September, 2005What IHE Delivers 1 Cor Loef – Board Member IHE International Acknowledgement for presentation input to: Acknowledgement for presentation input to: Christoph Dickmann – Member IHE Rad TC Charles Parisot – Co-chair IHE IT-I PC Integrating the Healthcare Enterprise: Building the Electronic Health Record

2 Business need: share in the Care setting Radiology Reports and Images Between Radiology and imaging specialists imaging specialists non-imaging professionals non-imaging professionals Within an enterprise Within an enterprise Cross-enterprise in a healthcare region Cross-enterprise in a healthcare region By network or media By network or media

3 Care Cycle Definition The array of health services and care settings that address: health promotion health promotion disease prevention disease prevention diagnosis, treatment, management, and rehabilitation diagnosis, treatment, management, and rehabilitation of a disease, injury, and/or disability…. Source: CDC, US government

4 The Care Cycle Approach Set of tools to identify: – –Different paths someone may follow through the care cycle – –Disciplines and roles – –Sites of care – –Technology requirements – –Information needs – –Clinical decisions taken – –Social and political changes required

5 Clinical guidelines ObservationsLiterature Deriving Care Cycles PCP office ED Cardiol- ogist office ICU/CCU Non- imaging testing HomeFloor OR / Cath Lab Non- invasive Imaging Rehab

6 Pragmatic definition of EHR Integrated data and workflow Multimedia data access Multimedia data access text, image, waveform, …text, image, waveform, … Communication among stakeholders in the care cycle Communication among stakeholders in the care cycle clinicians, caregivers, consumers, …clinicians, caregivers, consumers, … Support different views of data Clinical records Clinical records Details: episode, visit, studyDetails: episode, visit, study Longitudinal records Longitudinal records Summaries: episode, visitSummaries: episode, visit cross-department and cross-enterprise users Linking summaries and clinical details

7 EHR goals in IHE (compatible with U.S. NHII goals) Informed Clinical Practice IHE integrates clinical data and functions for an EHR IHE integrates clinical data and functions for an EHR Interconnected Clinicians Beyond the department: community or regional scope Beyond the department: community or regional scope Personalized Care Web-based data access and summary data Web-based data access and summary data Support for higher-level goals Better outcomes Better outcomes Increased patient safety Increased patient safety More efficient healthcare operations More efficient healthcare operations

8 EHR complexity Business dilemmas Significant, long-term investment Significant, long-term investment Investors may not be main beneficiaries Investors may not be main beneficiaries Coordination and cooperation Active collaboration among multiple stakeholders Active collaboration among multiple stakeholders Identify and work out commonalities and barriers Identify and work out commonalities and barriers Integration and interoperability Implement existing standards Implement existing standards Develop additional standards Develop additional standards Evolutionary system specification (system of systems)

9 Focus: Image-enabled EHR (connect two worlds) Non-imaging data Patient data Patient data Clinical data Clinical data Laboratory resultsLaboratory results Surgery reportsSurgery reports Prescriptions, medsPrescriptions, meds Letters or notesLetters or notes Integrate with imaging data and processes Imaging data Patient data Patient data Images and evidence Images and evidence RadiologyRadiology CardiologyCardiology Nuclear MedicineNuclear Medicine Integrate with non- imaging data and processes

10 Potential use cases of an image-enabled EHR Using images Neurologist: reviewing stroke patient transfer to ward Nurse: preparing GI ward round for Dr. X GP: seeing a post-MI patient after hospital discharge Patient: be prepared for an obstetric visit Producing images/ evidence Cardiologist: during catheter intervention Radiologist: starting an abdomen CT Physician: counseling at diabetes outpatient clinic Oncologist: planning radiotherapy Information need may include current or longitudinal evidence

11 Image-enabled EHR Pregnancy outpatient clinics encounter acquire evaluate index Image/ Report Repository store new data Ultrasound report and images Document Registry register (XDS architecture)

12 Image-enabled EHR Childbirth inpatient stay register index evaluate Document Registry Image/ Report/ Document Repositories index query retrieve Document Repository store new data Report, letters (incl. images) (XDS architecture)

13 Sharing Imaging Documents (XDS-I) Document Registry Register report & image references Retrieve selected imaging report references Radiology department patient Query for re- ports Document availability Shared re- pository Onco- logist GP (follow-up) Images, report (PACS, RIS) report Longitudinal record system: across encounters Care record sys- tems: specific care delivery Retrieve

14 Electronic Health Record Cardiology Laboratory Radiology Oncology Future Domains IHE IT Infrastructure 19 Integration Profiles Integration Profiles Patient Care Coordination 5 Integration Profile Patient Care Devices Eye Care 1 Integration Profile 1 Integration Profile Pathology IHE contributions to EHR implementation Each TF can contribute to EHR scenarios with Integration Profiles for Data access Workflow

15 Basic requirements of EMR/EHR systems Integrated healthcare provider systems EHR sources/ users, user interaction EHR sources/ users, user interaction Document handling Storage and retrieval of EHR documents Storage and retrieval of EHR documents Infrastructure services Basic data and application integration Basic data and application integrationNetwork EHR storage, inquiry, and retrieval path EHR storage, inquiry, and retrieval path

16 Desktop Integration as an EHR enabler Backend integration (services, data) EMR/EHR interoperability examples Appl. 1 Appl. 2 Appl. 3 Patient identifier matching Common person data or services Same patient selected Patient demographics Source 1 Source 2 Personnel/ staff data Any user Single sign on

17 IHE - Radiology images and reports for an EMR/EHR system Access to Radiology Information (Rad ARI) Retrieve diagnostic quality images, evidence, reports Evidence Documents(Rad ED) Create and use measurement or CAD objects Simple Image and Numeric Reports (Rad SINR) Access or export reports and related images Key Image Notes (Rad KIN) Mark, annotate, retrieve selected imaging evidence Portable Data for Imaging (Rad PDI) Export/ import/ view media data Nuclear Medicine Image (Rad NM Image) Capture and use complex NM result screens Mammography Image (Rad Mammo Image) Capture and use complex Mammography screens Consistent Presentation of Images(Rad CPI) Consistent image viewing on all review stations

18 IHE – Cardiology images and reports for an EMR/EHR system Cardiac Catheterization / Echo Workflow (Card CATH, ECHO) Retrieve catheterization and echocardiography imaging evidence Retrieve ECG for Display (Card ECG) Retrieve ECG summaries and results Displayable Reports (Card DRPT) Create and access reports for viewing

19 IHE - common interoperability services Common patient identification (ITI PIX) Common patient demographics (ITI PDQ) Desktop integration (ITI PSA) Running applications work on the same patient Single sign on (ITI EUA, XUA) Enterprise-wide or cross-enterprise user handling Security and privacy (ITI/ RAD ATNA, Accountability, document integrity DSG) Common staff data (ITI PWP) Health professionals are commonly recognized Fundamental enablers of cross-system health record system functions. Gradual enhancement and combination is the key.

20 IHE – documents for general purpose EHR functions Cross-Enterprise Document Sharing for Imaging (Rad XDS-I) Share DICOM instances via web or DICOM connection; share imaging information via web Cross-Enterprise Document Sharing (ITI XDS) Store & retrieve documents and summaries (focus: longitudinal data) Retrieve Information for Display (ITI RID) Query and retrieve documents and summaries/ lists Needs common services as a basis (e.g. security, patient identification)

21 IHE - clinical/context information for an EMR/EHR system Simple Image and Numeric Reports (Rad SINR) Access original or exported reports Cross-Enterprise Document Sharing (ITI XDS) Cross-Enterprise Doc. Sharing for Imaging (Rad XDS-I) Store & retrieve documents, summaries or reports with longitudinal data Cross-Enterprise Sharing of Medical Summaries (PCC MS) Emergency Department Referral (PCC EDR) Pre-procedure History and Physical (PCC PPHP) Retrieve Information for Display (ITI RID) Access documents and summaries (e.g. imaging, lab, discharge, medications, prescriptions) Sharing Laboratory report(Lab XD*-LAB) Access to laboratory results

22 IHE - workflow / patient management support Workflow integration (Rad, Card, Lab) Scheduled Workflow Scheduled Workflow Ordering, scheduling and tracking of image acquisition stepsOrdering, scheduling and tracking of image acquisition steps Appointment tracking to order placerAppointment tracking to order placer Import Reconciliation Workflow Import Reconciliation Workflow Import CDs into the local Patient/Study foldersImport CDs into the local Patient/Study folders Reporting Workflow Reporting Workflow Scheduling and tracking of report creation tasksScheduling and tracking of report creation tasks Patient data integration (Rad, Card, ITI) Patient Information Reconciliation Patient Information Reconciliation Modification and matching of patient data and imaging evidenceModification and matching of patient data and imaging evidence Patient Administration Management Patient Administration Management Creating and changing patient identifiers and encounter dataCreating and changing patient identifiers and encounter data Notification of Document Availability ( ITI NAV ) Send notification/ reference to new shared documents Send notification/ reference to new shared documents Overall concept (Rad whitepaper) Departmental workflow and interfaces to the enterprise Departmental workflow and interfaces to the enterprise

23 Envisaged IHE development Extend XDS document content Harmonize IHE domain-specific workflow and document content Realize overall workflow concept Link departmental documents, in particular diagnostic reports, to the enterprise EMR Code sets and master files Configuration support Security details, e.g. access control

24 Image-enabled EHR – Conclusion IHE Integration Profiles from different domains can be combined Combinations of current profiles can cover many EHR scenarios Information integration (imaging, textual) Information integration (imaging, textual) Enhanced functionality beyond one department Enhanced functionality beyond one department Intra- and cross enterprise communication Intra- and cross enterprise communication Scenarios enable system evolution IHE ensures integration testing and future Integration Profile development

25