2. Understanding IHE, BIR 20 Oct 2004 IHE : consistent presentation of images and key image notes and how to order IHE-systems Prof. Berthold B. Wein, MD User co-chair IHE-Europe Praxisgemeinschaft Kapuzinerkarree University Hospital Aachen Germany

3. Understanding IHE, BIR 20 Oct 2004 Problems Ensuring print quality outside of the departmentEnsuring print quality outside of the department Radiologist discussing images with remote physiciansRadiologist discussing images with remote physicians Capture image manipulation to avoid redundant work (coronal CT, MR reading, etc.)Capture image manipulation to avoid redundant work (coronal CT, MR reading, etc.)

4. Understanding IHE, BIR 20 Oct 2004 Consistent Presentation of Images Reporting Radiologist Referring Physician or Reviewing Radiologist Original ImageWindow LevelFlipZoom Area Of Interest Annotate Without Consistent Presentation Area Of Interest Achieving Consistent Presentation Presentation State Presentation LUT Grayscale Standard

5. Understanding IHE, BIR 20 Oct 2004 Grayscale Standard Display Function (GSDF) Acquisition Soft Copy Review Film Review 6 modalities  4 cameras, 26 workstations The current way = 180 calibrations Independent device calibration delivers consistency with simplicity Barten Curve Just Noticeable Differences LuminanceLuminanceLuminanceLuminance DICOM Standard Display Function The IHE way = only 36 calibrations

6. Understanding IHE, BIR 20 Oct 2004 Consistent Presentation of Images With films, image quality was the imaging department problem….With films, image quality was the imaging department problem…. Softcopy image distribution across the healthcare enterpriseSoftcopy image distribution across the healthcare enterprise –Enabled by digital radiology –Avoids lost films, reduce delays –Decreases utilization of staff and equipment –But …need to ensure quality and consistency ! This IHE Integration Profile is the cost effective and technically correct solution.This IHE Integration Profile is the cost effective and technically correct solution.

7. Understanding IHE, BIR 20 Oct 2004 Don’t Call Us, We’ll Call You “Dave, you read that 3000 slice MR study last night. Can you highlight the 5 most important images for me ?”“Dave, you read that 3000 slice MR study last night. Can you highlight the 5 most important images for me ?” –Thinking… “#$@%!%# You”, saying “Sure, Joe.” #$@%!%# You#$@%!%# You “Dr. Channin, I just reviewed 40 cases and marked my questions on yellow stickies. Can you review those ?”“Dr. Channin, I just reviewed 40 cases and marked my questions on yellow stickies. Can you review those ?” –Thinking... “He has to much paper at home...” Technician to radiologist: “The patient wouldn’t hold still !”Technician to radiologist: “The patient wouldn’t hold still !”

8. Understanding IHE, BIR 20 Oct 2004 for referring physician Here you can see the renal osteopathy. For teaching Fibroosteoclasia

9. Understanding IHE, BIR 20 Oct 2004 Different notes on different images Same note on different images for referring physician Here you can see the renal rupture. Note1 for referring physician This is the hematoma. Note2 for refering physician Here you can see the renal rupture. Note1 for refering physician This is the hematoma. Note2 for refering physician Hematoma everywhere Note3 for refering physician Hematoma everywhere Note3 for refering physician Hematoma everywhere Note3 for refering physician Hematoma everywhere Note3 for referring physician Hematoma everywhere Note3

10. Understanding IHE, BIR 20 Oct 2004 Key Image Notes Titles are Coded Defined by DICOM Supplement 59. May be extended Codes Of Interest Rejected for Quality Reasons For Referring Provider For Surgery For Teaching For Conference For Therapy For Patient For Peer Review For Research Quality Issue The note title defines the semantics of the reason of significance. Key Image Notes can be queried by code. The user comments are meant to be informal.

11. Understanding IHE, BIR 20 Oct 2004 Key Image Notes There is more to teamwork than images and reportsThere is more to teamwork than images and reports With IHE, it is possible to attach « electronic post-it™ » to images to increase informal but critical communication between:With IHE, it is possible to attach « electronic post-it™ » to images to increase informal but critical communication between: –The Technologist and the Radiologist about specific examination events –The Radiologist and the Technologist about image quality issues –The Radiologist and other department clinicians (surgeon, orthopedist,..) –The Radiologist and collegues about selecting images for conferences –The Radiologist to the Referring Provider, …..etc. This IHE Integration Profile is the cost effective solution (increases radiology and overall efficiency).This IHE Integration Profile is the cost effective solution (increases radiology and overall efficiency).

12. Understanding IHE, BIR 20 Oct 2004 Direct Advantages ? Composing of complex IT environmentsComposing of complex IT environments –PACS –Radiology Departments –Hospital information systems

13. Understanding IHE, BIR 20 Oct 2004 Radiology 2000-2005 Access to Radiology Information Patient Information Reconciliation Consistent Presentation of Images Basic Security Evidence Document Key Image Notes Simple Image and Numeric Report Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled Workflow

14. Understanding IHE, BIR 20 Oct 2004 Act1Act2Act3 Act4 Act5 Integration Prof.1Integration Prof.2 Act1Act2Act3 Integration Prof.3 Act1Act2Act3Act4 Result Communication Connect-a-thon - Matrix: Comp1 Comp2 Comp3 Comp4 Comp5 Comp6 Comp7 Published via Internet: www.ihe-europe.org

15. Understanding IHE, BIR 20 Oct 2004 European Connect-a-thon 2004 Published via Internet www.ihe-europe.org

16. Understanding IHE, BIR 20 Oct 2004 Vendors should and will offer Integration Statements to the users Product UVW supports IHE K Actor with IHE X and Y Integration Profiles IHE J Actor with IHE J Actor with IHE T Integrations Profil

17. Understanding IHE, BIR 20 Oct 2004 IHE Integration Statement VendorProduct NameVersionDate Huge Imaging Medical SystemsIntegrateRADV2.312 Oct 2002 Integration Profiles Implemented Actors ImplementedOptions Implemented Scheduled WorkflowImage Manager/Archiveenone Image DisplayPerformed Procedure Step Order FillerPPS Exception Management Simple Image and Numeric ReportReport Creatornone Link to vendor IHE page www.HImedicalsystems.fake/ihe Links to Standards Conformance Statements of the Implementation HL7 www.HImedicalsystems.fake/hl7 DICOM www.HImedicalsystems.fake/dicom/integrateRAD.pdf IHE Integration Statement

18. Understanding IHE, BIR 20 Oct 2004 IHE Integration Statement Accessible via Internet through www.ihe-europe.org

19. Understanding IHE, BIR 20 Oct 2004 Integration Profiles - Table Integration Profiles - Table Actors Integration Profiles Modality Image Creator Image Display Image Manager/ Archive DSS/Order Filler ADT Report Creator Maximum table

20. Understanding IHE, BIR 20 Oct 2004 Example: PACS Standard :Standard : –Actors: Image Manager, Image Archive, and Image Display –Integration Profiles: Scheduled Workflow and Patient Information Reconciliation Display and Printout:Display and Printout: –Actors: Image Display and Print Composer –Integration Profile: Consistent Presentation of Images

21. Understanding IHE, BIR 20 Oct 2004 Example: Tender Actors Image Display Image Manager/ Archive Report Creator Secure Node Maximum table for this tender

22. Understanding IHE, BIR 20 Oct 2004 Example: Tender Actors Image Display Image Manager/ Archive Report Creator Secure Node Maximum table for your intention

23. Understanding IHE, BIR 20 Oct 2004 Example: PACS X, Vendor Y Actors Image Display Image Manager/ Archive Report Creator Secure Node Offered system by vendor Y

24. Understanding IHE, BIR 20 Oct 2004 IHE 2004 achievements and expanding scope Over 80 vendors involved world-wide, 4 Technical Frameworks 31 Integration Profiles, Testing at yearly Connectathons, Demonstrations at major exhibitions world-wide Provider-Vendor cooperation to accelerate standards adoption

25. Understanding IHE, BIR 20 Oct 2004 What did we learn ? IHE gives solutions for real world problemsIHE gives solutions for real world problems IHE guarantees the understanding between users and vendorsIHE guarantees the understanding between users and vendors IHE deals with actors and transactionsIHE deals with actors and transactions IHE thinks in Integration ProfilesIHE thinks in Integration Profiles IHE is not a standard, but uses standards heavilyIHE is not a standard, but uses standards heavily IHE is something for hands-on, try to feel it work (demonstrations)

26. Understanding IHE, BIR 20 Oct 2004 More Informations available: Websites:Websites: www.ihe-europe.org -> www.ihe-uk.org ?www.ihe-europe.org -> www.ihe-uk.org ? www.rsna.org/ihewww.rsna.org/ihe www.himss.org/ihewww.himss.org/ihe IHE-Europe:IHE-Europe: user-co-chair: wein@radiologie-aachen.deuser-co-chair: wein@radiologie-aachen.de vendor-co-chair: geert.claeys@agfa.comvendor-co-chair: geert.claeys@agfa.com secretariat: bursig@cocir.orgsecretariat: bursig@cocir.org

27. Understanding IHE, BIR 20 Oct 2004 Thank you for your attention !