Presentation on theme: "Cor Loef – Co-chair IHE Rad TC"— Presentation transcript:
1Integrating the Healthcare Enterprise: Building the Electronic Health Record Cor Loef – Co-chair IHE Rad TCAcknowledgement for presentation input to:Christoph Dickmann – Member IHE Rad TCCharles Parisot – Co-chair IHE IT-I PC
2Business need: share in the Care setting Radiology Reports and Images Between Radiology andimaging specialistsnon-imaging professionalsWithin an enterpriseCross-enterprise in a healthcare regionBy network or media
3Care Cycle DefinitionThe array of health services and care settings that address:health promotiondisease preventiondiagnosis, treatment, management, and rehabilitationof a disease, injury, and/or disability…. Source: CDC, US government
4The Care Cycle Approach Set of tools to identify:Different paths someone may follow through the care cycleDisciplines and rolesSites of careTechnology requirementsSocial and political changes requiredCostsPotential future care cycles
5Deriving Care Cycles PCP office ED Cardiol- ogist ICU/CCU Non- imaging testingHomeFloorOR /Cath LabinvasiveImagingRehabClinical guidelinesObservationsIndustry leadersLiterature
6Pragmatic definition of EHR Integrated data and workflowMultimedia data accesstext, image, waveform, …Communication among stakeholders in the care cycleclinicians, caregivers, consumers, …Support different views of dataClinical recordsDetails: episode, visit, studyLongitudinal recordsSummaries: episode, visitcross-department and cross-enterprise usersLinking summaries and clinical details
7EHR goals in IHE (compatible with U.S. NHII goals) Informed Clinical PracticeIHE integrates clinical data and functions for an EHRInterconnected CliniciansBeyond the department: community or regional scopePersonalized CareWeb-based data access and summary dataSupport for higher-level goalsBetter outcomesIncreased patient safetyMore efficient healthcare operations
8EHR complexity Business dilemmas Coordination and cooperation Significant, long-term investmentInvestors may not be main beneficiariesCoordination and cooperationActive collaboration among multiple stakeholdersIdentify and work out commonalities and barriersIntegration and interoperabilityImplement existing standardsDevelop additional standards Evolutionary system specification (system of systems)
9Focus: Image-enabled EHR (connect two “worlds”) Non-imaging dataPatient dataClinical dataLaboratory resultsSurgery reportsPrescriptions, medsLetters or notesIntegrate with imaging data and processesImaging dataPatient dataImages and evidenceRadiologyCardiologyNuclear MedicineIntegrate with non-imaging data and processesDepartmental/ clinical information system world compared to imaging system world: both complement each other from an EHR viewpoint
10Potential use cases of an image-enabled EHR Using imagesNeurologist: reviewing stroke patient transfer to wardNurse: preparing GI ward round for Dr. XGP: seeing a post-MI patient after hospital dischargePatient: be prepared for an obstetric visitProducing images/ evidenceCardiologist: during catheter interventionRadiologist: starting an abdomen CTPhysician: counseling at diabetes outpatient clinicOncologist: planning radiotherapyThe left column describes use cases from the image usage point of view.The right column describes use cases from the image production or specific service point of view.Information need may include current or longitudinal evidence
11Image-enabled EHR Pregnancy outpatient clinics encounter evaluateacquireImage/ Report Repositorystore new dataUltrasound report and imagesindexDocument Registryregister(XDS architecture)The next 2 slides show use cases from 2 encounters of the same patient in different care institutions. The example is taken from pregnancy care before and for childbirth.The flow of information illustrates the primary IHE mechanism of document sharing.
12Image-enabled EHR Childbirth inpatient stay evaluateDocument RegistryImage/ Report/ Document RepositoriesindexDocument Repositorystore new dataReport, letters (incl. images)retrieveindexqueryregister(XDS architecture)
13Sharing Imaging Documents (XDS-I) Radiology departmentpatientOnco- logistGP (follow-up)Document availabilityImages, report (PACS, RIS)reportLongitudinal record system: across encountersCare record sys-tems: specific care deliveryRetrieveShared re- positoryQueryfor re-portsRetrieve selected imaging report referencesDocument RegistryRegister report & image referencesYour local imaging systems keep their DICOM objects, these are not copied to the shared information network.Shared repositories are not imaging-specific, a general “infrastructure” can be used.Imaging Information via native DICOM (imaging specialists) or WADO (general-purpose, web-based).You can learn more about XDS-I in the presentation “What is new in IHE” right here in the infoRAD classroom (please mention day/time).
14IHE contributions to EHR implementation EHR realizationIHE IT Infrastructure 7 Int. ProfilesIHE Radiology 7 Int. ProfilesIHE Laboratory 1 Int. ProfileIHE Cardiology 3 Int. ProfilesIHE Pat. Care Coord. 3 Int. ProfileIHE Rad and Card are the major existing imaging-related Technical Frameworks (TF) – and are likely to be needed in a combined way in many scenarios.IHE IT-I Profiles provide common services for EHR system implementation.IHE PCC can be assumed to specify a majority of document contentsIHE plans for the coming years include missing integration profiles to cover most EHR services.Each TF can contribute to EHR scenarios with Integration Profiles forData accessWorkflow
15Basic requirements of EMR/EHR systems Integrated healthcare provider systemsEHR sources/ users, user interactionDocument handlingStorage and retrieval of EHR documentsInfrastructure servicesBasic data and application integrationNetworkEHR storage, inquiry, and retrieval path
16EMR/EHR interoperability examples Backend integration (services, data)Source 1Source 2DesktopIntegrationas an EHR enablerAppl. 1Appl. 2Appl. 3Patient identifier matchingSingle sign onSame patient selectedPatient demographicsPersonnel/ staff dataAny userApplications may be forspecific purposes (e.g. department / specialist focus),for wider purpose (e.g. enterprise / distribution focus), orfor general access/ creation/ viewing purpose (e.g. RHIO/ community-wide document viewing focus)Common person data or services
17IHE - Radiology images and reports for an EMR/EHR system Access to Radiology (Rad ARI) Retrieve diagnostic quality images, evidence, reportsSimple Image and Numeric Reports (Rad SINR) Access or export reports and related imagesKey Image Notes (Rad KIN) Mark, annotate, retrieve selected imaging evidencePortable Data for Imaging (Rad PDI) Export/ import/ view media dataNuclear Medicine Image (Rad NM Image) Capture and use complex NM result screensMammography Image (Rad Mammo Image) Capture and use complex Mammography screensConsistent Presentation of Images (Rad CPI) Consistent image viewing on all review stations
18IHE – Cardiology images and reports for an EMR/EHR system Cardiac Catheterization / Echo Workflow (Card CATH, ECHO) Retrieve catheterization and echocardiography imaging evidenceRetrieve ECG for Display (Card ECG) Retrieve ECG summaries and resultsDisplayable Reports (Card DRPT) Create and access reports for viewing
19IHE - common interoperability services Common patient identification (ITI PIX)Common patient demographics (ITI PDQ)Desktop integration (ITI PSA) Running applications work on the same patientSingle sign on (ITI EUA, XUA) Enterprise-wide or cross-enterprise user handlingSecurity and privacy (ITI/ RAD ATNA, Accountability, document integrity DSG)Common staff data (ITI PWP) Health professionals are commonly recognizedNow, a comprehensive overview is given on all these aspects of EHR systems that can be enabled or realized by IHE Integration Profiles.You will see, IHE provides many steps in the gradual evolution of your IT system landscape to a comprehensive patient record system. The IHE Integration Profiles provide interoperability added value independently – however, if combined, they can complete the picture of an intra- or cross-enterprise EHR system.Fundamental enablers of cross-system health record system functions. Gradual enhancement and combination is the key.
20IHE – documents for general purpose EHR functions Cross-Enterprise Document Sharing for Imaging (Rad XDS-I) Share DICOM instances via web or DICOM connection; share imaging information via webCross-Enterprise Document Sharing (ITI XDS) Store & retrieve documents and summaries (focus: longitudinal data)Notification of Document Availability (ITI NAV) Send notification/ reference to new shared documentsRetrieve Information for Display (ITI RID) Query and retrieve documents and summaries/ listsNeeds common services as a basis (e.g. security, patient identification)
21IHE - clinical/ textual information for an EMR/EHR system Simple Image and Numeric Reports (Rad SINR) Access original or exported reportsCross-Enterprise Document Sharing (ITI XDS) Cross-Enterprise Doc. Sharing for Imaging (Rad XDS-I) Store & retrieve documents, summaries or reports with longitudinal dataRetrieve Information for Display (ITI RID) Access documents and summaries (e.g. imaging, lab, discharge, medications, prescriptions)Sharing Laboratory report (Lab XD*-LAB) Access to laboratory results
22IHE - workflow / patient management support Workflow integration (Rad, Card, Lab)Scheduled WorkflowOrdering, scheduling and tracking of image acquisition stepsAppointment tracking to order placerReporting WorkflowScheduling and tracking of report creation tasksPatient data integration (Rad, Card, ITI)Patient Information ReconciliationModification and matching of patient data and imaging evidencePatient Administration ManagementCreating and changing patient identifiers and encounter dataOverall concept (Rad whitepaper)Departmental workflow and interfaces to the enterprise
23Envisaged IHE development Extend XDS’ document contentHarmonize IHE domain-specific workflow and document contentRealize overall workflow conceptLink departmental documents, in particular diagnostic reports, to the enterprise EMRCode sets and master filesConfiguration supportSecurity details, e.g. access control
24Image-enabled EHR – IHE progress and plans IHE Integration Profiles from different domains can be combinedCombinations of current profiles can cover many EHR scenariosInformation integration (imaging, textual)Enhanced functionality beyond one departmentIntra- and cross enterprise communicationScenarios enable system evolution (organizational change management not to be forgotten)IHE ensures integration testing and future Integration Profile developmentIHE knows that it does not provide specifications to completely realize image-enabled EHR systems yet. But it has clear plans how to get there within the next few years.