IHE Integrating the Healthcare Enterprise

Understanding IHE, BIR20 Oct 2004

IHEIHEIntegrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

General Overview (again once)General Overview (again once)

Scheduled WorkflowScheduled Workflow

Patient Information ReconciliationPatient Information Reconciliation

Consistent Presentation of ImagesConsistent Presentation of Images

Key Image NotesKey Image Notes

How to deal with IHE-itemsHow to deal with IHE-items

Prof. Berthold B. WeinProf. Berthold B. Wein

User co-chair IHE-EuropeUser co-chair IHE-Europe


IHEIHE: : short overviewshort overview andand

scheduled workflow and scheduled workflow and patient information reconciliationpatient information reconciliation

Prof. Berthold B. Wein, MDProf. Berthold B. Wein, MD

User co-chair IHE-EuropeUser co-chair IHE-EuropePraxisgemeinschaft Praxisgemeinschaft

KapuzinerkarreeKapuzinerkarreeUniversity Hospital Aachen University Hospital Aachen

GermanyGermany


Healthcare IT – Main ObstaclesHealthcare IT – Main Obstacles

• Lack of financial funding :Lack of financial funding :– IT : 2.3% of hospital budget (in other industries : 2.8%) IT : 2.3% of hospital budget (in other industries : 2.8%)

[Gartner][Gartner]

• Lack of national/regional guidelines & incentivesLack of national/regional guidelines & incentives

• Lack of access to IT infrastructureLack of access to IT infrastructure

• Lack of solutions that meet clinical needsLack of solutions that meet clinical needs

• Lack of adequate healthcare IT standards and Lack of adequate healthcare IT standards and interoperabilityinteroperability– Integration cost : 20% of hospital IT budgetIntegration cost : 20% of hospital IT budget

IHE scope


IHE MissionIHE Mission

• Improve the quality and cost of healthcare by Improve the quality and cost of healthcare by removing the interoperability barriersremoving the interoperability barriers– Continuity & Integrity of Patient InformationContinuity & Integrity of Patient Information

– Clinical Workflow OptimizationClinical Workflow Optimization

• Provide an open interoperability framework, Provide an open interoperability framework, based on existing standardsbased on existing standards

• Enable cross-vendor environmentEnable cross-vendor environment

• Make life more easy for the users and vendorsMake life more easy for the users and vendors

IHE = Integrating the Healthcare EnterpriseIHE = Integrating the Healthcare Enterprise


• seamless information flowseamless information flow– from system to systemfrom system to system– within and across departmentswithin and across departments– within and across hospital borderswithin and across hospital borders

• access to all vital clinical data access to all vital clinical data – at the right time and at the right placeat the right time and at the right place

• workflow optimisationworkflow optimisation• elimination of redundancies in data entryelimination of redundancies in data entry• foster openess of productsfoster openess of products• less problems in interoperability and less problems in interoperability and

understandingunderstanding

Benefits of IHEBenefits of IHE


IHE is based onIHE is based on• Technical frameworkTechnical framework

– The bible for interoperability, the hope for us/vndrsThe bible for interoperability, the hope for us/vndrs

• Connect-a-thonConnect-a-thon– The real-life test of systems, the hell for productsThe real-life test of systems, the hell for products

• DemonstrationDemonstration– The show to others, how it worksThe show to others, how it works

• Integration statementsIntegration statements– The advertising to users, enabling understandingThe advertising to users, enabling understanding

• SucessSucess– The teaching by othersThe teaching by others


IHE MembersIHE Members• UsersUsers

– Clinicians, Medical Staff, Administrators, CIOs, …Clinicians, Medical Staff, Administrators, CIOs, …

• Vendors Vendors – Information Systems & Imaging Equipment (80 vendors)Information Systems & Imaging Equipment (80 vendors)

• Societies Representing Healthcare SegmentsSocieties Representing Healthcare Segments– EAR, ECR, ESC, Other Professional Societies…EAR, ECR, ESC, Other Professional Societies…

• Governmental agencies Governmental agencies – e.g. GMSIHe.g. GMSIH

• Active liaison with Standards Development Active liaison with Standards Development Organizations (SDOs)Organizations (SDOs)– HL7, DICOM, ASTM, others …HL7, DICOM, ASTM, others …


Year nYear n

Demo’sDemo’s

IHE TF Development ProcessIHE TF Development Process

Year nYear nConnectathonConnectathon

Year nYear nTrial ImplementationTrial Implementation

Year N Year N Technical FrameworkTechnical Framework

Standards’Standards’AssessmentAssessment

Year nYear nGoalsGoals

Year n-1Year n-1


IHE - Connect-a-thonIHE - Connect-a-thon

EuropeanEuropean

Application rather than protocol testing real lifeApplication rather than protocol testing real life

Paris, Aachen, Padua, NordwijkerhoutParis, Aachen, Padua, Nordwijkerhout2001 2002 2003 2004 2005

–2001, Paris, F: –13 vendors > 20 sys

–2002, Paris, F: –33 vendors > 60 sys

–2003, Aachen, D:–47 vendors > 85 sys

–2004, Padova, I: –49 vendors > 80 sys


IHE - DemonstrationsIHE - Demonstrations

F D I UK F D I UK EUREUR

First experiences with IHE-compliant systemsFirst experiences with IHE-compliant systemsduring hands-on trials on user congressesduring hands-on trials on user congresses


IHE Integration Statement

Vendor Product Name Version Date

Huge Imaging Medical Systems IntegrateRAD V2.3 12 Oct 2002

Integration Profiles Implemented

Actors Implemented Options Implemented

Scheduled Workflow Image Manager/Archivee none

Image Display Performed Procedure Step

Order Filler PPS Exception Management

Simple Image and Numeric Report Report Creator none

Link to vendor IHE page www.HImedicalsystems.fake/ihe

Links to Standards Conformance Statements of the Implementation

HL7 www.HImedicalsystems.fake/hl7

DICOM www.HImedicalsystems.fake/dicom/integrateRAD.pdf

IHE Integration StatementIHE Integration Statement


IHE EuropaIHE Europa

National initiativesNational initiatives

Well establishedWell established

F, D, I, NL, GBF, D, I, NL, GB

In organisationIn organisation

DK, N, EDK, N, E

beginningbeginning

SS


Technical FrameworkTechnical Framework

• Integration ProfilesIntegration Profiles– Practical solutions for daily-work integration Practical solutions for daily-work integration

problemsproblems

– Precise definitions of actors and transactionsPrecise definitions of actors and transactions

– Exact requirements for open standardsExact requirements for open standards

• Conversion tablesConversion tables– Defining correspondant fieldsDefining correspondant fields

– Describing characteristics of the fieldsDescribing characteristics of the fields

• Use casesUse cases– Depicting daily scenarios for easy understandingDepicting daily scenarios for easy understanding


TF and IHE DomainsTF and IHE Domains

• RadiologyRadiology

• Laboratory MedicineLaboratory Medicine

• Information Technology InfrastructureInformation Technology Infrastructure

• CardiologyCardiology

• General practicionersGeneral practicioners

• PathologyPathology

• DermatologyDermatology


Integration ProfilesIntegration Profiles

• Solving daily life problems by standardsSolving daily life problems by standards

• Exactly defining solutions and parts for Exactly defining solutions and parts for succeeding in interoperabilitysucceeding in interoperability

• Reduce the problem to Reduce the problem to – actorsactors

– transactionstransactions

therefore making it independent from real world therefore making it independent from real world limitations and offering a global strategy for limitations and offering a global strategy for solutionsolution


Laboratory Medicine 2004-2005Laboratory Medicine 2004-2005

Laboratory Scheduled Workflow (LSWF) done in 2003

Tests performed by a laboratory for an identified inpatient or outpatient

Laboratory Patient Information Reconciliation

(LPIR) year 2004Tests performed on an unidentified

or misidentified patient

Laboratory Code Set Distribution (LCSD) year 2004

Sharing the batteries and tests code sets throughout the enterprise

Laboratory Device Automation (LDA) year 2004

Pre-analytic process, analysis and post-analytical treatment

Laboratory Point Of Care Testing (LPOCT) year 2004

Tests performed on point of care or patient’s bedside


IHE IT Infrastructure 2004-2005IHE IT Infrastructure 2004-2005

Enterprise User Authentication

Provide users a single nameand centralized authentication

processacross all systems

Retrieve Information for Display

Access a patient’s clinical information and documents in a

format ready to be presentedto the requesting user

Retrieve Information for Display

Access a patient’s clinical information and documents in

a format ready to be presented

to the requesting user

Patient Identifier Cross-referencing

for MPIMap patient identifiers

across independent identification domains

Patient Identifier Cross-referencing for

MPI

Map patient identifiers across independent

identification domains

Synchronize multiple applications on a desktop to the

same patient

Patient Synchronized Applications

Consistent TimeCoordinate time across

networked systems

Audit Trail & Node Authentication

Centralized privacy audit trail and node to node authentication

to create a secured domain.

Patient Demographics Query

Personnel White PageAccess to workforcecontact information

Cross-Enterprise Document Sharing

Registration, distribution and access across health enterprises of clinical

documents forming a patient electronic health record


Radiology 2000-2005Radiology 2000-2005

Access to Radiology Information

Pat

ient

Inf

orm

atio

n R

econ

cilia

tion

Consistent Presentation of Images

Basic Security

Evidence Document

Key Image Notes

Simple Image and

Numeric Report

Presentation of Grouped Procedures

Post-Processing Workflow

Reporting Workflow

Charge Posting

Scheduled Workflow




Pat

ient

Inf

orm

atio

n R

econ

cilia

tion


Basic Security

Evidence Document

Key Image Notes

Simple Image and

Numeric Report



Reporting Workflow

Charge Posting

Scheduled Workflow




Pat

ient

Inf

orm

atio

n R

econ

cilia

tion


Basic Security

Evidence Document

Key Image Notes

Simple Image and

Numeric Report



Reporting Workflow

Charge Posting

Scheduled Workflow


ProblemsProblems• It is very hard to get the ball teed-up for the It is very hard to get the ball teed-up for the

technologist on the modality.technologist on the modality.• PaperPaper based workflow with based workflow with data redata re--entryentry

• RRisk of errorisk of error

• InefficientInefficient • Stale informationStale information

• CChanges between time of print and time of data entryhanges between time of print and time of data entry• Cancel ordersCancel orders• GGenericeneric Order Order / / OOrder rder CChangeshanges

• After the tech wacks the ball, how do I let all After the tech wacks the ball, how do I let all systems know where it went.systems know where it went.• When are things ready to be read (PACS)When are things ready to be read (PACS)• When can things be deleted (Modality)When can things be deleted (Modality)• How do I know what to bill (RIS)How do I know what to bill (RIS)• When do I wake up the referring physicianWhen do I wake up the referring physician


Key IHE ConceptsKey IHE Concepts

• Generalized SystemsGeneralized Systems =>=> ActorsActors

• Interactions between ActorsInteractions between Actors =>=> TransactionsTransactions

• Problem/Solution ScenariosProblem/Solution Scenarios =>=> Integration Integration 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)


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

Poduct XYZfrom Vendor T

ADT

MPI

HIS


The IHE The IHE WWorld….orld….

IHE Actor

ActorActor

Actor

IHEIHETransactionTransactionIHEIHE

TransactionTransaction

IHEIHETransactionTransaction

IHE Actor


HIS

MPI

ADT

Mapping IHE to ProductsMapping IHE to Products

Poduct XYZfrom Vendor T

IHE Actor

ActorActor

Actor

IHEIHETransactionTransactionIHEIHE

TransactionTransaction

IHEIHETransactionTransaction

IHE Actor



Easy to understand Easy to understand practical solutions for practical solutions for IT integration problems IT integration problems in daily life.in daily life.

Fostering the under-Fostering the under-standing between standing between users and vendorsusers and vendors

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





25: Report Issuing

Report Creator


Report Repository

Report Reader


Report Manager




25: Report Issuing

Report Creator


Report Repository

Report Reader


Report Manager




25: Report Issuing

Report Creator


Report Repository

Report Reader


Report Manager



Workflow involves several Workflow involves several IHE IHE ActorsActors

ADT PatientRegistration

OrderPlacer

DeptScheduler

ImageManager/Archive

Modality

Patient Registration (HIS):Patient Registration (HIS):ADT Focal Point for Patient Registration InformationADT Focal Point for Patient Registration Information

Department Scheduler (RIS):Department Scheduler (RIS):Focal Point for Requested Procedure ManagementFocal Point for Requested Procedure ManagementBreaks Order into Requested ProceduresBreaks Order into Requested ProceduresSchedules Steps for Each Requested ProcedureSchedules Steps for Each Requested Procedure

Acquisition Modality:Acquisition Modality:Focal Point for Performed Procedure StepsFocal Point for Performed Procedure StepsA PPS Tracks One or More Series of ImagesA PPS Tracks One or More Series of Images

Image Manager/Archive (PACS)Image Manager/Archive (PACS)Focal Point for Imaging Study. Manages ImagesFocal Point for Imaging Study. Manages ImagesTriggers Reading when All Expected PPS Are CompletedTriggers Reading when All Expected PPS Are Completed

Order Placer (HIS):Order Placer (HIS):Focal Point for Order ManagementFocal Point for Order Management


Scheduled WorkflowScheduled WorkflowADT

Patient Registration

Image Archive

Image Manager

Image Display

Image Creator

AcquisitionModality

DepartmentSystem Scheduler– Order Filler –

Order Placer

PerformedProcedure Step

ManagerModality Worklist


Procedure Scheduled

Images Availability Query

Procedure Update

ImagesStored

StorageCommit

Q /R KeyImage Note

Q /RPresentation

Sates

StorageCommit

ImagesStored

PPSIn-Progress/ Completed



Fil

ler

Ord

erM

anag

emen

t

Placer Order Management Present.

StateStored

Q /RImages

Key Image Note

StoredPresent.State

Stored

Key Image Note

Stored


Store ImagesStore Images

Storage CommitmentStorage CommitmentStorageStorage

CommitmentCommitment

List of ImagesList of Images

PACS &PACS &ArchiveArchive

RISRIS

ModalityModalityPerformedPerformedProcedure Procedure StepStep

Performed Step:Performed Step:

Status = CompletedStatus = CompletedPerformed CT HeadPerformed CT HeadPat Name/ID, Dose, Pat Name/ID, Dose,

Accession #, Study UIDAccession #, Study UIDComplete List of ImagesComplete List of Images

IHE Scheduled WorkflowIHE Scheduled WorkflowThe Connection sideThe Connection side

Modality WorklistModality Worklist

WorklistWorklist

Procedure ScheduledProcedure Scheduled

Patient Registration/UpdatePatient Registration/UpdateOrder ManagementOrder Management


ProblemsProblems

• John Doe John Doe TraumaTrauma Clean-Up Clean-Up

• Recovering after Recovering after Systems Systems are Dare Downown

• Error in Manual Entry at Modality Error in Manual Entry at Modality

• VIP and Getting MarriedVIP and Getting Married


Scheduled WorkflowScheduled WorkflowADT


Image Archive

Image Manager

Image Display

Image Creator

AcquisitionModality

DepartmentSystem Scheduler– Order Filler –

Order Placer

PerformedProcedure Step

ManagerModality Worklist


Procedure Scheduled

Images Availability Query

Procedure Update

ImagesStored

StorageCommit

Q /R KeyImage Note

Q /RPresentation

Sates

StorageCommit

ImagesStored




Fil

ler

Ord

erM

anag

emen

t

Placer Order Management Present.

StateStored

Q /RImages

Key Image Note

StoredPresent.State

Stored

Key Image Note

Stored

Patient Update

Patient Update

Patient Information ReconcilicationPatient Information Reconcilication


Thank you for your attention !Thank you for your attention !

Documents

IHE Integrating the Healthcare Enterprise