1September, 2005 What IHE Delivers

Implementing IHE insideImplementing IHE insidethe Enterprise Care Settingsthe Enterprise Care Settings

World of Health ITWorld of Health ITOctober 11, 2006 12:15-13:00October 11, 2006 12:15-13:00

Harm-Jan WesselsHarm-Jan Wesselsmanaging director, Forcaremanaging director, Forcarevendor co-chair, IHE-Netherlandsvendor co-chair, IHE-Netherlands

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Objective of this PresentationObjective of this Presentation

To provide an overview of how IHE integration profiles are applied across the care settings within an Enterprise

To show the analogies across the domains

To provide a structured approach to finding the right IHE integration profiles to use

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TopicsTopics

General IHE Introduction

Overview of the IHE domains

The building blocks Radiology Translating/Mapping to other care domains

IHE implementations

Guidance on using IHE

Questions / Answers

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Short IntroductionShort Introduction

My name: Harm-Jan WesselsMy name: Harm-Jan Wessels

Active in Healthcare IT since 1990Active in Healthcare IT since 1990 Applicare Medical Imaging (‘90-’99)Applicare Medical Imaging (‘90-’99)

• Co-founder, Technical DirectorCo-founder, Technical Director GE Healthcare – Netherlands (’99-’05)GE Healthcare – Netherlands (’99-’05)

• Engineering / General ManagerEngineering / General Manager Forcare – 2006Forcare – 2006

• Co-founder / Managing DirectorCo-founder / Managing Director

Involvement in IHE since ’98Involvement in IHE since ’98

Representing IHE-Netherlands as Vendor-chairRepresenting IHE-Netherlands as Vendor-chairsince January 1since January 1stst, 2006, 2006

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What is What is Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise??

IHE is a IHE is a global initiativeglobal initiative, providing a , providing a common common frameworkframework for passing health information for passing health information seamlessly:seamlessly: withinwithin the healthcare enterprise the healthcare enterprise acrossacross multiple healthcare enterprises multiple healthcare enterprises for local, regional & nationalfor local, regional & national health information networkshealth information networks..

IHE is sponsored by IHE is sponsored by healthcare professional healthcare professional associationsassociations: HIMSS, RSNA, ESC, ACC, BIR etc.: HIMSS, RSNA, ESC, ACC, BIR etc.

IHE is IHE is user-leduser-led and and vendor-drivenvendor-driven

IHE IHE drives standards adoptiondrives standards adoption to address specific to address specific clinical needs.clinical needs.

6Document Use Case Requirements

Identify available standards (e.g. HL7, DICOM, IETF, OASIS)

Develop technical

specifications

Testing at Connectathons IHE

Demonstrations

Products with IHE

Timely access to information Easy to integrate

products

The IHE ProcessThe IHE Process

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Key IHE deliverablesKey IHE deliverables

Techical Frameworks Integration Profiles

“A standard way to solve a standard problem using standards”

Testing and Demonstrations

Integration Statements

Real-world Implementations

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Benefits to IHE ParticipantsBenefits to IHE ParticipantsCare Providers (Clinicians and IT staff)Care Providers (Clinicians and IT staff) Improved workflowImproved workflow Information when and where neededInformation when and where needed Decreased cost and complexity of interface installation and Decreased cost and complexity of interface installation and

managementmanagement

VendorsVendors Decreased cost and complexity of interface installation and Decreased cost and complexity of interface installation and

managementmanagement Accelerate product developmentAccelerate product development Expand your market potential by leveraging European/ Expand your market potential by leveraging European/

International developmentsInternational developments

Standards-Developing Organizations (SDOs)Standards-Developing Organizations (SDOs) Rapid feedback to adjust standards to real-worldRapid feedback to adjust standards to real-world Establishment of critical mass and widespread adoptionEstablishment of critical mass and widespread adoption

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Electronic Health Record

Cardiology

Laboratory

Radiology

Oncology

Future

Domains

IHE

IT Infrastructure

19 Integration Profiles

3 Integration Profiles

8 Integration Profiles

17 Integration Profiles

Patient Care Coordination

5 Integration Profile

Patient Care

Devices

Eye Care

1 Integration Profile

Over 150 vendors involved world-wide,Over 150 vendors involved world-wide, 8 Technical Frameworks8 Technical Frameworks 55 Integration Profiles, Testing at yearly Connectathons55 Integration Profiles, Testing at yearly Connectathons

Demonstrations at major conferences world-wideDemonstrations at major conferences world-wide

IHE 2006 – Eight Active DomainsIHE 2006 – Eight Active Domains

1 Integration Profile 1 Integration Profile

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Overview IHE DomainsOverview IHE Domains

Cardiology Implantable Device Cardiac Observations Profile (IDCO) Cardiology Stress Testing Workflow Integration Profile (STRESS) Cardiology Patient Demographics Query: Urgent Implantable Device

Cardiac Identification Content Profile (PDQ-IDC) Cardiology Cardiac Catheterization Workflow (CATHCardiology Echocardiography Workflow (ECHO)Cardiology Retrieve ECG for Display (ECG)Cardiology Displayable Reports (DRPT)Cardiology Evidence Documents (ED)

Radiology Scheduled Workflow (SWF)Radiology Patient Information Reconciliation (PIR)Radiology Consistent Presentation of Images (CPI)Radiology Presentation of Grouped Procedures (PGP)Radiology Access to Radiology Information (ARI)Radiology Key Image Note (KIN)Radiology Simple Image and Numeric Report (SINR)Radiology Charge Posting (CHG)Radiology Post-Processing Workflow (PWF)Radiology Reporting Workflow (RWF)Radiology Evidence Documents (ED)Radiology Portable Data for Imaging (PDI)Radiology NM Image (NM)Radiology Cross-enterprise Document Sharing for Imaging (XDS-I) Radiology Teaching File and Clinical Trial Export (TCE) Radiology Nuclear Medicine Image Integration Profile (NMI) with Cardiac OptionRadiology Image Fusion (FUS) Radiology Import Reconciliation Workflow (IRWF)Radiology Mammography Image (MAMMO)

Eye Care Eye Care Workflow (EYECARE)Eye Care Charge Posting (CHG)Eye Care Eye Care Evidence Documents (ECED)

IT-Infra Retrieve Information for Display (RID)IT-Infra Enterprise User Authentication (EUA)IT-Infra Patient Identifier Cross-referencing (PIX)IT-Infra Patient Synchronized Applications (PSA)IT-Infra Consistent Time (CT)IT-Infra Patient Demographics Query (PDQ)IT-Infra Audit Trail and Node Authentication (ATNA)IT-Infra Personnel White Pages (PWP)IT-Infra Cross-Enterprise Document Sharing (XDS)IT-Infra Document Digital Signature (DSG) IT-Infra Notification of Document Availability (NAV) IT-Infra Patient Administration Management (PAM) IT-Infra Cross-enterprise Document Media Interchange (XDM) IT-Infra Cross-enterprise Document Reliable Interchange (XDR) IT-Infra Cross-enterprise Sharing of Scanned Documents (XDS-SD) IT-Infra Retrieve Form for Data Capture (RFD)IT-Infra Cross-Enterprise User Authentication (XUA)

Lab Laboratory Scheduled WorkflowLab Sharing Laboratory Reports (XD*-LAB) Lab LOINC Test Codes Subset (LTCS)

PC Coord Cross-Enterprise Sharing of Medical Summaries (XDS-MS)PC Coord Basic Patient Privacy Consents (BPPC)PC Coord Emergency Department Referral (EDR)PC Coord Exchange of Personal Health Record Content (XPHR) PC Coord Pre-procedure History and Physical (PPHP)

PC Devices Device Enterprise Communication (DEC)Rad Oncology RT Objects??

Can’t see the forest for the trees?Can’t see the forest for the trees?

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Back to the overviewBack to the overview

Focus: IHE inside the Enterprise Care Setting

Starting with Radiology

First IHE domain (1998)

Wide variety in available systems, but relatively streamlined and global process

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Main external ProcessMain external Process

Radiology

order

result

AcquisitionReporting

patient patient

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report

results

Radiology Dept Mgt

patient

modality

Acqui-sition

radiologist

Repor-ting

order

scheduling

images

patient

status updat.

Main Internal processMain Internal process

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IHE Actors / TransactionsIHE Actors / Transactions

Key terms Actor: A system performing a particular

transaction Transaction: A single interaction between

systems (actors)

A system can host multiple actors

Product A

Product B

Product C

Product D

IHETransaction

IHETransaction

IHETransaction

IHEActor

IHEActor

IHEActor

IHEActor

IHEActor

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IHE Actors / TransactionsIHE Actors / Transactions

report

results

Radiology Dept Mgt

patient

modality

Acqui-sition

radiologist

Repor-ting

order

scheduling

images

patient

status updat.

DepartmentSystem Scheduler– Order Filler –

Order Placer

AcquisitionModality

PerformedProcedure Step

Manager

Image Mgr / Archive

Image Display

Report Creator

Report Manager

Enterprise Report

RepositoryRIS

HIS HIS

IMAGING•PACS•Workstations•Modalities

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Radiology ProcessRadiology Process

Captured in Scheduled Workflow (SWF) Integration Profile

Backbone of IHE Radiology

Integrates Registration, Scheduling, Acquisition Workflow and Image Content

Bridges HL7 and DICOM Spaces

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Benefits of Scheduled WorkflowBenefits of Scheduled Workflow

Preserve Order Continuity / Improve Order Tracking “Close the loop”

Improve Demographic Integrity Eliminate manual entry and correction

Improve Workflow Efficiency Worklists

Reliable Storage Storage Commitment

End result: Reduce Integration Effort On site

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So how does this apply...So how does this apply...

to other domains then Radiology?

The key to understanding IHE is to see the process and the data flow

Taking a few steps back...

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Radiology Process and Data FlowRadiology Process and Data Flow

RadiologyAquisition &

Reporting

RadiologyAquisition &

Reporting

Charge CaptureCharge Capture

RegistrationRegistration

Evid

ence

Do

cum

ents

Evid

ence

Do

cum

ents

Rep

ort &

Imag

esR

epo

rt &Im

ages

ProcessFlow

ProcessFlowData

Flow

DataFlow

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Reviewing IHE Integration ProfilesReviewing IHE Integration Profiles

“Process View” and “Data View” apply across the domains

The generic process chain shows a great deal of overlap for the domains

IHE promotes the re-use of standards and transactions across the domain

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RadiologyAquisition &

Reporting

Charge Capture

Registration

Evid

ence

Do

cum

ents

Rep

ort &

Imag

es

DataFlow

DataFlow

ProcessFlow

ProcessFlow

Constructing the Process ChainConstructing the Process Chain

PatientAdmission

PatientAdmissionOrder

Placer

OrderPlacerOrder

Filler

OrderFillerAcquisitionAcquisition

ResultsGeneration

ResultsGenerationResults

Storage

ResultsStorage

ResultsAccess

ResultsAccess

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Process Flow

Radiology (1)Radiology (1)

PatientAdmission

PatientAdmission

OrderPlacer

OrderPlacer

OrderFiller

OrderFiller AcquisitionAcquisition Results

Generation

ResultsGeneration

ResultsStorage

ResultsStorage

ResultsAccess

ResultsAccess

Scheduled Workflow (SWF)

Charge Posting (CHG)

Post-Processing Workflow (PWF)

Reporting Workflow (RWF)

Import Reconciliation Workflow (IRWF)

Data Flow

Patient Information Reconciliation (PIR)

Consistent Presentation of Images (CPI)

Presentation of Grouped Procedures (PGP)

Access to Radiology Information (ARI)

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Data Flow

Radiology (2)Radiology (2)

Evidence Documents (ED)

Portable Data for Imaging (PDI)

NM Image (NM)

Cross-enterprise Document Sharing for Imaging (XDS-I)

Teaching File and Clinical Trial Export (TCE)

Image Fusion (FUS)

Mammography Image (MAMMO)

PatientAdmission

PatientAdmission

OrderPlacer

OrderPlacer

OrderFiller

OrderFiller AcquisitionAcquisition Results

Generation

ResultsGeneration

ResultsStorage

ResultsStorage

ResultsAccess

ResultsAccess

Key Image Note (KIN)

Simple Image and Numeric Report (SINR)

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Data Flow

Process Flow

CardiologyCardiology

PatientAdmission

PatientAdmission

OrderPlacer

OrderPlacer

OrderFiller

OrderFiller AcquisitionAcquisition Results

Generation

ResultsGeneration

ResultsStorage

ResultsStorage

ResultsAccess

ResultsAccess

Stress Testing Workflow Integration Profile (STRESS)

Cardiac Catheterization Workflow (CATH)

Echocardiography Workflow (ECHO)

Retrieve ECG for Display (ECG)

Evidence Documents (ED)

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Data Flow

Process Flow

LaboratoryLaboratory

PatientAdmission

PatientAdmission

OrderPlacer

OrderPlacer

OrderFiller

OrderFiller AcquisitionAcquisition Results

Generation

ResultsGeneration

ResultsStorage

ResultsStorage

ResultsAccess

ResultsAccess

Laboratory Scheduled Workflow

Sharing Laboratory Reports (XD*-LAB)

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Data Flow

Process Flow

Eye CareEye Care

PatientAdmission

PatientAdmission

OrderPlacer

OrderPlacer

OrderFiller

OrderFiller AcquisitionAcquisition Results

Generation

ResultsGeneration

ResultsStorage

ResultsStorage

ResultsAccess

ResultsAccess

Eye Care Workflow (EYECARE)

Charge Posting (CHG)

Eye Care Evidence Documents (ECED)

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IHE ImplementationsIHE Implementations

IHE has been in existence since 1998IHE has been in existence since 1998

IHE Integration Profiles are key building IHE Integration Profiles are key building blocks for interoperabilityblocks for interoperability

Examples of IHE Implementations can be Examples of IHE Implementations can be found at found at www.ihe.net or or

www.ihe-europe.org Success StoriesSuccess Stories

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Guidance on using IHEGuidance on using IHE

Practical Guidance on using IHE can be Practical Guidance on using IHE can be found at found at www.ihe.net

To apply IHE to Radiology, consult theTo apply IHE to Radiology, consult the Radiology User HandbookRadiology User Handbook

To study IHE’s approach to workflow, To study IHE’s approach to workflow, consult theconsult the Departmental Workflow – white paperDepartmental Workflow – white paper

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ConclusionsConclusions

IHE provides a comprehensive framework IHE provides a comprehensive framework for addressing interoperability challengesfor addressing interoperability challenges

IHE’s process model promotes re-use IHE’s process model promotes re-use across domains and stimulates similar across domains and stimulates similar solutions to similar problemssolutions to similar problems

IHE’s Integration Profiles are showing IHE’s Integration Profiles are showing rapid adoption and application – across rapid adoption and application – across the Enterprise Care Settingsthe Enterprise Care Settings

30September, 2005 What IHE Delivers

IHE Europe web site: IHE Europe web site: www.ihe-europe.orgwww.ihe-europe.org

Thank you for your attentionThank you for your attention

Any Questions?Any Questions?