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  • Systems means HIS, RIS, modalities, PACS, review stations, printers, etc.
  • E.G. too much data re-entry, too many manual steps “Who owns the problem?” The hospital can’t solve the problem with insufficient tools (although there have been impressive efforts) The integration problem was generally outside the scope of a single vendor/product
  • E.G. too much data re-entry, too many manual steps “Who owns the problem?” The hospital can’t solve the problem with insufficient tools (although there have been impressive efforts) The integration problem was generally outside the scope of a single vendor/product
  • **Consider making the cycle graphic Incremental approach: Can’t solve all at once Connectathon – Practical measure of progress, Validates the integration work accomplished. Refer the Scorecard. Demo – promotes standards based integration to users/purchasers
  • What’s wrong with DICOM? Nothing misinterpretation and ambiguity
  • !! Asking for Scheduled Workflow is a lot easier than comparing DICOM Conformance Statements (“Can your system buy train tickets?” is easier that asking for a list of verbs, nouns, and grammatical syntaxes) The problems are integration problems which means they are communication problems Dictionaries are great. But if I drop you on the Champs Elysee and you want to get a nice meal, Handing you a dictionary is not really solving your problem. Being resourceful individuals you Would start flipping through the dictionary and would eventually get yourself fed, but it would Be slow and painful and you might be surprised what actually showed up on your plate. What would be much more useful would be a phrasebook. It describes specifically how to use the language to accomplish a particular task. This requires a series of predictable transactions with a set of actors. Just like the section on restaurants defines a set of phrases for the maitre d’, the bartender, your waiter, etc for you to make a reservation, get a table, get a menu, order and receive food, pay your bill, etc. The IHE section for the Scheduled Radiology Workflow profile defines a set of transactions for the ADT, the Order Placer, the Modality, the PACS etc. to register a patient, order and schedule a study, pass that information to the modality, Receive status updates, etc.
  • Year 3: Consolidation for IHE (Status, Report/Study Linkage) Catch-up for the vendors and products Original plan called for a 5-year initiative …
  • Framework is being developed now. Likely to require AUDIT TRAIL, system login, node identification/certificates.
  • IHE_in_Cardiology-ACC.ppt

    1. 1. Integrating the Healthcare Enterprise IHE ’s Potential for Cardiology Joseph Biegel Mitra IHE Planning Committee
    2. 2. What is IHE? <ul><li>An industry-clinical partnership to integrate clinical information systems throughout healthcare </li></ul><ul><ul><li>Demographics, images, waveforms, reports </li></ul></ul><ul><li>Goal: Improve the efficiency and effectiveness of clinical practice by: </li></ul><ul><ul><li>Providing an implementation framework for open connectivity using existing standards </li></ul></ul><ul><ul><li>Improving clinical information flow </li></ul></ul>
    3. 3. Who participates in IHE? <ul><li>Industry sponsors: Radiological Society of North American (RSNA) and Health Information and Management Systems Society (HIMSS) </li></ul><ul><li>A neutral forum open to all vendors: Participants include GE, Phillips, Siemens, IDX, Cerner, Mitra, and some 30 others </li></ul><ul><li>Standards committee members: DICOM, HL7 </li></ul><ul><li>Clinicians, hospital information technology staff, healthcare administrators </li></ul>
    4. 4. Why is IHE needed? <ul><li>Serious Integration Challenges: </li></ul><ul><ul><li>Systems need information from other systems: patient demographics, referring physicians, echo/angio images, ECG waveforms, hemodynamics, clinical reports, etc. </li></ul></ul><ul><ul><li>But, systems communicate poorly or not at all </li></ul></ul><ul><ul><li>Result: - tedious, inefficient workflows - data that is inconsistent or unavailable </li></ul></ul><ul><ul><li>Responsibility for information flow between systems and between departments is often unclear. </li></ul></ul>
    5. 5. What does IHE do? <ul><li>Users and vendors work together to identify and design solutions for integration problems </li></ul><ul><li>Intensive process with annual cycles: </li></ul><ul><ul><li>Identify key specific healthcare workflows and integration problems </li></ul></ul><ul><ul><li>Research & select standards to specify a solution </li></ul></ul><ul><ul><li>Write, review and publish IHE Technical Framework </li></ul></ul><ul><ul><li>Perform cross-testing at “Connectathon” </li></ul></ul><ul><ul><li>Demonstrations at meetings (RSNA/HIMSS/ACC) </li></ul></ul>
    6. 6. What does IHE cover? <ul><li>Currently focused in Radiology </li></ul><ul><li>30 Vendors tested 70 systems at the Year 3 Connectathon </li></ul><ul><li>Systems include: </li></ul><ul><ul><li>HIS, RIS </li></ul></ul><ul><ul><li>MR, CT, US, CR, DX, … </li></ul></ul><ul><ul><li>PACS, Review Stations, Reporting Systems </li></ul></ul><ul><ul><li>Printers, Imagers </li></ul></ul>
    7. 7. Why aren’t existing industry standards sufficient? <ul><li>Standards are vital (HL7, DICOM, ICD, …) </li></ul><ul><ul><li>They provide consensus, tools & technologies </li></ul></ul><ul><ul><li>IHE is entirely standards-based </li></ul></ul><ul><li>But standards alone are insufficient </li></ul><ul><ul><li>Varying interpretations </li></ul></ul><ul><ul><li>Optional variations </li></ul></ul><ul><ul><li>No real-world specifications or scenarios </li></ul></ul><ul><ul><li>No assurance of portability or connectivity </li></ul></ul>
    8. 8. How is IHE related to standards? <ul><li>IHE focuses on specific, practical integration problems </li></ul><ul><li>Standards such as HL7 and DICOM provide “dictionaries” </li></ul><ul><li>IHE defines a “phrasebook” and/or “grammar” that solves real world problems by assembling pieces provided by DICOM/HL7 </li></ul>
    9. 9. Key IHE concepts <ul><li>Technical Framework: detailed, structured document delineating standards-based transactions among systems (“ IHE actors ”) to support specific workflow and integration capabilities </li></ul><ul><li>Integration Profiles: Documents specifying integration capabilities for specific patient-care problems </li></ul>
    10. 10. IHE’s track record <ul><li>Year 1 (1999): Proof of Concept (Basic Scheduled Workflow) </li></ul><ul><li>Year 2 (2000): Introduction of 7 Integration Profiles for Radiology </li></ul><ul><li>Year 3 (2001): Consolidation, Catch-up (Real Products) Expansion to France </li></ul><ul><li>Year 4 (2002): 3 New Profiles Expansion to Japan, Germany </li></ul><ul><li>Year 5 (2003): New Profiles Expansion to Cardiology, Lab, Pathology, …? </li></ul>
    11. 11. Integration Profile examples <ul><li>Scheduled Imaging-Encounter Workflow </li></ul><ul><ul><ul><li>Registration, ordering, scheduling, acquisition, distribution, storage </li></ul></ul></ul><ul><li>Patient Information Reconciliation </li></ul><ul><li>Consistent Presentation of Images </li></ul><ul><ul><ul><li>Across various devices, media </li></ul></ul></ul><ul><li>Key Image Note </li></ul><ul><ul><ul><li>Adding text notes and pointers to images </li></ul></ul></ul>
    12. 12. Why IHE in cardiology (1)? <ul><li>Cardiology workflow involves multiple diagnostic tests, images and reports </li></ul><ul><li>Cardiology clinical systems/devices typically are unintegrated </li></ul><ul><ul><li>Separate systems for ECG/Holter, EP, PPM/ICD, echo, angiographic images, hemodynamics, documents/reports </li></ul></ul><ul><ul><li>Each system typically requires redundant manual data entry, with inevitable errors </li></ul></ul>
    13. 13. Why IHE in cardiology (2)? <ul><li>Systems typically do not share data </li></ul><ul><ul><li>Patient demographics, directories of referring physicians or of images/documents </li></ul></ul><ul><li>Image formats often not portable </li></ul><ul><ul><li>Encrypted formats, proprietary readers, variable headers </li></ul></ul><ul><li>Fragmentation causes inefficiency, invalid or inaccessible clinical data, and compromises the quality of care </li></ul>
    14. 14. Why IHE in cardiology (2) ? <ul><li>Some of the concepts of the IHE TF have broad general applicability and many can be applied or adapted to Cardiology </li></ul><ul><li>The imaging vendors are largely the same </li></ul><ul><li>DICOM and HL7 are used in Cardiology today </li></ul><ul><ul><li>Other Cardiology specific standards could easily be leveraged in a Cardiology specific version of the TF </li></ul></ul>
    15. 15. Common characteristics <ul><li>Cardiology is similar in some vital respects to radiology </li></ul><ul><ul><li>Driven by imaging modalities </li></ul></ul><ul><ul><li>Managing distributed departmental resources </li></ul></ul><ul><ul><li>Need for an integrated patient-centered view and for administrative reporting </li></ul></ul><ul><ul><li>Need to improve lab efficiency via workflow management </li></ul></ul><ul><ul><li>Legacy installed base technology issues </li></ul></ul>
    16. 16. Cardiology workflow elements <ul><li>Workflow often similar to radiology: </li></ul><ul><ul><li>Patients are admitted </li></ul></ul><ul><ul><li>Demographics entered (often multiple times for the same patient) </li></ul></ul><ul><ul><li>Imaging studies are performed and read </li></ul></ul><ul><ul><li>Reports generated </li></ul></ul>
    17. 17. Distinct cardiology needs <ul><li>Clinical data content is more complex </li></ul><ul><ul><li>Therapeutic as well as diagnostic procedure reports, with richer report content </li></ul></ul><ul><ul><li>Richer graphical content: moving images, color </li></ul></ul><ul><ul><li>Clinical encounter data </li></ul></ul><ul><ul><li>Outcome reporting </li></ul></ul><ul><li>Cardiology focuses on an integrated patient view rather than on procedures, images and reports in isolation </li></ul>
    18. 18. IHE/cardiology possibilities (1) <ul><li>Image exchange/portability </li></ul><ul><ul><li>Even with DICOM, image transfer and display often don’t work </li></ul></ul><ul><ul><li>Difficulty importing outside images into local archives </li></ul></ul><ul><li>As part of a cardiology Technical Framework, IHE could specify unambiguous, vendor-supported, compatible DICOM implementations </li></ul>
    19. 19. IHE/cardiology possibilities (2) <ul><li>Redundant, manual patient demographic data entry is slow and error prone </li></ul><ul><ul><li>DICOM and HL7 can help, but the standards themselves are not enough </li></ul></ul><ul><li>IHE could leverage or adapt its Scheduled Workflow Integration Profile and Patient Information Reconciliation Profile for cardiology, resulting in a single entry point for patient demographics, accessible to all cardiology systems and devices </li></ul>
    20. 20. IHE/cardiology possibilities (3) <ul><li>IHE can develop generic, standards-based interfaces between cardiology devices/systems and enterprise systems for scheduling, ordering and results reporting </li></ul><ul><li>Cardiology makes large capital purchases of imaging and information systems without assurance that systems can co-exist or interface: The “fear at power on” factor </li></ul><ul><li>The IHE TF can define vendor-neutral requirements that assure interoperability </li></ul>
    21. 21. IHE/cardiology possibilities (4) <ul><li>Structured reporting: In partnership with ACC and clinicians, IHE could develop standards-based cardiology reports, including diagrams and graphics for anatomy, function and viability </li></ul><ul><li>Beyond static, black-and-white DICOM: IHE could develop Implementation Profiles for motion images, color images, waveforms, Doppler, pediatric echo </li></ul>
    22. 22. <ul><ul><li>IHE and industry will do the heavy lifting at the technical level </li></ul></ul><ul><ul><li>BUT IHE needs ACC involvement </li></ul></ul><ul><ul><ul><li>To ensure that IHE focuses on clinical needs and provides clinically relevant solutions </li></ul></ul></ul><ul><ul><ul><li>To act as impartial, patient-centered observers (rarely referees), so that IHE remains truly vendor-neutral </li></ul></ul></ul>An IHE/ACC partnership
    23. 23. Conclusions <ul><li>IHE can dramatically improve the care of cardiology patients and life for cardiologists. </li></ul><ul><li>To succeed--and to do justice to its goals--IHE needs both expert cardiology input and ACC involvement </li></ul>