G. Claeys, C. Loef, B.B. Wein Smooth running IT systems in digital imaging The role of the radiologist and IHE

G. Claeys, C. Loef, B.B. WeinG. Claeys, C. Loef, B.B. Wein

Smooth running IT systems in digital imagingSmooth running IT systems in digital imaging

The role of the radiologist and IHEThe role of the radiologist and IHE

ECR 2003How to get IHE into the Radiology Department

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Content:Content:

• Objective: Efficient Workflow, seamless info flowObjective: Efficient Workflow, seamless info flow

• Approach taken by IHE to improve functionality in Approach taken by IHE to improve functionality in Radiology departmentRadiology department

• How to specify a tender and judge vendor offeringsHow to specify a tender and judge vendor offerings

• Examples of using IHE in practiceExamples of using IHE in practice

• Some European success storiesSome European success stories

• ConclusionConclusion


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The objectiveThe objective

• Seamless information flowSeamless information flow

• Optimal support for workflowOptimal support for workflow

• Improve functionality in radiology departmentImprove functionality in radiology department

• Integrated Information Technology (IT) solutionsIntegrated Information Technology (IT) solutions

• Enable the Electronic Patient Record (EPR)Enable the Electronic Patient Record (EPR)


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The IHE initiativeThe IHE initiative IHE is an initiative promoting and IHE is an initiative promoting and

supporting the supporting the integrationintegration of of systemssystems in in the the healthcare enterprisehealthcare enterprise..

Goal: Improve the efficiency and Goal: Improve the efficiency and effectiveness of clinical practice by:effectiveness of clinical practice by: Improved Improved Information FlowInformation Flow Advanced Advanced Multi-System FunctionsMulti-System Functions


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Why is IHE needed?Why is IHE needed?

• Serious Integration Challenges in Healthcare:Serious Integration Challenges in Healthcare:

• Systems need informations from other systemsSystems need informations from other systems

• However, systems communicate poorly or not at all However, systems communicate poorly or not at all

• Result: - tedious, inefficient workflows Result: - tedious, inefficient workflows - redundant, inconsistent or unavailable data - redundant, inconsistent or unavailable data

ResponsibilityResponsibility for information flow between systems, for information flow between systems, and between departments, and between departments, is often unclearis often unclear..


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The Healthcare Information The Healthcare Information System ComplexSystem Complex

MPI

ADT

RIS

PACS

Modality

Display

HIS


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The approach for getting IHEThe approach for getting IHE• focus on Operational Workflow analysis, focus on Operational Workflow analysis,

• require information flow details for require information flow details for applications, current situation of products and applications, current situation of products and transactions, desired situation, gap analysis transactions, desired situation, gap analysis

• create requirements for new products and create requirements for new products and upgradesupgrades

• perform an expectation managementperform an expectation management

• let IHE support this process with a common let IHE support this process with a common framework, that all involved parties can understand framework, that all involved parties can understand and commit to.and commit to.


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Integration ProfilesIntegration ProfilesMain pointsMain points

• IHE is not a product itself. IHE is not a product itself.

• Functions are grouped in a set of Functions are grouped in a set of Integration Integration Profiles, Actors, Profiles, Actors, andand Transactions Transactions. .

• Need to map integration solution requirements Need to map integration solution requirements on these IHE concepts.on these IHE concepts.


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The Product World…..The Product World…..

Poduct XYZfrom Vendor T

ADT

MPI

HIS


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The IHE The IHE WWorld….orld….

IHE Actor

ActorActor

Actor

IHEIHETransactionTransactionIHEIHE

TransactionTransaction

IHEIHETransactionTransaction

IHE Actor


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ADT

MPI

HIS

Mapping IHE to ProductsMapping IHE to Products

Poduct XYZfrom Vendor T

IHE Actor

ActorActor

Actor

IHEIHETransactionTransactionIHEIHE

TransactionTransaction

IHEIHETransactionTransaction

IHE Actor


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IHE IHE : : An Integration ProfileAn Integration Profile

24: Report Submission

Structured Report Export: 28

25: Report Issuing

Report Creator

26: Query Reports27: Retrieve Reports

Report Repository

Report Reader

External Report Repository Access

Report Manager

Enterprise Report Repository

A set of ActorsActors cooperating

through TTransactionransactionss to perform a specific task


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Integration profiles, the easy way to Integration profiles, the easy way to deal with transactionsdeal with transactions

• easy-to-understandeasy-to-understand, , coherent coherent functionalfunctional sets and sets and

• a a convenient wayconvenient way for users and for users and vendors to communicate vendors to communicate

• about about integration requirementsintegration requirements and and needed functionalityneeded functionality in daily life. in daily life.


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Integration ProfilesIntegration Profiles

• Examples:Examples:– SWF (Scheduled WorkFlow)SWF (Scheduled WorkFlow)– KIN (Key Image Note)KIN (Key Image Note)– Consistent presentation of images (CPI)Consistent presentation of images (CPI)– Access to Radiology Information (ARI)Access to Radiology Information (ARI)


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Store ImagesStore Images

Storage CommitmentStorage CommitmentStorageStorage

CommitmentCommitment

List of ImagesList of Images

PACS &PACS &ArchiveArchive

RISRIS

A Closed LoopA Closed Loop•Update IS SchedulingUpdate IS Scheduling

•Match Procedure with OrderMatch Procedure with Order•Support Billing Based on MPPSSupport Billing Based on MPPS

•Avoid Reading incomplete ProceduresAvoid Reading incomplete Procedures

IHE Scheduled WorkflowIHE Scheduled Workflow

Modality Modality WorklistWorklist

Procedure Scheduled Procedure Scheduled

Proposed Protocols

Loaded and Reviewed

WorklistWorklistPt A, …, Pt A, …, SPS=P1, P4SPS=P1, P4

Pt C, …, Pt C, …, SPS=P1, P5SPS=P1, P5

Pt B, …, Pt B, …, SPS=P2SPS=P2

Pt E, …, Pt E, …, SPS=P4SPS=P4

ModalityModalityPerformedPerformedProcedure Procedure StepStep

With Performed With Performed Acquisition Acquisition ProtocolsProtocolsPerformed Step:Performed Step:

Status = CompletedStatus = CompletedPerformed Procedure: CT HeadPerformed Procedure: CT Head Performed Protocol Code=P1Performed Protocol Code=P1

Pat Name/ID, Dose, Pat Name/ID, Dose, Accession #, Study UIDAccession #, Study UIDComplete List of ImagesComplete List of Images

Scheduled Protocol Code=P1, PScheduled Protocol Code=P1, P55

Patient Registration/UpdatePatient Registration/UpdateOrder ManagementOrder Management

Order Order ProtocolizedProtocolized


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RadiologistRadiologistFlags Images:Flags Images:

Referring PhysicianReferring PhysicianSees Key Images First:Sees Key Images First:

for refering physicianThis image showsthe renal rupture.

Note1

for refering physicianThis image has the hematoma.

Note2

For referringphysician:This image showsthe renal rupture.

Note1

For referring physician:This image hasthe hematoma.

Note2

for refering physicianThis image showsthe renal rupture.

Note1

for refering physicianThis image has the hematoma.

Note2

Study & Key Image Notes

Key Image NotesKey Image Notes


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What the Radiologist What the Radiologist Displays:Displays:

What the Reviewing What the Reviewing Physician Sees:Physician Sees:

The Radiologist’s Transformations Are

Saved

Original Image& Presentation State

Original Image

Window Level

Flip

Zoom

Area Of

Interest

Annotate

The Radiologist’s Transformations Are

Lost

Original Image

Area Of

Interest

Prepared Image

Original Image

Consistent Presentation of Images Consistent Presentation of Images


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Access to Radiology InformationAccess to Radiology Information

Radiology Department – Images and

Reports

Emergency Department

Referring Physician

Other Departments:- Oncology- Surgery- Neurology- Pediatrics- etc.

Remote Clinics

Electronic Medical Record


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IHE Integration ProfilesIHE Integration Profiles

Access to Radiology InformationConsistent access to images and reports

Consistent Presentation of Images

Hardcopy and softcopy grayscale presentation state

Key ImageNotes

Flag significant images

Simple Image and Numeric Reports

Simple reports with image links and, optionally,

measurements

Basic SecurityAudit Trail Consolidation & Node Authentication

Presentation of Grouped Procedures

Subset of a single acquisition

Post- Processing Workflow

Schedule, perform, & notify image processing

& CAD steps

Charge Posting

Collection of billable procedure details

Scheduled Workflow

Admit, order, schedule, acquire images, notify of completed steps

Patient Information Reconciliation

Unknown patients and unscheduled orders


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General Integration Profiles TableGeneral Integration Profiles Table

ActorsIntegration Profiles

SWF PIR CPI PGP ARI KIN SINR SEC CHG PWF

Modality

Image Creator

Image Display

Image Manager/Archive

DSS/Order Filler

ADT

Report Creator


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Vendor should provideVendor should provide IHE Integration Statements IHE Integration Statements

ProductProduct U UVWVW supports the supports the

IHE IHE KK Actor Actor withwith thethe

IHE IHE XX and and YY Integration Profiles Integration Profiles

IHE IHE JJ ActorActor with the with the

IHE IHE TT Integration ProfileIntegration Profile


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IHE Integration StatementIHE Integration Statement


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Example: PACS X, Vendor YExample: PACS X, Vendor YActors SWF PIR CPI PGP ARI KIN SINR SEC CHG PWF

Image Display

Image Manager/Archive

Report Creator

Secure Node


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Example: PACSExample: PACS

• StandardStandard: :

– Actors: Actors: Image Manager, Image Archive, and Image Manager, Image Archive, and Image DisplayImage Display

– Integration Profiles: Scheduled Workflow and Integration Profiles: Scheduled Workflow and Patient Information ReconciliationPatient Information Reconciliation

• Display and Printing Quality:Display and Printing Quality:– Actors: Image Display and Print ComposerActors: Image Display and Print Composer– Integration Profiles: Consistent Presentation of Integration Profiles: Consistent Presentation of

ImagesImages


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Example: PACS, part 2Example: PACS, part 2

• Modalities with Procedure grouping:Modalities with Procedure grouping:– Actors: Image ArchiveActors: Image Archive– Integration Profiles: Presentation of Grouped ProceduresIntegration Profiles: Presentation of Grouped Procedures

• Flagging specific images:Flagging specific images:– Actors: Image Archive and/or Image DisplayActors: Image Archive and/or Image Display– Integration Profiles: Key Image NoteIntegration Profiles: Key Image Note


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Example: RIS UpgradeExample: RIS Upgrade

• StandardStandard: :

– Actors: Actors: Order FillerOrder Filler– Integration Profiles: Scheduled Workflow and Integration Profiles: Scheduled Workflow and

Patient Information ReconciliationPatient Information Reconciliation

• DICOM Structured ReportingDICOM Structured Reporting– Actors: Report Manager, Report Repository, Actors: Report Manager, Report Repository,

Report Creator and Report ReaderReport Creator and Report Reader– Integration Profiles: Simple Image and Integration Profiles: Simple Image and

Numerical ReportsNumerical Reports


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Example: New ModalityExample: New Modality

• EssentialEssential: : – Actors: Actors: Acquisition ModalityAcquisition Modality

– Integration Profiles: Scheduled WorkflowIntegration Profiles: Scheduled Workflow

• Complex ModalitiesComplex Modalities::

– Integration Profiles: Presentation of Grouped Integration Profiles: Presentation of Grouped ProceduresProcedures


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Example: New ModalityExample: New Modality

• Print Composer:Print Composer:

– Integration Profiles: Consistent Presentation Integration Profiles: Consistent Presentation of Imagesof Images

• Security:Security:– Integration Profiles: Basic SecurityIntegration Profiles: Basic Security


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Example: Modality UpgradeExample: Modality Upgrade

• New Modality RequirementsNew Modality Requirements

or, if not possible:or, if not possible:• Transactions:Transactions:

– Modality Image StoredModality Image Stored– Modality Worklist ProvidedModality Worklist Provided– Storage CommitmentStorage Commitment– Procedure Step CompleteProcedure Step Complete– Procedure Step in ProgressProcedure Step in Progress


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Example: other systems:Example: other systems:- Workstations- Workstations- Printers- Printers- Patient Registration- Patient Registration- Order Entry- Order Entry

• Just think about Just think about ActorsActors

and and Integration ProfilesIntegration Profiles

• University of PisaUniversity of PisaDepartment of Radiology, Pisa, ItalyDepartment of Radiology, Pisa, Italy

• Hôpital Universitaires de GenèveHôpital Universitaires de GenèveDepartment of Radiology, Genève, SwitzerlandDepartment of Radiology, Genève, Switzerland

• Johannes Gutenberg-UniversityJohannes Gutenberg-UniversityDepartment of Radiology , Mainz, GermanyDepartment of Radiology , Mainz, Germany

European User Success StoriesEuropean User Success Stories


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Example:Example:Johannes Gutenberg-UniversityJohannes Gutenberg-UniversityMainz, GermanyMainz, Germany


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The IHE Radiology WorkflowThe IHE Radiology Workflow

X


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MModality odality WWorkorkllist / ist / PPerformed erformed PProcedure rocedure SSteptepMModality odality WWorkorkllist / ist / PPerformed erformed PProcedure rocedure SSteptep

MPPS with auto-matic transfer of:

Exposure TimeTotal doseExposure doseFluoro doseNumber framesFluoro timeNumber series

Exposure TimeTotal doseExposure doseFluoro doseNumber framesFluoro timeNumber series

RIS gap it! GAP

Acq. modalityIntegris Philips

MWL:Name, Date of BirthAccession numberUIDs et al.

Name, Date of BirthAccession numberUIDs et al.


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Consistency and Completeness Consistency and Completeness of Image Archivingof Image Archiving

~ 25000 images / d

~ 500 studies / d

manual control takes 5 - 15 min / modality

~ 3h / d for the complete department

~ 25000 images / d

~ 500 studies / d

manual control takes 5 - 15 min / modality

~ 3h / d for the complete department


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Storage Commitment – Push ModelStorage Commitment – Push ModelStorage Commitment – Push ModelStorage Commitment – Push Model

Please take responsibility for safekeeping of data

O.k., commitment for archiving images

permanently

PACS(ImageDevices)

PACS(ImageDevices)

P A C SP A C S

Acq modality

DV

D


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Conclusions MainzConclusions Mainz• Standards allow a flexible implementation of different Standards allow a flexible implementation of different

applications independant from vendorapplications independant from vendor• MWL, MPPS, StComm improve clinical workflow, data MWL, MPPS, StComm improve clinical workflow, data

consistency, quality of documentation,...consistency, quality of documentation,...• IHE is a pragmatic model for the clinical scenariosIHE is a pragmatic model for the clinical scenarios• IHE profiles should become regular part of tendersIHE profiles should become regular part of tenders• IHE Profiles could be used outside Radiology, new IHE Profiles could be used outside Radiology, new

profiles will become necessary (Labarotory, OR)profiles will become necessary (Labarotory, OR)• Improved interest from vendors to support institutions Improved interest from vendors to support institutions

(e.g., pre-ß-tests for new software releases or (e.g., pre-ß-tests for new software releases or functionality)functionality)


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Will IHE do it all?Will IHE do it all?A lot, but:A lot, but:• Current scope is Radiology, first important step Current scope is Radiology, first important step

towards EPRtowards EPR• Need to address performance requirementsNeed to address performance requirements• Clinical applications requiredClinical applications required• Services are neededServices are needed

– Project managementProject management– TrainingTraining– Implementation / transition managementImplementation / transition management– Operational supportOperational support


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ConclusionConclusion• Using Using IHE Integration ProfilesIHE Integration Profiles when writing when writing

specifications will make systems integration specifications will make systems integration faster, faster, more efficient, less expensive more efficient, less expensive andand successful. successful.

• Can go for a Can go for a bigbangbigbang approach, but also for a approach, but also for a focus on a specific focus on a specific smaller areasmaller area..

• Ask your vendors about the Ask your vendors about the IHE Integration IHE Integration StatementStatement for the IHE support in the products they for the IHE support in the products they offer.offer.

• Actual Actual success storiessuccess stories show the realisation of show the realisation of benefits with IHE in practice.benefits with IHE in practice.

Documents

G. Claeys, C. Loef, B.B. Wein Smooth running IT systems in digital imaging The role of the radiologist and IHE