September, 2005What IHE Delivers 1 Purchasing & Integrating Radiology Systems Using IHE: A Tutorial & A Real-world Case Kevin ODonnell, Cor Loef, John Paganini, Chris Lindop, Christoph Dickmann

2 Integrating the Healthcare Enterprise IHE facilitates integrating systems for efficient, accurate patient care Systems that support IHE Integration Profiles: communicate better & integrate more easily communicate better & integrate more easily provide more complete and accurate information provide more complete and accurate information better support care providers workflow better support care providers workflow Each IHE Profile describes a clinical information need or workflow scenario describes a clinical information need or workflow scenario documents how to use standards (e.g. HL7, DICOM,...) to accomplish it documents how to use standards (e.g. HL7, DICOM,...) to accomplish it Systems that implement the same Profile address a need in a mutually compatible way Hundreds of products support one or more IHE Radiology Profiles.

3 Your Three Step Program Select Specific IHE Profiles List those Profiles in your RFP Check Vendors IHE Integration Statements

4 Selecting IHE Profiles Review the Profiles : What they do Benefits for your situation Some Helpful Resources: IHE Users Handbook - Radiology RSNA Demonstrations Educational Material (e.g. Workshop Presentations) IHE Technical Framework – Radiology Connectathon Results

5 RFPs Be Brief? The system must support DICOM The system must support DICOM Be Effective? The system must support the following DICOM services according to the following 100 pages of specifications: … The system must support the following DICOM services according to the following 100 pages of specifications: … Be Both: The system must support the IHE Scheduled Workflow Profile as the Acquisition Modality actor. The system must support the IHE Scheduled Workflow Profile as the Acquisition Modality actor. Vendor IHE Integration Statements Version 2.1 of the CardioCT 5000 supports IHE Scheduled Workflow as an Acquisition Modality Version 2.1 of the CardioCT 5000 supports IHE Scheduled Workflow as an Acquisition Modality

6 IHE Integration Statements Explicit claim by the vendor, for a specific product version Lists profiles, actors, options Short & Sweet

7 IHE Integration Statement Date: 03/10/2006 VendorProduct NameVersion Acme Medical SystemsPACS-o-MaticV3.9 This product implements all transactions required to support the IHE Integration Profiles, Actors and Options listed below: Integration Profiles ImplementedActors ImplementedOptions Implemented Scheduled WorkflowImage Manager / Archive. PPS Exception Management Patient Information ReconciliationImage Manager / Archive. None Consistent Presentation of ImagesImage Manager / Archive Image Display None Portable Data for Imaging Media Creator Media Importer None Audit Trail and Node AuthenticationAudit Record RepositoryNone Internet address for vendor's IHE information : Links to Standards Conformance Statements for the implementation Dicom: Health Level 7: Links to general information on IHE In North America : In Europe : In Japan :

8 Lets look at an Example From the IHE Radiology Users Handbook Suppose youre buying a modality (Chapter 1) Suppose your integration plan has identified two key targets: Reducing/Preventing Errors Reducing/Preventing Errors Improving Throughput/Turnaround Improving Throughput/Turnaround Reviewing the Profile Benefits (Section 1.1.1): Scheduled Workflow Profile has a significant impact on both targets: Scheduled Workflow Profile has a significant impact on both targets: Prevents manual data entry errors & also saves time at the modality console by downloading patient demographics and study details from the RIS (MWL) Prevents manual data entry errors & also saves time at the modality console by downloading patient demographics and study details from the RIS (MWL) Prevents lost studies and time wasted re-scanning by confirming PACS receipt of images to avoid accidental deletion; And saves time spent doing it manually by doing it automatically and electronically (Storage Commitment) Reduces missing or irrelevant priors by storing a full set of accurate patient and study identifiers and details in each study object (Store) Reduces delays in the review/reporting process by notifying the RIS of exams in progress and completed (MPPS)

9 IHE Scheduled Workflow Profile 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

10 Using IHE You present IHE as an integration priority to your vendors. A Business goal ! You specify appropriate Profiles, Actors, Options in your RFP The system must support the IHE Scheduled Workflow Profile as the Acquisition Modality actor and support the Exception Management Option. The system must support the IHE Scheduled Workflow Profile as the Acquisition Modality actor and support the Exception Management Option. You request Integration Statements from your vendors You plan acceptance testing (Section 1.2.2)

11 Dealing with Legacy Prepare to identify and address any legacy system issues (Section 1.2.4) Maximum benefit when all systems are IHE Most of you will have some non-compliant devices and systems Most of you will have some non-compliant devices and systems Make best effort to bring them up-to-date Make best effort to bring them up-to-date Incremental usage of IHE provides incremental benefit Its just clean DICOM and HL7 Its just clean DICOM and HL7 Get on the Yellow Brick Road... No sense buying New legacy equipment No sense buying New legacy equipment

12 First Steps Visit IHE Profile Demonstrations Cross-Enterprise Document Sharing for Imaging [XDS-I] Cross-Enterprise Document Sharing for Imaging [XDS-I] Teaching File & Clinical Trial Export [TCE] Teaching File & Clinical Trial Export [TCE] Here in Inforad and in participating Vendor Booths Here in Inforad and in participating Vendor Booths Interoperability Showcase at HIMSS 2007 Interoperability Showcase at HIMSS 2007 Visit - start learning about Profiles Talk about an IHE strategy with your CIO / IT staff, and with your vendors Now, lets look at a Real-world Experience

September, 2005What IHE Delivers 13 Nogah Haramati, MD Chief of Radiology Professor, Clinical Radiology & Surgery Albert Einstein College of Medicine and Montefiore Medical Center User IHE Implementation Experiences: Montefiore Medical Center, NY USA Beth Goodhew Peninsula Consulting Group

14 Montefiore Medical Center 1,400 bed tertiary care university hospital 2 major inpatient facilities 5 Km (3 miles) Multiple off site clinics, practices and offices Major data center 30 miles away

15 Montefiore Radiology 450,000 exams annually 2 major inpatient facilities 8 outpatient facilities 11 CT, 7 MRs, 14 US, 23 CR, 5 DR 50 attendings & 50 residents & fellows

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17 First Wave IHE Radiology Profiles Scheduled Workflow (SWF) Patient Information Reconciliation (PIR) Simple Image & Numeric Reports (SINR) Access to Radiology Information (ARI) Consistent Presentation of Images (CPI) Presentation of Grouped Procedures (PGP)

18 First Wave IHE ITI Profile Consistent Time (CT)

19 Reduced Errors with IHE Reduced errors Unified usage of worklists rather than free typing of patient names and identifiers Unified usage of worklists rather than free typing of patient names and identifiers IHE storage commitment step reduces risk of examinations not being archived IHE storage commitment step reduces risk of examinations not being archived

20 Reduced Errors with IHE Patient information reconciliation IHE profile enabled us to correct human errors and the problems regarding unknown patient unknown patient missing orders missing orders Performed procedure step allows real-time feedback to orders & scheduling system

21 The Human Factor People make mistakes - that is human nature IHE helps us avoid, catch & easily correct those errors

22 Patient Safety The more standardization between vendor transactions, the better the patients interests are served Standardizing display (CPI), document exchange formats (CDA), access to all patient information across multiple systems Standardizing audit trails Consistent Time

23 Patient Safety System authentication and security Cross enterprise or even inter-enterprise patient data exchange greatly enhances patient care

September, 2005What IHE Delivers 24 Improved Workflow & Throughput Better, Faster & More Cost Efficient

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