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Integrating the Healthcare Enterprise IHE for Consultants and System Integrators Andrei Leontiev John Paganini IDX Systems Corporation.

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Presentation on theme: "Integrating the Healthcare Enterprise IHE for Consultants and System Integrators Andrei Leontiev John Paganini IDX Systems Corporation."— Presentation transcript:

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2 Integrating the Healthcare Enterprise IHE for Consultants and System Integrators Andrei Leontiev John Paganini IDX Systems Corporation

3 RSNA 20022 The IHE Technical Framework presents the technical details for system integrators implementing an IHE networkThe IHE Technical Framework presents the technical details for system integrators implementing an IHE network It includes guidelines for defining dependency relationships, system validation and verification.It includes guidelines for defining dependency relationships, system validation and verification. These guidelines and tools will simplify the process, identify potential problems, and make systems integration faster, more efficient, less expensive and more successful.These guidelines and tools will simplify the process, identify potential problems, and make systems integration faster, more efficient, less expensive and more successful. IHE as an Integration Tool

4 RSNA 20023 IHE Technical Framework Organized in three sections that provide an increasing level of detail: Integration Profiles: Establish broad categories of compatible function. Actors: Identify specific kinds of operational participants in the healthcare enterprise. Transactions: Describe particular interactions between actors to perform specific operations.

5 RSNA 20024 IHE Integration Profiles Access to Radiology Information Retrieve & view images and reports Consistent Presentation of Images Hardcopy and softcopy grayscale presentation state Key Image Notes Flag & search for significant images Simple Image and Numeric Reports Simple reports with image links and measurements Basic Security Audit Trail Consolidation & Node Authentication Presentation of Grouped Procedures Manage subsets of a single acquisition Post- Processing Workflow Schedule, perform, & notify image processing & CAD steps Charge Posting Collection of billable procedure details Scheduled Workflow Admit, order, schedule, acquire & store images with notification of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders

6 RSNA 20025 Technical Framework: Actors Actors identify specific kinds of operational participants in the healthcare enterprise.Actors identify specific kinds of operational participants in the healthcare enterprise. An individual actor often corresponds to a device or software productAn individual actor often corresponds to a device or software product However, actors only reflect integration capabilities of such device or product Real-life products often implement multiple actorsReal-life products often implement multiple actors Actors may implement more than one IHE profile.Actors may implement more than one IHE profile. 17 types of actors IHE Year 417 types of actors IHE Year 4

7 RSNA 20026 Technical Framework: Transactions Transactions specify how actors communicate to each other in the integration profileTransactions specify how actors communicate to each other in the integration profile Transactions define standard protocolsTransactions define standard protocols (DICOM, HL7, etc.)(DICOM, HL7, etc.) If protocol allows for multiple options, certain choice of options is often dictatedIf protocol allows for multiple options, certain choice of options is often dictated May be required in multiple profiles; some transactions are optionalMay be required in multiple profiles; some transactions are optional Over 30 types of transactions in Year 4Over 30 types of transactions in Year 4

8 RSNA 20027 Generic Integration SolutionGeneric Integration Solution Implementation Guide Based on StandardsImplementation Guide Based on Standards Choice of Useful Standards DefinitionsChoice of Useful Standards Definitions Select Options Defined by StandardsSelect Options Defined by Standards Strict Conformance to Standards:Strict Conformance to Standards: –Health Level 7 ( HL7 ) –DICOM 3.0 –... IHE - Relationship to Standards

9 RSNA 20028 Use Case Roles & Interaction Diagrams Actor 1Actor 2 TRANSACTIONS Actor 3 Actor 1Actor 2Actor 3 Message 1 Message 2 Message 3 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

10 RSNA 20029 Use Case Roles & Interaction Diagrams Examples Interaction Diagram:Retrieve Reports Retrieve Reports ( C-MOVE ) Store Reports ( C-STORE ) View Reports Report Reader Report Repository External Report Repository Retrieve Reports ( C-MOVE ) Store Reports ( C-STORE ) View Reports

11 RSNA 200210 System Transactions Overview Order Placer Performed Procedure Step Manager ADT Patient Registration Image ArchiveImage Manager Image Display Image Creator Acquisition Modality Department System Scheduler – Order Filler – Modality Worklist Patient Registration Patient Update Procedure Scheduled Images Availability Query Patient Update Procedure Update Images Stored Storage Commit Q /R Key Image Note Q /R Presentation Sates Storage Commit Images Stored PPS In-Progress / Completed PPS In-Progress / Completed PPS In-Progress / Completed Filler Order Management Placer Order Management Present. State Stored Q /R Images Key Image Note Stored Present. State Stored Key Image Note Stored

12 RSNA 200211 Order Placer Performed Procedure Step Manager ADT Patient Registration Image Archive Image Manager Image Display Image Creator Acquisition Modality Department System Scheduler – Order Filler – Modality Worklist Patient Registration Patient Update Procedure Scheduled Images Availability Query Patient Update Procedure Update Images Stored Storage Commit Q /R Key Image Note Q /R Presentation Sates Storage Commit Images Stored PPS In-Progress / Completed PPS In-Progress / Completed PPS In-Progress / Completed Filler Order Management Placer Order Management Present. State Stored Q /R Images Key Image Note Stored Present. State Stored Key Image Note Stored System Transactions Overview PRINTING Print Server Print Request with Presentation LUT Print Composer External Report Repository Report Reader Report Creator Report Manager Report Repository Report Submission Report Issuing Query Report Retrieve Report Enterprise Result Repository Structured Report Export

13 RSNA 200212 Store Images Storage Commitment List of Images PACS & Archive RIS ModalityPerformed Procedure Step Performed Step: Status = Completed Performed CT Head Pat Name/ID, Dose, Accession #, Study UID Complete List of Images IHE Scheduled Workflow Modality Worklist Worklist Procedure Scheduled Patient Registration/Update Order Management

14 RSNA 200213 Scheduled Workflow Order Placer Performed Procedure Step Manager ADT Patient Registration Image Archive Image Manager Image Display Image Creator Acquisition Modality Department System Scheduler – Order Filler – Modality Worklist Patient Registration Procedure Scheduled Images Availability Query Images Stored Storage Commit Storage Commit Images Stored PPS In-Progress / Completed Filler Order Management Placer Order Management Patient Update Q /R Images PPS In-Progress / Completed PPS In-Progress / Completed

15 RSNA 200214 Example: Image Manager/ Image Archive Actor TransactionOptionalitySection in TF Procedure ScheduledR6.4 Modality Procedure Step In ProgressR6.6 Modality Procedure Step CompletedR6.7 Modality Images StoredR6.8 Storage CommitmentR6.10 Image Availability QueryR6.11 Query ImagesR6.14 Retrieve ImagesR6.16 Creator Images StoredR6.18 Creator Procedure Step in ProgressR6.20 Creator Procedure Step CompletedR6.21 Integration Profiles Actors and Transactions Scheduled Workflow

16 How to build the integrated healthcare enterprise

17 RSNA 200216 Where to start... First, recognize what systems you need to integrateFirst, recognize what systems you need to integrate See what Actors they implement and in what Profiles are supported.See what Actors they implement and in what Profiles are supported. Make sure Actors and Profiles match properly and fit into the Framework.Make sure Actors and Profiles match properly and fit into the Framework. … Otherwise it won’t work!… Otherwise it won’t work!

18 RSNA 200217 Next Steps Just matching of Actors and profiles is not enoughJust matching of Actors and profiles is not enough Most systems have much more complex functionality than that defined in frameworkMost systems have much more complex functionality than that defined in framework They need more data to function properlyThey need more data to function properly Identify what data systems need besides elements defined in the IHE transactions.Identify what data systems need besides elements defined in the IHE transactions.

19 RSNA 200218 Check Optional Transactions IHE Integration Profiles may contain optional transactions - make sure both sender and receiver treat such transactions similarlyIHE Integration Profiles may contain optional transactions - make sure both sender and receiver treat such transactions similarly –if receiver requires transaction, sender must be able to always generate it –If receiver does not utilize transaction, make sure it is gracefully handled when it “shows up”

20 RSNA 200219 Check the Options in Transactions Many data elements in the transactions are optional or conditionalMany data elements in the transactions are optional or conditional Make sure that sender generates conditional information when conditions are metMake sure that sender generates conditional information when conditions are met Make sure that receiver may operate without optional data or the sender must be able to always generate itMake sure that receiver may operate without optional data or the sender must be able to always generate it

21 RSNA 200220 Is it going to work now? Make sure the conformance statements are for correct versions of the softwareMake sure the conformance statements are for correct versions of the software Check HL7 interface specsCheck HL7 interface specs Review DICOM Conformance StatementsReview DICOM Conformance Statements Check the results of IHE Connect-a-thonCheck the results of IHE Connect-a-thon Ask vendors to provide output from the MESA test toolsAsk vendors to provide output from the MESA test tools

22 RSNA 200221 MESA Tools Test tools that are developed by the IHE Technical Project Management TeamTest tools that are developed by the IHE Technical Project Management Team Used in preparation for IHE Connect-a-thon.Used in preparation for IHE Connect-a-thon. MESA tools are in public domain.MESA tools are in public domain. Test outputs are fairly informative and may provide the extra information on how transactions are implementedTest outputs are fairly informative and may provide the extra information on how transactions are implemented

23 RSNA 200222 Are we there yet? One yet have to find the healthcare enterprise equipped so that all the systems are “IHE aware”One yet have to find the healthcare enterprise equipped so that all the systems are “IHE aware” Understand that you may have to deal with non-compliant devices and systemsUnderstand that you may have to deal with non-compliant devices and systems Make best effort to bring them “up-to-date”Make best effort to bring them “up-to-date” Follow yellow brick road...Follow yellow brick road...

24 RSNA 200223 Implementing Integration Projects with IHE

25 RSNA 200224 Project Considerations A working knowledge of rapidly changing technologyA working knowledge of rapidly changing technology An unbiased insight into the business strategies of potential suppliersAn unbiased insight into the business strategies of potential suppliers Incorporating existing equipmentIncorporating existing equipment Considering changes to current operationsConsidering changes to current operations Accounting for the various skills and apprehensions of a multitude of potential usersAccounting for the various skills and apprehensions of a multitude of potential users Accommodating complex practice patterns of radiologists and referring physiciansAccommodating complex practice patterns of radiologists and referring physicians Impact of organization changes within the enterpriseImpact of organization changes within the enterprise Impact of changes in the health care industryImpact of changes in the health care industry

26 RSNA 200225 Classic Consulting Process 1.Definition of Client Requirements – Site Analysis, Operational Workflow 2.Generation of Proposal - Review with Client, Modify as Needed 3.Solution Development and Implementation 4.Client Testing QA / Test 5.Client Signoff 6.Post Implementation Review

27 RSNA 200226 Solution and Development Current State AnalysisCurrent State Analysis Impact StudyImpact Study Current State AnalysisCurrent State Analysis Impact StudyImpact Study System Design and Implementation StrategySystem Design and Implementation Strategy Current State AnalysisCurrent State Analysis Impact StudyImpact Study System Design and Implementation StrategySystem Design and Implementation Strategy Cost EstimateCost Estimate Current State AnalysisCurrent State Analysis Impact StudyImpact Study System Design and Implementation StrategySystem Design and Implementation Strategy Cost EstimateCost Estimate Pay Back AnalysisPay Back Analysis Current State AnalysisCurrent State Analysis Department Layout Imaging Asset Analysis Room Utilization Hardcopy Utilization Digital Image Equivalents Workflow Analysis Cost Analysis Develop assumptions about system performance and specify performance requirements. Interviews with the radiologists and clinicians Questionnaires Short and long term outcomes. System design includes block diagrams and component lists. Physical network Acquisition devices Display systems Archives Interfaces Determine the pricing of the required products and services. Applications. Professional Services. Integrations. Training. Material costs and labor savings are combined with other potential savings

28 RSNA 200227 Vendor Considerations Cost - Look at whole pictureCost - Look at whole picture Flexibility - Integratable, ScalableFlexibility - Integratable, Scalable Functionality - Standard, customizableFunctionality - Standard, customizable Implementability - Mature, ComplexityImplementability - Mature, Complexity Stability - Revenue, Market SegmentStability - Revenue, Market Segment Usability - Hides complexity,ProductiveUsability - Hides complexity,Productive

29 RSNA 200228 Reengineering Analysis What works well now?What works well now? What does not work well now?What does not work well now? What is a "relic from the past"?What is a "relic from the past"? Search for redundanciesSearch for redundancies Search for important, missing dataSearch for important, missing data Check workload peaks & valleysCheck workload peaks & valleys Challenge traditions Expect innovation Document every detail Simplify the complex Still need all that paper? Shorten the start-to- finish cycle time Verify computations

30 RSNA 200229 User Analysis IHE brings users together in new waysIHE brings users together in new ways Each user vital to patient careEach user vital to patient care Each user has different perspectiveEach user has different perspective Each user needs to see how IHE can benefit themEach user needs to see how IHE can benefit them

31 RSNA 200230 Departmental Chief ROLE Responsible for prompt, reliable, cost-effective patient careResponsible for prompt, reliable, cost-effective patient care Analyzes workflow, visionary, road mapAnalyzes workflow, visionary, road map IHE INTEREST Purchase best of breed while conforming to IHEPurchase best of breed while conforming to IHE Seamless integrationSeamless integration Deliver on unique requirements of StaffDeliver on unique requirements of Staff Ensure optimized workflowEnsure optimized workflow

32 RSNA 200231 Department Manager ROLE Focused on superior service to patients and referring physiciansFocused on superior service to patients and referring physicians Workflow EfficiencyWorkflow Efficiency Maximum Procedures PerformedMaximum Procedures Performed Resource ManagementResource Management Information AccessibleInformation Accessible IHE INTEREST Reduction in data entry errorsReduction in data entry errors ROI from IHE from increase in efficienciesROI from IHE from increase in efficiencies Information is pushed to authorized usersInformation is pushed to authorized users

33 RSNA 200232 The Technologist ROLE High quality proceduresHigh quality procedures Patient comfort and expediencyPatient comfort and expediency Problem solverProblem solver Operational complexity increasingOperational complexity increasing Prepares images for viewingPrepares images for viewing IHE INTEREST Elimination of repetitive tasks (zoom, pan, etc…)Elimination of repetitive tasks (zoom, pan, etc…) Elimination of paper (scheduling, orders)Elimination of paper (scheduling, orders) Ensures images are storedEnsures images are stored Automation of image routing and accessibilityAutomation of image routing and accessibility

34 RSNA 200233 The Radiologist ROLE High quality patient careHigh quality patient care High level of customer service to referring physiciansHigh level of customer service to referring physiciansPROBLEMS Increasing regulationsIncreasing regulations Decreasing reimbursementDecreasing reimbursement Tight labor poolTight labor pool Competitive marketCompetitive market IHE INTEREST Must facilitate efficient workflowMust facilitate efficient workflow Electronic annotations on studyElectronic annotations on study Exceptions managementExceptions management Protocol managementProtocol management Images logically groupedImages logically grouped Presentation of imagesPresentation of images Reporting toolsReporting tools

35 RSNA 200234 The Non-Radiologist Clinician ROLE Best Healthcare PossibleBest Healthcare PossiblePROBLEMS Decreasing reimbursementDecreasing reimbursement Administrative ChoresAdministrative Chores Too much hunting for informationToo much hunting for information IHE INTEREST Know when the procedure started and when it is completedKnow when the procedure started and when it is completed Access to all patient images and reportsAccess to all patient images and reports Images accessible from anywhereImages accessible from anywhere Key images w/annotationsKey images w/annotations

36 RSNA 200235 Chief Information Officer ROLE Protector and Provider of Patient DataProtector and Provider of Patient Data Manages dozens of information systemsManages dozens of information systemsPROBLEMS Increasing policies, procedures, regulationsIncreasing policies, procedures, regulations Tight budgetsTight budgets Changing technologiesChanging technologies Tight technical labor marketTight technical labor market IHE INTEREST Workflow definedWorkflow defined Deploy best of breed systems with standardsDeploy best of breed systems with standards Technical Framework will enable application consolidationTechnical Framework will enable application consolidation Promotes healthy competition to vendors – improve performance and servicePromotes healthy competition to vendors – improve performance and service

37 RSNA 200236 Imaging Information System Vendor ROLE Provider of ImagesProvider of Images Optimize DICOM interoperabilityOptimize DICOM interoperabilityPROBLEMS Need to link images to documentsNeed to link images to documents Access to RIS and othersAccess to RIS and others IHE INTEREST IHE Enables teamwork between vendors - and usersIHE Enables teamwork between vendors - and users IHE solves real-world problemsIHE solves real-world problems Enables simpler dialog between vendors and customersEnables simpler dialog between vendors and customers Reduced service callsReduced service calls Satisfied customersSatisfied customers

38 RSNA 200237 Non-Imaging Information System Vendor ROLE Transform healthcare delivery by helping customers improve efficiency and provide quality patient careTransform healthcare delivery by helping customers improve efficiency and provide quality patient carePROBLEMS Need interface engineNeed interface engine Custom integrationsCustom integrations IHE INTEREST Mechanism to enable consistent clinical information exchangeMechanism to enable consistent clinical information exchange Growth, profit and customer satisfactionGrowth, profit and customer satisfaction Drives future product functionalityDrives future product functionality Insights into the issuesInsights into the issues Integration efforts - less time and moneyIntegration efforts - less time and money

39 RSNA 200238 Conclusion IHE should be part of the proposed solutionIHE should be part of the proposed solution IHE benefits users, providers and vendorsIHE benefits users, providers and vendors Year 5 - Key year for expansion into other domains while radiology continuesYear 5 - Key year for expansion into other domains while radiology continues Support and involvement building across disciplines and internationallySupport and involvement building across disciplines and internationally

40 RSNA 200239 Where is More Information Available? www.rsna.org/IHE IHE Technical framework for year 3 – V5.0 Non-Technical Brochures : IHE Primer and IHE FAQ IHE Integration Profiles: Guidelines for Buyers IHE Connectathon Results


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