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

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Integrating the Healthcare Enterprise - IHE An initiative of the ACC to improve data interoperability Slide 2 March 2005ACC Scientific Sessions1 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 Slide 3 March 2005ACC Scientific Sessions2 Why Are Standards Important? The 1905 systems integration problem Slide 4 March 2005ACC Scientific Sessions3 IHE bridges the gap between standards and their practical use in healthcare Slide 5 March 2005ACC Scientific Sessions4 Goals of IHE Advance standards-based healthcare data integration Improve clinical and administrative workflow Improve data flow where its needed, when its needed Improve the efficiency and effectiveness of clinical practice Slide 6 March 2005ACC Scientific Sessions5 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 Slide 7 March 2005ACC Scientific Sessions6 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/Oceania IHE-Cardiology additional participating societies - ASE, SCAI, ASNC, and more IHE-Cardiology in Europe sponsored by European Society of Cardiology (ESC) Slide 8 March 2005ACC Scientific Sessions7 IHE Clinical Domains Cardiology leverages the work of the other domains Cardiology contributes to the Electronic Health Record Being specified in IHE IT Infrastructure domain IHE EHR- Longitudinal Record IHE Cardiology IHE Laboratory IHE Radiology IHE Future Domain IHE IT Infrastructure Intra-Enterprise Cross-Enterprise 14 Integration Profiles 5 Integration Profiles 3 Integration Profiles 9 Integration Profiles IHE Radiation Oncology IHE Cardiology IHE EHR- Longitudinal Record Slide 9 March 2005ACC Scientific Sessions8 The ACC and IHE share a vision Slide 10 March 2005ACC Scientific Sessions9 ACC and IHE Shared Vision The Digital Integrated Cardiac Record as part of the greater Electronic Health Record (EHR) Cross Enterprise physician access (in/out of hospital) Access all departments information Secure access Populations outcomes Slide 11 March 2005ACC Scientific Sessions10 Cardiology and the Electronic 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 Slide 12 March 2005ACC Scientific Sessions11 IHE Cardiology the Cath Lab example 1 2 34 5 6 7 (A) room for improvement ! Slide 13 March 2005ACC Scientific Sessions12 IHE Annual Cycle Step 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 Slide 14 March 2005ACC Scientific Sessions13 IHE Cardiology Year 1 Three initial clinical problems to be addressed: 1. The ability to view an ECG from many locations - quickly and easily integrated into other applications 2. Effective integration of patient, order, and procedure information in an Echo Lab, including mobile echo 3. Effective integration of patient, order, and procedure information in a Cath Lab, including angio, hemo, and IVUS, especially for emergent cases Retrieve ECG for Display Echocardiography Workflow Cardiac Catheterization Workflow Slide 15 March 2005ACC Scientific Sessions14 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 Slide 16 March 2005ACC Scientific Sessions15 Retrieve ECG for Display Slide 17 March 2005ACC Scientific Sessions16 Could you do a TTE on this patient right 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 Slide 18 March 2005ACC Scientific Sessions17 Echocardiography Workflow Slide 19 March 2005ACC Scientific Sessions18 There is a patient being brought 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 Slide 20 March 2005ACC Scientific Sessions19 Cardiac Catheterization Workflow Slide 21 March 2005ACC Scientific Sessions20 IHE Annual Process Step 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) 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 Slide 22 March 2005ACC Scientific Sessions21 IHE Annual Process Step 3 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 Slide 23 March 2005ACC Scientific Sessions22 IHE Joint Connectathon January, 2005 Oak 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 doesnt take up your hospitals resources and no finger-pointing! Slide 24 March 2005ACC Scientific Sessions23 IHE Annual Process Step 4 1. Cardiologists identify clinical problems to be addressed - Integration Profiles 2. Engineers from vendors collaborate to define technical specifications (using existing 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 Slide 25 March 2005ACC Scientific Sessions24 Your Request for Proposals (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 !! Slide 26 March 2005ACC Scientific Sessions25 Long Road Ahead 5 yr Roadmap Year 1 (2005) Year 2 (2006) Year 3 (2007) Year 4 (2008) Year 5 (2009) Cath Echo ECG Nuclear EP Cardiology Technical Framework 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 ECG for display ECG/Stress/Holter orders Workflow & imaging, stress protocols Reporting workflow Multi-modality lab workflow & reporting Home health monitoring Retrieve guidelines for display Retrieve structured guidelines Registry data harvesting Workflow, reporting, & measurements Precision time synchronization Implantable device parameters & events PediatricMeasurement interoperability ECG waveform interoperability Stress testing workflow Slide 27 March 2005ACC Scientific Sessions26 Commitment to EHR David J. Brailer, MD, PhD National 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 Slide 28 March 2005ACC Scientific Sessions27 Why IHE? This is the cardiologist in healthcare Any Questions? This is healthcare Slide 29 March 2005ACC Scientific Sessions28 Custom integration at customer site is a lose-lose - High cost vendor and customer - Unpredictable and uncontrolled environment - Inefficient solutions often must come

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