1September, 2005 What IHE Delivers

Purchasing & IntegratingPurchasing & IntegratingRadiology SystemsRadiology Systems

Using IHE: Using IHE:

A Tutorial & A Real-world CaseA Tutorial & A Real-world Case

Kevin O’DonnellKevin O’DonnellCoChair, IHE Radiology Planning Cmte CoChair, IHE Radiology Planning Cmte Toshiba Medical SystemsToshiba Medical Systems

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Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise facilitates integrating systemsfacilitates integrating systems for efficient, accurate patient carefor efficient, accurate patient care

Systems that support IHE Integration Profiles:Systems that support IHE Integration Profiles: communicate better & integrate more easily communicate better & integrate more easily provide more complete and accurate informationprovide more complete and accurate information better support care providers workflow better support care providers workflow

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IHE = Integration ProfilesIHE = Integration Profiles

Each IHE ProfileEach IHE Profile describes a clinical information need or workflow scenariodescribes a clinical information need or workflow scenario documents how to use standards (e.g. HL7, DICOM, ...)documents how to use standards (e.g. HL7, DICOM, ...)

to accomplish itto accomplish it

Systems that implement the same Profile Systems that implement the same Profile address a need in a mutually compatible wayaddress a need in a mutually compatible way

Hundreds of products support one or more Hundreds of products support one or more IHE Radiology Profiles. IHE Radiology Profiles.

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YourYour Three Step Program Three Step Program

Select Specific IHE ProfilesSelect Specific IHE Profiles

List those Profiles in your RFPList those Profiles in your RFP

Check Vendors IHE Integration StatementsCheck Vendors IHE Integration Statements

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Selecting IHE ProfilesSelecting IHE ProfilesReview the Profiles :Review the Profiles :

What they doWhat they do

Benefits for your situationBenefits for your situation

Some Helpful Resources:Some Helpful Resources:

www.ihe.net/profileswww.ihe.net/profiles - Profile Catalog - Profile Catalog

IHE User’s Handbook - RadiologyIHE User’s Handbook - Radiology

RSNA DemonstrationsRSNA Demonstrations

Educational Material (e.g. Workshop Presentations)Educational Material (e.g. Workshop Presentations)

IHE Technical Framework – RadiologyIHE Technical Framework – Radiology

Connectathon ResultsConnectathon Results

www.ihe.net

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RFPsRFPs

Your choice:Your choice:

Be Brief?Be Brief? ““The system must support DICOM”The system must support DICOM”

Be Effective?Be Effective? ““The system must support the following DICOM services The system must support the following DICOM services

according to the following 100 pages of specifications: …”according to the following 100 pages of specifications: …”

Be Both:Be Both: ““The system must support the IHE Scheduled Workflow The system must support the IHE Scheduled Workflow

Profile as the Acquisition Modality actor.”Profile as the Acquisition Modality actor.”

Vendor IHE Integration StatementsVendor IHE Integration Statements Version 2.1 of the CardioCT 5000 supports IHE Scheduled Version 2.1 of the CardioCT 5000 supports IHE Scheduled

Workflow as an Acquisition ModalityWorkflow as an Acquisition Modality

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IHE Integration StatementsIHE Integration Statements

Explicit claim by the vendorExplicit claim by the vendorfor a specific product versionfor a specific product version

Lists IHE profiles, actors, optionsLists IHE profiles, actors, options

Short & SweetShort & Sweet

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IHE Integration Statement Date: 03/10/2006

Vendor Product Name Version

Acme Medical Systems PACS-o-Matic V3.9

This product implements all transactions required to support the IHE Integration Profiles, Actors and Options listed below:

Integration Profiles Implemented Actors Implemented Options Implemented

Scheduled Workflow Image Manager / Archive .

PPS Exception Management

Patient Information Reconciliation Image Manager / Archive .

None

Consistent Presentation of Images Image Manager / Archive Image Display

None

Portable Data for Imaging Media Creator Media Importer

None

Audit Trail and Node Authentication Audit Record Repository None

Internet address for vendor's IHE information : http://www.acme-medical.com/IHE

Links to Standards Conformance Statements for the implementation

Dicom: http://www.acme-medical.com/DICOM

Health Level 7: http://www.acme-medical.com/HL7

Links to general information on IHE

In North America : http://www.ihe.net

In Europe : http://www.ihe-europe.org

In Japan : http://www.jira-net.or.jp/ihe-j

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Let’s look at an ExampleLet’s look at an ExampleFrom the From the IHE Radiology User’s HandbookIHE Radiology User’s Handbook

Suppose you’re buying a modality (see Suppose you’re buying a modality (see Chapter 1Chapter 1))

Suppose your integration strategy has identified two key goals:Suppose your integration strategy has identified two key goals: Reducing/Preventing ErrorsReducing/Preventing Errors Improving Throughput/TurnaroundImproving Throughput/Turnaround

Reviewing the Profile Benefits (see Reviewing the Profile Benefits (see Section 1.1.1Section 1.1.1):): Scheduled Workflow ProfileScheduled Workflow Profile has a significant impact on both goals: has a significant impact on both goals:

Prevents Prevents manual data entry errorsmanual data entry errors & & saves timesaves time at the modality console by at the modality console by downloading patient demographics and study details from the RIS (MWL)downloading patient demographics and study details from the RIS (MWL)

Prevents lost studies & time wasted re-scanning by confirming PACS receipt of images to avoid accidental deletion (Storage Commitment);

And saves more time because confirmation is automatic and electronic Reduces missing or irrelevant priors by storing a full set of accurate patient

and study identifiers and details in each study object (Store) Reduces delays in the reporting process by notifying the RIS of exams in

progress and ready to read (MPPS)

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imagesstored

patientinformation

RIS

examination orders

imagesretrieved

HIS

PACS

procedurescheduled

Prefetch any relevantprior studies

modalityworklist

report

report

IHE Scheduled Workflow ProfileIHE Scheduled Workflow Profile

Registration

Orders Placed

Orders Filled

Film

FilmFolder

Image Manager& Archive

FilmLightbox

report ReportRepository

DiagnosticWorkstation

Modality

acquisitionacquisitionin-progressin-progressacquisitioncompleted

acquisitioncompleted

imagesprinted

AcquisitionModality

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Using IHEUsing IHE

Present IHE as an integration priority to your vendors. Present IHE as an integration priority to your vendors. A Business goal ! A Business goal !

Specify appropriate Profiles, Actors, Options Specify appropriate Profiles, Actors, Options in your RFPin your RFP ““The system must support the IHE Scheduled Workflow Profile as The system must support the IHE Scheduled Workflow Profile as

the Acquisition Modality actor and support the Exception the Acquisition Modality actor and support the Exception Management Option.”Management Option.”

Request Integration Statements from your vendorsRequest Integration Statements from your vendors

Plan acceptance testing (see Plan acceptance testing (see Section 1.2.2Section 1.2.2))

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Dealing with LegacyDealing with Legacy

Prepare to identify and address legacy system issues Prepare to identify and address legacy system issues (see (see Section 1.2.4Section 1.2.4))

Maximum benefit when all systems are IHEMaximum benefit when all systems are IHE Most of you will have some non-compliant devices and systemsMost of you will have some non-compliant devices and systems Make best effort to bring them “up-to-date”Make best effort to bring them “up-to-date”

Incremental usage of IHE provides incremental benefitIncremental usage of IHE provides incremental benefit It’s just clean DICOM and HL7; a great baselineIt’s just clean DICOM and HL7; a great baseline

Get on the Yellow Brick Road...Get on the Yellow Brick Road... No sense buying No sense buying NewNew legacy equipment legacy equipment

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First StepsFirst Steps

Visit IHE Profile DemonstrationsVisit IHE Profile Demonstrations Cross-Enterprise Document Sharing for Imaging [XDS-I]Cross-Enterprise Document Sharing for Imaging [XDS-I] Teaching File & Clinical Trial Export [TCE]Teaching File & Clinical Trial Export [TCE] IHE Product Showcase and participating Vendor BoothsIHE Product Showcase and participating Vendor Booths Interoperability Showcase at HIMSS 2008Interoperability Showcase at HIMSS 2008

Visit Visit www.ihe.netwww.ihe.net - start learning about Profiles- start learning about Profiles

Talk about an IHE strategy with your CIO / IT staff, Talk about an IHE strategy with your CIO / IT staff, and with your vendorsand with your vendors

Now, lets look at a Real-world ExperienceNow, lets look at a Real-world Experience

14September, 2005 What IHE Delivers

Thames Valley Hospital Thames Valley Hospital Planning Partnership, Planning Partnership,

London, OntarioLondon, OntarioCanadaCanada

Beth GoodhewBeth Goodhew

Peninsula Consulting GroupPeninsula Consulting Group

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Thames Valley Hospital Planning PartnershipThames Valley Hospital Planning Partnership

8 Corporations8 Corporations 2 in London (~75% volume)2 in London (~75% volume) 6 Community Facilities6 Community Facilities

750,000 Radiology exams annually750,000 Radiology exams annually

>200 DICOM Connections>200 DICOM Connections

~65 Radiologists, ~10 Residents and Fellows, ~65 Radiologists, ~10 Residents and Fellows, ~8 NM Physicians~8 NM Physicians

Canada Health Infoway sponsored project to create Canada Health Infoway sponsored project to create the South Western Ontario Image Repositorythe South Western Ontario Image Repository

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Project VisionProject Vision

Improved Improved electronic accesselectronic access to to Radiology images and reports Radiology images and reports

to increase to increase qualityquality and and timelinesstimeliness of patient care through of patient care through

collaborative regionalcollaborative regional partnerships and to enhance the partnerships and to enhance the

speedspeed of treatment decisions. of treatment decisions.

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Clinical ArchitectureClinical Architecture

GE PACSCERNERPOWERCHART

RADNET

CPIDiagnostic

ClinicalWeb

Community Billing

ClinicalUser

PrimaryRead ClinicalUser

Dictation

RadiologistTechnologist

Registration

LAB/PHARMACY

Goal: Seamless Integration

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Benefits of IHEBenefits of IHE

Improve Quality and Patient SafetyImprove Quality and Patient Safety Providing for positive transfer of information Providing for positive transfer of information

using non-proprietary methods using non-proprietary methods Eliminating manual data entryEliminating manual data entry

Improve the efficiency and effectiveness of clinical Improve the efficiency and effectiveness of clinical practice by:practice by:

Improved Improved Information FlowInformation Flow Advanced Advanced Multi-System FunctionsMulti-System Functions Eliminate manual steps from common processesEliminate manual steps from common processes

Systems IntegrationSystems Integration Enabling the sharing of health information locally, regionally Enabling the sharing of health information locally, regionally

and nationallyand nationally

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Alignment of IHE and Project VisionAlignment of IHE and Project Vision

VisionVision

Improved Improved electronic accesselectronic access to to Radiology images and Radiology images and

reports to increase reports to increase qualityquality and and timelinesstimeliness of patient of patient

care through care through collaborative collaborative regionalregional partnerships and partnerships and to enhance the to enhance the speedspeed of of

treatment decisions.treatment decisions.

IHE BenefitsIHE Benefits

Improve Improve QualityQuality and Patient and Patient SafetySafety

Providing for positive transfer Providing for positive transfer of informationof information

Eliminating manual data Eliminating manual data entryentry

Improve Improve EfficiencyEfficiency Eliminate manual steps from Eliminate manual steps from

common processescommon processes

Enable Enable sharingsharing of health of health information locally, information locally, regionallyregionally and nationallyand nationally

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Steps to IHE ImplementationSteps to IHE Implementation

Current state evaluationCurrent state evaluation Evaluate workflow challengesEvaluate workflow challenges Current levels of complianceCurrent levels of compliance

Future State AnalysisFuture State Analysis Desired workflow enhancementsDesired workflow enhancements Profile evaluationProfile evaluation Create future map of profiles and actorsCreate future map of profiles and actors

Gap AnalysisGap Analysis Assign Actor roles to current & future systemsAssign Actor roles to current & future systems Plan required software upgrades/replacementsPlan required software upgrades/replacements Flag remaining integration challengesFlag remaining integration challenges Decide on Workflow changesDecide on Workflow changes

• Impact on Technologist/RadiologistImpact on Technologist/Radiologist• QC processes/exception handlingQC processes/exception handling

Prepare new purchase requirementsPrepare new purchase requirements

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Non-IHE EquipmentNon-IHE Equipment

Prepare coping strategiesPrepare coping strategies

Need a clear plan of action for each deviceNeed a clear plan of action for each device

(See IHE Users Handbook – Radiology)(See IHE Users Handbook – Radiology)

Users can drive compliance to IHE by asking for it often

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Profiles ImplementedProfiles Implemented

Scheduled Workflow (SWF)Scheduled Workflow (SWF)

Patient Information Reconciliation (PIR)Patient Information Reconciliation (PIR)

Consistent Presentation of Images (CPI)Consistent Presentation of Images (CPI)

Charge Posting (CHG)Charge Posting (CHG)

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ReplicationReplication

After one site is properly implementedAfter one site is properly implemented

Additional sites are configured, trained and Additional sites are configured, trained and brought live in a rapid fashionbrought live in a rapid fashion

IHE Profiles served as templates which worked IHE Profiles served as templates which worked well in small and large hospitalswell in small and large hospitals

Experience in one site was easy to repeat Experience in one site was easy to repeat elsewhereelsewhere

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Rapid Roll-out of Successive SitesRapid Roll-out of Successive Sites

Q2’05Q1’05 Q3’05 Q4’05

FAST Alliance PACS Rollout

STEG RIS Rollout

PACS Rollout Strathroy

PACS Rollout Ingersoll

Community Hospital RIS/PACS

STEG PACS Rollout

Woodstock RIS Rollout

Woodstock PACS Rollout

PACS Rollout Tillsonburg

Sept 30 Adoption

Dec 31 Adoption

June 30 Adoption

PACS Rollout Newbury

RIS Rollout Ingersol

FAST Alliance RIS Rollout

RIS Build for FAST Sites

RIS Rollout Tillsonberg

RIS Rollout Strathroy

RIS Rollout Newbury

July 31 Adoption

Aug 30 Adoption

Oct 31 Adoption

DI-1 003.3

DI-1 003.4DI-1 003.5

DI-1 003.6

DI-1 003.7

DI-1 003.8

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Take Home TipTake Home Tip

Salvation = (SWF + PIR)Salvation = (SWF + PIR)

Scheduled Workflow Benefits:Scheduled Workflow Benefits:

Serves as un-biased roadmap providing directionServes as un-biased roadmap providing directionfor vendors and implementers alikefor vendors and implementers alike

Paves the way for true optimization of workflowPaves the way for true optimization of workflow FilmlessFilmless

• Rapid distribution, rapid accessRapid distribution, rapid access Paperless Paperless

• Up to the minute status, distributed accessUp to the minute status, distributed access

Forms foundation for future Integration ProfilesForms foundation for future Integration Profiles

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