens generated locally

30 days

Database Store reports, logs, audit trails, user accounts, etc.

Mirth instance for HL7 & DICOM, RSNA instance for everything else

50 days – 2 databases

Management App Create users, monitor logs, check health

Ajax gui front end, backend servlet, dicom targets etc.

45 days

Future DirectionsRefine Workflow

Initial workflow is to replace a CDExam updatesDownload DICOM data and archive in a local

PACSEdge server as a platform

Radiation MonitoringPeer ReviewQuality Metrics

Radiation Exposure Monitoring Profile -REMSupplement to Technical Framework for

Trail ImplementationAcquisition modalities inlcudes information

regarding dose exposureEstimates

Permits communication of that information to other systems

Useful for Individual lifetime estimates as well as Population analysis

30

Radiation Exposure Monitoring (REM)Includes

CTPlain X-RayMammography

Current ExclusionsNuclear MedicineRTBrachytherapy

31

DICOM Dose SR objectsDICOM 2008 PS 3.3: A.35.8 X-Ray Radiation

Dose SR IOD