Integrating the Healthcare Enterprise

1. Integratingthe Healthcare Enterprise IHE 2003:Meeting Clinical Goals and Technical Challenges

2. Authors & Presenters • Dr. Paul Vegoda • Malvern Group, FHIMSS, IHE Strategic Dev. Committee • Kevin O’Donnell • Toshiba, IHE Planning Committee Co-chair • Dr. David Channin • Northwestern University, Assistant Professor of Radiology, Chief of Imaging Informatics HIMSS 2003

3. 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 HIMSS 2003

4. Goals of IHE • Speed up the rate and quality of integration in healthcare environments • Foster communication between vendors • Prove that integration is attainable based on standards HIMSS 2003

5. IHE Participants • Representatives of Healthcare Providers • ( RSNA, HIMSS, … ) • Users • ( Radiologists, Medical Staff, Administrators, CIOs, … ) • Information Systems Vendors • ( RIS & HIS Vendors ) • Imaging Systems Vendors • ( Modality & PACS Vendors ) • Standards Committee Members • ( DICOM, HL7 ) HIMSS 2003

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 redundant, inconsistent or unavailable Responsibility for information flow between systems, and between departments, is often unclear. HIMSS 2003

7. How it Benefits Clinicians and Administrators • How is it relevant to their jobs • What do they get HIMSS 2003

8. Clinician Benefits • Clinical Users • More convenient access to more information • Preservation of continuity and integrity of Patient Record • Fewer opportunities for errors • Fewer tedious tasks/repeated work • Buyers • Specify/purchase integration capabilities easily • Freedom to acquire “Best of Breed” systems HIMSS 2003

9. Administrator Benefits • Administrators • Increased throughput • Better scheduling and tracking • IT Professionals • Faster, more predictable integration projects • Buyers • Specify/purchase integration capabilities easily • Freedom to acquire “Best of Breed” systems HIMSS 2003

10. IHE Penetration in Radiology • # of years (entering 5th) • # of vendors (over 50 worldwide) • # systems at Connectathon (over 100 worldwide) • kinds of capabilities (one or two easily grasped examples) • Geographic spread (U.S., France, Germany, Japan, Italy, U.K., …) HIMSS 2003

11. Expansion into New Areas • New IT Infrastructure Committee Formed (MPI, Query/Display, Security, …) • Cardiology Group forming in March • Work progressing in Lab, Pharmacy/Medication, … HIMSS 2003

12. IHE Accomplishments • 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) HIMSS 2003

13. 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 HIMSS 2003

14. 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 HIMSS 2003

15. 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 HIMSS 2003

16. 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 HIMSS 2003

17. 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 HIMSS 2003

18. Account Management ADT Terminal Report Generated / Signed CAD *Workstation 3-D *Workstation ReportRepository 3-D Performed CAD Performed AcquisitionModality Charge Posting Profile Post Charges *Billing System Charge Poster Study Performed / Materials Used … HIMSS 2003

19. Original Image & Presentation State Area Of Interest Area Of Interest The Radiologist’s Transformations Are Saved Flip Zoom Prepared Image Annotate 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: HIMSS 2003

20. 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 HIMSS 2003

21. 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: HIMSS 2003

22. 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 HIMSS 2003

23. 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” HIMSS 2003

24. The Annual “Connectathon” • Voluntary Participation • Neither a Demo nor a Certification • Well Designed End-to-End Scenarios • Advanced Testing Tools • Unprecedented Cross-Vendor Testing • Unprecedented Pool of Technical Talent HIMSS 2003

25. Connectathon Results • # of systems available(Check www.rsna.org/ihe/ihe_2002_participants) • IHE Integration Statements • what they are, what they include • where to find them HIMSS 2003

26. User Success Stories • Examples from the 13 Success Stories • Personal purchase experience? HIMSS 2003

27. How Did They Benefit • Types of benefits observed • “The water’s not too bad, come on in” HIMSS 2003

28. Start Checking It Out • Get informed • Get involved • Get on board HIMSS 2003

29. Resources • www.rsna.org/IHE • FAQs • Integration Profiles • Primer on IHE • Presentations • IHE Technical Framework HIMSS 2003

30. Questions? Ask your vendors: Which IHE Profiles do they support on which systems? www.rsna.org/IHE HIMSS 2003