1RSNA 2004

Christoph Dickmann – Member IHE Rad TCGlen Marshall – Co-chair IHE IT-I PC

Charles Parisot – Co-chair IHE IT-I TC

Image-enabled Health Records:IHE Progress and Plans

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

RSNA 20042

Pragmatic definition of “EHR”Pragmatic definition of “EHR”

Integrated data and workflow functionality– Multimedia data access

text, image, waveform, … – Communication among stakeholders

clinicians, caregivers, consumers, …

Support different views of data– Clinical records

Details: episode, visit, study– Longitudinal records

Summaries: episode, visit

cross-department or cross-enterprise users

Linking summaries and clinical details

RSNA 20043

What an EHR can do for youWhat an EHR can do for you

Combine multiple sources of patient data Enhance functionality by

– Connecting to specialized systems – Augmenting the data sources by combining them

Provide timely, relevant, comprehensive data– Surgeon preparing an operation by viewing an

abdomen CT and lab values– General practitioner receiving cardiac films via CD– Neurologist reading a brain MR report and viewing

an EKG

RSNA 20044

EHR goals in IHEEHR goals in IHE(compatible with U.S. NHII goals)(compatible with U.S. NHII goals)

Informed Clinical Practice– Leverage existing IHE basis to ease EHR adoption

Interconnected Clinicians– Beyond the department: community or regional scope

Personalized Care– Web-based data access and summary data

Support for higher-level goals– Better outcomes– Increased patient safety– More efficient healthcare operations

RSNA 20045

EHR complexityEHR complexity

Business dilemmas– Significant, long-term investment – Investors may not be main beneficiaries

Coordination and cooperation– Active collaboration among multiple stakeholders– Identify and work out commonalities and barriers

Integration and interoperability– Implement existing standards– Develop additional standards

Focus on selected aspects

RSNA 20046

Focus: Image-enabled EHRFocus: Image-enabled EHR(connect two “worlds”)(connect two “worlds”)

Textual data & functions– Patient data– Clinical data

Laboratory results Surgery reports Prescriptions, meds Letters or notes

Integrate with imaging data and related processes

Imaging data & functions– Patient data– Images and evidence

Radiology Cardiology Nuclear Medicine

Integrate with clinical data and related processes

RSNA 20047

Potential use cases of an Potential use cases of an image-enabled EHRimage-enabled EHR

Neurologist: reviewing stroke patient transfer to ward

Nurse: preparing GI ward round for Dr. X

Surgeon: planning gall bladder surgery

GP: seeing a post-MI patient after hospital discharge

Patient: preparing an obstetric visit

Cardiologist: during catheter intervention

Radiologist: starting an abdomen CT

Physician: counseling at diabetes outpatient clinic

Lab technologist: for immune-deficiency testing

Ophthalmologist: during history-taking with a new patient

Information need may include current or longitudinal evidence.

RSNA 20048

Image-enabled EHRImage-enabled EHRPregnancy outpatient clinics encounterPregnancy outpatient clinics encounter

acquire

index

evaluate

Image/ ReportRepository

store

Ultrasound reportwith images

DocumentRegistry

register

(XDS architecture)

RSNA 20049

Image-enabled EHRImage-enabled EHRMicrobiology test encounterMicrobiology test encounter

index

acquireanalyze

Document/ Report

Repository

store

Microbiology reportwith images

DocumentRegistry

register

(XDS architecture)

RSNA 200410

Image-enabled EHRImage-enabled EHRChildbirth inpatient stayChildbirth inpatient stay

registerindex

evaluate

DocumentRegistry

Image/ Report and DocumentRepositories

indexquery

retrieve

DocumentRepository

store

Report, letters(with images)

(XDS architecture)

RSNA 200411

Primary existing IHE mechanismPrimary existing IHE mechanismSharing documents (XDS)Sharing documents (XDS)

DocumentRepository

Longitudinal record system:across encounters

Care recordsystems:specific care delivery

Document Registry

Register documents (references)

Retrieve selected document references

Acute ambulatory care

patient Acute inpatient care Long term

care Specialized or diagnostic services

Query

Note: specific imaging documents are work in progress

Retrieve documents

RSNA 200412

Existing IHE contributions for Existing IHE contributions for EHR implementationEHR implementation

IHE LaboratoryIHE Radiology

EHR realization IHE IT Infrastructure

6 Integration Profiles

5 Integration Profiles

1 Integration Profile3 Integration

Profiles

Each TF can contribute to EHR scenarios with Integration Profiles for• Data access• Workflow handling

IHE Cardiology

RSNA 200413

Basic requirements of EHR Basic requirements of EHR systemssystems

Healthcare provider systems– EHR sources and users

Document handling– Storage and retrieval of EHR documents

Infrastructure services– Basic data and application integration

Network– EHR storage, inquiry, and retrieval path

RSNA 200414

IHE contributionIHE contributionProfiles for interoperable data and applicationsProfiles for interoperable data and applications

Common patient identification (IT-I PIX) Common patient demographics (IT-I PDQ) Desktop integration (IT-I PSA)

running applications work on the same patient Single sign on (IT-I EUA)

enterprise-wide user handling Common staff data (IT-I PWP)

health professionals are commonly recognized Security and privacy (IT-I ATNA, Rad SEC)

RSNA 200415

EHR interoperability examplesEHR interoperability examples

Appl. 1

Appl. 2

Appl. 3

Patient identifier matching

Common person data or services

Samepatient selected

Patientdemographics

Source 1

Source 2

Personnel/staff data

Single sign on

DesktopIntegrationas an EHR enabler

Any user

Backend integration (services, data)

RSNA 200416

IHE contributionIHE contributionProfiles for access to images and reports (1)Profiles for access to images and reports (1)

Radiology– Access to Radiology (Rad ARI)

Retrieve diagnostic quality images and reports– Simple Image and Numeric Reports (Rad SINR)

Access or export of reports and related images– Key Image Notes (Rad KIN)

Mark and annotate relevant imaging evidence– Portable Data for Imaging (Rad PDI)

Export/ import/ view media data– Nuclear Medicine Image (Rad NM Image)

Capture and use complex NM result screens

RSNA 200417

IHE contributionIHE contributionProfiles for access to images and reports (2)Profiles for access to images and reports (2)

Cardiology– Cardiac Catheterization Workflow (Card CATH),

Echo Workflow (Card ECHO) Retrieve catheterization and echocardiography imaging evidence

– Retrieve ECG for Display (Card ECG) Retrieve ECG summaries and results

IT Infrastructure– Retrieve Information for Display (IT-I RID)

Query and retrieve documents and summaries/ lists– Cross-Enterprise Clinical Document Sharing (IT-I XDS)

store & retrieve documents and summaries with longitudinal data

RSNA 200418

IHE contribution IHE contribution Profiles for access to clinical/ textual information (1)Profiles for access to clinical/ textual information (1)

Radiology– Simple Image and Numeric Reports (Rad SINR)

Access original or exported reports IT-Infrastructure

– Cross-Enterprise Clinical Document Sharing (IT-I XDS) Store & retrieve documents or summaries with longitudinal data

– Retrieve Information for Display (IT-I RID) Access documents and summaries (e.g. imaging, lab,

discharge, medications, prescriptions)

RSNA 200419

IHE contribution IHE contribution Profiles for access to clinical/ textual information (2)Profiles for access to clinical/ textual information (2)

Cardiology– Retrieve ECG for Display (Card ECG)

Access ECG summaries and results or reports Laboratory

– Lab Scheduled Workflow Notification of lab results

RSNA 200420

IHE contributionIHE contribution Profiles for workflow / patient management supportProfiles for workflow / patient management support Workflow integration

– Scheduled Workflow (Rad SWF, Card CATH/ ECHO, Lab) Ordering, scheduling and tracking of image acquisition steps Appointment Notification (Rad SWF option): report back to the order

placing system the date and time of the scheduled steps– Reporting Workflow (Rad RWF)

Scheduling and tracking of report creation tasks Patient data integration

– Patient Information Reconciliation (Rad PIR, Card CATH/ ECHO) Modification and matching of patient data and imaging evidence

Overall concept (Rad whitepaper)– Departmental workflow and interfaces to enterprise

RSNA 200421

Planned IHE developmentPlanned IHE development

Harmonize IHE domain-specific work Extend XDS’ document content (Rad, Card) Additional EHR contents Code sets and master files Realize overall workflow concept Configuration support Security details, e.g. access control

RSNA 200422

Image-enabled EHR – IHE Image-enabled EHR – IHE progress and plansprogress and plans

IHE Integration Profiles from different domains can be combined

Combinations of current profiles can cover many EHR scenarios– Information integration (imaging, textual)– Enhanced functionality beyond one department– Intra- and cross enterprise communication

Scenarios enable system evolution(organizational change management not to be forgotten)

IHE ensures integration testing and future Integration Profile development

23RSNA 2004

Thank you!Thank you!

Questions?Questions?

More information: http://www.rsna.org/IHE