Integrating the Healthcare Enterprise IHE

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Integrating the Healthcare Enterprise - IHE
An initiative of the ACC to improve data
interoperability
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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

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Why Are Standards Important?

• The 1905 systems integration problem

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IHE bridges the gapbetween standards and
their practical usein healthcare
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Goals of IHE

• Advance standards-based healthcare data
  integration
• Improve clinical and administrative workflow
• Improve data flow where its needed, when its
  needed
• Improve the efficiency and effectiveness of
  clinical practice

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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

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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/Oceania
• IHE-Cardiology additional participating societies
  
• ASE, SCAI, ASNC, and more
• IHE-Cardiology in Europe sponsored by European
  Society of Cardiology (ESC)

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IHE Clinical Domains
IHE
EHR
-
Longitudinal Record
IHE
Cross
-
Enterprise
IT Infrastructure
Intra
-
Enterprise
IHE
IHE
9 Integration Profiles
Cardiology
Radiology
14 Integration Profiles
3 Integration Profiles
IHE
IHE
Future Domain
IHE Radiation Oncology
Laboratory
5 Integration Profiles

• Cardiology leverages the work of the other
  domains
• Cardiology contributes to the Electronic Health
  Record
• Being specified in IHE IT Infrastructure domain

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The ACC and IHE share a vision
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ACC and IHE Shared Vision

• The Digital Integrated Cardiac Record as part
  of the greater Electronic Health Record (EHR)

• Cross Enterprise physician access (in/out of
  hospital)

• Access all departments information

• Populations outcomes

• Secure access

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Cardiology and the Electronic Health Record

• ACC Vision of the Electronic Health Record (1999)
• The Digital Integrated Cardiac Record
• All care areas
• Across organization boundaries
• 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

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IHE Cardiology the Cath Lab example
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(A) room for improvement !
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IHE Annual Cycle Step 1

• Cardiologists identify clinical problems to be
  addressed -Integration Profiles
• Engineers from vendors collaborate to define
  technical specification (using standards such as
  DICOM and HL7)
• Vendors implement the technical specification and
  participate in the Connectathon and demos
• Vendors publish IHE Integration Statements, and
  users can buy IHE systems

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IHE Cardiology Year 1

• Three initial clinical problems to be addressed
• The ability to view an ECG from many locations -
  quickly and easily integrated into other
  applications
• Effective integration of patient, order, and
  procedure information in an Echo Lab, including
  mobile echo
• Effective integration of patient, order, and
  procedure information in a Cath Lab, including
  angio, hemo, and IVUS, especially for emergent
  cases

? Retrieve ECG for Display
? Echocardiography Workflow
? Cardiac Catheterization Workflow
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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

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Retrieve ECG for Display
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Could you do a TTE on this patient right 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

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Echocardiography Workflow
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There is a patient being brought 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

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Cardiac Catheterization Workflow
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IHE Annual Process Step 2

• Cardiologists identify clinical problems to be
  addressed - Integration Profiles
• Engineers from vendors collaborate to define
  technical specifications (using standards such as
  DICOM and HL7)
• Vendors implement the technical specification and
  participate in the Connectathon and demos
• Vendors publish IHE Integration Statements, and
  users can buy IHE systems

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IHE Annual Process Step 3

• Cardiologists identify clinical problems to be
  addressed - Integration Profiles
• Engineers from vendors collaborate to define
  technical specification (using standards such as
  DICOM and HL7)
• Vendors implement the technical specification and
  participate in the Connectathon and demos
• Vendors publish IHE Integration Statements, and
  users can buy IHE systems

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IHE Joint ConnectathonJanuary, 2005Oak 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 doesnt take up your
hospitals resources and no finger-pointing!
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IHE Annual Process Step 4

• Cardiologists identify clinical problems to be
  addressed - Integration Profiles
• Engineers from vendors collaborate to define
  technical specifications (using existing
  standards such as DICOM and HL7)
• Vendors implement the technical specification and
  participate in the Connectathon and demos
• Vendors publish IHE Integration Statements, and
  users can buy IHE systems

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Your Request for Proposals (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 !!
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Long Road Ahead 5 yr Roadmap
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Commitment to EHR

• David J. Brailer, MD, PhD
• National 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
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Why IHE?
Any Questions?
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Why IHE? (for vendors)

• 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 dont work well if not
  designed into the product
• Exponential growth of pain as systems are added

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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

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IHE Benefits(Vendors)

• Improves onsite customer support
• Reduces development cost
• Standardizes interface engineering
• Enables the vendors to focus on competitive
  features
• Improves customer satisfaction

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IHE Benefits(Consultants Providers)

• IHE Profiles facilitate interaction of multiple
  providers services to improve quality of
  patient care
• IHE provides a consistent view of the entire
  end-to-end clinical workflow
• Improves cost effectiveness of system
  implementation and operations

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More Information

• Information Available On the Web at

http//www.acc.org/quality/ihe.htm
http//www.ihe.net
Home Page of IHE Europe
www.IHE-Europe.org
Home Page of IHE Japan
www.jira-net.or.jp/ihe-j/en/index.html
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Visit IHE Booth 4563

• To learn more about IHE, visit Booth 4563 in
  Hall D for
• Theatre Presentations
• Clinical Scenario Demonstrations
• Cath/ECG Emergent Angioplasty
• Cath/ECG Change of Rooms
• Echo/ECG Add on Mobile Procedure
• Echo/ECG Stress Echo Images

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IHE Cardiology Annual Schedule

• Feb Apr 2005 Define IHE Cardiology Year 2
  Technical Framework
• Apr-May 2005 Public Comment Period
• June 2005 Vendor Invitational Workshop
• June 2005 Technical Framework for Trial
  Implementation
• June Dec 2005 Vendor Implementation
• Jan 2006 Vendor Connectathon (Testing)
• March 2006 ACC Demonstrations Year 2

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Four Clinical Scenario Demonstrations

• Clinical Scenario Demonstrations
• Cath/ECG Emergent Angioplasty
• Cath/ECG Change of Rooms
• Echo/ECG Add on Mobile Procedure
• Echo/ECG Stress Echo Images

Join a 10 minute demonstration Watch us
connect the docs.