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IntegratingIntegratingthe the
Healthcare EnterpriseHealthcare Enterprise
What Does IHE Offer?What Does IHE Offer?
Kevin O’Donnell, Toshiba Corp.Co-chair, IHE Radiology Planning Cmte
HIMSS/RSNA SCAR 2003
What Does IHE Offer?What Does IHE Offer?
Systems Integration To achieve clinical goals Using non-proprietary methods
Improve the efficiency and effectiveness of clinical practice by: Improved Information FlowAdvanced Multi-System Functions
HIMSS/RSNA SCAR 2003
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
HIMSS/RSNA SCAR 2003
Scheduled Workflow BenefitsScheduled Workflow Benefits
Reduced Manual Data Entry– Increased efficiency, decreased error rates
Digital Scheduling, Tracking & Data– Managed workflow– Order loop closure, better billing– Paperless
Up to the minute status, distributed access
– Filmless Rapid distribution, rapid access
HIMSS/RSNA SCAR 2003
Patient Information Reconciliation ProfilePatient Information Reconciliation Profile
Extends Scheduled Workflow– Handle unidentified/emergency patient– Handle demographic information updates– Changes propagated to all affected systems,
affected data updated
HIMSS/RSNA SCAR 2003
Patient Information Reconciliation Patient Information Reconciliation BenefitsBenefits
Reduction of errors– Reduces incorrectly identified or “lost”
studiesMore complete medical record
– Supports maintenance of demographics to maintain database correspondence
Flexible Trauma Workflow
HIMSS/RSNA SCAR 2003
Charge Posting ProfileCharge Posting Profile
ChargeChargePosterPoster
*Billing System
CAD*Workstation
ReportRepository……
Report Generated / Signed
CADPerformed
PostCharges
AcquisitionModality
ADT Terminal
3-D*Workstation
Account Management
3-DPerformed
StudyPerformed
/ MaterialsUsed
HIMSS/RSNA SCAR 2003
Charge Posting BenefitsCharge Posting Benefits
Reduces Billing Errors– less manpower required in billing cycle
More timely billing, shorter billing cycleDetailed performed procedure information
– Billing more accurately reflects what was actually done: more details, fewer errors
HIMSS/RSNA SCAR 2003
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
HIMSS/RSNA SCAR 2003
Consistent Presentation of Images Consistent Presentation of Images BenefitsBenefits
More Consistent Views– Referring sees same thing as Radiologist– Softcopy matches Hardcopy
Less Work– don’t have to repeat manipulations– don’t have to calibrate every imaging device to
every display device
HIMSS/RSNA SCAR 2003
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
HIMSS/RSNA SCAR 2003
Presentation of Grouped Procedures Presentation of Grouped Procedures BenefitsBenefits
Improved patient experience (time/comfort)Improved acquisition throughputImproved reporting process
– images are grouped & sorted correctly and ready for display
Improved billing– multiple order/accession chains are preserved
Reduced load on Network and PACS
HIMSS/RSNA SCAR 2003
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
HIMSS/RSNA SCAR 2003
Key Image Note BenefitsKey Image Note BenefitsImproved communication
– key image display reduces clutter– note contents provide clarifications
Improved workflow– enables automatic display & routing
Improved Study & Image Handling– Key Images for Referring – Teaching Files– QA Issues– etc
HIMSS/RSNA SCAR 2003
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
HIMSS/RSNA SCAR 2003
Simple Image and Numeric Reports Simple Image and Numeric Reports BenefitsBenefits
Coded Values– enables data mining, decision support
Flexible Report Presentation– rich text with embed images and measurements
DICOM Management– Query/retrieve/archiving– Distribute reports through DICOM infrastructure
HIMSS/RSNA SCAR 2003
Post-Processing Workflow ProfilePost-Processing Workflow Profile
Post-Proc.Post-Proc.WorkflowWorkflowManagerManager
PACS System
CAD*Workstation
ReportRepository
AcquisitionModality
3-D*Workstation
Work Status
WorklistWorklist
…
Source Data
Results
Workstation
Results
WorkWork StatusStatus
HIMSS/RSNA SCAR 2003
Post-Processing Workflow Post-Processing Workflow BenefitsBenefits
Worklist Management– Provides todo list– Direct references to input data
Reduced Manual Data Entry– Increased efficiency, decreased error rates
Electronic Status– Status available quickly, Distributed access,
Trigger interpretation, better workflow Electronic Results
– Post-processed images / objects get associated with the correct study
HIMSS/RSNA SCAR 2003
Access to Radiology Information ProfileAccess to Radiology Information Profile
Radiology Department – Images and
Reports
Emergency Department
Referring Physician
Other Departments:- Oncology- Surgery- Neurology- Pediatrics- etc.
Remote Clinics
Electronic Medical Record
HIMSS/RSNA SCAR 2003
Access to Radiology InformationAccess to Radiology InformationBenefitsBenefits
Improved Access to Images, Reports, etc– More complete, timely patient views– Fewer requests to radiology staff
HIMSS/RSNA SCAR 2003
Basic Security ProfileBasic Security Profile
AuditAuditRecordRecord
RepositoryRepository
……
Image Manager& Archive
“Images Queried / Retrieved”
DiagnosticWorkstation
ReportRepository
……
Report & ImageReview
“Reports Queried / Retrieved”
“Images Printed”“Reports Stored”
“Reports Retrieved” “Reports Printed”
HIMSS/RSNA SCAR 2003
Basic Security BenefitsBasic Security Benefits
Centralized Activity Auditing– Monitor/Audit HIPAA policy conformance– Measure Departmental performance
Improved Security
HIMSS/RSNA SCAR 2003
What Do You Get for All This?What Do You Get for All This? Fewer errors, improved data accuracy Greater access to information Reduced study loss, retakes Fewer tedious tasks Better scheduling and tracking Increased modality throughput Freedom to acquire components from
multiple manufacturers
