Medicine

1
Medicine Information Science

• Presenter Dr. David Mayer
• Host Thomas Huffner

2
First Impressions

• Information science medicine?
• Scenarios - new ER patient
• Benefits - best care possible
• Drawbacks - privacy rights

3
Integrating the Healthcare Enterprise (IHE)

• Initiative started in November 1998 by the
  Radiological Society of North America (RSNA) in
  conjunction with the Hospital Information and
  Management Systems Society (HIMSS).
• Devise a technically viable specification for
  improving communication between the various
  healthcare systems and medical devices.

4
Integrating the Healthcare Enterprise (IHE)

• IHE is intended to improve communication between
  the various healthcare systems and medical
  devices.
• In short, the universal sharing of patient
  information and history for optimal diagnosis and
  treatment.

5
IHE Complexity

• Divided up into multi-year projects with each
  year focusing on various aspects of medical
  concern
• For example Year 1 concentrates on integrating
  the radiology department within the hospital
  environment.
• Ultimate goal achieving multidisciplinary
  clinical documentation with a complete and
  integrated Computerized Patient Record (CPR).

6
IHE Radiology

• Hospital Information System (HIS) - patient
  registration and admission, patient transfer,
  order placing and billing at the hospital level.
• Radiology Information System (RIS) - functions
  specifically for the radiology department, e.g.
  order-filling, patient/examination scheduling,
  reporting and materials management.
• Sometimes functionality is achieved by both
  systems in relevant situations.

7
Systems Integration

• Of utmost importance
• Different vendors with different systems must be
  integrated and cross-compatible
• Each vendor must meet specific requirements for
  the system it provides
• Vendor must also acknowledge other vendors
  systems and compatibility issues that may arise
  from them
• Therefore, flexibility and interoperability is a
  must!

8
System Workflow Integration

• System relations and operability with other
  systems must be devised and checked for accuracy
• Complex system standards come into play
• Emergency situations, deviations from the norm

9
Digital Image COmmunication in Medicine (DICOM)

• standard for digital image communication in
  medicine.
• Developed by ACR (American College of Radiology)
  and the NEMA (National Electrical Manufacturers
  Association) in 1980s
• Is still evolving a recent standards redesign
  occurred in 1993

10
DICOMs Purpose

• Initially, to communicate and print images
  through networks and media
• Currently, focus has shifted from the
  communication of images to the integration of
  modalities and workstations in the total
  hospital.
• This requires interoperability with hospital
  information systems (HIS) and radiology
  information systems (RIS).

11
Basis of DICOM

• model that assumes that a request or order for an
  examination consists of one or more requested
  procedures, which in turn consists of one or more
  procedure steps.
• - Basic worklist management
• - Performed procedure step

12
DICOM the HL7

• DICOM uses the Health Level 7 (HL7) as a standard
  interface for alphanumeric information
• Current goal achieve integration and
  interoperability within the current standards as
  well as achieving a more efficient workflow in
  the hospital
• Very complex for every integration, there is a
  custom solution
• Terminology is not universal between DICOM, HL7
  and real world

13
Standards Promotion The IHE

• Integrating the Healthcare Enterprise (IHE)
• Philips Medical Systems helped define and shape
  its initial principles
• Representatives of healthcare providers,
  information system vendors, imaging system
  vendors and standardization bodies were invited
  to attend
• to achieve non-proprietary workflow integration
  and interoperability across the healthcare
  enterprise, based on available standards, through
  a process of public demonstrations.

14
IHE the Real World
(Picture Archiving and Communications System)
15
IHE Benefits

• Vendors generally accepted solutions, etc.
• Users systems integration optimal treatment
• IHE Technical Framework function oriented
  approach orders contain procedures, etc
• However, the IHE Technical Framework is not a
  complete hospital information architecture. It
  only describes the parts relevant to the IHE
  demonstration.

16
IHE Functional ComponentsYear 1
17
The IHE

• Future challenges
• Integration of other standards including
  web-based technologies and those yet to be
  developed

18
Medical Image Management in Healthcare Enterprise

• Dr H K Wang - Professor of Radiology and Director
  of Informatics, Childrens Hospital Los
  Angeles/University of Southern California
• Regarding the digitization of medical images
  its drawbacks and benefits
• An average US hospital of 500 beds performing
  200,000 radiological examinations per year
  accumulates about 10 gigabytes per day or three
  to five terabytes per year. Management of these
  large image files involves picture archiving and
  communication system (PACS).

19
PACS

• Picture Archiving and Communication Systems
• Designed to manage medical images and related
  data and streamline operations throughout the
  whole patient care delivery process
• Expensive
• Goal shorten the time for diagnosis and thus
  improve the efficiency of healthcare delivery
• Used in North America, Europe and most Asian
  countries

20
Hospital Databases Image Modalities

• Clinical information databases
• Various sub-systems
• All deal with sharing of various image modalities
• Image Modality Examples
• Magnetic Resonance (MR)
• Ultrasound
• Digital subtraction angiography (DSA)
• Nuclear medicine
• Microscopy images
• Endoscopy images

21
PACS Functionality

• Image conversion
• Archiving
• Server-to-server transfer of data
• Work station functionality
• Diagnostic
• High resolution - 2500 x 2000 pixels
• Clinical
• Medium resolution 2000 x 1600
• Desktop
• Low resolution 1000 x 800

22
Electronic Patient Record (EPR)

• Can replace hospital information systems (HIS)
• Distributes image related patient data when
  necessary
• Functions
• Accept direct digital input of patient data
• Analyze patient and provider profiles
• Provide clinical decision support and suggest
  courses of treatment
• Perform outcome analysis and patient and
  physician profiling
• Distribute information across different data
  platforms and health information systems.

23
The PACS Business Model

• Cost
• 5 million plus 8 service and maintenance per
  year, varies
• Several models are used

24
Outright Purchase with Maintenance Contract

• the enterprise provides the finance for PACS
  equipment purchase and annual maintenance and
  also plans and designs the system.
• A system integrator would be responsible for
  implementation, training, service and system
  upgrade. The enterprise would run the daily
  operation.

25
Outsourcing

• the enterprise outsources the complete system
• Outsource company operations
• - Planning
• - Design
• - Implementation

26
Application Service Provider (ASP)

• Can be small or large.
• Supports either the complete image management
  system or subsets of the project
• Example supporting offsite archive, long-term
  image archive/retrieval or second copy archive,
  DICOM Web EPR server development and Web-based
  image database.

27
Pay-per-procedure

• This model is for a system integrator to take
  over the complete enterprise image management.
• The system integrator charges the enterprise a
  fee per use.

28
Software Purchase Model

• A new model is software purchase only
• The enterprise first designs the image management
  system architecture including hardware and
  workstation.
• The enterprise then decides what software can be
  implemented in-house and what needs to be
  purchased.

29
Loosely Coupled Partnership

• the enterprise forming a partnership with a
  system integrator
• The partners share some defined responsibility in
  the planning, design, implementation and
  operation
• The procurement is similar to the outright
  purchase but with a favorable discount because of
  certain contributions from the enterprise.

30
Tightly Coupled Partnership

• Sharing of responsibilities between the
  enterprise and the system integrator
• - Long term commitment of partnership
• - Sharing of technical materials related to the
  project
• - Sharing of personnel and manpower towards
  completion of project
• - Financial issues
• - Ethical issues
• - This is the preferred model for large-scale
  enterprise-level image distribution

31
Presenter Introduction

• Dr. David P. Mayer
• Chairman, Mercy Health System