integrating the healthcare enterprise ihe an overview eric poiseau laboratoire idm faculté de...

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

IHE an OverviewIHE an Overview

Eric PoiseauEric PoiseauLaboratoire IDM Faculté de MédecineLaboratoire IDM Faculté de Médecine

Université de Rennes 1Université de Rennes 1

What is IHE about? What is IHE about?

It’s an initiative promoting and It’s an initiative promoting and supporting the supporting the integrationintegration of of systemssystems in in the the healthcare enterprisehealthcare enterprise..

Integration Goal: Improve the efficiency Integration Goal: Improve the efficiency and effectiveness of clinical practice by: and effectiveness of clinical practice by: – Improved Improved Information FlowInformation Flow – Advanced Advanced Multi-System FunctionsMulti-System Functions

What is Integrating the Healthcare What is Integrating the Healthcare Enterprise ? Enterprise ?

Sponsored jointly by the Sponsored jointly by the user communityuser community::– EAR, ECR, SFR, GMSIH, SIRM, DRG, ESCEAR, ECR, SFR, GMSIH, SIRM, DRG, ESC– BIR, RCR, IPIM, CoR, NHS (joined from UK) BIR, RCR, IPIM, CoR, NHS (joined from UK) – RSNA, HIMSS, ACC, JRS (USA, Japan)RSNA, HIMSS, ACC, JRS (USA, Japan)

and by the and by the vendor communityvendor community

IHE focuses on the flow of information IHE focuses on the flow of information between between several systemsseveral systems in in several several departmentsdepartments operating operating withinwithin a healthcare a healthcare enterprise. enterprise.

In Europe:In Europe:

13 Vendors - 13 systems 13 Vendors - 13 systems in 2001in 2001


47 Vendors - 847 Vendors - 800 systems systems in 2003in 2003


How is IHE related to Standards?How is IHE related to Standards?

IHE is not a new standard !IHE is not a new standard ! Information needs to travel widely Information needs to travel widely Information is applied within a contextInformation is applied within a context

– Workflows cross Standard bordersWorkflows cross Standard borders

IHE specifies how to apply Standards IHE specifies how to apply Standards (DICOM, HL7, Web) to (DICOM, HL7, Web) to real world scenariosreal world scenarios & & integration problemsintegration problems– IHE defines a practical “IHE defines a practical “phrasebookphrasebook””

What is the Result? What is the Result?

Vendors implement well-defined subsets of Vendors implement well-defined subsets of IHE (actors & profiles) on their systems IHE (actors & profiles) on their systems

IHE is not a product;IHE is not a product;it is introduced by a software feature or it is introduced by a software feature or upgrade upgrade

Customers can request specific IHE Customers can request specific IHE Integration Profiles in a tender for clinical Integration Profiles in a tender for clinical systems systems

The systems have been pre-tested at the The systems have been pre-tested at the ConnectathonConnectathon

Unique test platform Unique test platform for vendorsfor vendors

– Peer to peer testsPeer to peer tests– Workflow tests Workflow tests

New collaboration New collaboration culture for engineersculture for engineers

– They learn to know They learn to know each othereach other

Warranty for usersWarranty for users

IHE ConnectathonIHE Connectathon

The IHE processThe IHE process

IHETechnical Framework

IHEConnectathon

IHEDemonstrations

Planning Committee

Product conform to one or more

integration profiles

We define

We test We show

We manage

Technical Framework : Document Technical Framework : Document OrganizationOrganization

Domain technical frameworks :Domain technical frameworks :– RAD, CARD, LAB, IT-IRAD, CARD, LAB, IT-I

Vol 1 : Actor and Integration ProfilesVol 1 : Actor and Integration ProfilesVol 2,3,.. : TransactionsVol 2,3,.. : TransactionsMaintenance :Maintenance :

– Change ProposalsChange Proposals– SupplementsSupplements

Technical FrameworkTechnical Framework

The IHE Technical Framework is based on The IHE Technical Framework is based on actorsactors that interact through that interact through transactionstransactions..

ActorsActors are information systems or components of are information systems or components of information systems that produce, manage, or act information systems that produce, manage, or act on information associated with operational on information associated with operational activities in the enterprise.activities in the enterprise.

TransactionsTransactions are interactions between actors that are interactions between actors that transfer the required information through transfer the required information through standards-based messages.standards-based messages.

Specific sets of actors and transactions are Specific sets of actors and transactions are specified in the specified in the Integration ProfilesIntegration Profiles

Actor descriptions examplesActor descriptions examples

Acquisition ModalityAcquisition Modality – A system that acquires – A system that acquires and creates medical images, e.g. a Computed and creates medical images, e.g. a Computed Tomography scanner or Nuclear Medicine Tomography scanner or Nuclear Medicine camera. A modality may also create Grayscale camera. A modality may also create Grayscale Softcopy Presentation States for the consistent Softcopy Presentation States for the consistent viewing of images and create Key Image Notes.viewing of images and create Key Image Notes.

ADT Patient RegistrationADT Patient Registration – A system – A system responsible for adding and/or updating patient responsible for adding and/or updating patient demographic and encounter information. In demographic and encounter information. In particular, it registers a new patient with the particular, it registers a new patient with the Order Placer and Department System Order Placer and Department System

Transaction descriptions exampleTransaction descriptions example

1.1. Patient RegistrationPatient Registration – The ADT system – The ADT system registers and/or admits a patient and forwards registers and/or admits a patient and forwards the information to other information systems.the information to other information systems.

2.2. Placer Order ManagementPlacer Order Management – The Order – The Order Placer informs the Order Filler of the initiation Placer informs the Order Filler of the initiation or cancellation of an order. The Placer/Filler or cancellation of an order. The Placer/Filler Order Management transaction will sometimes Order Management transaction will sometimes be referred to as “-New” when a new order is be referred to as “-New” when a new order is being initiated, or as “-Cancel” when an being initiated, or as “-Cancel” when an existing order is canceled.existing order is canceled.

Integration ProfilesIntegration Profiles

DescriptionDescriptionActors/Transactions interaction diagramActors/Transactions interaction diagramActors/Transactions requirementsActors/Transactions requirementsProcess flowProcess flow

Integration Profiles :DescriptionIntegration Profiles :Description

The The Scheduled Workflow Integration ProfileScheduled Workflow Integration Profile establishes the continuity and integrity of basic establishes the continuity and integrity of basic radiological data. It specifies a number of radiological data. It specifies a number of transactions that maintain the consistency of transactions that maintain the consistency of patient and ordering information as well as patient and ordering information as well as providing the scheduling and imaging acquisition providing the scheduling and imaging acquisition procedure steps. This profile also makes it procedure steps. This profile also makes it possible to determine whether images associated possible to determine whether images associated with a particular performed procedure step have with a particular performed procedure step have been stored (archived) and are available to enable been stored (archived) and are available to enable subsequent workflow steps, such as reporting.subsequent workflow steps, such as reporting.

Integration Profiles :Interactions diagramIntegration Profiles :Interactions diagram

Pt. Registration [1] 12: Patient Update [12]

Pt. Registration [1] Patient Update [12] Placer Order Management

[2] Filler Order Management [3]

ADT

Query Images [14] Retrieve Images [16]

Image Display

Storage Commitment [10]

Modality Image Stored [8] Evidence Documents Stored [43] Storage Commitment [10]

Creator Images Stored [18]

Procedure Scheduled [4] Image Availability Query [11] Patient Update [12] Performed Work Status Update [42]

Modality Worklist Provided [5]

Image Creator

Performed Procedure

Step Manager

Modality PS in Progress [6] Modality PS Completed [7] Creator PS in Progress [20] Creator PS Completed [21]

Modality PS in Progress [6] Modality PS Completed [7] Creator PS in Progress [20] Creator PS Completed [21]

Modality PS in Progress [6] Modality PS Completed [7]

Creator PS in Progress [20] Creator PS Completed [21]

Order PlacerOrder Filler

Acquisition Modality

Image Manager

Image Archive

Integration Profiles : Integration Profiles : Actors / Transactions tableActors / Transactions table

Actors Transactions Optionality Vol II / III Section

Patient Registration [1] R 4.1 ADT Patient Registration

Patient Update [12] R 4.12

Patient Registration [1] R 4.1

Patient Update [12] R 4.12

Placer Order Management [2] R 4.2

Order Placer

Filler Order Management [3] R 4.3

… … … …

Integration Profiles : Process FlowIntegration Profiles : Process Flow Image Manager/

Image Archive/ Secure Node

Image Display/ Secure Node

Audit Record Repository/ Secure Node

Time Server

Record Audit Event (User Authenticated)

Maintain Time

Query Images

Maintain Time

Retrieve Images

Record Audit Event (Query Images)

View Images

Authenticate Node

Record Audit Event (Retrieve Images)

Maintain Time

Record Audit Event (Retrieve Images)

Record Audit Event (Instances Used)

Transaction descriptionsTransaction descriptions

ScopeScopeUse case rolesUse case rolesReferences to standardsReferences to standards Interaction diagramInteraction diagram

Transaction: ScopeTransaction: Scope

Defines the scope of application of the Defines the scope of application of the transactiontransaction– « « This transaction involves the patient information, This transaction involves the patient information,

including demographics, captured at the point of including demographics, captured at the point of encounter. This may occur when the visit is encounter. This may occur when the visit is scheduled, if that precedes patient arrival at the scheduled, if that precedes patient arrival at the institution. This transaction is used for both in-institution. This transaction is used for both in-patients (i.e., those who are assigned a bed at the patients (i.e., those who are assigned a bed at the facility) and outpatients (i.e., those who are not facility) and outpatients (i.e., those who are not assigned a bed at the facility).assigned a bed at the facility). » »

Patient Registration

Order PlacerDepartment System Scheduler /

Order Filler

ADT PatientRegistration MPI

Transaction : Use case exampleTransaction : Use case example

Transaction : References to standardTransaction : References to standard

Example for transaction 32: « Authenticate Example for transaction 32: « Authenticate Node »Node »– DICOM 2001 PS 3.15: DICOM 2001 PS 3.15:

Security Profiles. Annex B1: The Basic TLS Security Profiles. Annex B1: The Basic TLS Secure Transport Connection profile.Secure Transport Connection profile.

– IETF:IETF: Transport Layer Security (TLS) 1.0 (RFC Transport Layer Security (TLS) 1.0 (RFC 2246)2246)

– ITU-T: Recommendation X.509 (03/00). ITU-T: Recommendation X.509 (03/00). “Information technology - Open Systems “Information technology - Open Systems Interconnection - The directory: Public-key and Interconnection - The directory: Public-key and attribute certificate frameworks"attribute certificate frameworks"

Transaction : Interaction diagramTransaction : Interaction diagram

ADT Patient Registration

Order Placer

HL7 ADT^*

HL7 ADT^*

HL7 ADT^*

Department System MPI

* - A01, A04, A05, A11, A38

IHE Radiology Integration ProfilesIHE Radiology Integration Profiles

Patient Info.

Recon-ciliation

Access to Radiology Information

Consistent Present-ation of Images

Basic Security

-

EvidenceDocs

KeyImageNotes

Simple Image & Numeric Reports

Presentation of Grouped Procedures

Post-

Processing Workflow

Reporting Workflow

Charge Posting

Scheduled Workflow

Portable Data for Imaging

NMImage

New

New

WorkflowWorkflow

Most critical issue in a Radiology EnvironmentMost critical issue in a Radiology Environment– Inter- or corrupted information chainInter- or corrupted information chain

Paper based information -> multiple re-entry of dataPaper based information -> multiple re-entry of data Different non adapted subsystems don‘t cooperateDifferent non adapted subsystems don‘t cooperate Error correction takes huge amount of timeError correction takes huge amount of time

– Stale information Stale information Brandnew information not known (cancellation, change)Brandnew information not known (cancellation, change)

– Status update informationStatus update information Exam registered, finished, archived, reported, deliveredExam registered, finished, archived, reported, delivered

Store ImagesStore Images

Storage CommitmentStorage CommitmentStorageStorage

CommitmentCommitment

List of ImagesList of Images

PACS &PACS &ArchiveArchive

RISRIS

ModalityModalityPerformedPerformedProcedure Procedure StepStep

Performed Step:Performed Step:

Status = CompletedStatus = CompletedPerformed CT HeadPerformed CT HeadPat Name/ID, Dose, Pat Name/ID, Dose,

Accession #, Study UIDAccession #, Study UIDComplete List of ImagesComplete List of Images

A Closed LoopA Closed Loop•Update IS SchedulingUpdate IS Scheduling

•Match Procedure with OrderMatch Procedure with Order•Support Billing Based on MPPSSupport Billing Based on MPPS

•Avoid Reading Incomplete ProceduresAvoid Reading Incomplete Procedures

Modality WorklistModality Worklist

WorklistWorklist

Procedure ScheduledProcedure Scheduled

IHE Scheduled Workflow in RadiologyIHE Scheduled Workflow in Radiology

Order Placer

PerformedProcedure Step

Manager

ADTPatient Registration

Image Archive

Image Manager

Image Display

Image Creator

AcquisitionModality

DepartmentSystem Scheduler– Order Filler –

Modality Worklist

Patient Registration

Procedure Scheduled

Images Availability QueryImagesStored

StorageCommit

StorageCommit

ImagesStored

PPSIn-Progress/ Completed

Fil

ler

Ord

erM

anag

emen

t

Placer Order Management

Q /RImages



HL7

DICOM

Scheduled WorkflowScheduled Workflow

Patient Information ReconciliationPatient Information Reconciliation

Trauma patientTrauma patientManual wrong data entry at the modalityManual wrong data entry at the modalitySystem crashedSystem crashedVIP personVIP person

Patient Update

Patient Update

Procedure Update

Order Placer

PerformedProcedure Step

Manager

ADTPatient Registration

Image Archive

Image Manager

Image Display

Image Creator

AcquisitionModality

DepartmentSystem Scheduler– Order Filler –

Procedure Scheduled

Images Availability QueryImagesStored

StorageCommit

StorageCommit

ImagesStored


Modality Worklist

Patient RegistrationF

ille

r O

rder

Man

agem

ent

Placer Order Management

Q /RImages



HL7

DICOM

Patient Information ReconciliationPatient Information Reconciliation

IHE-LaboratoryIHE-Laboratory

Provide users a single nameand

centralized authentication process

across all systems

Point of Care Testing(Future)

Extend laboratory testing with bedside testing devices

Retrieve Information for Display

Access a patient’s clinical information and documents in a format ready to be presented

to the requesting user

Laboratory Scheduled Workflow

Admit, Discharge, Transfer a patient, order lab tests, collect specimen, perform tests, report

results.

Synchronize multiple applications on a desktop to the same patient

Patient Synchronized Applications

Cooperation with external laboratory

Outside Healthcare Enterprise Testing (Future)

Provide users a single nameand

centralized authentication process

across all systems

Laboratory Patient Information

Reconciliation (Future)

Updates resulting from unidentified or misidentified

Patient

IHE IT InfrastructureIHE IT Infrastructure

Enterprise User AuthenticationEnterprise User Authentication

Provide users a single nameand centralized authentication

processacross all systems


Access a patient’s clinical information and documents in a

format ready to be presentedto the requesting user


Access a patient’s clinical information and documents in

a format ready to be presented

to the requesting user

Patient Identifier Cross-referencing

for MPIMap patient identifiers

across independent identification domains

Patient Identifier Cross-referencing for

MPI

Map patient identifiers across independent

identification domains

Synchronize multiple applications on a desktop to the

same patient

Patient Synchronized Applications

Consistent TimeCoordinate time across

networked systems

Audit Trail & Node Authentication

Centralized privacy audit trail and node to node authentication

to create a secured domain.

New

Patient Demographics Query New

Personnel White PageAccess to workforcecontact information

New

Cross-Enterprise Document Sharing

(XDS)Registration, distribution and

access across health enterprises of clinical

documents forming a patient electronic health record

New

Audit Trail & Node Authentication : ATNAAudit Trail & Node Authentication : ATNA

Protect Patient Privacy and System Security:Protect Patient Privacy and System Security:– Meet ethical and regulatory requirementsMeet ethical and regulatory requirements

Enterprise Administrative Convenience:Enterprise Administrative Convenience:– Unified and uniform auditing systemUnified and uniform auditing system– Common approach from multiple vendors simplifies definition Common approach from multiple vendors simplifies definition

of enterprise policies and protocols.of enterprise policies and protocols.– Common approach simplifies administrationCommon approach simplifies administration

Development and support cost reduction through Code Development and support cost reduction through Code Re-use:Re-use:– Allows vendors to leverage single development effort to Allows vendors to leverage single development effort to

support multiple actorssupport multiple actors– Allows a single development effort to support the needs of Allows a single development effort to support the needs of

different security policies and regulatory environments.different security policies and regulatory environments.

Patient Identifier Cross-referencing for Patient Identifier Cross-referencing for MPI : PIXMPI : PIX

Allow all enterprise participants to register the Allow all enterprise participants to register the identifiers they use for patients in their identifiers they use for patients in their domaindomain

Participants retain control over their own Participants retain control over their own domain’s patient index(es)domain’s patient index(es)

Support domain systems’ queries for other Support domain systems’ queries for other systems’ identifiers for their patientssystems’ identifiers for their patients

Optionally, notify domain systems when other Optionally, notify domain systems when other systems update identifiers for their patientssystems update identifiers for their patients

Patient Synchronized Applications : PSAPatient Synchronized Applications : PSA

Patient Synchronization of Multiple Patient Synchronization of Multiple Disparate ApplicationsDisparate Applications

Single Patient SelectionSingle Patient SelectionWhen combined with PIX Profile, allows When combined with PIX Profile, allows

patient synchronization across patient patient synchronization across patient identifier domainsidentifier domains

When combined with EUA Profile, When combined with EUA Profile, provides user Single Sign-on (SSO)provides user Single Sign-on (SSO)

Retrieve Information for Display : RIDRetrieve Information for Display : RID

SimpleSimple and and rapidrapid access to patient information access to patient information Access to existing Access to existing persistent documentspersistent documents in well- in well-

known presentation formats: CDA, PDF, JPEG.known presentation formats: CDA, PDF, JPEG. Access to Access to specific keyspecific key patient-centric information patient-centric information

for presentation to a clinician : allergies, current for presentation to a clinician : allergies, current medications, summary of reports, etc.. medications, summary of reports, etc..

Links with other IHE profiles - Enterprise User Links with other IHE profiles - Enterprise User Authentication, Patient Identifier Cross-Authentication, Patient Identifier Cross-referencing and Cross Enterprise Document referencing and Cross Enterprise Document SharingSharing

Enterprise User AuthenticationEnterprise User Authentication

Support a Support a single enterprisesingle enterprise governed by governed by a a single set of security policiessingle set of security policies and and having a having a common network domaincommon network domain. .

Establish Establish one name per userone name per user to be used to be used for all IT applications and devicesfor all IT applications and devices. .

Facilitate Facilitate centralized user authentication centralized user authentication managementmanagement. .

Provide users with Provide users with single sign-onsingle sign-on. .

Patient Demographics Query : PDQPatient Demographics Query : PDQ

Allow quick retrieval of a patient list including Allow quick retrieval of a patient list including common patient names, identifiers, contacts, common patient names, identifiers, contacts, and visit informationand visit information

Enable selection of correct patient when full Enable selection of correct patient when full identification data may not be availableidentification data may not be available

Limits access to only a subset of Limits access to only a subset of demographic and visit informationdemographic and visit information

Personnel White Pages : PWPPersonnel White Pages : PWP

Provide access to basic information Provide access to basic information about the human workforce membersabout the human workforce members– Does not include PatientsDoes not include Patients

Defines method for finding the PWPDefines method for finding the PWPDefines query/access methodDefines query/access methodDefines attributes of interestDefines attributes of interest

IHE Integration StatementIHE Integration Statement

ProductProduct U UVWVW supports the supports the

IHE IHE KK Actor Actor withwith thethe

IHE IHE XX and and YY Integration Profiles Integration Profiles

IHE IHE JJ ActorActor with the with the

IHE IHE TT Integration ProfileIntegration Profile

IHE Integration StatementIHE Integration Statement

Connectathon Results BrowserConnectathon Results Browser

More InformationMore Information

Links Links – http://www.ihe-europe.orghttp://www.ihe-europe.org– http://www.rsna.org/IHEhttp://www.rsna.org/IHE– http://www.ihe-uk.orghttp://www.ihe-uk.org

Technical FrameworksTechnical Frameworks

Thank you