2. Sept 13-15, 2004IHE Interoperability Workshop 1 Integrating the Healthcare Enterprise Integrating Systems using IHE Integration Profiles John Paganini IDX Systems Corporation

3. Sept 13-15, 2004IHE Interoperability Workshop 2 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. Sept 13-15, 2004IHE Interoperability Workshop 3 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. Sept 13-15, 2004IHE Interoperability Workshop 4 IHE Radiology Integration Profiles Patient Info. Recon- ciliation Access to Radiology Information Consistent Present- ation of Images Basic Security - Evidence Docs Key Image Notes Simple Image & Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled Workflow Portable Data for Imaging NM Image

6. Sept 13-15, 2004IHE Interoperability Workshop 5 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. Sept 13-15, 2004IHE Interoperability Workshop 6 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. Sept 13-15, 2004IHE Interoperability Workshop 7 Generic Integration Solution Implementation Guide Based on Standards Choice of Useful Standards Definitions Select Options Defined by Standards Strict Conformance to Standards:  Health Level 7 ( HL7 )  DICOM 3.0 ... IHE - Relationship to Standards

9. Sept 13-15, 2004IHE Interoperability Workshop 8 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. Sept 13-15, 2004IHE Interoperability Workshop 9 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. Sept 13-15, 2004IHE Interoperability Workshop 10 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. Sept 13-15, 2004IHE Interoperability Workshop 11 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. Sept 13-15, 2004IHE Interoperability Workshop 12 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. Sept 13-15, 2004IHE Interoperability Workshop 13 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. Sept 13-15, 2004IHE Interoperability Workshop 14 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. Sept 13-15, 2004IHE Interoperability Workshop 15 How to build the integrated healthcare enterprise

17. Sept 13-15, 2004IHE Interoperability Workshop 16 Where to start... First, recognize what systems you need to integrate See what Actors they implement and in what Profiles are supported. Make sure Actors and Profiles match properly and fit into the Framework. … Otherwise it won’t work!

18. Sept 13-15, 2004IHE Interoperability Workshop 17 Next Steps Just matching of Actors and profiles is not enough Most systems have much more complex functionality than that defined in framework They need more data to function properly Identify what data systems need besides elements defined in the IHE transactions.

19. Sept 13-15, 2004IHE Interoperability Workshop 18 Check Optional Transactions IHE 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. Sept 13-15, 2004IHE Interoperability Workshop 19 Check the Options in Transactions Many data elements in the transactions are optional or conditional Make 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 it

21. Sept 13-15, 2004IHE Interoperability Workshop 20 Is it going to work now? Make sure the conformance statements are for correct versions of the software Check HL7 interface specs Review DICOM Conformance Statements Check the results of IHE Connect-a-thon Ask vendors to provide output from the MESA test tools

22. Sept 13-15, 2004IHE Interoperability Workshop 21 MESA Tools Test tools that are developed by the IHE Technical Project Management Team Used in preparation for IHE Connect-a-thon. MESA tools are in public domain. Test outputs are fairly informative and may provide the extra information on how transactions are implemented

23. Sept 13-15, 2004IHE Interoperability Workshop 22 Are we there yet? 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 systems Make best effort to bring them “up-to-date” Follow yellow brick road...

24. Sept 13-15, 2004IHE Interoperability Workshop 23 Implementing Integration Projects with IHE

25. Sept 13-15, 2004IHE Interoperability Workshop 24 Project Considerations A working knowledge of rapidly changing technology An unbiased insight into the business strategies of potential suppliers Incorporating existing equipment Considering changes to current operations Accounting for the various skills and apprehensions of a multitude of potential users Accommodating complex practice patterns of radiologists and referring physicians Impact of organization changes within the enterprise Impact of changes in the health care industry

26. Sept 13-15, 2004IHE Interoperability Workshop 25 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. Sept 13-15, 2004IHE Interoperability Workshop 26 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. Sept 13-15, 2004IHE Interoperability Workshop 27 Vendor Considerations Cost - Look at whole picture Flexibility - Integratable, Scalable Functionality - Standard, customizable Implementability - Mature, Complexity Stability - Revenue, Market Segment Usability - Hides complexity,Productive

29. Sept 13-15, 2004IHE Interoperability Workshop 28 Reengineering Analysis What works well now? What does not work well now? What is a "relic from the past"? Search for redundancies Search for important, missing data Check 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. Sept 13-15, 2004IHE Interoperability Workshop 29 User Analysis IHE brings users together in new ways Each user vital to patient care Each user has different perspective Each user needs to see how IHE can benefit them

31. Sept 13-15, 2004IHE Interoperability Workshop 30 Departmental Chief ROLE Responsible for prompt, reliable, cost- effective patient care Analyzes workflow, visionary, road map IHE INTEREST Purchase best of breed while conforming to IHE Seamless integration Deliver on unique requirements of Staff Ensure optimized workflow

32. Sept 13-15, 2004IHE Interoperability Workshop 31 Department Manager ROLE Focused on superior service to patients and referring physicians Workflow Efficiency Maximum Procedures Performed Resource Management Information Accessible IHE INTEREST Reduction in data entry errors ROI from IHE from increase in efficiencies Information is pushed to authorized users

33. Sept 13-15, 2004IHE Interoperability Workshop 32 The Technologist ROLE High quality procedures Patient comfort and expediency Problem solver Operational complexity increasing Prepares images for viewing IHE INTEREST Elimination of repetitive tasks (zoom, pan, etc…) Elimination of paper (scheduling, orders) Ensures images are stored Automation of image routing and accessibility

34. Sept 13-15, 2004IHE Interoperability Workshop 33 The Radiologist ROLE High quality patient care High level of customer service to referring physicians PROBLEMS Increasing regulations Decreasing reimbursement Tight labor pool Competitive market IHE INTEREST Must facilitate efficient workflow Electronic annotations on study Exceptions management Protocol management Images logically grouped Presentation of images Reporting tools

35. Sept 13-15, 2004IHE Interoperability Workshop 34 The Non-Radiologist Clinician ROLE Best Healthcare Possible PROBLEMS Decreasing reimbursement Administrative Chores Too much hunting for information IHE INTEREST Know when the procedure started and when it is completed Access to all patient images and reports Images accessible from anywhere Key images w/annotations

36. Sept 13-15, 2004IHE Interoperability Workshop 35 Chief Information Officer ROLE Protector and Provider of Patient Data Manages dozens of information systems PROBLEMS Increasing policies, procedures, regulations Tight budgets Changing technologies Tight technical labor market IHE INTEREST Workflow defined Deploy best of breed systems with standards Technical Framework will enable application consolidation Promotes healthy competition to vendors – improve performance and service

37. Sept 13-15, 2004IHE Interoperability Workshop 36 Imaging Information System Vendor ROLE Provider of Images Optimize DICOM interoperability PROBLEMS Need to link images to documents Access to RIS and others IHE INTEREST IHE Enables teamwork between vendors - and users IHE solves real-world problems Enables simpler dialog between vendors and customers Reduced service calls Satisfied customers

38. Sept 13-15, 2004IHE Interoperability Workshop 37 Non-Imaging Information System Vendor ROLE Transform healthcare delivery by helping customers improve efficiency and provide quality patient care PROBLEMS Need interface engine Custom integrations IHE INTEREST Mechanism to enable consistent clinical information exchange Growth, profit and customer satisfaction Drives future product functionality Insights into the issues Integration efforts - less time and money

39. Sept 13-15, 2004IHE Interoperability Workshop 38 Conclusion IHE should be part of the proposed solution IHE benefits users, providers and vendors Year 6 - Key year for expansion into other domains while radiology continues Support and involvement building across disciplines and internationally

40. Sept 13-15, 2004IHE Interoperability Workshop 39 More information…. IHE Web sites: http://www.himss.org/IHE http://www.rsna.org/IHE http://www.acc.org/quality/ihe.htmhttp://www.acc.org/quality/ihe.htm. Technical Frameworks: ITI V1.0, RAD V5.5, LAB V1.0 Technical Framework Supplements - Trial Implementation May 2004: Radiology August 2004: Cardiology, IT Infrastructure 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