Integrating the Healthcare Enterprise Practical Tools for the CIO: Using IHE to Leverage Standards Nogah Haramati, MD Chief of Radiology, Professor, Radiology

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

Practical Tools for the CIO:Using IHE to Leverage Standards

Nogah Haramati, MD

Chief of Radiology, Professor, Radiology & Surgery

Jack D. Weiler Hospital

Albert Einstein College of Medicine

Bronx, NY

USA

ITAC IHE CanadaApril 30, 2004

AgendaAgenda

Is the IHE ready for prime time?How do I get it & use it?Provocative discussion…


Why Should You Care?Why Should You Care?

Single Vendor Solutions are a MythIntegration and Interfaces are DifficultYour Clients Want Integration,

SometimesIHE isn’t a Standard


PACS-RIS Integration PACS-RIS Integration Do Vendors Really Want this?Do Vendors Really Want this?

Most RIS vendors are now offering PACS products

The largest PACS vendors are now offering RIS products

Every vendor wants “their” system to be the “Seamlessly” integrated environment


Integrating the Healthcare Enterprise Integrating the Healthcare Enterprise (IHE)(IHE)

Every vendor can create their part of an IHE integrated environment in isolation

Technical Framework sufficiently detailed for each vendor’s piece to be created in isolation

One size fits all The customer can replace IHE vendors

without requiring massive integration projects Vendors do this ONLY because customers

want it!


IHE WorkflowsIHE Workflows

Each IHE Profile is composed of the architectural workflows related to that profile

IHE compliance can be verified by following the workflow in the profile and assuring the following:

Each actor’s role is fulfilled by the appropriate vendor

Every transaction is successfully executed


Advantages to using IHE Profiles for Advantages to using IHE Profiles for Acceptance TestingAcceptance Testing

Testing procedures cannot be “rigged” or “fixed” by the vendor

Testing procedures mirror the exact functionality that was purchased

Testing procedures assure that ALL the actors (regardless of vendor source) are working together



Figure 3.2-9. Exception

Management Workflow (Wrong

Worklist Entry Selected)



Case 1: Unidentified Patient Registered at ADT Case 1: Unidentified Patient Registered at ADT and Ordered at the Order Placerand Ordered at the Order Placer

Any unidentified patient is assigned a permanent Patient ID and a temporary name (e.g., “John Doe”)

When the real patient identity is known, the ADT is responsible for reconciliation of its own records

The ADT sends a Patient Update message to both the Order Placer and Department System Scheduler/Order Filler

The Department System Scheduler/Order Filler sends the Patient Update message to the Image Manager.


Case 1: Unidentified Patient Registered at ADT and Ordered at the Order Placer


Case 5: Image Acquisition Completed Case 5: Image Acquisition Completed Without Scheduling at DepartmentWithout Scheduling at Department

System Scheduler/Order FillerSystem Scheduler/Order Filler

In this case, no valid Patient ID is available to the Department System Scheduler/Order Filler

No scheduling is done before the procedure is performed.

A temporary ID and name are entered by the technologist at the Modality and conveyed to the Department System Scheduler/Order Filler and to the Image Manager. The Patient ID and name are selected by the technologist according to the locally defined rules


Case 5: Image Acquisition Completed Case 5: Image Acquisition Completed Without Scheduling at DepartmentWithout Scheduling at Department

System Scheduler/Order FillerSystem Scheduler/Order Filler When patient information is known, ADT sends new

patient information to both the Order Placer and Department System Scheduler/Order Filler.

The Department System Scheduler/Order Filler performs a merge of the permanent patient record with the temporary one and sends a Patient Update to the Image Manager.

At the same time, Department System Scheduler/Order Filler generates and submits an order to the Order Placer using a valid Patient ID.


Case 5: Image Acquisition Completed Without Scheduling at Department System

Scheduler/Order Filler

How do to leverage the IHE to How do to leverage the IHE to your advantage?your advantage?

The “How To” Piece…


Current RFPs and ContractsCurrent RFPs and Contracts

Do not purchase any system or modality without a vendor commitment to present or future IHE compliance!

Stipulate the level of IHE compliance– Specific integration profiles– Actors supported (present and/or future)– Deadline for compliance– Process for requiring additional IHE profiles


The Contractual ApproachThe Contractual Approach

Initially use a multiparty agreement including your organization and two vendors

The IHE integration profiles to be included initially are…

Vendor assignment of ACTOR roles for each profile should be included

Penalties for non-performance must be included for ALL parties

Acceptance testing parameters must be based on the same IHE profiles


Maintaining the Integration Maintaining the Integration

at the State-of-the-Artat the State-of-the-Art Integration Steering CMTE – one per party Knowledgeable reps from all parties Decide on new or modified profiles Unanimous CMTE vote includes the profile in the

integration agreement and is legally binding on all parties

Interval after profile is incorporated until delivery of actual product - We have used the longer of 18 months following the incorporation or the first IHE connectathon where that profile is demonstrated (or agree on a time)


What if one or both vendors do not agree What if one or both vendors do not agree to add a needed profile?to add a needed profile?

IHE is a customer driven initiative Vendors do not want to create custom products

for idiosyncratic customers Customer has ONLY one recourse! Customer must obtain a written expression of

interest in the profile from X number of the vendor’s existing customers

When the customer gets the written letters, the profile is legally binding on that vendor!

IHE is a customer driven initiative!


What if the go-live date arrivesWhat if the go-live date arrives A transaction does not work A transaction does not work

& all vendors blame the others?& all vendors blame the others? The IHE transactions are excruciatingly described

that by inspecting the actual transaction, fault is easily determined

If the transaction is properly formatted and constructed, then the recipient is at fault

If the transaction is improperly formatted, then the sender is at fault

Errors occur Build a window of tolerance to allow the vendors

to fix bugs


Use a lawyer/law firm that has experience Use a lawyer/law firm that has experience in IHE issues and conceptsin IHE issues and concepts

When do physicians ever have nice things to say about lawyers?

Put in language for binding arbitration of disputes

Specify from where an IHE ‘expert’ is to be found to resolve issues concerning transactions and non-performance if this becomes necessary

Specify the penalties and give them teeth!


Traditional RIS & PACS Acceptance Traditional RIS & PACS Acceptance TestingTesting

Traditional PACS acceptance testing criteria focused on image transmission, retrieval, display & manipulation criteria

RIS Acceptance criteria focused on ability to perform certain procedures


CIO Take HomeCIO Take Home

Today, vendors need motivation to create an IHE integrated environment

The customers are driving this effort Long term benefits of an IHE environment are

easier integration and replacement for future vendors

IHE is moving to the enterprise Require it now in your contracts so that you

don’t have to pay more later…

Provocative DiscussionProvocative Discussion

Should I install IHE now or wait?


Is the IHE just another fad?


Is this only something big, academic centers should do?


I don’t have IHE trained staff and have a lot of other priorities, why

should I need this now?


SummarySummary

What is the IHEIs the IHE ready for prime time?How do I get it & use it?Provocative discussion…


More information….More information….

Web sites: www.himss.org/ihewww.rsna.org/ihe– IHE Rad Technical framework for year 5 – V5.5– IHE IT Technical framework for year 1 – V 1.0

Non-Technical Brochures :– IHE Fact Sheet and IHE FAQ– IHE Integration Profiles: Guidelines for Buyers– IHE Connectathon Results

Documents

Integrating the Healthcare Enterprise Practical Tools for the CIO: Using IHE to Leverage Standards Nogah Haramati, MD Chief of Radiology, Professor, Radiology