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1 Integrating the Healthcare Enterprise IHE for Administrators: Confronting Deployment Obstacles Ellie Avraham, Kodak Health Group Paul Nagy, PhD University.

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Presentation on theme: "1 Integrating the Healthcare Enterprise IHE for Administrators: Confronting Deployment Obstacles Ellie Avraham, Kodak Health Group Paul Nagy, PhD University."— Presentation transcript:

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2 1 Integrating the Healthcare Enterprise IHE for Administrators: Confronting Deployment Obstacles Ellie Avraham, Kodak Health Group Paul Nagy, PhD University of Maryland

3 RSNA for Administrators Classroom Sessions Learning Objectives This is to address the Radiology Workflow Integration for the PACS/IT Administrators We will discuss the problems you face, the approach IHE takes, and some useful tools for testing

4 RSNA for Administrators Classroom Sessions Discussion Areas The Radiology Workflow – Values required Implementing the Radiology Workflow through the IHE Integrated Solutions Using the IHE Testing Tools (MESA) to test your products implementation of the Radiology Workflow

5 RSNA for Administrators Classroom Sessions Modern Hospital Information Flow Complexity MPI ADT RIS PACSModalityDisplay & Print HIS Billing Lab Cardio

6 RSNA for Administrators Classroom Sessions Institute of Medicine Model of Service and Redesign of Healthcare Safety Effectiveness Patient centeredness Timeliness Efficiency Equity Align to the patient Source: Insititute of Medicine, Crossing the chasm

7 RSNA for Administrators Classroom Sessions … a new generation of Healthcare IT solutions that have an order of magnitude greater level of integration. … a whole new level of Complexity Management to manage these interfaces. … we need to Decrease the time for integrating the Multi Vendors systems. … we need the capabilities for plug and play Automatic interoperability of systems. … we need to lower the total cost of integration To achieve these goals we need …

8 RSNA for Administrators Classroom Sessions Standards Exists: DICOM, HL7 The main purpose of standards is to provide the Interoperability among systems and lower the cost of integration between systems. The more plug and play integration the lower is the cost of the workflow implementation. However Standards are broad and include options that reduce the interoperability So we need to constrain the Standards options in order to improve the interoperability

9 RSNA for Administrators Classroom Sessions What is IHE Joint Initiative from RSNA, HIMSS and ACC since 1998 IHE is a collaboration of Users and Vendors on Integrating the Healthcare Imaging systems and Information systems IHE defines standardized clinical workflow solutions and a process for Development and validation implementations –Cross vendor & user discussion groups –Technical Framework for Integration Solutions: SWF, CPI, XDS-I,… –Validations testing tools - MESA –Connect-a-thons - Multi-vendor connectivity testing –Publication of success stories and integration statements –Educational materials and presentations The IHE profiles are defined in a Technical Framework that specify the Actors / functionality and the transactions that defines the exchanging information among the actors.

10 RSNA for Administrators Classroom Sessions IHE Technical Framework Components »The IHE Technical Framework (TF) defines Integrated Solutions, called Integration Profiles. A Profile defines a workflow or a specific problem solution. »A Profile defines a collaboration between Actors. An actor is a well defined entity, such as an Image Display, Image Manager, Image acquisition, etc. »The Actors communicate and collaborate among themselves by implementing a set of communication messages called Transactions. The Transactions defines the messages (actions) that an Actor needs to support.

11 RSNA for Administrators Classroom Sessions IHE Technical Framework – Use Case Roles & Interaction Diagrams Examples of Actors:Examples of Actors: -ADT / Patient Registration -Scheduler -Acquisition Modality -Image Display -Report Reader Examples of Transactions:Examples of Transactions: -Register Patient -Procedure Scheduled -Images Stored -Query / Retrieve Images -Query / Retrieve Reports

12 RSNA for Administrators Classroom Sessions Users IHE Vendors RFP (Profiles & Actors) Standards (DICOM, HL7, etc) Standards (DICOM, HL7, etc) Standards (DICOM, HL7, etc) IHE Integration Statement (Profiles & Actors) C-Thon Results Select IHE Profiles IHE Integration Profiles IHE Integration Profiles IHE Integration Profiles IHE Technical Framework Product with IHE Profile IHE Connectathons IHE Demonstrations Real-World Integration Problems The IHE Process

13 RSNA for Administrators Classroom Sessions The Connectathon Voluntary Participation Neither a Demonstration nor a Certification Well Designed End-to- End Scenarios Advanced Testing Tools Unprecedented Cross- Vendor Testing Unprecedented Pool of Technical Talent

14 RSNA for Administrators Classroom Sessions IHE Connectathon Results Consolidated Earlier Progress & Push for Market Adoption More Robust Connectathon –Results Recorded and Published Increased Industry Participation –31 companies –70 systems –21 Additional Companies in IHE Europe

15 RSNA for Administrators Classroom Sessions IHE Integration Statement Date 12 May 2006 VendorProduct NameVersion Any Medical Systems Co. IntegrateRADV2.3 This product implements all transactions required in the IHE Technical Framework to support the IHE Integration Profiles, Actors and Options listed below: Integration Profiles Implemented Actors ImplementedOptions Implemented Scheduled Workflow Image Manager/Image Archivenone Image Displaynone Internet address for vendors IHE information: Links to Standards Conformance Statements for the Implementation HL7 DICOM Links to general information on IHE North America: In Europe: Japan: net.or.jp/ihe-j

16 RSNA for Administrators Classroom Sessions Store Images PACS & Archive RIS Todays - Legacy Workflow

17 RSNA for Administrators Classroom Sessions Patient Registration/Update Order Management Order Protocol Defined Store Images Storage Commitment List of Images PACS & Archive RIS A Closed Loop Update Scheduling ISUpdate Scheduling IS Match Procedure with OrderMatch Procedure with Order Support Billing Based on MPPSSupport Billing Based on MPPS Avoid Reading Incomplete ProceduresAvoid Reading Incomplete Procedures IHE Workflow Modality Worklist Procedure Scheduled Proposed Protocols Loaded and ReviewedWorklist Pt A, …, SPS=P1, P4 Pt C, …, SPS=P1, P5 Pt B, …, SPS=P2 Pt E, …, SPS=P4 ModalityPerformed Procedure Step With Performed Acquisition Protocols Performed Step: Status = Completed Performed Procedure: CT Head Performed Protocol Code=P1 Performed Protocol Code=P1 Pat Name/ID, Dose, Accession #, Study UID Complete List of Images Scheduled Protocol Code=P1, P5

18 RSNA for Administrators Classroom Sessions acquisition in progress acquisition completed IHE Scheduled Workflow Profile IHE Scheduled Workflow Profile

19 RSNA for Administrators Classroom Sessions ADT^ Scheduled Workflow A01 Registration A04 Admission A05 Pre adminission A11 Cancellation A38 Cancellation of pre admission DICOM C-Store DICOM Modality Worklist DICOM Modality Performed Procedure DICOM Storage Commitment

20 RSNA for Administrators Classroom Sessions IHE Deployment – Testing the Integrated System Solutions For Healthcare to succeed in the digital transformation it will need much better integration between its systems. IHE is an open based standards approach to lower the cost of integrating healthcare and exposing many more processes. Open Source can accelerate the adoption of IHE by helping to educate administrators to learn how to test the integration

21 RSNA for Administrators Classroom Sessions Open Source - Integration testing tools There are many (dozens) of DICOM and HL7 tools. Too many to mention. The web site openrad.com has a repository with all the main open source Integration testing tools

22 RSNA for Administrators Classroom Sessions Open Source Toolbelt IHE MESA Tools DCM4JBOSS – Enterprise PACS Archive DVTK – DICOM Validation Toolkit HL7Browser – HL7 Message Viewer MIND – GUI DICOM query tool CTN – DICOM Send

23 RSNA for Administrators Classroom Sessions Todays Lesson Build an IHE Testing Environment Test IHE Scheduled Workflow Components On a windows laptop

24 RSNA for Administrators Classroom Sessions Standard Documentation Recommendation IHE Radiology Technical Framework: volumes #1, 2, 3 RAD Handbook App. H for Acceptance testing DICOM standard –Information Object Definition Pt.3 –DICOM Services Pt.4 –Data Dictionary Pt.6 –Medical.nema.org HL7 v2.3.1 standard

25 RSNA for Administrators Classroom Sessions IHE Medical Enterprise Simulators and Analyzers (MESA) Provides the Test Procedures and Simulation of all the IHE Profiles and Actors. Excellent Documentation. Developed by the Mallinckrodt Institute of Radiology MESA Tools runs on different operating systems: Windows 2000, Windows XP, Solaris 7.0, Red Hat Linux 7.0 & 9.0 from Intel. The MESA tool is organized for particular IHE actors as defined in the IHE Technical Framework

26 RSNA for Administrators Classroom Sessions Step 1. Install MESA tools Decide What Actors/Systems you need to test Read the Installation Guide for installing the tools you need to test your Actors/Systems Precompiled and Source Codes are available Recommend to Install the preferred Windows 2000 precompiled MESA s/w ready to be used

27 RSNA for Administrators Classroom Sessions MESA Tools

28 RSNA for Administrators Classroom Sessions Step 2: What & How to Test List your Products in terms of IHE Actors and Profiles that you need to test Review the MESA Test Procedures applicable for each Profile and actor that need to be tested Review the Test Procedures for the Workflows and Peer to Peer testing applicable actors.

29 RSNA for Administrators Classroom Sessions Test Example – Scheduled Workflow Profile (SWF) Figure Administrative Process Flow This case covers both inpatient and outpatient procedures. The patient may be new or known to the current healthcare facility. The following sequence of steps describes the typical process flow when a request is made to perform an imaging procedure on a patient

30 RSNA for Administrators Classroom Sessions Figure Procedure Performance Process Flow

31 RSNA for Administrators Classroom Sessions IdentifierDescription [Transaction] Source Destination a04.adt A04: Register BLACK as Outpatient Patient Class = E [1] ADTOrd Plc, Ord Fil o01.orm ORM: Order P1 for BLACK [2] Ord PlcOrd Fil o01.orm ORM: Schedule X1 [4] Ord FilImg Mgr dcm MWL C-FIND [5] ModalityOrd Fil dcm PPS: Begin Procedure X1 [6] ModalityPPS_Mgr dcm PPS: Begin Procedure X1 [6] PPS_MgrOrd Fil or Img Mgr dcm PPS: End Procedure X1 [7] ModalityPPS_Mgr dcm PPS: End Procedure X1 [7] PPS_MgrOrd Fil or Img Mgr C-Find: Images Available Query [11] Ord FilImg Mgr dcm C-Store: Images [8] ModalityImg Mgr dcm C-Find: Images Available Query [11] Ord FilImg Mgr dcm Storage Commitment: N-Action [10] ModalityImg Mgr dcm Storage Commitment: N-Event-Report [10] Img Mgr Modality dcm MESA Test case #131 – Administrative & Procedure Prerform Process (SWF)

32 RSNA for Administrators Classroom Sessions MESA Testing Environment - Actors

33 RSNA for Administrators Classroom Sessions Starting MESA Test case #131 Profile: Scheduled Workflow (SWF) Actor: Image Manager

34 RSNA for Administrators Classroom Sessions Running Several Transactions Test case #131

35 RSNA for Administrators Classroom Sessions Evaluating MESA Test Result case #131

36 RSNA for Administrators Classroom Sessions More information available…. IHE Web site: Technical Frameworks and Supplements Non-Technical Brochures : –Calls for Participation –IHE Fact Sheet and FAQ –IHE Integration Profiles: Guidelines for Buyers –IHE Connect-a-thon Results –Vendor Products Integration Statements IHE Wiki RSNA staff contacts: Questions?


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