1. Integrating the Healthcare Enterprise
Controlling the Radiology Workflow – A Necessary Step Towards EPR
Present & Future Extensions –
Dr. Nikolaus Wirsz
Siemens Medical Solutions

2. The IHE Radiology Workflow

3. IHE Technical Framework
Objectives:
Reduce Redundancy of Data and Functions
Enhance Data Integrity and Data Access
Improve Data Consistency
Close the Information Loop: HIS - RIS - PACS - Modalities
Functional Components
Interactions in the Healthcare Enterprise
Technical Framework Specification
IHE Data Model
IHE System Transactions Overview ( Enterprise Process Flow )
IHE Actors / Roles ( Generic Functional Entities )
IHE Transactions ( Interactions Between Actors )
IHE Integration Profiles ( Solutions for Real-World Scenarios )

4. IHE System Transactions Overview
ADT
Patient Registration
Performed
Procedure Step
Manager
Modality Worklist
Patient Registration
Patient Update
Procedure Scheduled
Images Availability Query
Procedure Update
Images
Stored
Storage
Commit
Q /R Key
Image Note
Q /R
Presentation
Sates
PPS
In-Progress
/ Completed
Filler Order
Management
Placer Order Management
Present.
State
Key Image Note
Image Display
Image Creator
Order Placer
Department
System Scheduler
– Order Filler –
Image Archive
Image Manager
Acquisition
Modality

5. IHE System Transactions Overview
ADT
Patient Registration
PRINTING
Print Server
Print Request with
Presentation LUT
Print Composer
Performed
Procedure Step
Manager
Modality Worklist
Patient Registration
Patient Update
Procedure Scheduled
Images Availability Query
Procedure Update
Images
Stored
Storage
Commit
Q /R Key
Image Note
Q /R
Presentation
Sates
PPS
In-Progress
/ Completed
Filler Order
Management
Placer Order Management
Present.
State
Key Image Note
Image Display
Image Creator
Order Placer
... And Even More Workflow Extensions ( IHE Year 4 ):
– FINANCIAL WORKFLOW ( Billing Transactions )
– POST-PROCESSING WORKFLOW ( Post-Acquisition - CAD )
– BASIC SECURITY ( Meeting HIPAA Requirements )
External
Report
Repository
Report Reader
Report Creator
Report Manager
Report Repository
Report Submission
Report Issuing
Query Report
Retrieve Report
REPORT MANAGEMENT
Department
System Scheduler
– Order Filler –
Image Archive
Image Manager
Acquisition
Modality

6. IHE System Transactions Overview
ADT
Patient Registration
Image Archive
Image Manager
Image Display
Image Creator
Acquisition
Modality
Department
System Scheduler
– Order Filler –
Order Placer
Performed
Procedure Step
Manager
Modality Worklist
Patient Update
Procedure Scheduled
Images Availability Query
Procedure Update
Images
Stored
Storage
Commit
Q /R Key
Image Note
Q /R
Presentation
Sates
PPS
In-Progress
/ Completed
Filler Order
Management
Placer Order Management
Present.
State
Key Image Note
HIS
IMAGING:
PACS
Workstations
Modalities
RIS

7. IHE = A Standards Harmonization Approach
IHE Goes Beyond Standards
IHE =
+ Multi-Vendor
+ Workflow-Driven
+ INTEGRATION
based on established medical IT Standards

8. The 2 Workflow Basics in IHE
1) Scheduled Workflow: – Enterprise Process Steps Under Normal Conditions – Admission / Registration, Order Entry, Scheduling, Images Acquisition, ...
2) Patient Information Reconciliation: – Exception Handling – Example: Image Acquisition Completed for an Unidentified Patient
Taking the Steps Towards EPR:
Closing the Information Loop: HIS ® RIS ® PACS ® Modalities
Optimized & Automated Radiology Workflow

9. Placer Order Management Images Availability Query
Scheduled Workflow
Prerequisites for Enabling EPR Solutions:
Reducing Data Redundancy
Eliminating Gaps in Data Access
Enhanced Access to Clinical Information
Order Placer
Performed
Procedure Step
Manager
ADT
Patient Registration
Image Archive
Image Manager
Image Display
Image Creator
Acquisition
Modality
Department
System Scheduler
– Order Filler –
Patient Registration
Storage
Commit
Filler Order
Management
Placer Order Management
PPS
In-Progress
/ Completed
Images
Stored
Q /R
Images
Procedure Scheduled
Modality Worklist
PPS
In-Progress
/ Completed
Images Availability Query
Images
Stored
Storage
Commit

10. Patient Information Reconciliation
Prerequisites for Enabling EPR Solutions:
Consistency of Patient Information
Enhanced Data Integrity
Order Placer
Performed
Procedure Step
Manager
ADT
Patient Registration
Image Archive
Image Manager
Image Display
Image Creator
Acquisition
Modality
Department
System Scheduler
– Order Filler –
Modality Worklist
Patient Registration
Procedure Scheduled
Images Availability Query
Images
Stored
Storage
Commit
PPS
In-Progress
/ Completed
Filler Order
Management
Placer Order Management
Q /R
Patient Information Reconciliation
( e.g. Patient Merge )
Patient Update
Procedure Update

11. IHE Past – Present – Future ( 1999 – 2002 – ... )
Year 1 – Proof of Concept:
Basic Scheduled Workflow
Year 2 – Integration Profiles ( Solutions for Real-World Problems ):
Patient Information Reconciliation
Access to Radiology Information
Consistent Presentation of Images
Presentation of Grouped Procedure
Simple Image & Numeric Reports
Key Image Notes
Year 3 – Consolidation ( Catch-Up with Real Products ) ® Expansion to France

12. IHE Past – Present – Future ( 1999 – 2002 – ... )
Year 4 – New Integration Profiles:
Post-Processing Workflow
Charge Posting ( Billing Transactions )
Basic Security ( Audit Trails & Node Authentication )
® Expansion to Germany, Italy, Japan
Year 5 – Potential Integration Profiles for 2003:
Teaching Files
Clinical Trials
Reporting Workflow ( Interpretation Worklists )
Desktop Integration ( HL7 CCOW )
® Expansion to UK ® Expansion into Other Domains ( Lab, Cardiology, ... )

13. A Multidimensional Expansion of Integration
IHE Vision for Growth
A Multidimensional Expansion of Integration
Dept Sched.
ADT
Order Mgt
Image Mgr
Modality
1st Dimension:
Vertical Integration for Radiology
IHE Years 1, 2, 3, 4, ...

14. A Multidimensional Expansion of Integration
IHE Vision for Growth
A Multidimensional Expansion of Integration
Patient Registration
ADT
Ordering Process
Master Patient Index
Order Mgt
Clinical Patient Record
. . .
Dept Sched.
2nd Dimension:
Growing the Horizontal
Healthcare Enterprise Integration
Image Mgr
Modality

15. A Multidimensional Expansion of Integration
IHE Vision for Growth
A Multidimensional Expansion of Integration
R a d i o l o g y
C a r d i o l o g y
Laboratory
P h a r m a c y
Patient Registration
O t h e r s . . .
Ordering Process
Master Patient Index
Clinical Patient Record
3rd Dimension:
Increasing the Number of
Vertically Integrated
Departments

16. IHE Vision for Growth Lab/Path Radiology ADT/ Reg Cardiology Int MedER
Endoscopy
Dental
Ophthalm

17. Shaping The Future Of IHE – The IHE Strategic Development Committee –
Expansion of IHE process to meet integration needs of entire enterprise
Engage leading medical professionals and associations from other key domains to help move IHE beyond Radiology
Identify integration needs / barriers and problems / solutions within and across domains
Identify and recommend clinical and operational domains
Populate domain specific sub-committees:
Cardiology
Laboratory
Pharmacy / Medication Administration
IT Infrastructure: Ad-hoc Query / Retrieve Master File Updates CCOW

18. IHE Strategic IT Infrastructure Issues
Desktop Integration (e.g. CCOW)
Master Patient Index
Security and Privacy (HIPAA)
Enterprise Wide Scheduling
Master File Updates
Interdepartmental Information Sharing (Results, Images)
Enabling Web Interfaces
Financial Transactions

19. Healthcare Needs Addressed By IHE
Conclusions
Healthcare Needs Addressed By IHE
Continuity and Integrity of Patient Information
Eliminating Gaps and Redundancies in Data Access
Clinical Workflow Optimization
Fostering Communication Among Diverse Medical Information Systems
Improving the Patient Care Process

20. Questions ? References: IHE Europe: http://www.IHE-Europe.org
IHE North America: