1. Integration Profiles - Overview Integrating the Healthcare Enterprise G. Claeys Agfa Healthcare R&D, Technology Manager Vendor co-chair IHE Europe Courtesy of IHE Committees

2. 7 February 2005IHE Europe Educational Event 2 Integration Profiles - Objective Address real-world interoperability problems (bottom-up approach) Leverage same integration solutions over multiple domains (top-down)  Generalized solutions  Example : Scheduling exams, display `exam results Integration Profiles are orthogonal  IPs are independent of each other  Applications may combine multiple Integration Profiles E.g. Information access + security

3. 7 February 2005IHE Europe Educational Event 3 Integration Profile - structure Referenced standard (HL7) Detailed messaging info ------------- ------------- Roles Integration Profile Actor … Transaction ……… Solves an Integration Problem: A collection of real world information exchange capabilities supported by a set of specific Actors using Standards-based Transactions

4. 7 February 2005IHE Europe Educational Event 4 IHE Roadmap Cardiology Labora- tory Pharmacy,….. Radiology Patient Identifier Linkage, Registries, Security Access to clinical information; Electronic Health Record Other (e.g. Acces Control, eHealthWorkflows) Patient Management Order Management

5. 7 February 2005IHE Europe Educational Event 5 IHE Scope

6. 7 February 2005IHE Europe Educational Event 6 IHE Radiology – Focus Points Streamline the workflow sub-processes  Upstream : Patient ADT – Ordering – Data creation & processing  Downstream : Reporting – Treatment – Billing  Exception management : e.g. update unknown patient IDs Quality control  Consistent presentation of images on displays & printers Improve communication with referring physicians  Access to information, generated in radiology (images, reports)  Image notes (post-its) Improve machine-machine communication (automatic processing)  Structured reports  Measurements and coded data Security :  Adhere to (parts of) existing Security&Privacy regulation  authentication, auditing Off-line medium distribution (new)

7. 7 February 2005IHE Europe Educational Event 7 Patient Information Reconciliation Reconcile Worklists, Status and Data Objects For Unknown Patients and Demographics Changes Access to Radiology Information Consistent Presentation of Images Create, store, manage, retrieve & use objects for hardcopy and softcopy grayscale presentation states Key Image Notes Create, store, manage, retrieve & use objects to flag significant images Simple Image and Numericc Reports Create, store, manage, retrieve & use simple diagnostic reports with optional image links & Scheduled Workflow Presentation of Grouped Procedures Manage individual procedure image subsets from a multi-procedure acquisition for viewing & reporting Basic Security Charge Posting Reporting Workflow Manage worklists, track status, perform & notify diagnostic reporting steps Evidence Documents Create, store, manage, retrieve & use objects to record study evidence Manage worklists, track status, perform & notify image processing & CAD steps Post - Processing Workflow Create, Store, Manage, Retrieve & Use Images Admission, Order Management, Scheduling, Store, Retrieve Manage Worklists, Track Status, Perform & Notify Acquisition Related Steps Radiology – Integration Profiles New NM Image Portable Data for Imaging New

8. 7 February 2005IHE Europe Educational Event 8 IHE IT Infrastructure – Focus Points Enterprise interoperability issues, common to multiple departments Improve information consistency among applications & departments :  Cross referencing patient IDs among hospitals (MPI)  Patient synchronisation of multiple desktop applications Simple access to patient’s clinical information from workstations and browsers  Reports, images, Simple access to administrative information of patient and staff  Patient’s demographic information, personnel directory Security :  Single sign-on (shared user context)  Centralized user management  Audit trails on enterprise level Sharing of clinical information among healthcare providers (e.g. regional health networks)

9. 7 February 2005IHE Europe Educational Event 9 IT Infrastructure – Integration Profiles Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications Consistent Time Coordinate time across networked systems Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. New Patient Demographics Query New Personnel White Page Access to workforce contact information New Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record New

10. 7 February 2005IHE Europe Educational Event 10 IHE Laboratory – Focus Points Leverage schedule workflow of radiology  Ordering, scheduling and performing clinical laboratory tests Support specimen testing on the point of care or on the patient’s bedside  Delivering the observation results to the medical staff, at various steps of validation. Manage the sequence of operations of automated lab equipment  E.g. analyzers, robotic decappers, centrifuges, conveyors All specialties working on specimen, not on the patient itself.

11. 7 February 2005IHE Europe Educational Event 11 Laboratory IHE Integration Profiles In Process –TI Nov 2004 Laboratory Device Automation (LDA) In Process –TI Nov 2004 Pre-analytic process, analysis and post-analytical treatment Laboratory Scheduled Workflow (LSWF) Completed in 2003 Tests performed by a laboratory for an identified inpatient or outpatient In Process Laboratory Patient Information Reconciliation (LPIR) In Process Tests performed on an unidentified or misidentified patient In Process Laboratory Code Set Distribution (LCSD) In Process Sharing the batteries and tests code sets throughout the enterprise In Process –TI Nov 2004 Laboratory Point Of Care Testing (LPOCT) In Process –TI Nov 2004 Tests performed on point of care or patient’s bedside

12. 7 February 2005IHE Europe Educational Event 12 IHE Cardiology – Focus Points Leverage “schedule workflow” (radiology) for cath lab and echocardiography Leverage “retrieve for display” for ECG’s Differences with radiology :  Echo cardio modalities are not always on-line  Ad-hoc scheduling is the rule, not the exception  Time synchronization among multiple modalities

13. 7 February 2005IHE Europe Educational Event 13 IHE Cardiology – Integration Profiles Cardiac Catheterization Workflow New Echocardiography Workflow New Retrieve ECG for Display Integration Profile (RED) Provide ECGs and related documents to enterprise New

14. 7 February 2005IHE Europe Educational Event 14 Example ECG in SVG Format

15. 7 February 2005IHE Europe Educational Event 15Conclusion Leverage existing IHE Integration Profiles in different domains Multi-year roadmap of IHE Integration Profiles per domain IT Infrastructure address enterprise level integration issues

16. 7 February 2005IHE Europe Educational Event 16 More information…. IHE Web sites: www.ihe.net http://ihe-europe.org http://www.rsna.org/IHE http://www.acc.org/quality/ihe.htm http://ihe-nl.org Technical Frameworks: ITI V1.0, RAD V5.5, LAB V1.0, CARDIO V1.0 Non-Technical Brochures : IHE Europe Business Case IHE Fact Sheet and FAQ IHE Integration Profiles: Guidelines for Buyers IHE Connectathon Results Vendor Products Integration Statements