Integrating the Healthcare Enterprise Understanding, Optimizing and Implementing Workflow with IHE Charles Parisot GE Medical Systems-IT John Paganini IDX Systems

Learning Objectives Understand how the IHE Scheduled Workflow Integration Profile streamlines radiology data workflow Learn how to practically apply IHE in solving some of the typical workflow cases

Discussion Areas Workflow Defined What Are The Benefits? How Do I Get It? What Systems Should Be Considered For Integration? What Is The Sequence To Follow?

“Enter the data one time and then pass it from system to system.” On Brookwood Medical Center, Birmngham, AL

IHE Integration Profiles – 2004 Patient Information Reconciliation Access to Radiology Information Consistent Presentation of Images Basic Security Evidence Documents Key Image Notes Simple Image and Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled Workflow

Workflow Definition Focus Is On Processes –Tasks –Procedural Steps –Organizations Or People –Data: Required Input And Output Information –Tools

Benefits Clinical UsersClinical Users Greater access to consistent informationGreater access to consistent information Fewer errors, fewer tedious tasksFewer errors, fewer tedious tasks AdministratorsAdministrators Increased throughputIncreased throughput Better scheduling and trackingBetter scheduling and tracking BuyersBuyers Specify/purchase integration capabilities easilySpecify/purchase integration capabilities easily Freedom to acquire “Best of Breed” systemsFreedom to acquire “Best of Breed” systems IT ProfessionalsIT Professionals Faster, more predictable integration projectsFaster, more predictable integration projects Facilitate cooperation of competing vendorsFacilitate cooperation of competing vendors What’s in it for Me?

IHE Technical Framework Organized in 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. What is backing IHE ? Transactions: Describe particular interactions between actors to perform specific operations.

Picking IHE Profiles ? Potential Efficiency Gains Cost-Effectiveness Vendor Readiness End-User Pain Clinical Priorities Available Resources / Skillsets Improvements in Department Performance Administrative Guidelines / Vision Considerations

Workflow 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 Simplify the complex Still need all that paper? Shorten the start-to-finish cycle time Expect innovation Questions Defines one actor that controls every major piece of shared data Remove ambiguities from standards Improves access to information Ensures synchronizing data in multiple systems Mechanisms for correcting incorrect data Eliminates “Vendor Lock-in” associated with proprietary data flows. Keep healthy competition on applications ease of use. IHE Answers

IHE Added Value Classic Project Lifecycle with IHE Added Value  Definition of Client Requirements – Site Analysis, Operational Workflow IHE Contribution – Use Cases ((Technical Framework Vol I)  Generation of Proposal - Review and Modify as Needed IHE Integration Statements Integration Profiles and Actors. Review vendors capabilities (Connectathon results)  Solution Development and Implementation Leverage Use Case Section in each Profile  Testing, QA and More Testing Connectathon Profile/Transaction Based-Testing SCAR Paper – QA and Acceptance Testing of PACS Project  Go-Live and Signoff Succeed with less Surprises  Post Implementation Review Evaluate benefits and ……. Submit your IHE User Success Story Leveraging IHE in your RIS/PACS projects

Start building the integrated healthcare enterprise IHE-Based Solution Development

Where to start... First, recognize what systems you need to integrate See what Actors they implement and what Profiles they support Ensure you have the Actors based on the Profiles you want to implement By leveraging IHE, the first part can be done easily Note: You still have to include additional integration needs not covered by IHE.

Registration Orders Placed Orders Filled Film Folder Image Manager & Archive Film Lightbox report Report Repository Diagnostic Workstation Modality acquisition in-progress acquisition completed images printed Acquisition Modality Scheduled Workflow Profile

Example: RIS to Modality Connection Order Filler RIS Acquisition Modality Requires the Scheduled Workflow Profile Two Actors and two Transactions: Modality Worklist and PPS modality Performed Procedure Step (PPS)

Understand Capabilities of Actors DICOM: MWL Capable PPS Capable DICOM: MWL Capable PPS Capable Order Filler RIS Acquisition Modality The IHE way: 1-Get the vendors to commit to the support of the same IHE Integration profile: Scheduled Workflow. 2-Confirm with their IHE Integration Statements: Claim the right actors for the desired Integration Profile ? modality Performed Procedure Step (PPS) The Classical way: Try, issues ? Read the DICOM CSs Try again.

Look at what was used from the IHE Technical Framework TRIGGER EVENTS The patient arrives at the Acquisition Modality for a procedure. MESSAGE SEMANTICS The Acquisition Modality uses the C- FIND Request of the DICOM Modality Worklist SOP Class to query for the worklist from the DSS/Order Filler. The Acquisition Modality performs the SCU role, and the DSS/Order Filler the SCP role.

Dealing with Legacy Understand that you may have to deal with non-compliant devices and systems Make best effort to bring them “up-to- date” Initial implementations may provide partial support Incremental usage of IHE is fine –It’s DICOM and HL7 anyway Follow IHE’s yellow brick road...

Communication Your Plans to the Vendor Present IHE as integration priority to Vendors. A Business goal ! Use as a checklist for dealing w/vendors Ensure you specify Actors, Profiles etc, Ask for Integration Statements in RFP Ensure Project Manager and team are knowledgeable at implementing IHE

Putting the Pieces Together 1.IHE compliant products exist 2.Review Products IHE Integration Statements 1.IHE Booth has dedicated workstation 2.Website – 3.Make sure the IHE Integration Statements are for the correct versions of the software 4.Check the vendors’ results of IHE Connectathon 5.Ask your vendors to commit to deliver operational IHE Integration Profiles

IHE Integration Statement Date 12 Oct 2002 VendorProduct NameVersion Any Medical Systems Co.IntegrateRADV2.3 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 ImplementedOptions Implemented Scheduled WorkflowImage Manager/Image Archivenone Image Displaynone Image CreatorPerformed Procedure Step Order FillerPPS Exception Management Simple Image and Numeric Report Report Creatornone Internet address for vendor’s IHE information: Links to Standards Conformance Statements for the Implementation HL7 DICOM Links to general information on IHE In North America: In Europe: Japan: net.or.jp/ihe-j Find them at:

Additional Information Brochures and Reprints –IHE Integration Profiles Overview –IHE At-a-Glance –Reprints of IHE technical papers –IHE Technical Framework –The IHE FAQ; IHE Video –IHE Fundamentals, Purchasing Strategies, IHE Primer –List of Vendors Product IHE Integration Statements –Connectathon Results –HIMSS Monograph