Andrew M. Keller, MD, FACC, FASE Chief of Cardiology, Danbury Hospital Danbury, CT, USA

1. Integrating the Healthcare EnterpriseIHE: Meeting Global needs for Integrated HealthcareJapanese Circulation Society (JCS)Kobe, JapanMarch 16th, 2007 Andrew M. Keller, MD, FACC, FASE Chief of Cardiology, Danbury Hospital Danbury, CT, USA

2. Thank you for the opportunity to be at the Japanese Circulation Society Scientific Sessions.

3. IHE’s vision and purpose • To apply the knowledge of physician, hospital, and office workflow in order to link and integrate modalities (actors) passing information from application to application seamlessly across the entire health care system.

4. Workflow that must be Integrated • Order entry • Pre-authorization • Patient Scheduling • Transportation • Registration and payer verification • Reconciliation of patient demographics • Coordination with physicians • Study acquisition • Notificationstudycompleted • Study archiving and storage • Image retrieval system • Preliminary reporting • Professional review • Transcription, reporting, and electronic signature • Report dissemination • Quality assurance • Statistical analysis • Billing and auditing

5. Integrate Clinical Information • Goal: optimal patient care • To attain optimal patient care, we need clinical information • When we need it • Wherever we need it • In a meaningful manner • Without repeating tests (time and money) • Originating from many different locations • Cardiology data is especially complex Proper integration of clinical information means better patient care.

6. Information from many places Hospital Doctor’s office Data pointers Home Extended Care

7. Information is difficult to integrate!

8. How can we integrate these system? • Today, at least in U.S. and Europe, each two systems that are connected are an “IT integration project”. • Very expensive • Very time consuming • Very resource intensive • Never works quite right • Usually involves third party • May break if software is upgraded on either system

9. How to integrate? • Instead, use standards: • DICOM • HL7 • XML • Define use of standards in Technical Framework • Have common testing plan in order to have vendors work together • Vendors implement Technical Framework in products

10. IHE comes in • A consortium of professional societies and vendors to facilitate the integration of healthcare information • 1997: IHE founded by RSNA • 1998: Becomes global project in radiology • 1999: Moves beyond radiology • 2003: IHE Cardiology formed with ACC/ESC • 2007: IHE Cardiology is excited to join with JCS and become a truly global organization

11. Testing at Connectathons IHE Demonstrations Develop technical specifications Products with IHE Identify available standards (e.g. HL7, DICOM, IETF, OASIS) Document Use Case Requirements Easy to integrate products Timely access to information Proven Standards Adoption Process

12. Veterinary Endoscopy Pathology Pharmacy Growth in IHE Domains IHE Global Developments Integration Profiles (# X) – Solutions to Real-World Interoperability Needs & Problems: • Within Clinical Departments e.g.: • Radiology • Cardiology • Lab • ... • Across Departmental &Institutional Boundaries – XDS • RHIOs (Regional Healthcare Information Organizations) • EHR Enablers Quality Patient Care Devices (1) Patient Care Coordination (5) Radiation Oncology (1) Eye Care (3) Laboratory (6) Cardiology (7) IT Infrastructure for Healthcare (17) Radiology (18) Year 5 (2003) Year 6 (2004) Year 8 (2006) Year 9 (2007) Year 4 (2002) Year 7 (2005) Year 1 (1999) Year 2 (2000) Year 3 (2001)

13. IHE Cardiology Profiles (9) Cath Lab Workflow Echocardiography Workflow Retrieve ECG for Display 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 Cross-Enterprise Document Sharing (EHR to EHR) Evidence Documents (Measurements) Implantable Cardiac Device Observation Displayable Reports Stress Testing Workflow Nuclear Medicine

14. Cath Lab Integration Procedure Log One patient; one order; one procedure; consistent time stamps

15. Stress Echo Integration Goodman PACS (or 5 other vendors) views stages Toshiba Aplio (or Philips or GE) Views defined; stages defined Consistent display of different vendor stress exams

16. Stress testing integration One patient; one order; one procedure across systems; Consistently defined Protocols and stages

17. Integration benefits • For users across the healthcare enterprise, IHE: • allows faster access to information, • reduces errors, • streamlines workflow, • simplifies interface projects, • optimizes resource utilization.

18. Working together with JCS How can IHE Cardiology North America, Europe, and Japan work together more closely: • Understand differences in clinical workflow Japan • Encourage additional direct involvement in the Planning Committee • Web-ex/tcon in May, 2007, to explain new Year 4 Profiles and gain direct feedback • Direct involvement in annual voting process for new Profiles (usually August/September timeframe) • Bi-annual joint tcons at mutually agreed upon times

19. More Resources - www.ihe.net • Frequently Asked Questions • Integration Profiles in Technical Frameworks: • Cardiology • IT Infrastructure • Laboratory • Patient Care Coordination • Patient Care Devices • Radiation Oncology • Radiology • Connectathon Results • Vendor Products Integration Statements • Participation in Committees and Connectathons