2. Integrating the Healthcare Enterprise IHE for Product Planers Ellie Avraham Kodak Health Group IHE Planning and Technical Committees member

3. IHE Classroom Sessions – RSNA 2005 2 Learning Objectives Learn the Clinical and Economic benefits of Integration for your customers – Users Handbook Improve Product Functionality by using the IHE Technical Framework Improve Integrated System Solutions Workflows by using IHE Integration Profiles Learn from IHE Success stories and other information to refine the Products Business case evaluation Learn the IHE Process to Synchronize it with the Product Planning & Development

4. IHE Classroom Sessions – RSNA 2005 3 Discussion Areas The IHE Deployment Process IHE Integration Profiles The Value Proposition from Planning Products and Integrated Solutions using IHE

5. IHE Classroom Sessions – RSNA 2005 4 Integration Solutions Available Today from Several Medical Systems Vendors – BUT... Modern Healthcare Enterprises Are Still Confronted with Problems: (In Spite of IT Standards and Advanced Technology) – Lack of Access to Complete Medical Information – Inconsistent or Redundant Medical Information Across Departments and Institutions – Inadequate Communicating of Medical Data Across Multiple Systems from Different Vendors – Risky Investments in Proprietary Solutions – Clinical Workflows are not Optimized Challenges of Integration

6. IHE Classroom Sessions – RSNA 2005 5 IHE drives healthcare standards based-integration

7. IHE Classroom Sessions – RSNA 2005 6 IHE Process - Annual Cycle 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 Technical Framework – Define Standard Integration Solutions IHE Connectathon Results – Most implemented and tested IHE Solutions IHE Integration Statements – Most Comertialized IHE Solutions IHE Success Story – Most Successful Used IHE Solutions IHE Users Handbook – IHE Solutions, Economical and Clinical benefits

8. IHE Classroom Sessions – RSNA 2005 7 IHE Annual Events for Synchronization with Product Planning April 2005 – IHE Supplements Profiles for Public Comment June – IHE Supplements Profiles for Trial Implementation June – IHE Participation Workshop Sept. – IHE Participation Registration: Connectathon & Demo Oct. - IHE Vendor Workshop for the Connectathon Oct. – Dec. IHE MESA Testing Validations for Connectathon Nov. - RSNA – IHE Radiology Demo Jan. 2006 – IHE Connectathon Feb. – HIMSS IHE ITI Demo Mar. – ACC IHE Cardiology Demo

9. IHE Classroom Sessions – RSNA 2005 8 Using IHE for Product Planning IHE Aid for Global Product Planning – IHE Technical Framework (TF) > Vol 1: Defines Global Integration Profiles > Vol 2,3: Defines the TF Transactions details for Development > Vol 4: Defines the Local National specialization details – IHE Connectathon Results – Learn what IHE solutions are developed – IHE User Success Stories & IHE Users Handbook – Learn the Clinical and Economic benefits of using products with IHE capabilities – IHE Integration Statements – The Commercialized products with IHE capabilities – RFPs from customers

10. IHE Classroom Sessions – RSNA 2005 9 IHE Connectathon Results http://www.ihe.net/Events/connectathon_results.cfm Consolidated Earlier Progress & Push for Market Adoption More Robust Connectathon – Results Recorded and Published Increased Industry Participation – 31 companies – 70 systems – 21 Additional Companies in IHE Europe

11. IHE Classroom Sessions – RSNA 2005 10 IHE User Success Stories http://www.ihe.net/resources/user_success_stories.cfm Cleveland Clinic Foundation Detroit Medical Center Grossman Imaging Centers Hôpitaux Universitaires de Genèv IHE McKay-Dee Hospital Johannes Gutenberg University Hospital Magic Valley Regional Medical Center Mayo Clinic Jacksonville Our Lady Of The Lake Regional Medical Center (OLOL) VA Puget Sound Health Care System St. Vincent Hospital and Health Services Steinberg Diagnostic Medical Imaging University of Pisa University of Wisconsin

12. IHE Classroom Sessions – RSNA 2005 11 Deployment of IHE Profiles – Most Used: - Scheduled Workflow (SWF) - Patient Information Reconciliation (PIR) - Consistent Presentation of Images (CPI) - Reporting Workflow (RWF) - Basic Security for HIPAA regulations (SEC) Clinical and Economics Accomplishments - Improve the Patient Care – Improved data accuracy and Safety, Image Quality & Consistency and time saving due to optimized Workflows and integrated systems - Improve the clinical practice productivity - reduced manual data entry using the ADT registration in one place and propagate it to all the other systems (PACS, RIS Modality) and reduced errors. - Optimize the Radiological Workflow (SWF) Reduced the incorrectly or lost studies, using DICOM MWL, MPPS IHE User Success Stories IHE User Success Stories

13. IHE Classroom Sessions – RSNA 2005 12 IHE Integration Statements http://www.ihe.net/resources/ihe_integration_statements.cfm IHE Integration Statements document the product IHE capabilities in terms of IHE: Actors and Integration Profiles. - Promote your products with the Integration Statements - Learn from other Vendors Integration Statements the IHE Profiles and Actors supported The RSNA links to IHE Integration Statements published by the companies: - Agfa HealthCare- Philips Medical Systems - Cerner Corporation- Sectra - Eastman Kodak Company- Siemens Medical Solutions - Emageon- Softmedical - Fujifilm Medical Systems USA- Stentor - GE Medical Systems- StorCOMM, Inc - INFINITT Co., Ltd.- Tiani Medgraph AG - McKesson Information Solutions- Toshiba America Medical Systems - Medcon- Voxar Limited

14. IHE Classroom Sessions – RSNA 2005 13 IHE Integration StatementDate 12 May 2004 VendorProduct NameVersion Any Medical Systems Co. IntegrateRADV2.3 This product implements all transactions required in the IHE Technical Framework to support the IHE Integration Profiles, Actors and Options listed below: Integration Profiles Implemented Actors ImplementedOptions Implemented Scheduled Workflow Image Manager/Image Archivenone Image Displaynone Internet address for vendors IHE information: www.anymedicalsystemsco.com/ihe Links to Standards Conformance Statements for the Implementation HL7 www.anymedicalsystemsco.com/hl7 DICOM www.anymedicalsystemsco.com/dicom/integrateRAD.pdf Links to general information on IHE North America: www.ihe.net In Europe: www.ihe-europe.orgIn Japan: www.jira- net.or.jp/ihe-j

15. IHE Classroom Sessions – RSNA 2005 14 IHE Technical Framework Organized in sections that provide an increasing level of detail Integration Profiles: Establish broad categories of compatible function. Actors: Identify specific kinds of operational participants in the healthcare enterprise. IHE Foundation http://www.ihe.net/Technical_Framework/index.cfm Transactions: Describe particular interactions between actors to perform specific operations.

16. IHE Classroom Sessions – RSNA 2005 15 IHE Radiology Integration Profiles - Y7, 2005 Patient Info. Recon- ciliation Access to Radiology Information Consistent Present- ation of Images Audit Trial and Node Authentication (ATNA) – Radiology Option - Evidence Docs Key Image Notes Simple Image & Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled Workflow Portable Data for Imaging NM Image Cross Enterprise Document Sharing For Imaging (XDS-I) Teaching Files and Clinical Trial Export (TCE)

17. IHE Classroom Sessions – RSNA 2005 16 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 Scheduled Workflow Profile

18. IHE Classroom Sessions – RSNA 2005 17 Patient Information Reconciliation

19. IHE Classroom Sessions – RSNA 2005 18 Consistent Presentation of Images Reporting Radiologist Referring Physician or Reviewing Radiologist Presentation State Presentation LUT Grayscale Standard Original ImageWindow LevelFlip Zoom Area Of Interest Annotate Without Consistent Presentation Achieving Consistent Presentation Area Of Interest

20. IHE Classroom Sessions – RSNA 2005 19 Radiology Option for Audit Trail and Node Authentication (ATNA) Radiology Option for Audit Trail and Node Authentication (ATNA) System A System B Secured System Secure network TLS authentication of remote node (digital certificates) with/without encryption Secured System Audit PHI trail with: Real-time access Time synchronization Central Audit Trail Repository

21. IHE Classroom Sessions – RSNA 2005 20 MODALITY Presentation of Grouped Procedures Profile Requested Procedure: CHEST Report: CHEST Report: AB/PELVIS Performs a single exam Operator groups 2 procedures Chest View RIS / PACS Requested Procedure: AB/PELVIS Chest View Ab/Pelvis View

22. IHE Classroom Sessions – RSNA 2005 21 Portable Data for Imaging (PDI) Distribute Imaging Information on Media CD Creator Printer Image/ Report Display Media Importer John Doe CD

23. IHE Classroom Sessions – RSNA 2005 22 Teaching File and Clinical Trial Export Export SelectorExport ManagerReceiver Export Instances [Rad 53] Store Export Selection [Rad 51] Store Instances [Rad 50] Store Additional TF Info [Rad 52] Delay for pathology De-identify attributes De-identify pixel data Re-map identifiers

24. IHE Classroom Sessions – RSNA 2005 23 Document Consumer Retrieve Document Query Documents Patient Identity Source Patient Identity Feed Document Source Document Registry Document Repository Provide & Register Document Set Register Document Set Cross-enterprise Document Sharing for Imaging (XDS- I) Image Manager Image Archive Retrieve Images Retrieve Presentation States Retrieve Key Image Note Retrieve Evidence Documents WADO Retrieve

25. IHE Classroom Sessions – RSNA 2005 24 Simple Image & Numeric Reports Profile Simple Image & Numeric Reports Profile Images Retrieved Preliminary Report Verified Report Report & Images Retrieved Image Manager & Archive Report Verification Images and Exam data presented for diagnosis Reports stored for Network Access Report & Image Review for Patient Care

26. IHE Classroom Sessions – RSNA 2005 25 Radiologist Flags Images: Referring Physician Sees Key Images First: for refering physician This image shows the renal rupture. Note1 for refering physician This image has the hematoma. Note2 For referring physician: This image shows the renal rupture. Note1 For referring physician: This image has the hematoma. Note2 for refering physician This image shows the renal rupture. Note1 for refering physician This image has the hematoma. Note2 Study & Key Image Notes Key Image Notes Profile

27. IHE Classroom Sessions – RSNA 2005 26 Access to Radiology Information Access to Radiology Information Radiology Department – Images and Reports Emergency Department Referring Physician Other Departments: - Oncology - Surgery - Neurology - Pediatrics - etc. Remote Clinics Electronic Medical Record

28. IHE Classroom Sessions – RSNA 2005 27 Post-Processing Workflow Profile Post-Proc.WorkflowManager PACS System CAD *Workstation Report Repository Acquisition Modality 3-D *Workstation Work Status Worklist … Source Data Results Workstation Results Work Status

29. IHE Classroom Sessions – RSNA 2005 28 Charge Posting Profile ChargePoster *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

30. IHE Classroom Sessions – RSNA 2005 29 Evidence Documents Evidence Documents Image Manager & Archive Report Creator & Image Display Radiology Acquisition Modality Processing Workstation Images Evidence Documents Evidence Documents

31. IHE Classroom Sessions – RSNA 2005 30 IHE Reporting Workflow ReportingWorklist Work Item Claimed Retrieve Images & Evidence Documents Measurements CAD Reports ………………… Reporting Procedure Step STARTED Reporting Procedure Step STARTED StoreReports Reporting Procedure Step COMPLETED Reporting Procedure Step COMPLETED Report Manager RIS Image Manager/ Archive PACS & Archive Report Reader/Creator

32. IHE Classroom Sessions – RSNA 2005 31 IHE Value Proposition Product PlanningProduct Planning IHE Solutions are Driven by Strategic Healthcare Lead Users that collaborate with Healthcare VendorsIHE Solutions are Driven by Strategic Healthcare Lead Users that collaborate with Healthcare Vendors IHE Solutions are Generic, Reusable and Interoperable based on Healthcare Standards: DICOM, HL7, RFCIHE Solutions are Generic, Reusable and Interoperable based on Healthcare Standards: DICOM, HL7, RFC IHE Solutions Optimize the Clinical WorkflowsIHE Solutions Optimize the Clinical Workflows IHE Deployment process – Connectathon, Integration Statements and Users Success Stories information helps to refine the product Business CaseIHE Deployment process – Connectathon, Integration Statements and Users Success Stories information helps to refine the product Business Case IHE Technical Framework specification describes the Global IHE solutions at a High Level for Planning & Marketing and in details for products Architects and Engineering developmentIHE Technical Framework specification describes the Global IHE solutions at a High Level for Planning & Marketing and in details for products Architects and Engineering development

33. IHE Classroom Sessions – RSNA 2005 32 IHE Benefits Clinical UsersClinical Users Greater access to consistent informationGreater access to consistent information Fewer errors, fewer tedious tasksFewer errors, fewer tedious tasks AdministratorsAdministrators Increased throughputIncreased throughput Better scheduling and trackingBetter scheduling and tracking BuyersBuyers Specify/purchase integration capabilities easilySpecify/purchase integration capabilities easily Freedom to acquire Best of Breed systemsFreedom to acquire Best of Breed systems IT ProfessionalsIT Professionals Faster, more predictable integration projectsFaster, more predictable integration projects Facilitate cooperation of competing vendorsFacilitate cooperation of competing vendors

34. IHE Classroom Sessions – RSNA 2005 33 Picking IHE Profiles Customer RFPs Product positioning in the market with a Good Business Case IHE Technical Framework Volume 1 Healthcare Institution Needs: > Optimized Clinical Workflow : SWF, PIR, RWF > Improve the Patient Health Care: SWF, PIR, CPI, PGP,KIN > Economy - Reduce Healthcare cost: SWF, CHG > Protect the Patient Health Information: SEC Considerations Considerations

35. IHE Classroom Sessions – RSNA 2005 34 IHE for Product Planers Questions? IHE North America:RSNA - http:// www.ihe.net HIMSS - http://www.himss.org/IHE ACC - http://www.acc.org/quality/ihe/ihe.htm IHE Europe:http://www.IHE-Europe.org IHE France:http://www.gmsih.fr/fr/som_comm.htm IHE Germany:http://www.IHE-D.org IHE Italy:http://www.rad.unipd.it/IHE IHE UK:http://www.IHE-UK-org IHE Japan:http://www.jira-net.or.jp/ihe-j/en/index.html