March 17, 2005IHE and medical Standards in Denmark 1 Integrating the Healthcare Enterprise IHE for interoperability within the enterprise - Overview Charles

March 17, 2005 IHE and medical Standards in Denmark1

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

IHE for interoperability within the enterprise - Overview

Charles Parisot, GE Healthcare

IHE IT Infrastructure Technical Committee Co-chair

IHE Europe Committee

Copenhagen, March 17th 2005Copenhagen, March 17th 2005


W W W . I H E . N E TW W W . I H E . N E T

Providers and VendorsProviders and Vendors

Working Together to DeliverWorking Together to Deliver

Interoperable Health Information SystemsInteroperable Health Information Systems

In the EnterpriseIn the Enterprise

and Across Care Settingsand Across Care Settings

W W W . I H E – Europe. o r gW W W . I H E – Europe. o r g


IHE

EHR- Longitudinal Record

IHE Cardiology

IHE Laboratory

IHE Radiology

IHE

Oncology

IHE

Future Domain

IHE

IT Infrastructure Intra-Enterprise

Cross-Enterprise

14 Integration Profiles

1 Integration Profile



Achievements and expanding scopeOver 100 vendors involved world-wide, 4 Technical Frameworks

27 Integration Profiles, Testing at yearly Connectathons,Demonstrations at major exhibitions world-wide

To claim compliance to IHE Integration Profiles vendors shall publish for each product an IHE Integration Statement.

Patient care Coordination, Quality, Pharmacy, Anatomical Pathology, Surgery, etc.


IHE Radiology Integration ProfilesIHE Radiology Integration Profiles

Patient Info.

Recon-ciliation

Access to Radiology Information

Consistent Present-ation of Images

Basic Security

-

EvidenceDocs

KeyImageNotes

Simple Image & Numeric Reports

Presentation of Grouped Procedures

Post-

Processing Workflow

Reporting Workflow

Charge Posting

Scheduled Workflow

Portable Data for Imaging

NMImage

New

Extensions

New


““Departmental Actors” in SWFDepartmental Actors” in SWF

Query Images [14] Retrieve Images [16]

Image Display

Storage Commitment [10]

Modality Image Stored [8] Storage Commitment [10]

Creator Images Stored [18]

Procedure Scheduled [4] Image Availability Query [11] Procedure Updated [13] Performed Work Status Update [42] Performed Work Status Update [42]

Modality Worklist Provided [5]

Evidence Creator

Performed Procedure

Step Manager

Modality PS in Progress [6] Modality PS Completed [7] Creator PS in Progress [20] Creator PS Completed [21]

Modality PS in Progress [6] Modality PS Completed [7] Creator PS in Progress [20] Creator PS Completed [21]

Modality PS in Progress [6] Modality PS Completed [7]

Creator PS in Progress [20] Creator PS Completed [21]

Acquisition Modality

Image Manager

Image Archive

DSS/ Order Filler

IHE Actors:DSS / Order Filler

PPS Manager

Image Manager /Archive


Evidence Creator

Image Display


Example of Radiology Use CasesExample of Radiology Use CasesLocal policy calls for ADT to pre-register ER patients (“John Doe”, “Jane Doe”): Case 1: Unidentified Patient registered at ADT

and order is placed at Order Placer. Case 2: Unidentified Patient registered at ADT

and order is placed at DSS/Order Filler. Case 3: Unidentified Patient registered at ADT but

acquisition completed at Modality prior to order.


Unidentified Patient - Case 3Unidentified Patient - Case 3ADT

Order

Placer

Image

ManagerModality

Department SystemDatabase/Scheduler/

Order Filler

Filler Order Mgmt

New Order [3]

Procedure

Scheduled [4]

Patient Reconciliation

J.Doe -> J.Smith

Patient

Update [12]

Schedule Procedure

Images

Acquired

Modality Procedure

Step Completed [7]

Modality Procedure

Step Completed [7]

Register J.Doe

Patient

Update [12]

Patient

Registration [1]


PDI – Value PropositionPDI – Value Proposition

Removable media that contains DICOM and may contain browser viewable data. For patient personal records For referral For enterprise data interchange For use in other departments, e.g. surgery For printing

Media interoperability validation

Browser compatibility

Get CDs that you can create and read anywhere


PDI –Value PropositionPDI –Value Proposition

Interoperability validation is especially important for media Network Interoperability Problems

• Immediate, Unambiguous• Rapidly resolved

Media Interoperability Problems• Long delays in detection and recognition• Ambiguous or unknown source vendor/version• Long delays in resolution• Large volume of non-interoperable media created due to delays

IHE Virtual Connectathon for PDI solves the media validation problem

• Provides rapid, unambiguous detection of problems• Enabling rapid resolution of problems


PDI – Actors and TransactionsPDI – Actors and Transactions

Portable MediaCreator

Print Composer

Report Reader

Image Display

Display

Distribute ImagingInformation on Media

Media Importer


CDROM StructureCDROM Structure

DICOMDIR

INDEX.HTM

README.TXT

Directory of DICOM files

IHE_PDIDirectory of web files

Other optional content

Web content (optional)


IHE Cardiology 2004-2005IHE Cardiology 2004-2005

Retrieve Information for Display

Access a patient’s clinical information and documents in a format ready to be

presentedto the requesting user

EchoCardiography Worklflow

Admit, order, schedule, acquire images, notify of completed

steps, on fixed and mobile stress echo modalities.

Provide high-quality ECG and related reportsto the enterprise and outside in a ready-to-display format

Retrieve ECG for Display

Cardiac Catheterization Workflow

Scheduled & unscheduled acquisition and management of cathlab information,

notification of completed steps.


Management of cath exams Similar to IHE-Radiology SWF Multi-modality, multiple procedure steps Handle multiframe images (XA and IVUS)

Reconciliation of patient information Similar to IHE-Radiology PIR Unscheduled cath is the norm, not the exception

Time synchronization Modalities must support IHE-ITI Consistent Time

Out of scope for 2004-2005 Pre-cath and post-cath activity, Hemo waveforms and reports, Procedure

logs, QCA/QVA, Final cath reports

Cardiac Catheterization WorkflowCardiac Catheterization Workflow


Cath actors and transactionsCath actors and transactions

Pt. Registration [Rad-1] Patient Update [Rad-12]


Placer Order Management [Rad-2] Filler Order Management [Rad-3]

ADT

Query Images [Rad-14] Retrieve Images [Card-4]

Image Display

Modality Image/Evidence Stored [Card-2]

Storage Commitment

[Card-3]

Procedure Scheduled [Rad-4]

Procedure Updated [Rad-13]

Query Modality Worklist [Rad-5]

Performed Procedure

Step Manager

Modality PS in Progress [Card-1] Modality PS Completed [Rad-7]



Order Placer


ImageManager

Image Archive

DSS/ Order Filler

Patient Update [Rad-12]


Cath actors and transactionsCath actors and transactions




ADT


Image Display


Storage Commitment

[Card-3]




Performed Procedure

Step Manager




Order Placer


ImageManager

Image Archive

DSS/ Order Filler


Many actors cooperating in a complete end-to-end Many actors cooperating in a complete end-to-end workflowworkflow

Documented in the IHE CARD Technical Framework Documented in the IHE CARD Technical Framework Vol 1 & Vol 2 with reference to RAD TF-Vol 2Vol 1 & Vol 2 with reference to RAD TF-Vol 2




Scheduled & unscheduled acquisition and management of cathlab information, notification

of completed steps.




Access a patient’s clinical information and documents in a format ready to be presented

to the requesting user


Admit, order, schedule, acquire images, notify of completed steps, on fixed and

mobile stress echo modalities.


Reuse of similar IHE-Radiology Profiles Scheduled Workflow (IHE-R SWF) Patient Information Reconciliation (IHE-R PIR)

Intermittently Connected Modality Workflow Acquisition Modality storage

Stress Echo Workflow Staged Protocol

• Acquisition Modality (optional)• Image Display (required)

Digital vs. Videotape

2004-2005 Scope: Imaging Workflow2004-2005 Scope: Imaging Workflow


Echo Actors & TransactionsEcho Actors & Transactions




ADT


Image Display


Storage Commitment

[Card-3]




Performed Procedure

Step Manager




Order Placer


ImageManager

Image Archive

DSS/ Order Filler





Access a patient’s clinical information and documents in a format ready to be

presentedto the requesting user


Admit, order, schedule, acquire images, notify of completed

steps, on fixed and mobile stress echo modalities.


Scheduled & unscheduled acquisition and management of cathlab information, notification

of completed steps.




Retrieve ECG for DisplayRetrieve ECG for DisplayProvide ECGs and related reports to enterpriseExtension to IHE-ITI RID ECGs served in ready-to-display format

• Requirements on PDF displayable quality

Includes XML-based ECG/report listOut of scope 2004-2005

ECG acquisition and reading workflow ECG raw data interchange Export of reports to external repository


Example ECG in PDF FormatExample ECG in PDF Format


PDFPDFECG Source required to support PDF so it is compatible with existing IHE ITI RID clients.

PDF is a common document type and most computers already have a viewer.

ECG Source required to use vector graphics for waveforms in PDF. Gives high quality line drawings at any screen resolution and

zoom factor. Rasterized (e.g. scanned, bitmapped) ECG “images” not

allowed.


Transaction Diagram

Retrieve ECG for DisplayRetrieve ECG for Display

Display InformationSource

Retrieve Specific Info for Display [ITI-11]Retrieve Specific Info for Display [ITI-11]

Retrieve Document for Display [ITI-12]Retrieve Document for Display [ITI-12]

Retrieve ECG List [Retrieve ECG List [CARD-5CARD-5]]

Retrieve ECG Doc for Display [Retrieve ECG Doc for Display [CARD-6CARD-6]]


Laboratory IHE Integration ProfilesLaboratory IHE Integration Profiles

Laboratory Device Automation (LDA)

In Process –TI Nov 2004In Process –TI Nov 2004

Pre-analytic process, analysis and post-analytical treatment

Laboratory Scheduled Workflow (LSWF)Completed in 2003Completed in 2003

Tests performed by a laboratory for an identified

inpatient or outpatient

Laboratory Patient Information Reconciliation (LPIR) In ProcessIn Process

Tests performed on an unidentified or misidentified patient

Laboratory Code Set Distribution (LCSD) In ProcessIn Process

Sharing the batteries and tests code sets throughout the enterprise

Laboratory Point Of Care Testing (LPOCT) In Process –TI Nov 2004In Process –TI Nov 2004

Tests performed on point of care or patient’s bedside

In Dev.

In Dev.

In Dev.

In Dev.


LSWF: Three major use casesLSWF: Three major use casesExternally placed order with identified specimens The ordering provider collects the specimens and uniquely identifies them

(in the order sent in the message as well as on the container with a barcode label)

Externally placed order with specimens unidentified or to be collected by the laboratory

Filler order with specimens identified by the laboratory

Breakthrough: All three workflows are required and have been designed consistently.


LSWF:LSWF: Workflow Workflow

ADT

Order FillerOrder Placer

RAD-1. Pt registrationRAD-12. Pt Update

LAB-1. Placer Order Mgmt

Automation Manager

LAB-4. Work Order Mgmt

Order Result Tracker

LAB-2. Filler Order Mgmt

LAB-3. Order Results Mgmt

LAB-5. Test Results Mgmt

Laboratory



Technicalvalidation

Clinicalvalidation

Selected standard: HL7 version 2.5


Example 1: Microbiology with two Example 1: Microbiology with two specimens and three germsspecimens and three germs

Day 1 at 8:10: Order placed

Day 1 at 8:20: Specimens checked, order scheduled

Day 1 at 14:46: Partial urin results not validated

Day 2 at 09:40: Antibiogram order generated / urin

Day 2 at 09:45: Antibiogram order generated / pus

Day 3 at 11:30: Final validated results


Example 2: Glucose tolerance Example 2: Glucose tolerance study on a series of specimensstudy on a series of specimens

Step 1: Order placed with first specimens

Step 2: order scheduled and started, one broken tube

Step 3: Partial results not validated

Step 4: Last specimens provided

Step 5: Last specimens accepted

Step 7: Final validated results

Step 6: Last results from AM

Order Placer Order Filler Automation Manager

Order Result Tracker

Order entered

OMLÔ21 (NW) 9.3.3.1

First 3 specimens

sent to laboratory Specimens checked.

Order started

OMLÔ21 (NW) 9.3.3.2

OMLÔ21 (SC) 9.3.3.3

OUL^R24 (NW) 9.3.3.4

first technical validationOUL^R21 (SC)

9.3.3.5OMLÔ21 (SC)

9.3.3.6 OUL^R24 (SC) 9.3.3.7

OMLÔ21 (XO) 9.3.3.8

Last 2specimens

sent to laboratory

Last specimens checked.

OMLÔ21 (NW) 9.3.3.9 OUL^R24 (SC)

9.3.3.11

OMLÔ21 (SC) 9.3.3.10

last technical validationOUL^R21 (SC) 9.3.3.12

OMLÔ21 (SC) 9.3.3.13

OUL^R24 (SC) 9.3.3.14

Clinical validation


W W W . I H E . N E TW W W . I H E . N E T

Providers and VendorsProviders and Vendors

Working Together to DeliverWorking Together to Deliver

Interoperable Health Information SystemsInteroperable Health Information Systems

In the EnterpriseIn the Enterprise

and Across Care Settingsand Across Care Settings

W W W . I H E – Europe. o r gW W W . I H E – Europe. o r g

Documents

March 17, 2005IHE and medical Standards in Denmark 1 Integrating the Healthcare Enterprise IHE for interoperability within the enterprise - Overview Charles