whit conference 10-13 october 2006 what ihe delivers 1 peter künecke / dr. nikolaus wirsz siemens...

1WHIT Conference10-13 October 2006

What IHE Delivers

Peter Künecke / Dr. Nikolaus Wirsz

SIEMENS Medical Solutions

IHE Radiology – OverviewIHE Radiology – Overview


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

Common Problems of Modern Healthcare Enterprises:(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 ofMedical 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


Evolution of IHE DomainsEvolution of IHE Domains

Radiology

IT Infrastructure for Healthcare

Cardiology

Laboratory

Radiation Oncology

Patient Care Coordination

Patient Care Devices

Pathology

Pharmacy

IHE Global Developments

Integration Profiles – Solutions to Real-World Needs & Problems:

Within Clinical Departments e.g.:o Radiologyo Cardiologyo Labo ...

Across Departmental &Institutional Boundaries – XDS

o RHIOs (Regional Healthcare Information Organizations)

o EHR Enablers

Veterinarian

Endoscopy

Eye Care / Ophthalmology

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9)

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0)

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report

Examination

Ordered

Patient Registration

initial capture of

patient demographic information

Patient Informatio

n

HISHIS

Orders Placed

physician orders desired

procedure

RISRIS

Orders Filled

Break down entered order:

specific radiology procedure

steps to be

performed

procedurescheduledPrefetch any relevant prior

studies

PACSPACS

Image Manager

and Archive

modalit

yworklis

t

Patient and procedure

information retrieved by the

modalityPosition patient

and acquire images

storagecommitmen

tprint

images

Printer

Film Folder

acquisitioncompleted

acquisition

completed

Diagnostic image and demographic

info stored for network access

query/retriev

e images

Light Box

Diagnostic image and

demographic info for

radiologist

ReportRepository

report Radiologist report stored for network

access

Modality

* IHE = Integrating the Healthcare Enterprise

Workstation

IHE & the Radiology Workflow


ADT Patient Registration

Image Archive

Image Manager

Image Display

Image Creator

AcquisitionModality

DepartmentSystem Scheduler– Order Filler –

Order Placer

Modality Worklist


Patient Update

Procedure Scheduled

Images Availability QueryStorageCommit

StorageCommit

PPSIn-Progress/ Completed

Fil

ler

Ord

erM

anag

emen

t

Placer Order Management

Patient Update

Procedure Update

PerformedProcedure Step

Manager



Q /R KeyImage Note

Q /RPresentation

SatesQ /RImages

ImagesStored

Key Image Note

StoredPresent.State

Stored

ImagesStored

Present.State

Stored

Key Image Note

Stored

IHE Systems Transactions OverviewIHE Systems Transactions Overview



Image Archive

Image Manager

Image Display

Image Creator

AcquisitionModality


Order Placer

Modality Worklist


Patient Update

Procedure Scheduled


StorageCommit


Fil

ler

Ord

erM

anag

emen

t


Patient Update

Procedure Update


Manager



Q /R KeyImage Note

Q /RPresentation

SatesQ /RImages

ImagesStored

Key Image Note

StoredPresent.State

Stored

ImagesStored

Present.State

Stored

Key Image Note

Stored

IHE Systems Transactions OverviewIHE Systems Transactions Overview

HIS

RIS

IMAGING:•PACS•Workstations•Modalities


HIS

RIS

PACS

Modality

HIS

HL7

HL7

––

––

RIS

HL7

HL7

HL7 / DICOM

DICOM

PACS

––

HL7 / DICOM

DICOM

DICOM

Modality

––

DICOM

DICOM

DICOM

IHE Goes Beyond StandardsIHE =

+ Multi-Vendor+ Workflow-Driven+ INTEGRATION

based on established medical IT Standards

IHE = A Standards Harmonization ApproachIHE = A Standards Harmonization Approach


Integration Profile

Actor

IntegrationProfile

Actors

Transactions

Actor

Tra

sact

ion

Tra

sact

ion

Tra

sact

ion

Actor

Tra

sact

ion

Tra

sact

ion

Tra

sact

ion

Tra

sact

ion

Tra

sact

ion

ReferencedStandards:

DICOM & HL7

Role

Detailed Messaging

Info

Tra

sact

ion

Integration Profiles Actors

Transactions Standards

User Focus:Solutions to Clinical Problems

Tra

nsa

ctio

nT

ran

sact

ion

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nsa

ctio

nT

ran

sact

ion

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ran

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ion

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ran

sact

ion

Tra

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ran

sact

ion

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ran

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ion

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ion

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ion

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sact

ionImplementation:

Technical Details (Standards)


• Integration Profiles - Group related transactionsand associate them with real-world functions

• Integration Profiles allow the customer to focus onhigh-level integration while vendor products handle the details

• Reduce Ambiguities

• Manage Customer Expectations

IHE Integration Profiles: http://www.ihe.net/resources/ihe_integration_profiles.cfm

IHE FAQ: http://www.ihe.net/About/ihe_faq.cfm

IHE User’s Handbook:http://www.ihe.net/Resources/upload/ihe_radiology_users_handbook_2005edition.pdf


IHE Radiology Integration Profiles – Solutions to Real-World Problems in RadiologyIHE Radiology Integration Profiles – Solutions to Real-World Problems in Radiology

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


& 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

WorkflowsBilling

Teaching/Research

Contents & Display

Common Infrastructure


Contents – Consistency – Presentation

Consistent Presentation of Images

Evidence Documents

Key Image Notes

Simple Image & Numeric Reports

NM Image

IHE Radiology – Integration ProfilesWorkflow Support:

Scheduled Workflow

Patient Information Reconciliation


Reporting Workflow

Presentation of Grouped Procedure

Common IT Infrastructure & Data Sharing

Access to Radiology Information

Portable Data for Imaging

Cross-Enterprise Data & Image Sharing

Security: Audit Trails & Node Authentication

Others:

Billing / Charge Posting

Teaching Files & Clinical Trials



Key Image Notes


images




optional images,

measurements


viewing & reporting

Charge Posting


procedure details


Reporting Workflow


& notify diagnostic

reporting steps

Evidence Documents



evidence



NM Image





Trials Export


and Anonymization






Scheduled Workflow Charge Posting



related step,

create, store,

manage, retrieve &

use images

Admit, Order, Schedule

Scheduled Workflow (SWF)Scheduled Workflow (SWF)

Patient Information

Reconciliat

ion




changes



Image Archive

Image Manager

Image Display

Image Creator

AcquisitionModality


Order Placer

Modality Worklist


Patient Update

Procedure Scheduled


StorageCommit


Fil

ler

Ord

erM

anag

emen

t


Patient Update

Procedure Update


Manager



Q /R KeyImage Note

Q /RPresentation

SatesQ /RImages

ImagesStored

Key Image Note

StoredPresent.State

Stored

ImagesStored

Present.State

Stored

Key Image Note

Stored

The IHE Benefits: Data Consistency & Process Optimization

Scheduled Workflow (SWF)Scheduled Workflow (SWF)





related step,

create, store,

manage, retrieve &

use images

Admit, Order, SchedulePatient Information

Reconciliat

ion




changes


Key Image Notes


images




optional images,

measurements


viewing & reporting

Charge Posting


procedure details


Evidence Documents



evidence



NM Image





Trials Export


and Anonymization






Reporting Workflow (RWF)Reporting Workflow (RWF)

Reporting Workflow


& notify diagnostic

reporting steps


Reporting WorklistReporting Worklist

Work Item ClaimedWork Item Claimed

ReportingProcedure Step

STARTED


STARTED

Store ReportsStore Reports


COMPLETED


COMPLETED

ReportManager

RIS

ImageManager/Archive

PACS & Archive

Report Reader/Creator

Retrieve Images &Retrieve Images &Evidence DocumentsEvidence Documents

MeasurementsCAD Reports…………………

Released (Completed)Released (Completed)

Reporting Workflow (RWF)Reporting Workflow (RWF)The IHE Benefits: Manage Reporting Tasks & Improve Workflow Efficiency


Reporting Workflow


& notify diagnostic

reporting steps




related step,

create, store,

manage, retrieve &

use images


Reconciliat

ion




changes


Key Image Notes


images




optional images,

measurements


viewing & reporting

Charge Posting


procedure details


Evidence Documents



evidence



NM Image





Trials Export


and Anonymization


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






Reporting Radiologist Referring Physician orReviewing Radiologist

Original Image

Window Level

Flip

WithoutConsistent Presentation

Area Of

Interest

AchievingConsistent Presentation

Presentation StatePresentation StatePresentation LUTPresentation LUT

Grayscale StandardGrayscale Standard

Zoom

Area Of

Interest

Annotate

The IHE Benefits: Enhancing & Preserving Image Quality

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







Reporting Workflow


& notify diagnostic

reporting steps




related step,

create, store,

manage, retrieve &

use images


Reconciliat

ion




changes





optional images,

measurements


viewing & reporting

Charge Posting


procedure details


Evidence Documents



evidence



NM Image





Trials Export


and Anonymization

Key Image Notes (KIN)Key Image Notes (KIN)

Key Image Notes


images


RadiologistFlags Images:

Referring PhysicianSees Key Images First:

Study Including Key Image Notes

Note 1For referring physician:

This image showsthe renal rupture.

Key Image Notes (KIN)Key Image Notes (KIN)


This image hasthe hematoma.









The IHE Benefits: Enhancing Communication Among Medical Specialties

21WHIT Conference10-13 October 2006 ITI ATNA – Radiology Option (Replaces Basic Security)






Reporting Workflow


& notify diagnostic

reporting steps




related step,

create, store,

manage, retrieve &

use images


Reconciliat

ion




changes


Key Image Notes


images




optional images,

measurements


viewing & reporting

Charge Posting


procedure details

Evidence Documents



evidence



NM Image




Trials Export


and Anonymization

Portable Data for Imaging (PDI)Portable Data for Imaging (PDI)



What Is the IHE PDI Integration Profile?What Is the IHE PDI Integration Profile?

Images

Evidence Objects

Diagnostic Reports

for:

ImportStorageDisplayPrinting

Enables the Reliable Interchange ofPatient Records on CD including:

CDs that Work !


Distribution of Imaging Information on CD MediaDistribution of Imaging Information on CD Media

CDCreator

Printer

Image / Report Display

Media Importer

John Doe

CD

For use in other departments, e.g. surgery For enterprise data interchange For referral For printing For patient personal records


IHE PDI – Media CreatorIHE PDI – Media CreatorCreate DICOM Compliant CDROM media

Create web content (optional)DICOMDIR

INDEX.HTM

README.TXT

Directory of DICOM files

IHE_PDIDirectory of web files

Other optional content

Web content (optional)

CDROM Structure:


IHE PDI – Value PropositionIHE PDI – Value Proposition

Get CDs that can be Created and Read Anywhere

Media Interoperability Validation:– Eliminate Sources of Problems & Incompatibilities

Support for Exchange of DICOM Data

Optional Support for Web Data: – View of Images and Reports in a Browser

Allow Import of Patient Data into theLocal Information Base






Reporting Workflow


& notify diagnostic

reporting steps




related step,

create, store,

manage, retrieve &

use images


Reconciliat

ion




changes


Key Image Notes


images




optional images,

measurements


viewing & reporting

Charge Posting


procedure details


Evidence Documents



evidence



NM Image





Trials Export


and Anonymization

Cross-Enterprise Image & Data Sharing (XDS-I)Cross-Enterprise Image & Data Sharing (XDS-I)



Enterprise A

Enterprise B

Physician Office

• Between Radiology ando Imaging Specialistso Non-imaging Professionals

• Between EnterprisesPACS B

PACS A

Radiology -to-Radiology

Radiology -to-Physicians

PACS C

• Within an Enterprise

Cross-Enterprise Image & Data Sharing (XDS-I)Cross-Enterprise Image & Data Sharing (XDS-I)

Business Need: Share Radiology Reports & ImageBusiness Need: Share Radiology Reports & Image


Image-Enabled EHRImage-Enabled EHRPregnancy Outpatient Clinics EncounterPregnancy Outpatient Clinics Encounter

acquireevaluate

index

Image/ ReportRepository

storenew data

Ultrasound reportand images

DocumentRegistry

register

(XDS architecture)


registerindex

evaluate

DocumentRegistry

Image/ Report/ Document

Repositories

index

query

retrieve

DocumentRepository

storenew data

Report, letters(incl. images)

(XDS architecture)

Image-Enabled EHRImage-Enabled EHR Childbirth Inpatient Stay Childbirth Inpatient Stay


IHE Radiology – Integration ProfilesNewest Additions in 2006

Workflow Extensions

Import Reconciliation Workflow (IRWF)

Describes workflow details for the import of “external” data: Evidence Objects e.g. DICOM images (on a CD) and Non-Digital Data e.g. scanned films, documents

into the EnterpriseExtends the PDI profile (interchange of CDs) with

workflow integration capabilities

Content Profiles

Nuclear Medicine Image with Cardiac Option

Addition of a Cardiac NM option to the existing NM Image Profile –improve functionality for nuclear medicine cardiac image viewing

synchronous viewing of gated images or projections of tomographic images ability to display myocardial perfusion data


IHE Radiology – Integration ProfilesNewest Additions in 2006 (continued)

Content Profiles (continued)

Image Fusion (FUS)

Specifies communications between systems creating and registeringimage sets and systems displaying fused images

Defines how DICOM objects for spatial registration, blended presentation and the images themselves are created, stored, queried, retrieved, processed and displayed

Mammography Image (MAMMO)

Specifies how DICOM Mammography images & evidence objectsare created, exchanged & used

Full Field Digital Mammography (FFDM) Images on Acquisition Modalities CAD Systems acting as Evidence Creators Attributes & Capabilities for Image Displays

IHE Brochure “Going Digital: An IHE Guide for Mammography”http://www.ihe.net/Mammo/going_digital_mammography.cfm


IHE Radiology – Integration ProfilesAn Outlook for 2007 (Year 9)

Incremental Developments ~2 New Integration Profiles / Year

Work Item Proposals for 2007

Mammography Workflow

Enhanced CT / MR Image

Reporting Strategy / Improvements / Workflow Considerations

DICOM SR HL7 CDA PDF

Multi-Study Acquisition

Local „hard split“ on Acquisition Modalitiesan „easy entry“ alternative to PGP (Presentation of Grouped Procedures)

… others …

Selection / priorities to be determined in October 2006


International Adoption of IHEInternational Adoption of IHEY

ear

1 (1

999)

Yea

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(200

0)

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(200

1)

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r 4

(200

2)

Yea

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3)

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(200

4)

Yea

r 7

(200

5)

France

Local Deployment National Extensions (Local Adaptions) Promotional & Live Demonstration Events Funding

USA

Germany

Italy

JapanUK

Canada

Korea

TaiwanNorway

Holland

SpainChina


IHE Organizational Structure

ACCHIMSSRSNA

JAHISJIRAJRS

METI-MLHWMEDIS-DCJAMI

GMSIHSFRSFIL

SIRMBIREuroRec

COCIREAR-ECRDRG

ESCProfessional Societies / Sponsors Contributing &

ParticipatingVendors

IHE (International) Strategic Development Committee

Global Development

Radiology

Cardiology

ITInfrastructure

Patient CareCoordination

Patient CareDevices

Laboratory

Pathology

Pharmacy /Medication Admin

RadiationOncology

Ne

w

Ne

w

Ne

w

Ne

w

IHE Europe

IHE North America

France

USA

Canada

IHE Asia-Oceania

Japan

Korea Taiwan

Netherlands

Spain Sweden UK

ItalyGermany

Norway

Regional Deployment

ChinaNe

w


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

IHE Main Web Site: http://www.IHE.net

Questions ?

whit conference 10-13 october 2006 what ihe delivers 1 peter künecke / dr. nikolaus wirsz siemens...

Documents

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