1September, 2005 What IHE Delivers

Chris Lindop Chris Lindop , GE Healthcare GE Healthcare Co-chair, IHE Radiology Planning CommitteeCo-chair, IHE Radiology Planning Committee

RadiologyRadiology

2008 Update2008 Update

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An Incremental Multi-Year ProjectAn Incremental Multi-Year ProjectLaunched in 1998Launched in 1998

Goal:Goal:

Enhance the Access to Clinical InformationEnhance the Access to Clinical Information Ensure Continuity and Integrity of Patient InformationEnsure Continuity and Integrity of Patient Information Speed Up the Integration in Healthcare EnvironmentsSpeed Up the Integration in Healthcare Environments Fosters Communication Between Vendors ofFosters Communication Between Vendors of

Medical Information TechnologyMedical Information Technology

ProveProve that that IntegrationIntegration is Attainable is Attainable Based on StandardsBased on Standards

Participants:Participants:

Representatives of Healthcare Providers Representatives of Healthcare Providers Information Systems VendorsInformation Systems Vendors Imaging Systems VendorsImaging Systems Vendors Standardization GroupsStandardization Groups

The IHE Initiative

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IHE RadiologyIHE Radiology

Scope: Scope: Radiology including Nuclear Medicine, MammographyRadiology including Nuclear Medicine, Mammography

VendorsVendors Acquisition Modalities, RIS, PACS, Workstations, Displays, PrintersAcquisition Modalities, RIS, PACS, Workstations, Displays, Printers

Established 1998 (first IHE domain)Established 1998 (first IHE domain)

Sponsor: RSNASponsor: RSNA

Supporters: COCIR, DRG, EAR, ECR, EuroPACS, Supporters: COCIR, DRG, EAR, ECR, EuroPACS, GMSIH, JIRA, JAHIS, JRS, JSRT, METI, MEDIS-DC, GMSIH, JIRA, JAHIS, JRS, JSRT, METI, MEDIS-DC, SFR, SIRM SFR, SIRM

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IHE Radiology - AchievementsIHE Radiology - AchievementsNow entering 10th yearNow entering 10th year Robust Vendor Participation at ConnectathonsRobust Vendor Participation at Connectathons Over 200 IHE Integration Statements published Over 200 IHE Integration Statements published Over 1000 Actors in Radiology implementedOver 1000 Actors in Radiology implemented IHE Profiles appearing in User Purchasing ProcessesIHE Profiles appearing in User Purchasing Processes

Have addressed basic radiology workflowsHave addressed basic radiology workflows Acquisition, Post-Processing, Reporting, Teaching Files/Clinical TrialsAcquisition, Post-Processing, Reporting, Teaching Files/Clinical Trials

Have addressed imaging content handlingHave addressed imaging content handling Measurements, CAD Results, NM, Mammo, Presentation States, Reports, Measurements, CAD Results, NM, Mammo, Presentation States, Reports,

Key Image NotesKey Image Notes

Have addressed distribution of imaging informationHave addressed distribution of imaging information on CDs, to enterprise, to EHRs, keeping Audit Trails on CDs, to enterprise, to EHRs, keeping Audit Trails

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IHE Radiology – Recent Development ActivitiesIHE Radiology – Recent Development ActivitiesExpand focus to integration and workflow Expand focus to integration and workflow spanningspanning departments/enterprises/regionsdepartments/enterprises/regions Teaching Files and Clinical Export***Teaching Files and Clinical Export*** Scheduled Workflow II****Scheduled Workflow II**** PDI-large image set option****PDI-large image set option****

Expand focus to Quality Initiatives in RadiologyExpand focus to Quality Initiatives in Radiology Radiation Emission Monitoring (REM) *Radiation Emission Monitoring (REM) *

Focused support for specialtiesFocused support for specialties Modality Acquisition Workflow *Modality Acquisition Workflow * NM Image Cardiology Option **NM Image Cardiology Option ** Image Fusion **Image Fusion **

** Approved for Trial Implementation 2008/09 Approved for Trial Implementation 2008/09

**** Carried over for Trial Implementation in 2008/09 Carried over for Trial Implementation in 2008/09

*** *** Approved for release in Technical Framework V9.0 Approved for release in Technical Framework V9.0

**** Strategic - to be carried over in next Development cycle**** Strategic - to be carried over in next Development cycle

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Connectathon StatusConnectathon StatusNorth AmericanNorth American Jan 28 – Feb 1, Chicago, ILJan 28 – Feb 1, Chicago, IL 70 Vendors, 136 products70 Vendors, 136 products

JapanJapan February, Tokyo, JapanFebruary, Tokyo, Japan 36 Vendors, 60 systems36 Vendors, 60 systems

EuropeEurope 20-26 April, Oxford, England20-26 April, Oxford, England 72 Vendors, 120 products72 Vendors, 120 products

ChinaChina May, BeijingMay, Beijing

AustraliaAustralia July, SydneyJuly, Sydney

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Radiology ProfilesRadiology Profiles

Access to Radiology Information

-

ConsistentPresentation

of Images

EvidenceDocument

KeyImageNotes

Simple Image & Numeric Reports

Presentation of

Grouped Procedures

Post-Processing Workflow

Reporting Workflow

Charge Posting

Patien

t Info

. Reco

nciliatio

n

Scheduled Workflow

Portable Data for Imaging

Mammo-graphy

Image

Audit Trail & Node Authentication – Radiology Option

Image Fusion

Teaching Files & Clinical Export

Import Reconcil-

iation Workflow

Cross-Enterprise Document Sharing for Imaging

NMImageCard

Option

Radiation Emission

Monitoring

Mammo-graphy

Acquisition Workflow

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IHE Radiology – Integration ProfilesIHE Radiology – Integration ProfilesWorkflow

Scheduled Workflow

Patient Information Reconciliation

Post-Processing Workflow

Reporting Workflow

Import Reconciliation Workflow

Mammography Acquisition Workflow**

Infrastructure

Access to Radiology Information

Portable Data for Imaging

Cross-Enterprise Data Sharing for Images

Security: Audit Trails & Node Authentication

Charge Posting

Teaching Files & Clinical Trials Export

Presentation & ContentConsistent Presentation of Images

Key Image Notes

Image Fusion **

Presentation of Grouped Procedure

Evidence Documents

Simple Image & Numeric Reports

NM Image*

Mammography Image

Radiation Emission Monitoring**

* Cardiology Option – in Trial Implementation* Cardiology Option – in Trial Implementation** in Trial Implementation** in Trial Implementation

Publications

Radiology Users Guide

Mammography Users Guide

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2008 Trial Implementation Profiles2008 Trial Implementation Profiles

Radiation Emmission MonitoringRadiation Emmission Monitoring

Mammography Acquisition WorkflowMammography Acquisition Workflow

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Dose ReportingDose Reporting

Facilitates the collection and distribution of reports detailing patient radiation exposure resulting from imaging procedures.

Retrieve Dose Information

Query Dose Information

PerformStudy 

Submit Dose Information

Prepare Monthly Submission 

Store Dose Information (CT)

Store Dose Information (XR)

Retrieve Dose Information

Query Dose Information

Generate Weekly Reports 

. . .

Acquisition Modality 1

(XR)

Image Archive

Dose Information

Monitor

Dose Registry 

Acquisition Modality 2

(CT)

. . .

Initiate Weekly Report Task 

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Mammography Acquisition Workflow (MAWF)Mammography Acquisition Workflow (MAWF)

MAWF addresses specific Digital XR MAWF addresses specific Digital XR Mammo Workflow issues:Mammo Workflow issues:

• High ThroughputHigh Throughput• Screening vs. diagnostic acquisition contextScreening vs. diagnostic acquisition context• Procedure conversion done at acquisition Procedure conversion done at acquisition

– screening -> diagnostic, self referralscreening -> diagnostic, self referral

MAWF leverages existing profiles and options of IHE MAWF leverages existing profiles and options of IHE (SWF, KIN)(SWF, KIN)

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MAWF – Use cases overviewMAWF – Use cases overview

3 main uses:3 main uses:• Procedure error or modificationProcedure error or modification• Finish an exam with supplemental viewsFinish an exam with supplemental views• Correct / Remove images at modality or workstationCorrect / Remove images at modality or workstation

Each use case drives new requirements for each Each use case drives new requirements for each actor of the radiology department: actor of the radiology department:

• Acquisition modalities, Acquisition modalities, • DSS/OFs (RIS) DSS/OFs (RIS) • Image managers/archives (PACS)Image managers/archives (PACS)• Image displays (Workstations)Image displays (Workstations)

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Use of coded valuesUse of coded values

IHE provides baseline ofIHE provides baseline of codes codes

MAWF uses cases rely onMAWF uses cases rely on extensive use of codes (incl. extensive use of codes (incl. Assisted protocol setting and Assisted protocol setting and exception management)exception management)

Codes are configurable on a enterprise basisCodes are configurable on a enterprise basis

Codes allow for a better workflow integration and exception Codes allow for a better workflow integration and exception cases (see previous uses cases)cases (see previous uses cases)

Coding Scheme Designator (0008,0102)

Code Value (0008,0100)

Code Meaning (0008,0104)

IHERADTF MAWF0001 Screening Mammography, bilateral

IHERADTF MAWF0002 Screening Mammography, left

IHERADTF MAWF0003 Screening Mammography, right

IHERADTF MAWF0004 Diagnostic Mammography, bilateral

IHERADTF MAWF0005 Diagnostic Mammography, left

IHERADTF MAWF0006 Diagnostic Mammography, right

IHERADTF MAWF0007 Mammary Ductogram, Single Duct

IHERADTF MAWF0008 Mammary Ductogram, Multiple Ducts

IHERADTF MAWF0009 Mammogram for clip placement, bilateral

IHERADTF MAWF0010 Mammogram for clip placement, left

IHERADTF MAWF0011 Mammogram for clip placement, right

IHERADTF MAWF0012 Needle Localization, Image Guided, Mammography, bilateral

IHERADTF MAWF0013 Needle Localization, Image Guided, Mammography, left

IHERADTF MAWF0014 Needle Localization, Image Guided, Mammography, right

IHERADTF MAWF0015 Stereotactic Biopsy, Image Guidance, bilateral

IHERADTF MAWF0016 Stereotactic Biopsy, Image Guidance, left

IHERADTF MAWF0017 Stereotactic Biopsy, Image Guidance, right

IHERADTF MAWF0018 Breast Specimen Mammography, bilateral

IHERADTF MAWF0019 Breast Specimen Mammography, left

IHERADTF MAWF0020 Breast Specimen Mammography, right

IHERADTF MAWF0021 Quality Control, Mammography

IHERADTF MAWF0022 Additional Mammography Views

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2008 Development Schedule2008 Development ScheduleTimeframe Activity Scheduled Location

2007

Aug. Submit Brief Profile Proposals to Planning Committee (PC) by Aug 31 E-mail

Sept. PC Selects "Short List" of Proposals Sept 4 T-Con

Sept. PC Drafts Detailed Profile Proposals for "Short Listed" Proposals by Sept 14 E-mail

Oct. TC Completes technical review of Detailed Proposals T-Con

Oct. PC makes Final Selection of Proposals for this year Oct 24 T-Con

Nov. TC Profile development kickoff meeting Nov. 5-7 Chicago

2008

Jan. TC Finalizes profile supplements for public comment Feb 4-7 Chicago

Feb. Publication of Public Comment Supplements approx. Feb 27 www.ihe.net

Mar. Deadline for submission of public comments on profile supplements approx. Mar 27 www.ihe.net

Mar. TC reconciles public comments Mar 31-Apr 2 Chicago

Jun. Publication of Trial Implementation Supplements www.ihe.net

Jun. Publication of Final Text Technical Framework www.ihe.net

2009

Jan. First Test implementations at Connectathon Chicago

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Strategic Profile Development for 2008Strategic Profile Development for 2008

PDI – Large Data Sets (DVD/USB media)PDI – Large Data Sets (DVD/USB media)

Scheduled Workflow II (Volume 1 only)Scheduled Workflow II (Volume 1 only)

Profiles not yet released!Profiles not yet released!

Development is still in progressDevelopment is still in progress

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MediaCreator

Printer[Media Reader]

Image Display[Media Reader]

PACS[Media Importer]

CD DVD*USB*

John DoeDICOM Data

Web Data(Optional)

DICOM

DICOM

DICOM

PC BrowserWeb Data

Required to cleanup Patient ID, Acc#, etc.

Portable Data for ImagingPortable Data for Imaging

* New Option

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Scheduled Workflow IIScheduled Workflow II

Scheduled Workflow ScopeScheduled Workflow Scope Volume 1 onlyVolume 1 only PAM AdoptionPAM Adoption Use of Current HL-7 Version (v 2.5)Use of Current HL-7 Version (v 2.5) Options ReviewOptions Review

• Incorporate, remove or maintain statusIncorporate, remove or maintain status Actor EvaluationActor Evaluation

• ExamplesExamples– MPPS Mgr – is it neededMPPS Mgr – is it needed– Image Archive/Manager should they be grouped?Image Archive/Manager should they be grouped?

TransactionsTransactions• ExamplesExamples

– Image availability QueryImage availability Query

Profile Grouping Profile Grouping • Incorporate PIRIncorporate PIR

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Strategic Profile Deployment for 2008Strategic Profile Deployment for 2008

Global Deployment priorityGlobal Deployment priority PDIPDI XDS-IXDS-I

for North America for North America TCETCE

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PDI Use Case for External AcquisitionPDI Use Case for External Acquisition

Radiology Enterprise A

Radiology Enterprise B

Provider A

Radiology Site B

PACS A

Portable Data Creator Patient Data

2. Radiology Site B creates portable media with patient images

1. Provider A orders External Radiology Procedure

3. Portable Media is sent to Reading Site A via CD. Patient Data is imported and read.

4. Study Results sent to Provider

Radiologist

PDI Disk

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Radiology Enterprise B

Radiology Enterprise A

PACS B

Portable Data Creator

Patient Data

2.Relevant Data (including film) is collected and Enterprise A creates portable media with patient’s radiology information.

1. Request for Patient’s case data to be transferred from Enterprise A to B.

3.Data is transported to Site B via CD. Patient Demographics are reconciled and data is imported into archive.

4. Patient Data is now associated with B’s electronic health record system.

PDI Use Case for Patient ReferralPDI Use Case for Patient Referral

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XDS-I Actors and TransactionsXDS-I Actors and Transactions

Document Consumer

Retrieve Document

Query Documents

Patient Identity Source

Patient Identity Feed

Imaging Document Source

Document Registry

Document Repository

Provide & RegisterDocument Set

RegisterDocument Set

Imaging Document Consumer

Retrieve Images

Retrieve Presentation StatesRetrieve Key Image NoteRetrieve Evidence DocumentsWADO Retrieve

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Teaching File & Clinical Trail ExportTeaching File & Clinical Trail Export

Priority Profile for IHE USA

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ParticipatingParticipatingVendorsVendors Implement IHE Profiles in your productsImplement IHE Profiles in your products Test your products at the IHE ConnectathonTest your products at the IHE Connectathon Publish IHE Integration StatementsPublish IHE Integration Statements

UsersUsers Learn about the IHE ProfilesLearn about the IHE Profiles Include specific IHE Profiles in your RFPsInclude specific IHE Profiles in your RFPs

IHE ProcessIHE Process Review Draft Profiles during Public Comment phaseReview Draft Profiles during Public Comment phase Participate on CommitteesParticipate on Committees

• Radiology Planning Committee: Radiology Planning Committee: – Kevin O’Donnell (Toshiba) & Chris Lindop (GE Healthcare)Kevin O’Donnell (Toshiba) & Chris Lindop (GE Healthcare)

• Radiology Technical Committee: Radiology Technical Committee: – Cindy Levy ( Cedara)Cindy Levy ( Cedara)

• Chris Carr (RSNA) – ihe@rsna.orgChris Carr (RSNA) – ihe@rsna.org

24September, 2005 What IHE Delivers