IHE IT Infrastructure & Radiology Integration Profiles IHE Update to DICOM Committee Charles Parisot, GE Medical Systems Information Technologies

IHE IT Infrastructure IHE IT Infrastructure & Radiology & Radiology Integration ProfilesIntegration Profiles

IHE Update to DICOM CommitteeCharles Parisot, GE Medical Systems Information Technologies

HIMSS/RSNA IHE IT Infrastructure 2

IHEIntegrationProfiles B

A Proven Standards Adoption ProcessA Proven Standards Adoption Process

IHE Integration Profiles:– Detailled selection of standards and options each solving a specific

integration problem– A growing set of effective provider/vendor agreed solutions– Vendors can implement with ROI– Providers can deploy with stability

Standards

Easy toIntegrateProducts

IHEIntegrationProfile A

IHEDemonstration

IHEConnectathon

ProductWith IHE

User Site

RFPRFP

IHETechnical

Framework


The IHE Technical ApproachThe IHE Technical Approach

Identify the transactions required to integrate a specific information flow between several information systems/devices

For each transaction, select a single standard (e.g.HL7 messages, RFC) for use in implementing the transaction

Specify in detail the use of the standard in implementing the transaction


IHE IT InfrastructureIHE IT Infrastructure5 Integration Profiles5 Integration Profiles

Enterprise User Authentication

Provide users a single nameand

centralized authentication process

across all systems




across all systems

Retrieve Information for Display

Access a patient’s clinical information and documents in a

format ready to be presentedto the requesting user




Patient Identifier Cross-referencing

for MPI

Map patient identifiers across independent

identification domains


for MPI



Synchronize multiple applications on a desktop to the same patient

Patient Synchronized Applications



Consistent Time

Coordinate time across networked

systems

Consistent Time


systems






across all systems




across all systems


for MPI




for MPI







Consistent Time


systems

Consistent Time


systems


Access a patient’s clinical information and documents

in a format ready to be presented

to the requesting user






Abstract / Scope Simple and rapid access to patient information Access to existing persistent documents in well-

known presentation formats: CDA, PDF, JPEG. Access to specific key patient-centric information for

presentation to a clinician : allergies, current medications, summary of reports, etc..

Links with other IHE profiles - Enterprise User Authentication & Patient Identifier Cross-referencing.

Complementary to DICOM-ISO WADO

Retrieve Information for DisplayRetrieve Information for Display


Value Proposition: User Convenience:

– Healthcare providers can "see" the information. A significant integration step.

– Workflows from within the users’ on-screen workspace or application.

– Complements multiple simultaneous apps workflow of Patient Synchronized Apps

Broad Enterprise-Wide access to information:– Web technology for simple clients– Clinical data handling fully assumed by the information

source that holds clinical data.



Key Technical Properties: Standards Used:

– Web Services (WSDL for HTTP Get).– General purpose IT Presentation Formats: XHTML, PDF,

JPEG plus CDA L1.– Client may be off-the-shelf browser or display app.

Two services :– Retrieve of Specific Information:

Patient centric: patient ID Type of Request (see next slide) Date, Time, nMostRecent

– Retrieve a Document Object Unique Instance Identifier (OID) Type of Request Content Type Expected



Transaction Diagram


Display InformationSource

Retrieve Specific Info for Display [11]

Summary of All ReportsSummary of Laboratory ReportsSummary of Radiology ReportsSummary of Cardiology ReportsSummary of Surgery ReportsSummary of Intensive Care ReportsSummary of Emergency ReportsSummary of Discharge ReportsList of AllergiesList of Medications

Retrieve Document for Display [12]

Persistent Document

Types ofRequests






across all systems




across all systems








for MPI




for MPI



Consistent Time


systems

Consistent Time


systems

Synchronize multiple applications on a desktop to

the same patient


Synchronize multiple applications on a desktop to

the same patient



Abstract / Scope

Patient Synchronization of Multiple Disparate Applications

Single Patient Selection

When combined with PIX Profile, allows patient synchronization across patient identity domains

Patient Synchronized ApplicationsPatient Synchronized Applications


Value Proposition:User Convenience:

– Eliminates the repetitive task of selecting the patient in each application

– Permits the user to select the patient in the application for which they are most familiar and / or appropriate to the clinical workflow

Patient Safety:– Ensures all data being viewed across applications is

for the same patient



Key Technical Properties:Standards Used:

– HL7 Context Management “CCOW” Standard, Version 1.4

– Support for both Windows and Web Technology– Support of “Patient Subject”

IHE Constraints:– Specifies use of Patient.Id.IdList item

Ensures maximum interoperability with PIX Profile Protects against future deprecation of patient identifier

items



Transaction Diagram







across all systems




across all systems






format ready to be presentedto the requesting user Synchronize multiple applications

on a desktop to the same patient




Consistent Time


systems

Consistent Time


systems


for MPI




for MPI




Patient Identifier Cross-referencingPatient Identifier Cross-referencingAbstract / ScopeAbstract / Scope

Allow all enterprise participants to register the identifiers they use for patients in their domain

Support domain systems’ queries for other systems’ identifiers for their patients

Optionally, notify domain systems when other systems update identifiers for their patients


Patient Identifier Cross-referencingPatient Identifier Cross-referencingValue PropositionValue Proposition

Maintain all systems’ identifiers for a patient in a single location

Use any algorithms (encapsulated) to find matching patients across disparate identifier domains

Lower cost for synchronizing data across systems– No need to force identifier and format changes onto

existing systems Leverages standards and transactions already

used within IHE


Patient Identifier Cross-referencingPatient Identifier Cross-referencingID Domains & TransactionsID Domains & Transactions

Patient Identification Domain C

Other IHE Actor

Identity Patient

Cross References

Patient Identity Consumer

Patient Identification Domain B

Patient Identity

Feed Patient Identity

Source

Patient Identity Cross-reference

Manager

Patient Identification Cross-reference Domain

Patient Identity Feed & Patient Identity References

Internal Domain transactions

Other IHE Actor

Patient Identity Cross References


Patient Identification Domain A

Patient Identity

Feed Patient Identity

Source

Internal Domain transactions


Patient Identifier Cross-referencingPatient Identifier Cross-referencingKey Technical PropertiesKey Technical Properties

Standards Used– HL7 Version 2.3.1 and Version 2.4

ADT Registration and Update Trigger Events– A01: inpatient admission– A04: outpatient registration– A05: pre-admission– A08: patient update– A40: merge patient

Queries for Corresponding Identifiers (ADT^Q23/K23) Notification of Identifiers Lists Updates (ADT^A31)

Key Properties– ADTs remain in charge of their domains– No need for a master ID or MRN, but supported as another ID domain












for MPI




for MPI



Consistent Time


systems

Consistent Time


systems






Provide users a single name

andcentralized

authentication process

across all systems


Provide users a single name

andcentralized

authentication process

across all systems


Enterprise User AuthenticationEnterprise User AuthenticationAbstract / ScopeAbstract / Scope

Support a single enterprise governed by a single set of security policies and having a common network domain.

Establish one name per user that can then be used on all of the devices and software in a healthcare enterprise.

Facilitate centralized user authentication management.

Provide users with single sign-on.


Enterprise User AuthenticationEnterprise User AuthenticationValue PropositionValue Proposition

Start at the beginning– Recognize user authentication as a necessary step for

most application and data access operations.– Enable benefits from future integration profiles, such as

authorization management. Achieve cost savings/containment.

– Centralize user authentication management.– Simplify multi-vendor implementations

Provide workflow improvement for users.– Increase user acceptance.– Decrease unproductive user task-switching time.

Increase level of assurance in security protection.


Enterprise User AuthenticationEnterprise User AuthenticationKey Technical PropertiesKey Technical Properties

Standards Used– Kerberos v5 (RFC 1510)

Stable since 1993, Widely implemented on current operating system

platforms Successfully withstood attacks in its 10-year history Fully interoperable among all platforms

– HL7 CCOW user subjectMinimal Application Changes

– Eliminate application-specific, non-interoperable authentication.

– Replace less secure proprietary security techniques.


Enterprise User AuthenticationEnterprise User AuthenticationTransaction DiagramTransaction Diagram






across all systems




across all systems








for MPI




for MPI







Consistent Time


systems

Consistent Time


systems

Synergy between IHE IT Int. ProfilesSynergy between IHE IT Int. ProfilesRID with EUA/CT & PIXRID with EUA/CT & PIX

Display

Client AuthenticationAgent

Time Client

Information Source

KerberosAuthentication

Server

TimeServer


Patient Identity X-ref

Manager

Example of support ofmultiple actors/profiles

Synergy between IHE IT Int. ProfilesSynergy between IHE IT Int. ProfilesApps with PSA, EUA & PIXApps with PSA, EUA & PIX

Application A

Client AuthenticationAgent

Time Client KerberosAuthentication

Server

TimeServer


Patient Identity X-ref

Manager

Context Manager

Application BContext participant

Context participant

Example of support ofmultiple actors/profiles

How to proceed with IHE ITHow to proceed with IHE IT Infra Infra1. Read IHE Fact Sheet & this presentation

• www.himss.org/ihe

2. Read ITI Technical Framework Vol 1 Integration Profiles: Comment due July 15th.

• www.himss.org/ihe :

3. Read ITI Technical Framework Vol 2 Transactions : Comments due July 15th.

• www.himss.org/ihe :

4. Join the IHE IT Infrastructure Tech. Committee consolidation meeting July 28-August 1 in Oakbrook (Chicago).

How to proceed with IHE How to proceed with IHE RadiologyRadiology

1. 12 Radiology Integration Profiles that can be combined with the IT Infrastructure Int. Profiles.

• www.rsna.org/ihe

2. Read Rad Technical Framework Vol 1 (Int. Profiles)

• www.rsna.org/ihe :

3. Read Rad Technical Framework Vol 2 (transactions)

• www.rsna.org/ihe :

IHE IHE Radiology, what is new ?Radiology, what is new ?

1. 2 New Radiology Integration Profiles:• Evidence Document

• Reporting Workflow

2. One new option in access to radiology:• Multiple Source Option

3. Radiology Connectathon: October 2003


IHE Integration profilesIHE Integration profilesPatient

Informa-tion

Reconci-liation

,

Access to Radiology Information

Consistent Presentation

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


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


Integration profiles, the easy way Integration profiles, the easy way to deal with transactionsto deal with transactions

easy-to-understand, coherent functional sets and

a convenient way for users and vendors to communicate

about integration requirements and needed functionality in daily life.