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IHE Takes PACS to the Next Level

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IHE Takes PACS to the Next Level

  1. 1. IntegratingIntegrating thethe Healthcare EnterpriseHealthcare Enterprise IHE takes PACS to the nextIHE takes PACS to the next levellevel Paul Nagy, PhD Assistant Professor of Radiology Medical College of Wisconsin
  2. 2. IHE takes PACS to the nextIHE takes PACS to the next levellevel Six reasons to use IHE today
  3. 3. Diffusion of innovation modelDiffusion of innovation model  1943 model of Iowa farmers adoption of hybrid seeds  Five personality and socioeconomic categories Time Innovators Early Adopters Early Majority Late Majority Traditionalists B. Reiner, E. Siegel “Psychological factors affecting the adoption of PACS” Applied Radiology Volume: 31 Number: 4 April 2002
  4. 4. There is PACS and then there isThere is PACS and then there is PACSPACS The difference is integration With the RIS With the Modalities With the Dictation system With the Hospital Network IHE covers some of the more pressing integration problems
  5. 5. Reason #1: Life expectancy ofReason #1: Life expectancy of your PACSyour PACS If you …  Want  Hope  Expect  Need  Pray .. your PACS will last more than 3-4 years, you should be trying to use IHE where possible.
  6. 6. Technology LifetimeTechnology Lifetime Standards (DICOM, HL7, IHE, SNIA…) 25- 50 years Infrastructure (IP, SAN,…) 10- 20 years Programming Languages (PL/1, Pascal, C, C++, Java, …) 5-10 years Software (data formats, compatibility, …) 2-5 years Hardware (Network cards, video cards, processors, …) 1-2 years Shapiro, IBM
  7. 7. Reason #2: PACS alone doesn’tReason #2: PACS alone doesn’t magically fix errorsmagically fix errors What happens when you get rid of all the film room personnel (and your human safety net)? Will the electronic systems protect you from making mistakes?
  8. 8. MalpracticeMalpractice Smith J, Berlin L, “Malpractice Issues in Radiology: Picture Archiving and Communication Systems (PACS) and the Loss of Patient Examination Records”, AJR: 176, June (2001), pp1381-4 Failures of second generation systems without robust interfaces and integrity checking
  9. 9. Reason #3: PACS alone doesn’tReason #3: PACS alone doesn’t increase productivityincrease productivity Errors causes rework Redesigning your work Automating steps through interfaces IHE provides a framework for robust interfaces
  10. 10. Sending safely from modality to PACSSending safely from modality to PACS Basic PACS W/ IHE SWF 1. Scanner sends CT data to PACS 2. Tech logs into PACS and confirms all the images made across by the image count on the modality. 3. Tech manually selects, deletes, and confirms the deletion on the modality. 1. Scanner sends CT data to PACS 2. Scanner requests commitment of storage 3. PACS returns a commit for every image sent 4. Modality registers commit and sets study as archived and available for deletion off of the modality. What if the tech forgets to delete the study? What if the tech makes a mistake and deletes a study that hasn’t been archived. What if the tech misses the count? Which way is more efficient and more effective? Deming rule “Cease dependence upon inspection”
  11. 11. Reason #4: Getting vendors toReason #4: Getting vendors to work togetherwork together
  12. 12. If getting one vendor to doIf getting one vendor to do what you want is hard.what you want is hard.
  13. 13. How do you get two to workHow do you get two to work together?together?
  14. 14. IHE is for the relief of painsIHE is for the relief of pains that PACS can causethat PACS can cause
  15. 15. Reason #5: IHE is easierReason #5: IHE is easier than DICOMthan DICOM And more reliable IHE sits atop DICOM and HL7 Is more stringent in mandatory fields to enable workflow
  16. 16. Reason #6: People will thinkReason #6: People will think you are really smart at workyou are really smart at work  IHE is not a standard  It is really a blueprint trying to solve tricky workflow problems.  There is enormous intellectual property in IHE and extremely thorough solutions to problems.  Tap into the experience and knowledge.  In many ways IHE is the lessons learned from all those who have tried to go soft-copy in the past decade and ran into stumbling blocks.
  17. 17. Product Evaluation WorksheetProduct Evaluation Worksheet
  18. 18. Vendor IntegrationVendor Integration StatementsStatements IHE Integration Statement Vendor Product Name Version Date Great Medical Systems IntegrateRAD V2.3 12 Oct 2002 This product implements all transactions specified in the IHE Technical Framework to support the IHE Integration Profile, Actors and Options stated below: Integration Profiles Implemented Actors Implemented Options Implemented Image Manager/Image Archive none Image Display Performed Procedure Step Scheduled Workflow Order Filler PPS Exception Management Simple Image and Numeric Report Report Creator none Link to the vendor IHE page www.greatmedicalsystems.fake/ihe Links to Standards Conformance Statements for the Implementation HL7 www.greatmedicalsystems.fake/hl7 DICOM www.greatmedicalsystems.fake/dicom/integrateRAD.pdf For general Information on IHE In America: www.rsna.com/ihe In Europe: www.ihe-europe.org In Asia:
  19. 19. Contract NegotiationContract Negotiation “…90% payment contingent upon successful implementation and operation of … profile.” Integration with other information systems is becoming more and more a differentiator between medical devices.
  20. 20. So What Now?So What Now?  Users drive the market, you have the power.  Consider including IHE in your integration planning strategies  Take a look at the IHE Technical Framework and supporting information  Use IHE Integration Profiles when writing RFPs and purchasing specifications
  21. 21. Information ResourcesInformation Resources Brochures and Reprints IHE Integration ProfilesIHE Integration Profiles IHE At-a-GlanceIHE At-a-Glance Reprints of IHE technical papersReprints of IHE technical papers IHE Product Evaluation WorksheetsIHE Product Evaluation Worksheets IHE Technical FrameworkIHE Technical Framework The IHE FAQ; IHE VideoThe IHE FAQ; IHE Video IHE Fundamentals, Purchasing Strategies, IHE PrimerIHE Fundamentals, Purchasing Strategies, IHE Primer IHE Integration Checklist, Connectathon ResultsIHE Integration Checklist, Connectathon Results HIMSS MonographHIMSS Monograph www.rsna.org/ihe

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