IHE Changing the Way Healthcare Connects in HOSPITALS

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IHE Changing the Way Healthcare Connects in
HOSPITALS

• HIMSS AsiaPAC Interoperability Showcase
• May 2007
• Chris Lindop (GE)
• IHE Radiology Planning Committee Co-Chair

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The IHE Initiative

• An Incremental Multi-Year ProjectLaunched 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 ofMedical
  Information Technology
• Deliver Quality Integration Based on Standards

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IHE Participants

• Care Providers (Clinicians and IT staff)
• Improved workflow
• Information when and where needed
• Decreased cost and complexity of interface
  installation and management
• Vendors
• Decreased cost and complexity of interface
  installation and management
• Accelerate product development
• Expand your market potential by leveraging
  European/ International developments
• Standards-Developing Organizations (SDOs)
• Rapid feedback to adjust standards to real-world
• Establishment of critical mass and widespread
  adoption

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Growth in IHE Domains

• Over 100 vendors involved world-wide
• 8 Technical Frameworks
• 48 Integration Profiles
• Testing at Connectathons world-wide
• Demonstrations at major conferences world-wide

Veterinary Endoscopy Pathology Pharmacy
Quality
Patient Care Devices (1)
Patient Care Coordination (5)
Radiation Oncology (1)
Eye Care (3)
Laboratory (6)
Cardiology (7)
IT Infrastructure for Healthcare (17)
Radiology (18)
Year 1 (1999)
Year 2 (2000)
Year 3 (2001)
Year 4 (2002)
Year 5 (2003)
Year 6 (2004)
Year 7 (2005)
Year 8 (2006)
Year 9 (2007)
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International Adoption of IHE

• Local Deployment
• National Extensions (Local Adaptions)
• Promotional Live Demonstration Events
• Funding

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IHE Organizational Structure
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The IHE Process
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Key IHE deliverables

• Techical Frameworks
• Integration ProfilesA standard way to solve a
  standard problem using standards
• Testing and Demonstrations
• Integration Statements
• Real-world Implementations

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IHE Solutions within the Enterprise
EMR - HIS
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IHE Solutions within the Enterprise Radiology
EMR - HIS
EnterpriseIT Infrastructure

• Radiology Integration Profiles
• Radiology Scheduled Workflow
• Patient Information Reconciliation
• Access to Radiology Information
• Portable Data for Imaging
• Consistent Presentation of Images
• Key Image Note
• Presentation of Grouped Procedures
• Evidence Documents
• Audit trail and Node Authentication (Rad option)
• Teaching Files and Clinical Trials Export
• Post-processing Workflow
• Reporting Workflow
• Charge Posting
• Simple Image and Numeric Reports
• Media Import Reconciliation Workflow

RIS
CIS
LIS
-Radiation Therapy -Patient Care
Devices -Pathology
-Eye Care
PACS
Img Acq
Cath
ECG
Auto Mgr
Analyzer
Cardiology
Laboratory
Radiology
How to use IHE ? ?IHE Radiology Handbook
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Scheduled Workflow patient Info reconciliation

• Backbone of IHE Radiology
• Integrates Registration, Scheduling, Acquisition
  Workflow and Image Content
• Bridges HL7 and DICOM Spaces
• Preserve Order Continuity
• Improve Demographic Integrity
• Improve Workflow Efficiency synchronized
  Worklists
• Reliable Storage
• Improve Order Tracking
• Reduce Integration Effort at Site

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IHE the Radiology Workflow
Diagnostic image and demographic info for
radiologist
Patient Registration
report
initial capture of patient demographic information
report
Radiologist report stored for network access
HIS
Patient Information
Orders Placed
query/ retrieve images
acquisition completed
Image Manager and Archive
physician orders desired procedure
Diagnostic image and demographic info stored for
network access
PACS
Examination Ordered
procedure scheduled
Orders Filled
Prefetch any relevant prior studies
Break down entered order specific radiology
procedure steps to be performed
modality worklist
Modality
storage
Patient and procedure information retrieved by
the modality
commitment
RIS
print images
acquisition completed
Position patient and acquire images
IHE Integrating the Healthcare Enterprise
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IHE Systems Transactions Overview
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IHE Systems Transactions Overview
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IHE Solutions within the Enterprise
EMR - HIS
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IHE Solutions within the Enterprise Cardiology
EMR - HIS
EnterpriseIT Infrastructure
RIS
CIS
LIS
-Radiation Therapy -Patient Care
Devices -Pathology
PACS
Img Acq
Cath
ECG
Auto Mgr
Analyzer
Cardiology
Laboratory
Radiology

• Cardiology Integration Profiles
• Cardiac Catheterization Lab Workflow
• Echocardiography Lab Workflow
• Retrieve ECG for Display
• Displayable Reports
• Cath and Echo Evidence Documents
• Implanted Device Observations

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Cath Lab Workflow
The Cure for
Multiple re-entry of Patient ID Error prone data
entry Results fragmented across systems Results
inconsistently time-tagged Custom solutions
needed for data sharing Difficult to
manage Uncoordinated with Hospital Information
System Unidentified patients (emergency) Un-ordere
d cath exams Diagnostic and interventional
procedures Ad hoc scheduling of cath labs Change
of rooms during procedure
note IHE Cath Profile includes Electrophysiology
lab
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Echo Workflow

• Need to solve the drive-by echo ?Cardiologist
  to sonographer in CCU While youre here, do a
  TTE on bed 3
• Unordered, unscheduled exam
• Machine disconnected from network
• Stress echo, need more automation ?After exam,
  sonographer creates new quad displays of stages
  and views
• No intrinsic value add
• Data is redundantly copied to storage

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Stress Workflow

• 85 of stress tests are multi-modality (ECG
  imaging)
• 0 of current architectures manage ECG and
  imaging workflow and results in an integrated
  manner

IHE Stress Testing Profile and IHE Nuclear
Medicine Image Profile
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IHE Solutions within the Enterprise
EMR - HIS
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IHE Solutions within the Enterprise Laboratory
EMR - HIS
EnterpriseIT Infrastructure
RIS
CIS
LIS
-Radiation Therapy -Patient Care
Devices -Pathology
-Eye Care

• Laboratory Integration Profiles
• Laboratory Scheduled Workflow
• Laboratory Information Reconciliation
• Laboratory Point Of Care Testing
• Laboratory Device Automation
• Laboratory Code Set Distribution

PACS
Img Acq
Cath
ECG
Auto Mgr
Analyzer
Cardiology
Laboratory
Radiology
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Laboratory Scheduled Workflow - Value Proposition

• A comprehensive workflow approach
• Address specimen linkage
• most lab specialties Blood gases, Chemistry,
  Hematology, Immunology, Laboratory, Microbiology,
  Mycobacteriology, Mycology, Serology, Toxicology,
  Virology.
• Provides workflow improvement
• Increases continuity and integrity of clinical
  data
• Decreases user need for manual tasks.
• Spans ordering, conformity of specimens, lab
  automation, results delivery.
• Externally placed order with identified specimens
• Externally placed order with specimens
  unidentified or to be collected by the laboratory
• Internally placed order with specimens identified
  by third party or collected by the laboratory

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IHE Solutions within the Enterprise
EMR - HIS
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IHE Solutions within the EnterpriseIT
Infrastructure (Enterprise)
EMR - HIS
EnterpriseIT Infrastructure

• IT Infrastructure Integration Profiles
• Patient Administration Management
• Patient Demographics Query
• Patient Identifier Cross-referencing
• Retrieve Information for Display
• Enterprise User Authentication
• Consistent Time
• Patient Synchronized Applications
• Audit Trail and Node Authentication
• Personnel White Pages

RIS
CIS
LIS
-Radiation Therapy -Patient Care
Devices -Pathology
-Eye Care
PACS
Img Acq
Cath
ECG
Auto Mgr
Analyzer
Cardiology
Laboratory
Radiology
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Patient Administration Mgt (PAM)

• Coordinates exchange of patient registrations,
  updates, and movements for all clinical areas
• Information may be received and processed by
  consuming applications in any clinical domain
• Optionally allows unambiguous updating of
  historic patient movement events
• Demographic and encounter tracking works in both
  inpatient and ambulatory care settings
• Standardizes on HL7 V2.5 and its conformance
  structures

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Patient Administration Management Actor
Transaction flexibility and compatibility
Flexible Actor grouping
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Patient Demographics Query HL7 V2.5
Registration system or departmental system that
is connected on demand to it.

Patient Demographics
Supplier

Patient
Patient
Demographics
Demographics
Query

and Visit Query

Diverse systems including bedside monitors,
physician office systems, lab applications,
mobile blood bank registries might be any system
at the point of care.
Patient Demographics
Consumer

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Patient Identifier Cross-referencing-HL7
V2.5Adopted b y HITSP
Departmental or Outpatient system
Registration system
Registration system or eMPI
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IHE Solutions for extending the Enterprise
EMR - HIS
EnterpriseIT Infrastructure
RIS
LIS
-Radiation Therapy -Patient Care
Devices -Pathology
-Eye Care
PACS
Auto Mgr
Analyzer
Img Acq
Laboratory
Cardiology
Radiology
Index of sharedpatients records
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IHE Solutions for Extending the
EnterpriseIntegrated Delivery Networks
See presentation IHE Changing the Way Healthcare
Connects Communities
EMR - HIS
EnterpriseIT Infrastructure
RIS
LIS
-Radiation Therapy -Patient Care
Devices -Pathology
-Eye Care
PACS
Auto Mgr
Analyzer
Img Acq
Laboratory
Cardiology
Radiology
Index of sharedpatients records

• Integration Profiles for an IDN
• Cross-Enterprise Document Sharing
• Patient Id Cross-Referencing
• Patient Demographics Query
• Audit Trail and Node Authentication
• Consistent Time
• Sharing of Medical Summaries
• Sharing of Lab Reports
• Sharing of Imaging Information
• Sharing of Scanned Documents

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What can you do?

• Attend the IHE Domain specific sessions in this
  Theater
• Learn about IHE, www.ihe.net
• Insist on IHE compliance in your RFPs and
  contract documents
• Select Integration Profiles, and Appropriate
  Actor(s)
• Ask vendors for their products IHE Integration
  Statements.
• Need more interoperability ?
• Contribute to IHE Committees

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How can I participate?

• As a Provider or Vendor Contributor
• Offer Clinical Use Case Input to Drive IHE
  Profile Development
• Become a member of relevant domains Planning or
  Technical Committees
• Become a member of relevant Regional/National
  Committees
• Help to shape IHEs future direction
• As a Vendor Participant
• Respond to Public Comments of Domain Supplements
• Participate in Connect-a-thons and Demonstrations
• As a Provider/Consultant Participant
• Respond to Public Comments of Domain Supplements
• Attend Demonstrations and include IHE Integration
  Profiles in your RFPs and Integration Projects.

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IHE Web site www.IHE .net

• Frequently Asked Questions
• Integration Profiles in Technical Frameworks
  See Volume 1 of each TF for Use cases
• Cardiology
• IT Infrastructure
• Laboratory
• Patient Care Coordination
• Radiology
• Connectathon Result www.ihe.net/Events/connectath
  on_results.cfm
• Vendor Products Integration Statements
• Participation in Committees Connectathons

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