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IHE Cardiology – Discussion with EP Subcommittee

IHE Cardiology – Discussion with EP Subcommittee. Harry Solomon, co-chair IHE Cardiology Tech Cttee 12 August 2005. Why IHE?. Cardiology has hard system and data integration problems Multiple locations (office, in-patient, ED …) Multiple devices and modalities

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IHE Cardiology – Discussion with EP Subcommittee

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  1. IHE Cardiology – Discussion with EP Subcommittee Harry Solomon, co-chair IHE Cardiology Tech Cttee 12 August 2005

  2. Why IHE? • Cardiology has hardsystem and data integration problems • Multiple locations (office, in-patient, ED …) • Multiple devices and modalities • Long term patient care by many care providers • Data integration is essential to quality patient care • Care providers must work with industry to develop solutions to meet their needs • Implementations must be based on open standards

  3. What is IHE? • An initiative to improve systems integration and interoperability for a multi-vendor Enterprise • A process for coordinated adoption of standards • Clinicians define their highest priority integration problems • Vendor committees develop solutions and produce a Technical Framework • Industry adopts and implements solutions in products • Professional Society sponsors supervise documentation, testing, demonstration and promotion

  4. Goals of IHE • Accelerate standards-based healthcare data integration • Improve clinical and administrative workflow • Improve data flow – where it’s needed, when it’s needed • Improve the efficiency and effectiveness of clinical practice • Advance the healthcare IT market

  5. Who is IHE? • IHE is a joint initiative of: • American College of Cardiology (ACC) • Radiological Society of North America (RSNA) • Healthcare Information and Management Systems Society (HIMSS) • Vendors/manufacturers in major supporting role • Local sponsorship internationally • IHE-Europe and IHE-Asia/Oceania • IHE-Cardiology additional participating societies • ASE, ASNC, HRS, SCAI and more • IHE-Cardiology in Europe sponsored by European Society of Cardiology (ESC)

  6. What IHE is NOT! SDO • NOT a standards development organization • Profiles use of established standards (HL7, DICOM, IETF, others) to address specific clinical needs • Standards promotion organization - complementary to SDOs • NOT a product certification organization • Interoperability testing supervised by Professional societies with vendor-independent test tools • Vendor self-certification based on test results • NOT simply a demonstration project • Demos only one means to the end: adoption

  7. IHE and Standards • Standards are necessary… • but not sufficient – Why ? • Multiple standards and domains - overlap and redundancy • Conflict because domain boundaries are unclear and information models are different • Standards are broad, abstract and flexible • Room for interpretation in implementation hinders interoperability • Standards deal with getting data from A to B… but do not define full end-to-end user workflow across points A, B, C & D • Different techniques for standards development vs. deployment

  8. The IHE Value Proposition • Users get a comprehensive, end-to-end workflow • Uniting multiple systems and multiple standards • Improving cost-effectiveness and quality of patient care • Products can rely on other vendors’ products providing critical information in a consistent manner • Reducing development, validation, and integration costs • Avoiding chicken-and-egg adoption problem • Integration occurs proactively in controlled environment with defined timetable, not reactively at customer site • Common approach creates the market in which vendors can sell and users can buy with confidence • “We each succeed when we all succeed”

  9. IHE Process • Users and vendors work together to identify and design solutions for integration problems • Intensive process with annual cycles: • Identify key healthcare workflows and integration problems • Research & select standards to specify a solution • Write, review and publish IHE Technical Framework • Perform cross-testing at “Connectathon” • Demonstrations at trade shows • Yearly cycle focuses on most important tractable problems

  10. IHE Strategic Development Committee Global Development Regional Deployment IHE North America IHE Asia-Oceania RadiologyPlanning Committee IT Infrastructure Planning Committee Japan CardiologyPlanning Committee USA Canada Taiwan Korea IT Infrastructure Technical Committee Radiology Technical Committee Cardiology Technical Committee IHE Europe LaboratoryPlanning and TechnicalCommittee Pharmacy Exploratory Committee France Germany Italy UK Netherlands Spain Sweden Norway Professional Societies / Sponsors Contributing and participatingVendors ACCHIMSSRSNA GMSIH SFRSFIL COCIR EAR-ECR DRG SIRM BIR EuroRec ESC JAHISJIRAJRS METIMEDIS-DCJAMI IHE Organizational Structure

  11. Achievements and expanding scope 15 Active national chapters on 4 continents 4 Technical Frameworks 39 Integration Profiles, Testing at yearly Connectathons, Demonstrations at major exhibitions world-wide IHE 1 Integration Profile Patient Care Coordination EHR IHE IT Infrastructure IHE IHE 13 Integration Profiles Radiology Cardiology 16 Integration Profiles 4 Integration Profiles IHE IHE New IHE Radiation Oncology Laboratory Domains 5 Integration Profiles Eye care, Pathology, Intensive care devices, etc.

  12. Timeline20 months from concept to demo

  13. Overlapping yearly cycles July Oct Jan Apr July Oct Jan Apr July Oct Jan Apr Connectathon Roadmap Profile Proposals Tech Frmwk Developmt Vendor Implementation Pub Rvw Demo Connectathon Roadmap Profile Proposals Tech Frmwk Developmt Vendor Implementation Pub Rvw Demo Roadmap Profile Proposals Tech Frmwk Developmt

  14. Integration Profile:A Solution to an Integration Problem Actorscooperating throughTransactionsto solve a specific problem Report Creator 24: Report Submission Structured Report Export: 28  Report Manager Enterprise Report Repository 25: Report Issuing Report Repository External Report Repository Access 26: Query Reports 27: Retrieve Reports Report Reader

  15. Key IHE Concepts • Generalized Systems -> Actors • Interactions between Actors -> Transactions • Problem/Solution Scenarios -> Integration Profiles • For each Integration Profile: • the context is described (which real-world problem) • the actors are defined (what systems are involved) • the transactions are defined (what must they do)

  16. IHE Technical Frameworks • Detailed standards implementation guides • Cardiology • IT Infrastructure • Lab • Radiology • Patient Care Coordination

  17. Connectathon • Weeklong interoperability testing event • Validation of the participants’ integration work • Prerequisite testing with MESA tools • Test all transactions under all profiles • 100s products, 1000s connections, 10000s messages • Primary IHE benefit for vendors • Test against all other players in one week, in one location (not at customer installation sites!)

  18. Demonstrations • Part of the IHE marketing effort to end-users and system purchasing decision makers • Involve educational sessions, handouts, and interoperating systems demos • Structured to be fair to all participating vendors • Prerequisite is successful completion of Connectathon

  19. IHE Cardiology – where we have been • Year 1 – three profiles with “success path”, addressing broad range of integration problems • Workflow management in a Cath Lab, including angio, hemo, and IVUS, especially for emergent cases • Workflow management in Echocardiography, including mobile echo • Ability to view an ECG from many locations - quickly and easily integrated into other applications • Broad participation in North America and Europe Connectathons and demos

  20. Cath Lab Multiple re-entry of Patient ID Error prone Results fragmented across systems Results inconsistently time-tagged Custom solutions needed for data sharing Difficult to manage Uncoordinated with Hospital Information System Un-ordered cath exams (emergency) Unidentified patients Diagnostic and interventional procedures Ad hoc scheduling of cath labs Change of rooms during procedure 7 6 5 8 10 9 11 4 3 2 1

  21. Echo Workflow • The “drive-by echo” - Cardiologist to sonographer in CCU: “While you’re here, do a TTE on bed 3” • Unordered, unscheduled exam • Modality not on network • Stress echo –After exam, sonographer creates new quad displays of stages and views • No intrinsic value add • Data is redundantly copied to storage

  22. IHE Cardiology – where we are now • Year 2 – enhance profiles to address measurement gathering, and production of final reports • Evidence Document options in Cath and Echo, including procedure log, QCA/QVA, hemo, IVUS measurements • PDF-based Displayable Reports production, archive, and distribution • Demonstration of Cross-Enterprise DocumentSharing between inpatient and ambulatory settings (RHIO)

  23. Evidence Documents Echocardiography Measurement Patient: Doe, John Technologist: der Payd, N Measurements: Mitral valve diameter 3.1cm - shown in image at [ ] Ventricular length, diastolic 5.97 cm - shown in image at [ ] Ventricular volume, diastolic 14.1 ml - inferred from [ ] - inferred from VLZ algorithm • Pick your kludge: • Measurements made on modality or workstation, and written onto a paper worksheet, then transcribed into a report • Measurements output to a printer port, intercepted by an application that scrapes the values • Screen capture of measurements sent to a reporting system, which uses OCR (optical character recognition) to reconstruct the original measurement names and numbers

  24. Displayable Report Management

  25. Cross-enterprise document sharing problem Long Term Care Acute Care (Inpatient) Other Specialized Care(incl. Diagnostics Services) GPs and Clinics (Ambulatory) Typically, a patient goes through a sequence of encounters in different Care Settings

  26. Long Road Ahead – 5 yr Roadmap Year 1(2005) Year 2(2006) Year 3(2007) Year 4(2008) Year 5(2009) Multi-modality workflow & imaging Procedure log, measurements Hemo waveform Supplies, inventory,& charge capture Cardiology Technical Framework Cath Workflow & imaging,stress protocols Measurements 4-D imaging Pediatric Echo Retrieve ECGfor display ECG waveform interoperability ECG Stress testing workflow Workflow & imaging,stress protocols Nuclear Lab workflow, device params & events Device registries Home healthmonitoring EP Reporting & distribution Reports Retrieve guidelinesfor display Registry dataharvesting Retrieve structuredguidelines Quality

  27. For more information • www.ihe.net – overviews, presentations, etc. • ftp://iheyr1:iheyr1@ftp.rsna.org/IHE/Cardio/EP - file server for EP sub-committee • harry.solomon@med.ge.com – e-mail me if you’re stuck!

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