1. VA Success Story – Image Acquisition using IHE Scheduled Workflow June 6~7, 2006
Peter Kuzmak, Andrew Casertano,
and Dr. Ruth Dayhoff
Department of Veterans Affairs

2. VA Healthcare Enterprise
157 Medical Centers & 850+ Outpatient Clinics
Serves an active patient population of 5 million veterans
All sites acquire DICOM images
½ billion images online
½ million images acquired each day

3. VistA & Computerized Patient Record System

4. Multimedia Patient Record
Computerized Patient Record and VistA Imaging
Chart Data
Textual chart data
Computable data
Handwritten and non-electronic chart data
Multimedia Data
Images, graphics, waveforms, audio, etc.

5. Wide Variety of Images Integrated with the Online Patient Record
Cardiology
Bronchoscopy
Gastrointestinal Endoscopy
Hematology
Pathology
Surgery
Nuclear Medicine
Dental
Radiology
Dermatology
Ophthalmology
Podiatry
Vascular
Urology
Nursing
Electrocardiography
Scanned Documents

6. VA IHE Success Story
All VA DICOM image acquisition uses IHE Radiology Transactions to interface modalities to PACS: 
#5 - Modality Worklist Provided - download patient and study
#8 - Modality Images Stored - send images to the PACS.
One interface for 250 different models of instruments!
Radiology, ophthalmology, dentistry, endoscopy, pathology, and cardiology.
VA/DoD DICOM Modality requirements documents:
The VA will not purchase a new modality unless it supports these capabilities.

7. Using Consults for Clinical Specialties (Simplified Workflow)
Consult Ordered
Schedule Appointment
Patient Arrives
Images Acquired
Patient Leaves
Diagnostic Reporting
Follow up Visits

8. Workflow Transactions
P A C S
VA Hospital Information System
Worklist Query
Worklist Response
DICOM offers a great many services.
We will look at the core services by considering the case
of scheduled acquisition workflow in an integrated, digital department.
The outside world is HL7 where the order is typically placed.
This is outside the scope of DICOM.
Starting at the RIS…
RIS - Mod MWL Query
Mod - RIS MPPS (In-Prog, Complete) note time free
[Mod - PACS Store (note the different image classes)]
Mod - PACS Store Commit
PACS-Other Instance Availability Notification
[PACS - WS Query / Retrieve]
Mod/PACS - Prt Print Management
[presume that Association Negotiation is covered]
Mention PIR issue and flavor of solution and point to IHE.
Really it's more of a policy thing than a service thing.
Acquisition Modality

9. Workflow Transactions
Image Retrieval
P A C S
VA Hospital Information System
Worklist Query
Storage
Worklist Response
DICOM offers a great many services.
We will look at the core services by considering the case
of scheduled acquisition workflow in an integrated, digital department.
The outside world is HL7 where the order is typically placed.
This is outside the scope of DICOM.
Starting at the RIS…
RIS - Mod MWL Query
Mod - RIS MPPS (In-Prog, Complete) note time free
[Mod - PACS Store (note the different image classes)]
Mod - PACS Store Commit
PACS-Other Instance Availability Notification
[PACS - WS Query / Retrieve]
Mod/PACS - Prt Print Management
[presume that Association Negotiation is covered]
Mention PIR issue and flavor of solution and point to IHE.
Really it's more of a policy thing than a service thing.
Acquisition Modality

10. VA’s Role in Advancement of DICOM in Ophthalmology
Initially no Ophthalmology specification in DICOM
Could not even tell left from right
VA encouraged AAO develop new specification
Ophthalmic Photography Image DICOM Supplement 91
2005 – Organized the IHE Eye Care Showcase
2006 – VA national Diabetic Retinopathy Surveillance program
Fundus Image
3072 x bit

11. 2005 IHE Eye Care Showcase

13. VA National Diabetic Retinopathy Surveillance Network

14. IHE Value to Vendors
IHE Technical Framework defines implementation specifications in detail
Resources needed to developed, test, and maintain just a single interface
IHE provides interface testing tools and vendor-to-vendor interoperability Connectathon.
IHE saves vendors money

15. Conclusion: Follow IHE for Success
IHE enables interoperability and saves money
Using industry standards avoids having to develop custom interface methodologies
Provides smoother integration
Accelerates acceptance testing
Cost-effective for all participants

16. More information…. IHE Web site: www.ihe.net Technical Frameworks
ihe_eyecare_tf_TI_vol1_2006_06_01 (Trial Implementation version)
ihe_eyecare_tf_TI_vol2_2006_06_01 (Trial Implementation version)
ihe_tf_rev6.0ft_vol1_ FINAL (Radiology)
ihe_tf_rev6.0ft_vol2_ FINAL (Radiology)
ihe_CARD_tf_vol2_2.1_FT (Cardiology)
Standards used by IHE Eye Care
DICOM Standard
HL7 Standard
IHE Connectathon Oct at RSNA HQ
IHE Showcase at Nov AAO Conference
Vendor Products Integration Statements

17. Thank You!