Integrating the Healthcare Enterprise IHE Pathology

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Integrating the Healthcare EnterpriseIHE
Pathology

• Karima BOURQUARD
• USER COCHAIR- FRANCE
• Karima.bourquard_at_gmsih.fr

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Integrating the Healthcare Enterprise (IHE)

• Objective stimulate the integration of the
  Healthcare informations exchanging between
  systems that support modern healthcare
  institutions
• all required informations for medical decisions
  is both correct and available to healthcare
  professionals
• IHE is a process and a forum for encouraging
  integration efforts, based on
• Technical framework for the implementation of
  established messaging standards to achieve
  specific clinical goals? specifications
• Rigorous testing process for the implementation
  of this framework ? connect-a-thon
• Educational sessions exhibits at major meetings
  of medical professionals ? demonstration

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IHE-Pathology the beginning

• Starting in 2005
• Pathologists have expressed their interest to
  develop interoperability in Pathology domain
• Integration of the pathology systems in HIS
• Sharing information with others pathologists
• Development of the software in this domain
• Development of the Images inside and outside
• Development of National EHRs
• .

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The user needs

• An order for the pathological examination is
  communicated to the pathologist
• In the pathology department environment, the set
  of procedures and sub-procedures (procedure
  steps) are identified and have to be performed in
  the process of fulfilling the order by one or
  multiple pathologists
• Each Order is identified by an Order ID
• For each Requested Procedure, the basic or
  special techniques involved in the processing of
  the corresponding specimen(s) may require
  different devices (automatons, image acquisition
  modality, etc).
• Each Requested Procedure may contain one or more
  Procedure Steps. A Procedure Step is the smallest
  unit of work in the workflow that is scheduled
  (work to do) and/or performed (work done) by a
  person or a machine (automaton, image acquisition
  modality, etc) on an object (specimen, tissue
  sample, tissue section, etc)
• Observation results progress through different
  steps of validation (non validation,technically
  validation, pathologist validation)
• Complex diagnostic structured reports include
  numeric quantitative measurement, images or
  graphs, image annotation and links between image
  (and/or evidence) information and textual
  information

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Pathology workflow
Care department
Pathology department
Admission Discharge Transfer
Order management Tissue bank management Pre
analytical process Images and/or virtual slides
acquisition Report editing, diagnostic
coding Billing
Order entry
Images and/or reports archiving and management
Results (reports and/or images) visualization
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Specimen, parts, blocks

• Specimen description requires a controlled
  vocabulary including the list of
• ? Harvest procedure (biopsy, operating specimen
  (described according to the surgical procedure),
  cytological liquid, smear, etc)
• ? Conservative conditions (fixative, fresh
  tissue, etc)
• ? Origin of specimen (breast, colon, etc)
• ? Precise localization (side, part of the organ
  (fundus,antrum, etc))
• ? Requested technical procedure step
  (histopathological examination, cytopathological
  examination, frozen section, tissue banking,
  etc).
• ? A controlled vocabulary is required for this
  specimen description.

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Specimen, part, block and slide

• ? We distinguish specimen collected in care
  department (Parts) and tissue samples resulting
  from sampling processes within the pathology
  department (Blocks). Tissue sections or smearare
  called Slides.
• ? Each Part, Block, Slide is identified and
  described. The pathology department Part(s) ID,
  Block(s) ID and Slide(s) ID are shared with
  Report Creator and Image Acquisition Modalities,
  (Automation managers in the future), etc).

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Description of the specimen
Order
Order (by Sammy Surgeon) OR-321 Requested
Procedure 1 Breast surgical specimen with
axillary lymph node - Frozen sections
pathological examination DP06-999 (Study
Accession Number) DP06-999-1 Tumorectomy
(Specimen Accession Number) DP06-999-1-1 Block
for frozen sections DP06-999-1-1-a
HS DP06-999-1-1-b Toluidine blue DP06-999-1-2
DP06-999-1-3 DP06-999-1-4 fresh
samples DP06-999-1-5 DP06-999-1-6 DP06-999-1-7
mirror paraffin blocks DP06-999-1-8
tumor DP06-999-1-9 tumor DP06-999-1-10
tumor DP06-999-1-10-a HS DP06-999-1-10-b
HS DP06-999-1-10-c IHC DP06-999-1-10 to
DP06-999-1-14 margins DP06-999-1-15 to
DP06-999-1-16 adjacent breast tissue DP06-999-2
Additional tissue (Specimen Accession
Number) DP06-999-2-1 to DP06-999-2-5 margins of
the initial tumorectomy DP06-999-2-6 to
DP06-999-2-8 margins of the additional breast
tissue excision DP06-999-3 Axillary lymph node
(Specimen Accession Number) Requested Procedure
2 Nevus - Pathological examination
DP06-1000 (Study Accession Number) DP06-1000-1
nevus DP06-1000-1-1 DP06-1000-1-2
Requested Procedure
Part
Blocks
Slides
Part
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Overview of the workflow
? RAD-26 Query report ? RAD-27 Retrieve report
Patient Demographic Source
Enterprise Report Manager
Report Reader
Report Depository
PAT-3 Report Management
? RAD-26 Query report ? RAD-27 Retrieve report
? ITI-30 ? ITI-31
RAD-25 Report issuing
PAT-1 Placer Order Management PAT-2 Filler
Order Management
Order Placer
Order Filler Report Manager
Report Creator
PAT-4 Work Report Mgmt PAT-5 Report Result Mgmt
Yellow HL7 Messages Green DICOM Messages
PPS
Image Availability Query
Performed Procedure Step Manager
Modality Worklist Provided
Procedure Scheduled /Updated
Creator PPS
Modality PPS
Evidence Creator
Acquisition Modality
PPS
Image Archive
Image Manager
Image Display
Query Images
Creator Image Stored
Storage Commitment
Modality Image Stored
Storage Commitment
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PAM Patient administration Management
Patient Demographic Source
Enterprise Report Manager
? ITI-30 ? ITI-31
Order Placer
The profile PAM is completly on line with the
needs of pathology
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Order/report workflow
? RAD-26 Query report ? RAD-27 Retrieve report
Enterprise Report Manager
Report Reader
Report Depository
PAT-3 Report Management
? RAD-26 Query report ? RAD-27 Retrieve report
RAD-25 Report issuing
PAT-1 Placer Order Management PAT-2 Filler
Order Management
Order Placer
Order Filler Report Manager
Report Creator
PAT-4 Work Report Mgmt PAT-5 Report Result Mgmt
Yellow HL7 Messages Green DICOM Messages
PPS
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Imaging workflow
Performed Procedure Step Manager
Creator PPS
Modality PPS
Evidence Creator
Acquisition Modality
PPS
Image Archive
Image Manager
Image Display
Query Images
Creator Image Stored
Storage Commitment
Modality Image Stored
Storage Commitment
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Next steps

• The technical Framework(vol1 and vol 2) is
  already written
• Work to do
• Spécification of identification of specimen
• In liaison with DICOM ad HL7
• Finalize the transactions
• TF for Public Comments end of the year
• On March WG for PC
• Pulication in April at the next HL7 meeting in
  Köln

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More information.

• IHE Web sites
• http //www.ihe.net
• Europe
• http//www.ihe-europe.org
• http //www.gmsih.fr/IHE

Thank for your attention Questions?