September, 2005What IHE Delivers 1 IHE for Product Planners Ellie Avraham - Carestream Health Co-Chair IHE Radiology, Technical Committee

1September, 2005 What IHE Delivers

IHE for Product PlannersIHE for Product Planners

Ellie AvrahamEllie Avraham - - Carestream HealthCarestream Health

Co-Chair IHE Radiology, Technical CommitteeCo-Chair IHE Radiology, Technical Committee

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Learning ObjectivesLearning ObjectivesClinical and Economic benefitsClinical and Economic benefits of Integration for your of Integration for your customers – customers – IHE RadiologyIHE Radiology Users HandbookUsers Handbook

Improve Product FunctionalityImprove Product Functionality by using the by using the IHEIHE Technical Technical FrameworkFramework

Improve Integrated System Solutions WorkflowsImprove Integrated System Solutions Workflows by using by using IHE IHE Integration ProfilesIntegration Profiles

IHE Success storiesIHE Success stories and other information to refine the and other information to refine the Products “Business case”Products “Business case” evaluation evaluation

IHE ProcessIHE Process to Synchronize it with the Product Planning & to Synchronize it with the Product Planning & DevelopmentDevelopment

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Discussion AreasDiscussion Areas

IHE Deployment ProcessIHE Deployment Process

IHE Integration Profiles IHE Integration Profiles

The Value Proposition from Planning Products and The Value Proposition from Planning Products and Integrated Solutions using IHEIntegrated Solutions using IHE

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Integration Solutions Available Today fromIntegration Solutions Available Today fromSeveral Medical Systems Vendors – Several Medical Systems Vendors – BUTBUT ... ...

Modern Healthcare Enterprises AreModern Healthcare Enterprises AreStill Confronted with Problems:Still Confronted with Problems:((In Spite of IT Standards and Advanced Technology)In Spite of IT Standards and Advanced Technology)

Lack of Access to Complete Medical InformationLack of Access to Complete Medical Information Inconsistent or Redundant Medical InformationInconsistent or Redundant Medical Information

Across Departments and InstitutionsAcross Departments and Institutions Inadequate Communicating of Medical DataInadequate Communicating of Medical Data

Across Multiple Systems from Different VendorsAcross Multiple Systems from Different Vendors Risky Investments in Risky Investments in Proprietary SolutionsProprietary Solutions Clinical Workflows are not OptimizedClinical Workflows are not Optimized

Challenges of Integration

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Prof. Societies Sponsorship

Healthcare Providers & Vendors

Healthcare IT Standards HL7, DICOM, etc.

General IT Standards Internet, ISO, etc.

Interoperable Healthcare IT Solution Specifications

IHE Integration Profile Interoperable Healthcare IT

Solution Specifications IHE Integration Profile

Interoperable Healthcare IT Solution Specifications

IHE Integration Profile Interoperable Healthcare IT

Solution Specifications IHE Integration Profile

IHE Process

IHE drives healthcare standards based-integrationIHE drives healthcare standards based-integration

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IHEIHE Process Process - Annual Cycle- Annual Cycle

IHEIntegrationProfiles B

IHEIntegrationProfile A

Easy toIntegrateProducts

IHEConnectathon

ProductWith IHE

IHEDemonstration

User Site

RFPRFP

Standards

IHETechnical

Framework

Product IHE IntegrationProduct IHE IntegrationStatementStatement

IHE IHE ConnectathonConnectathonResultsResults

IHE Technical Framework – IHE Technical Framework – DefinDefine Standard Integration Solutionse Standard Integration Solutions

IHE Connectathon Results – Most implemented and tested IHE SolutionsIHE Connectathon Results – Most implemented and tested IHE Solutions

IHE Integration Statements – Most Comertialized IHE SolutionsIHE Integration Statements – Most Comertialized IHE Solutions

IHE Success Story – Most Successful Used IHE SolutionsIHE Success Story – Most Successful Used IHE Solutions

IHE Users Handbook – IHE Solutions, Economical and Clinical benefitsIHE Users Handbook – IHE Solutions, Economical and Clinical benefits

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IHE Calendar Annual Events for IHE Calendar Annual Events for Synchronization with Product PlanningSynchronization with Product Planning

Feb. 2007 – IHE Supplements Profiles for Public CommentFeb. 2007 – IHE Supplements Profiles for Public Comment

May – IHE Supplements Profiles for Trial ImplementationMay – IHE Supplements Profiles for Trial Implementation

Aug. – IHE Participation WorkshopAug. – IHE Participation Workshop

Sept. – IHE Participation Registration: Sept. – IHE Participation Registration: Connectathon & DemosConnectathon & Demos

Oct. - IHE Vendor Workshop for the ConnectathonOct. - IHE Vendor Workshop for the Connectathon

Oct. – Dec. IHE MESA Testing Validations for Oct. – Dec. IHE MESA Testing Validations for ConnectathonConnectathon

Nov. - RSNA – IHE Radiology DemoNov. - RSNA – IHE Radiology Demo

Jan. 2008 – IHE ConnectathonJan. 2008 – IHE Connectathon

Feb. 2008 – HIMSS IHE ITI DemoFeb. 2008 – HIMSS IHE ITI Demo

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Using IHE for Product Planning

IHE Aid for Global / IHE Aid for Global / International Product PlanningInternational Product Planning IHE Technical FrameworkIHE Technical Framework (TF) (TF)

> Vol 1: Defines Global Integration Profiles> Vol 1: Defines Global Integration Profiles

> Vol 2,3: Defines the TF Transactions details for Development> Vol 2,3: Defines the TF Transactions details for Development

> Vol 4: Defines the Local National specialization details> Vol 4: Defines the Local National specialization details

IHE Connectathon ResultsIHE Connectathon Results – Learn what IHE solutions are – Learn what IHE solutions are developeddeveloped

IHE User Success Stories & IHE Users HandbookIHE User Success Stories & IHE Users Handbook – Learn the – Learn the Clinical and Economic benefits of using products with IHE capabilitiesClinical and Economic benefits of using products with IHE capabilities

IHE Integration StatementsIHE Integration Statements – The Commercialized products with IHE – The Commercialized products with IHE capabilitiescapabilities

RFP’s from customersRFP’s from customers

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IHE Connectathon Results http://www.ihe.net/Events/connectathon_results.cfm

Consolidated Earlier Progress &Consolidated Earlier Progress &Push for Market AdoptionPush for Market Adoption

More Robust ConnectathonMore Robust Connectathon Results Recorded and PublishedResults Recorded and Published

Increased Industry ParticipationIncreased Industry Participation 31 companies31 companies 70 systems70 systems 21 Additional Companies in21 Additional Companies in

IHE EuropeIHE Europe

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IHE User Success Story http://www.ihe.net/resources/user_success_stories.cfm

•Cleveland Clinic Foundation•Detroit Medical Center•Grossman Imaging Centers•Hôpitaux Universitaires de Genèv•IHE McKay-Dee Hospital•Johannes Gutenberg University Hospital•Magic Valley Regional Medical Center•Mayo Clinic Jacksonville•Our Lady Of The Lake Regional Medical Center (OLOL)•VA Puget Sound Health Care System•St. Vincent Hospital and Health Services•Steinberg Diagnostic Medical Imaging•University of Pisa•University of Wisconsin

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Deployment of IHE Profiles – Most Used:Deployment of IHE Profiles – Most Used:- Scheduled Workflow (SWF)- Scheduled Workflow (SWF)

- Patient Information Reconciliation (PIR)- Patient Information Reconciliation (PIR)

- Consistent Presentation of Images (CPI)- Consistent Presentation of Images (CPI)

- Reporting Workflow (RWF)- Reporting Workflow (RWF)

- Basic Security for HIPAA regulations (ATNA)- Basic Security for HIPAA regulations (ATNA)

Clinical and Economics AccomplishmentsClinical and Economics Accomplishments

- - Improve the Patient CareImprove the Patient Care – Improved data accuracy and Safety, Image – Improved data accuracy and Safety, Image Quality & Consistency and time saving due to optimized Workflows and Quality & Consistency and time saving due to optimized Workflows and integrated systemsintegrated systems

- - Improve the clinical practice productivityImprove the clinical practice productivity - - reduced manual data reduced manual data entry using the ADT registration in one place and propagate it to all the other entry using the ADT registration in one place and propagate it to all the other systems (PACS, RIS Modality) and reduced errors. systems (PACS, RIS Modality) and reduced errors.

- - Optimize the Radiological WorkflowOptimize the Radiological Workflow (SWF) (SWF) Reduced the incorrectly or lost studies, using DICOM MWL, MPPSReduced the incorrectly or lost studies, using DICOM MWL, MPPS

IHE User Success Story & HandbookIHE User Success Story & Handbook

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IHE Integration Statement http://www.ihe.net/resources/ihe_integration_statements.cfmIHE Integration Statements document the product IHE capabilities in terms of IHE: Actors and Integration Profiles.- Promote your products with the Integration Statements - Learn from other Vendors Integration Statements the IHE Profiles and Actors supportedThe RSNA links to IHE Integration Statements published by the companies:

- Agfa HealthCare - Philips Medical Systems- Cerner Corporation - Sectra- Eastman Kodak Company - Siemens Medical Solutions - Emageon - Softmedical- Fujifilm Medical Systems USA - Stentor- GE Medical Systems - StorCOMM, Inc- INFINITT Co., Ltd. - Tiani Medgraph AG- McKesson Information Solutions - Toshiba America Medical Systems- Medcon - Voxar Limited

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IHE Integration Statement Date: 03/10/2006

Vendor Product Name Version

Acme Medical Systems PACS-o-Matic V3.9

This product implements all transactions required to support the IHE Integration Profiles, Actors and Options listed below:

Integration Profiles Implemented Actors Implemented Options Implemented

Scheduled Workflow Image Manager / Archive .

PPS Exception Management

Patient Information Reconciliation Image Manager / Archive .

None

Consistent Presentation of Images Image Manager / Archive Image Display

None

Portable Data for Imaging Media Creator Media Importer

None

Audit Trail and Node Authentication Audit Record Repository None

Internet address for vendor's IHE information : http://www.acme-medical.com/IHE

Links to Standards Conformance Statements for the implementation

Dicom: http://www.acme-medical.com/DICOM

Health Level 7: http://www.acme-medical.com/HL7

Links to general information on IHE

In North America : http://www.ihe.net

In Europe : http://www.ihe-europe.org

In Japan : http://www.jira-net.or.jp/ihe-j

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IHE Technical FrameworkIHE Technical FrameworkOrganized in sections that provide an Organized in sections that provide an

increasing level of detailincreasing level of detail

Integration ProfilesIntegration Profiles:: Defines a Problem and the Solution in terms of Actors and communication in terms of Actors and communication transactionstransactionsActorsActors:: Identify specific kinds of operational Identify specific kinds of operational participants in the healthcare enterprise.participants in the healthcare enterprise.

IHE FoundationIHE Foundationhttp://www.ihe.net/Technical_Framework/index.cfm

TransactionsTransactions: : Describe particular interactions Describe particular interactions between actors to perform between actors to perform specific operationsspecific operations..

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IHE Radiology Integration ProfilesIHE Radiology Integration Profiles

Patient Info.

Recon-ciliation

Access to Radiology Information

Consistent Presentation

ofImages

Audit Trail & Node Authentication - Radiology Option

EvidenceDocs

KeyImageNotes

Simple Image & Numeric Reports

Presentation of

Grouped Procedures

Post-

Processing Workflow

Reporting Workflow

Charge Posting

XDS for Imaging

NMImage

Scheduled Workflow

Teaching Files &

Clinical Trials Export

Portable Data for Imaging

NMImage

Cardiac NM Option

ImageFusion

ImageFusion

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imagesstored

patientinformation

RIS

examination orders

imagesretrieved

HIS

PACS

procedurescheduled

Prefetch any relevantprior studies

modalityworklist

report

report

IHE Scheduled Workflow ProfileIHE Scheduled Workflow Profile

Registration

Orders Placed

Orders Filled

Film

FilmFolder

Image Manager& Archive

FilmLightbox

report ReportRepository

DiagnosticWorkstation

Modality

acquisitionacquisitionin-progressin-progressacquisitioncompleted

acquisitioncompleted

imagesprinted

AcquisitionModality

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Patient Information ReconciliationPatient Information Reconciliation

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Consistent Presentation of ImagesConsistent Presentation of Images

Reporting RadiologistReferring Physician orReviewing Radiologist

Presentation StatePresentation LUT

Grayscale Standard

Original Image

Window Level

Flip

Zoom

Area Of

Interest

Annotate

WithoutConsistent Presentation

AchievingConsistent Presentation

Area Of

Interest

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Radiology Option for Audit Trail and Node Radiology Option for Audit Trail and Node Authentication (ATNA)Authentication (ATNA)

System A System B

Secured SystemSecure network

• TLS authentication of remote node (digital certificates)• with/without encryption

Secured System

• Audit PHI trail with:• Real-time access • Time synchronization

Central Audit TrailRepository

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MODALITY

Presentation of Grouped Procedures ProfilePresentation of Grouped Procedures Profile

Requested 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

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Portable Data for Imaging Portable Data for Imaging (PDI)(PDI)

Distribute Imaging Information Distribute Imaging Information on Mediaon Media

CDCreator

Printer

Image/ Report Display

Media Importer

John Doe

CD

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Document Consumer

Retrieve Document

Query Documents

Patient Identity Source

Patient Identity Feed

Document Source

Document Registry

Document Repository

Provide & Register Document Set

Register Document Set

Cross-enterprise Document Cross-enterprise Document Sharing for Imaging (XDS- I)Sharing for Imaging (XDS- I)

Image ManagerImage Archive

Retrieve Images

Retrieve Presentation StatesRetrieve Key Image NoteRetrieve Evidence DocumentsWADO Retrieve

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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

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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

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IHE Reporting WorkflowIHE Reporting Workflow

ReportingReportingWorklistWorklist

Work ItemWork ItemClaimedClaimed

Retrieve Images &Retrieve Images &Evidence DocumentsEvidence Documents

MeasurementsCAD Reports…………………

ReportingProcedure Step

STARTED


STARTED

StoreStoreReportsReports


COMPLETED


COMPLETED

ReportManager

RIS

ImageManager/Archive

PACS & Archive

Report Reader/Creator

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IHE Value PropositionIHE Value Proposition• Product PlanningProduct Planning

• IHE Solutions are Driven by Strategic Healthcare Lead IHE Solutions are Driven by Strategic Healthcare Lead UsersUsers that that collaboratecollaborate with Healthcare with Healthcare VendorsVendors

• IHE Solutions are IHE Solutions are Generic, Reusable and InteroperableGeneric, Reusable and Interoperable based on Healthcare based on Healthcare StandardsStandards: : DICOM, HL7, RFCDICOM, HL7, RFC

• IHE Solutions IHE Solutions Optimize the Clinical WorkflowsOptimize the Clinical Workflows

• IHE Deployment process – Connectathon, Integration IHE Deployment process – Connectathon, Integration Statements and Users Success Stories information helps to Statements and Users Success Stories information helps to refinerefine the product “ the product “Business CaseBusiness Case””

• IHE Technical Framework specification describes the IHE Technical Framework specification describes the Global IHE solutionsGlobal IHE solutions at a High Level for Planning & at a High Level for Planning & Marketing and in details for products Architects and Marketing and in details for products Architects and Engineering developmentEngineering development

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IHE BenefitsIHE Benefits • Clinical UsersClinical Users

• Greater access to consistent informationGreater access to consistent information• Fewer errors, fewer tedious tasksFewer errors, fewer tedious tasks

• AdministratorsAdministrators• Increased throughput - Better scheduling Increased throughput - Better scheduling • Reduce CostReduce Cost

• BuyersBuyers• Specify/purchase RFP’s integration capabilities Specify/purchase RFP’s integration capabilities

easily and Freedom to acquire “Best of Breed” easily and Freedom to acquire “Best of Breed” systems systems

• IT ProfessionalsIT Professionals• Faster, more predictable integration projectsFaster, more predictable integration projects• Facilitate cooperation of competing vendorsFacilitate cooperation of competing vendors

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Picking IHE ProfilesPicking IHE Profiles

Customer RFP’sCustomer RFP’s

Product positioning in the market with a Good Business Product positioning in the market with a Good Business Case – Selecting IHE ProfilesCase – Selecting IHE Profiles

IHE Technical Framework Volume 1, Users HandbookIHE Technical Framework Volume 1, Users Handbook

Healthcare Institution Needs: Healthcare Institution Needs:

> Optimized Clinical Workflow : > Optimized Clinical Workflow : SWF, PIR, RWFSWF, PIR, RWF

> Improve the Patient Health Care: > Improve the Patient Health Care: SWF, PIR, CPI, PGP,KINSWF, PIR, CPI, PGP,KIN

> Economy - Reduce Healthcare cost: > Economy - Reduce Healthcare cost: SWF, CHGSWF, CHG

> Protect the Patient Health Information: > Protect the Patient Health Information: SECSECP

atie

nt In

form

atio

n R

econ

cilia

tion



of Images

Basic Security

Evidence Documents

Key Image Notes

Simple Image and Numeric

Reports

Presentation of Grouped Procedures

Post-Processing Workflow

Reporting Workflow

Charge Posting

Scheduled Workflow

Pat

ient

Info

rma

tion

Rec

onci

liatio

n



of Images

Basic Security

Evidence Documents

Key Image Notes


Reports



Reporting Workflow

Charge Posting

Scheduled Workflow

Pat

ient

Info

rma

tion

Rec

onci

liatio

n P

atie

nt In

form

atio

n R

econ

cilia

tion

Access to Radiology InformationAccess to Radiology Information


of Images


of Images

Basic SecurityBasic Security

Evidence DocumentsEvidence

DocumentsKey Image

NotesKey Image

Notes


Reports


Reports





Reporting WorkflowReporting Workflow

Charge PostingCharge Posting

Scheduled WorkflowScheduled Workflow

ConsiderationsConsiderations

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IHE for Product PlanersIHE for Product Planers

Questions?Questions?IHE North America:IHE North America: RSNA - RSNA - http:// http:// www.ihe.netwww.ihe.net

HIMSS -HIMSS - http://www.himss.org/IHE http://www.himss.org/IHE

ACC - ACC - http://www.acc.org/quality/ihe/ihe.htmhttp://www.acc.org/quality/ihe/ihe.htm

IHE Europe:IHE Europe: http://www.IHE-Europe.orghttp://www.IHE-Europe.org

IHE France:IHE France: http://www.gmsih.fr/fr/som_comm.htmhttp://www.gmsih.fr/fr/som_comm.htm

IHE Germany:IHE Germany: http://www.IHE-D.orghttp://www.IHE-D.org

IHE Italy:IHE Italy: http://www.rad.unipd.it/IHEhttp://www.rad.unipd.it/IHE

IHE UK:IHE UK: http://www.IHE-UK-orghttp://www.IHE-UK-org

IHE Japan:IHE Japan: http://www.jira-net.or.jp/ihe-j/en/index.htmlhttp://www.jira-net.or.jp/ihe-j/en/index.html

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