1RSNA 2005

Christoph Dickmann – Member IHE Rad TC

Charles Parisot – Co-chair IHE IT-I TC

Image-enabled Health Records:IHE Progress and Plans

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

RSNA 20052

Pragmatic definition of EHRPragmatic definition of EHR

Integrated data and workflow– Multimedia data access

text, image, waveform, … – Communication among stakeholders

clinicians, caregivers, consumers, …

Support different views of data– Clinical records

Details: episode, visit, study– Longitudinal records

Summaries: episode, visit

Cross-department or cross-enterprise users

Linking summaries and clinical details

RSNA 20053

Business need: share Radiology Business need: share Radiology Reports and ImagesReports and Images

Enterprise A

Enterprise B

Physician Office

• Between Radiology andBetween Radiology and• imaging specialistsimaging specialists• non-imaging professionalsnon-imaging professionals

• Between enterprisesBetween enterprisesPACS B

PACS A

Radiology -to-Radiology

Radiology -to-Physicians

PACS C

• Within an enterpriseWithin an enterprise• By network or By network or media media

RSNA 20054

EHR goals in IHEEHR goals in IHE(compatible with U.S. NHII goals)(compatible with U.S. NHII goals)

Informed Clinical Practice– IHE integrates clinical data and functions for an EHR

Interconnected Clinicians– Beyond the department: community or regional scope

Personalized Care– Web-based data access and summary data

Support for higher-level goals– Better outcomes– Increased patient safety– More efficient healthcare operations

RSNA 20055

EHR complexityEHR complexity

Business dilemmas– Significant, long-term investment – Investors may not be main beneficiaries

Coordination and cooperation– Active collaboration among multiple stakeholders– Identify and work out commonalities and barriers

Integration and interoperability– Implement existing standards– Develop additional standards

Evolutionary system specification (system of systems)

RSNA 20056

Focus: Image-enabled EHRFocus: Image-enabled EHR(connect two “worlds”)(connect two “worlds”)

Non-imaging data– Patient data– Clinical data

Laboratory results Surgery reports Prescriptions, meds Letters or notes

Integrate with imaging data and processes

Imaging data– Patient data– Images and evidence

Radiology Cardiology Nuclear Medicine

Integrate with non-imaging data and processes

RSNA 20057

Potential use cases of an Potential use cases of an image-enabled EHRimage-enabled EHR

Using images Neurologist: reviewing

stroke patient transfer to ward

Nurse: preparing GI ward round for Dr. X

GP: seeing a post-MI patient after hospital discharge

Patient: preparing an obstetric visit

Producing images/ evidence Cardiologist: during catheter

intervention Radiologist: starting an

abdomen CT Physician: counseling at

diabetes outpatient clinic Oncologist: planning

radiotherapy

Information need may include current or longitudinal evidence

RSNA 20058

Image-enabled EHRImage-enabled EHRPregnancy outpatient clinics encounterPregnancy outpatient clinics encounter

acquireevaluate

index

Image/ ReportRepository

storenew data

Ultrasound reportand images

DocumentRegistry

register

(XDS architecture)

RSNA 20059

Image-enabled EHRImage-enabled EHRChildbirth inpatient stayChildbirth inpatient stay

registerindex

evaluate

DocumentRegistry

Image/ Report/ Document

Repositories

index

query

retrieve

DocumentRepository

storenew data

Report, letters(incl. images)

(XDS architecture)

RSNA 200510

Sharing Imaging Documents Sharing Imaging Documents (XDS-I)(XDS-I)

Document Registry

Register report & image references

Retrieve selected imaging report references

Radiologydepartment

patient

Query for re-ports

Documentavailability

Shared re- pository

Onco-logist

GP(follow-up)

Images, report(PACS, RIS) report

Longitudinal record system: across encounters

Care record sys-tems: specific care deliveryRetrieve

How does XDS-I work? “What is new in IHE”

RSNA 200511

IHE contributions to EHR IHE contributions to EHR implementationimplementation

IHE Laboratory1 Int. Profile

IHE Radiology7 Int. Profiles

EHR realization

IHE IT Infrastructure8 Int. Profiles

Each TF can contribute to EHR scenarios with Integration Profiles for• Data access• Workflow

IHE Cardiology4 Int. Profiles IHE Pat. Care Coord.

1 Int. Profile

RSNA 200512

Basic requirements of EHR Basic requirements of EHR systemssystems

Integrated healthcare provider systems– EHR sources/ users, user interaction

Document handling– Storage and retrieval of EHR documents

Infrastructure services– Basic data and application integration

Network– EHR storage, inquiry, and retrieval path

RSNA 200513

DesktopIntegrationas an EHR enabler

Backend integration (services, data)

EHR interoperability examplesEHR interoperability examples

Appl. 1

Appl. 2

Appl. 3

Patient identifier matching

Common person data or services

Samepatient selected

Patientdemographics

Source 1

Source 2

Personnel/staff data

Any user Single

sign on

RSNA 200514

IHE - common interoperability IHE - common interoperability servicesservices

Common patient identification (ITI PIX) Common patient demographics (ITI PDQ) Desktop integration (ITI PSA)

Running applications work on the same patient Single sign on (ITI EUA,

XUA) Enterprise-wide or cross-enterprise user handling

Security and privacy (ITI/ RAD ATNA, DSG)Accountability, document integrity

Common staff data (ITI PWP)Health professionals are commonly recognizedFundamental enablers of cross-system health record system functions.

Gradual enhancement and combination is the key.

RSNA 200515

IHE – documents for general IHE – documents for general purpose EHR functions purpose EHR functions

Cross-Enterprise Document Sharing for Imaging (XDS-I)Share DICOM instances via web or DICOM connection;share imaging information via web

Cross-Enterprise Document Sharing (ITI XDS)Store & retrieve documents and summaries (focus: longitudinal data)

Notification of Document Availability (ITI NAV)Send notification/ reference to new shared documents

Retrieve Information for Display (ITI RID)Query and retrieve documents and summaries/ lists

Needs common services as a basis (e.g. security, patient identification)

RSNA 200516

IHE - Radiology images and IHE - Radiology images and reports for an EHR systemreports for an EHR system

Access to Radiology (Rad ARI)Retrieve diagnostic quality images, evidence, reports

Simple Image and Numeric Reports (Rad SINR)Access or export reports and related images

Key Image Notes (Rad KIN)Mark, annotate, retrieve selected imaging evidence

Portable Data for Imaging (Rad PDI)Export/ import/ view media data

Nuclear Medicine Image (Rad NM Image)Capture and use complex NM result screens

RSNA 200517

IHE – Cardiology IHE – Cardiology images and images and reports for an EHR systemreports for an EHR system

Cardiac Catheterization / Echo Workflow (CATH, ECHO)Retrieve catheterization and echocardiography imaging evidence

Retrieve ECG for Display (Card ECG)Retrieve ECG summaries and results

Displayable Reports (Card DRPT)Create and access reports for viewing

RSNA 200518

IHE - clinical/ textual information IHE - clinical/ textual information for an EHR systemfor an EHR system

Simple Image and Numeric Reports (Rad SINR)Access original or exported reports

Cross-Enterprise Document Sharing (ITI XDS) Cross-Enterprise Doc. Sharing for Imaging (Rad XDS-I)Store & retrieve documents, summaries or reports with longitudinal data

Retrieve Information for Display (ITI RID) Access documents and summaries (e.g. imaging, lab, discharge, medications, prescriptions)

Lab Scheduled WorkflowNotification of laboratory results

RSNA 200519

IHE - workflow / patient IHE - workflow / patient management supportmanagement support

Workflow integration (Rad, Card)– Scheduled Workflow

Ordering, scheduling and tracking of image acquisition steps Appointment tracking to order placer

– Reporting Workflow Scheduling and tracking of report creation tasks

Patient data integration (Rad, Card, ITI)– Patient Information Reconciliation

Modification and matching of patient data and imaging evidence– Patient Administration Management

Creating and changing patient identifiers and encounter data Overall concept (Rad whitepaper)

– Departmental workflow and interfaces to the enterprise

RSNA 200520

Planned IHE developmentPlanned IHE development

Harmonize IHE domain-specific workExtend XDS’ document contentCode sets and master filesRealize overall workflow conceptConfiguration supportSecurity details, e.g. access control

RSNA 200521

Image-enabled EHR – IHE Image-enabled EHR – IHE progress and plansprogress and plans

IHE Integration Profiles from different domains can be combined

Combinations of current profiles can cover many EHR scenarios– Information integration (imaging, textual)– Enhanced functionality beyond one department– Intra- and cross enterprise communication

Scenarios enable system evolution(organizational change management not to be forgotten)

IHE ensures integration testing and future Integration Profile development

22RSNA 2005

Thank you!Thank you!

Questions?Questions?

More information: http://www.ihe.net