Integrating the Healthcare Enterprise

1. Integrating the Healthcare Enterprise IHE for Consultants and System Integrators Andrei Leontiev John Paganini IDX Systems Corporation

2. IHE as an Integration Tool • The IHE Technical Framework presentsthe technical details for system integrators implementing an IHE network • It includes guidelines for defining dependency relationships, system validation and verification. • These guidelines and tools will simplify the process, identify potential problems, and make systems integration faster, more efficient, less expensive and more successful. RSNA 2002

3. IHE Technical Framework • Organized in three sections that provide an increasing level of detail: • Integration Profiles: Establish broad categories of compatible function. • Actors: Identify specific kinds of operational participants in the healthcare enterprise. • Transactions: Describe particular interactions between actors to perform specific operations. RSNA 2002

4. Scheduled Workflow Post- Processing Workflow Patient Information Reconciliation ChargePosting Admit, order, schedule, acquire & store images with notification of completed steps Schedule, perform, & notify image processing & CAD steps Collection of billable procedure details Unknown patients and unscheduled orders Consistent Presentation of Images Key ImageNotes Simple Image and Numeric Reports Simple reports with image links and measurements Hardcopy and softcopy grayscale presentation state Flag & search for significant images Presentation of Grouped Procedures Manage subsets of a single acquisition Access to Radiology Information Retrieve & view images and reports Basic Security Audit Trail Consolidation & Node Authentication IHE Integration Profiles RSNA 2002

5. Technical Framework: Actors • Actors identify specific kinds of operational participants in the healthcare enterprise. • An individual actor often corresponds to a device or software product • However, actors only reflect integration capabilities of such device or product • Real-life products often implement multiple actors • Actors may implement more than one IHE profile. • 17 types of actors IHE Year 4 RSNA 2002

6. Technical Framework:Transactions • Transactions specify how actors communicate to each other in the integration profile • Transactions define standard protocols • (DICOM, HL7, etc.) • If protocol allows for multiple options, certain choice of options is often dictated • May be required in multiple profiles; some transactions are optional • Over 30 types of transactions in Year 4 RSNA 2002

7. IHE - Relationship to Standards • Generic Integration Solution • Implementation Guide Based on Standards • Choice of Useful Standards Definitions • Select Options Defined by Standards • Strict Conformance to Standards: • Health Level 7 ( HL7 ) • DICOM 3.0 • ... RSNA 2002

8. Actor 1 Actor 2 Actor 3 TRANSACTIONS Actor 1 Actor 2 Actor 3 Message 1 Message 2 Message 3 Use Case Roles & Interaction Diagrams • Examples of Actors: • ADT / Patient Registration • Scheduler • Acquisition Modality • Image Display • Report Reader • Examples of Transactions: • Register Patient • Procedure Scheduled • Images Stored • Query / Retrieve Images • Query / Retrieve Reports RSNA 2002

9. External Report Repository Report Repository Report Reader Retrieve Reports ( C-MOVE ) Retrieve Reports ( C-MOVE ) Store Reports ( C-STORE ) Store Reports ( C-STORE ) View Reports View Reports Use Case Roles & Interaction Diagrams Examples Interaction Diagram: Retrieve Reports RSNA 2002

10. Department System Scheduler – Order Filler – Image Archive Image Manager System Transactions Overview ADT Patient Registration Patient Registration Patient Update Image Creator Order Placer Storage Commit Image Display Images Stored Filler Order Management Placer Order Management Q /R Key Image Note Present. State Stored Q /R Presentation Sates Q /R Images Patient Update Key Image Note Stored Procedure Update Procedure Scheduled Key Image Note Stored Images Availability Query Images Stored Storage Commit Present. State Stored PPS In-Progress / Completed Performed Procedure Step Manager PPS In-Progress / Completed Acquisition Modality PPS In-Progress / Completed Modality Worklist RSNA 2002

11. ADT Patient Registration PRINTING Patient Registration Print Composer Print Server Patient Update Image Creator Order Placer Storage Commit Print Request with Presentation LUT Image Display Images Stored Filler Order Management Placer Order Management Q /R Key Image Note Present. State Stored Enterprise Result Repository Q /R Presentation Sates Report Reader Report Creator Q /R Images Department System Scheduler – Order Filler – Patient Update Key Image Note Stored Report Submission Procedure Update Image Archive Query Report Procedure Scheduled Image Manager Report Issuing Retrieve Report Structured Report Export Key Image Note Stored Images Availability Query Images Stored External Report Repository Storage Commit Present. State Stored PPS In-Progress / Completed Report Repository Performed Procedure Step Manager Report Manager PPS In-Progress / Completed Acquisition Modality PPS In-Progress / Completed Modality Worklist System Transactions Overview RSNA 2002

12. Patient Registration/UpdateOrder Management Worklist Modality Worklist Procedure Scheduled Store Images StorageCommitment Storage Commitment List of Images Modality Performed Procedure Step Performed Step: Status = Completed Performed CT Head Pat Name/ID, Dose, Accession #, Study UID Complete List of Images IHE Scheduled Workflow RIS PACS &Archive RSNA 2002

13. ADT Patient Registration Patient Registration Patient Update Image Creator Order Placer Image Display Storage Commit Images Stored Filler Order Management Placer Order Management Q /R Images Department System Scheduler – Order Filler – Image Archive Procedure Scheduled Image Manager Images Availability Query Images Stored Storage Commit PPS In-Progress / Completed Performed Procedure Step Manager PPS In-Progress / Completed Acquisition Modality PPS In-Progress / Completed Modality Worklist Scheduled Workflow RSNA 2002

14. Integration Profiles Actors and Transactions Scheduled Workflow Example: Image Manager/ Image Archive Actor Transaction Optionality Section in TF Procedure Scheduled R 6.4 Modality Procedure Step In Progress R 6.6 Modality Procedure Step Completed R 6.7 Modality Images Stored R 6.8 Storage Commitment R 6.10 Image Availability Query R 6.11 Query Images R 6.14 Retrieve Images R 6.16 Creator Images Stored R 6.18 Creator Procedure Step in Progress R 6.20 Creator Procedure Step Completed R 6.21 RSNA 2002

15. How to build the integrated healthcare enterprise

16. Where to start... • First, recognize what systems you need to integrate • See what Actors they implement and in what Profiles are supported. • Make sure Actors and Profiles match properly and fit into the Framework. • … Otherwise it won’t work! RSNA 2002

17. Next Steps • Just matching of Actors and profiles is not enough • Most systems have much more complex functionality than that defined in framework • They need more data to function properly • Identify what data systems need besides elements defined in the IHE transactions. RSNA 2002

18. Check Optional Transactions • IHE Integration Profiles may contain optional transactions - make sure both sender and receiver treat such transactions similarly • if receiver requires transaction, sender must be able to always generate it • If receiver does not utilize transaction, make sure it is gracefully handled when it “shows up” RSNA 2002

19. Check the Options in Transactions • Many data elements in the transactions are optional or conditional • Make sure that sender generates conditional information when conditions are met • Make sure that receiver may operate without optional data or the sender must be able to always generate it RSNA 2002

20. Is it going to work now? • Make sure the conformance statements are for correct versions of the software • Check HL7 interface specs • Review DICOM Conformance Statements • Check the results of IHE Connect-a-thon • Ask vendors to provide output from the MESA test tools RSNA 2002

21. MESA Tools • Test tools that are developed by the IHE Technical Project Management Team • Used in preparation for IHE Connect-a-thon. • MESA tools are in public domain. • Test outputs are fairly informative and may provide the extra information on how transactions are implemented RSNA 2002

22. Are we there yet? • One yet have to find the healthcare enterprise equipped so that all the systems are “IHE aware” • Understand that you may have to deal with non-compliant devices and systems • Make best effort to bring them “up-to-date” • Follow yellow brick road... RSNA 2002

23. Implementing Integration Projects with IHE RSNA 2002

24. Project Considerations • A working knowledge of rapidly changing technology • An unbiased insight into the business strategies of potential suppliers • Incorporating existing equipment • Considering changes to current operations • Accounting for the various skills and apprehensions of a multitude of potential users • Accommodating complex practice patterns of radiologists and referring physicians • Impact of organization changes within the enterprise • Impact of changes in the health care industry RSNA 2002

25. Classic Consulting Process • Definition of Client Requirements – Site Analysis, Operational Workflow • Generation of Proposal - Review with Client, Modify as Needed • Solution Development and Implementation • Client Testing QA / Test • Client Signoff • Post Implementation Review RSNA 2002

26. Solution and Development • Current State Analysis • Impact Study • Current State Analysis • Impact Study • System Design and Implementation Strategy • Current State Analysis • Impact Study • System Design and Implementation Strategy • Cost Estimate • Current State Analysis • Impact Study • System Design and Implementation Strategy • Cost Estimate • Pay Back Analysis • Current State Analysis Department Layout Imaging Asset Analysis Room Utilization Hardcopy Utilization Digital Image Equivalents Workflow Analysis Cost Analysis Develop assumptions about system performance and specify performance requirements. Interviews with the radiologists and clinicians Questionnaires Short and long term outcomes. System design includes block diagrams and component lists. Physical network Acquisition devices Display systems Archives Interfaces • Determine the pricing of the required products and services. • Applications. • Professional Services. • Integrations. • Training. Material costs and labor savings are combined with other potential savings RSNA 2002

27. Vendor Considerations • Cost  - Look at whole picture • Flexibility  - Integratable, Scalable • Functionality  - Standard, customizable • Implementability - Mature, Complexity • Stability  - Revenue, Market Segment • Usability - Hides complexity,Productive RSNA 2002

28. What works well now? What does not work well now? What is a "relic from the past"? Search for redundancies Search for important, missing data Check workload peaks & valleys Challenge traditions Expect innovation Document every detail Simplify the complex Still need all that paper? Shorten the start-to-finish cycle time Verify computations Reengineering Analysis RSNA 2002

29. User Analysis • IHE brings users together in new ways • Each user vital to patient care • Each user has different perspective • Each user needs to see how IHE can benefit them What's in it for ME? RSNA 2002

30. ROLE Focused on superior service to patients and referring physicians Workflow Efficiency Maximum Procedures Performed Resource Management Information Accessible Department Manager IHE INTEREST • Reduction in data entry errors • ROI from IHE from increase in efficiencies • Information is pushed to authorized users RSNA 2002

31. ROLE High quality procedures Patient comfort and expediency Problem solver Operational complexity increasing Prepares images for viewing The Technologist IHE INTEREST • Elimination of repetitive tasks (zoom, pan, etc…) • Elimination of paper (scheduling, orders) • Ensures images are stored • Automation of image routing and accessibility RSNA 2002

32. ROLE High quality patient care High level of customer service to referring physicians PROBLEMS Increasing regulations Decreasing reimbursement Tight labor pool Competitive market The Radiologist IHE INTEREST • Must facilitate efficient workflow • Electronic annotations on study • Exceptions management • Protocol management • Images logically grouped • Presentation of images • Reporting tools RSNA 2002

33. Conclusion • IHE should be part of theproposed solution • IHE benefits users, providers and vendors • Year 5 - Key year for expansion into other domains while radiology continues • Support and involvement building across disciplines and internationally RSNA 2002

34. Where is More Information Available? www.rsna.org/IHE IHE Technical framework for year 3 – V5.0 Non-Technical Brochures : IHE Primer and IHE FAQ IHE Integration Profiles: Guidelines for Buyers IHE Connectathon Results RSNA 2002