1. September, 2005What IHE Delivers Andrew M. Keller, MD, FACC, FASE, FACP Chief of Cardiology, Danbury Hospital Danbury, CT, USA Integrating the Healthcare Enterprise I HE: Meeting Global needs for Integrated Healthcare Japanese Circulation Society (JCS) Kobe, Japan March 16 th, 2007

2. 1 Thank you for the opportunity to be at the Japanese Circulation Society Scientific Sessions. IHE Cardiology:

3. 2 Integrate Clinical Information Goal: optimal patient care To attain optimal patient care, we need clinical information When we need it Wherever we need it In a meaningful manner Without repeating tests (time and money) Originating from many different locations Cardiology data is especially complex Proper integration of clinical information means better patient care.

4. 3 Integrated Clinical Information

5. 4 Information from many places Hospital Home Doctors office Extended Care Data pointers

6. 5 Information is difficult to integrate!

7. 6 How can we integrate these system? Today, at least in U.S. and Europe, each two systems that are connected are an IT integration project. Very expensive Very time consuming Very resource intensive Never works quite right Usually involves third party Do not attempt to upgrade software on either system

8. 7 How to integrate? Instead, use standards: DICOM HL7 XML Define use of standards in Technical Framework Have common testing plan Vendors implement Technical Framework in products Allow vendors to work together, before it gets to our hospitals An integrated product…

9. 8 IHE is formed IHE is a consortium of professional societies and vendors working together to facilitate the integration of healthcare information 1997: IHE Radiology established; sponsored by RSNA 2000: First European Connectathon 2003: IHE Cardiology established; sponsored by ACC 2004: ESC joins IHE Cardiology 2007: IHE International formalized 2007: We are excited to have JCS join IHE Cardiology in expanding support to Asia

10. 9 Global Support I am convinced that IHE is the best possible pathway to the true integrated patient record and all of the benefits that are associated with it. -Ruediger Simon, MD, FESC, FACC Chief of Cardiology University of Kiel Kiel, Germany IHE-Europe Co-Chair

11. 10 Growth in IHE Domains Radiology (18) IT Infrastructure for Healthcare (17) Cardiology (7) Laboratory (6) Radiation Oncology (1) Patient Care Coordination (5) Patient Care Devices (1) Quality Eye Care (3) Veterinary Endoscopy Pathology Pharmacy IHE Global Developments Integration Profiles (# X) – Solutions to Real-World Interoperability Needs & Problems: Within Clinical Departments e.g.: Within Clinical Departments e.g.: Radiology Radiology Cardiology Cardiology Lab Lab...... Across Departmental & Institutional Boundaries – XDS Across Departmental & Institutional Boundaries – XDS RHIOs (Regional Healthcare Information Organizations) RHIOs (Regional Healthcare Information Organizations) EHR Enablers EHR Enablers Year 1 (1999)Year 2 (2000)Year 3 (2001) Year 4 (2002) Year 5 (2003)Year 6 (2004) Year 7 (2005) Year 8 (2006)Year 9 (2007)

12. 11 Proven Standards Adoption Process Document Use Case Requirements Identify available standards ( e.g. HL7, DICOM, IETF, OASIS) Develop technical specifications Testing at Connectathons IHE Demonstrations Products with IHE Timely access to information Easy to integrate products

13. 12 IHE Cardiology Profiles (9) Cath Lab Workflow Echocardiography Workflow Retrieve ECG for Display Echocardiography Measurement Patient: Doe, John Technologist: der Payd, N Measurements: Mitral valve diameter 3.1cm - shown in image at [ ] Ventricular length, diastolic 5.97 cm - shown in image at [ ] Ventricular volume, diastolic 14.1 ml - inferred from [ ] - inferred from VLZ algorithm Evidence Documents (Measurements) Displayable Reports Cross-Enterprise Document Sharing (EHR to EHR) Stress Testing Workflow Nuclear Medicine Implantable Cardiac Device Observation

14. 13 Cath Lab Integration One patient; one order; one procedure; consistent time stamps Procedure Log

15. 14 Stress Echo Integration Views defined; stages defined Consistent display of different vendor stress exams Toshiba Aplio (or Philips or GE) Goodman PACS (or 5 other vendors) views stages

16. 15 Stress testing integration One patient; one order; one procedure across systems; Consistently defined Protocols and stages

17. 16 Brigham and Womens Hospital Patient info and orders Philips Allura x6 Witt hemo x6 Patient info, Order, schedule, and procedure status SecureStorage Cath Workflow Profile:

18. 17 Brigham and Womens Hospital Realized Benefits at Brigham: Accurate and automated patient demographics Happier technologists (less busy work –typing) Fewer interruptions for Cath Lab Flow Manager (procedure status and cancellations) Faster room turn around time Better communication between cath lab teams Improved efficiency of billing Providing data to be able to optimize resource utilization It works!

19. 18 Integration benefits For users across the healthcare enterprise, IHE: allows faster access to information, reduces errors, streamlines workflow, simplifies interface projects, optimizes resource utilization. Spend time with patients; not chasing information.

20. 19 Working together with JCS How can IHE Cardiology and IHE-Japan work together more closely: Visit the IHE Interoperability Workshop at ACC.07 if you are attending (booth #2251) Understand differences in clinical workflow in Japan Encourage additional direct involvement in the Planning Committee Web-ex/tcon in May, 2007, to explain new Year 4 Profiles and gain direct feedback Direct involvement in annual IHE Cardiology prioritization process for new Profiles (usually August/September timeframe) Bi-annual joint tcons at mutually agreed upon times

21. 20 More Resources - www.ihe.net www.ihe.net www.ihe-j.org Frequently Asked Questions Integration Profiles in Technical Frameworks: Cardiology Cardiology IT Infrastructure IT Infrastructure Laboratory Laboratory Patient Care Coordination Patient Care Coordination Patient Care Devices Patient Care Devices Radiation Oncology Radiation Oncology Radiology Radiology Connectathon Results Vendor Products Integration Statements Participation in Committees and Connectathons

22. September, 2005What IHE Delivers