September, 2005 What IHE Delivers

Andrew M. Keller, MD, FACC, FASE, FACPAndrew M. Keller, MD, FACC, FASE, FACP

Chief of Cardiology, Danbury HospitalChief of Cardiology, Danbury Hospital

Danbury, CT, USADanbury, CT, USA

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

IIHE: Meeting Global needs HE: Meeting Global needs for Integrated Healthcarefor Integrated HealthcareJapanese Circulation Society (JCS)Japanese Circulation Society (JCS)

Kobe, JapanKobe, JapanMarch 16March 16thth, 2007, 2007

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Thank you for the opportunity to beThank you for the opportunity to beat the Japanese Circulation Societyat the Japanese Circulation Society

Scientific Sessions.Scientific Sessions.

IHE Cardiology:IHE Cardiology:

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Integrate Clinical InformationIntegrate Clinical Information

Goal: optimal patient careGoal: optimal patient care

To attain optimal patient care, we need clinical To attain optimal patient care, we need clinical informationinformation When we need it Wherever we need it In a meaningful manner Without repeating tests (time and money) Originating from many different locations Cardiology data is especially complex

Proper integration of clinical information means Proper integration of clinical information means better patient care.better patient care.

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Integrated Clinical InformationIntegrated Clinical Information

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Information from many placesInformation from many places

HospitalHospital

HomeHome

Doctor’s officeDoctor’s office

Extended CareExtended Care

Data pointersData pointers

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Information is difficult to integrate!Information is difficult to integrate!

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How can we integrate these system?How can we integrate these system?

Today, at least in U.S. and Europe, each two Today, at least in U.S. and Europe, each two systems that are connected are an “IT integration systems that are connected are an “IT integration project”.project”. Very expensive Very time consuming Very resource intensive Never works quite right Usually involves third party Do not attempt to upgrade software on either system

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How to integrate?How to integrate?

Instead, use standards: DICOM HL7 XML

Define use of standards in Technical Framework

Have common testing plan

Vendors implement Technical Framework in products

Allow vendors to work together, before it gets to our hospitals

An integrated product…An integrated product…

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IHE is formedIHE is formed

IHE is a consortium of professional societies and vendors working together to facilitate the integration of healthcare information 1997: IHE Radiology established; sponsored by RSNA 2000: First European Connectathon 2003: IHE Cardiology established; sponsored by ACC 2004: ESC joins IHE Cardiology 2007: IHE International formalized 2007: We are excited to have JCS join IHE Cardiology

in expanding support to Asia

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Global SupportGlobal Support

“I am convinced that IHE is the best possible pathway to the true integrated patient record and all of the benefits that are associated with it.”

-Ruediger Simon, MD, FESC, FACC

Chief of Cardiology

University of Kiel

Kiel, Germany

IHE-Europe Co-Chair

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Growth in IHE DomainsGrowth in IHE Domains

Radiology (18)

IT Infrastructure for Healthcare (17)

Cardiology (7)

Laboratory (6)

Radiation Oncology (1)

Patient Care Coordination (5)

Patient Care Devices (1)

Quality

Eye Care (3)

Veterinary

Endoscopy

Pathology

Pharmacy

IHE Global DevelopmentsIHE Global DevelopmentsIntegration Profiles (# X) – Solutions to Real-World Interoperability Integration Profiles (# X) – Solutions to Real-World Interoperability

Needs & Problems:Needs & Problems:

Within Clinical Departments e.g.:Within Clinical Departments e.g.:RadiologyRadiologyCardiologyCardiologyLabLab ......

Across Departmental &Across Departmental &Institutional Boundaries – XDSInstitutional Boundaries – XDS

RHIOsRHIOs (Regional Healthcare Information Organizations) (Regional Healthcare Information Organizations)

EHR EnablersEHR Enablers

Yea

r 1

(199

9)

Yea

r 2

(200

0)

Yea

r 3

(200

1)

Yea

r 4

(200

2)

Yea

r 5

(200

3)

Yea

r 6

(200

4)

Yea

r 7

(200

5)

Yea

r 8

(200

6)

Yea

r 9

(200

7)

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Proven Standards Adoption ProcessProven Standards Adoption Process

Document Use Document Use Case Case RequirementsRequirements

Document Use Document Use Case Case RequirementsRequirements

Identify available Identify available standards (standards (e.g. HL7, e.g. HL7, DICOM, IETF, OASIS)DICOM, IETF, OASIS)

Identify available Identify available standards (standards (e.g. HL7, e.g. HL7, DICOM, IETF, OASIS)DICOM, IETF, OASIS)

Develop Develop technical technical

specificationsspecifications

Develop Develop technical technical

specificationsspecifications

Testing at Testing at ConnectathonsConnectathonsTesting at Testing at ConnectathonsConnectathons

IHE IHE DemonstrationsDemonstrationsIHE IHE DemonstrationsDemonstrations

Products Products with IHEwith IHEProducts Products with IHEwith IHE

Timely access to Timely access to informationinformationTimely access to Timely access to informationinformation

Easy to integrate Easy to integrate productsproductsEasy to integrate Easy to integrate productsproducts

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IHE Cardiology Profiles (9)IHE Cardiology Profiles (9)

Cath Lab WorkflowCath Lab Workflow Echocardiography WorkflowEchocardiography Workflow Retrieve ECG for DisplayRetrieve ECG for Display

Echocardiography Measurement

Patient: Doe, John Technologist: der Payd, N

Measurements:

Mitral valve diameter 3.1cm

- shown in image at [ ]

Ventricular length, diastolic 5.97 cm

- shown in image at [ ]

Ventricular volume, diastolic 14.1 ml

- inferred from [ ]

- inferred from VLZ algorithm

Evidence Documents (Measurements)Evidence Documents (Measurements)

Displayable ReportsDisplayable Reports

Cross-Enterprise Document Cross-Enterprise Document Sharing (EHR to EHR)Sharing (EHR to EHR)

Stress Testing WorkflowStress Testing Workflow Nuclear MedicineNuclear MedicineImplantable CardiacImplantable CardiacDevice ObservationDevice Observation

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Cath Lab Integration Cath Lab Integration

One patient; one order; one procedure; consistent time stampsOne patient; one order; one procedure; consistent time stamps

Procedure LogProcedure Log

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Stress Echo IntegrationStress Echo Integration

Views defined; stages definedViews defined; stages definedConsistent display of different vendor stress examsConsistent display of different vendor stress exams

Toshiba AplioToshiba Aplio(or Philips or GE)(or Philips or GE)

Goodman Goodman PACS (or 5PACS (or 5other vendors)other vendors)

viewsviewsstagesstages

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Stress testing integrationStress testing integration

One patient; one order; one procedure across systems;One patient; one order; one procedure across systems;Consistently defined Protocols and stagesConsistently defined Protocols and stages

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Brigham and Women’s HospitalBrigham and Women’s Hospital

Patient infoPatient infoand ordersand orders

Philips Allura x6Philips Allura x6

Witt hemo x6Witt hemo x6

Patient info,Patient info,Order, schedule,Order, schedule,and procedure statusand procedure status

Secure Secure StorageStorage

Cath Workflow Profile:Cath Workflow Profile:

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Brigham and Women’s HospitalBrigham and Women’s Hospital

Realized Benefits at Brigham:Realized Benefits at Brigham:• Accurate and automated patient demographics • Happier technologists (less busy work –typing)• Fewer interruptions for Cath Lab Flow Manager (procedure status and cancellations) • Faster room turn around time• Better communication between cath lab teams• Improved efficiency of billing• Providing data to be able to optimize resource utilization• It works!

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Integration benefitsIntegration benefits

For users across the healthcare enterprise, IHE: allows faster access to information, reduces errors, streamlines workflow, simplifies interface projects, optimizes resource utilization.

Spend time with patients; not chasing information.Spend time with patients; not chasing information.

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Working together with JCSWorking together with JCS

How can IHE Cardiology and IHE-Japan work together more closely: Visit the IHE Interoperability Workshop at ACC.07 if you are

attending (booth #2251) Understand differences in clinical workflow in Japan Encourage additional direct involvement in the Planning

Committee Web-ex/tcon in May, 2007, to explain new Year 4 Profiles

and gain direct feedback Direct involvement in annual IHE Cardiology prioritization

process for new Profiles (usually August/September timeframe)

Bi-annual joint tcons at mutually agreed upon times

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More Resources - More Resources - www.ihe.netwww.ihe.net www.ihe-j.orgwww.ihe-j.org

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

September, 2005 What IHE Delivers