IntegratingIntegratingthe the

Healthcare EnterpriseHealthcare Enterprise

IHE 2003:IHE 2003:Meeting Clinical Goals and Technical Meeting Clinical Goals and Technical

ChallengesChallenges

HIMSS 2003

Authors & PresentersAuthors & PresentersPaul Vegoda, FHIMSSPaul Vegoda, FHIMSS

Malvern GroupMalvern GroupIHE Strategic Development CommitteeIHE Strategic Development Committee

Kevin O’DonnellKevin O’DonnellToshiba America, Inc.Toshiba America, Inc.

IHE Planning Committee Co-chairIHE Planning Committee Co-chair

David S. Channin, MD CPHIMSDavid S. Channin, MD CPHIMSNorthwestern UniversityNorthwestern University

IHE Strategic Development CommitteeIHE Strategic Development Committee

HIMSS 2003

The ProblemThe Problem

Poor Information System Support for Poor Information System Support for Healthcare DeliveryHealthcare Delivery

– Information not available when and where Information not available when and where needed for medical, research, education or needed for medical, research, education or administrative decision supportadministrative decision support

– Errors, both manual and electronicErrors, both manual and electronic– InefficientInefficient– Paper based and cloggedPaper based and clogged

HIMSS 2003

Why is IHE needed?Why is IHE needed?

• Serious Integration Challenges in Healthcare:Serious Integration Challenges in Healthcare:

• Systems need Information other systems haveSystems need Information other systems have

• But, systems communicate poorly or not at all But, systems communicate poorly or not at all

• Result: - tedious, inefficient workflows Result: - tedious, inefficient workflows - data that is redundant, inconsistent or unavailable - data that is redundant, inconsistent or unavailable

Responsibility for information flow between systems, Responsibility for information flow between systems, and between departments, is often unclear.and between departments, is often unclear.

HIMSS 2003

A CIO’s dreamA CIO’s dream

• A fully integrated healthcare information systemA fully integrated healthcare information system– Best of breed systems working together to facilitate Best of breed systems working together to facilitate

efficient workflowefficient workflow

• Documented iDocumented improvement of efficiency and mprovement of efficiency and quality of delivered carequality of delivered care

• Easy to deploy and manageEasy to deploy and manage

• Good, fast and cheap (pick two)Good, fast and cheap (pick two)

HIMSS 2003

What my CIO sees:

120 Server Systems62 point to pointHL7 connections•includes 3 to PACS

Dreams of ‘Best of Breed’?!

PACS

RIS

HIMSS 2003

What some would like to see:

Dreams of ‘Single Vendor’‘Mangy Mutt’

HIMSS 2003

Alas….Alas….

  Best of Breed vs. IntegratedBest of Breed vs. Integrated

… “… “tis a consummation devoutly to be tis a consummation devoutly to be wished.”wished.”

Will Shakespeare, HamletWill Shakespeare, Hamlet

HIMSS 2003

Then suddenly…Then suddenly…

  

““What light from yonder window What light from yonder window breaks?”breaks?”

Will Shakespeare, Romeo and JulietWill Shakespeare, Romeo and Juliet

It is IHE! It is IHE!

HIMSS 2003

What is IHE?What is IHE?

IHE is an IHE is an initiativeinitiative to speed the to speed the integrationintegration of information systems in the of information systems in the healthcarehealthcare

enterpriseenterprise to achieve better workflow to achieve better workflow

HIMSS 2003

Goals of IHEGoals of IHE

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

• Foster communication among vendors Foster communication among vendors

• Prove that integration is attainable Prove that integration is attainable based on standardsbased on standards

HIMSS 2003

IHE Penetration in RadiologyIHE Penetration in Radiology

• Now entering Year 5!!Now entering Year 5!!• 50+ vendors worldwide50+ vendors worldwide• 100+ systems in annual Connectathons100+ systems in annual Connectathons• Geographic spreadGeographic spread

– U.S., France, Germany, Japan, Italy, U.K.U.S., France, Germany, Japan, Italy, U.K.

HIMSS 2003

IHE Expansion into New AreasIHE Expansion into New Areas

• New IT Infrastructure Committee FormedNew IT Infrastructure Committee Formed– (EMPI, Query-Display, Synchronized Patient (EMPI, Query-Display, Synchronized Patient

Views, and Advanced Security)Views, and Advanced Security)

• Cardiology Group forming in March (ACC)Cardiology Group forming in March (ACC)

• Work progressing in:Work progressing in:– LabLab– Pharmacy/Medication ManagementPharmacy/Medication Management

HIMSS 2003

IHE ParticipantsIHE Participants• Societies Representing Healthcare SegmentsSocieties Representing Healthcare Segments

– ( RSNA, HIMSS, ACC, … )( RSNA, HIMSS, ACC, … )

• UsersUsers– ( Clinicians, Medical Staff, Administrators, CIOs, … )( Clinicians, Medical Staff, Administrators, CIOs, … )

• Information Systems VendorsInformation Systems Vendors• Imaging Systems VendorsImaging Systems Vendors• Standards Development Organizations (SDOs)Standards Development Organizations (SDOs)

– DICOMDICOM– HL7HL7– Others …Others …

HIMSS 2003

Benefits to IHE ParticipantsBenefits to IHE Participants• CliniciansClinicians

– Improved workflowImproved workflow– Information when and where neededInformation when and where needed– Fewer opportunities for errorsFewer opportunities for errors– Fewer tedious tasks/repeated workFewer tedious tasks/repeated work

• AdministratorsAdministrators– Improved efficiencyImproved efficiency– Best of breed opportunitiesBest of breed opportunities– Decreased cost and complexity of interface Decreased cost and complexity of interface

deployment and managementdeployment and management

HIMSS 2003

Benefits to IHE ParticipantsBenefits to IHE Participants• VendorsVendors

– Decreased cost and complexity of interface Decreased cost and complexity of interface installation and managementinstallation and management

– Validation of integration at ConnectathonValidation of integration at Connectathon– Focus competition on functionality/service Focus competition on functionality/service

space not information transport spacespace not information transport space

• SDOsSDOs– Rapid feedback to adjust standards to real-Rapid feedback to adjust standards to real-

worldworld

HIMSS 2003

IHE ProcessIHE Process• Users and vendors work together to identify Users and vendors work together to identify

and design solutions for integration problemsand design solutions for integration problems

• Intensive process with Intensive process with annual cyclesannual cycles::– Identify key healthcare workflows and integration Identify key healthcare workflows and integration

problemsproblems– Research & select standards to specify a solutionResearch & select standards to specify a solution– Write, review and publish IHE Technical FrameworkWrite, review and publish IHE Technical Framework– Perform cross-testing at “Connectathon”Perform cross-testing at “Connectathon”– Demonstrations at tradeshows (HIMSS/RSNA/…)Demonstrations at tradeshows (HIMSS/RSNA/…)

HIMSS 2003

IHE DeliverablesIHE Deliverables

1.1. Venues for discussion between users and vendorsVenues for discussion between users and vendors

2.2. Common vocabulary; Common view of the world Common vocabulary; Common view of the world based on:based on:

– HL7 and DICOM Model of the real worldHL7 and DICOM Model of the real world– Pieces of information Pieces of information and their meaningand their meaning

3.3. Technical Framework - Technical Framework - INTEGRATION PROFILESINTEGRATION PROFILES– ACTORSACTORS in Roles performing in Roles performing TRANSACTIONSTRANSACTIONS to to

accomplish accomplish Specific ProcessesSpecific Processes

4.4. Connect-a-thonConnect-a-thon

5.5. Public Demonstrations / Education ExhibitsPublic Demonstrations / Education Exhibits

HIMSS 2003

IHE Concepts and IHE Concepts and VocabularyVocabulary

• ActorsActors• TransactionsTransactions• Integration ProfilesIntegration Profiles

HIMSS 2003

ActorsActors

• Represent a role performed by a systemRepresent a role performed by a system• Collect a subset of related responsibilities Collect a subset of related responsibilities 

Examples:Examples:– Order PlacerOrder Placer– Order FillerOrder Filler– Acquisition ModalityAcquisition Modality– Image DisplayImage Display– Report CreatorReport Creator

HIMSS 2003

TransactionsTransactions

• Unambiguously defines how several Unambiguously defines how several actors communicateactors communicate

• Using existing standards such as HL7 Using existing standards such as HL7 or DICOM to accomplish a specific task.or DICOM to accomplish a specific task.

Examples: Examples: – Procedure ScheduledProcedure Scheduled– Modality Worklist ProvidedModality Worklist Provided

HIMSS 2003

Integration ProfilesIntegration ProfilesIHE Integration Profiles define a collection of IHE Integration Profiles define a collection of

real world functionality and group together real world functionality and group together the necessary Actors and Transactions to the necessary Actors and Transactions to make it work.make it work.

• Examples: Examples: – Scheduled WorkflowScheduled Workflow– Patient Information ReconciliationPatient Information Reconciliation– Presentation of Grouped ProceduresPresentation of Grouped Procedures

HIMSS 2003

IHE Technical FrameworkIHE Technical Framework• Defines enterprise Integration ProfilesDefines enterprise Integration Profiles• Defines <Defines <preciselyprecisely> what to do to support > what to do to support

the Integration Profilesthe Integration Profiles• 3 volumes, 450+ pages3 volumes, 450+ pages• Version controlledVersion controlled

– 5.4 is latest revision (5.4 is latest revision (www.rsna.org/IHEwww.rsna.org/IHE))

• May be incorporated by reference into May be incorporated by reference into contract documentscontract documents

HIMSS 2003

The Annual “Connectathon”The Annual “Connectathon”

Unprecedented Cross-Vendor TestingUnprecedented Cross-Vendor TestingVoluntary ParticipationVoluntary ParticipationNeither a Demo nor a CertificationNeither a Demo nor a CertificationWell Designed End-to-End ScenariosWell Designed End-to-End ScenariosAdvanced Testing ToolsAdvanced Testing ToolsUnprecedented Pool of Technical TalentUnprecedented Pool of Technical Talent

HIMSS 2003

Public Demonstrations / Public Demonstrations / Education ExhibitsEducation Exhibits

• RSNA Annual Meeting (November)RSNA Annual Meeting (November)

• HIMSS Annual Meeting (Here and NOW!!)HIMSS Annual Meeting (Here and NOW!!)– Check your program books for a large number Check your program books for a large number

of IHE related presentations and exhibitsof IHE related presentations and exhibits

HIMSS 2003

IHE Integration ProfilesIHE Integration Profiles

Access to Radiology InformationRetrieve & view images and reports

Consistent Presentation of Images

Hardcopy and softcopy grayscale presentation state

Key ImageNotes

Flag & search for significant images

Simple Image and Numeric Reports

Simple reports with image links and measurements

Basic SecurityAudit Trail Consolidation & Node Authentication

Presentation of Grouped Procedures

Manage subsets of a single acquisition

Post- Processing Workflow

Schedule, perform, & notify image processing

& CAD steps

Charge Posting

Collection of billable procedure details

Scheduled Workflow

Admit, order, schedule, acquire & store images with notification of

completed steps

Patient Information Reconciliation

Unknown patients and unscheduled orders

HIMSS 2003

Scheduled Workflow Scheduled Workflow Integration ProfileIntegration Profile

• Real World Problem:Real World Problem:– Patient-centric, service oriented care deliveryPatient-centric, service oriented care delivery– Multiple actors, multi-vendor, multi-systemMultiple actors, multi-vendor, multi-system

• Registration

• Order Placer

• Order Filler

• Modality

• Image Manager / Image Archive

• Image Display

• Report Creator

• Etc.

HIMSS 2003

imagesstored

patientinformation

RIS

examination orders

imagesretrieved

HIS

PACS

procedurescheduled

Prefetch any relevantprior studies

modalityworklist

report

report

Scheduled Workflow ProfileScheduled Workflow Profile

Registration

Orders Placed

Orders Filled

Film

FilmFolder

Image Manager& Archive

FilmLightbox

report ReportRepository

DiagnosticWorkstation

Modality

acquisitionacquisitionin-progressin-progressacquisitioncompleted

acquisitioncompleted

imagesprinted

AcquisitionModality

HIMSS 2003

Year 4 Enhancements to Year 4 Enhancements to Scheduled WorkflowScheduled Workflow

1.1. Reduce variance on how procedures are performed Reduce variance on how procedures are performed • Imaging protocolsImaging protocols Assisted Acquisition Protocol Setting (option)Assisted Acquisition Protocol Setting (option)

2.2. Exception managementException management• When errors are made on the modalities how can these be When errors are made on the modalities how can these be

correctedcorrected PPS Exception Management (option)PPS Exception Management (option)

HIMSS 2003

Patient Information Reconciliation Patient Information Reconciliation Integration ProfileIntegration Profile

• Real World Problem:Real World Problem:– ‘‘To err is human, but to really mess things up you need a computer’To err is human, but to really mess things up you need a computer’5 scenarios of patient/order/images reconciliation addressed:5 scenarios of patient/order/images reconciliation addressed:

1.1. Unidentified Patient registered at ADT and ordered at Order PlacerUnidentified Patient registered at ADT and ordered at Order Placer

2.2. Unidentified Patient registered at ADT and ordered at Dept Scheduler/Order FillerUnidentified Patient registered at ADT and ordered at Dept Scheduler/Order Filler

3.3. Unidentified Patient registered at ADT but completed at ModalityUnidentified Patient registered at ADT but completed at Modality prior to Orderprior to Order

4.4. Unidentified Patient assigned Temporary Departmental ID andUnidentified Patient assigned Temporary Departmental ID and Scheduled at DScheduled at Dept ept SSchedulercheduler/Order Filler/Order Filler

5.5. Image Acquisition Completed without Scheduling at DImage Acquisition Completed without Scheduling at Dept Scheduler/ept Scheduler/OrderOrder FillerFiller

HIMSS 2003

Post-Processing WorkflowPost-Processing WorkflowIntegration ProfileIntegration Profile

• Clinical Problem:Clinical Problem:– How do I know when there is post-processing How do I know when there is post-processing

(3D, CAD, etc.) to be done?(3D, CAD, etc.) to be done?– How do I know when the post-processing is done How do I know when the post-processing is done

and ready to be billed, distributed, and and ready to be billed, distributed, and interpreted?interpreted?

– How do I make sure the post-processed images / How do I make sure the post-processed images / objects get associated with the correct study?objects get associated with the correct study?

HIMSS 2003

Post-Processing Workflow ProfilePost-Processing Workflow Profile

Post-Proc.Post-Proc.WorkflowWorkflowManagerManager

PACS System

CAD*Workstation

ReportRepository

AcquisitionModality

3-D*Workstation

Work Status

WorklistWorklist

…

Source Data

Results

ReviewWorkstation

Results

Work StatusWork Status

HIMSS 2003

Charge Posting Charge Posting Integration ProfileIntegration Profile

• Clinical Problem:Clinical Problem:– Can my information systems send consistent Can my information systems send consistent

messages to a ‘charge processor’ for timely messages to a ‘charge processor’ for timely technical and professional fee billing?technical and professional fee billing?

– Can my billing / coding process more Can my billing / coding process more accurately reflect what was actually done?accurately reflect what was actually done?

– Can I shrink my back office?Can I shrink my back office?

HIMSS 2003

Charge Posting ProfileCharge Posting Profile

ChargeChargePosterPoster

*Billing System

CAD*Workstation

ReportRepository……

Report Generated / Signed

CADPerformed

PostCharges

AcquisitionModality

ADT Terminal

3-D*Workstation

Account Management

3-DPerformed

StudyPerformed

/ MaterialsUsed

HIMSS 2003

Consistent Presentation of Images Consistent Presentation of Images Integration ProfileIntegration Profile

• Real World Problems:Real World Problems:– Is my referring clinician seeing the same Is my referring clinician seeing the same

picture as I am?picture as I am?– Can I avoid calibrating every imaging device Can I avoid calibrating every imaging device

to every display device?to every display device?– Why do I have to repeat image manipulations Why do I have to repeat image manipulations

that the technologist already performed?that the technologist already performed?– Can I view the images the way Dr. X did?Can I view the images the way Dr. X did?

HIMSS 2003

What the Radiologist What the Radiologist Displays:Displays:

What the Reviewing What the Reviewing Physician Sees:Physician Sees:

The Radiologist’s Transformations

Are Saved

Original Image & Presentation State

Original Image

Window Level

Flip

Zoom

Area Of

Interest

Annotate

The Radiologist’s Transformations

Are Lost

Original Image

Area Of

Interest

Prepared Image

Original Image

Consistent Presentation of Images ProfileConsistent Presentation of Images Profile

HIMSS 2003

Presentation of Grouped Procedures Presentation of Grouped Procedures Integration ProfileIntegration Profile

• Clinical Problem:Clinical Problem:– Single physical acquisition of images must be Single physical acquisition of images must be

‘split’ for interpretation, viewing or billing‘split’ for interpretation, viewing or billing• E.g., Spiral CT of Chest, Abdomen, PelvisE.g., Spiral CT of Chest, Abdomen, Pelvis• E.g., One order, two procedures, one data set, two E.g., One order, two procedures, one data set, two

reportsreports

– How can I optimize both patient experience (time How can I optimize both patient experience (time and comfort) and throughput?and comfort) and throughput?

– How can I make sure images are grouped and How can I make sure images are grouped and sorted correctly and ready for display sorted correctly and ready for display

HIMSS 2003

MODALITY

Presentation of Grouped Procedures ProfilePresentation of Grouped Procedures ProfileRequested Procedure:

CHEST

Report:CHEST

Report:AB/PELVIS

Performs a single exam

Operatorgroups

2 procedures

Chest Chest ViewView

RIS / PACS

Requested Procedure:AB/PELVIS

Chest Chest ViewView

Ab/Pelvis Ab/Pelvis ViewView

Ab/Pelvis Ab/Pelvis ViewView

HIMSS 2003

Key Image Note Key Image Note Integration ProfileIntegration Profile

• Clinical Problem:Clinical Problem:– How can I flag images in a procedure for How can I flag images in a procedure for

various purposes:various purposes:• To clarify findings for referring physicians or To clarify findings for referring physicians or

teachingteaching• QAQA• Technical inadequacyTechnical inadequacy• Etc.Etc.

HIMSS 2003

RadiologistRadiologistFlags Images:Flags Images:

Referring PhysicianReferring PhysicianSees Key Images First:Sees Key Images First:

for refering physicianThis image showsthe renal rupture.

Note1

for refering physicianThis image has the hematoma.

Note2

For referringphysician:This image showsthe renal rupture.

Note1

For referring physician:This image hasthe hematoma.

Note2

for refering physicianThis image showsthe renal rupture.

Note1

for refering physicianThis image has the hematoma.

Note2

Study & Key Image Notes

Key Image Notes ProfileKey Image Notes Profile

HIMSS 2003

Simple Image & Numeric Report Simple Image & Numeric Report Integration ProfileIntegration Profile

• Clinical Problem:Clinical Problem:– How can I How can I startstart to use DICOM Structured to use DICOM Structured

Reporting for my reports?Reporting for my reports?– How can I capture report information other than How can I capture report information other than

as blobs of text?as blobs of text?– How can I mine my report data?How can I mine my report data?– How can I disseminate reports to all How can I disseminate reports to all

downstream systems?downstream systems?

HIMSS 2003

Example: ‘Simple Image and Numeric Example: ‘Simple Image and Numeric Report’Report’

DiscussionDiscussionComparison is made to the prior study of Comparison is made to the prior study of 4/11/994/11/99. The left . The left paratracheal lymph nodeparatracheal lymph node ((image 8image 8, , image 11image 11) now measures ) now measures 2.5x2.7x3.1 2.5x2.7x3.1 cmcm increasing from increasing from 2.0x2.1x2.62.0x2.1x2.6 previously. No previously. No other mediastinal, upper abdominal or axillary other mediastinal, upper abdominal or axillary adenopathy is identified. No focal pulmonary adenopathy is identified. No focal pulmonary lesions are seen. The yadda, yadda, yadda are lesions are seen. The yadda, yadda, yadda are normal.normal.

ImpressionImpression

Worsening L Paratracheal adenopathyWorsening L Paratracheal adenopathy..

HIMSS 2003

Simple Image & Numeric Reports ProfileSimple Image & Numeric Reports Profile

PACS

Images Retrieved

Preliminary Report

Verified Report

Report & Images Retrieved

Image Manager& Archive

ReportVerification

Images and Examdata presented for

diagnosis

Reports storedfor

Network Access

Report & ImageReview for

Patient Care

HIMSS 2003

Access to Radiology InformationAccess to Radiology InformationIntegration ProfileIntegration Profile

• Clinical Problem:Clinical Problem:– How can other information systems get How can other information systems get

information from me without interrupting information from me without interrupting me?me?• ImagesImages• Gray Scale Presentation StatesGray Scale Presentation States• Key Image NotesKey Image Notes• Simple Image and Numeric ReportsSimple Image and Numeric Reports

HIMSS 2003

Access to Radiology Information ProfileAccess to Radiology Information Profile

Radiology Department – Images and

Reports

Emergency Department

Referring Physician

Other Departments:- Oncology- Surgery- Neurology- Pediatrics- etc.

Remote Clinics

Electronic Medical Record

HIMSS 2003

Basic Security Basic Security Integration ProfileIntegration Profile

• Clinical Problem:Clinical Problem:– How can I begin to coordinate HIPAA / security requirements between systems?How can I begin to coordinate HIPAA / security requirements between systems?

• Secure communications between nodesSecure communications between nodes• Common audit repositoryCommon audit repository• Common date and time across systemsCommon date and time across systems

HIMSS 2003

Basic Security ProfileBasic Security Profile

AuditAuditRecordRecord

RepositoryRepository

……

Image Manager& Archive

“Images Queried / Retrieved”

DiagnosticWorkstation

ReportRepository

……

Report & ImageReview

“Reports Queried / Retrieved”

“Images Printed”“Reports Stored”

“Reports Retrieved” “Reports Printed”

HIMSS 2003

What is Available?What is Available?

• IHE Integration StatementsIHE Integration Statements– Vendor claims of IHE Profile support on specific Vendor claims of IHE Profile support on specific

productsproducts– Simple formatSimple format– backed up by Technical Frameworkbacked up by Technical Framework

• Connectathon ResultsConnectathon Results– what types of systems, which companies are what types of systems, which companies are

testing at the Connectathonstesting at the Connectathons

See links at www.rsna.org/IHESee links at www.rsna.org/IHE

HIMSS 2003

Clinical IHE Success ProgressClinical IHE Success Progress

IHE at NorthwesternIHE at Northwestern

HIMSS 2003

HIMSS 2003

GoalsGoals• Define the PACS / modality environment:Define the PACS / modality environment:

– Northwestern Memorial HospitalNorthwestern Memorial Hospital

• Measure a specific PACS / modality Measure a specific PACS / modality workflow metric in the absence of IHE workflow metric in the absence of IHE transactionstransactions

• Deploy coreDeploy core IHE Scheduled Workflow IHE Scheduled Workflow Integration ProfileIntegration Profile transactions (MPPS) transactions (MPPS) between modalities and PACSbetween modalities and PACS

• Re-measure the metric in the presence of Re-measure the metric in the presence of the IHE transactionsthe IHE transactions

HIMSS 2003

NMH EnvironmentNMH Environment

• Patient Reg. Actor (ADT)Patient Reg. Actor (ADT)– Plus 2000 (McKesson)Plus 2000 (McKesson)

• Order Placer Actor (CIS)Order Placer Actor (CIS)– PowerChart (Cerner)PowerChart (Cerner)

• Order Filler Actor (RIS)Order Filler Actor (RIS)– Classic RadNet (Cerner)Classic RadNet (Cerner)

• Image Manager / Image Image Manager / Image ArchiveArchive– Centricity 1.0 PACS (GEMS)Centricity 1.0 PACS (GEMS)

• Acquisition Modality: MRAcquisition Modality: MR– Syngo MR (Siemens)Syngo MR (Siemens)

• Acquisition Modality: CTAcquisition Modality: CT– LightSpeed CT (GEMS)LightSpeed CT (GEMS)

Non-IHE Compliant Systems Systems Supporting IHE Transactions

HIMSS 2003

Process to be measuredProcess to be measured• Order received by PACS: Order received by PACS:

– Procedure is in ‘Ordered’ statusProcedure is in ‘Ordered’ status• Images received by PACS:Images received by PACS:

– Procedure transitions to ‘Arrived’ statusProcedure transitions to ‘Arrived’ status

Procedure closed for acquisition:Procedure closed for acquisition:– Procedure transitions to ‘Verified’ statusProcedure transitions to ‘Verified’ status

• Procedure dictated:Procedure dictated:– Procedure transitions to ‘Dictated’ statusProcedure transitions to ‘Dictated’ status

• Dictation transcribed:Dictation transcribed:– Procedure transitions to ‘Transcribed’ statusProcedure transitions to ‘Transcribed’ status

• Electronically signed report received:Electronically signed report received:– Procedure transitions to ‘Complete’ statusProcedure transitions to ‘Complete’ status

HIMSS 2003

The Problem (I)The Problem (I)

• ‘‘Verification’ as defined above can occur:Verification’ as defined above can occur:– ManuallyManually– By dictation (jumps over ‘verified’ status)By dictation (jumps over ‘verified’ status)– Automatically at 5 hoursAutomatically at 5 hours– On receipt of complete message from RISOn receipt of complete message from RIS

• Not used due to unreliable usage by technologistsNot used due to unreliable usage by technologists

• Time to ‘Verification’ is variable and Time to ‘Verification’ is variable and inconsistent inconsistent

HIMSS 2003

The Problem (II)The Problem (II)

• Timely verification is critical because it Timely verification is critical because it triggers:triggers:– Closing a procedure for further acquisition Closing a procedure for further acquisition

signifying procedure is done.signifying procedure is done.– Writing of the images to permanent long-term Writing of the images to permanent long-term

storagestorage• Which triggers DICOM Storage Commitment back to Which triggers DICOM Storage Commitment back to

the Modalitythe Modality

– Procedure is ready to be interpretedProcedure is ready to be interpreted

HIMSS 2003

Time to verify (or dictate) a Study Time to verify (or dictate) a Study before IHEbefore IHE

HIMSS 2003

The PromiseThe Promise

• Use of DICOM Modality Performed Use of DICOM Modality Performed Procedure Step Transaction as defined Procedure Step Transaction as defined by IHE Framework can automatically by IHE Framework can automatically trigger ‘Verification’trigger ‘Verification’

HIMSS 2003

Time to verify (or dictate) a Study Time to verify (or dictate) a Study after IHEafter IHE

HIMSS 2003

So What?So What?

Radiology at NMH is big businessRadiology at NMH is big business

• If:If:– 40,000 CT studies per year40,000 CT studies per year– CT exam slot is 20 minutesCT exam slot is 20 minutes– Reimbursement of 50Reimbursement of 50¢ on the dollar¢ on the dollar– One minute of CT slot time is worth $14 in One minute of CT slot time is worth $14 in

Gross Revenue!Gross Revenue!

HIMSS 2003

Lessons LearnedLessons Learned

• IHE functionality can be purchased / deployed in select IHE functionality can be purchased / deployed in select commercial productscommercial products

• IHE functions at the ‘least common denominator’ levelIHE functions at the ‘least common denominator’ level• Connect-a-thon success does not guarantee clinical Connect-a-thon success does not guarantee clinical

success: success: – test, test, then test some moretest, test, then test some more

• Upgrading legacy equipment to support IHE may Upgrading legacy equipment to support IHE may be expensive and take a long time be expensive and take a long time (and involve (and involve forklifts and other heavy machinery)forklifts and other heavy machinery)

HIMSS 2003

Clinical ConclusionClinical Conclusion

• The promise of efficiencies from The promise of efficiencies from implementation of IHE Integration Profiles is implementation of IHE Integration Profiles is so great that it merits continued dedication so great that it merits continued dedication and commitment from the user community.and commitment from the user community.

• The perils of IHE deployment indicate that The perils of IHE deployment indicate that vendors must continue their dedication and vendors must continue their dedication and commitment to improving implementations commitment to improving implementations and understanding details of clinical and understanding details of clinical operationsoperations

HIMSS 2003

What can you do?What can you do?• Learn about IHELearn about IHE• Find problems at your institution that can benefit Find problems at your institution that can benefit

from the IHE Initiativefrom the IHE Initiative• Participate in IHE committeesParticipate in IHE committees• Ask vendors about IHE when ‘shopping’Ask vendors about IHE when ‘shopping’• Stress to your vendors the importance of Stress to your vendors the importance of

connectivity and integration in your next connectivity and integration in your next purchase!purchase!

• Require IHE participation and compliance in Require IHE participation and compliance in your contracts!your contracts!

HIMSS 2003

ResourcesResources

• www.rsna.org/IHEwww.rsna.org/IHE– FAQsFAQs– Buyer’s guidelinesBuyer’s guidelines– IHE Technical FrameworkIHE Technical Framework– Primer on IHEPrimer on IHE– PresentationsPresentations

• www.himss.orgwww.himss.org– IHE monographIHE monograph