Integrating the Healthcare Enterprise - IHE An initiative of the ACC to improve data interoperability

Integrating Integrating thethe Healthcare Enterprise - Healthcare Enterprise -

IHEIHEAn initiative of the ACC to improve data interoperability

March 2005 ACC Scientific Sessions 2

Why IHE?Why IHE?Cardiology has hard system and data integration problems- Multiple locations (office, in-patient, ED …)- Multiple devices and modalities- Long term patient care by many care providers

Data integration is essential to quality patient care

Care providers must work with industry to develop solutions to meet their needs- Implementations must be based on open standards


Goals of IHEGoals of IHE

Advance standards-based healthcare data integration

Improve clinical and administrative workflow

Improve data flow – where it’s needed, when it’s needed

Improve the efficiency and effectiveness of clinical practice


What is IHE?What is IHE?

A collaboration of clinicians and vendors

- International and multi-specialty

A proven systems integration process

- Refined through seven years of experience

Produces results on a yearly cycle

- Problem identification, Technical specification, Vendor implementation, Test, Demonstration

- Yearly cycle focuses on most important tractable problems


Who is IHE?Who is IHE?

IHE is a joint initiative of:

- American College of Cardiology (ACC)- Radiological Society of North America (RSNA)- Healthcare Information and Management Systems

Society (HIMSS)Vendors/manufacturers in major supporting role

Local sponsorship internationally

- IHE-Europe and IHE-Asia/OceaniaIHE-Cardiology additional participating societies

- ASE, SCAI, ASNC, and moreIHE-Cardiology in Europe sponsored by European Society of Cardiology (ESC)


IHE Clinical DomainsIHE Clinical Domains

Cardiology leverages the work of the other domains

Cardiology contributes to the Electronic Health Record– Being specified in IHE IT Infrastructure domain

IHEEHR- Longitudinal Record

IHECardiology

IHELaboratory

IHERadiology

IHEFuture Domain

IHEIT Infrastructure

Intra-Enterprise

Cross-Enterprise

14 Integration Profiles




IHE RadiationOncology

IHECardiology

IHEEHR- Longitudinal Record


Cardiology and the Cardiology and the Electronic Health RecordElectronic Health Record

ACC Vision of the Electronic Health Record (1999)- “The Digital Integrated Cardiac Record” - All care areas- Across organization boundaries

EHR is a key area of IHE development - XDS – HIMSS 2005

To play in the EHR, data must be managed and properly identified

So, this is where we started in Year 1 of IHE-Cardiology – lay the foundation


IHE Cardiology – IHE Cardiology – the Cath Lab examplethe Cath Lab example

1 2 3 4

5

6

7

(A) room for improvement !(A) room for improvement !


IHE Annual Cycle – IHE Annual Cycle – Step 1Step 1

1. Cardiologists identify clinical problems to be addressed -“Integration Profiles”

2. Engineers from vendors collaborate to define technical specification (using standards such as DICOM and HL7)

3. Vendors implement the technical specification and participate in the “Connectathon” and demos

4. Vendors publish IHE Integration Statements, and users can buy IHE systems


““I need to see the ECG!”I need to see the ECG!”

Clinical Problem:

- Diagnostic quality ECGs needed everywhere

IHE Tasks:

- Simple and fast access- Ubiquitous (Web based) communication- Integrated into other software systems

Retrieve ECG for Display Integration Profile


““Could you do a TTE on this patient right Could you do a TTE on this patient right now since you are in the CCU anyway?”now since you are in the CCU anyway?”

Clinical Problems: - Lost and unbilled echo exams because carts are

constantly on the move- Patient and order info manually entered (potential for

errors) or not at all- Stress echo image ID inconsistent across vendors

IHE Tasks:- Accurate and automatic demographic and order

reconciliation- Verify all images are securely archived- Accurate display of Stress Images

Echocardiography Workflow Profile


““There is a patient being brought There is a patient being brought up to cath from the ER…”up to cath from the ER…”

Clinical Problems: - Need to enter patient and procedure information into

multiple systems in cath lab- No order created; emergent case (unidentified patient)- Change of rooms during procedure – data scattered- Inconsistently time-stamped events

IHE Tasks:- Automate download of patient info to all systems- Accurate and automatic patient demographic and order

reconciliation- Verify all data is securely archived in single “folder”- All data consistently time-stamped

Cardiac Catheterization Workflow Profile


IHE Annual Process – IHE Annual Process – Step 2Step 2

1. Cardiologists identify clinical problems to be addressed - “Integration Profiles”

2. Engineers from vendors collaborate to define technical specifications (using standards such as DICOM and HL7)






2. Engineers from vendors collaborate to define technical specification (using standards such as DICOM and HL7)




IHE Joint ConnectathonIHE Joint ConnectathonJanuary, 2005January, 2005Oak Brook, ILOak Brook, IL

300 engineers

43 companies

110 products

– Working together in a collegial environment – 2800 monitored test cases executed in 5 days

This is integration that doesn’t take up your hospital’s resources –and no finger-pointing!




2. Engineers from vendors collaborate to define technical specifications (using existing standards such as DICOM and HL7)




Your Request for Proposals Your Request for Proposals (RFPs)(RFPs)

Incorporate IHE framework into RFP documents & product selection

Much easier to specify an IHE Integration Profile than detailed technical specs

Use IHE framework to evaluate your current workflow, even if not buying now

Vendors build product functions that are requested by customers

Ask for IHE Integration Loud & Often !!


Long Road Ahead – Long Road Ahead – 5 yr Roadmap5 yr Roadmap

Year 1(2005)

Year 2(2006)

Year 3(2007)

Year 4(2008)

Year 5(2009)

Cath

Echo

ECG

Nuclear

EP

Ca

rdio

log

y T

ec

hn

ica

l Fra

me

wo

rk

Quality

MR/CT

Multi-modality workflow & imaging

Procedure log &reporting

Hemo waveform & measures, QCA/QVA

Supplies, inventory,& charge capture

Workflow & imaging,stress protocols

Reporting workflow

Retrieve ECGfor display

ECG/Stress/Holterorders

Workflow & imaging,stress protocols

Reporting workflow

Multi-modality labworkflow & reporting

Home healthmonitoring

Retrieve guidelinesfor display

Retrieve structuredguidelines

Registry dataharvesting

Workflow, reporting,& measurements

Precision timesynchronization

Implantable device parameters & events

PediatricMeasurementinteroperability

ECG waveform interoperability

Stress testing workflow


Commitment to EHRCommitment to EHR

David J. Brailer, MD, PhDNational Coordinator for Health Information Technology, US

Department of Health and Human Services (HHS)

Directive: Execute the Presidential Order for widespread deployment of Health Information Technology within 10 years.

“The capacity to share clinical data is generally not available in the market, and I have placed a high priority on ensuring that it does come to exist before widespread EHR adoption is underway.”

“IHE… is becoming the obvious thing to do. It is our goal to make it the inevitable thing to do.”

HIMSS Conference, February 2005


Why IHE?Why IHE?

This is the cardiologist in

healthcare

Any Questions?

This is healthcare


Custom integration at customer site is a lose-lose- High cost – vendor and customer- Unpredictable and uncontrolled environment- Inefficient – solutions often must come from other locations

(home office) with delays in delivery- Usually insufficiently documented – fragile and

unmaintainable solutions- Resources expended on non-value-add effort- Ineffective use of available standards

Bolt-on integration is a problem- Data sharing functions don’t work well if not designed into

the product

Exponential growth of pain as systems are added

Why IHE? (for vendors)Why IHE? (for vendors)


Goals of IHE (for vendors)Goals of IHE (for vendors)

Effective use of standards

Reduce variability in interfaces

Controlled integration testing environment- Defined timetable- No extraneous distractions

Effective use of resources for integration testing

Coordinated deployment of cross-system functions- Avoid chicken-and-egg syndrome

Common approach creates the market in which vendors can sell and users can buy with confidence


IHE BenefitsIHE Benefits(Vendors)(Vendors)

Improves onsite customer support

Reduces development cost

Standardizes interface engineering

Enables the vendors to focus on competitive features

Improves customer satisfaction


Four Clinical Scenario Four Clinical Scenario DemonstrationsDemonstrations

Clinical Scenario Demonstrations:

- Cath/ECG: Emergent Angioplasty- Cath/ECG: Change of Rooms- Echo/ECG: “Add on” Mobile Procedure- Echo/ECG: Stress Echo Images

Watch us “connect the docs”.

Documents

Integrating the Healthcare Enterprise - IHE An initiative of the ACC to improve data interoperability