RSNA 2003

The IHE Technical ApproachThe IHE Technical Approach

Identify the transactions required to integrate information flow between information systems

For each transaction, select a single standard for use in implementing the transaction

Specify in detail the use of the standard in implementing the transaction

RSNA 2003

What is IHE?What is IHE?IHE is a specification of transactions

between systems.

IHE describes only integration features.

IHE is not a product itself, but…

IHE is very useful in purchasing products that integrate into workflow

RSNA 2003

Integration ProfilesIntegration Profiles--Transactions packaged in solutionsTransactions packaged in solutions--

Coherent functional sets of transactions related to workflow

46 Rad. + 13 IT transactions grouped into 12 + 5 Integration Profiles

Integration Profiles are the only practical way to communicate integration requirements precisely.

RSNA 2003

Level 0: Level 0: Modalities connected to Modalities connected to printerprinter

No RIS integrationNo RIS integration

Laser Printer

DICOM Basic Print Service

RSNA 2003

Level 1: Level 1: Modalities connected to Modalities connected to printerprinter

No RIS integrationNo RIS integrationPost-processing workstationsPost-processing workstations

Laser Printer

IHE Integration Profile:Consistent Presentationof Images

Sameperception??

RSNA 2003

What the Technologist What the Technologist Displays:Displays:

What the Radiologist What the Radiologist Sees:Sees:

The Technologist’s Transformations Are

Saved

Grayscale Calibration& Presentation State

Original Image

Window Level

Flip

Zoom

Area Of

Interest

Annotate

The Technologist’s Transformations Are

Lost

Original Image

Area Of

Interest

Prepared Image

Original Image

Consistent Presentation of Images Consistent Presentation of Images

RSNA 2003

Level 2: Modalities with RIS ConnectionLevel 2: Modalities with RIS Connection

IHE Integration Profile:Scheduled Workflow

(DICOM Modality Worklist)

RSNA 2003

RISRIS

Scheduled Workflow (Modality Worklist)Scheduled Workflow (Modality Worklist)

Modality Modality WorklistWorklist

Proposed Protocols

Loaded and Reviewed

WorklistWorklistPatient Name, IDPatient Name, ID

Requested ProcedureRequested Procedure

Examination TypeExamination Type

Scheduled Date, TimeScheduled Date, Time

RSNA 2003

Level 3:Level 3: Modalities with RIS Modalities with RIS ConnectionConnection

PACSPACS

IHE Integration Profiles:•Scheduled Workflow (full)•Patient Information Reconciliation•Presentation of Grouped Procedures•Access to Radiology Information

RSNA 2003

Patient Registration/UpdatePatient Registration/UpdateOrder ManagementOrder Management

Order Order Protocol Protocol DefinedDefinedStore ImagesStore Images

Storage CommitmentStorage CommitmentStorageStorage

CommitmentCommitment

List of ImagesList of Images

PACS &PACS &ArchiveArchive

RISRIS

A Closed LoopA Closed Loop•Update Scheduling ISUpdate Scheduling IS

•Match Procedure with OrderMatch Procedure with Order•Support Billing Based on MPPSSupport Billing Based on MPPS

•Avoid Reading incomplete ProceduresAvoid Reading incomplete Procedures

Scheduled WorkflowScheduled Workflow

Modality Modality WorklistWorklist

Procedure Scheduled Procedure Scheduled

Proposed Protocols

Loaded and Reviewed

WorklistWorklistPt A, …, Pt A, …, SPS=P1, P4SPS=P1, P4

Pt C, …, Pt C, …, SPS=P1, P5SPS=P1, P5

Pt B, …, Pt B, …, SPS=P2SPS=P2

Pt E, …, Pt E, …, SPS=P4SPS=P4

ModalityModalityPerformedPerformedProcedure Procedure StepStep

With Performed With Performed Acquisition Acquisition ProtocolsProtocolsPerformed Step:Performed Step:

Status = CompletedStatus = CompletedPerformed Procedure: CT HeadPerformed Procedure: CT Head Performed Protocol Code=P1Performed Protocol Code=P1

Pat Name/ID, Dose, Pat Name/ID, Dose, Accession #, Study UIDAccession #, Study UIDComplete List of ImagesComplete List of Images

Scheduled Protocol Code=P1, PScheduled Protocol Code=P1, P55

RSNA 2003

Patient Information ReconciliationPatient Information Reconciliation

Extends Scheduled Workflow– Handles unidentified patient (e.g. trauma)– Handles demographic information mistakes– Propagates changes to all affected

systems, updates all affected dataReduces incorrectly identified or lost

studies

RSNA 2003

MODALITY

Presentation of Grouped Procedures Presentation of Grouped Procedures Requested Procedure:

CHEST

Report:CHEST

Report:AB/PELVIS

Performs a single exam

Operatorgroups

2 procedures

Chest Chest ViewView

RIS / PACS

Requested Procedure:AB/PELVIS

Chest Chest ViewView

Ab/Pelvis Ab/Pelvis ViewView

Ab/Pelvis Ab/Pelvis ViewView

RSNA 2003

Access to Radiology InformationAccess to Radiology Information

Radiology Department – Images and

Reports

Emergency Department

Referring Physician

Other Departments:- Oncology- Surgery- Neurology- Pediatrics- etc.

Remote Clinics

Electronic Medical Record

RSNA 2003

Level 4:Level 4: More than images: More than images: Measurements, Key images, CAD Measurements, Key images, CAD

objectsobjects

IHE Integration Profiles:•Key Image Note•Evidence Documents•Post-processing workflow

RSNA 2003

RadiologistRadiologistFlags Images:Flags Images:

Referring PhysicianReferring PhysicianSees Key Images First:Sees Key Images First:

for refering physicianThis image showsthe renal rupture.

Note1

For referringphysician:This image showsthe renal rupture.

Note1

for refering physicianThis image has the hematoma.

Note2

For referring physician:This image hasthe hematoma.

Note2

for refering physicianThis image showsthe renal rupture.

Note1

for refering physicianThis image has the hematoma.

Note2

Study & Key Image Notes

Key Image NotesKey Image Notes

RSNA 2003

Findings:

Image Refs.:

Header:

Report

Type:

Evidence DocumentsEvidence Documents

Image data

from Modality

Coding Schemes

Thorax…..…..…..

Mass…..…..

Daim.Infiltr.

…..…..

(Pointer)

select

Evidence

Creator

application

(DIC

OM

) S

R O

bjec

t

Measurement Templates

RSNA 2003

PACS &PACS &WF MgrWF Mgr

RISRIS

Post-Processing WorkflowPost-Processing Workflowwith Post-Processing Manager Grouped with Image Managerwith Post-Processing Manager Grouped with Image Manager

Post-ProcessingPost-ProcessingWorklistWorklist

RetrieveRetrieveImagesImages

StoreStoreReportsReports Measurements

CAD Reports……....……… ArchiveArchive

DocumentsDocuments

Post-ProcessingProcedure Step

STARTED

Work Item Work Item ClaimedClaimed

Post-ProcessingProcedure Step

STARTED

Post-ProcessingProcedure Step

COMPLETED

Post-ProcessingProcedure Step

COMPLETED

RSNA 2003

Level 5: Reporting and billingLevel 5: Reporting and billing

IHE Integration Profiles:•Simple Image and Numeric Report•Reporting Workflow•Charge Posting

HIS

RSNA 2003

Findings:

Conclusions:

Image Refs:

Header:

Report

Type:

Simple Image and Numeric ReportSimple Image and Numeric Report

Image data

from PACS

Coding Schemes

Thorax…..…..…..

Mass…..…..

Daim.Infiltr.

…..…..

(Pointer)

select

Report Creator

application

RIS data

DICOM: Report Templates

(DIC

OM

) S

R O

bjec

t

RSNA 2003

PACS &PACS &Rep. MgrRep. Mgr

RISRIS

Reporting WorkflowReporting Workflowwith Report Manager Grouped with Image Managerwith Report Manager Grouped with Image Manager

ReportingReportingWorklistWorklist

RetrieveRetrieveImagesImages

ReportingProcedure Step

STARTED

Work Item Work Item ClaimedClaimed

ReportingProcedure Step

STARTED

ReportingProcedure Step

COMPLETED

ReportingProcedure Step

COMPLETED

IssueIssueReportsReports

StoreStoreReportReport Diagnostic

Reports……....………

RSNA 2003

Charge Posting ProfileCharge Posting Profile

ChargePoster

*Billing System

CAD*Workstation

ReportRepository……

Report Generated& Signed

CADPerformed

PostCharges

AcquisitionModality

ADT Terminal

3-D*Workstation

Account Management

3-DPerformed

StudyPerformed

MaterialsUsed

RSNA 2003

IHE Integration StatementIHE Integration Statement

RSNA 2003

Integrating the Integrating the Healthcare EnterpriseHealthcare Enterprise

The 2003 Radiology Connectathon:

36 vendors & 77 products

IHE is a reality, and it’s here to stay.

RSNA 2003

Where Is More Information Where Is More Information Available?Available?

www.rsna.org/IHE and www.himss.org/IHE – IHE RAD Technical framework for year 5 – V5.5– IHE IT Technical framework for year 1 – V 1.0

Non-Technical Brochures :– IHE Primer and IHE FAQ– IHE Integration Profiles: Guidelines for Buyers– IHE Connectathon Results