Implementation of IHE Integration Profiles at the Cleveland Clinic Foundation

1. Implementation of IHE Integration Profiles at the Cleveland Clinic Foundation Dr. David Piraino, Section Head of Radiology Informatics RSNA 2002

2. Conflict of Interest Statement • IDX Alpha Partner • Members of Siemens Medical Advisory Board • No product or vendor endorsements are implied by this presentation RSNA 2002

3. About Cleveland Clinic • Multispecialty academic medical center and National Referral Center • One of the world’s first group practices, it was formed in 1921 • 4 Cleveland physicians came together and set forth their professional standards: “Better care of the sick, investigation of their problems, and further education of those who serve.” • 2nd largest medical group practice in the world, largest hospital in Ohio, • Nearly 73,000 outpatient visits are recorded each month • 934 staffed-bed hospital • Children’s Hospital, Educational Foundation & Lerner Research Institute. • In 2000, 2 million outpatient visits and 51,000 hospital admissions.  • More than 1,100 full-time physicians and scientists • 100 specialties and subspecialties. RSNA 2002

4. About Cleveland Clinic Radiology • 8 hospitals • 15 out patient imaging centers • Over 1 million exams per year • Over 700,000 digital exams archived per year • Not enough radiologists and technologists RSNA 2002

5. In order to provide better patient care and provide an efficient operational workflow, the Cleveland Clinic Foundation has implemented the "Scheduled Workflow" and "Patient Information Reconciliation" integration profiles. These transactions are supportedand are in production or in pilot mode at the Cleveland Clinic. RSNA 2002

6. Main Benefits • Time savings during patient registration -MWL • Elimination or at least significant reduction of errors during patient registration – MWL • Elimination of manual input at RIS terminal - MPPS • Elimination of manual check of archiving the images - Storage Commitment • Reduction of incorrectly identified or “lost” studies – All of the above RSNA 2002

7. Prior to IHE • Before the IHE implementations, the process was very paper-based and there was a great amount of data entry required. Much of the same information was being entered into different systems – the HIS, the RIS, the PACS and the Modality. This slowed down the operational workflow. By using the IHE Technical Framework as a guideline, much of the mapping exercises were shortened as it provided a common understanding and language between all the different information system, imaging system, and modality vendors. RSNA 2002

8. Where are we? • Patient demographics and exam information being sent from the HIS to the RIS (ADT/Order Placer and Order Filler) has been in place for the past 4 years. • Implementation of Modality Worklist has been an ongoing process for the past 3 years and is currently approaching 100 integrated modalities. • Storage Commitment and Modality Perform Procedure Step are in their initial implementation stage in CT. Ongoing process to implement IHE Integration Profiles RSNA 2002

9. The HL7 ADT Patient Registration and Update, Filler and Order Management transactions are sent from various HIS systems to the IDXrad RIS. The transactions "Modality Worklist Provided" and "Modality Images Stored" are in use in the CT department at the Cleveland Clinic. With the recent update of the Siemens CT Scanners these imaging modalities now support the transactions "Modality PPS in Progress", "Modality PPS Completed" and "Storage Commitment". With the exception of "Storage Commitment", the IDXrad RIS also supports these transactions. The Siemens image archive supports “Storage Commitment” How it Works RSNA 2002

10. Patient Registration/UpdateOrder Management Performed Step Status = begun 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

11. Patient Registration/UpdateOrder Management Manual Begin Exam Worklist Manual Patient Entry Manual Prefetch Store Images Technologist check archive Modality Performed Procedure Step Technologists manually Complete examination CCF Scheduled Workflow RIS PACS &Archive RSNA 2002

12. Patient Registration/UpdateOrder Management Performed Procedure “begin” Worklist Modality Work-list Procedure scheduled Store Images Storage commitment Modality Performed Procedure Step Technologists manually Complete examination CCF Scheduled Workflow RIS PACS &Archive RSNA 2002

13. Standards & Mechanisms • HL7 • ADT Messages (A01-08, A11-13, A38, A40) • ORM Messages • DICOM • Modality Worklist Management (MWL) • Modality Performed Procedure Step (MPPS) • Storage, Storage Commitment • Query/Retrieve RSNA 2002

14. Results CT • Modality Work-list • Reduction in miss identified studies • Reduction in time between exam completion and dictation because of fewer miss identified studies RSNA 2002

15. Results CT • Modality Perform Procedure Step • Currently in pilot • Provides more accurate begin exam time • Questions remain about completion • Billing requirements • Group procedures give that we have not implemented the Grouped Procedure Profile RSNA 2002

16. Results Orthopedic Out Patient Clinic Completion to Dictation • Analog films 120 hours • CR 60 hours • Modality work-list 40 hours • Work flow change 20 hours • Large portion of the delay is “lost” images from film or incorrectly identified studies RSNA 2002

17. Production Test Implementation Issue The challenge of managing each vendor's update to their software was overcome by creating a fully-functional test environment. This approach enables Cleveland Clinic to effectively simulate their production environment. RSNA 2002

18. Customer/Vendor Collaboration Step 1. Following a controlled change management process, each vendor installs their latest update into the test environment. Step 2. Extensive testing occurs until all vendors and Cleveland Clinic approve the update; then it is scheduled to be placed into production. RSNA 2002

19. Thinking about the Workflow • Need to manage the business processes and workflow changes • Business process re-engineering requires an intense user education process which includes user feedback. • For successful integration, it is critical to work closely with all users of the solution. RSNA 2002

20. Questions Dr. David Piraino – piraind@ccf.org RSNA 2002