Integrating Integrating thethe Healthcare Enterprise - Healthcare Enterprise -
IHEIHEAn initiative of the ACC to improve data interoperability
March 2005 ACC Scientific Sessions 2
Why IHE?Why IHE?Cardiology has hard system and data integration problems- Multiple locations (office, in-patient, ED …)- Multiple devices and modalities- Long term patient care by many care providers
Data integration is essential to quality patient care
Care providers must work with industry to develop solutions to meet their needs- Implementations must be based on open standards
March 2005 ACC Scientific Sessions 5
Goals of IHEGoals of IHE
Advance standards-based healthcare data integration
Improve clinical and administrative workflow
Improve data flow – where it’s needed, when it’s needed
Improve the efficiency and effectiveness of clinical practice
March 2005 ACC Scientific Sessions 6
What is IHE?What is IHE?
A collaboration of clinicians and vendors
- International and multi-specialty
A proven systems integration process
- Refined through seven years of experience
Produces results on a yearly cycle
- Problem identification, Technical specification, Vendor implementation, Test, Demonstration
- Yearly cycle focuses on most important tractable problems
March 2005 ACC Scientific Sessions 7
Who is IHE?Who is IHE?
IHE is a joint initiative of:
- American College of Cardiology (ACC)- Radiological Society of North America (RSNA)- Healthcare Information and Management Systems
Society (HIMSS)Vendors/manufacturers in major supporting role
Local sponsorship internationally
- IHE-Europe and IHE-Asia/OceaniaIHE-Cardiology additional participating societies
- ASE, SCAI, ASNC, and moreIHE-Cardiology in Europe sponsored by European Society of Cardiology (ESC)
March 2005 ACC Scientific Sessions 8
IHE Clinical DomainsIHE Clinical Domains
Cardiology leverages the work of the other domains
Cardiology contributes to the Electronic Health Record– Being specified in IHE IT Infrastructure domain
IHEEHR- Longitudinal Record
IHECardiology
IHELaboratory
IHERadiology
IHEFuture Domain
IHEIT Infrastructure
Intra-Enterprise
Cross-Enterprise
14 Integration Profiles
5 Integration Profiles
3 Integration Profiles
9 Integration Profiles
IHE RadiationOncology
IHECardiology
IHEEHR- Longitudinal Record
March 2005 ACC Scientific Sessions 11
Cardiology and the Cardiology and the Electronic Health RecordElectronic Health Record
ACC Vision of the Electronic Health Record (1999)- “The Digital Integrated Cardiac Record” - All care areas- Across organization boundaries
EHR is a key area of IHE development - XDS – HIMSS 2005
To play in the EHR, data must be managed and properly identified
So, this is where we started in Year 1 of IHE-Cardiology – lay the foundation
March 2005 ACC Scientific Sessions 12
IHE Cardiology – IHE Cardiology – the Cath Lab examplethe Cath Lab example
1 2 3 4
5
6
7
(A) room for improvement !(A) room for improvement !
March 2005 ACC Scientific Sessions 13
IHE Annual Cycle – IHE Annual Cycle – Step 1Step 1
1. Cardiologists identify clinical problems to be addressed -“Integration Profiles”
2. Engineers from vendors collaborate to define technical specification (using standards such as DICOM and HL7)
3. Vendors implement the technical specification and participate in the “Connectathon” and demos
4. Vendors publish IHE Integration Statements, and users can buy IHE systems
March 2005 ACC Scientific Sessions 15
““I need to see the ECG!”I need to see the ECG!”
Clinical Problem:
- Diagnostic quality ECGs needed everywhere
IHE Tasks:
- Simple and fast access- Ubiquitous (Web based) communication- Integrated into other software systems
Retrieve ECG for Display Integration Profile
March 2005 ACC Scientific Sessions 17
““Could you do a TTE on this patient right Could you do a TTE on this patient right now since you are in the CCU anyway?”now since you are in the CCU anyway?”
Clinical Problems: - Lost and unbilled echo exams because carts are
constantly on the move- Patient and order info manually entered (potential for
errors) or not at all- Stress echo image ID inconsistent across vendors
IHE Tasks:- Accurate and automatic demographic and order
reconciliation- Verify all images are securely archived- Accurate display of Stress Images
Echocardiography Workflow Profile
March 2005 ACC Scientific Sessions 19
““There is a patient being brought There is a patient being brought up to cath from the ER…”up to cath from the ER…”
Clinical Problems: - Need to enter patient and procedure information into
multiple systems in cath lab- No order created; emergent case (unidentified patient)- Change of rooms during procedure – data scattered- Inconsistently time-stamped events
IHE Tasks:- Automate download of patient info to all systems- Accurate and automatic patient demographic and order
reconciliation- Verify all data is securely archived in single “folder”- All data consistently time-stamped
Cardiac Catheterization Workflow Profile
March 2005 ACC Scientific Sessions 21
IHE Annual Process – IHE Annual Process – Step 2Step 2
1. Cardiologists identify clinical problems to be addressed - “Integration Profiles”
2. Engineers from vendors collaborate to define technical specifications (using standards such as DICOM and HL7)
3. Vendors implement the technical specification and participate in the “Connectathon” and demos
4. Vendors publish IHE Integration Statements, and users can buy IHE systems
March 2005 ACC Scientific Sessions 22
IHE Annual Process – IHE Annual Process – Step 3Step 3
1. Cardiologists identify clinical problems to be addressed - “Integration Profiles”
2. Engineers from vendors collaborate to define technical specification (using standards such as DICOM and HL7)
3. Vendors implement the technical specification and participate in the “Connectathon” and demos
4. Vendors publish IHE Integration Statements, and users can buy IHE systems
March 2005 ACC Scientific Sessions 23
IHE Joint ConnectathonIHE Joint ConnectathonJanuary, 2005January, 2005Oak Brook, ILOak Brook, IL
300 engineers
43 companies
110 products
– Working together in a collegial environment – 2800 monitored test cases executed in 5 days
This is integration that doesn’t take up your hospital’s resources –and no finger-pointing!
March 2005 ACC Scientific Sessions 24
IHE Annual Process – IHE Annual Process – Step 4Step 4
1. Cardiologists identify clinical problems to be addressed - “Integration Profiles”
2. Engineers from vendors collaborate to define technical specifications (using existing standards such as DICOM and HL7)
3. Vendors implement the technical specification and participate in the “Connectathon” and demos
4. Vendors publish IHE Integration Statements, and users can buy IHE systems
March 2005 ACC Scientific Sessions 25
Your Request for Proposals Your Request for Proposals (RFPs)(RFPs)
Incorporate IHE framework into RFP documents & product selection
Much easier to specify an IHE Integration Profile than detailed technical specs
Use IHE framework to evaluate your current workflow, even if not buying now
Vendors build product functions that are requested by customers
Ask for IHE Integration Loud & Often !!
March 2005 ACC Scientific Sessions 26
Long Road Ahead – Long Road Ahead – 5 yr Roadmap5 yr Roadmap
Year 1(2005)
Year 2(2006)
Year 3(2007)
Year 4(2008)
Year 5(2009)
Cath
Echo
ECG
Nuclear
EP
Ca
rdio
log
y T
ec
hn
ica
l Fra
me
wo
rk
Quality
MR/CT
Multi-modality workflow & imaging
Procedure log &reporting
Hemo waveform & measures, QCA/QVA
Supplies, inventory,& charge capture
Workflow & imaging,stress protocols
Reporting workflow
Retrieve ECGfor display
ECG/Stress/Holterorders
Workflow & imaging,stress protocols
Reporting workflow
Multi-modality labworkflow & reporting
Home healthmonitoring
Retrieve guidelinesfor display
Retrieve structuredguidelines
Registry dataharvesting
Workflow, reporting,& measurements
Precision timesynchronization
Implantable device parameters & events
PediatricMeasurementinteroperability
ECG waveform interoperability
Stress testing workflow
March 2005 ACC Scientific Sessions 27
Commitment to EHRCommitment to EHR
David J. Brailer, MD, PhDNational Coordinator for Health Information Technology, US
Department of Health and Human Services (HHS)
Directive: Execute the Presidential Order for widespread deployment of Health Information Technology within 10 years.
“The capacity to share clinical data is generally not available in the market, and I have placed a high priority on ensuring that it does come to exist before widespread EHR adoption is underway.”
“IHE… is becoming the obvious thing to do. It is our goal to make it the inevitable thing to do.”
HIMSS Conference, February 2005
March 2005 ACC Scientific Sessions 28
Why IHE?Why IHE?
This is the cardiologist in
healthcare
Any Questions?
This is healthcare
March 2005 ACC Scientific Sessions 29
Custom integration at customer site is a lose-lose- High cost – vendor and customer- Unpredictable and uncontrolled environment- Inefficient – solutions often must come from other locations
(home office) with delays in delivery- Usually insufficiently documented – fragile and
unmaintainable solutions- Resources expended on non-value-add effort- Ineffective use of available standards
Bolt-on integration is a problem- Data sharing functions don’t work well if not designed into
the product
Exponential growth of pain as systems are added
Why IHE? (for vendors)Why IHE? (for vendors)
March 2005 ACC Scientific Sessions 30
Goals of IHE (for vendors)Goals of IHE (for vendors)
Effective use of standards
Reduce variability in interfaces
Controlled integration testing environment- Defined timetable- No extraneous distractions
Effective use of resources for integration testing
Coordinated deployment of cross-system functions- Avoid chicken-and-egg syndrome
Common approach creates the market in which vendors can sell and users can buy with confidence
March 2005 ACC Scientific Sessions 31
IHE BenefitsIHE Benefits(Vendors)(Vendors)
Improves onsite customer support
Reduces development cost
Standardizes interface engineering
Enables the vendors to focus on competitive features
Improves customer satisfaction
March 2005 ACC Scientific Sessions 37
Four Clinical Scenario Four Clinical Scenario DemonstrationsDemonstrations
Clinical Scenario Demonstrations:
- Cath/ECG: Emergent Angioplasty- Cath/ECG: Change of Rooms- Echo/ECG: “Add on” Mobile Procedure- Echo/ECG: Stress Echo Images
Watch us “connect the docs”.
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