Integrating the Healthcare Enterprise

1. Integrating the Healthcare Enterprise Integration Profiles - Overview Courtesy of IHE Committees

2. Integration Profiles - Objective • Address real-world interoperability problems (bottom-up approach) • Leverage same integration solutions over multiple domains (top-down) • Generalized solutions • Example : Scheduling exams, display `exam results • Integration Profiles are orthogonal • IPs are independent of each other • Applications may combine multiple Integration Profiles • E.g. Information access + security IHE Europe Educational Event

3. Integration Profile - structure Integration Profile … Actor Actor Actor … … … Transaction Transaction Transaction Transaction Transaction Referenced standard (HL7) Detailed messaging info -------------------------- Roles • Solves an Integration Problem: • A collection of real world information exchange capabilities supported by a set of specific Actors using Standards-based Transactions IHE Europe Educational Event

4. IHE Roadmap Patient Management Order Management Patient Identifier Linkage, Registries, Security Access to clinical information; Electronic Health Record Other (e.g. Acces Control, eHealthWorkflows) Labora- tory Pharmacy,….. Radiology Cardiology IHE Europe Educational Event

5. IHE Scope IHE Europe Educational Event

6. IHE Radiology – Focus Points • Streamline the workflow sub-processes • Upstream : Patient ADT – Ordering – Data creation & processing • Downstream : Reporting – Treatment – Billing • Exception management : e.g. update unknown patient IDs • Quality control • Consistent presentation of images on displays & printers • Improve communication with referring physicians • Access to information, generated in radiology (images, reports) • Image notes (post-its) • Improve machine-machine communication (automatic processing) • Structured reports • Measurements and coded data • Security : • Adhere to (parts of) existing Security&Privacy regulation • authentication, auditing • Off-line medium distribution (new) IHE Europe Educational Event

7. Radiology – Integration Profiles Scheduled Workflow Charge Patient Information Reconciliation Posting Admission, Order Management, Scheduling, Store, Retrieve Manage Worklists, Track Status,Perform &NotifyAcquisitionRelated Steps Presentation of Reporting Post - ReconcileWorklists,StatusandData Objects ForUnknownPatientsandDemographicsChanges Grouped Processing Workflow Procedures Workflow Manage NMImage Manage Manage individual worklists, track worklists, track procedure image status, perform status, perform subsets from a & notify & notify image multi - procedure diagnostic processing & acquisition for reporting steps CAD steps viewing & reporting Simple Image Evidence Consistent Key Image Create,Store,Manage,Retrieve &UseImages and Numeric c Documents Presentation of Notes Reports Images Create, store, Create, store, Create, store, Create, store, manage, retrieve & manage, retrieve & manage, retrieve & manage, retrieve use objects to flag use simple use objects for & use objects to significant images diagnostic reports hardcopy and record study with optional image softcopy grayscale evidence links & presentation states Portable Data for Imaging Access to Radiology Information Basic Security New New IHE Europe Educational Event

8. IHE IT Infrastructure – Focus Points • Enterprise interoperability issues, common to multiple departments • Improve information consistency among applications & departments : • Cross referencing patient IDs among hospitals (MPI) • Patient synchronisation of multiple desktop applications • Simple access to patient’s clinical information from workstations and browsers • Reports, images, • Simple access to administrative information of patient and staff • Patient’s demographic information, personnel directory • Security : • Single sign-on (shared user context) • Centralized user management • Audit trails on enterprise level • Sharing of clinical information among healthcare providers (e.g. regional health networks) IHE Europe Educational Event

9. IT Infrastructure – Integration Profiles Personnel White Page New Access to workforcecontact information New Retrieve Information for Display Retrieve Information for Display Cross-Enterprise Document Sharing Access a patient’s clinical information and documents in a format ready to be presentedto the requesting user Access a patient’s clinical information and documents in a format ready to be presentedto the requesting user Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Patient Demographics Query New Audit Trail & Node Authentication New Centralized privacy audit trail and node to node authentication to create a secured domain. Enterprise User Authentication Enterprise User Authentication Consistent Time Provide users a single nameand centralized authentication processacross all systems Coordinate time across networked systems Patient Synchronized Applications Synchronize multiple applications on a desktop to the same patient Patient Identifier Cross-referencing for MPI Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Map patient identifiers across independent identification domains IHE Europe Educational Event

10. IHE Laboratory – Focus Points • Leverage schedule workflow of radiology • Ordering, scheduling and performing clinical laboratory tests • Support specimen testing on the point of care or on the patient’s bedside • Delivering the observation results to the medical staff, at various steps of validation. • Manage the sequence of operations of automated lab equipment • E.g. analyzers, robotic decappers, centrifuges, conveyors • All specialties working on specimen, not on the patient itself. IHE Europe Educational Event

11. Laboratory IHE Integration Profiles Laboratory Scheduled Workflow (LSWF) Completed in 2003 Laboratory Point Of Care Testing (LPOCT) In Process –TI Nov 2004 Tests performed by a laboratory for an identified inpatient or outpatient Tests performed on point of care or patient’s bedside Laboratory Patient Information Reconciliation (LPIR) In Process Laboratory Device Automation (LDA)In Process –TI Nov 2004 Tests performed on an unidentified or misidentified patient Pre-analytic process, analysis and post-analytical treatment Laboratory Code Set Distribution (LCSD) In Process Sharing the batteries and tests code sets throughout the enterprise IHE Europe Educational Event

12. IHE Cardiology – Focus Points • Leverage “schedule workflow” (radiology) for cath lab and echocardiography • Leverage “retrieve for display” for ECG’s • Differences with radiology : • Echo cardio modalities are not always on-line • Ad-hoc scheduling is the rule, not the exception • Time synchronization among multiple modalities IHE Europe Educational Event

13. IHE Cardiology – Integration Profiles Cardiac Catheterization Workflow Echocardiography Workflow Retrieve ECG for Display Integration Profile (RED) Provide ECGs and related documents to enterprise New New New IHE Europe Educational Event

14. Example ECG in SVG Format IHE Europe Educational Event

15. Conclusion • Leverage existing IHE Integration Profiles in different domains • Multi-year roadmap of IHE Integration Profiles per domain • IT Infrastructure address enterprise level integration issues IHE Europe Educational Event

16. More information…. • IHE Web sites: • www.ihe.net • http://ihe-europe.org • http://www.rsna.org/IHE • http://www.acc.org/quality/ihe.htm • http://ihe-nl.org • Technical Frameworks: • ITI V1.0, RAD V5.5, LAB V1.0, CARDIO V1.0 • Non-Technical Brochures : • IHE Europe Business Case • IHE Fact Sheet and FAQ • IHE Integration Profiles: Guidelines for Buyers • IHE Connectathon Results • Vendor Products Integration Statements IHE Europe Educational Event