IHE – Radiation Oncology

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What is IHE?

• Standards-based,Standards-based,• Global InitiativeGlobal Initiative

generatinggenerating

• Real-world ImplementationsReal-world Implementationsin patient carein patient care

““Defining, testing, and implementing standards-based Defining, testing, and implementing standards-based interoperability for EHR’s”interoperability for EHR’s”

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IHE brings reality to workflow

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IHE Organizational StructureIHE Organizational Structure

Contributing &Participating

Vendors

IHE International Board

Global Development

Radiology

Cardiology

ITInfrastructure

Patient CareCoordination

Patient CareDevices

Laboratory

Eye Care

QualityRadiationOncology

IHE Europe

IHE Americas

France

USA

Canada

IHE Asia-Oceania

Japan

Korea Taiwan

Netherlands

Spain Sweden UK

ItalyGermany

Norway

Regional Deployment

China

ACCACPHIMSSRSNA

JAHISJIRAJRS

METI-MLHWMEDIS-DCJAMI

GMSIHSFRSFIL

SIRMBIREuroRec

COCIREAR-ECRDRG

ESCProfessional Societies / Sponsors

AAOASTRO

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IHE – Standards-Based Integration Solutions IHE – Standards-Based Integration Solutions

Professional Societies Sponsorship Healthcare Providers & Software Developers

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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What are these Standards?

• DICOM (Digital Imaging and Communications in Medicine)DICOM (Digital Imaging and Communications in Medicine)– DICOM is a standard for handling, storing, printing, and transmitting DICOM is a standard for handling, storing, printing, and transmitting

information in information in medical imaging. . – DICOM enables the integration of scanners, servers, workstations, DICOM enables the integration of scanners, servers, workstations,

printers, and network hardware from multiple manufacturers printers, and network hardware from multiple manufacturers – http://medical.nema.orghttp://medical.nema.org

• HL7 (Health Level 7)HL7 (Health Level 7)– HL7 is an international community of healthcare subject matter HL7 is an international community of healthcare subject matter

experts and information scientists collaborating to create standards experts and information scientists collaborating to create standards for the exchange, management and integration of electronic for the exchange, management and integration of electronic healthcare information. healthcare information.

– HL7 promotes the use of such standards within and among HL7 promotes the use of such standards within and among healthcare organizations to increase the effectiveness and healthcare organizations to increase the effectiveness and efficiency of healthcare delivery for the benefit of all. efficiency of healthcare delivery for the benefit of all.

– http://www.HL7.orghttp://www.HL7.org

Parts from http://www.wikipedia.org

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IHE – Domain Sponsors

• Domain Sponsors shall be Member Organizations in the Domain Sponsors shall be Member Organizations in the User Category with no direct or indirect responsibilities in User Category with no direct or indirect responsibilities in the acquisition decision of systems implementing IHE the acquisition decision of systems implementing IHE specified capabilities. Domain Sponsors generally come specified capabilities. Domain Sponsors generally come from Healthcare Professional Organizations (clinical, IT, from Healthcare Professional Organizations (clinical, IT, administrative, public health, etc.) or Governmental administrative, public health, etc.) or Governmental Agencies. In supporting development activities of IHE Agencies. In supporting development activities of IHE International in the domain (or domains) relevant to their International in the domain (or domains) relevant to their membership and mission, they shall adhere to the membership and mission, they shall adhere to the principles of IHE and promote the broad success of the principles of IHE and promote the broad success of the initiative worldwide. initiative worldwide.

• Domain Sponsors take responsibility for development of Domain Sponsors take responsibility for development of IHE Technical Frameworks and associated documents in IHE Technical Frameworks and associated documents in the domain (or domains) relevant to their membership and the domain (or domains) relevant to their membership and mission. mission.

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IHE – Domain Secretary

• Organizing and hosting domain planning and Organizing and hosting domain planning and technical committees composed of volunteer domain technical committees composed of volunteer domain experts and IHE Member representatives. experts and IHE Member representatives.

• Coordinating with the IHE International Sponsors and Coordinating with the IHE International Sponsors and Domain Coordination Committee to publish the work Domain Coordination Committee to publish the work of their domain committees under IHE International of their domain committees under IHE International Copyright; Copyright;

• Providing information for publication about their Providing information for publication about their membership, plans, process and work product (e.g., membership, plans, process and work product (e.g., via the www.ihe.net Website). via the www.ihe.net Website).

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Why is IHE-RO Important?

• ASTRO’s 6-point patient protection planASTRO’s 6-point patient protection plan– 5) Further developing our Integrating the Healthcare Enterprise – 5) Further developing our Integrating the Healthcare Enterprise –

Radiation Oncology (IHE-RO) connectivity compliance program to Radiation Oncology (IHE-RO) connectivity compliance program to ensure that medical technologies from different manufacturers can ensure that medical technologies from different manufacturers can safely transfer information to reduce the chance of a medical error. safely transfer information to reduce the chance of a medical error.

• Promotes discussion and correction of protocols / Promotes discussion and correction of protocols / standards for data communication to improve the reliability standards for data communication to improve the reliability and safety of data exchange in radiation oncologyand safety of data exchange in radiation oncology

• Provides a mechanism for inter-manufacturer testing of Provides a mechanism for inter-manufacturer testing of radiation oncology products prior to deliveryradiation oncology products prior to delivery– Domain Pre-testingDomain Pre-testing– ConnectathonConnectathon

The Connectathon:IHE’s Conformance Testing Process

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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

Products Products with IHEwith IHEProducts Products with IHEwith IHE

IHE IHE DemonstrationsDemonstrationsIHE IHE DemonstrationsDemonstrations

Develop Develop technical technical

specificationsspecifications

Develop Develop technical technical

specificationsspecifications

Proven 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)

Testing at Testing at ConnectathonsConnectathonsTesting at Testing at ConnectathonsConnectathons

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What is a Connectathon?

Cross-vendor, live, supervised, structured testsCross-vendor, live, supervised, structured tests

• All participating vendors’ products tested together in the All participating vendors’ products tested together in the same place/timesame place/time

• Experts from each vendor available for immediate problem Experts from each vendor available for immediate problem resolution… fixes are done in minutes, not months!!resolution… fixes are done in minutes, not months!!

• Each vendor tests with multiple trading partners (actual Each vendor tests with multiple trading partners (actual product to product)product to product)

• Testing of real-world clinical scenarios with IHE Integration Testing of real-world clinical scenarios with IHE Integration ProfilesProfiles

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Connectathon Testing is based on specifications laid out in the Technical Framework

Technical FrameworkTechnical Framework

Part 1Part 1: : Integration Profiles Integration Profiles model the business process model the business process problem (use case) and its problem (use case) and its solution.solution.

Part 2Part 2: : Transactions Transactions define in how current define in how current standards are used to solve standards are used to solve the business problem the business problem defined in the Integrationdefined in the IntegrationProfiles.Profiles.

ConnectathonConnectathon: : Vendors Vendors register to test their product register to test their product as an actor(s) within an as an actor(s) within an Integration ProfileIntegration Profile

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What happens after the Connectathon?

• Successful results (specific by IHE profile/actor) are Successful results (specific by IHE profile/actor) are published by the sponsors published by the sponsors (www.ihe.net/connectahons)(www.ihe.net/connectahons)

• Vendors self-certify, by publishing Vendors self-certify, by publishing IHE Integration IHE Integration StatementsStatements: Precise and explicit public interoperability : Precise and explicit public interoperability commitment fro a specific commercial product.commitment fro a specific commercial product.

• Only vendors who are successful are entitled to participate in Only vendors who are successful are entitled to participate in Interoperability Showcase demonstrations:Interoperability Showcase demonstrations:– HIMSS Annual Conference (February 26HIMSS Annual Conference (February 26thth – March 1 – March 1stst, New Orleans), New Orleans)– ACC Annual Conference (March 24ACC Annual Conference (March 24thth – 27 – 27thth, New Orleans), New Orleans)– Canada e-Health 2007 Conference (May 27Canada e-Health 2007 Conference (May 27 thth – 30 – 30thth, Quebec City), Quebec City)– RSNA Annual Conference (November 25RSNA Annual Conference (November 25thth – 30 – 30thth, Chicago), Chicago)– others…others…

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IHE Integration Statement

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RFPs & Integration Statements

• Be Brief ?Be Brief ?– ““The system must support HL7”The system must support HL7”

• Be Effective ?Be Effective ?– ““The system must support the following HL7 V2 messages The system must support the following HL7 V2 messages

according to the following 100 pages of specifications”according to the following 100 pages of specifications”

• Be Both:Be Both:– ““The system must support IHE Patient Id Cross-reference The system must support IHE Patient Id Cross-reference

as a Patient Identifier Source actor”as a Patient Identifier Source actor”

• Integration StatementIntegration Statement– Version 2.1 of the Enterprise HIS supports IHE Patient Id Version 2.1 of the Enterprise HIS supports IHE Patient Id

Cross-referencing as Patient Identifier Source actorCross-referencing as Patient Identifier Source actor

Requiring vendors to publish their products Requiring vendors to publish their products IHE Integration IHE Integration Statements Statements provide a very effective pressure point provide a very effective pressure point

for market-driven interoperabilityfor market-driven interoperability

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RFP Language (actual example)

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How Does IHE-RO Function?

• Planning CommitteePlanning Committee– Identifies information Identifies information

systems or components of systems or components of information systems that information systems that produce, manage, or act produce, manage, or act on information associated on information associated with clinical and with clinical and operational activities that operational activities that require integration.require integration.

• Technical CommitteeTechnical Committee– Identifies and implements Identifies and implements

standards for interactions standards for interactions between actors that between actors that communicate the required communicate the required information through information through standards-based standards-based messages.messages.

The PC and TC work together to Prioritize Efforts, Propose Solutions, and Eventually Demonstrate Connectivity

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IHE-RO Progress

• ProfilesProfiles– 2007 2007

• Basic InteroperabilityBasic Interoperability

– 20082008• Multi-Modality Image RegistrationMulti-Modality Image Registration

– 20092009• Basic Worklist / Workflow IntegrationBasic Worklist / Workflow Integration

• Advanced InteroperabilityAdvanced Interoperability

– 20102010• Dose CompositingDose Compositing

• Treatment Delivery WorkflowTreatment Delivery Workflow

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Domain Pre-Testing 2006

•25+ participants, 9 Vendors, 10+ systems25+ participants, 9 Vendors, 10+ systems•95+ monitored test cases95+ monitored test cases

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IHE-RO 2007 Formal Connect-a-thon

ASTRO HQ

NucletronNucletron VarianVarianPhilipsPhilips

TomotherapyTomotherapy

ImpacImpac

CMSCMSBrainlabBrainlab

ElektaElekta

Courtesy of ASTRO HQ

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Imaging StudyContouring

System

SimulationSystem

PlanningWorkstation

Rad OncIMS

TreatmentDelivery

TreatmentVerification

IHE-RO 2007 (Basic Interoperability)

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Imaging StudiesContouring

System

SimulationSystem

PlanningWorkstation

Rad OncIMS

TreatmentDelivery

TreatmentVerification

IHE-RO 2008 (Image Registration)

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Imaging StudyContouring

System

SimulationSystem

PlanningWorkstation

Rad OncIMS

TreatmentDelivery

TreatmentVerification

IHE-RO 2009 (Modality Worklist)

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Where can you learn more?

http://wiki.ihe.net

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Where can you learn more?

http://www.ihe.net