September, 2005 What IHE Delivers

Introduction to IHEIntroduction to IHE

ACCA IHE Workshop 2007ACCA IHE Workshop 2007Jon Elion MD, FACCJon Elion MD, FACC

Associate Professor of Medicine, Brown UniversityAssociate Professor of Medicine, Brown University

Co-Chair, IHE-Cardiology Planning CommitteeCo-Chair, IHE-Cardiology Planning Committee

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Overview of Today’s WorkshopOverview of Today’s Workshop

Introduction to IHEIntroduction to IHE

Review of Profiles Part 1:Review of Profiles Part 1: Cardiology Workflows: Cath, Echo StressCardiology Workflows: Cath, Echo Stress Content Display Requirements: Stress Echo, StressContent Display Requirements: Stress Echo, Stress

BreakBreak

Review of Profiles Part 2:Review of Profiles Part 2: ECG for DisplayECG for Display Nuclear CardiologyNuclear Cardiology Implantable Device Cardiac ObservationsImplantable Device Cardiac Observations Displayable reports (status updates)Displayable reports (status updates) XDS and related profilesXDS and related profiles IHE’s Relationship to government initiatives.IHE’s Relationship to government initiatives.

Interactive RFP SessionInteractive RFP Session

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Why Standards Are ImportantWhy Standards Are Important

Bernstein Heisler

Thomson-Houston(arc current)

Municipal Edison Municipal Bernstein

Thomson-Houston(alternating current)

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IHEIHE

• … … is an initiative by healthcare professionals is an initiative by healthcare professionals and industry to improve the way computer and industry to improve the way computer systems in healthcare share informationsystems in healthcare share information

• … … promotes the coordinated use of promotes the coordinated use of established standards such as DICOM and HL7 established standards such as DICOM and HL7 to address specific clinical needs to address specific clinical needs

• … … leads to systems that communicate better, leads to systems that communicate better, are easier to implement, and enable care are easier to implement, and enable care providers to use information more effectivelyproviders to use information more effectively

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Goals of IHEGoals of IHE

• Speed up the rate and quality of integration in Speed up the rate and quality of integration in healthcare environments healthcare environments

• Foster communication among vendors and Foster communication among vendors and care providers care providers

• Improve the efficiency and effectiveness of Improve the efficiency and effectiveness of clinical practiceclinical practice

• Improve interoperability among care domains Improve interoperability among care domains and build foundation for the EHRand build foundation for the EHR

• Integration solutions within the healthcare Integration solutions within the healthcare enterprise and across healthcare enterprisesenterprise and across healthcare enterprises

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Who is IHE?Who is IHE?

IHE is a joint initiative among:IHE is a joint initiative among: American College of Cardiology (ACC), Echocardiography (ASE)American College of Cardiology (ACC), Echocardiography (ASE) American College of PhysiciansAmerican College of Physicians Radiological Society of North America (RSNA)Radiological Society of North America (RSNA) Healthcare Information Management Systems Society (HIMSS)Healthcare Information Management Systems Society (HIMSS) GMSIH, HPRIM, JAHIS (laboratory)GMSIH, HPRIM, JAHIS (laboratory) American Society of OphthalmologyAmerican Society of Ophthalmology And many more….And many more….

Began in 1997 in Radiology (RSNA) and IT (HIMSS)Began in 1997 in Radiology (RSNA) and IT (HIMSS)

International effort: IHE- Europe and IHE-JapanInternational effort: IHE- Europe and IHE-Japan

Additional sponsors for Cardiology including ASE, ESC, Additional sponsors for Cardiology including ASE, ESC, ASNC, SCA&I, HRS and moreASNC, SCA&I, HRS and more

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IHE ParticipantsIHE Participants

• Societies Representing Healthcare Segments:Societies Representing Healthcare Segments: RSNA, HIMSS, ACC, ASE, ACP…RSNA, HIMSS, ACC, ASE, ACP…

• Users:Users: Clinicians, Medical Staff, Administrators, Clinicians, Medical Staff, Administrators, CIOs, …CIOs, …

• ConsultantsConsultants

• Imaging and Information Systems VendorsImaging and Information Systems Vendors

• Standards Development Organizations:Standards Development Organizations: DICOM, DICOM, HL7, ASTM, …HL7, ASTM, …

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IHE DeliverablesIHE Deliverables

• Venue for communication (committees)Venue for communication (committees)

• Integration Profiles (what needs to be done)Integration Profiles (what needs to be done)

• Technical Framework (how to do it)Technical Framework (how to do it)

• Connect-a-thon (actually do it!)Connect-a-thon (actually do it!)

• Public Demonstrations (example: ACC ’07 for Public Demonstrations (example: ACC ’07 for Cardiology)Cardiology)

• Tools for Acquiring Conformant Products (RFP’s)Tools for Acquiring Conformant Products (RFP’s)

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Standards-Based Integration Standards-Based Integration Standards-Based Integration Standards-Based Integration

Professional Societies Sponsorship Healthcare Providers & Vendors

Healthcare IT Standards HL7, DICOM, etc.

General IT Standards Internet, ISO, etc.

Interoperable Healthcare IT Solution Specifications

IHE Integration Profile Interoperable Healthcare IT

Solution Specifications IHE Integration Profile

Interoperable Healthcare IT Solution Specifications

IHE Integration Profile Interoperable Healthcare IT

Solution Specifications IHE Integration Profile

IHE Process

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IHE Organizational StructureIHE Organizational StructureIHE Organizational StructureIHE Organizational Structure

Participants

contribute

Global Development:Radiology,IT Infrastructure,Cardiology,Laboratory,Eye Care,Patient Care CoordinationPatient Care Devices

Delegates

IHE Europe

IHE North America

IHE Asia/Oceania

Regional &NationalDeployment

supervises reports

IHE (International) Strategic Development Committee

SponsorCo-Chairs

Global

Interoperability

IHE Domain-related Planning and

Technical Committees

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Standards Adoption ProcessStandards Adoption Process

IHEIntegration

Profiles

Easy toIntegrateProducts

IHEIHEDemonstrationDemonstration

User Site

RFPRFP

StandardsStandards

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/vendor agreed solutionsA growing set of effective provider/vendor 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

IHEIHEConnect-a-thonConnect-a-thon

ProductWith IHE

IHE Connect-a-thonResults

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What is IHE NOTWhat is IHE NOT• IHE is not a standardIHE is not a standard

You You conformconform to a standard to a standard You You complycomply with IHE Technical Framework with IHE Technical Framework

• IHE is not a standards development organizationIHE is not a standards development organization

• IHE is not a certifying authorityIHE is not a certifying authority

• IHE is not simply a demonstration projectIHE is not simply a demonstration project

Demos are only one means to the end: Demos are only one means to the end: AdoptionAdoption Backed up by documentation, tools, testing, and Backed up by documentation, tools, testing, and

publication of informationpublication of information• IHE is not just for radiology any more!IHE is not just for radiology any more!

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IHE Annual Cycle IHE Annual Cycle

1.1. Clinicians identify clinical problems to be Clinicians identify clinical problems to be addressed -“Integration Profiles”addressed -“Integration Profiles”

2.2. Engineers from vendors collaborate to define Engineers from vendors collaborate to define technical specification (using existing standards technical specification (using existing standards such as DICOM and HL7)such as DICOM and HL7)

3.3. Vendors implement the technical specification Vendors implement the technical specification and participate in the “Connectathon”and participate in the “Connectathon”

4.4. Demonstrations at trade shows (ACC, HIMSS, Demonstrations at trade shows (ACC, HIMSS, etc.)etc.)

5.5. Vendors publish Vendors publish IHE Integration StatementsIHE Integration Statements

6.6. Customers reference IHE profiles in RFP’s Customers reference IHE profiles in RFP’s

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Cardiology Example (Year 1)Cardiology Example (Year 1)

The Planning Committee identified three initial clinical The Planning Committee identified three initial clinical problems to be addressed:problems to be addressed:

1.1. The ability to view an ECG from many The ability to view an ECG from many locations - quickly and easilylocations - quickly and easily

2.2. Lab systems integration of patient, order, and Lab systems integration of patient, order, and procedure information in an Echo Lab, procedure information in an Echo Lab, including mobile echoincluding mobile echo

3.3. Lab systems integration of patient, order, and Lab systems integration of patient, order, and procedure information in a Cath Lab, including procedure information in a Cath Lab, including angio, hemo, and IVUSangio, hemo, and IVUS

► “Retrieve ECG for Display”

► “Echocardiography Workflow”

► “Cardiac Catheterization Workflow”

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IHE Annual Cycle IHE Annual Cycle

1.1. Clinicians identify clinical problems to be Clinicians identify clinical problems to be addressed -“Integration Profiles”addressed -“Integration Profiles”

2.2. Engineers from vendors collaborate to define Engineers from vendors collaborate to define technical specification (using existing standards technical specification (using existing standards such as DICOM and HL7)such as DICOM and HL7)

3.3. Vendors implement the technical specification Vendors implement the technical specification and participate in the “Connectathon”and participate in the “Connectathon”

4.4. Demonstrations at trade shows (ACC, HIMSS, Demonstrations at trade shows (ACC, HIMSS, etc.)etc.)

5.5. Vendors publish Vendors publish IHE Integration StatementsIHE Integration Statements

6.6. Customers reference IHE profiles in RFP’sCustomers reference IHE profiles in RFP’s

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IHE Technical FrameworksIHE Technical Frameworks

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

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 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]

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

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

Order Placer

Acquisition Modality

ImageManager

ImageArchive

DSS/ Order Filler

Patient Update [RAD-12]

Modality Image/Evidence Stored [CARD-2]

Storage Commitment

[CARD-3]

Evidence Creator Modality PS in Progress [CARD-1]

Modality PS Completed [RAD-7]

Instance Availability Notification [RAD-49]

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

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 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]

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

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

Order Placer

Acquisition Modality

ImageManager

ImageArchive

DSS/ Order Filler

Patient Update [RAD-12]

Modality Image/Evidence Stored [CARD-2]

Storage Commitment

[CARD-3]

Evidence Creator Modality PS in Progress [CARD-1]

Modality PS Completed [RAD-7]

Instance Availability Notification [RAD-49]

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]

Modality Procedure Step In Progress [CARD-1]

Perform Acquisition

Filler Order Mgmt - Status Update [RAD-3]

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

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]

Modality Procedure Step In Progress [CARD-1]

Perform Acquisition

Filler Order Mgmt - Status Update [RAD-3]

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

Detailed standards implementation guides:

CardiologyIT InfrastructureLabRadiologyEye CarePatient Care CoordinationPatient Care Devices

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Organization of FrameworksOrganization of Frameworks

Volume 1: Integration ProfilesVolume 1: Integration Profiles

Describes clinical need and use casesDescribes clinical need and use cases Identifies the actors and transactionsIdentifies the actors and transactions

Volume 2+ of Technical FrameworkVolume 2+ of Technical Framework

Provides implementation specification for Provides implementation specification for each transaction by specific reference to each transaction by specific reference to StandardsStandards

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Transactions & Actors: ExampleTransactions & Actors: Example

Encapsulated Report Retrieve [CARD-11]

Encapsulated Report

Report Repository

ReportManager

Enterprise Report

Repository

Encapsulated Report QueryEncapsulated Report Retrieve

Report Reader

Report Creator

Encapsulated Report

Storage Commitment

Retrieve Document for Display

InformationSource

Report Reference

Web DisplayPatient

Demographics Source

Patient Identity Feed Patient Demographics

Consumer

Dept Scheduler /Order Filler

Encapsulated Report or

Report Completion Notify

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IHE Annual Cycle IHE Annual Cycle

1.1. Clinicians identify clinical problems to be Clinicians identify clinical problems to be addressed -“Integration Profiles”addressed -“Integration Profiles”

2.2. Engineers from vendors collaborate to define Engineers from vendors collaborate to define technical specification (using existing standards technical specification (using existing standards such as DICOM and HL7)such as DICOM and HL7)

3.3. Vendors implement the technical specification Vendors implement the technical specification and participate in the “Connectathon”and participate in the “Connectathon”

4.4. Demonstrations at trade shows (ACC, HIMSS, Demonstrations at trade shows (ACC, HIMSS, etc.)etc.)

5.5. Vendors publish Vendors publish IHE Integration StatementsIHE Integration Statements

6.6. Customers reference IHE profiles in RFP’sCustomers reference IHE profiles in RFP’s

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IHE ConnectathonIHE Connectathon

• Open invitation to vendor communityOpen invitation to vendor community

• Advance testing tools (MESA)Advance testing tools (MESA)

• Testing organized and supervised by project Testing organized and supervised by project management teammanagement team

• Thousands of cross-vendor tests performedThousands of cross-vendor tests performed

• Results recorded and publishedResults recorded and published

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IHE Connectathon, January 2007IHE Connectathon, January 2007165 systems from 79 vendors, 3500 monitored test cases165 systems from 79 vendors, 3500 monitored test cases

Workflow: Cath (22) and Echo (20)Workflow: Cath (22) and Echo (20)Evidence Documents (measurement interchange): 13Evidence Documents (measurement interchange): 13Nuclear Cardiology: 12Nuclear Cardiology: 12Stress Testing Workflow: 15Stress Testing Workflow: 15Retrieve ECG for Display: 5Retrieve ECG for Display: 5Cross Enterprise Document Sharing (XDS): 45 Cross Enterprise Document Sharing (XDS): 45

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IHE ConnectathonIHE Connectathon

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Looks like it’s working

just fine!

Egad! They’ve totally misunderstood the

Technical Framework!

Ohmagawd – we’re next!

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IHE Annual Cycle IHE Annual Cycle

1.1. Clinicians identify clinical problems to be Clinicians identify clinical problems to be addressed -“Integration Profiles”addressed -“Integration Profiles”

2.2. Engineers from vendors collaborate to define Engineers from vendors collaborate to define technical specification (using existing standards technical specification (using existing standards such as DICOM and HL7)such as DICOM and HL7)

3.3. Vendors implement the technical specification Vendors implement the technical specification and participate in the “Connectathon”and participate in the “Connectathon”

4.4. Demonstrations at trade shows (ACC, HIMSS, Demonstrations at trade shows (ACC, HIMSS, etc.)etc.)

5.5. Vendors publish Vendors publish IHE Integration StatementsIHE Integration Statements

6.6. Customers reference IHE profiles in RFP’s Customers reference IHE profiles in RFP’s

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Total ACC attendance is typically over 28,000.Total ACC attendance is typically over 28,000.

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2005: Over 1,000 visitors from 47 countries attended2005: Over 1,000 visitors from 47 countries attended the IHE presentations and demonstrations. the IHE presentations and demonstrations.

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IHE Annual Cycle IHE Annual Cycle

1.1. Clinicians identify clinical problems to be Clinicians identify clinical problems to be addressed -“Integration Profiles”addressed -“Integration Profiles”

2.2. Engineers from vendors collaborate to define Engineers from vendors collaborate to define technical specification (using existing standards technical specification (using existing standards such as DICOM and HL7)such as DICOM and HL7)

3.3. Vendors implement the technical specification Vendors implement the technical specification and participate in the “Connectathon”and participate in the “Connectathon”

4.4. Demonstrations at trade shows (ACC, HIMSS, Demonstrations at trade shows (ACC, HIMSS, etc.)etc.)

5.5. Vendors publish Vendors publish IHE Integration StatementsIHE Integration Statements

6.6. Customers reference IHE profiles in RFP’sCustomers reference IHE profiles in RFP’s

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IHE Integration StatementIHE Integration Statement

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IHE Annual Cycle IHE Annual Cycle

1.1. Clinicians identify clinical problems to be Clinicians identify clinical problems to be addressed -“Integration Profiles”addressed -“Integration Profiles”

2.2. Engineers from vendors collaborate to define Engineers from vendors collaborate to define technical specification (using existing standards technical specification (using existing standards such as DICOM and HL7)such as DICOM and HL7)

3.3. Vendors implement the technical specification Vendors implement the technical specification and participate in the “Connectathon”and participate in the “Connectathon”

4.4. Demonstrations at trade shows (ACC, HIMSS, Demonstrations at trade shows (ACC, HIMSS, etc.)etc.)

5.5. Vendors publish Vendors publish IHE Integration StatementsIHE Integration Statements

6.6. Customers reference IHE profiles in RFP’s Customers reference IHE profiles in RFP’s

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RFPs & IHE IntegrationRFPs & IHE Integration• Be Brief:Be Brief:

““The system must support DICOM”The system must support DICOM”• Be Effective:Be Effective:

““The system must support the following DICOM The system must support the following DICOM services (see following 100 pages of specs)”services (see following 100 pages of specs)”

• Be Both:Be Both:

““The system must support IHE Scheduled The system must support IHE Scheduled Workflow as an Acquisition Modality”Workflow as an Acquisition Modality”

• IHE Integration Statements:IHE Integration Statements:

““Version 2.1 of the Acme RoadRunner Trap Version 2.1 of the Acme RoadRunner Trap supports IHE Scheduled Workflow as an supports IHE Scheduled Workflow as an Acquisition Modality”Acquisition Modality”

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Request for Proposals (RFPs)Request for Proposals (RFPs)

Incorporate IHE framework into RFP documents Incorporate IHE framework into RFP documents & product selection& product selection

Much easier to specify an IHE Integration Profile Much easier to specify an IHE Integration Profile than detailed technical specsthan detailed technical specs

““Device must support IHE Echo Integration Device must support IHE Echo Integration Profile, and vendor must supply an IHE Profile, and vendor must supply an IHE Integration Statement.”Integration Statement.”

Use IHE framework to evaluate your current Use IHE framework to evaluate your current workflow, even if not buying now workflow, even if not buying now

Vendors build product functions that are Vendors build product functions that are requested by customersrequested by customers

Ask for IHE Integration Loud & Often !!

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