IntegratingIntegratingthe the

Healthcare EnterpriseHealthcare Enterprise

IHE IHE FundamentalsFundamentals

Kevin O’Donnell, ToshibaKevin O’Donnell, ToshibaNiki Wirsz, SiemensNiki Wirsz, Siemens

Ellie Avraham, KodakEllie Avraham, Kodak[30 minutes][30 minutes]

RSNA 20022

IHE IHE FundamentalsFundamentals• What is it about?What is it about?

• How do I get it?How do I get it?

• Why is it needed?Why is it needed?

• Who is IHE?Who is IHE?

• Where can I learn more?Where can I learn more?

• How does it work?How does it work?

• How do I use it?How do I use it?

• What do I get out of it?What do I get out of it?

• What about DICOM?What about DICOM?

• What does IHE create?What does IHE create?

RSNA 20023

What is IHE about?What is IHE about?

IHE is an initiative promoting and IHE is an initiative promoting and supporting the supporting the integrationintegration of of systemssystems in in the the healthcare enterprisehealthcare enterprise..

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

RSNA 20024

How do you Use IHE?How do you Use IHE?

• IHE “Integration Profiles”IHE “Integration Profiles”– Are Are Integration solutions in the Healthcare EnterpriseIntegration solutions in the Healthcare Enterprise to to

support specific capabilities.support specific capabilities.

• Customer – Vendor CommunicationCustomer – Vendor Communication– Review the ProfilesReview the Profiles– Decide what you Decide what you NeedNeed– Ask vendors for that profile on the relevant systemsAsk vendors for that profile on the relevant systems

““Which IHE Profiles do you support on System X as Which IHE Profiles do you support on System X as which actors? - which actors? - The IHE Product Evaluation The IHE Product Evaluation Worksheet.Worksheet.

RSNA 20025

Why is IHE needed?Why is IHE needed?

• Serious Integration Challenges in Healthcare:Serious Integration Challenges in Healthcare:

• Systems need Information other systems haveSystems need Information other systems have

• But, systems communicate poorly or not at all But, systems communicate poorly or not at all

• Result: - tedious, inefficient workflows Result: - tedious, inefficient workflows - data that is inconsistent, - data that is inconsistent, redundant redundant or or unavailable unavailable

Responsibility for information flow between systems, Responsibility for information flow between systems, and between departments, is often unclear.and between departments, is often unclear.

RSNA 20026

Who is IHE?Who is IHE? Participants:Participants:

Professional Societies Professional Societies Radiological Society of North America (RSNA)Radiological Society of North America (RSNA) Healthcare Information and Management Systems Society Healthcare Information and Management Systems Society

(HIMSS) (HIMSS) Other societies (European, Japanese, Lab HC PartnershipOther societies (European, Japanese, Lab HC Partnership

ACC, …)ACC, …) Vendors (over 30 companies)Vendors (over 30 companies) Standards Group Committee Members Standards Group Committee Members of DICOM & HL7of DICOM & HL7

RSNA and HIMSS sponsor IHE to provide a RSNA and HIMSS sponsor IHE to provide a neutral forumneutral forum for working on the for working on the Big PictureBig Picture

RSNA 20027

How Established is IHE?How Established is IHE?• Year 1 (1999):Year 1 (1999): Proof of ConceptProof of Concept

(Basic Scheduled Workflow)(Basic Scheduled Workflow)

• Year 2 (2000): Year 2 (2000): Introduction of the 7 ProfilesIntroduction of the 7 Profiles(Full Featured)(Full Featured)

• Year 3 (2001): Year 3 (2001): Consolidation, Catch-up (Real Consolidation, Catch-up (Real Products)Products) Expansion to FranceExpansion to France

• Year 4 (2002): Year 4 (2002): 3 New Profiles3 New ProfilesExpansion to Japan, Germany, ItalyExpansion to Japan, Germany, Italy

• Year 5 (2003): Year 5 (2003): New ProfilesNew ProfilesExpansion to UK, IT Infrastructure, Expansion to UK, IT Infrastructure,

Cardiology, Nuclear Medicine, Cardiology, Nuclear Medicine, Lab, …?Lab, …?

RSNA 20028

What does IHE cover?What does IHE cover?• [37] Vendors participated in IHE Year 4 with [71] [37] Vendors participated in IHE Year 4 with [71]

Systems Systems

• Systems include:Systems include:

• HIS, RISHIS, RIS

• CT, MR, US, CR, DX, XA, NM, …CT, MR, US, CR, DX, XA, NM, …

• PACS, Review Stations, Reporting SystemsPACS, Review Stations, Reporting Systems

• Printers, Imagers Printers, Imagers

RSNA 20029

Why Integrate?Why Integrate?• Interfacing products from different Vendors for Interfacing products from different Vendors for

Interoperable and effective Enterprise operation.Interoperable and effective Enterprise operation.• Integrated Systems -> cooperative exchange of Integrated Systems -> cooperative exchange of

informationinformation

• Your system receives relevant informationYour system receives relevant information– Patient DemographicsPatient Demographics– Order InformationOrder Information– Related Clinical DataRelated Clinical Data>>> More efficient workflow, reduced errors, more intelligent >>> More efficient workflow, reduced errors, more intelligent

equipment equipment

• Your system distributes relevant informationYour system distributes relevant information– Clinical Data – test results, images, measurements, reportsClinical Data – test results, images, measurements, reports>>> More valuable if it’s available anywhere, anytime>>> More valuable if it’s available anywhere, anytime>>> More valuable when combined with other data>>> More valuable when combined with other data

(No single device has all the answers) (No single device has all the answers)

RSNA 200210

Why Integrate?Why Integrate?• Cooperative Information Flow Enables ProcessesCooperative Information Flow Enables Processes

– Order Workflow: Scheduling, Worklists, Status, ResultsOrder Workflow: Scheduling, Worklists, Status, Results

– Specialist Consultation: Sharing Data, Views, ObservationsSpecialist Consultation: Sharing Data, Views, Observations

– Electronic Medical Records: Data Collection, Storage, DistributionElectronic Medical Records: Data Collection, Storage, Distribution

– Clinical Workflow: Data Access, Review, Analysis, RecordingClinical Workflow: Data Access, Review, Analysis, Recording

– Research Workflow: Clinical Studies, Evidence Based MedicineResearch Workflow: Clinical Studies, Evidence Based Medicine

– Financial Workflow: Order Authorization, Status, Billing, CollectionFinancial Workflow: Order Authorization, Status, Billing, Collection

– Collaboration for resolving problems such as Consistent Collaboration for resolving problems such as Consistent Presentation of Images or Managing Subset of single Acquisition.Presentation of Images or Managing Subset of single Acquisition.

RSNA 200211

How is IHE related to Standards?How is IHE related to Standards?• Information is applied within a contextInformation is applied within a context

– Order: Clinical View, Financial View, Dept. ViewOrder: Clinical View, Financial View, Dept. View

• Information needs to travel widelyInformation needs to travel widely>>> Workflows cross Standard borders>>> Workflows cross Standard borders

• Standards provide tools & technologiesStandards provide tools & technologies– HL7 and DICOM provide dictionariesHL7 and DICOM provide dictionaries

• IHE specifies how to apply them to real world IHE specifies how to apply them to real world scenarios & integration problemsscenarios & integration problems– IHE defines a “phrasebook”IHE defines a “phrasebook”

RSNA 200212

What Does IHE Do?What Does IHE Do?• Users and Vendors work together to identify Users and Vendors work together to identify

and design solutions for integration problemsand design solutions for integration problems

• Intensive process with Intensive process with annual cyclesannual cycles::– Identify key healthcare workflows and integration Identify key healthcare workflows and integration

problemsproblems– Research & select standards to specify a solutionResearch & select standards to specify a solution– Write, review and publish IHE Technical FrameworkWrite, review and publish IHE Technical Framework– Perform cross-testing at “Connectathon”Perform cross-testing at “Connectathon”– Demonstrations at tradeshows (HIMSS/RSNA)Demonstrations at tradeshows (HIMSS/RSNA)

RSNA 200213

What are What are Key IHE ConceptsKey IHE Concepts??• Generalized Systems Generalized Systems -> -> ActorsActors

• Interactions between Actors Interactions between Actors -> -> TransactionsTransactions

• Problem/Solution ScenariosProblem/Solution Scenarios -> -> IntegrationIntegration ProfilesProfiles

• For each Integration Profile:For each Integration Profile:

• the context is described (which real-world problem)the context is described (which real-world problem)

• the actors are defined (what systems are involved)the actors are defined (what systems are involved)

• the transactions are defined (what must they do)the transactions are defined (what must they do)

RSNA 200214

What is the Result?What is the Result?• Vendors implement selected actors and Vendors implement selected actors and

support selectedsupport selected profiles on their systems profiles on their systems

• IHE is IHE is not a productnot a product;;it is it is a software feature or upgradea software feature or upgrade

• Customers can request specific Integration Customers can request specific Integration Profiles in RFPs for clinical systemsProfiles in RFPs for clinical systems

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

RSNA 200215

Who benefits?Who benefits?• Clinical UsersClinical Users

• Greater access to more consistent informationGreater access to more consistent information• Fewer errors, fewer tedious tasksFewer errors, fewer tedious tasks

• AdministratorsAdministrators• Increased throughputIncreased throughput• Better scheduling and trackingBetter scheduling and tracking

• BuyersBuyers• Specify/purchase integration capabilities easily Specify/purchase integration capabilities easily • Freedom to acquire “Best of Breed” systems Freedom to acquire “Best of Breed” systems

• IT ProfessionalsIT Professionals• Faster, more predictable integration projectsFaster, more predictable integration projects

RSNA 200216

IHE Integration ProfilesIHE Integration Profiles

Access to Radiology InformationRetrieve & view images and reports

Consistent Presentation of Images

Hardcopy and softcopy grayscale presentation state

Key ImageNotes

Flag & search for significant images

Simple Image and Numeric Reports

Simple reports with image links and measurements

Basic SecurityAudit Trail Consolidation & Node Authentication

Presentation of Grouped Procedures

Manage subsets of a single acquisition

Post- Processing Workflow

Schedule, perform, & notify image processing

& CAD steps

Charge Posting

Collection of billable procedure details

Scheduled Workflow

Admit, order, schedule, acquire & store images with notification of

completed steps

Patient Information Reconciliation

Unknown patients and unscheduled orders

RSNA 200217

imagesstored

patientinformation

RIS

examination orders

imagesretrieved

HIS

PACS

procedurescheduled

Prefetch any relevantprior studies

modalityworklist

report

report

Scheduled Workflow ProfileScheduled Workflow Profile

Registration

Orders Placed

Orders Filled

Film

FilmFolder

Image Manager& Archive

FilmLightbox

report ReportRepository

DiagnosticWorkstation

Modality

acquisitionacquisitionin-progressin-progressacquisitioncompleted

acquisitioncompleted

imagesprinted

AcquisitionModality

RSNA 200218

Patient Information Reconciliation ProfilePatient Information Reconciliation Profile

• Extends Scheduled WorkflowExtends Scheduled Workflow– Handle unidentified patient (e.g. trauma)Handle unidentified patient (e.g. trauma)– Handle demographic information mistakesHandle demographic information mistakes– Propagate changes to all affected systems, update Propagate changes to all affected systems, update

all affected dataall affected data

• Reduces incorrectly identified or “lost” studiesReduces incorrectly identified or “lost” studies

RSNA 200219

Post-Processing Workflow ProfilePost-Processing Workflow Profile

Post-Proc.Post-Proc.WorkflowWorkflowManagerManager

PACS System

CAD*Workstation

ReportRepository

AcquisitionModality

3-D*Workstation

Work Status

WorklistWorklist

…

Source Data

Results

Workstation

Results

Work StatusWork Status

RSNA 200220

Simple Image & Numeric Reports ProfileSimple Image & Numeric Reports Profile

PACS

Images Retrieved

Preliminary Report

Verified Report

Report & Images Retrieved

Image Manager& Archive

ReportVerification

Images and Examdata presented for

diagnosis

Reports storedfor

Network Access

Report & ImageReview for

Patient Care

RSNA 200221

Charge Posting ProfileCharge Posting Profile

ChargeChargePosterPoster

*Billing System

CAD*Workstation

ReportRepository……

Report Generated / Signed

CADPerformed

PostCharges

AcquisitionModality

ADT Terminal

3-D*Workstation

Account Management

3-DPerformed

StudyPerformed

/ MaterialsUsed

RSNA 200222

What the Radiologist What the Radiologist Displays:Displays:

What the Reviewing What the Reviewing Physician Sees:Physician Sees:

The Radiologist’s Transformations Are

Saved

Original Image& Presentation State

Original Image

Window Level

Flip

Zoom

Area Of

Interest

Annotate

The Radiologist’s Transformations Are

Lost

Original Image

Area Of

Interest

Prepared Image

Original Image

Consistent Presentation of Images ProfileConsistent Presentation of Images Profile

RSNA 200223

MODALITY

Presentation of Grouped Procedures ProfilePresentation of Grouped Procedures ProfileRequested Procedure:

CHEST

Report:CHEST

Report:AB/PELVIS

Performs a single exam

Operatorgroups

2 procedures

Chest Chest ViewView

RIS / PACS

Requested Procedure:AB/PELVIS

Chest Chest ViewView

Ab/Pelvis Ab/Pelvis ViewView

Ab/Pelvis Ab/Pelvis ViewView

RSNA 200224

RadiologistRadiologistFlags Images:Flags Images:

Referring PhysicianReferring PhysicianSees Key Images First:Sees Key Images First:

for refering physicianThis image showsthe renal rupture.

Note1

for refering physicianThis image has the hematoma.

Note2

For referringphysician:This image showsthe renal rupture.

Note1

For referring physician:This image hasthe hematoma.

Note2

for refering physicianThis image showsthe renal rupture.

Note1

for refering physicianThis image has the hematoma.

Note2

Study & Key Image Notes

Key Image Notes ProfileKey Image Notes Profile

RSNA 200225

Access to Radiology Information ProfileAccess to Radiology Information Profile

Radiology Department – Images and

Reports

Emergency Department

Referring Physician

Other Departments:- Oncology- Surgery- Neurology- Pediatrics- etc.

Remote Clinics

Electronic Medical Record

RSNA 200226

Basic Security ProfileBasic Security Profile

AuditAuditRecordRecord

RepositoryRepository

……

Image Manager& Archive

“Images Queried / Retrieved”

DiagnosticWorkstation

ReportRepository

……

Report & ImageReview

“Reports Queried / Retrieved”

“Images Printed”“Reports Stored”

“Reports Retrieved” “Reports Printed”

RSNA 200227

ResourcesResources

• www.rsna.org/IHEwww.rsna.org/IHE

• FAQsFAQs

• Integration ProfilesIntegration Profiles

• Primer on IHEPrimer on IHE

• PresentationsPresentations

• IHE Technical FrameworkIHE Technical Framework

RSNA 200228

Questions?Questions?

Ask your vendorsAsk your vendors: :

Which IHE Profiles do they support on which systems?Which IHE Profiles do they support on which systems?

www.rsna.org/IHE