Integrating the Healthcare Enterprise

1. Integrating the Healthcare Enterprise Improving Connectivity for Optimal Patient Care Sponsored by:the Healthcare Information and Management System Society

2. Presenters: • Joyce Sensmeier MS, RN, BC, CPHIMS • Director of Professional Services, HIMSS • Kevin O’Donnell - Toshiba Corp. • Co-chair IHE Planning Committee • David Channin, MD, CPHIMS • Assistant Professor of Radiology • Chief of Imaging Informatics, Northwestern University, Department of Radiology

3. Objectives • Describe the problems and solutions for integration in the healthcare enterprise • Identify the accomplishments and future direction of the Integrating the Healthcare Enterprise (IHE) initiative

4. IHE Fundamentals • Who is IHE? • What is it about? • Why is it needed? • What’s wrong with DICOM? • How does it work? • How do I get it? • What do they do? • What comes out of it? • What do I get out of it? • Where can I learn more?

5. What is IHE about? • IHE is an initiative promoting and supporting the integration of systems in the healthcare enterprise. • Goal: Improve the efficiency and effectiveness of clinical practice by: • Improved Information Flow • Advanced Multi-System Functions

6. Why is IHE needed? • Serious Integration Challenges in Healthcare: • Systems need Information other systems have • But, systems communicate poorly or not at all • Result: - tedious, inefficient workflows - data that is inconsistent or unavailable • Responsibility for information flow between systems, and between departments, is often unclear.

7. Who is IHE? • Participants: • Professional Societies • Healthcare Information and Management Systems Society (HIMSS) • Radiological Society of North America (RSNA) • Vendors (over 30 companies) • Standards Group Committee Members • RSNA and HIMSS sponsor IHE to provide a neutral forum for working on the Big Picture

8. How Established is IHE? • Year 1 (1999): Proof of Concept (Basic Scheduled Workflow) • Year 2 (2000): Introduction of the 7 Profiles (Full Featured) • Year 3 (2001): Consolidation, Catch-up (Real Products) Expansion to France • Year 4 (2002): 3 New Profiles Expansion to Japan, Germany • Year 5 (2003): New Profiles Expansion to NM, Lab, Pathology, …?

9. What does IHE cover? • Currently focused in Radiology • 30 Vendors tested 70 systems at the Year 3 Connectathon • Systems include: • HIS, RIS • MR, CT, US, CR, DX, … • PACS, Review Stations, Reporting Systems • Printers, Imagers

10. What Does IHE Accomplish? • Integrated Systems -> exchanging information • Your system receives relevant information • Patient Demographics • Order Information • Related Clinical Data >>> More efficient workflow, reduced errors, more intelligent equipment • Your system distributes relevant information • Clinical Data – measurements, tests, monitoring >>> More valuable if it’s available anywhere, anytime >>> More valuable when combined with other data (No single device has all the answers)

11. How is IHE related to Standards? • Information needs to travel widely • Information is applied within a context >>> Workflows cross Standard borders • Standards provide tools & technologies • HL7 and DICOM provide dictionaries • IHE specifies how to apply them to real world scenarios & integration problems • IHE defines a “phrasebook”

12. What Does IHE Do? • Users and vendors work together to identify and design solutions for integration problems • Intensive process with annual cycles: • Identify key healthcare workflows and integration problems • Research & select standards to specify a solution • Write, review and publish IHE Technical Framework • Perform cross-testing at “Connectathon” • Demonstrations at tradeshows (HIMSS/RSNA)

13. What are Key IHE Concepts? • Generalized Systems -> Actors • Interactions between Actors -> Transactions • Problem/Solution Scenarios -> IntegrationProfiles • For each Integration Profile: • the context is described (which real-world problem) • the actors are defined (what systems are involved) • the transactions are defined (what must they do)

14. What is the Result? • IHE is not a product;it is a software feature or upgrade • Vendors implement selected actors and profiles on their systems • Customers can request specific Integration Profiles in RFPs for clinical systems • The systems have been pre-tested at the Connectathon

15. Who benefits? • Clinical Users • Greater access to more consistent information • Fewer errors, fewer tedious tasks • Buyers • Specify/purchase integration capabilities easily • Freedom to acquire “Best of Breed” systems • IT Professionals • Faster, more predictable integration projects • Administrators • Increased throughput • Better scheduling and tracking

16. 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

18. Referring Physician Patient $ $ Referring Physician Patient Scan Post Process Dictate Transcribe $

19. Referring Physician Patient $ $ Referring Physician Patient Scan Post Process Dictate Transcribe Radiology (PACS/RIS) $

20. Referring Physician Patient $ $ Referring Physician Patient Scan Post Process Dictate Transcribe $ Year 3

21. Referring Physician Patient $ $ Referring Physician Patient Scan Post Process Dictate Transcribe $ Year 4

22. Referring Physician Patient $ $ Referring Physician Patient Scan Post Process Dictate Transcribe $ Year 5?!

23. RIS • What my CIO sees: • 120 Server Systems • 62 point to point HL7 connections • includes 3 to PACS Dreams of ‘Best of Breed’?!  PACS

24. What some would like to see: Dreams of ‘Single Vendor’ ‘Mangy Mutt’ 

25. Interface Consolidate Integrate

26. Scheduled Workflow Profile report Registration Film Lightbox Image Manager & Archive Orders Filled Film Folder Diagnostic Workstation Film Report Repository Orders Placed AcquisitionModality acquisitioncompleted acquisitionin-progress imagesprinted Modality acquisitioncompleted

27. Patient Information Reconciliation Profile • Extends Scheduled Workflow • Handle unidentified patient (e.g. trauma) • Handle demographic information mistakes • Propagate changes to all affected systems, update all affected data • Reduces incorrectly identified or “lost” studies

28. Year 4 Enhancements to Scheduled Workflow • Reduce variance on how procedures are performed • Imaging protocols • Assisted Acquisition Protocol Setting (option)

29. Year 4 Enhancements to Scheduled Workflow • Exception management • When errors are made on the modalities how can these be corrected • PPS Exception Management (option)

30. Code Meaning (0008,0104) Doctor cancelled procedure Equipment failure Incorrect procedure ordered Patient allergic to media/contrast Patient died Patient refused to continue procedure Patient taken for treatment or surgery Patient did not arrive Patient pregnant Change of procedure for correct charging Duplicate order Nursing unit cancel Incorrect side ordered Discontinued for unspecified reason Incorrect worklist entry selected Patient condition Discontinue Reason Codes No specific action by Image Manager and Order Filler defined by IHE.

31. Original Image & Presentation State Area Of Interest Area Of Interest The Radiologist’s Transformations Are Saved Flip Zoom Annotate Prepared Image Original Image Original Image Window Level Original Image The Radiologist’s Transformations Are Lost Consistent Presentation of Images Profile What the Radiologist Displays: What the Reviewing Physician Sees:

32. Report:CHEST Report:AB/PELVIS Ab/Pelvis View Chest View Chest View MODALITY Performs a single exam Operator groups 2 procedures Ab/Pelvis View Presentation of Grouped Procedures Profile Requested Procedure:CHEST RIS / PACS Requested Procedure:AB/PELVIS

33. Images and Examdata presented fordiagnosis Verified Report Preliminary Report Image Manager & Archive ReportVerification Reports storedforNetwork Access Report & ImageReview forPatient Care Report & Images Retrieved Images Retrieved Simple Image & Numeric Reports Profile

34. Note1 Note2 For referring physician: This image shows the renal rupture. For referring physician: This image has the hematoma. Study & Key Image Notes Note2 Note1 for refering physician This image shows the renal rupture. Note1 Note2 for refering physician This image has the hematoma. for refering physician This image has the hematoma. for refering physician This image shows the renal rupture. Key Image Notes Profile Radiologist Flags Images: Referring PhysicianSees Key Images First:

35. Emergency Department Referring Physician Radiology Department – Images and Reports Remote Clinics Other Departments:- Oncology- Surgery- Neurology- Pediatrics- etc. Electronic Medical Record Access to Radiology Information Profile

36. Charge Posting Profile • Facilitates Collection of Procedure Details for Billing • Performed Procedure Technical Fees • Materials Usage • Reporting Professional Fees • Etc. • Maintains Correspondence of Account Details in Procedure Records

37. Source Data Worklist PACS System CAD *Workstation 3-D *Workstation Workstation ReportRepository Work Status Results AcquisitionModality Post-Processing Workflow Profile Post-Proc. Workflow Manager Work Status … Results

38. Account Management *Billing System ADT Terminal Report Generated / Signed CAD *Workstation 3-D *Workstation ReportRepository 3-D Performed CAD Performed AcquisitionModality Charge Posting Profile Post Charges Charge Poster Study Performed / Materials Used …

39. Image Manager & Archive Diagnostic Workstation ReportRepository Report & ImageReview Basic Security Profile Audit Record Repository … … “Images Queried / Retrieved” “Reports Retrieved” “Reports Printed” “Images Printed” “Reports Stored” “Reports Queried / Retrieved”

40. Other Actors Other Actors Other Actors Other Actors Secured Node Actor Central Audit TrailRepository Other Actors Other Actors Other Actors Other Actors TimeServer Secured Node Actor Secured Node Actor Secured Node Actor Secured Domain: integrating trusted nodes

41. PDR HR & MM Radiology RIS PACS ADT/ Billing Outpatient EMR(s) CIS and

42. PDR HR & MM Radiology RIS PACS ADT/ Billing Outpatient EMR(s) CIS and

43. PDR HR & MM Radiology RIS PACS ADT/ Billing Outpatient EMR(s) Lab?? Pharm?? Cardiology?? Etc.?? CIS and

44. Where is IHE going next? • Expansion: • Reporting Workflow in Year 5 • Subcommitees being formed for IT Infrastructure, Cardiology, Lab, Pharmacy/Medication Mgt & Nuclear Medicine • Instrumentation presentation at AAMI • NM Presentation at SNM • Cardiology presentations at ASE, ACC • Lab presentation at AACC • France, Germany, Japan, … • UK, Italy

45. What should You do? • Learn more… • Leverage the IHE infrastructure • Form a sub-committee • Identify your information sources and your information users • Define workflows and specify how to use the standards …

46. Resources • http://www.rsna.org/IHE/index.shtml • FAQs • Integration Profiles • Primer on IHE • IHE Technical Framework • Presentations • Rules for Participation

47. Resources Learning Objectives: • Understand what the IHE Initiative is and what problems it addresses • Identify the basics of the IHE information model • Understand the IHE integration profiles and the problems they resolve in radiology The IHE Initiative -Presented by: David Channin MD http://www.himss.org

48. Resources • Integrating the Healthcare Enterprise • 2001 Monograph published by HIMSS • Edited by Paul Vegoda • Located at: www.himss.org

49. Questions? Materials available on the Web sites at: www.rsna.org/IHE www.himss.org