September, 2005What IHE Delivers 1 Chris Lindop – GE Healthcare IHE Radiology Planning/Technical Committee Co-Chair IHE XDS-I: Planning for an Image Enabled

1September, 2005 What IHE Delivers

Chris Lindop –Chris Lindop – GE Healthcare GE Healthcare

IHE Radiology Planning/Technical Committee Co-ChairIHE Radiology Planning/Technical Committee Co-Chair

IHE XDS-I: Planning for an Image IHE XDS-I: Planning for an Image Enabled EHR Enabled EHR

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Focus: Image-enabled EHRFocus: Image-enabled EHR

Non-imaging dataNon-imaging data Patient dataPatient data Clinical dataClinical data

• Laboratory resultsLaboratory results• Surgery reportsSurgery reports• Prescriptions, medsPrescriptions, meds• Letters or notesLetters or notes

Integrate with imaging Integrate with imaging data and processesdata and processes

Imaging dataImaging data Patient dataPatient data Images and evidenceImages and evidence

• RadiologyRadiology• CardiologyCardiology• Nuclear MedicineNuclear Medicine

Integrate with non-Integrate with non-imaging data and imaging data and processesprocesses

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Business need: share in the Care settingBusiness need: share in the Care settingRadiology Reports and ImagesRadiology Reports and Images

Between Care Providers:Between Care Providers: RadiologistsRadiologists Radiologists and TechnologistsRadiologists and Technologists Radiologists and SurgeonsRadiologists and Surgeons Radiologists and CliniciansRadiologists and Clinicians

Between Care Providers and PatientsBetween Care Providers and Patients

Within an enterpriseWithin an enterprise

Cross-enterprise in a healthcare regionCross-enterprise in a healthcare region

Cross-healthcare regionsCross-healthcare regions

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

Using imagesUsing images

NeurologistNeurologist: reviewing : reviewing stroke patient transfer to stroke patient transfer to wardward

NurseNurse: preparing GI ward : preparing GI ward round for Dr. Xround for Dr. X

GPGP: seeing a post-MI : seeing a post-MI patient after hospital patient after hospital dischargedischarge

PatientPatient: be prepared for an : be prepared for an obstetric visitobstetric visit

Producing images/ evidenceProducing images/ evidence

CardiologistCardiologist: during catheter : during catheter interventionintervention

RadiologistRadiologist: starting an : starting an abdomen CTabdomen CT

PhysicianPhysician: counseling at : counseling at diabetes outpatient clinicdiabetes outpatient clinic

OncologistOncologist: planning : planning radiotherapyradiotherapy

Technologist:Technologist: fulfilling an fulfilling an imaging orderimaging order

Information need may include current or longitudinal evidence

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IHEIHE - - Connecting standards to careConnecting standards to care

Care providers and IT professionals work with Care providers and IT professionals work with vendors to coordinate the implementation of vendors to coordinate the implementation of standards to meet their needsstandards to meet their needs Care providers identify the key interoperability problems Care providers identify the key interoperability problems

they facethey face Drive industry to develop and make available Drive industry to develop and make available

standards-based solutionsstandards-based solutions Implementers follow common guidelines in purchasing Implementers follow common guidelines in purchasing

and integrating systems that deliver these solutionsand integrating systems that deliver these solutions

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IHE Participants and RelationshipsIHE Participants and RelationshipsParticipants include:Participants include: Users - Clinicians, Staff, Administrators, CIOs, Governments Users - Clinicians, Staff, Administrators, CIOs, Governments

• RSNA, HIMSS, etcRSNA, HIMSS, etc Vendors - Information Systems and EquipmentVendors - Information Systems and Equipment

• e.g., imaging, Clinical Information Systems, Consultantse.g., imaging, Clinical Information Systems, Consultants

Maintains formal liaison with Standards Development Organizations Maintains formal liaison with Standards Development Organizations (SDOs):(SDOs): HL7, DICOM, ISO (Liaison D)HL7, DICOM, ISO (Liaison D)

ISO TC215 (including ANSI) approved IHE Process and Profiles to ISO TC215 (including ANSI) approved IHE Process and Profiles to be published as technical reportsbe published as technical reports

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IHE Organizational StructureIHE Organizational Structure

Contributing &Participating

Vendors

IHE North America

USA

Canada

IHE Asia

Japan

Korea Taiwan

China

ACCACCEACEP

JAHISJIRAJRS

METI-MLHWMEDIS-DCJAMI

RSNA SFRSFIL

SIRMBIREuroRec

COCIREAR-ECRDRG

ESC

Professional Societies / SponsorsACPGMSIHIMSS

IHE International Board

Global Development

Radiology

Cardiology

ITInfrastructure

Patient CareCoordination

Patient CareDevices

Laboratory

Pathology

Eye CareRadiationOncology

Public Health, Quality and Research

IHE Asia-Pacific

New ZealandAustralia Malaysia

IHE Europe

France Netherlands

Spain Sweden UKItaly

Germany

Norway

Austria

Regional Deployment

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IHE: A Framework for InteroperabilityIHE: A Framework for Interoperability

• A common framework for harmonizing and A common framework for harmonizing and implementing multiple standardsimplementing multiple standards

Application-to-applicationApplication-to-application System-to-systemSystem-to-system Setting-to-settingSetting-to-setting

Enables seamless health information movement within Enables seamless health information movement within and between enterprises, regions, nationsand between enterprises, regions, nations

Promotes unbiased selection and coordinated use of Promotes unbiased selection and coordinated use of established healthcare established healthcare andand IT standards to address IT standards to address specific clinical needsspecific clinical needs

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IHE Technical FrameworksIHE Technical FrameworksImplementation Guide for each Integration ProfileImplementation Guide for each Integration Profile

An Integration Profile : A Set of Actors Exchanging Transactions

Query Modality Worklist [RAD-5]

ADT Order Placer

Register J.Doe

AcquisitionModality

Placer OrderManagement –New [RAD-2]

Patient Reconciliation

Department System Scheduler/Order Filler

Schedule Procedure

Procedure Scheduled [RAD-4]

Modality Procedure Step Completed [RAD-7]J.Doe ->

J.Smith

Patient Update/Merge [RAD-12]

Modality Procedure Step Completed [RAD-7]

PatientRegistration [RAD-1]

Patient Update/

Merge [RAD-12]

Modality Procedure Step In Progress [CARD-1]


Perform Acquisition

Filler Order Mgmt - Status Update [RAD-3]


ImageManager/

PPS Manager

Filler Order Management -New [RAD-3]

One or the other methods of creating an order is used


ADT Order Placer

Register J.Doe

AcquisitionModality

Placer OrderManagement –New [RAD-2]

Patient Reconciliation

Department System Scheduler/Order Filler

Schedule Procedure


Modality Procedure Step Completed [RAD-7]J.Doe ->

J.Smith

Patient Update/Merge [RAD-12]

Modality Procedure Step Completed [RAD-7]

PatientRegistration [RAD-1]

Patient Update/

Merge [RAD-12]



Perform Acquisition



ImageManager/

PPS Manager

Filler Order Management -New [RAD-3]

One or the other methods of creating an order is used

Use casesProcess Flows

For each transaction: Std referenced Options specified Mapping required

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/Evidence [CARD-4]

Image Display

Modality Image/Evidence Stored [CARD-2]

Storage Commitment

[CARD-3]


Procedure Updated [RAD-13]


Performed Procedure

Step Manager

Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]



Order Placer

Acquisition Modality

ImageManager

ImageArchive

DSS/ Order Filler

Patient Update [RAD-12]


Storage Commitment

[CARD-3]

Evidence Creator Modality PS in Progress [CARD-1]

Modality PS Completed [RAD-7]

Instance Availability Notification [RAD-49]



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

ADT

Query Images [RAD-14] Retrieve Images/Evidence [CARD-4]

Image Display


Storage Commitment

[CARD-3]


Procedure Updated [RAD-13]


Performed Procedure

Step Manager




Order Placer

Acquisition Modality

ImageManager

ImageArchive

DSS/ Order Filler

Patient Update [RAD-12]


Storage Commitment

[CARD-3]

Evidence Creator Modality PS in Progress [CARD-1]

Modality PS Completed [RAD-7]

Instance Availability Notification [RAD-49]

Actors Transactions

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Proven Standards Adoption ProcessProven Standards Adoption Process

IHEIntegrationProfiles B

IHEIntegrationProfile A

Easy toIntegrateProducts

IHEDemonstration

User Site

RFP

Standards

IHETechnical

Framework

Product IHE IntegrationStatement

IHE Integration Profiles at the heart of IHE :IHE Integration Profiles at the heart of IHE : Detailed selection of standards and options each solving a specific integration problemDetailed selection of standards and options each solving a specific integration problem A growing set of effective provider/A growing set of effective provider/software-developersoftware-developer agreed solutions agreed solutions Vendors can implement with ROIVendors can implement with ROI Providers can deploy with stabilityProviders can deploy with stability Process started in 1998; continuously improvedProcess started in 1998; continuously improved

IHEConnect-a-thon

ProductWith IHE

IHE Connect-a-thonResults

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RadiologyRadiology Profiles Profiles

Access to Radiology Information

ConsistentPresentation

of Images

EvidenceDocument

KeyImageNotes

Simple Image & Numeric Reports

Presentation of

Grouped Procedures

Post-Processing Workflow

Reporting Workflow

Charge Posting

Patien

t Info

. Reco

nciliatio

n

Scheduled Workflow

Portable Data for Imaging

Mammo-graphy

Image

Audit Trail & Node Authentication – Radiology

Image Fusion

Teaching Files & Clinical Export

Import Reconcil-

iation Workflow

Cross-Enterprise Document Sharing for Imaging

NMImageCard

Option

Radiation Exposure

Monitoring

Mammo-graphy

Acquisition Workflow

InfrastructureInfrastructure

Presentation & ContentPresentation & Content

WorkflowWorkflow

Users GuidesUsers Guides

Radiology Departmental Workflow Mammography Workflow

Trial ImplementationTrial Implementation ITI Profile(radiology option ITI Profile(radiology option

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IHE Integration Profiles for Health Info NetsIHE Integration Profiles for Health Info Nets What What is availableis available and and has been added in 2007has been added in 2007

Clinical and PHR ContentClinical and PHR Content

Health Data ExchangeHealth Data Exchange

Patient Demographics Query

Patient Identifier Cross-referencing

Map patient identifiers across independent identification

domains

Notification of Document Availability

Notification of a remote provider/ health enterprise

Request Formfor Data Capture

External form with custom import/export scripting

Patient ID MgmtPatient ID Mgmt

OtherOther

Final Text ApprovedFinal Text Approved

Trial Implementation-2007 Trial Implementation-2007 –– Final Txt 2008Final Txt 2008

Cross-Enterprise Document Sharing

Registration, distribution and access across health enterprises of clinical

documents forming a longitudinal record

Cross-Enterprise Document Pt-Pt Reliable InterchangeCross-Enterprise Document

Media InterchangeCross-Community Access

Security & PrivacySecurity & Privacy

Consistent TimeCoordinate time across networked

systems

Audit Trail & Node Authentication

Centralized privacy audit trail and node to node authentication to create

a secured domain.

Basic Patients Privacy Consents

Establish Consents & Enable Access Control

Document Digital Signature

Attesting “true-copy and origin

Cross-Enterprise User Assertion

Provides Trusted Identity

Medical Summary (Meds, Allergies, Pbs)

Format of the Document Contentand associated coded vocabulary

Emergency Referrals Format of the Document Content

and associated coded vocabulary PHR Extracts/Updates

Format of the Document Content and associated coded vocabulary

ECG Report Document


Lab Results Document Content


Scanned Documents Format of the Document ContentImaging Information

(Images & Reports)Format of the Document Content

and associated coded vocabulary

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Categories of Healthcare Communication ServicesCategories of Healthcare Communication Services

Security

DocumentSharing

Patient and Provider ID Mgt

DynamicInformation

Access

WorkflowManagement

Source persisted and attested health

records

Specific info snapshot

provided on demand

2 or more entitiessynchronize

a task

e.g. access to last 6 months historical

labs and encounter summaries

e.g. order a lab test, track status and receive results

e.g. get a current list of allergies or med list from a source

HospitalsHIEs and RHIOs

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Combining IHE ProfilesCombining IHE ProfilesDocument Content & Modes of Document ExchangeDocument Content & Modes of Document Exchange

Document Exchange Integration ProfilesDocument Exchange Integration Profiles

DocumentDocument SharingSharing

XDSXDS

MediaMediaInterchangeInterchange

XDMXDM

Reliable Pt-PtReliable Pt-PtInterchangeInterchange

XDRXDR

Doc Content Profiles Doc Content Profiles (Semantics content)(Semantics content)

Scanned DocScanned Doc

XDS-SDXDS-SD

LaboratoryLaboratory

XD*-LabXD*-LabPHR PHR

ExchangeExchange

XPHRXPHR

Discharge &Discharge &ReferralsReferrals

XDS-MSXDS-MS

ImagingImaging

XDS-IXDS-I

ConsentConsent

BPPCBPPCEmergencyEmergency

EDREDRPre-Pre-

SurgerySurgery

PPHPPPHP

Functional Status Functional Status AssesmentAssesment

FSAFSA

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Use of a shared XDS infrastructure to access Use of a shared XDS infrastructure to access Radiology Reports and Images (XDS-I)Radiology Reports and Images (XDS-I)

HospitalHospital

Imaging CenterImaging CenterPhysician PracticePhysician Practice

Between Radiology and :Between Radiology and :• IImaging specialistsmaging specialists• Non-imaging cliniciansNon-imaging clinicians• PatientsPatients

PACS Y

PACS Z

Radiology -to-Radiology -to-RadiologyRadiology

Radiology -to- PhysiciansRadiology -to- Physicians

Same XDS InfrastructureSame XDS Infrastructure (Registry and Repositories) (Registry and Repositories) for medical for medical summaries and imaging information !summaries and imaging information !

Patient HomePatient Home

17Radiology Enterprise A

Radiology Enterprise B

Physician Office

Regional Health Regional Health Information Information NetworkNetwork

Cross-Cross-Enterprise Enterprise RegistryRegistry

Patient Id= 3547F45• Report 5/21/1998 : CT Head B• Study 5/21/1998 : CT Head B• Report 2/18/2005 : Chest Xray A• Study 2/18/2005 : Chest Xray A

PACS B

PACS A

Sharing Radiology Reports and ImagesSharing Radiology Reports and Imagesin a Regional Health Information Networkin a Regional Health Information Network



Physician Office


Query for Query for Documents Documents

Register Imaging Register Imaging Information for Information for

sharingsharing

Priorimaging

Reports & Studies


Register Imaging Register Imaging Information for Information for sharingsharing

Patient Id= 3547F45• Report 5/21/1998 : CT Head B• Study 5/21/1998 : CT Head B

Physicians and Systems within a Regional Physicians and Systems within a Regional Health Network - Routine Imaging ReferralHealth Network - Routine Imaging Referral



Physician Office


Register Imaging Register Imaging Information for Information for

sharingsharing


Notification of Notification of Doc AvailabilityDoc Availability

Register Imaging Register Imaging Information for Information for sharingsharing

Physicians and Systems within a Regional Physicians and Systems within a Regional Health Network - Routine Imaging ReferralHealth Network - Routine Imaging Referral



Physician Office

Prior Imaging Report & Study


Query for Query for documents documents

Imaging Report Imaging Report & Study& Study


Patient Id= 3547F45• Report 5/21/1998 : CT Head B• Study 5/21/1998 : CT Head B• Report 2/18/2005 : Chest Xray A• Study 2/18/2005 : Chest Xray A

Notification of Notification of Doc AvailabilityDoc Availability

Physicians and Systems within a Regional Physicians and Systems within a Regional Health Network for a Routine Imaging ReferralHealth Network for a Routine Imaging Referral

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XDS-I DependenciesXDS-I Dependencies

XDS-I depends on IT Infrastructure Cross-Enterprise XDS-I depends on IT Infrastructure Cross-Enterprise Document Sharing (XDS)Document Sharing (XDS)

New ActorsNew Actors Imaging Document SourceImaging Document Source Imaging Document Consumer (should be grouped with Document Imaging Document Consumer (should be grouped with Document

Consumer)Consumer)

Same Actors as in XDSSame Actors as in XDS Document ConsumerDocument Consumer Document RegistryDocument Registry Document Repository Document Repository

Added extension to support imaging data (images and Added extension to support imaging data (images and reports)reports)

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Document Consumer

Retrieve Document

Query Documents

Patient Identity Source

Patient Identity Feed

Imaging Document Source

Document Registry

Document Repository

Provide & Register Document Set

Register Document Set

Imaging Document Consumer

Retrieve Images

Retrieve Presentation StatesRetrieve Key Image NoteRetrieve Evidence DocumentsWADO Retrieve

XDS-I Actors and TransactionsXDS-I Actors and Transactions

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XDS-I Transaction requirementsXDS-I Transaction requirements

XDS-I Actors:XDS-I Actors: Imaging Document ConsumerImaging Document Consumer

• at least one Retrieve ( [RAD-55], [RAD-16], [RAD-17], [RAD-27], [RAD-31] [RAD-at least one Retrieve ( [RAD-55], [RAD-16], [RAD-17], [RAD-27], [RAD-31] [RAD-35])35])

Imaging Document SourceImaging Document Source• Provide and Register Document Set [RAD-54]Provide and Register Document Set [RAD-54]• WADO Retrieve [RAD-55]WADO Retrieve [RAD-55]• Retrieve Images [RAD-16], Retrieve Presentation States [RAD-17] Retrieve Retrieve Images [RAD-16], Retrieve Presentation States [RAD-17] Retrieve

Reports [RAD-27], Retrieve Key Image Note [RAD-31], Retrieve Evidence Reports [RAD-27], Retrieve Key Image Note [RAD-31], Retrieve Evidence Documents [RAD-45]Documents [RAD-45]

XDS ActorsXDS Actors Document RepositoryDocument Repository

• Provide and Register Document Set [RAD-54]Provide and Register Document Set [RAD-54]

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OptionsOptions

Imaging Document Source must support at least one of the Imaging Document Source must support at least one of the following options:following options:

Extensive Set of DICOM Instances Extensive Set of DICOM Instances PDF Report PDF Report Text Report wrapped in a CDA DocumentText Report wrapped in a CDA Document

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Sharing of Sharing of Extensive DICOM Extensive DICOM

Instance SetInstance Set

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Document Registry

Document Repository

Manifest

Reference to image 1

DICOM Manifest


Reference to image 3Manifest Manifest

Clinical Encounter

Clinical IT System

Query Registry

Manifest

Retrieve Manifest


DICOM Manifest



Retrieve Images

Register Manifest

Manifest

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Sharing of Sharing of Extensive DICOM Instance SetExtensive DICOM Instance Set

The shared Document is a manifest The shared Document is a manifest

a Key Object Selection DICOM Instance a Key Object Selection DICOM Instance • title : manifesttitle : manifest

Imaging Document Source is required Imaging Document Source is required

to ensure that the referenced images from within a published to ensure that the referenced images from within a published manifest are available to be retrievedmanifest are available to be retrieved

Imaging Document Source is responsible Imaging Document Source is responsible

for replacing a previously submitted manifest Document for replacing a previously submitted manifest Document when a change occurs to the manifest content (eg. Change when a change occurs to the manifest content (eg. Change of the DICOM SOP instances referenced within the of the DICOM SOP instances referenced within the manifest)manifest)

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Sharing of Sharing of Imaging ReportImaging Report

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Radiology systemReport Source

…..

Findings:

Header:

Report Type: OB / Gyn

BPD ...…..

Radiology Report

Impressions: GestationalAge

...

Text wrapped into CDA Report

PDF Report

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Document Registry

Document Repository

Report Report

Clinical Encounter

Clinical IT System

Query Registry

Retrieve Report

Register Report

Report

…..

Findings:

Header:


BPD ...…..

Radiology Report

Impressions: GestationalAge

...

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Sharing of ReportsSharing of Reports

The shared Report Document format is The shared Report Document format is

PDF, Text wrapped in a CDAPDF, Text wrapped in a CDAA report can A report can

embed selected images in its PDF format embed selected images in its PDF format include fully resolved hyperlinks (interactively clickable) that include fully resolved hyperlinks (interactively clickable) that

point to the selected imagespoint to the selected imagesImaging Document Source is responsible Imaging Document Source is responsible

for formatting the hyperlink to reference relevant images as for formatting the hyperlink to reference relevant images as a DICOM WADO URI or as IHE RID Request for Documenta DICOM WADO URI or as IHE RID Request for Document

Imaging Document Source is required Imaging Document Source is required

to ensure that image references are valid linksto ensure that image references are valid links

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Linking Report to Complete Set of ImagesLinking Report to Complete Set of Images

Document RepositoryDocument Repository

Document RegistryDocument Registry

Study

Manifest

Report

DocumentEntry

DocumentEntry

SubmissionSet

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Linking Report to Complete Set of ImagesLinking Report to Complete Set of Images



DocumentEntry

SubmissionSet 1

Report

DocumentEntry

SubmissionSet 2

Study

Manifest

34

Linking Report to Prior Images and Prior ReportLinking Report to Prior Images and Prior Report



DocumentEntry

SubmissionSet 3

Prior Study

Manifest

DocumentEntry

SubmissionSet 1

Prior

Report

DocumentEntry

SubmissionSet 2

Report

DocumentEntry

SubmissionSet 4

Study

Manifest

35

Linking Report to Selected ImagesLinking Report to Selected Images


…..

Findings:

Header:


BPD ...…..

Radiology Report

Relevant Image

GestationalAge

...WADO URI

Link to image

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XDS-I MetadataXDS-I Metadata

Radiology specificRadiology specific

Acquisition Modality (e.g. CT, MR)Acquisition Modality (e.g. CT, MR) Anatomic Region (e.g. Arm, Elbow, Hand)Anatomic Region (e.g. Arm, Elbow, Hand) Requested procedure (e.g. MRI Knee with contrast)Requested procedure (e.g. MRI Knee with contrast)

Query example Query example

find all “find all “CT of the HeadCT of the Head” of patient John Doe for the last 2 ” of patient John Doe for the last 2 yearsyears

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Sharing Imaging Documents (XDS-I)Sharing Imaging Documents (XDS-I)

Document Registry

Register report & image references

Retrieve selected imaging report references

Radiologydepartment

patient

Query for re-ports

Documentavailability

Shared repository

Onco-logist

GP(follow-up)

Images, report(PACS, RIS) report

Longitudinal record system: across encounters

Care record sys-tems: specific care deliveryRetrieve

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How to ParticipateHow to Participate

As a User or Vendor Committee MemberAs a User or Vendor Committee Member

Become a member of relevant Domains Planning Become a member of relevant Domains Planning or Technical Committeesor Technical Committees

As a User, Consultant or Vendor Interested As a User, Consultant or Vendor Interested ObserverObserver

Provide Public Comments on Technical Provide Public Comments on Technical Framework SupplementsFramework Supplements

Attend Demonstrations, Educational Events and Attend Demonstrations, Educational Events and WorkshopsWorkshops

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How to Use IHEHow to Use IHE

As a Vendor ImplementerAs a Vendor ImplementerImplement IHE Integration ProfilesImplement IHE Integration Profiles

Test systems through Connectathon processTest systems through Connectathon process

Publish an IHE Integration Statement for productsPublish an IHE Integration Statement for products

As a User Implementer or ConsultantAs a User Implementer or ConsultantUse IHE Integration Profiles to develop Use IHE Integration Profiles to develop interoperability strategyinteroperability strategy

Use Connectathon Results and Integration Use Connectathon Results and Integration Statements to evaluate vendorsStatements to evaluate vendors

Demand IHE Integration Profile compliance in RFPsDemand IHE Integration Profile compliance in RFPs

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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

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More Resources - More Resources - www.www.iheihe.net.net

Frequently Asked QuestionsFrequently Asked Questions

Integration Profiles in Technical Frameworks:Integration Profiles in Technical Frameworks: CardiologyCardiology IT InfrastructureIT Infrastructure LaboratoryLaboratory Patient Care CoordinationPatient Care Coordination Patient Care DevicesPatient Care Devices Radiation OncologyRadiation Oncology RadiologyRadiology

Connectathon ResultsConnectathon Results

Vendor Products Integration StatementsVendor Products Integration Statements

Participation in Committees and ConnectathonsParticipation in Committees and Connectathons

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42September, 2005 What IHE Delivers