September, 2005 What IHE Delivers

IHE Eye Care Integration IHE Eye Care Integration ProfilesProfiles

Andrew Casertano Andrew Casertano Department of Veterans AffairsDepartment of Veterans Affairs

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Learning ObjectivesLearning Objectives

How to read the IHE Eye Care Technical Framework

What is an Integration Profile? They are a practical way to communicate integration problems and solution requirements precisely.

How IHE Eye Care Integration Profiles simplify the integration process.

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The Goal of IHE Eye CareThe Goal of IHE Eye Care

Any Eye Care Image, Any Eye Care Image, Anywhere, Intact, AnytimeAnywhere, Intact, Anytime

Seamless integration from Seamless integration from check-in to acquisition check-in to acquisition through archive and billingthrough archive and billing

Standardization and Standardization and guidelines for Quality guidelines for Quality Assurance & Patient Assurance & Patient SafetySafety

Protection of the integrity Protection of the integrity of the dataof the data

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What is IHE Eye Care?What is IHE Eye Care?

IHE is a proven systems integration IHE is a proven systems integration processprocess – – eight years of experienceeight years of experience

A collaboration of clinicians and vendorsA collaboration of clinicians and vendors Promote integrated solutions based on Promote integrated solutions based on open standardsopen standards International and multi-specialtyInternational and multi-specialty

Produces results on a yearly cycleProduces results on a yearly cycle

1.1. Clinicians identify and prioritize clinical problems (Use Cases)Clinicians identify and prioritize clinical problems (Use Cases)

2.2. Engineers from industry define solutions (Technical Framework)Engineers from industry define solutions (Technical Framework)

3.3. Participating vendors implement and test at “Connectathon” Participating vendors implement and test at “Connectathon” (Test)(Test)

4.4. Vendors publish “Integration Statements” for products;Vendors publish “Integration Statements” for products;users request in RFPs (Products)users request in RFPs (Products)

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Why IHE Eye Care?Why IHE Eye Care?Multiple devices and systems from multiple vendorsMultiple devices and systems from multiple vendors Need to integrate data sources for comprehensive view of patientNeed to integrate data sources for comprehensive view of patient List of Different EquipmentList of Different Equipment Multiple specialists cooperating on single patientMultiple specialists cooperating on single patient

Multiple locationsMultiple locations Individual patient is seen in multiple locations – distributed patient Individual patient is seen in multiple locations – distributed patient

recordrecord Individual clinician practices in multiple locations – across Individual clinician practices in multiple locations – across

organizational boundariesorganizational boundaries Office, small and large clinics, linking to hospitalsOffice, small and large clinics, linking to hospitals

Chronic DiseaseChronic Disease Long term patient care – persistent and evolving patient recordLong term patient care – persistent and evolving patient record

Lots of Lots of hardhard data integration problems data integration problems

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Costs of non-integrationCosts of non-integration

QualityQuality - Less accurate care due to lack of - Less accurate care due to lack of relevant patient records at point of carerelevant patient records at point of care

TimeTime - Delay in treatment due to unavailability of - Delay in treatment due to unavailability of critical informationcritical information

MoneyMoney - Higher costs needed to support manual - Higher costs needed to support manual rather than automated record keeping processesrather than automated record keeping processes

EmotionalEmotional - Patient dissatisfaction with provider; - Patient dissatisfaction with provider; clinician frustration with data environmentclinician frustration with data environment

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Why Is Integration Hard?Why Is Integration Hard?

The Different Systems Don’t Use a Common Vocabulary

The Different Systems Don’t Use Common Communication Standards Consistently

The Flow of Information Through the Enterprise Changes With the Circumstances of the Case

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Benefits of IntegrationBenefits of Integration

Reading efficiency: user-friendly, Reading efficiency: user-friendly, intuitive,intuitive, multi-modality, universal multi-modality, universal workstation that will display and workstation that will display and lay-out images from an eye care lay-out images from an eye care acquisition device as needed for acquisition device as needed for the the complete integrated imaging complete integrated imaging evaluation.evaluation.

Quality: Quality: preservation ofpreservation of rendered rendered image quality image quality on multiple displays.on multiple displays.

Quality/SafetyQuality/Safety: : patient and image patient and image identifiersidentifiers are available and are available and properly located.properly located.

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Electronic Health Record

Cardiology

Laboratory

Radiology

Oncology

IT

Infrastructure

Eye Care

16 Integration Profiles

5 Integration Profiles

4 Integration Profiles

1133 IInntteeggrraattiioonn PPrrooffiilleess

Patient Care Coordination

1 Integration Profile

Patient Care

Devices

Pathology

33 IInntteeggrraattiioonn PPrrooffiilleess

IHE 2006 – Integrated EHRIHE 2006 – Integrated EHR Over 100 vendors involved world-wide,Over 100 vendors involved world-wide, 6 Technical Frameworks6 Technical Frameworks

39 Integration Profiles, Testing at Connectathons, 39 Integration Profiles, Testing at Connectathons, Result in an Integrated Electronic Health Record Result in an Integrated Electronic Health Record

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Use Cases Use Cases ➨ IHE Profiles➨ IHE Profiles

IHE develops incrementally

Use cases are developed for specific data sharing problems with practical solutions in 1-2 year timeframe

Use case becomes an IHE Profile with a technical solution in the Technical Framework

IHE Eye Care Profiles: Scheduled Workflow Charge Posting Evidence Documents

More coming next year, and next …

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What is the Big Picture?What is the Big Picture?

IHE Defines Integration Profiles to Group Related Transactions and Connects Them With Real-world Functions

Integration Profiles Allow the Customer to Focus on High-level Integration While IHE handles the details

Proprietary Solutions create instant legacies

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IHE Technical Framework ComponentsIHE Technical Framework Components

IHE defines a set of Integration Profiles which describe a problem and provide a packaged Solution containing Integration requirements and functionality

IHE defines a set of Actors which represent the roles systems can play in a Profile

IHE defines a set of Transactions precisely define interactions between Actors

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TF Vol. I – Integration ProfilesTF Vol. I – Integration Profiles

Integration Profiles are a clinical problem defined and a description of its solution.

Each problem’s use case and process flow consists of IHE Actors and Transactions.

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The Integration ProfileThe Integration Profile

Actors cooperating

through TransactionsTransactions to solve the

problem

Pt. Registration [RAD - 1] Patient Update [RAD - 12]

Pt. Registration [RAD - 1] Patient Update [RAD - 12]

Placer Order Management [RAD - 2] Filler Order Management [RAD - 3]

ADT

Query Images [RAD - 14]

Image Display

Storage Commitment

[CARD - 3]

Performed Procedure

Step Manager

Modality PS in Progress [RAD-6] Modality PS Completed [RAD-7]

Order Placer

Acquisition Modality

Image Manager

Image Archive

DSS/ Order Filler

Pt. Registration [RAD - 1] Patient Update [RAD - 12]

Pt. Registration [RAD - 1] Patient Update [RAD - 12]

Placer Order Management [RAD - 2] Filler Order Management [RAD - 3]

ADT/Pt. Registration

Query Images [RAD - 14] Retrieve Image [EYECARE-3]

Image Display

Modality Image/Evidence Stored [EYECARE-2]

Storage Commitment

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Query Modality Worklist [EYECARE-1]

Performed Procedure

Step Manager

Modality PS in Progress [RAD-6] Modality PS Completed [RAD-7]

Modality PS in Progress [RAD-6] Modality PS Completed [RAD-7]

Order Placer

Acquisition Modality

Image Manager

Image Archive

DSS/ Order Filler

Storage Commitment [CARD-3]

Modality Images /Evidence Stored [EYECARE-2]

Evidence Creator

Procedure Scheduled [RAD-4] Image Availability Query [RAD-11] Procedure Updated [RAD-13] Instance Availability Notification [RAD-49]

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TheThe Vocabulary FoundationVocabulary Foundation

IHE Defines a Common Vocabulary for Patient and Administrative Information

• Order• Requested Procedure• Accession Number• Procedure Step• Others

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Identifying TransactionsIdentifying Transactions

IHE Defines the Eye Care workflow from from patient check-in to patient check-in to acquisition through acquisition through archive and billing …archive and billing …

IHE identifies the transactions required to make integration work

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The Right SelectionThe Right Selection

IHE Selects an Existing Industry Standard for each Transaction and Specifies the Transaction Unambiguously

• HL7 Patient Registration and Order

• DICOM Modality Worklist• DICOM Objects

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Mapping to Real-World ProductsMapping to Real-World Products

The IHE Actors and transactions are abstractions of real products in the real-world eye care information system environment. The order placer may be realized in either the

practice management system or the Electronic Medical Record (EMR) products.

The Performed Procedure Step Manager may be realized in either the Picture Archive and Communications System (PACS) or the Electronic Medical Record (EMR) products.

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Six Key ActorsSix Key Actors

A Patient registration system (also known as Admit, Discharge and Transfer (ADT) system is responsible patient demographic and encounter information.

An Order Placer generates eye care orders and distributes those orders. This may be hospital level system.

A Department System Scheduler/Order Filler provides worklists and monitors progress.

An Acquisition Modality acquires and creates DICOM objects.

An Image Manager/ Image Archive provides long-term storage.

An Image Display offers browsing of patients’ studies.

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Dependencies between Integration ProfilesDependencies between Integration Profiles

Eye Care Workflow

Manage eye care Workflow (IHE Eye Care)

Scheduled Workflow Admit, order, schedule, worklist, status, create, manage, store, display images, etc. (IHE Radiology)

Charge Posting

Collect and post timely billable procedure details (IHE Radiology)

Eye care Evidence Document

Create, store, retrieve & use objects to record Eye Care evidence (IHE Eye Care)

Evidence Document Create, store, retrieve & use objects to record evidence (IHE Radiology)

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Process Flow DiagramsProcess Flow Diagrams ADT

Order Placer

Image Manager

Acquisition Modality

Placer Order Mgmt - New [RAD - 2]

Department System Scheduler/ Order Filler

Procedure Scheduled [RAD - 4]

Register/ Admit Patient

Schedule Procedure

Patient Registration [RAD - 1]

Select Patient

ADT Order Placer

Image Manager

Acquisition Modality 1-n

Placer Order Mgmt - New [RAD - 2]

Department System Scheduler/ Order Filler

Procedure Scheduled [RAD - 4]

Admit Patient

Schedule Procedure

Patient Registration [RAD - 1]

Select Patient

Query Modality Worklist [EYECARE-1]

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TF Vol. II - TransactionsTF Vol. II - Transactions

Vol. II defines eye care transactions in detail, specifying the roles for each actor, the standards employed, the information exchanged.

The appendices provide clarification of technical details of the IHE data model and transactions.

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We care!We care!

The AAO and the VA have made fixing the Eye Care data integration problem a priority

The IHE participating vendors have responded to cooperatively develop data interoperability

OurOur success is measured success is measured by by youryour success success

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To find out moreTo find out more … … www.ihe.netwww.ihe.net

Join and participate in IHE Eye Care Join and participate in IHE Eye Care

IHE Technical Frameworks leveraged by Eye CareIHE Technical Frameworks leveraged by Eye Care CardiologyCardiology IT InfrastructureIT Infrastructure Radiology Radiology

Standards used by IHE Eye CareStandards used by IHE Eye CareDICOM Standard DICOM Standard www.nema.medical.orgHL7 Standard HL7 Standard www.hl7.org

IHE Connectathon 2006 at RSNA HQIHE Connectathon 2006 at RSNA HQ

IHE Showcase at 2006 AAO ConferenceIHE Showcase at 2006 AAO Conference

Vendor Products Integration StatementsVendor Products Integration Statements

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