Post on 27-Mar-2015
1RSNA 2007 – Informatics Classroom What IHE Delivers
Kevin O’Donnell, Toshiba Medical SystemsKevin O’Donnell, Toshiba Medical Systems
Chris Lindop, GE HealthcareChris Lindop, GE Healthcare
Your Problems;Your Problems;IHE SolutionsIHE Solutions
2RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
Learning ObjectivesLearning Objectives
Review well-known sources of pain still commonly afflicting radiologists, department managers, PACS administrators and referring physicians in practice today
Enumerate some of the specific ways the quality, speed, cost and efficiency of the care you provide may be being degraded
Understand how you should be benefiting from new electronic infrastructure and integrated systems
Learn which IHE Integration Profiles would be good first steps for each problem
3RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
Images on CDsImages on CDs
Scenario: “A referred patient arrives with relevant prior
imaging on a CD”
And then the fun starts…
4RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
Your Problems with CDsYour Problems with CDs
“I plug the CD into my workstation and nothing happens” The CD format is not compatible with my workstation The images are not in DICOM The images are DICOM but are not properly encoded The CD tries to auto-launch a viewer that collides with the one
on my workstation
Impact Time is wasted Relevant clinical data is inaccessible
5RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
Your Problems with CDsYour Problems with CDs
“Every CD seems to have a different viewer”
It costs me time trying to learn them all
I don’t work as quickly when I don’t know how to use them
The viewers lack specific features I need
The viewers require additional software that I do not have
My IT group has security concerns about running “unknown” software
from CDs
Impact More wasted time Less effective review of data
6RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
Your Problems with CDsYour Problems with CDs
“The Images are in the PACS but are messed up”
The patient ID is wrong, it doesn’t come up in a query
I can’t display the new images with the old
The unknown procedure codes mess up my hanging protocols
Impact: More lost time More drags on effectiveness
7RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
How It Should WorkHow It Should Work
I insert the CD into my workstation The DICOM Viewer installed on my workstation displays the CD
contents my way
I decide to import the data into my PACS The CD content is retrieved from the disk The content is reconciled and automatically prepared for importation
into the patient’s electronic medical record The images and reports are reviewed on PACS in the
context of the current patient encounter
I insert the CD into a “random” PC (uncommon) CD may have a DICOM viewer CD may have “Browser” versions of images and report
8RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
IHE SolutionIHE Solution
Two relevant Integration Profiles
(PDI) - Portable Data for Imaging Uses only the most common, most compatible DICOM CD
format Adds requirements to remove common sources of problems Based on cross-testing between vendors
(IRWF) – Import Reconciliation Workflow During image import, the details are fixed to match (or not
conflict with) local values• Patient IDs, Name• Procedure Codes, Accession Numbers, etc.
9RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
Acquisition WorkflowAcquisition Workflow
Scenario: “ I order an imaging procedure for my patient.”
Really, what could be simpler?
10RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
Your Problems with WorkflowYour Problems with Workflow
“Why are my techs entering patient and procedure information on all the systems?” Why is this a manual task?
• My techs should be doing scans, not duplicating data entry All too often, data entry mistakes are made
• Patient records get fragmented• Priors are not always available at time of reading
Impact Degraded care, reduced productivity
11RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
Your Problems with WorkflowYour Problems with Workflow
“Why is it so hard to close an order?” Somewhere in the process of getting the images and distributing
the reports, the accession # keeps getting messed up Studies get disconnected and go unread Billing details don’t match what was actually performed
(so the payor doesn’t want to pay)
Impact Delayed care, reduced productivity, lost revenues
12RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
Your Problems with WorkflowYour Problems with Workflow
“Why aren’t my images showing up on PACS?” If patient info was mistyped at acquisition, the query won’t match
• Someone spends time searching or we re-scan
Network failure; modality didn’t know they weren’t on PACS and deleted them
We make techs manually confirm all images are on the PACS• It only takes a couple minutes• At 100,000 studies per year, that’s only 416 8-hour shifts of work
Impact Delayed care, increased dose, reduced productivity
13RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
Your Problems with WorkflowYour Problems with Workflow
“When a name needs to be fixed I never know when/if the patient record will be properly reassembled.” John Doe’s get scanned and identified later
• images/report needs to be reintegrated
Patients get incorrectly entered (or mis-selected in a worklist) Peoples names change (e.g. marriage) People are changing things on the modality, in the PACS, in the RIS,
sometimes inconsistently, or at different times So their clinical history is missing, or their images have been moved
and I can’t find them, or both
Impact Delayed care, incomplete information, reduced productivity
14RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
How It Should WorkHow It Should WorkRegistration feeds the Scheduling System Patient demographics are entered once at registration & centrally
managedModalities download Worklists Patient demographics & Procedure detail entry is automatic, fast,
accurate & up-to-the-minute Relevant clinical and protocol information details are included Procedure code in worklist can optionally trigger protocol selection
PACS is notified of scheduled procedures Relevant priors can be automatically pre-fetched
Modalities report procedure progress to RIS and PACS
Accession # consistently replicated in Images and Reports Better tracking/closure of orders, better billing
PACS receipt of Images is automatically confirmed by Modality Fewer Lost Studies
15RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
IHE SolutionIHE Solution
Two relevant IHE Integration Profiles
(SWF) – Scheduled Workflow Integrates Registration, Scheduling, Acquisition Workflow and
Image Content Bridges HL7 and DICOM spaces properly Most current products support it (but ask for it to be sure)
(PIR) – Patient Information Reconciliation Facilitates coordinated reconciliation between PACS, RIS and HIS Handles John Does, fixing mistakes and back-filling orders for
unscheduled exams
16RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
Cross-Enterprise Image SharingCross-Enterprise Image Sharing
Scenario
An ER patient with abdominal pain has a lesion on their x-ray.
The H&P noted an earlier x-ray (in another state) with an
abnormal finding. I need the prior images STAT!
OK, no one expects this to be easy…
17RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
Your Image Sharing ProblemsYour Image Sharing Problems
“How do I even find out who has the images?”
Patient said it was “an imaging center in downtown LA”
How many imaging centers are there in downtown LA?
Patient was not sure of the name of the PCP
Impact
Time wasted trying to track down and obtain the images
Potentially unnecessary procedures (imaging, surgery)
18RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
Your Image Sharing ProblemsYour Image Sharing Problems
How do I find the matching Patient Record at the other institution? Patient doesn’t know their patient ID from the other site
I only have the Patient ID for my institution
The other site doesn’t really want to let me go browsing their patient database
Impact More delays and uncertainty
19RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
Your Image Sharing ProblemsYour Image Sharing Problems
How do I get the Images? Mail? No - need images STAT Fax? Not good for sending images E-mail? Do we both have secured e-mail systems? How
do I view them? Their web viewer? No account on their system - No
experience with their product
Impact Delayed care or incomplete information
20RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
Your Image Sharing ProblemsYour Image Sharing Problems
What about security and privacy policies? I don’t have privileges at the other hospital. Who do I have to talk to to get access to the data? Isn’t there some way to get emergency access?
I’m just trying to treat the patient.
Impact Delayed care and/or incomplete information
21RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
How It Should WorkHow It Should Work
My EHR Terminal handles everything:
I select my patient on my system I select the RHIO that supported my patient’s care My system automatically matches the patient and lets me confirm
(either by ID cross-reference table or demographics matching) I ask for a list of relevant priors. Success! We have no BAA with the other site so I click “Break Glass”.
My ID and access of the data is logged for later security review. My system pulls the images and reports electronically from the
other system for my review
I determine there is no change in the lesion & diagnose an Aortic Transsection, avoiding unnecessary surgery
22RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
IHE SolutionIHE Solution
(XDS-I) Cross-Enterprise Document Sharing for Imaging Shares images, diagnostic reports and related information
between healthcare enterprises
(PIX) Patient ID Cross-referencing Cross-index patient IDs across multiple sites
(PDQ) Patient Demographics Query Query and retrieve a patient’s demographic and visit information
(ATNA) Audit Trail and Node Authentication Systems Authentication PHI-related audit events management
(BPPC) Basic Patient Privacy and Consent Patient privacy consents & enforcement
23RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
Teaching Files or Clinical TrialsTeaching Files or Clinical Trials
Scenario: This study I’m reading would make a good case for my/our
teaching files
or
This study should be included in a clinical trial we are participating in
It seems so simple…
24RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
Your Teaching/Clinical Trial ProblemsYour Teaching/Clinical Trial Problems
“Where did I put my notes?” Why am I the one digging through PACS for the studies? Tracking down images after the fact is a pain
Impact Inefficient use of time Can’t find study later Lower participation in clinical trial No cool images to share
25RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
Your Teaching/Clinical Trial ProblemsYour Teaching/Clinical Trial Problems
“How am I supposed to get the images to the clinical trial, or to my teaching file account?” The images are raw material; I need to get them to a system
where I can work up a proper teaching file We’re in 5 clincal trials, each with their own file server; I need to
get the images to the right one.
Impact Inefficient use of time Becomes “more trouble than it’s worth”
26RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
Your Teaching/Clinical Trial ProblemsYour Teaching/Clinical Trial Problems
“De-identifying the data for HIPAA is painful” What are “DICOM Attributes” and why is PHI hiding in so many of
them? The tools provided require an IT savvy that I do not have PACS Admin says I screwed up the images when I edited them
Impact Inefficient use of time Becomes “more trouble than it’s worth” Might fail to protect patient privacy
27RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
How should it work?How should it work?
I flag the image(s) of interest
I identify the clinical trial and/oradd a few notes about the clinical context (optional)
Images are de-identified automatically
Images and supporting information are bundled and automatically routed to the appropriate destination Teaching File Authoring System; Clinical Trial Export Node
Later, I login to my Teaching File account: My images and notes are waiting for me I finalize the teaching case and put it in our repository
28RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
IHE SolutionIHE Solution
(TCE) – Teaching File & Clinical Trial Export
Automatic De-identification Automatic Routing Can include brief notes Compatible with free RSNA MIRC tools
• Teaching File Server• Teaching File Authoring Tool• Clinical Trial Node• mirc.rsna.org
29RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
Integration ChallengeIntegration Challenge
Notice the pattern?
Scenario: I want to do something that requires some of the (literally)
dozens/hundreds of systems in my department to collaborate…
30RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
Your Integration ProblemYour Integration Problem
“My systems claim to be standards-based, but they still can’t integrate to do what I want.” Some of my systems use different parts of the same standard Some of my systems use the same standard in different ways Some of my systems use multiple standards Some of my systems use the “enhanced proprietary standard”
preferred by the vendor My vendors have different ideas about what each other should do Many of my vendors products have never been directly tested
together
Impact Lack of interoperability Costly point-to-point integration Long install & deployment cycle Have to do it over again with each new system
31RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
IHE SolutionIHE Solution
Working with vendors, care providers and standards
organizations, IHE:
Distills a clear description of the problem
Determines the right way to solve it using standards
(IHE Profile)
Documents the solution in an implementation guide
(IHE Technical Framework)
Coordinates cross-vendor testing of the solution
(IHE Connectathon)
Go see the rest of the profiles
32RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
IHE in ActionIHE in Action
Visit IHE Demonstrations at RSNA 2007 Cross-Enterprise Document Sharing for Imaging [XDS-I] Teaching File & Clinical Trial Export [TCE] IHE Product Showcase and participating Vendor Booths
Visit IHE Demonstrations at HIMSS 2008 Integration Showcase Covers IT, Radiology, Cardiology, ….
Visit www.ihe.net/profiles There are MANY more Profiles Start learning about them and IHE
33RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom
SummarySummary
Become familiar with the IHE Profiles that address your pain points
Make IHE Profiles part of your purchase and upgrade requirements; List them in your RFP
34RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom