Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

Transforming the Radiologic Interpretation Process (TRIP™)

Using IHE™

Sanjay Jain, Kevin O’Donnell, Dave Channin IHE Radiology Planning Committee

RSNA 2003

DisclaimersDisclaimersSanjay Jain is an associate of Cerner

CorporationKevin O’Donnell is an employee of

Toshiba America Medical SystemsDr. Channin, Northwestern

Radiology, receives a portion of his research funding from GE Medical Systems

RSNA 2003

What is TRIP™?What is TRIP™?An initiative of the Society for

Computer Applications in Radiology (SCAR)

Supported by RSNA and IHE™

Radically change the way we think about the radiology process given the ‘digitization’ of radiology, and the role of technology in delivering healthcare

RSNA 2003

Why is this important?Why is this important?

Application of technology Can:Reduce Errors and/or Delays in

TreatmentProvide complete Information for

Decision-makingImprove efficiencies in Utilization of

Staff and Equipment

RSNA 2003

This is your healthcare provider in healthcareThis is your healthcare provider in healthcare

Any Questions?Any Questions?

This is healthcareThis is healthcare

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What’s driving the Rat What’s driving the Rat Race?Race?

Volume of procedures is growing– New procedures / modalities– New uses for existing technologies– Aging population

Size and complexity of studies is growing– Implications for technology, but…– More important implications for human interpretation

Data set navigation Timely delivery of radiologist value-add back to referring

physician Shortage of radiologists and technologists

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Why Does Anything in Why Does Anything in Radiology Matter?Radiology Matter?

Improve service to patients Improve service to referring physicians Improve efficiency and workflow Enhance the academic mission Modernize information systems

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How Can IHEHow Can IHE™™ Help? Help?Integrating the Healthcare Enterprise

is an initiative to:– Enhance the Access to Clinical Information– Ensure Continuity and Integrity of Patient Information– Speed Up the Integration in Healthcare Environments– Foster Communication Between Vendors of

Medical Information Technology– Prove that Integration is Attainable Based on Standards

Yes, but… what does IHE™ really do to help?

RSNA 2003

IHEIntegrationProfiles B

The IHEThe IHE™™ Process – Integration Profiles Process – Integration Profiles

IHE Integration Profiles:– Detailed selection of standards and options each solving a

specific integration problem– A growing set of effective provider/vendor agreed solutions– Vendors can implement with ROI– Providers can deploy with stability

Standards

Easy toIntegrateProducts

IHEIntegrationProfile A

IHEDemonstration

IHEConnectathon

ProductWith IHE

User Site

RFP

IHETechnical

Framework

RSNA 2003

IHEIHE™™ Integration Profiles Integration Profiles 12 Profiles in Radiology 5 Profiles in IT Infrastructure 1 Profile in Lab

(Complex, problematic) workflow processes that involve cooperative manipulation of healthcare information by various information systems

RSNA 2003

Pat

ient

Info

rmat

ion

Rec

onci

liatio

n

Access to Radiology Information

Consistent Presentation

of Images

Workflow

Basic Security

Evidence Documents

Key Image Notes

SimpleImage &Numeric Reports

Presentation of Grouped Procedures

Post-Processing Workflow

Reporting Workflow

Charge Posting

Scheduled

IHE™™ Success – Radiology Profiles

RSNA 2003

Consider the ‘Workflow Consider the ‘Workflow Profiles’Profiles’

Scheduled Workflow– Efficient, integrated acquisition

Post-Processing Workflow– Efficient, integrated 2D, 3D and CAD

Reporting Workflow– Efficient, integrated reporting

RSNA 2003

CommonalitiesCommonalities Generate a work list of work to be done Claim work list items (with pointers to

inputs) Do the work Tell what you did and when you are done Loop closure (for local or distributed

workflow) Positive hand-offs

Efficient, error-resistant operations

RSNA 2003

Now Add…Now Add… Assisted Protocol Option to SWF

– Decreased variance in performance of procedures

– Procedure tailoring only when it makes clinical sense

Patient Information Reconciliation Profile– Manage information gaps & recovery

Unavailable computer systems (downtime) Unknown patients (trauma, Doe, VIPs) Operator errors

RSNA 2003

That cover’s the basics;That cover’s the basics;

Now,Now,

How do we kick it up a How do we kick it up a notch?!notch?!

RSNA 2003

Pat

ient

Info

rmat

ion

Rec

onci

liatio

n

Access to Radiology Information

Consistent Presentation

of Images

Workflow

Basic Security

Evidence Documents

Key Image Notes

SimpleImage &Numeric Reports

Presentation of Grouped Procedures

Post-Processing Workflow

Reporting Workflow

Charge Posting

Scheduled

IHE™™ Success – Radiology Profiles

RSNA 2003

Make the radiologist more Make the radiologist more productive on the PACS workstationproductive on the PACS workstation

Use Key Image Notes to ‘filter’ ‘significant images’ for referring physicians, QA, teaching, etc.

Use Evidence Documents to capture measurements, procedure logs & CAD results as structured study data and feed into reporting system.

Generate Simple Image and Numeric Reports in DICOM S/R; avoid dictation (even voice recognition) whenever possible.

RSNA 2003

And then,And then,

Another Notch!!Another Notch!!

RSNA 2003

IHE™™ ITI Integration Profiles

Enterprise User Authentication

Provide users a single name

andcentralized

authentication process

across all systems

Enterprise User Authentication

Provide users a single nameand

centralized authentication

processacross all systems

Retrieve Information for Display

Access a patient’s clinical information and documents

in a format ready to be presented

to the requesting user

Retrieve Information for Display

Access a patient’s clinical information and documents in a

format ready to be presentedto the requesting user

Patient Identifier Cross-referencing

for MPI

Map patient identifiers across independent

identification domains

Patient Identifier Cross-referencing

for MPI

Map patient identifiers across independent

identification domains

Consistent Time

Coordinate time across networked

systems

Consistent Time

Coordinate time across networked

systems

HL7 CDA / PDF / JPEG

HL7 2.x ADT Triggers / Queries Kerberos (RFC 1510) / HL7 CCOWNTP (RFC 1305)

Synchronize multiple applications on a desktop to the same patient

Patient Synchronized Applications

HL7 CCOW

RSNA 2003

Use the IT Infrastructure ProfilesUse the IT Infrastructure Profiles Use Retrieve Information for Display (RID)

– Facilitate access by radiologist to EMR details– (ARI Profile facilitates access to radiology

information) Use Patient Synchronized Applications (PSA)

– Share context with other applications that radiologist needs

Enterprise User Authentication (EUA)– Provides for single sign-on

Patient Identifier X-ref (PIX)– Allows radiologist to access information across

multiple enterprises

RSNA 2003

ConclusionConclusionIHE™ provides a platform upon which

to build new concepts to transform the radiologic interpretation process (TRIP™)

With integration reliably distributing relevant information, Vendors can compete on providing new features and functionalities to make radiologists much more efficient

RSNA 2003

More information…More information… SCAR / TRIP™

– www.scarnet.org IHE™

– www.rsna.org/ihe– www.himss.org/ihe

IHE Rad Technical Framework for Year 5 - V5.5 IHE IT Technical Framework for Year 1 - V1.0 IHE Lab Technical Framework for Year 1 (Public

Comment) Non-Technical Brochures :

– IHE Fact Sheet and IHE FAQ– IHE Integration Profiles: Guidelines for Buyers– IHE Connectathon Results– Vendor Integration Statements