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

2. 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
RSNA 2006
for Administrators Classroom Sessions

3. 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
RSNA 2006
for Administrators Classroom Sessions

4. Modern Hospital Information Flow Complexity
Cardio
Lab
MPI
Billing
ADT
RIS
HIS
Modality
PACS
Display & Print
RSNA 2006
for Administrators Classroom Sessions

5. 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
RSNA 2006
for Administrators Classroom Sessions

6. To achieve these goals we need …
… 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
RSNA 2006
for Administrators Classroom Sessions

7. 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
RSNA 2006
for Administrators Classroom Sessions

8. 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.
RSNA 2006
for Administrators Classroom Sessions

9. 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.
RSNA 2006
for Administrators Classroom Sessions

10. IHE Technical Framework – Use Case Roles & Interaction Diagrams
Examples of Actors:
ADT / Patient Registration
Scheduler
Acquisition Modality
Image Display
Report Reader
Examples of Transactions:
Register Patient
Procedure Scheduled
Images Stored
Query / Retrieve Images
Query / Retrieve Reports
RSNA 2006
for Administrators Classroom Sessions

11. The IHE Process Users IHE Vendors Standards RFP IHE Integration
Real-World
Integration
Problems
RFP
(Profiles &
Actors)
Select
IHE
Profiles
IHE
Standards
(DICOM, HL7, etc)
IHE
Integration
Profiles
IHE Technical
Framework
C-Thon Results
IHE
Connectathons
IHE
Demonstrations
Vendors
IHE
Integration
Statement
(Profiles &
Actors)
Product
with IHE Profile
RSNA 2006
for Administrators Classroom Sessions

12. 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
RSNA 2006
for Administrators Classroom Sessions

13. IHE Connectathon Results http://www. ihe
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
RSNA 2006
for Administrators Classroom Sessions

14. IHE Integration Statement
Date
12 May 2006
Vendor
Product Name
Version
Any Medical Systems Co.
IntegrateRAD
V2.3
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 Implemented
Options Implemented
Scheduled Workflow
Image Manager/Image Archive
none
Image Display
Internet address for vendor’s IHE information:
Links to Standards Conformance Statements for the Implementation
HL7
DICOM
Links to general information on IHE
North America:
In Europe:
In Japan:
RSNA 2006
for Administrators Classroom Sessions

15. Today’s - Legacy Workflow
RIS
Store Images
PACS & Archive
RSNA 2006
for Administrators Classroom Sessions

16. Scheduled Protocol Code=P1, P5
IHE Workflow
Patient Registration/Update Order Management
Order Protocol Defined
Modality Worklist
Procedure Scheduled
Proposed Protocols
Loaded and Reviewed
Worklist
Pt A, …, SPS=P1, P4
Pt C, …, SPS=P1, P5
Pt B, …, SPS=P2
Pt E, …, SPS=P4
RIS
Modality
Performed
Procedure Step
With Performed Acquisition Protocols
Performed Step:
Status = Completed
Performed Procedure: CT Head
Performed Protocol Code=P1
Pat Name/ID, Dose, Accession #, Study UID
Complete List of Images
Scheduled Protocol Code=P1, P5
Storage Commitment
List of Images
Store Images
PACS & Archive
A Closed Loop
Update Scheduling IS
Match Procedure with Order
Support Billing Based on MPPS
Avoid Reading Incomplete Procedures
RSNA 2006
for Administrators Classroom Sessions

17. IHE Scheduled Workflow Profile
acquisition
completed
acquisition
in progress
RSNA 2006
for Administrators Classroom Sessions

18. 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
RSNA 2006
for Administrators Classroom Sessions

19. 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
RSNA 2006
for Administrators Classroom Sessions

20. 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
RSNA 2006
for Administrators Classroom Sessions

21. 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
RSNA 2006
for Administrators Classroom Sessions

22. Today’s Lesson Build an IHE Testing Environment
Test IHE Scheduled Workflow Components
On a windows laptop
RSNA 2006
for Administrators Classroom Sessions

23. 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
RSNA 2006
for Administrators Classroom Sessions

24. Developed by the Mallinckrodt Institute of Radiology
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
RSNA 2006
for Administrators Classroom Sessions

25. 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
RSNA 2006
for Administrators Classroom Sessions

26. MESA Tools http://www.erl.wustl.edu/mesa/index.html RSNA 2006
for Administrators Classroom Sessions

27. 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.
RSNA 2006
for Administrators Classroom Sessions

28. Test Example – Scheduled Workflow Profile (SWF)
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
Figure Administrative Process Flow
RSNA 2006
for Administrators Classroom Sessions

29. Figure 3.3-2. Procedure Performance Process Flow
RSNA 2006
for Administrators Classroom Sessions

30. Description [Transaction]
MESA Test case #131 – Administrative & Procedure Prerform Process (SWF)
Identifier
Description [Transaction]
Source
Destination
a04.adt
A04: Register BLACK as Outpatient
Patient Class = ‘E’ [1]
ADT
Ord Plc, Ord Fil
o01.orm
ORM: Order P1 for BLACK [2]
Ord Plc
Ord Fil
o01.orm
ORM: Schedule X [4]
Img Mgr
dcm
MWL C-FIND [5]
Modality
dcm
PPS: Begin Procedure X [6]
PPS_Mgr
dcm
Ord Fil or Img Mgr
dcm
PPS: End Procedure X [7]
dcm
C-Find: Images Available Query [11]
dcm
C-Store: Images [8]
dcm
dcm
Storage Commitment: N-Action [10]
dcm
Storage Commitment: N-Event-Report [10]
dcm
RSNA 2006
for Administrators Classroom Sessions

31. MESA Testing Environment - Actors
RSNA 2006
for Administrators Classroom Sessions

32. Starting MESA Test case #131 Profile: Scheduled Workflow (SWF) Actor: Image Manager
RSNA 2006
for Administrators Classroom Sessions

33. Running Several Transactions Test case #131
RSNA 2006
for Administrators Classroom Sessions

34. Evaluating MESA Test Result case #131
RSNA 2006
for Administrators Classroom Sessions

35. 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?
RSNA 2006
for Administrators Classroom Sessions