Integrating the Healthcare Enterprise

1. Integrating the Healthcare Enterprise IHE ’s Potential for CardiologyJoseph BiegelMitraIHE Planning Committee

2. What is IHE? • An industry-clinical partnership to integrate clinical information systems throughout healthcare • Demographics, images, waveforms, reports • Goal: Improve the efficiency and effectiveness of clinical practice by: • Providing an implementation framework for open connectivity using existing standards • Improving clinical information flow ACC 2002

3. Who participates in IHE? • Industry sponsors: Radiological Society of North American (RSNA) and Health Information and Management Systems Society (HIMSS) • A neutral forum open to all vendors: Participants include GE, Phillips, Siemens, IDX, Cerner, Mitra, and some 30 others • Standards committee members: DICOM, HL7 • Clinicians, hospital information technology staff, healthcare administrators ACC 2002

4. Why is IHE needed? • Serious Integration Challenges: • Systems need information from other systems: patient demographics, referring physicians, echo/angio images, ECG waveforms, hemodynamics, clinical reports, etc. • But, systems communicate poorly or not at all • Result: - tedious, inefficient workflows - data that is inconsistent or unavailable • Responsibility for information flow between systems and between departments is often unclear. ACC 2002

5. What does IHE do? • Users and vendors work together to identify and design solutions for integration problems • Intensive process with annual cycles: • Identify key specific 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 meetings (RSNA/HIMSS/ACC) ACC 2002

6. What does IHE cover? • Currently focused in Radiology • 30 Vendors tested 70 systems at the Year 3 Connectathon • Systems include: • HIS, RIS • MR, CT, US, CR, DX, … • PACS, Review Stations, Reporting Systems • Printers, Imagers ACC 2002

7. Why aren’t existing industry standards sufficient? • Standards are vital (HL7, DICOM, ICD, …) • They provide consensus, tools & technologies • IHE is entirely standards-based • But standards alone are insufficient • Varying interpretations • Optional variations • No real-world specifications or scenarios • No assurance of portability or connectivity ACC 2002

8. How is IHE related to standards? • IHE focuses on specific, practical integration problems • Standards such as HL7 and DICOM provide “dictionaries” • IHE defines a “phrasebook” and/or “grammar” that solves real world problems by assembling pieces provided by DICOM/HL7 ACC 2002

9. Key IHE concepts • Technical Framework: detailed, structured document delineating standards-based transactions among systems (“IHE actors”) to support specific workflow and integration capabilities • Integration Profiles: Documents specifying integration capabilities for specific patient-care problems ACC 2002

10. IHE’s track record • Year 1 (1999): Proof of Concept (Basic Scheduled Workflow) • Year 2 (2000): Introduction of 7 Integration Profiles for Radiology • Year 3 (2001): Consolidation, Catch-up (Real Products) Expansion to France • Year 4 (2002): 3 New Profiles Expansion to Japan, Germany • Year 5 (2003): New Profiles Expansion to Cardiology, Lab, Pathology, …? ACC 2002

11. Integration Profile examples • Scheduled Imaging-Encounter Workflow • Registration, ordering, scheduling, acquisition, distribution, storage • Patient Information Reconciliation • Consistent Presentation of Images • Across various devices, media • Key Image Note • Adding text notes and pointers to images ACC 2002

12. Why IHE in cardiology (1)? • Cardiology workflow involves multiple diagnostic tests, images and reports • Cardiology clinical systems/devices typically are unintegrated • Separate systems for ECG/Holter, EP, PPM/ICD, echo, angiographic images, hemodynamics, documents/reports • Each system typically requires redundant manual data entry, with inevitable errors ACC 2002

13. Why IHE in cardiology (2)? • Systems typically do not share data • Patient demographics, directories of referring physicians or of images/documents • Image formats often not portable • Encrypted formats, proprietary readers, variable headers • Fragmentation causes inefficiency, invalid or inaccessible clinical data, and compromises the quality of care ACC 2002

14. Why IHE in cardiology (2) ? • Some of the concepts of the IHE TF have broad general applicability and many can be applied or adapted to Cardiology • The imaging vendors are largely the same • DICOM and HL7 are used in Cardiology today • Other Cardiology specific standards could easily be leveraged in a Cardiology specific version of the TF ACC 2002

15. Common characteristics • Cardiology is similar in some vital respects to radiology • Driven by imaging modalities • Managing distributed departmental resources • Need for an integrated patient-centered view and for administrative reporting • Need to improve lab efficiency via workflow management • Legacy installed base technology issues ACC 2002

16. Cardiology workflow elements • Workflow often similar to radiology: • Patients are admitted • Demographics entered (often multiple times for the same patient) • Imaging studies are performed and read • Reports generated ACC 2002

17. Distinct cardiology needs • Clinical data content is more complex • Therapeutic as well as diagnostic procedure reports, with richer report content • Richer graphical content: moving images, color • Clinical encounter data • Outcome reporting • Cardiology focuses on an integrated patient view rather than on procedures, images and reports in isolation ACC 2002

18. IHE/cardiology possibilities (1) • Image exchange/portability • Even with DICOM, image transfer and display often don’t work • Difficulty importing outside images into local archives • As part of a cardiology Technical Framework, IHE could specify unambiguous, vendor-supported, compatible DICOM implementations ACC 2002

19. IHE/cardiology possibilities (2) • Redundant, manual patient demographic data entry is slow and error prone • DICOM and HL7 can help, but the standards themselves are not enough • IHE could leverage or adapt its Scheduled Workflow Integration Profile and Patient Information Reconciliation Profile for cardiology, resulting in a single entry point for patient demographics, accessible to all cardiology systems and devices ACC 2002

20. IHE/cardiology possibilities (3) • IHE can develop generic, standards-based interfaces between cardiology devices/systems and enterprise systems for scheduling, ordering and results reporting • Cardiology makes large capital purchases of imaging and information systems without assurance that systems can co-exist or interface: The “fear at power on” factor • The IHE TF can define vendor-neutral requirements that assure interoperability ACC 2002

21. IHE/cardiology possibilities (4) • Structured reporting: In partnership with ACC and clinicians, IHE could develop standards-based cardiology reports, including diagrams and graphics for anatomy, function and viability • Beyond static, black-and-white DICOM: IHE could develop Implementation Profiles for motion images, color images, waveforms, Doppler, pediatric echo ACC 2002

22. An IHE/ACC partnership • IHE and industry will do the heavy lifting at the technical level • BUT IHE needs ACC involvement • To ensure that IHE focuses on clinical needs and provides clinically relevant solutions • To act as impartial, patient-centered observers (rarely referees), so that IHE remains truly vendor-neutral ACC 2002

23. Conclusions • IHE can dramatically improve the care of cardiology patients and life for cardiologists. • To succeed--and to do justice to its goals--IHE needs both expert cardiology input and ACC involvement ACC 2002