1. September, 2005What IHE Delivers Andrew M. Keller, MD, FACC, FASE Chief of Cardiology, Danbury Hospital Danbury, CT, USA Integrating the Healthcare Enterprise I HE: Meeting Global needs for Integrated Healthcare Japanese Circulation Society (JCS) Kobe, Japan March 16 th, 2007

2. 1 Thank you for the opportunity to be at the Japanese Circulation Society Scientific Sessions.

3. 2 IHEs vision and purpose To apply the knowledge of physician, hospital, and office workflow in order to link and integrate modalities (actors) passing information from application to application seamlessly across the entire health care system.

4. 3 Workflow that must be Integrated Order entry Pre-authorization Patient Scheduling Transportation Registration and payer verification Reconciliation of patient demographics Coordination with physicians Study acquisition Notification study completed Study archiving and storage Image retrieval system Preliminary reporting Professional review Transcription, reporting, and electronic signature Report dissemination Quality assurance Statistical analysis Billing and auditing

5. 4 Integrate Clinical Information Goal: optimal patient care To attain optimal patient care, we need clinical information When we need it Wherever we need it In a meaningful manner Without repeating tests (time and money) Originating from many different locations Cardiology data is especially complex Proper integration of clinical information means better patient care.

6. 5 Information from many places Hospital Home Doctors office Extended Care Data pointers

7. 6 Information is difficult to integrate!

8. 7 How can we integrate these system? Today, at least in U.S. and Europe, each two systems that are connected are an IT integration project. Very expensive Very time consuming Very resource intensive Never works quite right Usually involves third party May break if software is upgraded on either system

9. 8 How to integrate? Instead, use standards: DICOM HL7 XML Define use of standards in Technical Framework Have common testing plan in order to have vendors work together Vendors implement Technical Framework in products

10. 9 IHE comes in A consortium of professional societies and vendors to facilitate the integration of healthcare information 1997: IHE founded by RSNA 1998: Becomes global project in radiology 1999: Moves beyond radiology 2003: IHE Cardiology formed with ACC/ESC 2007: IHE Cardiology is excited to join with JCS and become a truly global organization

11. 10 How IHE Cardiology Works Process driven by Cardiologists, implemented by vendors!

12. 11 Proven Standards Adoption Process Document Use Case Requirements Identify available standards ( e.g. HL7, DICOM, IETF, OASIS) Develop technical specifications Testing at Connectathons IHE Demonstrations Products with IHE Timely access to information Easy to integrate products

13. 12 Global Support I am convinced that IHE is the best possible pathway to the true integrated patient record and all of the benefits that are associated with it. -Ruediger Simon, MD, FESC, FACC Chief of Cardiology University of Kiel Kiel, Germany IHE-Europe Co-Chair

14. 13 Growth in IHE Domains Radiology (18) IT Infrastructure for Healthcare (17) Cardiology (7) Laboratory (6) Radiation Oncology (1) Patient Care Coordination (5) Patient Care Devices (1) Quality Eye Care (3) Veterinary Endoscopy Pathology Pharmacy IHE Global Developments Integration Profiles (# X) – Solutions to Real-World Interoperability Needs & Problems: Within Clinical Departments e.g.: Within Clinical Departments e.g.: Radiology Radiology Cardiology Cardiology Lab Lab...... Across Departmental & Institutional Boundaries – XDS Across Departmental & Institutional Boundaries – XDS RHIOs (Regional Healthcare Information Organizations) RHIOs (Regional Healthcare Information Organizations) EHR Enablers EHR Enablers Year 1 (1999)Year 2 (2000)Year 3 (2001) Year 4 (2002) Year 5 (2003)Year 6 (2004) Year 7 (2005) Year 8 (2006)Year 9 (2007)

15. 14 IHE Cardiology Profiles (9) Cath Lab Workflow Echocardiography Workflow Retrieve ECG for Display Echocardiography Measurement Patient: Doe, John Technologist: der Payd, N Measurements: Mitral valve diameter 3.1cm - shown in image at [ ] Ventricular length, diastolic 5.97 cm - shown in image at [ ] Ventricular volume, diastolic 14.1 ml - inferred from [ ] - inferred from VLZ algorithm Evidence Documents (Measurements) Displayable Reports Cross-Enterprise Document Sharing (EHR to EHR) Stress Testing Workflow Nuclear Medicine Implantable Cardiac Device Observation

16. 15 Cath Lab Integration One patient; one order; one procedure; consistent time stamps Procedure Log

17. 16 Stress Echo Integration Views defined; stages defined Consistent display of different vendor stress exams Toshiba Aplio (or Philips or GE) Goodman PACS (or 5 other vendors) views stages

18. 17 Stress testing integration One patient; one order; one procedure across systems; Consistently defined Protocols and stages

19. 18 Integration benefits For users across the healthcare enterprise, IHE: allows faster access to information, reduces errors, streamlines workflow, simplifies interface projects, optimizes resource utilization.

20. 19 Working together with JCS How can IHE Cardiology North America, Europe, and Japan work together more closely: Understand differences in clinical workflow Japan Encourage additional direct involvement in the Planning Committee Web-ex/tcon in May, 2007, to explain new Year 4 Profiles and gain direct feedback Direct involvement in annual voting process for new Profiles (usually August/September timeframe) Bi-annual joint tcons at mutually agreed upon times

21. 20 More Resources - www.ihe.net www.ihe.net Frequently Asked Questions Integration Profiles in Technical Frameworks: Cardiology Cardiology IT Infrastructure IT Infrastructure Laboratory Laboratory Patient Care Coordination Patient Care Coordination Patient Care Devices Patient Care Devices Radiation Oncology Radiation Oncology Radiology Radiology Connectathon Results Vendor Products Integration Statements Participation in Committees and Connectathons

22. September, 2005What IHE Delivers