Integrating the Integrating the Healthcare EnterpriseHealthcare Enterprise

Understanding, Optimizingand ImplementingWorkflow with IHE

Charles Parisot

GE Medical Systems-IT

John Paganini

IDX Systems

Learning ObjectivesLearning Objectives

Understand how the IHE Scheduled Workflow Integration Profile streamlines radiology data workflow

Learn how to practically apply IHE in solving some of the typical workflow cases

Discussion Areas Discussion Areas

Workflow Defined What Are The Benefits? How Do I Get It? What Systems Should Be Considered

For Integration? What Is The Sequence To Follow?

““Enter the data one time Enter the data one time and then pass it from and then pass it from system to system.”system to system.”

On Brookwood Medical Center, Birmngham, ALOn Brookwood Medical Center, Birmngham, AL

IHE Integration Profiles – 2004IHE Integration Profiles – 2004P

atie

nt In

form

atio

n R

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ncili

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Access to Radiology Information

Consistent Presentation

of Images

Basic Security

Evidence Documents

Key Image Notes

Simple Image and Numeric

Reports

Presentation of Grouped Procedures

Post-Processing Workflow

Reporting Workflow

Charge Posting

Scheduled Workflow

Workflow DefinitionWorkflow Definition

Focus Is On Processes– Tasks– Procedural Steps– Organizations Or People – Data: Required Input And Output Information– Tools

Benefits Benefits • Clinical UsersClinical Users

• Greater access to consistent informationGreater access to consistent information• Fewer errors, fewer tedious tasksFewer errors, fewer tedious tasks

• AdministratorsAdministrators• Increased throughputIncreased throughput• Better scheduling and trackingBetter scheduling and tracking

• BuyersBuyers• Specify/purchase integration capabilities easily Specify/purchase integration capabilities easily • Freedom to acquire “Best of Breed” systems Freedom to acquire “Best of Breed” systems

• IT ProfessionalsIT Professionals• Faster, more predictable integration projectsFaster, more predictable integration projects• Facilitate cooperation of competing vendorsFacilitate cooperation of competing vendors

What’s in it for Me?What’s in it for Me?

IHE Technical FrameworkIHE Technical FrameworkOrganized in sections that provide an Organized in sections that provide an

increasing level of detailincreasing level of detail

Integration ProfilesIntegration Profiles:: Establish broad categories of Establish broad categories of compatible function. compatible function.

ActorsActors:: Identify specific kinds of operational Identify specific kinds of operational participants in the healthcare participants in the healthcare enterprise.enterprise.

What is backing IHE ?What is backing IHE ?www.rsna.org/ihe

TransactionsTransactions: Describe particular interactions : Describe particular interactions between actors to perform between actors to perform specific operations.specific operations.

Picking IHE Profiles ?Picking IHE Profiles ?

Potential Efficiency Gains Cost-Effectiveness Vendor Readiness End-User Pain Clinical Priorities Available Resources / Skillsets Improvements in Department Performance Administrative Guidelines / Vision

Pat

ient

Info

rma

tion

Rec

onci

liatio

n

Access to Radiology Information

Consistent Presentation

of Images

Basic Security

Evidence Documents

Key Image Notes

Simple Image and Numeric

Reports

Presentation of Grouped Procedures

Post-Processing Workflow

Reporting Workflow

Charge Posting

Scheduled Workflow

Pat

ient

Info

rma

tion

Rec

onci

liatio

n

Access to Radiology Information

Consistent Presentation

of Images

Basic Security

Evidence Documents

Key Image Notes

Simple Image and Numeric

Reports

Presentation of Grouped Procedures

Post-Processing Workflow

Reporting Workflow

Charge Posting

Scheduled Workflow

Pat

ient

Info

rma

tion

Rec

onci

liatio

n P

atie

nt In

form

atio

n R

econ

cilia

tion

Access to Radiology InformationAccess to Radiology Information

Consistent Presentation

of Images

Consistent Presentation

of Images

Basic SecurityBasic Security

Evidence DocumentsEvidence

DocumentsKey Image

NotesKey Image

Notes

Simple Image and Numeric

Reports

Simple Image and Numeric

Reports

Presentation of Grouped Procedures

Presentation of Grouped Procedures

Post-Processing Workflow

Post-Processing Workflow

Reporting WorkflowReporting Workflow

Charge PostingCharge Posting

Scheduled WorkflowScheduled Workflow

ConsiderationsConsiderations

Workflow Reengineering AnalysisWorkflow Reengineering Analysis

What works well now? What does not work well now? What is a "relic from the

past"? Search for redundancies Search for important, missing

data Simplify the complex Still need all that paper?

Shorten the start-to-finish cycle time

Expect innovation

QuestionsQuestions Defines one actor that controls

every major piece of shared data

Remove ambiguities from standards

Improves access to information Ensures synchronizing data in

multiple systems Mechanisms for correcting

incorrect data Eliminates “Vendor Lock-in”

associated with proprietary data flows.

Keep healthy competition on applications ease of use.

IHE AnswersIHE Answers

Classic Project Lifecyclewith IHE IHE Added Added ValueValue

Definition of Client Requirements – Site Analysis, Operational Workflow

IHE Contribution – Use Cases ((Technical Framework Vol I)

Generation of Proposal - Review and Modify as Needed IHE Integration Statements Integration Profiles and Actors.

Review vendors capabilities (Connectathon results)

Solution Development and Implementation Leverage Use Case Section in each Profile

Testing, QA and More Testing Connectathon Profile/Transaction Based-Testing SCAR Paper – QA and Acceptance Testing of PACS Project

Go-Live and Signoff Succeed with less Surprises

Post Implementation Review Evaluate benefits and …….

Submit your IHE User Success Story

Leveraging IHE in your RIS/PACS projectsLeveraging IHE in your RIS/PACS projects

Start building the integrated Start building the integrated healthcare enterprisehealthcare enterprise

IHE-Based Solution IHE-Based Solution Development Development

Where to start...Where to start...

First, recognize what systems you need to integrate

See what Actors they implement and what Profiles they support

Ensure you have the Actors based on the Profiles you want to implement

By leveraging IHE, the first part can be done easily

Note: You still have to include additional integration needs not covered by IHE.

imagesstored

patientinformation

RIS

examination orders

imagesretrieved

HIS

PACS

procedurescheduled

Prefetch any relevantprior studies

modalityworklist

report

report

Registration

Orders Placed

Orders Filled

Film

FilmFolder

Image Manager& Archive

FilmLightbox

report ReportRepository

DiagnosticWorkstation

Modality

acquisitionacquisitionin-progressin-progressacquisitioncompleted

acquisitioncompleted

imagesprinted

AcquisitionModality

Scheduled Workflow ProfileScheduled Workflow Profile

Example: RIS to Modality ConnectionExample: RIS to Modality Connection

Order Filler RIS

AcquisitionModality

Requires the Requires the Scheduled Workflow ProfileScheduled Workflow ProfileTwo Actors and Two Actors and two Transactions: Modality Worklist and PPStwo Transactions: Modality Worklist and PPS

modalityworklist

PPSmodality PerformedProcedure Step (PPS)

Understand Capabilities of ActorsUnderstand Capabilities of Actors

DICOM: MWL Capable PPS Capable

DICOM: MWL Capable PPS Capable

Order Filler RIS

AcquisitionModality

The IHE way:The IHE way:1-Get the vendors to commit to the support of the same IHE 1-Get the vendors to commit to the support of the same IHE Integration profile: Scheduled Workflow.Integration profile: Scheduled Workflow.2-Confirm with their IHE Integration Statements:2-Confirm with their IHE Integration Statements:Claim the right actors for the desired Integration Profile ? Claim the right actors for the desired Integration Profile ?

modalityworklist

PPSmodality PerformedProcedure Step (PPS)

The Classical way:The Classical way:Try, issues ?Try, issues ?

Read the DICOM CSsRead the DICOM CSsTry again. Try again.

Look at what was used from the Look at what was used from the IHE Technical FrameworkIHE Technical Framework

TRIGGER EVENTSThe patient arrives at the Acquisition Modality for a procedure.

MESSAGE SEMANTICSThe Acquisition Modality uses the C-FIND Request of the DICOM Modality Worklist SOP Class to query for the worklist from the DSS/Order Filler. The Acquisition Modality performs the SCU role, and the DSS/Order Filler the SCP role.

Query Keys Matching Query Keys Return Attribute Name Tag

SCU SCP SCU SCP

Scheduled Procedure Step

Scheduled Procedure Step Sequence

(0040,0100) R+* R R+* [IHE-1] R [IHE-2]

>Scheduled Station AE Title (0040,0001) R+ R R+* R

>Scheduled Procedure Step Start Date

(0040,0002) R+ R R+ R

>Scheduled Procedure Step Start Time

(0040,0003) O R R+ R

> Scheduled Procedure Step Location

(0040,0011) O O O O

>Modality (0008,0060) R+ R R+ R

>Scheduled Performing Physician's Name

(0040,0006) O O O R

>Scheduled Procedure Step ID (0040,0009) O O R+* R

>Scheduled Protocol Code Sequence

(0040,0008) O O R+* R

>>Code Value (0008,0100) O O R+* R

>>Coding Scheme Version (0008,0103) O O O O

>>Coding Scheme Designator (0080,0102) O O R+* R

>>Code Meaning (0080,0104) O O R+* R+

>Scheduled Procedure Step Description

(0040,0007) O O R+ R

Requested Procedure

Requested Procedure Comments (0040,1400) O O O O

Requested Procedure Description

(0032,1060) O O R+ R

Requested Procedure Code Sequence

(0032,1064) O O R+* R

>Code Value (0008,0100) O O R+* R

>Coding Scheme Version (0008,0103) O O O O

>Coding Scheme Designator (0008,0102) O O R+* R

>Code Meaning (0008,0104) O O R+* R+

Requested Procedure ID (0040,1001) R+ R+ R+ R

Names of Intended recipients of results

(0040,1010) O O O O

Study Instance UID (0020,000D) O O R+* R

Referenced Study Sequence (0008,1110) O O R+* R

>Referenced SOP Class UID (0008,1150) O O R+* R

>Referenced SOP Instance UID (0008,1155) O O R+* R

Imaging Service Request

Imaging Service Request Comments

(0040,2400) O O O O

Accession Number (0008,0050) R+ R+ R+ R

Requesting Physician (0032,1032) O O O R

Dealing with LegacyDealing with Legacy Understand that you may have to deal

with non-compliant devices and systems

Make best effort to bring them “up-to-date”

Initial implementations may provide partial support

Incremental usage of IHE is fine– It’s DICOM and HL7 anyway

Follow IHE’s yellow brick road...

Communication Your Plans to the Communication Your Plans to the VendorVendor

Present IHE as integration priority to Vendors. A Business goal !

Use as a checklist for dealing w/vendors Ensure you specify Actors, Profiles etc, Ask for Integration Statements in RFP Ensure Project Manager and team are

knowledgeable at implementing IHE

Putting the Pieces TogetherPutting the Pieces Together

1. IHE compliant products exist

2. Review Products IHE Integration Statements

1. IHE Booth has dedicated workstation

2. Website – www.rsna.org/ihe

3. Make sure the IHE Integration Statements are for the correct versions of the software

4. Check the vendors’ results of IHE Connectathon

5. Ask your vendors to commit to deliver operational IHE Integration Profiles

IHE Integration StatementIHE Integration StatementIHE Integration Statement Date 12 Oct

2002Vendor Product Name Version

Any Medical Systems Co. IntegrateRAD V2.3

This product implements all transactions required in the IHE Technical Framework to support the IHE Integration Profiles, Actors and Options listed below:

Integration Profiles Implemented

Actors Implemented Options Implemented

Scheduled Workflow Image Manager/Image Archive none

Image Display none

Image Creator Performed Procedure Step

Order Filler PPS Exception Management

Simple Image and Numeric Report

Report Creator none

Internet address for vendor’s IHE information: www.anymedicalsystemsco.com/ihe

Links to Standards Conformance Statements for the Implementation

HL7 www.anymedicalsystemsco.com/hl7

DICOM www.anymedicalsystemsco.com/dicom/integrateRAD.pdf

Links to general information on IHE

In North America: www.rsna.org/IHE

In Europe: www.ihe-europe.org In Japan: www.jira-net.or.jp/ihe-j

Find them at:Find them at: www.rsna.org www.rsna.org//IHEIHE//integration_statements integration_statements

Additional InformationAdditional Information

Brochures and Reprints– IHE Integration Profiles OverviewIHE Integration Profiles Overview– IHE At-a-GlanceIHE At-a-Glance– Reprints of IHE technical papersReprints of IHE technical papers– IHE Technical FrameworkIHE Technical Framework– The IHE FAQ; IHE VideoThe IHE FAQ; IHE Video– IHE Fundamentals, Purchasing Strategies, IHE IHE Fundamentals, Purchasing Strategies, IHE

PrimerPrimer– List of Vendors Product IHE Integration StatementsList of Vendors Product IHE Integration Statements– Connectathon ResultsConnectathon Results– HIMSS MonographHIMSS Monograph

www.himss.orgwww.rsna.org/ihe