rsna/himss integrating the healthcare enterprise the ihe initiative worldwide – an update nikolaus...

RSNA/HIMSS

Integrating the Healthcare Enterprise

The IHE Initiative Worldwide – An Update

• Nikolaus Wirsz, PhDSiemens Medical Solutions – IHE Radiology Planning Committee

• Emmanuel CordonnierETIAM – IHE Europe Committee Industry Co-Chairman

• Minoru Hosoba, PhDKyoto College of Medical Technology – Vice-Chairman of IHE Japan Strategic Planning

Committee

• Prof. Hee-Joung Kim, PhDYonsei University College of Health Science/Medicine – President of IHE Korea

• Prof. David Koff, MDSunnybrook and Women's College, Toronto – IHE Canada Committee

• Xinrong Chen et al.Director of IHE China Steering Committee

2IHE Classroom Sessions – RSNA 2005

Integration Solutions Available Today fromMedical Systems Vendors – BUT ...

Common Problems of Modern Healthcare Enterprises – in All Countries:(In Spite of IT Standards and Advanced Technology)– Lack of Access to Complete Medical Information– Inconsistent Medical Information

Across Departments and Institutions– Inadequate Communicating of Medical Data

Across Multiple Systems from Different Vendors– Risky Investments in Proprietary Solutions

Challenges of Integration


An Incremental Multi-Year ProjectLaunched in 1998 by RSNA & HIMSS

Enhance the Access to Clinical Information Ensure Continuity and Integrity of Patient Information Speed Up the Integration in Healthcare Environments Foster Communication Between Vendors of

Medical Information Technology Prove that Integration is Attainable Based on Standards Participants:

– Representatives of Healthcare Providers– Information Systems Vendors– Imaging Systems Vendors– Standardization Groups

The IHE Initiative


HIMSS / RSNA IHE Kick-Off Workshop October 13-14, 1998


IHE Progress: Year 1 – 7 (1999 – 2005)Y

ear

1 (1

999)

Yea

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(200

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Radiology

IT Infrastructure for Healthcare

Cardiology

Laboratory

Radiation Oncology

Patient Care Coordination

Patient Care Devices

Pathology

Pharmacy

IHE DevelopmentsIntegration Profiles – Solutions to Real-World Needs & Problems:• Within clinical departments &• Across departmental / institutional boundaries

Prove of Concept• Connectathons – Cross-Vendor Tests in North-America, Europe and Asia• Demonstrations

• 24 Vendors 60+ Vendors• 35 Systems 100+Systems

France

Germany

Italy

Japan

UK

Canada

Korea

Taiwan

Norway

Holland

Spain

ChinaInternational Adoption


Patient Information

Reconciliat

ion

Reconcile worklists,

status, and data objects for unknown

patients and demographics

changes

Access to Radiology Information - Consistent access to images and reports

Consistent Presentation

of ImagesManage, retrieve &

use objects for hardcopy and

softcopy grayscale presentation states

Key Image Notes

Create, store, manage, retrieve & use objects to flag significant

images

Simple Image and Numeric

ReportsManage simple

diagnostic reports with

optional images,

measurements

Scheduled Workflow

Presentation of Grouped ProcsManage individual procedure image subsets from a multi-procedure acquisition for

viewing & reporting

Charge Posting

Collect and post timely billable

procedure details

ITI ATNA – Radiology Option (Replaces Basic Security)

Reporting Workflow

Manage worklists, track status, perform

& notify diagnostic

reporting steps

Evidence Documents

Manage, retrieve & use

objects to record study

evidence

Manage worklists, track status, perform & notify image processing & CAD steps

Post-Processing Workflow

Manage worklists, track status, perform

& notify acquisition

related step,

create, store,

manage, retrieve &

use images

NM Image

Create, store, manage,

retrieve & use NM image objects

Portable Data for Imaging - Consistent access to images and reports on CD Media

Admit, Order, Schedule

Teaching Files & Clinical

Trials Export

Standardize Clinical Trial Data

and Anonymization

XDS for Imaging - Sharing of Imaging Information across health enterprises

IHE Success: Integration ProfilesSolutions to Real-World Problems in RadiologyWorkflows Billing

Teaching/Trials

Contents & Display

Common Infrastructure


Integration is Needed Everywhere

Integration, Interoperability and Workflow Optimization are Global Issues NOT Local Needs

IHE has had an international vision from the beginning

IHE is promoting its adoption worldwide

IHE encourages the formation of national and regional initiatives to address local healthcare needs


International Scope of the IHE Initiative

Providing a Global Integration Framework:– Identify Common Integration Requirements– Define Generic Solutions (Integration Profiles) to Solve Real-World

Problems– Specify the Details for Implementing the IHE Solutions

Selection of Established Standards for Specifying Systems Functionality and Transactions for Information Exchange (e.g. DICOM, HL7, …)

Providing a Generic Technical Framework to Address the Vast Majority of Implementation Issues


National Scope of the IHE Initiatives inNorth America – Europe – Asia

Address Specific Needs of National Healthcare Systems According to:

– Local Policies and Practices– Support for Native Languages– National Reimbursement Procedures

Manage Regional Cross-Vendor Tests (Connectathons)

Organize Demonstrations at National Venues

Promote IHE User Success Stories of Local Sites

Organize Educational Events to Raise Awareness and Acceptance of IHE


The IHE Radiology Technical FrameworkThe IHE Radiology Technical Framework

Common Definitions – Overall Integration in Healthcare:– High-Level Description of Integration Profiles – Volume I– Detailed Implementation Specification – Volumes II and

III

National Extensions – Volume IVExamples:– Character Sets for National Languages– Extensions of Patient and Provider Information According to

National Policies (Privacy, Confidentiality, …)– Financial Information and Transactions for

Specific National Health Reimbursement System– Clinical Workflow Optimization and Information Access to

Support National Care Practices and Policies

Addressing Global & National Integration Needs


Global Development

Radiology

Cardiology

ITInfrastructure

Patient CareCoordination

Patient CareDevices

Laboratory

Pathology

Pharmacy /Medication Admin

RadiationOncology

IHE Organizational Structure

ACCHIMSSRSNA

JAHISJIRAJRS

METI-MLHWMEDIS-DCJAMI

GMSIHSFRSFIL

SIRMBIREuroRec

COCIREAR-ECRDRG

ESCProfessional Societies / SponsorsProfessional Societies / Sponsors Contributing and participatingContributing and participating

VendorsVendors

IHE Europe

IHE North America

France

USA

Canada

IHE Asia-Oceania

Japan

Korea Taiwan

Netherlands

Spain Sweden UK

ItalyGermany

Norway

Regional Deployment

China

IHE (International) Strategic Development Committee


Updates from National IHE Initiatives

IHE Asia / Oceania IHE China IHE Japan IHE Korea

IHE Europe

IHE North America IHE Canada

RSNA/HIMSS

IHE Activities in ChinaIHE Activities in China

Xinrong Chen – Director of IHE China Steering CommitteeQiyong Fan – Director of IHE China Planning GroupGuokang Zhong – Director of IHE China Project GroupTianzhen Shen – Director of IHE China Auditing Group


Why IHE in ChinaWhy IHE in ChinaHealthcare IT – a huge market to be activated

in ChinaStandards are especially important for all

players in this domain– IHE is very useful for end users to do

benchmarking while selecting products– IHE brings standards to the market– China market needs IHE in Radiology, Cardiology,

Laboratory, Patient Care, Pathology etc. now.


IHE China Year 1 (2005) ReviewIHE China Year 1 (2005) Review

Establishing IHE China–2004.08.19 – First Meeting

for Establishing IHE China–2004.08.31 – Second Meeting

for Establishing IHE China–2004.09.15 – Third Meeting

for Establishing IHE China

2005.06.28 – IHE China Inaugural Meeting


IHE China OrganizationIHE China Organization

IHE

China

Steering

Committee

Technical

Group

Project

Group

Auditing

Group


Planned activities in IHE China Planned activities in IHE China Year 2 (2006) Year 2 (2006)

Education Workshop (February, 2006)Participant WorkshopMesa Tests

– Scheduled Workflow

Connectathon


Support from industry in IHE China

RSNA/HIMSS

Minoru Hosoba Ph.D.Minoru Hosoba Ph.D.Kyoto College of Medical TechnologyKyoto College of Medical Technology

Vice-Chair, IHE-J Strategic Planning CommitteeVice-Chair, IHE-J Strategic Planning Committee

Activity of IHE-Japan Activity of IHE-Japan


IHE-J Japanese Extension of the Technical frameworks

(Radiology ) based on:– JIRA &JAHIS JJ1017 Guideline ver.3.0

Adopted JJ1017 ver.3.0 code Descriptive code. 32 byte-coding system.

Expantion of Technical frameworks in new domain– Scheduled workflow profiles for endoscopic and

pathologic exams are being developed Integration Profiles for Cardiology and IT

infrastructure are being studied and reviewed if it might be applicable to clinical sites in Japan


IHE-J (continued)IHE-J (continued) Connectathon 2005

– Feb. 22 and 25– 25 companies and 48 systems participated

Demonstration 2005– Radiological field (CyberRad at JRC)– Medical informatics field (Hospital show and

JAMI) Implementation of IHE in hospitals in

Japan Publication of guide book

"Introduction to IHE"– April,2005, 245 pages


Endoscopy Scheduled WorkflowEndoscopy Scheduled Workflow (Draft Aug. 2005) (Draft Aug. 2005)

ADT

OrderPlacer

OrderFiller

AcquisitionModality

ImageManager

ImageArchive

ImageCreator

ImageDisplay

Pt.Registration Pt.Registration

Filler Order Management

Modality Worklist Provided

Procedure Scheduled

Modality PPS

PPS

PPS

Modality Image Stored

Storage Commitment

Creator PPS

Storage Commitment

Creator Image Stored

Query Images

①Placer Order Management

Pt.Update Pt.Update

Pt.Update

Image Availability Query

Retrieve Images

ReportManager

ReportCreator

ReportReader

ReportRepository

OrderManager

Patho OrderPlacer

Patho OrderFiller IHE Pathology

Accept specimens

Check images Ready

ImageDisplay

Order of Endoscopy accepted

Reporting finish

Patho Order Request ・ Patho Order No.

SpecimenManager

Modality Worklist Provided PPS

PPSManager

Blue: HL7 MessagesGreen: DICOM Messages

Endoscopy Reporting WF

Patho Order Request.

Patho Order No.


IHE-J Connectathon 2005IHE-J Connectathon 2005Basic

SecuritySEC

Presentaion of

GroupedProcedure

PGP

ChargePostingCHG

NuclearImageNM

Vendors AD

T

Ord

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DS

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Ord

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Mod

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1 ALOKA CO.,LTD. ● ●

2 EBM J apan ● △ ● ● ● ● △ ● ● ● ● ● ● ● ● △ ● ● ● ● ● ● ● ● ● ● ●

3 Infinit Technology ● ● ● ● ● ● ● ● △ ● ● △ ● ● ● ● ● ● ● ● ● ● ● ● ☆

4 INFOCOM CORPORATION ● ● ● ● ● ☆

5 SBS Information Systems ● ●

6 Canon Inc. ● ● ● ●

7 Goodman Co.,Ltd. ● ● ● ●

8 Climb Medical Systems ● ● ● ● ● ● ● ● ● ● ● ● ● ●

9 Konica Minolta Medical & Graphic ● ● ● ● ● ● ● ● ●

10 GE Yokogawa Medical Systems ● ● ● ● ● ● ● △ ● ● ● ● ● ● ● ●

11 J -MAC SYSTEM ● ● ● ●

12 Shimadzu Corporation ● ●

13 TechMatirix Corporation ● ●

14 Toshiba Medical Systems ● ● ● ● ●

15 Agfa Gevaert, J apan ● ●

16 Nihon Koden ● ● ●

17 NEC Corpration ●

18 Hitachi Computer Peripherals ● ●

19 Hitachi, Ltd. ● ●

20 Hitachi Medical ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ☆ ☆ ☆

21 Fujitsu Limited ● ● ● ● ● ●

22 FUJ IFILM MEDICAL ● ● ● ● ● ● ● ● ☆

23 Yokocawa Electric Corpration ● ●

ReportingWorkflow

RWFIHE- J Connectathon 2005

Results

Scheduled Workflow

SWF

Portable Data forImaging

PDI

Patient InformationReconciliation

PIR

Consistent Presentation ofImages

CPI

Key ImageNoteKIN

Simple Image &Numreric Report

SINR

Access toRadiology

InformationARI

Feb. 2004:Feb. 2004:20 companies and 33 systems participated20 companies and 33 systems participated

Feb. 2005:Feb. 2005:25 companies and 48 systems participated25 companies and 48 systems participated

Jan. 2006:Jan. 2006:29 companies and 60 systems will participate29 companies and 60 systems will participate


Guided TourGuided Tourin CyberRadin CyberRad

2005.4.8-102005.4.8-10

IHE-J DemonstrationIHE-J Demonstration


IHE-J ImplementationsIHE-J Implementations

Saitama Medical Center: March 2005Saitama Medical Center: March 2005 Fujita Health University Hospital: April 2005Fujita Health University Hospital: April 2005 Okazaki City Hospital: January 2006Okazaki City Hospital: January 2006 National Institute of Radiological Sciences National Institute of Radiological Sciences

(NIRS) Hospital: April 2006(NIRS) Hospital: April 2006


For more informationhttp://www.ihe-j.org

Dec.2005, the web site renewed– Japanese version, English version

Contents:– Schedule of the Meeting, Demonstration, Workshop etc.– Documents (Technical framework, Integration profiles, etc.)– Streaming video (The introduction to IHE)

Thank YouThank You

RSNA/HIMSS

IHE-KR Year2IHE-KR Year2

IHE KoreaHee-Joung Kim, Ph.D. ([email protected])

Yonsei University

Registration

Orders PlacedImage Managerand Archive


IHE-KR FoundationInaugural General Meeting

LG-POSCO, Korea Univ.(06/25/04)

President of IHE-KRHee-Joung Kim

President of KSOMIPresident of KPACS

URL for IHE-KRhttp://www.ihekorea.org


President

Vice-President

Office Audit

Steering Committee Technical Committee

총무이사 Infinitt 최승욱 이사

재무이사 한국의학물리학회 총무이사

홍보이사 Marotech 이진형 실장

대한의료정보학회 총무이사

대한 PACS 학회 총무이사

무선의료정보포럼 부회장

서울대 이경호 교수

LG CNS 손주영 수석

Samsung SDS 조성돈 수석

GE Healthcare 윤영욱 부장

Medical Standard 이원용 실장

위원장 연세대 정해조

부위원장 경북대 조 훈

경북대 김일곤

Infinitt 최승욱

LG CNS 황용돈

Samsung SDS 김도준

GE Healthcare 황용기

Marotech 이진형

중외메디칼 김한명

사이버메드 허원창

메드벤 고명자

루벤틱스 김태호

서울 C&J 권대근

현대정보기술 구전서

아그파 고희관

리스템 민진영

Technical Manager

연세대 강원석

IHE-KR OrgIHE-KR Org


IHE-KR Yr2 (2005)

Submission of MESA Test Results - 11/05/05

IHE-KR 05 Connectathon - 11/11/05

IHE Korea 05 Workshop - 07/08/04

IHE-KR 05 Demo at KSOMI - 11/18/05


IHE-KR Yr2 Workshop (2005)


IHE-KR Yr2 Connectathon IHE-KR Yr2 Connectathon SCENARIOSCENARIO

Patient #2: A man (Kil-Dong), 48 years old with hepatitis,

attended the Y hospital due to indigestion and icterus.

Physician suspects the liver cirrhosis and orders an

ultrasound examination with code of “Liver Ultrasound”.

Patient #1: A man (Min-Soo Kim), 35 years old with no

known medical problems and in good health, unfortunately,

had broken his left ankle and femur due to an auto-accident

at the road. He underwent orthopedic treatment at the Y

hospital. After treatment, physician orders X-ray with code of

“Ankle lateral” and “Femur AP” in order to follow up.

Radiographic Room #1, 2

Radiographic Room #3


Modality (DX)

Choong-Wae Medical Co.

DICOM MPPSDICOM Storage

DICOM Storage Commitment DICOM MPPSDICOM StorageDICOM Storage Commitment

DICOM MWL

DICOM MWL

DICOM Query

DICOM Retrieve

Radiographic Room 1

Modality (DX)

Phoenix Vision

Radiographic Room 2

Modality (US)

Medison

Radiographic Room 3

PACS Room Image

Mgr./Arch.MPPS Manager

Order Filler (Sim.)Infinitt

Technology

DICOM MWL

DICOM MPPSDICOM StorageDICOM Storage Commitment

Reading Room

Image Display

MevisysY Hospital

IHE-KR Yr2 Connectathon IHE-KR Yr2 Connectathon SCENARIOSCENARIO


IHE-KR Yr2 Connectathon (2005)IHE-KR Yr2 Connectathon (2005)


SWF

Acq

uisitio

n M

od

ality

Image

Arch

./Manag

er

PPS M

an

ag

er

Image D

ispla

y

MEDISON ●

Choong-Wae Medical ●

Phoenix Vision ●

MEVISYS ●

INFINITT Technology ● ●

Results: IHE-KR Connectathon

2005


www.ihekorea.orgwww.ihekorea.org

◈ ◈ LogoLogo ◈ ◈ HomepageHomepage

RSNA/HIMSS

IHE-Europe ReportIHE-Europe ReportIHE-Europe ReportIHE-Europe Report

Emmanuel CordonnierIHE-Europe Vendors co-chair

[email protected]


Expanding IHE in Europe

France, Germany, Italy, UK « running for years »

Real start of Netherlands and SpainNorway startingDemand from other Scandinavian

countries, Portugal and European East Countries


Official recognition of IHE in Europe

More and more national initiatives are referring to IHE: Italian Regional projects and National French projects…

Submission of an European research project « IHE Standardization of Health Care information sharing crossing borders between European clusters, region and languages »

Citation of IHE in the eHealth Forum initiative driven by the European Commission


Evolution of organization

Creation of official organizations (associations) in Germany, Italy and Spain

Replacement of Geerd Claeys – Agfa - (thanks to him) by Emmanuel Cordonnier – Etiam (/ Peter Kuenecke – Siemens after 12 months)

Proposal made by INRIA (3,500 employees) French research organization to consolidate IHE Europe management and working force


Participation to Participation to Technical FrameworkTechnical Framework

Leadership of IHE Laboratory (4 new profiles)Key contribution to IHE Cardiology – success of demo

at ESC StockholmLaunch of IHE Pathology (France & Spain)Active contribution to IT Infrastructure Patient

Administration Management (PAM)Launch of European contribution to PCCEmergence of IHE Pharmacy


2005 Connectathon2005 Connectathon

Well organized by IHE Netherlands in Noordwijkerhout (don’t try to pronounce it!)

62 companies, 98 + 1 + 2 systems230 engineers (average of 210 per day)15 project managers (including Steeve & Bill)Success of XDS (with off-line mode and Atna)30 workflow tests (10Radio, 7XDS-PIX, 2Lab,

4Cardio, 4UK), 1600 tests (1227 verified)


IHE-Europe 2006IHE-Europe 2006

The « Spain » year: workshop (February) and Connectathon (April) in Barcelona

Launch of cooperation with INRIA (6 months to define a cooperation agreement of stop)

Closer cooperation with European Commission and CEN (in PCC for example)

Contribution to IHE TFs (Lab, Pathology, PCC, ITI peer to peer exchange…)

RSNA/HIMSS

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

IHE CanadaAchievements 2005

David Koff MD


IHE Canada Founding ParticipantsIHE Canada Founding Participants

Update (Feb/05): AITS (Association de l’industrie des technologies de la Santé) joins IHE Canada


IHE Canada structureIHE Canada structure

IHE Canada activities are coordinated by a Strategic Steering Committee

Supported by several sub-committees:– Communication– Radiology– IT Infrastructure

Relies on volunteers from all healthcare sectors– Vendors – Users– Administrators– Government


Goals of IHE CanadaGoals of IHE Canada

Improve the efficiency and effectiveness of clinical practice

Foster collaboration among vendors, purchasers and providers

Promote and accelerate interoperability across healthcare domains and build foundation for the EHR

Demonstrate that system integration within and across healthcare enterprises is attainable when based on implementable standards

Educate stakeholders on the benefits of adopting standards-based solutions

Develop Canadian extensions to IHE integration profiles

Participate and possibly lead the definition of new IHE specifications


National EHRNational EHR

Important complement to Infoway activities and the Pan-Canadian standards initiatives by:– Ensuring completeness and eliminating

ambiguities on specifications– Demonstrating applicability and usability of

interoperability profiles– Promoting international awareness of

requirements for a national EHR


National ExtensionsNational Extensions

Character sets for National Languages Extensions of patient and provider

Information to support EHRS requirements (Privacy, Confidentiality, Unique Patient ID…)

The National Extensions are ready to be submitted to IHE global for inclusion in Part IV of the Technical Frameworks.


XDS-IXDS-I

All jurisdictions across Canada recognize the necessity and benefit of sharing imaging information among healthcare professionals. In addition, there is wide acceptance that DI information is seen as a core data component of the electronic health record.


XDS-IXDS-I

Development of the profile was based on a common set of “process flows” that reflect use case scenarios encountered in the Canadian healthcare setting. These scenarios address the DI information sharing between all health professionals and geographic locations.

The process flows and use case scenarios were developed by the IHE Radiology Technical Committee and vetted by the pCSG for DI/Teleradiology. As such, the interoperability profile is clinically relevant.


XDS-IXDS-I

Definition of DI document types to be supported

Development of x-enterprise (EHR) use cases

Selection of registration and retrieval protocols (DICOM-WADO, ebXML)

Extension to XDS registry metadata


XDS-IXDS-I

In complement of XDS-I, have been developed:An up-date of the toolkit to enable

testing of XDS-I at the next Connectathon.

XDS-I use cases which have been submitted to IHE global.


Future developmentsFuture developments

The IT infrastructure planning committee has submitted to IHE Global a proposal for a new profile : Client Registry using HL7 V3.

Imagination: a new Canadian forum to promote the sharing of information and knowledge.


The IHE Initiative Worldwide – An The IHE Initiative Worldwide – An UpdateUpdate

Questions ?Questions ? IHE Main Web Site:

http://www.IHE.net

IHE Canada:http://www.ihe-canada.com

IHE Europe:http://www.IHE-Europe.org

IHE Japan:http://www. ihe-j.org

IHE Korea:http://www.ihekorea.org/

IHE Taiwan:http://www.dicom.org.tw

• Emmanuel CordonnierETIAMIHE Europe Committee Industry Co-Chairman

• Minoru Hosoba, PhDKyoto College of Medical TechnologyVice-Chairman of IHE Japan Strategic Committee

• Prof. Hee-Joung Kim, PhDYonsei University College of Health SciencePresident of IHE Korea

• David Koff, MDSunnybrook and Women's College, TorontoIHE Canada Committee

• Xinrong Chen et al.Director of IHE China Steering Committee

• Nikolaus Wirsz, PhDSiemens Medical SolutionsIHE Radiology Planning Committee

IHE International Meeting

Tuesday – November 29, 20059:00AM – 3:00PM

Room E271AIHE Asia-Oceania Meeting

Tuesday – November 29, 20054:00PM – 6:00PM

Room E257