Integrating the Healthcare Enterprise

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Integrating the Healthcare Enterprise
IHE s Potential for CardiologyJoseph
BiegelMitraIHE Planning Committee
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What is IHE?

• An industry-clinical partnership to integrate
  clinical information systems throughout
  healthcare
• Demographics, images, waveforms, reports
• Goal Improve the efficiency and effectiveness
  of clinical practice by
• Providing an implementation framework for open
  connectivity using existing standards
• Improving clinical information flow

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Who participates in IHE?

• Industry sponsors Radiological Society of North
  American (RSNA) and Health Information and
  Management Systems Society (HIMSS)
• A neutral forum open to all vendors Participants
  include GE, Phillips, Siemens, IDX, Cerner,
  Mitra, and some 30 others
• Standards committee members DICOM, HL7
• Clinicians, hospital information technology
  staff, healthcare administrators

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Why is IHE needed?

• Serious Integration Challenges
• Systems need information from other systems
  patient demographics, referring physicians,
  echo/angio images, ECG waveforms, hemodynamics,
  clinical reports, etc.
• But, systems communicate poorly or not at all

• Result - tedious, inefficient workflows
  - data that is inconsistent or unavailable

Responsibility for information flow between
systems and between departments is often unclear.
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What does IHE do?

• Users and vendors work together to identify and
  design solutions for integration problems
• Intensive process with annual cycles
• Identify key specific healthcare workflows and
  integration problems
• Research select standards to specify a solution
• Write, review and publish IHE Technical Framework
• Perform cross-testing at Connectathon
• Demonstrations at meetings (RSNA/HIMSS/ACC)

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What does IHE cover?

• Currently focused in Radiology
• 30 Vendors tested 70 systems at the Year 3
  Connectathon
• Systems include
• HIS, RIS
• MR, CT, US, CR, DX,
• PACS, Review Stations, Reporting Systems
• Printers, Imagers

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Why arent existing industry standards sufficient?

• Standards are vital (HL7, DICOM, ICD, )
• They provide consensus, tools technologies
• IHE is entirely standards-based
• But standards alone are insufficient
• Varying interpretations
• Optional variations
• No real-world specifications or scenarios
• No assurance of portability or connectivity

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How is IHE related to standards?

• IHE focuses on specific, practical integration
  problems
• Standards such as HL7 and DICOM provide
  dictionaries
• IHE defines a phrasebook and/or grammar that
  solves real world problems by assembling pieces
  provided by DICOM/HL7

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Key IHE concepts

• Technical Framework detailed, structured
  document delineating standards-based transactions
  among systems (IHE actors) to support specific
  workflow and integration capabilities
• Integration Profiles Documents specifying
  integration capabilities for specific
  patient-care problems

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IHEs track record

• Year 1 (1999) Proof of Concept (Basic
  Scheduled Workflow)
• Year 2 (2000) Introduction of 7 Integration
  Profiles for Radiology
• Year 3 (2001) Consolidation, Catch-up (Real
  Products) Expansion to France
• Year 4 (2002) 3 New Profiles Expansion to
  Japan, Germany
• Year 5 (2003) New Profiles Expansion to
  Cardiology, Lab, Pathology, ?

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Integration Profile examples

• Scheduled Imaging-Encounter Workflow
• Registration, ordering, scheduling, acquisition,
  distribution, storage
• Patient Information Reconciliation
• Consistent Presentation of Images
• Across various devices, media
• Key Image Note
• Adding text notes and pointers to images

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Why IHE in cardiology (1)?

• Cardiology workflow involves multiple diagnostic
  tests, images and reports
• Cardiology clinical systems/devices typically are
  unintegrated
• Separate systems for ECG/Holter, EP, PPM/ICD,
  echo, angiographic images, hemodynamics,
  documents/reports
• Each system typically requires redundant manual
  data entry, with inevitable errors

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Why IHE in cardiology (2)?

• Systems typically do not share data
• Patient demographics, directories of referring
  physicians or of images/documents
• Image formats often not portable
• Encrypted formats, proprietary readers, variable
  headers
• Fragmentation causes inefficiency, invalid or
  inaccessible clinical data, and compromises the
  quality of care

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Why IHE in cardiology (2) ?

• Some of the concepts of the IHE TF have broad
  general applicability and many can be applied or
  adapted to Cardiology
• The imaging vendors are largely the same
• DICOM and HL7 are used in Cardiology today
• Other Cardiology specific standards could easily
  be leveraged in a Cardiology specific version of
  the TF

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Common characteristics

• Cardiology is similar in some vital respects to
  radiology
• Driven by imaging modalities
• Managing distributed departmental resources
• Need for an integrated patient-centered view and
  for administrative reporting
• Need to improve lab efficiency via workflow
  management
• Legacy installed base technology issues

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Cardiology workflow elements

• Workflow often similar to radiology
• Patients are admitted
• Demographics entered (often multiple times for
  the same patient)
• Imaging studies are performed and read
• Reports generated

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Distinct cardiology needs

• Clinical data content is more complex
• Therapeutic as well as diagnostic procedure
  reports, with richer report content
• Richer graphical content moving images, color
• Clinical encounter data
• Outcome reporting
• Cardiology focuses on an integrated patient view
  rather than on procedures, images and reports in
  isolation

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IHE/cardiology possibilities (1)

• Image exchange/portability
• Even with DICOM, image transfer and display often
  dont work
• Difficulty importing outside images into local
  archives
• As part of a cardiology Technical Framework, IHE
  could specify unambiguous, vendor-supported,
  compatible DICOM implementations

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IHE/cardiology possibilities (2)

• Redundant, manual patient demographic data entry
  is slow and error prone
• DICOM and HL7 can help, but the standards
  themselves are not enough
• IHE could leverage or adapt its Scheduled
  Workflow Integration Profile and Patient
  Information Reconciliation Profile for
  cardiology, resulting in a single entry point for
  patient demographics, accessible to all
  cardiology systems and devices

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IHE/cardiology possibilities (3)

• IHE can develop generic, standards-based
  interfaces between cardiology devices/systems and
  enterprise systems for scheduling, ordering and
  results reporting
• Cardiology makes large capital purchases of
  imaging and information systems without assurance
  that systems can co-exist or interface The fear
  at power on factor
• The IHE TF can define vendor-neutral requirements
  that assure interoperability

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IHE/cardiology possibilities (4)

• Structured reporting In partnership with ACC and
  clinicians, IHE could develop standards-based
  cardiology reports, including diagrams and
  graphics for anatomy, function and viability
• Beyond static, black-and-white DICOM IHE could
  develop Implementation Profiles for motion
  images, color images, waveforms, Doppler,
  pediatric echo

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An IHE/ACC partnership

• IHE and industry will do the heavy lifting at the
  technical level
• BUT IHE needs ACC involvement
• To ensure that IHE focuses on clinical needs and
  provides clinically relevant solutions
• To act as impartial, patient-centered observers
  (rarely referees), so that IHE remains truly
  vendor-neutral

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Conclusions

• IHE can dramatically improve the care of
  cardiology patients and life for cardiologists.
• To succeed--and to do justice to its goals--IHE
  needs both expert cardiology input and ACC
  involvement