1. 1 Integrating the Healthcare Enterprise IHE for Administrators: Confronting Deployment Obstacles Ellie Avraham, Kodak Health Group Paul Nagy, PhD University of Maryland

2. RSNA 20062 for Administrators Classroom Sessions Modern Hospital Information Flow MPI ADT RIS PACSModalityDisplay & Print HIS Billing Lab Cardio

3. RSNA 20063 for Administrators Classroom Sessions Institute of Medicine Model of Service Redesign of Healthcare Safety Effectiveness Patient centeredness Timeliness Efficiency Equity Align to the patient Source: Insititute of Medicine, Crossing the chasm

4. RSNA 20064 for Administrators Classroom Sessions … a new generation of Healthcare IT solutions that have an order of magnitude greater level of integration. … a whole new level of Complexity Management to manage these interfaces. … we need to Decrease the time for integrating the Multi Vendors systems. … we need the capabilities for plug and play interoperability of systems. … we need to lower the total cost of integration To achieve these goals we need …

5. RSNA 20065 for Administrators Classroom Sessions Standards Exists: DICOM, HL7 The main purpose of standards is to lower the cost of integration between systems. The more plug and play integration the lower is the cost of the implementation. However Standards are broad and include options that reduce the interoperability So we need to constrain the Standards in order to improve the interoperability

6. RSNA 20066 for Administrators Classroom Sessions What is IHE Joint Initiative from HIMSS and RSNA since 1998 IHE is a specification of transactions between systems that defines integration profiles solution (SWF, PIR, RWF) based on standards Uses a combination of standards to achieve a fully Interoperable workflow Reinforces constrained standards to achieve fully Interoperability

7. RSNA 20067 for Administrators Classroom Sessions IHE Organizational Structure Multi-Domain & Multi-National IHE Organizational Structure Multi-Domain & Multi-National Participants contribute Global Development: Radiology, IT Infrastructure, Cardiology, Lab, etc. Delegates IHE Europe IHE North America IHE Asia/Oceania Regional & National Deployment supervises reports IHE (International) Strategic Development Committee Sponsor Co-Chairs Global Interoperability IHE Domain-related Planning and Technical Committees

8. RSNA 20068 for Administrators Classroom Sessions IHE Process IHE Integration Profiles B IHE Integration Profile A Easy to Integrate Products IHE Connectathon Product With IHE IHE Demonstration User Site RFP Standards IHE Technical Framework Product IHE Integration Statement IHE Connectathon Results IHE Integration Profiles at the heart of IHE : –Detailed selection of standards and options each solving a specific integration problem –A growing set of effective provider/vendor agreed solutions –Vendors can implement with ROI –Providers can deploy with stability

9. RSNA 20069 for Administrators Classroom Sessions The Connectathon Voluntary Participation Neither a Demonstration nor a Certification Well Designed End-to- End Scenarios Advanced Testing Tools Unprecedented Cross- Vendor Testing Unprecedented Pool of Technical Talent

10. RSNA 200610 for Administrators Classroom Sessions IHE Connectathon Results http://www.rsna.org/IHE/connectathon.shtml http://www.ihe-europe.org/con_result

11. RSNA 200611 for Administrators Classroom Sessions IHE Integration Statement

12. RSNA 200612 for Administrators Classroom Sessions Store Images PACS & Archive RIS Todays - Legacy Workflow

13. RSNA 200613 for Administrators Classroom Sessions Patient Registration/Update Order Management Order Protocol Defined Store Images Storage Commitment List of Images PACS & Archive RIS A Closed Loop Update Scheduling ISUpdate Scheduling IS Match Procedure with OrderMatch Procedure with Order Support Billing Based on MPPSSupport Billing Based on MPPS Avoid Reading Incomplete ProceduresAvoid Reading Incomplete Procedures IHE Workflow Modality Worklist Procedure Scheduled Proposed Protocols Loaded and ReviewedWorklist Pt A, …, SPS=P1, P4 Pt C, …, SPS=P1, P5 Pt B, …, SPS=P2 Pt E, …, SPS=P4 ModalityPerformed Procedure Step With Performed Acquisition Protocols Performed Step: Status = Completed Performed Procedure: CT Head Performed Protocol Code=P1 Performed Protocol Code=P1 Pat Name/ID, Dose, Accession #, Study UID Complete List of Images Scheduled Protocol Code=P1, P5

14. RSNA 200614 for Administrators Classroom Sessions acquisition in progress acquisition completed IHE Scheduled Workflow Profile IHE Scheduled Workflow Profile

15. RSNA 200615 for Administrators Classroom Sessions ADT^ Scheduled Workflow A01 Registration A04 Admission A05 Pre adminission A11 Cancellation A38 Cancellation of pre admission DICOM C-Store DICOM Modality Worklist DICOM Modality Performed Procedure DICOM Storage Commitment

16. RSNA 200616 for Administrators Classroom Sessions IHE Deployment – Testing the Integrated System Solutions For Healthcare to succeed in the digital transformation it will need much better integration between its systems. IHE is an open standards approach to lower the cost of integrating healthcare and exposing many more processes. Open Source can accelerate the adoption of IHE by helping to educate administrators to learn how to test the integration

17. RSNA 200617 for Administrators Classroom Sessions Open Source - Integration testing tools There are many (dozens) of DICOM and HL7 tools. Too many to mention. The web site openrad.com has a repository with all the main open source Integration testing tools

18. RSNA 200618 for Administrators Classroom Sessions Open Source Toolbelt IHE MESA Tools DCM4JBOSS – Enterprise PACS Archive DVTK – Dicom Validation Toolkit HL7Browser – HL7 Message Viewer MIND – GUI DICOM query tool CTN – DICOM Send

19. RSNA 200619 for Administrators Classroom Sessions Todays Lesson Build an IHE Testing Environment Test IHE Scheduled Workflow Components On a windows laptop

20. RSNA 200620 for Administrators Classroom Sessions Standard Documentation Recommendation IHE Technical Framework: volumes #1, 2, 3 –Scheduled Workflow DICOM standard –Information Object Definition Pt.3 –Services Pt.4 –Data Dictionary Pt.6 –Medical.nema.org HL7 v2.3.1 standard

21. RSNA 200621 for Administrators Classroom Sessions IHE Medical Enterprise Simulators and Analyzers (MESA) http://ihedoc.wustl.edu/mesasoftware/index.htm Provides the Test Procedures and Simulation of all the IHE Profiles and Actors. Excellent Documentation. Developed by the Mallinckrodt Institute of Radiology MESA Tools runs on different operating systems: Windows 2000, Windows XP, Solaris 7.0, Red Hat Linux 7.0 & 9.0 from Intel. The MESA tool is organized for particular IHE actors as defined in the IHE Technical Framework

22. RSNA 200622 for Administrators Classroom Sessions Step 1. Install MESA tools Decide What Actors/Systems you need to test Read the Installation Guide for installing the tools you need to test your Actors/Systems Precompiled and Source Codes are available Recommend to Install the preferred Windows 2000 precompiled MESA s/w ready to be used

23. RSNA 200623 for Administrators Classroom Sessions Step 2: What & How to Test List your Actors/Profiles that you need to test Review the MESA Test Procedures applicable for each actor that need to be tested Review the Test Procedures for the Peer to Peer testing applicable actors.

24. RSNA 200624 for Administrators Classroom Sessions Test Example – Scheduled Workflow Profile (SWF) Figure 3.3-1. Administrative Process Flow This case covers both inpatient and outpatient procedures. The patient may be new or known to the current healthcare facility. The following sequence of steps describes the typical process flow when a request is made to perform an imaging procedure on a patient

25. RSNA 200625 for Administrators Classroom Sessions Figure 3.3-2. Procedure Performance Process Flow

26. RSNA 200626 for Administrators Classroom Sessions IdentifierDescription [Transaction] Source Destination 131.102.a04.adt A04: Register BLACK as Outpatient Patient Class = E [1] ADTOrd Plc, Ord Fil 131.104.o01.orm ORM: Order P1 for BLACK [2] Ord PlcOrd Fil 131.106.o01.orm ORM: Schedule X1 [4] Ord FilImg Mgr 131.108.dcm MWL C-FIND [5] ModalityOrd Fil 131.110.dcm PPS: Begin Procedure X1 [6] ModalityPPS_Mgr 131.112.dcm PPS: Begin Procedure X1 [6] PPS_MgrOrd Fil or Img Mgr 131.114.dcm PPS: End Procedure X1 [7] ModalityPPS_Mgr 131.116.dcm PPS: End Procedure X1 [7] PPS_MgrOrd Fil or Img Mgr C-Find: Images Available Query [11] Ord FilImg Mgr 131.118.dcm C-Store: Images [8] ModalityImg Mgr 131.120.dcm C-Find: Images Available Query [11] Ord FilImg Mgr 131.122.dcm Storage Commitment: N-Action [10] ModalityImg Mgr 131.124.dcm Storage Commitment: N-Event-Report [10] Img Mgr Modality 131.117.dcm MESA Test case #131 – Administrative & Procedure Prerform Process (SWF)

27. RSNA 200627 for Administrators Classroom Sessions MESA Testing Environment

28. RSNA 200628 for Administrators Classroom Sessions Starting MESA Test case #131

29. RSNA 200629 for Administrators Classroom Sessions Running Several Transactions Test case #131

30. RSNA 200630 for Administrators Classroom Sessions Evaluating MESA Test Result case #131

31. RSNA 200631 for Administrators Classroom Sessions Where Is More Information Available? http://www.ihttp://www.ihe.net Non-Technical Brochures: –IHE Radiology Users Handbook –IHE Primer and IHE FAQ –IHE Integration Profiles: Guidelines for Buyers –IHE Connectathon Results