1. Integrating the Healthcare Enterprise Transforming the Radiologic Interpretation Process (TRIP ™ ) Using IHE ™ Sanjay Jain, Kevin O’Donnell, Dave Channin IHE Radiology Planning Committee

2. RSNA 2003 Disclaimers Sanjay Jain is an associate of Cerner Corporation Kevin O’Donnell is an employee of Toshiba America Medical Systems Dr. Channin, Northwestern Radiology, receives a portion of his research funding from GE Medical Systems

3. RSNA 2003 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

4. RSNA 2003 Why is this important? Application of technology Can: Reduce Errors and/or Delays in Treatment Provide complete Information for Decision-making Improve efficiencies in Utilization of Staff and Equipment

5. RSNA 2003 This is your healthcare provider in healthcare Any Questions? This is healthcare

6. RSNA 2003 What’s driving the Rat 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

7. RSNA 2003 Why Does Anything in Radiology Matter? Improve service to patients Improve service to referring physicians Improve efficiency and workflow Enhance the academic mission Modernize information systems

8. RSNA 2003 How Can IHE ™ 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?

9. RSNA 2003 IHE Integration Profiles B The IHE ™ 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 to Integrate Products IHE Integration Profile A IHE Demonstration IHE Connectathon Product With IHE User Site RFP IHE Technical Framework

10. RSNA 2003 IHE ™ 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

11. RSNA 2003 Patient Information Reconciliation Access to Radiology Information Consistent Presentation of Images Workflow Basic Security Evidence Documents Key Image Notes Simple Image & Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled ™ IHE ™ Success – Radiology Profiles

12. RSNA 2003 Consider the ‘Workflow Profiles’ Scheduled Workflow – Efficient, integrated acquisition Post-Processing Workflow – Efficient, integrated 2D, 3D and CAD Reporting Workflow – Efficient, integrated reporting

13. RSNA 2003 Commonalities 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

14. RSNA 2003 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

15. RSNA 2003 That cover’s the basics; Now, How do we kick it up a notch?!

16. RSNA 2003 Patient Information Reconciliation Access to Radiology Information Consistent Presentation of Images Workflow Basic Security Evidence Documents Key Image Notes Simple Image & Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled ™ IHE ™ Success – Radiology Profiles

17. RSNA 2003 Make the radiologist more productive 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.

18. RSNA 2003 And then, Another Notch!!

19. RSNA 2003 ™ IHE ™ ITI Integration Profiles Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Enterprise User Authentication Provide users a single name and centralized authentication process across 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 presented to 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 / JPEGHL7 2.x ADT Triggers / QueriesKerberos (RFC 1510) / HL7 CCOWNTP (RFC 1305) Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications HL7 CCOW

20. RSNA 2003 Use 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

21. RSNA 2003 Conclusion IHE ™ 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

22. RSNA 2003 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