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Integrating the Healthcare Enterprise. Practical Tools for the CIO: Using IHE to Leverage Standards. Nogah Haramati, MD Chief of Radiology, Professor, Radiology & Surgery Jack D. Weiler Hospital Albert Einstein College of Medicine Bronx, NY USA. Agenda. Is the IHE ready for prime time?
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Integrating the Healthcare Enterprise Practical Tools for the CIO: Using IHE to Leverage Standards Nogah Haramati, MD Chief of Radiology, Professor, Radiology & Surgery Jack D. Weiler Hospital Albert Einstein College of Medicine Bronx, NY USA
Agenda • Is the IHE ready for prime time? • How do I get it & use it? • Provocative discussion… ITAC IHE Canada April 30, 2004
Why Should You Care? • Single Vendor Solutions are a Myth • Integration and Interfaces are Difficult • Your Clients Want Integration, Sometimes • IHE isn’t a Standard ITAC IHE Canada April 30, 2004
PACS-RIS Integration Do Vendors Really Want this? • Most RIS vendors are now offering PACS products • The largest PACS vendors are now offering RIS products • Every vendor wants “their” system to be the “Seamlessly” integrated environment ITAC IHE Canada April 30, 2004
Integrating the Healthcare Enterprise (IHE) • Every vendor can create their part of an IHE integrated environment in isolation • Technical Framework sufficiently detailed for each vendor’s piece to be created in isolation • One size fits all • The customer can replace IHE vendors without requiring massive integration projects • Vendors do this ONLY because customers want it! ITAC IHE Canada April 30, 2004
IHE Workflows • Each IHE Profile is composed of the architectural workflows related to that profile • IHE compliance can be verified by following the workflow in the profile and assuring the following: • Each actor’s role is fulfilled by the appropriate vendor • Every transaction is successfully executed ITAC IHE Canada April 30, 2004
Advantages to using IHE Profiles for Acceptance Testing • Testing procedures cannot be “rigged” or “fixed” by the vendor • Testing procedures mirror the exact functionality that was purchased • Testing procedures assure that ALL the actors (regardless of vendor source) are working together ITAC IHE Canada April 30, 2004
ITAC IHE Canada April 30, 2004
Figure 3.2-9. Exception Management Workflow (Wrong Worklist Entry Selected) ITAC IHE Canada April 30, 2004
ITAC IHE Canada April 30, 2004
Case 1: Unidentified Patient Registered at ADT and Ordered at the Order Placer • Any unidentified patient is assigned a permanent Patient ID and a temporary name (e.g., “John Doe”) • When the real patient identity is known, the ADT is responsible for reconciliation of its own records • The ADT sends a Patient Update message to both the Order Placer and Department System Scheduler/Order Filler • The Department System Scheduler/Order Filler sends the Patient Update message to the Image Manager. ITAC IHE Canada April 30, 2004
Case 1: Unidentified Patient Registered at ADT and Ordered at the Order Placer ITAC IHE Canada April 30, 2004
Case 5: Image Acquisition Completed Without Scheduling at DepartmentSystem Scheduler/Order Filler • In this case, no valid Patient ID is available to the Department System Scheduler/Order Filler • No scheduling is done before the procedure is performed. • A temporary ID and name are entered by the technologist at the Modality and conveyed to the Department System Scheduler/Order Filler and to the Image Manager. The Patient ID and name are selected by the technologist according to the locally defined rules ITAC IHE Canada April 30, 2004
Case 5: Image Acquisition Completed Without Scheduling at DepartmentSystem Scheduler/Order Filler • When patient information is known, ADT sends new patient information to both the Order Placer and Department System Scheduler/Order Filler. • The Department System Scheduler/Order Filler performs a merge of the permanent patient record with the temporary one and sends a Patient Update to the Image Manager. • At the same time, Department System Scheduler/Order Filler generates and submits an order to the Order Placer using a valid Patient ID. ITAC IHE Canada April 30, 2004
Case 5: Image Acquisition Completed Without Scheduling at Department System Scheduler/Order Filler ITAC IHE Canada April 30, 2004
How do to leverage the IHE to your advantage? The “How To” Piece…
Current RFPs and Contracts • Do not purchase any system or modality without a vendor commitment to present or future IHE compliance! • Stipulate the level of IHE compliance • Specific integration profiles • Actors supported (present and/or future) • Deadline for compliance • Process for requiring additional IHE profiles ITAC IHE Canada April 30, 2004
The Contractual Approach • Initially use a multiparty agreement including your organization and two vendors • The IHE integration profiles to be included initially are… • Vendor assignment of ACTOR roles for each profile should be included • Penalties for non-performance must be included for ALL parties • Acceptance testing parameters must be based on the same IHE profiles ITAC IHE Canada April 30, 2004
Maintaining the Integration at the State-of-the-Art • Integration Steering CMTE – one per party • Knowledgeable reps from all parties • Decide on new or modified profiles • Unanimous CMTE vote includes the profile in the integration agreement and is legally binding on all parties • Interval after profile is incorporated until delivery of actual product - We have used the longer of 18 months following the incorporation or the first IHE connectathon where that profile is demonstrated (or agree on a time) ITAC IHE Canada April 30, 2004
What if one or both vendors do not agree to add a needed profile? • IHE is a customer driven initiative • Vendors do not want to create custom products for idiosyncratic customers • Customer has ONLY one recourse! • Customer must obtain a written expression of interest in the profile from X number of the vendor’s existing customers • When the customer gets the written letters, the profile is legally binding on that vendor! • IHE is a customer driven initiative! ITAC IHE Canada April 30, 2004
What if the go-live date arrives A transaction does not work & all vendors blame the others? • The IHE transactions are excruciatingly described that by inspecting the actual transaction, fault is easily determined • If the transaction is properly formatted and constructed, then the recipient is at fault • If the transaction is improperly formatted, then the sender is at fault • Errors occur • Build a window of tolerance to allow the vendors to fix bugs ITAC IHE Canada April 30, 2004
Use a lawyer/law firm that has experience in IHE issues and concepts • When do physicians ever have nice things to say about lawyers? • Put in language for binding arbitration of disputes • Specify from where an IHE ‘expert’ is to be found to resolve issues concerning transactions and non-performance if this becomes necessary • Specify the penalties and give them teeth! ITAC IHE Canada April 30, 2004
Traditional RIS & PACS Acceptance Testing • Traditional PACS acceptance testing criteria focused on image transmission, retrieval, display & manipulation criteria • RIS Acceptance criteria focused on ability to perform certain procedures ITAC IHE Canada April 30, 2004
CIO Take Home • Today, vendors need motivation to create an IHE integrated environment • The customers are driving this effort • Long term benefits of an IHE environment are easier integration and replacement for future vendors • IHE is moving to the enterprise • Require it now in your contracts so that you don’t have to pay more later… ITAC IHE Canada April 30, 2004
Provocative Discussion Should I install IHE now or wait?
Provocative Discussion Is the IHE just another fad?
Provocative Discussion Is this only something big, academic centers should do?
Provocative Discussion I don’t have IHE trained staff and have a lot of other priorities, why should I need this now?
Summary • What is the IHE • Is the IHE ready for prime time? • How do I get it & use it? • Provocative discussion… ITAC IHE Canada April 30, 2004
More information…. • Web sites: www.himss.org/ihe www.rsna.org/ihe • IHE Rad Technical framework for year 5 – V5.5 • IHE IT Technical framework for year 1 – V 1.0 • Non-Technical Brochures : • IHE Fact Sheet and IHE FAQ • IHE Integration Profiles: Guidelines for Buyers • IHE Connectathon Results ITAC IHE Canada April 30, 2004