2. MIR 2002 The Clinical Benefits of IHE Berthold Wein, Dept. Diagnostic Radiology University Hospital Aachen The Clinical Benefits of IHE The first 7 IHE Integration Profiles, for a Better Practice

3. MIR 2002 The Clinical Benefits of IHE Selected Problems: (Overview) Seamless workflowSeamless workflow Data consistencyData consistency Image presentationImage presentation Spiral CT examinationsSpiral CT examinations Information distributionInformation distribution Image notificationImage notification Parametric access to images and reportsParametric access to images and reports

4. MIR 2002 The Clinical Benefits of IHE Workflow Most critical issue in a Radiology EnvironmentMost critical issue in a Radiology Environment –Inter- or corrupted information chain Paper based informations -> multiple re-entry of dataPaper based informations -> multiple re-entry of data Different non adapted subsystems don‘t cooperateDifferent non adapted subsystems don‘t cooperate Error correction takes huge amount of timeError correction takes huge amount of time –Stale information Brandnew information not known (cancellation, change)Brandnew information not known (cancellation, change) –Status update information Exam registered, finished, archived, reported, deliveredExam registered, finished, archived, reported, delivered

5. MIR 2002 The Clinical Benefits of IHE Workflow Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps IHE Integration Profiles 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 Registration Patient Update Procedure Scheduled Images Availability Query Patient Update Procedure Update Images Stored Storage Commit Q /R Key Image Note Q /R Presentation Sates Storage Commit Images Stored PPS In-Progress / Completed PPS In-Progress / Completed PPS In-Progress / Completed Filler Order Management Placer Order Management Present. State Stored Q /R Images Key Image Note Stored Present. State Stored Key Image Note Stored

6. MIR 2002 The Clinical Benefits of IHE Store Images Storage Commitment List of Images PACS & Archive RIS ModalityPerformed Procedure Step Performed Step: Status = Completed Performed CT Head Pat Name/ID, Dose, Accession #, Study UID Complete List of Images A Closed Loop Update IS SchedulingUpdate IS Scheduling Match Procedure with OrderMatch Procedure with Order Support Billing Based on MPPSSupport Billing Based on MPPS Avoid Reading Incomplete ProceduresAvoid Reading Incomplete Procedures IHE Scheduled Workflow in Radiology Modality Worklist Worklist Procedure Scheduled

7. MIR 2002 The Clinical Benefits of IHE Data Consistency Trauma patientTrauma patient Manual wrong data entry at the modalityManual wrong data entry at the modality System crashedSystem crashed VIP personVIP person

8. MIR 2002 The Clinical Benefits of IHE Patient Information Reconciliation Unknown patients and unscheduled orders Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps IHE Integration Profiles

9. MIR 2002 The Clinical Benefits of IHE Image presentation Viewing on different monitors / systemsViewing on different monitors / systems Ensuring print quality outside of the departmentEnsuring print quality outside of the department Radiologist discussing images with remote physiciansRadiologist discussing images with remote physicians Capture image manipulation to avoid redundant work (coronal CT, MR reading, etc.)Capture image manipulation to avoid redundant work (coronal CT, MR reading, etc.)

10. MIR 2002 The Clinical Benefits of IHE Patient Information Reconciliation Unknown patients and unscheduled orders Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps IHE Integration Profiles Consistent Presentation of Images Hardcopy and softcopy grayscale and presentation state Consistent Presentation of Images Hardcopy and softcopy grayscale and presentation state

11. MIR 2002 The Clinical Benefits of IHE Consistent Presentation of Images Reporting Radiologist Referring Physician or Reviewing Radiologist Original ImageWindow LevelFlipZoom Area Of Interest Annotate Without Consistent Presentation Area Of Interest Achieving Consistent Presentation Presentation State Presentation LUT Grayscale Standard

12. MIR 2002 The Clinical Benefits of IHE CT/MR:Head bone / brain separation (external/internal)CT/MR:Head bone / brain separation (external/internal) CR:Foot/ankle - hand/wristCR:Foot/ankle - hand/wrist –E.g., lateral image of foot shared between AP of ankle and AP of foot DR:Trauma patient AP / Lat re-groupingDR:Trauma patient AP / Lat re-grouping –I.e., do all the Aps then rotate the patient once then do Lats MR:MRI/MRAMR:MRI/MRA –To be viewed and billed separately IR:Diagnostic run and therapeutic runIR:Diagnostic run and therapeutic run –Performed contemporaneously, viewed/billed separately US:Abdomen and kidneys / retroperitoneumUS:Abdomen and kidneys / retroperitoneum and lymphnodes Re-arranging Series

13. MIR 2002 The Clinical Benefits of IHE Presentation of Grouped Procedures Subset a single acquisition IHE Integration Profiles Patient Information Reconciliation Unknown patients and unscheduled orders Consistent Presentation of Images Hardcopy and softcopy grayscale and presentation state Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Presentation of Grouped Procedures Subset a single acquisition

14. MIR 2002 The Clinical Benefits of IHE MODALITY IHE – Presentation of Grouped Procedures Requested Procedure: CHEST Report: CHEST Requested Procedure: ABDOMEN Report: ABDOMEN Performs a single exam Operator groups 2 procedures Chest View Abdomen View RIS / PACS Chest View Abdomen View

15. MIR 2002 The Clinical Benefits of IHE Information distribution Therapy related imagingTherapy related imaging –Radiation therapy –Computer assisted surgery (orthopaedic, neurosurgery,...) Secure image distribution within the enterprise and to the outside worldSecure image distribution within the enterprise and to the outside world

16. MIR 2002 The Clinical Benefits of IHE Presentation of Grouped Procedures Subset a single acquisition IHE Integration Profiles Patient Information Reconciliation Unknown patients and unscheduled orders Consistent Presentation of Images Hardcopy and softcopy grayscale and presentation state Access to Radiology Information Consistent access to images and reports Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Access to Radiology Information Consistent access to images and reports

17. MIR 2002 The Clinical Benefits of IHE Access to Radiology Information Providing Access to Radiology Information: –Internally to Radiology –From Other Departments Surgery, Oncology, Pediatrics, etc. Query and RetrieveImages Reports Query and Retrieve Reports Image Archive Image Manager Image Display Report Reader Report Repository Query and Retrieve Presentation States Query and Retrieve Key Image Notes DICOM Based Transactions

18. MIR 2002 The Clinical Benefits of IHE Image notification Flag images within a huge CT-seriesFlag images within a huge CT-series Informations from radiographer to radiologistInformations from radiographer to radiologist Dedicated image descriptionsDedicated image descriptions........

19. MIR 2002 The Clinical Benefits of IHE Presentation of Grouped Procedures Subset a single acquisition IHE Integration Profiles Patient Information Reconciliation Unknown patients and unscheduled orders Consistent Presentation of Images Hardcopy and softcopy grayscale and presentation state Access to Radiology Information Consistent access to images and reports Key Image Notes Exchange flagging significant images Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Key Image Notes Exchange flagging significant images

20. MIR 2002 The Clinical Benefits of IHE Different notes on different images Same note on different images for referring physician Here you can see the renal rupture. Note1 for referring physician This is the hematoma. Note2 for refering physician Here you can see the renal rupture. Note1 for refering physician This is the hematoma. Note2 for refering physician Hematoma everywhere Note3 for refering physician Hematoma everywhere Note3 for refering physician Hematoma everywhere Note3 for refering physician Hematoma everywhere Note3 for referring physician Hematoma everywhere Note3

21. MIR 2002 The Clinical Benefits of IHE Parametric access to images and reports Discussion Comparison is made to the prior study of 11.04.1999. The left paratracheal lymph node (image 8, image 11) now measures 2.5x2.7x3.1 cm increasing from 2.0x2.1x2.6 previously. No other mediastinal, upper abdominal or axillary adenopathy is identified. No focal pulmonary lesions are seen. The yadda, yadda, yadda are normal. Impression Worsening left paratracheal adenopathy. Signature

22. MIR 2002 The Clinical Benefits of IHE Presentation of Grouped Procedures Subset a single acquisition IHE Integration Profiles Patient Information Reconciliation Unknown patients and unscheduled orders Consistent Presentation of Images Hardcopy and softcopy grayscale and presentation state Access to Radiology Information Consistent access to images and reports Key Image Notes Exchange flagging significant images Simple Image and Numeric Reports Exchange simple reports with image links and, optionally, measurements Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Simple Image and Numeric Reports Exchange simple reports with image links and, optionally, measurements

23. MIR 2002 The Clinical Benefits of IHE Pattern – Simple Image & Numeric Report Simply Adds Measurements to Simple Image Reports

24. MIR 2002 The Clinical Benefits of IHE Simple Image and Numeric Reports

25. MIR 2002 The Clinical Benefits of IHE IHE Year 4 Integration Profiles Access to Radiology Information Consistent access to images and reports Consistent Presentation of Images Hardcopy and softcopy grayscale presentation state Key Image Notes Flag significant images Simple Image and Numeric Reports Simple reports with image links and, optionally, measurements Presentation of Grouped Procedures Subset of a single acquisition Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders Basic Security Audit Trail Consolidation & Node Authentication Post- Processing Workflow Schedule, perform, & notify image processing & CAD steps Charge Posting Collection of billable procedure details

26. MIR 2002 The Clinical Benefits of IHE Clinical Benefits by IHE The power of IHE to improve productivity and reduce errors is really greatThe power of IHE to improve productivity and reduce errors is really great Clinical workflow will re-gain resourcesClinical workflow will re-gain resources Systems connectivity increasesSystems connectivity increases => Daily work will become worthwhile again=> Daily work will become worthwhile again