1. RSNA/HIMSS Integrating the Healthcare Enterprise IHE in an International Context Ellie Avraham – Eastman Kodak – IHE Planning and Technical Committees Niki Wirsz – Siemens – IHE Planning Committee

2. Introduction Integrating the Healthcare (IHE) is an initiative to stimulate the integration of Healthcare Information and Imaging systems. IHE was initiated in the USA (1998) by the RSNA & HIMSS societies. The foundation of IHE is the Technical Framework that contains the Global framework and the national specializations framework. IHE has an international vision encouraging the IHE nationals initiatives to address the National specific Healthcare policies and practices.

3. Scope of IHE Nationals: North America, Europe, Asia International – Global Technical Framework - Define integration Solutions and optimize workflows (Profiles) - Define the Actors and Transactions for the Profiles National Healthcare Specializations - Define specific information for National Healthcare: Policies, Practices and Information in native language. Developing testing and simulation tools: MESA - Testing peer to peer Global & National Framework Connect-ta-thon – Multi vendor testing: - Testing integration solution based Global & National Framework Demonstration, Education and Success Story.

4. IHE Imitatives IHE North America IHE Europe – IHE-F France – IHE-G Germany – IHE-I Italy – IHE-UK United Kingdom IHE Asia – IHE-J Japan – IHE-CH China – IHE-KR Korea

5. IHE Organization IHE Steering Committee IHE Strategic Development IHE International Coordinating IHE North America IHE Europe IHE Asia IHE-F IHE-D IHE-I IHE-UK IHE-J IHE-KR IHE-CN Regional Domains Review Committees Domain-Oriented Sponsor Society RSNA HIMSS ACC GMSIH SFIL JAHIS RAD IT INFRA CARDIO LAB

6. Standards driving the IHE Globalization DICOM & HL7 Standards and IHE Technical Framework defines the National Localizations: > National Character Set are defined for translating the Patient, Clinical information and User Interfaces in the native national languages. > N ational Policies and Practices drives: - Extensions of Patient and/or Procedure Information (MWL) - Changes in the Clinical Workflows

7. Global IHE RAD Technical Framework Volumes I, II, III IHE RAD Technical Framework Volumes 1,2,3 Defines the Global integration of Healthcare systems: * PACS * RIS * HIS * Digital Capture * Digital Output * Workstations

8. National IHE RAD Technical Framework - Volume IV IHE RAD Process for developing National Extensions IHE RAD national extensions - Scope: * Character set for National languages * Translations of IHE concepts and data fields to national languages * Extension of Patient and Provider information for national policies (Privacy, confidentiality…) * Financial Information and transactions updates due to national Health system payment * Clinical Workflow optimization and Information Access to support the national care practices and policies

9. IHE Testing & Verification by Nationals RSNA Connecttahon for USA IHE-E Connecttahon for Europe countries: France, Germany, Italy, UK IHE-J Connectahon for Japan, China, Korea

10. IHE Japan Localizations Japanese Characters “ISO 2022 IR 87” and “ISO IR 159” for the Kanji Specifications of “Modality Protocol” in HL7 Orders Specification of “Modality Protocol in DICOM MWL (JRS codes) MWL Push versus Pull

11. IHE Japan – Main events IHE-J Connect-a-thon in February 2004 IHE-J JRC-2004 demo in April 8-10 at Yokohama. Presenting RAD profiles: SWF, PIR, CPI, SINR and LAB SWF Initiate a new IHE Domain group to develop the Technical Framework for the “Endoscopic and Physiological Examination Analyze the Cardiology Workflow for Japan Analyze the NM Workflow for Japan

12. IHE Europe Localizations Character set – Latin 1 (ISO 8859-1) Translation of specific fields in PID Segment and PV1 (Visit number, Patient Class, Physician type, Visit indicator and Admit Reason) Insurance Information (IN1, IN2 Segments) Forbidden PID Fields in France (Privacy policy) Extension of Marital Status (G, P), Patient Class, Admission type, Physician type and Admit Reason. Visit number usage and Interpretation Patient Account number in France is optional. Patient management in France is under a functional unit Rather then attending physician (ZFU segment). The ADT is extended in Germany by the addition of the ZBE Segment

13. IHE Europe – Main events Initiate the “LAB” IHE Domain and developed the Technical Framework. IHE-E Connect-a-thon, in Italy Padova on April 2004. It will include the RAD and LAB Profiles IHE-F JFR-2004 IHE-D DRK-2004 IHE-I SIRM-2004 IHE-UK UKRC-2004

14. IHE National Examples PACS & RIS System - Data is presented in the National Character Set > Patient Registration is displayed on the RIS screens in the native language. > Clinical Procedures information is displayed on the Modality console in the native Language. > Billing information is displayed on the RIS screens in the native language. - National policies and Practices > Restrict unauthorized Patient Data: In France, it is illegal to transmit the Patient Race and Ethnic Group.

15. IHE National Examples Continue PACS & RIS System – Add specific National information Data Marital Status in France has an addition for Living together or Partners. Visit Number and Patient Account are required in some nations and optional in other nations

16. IHE National Examples Continue PACS & RIS System – The Patient management can be at the level of either an Institution or at the level of an attending doctor. This change requires additional data for : Nursing Patient care, Housing, etc.

17. IHE National Examples Continue IHE Japan is working on modifications in the Radiology Workflow. – In Japan the HIS and RIS are in many cases unifyed (grouped) to one system. – The data necessity is categorized different then in USA. – Procedure Codes are Locally extended For example: Radiation Recording is Mandatory, while it is optional in USA.

18. IHE International Summary The IHE initiative is strongly supporting the Globalization of the Integration Solutions