Integrating the Healthcare Enterprise Overview of IHE & the 7 Profiles Kevin O’Donnell - Toshiba Corp. IHE Planning Committee Co-chair

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

Overview ofOverview ofIHE & the 7 ProfilesIHE & the 7 Profiles

Kevin O’Donnell - Toshiba Corp.Kevin O’Donnell - Toshiba Corp.IHE Planning Committee Co-chair IHE Planning Committee Co-chair

Vendor WorkshopApril 8-9, 2002

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IHE MissionIHE Mission

IHE is an initiative promoting and supporting IHE is an initiative promoting and supporting the the integrationintegration of of systemssystems in the in the healthcare healthcare enterpriseenterprise..


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IHE Integration GoalsIHE Integration Goals

Improve the efficiency and effectiveness of Improve the efficiency and effectiveness of clinical practice:clinical practice:

Improve Improve WorkflowWorkflow Improve Improve Information AccuracyInformation Accuracy Improve Improve Information AvailabilityInformation Availability Enable Enable Cross-System FunctionalityCross-System Functionality


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IHE Annual CycleIHE Annual Cycle

Identify several key healthcare workflows and integration Identify several 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

Hold workshops and support vendor implementationHold workshops and support vendor implementation

Perform cross-testing at “Connectathon”Perform cross-testing at “Connectathon”

Demonstrate/Promote at tradeshows (RSNA/HIMSS)Demonstrate/Promote at tradeshows (RSNA/HIMSS)


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Who Does What?Who Does What? RSNA and HIMSS (Chris & Joyce):RSNA and HIMSS (Chris & Joyce):

Provide a Provide a neutral forumneutral forum for working on the for working on the Big PictureBig Picture Involve users/professionals and recruit companiesInvolve users/professionals and recruit companies Sponsor IHE and provide infrastructure/continuitySponsor IHE and provide infrastructure/continuity Organize demonstrations and public educationOrganize demonstrations and public education

Mallinkrodt (Steve):Mallinkrodt (Steve): Manage the Connectathon processManage the Connectathon process Create and administer the MESA Test ToolsCreate and administer the MESA Test Tools

IHE Committees:IHE Committees: Identify and design solutions for integration problemsIdentify and design solutions for integration problems

Vendors:Vendors: Implement profiles on productsImplement profiles on products


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IHE & DICOM / HL7IHE & DICOM / HL7• Standards are vital (HL7, DICOM, ICD, Standards are vital (HL7, DICOM, ICD,

…)…)– They provide tools & technologiesThey provide tools & technologies

• But Standards alone are insufficientBut Standards alone are insufficient– They are open to interpretationThey are open to interpretation– There is room for optional variationsThere is room for optional variations– They avoid specifying how to apply them to They avoid specifying how to apply them to

particular real world scenariosparticular real world scenarios


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How is IHE related to Standards?How is IHE related to Standards?• Profiles are packagingProfiles are packaging

• IHE attacks real world radiology integration IHE attacks real world radiology integration problemsproblems

• HL7 and DICOM provide dictionariesHL7 and DICOM provide dictionaries

• IHE defines a “phrasebook” that solves real IHE defines a “phrasebook” that solves real world problems by assembling pieces world problems by assembling pieces provided by DICOM/HL7provided by DICOM/HL7


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Key IHE ConceptsKey IHE Concepts• Generalized Systems Generalized Systems -> -> ActorsActors

• Interactions between Actors Interactions between Actors -> -> TransactionsTransactions

• Problem/Solution ScenariosProblem/Solution Scenarios -> -> IntegrationIntegration 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)


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IHE TransactionsIHE Transactions• <Insert Transaction Diagram Here><Insert Transaction Diagram Here>


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Presentation ofGrouped Procedures

Subset a single acquisition

IHE Year 3 Integration ProfilesIHE Year 3 Integration Profiles

Patient Information

Reconciliation

Unknown patients and unscheduled

orders

ConsistentPresentation of

Images

Hardcopy and softcopy

grayscale and presentation state

Access toRadiology

Information

Consistentaccess to

images andreports

Key ImageNotes

Exchange flaggingsignificant images

Simple Image andNumeric Reports

Exchange simplereports with image

links and, optionally,measurements

Scheduled WorkflowAdmit, order, schedule, acquire images, notify of completed steps


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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


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Patient Information Reconciliation ProfilePatient Information Reconciliation Profile

• Extends Scheduled WorkflowExtends Scheduled Workflow– Handle unidentified patient (e.g. trauma)Handle unidentified patient (e.g. trauma)– Handle demographic information mistakesHandle demographic information mistakes– Propagate changes to all affected systems, update Propagate changes to all affected systems, update

all affected dataall affected data

• Reduces incorrectly identified or “lost” studiesReduces incorrectly identified or “lost” studies


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Standards & MechanismsStandards & Mechanisms• HL7HL7

• ADT Messages (A01-08, A11-13, A38, A40)ADT Messages (A01-08, A11-13, A38, A40)

• ORM MessagesORM Messages

• DICOMDICOM

• Modality Worklist Management (MWL)Modality Worklist Management (MWL)

• Modality Performed Procedure Step (MPPS)Modality Performed Procedure Step (MPPS)

• Storage, Storage CommitmentStorage, Storage Commitment

• Query/Retrieve Query/Retrieve


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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


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• DICOMDICOM

• Grayscale Standard Display Function (GSDF)Grayscale Standard Display Function (GSDF)

• Grayscale Softcopy Presentation State (GSPS)Grayscale Softcopy Presentation State (GSPS)


• Query/RetrieveQuery/Retrieve

• Print ManagementPrint Management

• Presentation LUT (P-LUT)Presentation LUT (P-LUT)

• IHE Scheduled Workflow ProfileIHE Scheduled Workflow Profile

Consistent Presentation of Images ProfileConsistent Presentation of Images Profile


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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


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• IHE Consistent Presentation of Images ProfileIHE Consistent Presentation of Images Profile

Presentation of Grouped Procedures ProfilePresentation of Grouped Procedures Profile


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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


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• DICOMDICOM

• Structured Reports (SR)Structured Reports (SR)

• SR Template TID 2000SR Template TID 2000



• HL7HL7

• ORU MessagesORU Messages


Simple Image & Numeric Reports ProfileSimple Image & Numeric Reports Profile


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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


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• DICOMDICOM

• Structured Reports (SR)Structured Reports (SR)

• Key Object SelectionKey Object Selection




Key Image Note ProfileKey Image Note Profile


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Access to Radiology InformationAccess to Radiology Information

Radiology Department – Images and

Reports

Emergency Department

Referring Physician

Other Departments:- Oncology- Surgery- Neurology- Pediatrics- etc.

Remote Clinics

Electronic Medical Record


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• DICOMDICOM


Access to Radiology Information ProfileAccess to Radiology Information Profile


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Year 4 Profiles (Tomorrow)Year 4 Profiles (Tomorrow)

Security (HIPAA)Security (HIPAA) General Purpose WorklistGeneral Purpose Worklist

Post-Processing WorkflowPost-Processing Workflow Charge PostingCharge Posting (Modality Worklist Exception Handling)(Modality Worklist Exception Handling)


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ReferencesReferences• www.rsna.org/IHE

• IHE Technical Framework - Year 3 & Year 4IHE Technical Framework - Year 3 & Year 4

• Part I:Part I: The ProfilesThe Profiles

• Part II:Part II: The TransactionsThe Transactions

• Part III: The New TransactionsPart III: The New Transactions

• IHE Mailing Lists and Comment ServerIHE Mailing Lists and Comment Server

• Educational MaterialsEducational Materials• IHE Integration Profiles; The IHE FAQ; IHE VideoIHE Integration Profiles; The IHE FAQ; IHE Video

• IHE Fundamentals, Purchasing Strategies, IHE PrimerIHE Fundamentals, Purchasing Strategies, IHE Primer

• IHE Integration Checklist, Connectathon ResultsIHE Integration Checklist, Connectathon Results

http://www.rsna.org/IHE


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Questions?Questions?


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How Established is IHE?How Established is IHE?• Year 1 (1999):Year 1 (1999): Proof of ConceptProof of Concept

(Basic Scheduled Workflow)(Basic Scheduled Workflow)

• Year 2 (2000): Year 2 (2000): Introduction of the 7 ProfilesIntroduction of the 7 Profiles(Full Featured)(Full Featured)

• Year 3 (2001): Year 3 (2001): Consolidation, Catch-up (Real Consolidation, Catch-up (Real Products)Products) Expansion to FranceExpansion to France

• Year 4 (2002): Year 4 (2002): 3 New Profiles 3 New Profiles Expansion to Japan, GermanyExpansion to Japan, Germany

• Year 5 (2003): Year 5 (2003): New ProfilesNew ProfilesExpansion to Lab, Pathology, …?Expansion to Lab, Pathology, …?


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How do I benefit?How do I benefit?• Clinical UsersClinical Users

• Greater access to more consistent informationGreater access to more consistent information• Fewer errors, fewer tedious tasksFewer errors, fewer tedious tasks

• AdministratorsAdministrators• Increased throughputIncreased throughput• Better scheduling and trackingBetter scheduling and tracking

• BuyersBuyers• Specify/purchase integration capabilities easily Specify/purchase integration capabilities easily • Freedom to acquire “Best of Breed” systems Freedom to acquire “Best of Breed” systems

• IT ProfessionalsIT Professionals• Faster, more predictable integration projectsFaster, more predictable integration projects

Documents

Integrating the Healthcare Enterprise Overview of IHE & the 7 Profiles Kevin O’Donnell - Toshiba Corp. IHE Planning Committee Co-chair