1. Integrating the Healthcare Enterprise - IHE An initiative of the ACC to improve data interoperability

2. March 2005ACC Scientific Sessions1 Why IHE? Cardiology has hard system and data integration problems - Multiple locations (office, in-patient, ED …) - Multiple devices and modalities - Long term patient care by many care providers Data integration is essential to quality patient care Care providers must work with industry to develop solutions to meet their needs - Implementations must be based on open standards

3. March 2005ACC Scientific Sessions2 Why Are Standards Important? The 1905 systems integration problem

4. March 2005ACC Scientific Sessions3 IHE bridges the gap between standards and their practical use in healthcare

5. March 2005ACC Scientific Sessions4 Goals of IHE Advance standards-based healthcare data integration Improve clinical and administrative workflow Improve data flow – where it’s needed, when it’s needed Improve the efficiency and effectiveness of clinical practice

6. March 2005ACC Scientific Sessions5 What is IHE? A collaboration of clinicians and vendors - International and multi-specialty A proven systems integration process - Refined through seven years of experience Produces results on a yearly cycle - Problem identification, Technical specification, Vendor implementation, Test, Demonstration - Yearly cycle focuses on most important tractable problems

7. March 2005ACC Scientific Sessions6 Who is IHE? IHE is a joint initiative of: - American College of Cardiology (ACC) - Radiological Society of North America (RSNA) - Healthcare Information and Management Systems Society (HIMSS) Vendors/manufacturers in major supporting role Local sponsorship internationally - IHE-Europe and IHE-Asia/Oceania IHE-Cardiology additional participating societies - ASE, SCAI, ASNC, and more IHE-Cardiology in Europe sponsored by European Society of Cardiology (ESC)

8. March 2005ACC Scientific Sessions7 IHE Clinical Domains Cardiology leverages the work of the other domains Cardiology contributes to the Electronic Health Record – Being specified in IHE IT Infrastructure domain IHE EHR- Longitudinal Record IHE Cardiology IHE Laboratory IHE Radiology IHE Future Domain IHE IT Infrastructure Intra-Enterprise Cross-Enterprise 14 Integration Profiles 5 Integration Profiles 3 Integration Profiles 9 Integration Profiles IHE Radiation Oncology IHE Cardiology IHE EHR- Longitudinal Record

9. March 2005ACC Scientific Sessions8 The ACC and IHE share a vision…

10. March 2005ACC Scientific Sessions9 ACC and IHE Shared Vision The “Digital Integrated Cardiac Record” as part of the greater Electronic Health Record (EHR) Cross Enterprise physician access (in/out of hospital) Access all department’s information Secure access Populations outcomes

11. March 2005ACC Scientific Sessions10 Cardiology and the Electronic Health Record ACC Vision of the Electronic Health Record (1999) - “The Digital Integrated Cardiac Record” - All care areas - Across organization boundaries To play in the EHR, data must be managed and properly identified So, this is where we started in Year 1 of IHE-Cardiology – lay the foundation

12. March 2005ACC Scientific Sessions11 IHE Cardiology – the Cath Lab example 1 2 34 5 6 7 (A) room for improvement !

13. March 2005ACC Scientific Sessions12 IHE Annual Cycle – Step 1 1. Cardiologists identify clinical problems to be addressed - “Integration Profiles” 2. Engineers from vendors collaborate to define technical specification (using standards such as DICOM and HL7) 3. Vendors implement the technical specification and participate in the “Connectathon” and demos 4. Vendors publish IHE Integration Statements, and users can buy IHE systems

14. March 2005ACC Scientific Sessions13 IHE Cardiology Year 1 Three initial clinical problems to be addressed: 1. The ability to view an ECG from many locations - quickly and easily integrated into other applications 2. Effective integration of patient, order, and procedure information in an Echo Lab, including mobile echo 3. Effective integration of patient, order, and procedure information in a Cath Lab, including angio, hemo, and IVUS, especially for emergent cases ► “Retrieve ECG for Display” ► “Echocardiography Workflow” ► “Cardiac Catheterization Workflow”

15. March 2005ACC Scientific Sessions14 “I need to see the ECG!” Clinical Problem: - Diagnostic quality ECGs needed everywhere IHE Tasks: - Simple and fast access - Ubiquitous (Web based) communication - Integrated into other software systems Retrieve ECG for Display Integration Profile

16. March 2005ACC Scientific Sessions15 Retrieve ECG for Display

17. March 2005ACC Scientific Sessions16 “Could you do a TTE on this patient right now since you are in the CCU anyway?” Clinical Problems: - Lost and unbilled echo exams because carts are constantly on the move - Patient and order info manually entered (potential for errors) or not at all - Stress echo image ID inconsistent across vendors IHE Tasks: - Accurate and automatic demographic and order reconciliation - Verify all images are securely archived - Accurate display of Stress Images Echocardiography Workflow Profile

18. March 2005ACC Scientific Sessions17 Echocardiography Workflow

19. March 2005ACC Scientific Sessions18 “There is a patient being brought up to cath from the ER…” Clinical Problems: - Need to enter patient and procedure information into multiple systems in cath lab - No order created; emergent case (unidentified patient) - Change of rooms during procedure – data scattered - Inconsistently time-stamped events IHE Tasks: - Automate download of patient info to all systems - Accurate and automatic patient demographic and order reconciliation - Verify all data is securely archived in single “folder” - All data consistently time-stamped Cardiac Catheterization Workflow Profile

20. March 2005ACC Scientific Sessions19 Cardiac Catheterization Workflow

21. March 2005ACC Scientific Sessions20 IHE Annual Process – Step 2 1. Cardiologists identify clinical problems to be addressed - “Integration Profiles” 2. Engineers from vendors collaborate to define technical specifications (using standards such as DICOM and HL7) 3. Vendors implement the technical specification and participate in the “Connectathon” and demos 4. Vendors publish IHE Integration Statements, and users can buy IHE systems

22. March 2005ACC Scientific Sessions21 IHE Annual Process – Step 3 1. Cardiologists identify clinical problems to be addressed - “Integration Profiles” 2. Engineers from vendors collaborate to define technical specification (using standards such as DICOM and HL7) 3. Vendors implement the technical specification and participate in the “Connectathon” and demos 4. Vendors publish IHE Integration Statements, and users can buy IHE systems

23. March 2005ACC Scientific Sessions22 IHE Joint Connectathon January, 2005 Oak Brook, IL 300 engineers 43 companies 110 products – Working together in a collegial environment – 2800 monitored test cases executed in 5 days This is integration that doesn’t take up your hospital’s resources – and no finger-pointing!

24. March 2005ACC Scientific Sessions23 IHE Annual Process – Step 4 1. Cardiologists identify clinical problems to be addressed - “Integration Profiles” 2. Engineers from vendors collaborate to define technical specifications (using existing standards such as DICOM and HL7) 3. Vendors implement the technical specification and participate in the “Connectathon” and demos 4. Vendors publish IHE Integration Statements, and users can buy IHE systems

25. March 2005ACC Scientific Sessions24 Your Request for Proposals (RFPs) Incorporate IHE framework into RFP documents & product selection Much easier to specify an IHE Integration Profile than detailed technical specs Use IHE framework to evaluate your current workflow, even if not buying now Vendors build product functions that are requested by customers Ask for IHE Integration Loud & Often !!

26. March 2005ACC Scientific Sessions25 Long Road Ahead – 5 yr Roadmap Year 1 (2005) Year 2 (2006) Year 3 (2007) Year 4 (2008) Year 5 (2009) Cath Echo ECG Nuclear EP Cardiology Technical Framework Quality MR/CT Multi-modality workflow & imaging Procedure log & reporting Hemo waveform & measures, QCA/QVA Supplies, inventory, & charge capture Workflow & imaging, stress protocols Reporting workflow Retrieve ECG for display ECG/Stress/Holter orders Workflow & imaging, stress protocols Reporting workflow Multi-modality lab workflow & reporting Home health monitoring Retrieve guidelines for display Retrieve structured guidelines Registry data harvesting Workflow, reporting, & measurements Precision time synchronization Implantable device parameters & events PediatricMeasurement interoperability ECG waveform interoperability Stress testing workflow

27. March 2005ACC Scientific Sessions26 Commitment to EHR David J. Brailer, MD, PhD National Coordinator for Health Information Technology, US Department of Health and Human Services (HHS) Directive: Execute the Presidential Order for widespread deployment of Health Information Technology within 10 years. “The capacity to share clinical data is generally not available in the market, and I have placed a high priority on ensuring that it does come to exist before widespread EHR adoption is underway.” “IHE… is becoming the obvious thing to do. It is our goal to make it the inevitable thing to do.” HIMSS Conference, February 2005

28. March 2005ACC Scientific Sessions27 Why IHE? This is the cardiologist in healthcare Any Questions? This is healthcare

29. March 2005ACC Scientific Sessions28 Custom integration at customer site is a lose-lose - High cost – vendor and customer - Unpredictable and uncontrolled environment - Inefficient – solutions often must come from other locations (home office) with delays in delivery - Usually insufficiently documented – fragile and unmaintainable solutions - Resources expended on non-value-add effort - Ineffective use of available standards Bolt-on integration is a problem - Data sharing functions don’t work well if not designed into the product Exponential growth of pain as systems are added Why IHE? (for vendors)

30. March 2005ACC Scientific Sessions29 Goals of IHE (for vendors) Effective use of standards Reduce variability in interfaces Controlled integration testing environment - Defined timetable - No extraneous distractions Effective use of resources for integration testing Coordinated deployment of cross-system functions - Avoid chicken-and-egg syndrome Common approach creates the market in which vendors can sell and users can buy with confidence

31. March 2005ACC Scientific Sessions30 IHE Benefits (Vendors) Improves onsite customer support Reduces development cost Standardizes interface engineering Enables the vendors to focus on competitive features Improves customer satisfaction

32. March 2005ACC Scientific Sessions31 IHE Benefits (Consultants & Providers) IHE Profiles facilitate interaction of multiple providers & services to improve quality of patient care IHE provides a consistent view of the entire end-to-end clinical workflow Improves cost effectiveness of system implementation and operations

33. March 2005ACC Scientific Sessions32 More Information Information Available On the Web at: http://www.acc.org/quality/ihe.htm Home Page of IHE Europe: www.IHE-Europe.org Home Page of IHE Japan: www.jira-net.or.jp/ihe-j/en/index.html http://www.ihe.net

34. March 2005ACC Scientific Sessions33 Visit IHE Booth #4563 To learn more about IHE, visit Booth #4563 in Hall D for: Theatre Presentations Clinical Scenario Demonstrations: - Cath/ECG: Emergent Angioplasty - Cath/ECG: Change of Rooms - Echo/ECG: “Add on” Mobile Procedure - Echo/ECG: Stress Echo Images

35. March 2005ACC Scientific Sessions34 IHE Cardiology Annual Schedule Feb – Apr 2005: Define IHE Cardiology Year 2 Technical Framework Apr-May 2005: Public Comment Period June 2005: Vendor Invitational Workshop June 2005: Technical Framework for Trial Implementation June – Dec 2005: Vendor Implementation Jan 2006: Vendor Connectathon (Testing) March 2006: ACC Demonstrations Year 2

36. March 2005ACC Scientific Sessions35 Four Clinical Scenario Demonstrations Clinical Scenario Demonstrations: - Cath/ECG: Emergent Angioplasty - Cath/ECG: Change of Rooms - Echo/ECG: “Add on” Mobile Procedure - Echo/ECG: Stress Echo Images Join a 10 minute demonstration – Watch us “connect the docs”.