1. September, 2005What IHE Delivers Andrew M. Keller, MD, FACC, FACP, 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 Annual Scientific Meeting.

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

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? Use existing 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 is formed IHE is a consortium of professional societies and vendors working together to facilitate the integration of healthcare information 1997: IHE Radiology established; sponsored by RSNA 2000: First European Connectathon 2003: IHE Cardiology established; sponsored by ACC 2004: ESC joins IHE Cardiology 2007: IHE International formalized 2007: We are excited to have JCS join IHE Cardiology in expanding support to Asia

11. 10 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

12. 11 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)

13. 12 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

14. 13 Brigham and Womens Hospital Patient info and orders Philips Allura x6 Witt hemo x6 Patient info, Order, schedule, and procedure status SecureStorage Cath Workflow Profile:

15. 14 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

16. 15 Stress testing integration One patient; one order; one procedure across systems; Consistently defined Protocols and stages

17. 16 Integration benefits For users across the healthcare enterprise, IHE: allows faster access to information, reduces errors, streamlines workflow, simplifies interface projects, optimizes resource utilization. Spend time with patients; not chasing information.

18. 17 Working together with JCS How can IHE Cardiology and IHE-Japan work together more closely: Come to the IHE Interoperability Workshop at ACC.07 if you are attending (booth #2251) Work together to understand differences in clinical workflow 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 IHE Cardiology prioritization process for new Profiles (usually August/September timeframe) Bi-annual joint tcons at mutually agreed upon times

19. 18 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

20. September, 2005What IHE Delivers