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Integrating the Healthcare Enterprise

Integrating the Healthcare Enterprise. IHE for Administrators: Confronting Deployment Obstacles. Ellie Avraham, Kodak Health Group Paul Nagy, PhD University of Maryland. Cardio. Modern Hospital Information Flow. Lab. MPI. Billing. ADT. RIS. HIS. Modality. PACS. Display & Print.

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Integrating the Healthcare Enterprise

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  1. Integrating the Healthcare Enterprise IHE for Administrators: Confronting Deployment Obstacles Ellie Avraham, Kodak Health Group Paul Nagy, PhD University of Maryland

  2. Cardio Modern HospitalInformation Flow Lab MPI Billing ADT RIS HIS Modality PACS Display & Print RSNA 2006

  3. Institute of Medicine Model of Service Redesign of Healthcare • Safety • Effectiveness • Patient centeredness • Timeliness • Efficiency • Equity Align to the patient Source: Insititute of Medicine, Crossing the chasm RSNA 2006

  4. To achieve these goals we need … • … a new generation of Healthcare IT solutions that have an order of magnitude greater level of integration. • … a whole new level of Complexity Management to manage these interfaces. • … we need to Decrease the time for integrating the Multi Vendors systems. • … we need the capabilities for plug and play interoperability of systems. • … we need to lower the total cost of integration RSNA 2006

  5. Standards Exists: DICOM, HL7 • The main purpose of standards is to lower the cost of integration between systems. • The more plug and play integration the lower is the cost of the implementation. • However Standards are broad and include options that reduce the interoperability • So we need to constrain the Standards in order to improve the interoperability RSNA 2006

  6. What is IHE • Joint Initiative from HIMSS and RSNA since 1998 • IHE is a specification of transactions between systems that defines integration profiles solution (SWF, PIR, RWF) based on standards • Uses a combination of standards to achieve a fully Interoperable workflow • Reinforces constrained standards to achieve fully Interoperability RSNA 2006

  7. IHE (International) Strategic Development Committee SponsorCo-Chairs Global reports supervises IHE North America IHE Europe IHE Asia/Oceania Interoperability Regional &NationalDeployment Delegates IHE Organizational Structure Multi-Domain & Multi-National IHE Domain-related Planning and Technical Committees Global Development:Radiology,IT Infrastructure,Cardiology,Lab, etc. contribute Participants RSNA 2006

  8. IHE Process Product IHE IntegrationStatement IHEConnectathon IHEDemonstration Product With IHE Easy to Integrate Products Standards IHEIntegration Profiles B IHEIntegration Profile A RFP IHE ConnectathonResults IHETechnicalFramework User Site • IHE Integration Profiles at the heart of IHE : • Detailed selection of standards and options each solving a specific integration problem • A growing set of effective provider/vendor agreed solutions • Vendors can implement with ROI • Providers can deploy with stability RSNA 2006

  9. The “Connectathon” • Voluntary Participation • Neither a Demonstration nor a Certification • Well Designed End-to-End Scenarios • Advanced Testing Tools • Unprecedented Cross-Vendor Testing • Unprecedented Pool of Technical Talent RSNA 2006

  10. IHE Connectathon Resultshttp://www.rsna.org/IHE/connectathon.shtmlhttp://www.ihe-europe.org/con_result RSNA 2006

  11. IHE Integration Statement RSNA 2006

  12. Store Images Today’s - Legacy Workflow RIS PACS &Archive RSNA 2006

  13. Patient Registration/UpdateOrder Management Proposed Protocols Loaded and Reviewed Worklist Modality Worklist Pt A, …, SPS=P1, P4 Pt C, …, SPS=P1, P5 Pt B, …, SPS=P2 Pt E, …, SPS=P4 Procedure Scheduled Order Protocol Defined Store Images StorageCommitment Storage Commitment List of Images With Performed Acquisition Protocols Performed Step: Status = Completed Modality Performed Procedure Step Performed Procedure: CT Head Performed Protocol Code=P1 Scheduled Protocol Code=P1, P5 Pat Name/ID, Dose, Accession #, Study UID Complete List of Images IHE Workflow RIS PACS &Archive • A Closed Loop • Update Scheduling IS • Match Procedure with Order • Support Billing Based on MPPS • Avoid Reading Incomplete Procedures RSNA 2006

  14. IHE Scheduled Workflow Profile acquisition in progress acquisition completed RSNA 2006

  15. ADT^ Scheduled Workflow • A01 Registration • A04 Admission • A05 Pre adminission • A11 Cancellation • A38 Cancellation of pre admission • DICOM C-Store • DICOM Modality Worklist • DICOM Modality Performed Procedure • DICOM Storage Commitment RSNA 2006

  16. IHE Deployment – Testing the Integrated System Solutions • For Healthcare to succeed in the digital transformation it will need much better integration between its systems. • IHE is an open standards approach to lower the cost of integrating healthcare and exposing many more processes. • Open Source can accelerate the adoption of IHE by helping to educate administrators to learn how to test the integration RSNA 2006

  17. Open Source - Integration testing tools • There are many (dozens) of DICOM and HL7 tools. Too many to mention. • The web site “openrad.com” has a repository with all the main open source Integration testing tools RSNA 2006

  18. Open Source Toolbelt • IHE MESA Tools • DCM4JBOSS – Enterprise PACS Archive • DVTK – Dicom Validation Toolkit • HL7Browser – HL7 Message Viewer • MIND – GUI DICOM query tool • CTN – DICOM Send RSNA 2006

  19. Today’s Lesson • Build an IHE Testing Environment • Test IHE Scheduled Workflow Components • On a windows laptop RSNA 2006

  20. Standard Documentation Recommendation • IHE Technical Framework: volumes #1, 2, 3 • Scheduled Workflow • DICOM standard • Information Object Definition Pt.3 • Services Pt.4 • Data Dictionary Pt.6 • Medical.nema.org • HL7 v2.3.1 standard RSNA 2006

  21. IHE “Medical Enterprise Simulators and Analyzers” (MESA)http://ihedoc.wustl.edu/mesasoftware/index.htm • Provides the Test Procedures and Simulation of all the IHE Profiles and Actors. Excellent Documentation. • Developed by the Mallinckrodt Institute of Radiology • MESA Tools runs on different operating systems: Windows 2000, Windows XP, Solaris 7.0, Red Hat Linux 7.0 & 9.0 from Intel. • The MESA tool is organized for particular IHE actors as defined in the IHE Technical Framework RSNA 2006

  22. Step 1. Install MESA tools • Decide What Actors/Systems you need to test • Read the Installation Guide for installing the tools you need to test your Actors/Systems • Precompiled and Source Codes are available • Recommend to Install the preferred Windows 2000 precompiled MESA s/w ready to be used RSNA 2006

  23. Step 2: What & How to Test • List your Actors/Profiles that you need to test • Review the MESA Test Procedures applicable for each actor that need to be tested • Review the Test Procedures for the Peer to Peer testing applicable actors. RSNA 2006

  24. Test Example – Scheduled Workflow Profile (SWF) This case covers both inpatient and outpatient procedures. The patient may be new or known to the current healthcare facility. The following sequence of steps describes the typical process flow when a request is made to perform an imaging procedure on a patient Figure 3.3-1. Administrative Process Flow RSNA 2006

  25. Figure 3.3-2. Procedure Performance Process Flow RSNA 2006

  26. MESA Test case #131 – Administrative & Procedure Prerform Process (SWF) Identifier Description [Transaction] Source Destination 131.102.a04.adt A04: Register BLACK as Outpatient Patient Class = ‘E’[1] ADT Ord Plc, Ord Fil 131.104.o01.orm ORM: Order P1 for BLACK [2] Ord Plc Ord Fil 131.106.o01.orm ORM: Schedule X1 [4] Ord Fil Img Mgr 131.108.dcm MWL C-FIND [5] Modality Ord Fil 131.110.dcm PPS: Begin Procedure X1 [6] Modality PPS_Mgr 131.112.dcm PPS: Begin Procedure X1 [6] PPS_Mgr Ord Fil or Img Mgr 131.114.dcm PPS: End Procedure X1 [7] Modality PPS_Mgr 131.116.dcm PPS: End Procedure X1 [7] PPS_Mgr Ord Fil or Img Mgr C-Find: Images Available Query [11] Ord Fil Img Mgr 131.118.dcm C-Store: Images [8] Modality Img Mgr 131.120.dcm C-Find: Images Available Query [11] Ord Fil Img Mgr 131.122.dcm Storage Commitment: N-Action [10] Modality Img Mgr 131.124.dcm Storage Commitment: N-Event-Report [10] Img Mgr Modality 131.117.dcm RSNA 2006

  27. MESA Testing Environment RSNA 2006

  28. Starting MESA Test case #131 RSNA 2006

  29. Running Several Transactions Testcase #131 RSNA 2006

  30. Evaluating MESA Test Result case #131 RSNA 2006

  31. Where Is More Information Available? http://www.ihe.net • Non-Technical Brochures: • IHE Radiology Users Handbook • IHE Primer and IHE FAQ • IHE Integration Profiles: Guidelines for Buyers • IHE Connectathon Results RSNA 2006

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