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IntegratingIntegratingthe the
Healthcare EnterpriseHealthcare Enterprise
IHE 2003:IHE 2003:Meeting Clinical Goals and Technical Meeting Clinical Goals and Technical
ChallengesChallenges
HIMSS 2003
Authors & PresentersAuthors & PresentersPaul Vegoda, FHIMSSPaul Vegoda, FHIMSS
Malvern GroupMalvern GroupIHE Strategic Development CommitteeIHE Strategic Development Committee
Kevin O’DonnellKevin O’DonnellToshiba America, Inc.Toshiba America, Inc.
IHE Planning Committee Co-chairIHE Planning Committee Co-chair
David S. Channin, MD CPHIMSDavid S. Channin, MD CPHIMSNorthwestern UniversityNorthwestern University
IHE Strategic Development CommitteeIHE Strategic Development Committee
HIMSS 2003
The ProblemThe Problem
Poor Information System Support for Poor Information System Support for Healthcare DeliveryHealthcare Delivery
– Information not available when and where Information not available when and where needed for medical, research, education or needed for medical, research, education or administrative decision supportadministrative decision support
– Errors, both manual and electronicErrors, both manual and electronic– InefficientInefficient– Paper based and cloggedPaper based and clogged
HIMSS 2003
Why is IHE needed?Why is IHE needed?
• Serious Integration Challenges in Healthcare:Serious Integration Challenges in Healthcare:
• Systems need Information other systems haveSystems need Information other systems have
• But, systems communicate poorly or not at all But, systems communicate poorly or not at all
• Result: - tedious, inefficient workflows Result: - tedious, inefficient workflows - data that is redundant, inconsistent or unavailable - data that is redundant, inconsistent or unavailable
Responsibility for information flow between systems, Responsibility for information flow between systems, and between departments, is often unclear.and between departments, is often unclear.
HIMSS 2003
A CIO’s dreamA CIO’s dream
• A fully integrated healthcare information systemA fully integrated healthcare information system– Best of breed systems working together to facilitate Best of breed systems working together to facilitate
efficient workflowefficient workflow
• Documented iDocumented improvement of efficiency and mprovement of efficiency and quality of delivered carequality of delivered care
• Easy to deploy and manageEasy to deploy and manage
• Good, fast and cheap (pick two)Good, fast and cheap (pick two)
HIMSS 2003
What my CIO sees:
120 Server Systems62 point to pointHL7 connections•includes 3 to PACS
Dreams of ‘Best of Breed’?!
PACS
RIS
HIMSS 2003
What some would like to see:
Dreams of ‘Single Vendor’‘Mangy Mutt’
HIMSS 2003
Alas….Alas….
Best of Breed vs. IntegratedBest of Breed vs. Integrated
… “… “tis a consummation devoutly to be tis a consummation devoutly to be wished.”wished.”
Will Shakespeare, HamletWill Shakespeare, Hamlet
HIMSS 2003
Then suddenly…Then suddenly…
““What light from yonder window What light from yonder window breaks?”breaks?”
Will Shakespeare, Romeo and JulietWill Shakespeare, Romeo and Juliet
It is IHE! It is IHE!
HIMSS 2003
What is IHE?What is IHE?
IHE is an IHE is an initiativeinitiative to speed the to speed the integrationintegration of information systems in the of information systems in the healthcarehealthcare
enterpriseenterprise to achieve better workflow to achieve better workflow
HIMSS 2003
Goals of IHEGoals of IHE
• Speed up the rate and quality of Speed up the rate and quality of integration in healthcare environmentsintegration in healthcare environments
• Foster communication among vendors Foster communication among vendors
• Prove that integration is attainable Prove that integration is attainable based on standardsbased on standards
HIMSS 2003
IHE Penetration in RadiologyIHE Penetration in Radiology
• Now entering Year 5!!Now entering Year 5!!• 50+ vendors worldwide50+ vendors worldwide• 100+ systems in annual Connectathons100+ systems in annual Connectathons• Geographic spreadGeographic spread
– U.S., France, Germany, Japan, Italy, U.K.U.S., France, Germany, Japan, Italy, U.K.
HIMSS 2003
IHE Expansion into New AreasIHE Expansion into New Areas
• New IT Infrastructure Committee FormedNew IT Infrastructure Committee Formed– (EMPI, Query-Display, Synchronized Patient (EMPI, Query-Display, Synchronized Patient
Views, and Advanced Security)Views, and Advanced Security)
• Cardiology Group forming in March (ACC)Cardiology Group forming in March (ACC)
• Work progressing in:Work progressing in:– LabLab– Pharmacy/Medication ManagementPharmacy/Medication Management
HIMSS 2003
IHE ParticipantsIHE Participants• Societies Representing Healthcare SegmentsSocieties Representing Healthcare Segments
– ( RSNA, HIMSS, ACC, … )( RSNA, HIMSS, ACC, … )
• UsersUsers– ( Clinicians, Medical Staff, Administrators, CIOs, … )( Clinicians, Medical Staff, Administrators, CIOs, … )
• Information Systems VendorsInformation Systems Vendors• Imaging Systems VendorsImaging Systems Vendors• Standards Development Organizations (SDOs)Standards Development Organizations (SDOs)
– DICOMDICOM– HL7HL7– Others …Others …
HIMSS 2003
Benefits to IHE ParticipantsBenefits to IHE Participants• CliniciansClinicians
– Improved workflowImproved workflow– Information when and where neededInformation when and where needed– Fewer opportunities for errorsFewer opportunities for errors– Fewer tedious tasks/repeated workFewer tedious tasks/repeated work
• AdministratorsAdministrators– Improved efficiencyImproved efficiency– Best of breed opportunitiesBest of breed opportunities– Decreased cost and complexity of interface Decreased cost and complexity of interface
deployment and managementdeployment and management
HIMSS 2003
Benefits to IHE ParticipantsBenefits to IHE Participants• VendorsVendors
– Decreased cost and complexity of interface Decreased cost and complexity of interface installation and managementinstallation and management
– Validation of integration at ConnectathonValidation of integration at Connectathon– Focus competition on functionality/service Focus competition on functionality/service
space not information transport spacespace not information transport space
• SDOsSDOs– Rapid feedback to adjust standards to real-Rapid feedback to adjust standards to real-
worldworld
HIMSS 2003
IHE ProcessIHE Process• Users and vendors work together to identify Users and vendors work together to identify
and design solutions for integration problemsand design solutions for integration problems
• Intensive process with Intensive process with annual cyclesannual cycles::– Identify key healthcare workflows and integration Identify key healthcare workflows and integration
problemsproblems– Research & select standards to specify a solutionResearch & select standards to specify a solution– Write, review and publish IHE Technical FrameworkWrite, review and publish IHE Technical Framework– Perform cross-testing at “Connectathon”Perform cross-testing at “Connectathon”– Demonstrations at tradeshows (HIMSS/RSNA/…)Demonstrations at tradeshows (HIMSS/RSNA/…)
HIMSS 2003
IHE DeliverablesIHE Deliverables
1.1. Venues for discussion between users and vendorsVenues for discussion between users and vendors
2.2. Common vocabulary; Common view of the world Common vocabulary; Common view of the world based on:based on:
– HL7 and DICOM Model of the real worldHL7 and DICOM Model of the real world– Pieces of information Pieces of information and their meaningand their meaning
3.3. Technical Framework - Technical Framework - INTEGRATION PROFILESINTEGRATION PROFILES– ACTORSACTORS in Roles performing in Roles performing TRANSACTIONSTRANSACTIONS to to
accomplish accomplish Specific ProcessesSpecific Processes
4.4. Connect-a-thonConnect-a-thon
5.5. Public Demonstrations / Education ExhibitsPublic Demonstrations / Education Exhibits
HIMSS 2003
IHE Concepts and IHE Concepts and VocabularyVocabulary
• ActorsActors• TransactionsTransactions• Integration ProfilesIntegration Profiles
HIMSS 2003
ActorsActors
• Represent a role performed by a systemRepresent a role performed by a system• Collect a subset of related responsibilities Collect a subset of related responsibilities
Examples:Examples:– Order PlacerOrder Placer– Order FillerOrder Filler– Acquisition ModalityAcquisition Modality– Image DisplayImage Display– Report CreatorReport Creator
HIMSS 2003
TransactionsTransactions
• Unambiguously defines how several Unambiguously defines how several actors communicateactors communicate
• Using existing standards such as HL7 Using existing standards such as HL7 or DICOM to accomplish a specific task.or DICOM to accomplish a specific task.
Examples: Examples: – Procedure ScheduledProcedure Scheduled– Modality Worklist ProvidedModality Worklist Provided
HIMSS 2003
Integration ProfilesIntegration ProfilesIHE Integration Profiles define a collection of IHE Integration Profiles define a collection of
real world functionality and group together real world functionality and group together the necessary Actors and Transactions to the necessary Actors and Transactions to make it work.make it work.
• Examples: Examples: – Scheduled WorkflowScheduled Workflow– Patient Information ReconciliationPatient Information Reconciliation– Presentation of Grouped ProceduresPresentation of Grouped Procedures
HIMSS 2003
IHE Technical FrameworkIHE Technical Framework• Defines enterprise Integration ProfilesDefines enterprise Integration Profiles• Defines <Defines <preciselyprecisely> what to do to support > what to do to support
the Integration Profilesthe Integration Profiles• 3 volumes, 450+ pages3 volumes, 450+ pages• Version controlledVersion controlled
– 5.4 is latest revision (5.4 is latest revision (www.rsna.org/IHEwww.rsna.org/IHE))
• May be incorporated by reference into May be incorporated by reference into contract documentscontract documents
HIMSS 2003
The Annual “Connectathon”The Annual “Connectathon”
Unprecedented Cross-Vendor TestingUnprecedented Cross-Vendor TestingVoluntary ParticipationVoluntary ParticipationNeither a Demo nor a CertificationNeither a Demo nor a CertificationWell Designed End-to-End ScenariosWell Designed End-to-End ScenariosAdvanced Testing ToolsAdvanced Testing ToolsUnprecedented Pool of Technical TalentUnprecedented Pool of Technical Talent
HIMSS 2003
Public Demonstrations / Public Demonstrations / Education ExhibitsEducation Exhibits
• RSNA Annual Meeting (November)RSNA Annual Meeting (November)
• HIMSS Annual Meeting (Here and NOW!!)HIMSS Annual Meeting (Here and NOW!!)– Check your program books for a large number Check your program books for a large number
of IHE related presentations and exhibitsof IHE related presentations and exhibits
HIMSS 2003
IHE Integration ProfilesIHE Integration Profiles
Access to Radiology InformationRetrieve & view images and reports
Consistent Presentation of Images
Hardcopy and softcopy grayscale presentation state
Key ImageNotes
Flag & search for significant images
Simple Image and Numeric Reports
Simple reports with image links and measurements
Basic SecurityAudit Trail Consolidation & Node Authentication
Presentation of Grouped Procedures
Manage subsets of a single acquisition
Post- Processing Workflow
Schedule, perform, & notify image processing
& CAD steps
Charge Posting
Collection of billable procedure details
Scheduled Workflow
Admit, order, schedule, acquire & store images with notification of
completed steps
Patient Information Reconciliation
Unknown patients and unscheduled orders
HIMSS 2003
Scheduled Workflow Scheduled Workflow Integration ProfileIntegration Profile
• Real World Problem:Real World Problem:– Patient-centric, service oriented care deliveryPatient-centric, service oriented care delivery– Multiple actors, multi-vendor, multi-systemMultiple actors, multi-vendor, multi-system
• Registration
• Order Placer
• Order Filler
• Modality
• Image Manager / Image Archive
• Image Display
• Report Creator
• Etc.
HIMSS 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 2003
Year 4 Enhancements to Year 4 Enhancements to Scheduled WorkflowScheduled Workflow
1.1. Reduce variance on how procedures are performed Reduce variance on how procedures are performed • Imaging protocolsImaging protocols Assisted Acquisition Protocol Setting (option)Assisted Acquisition Protocol Setting (option)
2.2. Exception managementException management• When errors are made on the modalities how can these be When errors are made on the modalities how can these be
correctedcorrected PPS Exception Management (option)PPS Exception Management (option)
HIMSS 2003
Patient Information Reconciliation Patient Information Reconciliation Integration ProfileIntegration Profile
• Real World Problem:Real World Problem:– ‘‘To err is human, but to really mess things up you need a computer’To err is human, but to really mess things up you need a computer’5 scenarios of patient/order/images reconciliation addressed:5 scenarios of patient/order/images reconciliation addressed:
1.1. Unidentified Patient registered at ADT and ordered at Order PlacerUnidentified Patient registered at ADT and ordered at Order Placer
2.2. Unidentified Patient registered at ADT and ordered at Dept Scheduler/Order FillerUnidentified Patient registered at ADT and ordered at Dept Scheduler/Order Filler
3.3. Unidentified Patient registered at ADT but completed at ModalityUnidentified Patient registered at ADT but completed at Modality prior to Orderprior to Order
4.4. Unidentified Patient assigned Temporary Departmental ID andUnidentified Patient assigned Temporary Departmental ID and Scheduled at DScheduled at Dept ept SSchedulercheduler/Order Filler/Order Filler
5.5. Image Acquisition Completed without Scheduling at DImage Acquisition Completed without Scheduling at Dept Scheduler/ept Scheduler/OrderOrder FillerFiller
HIMSS 2003
Post-Processing WorkflowPost-Processing WorkflowIntegration ProfileIntegration Profile
• Clinical Problem:Clinical Problem:– How do I know when there is post-processing How do I know when there is post-processing
(3D, CAD, etc.) to be done?(3D, CAD, etc.) to be done?– How do I know when the post-processing is done How do I know when the post-processing is done
and ready to be billed, distributed, and and ready to be billed, distributed, and interpreted?interpreted?
– How do I make sure the post-processed images / How do I make sure the post-processed images / objects get associated with the correct study?objects get associated with the correct study?
HIMSS 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
ReviewWorkstation
Results
Work StatusWork Status
HIMSS 2003
Charge Posting Charge Posting Integration ProfileIntegration Profile
• Clinical Problem:Clinical Problem:– Can my information systems send consistent Can my information systems send consistent
messages to a ‘charge processor’ for timely messages to a ‘charge processor’ for timely technical and professional fee billing?technical and professional fee billing?
– Can my billing / coding process more Can my billing / coding process more accurately reflect what was actually done?accurately reflect what was actually done?
– Can I shrink my back office?Can I shrink my back office?
HIMSS 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 2003
Consistent Presentation of Images Consistent Presentation of Images Integration ProfileIntegration Profile
• Real World Problems:Real World Problems:– Is my referring clinician seeing the same Is my referring clinician seeing the same
picture as I am?picture as I am?– Can I avoid calibrating every imaging device Can I avoid calibrating every imaging device
to every display device?to every display device?– Why do I have to repeat image manipulations Why do I have to repeat image manipulations
that the technologist already performed?that the technologist already performed?– Can I view the images the way Dr. X did?Can I view the images the way Dr. X did?
HIMSS 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 2003
Presentation of Grouped Procedures Presentation of Grouped Procedures Integration ProfileIntegration Profile
• Clinical Problem:Clinical Problem:– Single physical acquisition of images must be Single physical acquisition of images must be
‘split’ for interpretation, viewing or billing‘split’ for interpretation, viewing or billing• E.g., Spiral CT of Chest, Abdomen, PelvisE.g., Spiral CT of Chest, Abdomen, Pelvis• E.g., One order, two procedures, one data set, two E.g., One order, two procedures, one data set, two
reportsreports
– How can I optimize both patient experience (time How can I optimize both patient experience (time and comfort) and throughput?and comfort) and throughput?
– How can I make sure images are grouped and How can I make sure images are grouped and sorted correctly and ready for display sorted correctly and ready for display
HIMSS 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 2003
Key Image Note Key Image Note Integration ProfileIntegration Profile
• Clinical Problem:Clinical Problem:– How can I flag images in a procedure for How can I flag images in a procedure for
various purposes:various purposes:• To clarify findings for referring physicians or To clarify findings for referring physicians or
teachingteaching• QAQA• Technical inadequacyTechnical inadequacy• Etc.Etc.
HIMSS 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 2003
Simple Image & Numeric Report Simple Image & Numeric Report Integration ProfileIntegration Profile
• Clinical Problem:Clinical Problem:– How can I How can I startstart to use DICOM Structured to use DICOM Structured
Reporting for my reports?Reporting for my reports?– How can I capture report information other than How can I capture report information other than
as blobs of text?as blobs of text?– How can I mine my report data?How can I mine my report data?– How can I disseminate reports to all How can I disseminate reports to all
downstream systems?downstream systems?
HIMSS 2003
Example: ‘Simple Image and Numeric Example: ‘Simple Image and Numeric Report’Report’
DiscussionDiscussionComparison is made to the prior study of Comparison is made to the prior study of 4/11/994/11/99. The left . The left paratracheal lymph nodeparatracheal lymph node ((image 8image 8, , image 11image 11) now measures ) now measures 2.5x2.7x3.1 2.5x2.7x3.1 cmcm increasing from increasing from 2.0x2.1x2.62.0x2.1x2.6 previously. No previously. No other mediastinal, upper abdominal or axillary other mediastinal, upper abdominal or axillary adenopathy is identified. No focal pulmonary adenopathy is identified. No focal pulmonary lesions are seen. The yadda, yadda, yadda are lesions are seen. The yadda, yadda, yadda are normal.normal.
ImpressionImpression
Worsening L Paratracheal adenopathyWorsening L Paratracheal adenopathy..
HIMSS 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 2003
Access to Radiology InformationAccess to Radiology InformationIntegration ProfileIntegration Profile
• Clinical Problem:Clinical Problem:– How can other information systems get How can other information systems get
information from me without interrupting information from me without interrupting me?me?• ImagesImages• Gray Scale Presentation StatesGray Scale Presentation States• Key Image NotesKey Image Notes• Simple Image and Numeric ReportsSimple Image and Numeric Reports
HIMSS 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 2003
Basic Security Basic Security Integration ProfileIntegration Profile
• Clinical Problem:Clinical Problem:– How can I begin to coordinate HIPAA / security requirements between systems?How can I begin to coordinate HIPAA / security requirements between systems?
• Secure communications between nodesSecure communications between nodes• Common audit repositoryCommon audit repository• Common date and time across systemsCommon date and time across systems
HIMSS 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 2003
What is Available?What is Available?
• IHE Integration StatementsIHE Integration Statements– Vendor claims of IHE Profile support on specific Vendor claims of IHE Profile support on specific
productsproducts– Simple formatSimple format– backed up by Technical Frameworkbacked up by Technical Framework
• Connectathon ResultsConnectathon Results– what types of systems, which companies are what types of systems, which companies are
testing at the Connectathonstesting at the Connectathons
See links at www.rsna.org/IHESee links at www.rsna.org/IHE
HIMSS 2003
Clinical IHE Success ProgressClinical IHE Success Progress
IHE at NorthwesternIHE at Northwestern
HIMSS 2003
HIMSS 2003
GoalsGoals• Define the PACS / modality environment:Define the PACS / modality environment:
– Northwestern Memorial HospitalNorthwestern Memorial Hospital
• Measure a specific PACS / modality Measure a specific PACS / modality workflow metric in the absence of IHE workflow metric in the absence of IHE transactionstransactions
• Deploy coreDeploy core IHE Scheduled Workflow IHE Scheduled Workflow Integration ProfileIntegration Profile transactions (MPPS) transactions (MPPS) between modalities and PACSbetween modalities and PACS
• Re-measure the metric in the presence of Re-measure the metric in the presence of the IHE transactionsthe IHE transactions
HIMSS 2003
NMH EnvironmentNMH Environment
• Patient Reg. Actor (ADT)Patient Reg. Actor (ADT)– Plus 2000 (McKesson)Plus 2000 (McKesson)
• Order Placer Actor (CIS)Order Placer Actor (CIS)– PowerChart (Cerner)PowerChart (Cerner)
• Order Filler Actor (RIS)Order Filler Actor (RIS)– Classic RadNet (Cerner)Classic RadNet (Cerner)
• Image Manager / Image Image Manager / Image ArchiveArchive– Centricity 1.0 PACS (GEMS)Centricity 1.0 PACS (GEMS)
• Acquisition Modality: MRAcquisition Modality: MR– Syngo MR (Siemens)Syngo MR (Siemens)
• Acquisition Modality: CTAcquisition Modality: CT– LightSpeed CT (GEMS)LightSpeed CT (GEMS)
Non-IHE Compliant Systems Systems Supporting IHE Transactions
HIMSS 2003
Process to be measuredProcess to be measured• Order received by PACS: Order received by PACS:
– Procedure is in ‘Ordered’ statusProcedure is in ‘Ordered’ status• Images received by PACS:Images received by PACS:
– Procedure transitions to ‘Arrived’ statusProcedure transitions to ‘Arrived’ status
Procedure closed for acquisition:Procedure closed for acquisition:– Procedure transitions to ‘Verified’ statusProcedure transitions to ‘Verified’ status
• Procedure dictated:Procedure dictated:– Procedure transitions to ‘Dictated’ statusProcedure transitions to ‘Dictated’ status
• Dictation transcribed:Dictation transcribed:– Procedure transitions to ‘Transcribed’ statusProcedure transitions to ‘Transcribed’ status
• Electronically signed report received:Electronically signed report received:– Procedure transitions to ‘Complete’ statusProcedure transitions to ‘Complete’ status
HIMSS 2003
The Problem (I)The Problem (I)
• ‘‘Verification’ as defined above can occur:Verification’ as defined above can occur:– ManuallyManually– By dictation (jumps over ‘verified’ status)By dictation (jumps over ‘verified’ status)– Automatically at 5 hoursAutomatically at 5 hours– On receipt of complete message from RISOn receipt of complete message from RIS
• Not used due to unreliable usage by technologistsNot used due to unreliable usage by technologists
• Time to ‘Verification’ is variable and Time to ‘Verification’ is variable and inconsistent inconsistent
HIMSS 2003
The Problem (II)The Problem (II)
• Timely verification is critical because it Timely verification is critical because it triggers:triggers:– Closing a procedure for further acquisition Closing a procedure for further acquisition
signifying procedure is done.signifying procedure is done.– Writing of the images to permanent long-term Writing of the images to permanent long-term
storagestorage• Which triggers DICOM Storage Commitment back to Which triggers DICOM Storage Commitment back to
the Modalitythe Modality
– Procedure is ready to be interpretedProcedure is ready to be interpreted
HIMSS 2003
Time to verify (or dictate) a Study Time to verify (or dictate) a Study before IHEbefore IHE
HIMSS 2003
The PromiseThe Promise
• Use of DICOM Modality Performed Use of DICOM Modality Performed Procedure Step Transaction as defined Procedure Step Transaction as defined by IHE Framework can automatically by IHE Framework can automatically trigger ‘Verification’trigger ‘Verification’
HIMSS 2003
Time to verify (or dictate) a Study Time to verify (or dictate) a Study after IHEafter IHE
HIMSS 2003
So What?So What?
Radiology at NMH is big businessRadiology at NMH is big business
• If:If:– 40,000 CT studies per year40,000 CT studies per year– CT exam slot is 20 minutesCT exam slot is 20 minutes– Reimbursement of 50Reimbursement of 50¢ on the dollar¢ on the dollar– One minute of CT slot time is worth $14 in One minute of CT slot time is worth $14 in
Gross Revenue!Gross Revenue!
HIMSS 2003
Lessons LearnedLessons Learned
• IHE functionality can be purchased / deployed in select IHE functionality can be purchased / deployed in select commercial productscommercial products
• IHE functions at the ‘least common denominator’ levelIHE functions at the ‘least common denominator’ level• Connect-a-thon success does not guarantee clinical Connect-a-thon success does not guarantee clinical
success: success: – test, test, then test some moretest, test, then test some more
• Upgrading legacy equipment to support IHE may Upgrading legacy equipment to support IHE may be expensive and take a long time be expensive and take a long time (and involve (and involve forklifts and other heavy machinery)forklifts and other heavy machinery)
HIMSS 2003
Clinical ConclusionClinical Conclusion
• The promise of efficiencies from The promise of efficiencies from implementation of IHE Integration Profiles is implementation of IHE Integration Profiles is so great that it merits continued dedication so great that it merits continued dedication and commitment from the user community.and commitment from the user community.
• The perils of IHE deployment indicate that The perils of IHE deployment indicate that vendors must continue their dedication and vendors must continue their dedication and commitment to improving implementations commitment to improving implementations and understanding details of clinical and understanding details of clinical operationsoperations
HIMSS 2003
What can you do?What can you do?• Learn about IHELearn about IHE• Find problems at your institution that can benefit Find problems at your institution that can benefit
from the IHE Initiativefrom the IHE Initiative• Participate in IHE committeesParticipate in IHE committees• Ask vendors about IHE when ‘shopping’Ask vendors about IHE when ‘shopping’• Stress to your vendors the importance of Stress to your vendors the importance of
connectivity and integration in your next connectivity and integration in your next purchase!purchase!
• Require IHE participation and compliance in Require IHE participation and compliance in your contracts!your contracts!
HIMSS 2003
ResourcesResources
• www.rsna.org/IHEwww.rsna.org/IHE– FAQsFAQs– Buyer’s guidelinesBuyer’s guidelines– IHE Technical FrameworkIHE Technical Framework– Primer on IHEPrimer on IHE– PresentationsPresentations
• www.himss.orgwww.himss.org– IHE monographIHE monograph