Integrating the HealthcareIntegrating the Healthcare EnterpriseEnterprise

Margarita Zuley, M.D.Margarita Zuley, M.D.

Elizabeth Wende Breast ClinicElizabeth Wende Breast Clinic

Rochester, NYRochester, NY

What is IHE?What is IHE?

Integrating the Healthcare Enterprise™Integrating the Healthcare Enterprise™

““A A processprocess that drives the use of existing that drives the use of existing standards to solve complex healthcare standards to solve complex healthcare

information processes that span multiple, information processes that span multiple, heterogeneous information systems.”heterogeneous information systems.”

Goal of IHEGoal of IHE

To ensure that all required information is correctTo ensure that all required information is correct

and available to the medical professional forand available to the medical professional for

optimal patient care.optimal patient care.

IHE Domain SponsorsIHE Domain Sponsors

LaboratoryDomain Sponsors:

GMSIH, JAHIS, SFIL

Cardiology Domain Sponsor: ACC

Assoc. Domain Sponsor: ASE

IT InfrastructureDomain Sponsor: HIMSS

Eye CareDomain Sponsor: AAO

Patient Care CoordinationDomain Sponsor:

HIMSS

Patient Care Devices

Domain Sponsors: IEEE, ACCE

RadiologyDomain Sponsor: RSNA

Associate Domain Sponsors: ASTRO, SNM

How Does IHE Work?How Does IHE Work?

Defines components of the healthcare Defines components of the healthcare enterprise called enterprise called ACTORSACTORS

Describes coordinated, standards based Describes coordinated, standards based transactions that each actor has with all other transactions that each actor has with all other actorsactors

Integration ProfilesIntegration Profiles are functional groups of are functional groups of these transactions that solve specific clinical these transactions that solve specific clinical needsneeds

IHE Radiology Integration ProfilesIHE Radiology Integration Profiles

Patient Info.

Recon-ciliation

Access to Radiology Information

Consistent Presentation

ofImages

Audit Trail & Node Authentication - Radiology Option

EvidenceDocs

KeyImageNotes

Simple Image & Numeric Reports

Presentation of

Grouped Procedures

Post-

Processing Workflow

Reporting Workflow

Charge Posting

XDS for Imaging

NMImage

Scheduled Workflow

Teaching Files &

Clinical Trials Export

Portable Data for Imaging

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

How do you use IHE?How do you use IHE?

Vendors implement Actors and Integration Vendors implement Actors and Integration Profiles in their systems and test them at the Profiles in their systems and test them at the annual Connectathonannual Connectathon

Users specify Actors and Integration Profiles Users specify Actors and Integration Profiles in RFPs when acquiring, upgrading or in RFPs when acquiring, upgrading or integrating systemsintegrating systems

IHE ConnectathonIHE Connectathon

Massive Cross-vendor TestingMassive Cross-vendor Testing One week; dozens of vendors; thousands of testsOne week; dozens of vendors; thousands of tests Opportunity to find/resolve issuesOpportunity to find/resolve issues

Participation is VoluntaryParticipation is Voluntary Litmus test not a pre-requisite or certification Litmus test not a pre-requisite or certification

Engineering eventEngineering event Huge Congregation of Engineering TalentHuge Congregation of Engineering Talent Project Management by MallinckrodtProject Management by Mallinckrodt Pre-Validation Tools (MESA)Pre-Validation Tools (MESA) Defined Test Protocols with VerificationDefined Test Protocols with Verification

IHE ConnectathonIHE ConnectathonManaged Managed by the IHE by the IHE SponsorsSponsors

Shortcut to rsna-connectivity2.lnk

Connectathon ResultsConnectathon Results

Published at Published at www.ihe.netwww.ihe.net and and www.ihe-europe.orgwww.ihe-europe.org

NOT Product CertificationNOT Product Certification Demonstration of Engineering CompetenceDemonstration of Engineering Competence

Recent ConnectathonsRecent Connectathons IHE-North America in January 2006 (Chicago, IL)IHE-North America in January 2006 (Chicago, IL)

59 Vendors, 140 Systems, 300+ Engineers59 Vendors, 140 Systems, 300+ Engineers

IHE-Europe in April 2005 (Noordwijkerhout, Netherlands)IHE-Europe in April 2005 (Noordwijkerhout, Netherlands) 62 Vendors, 98 Systems, 230 Engineers62 Vendors, 98 Systems, 230 Engineers

IHE-Japan Connectathon in January 2006 (Tokyo, Japan)IHE-Japan Connectathon in January 2006 (Tokyo, Japan) 28 Vendors, 60 Systems28 Vendors, 60 Systems

Healthcare Sitewith

Complex Problematic Process involving

heterogeneous information system

Vendorexpertise

Integration Profile

Proposed solutionUsing existing standards

IHE Technical Frameworkdetails solution

Vendor implements solutioninto

REAL product

Vendor tests solutionat

Connect-a-thon

Professional SocietiesDemonstrate/EducateThat solution exists

Healthcare SiteIncludes IHE

in RFP

IHE Web site: IHE Web site:

www.IHE .netwww.IHE .net Frequently Asked QuestionsFrequently Asked QuestionsIntegration Profiles in Technical Integration Profiles in Technical

Frameworks:Frameworks: CardiologyCardiology IT InfrastructureIT Infrastructure LaboratoryLaboratory Patient Care CoordinationPatient Care Coordination RadiologyRadiology

Connectathon ResultsConnectathon ResultsVendor Products Integration Vendor Products Integration

StatementsStatementsParticipation in Committees & Participation in Committees &

ConnectathonsConnectathons

Vendor AFFDM

Vendor AFFDM

Breast MRI

U/S

Multi Modality

DiagnosticWorkstation

Vendor ADiagnostic

Workstation

Vendor ADiagnostic

Workstation

Vendor BDiagnostic

Workstation

Vendor BDiagnostic

Workstation

Vendor CDiagnostic

Workstation

Vendor CDiagnostic

Workstation

Vendor CFFDM

Vendor CFFDM

Vendor BFFDM

Vendor BFFDM

System wide PACS

System wide PACS

Vendor AMini PACS

Vendor AMini PACS

Vendor BMini PACS

Vendor BMini PACS

Vendor CMini PACS

Vendor CMini PACS

Ideal Configuration: Maintain IntegrityIdeal Configuration: Maintain Integrity

Vendor AFFDM

Vendor AFFDM

Breast MRIBreast MRI

Anymulti modality

workstation

Anymulti modality

workstationAny

multi modality workstation

Anymulti modality

workstation

Anymulti modality

workstation

Anymulti modality

workstation

U/SU/S

Vendor CFFDM

Vendor CFFDMVendor B

FFDM

Vendor BFFDM

Any PACS

Any PACS

FFDM ProblemsFFDM Problems

Content/Display IncompatibilitiesContent/Display Incompatibilities Workflow ConstraintsWorkflow Constraints

Content/Display IssuesContent/Display Issues

Image SizeImage Size Image Orientation and JustificationImage Orientation and Justification Image Contrast Adjustment Image Contrast Adjustment Background Blackness MaintenanceBackground Blackness Maintenance Annotation of Identification and Technical Annotation of Identification and Technical

Factor InformationFactor Information Display of CAD MarksDisplay of CAD Marks

Image SizeImage Size

Image orientation

Annotations

Mammo IHE TimelineMammo IHE Timeline

June ’05 June ’05 (SCAR) forum to discuss problems(SCAR) forum to discuss problems July ‘05 July ‘05 IHE mammo group formedIHE mammo group formed Oct ‘05 Oct ‘05 11stst Draft of profile Draft of profile RSNA ’05 RSNA ’05 Discuss time frame and most critical Discuss time frame and most critical

limitations limitations Jan ’06 Jan ’06 Prelim testing at connect-a-thonPrelim testing at connect-a-thon Jan ’06 Jan ’06 Mammo Image Profile completedMammo Image Profile completed Today Today 11stst display of components of the display of components of the

profileprofile

Planned TimetablePlanned Timetable

Spring 06-Jan ’07Spring 06-Jan ’07Vendors implement Mammography Image profileVendors implement Mammography Image profile

Jan ’07 Jan ’07 Official testing at connect-a-thonOfficial testing at connect-a-thon

April ’07 (SBI)April ’07 (SBI)Public display of implementationPublic display of implementation

Mammography Workflow ProfileMammography Workflow Profile

Spring ’06 Spring ’06 White paper draftedWhite paper drafted June ’06 –Jan ’07 June ’06 –Jan ’07 Integration Profile writtenIntegration Profile written Spring ’07 Spring ’07 Profile finalizedProfile finalized Spring’07-Jan ’08 Spring’07-Jan ’08 Vendors implement Vendors implement

ProfileProfile Jan ’08 Jan ’08 Testing at connect-a-thonTesting at connect-a-thon Spring ’08 Spring ’08 Public display Public display

Why Does this take so Long?Why Does this take so Long?

Problems must be clearly definedProblems must be clearly defined Many vendors must be willing to participateMany vendors must be willing to participate Solutions can be complicatedSolutions can be complicated Solutions need to work for everyoneSolutions need to work for everyone The implementation is very labor intensive, The implementation is very labor intensive,

time consuming, and costly for the vendorstime consuming, and costly for the vendors

RFPsRFPs 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 services The system must support the following DICOM services according to the following 100 pages of specifications: …”according to the following 100 pages of specifications: …”

Be Both:Be Both: ““The system must support the IHE Echocardiography The system must support the IHE Echocardiography

Workflow Profile as the Acquisition Modality actor.”Workflow Profile as the Acquisition Modality actor.”

Request IHE Integration StatementsRequest IHE Integration Statements Version 2.1 of the SuperSono XT supports IHE Version 2.1 of the SuperSono XT supports IHE

Echocardiography Workflow as an Acquisition ModalityEchocardiography Workflow as an Acquisition Modality

RFPRFP

Itemize which options in each profile that you Itemize which options in each profile that you specifically want, or wish to excludespecifically want, or wish to exclude

Ask your vendor to commit to all of the IHE Ask your vendor to commit to all of the IHE requirements agreed uponrequirements agreed upon

RFPRFP

Look at the user’s handbook prior to purchasesLook at the user’s handbook prior to purchases Do your homework and understand what each Do your homework and understand what each

profile is giving youprofile is giving you Specify for each piece of equipment (actor) Specify for each piece of equipment (actor)

that you purchase, all IHE profiles you requirethat you purchase, all IHE profiles you require If the profiles are not yet implemented by the If the profiles are not yet implemented by the

vendor, get a date of conformance vendor, get a date of conformance

IHE Integration StatementsIHE Integration Statements

Explicit claim by the vendor,Explicit claim by the vendor, for a specific product version for a specific product version

Lists profiles, actors, optionsLists profiles, actors, options

Short & SweetShort & Sweet

User’s HandbookUser’s Handbook

Information to help in purchasing of digital Information to help in purchasing of digital equipmentequipment

Diagnostic WorkstationDiagnostic Workstation ModalityModality Understanding the IHE profiles and Understanding the IHE profiles and

specifically what each offers for each piece of specifically what each offers for each piece of equipmentequipment

RFP templateRFP template

FFDM Paradise

Any Image, anywhere intact, anytime.

Seamless integration from check-in to acquisition through archive

Standardization and guidelines for Quality Assurance

Protection of the integrity of the data