RSNA/HIMSS Integrating the Healthcare Enterprise What’s New in IHE: New Profiles & New Options

RSNA/HIMSS RSNA Authors & Presenters Kevin O’DonnellKevin O’Donnell –Toshiba, IHE Planning Committee Co-Chair John PaganiniJohn Paganini –IDX, IHE Planning Committee Member Rob HornRob Horn –Agfa, IHE Planning Committee Member

RSNA/HIMSS RSNA IHE Integration Profiles Access to Radiology Information Retrieve & view images and reports Consistent Presentation of Images Hardcopy and softcopy grayscale presentation state Key Image Notes Flag & search for significant images Simple Image and Numeric Reports Simple reports with image links and measurements Basic Security Audit Trail Consolidation & Node Authentication Presentation of Grouped Procedures Manage subsets of a single acquisition Post- Processing Workflow Schedule, perform, & notify image processing & CAD steps Charge Posting Collection of billable procedure details Scheduled Workflow Admit, order, schedule, acquire & store images with notification of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders

RSNA/HIMSS RSNA Year 4 Additions to IHE Technical Framework 3 New Integration Profiles3 New Integration Profiles  Post-Processing Workflow  Charge Posting  Basic Security 2 New Options for Scheduled Workflow2 New Options for Scheduled Workflow  PPS Exception Management  Assisted Protocol Setting IHE Integration StatementsIHE Integration Statements

RSNA/HIMSS RSNA Post-Processing Workflow Profile

RSNA/HIMSS RSNA Post-Processing Workflow: Features Supports Workflow for Post-Processing Tasks: Computer Aided Detection Image Processing Image Reconstruction etc... Task Scheduling, Worklists & Status Tracking Worklist Entries Reference Input Data Status Messages support Workflow Metrics and Billing Associate Post-Processing Output with Acquired Images and other Order Results for easier review

RSNA/HIMSS RSNA PACS & Archive RIS IHE Post-Processing Workflow with Post-Processing Manager Grouped with Image Manager Post-Processing Worklist Retrieve Images StoreReports Measurements CAD Reports ……....……… ArchiveImages Post-Processing Procedure Step STARTED Work Item Claimed Post-Processing Procedure Step STARTED Post-Processing Procedure Step COMPLETED Post-Processing Procedure Step COMPLETED

RSNA/HIMSS RSNA Post-Processing Workflow: Technical Details Based on DICOMBased on DICOM –General Purpose Worklist –General Purpose Scheduled Procedure Step –General Purpose Performed Procedure Step Dept. System Scheduler/Order Filler Actor Schedules Post-ProcessingDept. System Scheduler/Order Filler Actor Schedules Post-Processing New Post-Processing Manager ActorNew Post-Processing Manager Actor Image Creator/Report Creator Actors Perform Post-ProcessingImage Creator/Report Creator Actors Perform Post-Processing

RSNA/HIMSS RSNA Charge Posting Profile

RSNA/HIMSS RSNA Charge Posting Profile: Features  Facilitates Collection of Procedure Details for Billing  Performed Procedure Technical Fees  Materials Usage  Reporting Professional Fees  Etc.  Facilitates Management of Account Details in Multiple Systems and Procedure Records

RSNA/HIMSS RSNA Charge Posting Profile DSS / Order Filler Charge Processor (Billing System) CAD *Workstation Report Repository … Report Generated / Signed CAD Performed Post Charges Acquisition Modality ADT Terminal 3-D *Workstation Account Management 3-D Performed Study Performed / Materials Used

RSNA/HIMSS RSNA Workflow BENEFITS Initial Capture of Patient Demographics HIS BILLING SYSTEM Modality Patient Information Account Complete Procedure Information RIS Redundancy Eliminated All Systems Updated Maximum Data Integrity Billing Available ASAP

RSNA/HIMSS RSNA Charge Posting Profile: Technical Details HL7 Messages manage account details between systemsHL7 Messages manage account details between systems –Open, Update, Close Account DICOM Performed Procedure Step Messages (MPPS, GP-PPS) provide optional details to Order Filler :DICOM Performed Procedure Step Messages (MPPS, GP-PPS) provide optional details to Order Filler : –Performed (Billable) Technical Activities –Performed (Billable) Professional Activities –Usage of Materials HL7 Messages allow Order Filler to post charges to the Charge ProcessorHL7 Messages allow Order Filler to post charges to the Charge Processor New Charge Processor Actor (financial system)New Charge Processor Actor (financial system)

RSNA/HIMSS RSNA Charge Posting Profile: Benefits Billing System receives more complete, timely and accurate dataBilling System receives more complete, timely and accurate data Eliminates Redundant Data EntryEliminates Redundant Data Entry Reduces Billing ErrorsReduces Billing Errors Reduces Billing Resource RequirementsReduces Billing Resource Requirements Reduces System Interface Installation TimeReduces System Interface Installation Time Reduces Need for Billing System to Know Radiology DetailsReduces Need for Billing System to Know Radiology Details

RSNA/HIMSS RSNA Basic Security Profile

RSNA/HIMSS RSNA Basic Security Profile: Features  Verifies that only secure nodes exchange data.  Provides audit facility to:  Verify compliance with procedures  Permit detection of inappropriate behavior  Avoid interfering with time critical activities

RSNA/HIMSS RSNA Secure Node Actor Verifies and Authenticates the User AuditRepository Failures are reported Picture of Login Login

RSNA/HIMSS RSNA Network Connection Verification AuditRepository Security Provides Certificates Identity Confirmed during connection IHE Transactions Failures are reported

RSNA/HIMSS RSNA Basic Security Profile AuditRecordRepository … Image Manager & Archive “Images Queried / Retrieved” Diagnostic Workstation Report Repository … Report & Image Review “Reports Queried / Retrieved” “Images Printed” “Reports Stored” “Reports Retrieved” “Reports Printed”

RSNA/HIMSS RSNA Audit Records Detailed Records from many sub-systems, not just IHE Detailed Records from many sub-systems, not just IHE Gathers audit reports in one location Gathers audit reports in one location May provide analysis or detection facility (beyond the scope of IHE) May provide analysis or detection facility (beyond the scope of IHE)

RSNA/HIMSS RSNA Basic Security Environment Required Physical Security Doors, key access, etc. restrict access Communications and Equipment are kept in restricted access areas Access to equipment is controlled Cabinets, wiring, etc. are protected.

RSNA/HIMSS RSNA Basic Security Environment Required Network Security Firewalls, VPN, and other access controls. Unauthorized external access is denied. Additional security facilities may be in place if warranted by local conditions.

RSNA/HIMSS RSNA Basic Security Profile: Technical Details Certificates used to authenticate Secure NodesCertificates used to authenticate Secure Nodes Syslog Protocol used to transmit and store audit messagesSyslog Protocol used to transmit and store audit messages Network Time Protocol (NTP) used to synchronize / stamp audit messagesNetwork Time Protocol (NTP) used to synchronize / stamp audit messages

RSNA/HIMSS RSNA Scheduled Workflow Profile: New Options

RSNA/HIMSS RSNA 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

RSNA/HIMSS RSNA PPS Exception Management Option

RSNA/HIMSS RSNA PPS Exception Management Option: Defines method & codes for signaling problems, E.g.:Defines method & codes for signaling problems, E.g.: Technologist selects incorrect entry from Modality Worklist, images are acquiredTechnologist selects incorrect entry from Modality Worklist, images are acquired Study is started but must be discontinuedStudy is started but must be discontinued Some behaviors are specified, most left to the discretion of the Modality / Image Manager / Order Filler.Some behaviors are specified, most left to the discretion of the Modality / Image Manager / Order Filler.

RSNA/HIMSS RSNA Discontinue Reason Codes Code Meaning (0008,0104) Doctor cancelled procedure Equipment failure Incorrect procedure ordered Patient allergic to media/contrast Patient died Patient refused to continue procedure Patient taken for treatment or surgery Patient did not arrive Patient pregnant Change of procedure for correct charging Duplicate order Nursing unit cancel Incorrect side ordered Discontinued for unspecified reason Incorrect worklist entry selected Patient condition

RSNA/HIMSS RSNA Assisted Protocol Setting Option

RSNA/HIMSS RSNA Assisted Protocol Setting Option Allows DSS / Order Filler to provide more precise protocol codes to the ModalityAllows DSS / Order Filler to provide more precise protocol codes to the Modality Based on multiple Protocol Codes in the Scheduled Procedure StepBased on multiple Protocol Codes in the Scheduled Procedure Step Provides more detailed communicationProvides more detailed communication Promotes more consistent performance of proceduresPromotes more consistent performance of procedures

RSNA/HIMSS RSNA IHE Integration Statements

RSNA/HIMSS RSNA IHE Integration Statements Provides a Clear, Simple, but Precise, statement of the integration capabilities of a vendor systemProvides a Clear, Simple, but Precise, statement of the integration capabilities of a vendor system “Integration for people who aren’t DICOM engineers”“Integration for people who aren’t DICOM engineers” For a Vendor System it States:For a Vendor System it States: –the product name, version –which IHE Actors the system implements in each IHE Profile

RSNA/HIMSS RSNA Resources FAQsFAQs Integration Profiles DocumentIntegration Profiles Document Web TutorialsWeb Tutorials Primer on IHEPrimer on IHE PresentationsPresentations IHE Technical FrameworkIHE Technical Framework Product Evaluation WorksheetProduct Evaluation Worksheet

RSNA/HIMSS RSNA Questions? Ask your vendors: Which IHE Profiles do they support on which systems?