IHE / RSNA Image Sharing Project - IHE Colombia Workshop (12/2014) Module 5a

1. RSNA 2014
IHE Profiles for
Radiology Applications
Written by: David S. Mendelson, M.D.
Professor of Radiology
The Icahn School of Medicine at Mount
Sinai
Senior Associate - Clinical Informatics
The Mount Sinai Medical Center
Co-chair IHE International Board
Adapted and presented for the
IHE Colombia IHEWorkshop by:
Elliot B. Sloane, PhD, CCE,
FHIMSS
Co-chair IHE International Board
President, Center for Healthcare
Information Research and Policy
(CHIRP)

2. Integrating the Healthcare
Enterprise
The state of IHE - 2014

3. Integrating the Healthcare
Enterprise
The state of IHE - 2014
X

4. What is IHE?
 IHE is International
 Provides for local variation
 IHE includes
participation from
 Professional organizations
 Vendors
 End users
 1997: Founded in Radiology (RSNA)
and IT (HIMSS)
 Many professional societies
(stakeholder representation)
 American Academy of Ophthalmology
(AAO)
 American College of Cardiology (ACC)
 American College of Physicians (ACP)
 American College of Clinical Engineering
(ACCE)
 American College of Emergency
Physicians (ACEP)
 American Society forTherapeutic
Radiation Oncology (ASTRO)
 GMSIH (IT France), JAHIS (IT Japan), SFIL
(laboratory)
 Healthcare Information Management
Systems Society (HIMSS)
 Radiological Society of North America
(RSNA)
 And many more….

5. 5
IHE: A Framework for Interoperability
 A common framework for harmonizing and implementing
multiple standards
 Application-to-application
 System-to-system
 Setting-to-setting
 Enables seamless health information movement within and
between enterprises, regions, nations
 Promotes unbiased selection and coordinated use of
established healthcare and IT standards to address specific
clinical needs

6. 6
Stakeholder Benefits
 Healthcare providers and health authorities
 Improved workflows
 Information whenever and wherever needed
 Reduced implementation costs
 Vendors
 Align product interoperability with industry consensus
 Decreased cost and complexity of interface installation and management
 Focus competition on functionality/service not information transport
 SDOs- Standards Development Organizations
 Rapid feedback to adjust standards to real-world
 Establishment of critical mass and widespread adoption

7. 7
Standards: Necessary…Not Sufficient
 Foundational - to interoperability and communications
 Broad - varying interpretations and implementations
 Narrow - may not consider relationships between standards
domains
 Plentiful - often redundant or disjointed
 Focused - standards implementation guides focus only on a
single standard
IHE provides a process to implement an
integrated solution based upon multiple
standards

8. Over 650 Contributing
Vendors & Organizations
21 Societies Serving as Sponsors

9. Finland
Brazil
New Zealand
Israel
Malaysia
Poland
Switzerland
Saudi Arabia Colombia
Global Adoption of IHE

10. Coordination of Deployment Activities
3-Tier Model
Global Deployment Coordination Committee (GDC)
Continental Mirror Committees
IHE Americas IHE Europe IHE Asia
Representatives from each
Continental Mirror Committee
Meet regularly by Tcon
Others …
IHE World Summit
rotating country/continent, e.g. aligned with another global event like ISO
All Deployment Committees are
invited to an annual World Summit
Organizes
US CDN FRA TUR JPN CN

11. IHE – the process
 Identify Interoperability issues
 Develop Integration Profiles
 Actors andTransactions
 Workflow
 Gather relevant standards
 ConnectathonTesting
 Publish Integration Statements
 Vendors list tested profiles
12

12. IHE terminology
 Integration Profiles
 Describe workflow use cases, standards and the overall
relationships to achieve transparent interoperability
 Integration Statements
 Tell customers the IHE Profiles supported by a specific
release of a specific product.
 Technical Frameworks
 The documents for each “domain” that specify the
Integration Profiles and the associated systems (actors) and
transactions.
 Connectathons
 Testing events
 ? Certification

14. Actors and Transactions

15. Development - IHE Domains
• Anatomic Pathology
• Cardiology
• Dental
• Eye Care
• IT Infrastructure (ITI)
• Laboratory
• Patient Care Coordination
• Patient Care Devices
• Pharmacy
• Quality, Research and Public Health
• Radiation Oncology
• Radiology
• Mammography

16. ITI Profiles
 XDS,XDS- I Cross Enterprise Document Sharing
 XCA, XCA-I Cross Community Access
 XDR, XDR-I Cross-Enterprise Document Reliable Interchange
 Document sharing in the absence of a registry and repository
 XDM Cross-enterprise Document Media Interchange
 XUA Cross Enterprise User Assertion Integration Profile
 XDS-SD Cross-Enterprise Sharing of Scanned Documents
 BPPC Basic Patient Privacy Consents
 ATNA AuditTrail and Node Authentication

17. ITI- Trial implementation
 Cross-Community Fetch (XCF) - Published
2011-08-19
 Cross-Community Patient Discovery (XCPD) -
Revised 2012-08-31
 Cross-Enterprise DocumentWorkflow (XDW)
- Revised 2013-09-20

18. Interoperability Profiles-
Radiology specific
 PDI Portable Documents for Imaging
 IRWF Import ReconciliationWorkflow
 TCE Teaching File and ClinicalTrial Export
Trial Implementation
 IOCM Imaging Object Change Management
 MIMA Multiple Image Manager/Archive
 IID Invoke Image Display
Development
 Mobile Access to Health Documents - Imaging

19. Radiology Profiles
 PDI Portable Documents for Imaging
 IRWF Import Reconciliation Workflow
 REM Radiation Exposure Monitoring
 TCE Teaching File and ClinicalTrial Export
 MAWF Mamography Acquisition Workflow
 IOCM Imaging Object Change Management
 MIMA Multiple Image Manager/Archive

20. Major Radiology IT Themes-
Meaningful Use for the Radiologist
 Radiation Exposure- REM
 Aggregating and monitoring patient and population
exposure
 ACR DIR mapping tool
 RadLex Playbook- vendors are interested in making this part of
an IHE profile
 Image Sharing- XDS
 IHE XDS; Personal Health Records as a vehicle
 Reporting
 Teaching and Research- TCE
 MIRC
 CTP
 Meaningful Use – ONC/CMS

21. New Radiology Profiles
 MRRT
 Management of Radiology ReportingTemplates
 IID
 Invoke Image Display

22. Radiation Exposure
 Evaluating legacy dose information
 OCR solutions
 Evaluating dose today
 Within the institution
 Comparing multiple instruments
 Patient
 Site comparison
 IHE- REM profile
 ACR registry- Dose Index Registry (DIR)
 Site to Site comparison as well as within an enterprise
 Radlex terms- RadLex Playbook mapping tool

23. REM
Actors and Transactions to move dose information stored as DICOM SR

24. TCE- Teaching File and
Clinical Trial Export
 How to get images directly out of PACS as a
part of your normal workflow
 MIRC compatible
 Image Selector
 Image Exporter
 Receiver

25. TCE

26. TCE – Actors and
Transactions
MIRC compatible

27. IHE-XDS (Cross-Enterprise Document Sharing)
 XDS.a
 XDS- I.a
 XDS.b
 XDS-I.b
 a vs. b
 Related to web standards and transactions

28. XDS-I.b

29. NIBIB/RSNA Image Sharing Project
 Consumer Control-Patient
Engagement
 Diminishes the need for BAAs
between enterprises
 Imaging Site to Clearinghouse
 Clearinghouse to PHR
 Bootstrap an IHE based network
 Employ IHE solutions whenever
possible
 IHE generally has not focused on
consumer driven solutions but
rather on institutional and
enterprise workflow
 Can be extended to other forms of
sharing
 HIE
 Security, Security…….
 5 Academic Institutions
 Develop a solution for all
Radiology Sites
 Establish a clearinghouse
 Engage PHRs
 Primary emphasis is Consumer
Control through PHRs
 Security and Confidentiality are
drivers
 Replacement / Alternative to CD
A Standards Based Solution

30. Technical Framework
 Planning Committees identify the work to be done
in a yearly cycle
 Technical committees develop a solution
 Public Comment
 Refined solution is released for “Trial
Implementation”
 FinalText is published as part of theTechnical
Framework

31. Technical Framework
• http://www.ihe.net/Techical_Framework/index.cfm

32. Document 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
IHE Deployment Process

33. Connectathons- Testing
 How does the end user know
that a system is compliant?
 Vendor develops a solution
following the specifications of a
profile
 Vendors test their solutions with
one another at a Connectathon
 “Monitors” judge success
 Modules are tested
 Vendors that pass testing can
then implement these modules
as part of larger systems
 The first Connectathon was held
in 1999 in Chicago, IL, within the
basement of the Radiological
Society of North America's
(RSNA) parking garage.
 At the first Connectathon there
were 23 vendors, 47 applications
tested, and 1 IHE Integration
Profile tested.
 The IHE NA Connectathon 2012
held over 150 organizations and
has grown dramatically to
include over 450 participants,
which is held annually at the
Hyatt Regency Chicago.

34. IHE Connectathon 2011

35. 41
Events: Connectathon
The IHE-C Connectathon was held at April 26, 2008 in Beijing Tiantan Hospital
There are 7 companies attendedDr. Zhu, Chairman of IHE China, past vice
Minister of Healthcare attended

36. After the Connectathon
 Vendor may publish an “Integration Statement”
 IHE maintains a product registry
 End Users can use this information when
evaluating an RFP response
42

37. IHE Product Registry
http://product-registry.ihe.net/

38. IHE Product Registry

39. Integration Statement

40. Certification- IHE Profiles
Currently Connectathon testing results in a vendor being
able to state they are compliant. IHE USA has
embarked on a formal certification process. Trial
Working Group – IHE International wished to provide
more structure for all such activities and created a
working group

41. Conclusions
 IHE provides workflow driven standards based
interoperability solutions
 Easier to implement
 Promotes transparent interoperability between
disparate systems
 Diminishes costs
 Promotes quality
 www.ihe.net