IHE E Integrating the Healthcare Enterprise Ideas to Europe

1
IHE EIntegrating the Healthcare
EnterpriseIdeas to Europe ?

• The COCIR IHE-E Working Group
• Siegfried Bocionek, Nicki Wirsz (Siemens),
• Kees Smedema (Philips), Charles Parisot (GE),
• Willem Overlaet (Toshiba), Emmanuel Cordonnier
  (Etiam),
• Peter Bursig (COCIR), Berthold Wein (Univ. of
  Aachen)
• Joel Chabriais (Necker Hospital, Paris)

with material of IHE included
2
Organization of the Talk

• IHE, What is it ?
• Why IHE-Europe ?
• How could we implement IHE-Europe
• Status of IHE-E, Challenges

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IHE Foundation Goal Improve Interoperability

• HIMSS and RSNA initiative to foster communication
  among diverse medical information systems

www.rsna.org/IHE

• 23 Participants IHE Year 1, Chicago 1999

Agfa-Gevaert N.V. Algotec Systems
LTD. Analogic Corporation Canon Medical
SystemsCedara Software (formerly ISG
Technologies) Cerner Corporation CSIST
(Taiwan) DeJarnette Research Systems,
Inc.Direct Radiography Corp., a Hologic
Company eMed Technologies CorporationFuji
Medical Systems U.S.A., Inc. GE Medical
SystemsIDX Systems Corporation Merge
Technologies Inc.Mitra Philips Medical
Systems North America Picker International,
Inc. RASNA Imaging Systems Siemens Medical
Systems, Inc. Softmedical StorCOMM,
Inc.Toshiba America Medical Systems Vital
Images, Inc.
HIMSS Hospital Management Information Systems
Society RSNA Radiological Society of North
America
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Informatics Integration Issues

• Disconnected information flows
• inconsistent identifiers
• Info systems vs imaging modalities
• Disconnected workflows
• administrative information not fed into the
  workflows of radiology, other departments.
• Disconnected procedures
• difficult to integrate procedures for reporting
  when information does not flow

5
Technology Integration Issues

• Different Standards DICOM, HL7
• HL7 different interpretations/implementations
• Optional/Different ways to achieve the same
• No agreed system boundaries
• No guaranteed application interoperability
• Different information models

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Resolution by the IHE Process

• Develop vendor-neutral terminology of actors and
  roles for describing informatics flows
• Develop Technical Framework defining flows and
  the data formats to be transferred
• Implement the Framework in demonstrations that
  annually increase in complexity

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Patient Scenario
Acute Disease
Pulmonary Embolism

• 60 y male, light cardiac insufficiency, moist and
  warm weather,
• sudden chest pain and severe dyspnoe
• via ambulance into the hospital
• medical procedures
• anamnesis
• ECG
• fibrin-dimer-test
• pulmonary szintigraphy
• CT/MRI pulmonary arteries
• (phlebography)
• interventional pulmography

information-flow
demographic data creating patient folder first
contact to physician electrophysical
examination laboratory information nuclear
medical examination radiological
examination interventional treatment
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Patient Scenario
Acute Disease
Pulmonary Embolism
successive systems
During Hospital Stay 1. Diabetes 2.
Arteriosclerosis with myocardial
infarction 3. Allergy on Iodine
central catering system -gt dietary
plan cardiac surgeon -gt (?) thrombectomy
-gt aortocoronary
bypass radiologist -gt diagnostic follow
up recover sanatorium
Even more Integration is needed, but on what
standards ??
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Pulmonary Embolism IHE Approach
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Standards are not enough to achieve the goal !
DICOM
HL7
Topic
Others
ADT
Patient Mgmt (Visit Mgmt)
ADT Messages
CorbaMed EDI http XML WAP ...
Order Entry
ORM, ORR OSQ/OSR
Modality Worklist Mgmt
Image Acquisition/ Distribution
Study Mgmt (MPPS) Storage Storage Commitment
Very limited
Results Reporting
Results Mgmt (Structured Reporting)
ORU/ACK QRY/ORF
Financial Management Messages
Billing
- - -
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IHE Year 1 Technical FrameworkStandards and
Interoperable Products

• Conformance to Standards (HL7, DICOM), not to
  IHE.
• Standards have been implemented according to the
  IHE Technical Framework.
• IHE Technical Frameworkaddresses only a subset
  of a Healthcare Enterprise Information System
  Architecture

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IHE Year 1 Achievements

• Identification of key process steps
• Data model integrating DICOM and HL-7
• Role-based systems architecture
• Actors participate in process steps
• Actors perform roles in specific transactions
• System transactions define messages between actors

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IHE Year 1 Picture of IHE Booth at RSNA 99
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IHE Year 1 Picture of IHE Booth at RSNA 99
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IHE Year 1 Demonstrations at RSNA / HIMSS
Single Community Hospital
Multi-Hospital Network
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IHE Year 1 Picture of IHE Booth at RSNA 99
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IHE Year 1 System Transactions
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IHE Year 1 Visitors at IHE Booth, RSNA 99
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IHE Year 1 Scope and Limits
Vertical Integration for Radiology
ADT

• Internal radiology focus
• A core set of process steps from patient
  registration
• to images available for interpretation
• Modality integration with RIS and PACS
• Initial link between PACS and RIS

OrderMgt
DeptSched.
ImageMgr
Consistent Managementof the Image Acquisition
Workflow
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IHE Year 2 Beyond Roadmap
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IHE Year 2 Preliminary Scope

• Demonstrate Evolving Capabilities of Standards
• Build Upon Year 1 Evolution Acceptance
• European Initiative IHEEUROPE
• Round-Up Radiology Workflow
• Reporting
• Prefetching
• Presentation State
• Expand Scope Beyond Radiology
• Softcopy/Hardcopy Consistency
• Report Creation and Access
• Images Available Enterprise-wide
• Information Query
• Trauma Case Management

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IHE Year 2 Transaction Diagram
Trauma Case Mgmt
Information Query
Softcopy/Hardcopy Consistency
Images Available
Report Creation and Access
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Consistent Image PresentationSoftcopy/Hardcopy
Consistency

• Implementation of Grayscale Softcopy Presentation
  State Storage - DICOM Supplement 33
• Allows modalities to transmit information to
  ensure consistent image display
• Ensures that all displays and printers render the
  image as consistently as possible given their
  inherent limitations
• Covers both image and annotation information

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Report Creation and Access

• Implementation of Structured Reporting -DICOM
  Supplement 23
• Consistent methodology for capturing information
• Allow for computer interpretation of report
  collections
• Support referencing of key images within reports
• Consistent model for report storage and access

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Images Available

• Consistent method for identifying when images are
  available for reading
• Uses MPPS for acquisition completion
• First steps towards
• Interpretation worklist
• Interpretation Performed Procedure Step (IPPS)
• Store/Archive state reporting

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Information Query

• Define a standard method for interdepartmental
  information exchange using DICOM Query/Retrieve
• Other departments may access radiology
  information
• Radiology may access information from other
  departments
• Opportunity to apply IHE methodology to other
  departments
• First step towards broad information access

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Trauma

• Consistent method to reconcile information for
  unknown/emergency patients
• When reconciled, information systems are notified

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IHE Over Time

• Year 1 - Initial functional systems architecture
• Year 2 - Expanding radiological transactions from
  registration to reporting
• Coming in Year 3
• Further expansion of radiological transactions
• Include other disciplines?

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IHE in Practice

• IHE is not a standard, it defines the use of
  established standards (DICOM HL7 for Year 1)
  for higher levels of integration.
• IHE Technical Framework (TF 3.1 document)
• Products implemented according to TF 3.1 are
  easier-to-integrate
• Flexibility to address a variety of healthcare
  enterprises needs
• Integrating the Healthcare Enterprise requires a
  collaborative effort between users and vendors

Reduced integration costs and increased efficiency
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Organization of the Talk

• IHE, What is it ?
• Why IHE-Europe ?
• How could we implement IHE-Europe
• Status of IHE-E, Challenges

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Why IHE-Europe ?

• To address European-based healthcare information
  system vendors (RIS, HIS).
• To provide information to, and get feedback from
  European healthcare providers.
• To facilitate European influence in the IHE and
  avoid local European solutions if global
  solutions are adequate.

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European healthcare information systems market
is different

• Healthcare information system vendors often
  address only national markets in Europe
• Vendors are relatively small and cannot afford to
  demonstrate at RSNA and HIMSS
• Most imaging vendors have a global presence.
  However integration with European IS vendors is
  needed.
• Provide European vendors with a platform to
  develop and test world-class interoperability

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Get European healthcare providers involved

• Inform European healthcare providers about the
  IHE
• Organize feedback from European healthcare
  providers to the IHE
• Avoid non-global solutions for the same problems
  in healthcare integration

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Organization of the Talk

• IHE, What is it ?
• Why IHE-Europe ?
• How could we implement IHE-Europe
• Status of IHE-E, Challenges

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IHE-Europe How

• Sponsors COCIR (European imaging vendors), EAR
  and ECR
• Series of IHE-demonstrations at ECR, similar to
  IHE at RSNA and HIMSS, starting 2001
• Formation of IHE-Europe Planning Committee
• No IHE-Europe Technical Committee re-use of IHE
  Technical Framework
• Required substantial funding by EU

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IHE-Europe Proposal for the next steps

• Workshop for interested European healthcare IT
  vendors
• Brussels, 3-May-2000
• Sufficient number of the vendors sign membership
  in
• COCIR IHE-E Working Group (yearly fee) --
  --
• Planning Committee formed -- --
• Confirmation of funding June 00, at the
  latest
• Project leader hired, start of implementation Jul
  y 00, at the latest
• Distribution of scenarios August 00
• Distribution of test tools October 00
• Connect-a-thon for IHE-E January 01
• Final tests before ECR 2001 February 01

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Organization of the Talk

• IHE, What is it ?
• Why IHE-Europe ?
• How could we implement IHE-Europe
• Status of IHE-E, Challenges

38
Status of IHE-E Activities

• First initiative of COCIR June 99
• Workplan and rough framework Sept. 99
• Membership of COCIR in EHTEL (umbrella)
• COCIR offer for RSNA like IHE demo at ECR 2000
• (cancelled, no financial support)
• Request for funding at EU (5th Framework) Oct.
  99
• Request for funding at ECR and EAR Oct. 99
• Information material at the COCIR booth of
  RSNA Dec. 99
• COCIR decisions
• no funding, no IHE-E vendors wont bear the
  costs alone
• no significant interest from healthcare IT
  vendors, no IHE-E

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Thank You
Visit also - http/www.rad.rwth-aachen.de/wein/I
HEE/ - presentation IHE Technical
Perspective ECR, March 8th, 11 am -
presentation IHE in Practice ECR, March 10th,
9 am
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Scenario 1 shows why . . .
Chronic Disease
Recurrent Lymphoma
36 y female, recurrent exhaustion
time-course

• Multiple multimodality imaging
• CT for lymphnodes in chest and
• abdomen
• MRI for bone/musculosceletal infiltration
• PET for vitality estimation
• Hematological parameter analysis
• bone marrow analysis
• humoral activity
• LDH, ß-2-Microglobulin

Images
Discrete Parameters
ext.
int.
int.
Challenge bring all data to the Point of Care
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IHE Year 1 System Transactions Diagram
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Pulmonary Embolism Diagnosis Process

• hypoxia test - stop if problem detected,
  otherwise...
• chest x-ray - save to compare with NM image
• check for pulmonary hypertension - stop if
  detected, otherwise..
• inhale tagged gas, NM images assess lung
  ventilation
• inject marked material, NM images assesslung
  perfusion - penicillin allergy noted in marker
  choice
• Interpret x-ray and NM image sets together

V-P images courtesy http//brighamrad.harvard.edu/
Cases/bwh/hcache/116/step-2.html
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Patient Scenario 1
Chronic Disease
Recurrent Lymphoma
Conventional System
Integrated System
- Distributed enterprises - Different vendors
gt - Reduced availability of
reports and images - Lack of data interchange
- Distributed enterprises - Different vendors
gt - High availability of reports
and images - Perfect data interchange
Integration is needed, but on what standards ??
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Overview of IHE Topics

• Processes/Functions
• Admission/Discharge/Transfer
• Order Entry
• Image Acquisition/Distribution
• Results Reporting
• Billing ...

• Healthcare Standards
• HL7
• -SIG Visual Integration (formerly CCOW)
• DICOM
• CORBAmed
• EDI messages for billing (X12, EDIFACT)

• Technology
• Components
• Messaging
• Distributed Objects (CORBA, COM/DCOM)
• XML (eXtensible Markup Language)

Technologies
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Standards are not enough to achieve the goal !
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IHE Year 1 Standards Application