2. Integrating the Healthcare Enterprise IHE in Radiology and Beyond Dr. Nikolaus Wirsz Siemens Medical Solutions IHE Planning Committee Member Sanjay Jain Cerner Corporation IHE Planning Committee Co-Chairman

3. IHE Classroom Sessions – RSNA 2003 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 Medical Information Across Departments and Institutions – Inadequate Communicating of Medical Data Across Multiple Systems from Different Vendors – Risky Investments in Proprietary Solutions Challenges of Integration

4. IHE Classroom Sessions – RSNA 2003 An Incremental Multi-Year Project Launched in 1998 by RSNA & HIMSS Enhance the Access to Clinical Information Ensure Continuity and Integrity of Patient Information Speed Up the Integration in Healthcare Environments Foster Communication Between Vendors of Medical Information Technology Prove that Integration is Attainable Based on Standards Participants: – Representatives of Healthcare Providers – Information Systems Vendors – Imaging Systems Vendors – Standardization Groups The IHE Initiative

5. IHE Classroom Sessions – RSNA 2003 Progress: IHE Year 1 (1999) 1 st Publication of the IHE Technical Framework – Defines General Integration Model: IHE Actors & IHE Transactions – Using DICOM and HL7 Messages – Basic Scheduled Workflow - Proof of Concept (Admission → Ordering → Scheduling → Acquisition → Storage) Successful Demonstration – 24 companies – 35 systems

6. IHE Classroom Sessions – RSNA 2003 Progress: IHE Year 2 (2000) Defined 7 IHE Integration Profiles (Solutions for Real-World Problems) – Patient Information Reconciliation (Patient Data Update, Patient Merge) – Simple Image & Numeric Reports (Exchange of Report Data) – Key Image Notes (Flag Relevant Images) – Access to Radiology Information (Images, Reports) – Consistent Presentation of Images (Hard & Soft Copies) – Presentation of Grouped Procedure (Managing Subsets of a Single Large Acquisition) Expanded Demonstration – 30 companies – 58 systems

7. IHE Classroom Sessions – RSNA 2003 Progress: IHE Year 3 (2001) 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

8. IHE Classroom Sessions – RSNA 2003 Progress: IHE Year 4 (2002) 3 Additional Radiology Integration Profiles – Post-Processing Workflow (Image Processing, Reconstruction, CAD) – Charge Posting Billing Transaction) – Basic Security (Audit Trails & Node Authentication) Expansion Beyond Radiology – Healthcare IT Infrastructure Launched – Laboratory Integration Launched in Europe – Exploring Integration in Cardiology Growing Industry Participation – 35 companies – 73 systems – 43 companies in IHE Europe!

9. IHE Classroom Sessions – RSNA 2003 Progress: IHE Year 4 (2002) – continued Driving Market Adoption – First IHE User Success Stories - 13 Posted at RSNA 2002 (IHE Becomes Reality) – First Product Evaluation Worksheet (Support for Purchasing Products with IHE Capabilities) – First IHE Integration Statements for Available Products (Industry Commitment to IHE)

10. IHE Classroom Sessions – RSNA 2003 Progress: IHE Year 5 (2003) 3 New Radiology Integration Profiles – Access to Radiology Information + Multiple Source Option (Multiple PACS / Archives) – Evidence Documents (Measurements / Procedure Logs / CAD Results) – Reporting Workflow (Interpretation / Transcription Worklists) IHE Radiology Well Established internationally – 12 IHE Integration Profiles – Connectathons & Demonstrations in North America, Europe, Japan:  60+ Participating Vendors  100+ Systems – Growing Recognition by Key Players  Radiologists, IT professionals – Market Adoption  100+ Products with IHE Integration Statements  Frequency of IHE Inclusion in RFPs  More IHE User Success Stories in North American and Europe

11. IHE Classroom Sessions – RSNA 2003 Outlook: IHE Year 6 (2004) Nuclear Medicine Integration – Addressing NM Specific Needs Media Distribution – Exchangeability of Clinical Information on Removable Media (CD) Departmental Workflow – Linking Sub-Workflows in Radiology: – Scheduling Workflow – Post-Processing Workflow – Reporting Workflow Cross-Domain Cooperation on Common Integration Issues in IHE Radiology & IHE IT Infrastructure

12. IHE Classroom Sessions – RSNA 2003 RIS HIS PACS acquisition in progress / completed acquisition in progress / completed IHE Success – Closing the Loop

13. IHE Classroom Sessions – RSNA 2003 IHE Success – Integration Profiles Patient Information Reconciliation Reconcile Worklists, Status and Data Objects For Unknown Patients and Demographics Changes Access to Radiology Information Consistent access to images and reports Consistent Presentation of Images Create, store, manage, retrieve & use objects for hardcopy and softcopy grayscale presentation states Key Image Notes Create, store, manage, retrieve & use objects to flag significant images Simple Image and Numericc Reports Create, store, manage, retrieve & use simple diagnostic reports with optional image links & Scheduled Workflow Presentation of Grouped Procedures Manage individual procedure image subsets from a multi-procedure acquisition for viewing & reporting Basic Security Charge Posting Collect and post timely billable procedure details Audit Trail Consolidation & Node Authentication Reporting Workflow Manage worklists, track status, perform & notify diagnostic reporting steps Evidence Documents Create, store, manage, retrieve & use objects to record study evidence Manage worklists, track status, perform & notify image processing & CAD steps Post - Processing Workflow Create, Store, Manage, Retrieve & Use Images Admission, Order Management, Scheduling, Store, Retrieve Manage Worklists, Track Status, Perform & Notify Acquisition Related Steps

14. IHE Classroom Sessions – RSNA 2003 A Multidimensional Expansion of Integration IHE Vision for Growth Dept Sched. ADT Order Mgt Image Mgr Modality 1 st Dimension: Vertical Integration for Radiology IHE Years 1 - 6 -...

15. IHE Classroom Sessions – RSNA 2003 2 nd Dimension: Growing the Horizontal Healthcare Enterprise Integration Master Patient Index Electronic Health Record Ordering Process... Dept Sched. ADT Order Mgt Image Mgr Modality Patient Registration A Multidimensional Expansion of Integration IHE Vision for Growth

16. IHE Classroom Sessions – RSNA 2003 3 rd Dimension: Increasing the Number of Vertically Integrated Departments Master Patient Index Electronic Health Record Ordering Process Patient Registration R a d i o l o g y C a r d i o l o g y Laboratory / Pathology Additional Clinical Fields Nuclear Medicine A Multidimensional Expansion of Integration IHE Vision for Growth

17. IHE Classroom Sessions – RSNA 2003 Lab/Path. Radiology Nuc. Med IHE Vision for Growth IT Infrastructure Cardiology ADT/ Reg. Endoscopy Ophthalm Dental ER 1999 - 2004 -... 2003 -... 2004 -... 2003 -... 2004 -...

18. IHE Classroom Sessions – RSNA 2003 Progress: IHE IT Infrastructure (ITI) IHE ITI Committees Founded End of 2002 Liaison & Cooperation with the HL7 Standards Organization Identified Initial Set of Integration Requirements – Exchanging Relevant Medical Data Beyond Departmental Boundaries – Common Patient View Across Multiple Registration Domains – Query for Well-Known Key Patient Data: Allergies, Current Medications, Lab Panel Results … – Viewing the same patient while moving among multiple desktop applications – User Authentication and Security Issues IHE ITI Technical Framework V1.0 Released – 5 Initial IHE ITI Integration Profiles First IHE ITI Connectathon – Jan. 2004 First IHE ITI Demonstration – Feb. 2004 at HIMSS – Joint Interoperability Demo with HL7 and IHE Radiology

19. IHE Classroom Sessions – RSNA 2003 IHE ITI Integration Profiles Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Consistent Time Coordinate time across networked systems Consistent Time Coordinate time across networked systems HL7 CDA / PDF / JPEGHL7 2.x ADT Triggers / QueriesKerberos (RFC 1510) / HL7 CCOWNTP (RFC 1305) Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications HL7 CCOW

20. IHE Classroom Sessions – RSNA 2003 Retrieve Information For Display Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Consistent Time Coordinate time across networked systems Consistent Time Coordinate time across networked systems HL7 2.x ADT Triggers / QueriesKerberos (RFC 1510) / HL7 CCOWNTP (RFC 1305) Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications HL7 CCOW Query for Existing Reports in Well Known Presentation Formats – CDA, PDF, RTF, … Query for Well-Known Key Data – Allergies, Current Medications, Lab Panel Results… Linked to user authentication and EMPI services Value Proposition – Simple, rapid access to patient information for better care – Patients win! – Supports workflow from within current workspace or application – Users win! Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user HL7 CDA / PDF / JPEG IHE ITI Integration Profiles

21. IHE Classroom Sessions – RSNA 2003 Patient Synchronized Applications Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Consistent Time Coordinate time across networked systems Consistent Time Coordinate time across networked systems HL7 CDA / PDF / JPEG HL7 2.x ADT Triggers / QueriesKerberos (RFC 1510) / HL7 CCOWNTP (RFC 1305) Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications HL7 CCOW Viewing the same patient while moving among applications on a desktop Linked to user authentication and EMPI services Value Proposition –Reduce the repetitive tasks of selecting same patient in multiple applications – Users win! –Reduce likelihood of working with wrong patient – Patient safety win! IHE ITI Integration Profiles

22. IHE Classroom Sessions – RSNA 2003 Enterprise User Authentication Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Consistent Time Coordinate time across networked systems Consistent Time Coordinate time across networked systems HL7 CDA / PDF / JPEG HL7 2.x ADT Triggers / QueriesNTP (RFC 1305) Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications HL7 CCOW Standards based user log-in for workstations and applications Provisions for emergency access Value Proposition –Facilitates centralized user access management – IT win! –Single sign-on speed and convenience – Users win! Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Kerberos (RFC 1510) / HL7 CCOW IHE ITI Integration Profiles

23. IHE Classroom Sessions – RSNA 2003 Patient Identifier Cross-Referencing for MPI Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Enterprise User Authentication Provide users a single name and centralized authentication process across all systems Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Retrieve Information for Display Access a patient’s clinical information and documents in a format ready to be presented to the requesting user Consistent Time Coordinate time across networked systems Consistent Time Coordinate time across networked systems HL7 CDA / PDF / JPEG Kerberos (RFC 1510) / HL7 CCOWNTP (RFC 1305) Synchronize multiple applications on a desktop to the same patient Patient Synchronized Applications HL7 CCOW Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains Patient Identifier Cross-referencing for MPI Map patient identifiers across independent identification domains HL7 2.x ADT Triggers / Queries Mapping a patient’s multiple identities across registration domains Enable access to data and information across independent domain boundaries Value Proposition –Broader access to needed patient data wherever it is – Users win! –Lower costs to use data in existing systems anywhere in the enterprise – IT wins! IHE ITI Integration Profiles

24. IHE Classroom Sessions – RSNA 2003 IHE Laboratory – Status Work in Progress in Europe & Japan Workflow Support for Lab Test Orders & Observation Reports Initial Scope (2003) Limited to Lab Specimens (Chemistry, Hematology, Microbiology,…) Identified IHE Lab Integration Profiles: – Laboratory Scheduled Workflow (LSWF) – Laboratory Patient Information Reconciliation (LPIR) – Point of Care Testing (POCT) IHE Lab Technical Framework Released for LSWF First IHE Lab Connectathon – April 2004 in Europe First IHE Lab Demonstrations in Europe: – May 2004 at Hôpital Expo in France – Nov. 2004 at MEDICA in Germany

25. IHE Classroom Sessions – RSNA 2003 Other IHE Expansion Domains IHE Cardiology: – Sponsoring Organizations:  ACC (American College of Cardiology)  ESC (European Society of Cardiology) – Kick-Off Meeting Mar. 2003 - White Paper Issued – Planning Meeting Dec. 8-9, 2004 at ACC in Washington DC → Starting Activities IHE Pharmacy / Medication Administration: – Exploratory Phase - Problems Identification & Use Cases – White Paper in Review – Recruiting Contributors

26. IHE Classroom Sessions – RSNA 2003 IHE Organizational Structure Multi-Domain & Multi-National IHE Europe IHE North America IHE Asia / Oceania Participants supervises reports contribute Delegates IHE (International) Strategic Development Committee Global Development: Radiology, IT Infrastructure, Cardiology, Lab, etc. Regional & National Deployment IHE Domain-related Planning and Technical Committees Sponsor Co-Chairs Global Interoperability

27. IHE Classroom Sessions – RSNA 2003 5+ Years of IHE Evolution and More to Come … IHE Is Essential to All Aspects of Healthcare: –Radiology – Cardiology – Lab – IT Infrastructure – … IHE - A Well Established International Program –A Global Blueprint for Integrated Solutions IHE Is Highly Visible in the User Community –High Expectations from an Integrated Workflow –Increased Demand for IHE Support by the Industry IHE - Critical to Successful Purchasing Decisions Conclusions

28. IHE Classroom Sessions – RSNA 2003 IHE in Radiology and Beyond Questions? IHE North America:http://www.rsna.org/IHEor http://www.himss.org/IHE 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