Integrating the Healthcare Enterprise Controlling the Radiology Workflow – A Necessary Step Towards EPR Present & Future Extensions – Dr. Nikolaus Wirsz Siemens Medical Solutions

The IHE Radiology Workflow

IHE Technical Framework Objectives: Reduce Redundancy of Data and Functions Enhance Data Integrity and Data Access Improve Data Consistency Close the Information Loop: HIS - RIS - PACS - Modalities Functional Components Interactions in the Healthcare Enterprise Technical Framework Specification IHE Data Model IHE System Transactions Overview ( Enterprise Process Flow ) IHE Actors / Roles ( Generic Functional Entities ) IHE Transactions ( Interactions Between Actors ) IHE Integration Profiles ( Solutions for Real-World Scenarios )

IHE System Transactions Overview ADT Patient Registration Performed Procedure Step Manager Modality Worklist Patient Registration Patient Update Procedure Scheduled Images Availability Query Procedure Update Images Stored Storage Commit Q /R Key Image Note Q /R Presentation Sates PPS In-Progress / Completed Filler Order Management Placer Order Management Present. State Key Image Note Image Display Image Creator Order Placer Department System Scheduler – Order Filler – Image Archive Image Manager Acquisition Modality

IHE System Transactions Overview ADT Patient Registration PRINTING Print Server Print Request with Presentation LUT Print Composer Performed Procedure Step Manager Modality Worklist Patient Registration Patient Update Procedure Scheduled Images Availability Query Procedure Update Images Stored Storage Commit Q /R Key Image Note Q /R Presentation Sates PPS In-Progress / Completed Filler Order Management Placer Order Management Present. State Key Image Note Image Display Image Creator Order Placer ... And Even More Workflow Extensions ( IHE Year 4 ): – FINANCIAL WORKFLOW ( Billing Transactions ) – POST-PROCESSING WORKFLOW ( Post-Acquisition - CAD ) – BASIC SECURITY ( Meeting HIPAA Requirements ) External Report Repository Report Reader Report Creator Report Manager Report Repository Report Submission Report Issuing Query Report Retrieve Report REPORT MANAGEMENT Department System Scheduler – Order Filler – Image Archive Image Manager Acquisition Modality

IHE System Transactions Overview ADT Patient Registration Image Archive Image Manager Image Display Image Creator Acquisition Modality Department System Scheduler – Order Filler – Order Placer Performed Procedure Step Manager Modality Worklist Patient Update Procedure Scheduled Images Availability Query Procedure Update Images Stored Storage Commit Q /R Key Image Note Q /R Presentation Sates PPS In-Progress / Completed Filler Order Management Placer Order Management Present. State Key Image Note HIS IMAGING: PACS Workstations Modalities RIS

IHE = A Standards Harmonization Approach IHE Goes Beyond Standards IHE = + Multi-Vendor + Workflow-Driven + INTEGRATION based on established medical IT Standards

The 2 Workflow Basics in IHE 1) Scheduled Workflow: – Enterprise Process Steps Under Normal Conditions – Admission / Registration, Order Entry, Scheduling, Images Acquisition, ... 2) Patient Information Reconciliation: – Exception Handling – Example: Image Acquisition Completed for an Unidentified Patient Taking the Steps Towards EPR: Closing the Information Loop: HIS ® RIS ® PACS ® Modalities Optimized & Automated Radiology Workflow

Placer Order Management Images Availability Query Scheduled Workflow Prerequisites for Enabling EPR Solutions: Reducing Data Redundancy Eliminating Gaps in Data Access Enhanced Access to Clinical Information Order Placer Performed Procedure Step Manager ADT Patient Registration Image Archive Image Manager Image Display Image Creator Acquisition Modality Department System Scheduler – Order Filler – Patient Registration Storage Commit Filler Order Management Placer Order Management PPS In-Progress / Completed Images Stored Q /R Images Procedure Scheduled Modality Worklist PPS In-Progress / Completed Images Availability Query Images Stored Storage Commit

Patient Information Reconciliation Prerequisites for Enabling EPR Solutions: Consistency of Patient Information Enhanced Data Integrity 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 PPS In-Progress / Completed Filler Order Management Placer Order Management Q /R Patient Information Reconciliation ( e.g. Patient Merge ) Patient Update Procedure Update

IHE Past – Present – Future ( 1999 – 2002 – ... ) Year 1 – Proof of Concept: Basic Scheduled Workflow Year 2 – Integration Profiles ( Solutions for Real-World Problems ): Patient Information Reconciliation Access to Radiology Information Consistent Presentation of Images Presentation of Grouped Procedure Simple Image & Numeric Reports Key Image Notes Year 3 – Consolidation ( Catch-Up with Real Products ) ® Expansion to France

IHE Past – Present – Future ( 1999 – 2002 – ... ) Year 4 – New Integration Profiles: Post-Processing Workflow Charge Posting ( Billing Transactions ) Basic Security ( Audit Trails & Node Authentication ) ® Expansion to Germany, Italy, Japan Year 5 – Potential Integration Profiles for 2003: Teaching Files Clinical Trials Reporting Workflow ( Interpretation Worklists ) Desktop Integration ( HL7 CCOW ) ® Expansion to UK ® Expansion into Other Domains ( Lab, Cardiology, ... )

A Multidimensional Expansion of Integration IHE Vision for Growth A Multidimensional Expansion of Integration Dept Sched. ADT Order Mgt Image Mgr Modality 1st Dimension: Vertical Integration for Radiology IHE Years 1, 2, 3, 4, ...

A Multidimensional Expansion of Integration IHE Vision for Growth A Multidimensional Expansion of Integration Patient Registration ADT Ordering Process Master Patient Index Order Mgt Clinical Patient Record . . . Dept Sched. 2nd Dimension: Growing the Horizontal Healthcare Enterprise Integration Image Mgr Modality

A Multidimensional Expansion of Integration IHE Vision for Growth A Multidimensional Expansion of Integration R a d i o l o g y C a r d i o l o g y Laboratory P h a r m a c y Patient Registration O t h e r s . . . Ordering Process Master Patient Index Clinical Patient Record 3rd Dimension: Increasing the Number of Vertically Integrated Departments

IHE Vision for Growth Lab/Path Radiology ADT/ Reg Cardiology Int Med ER Endoscopy Dental Ophthalm

Shaping The Future Of IHE – The IHE Strategic Development Committee – Expansion of IHE process to meet integration needs of entire enterprise Engage leading medical professionals and associations from other key domains to help move IHE beyond Radiology Identify integration needs / barriers and problems / solutions within and across domains Identify and recommend clinical and operational domains Populate domain specific sub-committees: Cardiology Laboratory Pharmacy / Medication Administration IT Infrastructure: Ad-hoc Query / Retrieve Master File Updates CCOW

IHE Strategic IT Infrastructure Issues Desktop Integration (e.g. CCOW) Master Patient Index Security and Privacy (HIPAA) Enterprise Wide Scheduling Master File Updates Interdepartmental Information Sharing (Results, Images) Enabling Web Interfaces Financial Transactions

Healthcare Needs Addressed By IHE Conclusions Healthcare Needs Addressed By IHE Continuity and Integrity of Patient Information Eliminating Gaps and Redundancies in Data Access Clinical Workflow Optimization Fostering Communication Among Diverse Medical Information Systems Improving the Patient Care Process

Questions ? References: IHE Europe: http://www.IHE-Europe.org IHE North America: http://www.rsna.org/IHE