1. RSNA 2004 1 Christoph Dickmann – Member IHE Rad TC Glen Marshall – Co-chair IHE IT-I PC Charles Parisot – Co-chair IHE IT-I TC Image-enabled Health Records: IHE Progress and Plans Integrating the Healthcare Enterprise

2. RSNA 2004 2 Pragmatic definition of “EHR” Integrated data and workflow functionality – Multimedia data access text, image, waveform, … – Communication among stakeholders clinicians, caregivers, consumers, … Support different views of data – Clinical records Details: episode, visit, study – Longitudinal records Summaries: episode, visit cross-department or cross-enterprise users Linking summaries and clinical details

3. RSNA 2004 3 What an EHR can do for you Combine multiple sources of patient data Enhance functionality by – Connecting to specialized systems – Augmenting the data sources by combining them Provide timely, relevant, comprehensive data – Surgeon preparing an operation by viewing an abdomen CT and lab values – General practitioner receiving cardiac films via CD – Neurologist reading a brain MR report and viewing an EKG

4. RSNA 2004 4 EHR goals in IHE (compatible with U.S. NHII goals) Informed Clinical Practice – Leverage existing IHE basis to ease EHR adoption Interconnected Clinicians – Beyond the department: community or regional scope Personalized Care – Web-based data access and summary data Support for higher-level goals – Better outcomes – Increased patient safety – More efficient healthcare operations

5. RSNA 2004 5 EHR complexity Business dilemmas – Significant, long-term investment – Investors may not be main beneficiaries Coordination and cooperation – Active collaboration among multiple stakeholders – Identify and work out commonalities and barriers Integration and interoperability – Implement existing standards – Develop additional standards  Focus on selected aspects

6. RSNA 2004 6 Focus: Image-enabled EHR (connect two “worlds”) Textual data & functions – Patient data – Clinical data Laboratory results Surgery reports Prescriptions, meds Letters or notes Integrate with imaging data and related processes Imaging data & functions – Patient data – Images and evidence Radiology Cardiology Nuclear Medicine Integrate with clinical data and related processes

7. RSNA 2004 7 Potential use cases of an image-enabled EHR Neurologist: reviewing stroke patient transfer to ward Nurse: preparing GI ward round for Dr. X Surgeon: planning gall bladder surgery GP: seeing a post-MI patient after hospital discharge Patient: preparing an obstetric visit Cardiologist: during catheter intervention Radiologist: starting an abdomen CT Physician: counseling at diabetes outpatient clinic Lab technologist: for immune-deficiency testing Ophthalmologist: during history-taking with a new patient Information need may include current or longitudinal evidence.

8. RSNA 2004 8 Image-enabled EHR Pregnancy outpatient clinics encounter acquire index evaluate Image/ Report Repository store Ultrasound report with images Document Registry register (XDS architecture)

9. RSNA 2004 9 Image-enabled EHR Microbiology test encounter index acquire analyzeDocument/ Report Repository store Microbiology report with images Document Registry register (XDS architecture)

10. RSNA 2004 10 Image-enabled EHR Childbirth inpatient stay register index evaluate Document Registry Image/ Report and Document Repositories index query retrieve Document Repository store Report, letters (with images) (XDS architecture)

11. RSNA 2004 11 Primary existing IHE mechanism Sharing documents (XDS) Document Repository Longitudinal record system: across encounters Care record systems: specific care delivery Document Registry Register documents (references) Retrieve selected document references Acute ambulatory care patient Acute inpatient care Long term care Specialized or diagnostic services Query Note: specific imaging documents are work in progress Retrieve documents

12. RSNA 2004 12 Existing IHE contributions for EHR implementation IHE Laboratory IHE Radiology EHR realization IHE IT Infrastructure 6 Integration Profiles 5 Integration Profiles 1 Integration Profile 3 Integration Profiles Each TF can contribute to EHR scenarios with Integration Profiles for Data access Workflow handling IHE Cardiology

13. RSNA 2004 13 Basic requirements of EHR systems Healthcare provider systems – EHR sources and users Document handling – Storage and retrieval of EHR documents Infrastructure services – Basic data and application integration Network – EHR storage, inquiry, and retrieval path

14. RSNA 2004 14 IHE contribution Profiles for interoperable data and applications Common patient identification (IT-I PIX) Common patient demographics (IT-I PDQ) Desktop integration (IT-I PSA) running applications work on the same patient Single sign on (IT-I EUA) enterprise-wide user handling Common staff data (IT-I PWP) health professionals are commonly recognized Security and privacy (IT-I ATNA, Rad SEC)

15. RSNA 2004 15 EHR interoperability examples Appl. 1 Appl. 2 Appl. 3 Patient identifier matching Common person data or services Same patient selected Patient demographics Source 1 Source 2 Personnel/ staff data Single sign on Desktop Integration as an EHR enabler Any user Backend integration (services, data)

16. RSNA 2004 16 IHE contribution Profiles for access to images and reports (1) Radiology – Access to Radiology (Rad ARI) Retrieve diagnostic quality images and reports – Simple Image and Numeric Reports (Rad SINR) Access or export of reports and related images – Key Image Notes (Rad KIN) Mark and annotate relevant imaging evidence – Portable Data for Imaging (Rad PDI) Export/ import/ view media data – Nuclear Medicine Image (Rad NM Image) Capture and use complex NM result screens

17. RSNA 2004 17 IHE contribution Profiles for access to images and reports (2) Cardiology – Cardiac Catheterization Workflow (Card CATH), Echo Workflow (Card ECHO) Retrieve catheterization and echocardiography imaging evidence – Retrieve ECG for Display (Card ECG) Retrieve ECG summaries and results IT Infrastructure – Retrieve Information for Display (IT-I RID) Query and retrieve documents and summaries/ lists – Cross-Enterprise Clinical Document Sharing (IT-I XDS) store & retrieve documents and summaries with longitudinal data

18. RSNA 2004 18 IHE contribution Profiles for access to clinical/ textual information (1) Radiology – Simple Image and Numeric Reports (Rad SINR) Access original or exported reports IT-Infrastructure – Cross-Enterprise Clinical Document Sharing (IT-I XDS) Store & retrieve documents or summaries with longitudinal data – Retrieve Information for Display (IT-I RID) Access documents and summaries (e.g. imaging, lab, discharge, medications, prescriptions)

19. RSNA 2004 19 IHE contribution Profiles for access to clinical/ textual information (2) Cardiology – Retrieve ECG for Display (Card ECG) Access ECG summaries and results or reports Laboratory – Lab Scheduled Workflow Notification of lab results

20. RSNA 2004 20 IHE contribution Profiles for workflow / patient management support Workflow integration – Scheduled Workflow (Rad SWF, Card CATH/ ECHO, Lab) Ordering, scheduling and tracking of image acquisition steps Appointment Notification (Rad SWF option): report back to the order placing system the date and time of the scheduled steps – Reporting Workflow (Rad RWF) Scheduling and tracking of report creation tasks Patient data integration – Patient Information Reconciliation (Rad PIR, Card CATH/ ECHO) Modification and matching of patient data and imaging evidence Overall concept (Rad whitepaper) – Departmental workflow and interfaces to enterprise

21. RSNA 2004 21 Planned IHE development Harmonize IHE domain-specific work Extend XDS’ document content (Rad, Card) Additional EHR contents Code sets and master files Realize overall workflow concept Configuration support Security details, e.g. access control

22. RSNA 2004 22 Image-enabled EHR – IHE progress and plans IHE Integration Profiles from different domains can be combined Combinations of current profiles can cover many EHR scenarios – Information integration (imaging, textual) – Enhanced functionality beyond one department – Intra- and cross enterprise communication Scenarios enable system evolution (organizational change management not to be forgotten) IHE ensures integration testing and future Integration Profile development

23. RSNA 2004 23 Thank you! Questions? More information: http://www.rsna.org/IHEhttp://www.rsna.org/IHE