Image%20Sharing-%20the%20NIBIB/RSNA%20image%20sharing%20project%20employing%20IHE%20solutions

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Image Sharing- the NIBIB/RSNA image sharing
project employing IHE solutions
Fourth China-U.S. Roundtable Meeting on
Scientific Data Cooperation
IHE-Providing the Foundation for Interoperability
David S. Mendelson, M.D. Professor of
Radiology Chief of Clinical Informatics The Mount
Sinai Medical Center Co-chair IHE International
Board
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Presentation Objectives

• Integrating the Healthcare Enterprise (IHE)
• Overview- How is IHE organized?
• Healthcare Interoperability in the United States
• Challenges
• ARRA (American Recovery and Reinvestment Act)
• Image Sharing
• Via HIE
• Image Sharing Project- Personal Health Records
  (PHRs)

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Integrating the Healthcare Enterprise The state
of IHE - 2010

• David S. Mendelson, M.D.
• Chief of Clinical Informatics
• The Mount Sinai Medical Center
• Co-chair IHE Board

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International Adoption of IHE

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

Pragmatic global standards harmonization best
practices sharing
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National and Regional Projects Using IHE Profiles
Netherland Amsterdam
Italy (Conto Corrente Salute)
UK CfH (Radiology WF)
Denmark (Funen) Italy (Veneto) Spain (Aragon)
FranceDMP
Quebec, Toronto,Alberta, British ColumbiaCanada
Infoway
VITL-Vermont
Boston Medical Center - MA
Philadelphia HIE
CPHIC Pennsylvania
CareSpark TN VA
South Africa
THINC- New York NCHICA N. Carolina
CHINA-MoH Lab results sharing
JAPAN-Nagoya Imaging Info Sharing
Malaysia
CHINA-Shanghai Imaging Info Sharing
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IHE Organizational Structure
Regional Deployment
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IHE China http//www.ihe-c.org
Thank You for Your Attention
Prof. Jianping Dai, MD
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Events Promotion
Education and Promotion by Journals
Education and Promotion by Workshop
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Events Connectathon
There are 7 companies attended
Dr. Zhu, Chairman of IHE China, past vice
Minister of Healthcare attended
The IHE-C Connectathon was held at April 26, 2008
in Beijing Tiantan Hospital
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Events Connectathon
The IHE-C Connectathon was held at April 26, 2008
in Beijing Tiantan Hospital
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IHE the process

• Identify Interoperability issues
• Develop Integration Profiles
• Actors and Transactions
• Workflow
• Gather relevant standards
• Connectathon Testing
• Publish Integration Statements
• Vendors list tested profiles

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Problem to Profile
Problem Domain Integration Profile Transaction Actors
Patient Identity across multiple settings IT Infrastructure Patient Identifier Cross-Referencing (PIX) Patient Identity feed Patient Identity Source Patient Identity Cross Reference Manager
Make CAD results available with images Radiology Evidence Documents Evidence Document Stored Evidence Creator (Post Processing Workstation Image Manager/Image Archive
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Interoperability in the US-Challenges

• Privacy rights
• HIPAA
• No Single identifier

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Office of the National Coordinator for Healthcare
IT (ONC)

• Health Information Technology Standards Panel
  (HITSP)
• Certification Commission for HIT (CCHIT)
• American Recovery and Reinvestment Act (ARRA)
• Includes financial incentives for adoption of the
  Electronic Health Record throughout the US
• Interoperability is a cornerstone
• Funding for related research- NIH
• Quality -Comparative Effectiveness
• EHR

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XDS (Cross-Enterprise Document Sharing)

• XDS.a
• XDS- I.a
• XDS.b
• ?? XDS-I.b
• a vs. b
• Related to web standards and transactions

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XDS
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XDS-I
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NIBIB contract summary

• Consumer Control
• Employ IHE solutions whenever possible
• IHE generally has not focused on consumer driven
  solutions but rather on institutional and
  enterprise workflow

• 5 Academic Institutions
• Mayo Clinic
• Mount Sinai Medical Center
• University of California San Francisco
• University of Chicago
• University of Maryland
• Establish a clearinghouse
• Engage PHRs
• 300,000 patients over 2 years

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Elements of Solution

• Edge Server
• Register a patient
• Listens to a Radiology Information System (RIS)-
  looking for a complete exam
• Retrieves Image set from PACS and Report from RIS
• Send both to clearinghouse
• Clearinghouse functions as a secure router
• Transiently hold encrypted patient data
• PHR
• Consumer controls upload and future access
• Develop web based viewers
• Download full DICOM data set

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XDS (Cross-Enterprise Document Sharing)

• XDS.a
• XDS- I.a
• XDS.b
• ?? XDS-I.b

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Software architecture
Prepare content Poll database, get report, get exam,prepare big fat file Background java srvlet 25 days
Transfer content Poll database for transfer out, package content into xds.b Background java srvlet 35 days
HL7 receiver Receive HL7 A04 messages, extract reports and store them in database Mirth HL7 Channel. Let Mirth create its default database, all script work-but may have to customize per site 65 days for 5 sites
Token App Create new tokens based on two parts, associate token with accession numbers, update database, user interface with login, get patient info,create job Ajax based web front-end ,JavaServlet for CFIND using dcm4che, creating job in the RSNA database, creating tokens using kerberos tokens generated locally 30 days
Database Store reports, logs, audit trails, user accounts, etc. Mirth instance for HL7 DICOM, RSNA instance for everything else 50 days 2 databases
Management App Create users, monitor logs, check health Ajax gui front end, backend servlet, dicom targets etc. 45 days
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Future Directions

• Refine Workflow
• Initial workflow is to replace a CD
• Exam updates
• Download DICOM data and archive in a local PACS
• Edge server as a platform
• Radiation Monitoring
• Peer Review
• Quality Metrics

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Radiation Exposure Monitoring Profile -REM

• Supplement to Technical Framework for Trail
  Implementation
• Acquisition modalities inlcudes information
  regarding dose exposure
• Estimates
• Permits communication of that information to
  other systems
• Useful for Individual lifetime estimates as well
  as Population analysis

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Radiation Exposure Monitoring (REM)

• Includes
• CT
• Plain X-Ray
• Mammography
• Current Exclusions
• Nuclear Medicine
• RT
• Brachytherapy

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• DICOM Dose SR objects
• DICOM 2008 PS 3.3 A.35.8 X-Ray Radiation Dose SR
  IOD

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