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Integrating the Healthcare Enterprise

Learn about Integrating the Healthcare Enterprise (IHE) and how it drives the use of existing standards to solve complex healthcare information processes. Discover the goal of IHE, the different domain sponsors, and how IHE works through integration profiles. Explore the benefits of using IHE in healthcare systems and how vendors and users can implement it.

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Integrating the Healthcare Enterprise

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  1. Integrating the HealthcareEnterprise Margarita Zuley, M.D. Elizabeth Wende Breast Clinic Rochester, NY

  2. What is IHE? Integrating the Healthcare Enterprise™ “A process that drives the use of existing standards to solve complex healthcare information processes that span multiple, heterogeneous information systems.”

  3. Goal of IHE To ensure that all required information is correct and available to the medical professional for optimal patient care.

  4. IHE Domain Sponsors Cardiology Domain Sponsor: ACC Assoc. Domain Sponsor: ASE Eye Care Domain Sponsor: AAO IT Infrastructure Domain Sponsor: HIMSS Laboratory Domain Sponsors: GMSIH, JAHIS, SFIL Patient Care Coordination Domain Sponsor: HIMSS Patient Care Devices Domain Sponsors: IEEE, ACCE Radiology Domain Sponsor: RSNA Associate Domain Sponsors: ASTRO, SNM

  5. How Does IHE Work? • Defines components of the healthcare enterprise called ACTORS • Describes coordinated, standards based transactions that each actor has with all other actors • Integration Profiles are functional groups of these transactions that solve specific clinical needs

  6. Scheduled Workflow Charge Posting Presentation ofGrouped Procedures Teaching Files & Clinical Trials Export Reporting Workflow KeyImageNotes Simple Image & Numeric Reports NMImage Consistent Presentation ofImages EvidenceDocs Access to Radiology Information XDS for Imaging Portable Data for Imaging IHE Radiology Integration Profiles Patient Info. Recon-ciliation Post-Processing Workflow Audit Trail & Node Authentication - Radiology Option

  7. 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

  8. How do you use IHE? • Vendors implement Actors and Integration Profiles in their systems and test them at the annual Connectathon • Users specify Actors and Integration Profiles in RFPs when acquiring, upgrading or integrating systems

  9. IHE Connectathon • Massive Cross-vendor Testing • One week; dozens of vendors; thousands of tests • Opportunity to find/resolve issues • Participation is Voluntary • Litmus test not a pre-requisite or certification • Engineering event • Huge Congregation of Engineering Talent • Project Management by Mallinckrodt • Pre-Validation Tools (MESA) • Defined Test Protocols with Verification

  10. IHE Connectathon Managed by the IHE Sponsors

  11. Connectathon Results • Published at www.ihe.net and www.ihe-europe.org • NOT Product Certification • Demonstration of Engineering Competence • Recent Connectathons • IHE-North America in January 2006 (Chicago, IL) • 59 Vendors, 140 Systems, 300+ Engineers • IHE-Europe in April 2005 (Noordwijkerhout, Netherlands) • 62 Vendors, 98 Systems, 230 Engineers • IHE-Japan Connectathon in January 2006 (Tokyo, Japan) • 28 Vendors, 60 Systems

  12. Healthcare Site with Complex Problematic Process involving heterogeneous information system Vendor expertise Healthcare Site Includes IHE in RFP Integration Profile Proposed solution Using existing standards Professional Societies Demonstrate/Educate That solution exists IHE Technical Framework details solution Vendor tests solution at Connect-a-thon Vendor implements solution into REAL product

  13. IHE Web site: www.IHE .net • Frequently Asked Questions • Integration Profiles in Technical Frameworks: • Cardiology • IT Infrastructure • Laboratory • Patient Care Coordination • Radiology • Connectathon Results • Vendor Products Integration Statements • Participation in Committees & Connectathons

  14. U/S Breast MRI Vendor A FFDM Vendor B FFDM Vendor C FFDM Vendor A Diagnostic Workstation Vendor B Diagnostic Workstation Vendor C Diagnostic Workstation Multi Modality Diagnostic Workstation Vendor A Mini PACS Vendor B Mini PACS Vendor C Mini PACS System wide PACS

  15. Ideal Configuration: Maintain Integrity

  16. FFDM Problems • Content/Display Incompatibilities • Workflow Constraints

  17. Content/Display Issues • Image Size • Image Orientation and Justification • Image Contrast Adjustment • Background Blackness Maintenance • Annotation of Identification and Technical Factor Information • Display of CAD Marks

  18. Image Size

  19. Image orientation

  20. Annotations

  21. Mammo IHE Timeline • June ’05 (SCAR) forum to discuss problems • July ‘05 IHE mammo group formed • Oct ‘05 1st Draft of profile • RSNA ’05 Discuss time frame and most critical limitations • Jan ’06 Prelim testing at connect-a-thon • Jan ’06 Mammo Image Profile completed • Today 1st display of components of the profile

  22. Planned Timetable • Spring 06-Jan ’07 • Vendors implement Mammography Image profile • Jan ’07 • Official testing at connect-a-thon • April ’07 (SBI) • Public display of implementation

  23. Mammography Workflow Profile • Spring ’06 White paper drafted • June ’06 –Jan ’07 Integration Profile written • Spring ’07 Profile finalized • Spring’07-Jan ’08 Vendors implement Profile • Jan ’08 Testing at connect-a-thon • Spring ’08 Public display

  24. Why Does this take so Long? • Problems must be clearly defined • Many vendors must be willing to participate • Solutions can be complicated • Solutions need to work for everyone • The implementation is very labor intensive, time consuming, and costly for the vendors

  25. RFPs • Be Brief? • “The system must support DICOM” • Be Effective? • “The system must support the following DICOM services according to the following 100 pages of specifications: …” • Be Both: • “The system must support the IHE Echocardiography Workflow Profile as the Acquisition Modality actor.” • Request IHE Integration Statements • Version 2.1 of the SuperSono XT supports IHE Echocardiography Workflow as an Acquisition Modality

  26. RFP • Itemize which options in each profile that you specifically want, or wish to exclude • Ask your vendor to commit to all of the IHE requirements agreed upon

  27. RFP • Look at the user’s handbook prior to purchases • Do your homework and understand what each profile is giving you • Specify for each piece of equipment (actor) that you purchase, all IHE profiles you require • If the profiles are not yet implemented by the vendor, get a date of conformance

  28. IHE Integration Statements • Explicit claim by the vendor, for a specific product version • Lists profiles, actors, options • Short & Sweet

  29. User’s Handbook • Information to help in purchasing of digital equipment • Diagnostic Workstation • Modality • Understanding the IHE profiles and specifically what each offers for each piece of equipment • RFP template

  30. FFDM Paradise • Any Image, anywhere intact, anytime. • Seamless integration from check-in to acquisition through archive • Standardization and guidelines for Quality Assurance • Protection of the integrity of the data

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