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Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise
Overview ofOverview ofIHE & the 7 ProfilesIHE & the 7 Profiles
Kevin O’Donnell - Toshiba Corp.Kevin O’Donnell - Toshiba Corp.IHE Planning Committee Co-chair IHE Planning Committee Co-chair
Vendor WorkshopApril 8-9, 2002
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IHE MissionIHE Mission
IHE is an initiative promoting and supporting IHE is an initiative promoting and supporting the the integrationintegration of of systemssystems in the in the healthcare healthcare enterpriseenterprise..
Vendor WorkshopApril 8-9, 2002
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IHE Integration GoalsIHE Integration Goals
Improve the efficiency and effectiveness of Improve the efficiency and effectiveness of clinical practice:clinical practice:
Improve Improve WorkflowWorkflow Improve Improve Information AccuracyInformation Accuracy Improve Improve Information AvailabilityInformation Availability Enable Enable Cross-System FunctionalityCross-System Functionality
Vendor WorkshopApril 8-9, 2002
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IHE Annual CycleIHE Annual Cycle
Identify several key healthcare workflows and integration Identify several key healthcare workflows and integration problemsproblems
Research & select standards to specify a solutionResearch & select standards to specify a solution
Write, review and publish IHE Technical FrameworkWrite, review and publish IHE Technical Framework
Hold workshops and support vendor implementationHold workshops and support vendor implementation
Perform cross-testing at “Connectathon”Perform cross-testing at “Connectathon”
Demonstrate/Promote at tradeshows (RSNA/HIMSS)Demonstrate/Promote at tradeshows (RSNA/HIMSS)
Vendor WorkshopApril 8-9, 2002
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Who Does What?Who Does What? RSNA and HIMSS (Chris & Joyce):RSNA and HIMSS (Chris & Joyce):
Provide a Provide a neutral forumneutral forum for working on the for working on the Big PictureBig Picture Involve users/professionals and recruit companiesInvolve users/professionals and recruit companies Sponsor IHE and provide infrastructure/continuitySponsor IHE and provide infrastructure/continuity Organize demonstrations and public educationOrganize demonstrations and public education
Mallinkrodt (Steve):Mallinkrodt (Steve): Manage the Connectathon processManage the Connectathon process Create and administer the MESA Test ToolsCreate and administer the MESA Test Tools
IHE Committees:IHE Committees: Identify and design solutions for integration problemsIdentify and design solutions for integration problems
Vendors:Vendors: Implement profiles on productsImplement profiles on products
Vendor WorkshopApril 8-9, 2002
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IHE & DICOM / HL7IHE & DICOM / HL7• Standards are vital (HL7, DICOM, ICD, Standards are vital (HL7, DICOM, ICD,
…)…)– They provide tools & technologiesThey provide tools & technologies
• But Standards alone are insufficientBut Standards alone are insufficient– They are open to interpretationThey are open to interpretation– There is room for optional variationsThere is room for optional variations– They avoid specifying how to apply them to They avoid specifying how to apply them to
particular real world scenariosparticular real world scenarios
Vendor WorkshopApril 8-9, 2002
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How is IHE related to Standards?How is IHE related to Standards?• Profiles are packagingProfiles are packaging
• IHE attacks real world radiology integration IHE attacks real world radiology integration problemsproblems
• HL7 and DICOM provide dictionariesHL7 and DICOM provide dictionaries
• IHE defines a “phrasebook” that solves real IHE defines a “phrasebook” that solves real world problems by assembling pieces world problems by assembling pieces provided by DICOM/HL7provided by DICOM/HL7
Vendor WorkshopApril 8-9, 2002
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Key IHE ConceptsKey IHE Concepts• Generalized Systems Generalized Systems -> -> ActorsActors
• Interactions between Actors Interactions between Actors -> -> TransactionsTransactions
• Problem/Solution ScenariosProblem/Solution Scenarios -> -> IntegrationIntegration ProfilesProfiles
• For each Integration Profile:For each Integration Profile:
• the context is described (which real-world problem)the context is described (which real-world problem)
• the actors are defined (what systems are involved)the actors are defined (what systems are involved)
• the transactions are defined (what must they do)the transactions are defined (what must they do)
Vendor WorkshopApril 8-9, 2002
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IHE TransactionsIHE Transactions• <Insert Transaction Diagram Here><Insert Transaction Diagram Here>
Vendor WorkshopApril 8-9, 2002
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Presentation ofGrouped Procedures
Subset a single acquisition
IHE Year 3 Integration ProfilesIHE Year 3 Integration Profiles
Patient Information
Reconciliation
Unknown patients and unscheduled
orders
ConsistentPresentation of
Images
Hardcopy and softcopy
grayscale and presentation state
Access toRadiology
Information
Consistentaccess to
images andreports
Key ImageNotes
Exchange flaggingsignificant images
Simple Image andNumeric Reports
Exchange simplereports with image
links and, optionally,measurements
Scheduled WorkflowAdmit, order, schedule, acquire images, notify of completed steps
Vendor WorkshopApril 8-9, 2002
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imagesstored
patientinformation
RIS
examination orders
imagesretrieved
HIS
PACS
procedurescheduled
Prefetch any relevantprior studies
modalityworklist
report
report
Scheduled Workflow ProfileScheduled Workflow Profile
Registration
Orders Placed
Orders Filled
Film
FilmFolder
Image Manager& Archive
FilmLightbox
report ReportRepository
DiagnosticWorkstation
Modality
acquisitionacquisitionin-progressin-progressacquisitioncompleted
acquisitioncompleted
imagesprinted
AcquisitionModality
Vendor WorkshopApril 8-9, 2002
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Patient Information Reconciliation ProfilePatient Information Reconciliation Profile
• Extends Scheduled WorkflowExtends Scheduled Workflow– Handle unidentified patient (e.g. trauma)Handle unidentified patient (e.g. trauma)– Handle demographic information mistakesHandle demographic information mistakes– Propagate changes to all affected systems, update Propagate changes to all affected systems, update
all affected dataall affected data
• Reduces incorrectly identified or “lost” studiesReduces incorrectly identified or “lost” studies
Vendor WorkshopApril 8-9, 2002
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Standards & MechanismsStandards & Mechanisms• HL7HL7
• ADT Messages (A01-08, A11-13, A38, A40)ADT Messages (A01-08, A11-13, A38, A40)
• ORM MessagesORM Messages
• DICOMDICOM
• Modality Worklist Management (MWL)Modality Worklist Management (MWL)
• Modality Performed Procedure Step (MPPS)Modality Performed Procedure Step (MPPS)
• Storage, Storage CommitmentStorage, Storage Commitment
• Query/Retrieve Query/Retrieve
Vendor WorkshopApril 8-9, 2002
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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 ProfileConsistent Presentation of Images Profile
Vendor WorkshopApril 8-9, 2002
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• DICOMDICOM
• Grayscale Standard Display Function (GSDF)Grayscale Standard Display Function (GSDF)
• Grayscale Softcopy Presentation State (GSPS)Grayscale Softcopy Presentation State (GSPS)
• Storage, Storage CommitmentStorage, Storage Commitment
• Query/RetrieveQuery/Retrieve
• Print ManagementPrint Management
• Presentation LUT (P-LUT)Presentation LUT (P-LUT)
• IHE Scheduled Workflow ProfileIHE Scheduled Workflow Profile
Consistent Presentation of Images ProfileConsistent Presentation of Images Profile
Vendor WorkshopApril 8-9, 2002
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MODALITY
Presentation of Grouped Procedures ProfilePresentation of Grouped Procedures ProfileRequested Procedure:
CHEST
Report:CHEST
Report:AB/PELVIS
Performs a single exam
Operatorgroups
2 procedures
Chest Chest ViewView
RIS / PACS
Requested Procedure:AB/PELVIS
Chest Chest ViewView
Ab/Pelvis Ab/Pelvis ViewView
Ab/Pelvis Ab/Pelvis ViewView
Vendor WorkshopApril 8-9, 2002
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• IHE Scheduled Workflow ProfileIHE Scheduled Workflow Profile
• IHE Consistent Presentation of Images ProfileIHE Consistent Presentation of Images Profile
Presentation of Grouped Procedures ProfilePresentation of Grouped Procedures Profile
Vendor WorkshopApril 8-9, 2002
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Simple Image & Numeric Reports ProfileSimple Image & Numeric Reports Profile
PACS
Images Retrieved
Preliminary Report
Verified Report
Report & Images Retrieved
Image Manager& Archive
ReportVerification
Images and Examdata presented for
diagnosis
Reports storedfor
Network Access
Report & ImageReview for
Patient Care
Vendor WorkshopApril 8-9, 2002
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• DICOMDICOM
• Structured Reports (SR)Structured Reports (SR)
• SR Template TID 2000SR Template TID 2000
• Storage, Storage CommitmentStorage, Storage Commitment
• Query/RetrieveQuery/Retrieve
• HL7HL7
• ORU MessagesORU Messages
• IHE Scheduled Workflow ProfileIHE Scheduled Workflow Profile
Simple Image & Numeric Reports ProfileSimple Image & Numeric Reports Profile
Vendor WorkshopApril 8-9, 2002
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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 Notes ProfileKey Image Notes Profile
Vendor WorkshopApril 8-9, 2002
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• DICOMDICOM
• Structured Reports (SR)Structured Reports (SR)
• Key Object SelectionKey Object Selection
• Storage, Storage CommitmentStorage, Storage Commitment
• Query/RetrieveQuery/Retrieve
• IHE Scheduled Workflow ProfileIHE Scheduled Workflow Profile
Key Image Note ProfileKey Image Note Profile
Vendor WorkshopApril 8-9, 2002
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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
Vendor WorkshopApril 8-9, 2002
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• DICOMDICOM
• Query/RetrieveQuery/Retrieve
Access to Radiology Information ProfileAccess to Radiology Information Profile
Vendor WorkshopApril 8-9, 2002
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Year 4 Profiles (Tomorrow)Year 4 Profiles (Tomorrow)
Security (HIPAA)Security (HIPAA) General Purpose WorklistGeneral Purpose Worklist
Post-Processing WorkflowPost-Processing Workflow Charge PostingCharge Posting (Modality Worklist Exception Handling)(Modality Worklist Exception Handling)
Vendor WorkshopApril 8-9, 2002
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ReferencesReferences• www.rsna.org/IHE
• IHE Technical Framework - Year 3 & Year 4IHE Technical Framework - Year 3 & Year 4
• Part I:Part I: The ProfilesThe Profiles
• Part II:Part II: The TransactionsThe Transactions
• Part III: The New TransactionsPart III: The New Transactions
• IHE Mailing Lists and Comment ServerIHE Mailing Lists and Comment Server
• Educational MaterialsEducational Materials• IHE Integration Profiles; The IHE FAQ; IHE VideoIHE Integration Profiles; The IHE FAQ; IHE Video
• IHE Fundamentals, Purchasing Strategies, IHE PrimerIHE Fundamentals, Purchasing Strategies, IHE Primer
• IHE Integration Checklist, Connectathon ResultsIHE Integration Checklist, Connectathon Results
Vendor WorkshopApril 8-9, 2002
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Questions?Questions?
Vendor WorkshopApril 8-9, 2002
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How Established is IHE?How Established is IHE?• Year 1 (1999):Year 1 (1999): Proof of ConceptProof of Concept
(Basic Scheduled Workflow)(Basic Scheduled Workflow)
• Year 2 (2000): Year 2 (2000): Introduction of the 7 ProfilesIntroduction of the 7 Profiles(Full Featured)(Full Featured)
• Year 3 (2001): Year 3 (2001): Consolidation, Catch-up (Real Consolidation, Catch-up (Real Products)Products) Expansion to FranceExpansion to France
• Year 4 (2002): Year 4 (2002): 3 New Profiles 3 New Profiles Expansion to Japan, GermanyExpansion to Japan, Germany
• Year 5 (2003): Year 5 (2003): New ProfilesNew ProfilesExpansion to Lab, Pathology, …?Expansion to Lab, Pathology, …?
Vendor WorkshopApril 8-9, 2002
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How do I benefit?How do I benefit?• Clinical UsersClinical Users
• Greater access to more consistent informationGreater access to more consistent information• Fewer errors, fewer tedious tasksFewer errors, fewer tedious tasks
• AdministratorsAdministrators• Increased throughputIncreased throughput• Better scheduling and trackingBetter scheduling and tracking
• BuyersBuyers• Specify/purchase integration capabilities easily Specify/purchase integration capabilities easily • Freedom to acquire “Best of Breed” systems Freedom to acquire “Best of Breed” systems
• IT ProfessionalsIT Professionals• Faster, more predictable integration projectsFaster, more predictable integration projects