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Integrating the Healthcare Enterprise. What’s New in IHE. Kevin O’Donnell Toshiba Medical Systems. Rita Noumeir Ph.D. Softmedical. IHE Radiology Activities. New Supplements in 2005 Teaching File and Clinical Trial Export (TCE) Cross-enterprise Document Sharing for Imaging (XDS- I)

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integrating the healthcare enterprise

Integrating the Healthcare Enterprise

What’s New in IHE

Kevin O’Donnell

Toshiba Medical Systems

Rita Noumeir Ph.D.

Softmedical

ihe radiology activities
IHE Radiology Activities
  • New Supplements in 2005
    • Teaching File and Clinical Trial Export(TCE)
    • Cross-enterprise Document Sharing for Imaging (XDS- I)
    • Radiology Option for Audit Trail and Node Authentication (ATNA)
  • IHE Radiology Users Handbook
  • PDI Demonstration and Success Stories at RSNA 2005
ihe radiology integration profiles
IHE Radiology Integration Profiles

Do you we have a new updated radiology profile diagram ??

ihe it infrastructure activities
IHE IT Infrastructure Activities
  • Sponsored by HIMSS
  • 9 Profiles deployed including:
    • ATNA: Audit Trail & Node Authentication
    • PIX: Patient ID Cross-Referencing
    • XDS: Cross-Enterprise Document Sharing
  • New Supplements being finalized(Public Comment June 15 - July 15)
    • Digital Signatures
    • Cross-Enterprise User Authentication
    • Patient Management
    • Notification of Document Availability
  • HIMSS 2005
    • Interoperability Showcase
    • Brailer Press Conference
ihe cardiology activities
IHE Cardiology Activities
  • Sponsored by ACC, ESC, GMSIH
  • 3 Profiles deployed:
    • CATH: Cardiac Cath Workflow
    • ECHO: Echocardiography Workflow
    • ECG: Retrieve ECG for Display
  • New Supplements being published
    • Displayable Reports Profile
    • Cath & Echo Evidence Documents
  • ACC 2005
    • First Demo very successful
    • ~1,300 Attendees
  • ASE 2005
    • Demo Planned – June 8-15, Boston
ihe lab activities
IHE Lab Activities
  • Sponsored by GMSIH, HPRIM, JAHIS
  • 1 Profile deployed
    • LWF: Laboratory Scheduled Workflow
  • New Supplements being finalized (Public Comment June 15 – July 15)
    • Laboratory Point of Care
    • Laboratory Device Automation
    • Laboratory Code Set Distribution
    • Laboratory Information Reconciliation
new ihe domains
New IHE Domains
  • IHE Radiation Oncology
    • Sponsored by AAPM / ASTRO
    • Working on initial profiles
  • IHE Patient Care Coordination
    • Sponsored by HIMSS
    • New profile – “Cross Enterprise Document Sharing Content profile : Medical Summary Document”
  • IHE Point of Care Devices
    • Sponsored by ACCE / HIMSS
    • Forming committees
  • IHE Eyecare
    • Sponsored by AAO
    • Forming domain
ihe regions
IHE Regions
  • New national IHE initiatives; governmental interest
  • IHE-North America
    • U.S., Canada
    • Demonstrations at RSNA, HIMSS, ACC
    • Additional Presentations at SCAR, SPIE
  • IHE-Europe
    • France, Germany, Italy, UK, Norway, Netherlands, Spain & Denmark
    • Presentations/Demos at ECR, DRK, SIRM, Hopital Expo& UKRC
  • IHE-Asia
    • Japan, South Korea, Taiwan & China
    • Demo at JRC
ihe connectathon
IHE Connectathon
  • Massive Cross-vendor Testing
    • One week; dozens of vendors; thousands of tests
    • Opportunity to find/resolve issues
  • Participation is Voluntary
    • Litmus test not a pre-requisite or certification
  • Engineering event
    • Project Management by Mallinckrodt
    • Pre-Validation Tools (MESA)
    • Defined Test Protocols with Verification
annual ihe connectathons
Annual IHE Connectathons
  • IHE-North America
    • Connectathon in January 2005 (Chicago, IL)
      • 45 Vendors, 110 Systems, 300 Engineers, 22 Profiles
  • IHE-Europe
    • Connectathon in April 2005 (Noordwijkerhout, Netherlands)
      • 62 Vendors, 98 Systems, 230 Engineers, 23 Profiles
  • IHE-Asia
    • Connectathon in Feb 2005 (Yokohama, Japan)
      • 30 Vendors, 70 Systems, 8 Profiles
ihe radiology users handbook
IHE Radiology – Users Handbook
  • SCAR 2005 – Debut of first Edition
  • “Using IHE” for purchasers, system integrators & users
  • Real-world scenarios: acquiring a modality, RIS or PACS
  • Selecting IHE Profiles; Making the Business Case
    • Based on goals (e.g. reducing errors; increasing throughput)
    • Identify Profiles that contribute to each goal
    • Find products that support those Profiles
    • Specify Profiles in an RFP
  • Installing & Operating IHE Systems
    • Leverage electronic workflows
    • Install & Configure the systems
    • Do Acceptance Testing
    • Interface with non-IHE systems
teaching file and clinical trial export tce abstract scope
Teaching File and Clinical Trial ExportTCE Abstract/Scope
  • DICOM-based mechanism for connecting clinical systems to:
    • External teaching file systems
    • External clinical trial systems
  • Meets de-identification requirements for:
    • Teaching files (HIPAA)
    • Clinical trials (pseudonymization)
teaching file and clinical trial export value proposition for customers
Teaching File and Clinical Trial ExportValue Proposition for Customers
  • Brings digital imaging to traditionally film-based activities
  • Facilitates clinical research and grant acquisition
  • Standardizes clinical trial data collection
  • Improves the efficiency of teaching file production
  • Supports meeting the Accreditation Council on Graduate Medical Education requirements for teaching files
teaching file and clinical trial export value proposition for companies
Teaching File and Clinical Trial ExportValue Proposition for Companies
  • You can add TF and CT capability to your products just by implementing the TCE profile
  • MIRC is available as a TF and CT Receiver
    • Teaching File and Clinical Trial system
    • In use at many universities
    • Selected by the NCI for clinical trial image transport
    • Developed, supported and promoted by the RSNA
    • Free & open source (mirc.rsna.org)
    • Supported by other CT and TF systems
teaching file and clinical trial export
Teaching File and Clinical Trial Export
  • Export Selector
    • a system that identifies information to be sent to a teaching file or clinical trial system
    • example: a user at a PACS diagnostic workstation
  • Export Manager
    • de-identifies and re-identifies the images, reports, evidence documents, presentation states and additional information with pseudonymous values
    • supports the Remap Identifiers option to pseudonymize the images with the trial-specific identifiers and to populate the clinical trial specific attributes.
    • sends the pseudonymized DICOM objects and an updated manifest to a Receiver.
  • Receiver
    • a local teaching file or clinical trial system
    • a clinical trial system responsible for transferring images to the central review facility
teaching file and clinical trial export example teaching file use case part 1 selection
Teaching File and Clinical Trial ExportExample Teaching File Use Case- Part 1: Selection -
  • Radiologist views images for primary diagnosis on Image Display grouped with Export Selector.
  • Export Selector allows images, series and studies to be selected “For Teaching File Export”.
  • Export Selector may also provide a UI allowing the user to enter text notes and select additional items (SR, KIN, GSPS, etc.) for inclusion in exported objects.
teaching file and clinical trial export example teaching file use case part 2 export
Teaching File and Clinical Trial ExportExample Teaching File Use Case- Part 2: Export -
  • User action triggers Export Selector to send objects and a Key Image Note manifest to Export Manager.
    • Document Title of the KIN specifies “For Teaching File Export”.
    • Export Manager de-identifies objects.
  • Export Manager collects objects selected and sends to Receiver.
    • Receiver may be part of a Teaching File system.
  • TF system receives objects and manifest and stores them for later use by radiologist when authoring the teaching file case.
  • …other use cases are in the Technical Framework
teaching file and clinical trial export example clinical trial use case part 1 selection
Teaching File and Clinical Trial ExportExample Clinical Trial Use Case- Part 1: Selection -
  • A clinical trial administrator views images on Image Display grouped with Export Selector.
  • The Export Selector allows images, series and studies to be selected “For Clinical Trial Export”.
  • The administrator identifies the trial.
  • The Export Selector sends images and a KIN manifest to the Export Manager.
    • The Document Title of the KIN specifies “For Clinical Trial Export”.
    • Export Manager de-identifies objects.
teaching file and clinical trial export example clinical trial use case part 2 export
Teaching File and Clinical Trial ExportExample Clinical Trial Use Case- Part 2: Export -
  • The Export Manager collects all the objects selected and sends them to the Receiver which may be part of a Clinical Trial communication system.
  • The CT system receives the objects and the manifest and forwards the relevant data to the central facility of the Clinical Trial.
  • …other use cases are in the Technical Framework
teaching file and clinical trial export export selection
Teaching File and Clinical Trial ExportExport Selection
  • Key Image Note used as a manifest of exported objects:
    • List of images and other DICOM objects
    • Coded Document Title
      • “For Clinical Trial Export”
      • “For Teaching File Export”
    • Text “disposition”
    • Information about the requesting user
  • Sent via conventional C-STORE
    • Not a new SOP Class
teaching file and clinical trial export1
Teaching File and Clinical Trial Export

Export Selector

Export Manager

Receiver

Store Instances [Rad 50]

Store Export Selection [Rad 51]

Store Additional TF Info [Rad 52]

Delay for pathology

De-identify attributes

De-identify pixel data

Re-map identifiers

Export Instances [Rad 53]

teaching file and clinical trial export2
Teaching File and Clinical Trial Export

Export Selector

Image

Display

Evidence

Creator

Report

Creator

Acquisition

Modality

Store Instances [Rad 50]

Store Export Selection [Rad 51]

Store Additional teaching File Information [Rad 52]

Export Manager

Image

Manager/

Archive

Report

Manager

Report

Repository

Export Instances [Rad 53]

Receiver

Image

Archive/

Manager

Portable

Media

Creator

abstract scope
Abstract / Scope
  • Sharing of Imaging Information across health enterprises
  • Imaging Information includes
    • extensive sets of DICOM instances including images, evidence documents and presentation states
    • diagnostic reports provided in a "for display" form
    • selection of diagnostically significant images associated with the report content
sharing radiology reports and images in a regional health information network
Sharing Radiology Reports and Imagesin a Regional Health Information Network

Regional Health Information Network

Radiology Enterprise B

PACS B

Radiology-to-radiology

Radiology-to-Physicians

PACS A

Physician Office

Radiology Enterprise A

sharing radiology reports and images in a regional health information network1
Sharing Radiology Reports and Imagesin a Regional Health Information Network

Regional Health Information Network

Radiology Enterprise B

PACS B

  • Patient Id= 3547F45
  • Report 5/21/1998 : CT Head B
  • Study 5/21/1998 : CT Head B
  • Report 2/18/2005 : Chest Xray A
  • Study 2/18/2005 : Chest Xray A

Cross-Enterprise Registry

PACS A

Physician Office

Radiology Enterprise A

physicians and systems within a regional health network routine imaging referral

Register Imaging Information for sharing

Priorimaging Reports & Studies

Register Imaging Information for sharing

Query for Documents

Physicians and Systems within a Regional Health Network - Routine Imaging Referral

Regional Health Information Network

Radiology Enterprise B

Cross-Enterprise Registry

  • Patient Id= 3547F45
  • Report 5/21/1998 : CT Head B
  • Study 5/21/1998 : CT Head B

Physician Office

Radiology Enterprise A

physicians and systems within a regional health network routine imaging referral1

Register Imaging Information for sharing

Register Imaging Information for sharing

Notification of Doc Availability

Physicians and Systems within a Regional Health Network - Routine Imaging Referral

Regional Health Information Network

Radiology Enterprise B

Cross-Enterprise Registry

Physician Office

Radiology Enterprise A

physicians and systems within a regional health network for a routine imaging referral

Prior Imaging Report & Study

Query for documents

Notification of Doc Availability

Imaging Report & Study

Physicians and Systems within a Regional Health Network for a Routine Imaging Referral

Regional Health Information Network

Radiology Enterprise B

  • Patient Id= 3547F45
  • Report 5/21/1998 : CT Head B
  • Study 5/21/1998 : CT Head B
  • Report 2/18/2005 : Chest Xray A
  • Study 2/18/2005 : Chest Xray A

Cross-Enterprise Registry

Physician Office

Radiology Enterprise A

value proposition
Value Proposition
  • Imaging component of the Electronic Health Record: Shared imaging Record, in a community, region, etc.
  • Effective means to contribute and access imaging documents across health enterprises.
    • Without XDS-I, access to the radiology report across health enterprises is difficult
  • Scalable sharing of imaging documents between radiology departments, private physicians, clinics, long term care, acute care with different clinical IT systems.
  • Easy access: Care providers are offered means to query and retrieve imaging documents (images and reports) of interest
    • with the same mechanisms used to query other documents
value proposition1
Value Proposition
  • Distributed: Each Care delivery organization “publishes” imaging information for others. Actual images remain in the source/Image Manager.
  • Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain.
  • Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (DICOM KOS, PDF and/or text report)
  • Document Content Neutral: Document content is processed only by source and consumer IT systems.
  • Standardized Registry Attributes: Queries based on meaningful attributes ensure deterministic document searches.
xds i actors and transactions
XDS-I Actors and Transactions

Patient

Identity Source

Patient Identity

Feed

Query

Document

Documents

Document

Consumer

Registry

Register

Document Set

Retrieve

Provide & Register

Document

Document Set

Document

Document

Repository

Source

Retrieve Images

Image Manager

Image Archive

Retrieve Presentation States

Retrieve Key Image Note

Retrieve Evidence Documents

WADO Retrieve

slide35

Register Manifest

Query Registry

DICOM Manifest

DICOM Manifest

Retrieve Manifest

Reference to image 1

Reference to image 1

Reference to image 2

Reference to image 2

Reference to image 3

Reference to image 3

Retrieve Images

Manifest

Manifest

Manifest

Manifest

Manifest

Clinical IT System

Clinical Encounter

Document Registry

Document Repository

slide37

Radiology Report

Header:

Report Type:

OB / Gyn

BPD

…..

...

Findings:

…..

Gestational

Impressions:

Age

...

Text Report

PDF Report

Text +PDF Report

Radiology system

Report Source

slide38

Register Report

Query Registry

Radiology Report

Header:

Report Type:

OB / Gyn

BPD

Retrieve Report

…..

...

Findings:

…..

Gestational

Impressions:

Age

Report

Report

Report

...

Clinical IT System

Clinical Encounter

Document Registry

Document Repository

Radiology system

Report Source

linking report to selected images

BPD

...

…..

Linking Report to Selected Images

Radiology Report

Header:

Report Type:

OB / Gyn

…..

Findings:

Gestational

WADO URI

Link

to image

Age

...

Relevant Image

Radiology system

Report Source

audit trail and node authentication atna radiology option abstract scope
Audit Trail and Node Authentication (ATNA) + Radiology OptionAbstract / Scope
  • Defines basic security features for an individual system for use as part of the security and privacy environment for a healthcare enterprise.
    • Provides host level authentication, which is used in conjunction with the user authentication from EUA and XUA.
    • Provides audit trail mechanism for monitoring activities related to security and patient privacy
audit trail and node authentication atna radiology option compatibility with basic security
Audit Trail and Node Authentication (ATNA) + Radiology OptionCompatibility with Basic Security
  • “But, what if I already have systems that support Basic Security?”
    • ATNA + Radiology Option is backward compatible with Basic Security
    • Integration Statements should change support claim from “Basic Security” to “Radiology Option for ATNA”
atna value proposition
ATNAValue Proposition
  • Protect Patient Privacy and System Security:
    • Meet ethical and regulatory requirements
  • Enterprise Administrative Convenience:
    • Unified and uniform auditing system
    • Common approach from multiple vendors simplifies definition of enterprise policies and protocols.
    • Common approach simplifies administration
  • Development and support cost reduction through Code Re-use:
    • Allows vendors to leverage single development effort to support multiple actors
    • Allows a single development effort to support the needs of different security policies and regulatory environments.
atna vs basic security value proposition
ATNA vs Basic SecurityValue Proposition
  • Why Change?
      • Use an Audit Repository that supports more than just imaging domains like Radiology.
      • Use a reliable, error correcting, secure transport for audit messages
atna security measures
ATNASecurity Measures
  • Authentication:Establish the user and/or system identity, answers question: “Who are you?”
      • ATNA defines: How to authenticate network connections.
      • ATNA Supports: Authentication mechanisms, e.g. Enterprise User Authentication (EUA) or Cross Enterprise User Authentication (XUA)..
  • Authorization and Access control:Establish user’s ability to perform an action, e.g. access to data, answers question: “Now that I know who you are, what can you do?”
      • ATNA defines: How to authorize network connections.
      • ATNA requires: System internal mechanisms for both local and network access.
atna security measures1
ATNASecurity Measures
  • Accountability and Audit trail:Establish historical record of user’s or system actions over period of time, answers question: “What have you done?”
      • ATNA Defines: Audit message format and transport protocol
atna node authentication
ATNANode Authentication
  • X.509 certificates for node identity and keys
  • TCP/IP Transport Layer Security Protocol (TLS) for node authentication, and optional encryption
  • Secure handshake protocol of both parties during Association establishment:
    • Identify encryption protocol
    • Exchange session keys
  • Actor must be able to configure certificate list of authorized nodes.
  • ATNA presently specifies mechanisms for HTTP, DICOM, and HL7
atna auditing system
ATNAAuditing System
  • Designed for surveillance rather than forensic use.
  • Two audit message formats
    • IHE Radiology interim format, for backward compatibility with radiology
    • IETF/DICOM/HL7/ASTM format, for future growth
      • DICOM Supplement 95
      • IETF Draft for Common Audit Message
      • ASTM E.214
      • HL7 Audit Informative documents
  • Both formats are XML encoded messages, permitting extensions using XML standard extension mechanisms.
update where is more information available
UPDATE Where Is More Information Available?
  • www.ihe.net
    • IHE Radiology Technical Framework V5.5
    • IHE IT Technical Framework V1.1
    • IHE Lab Technical Framework V1.1
    • IHE Cardiology Technical Framework V1.0
    • IHENews Mailing List
    • IHE Primer and IHE FAQ
    • IHE Integration Profiles: Guidelines for Buyers
    • IHE Presentations
    • IHE Connectathon Results
    • IHE Integration Statement Links
slide50
Ask your vendors:

Which IHE Profiles do they support on which systems?

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