1September, 2005 What IHE Delivers

Cor Loef –Cor Loef – Co-chair IHE Rad TC Co-chair IHE Rad TC

Acknowledgement for presentation input to:Acknowledgement for presentation input to:

Christoph Dickmann – Christoph Dickmann – Member IHE Rad TCMember IHE Rad TC

Charles Parisot –Charles Parisot – Co-chair IHE IT-I PC Co-chair IHE IT-I PC

Integrating the Healthcare Enterprise:Integrating the Healthcare Enterprise:Building the Building the

Electronic Health RecordElectronic Health Record

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Business need: share in the Care settingBusiness need: share in the Care settingRadiology Reports and ImagesRadiology Reports and Images

• Between Radiology andBetween Radiology and• imaging specialistsimaging specialists• non-imaging professionalsnon-imaging professionals

• Within an enterpriseWithin an enterprise• Cross-enterprise in a healthcare regionCross-enterprise in a healthcare region• By network or mediaBy network or media

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Care Cycle DefinitionCare Cycle Definition

The array of health services and care settings The array of health services and care settings that address:that address:

health promotionhealth promotion disease preventiondisease prevention diagnosis, treatment, management, and rehabilitationdiagnosis, treatment, management, and rehabilitation

of a disease, injury, and/or disability…. of a disease, injury, and/or disability…. Source: CDC, US governmentSource: CDC, US government

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The Care Cycle ApproachThe Care Cycle Approach

Set of tools to identify:– Different paths someone may follow

through the care cycle– Disciplines and roles– Sites of care – Technology requirements– Social and political changes

required– Costs– Potential future care cycles

Screening

Home MonitoringPrevention

Healthcare ITDecision Support

Imaging

StagingTherapy Planning

Therapy Delivery

Intensive CareUnit

Step Down FacilityMonitoring

Rehabilitation

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Clinical guidelinesClinical guidelines

Observations Observations

Industry leadersIndustry leaders

LiteratureLiterature

Deriving Care CyclesDeriving Care Cycles

PCPoffice

ED

Cardiol-ogistoffice

ICU/CCU

Non-imagingtesting

Home FloorOR /

Cath Lab

Non-invasiveImaging

Rehab

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Pragmatic definition of EHRPragmatic definition of EHR

Integrated data and workflowIntegrated data and workflow Multimedia data accessMultimedia data access

• text, image, waveform, … text, image, waveform, … Communication among stakeholders in the care cycleCommunication among stakeholders in the care cycle

• clinicians, caregivers, consumers, …clinicians, caregivers, consumers, …

Support different views of dataSupport different views of data Clinical recordsClinical records

• Details: episode, visit, studyDetails: episode, visit, study Longitudinal recordsLongitudinal records

• Summaries: episode, visitSummaries: episode, visit

cross-department and cross-enterprise users

Linking summaries and clinical details

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EHR goals in IHEEHR goals in IHE(compatible with U.S. NHII goals)(compatible with U.S. NHII goals)

Informed Clinical PracticeInformed Clinical Practice IHE integrates clinical data and functions for an EHRIHE integrates clinical data and functions for an EHR

Interconnected CliniciansInterconnected Clinicians Beyond the department: community or regional scopeBeyond the department: community or regional scope

Personalized CarePersonalized Care Web-based data access and summary dataWeb-based data access and summary data

Support for higher-level goalsSupport for higher-level goals Better outcomesBetter outcomes Increased patient safetyIncreased patient safety More efficient healthcare operationsMore efficient healthcare operations

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EHR complexityEHR complexity

Business dilemmasBusiness dilemmas Significant, long-term investment Significant, long-term investment Investors may not be main beneficiariesInvestors may not be main beneficiaries

Coordination and cooperationCoordination and cooperation Active collaboration among multiple stakeholdersActive collaboration among multiple stakeholders Identify and work out commonalities and barriersIdentify and work out commonalities and barriers

Integration and interoperabilityIntegration and interoperability Implement existing standardsImplement existing standards Develop additional standards Develop additional standards

Evolutionary system specification (system of systems)

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Focus: Image-enabled EHRFocus: Image-enabled EHR(connect two “worlds”)(connect two “worlds”)

Non-imaging dataNon-imaging data Patient dataPatient data Clinical dataClinical data

• Laboratory resultsLaboratory results• Surgery reportsSurgery reports• Prescriptions, medsPrescriptions, meds• Letters or notesLetters or notes

Integrate with imaging Integrate with imaging data and processesdata and processes

Imaging dataImaging data Patient dataPatient data Images and evidenceImages and evidence

• RadiologyRadiology• CardiologyCardiology• Nuclear MedicineNuclear Medicine

Integrate with non-Integrate with non-imaging data and imaging data and processesprocesses

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Potential use cases of an image-enabled EHRPotential use cases of an image-enabled EHR

Using imagesUsing images

NeurologistNeurologist: reviewing : reviewing stroke patient transfer to stroke patient transfer to wardward

NurseNurse: preparing GI ward : preparing GI ward round for Dr. Xround for Dr. X

GPGP: seeing a post-MI : seeing a post-MI patient after hospital patient after hospital dischargedischarge

PatientPatient: be prepared for an : be prepared for an obstetric visitobstetric visit

Producing images/ evidenceProducing images/ evidence

CardiologistCardiologist: during catheter : during catheter interventionintervention

RadiologistRadiologist: starting an : starting an abdomen CTabdomen CT

PhysicianPhysician: counseling at : counseling at diabetes outpatient clinicdiabetes outpatient clinic

OncologistOncologist: planning : planning radiotherapyradiotherapy

Information need may include current or longitudinal evidence

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Image-enabled EHRImage-enabled EHRPregnancy outpatient clinics encounterPregnancy outpatient clinics encounter

acquireevaluate

index

Image/ ReportRepository

storenew data

Ultrasound reportand images

DocumentRegistry

register

(XDS architecture)

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Image-enabled EHRImage-enabled EHRChildbirth inpatient stayChildbirth inpatient stay

registerindex

evaluate

DocumentRegistry

Image/ Report/ Document

Repositories

index

query

retrieve

DocumentRepository

storenew data

Report, letters(incl. images)

(XDS architecture)

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Sharing Imaging Documents (XDS-I)Sharing Imaging Documents (XDS-I)

Document Registry

Register report & image references

Retrieve selected imaging report references

Radiologydepartment

patient

Query for re-ports

Documentavailability

Shared re- pository

Onco-logist

GP(follow-up)

Images, report(PACS, RIS) report

Longitudinal record system: across encounters

Care record sys-tems: specific care deliveryRetrieve

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IHE contributions to EHR implementation IHE contributions to EHR implementation

IHE Laboratory1 Int. Profile

IHE Radiology7 Int. Profiles

EHR realization

IHE IT Infrastructure7 Int. Profiles

Each TF can contribute to EHR scenarios with Integration Profiles for• Data access• Workflow

IHE Cardiology3 Int. Profiles IHE Pat. Care Coord.

3 Int. Profile

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Basic requirements of EMR/EHR systemsBasic requirements of EMR/EHR systems

Integrated healthcare provider systemsIntegrated healthcare provider systems EHR sources/ users, user interactionEHR sources/ users, user interaction

Document handlingDocument handling Storage and retrieval of EHR documentsStorage and retrieval of EHR documents

Infrastructure servicesInfrastructure services Basic data and application integrationBasic data and application integration

NetworkNetwork EHR storage, inquiry, and retrieval pathEHR storage, inquiry, and retrieval path

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DesktopIntegrationas an EHR enabler

Backend integration (services, data)

EMR/EHR interoperability examplesEMR/EHR interoperability examples

Appl. 1

Appl. 2

Appl. 3

Patient identifier matching

Common person data or services

Samepatient selected

Patientdemographics

Source 1

Source 2

Personnel/staff data

Any user Single

sign on

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IHE - Radiology IHE - Radiology imagesimages and reports for an and reports for an EMR/EHR systemEMR/EHR system

Access to Radiology Access to Radiology (Rad ARI)(Rad ARI)Retrieve diagnostic quality images, evidence, reportsRetrieve diagnostic quality images, evidence, reports

Simple Image and Numeric Reports Simple Image and Numeric Reports (Rad SINR)(Rad SINR)Access or export reports and related imagesAccess or export reports and related images

Key Image Notes Key Image Notes (Rad KIN)(Rad KIN)Mark, annotate, retrieve selected imaging evidenceMark, annotate, retrieve selected imaging evidence

Portable Data for Imaging Portable Data for Imaging (Rad PDI)(Rad PDI)Export/ import/ view media dataExport/ import/ view media data

Nuclear Medicine Image Nuclear Medicine Image (Rad NM Image)(Rad NM Image)Capture and use complex NM result screensCapture and use complex NM result screens

Mammography Image Mammography Image (Rad Mammo Image)(Rad Mammo Image)Capture and use complex Mammography screensCapture and use complex Mammography screens

Consistent Presentation of ImagesConsistent Presentation of Images (Rad CPI)(Rad CPI)Consistent image viewing on all review stationsConsistent image viewing on all review stations

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IHE – Cardiology images and reports for an IHE – Cardiology images and reports for an EMR/EHR systemEMR/EHR system

Cardiac Catheterization / Echo WorkflowCardiac Catheterization / Echo Workflow (Card CATH, ECHO) (Card CATH, ECHO)Retrieve catheterization and echocardiography Retrieve catheterization and echocardiography imaging evidenceimaging evidence

Retrieve ECG for DisplayRetrieve ECG for Display (Card ECG)(Card ECG)Retrieve ECG summaries and resultsRetrieve ECG summaries and results

Displayable ReportsDisplayable Reports (Card DRPT)(Card DRPT)Create and access reports for viewingCreate and access reports for viewing

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IHE - common interoperability servicesIHE - common interoperability services

Common patient identification Common patient identification (ITI PIX)(ITI PIX)

Common patient demographics Common patient demographics (ITI PDQ)(ITI PDQ)

Desktop integration Desktop integration (ITI PSA)(ITI PSA)Running applications work on the same patientRunning applications work on the same patient

Single sign on Single sign on (ITI EUA, (ITI EUA, XUA)XUA) Enterprise-wide or cross-enterprise user handlingEnterprise-wide or cross-enterprise user handling

Security and privacy Security and privacy (ITI/ RAD ATNA, (ITI/ RAD ATNA, Accountability, document integrityAccountability, document integrity DSG) DSG)

Common staff data Common staff data (ITI PWP)(ITI PWP)Health professionals are commonly recognizedHealth professionals are commonly recognized

Fundamental enablers of cross-system health record system functions.Gradual enhancement and combination is the key.

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IHE – documents for general purpose IHE – documents for general purpose EHR functions EHR functions

Cross-Enterprise Document Sharing for Imaging Cross-Enterprise Document Sharing for Imaging (Rad XDS-I)(Rad XDS-I)Share DICOM instances via web or DICOM connection;Share DICOM instances via web or DICOM connection;share imaging information via webshare imaging information via web

Cross-Enterprise Document SharingCross-Enterprise Document Sharing (ITI XDS)(ITI XDS)Store & retrieve documents and summaries Store & retrieve documents and summaries (focus: longitudinal data)(focus: longitudinal data)

Notification of Document Availability Notification of Document Availability (ITI NAV)(ITI NAV)Send notification/ reference to new shared documents Send notification/ reference to new shared documents

Retrieve Information for DisplayRetrieve Information for Display (ITI RID)(ITI RID)Query and retrieve documents and summaries/ listsQuery and retrieve documents and summaries/ lists

Needs common services as a basis (e.g. security, patient identification)

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IHE - clinical/ textual information for an IHE - clinical/ textual information for an EMR/EHR systemEMR/EHR system

Simple Image and Numeric ReportsSimple Image and Numeric Reports (Rad SINR)(Rad SINR)Access original or exported reports Access original or exported reports

Cross-Enterprise Document SharingCross-Enterprise Document Sharing (ITI XDS) (ITI XDS) Cross-Enterprise Doc. Sharing for ImagingCross-Enterprise Doc. Sharing for Imaging (Rad XDS-I)(Rad XDS-I)Store & retrieve documents, summaries or reports Store & retrieve documents, summaries or reports with longitudinal datawith longitudinal data

Retrieve Information for DisplayRetrieve Information for Display (ITI RID) (ITI RID) Access documents and summaries Access documents and summaries (e.g. imaging, lab, discharge, medications, prescriptions)(e.g. imaging, lab, discharge, medications, prescriptions)

Sharing Laboratory reportSharing Laboratory report (Lab XD*-(Lab XD*-LAB)LAB)Access to Access to laboratory resultslaboratory results

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IHE - workflow / patient management supportIHE - workflow / patient management support

Workflow integration Workflow integration (Rad, Card, Lab)(Rad, Card, Lab) Scheduled WorkflowScheduled Workflow

• Ordering, scheduling and tracking of image acquisition stepsOrdering, scheduling and tracking of image acquisition steps• Appointment tracking to order placerAppointment tracking to order placer

Reporting WorkflowReporting Workflow• Scheduling and tracking of report creation tasksScheduling and tracking of report creation tasks

Patient data integrationPatient data integration (Rad, Card, (Rad, Card, ITI)ITI) Patient Information ReconciliationPatient Information Reconciliation

• Modification and matching of patient data and imaging evidenceModification and matching of patient data and imaging evidence Patient Administration ManagementPatient Administration Management

• Creating and changing patient identifiers and encounter dataCreating and changing patient identifiers and encounter data

Overall concept (Rad whitepaper)Overall concept (Rad whitepaper) Departmental workflow and interfaces to the enterpriseDepartmental workflow and interfaces to the enterprise

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Envisaged IHE developmentEnvisaged IHE development

Extend XDS’ document contentExtend XDS’ document content

Harmonize IHE domain-specific workflow and Harmonize IHE domain-specific workflow and document contentdocument content

Realize overall workflow conceptRealize overall workflow concept

Link departmental documents, in particular Link departmental documents, in particular diagnostic reports, to the enterprise EMR diagnostic reports, to the enterprise EMR

Code sets and master filesCode sets and master files

Configuration supportConfiguration support

Security details, e.g. access controlSecurity details, e.g. access control

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Image-enabled EHR – IHE progress and plansImage-enabled EHR – IHE progress and plans

IHE Integration Profiles from different domains can IHE Integration Profiles from different domains can be combinedbe combined

Combinations of current profiles can cover many Combinations of current profiles can cover many EHR scenariosEHR scenarios Information integration (imaging, textual)Information integration (imaging, textual) Enhanced functionality beyond one departmentEnhanced functionality beyond one department Intra- and cross enterprise communicationIntra- and cross enterprise communication

Scenarios enable system evolutionScenarios enable system evolution(organizational change management not to be forgotten)(organizational change management not to be forgotten)

IHE ensures integration testing and future IHE ensures integration testing and future Integration Profile developmentIntegration Profile development

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