Integrating the Healthcare Enterprise

1
Integrating the Healthcare Enterprise

• IHE an Overview

Eric Poiseau Laboratoire IDM Faculté de
Médecine Université de Rennes 1
2
What is IHE about?

• Its an initiative promoting and supporting the
  integration of systems in the healthcare
  enterprise.
• Integration Goal Improve the efficiency and
  effectiveness of clinical practice by
• Improved Information Flow
• Advanced Multi-System Functions

3
What is Integrating the Healthcare Enterprise ?

• Sponsored jointly by the user community
• EAR, ECR, SFR, GMSIH, SIRM, DRG, ESC
• BIR, RCR, IPIM, CoR, NHS (joined from UK)
• RSNA, HIMSS, ACC, JRS (USA, Japan)
• and by the vendor community
• IHE focuses on the flow of information between
  several systems in several departments operating
  within a healthcare enterprise.

In Europe 13 Vendors - 13 systems in 2001 33
Vendors - 60 systems in 2002 47 Vendors - 80
systems in 2003 49 Vendors - 82 systems in 2004

4
How is IHE related to Standards?

• IHE is not a new standard !
• Information needs to travel widely
• Information is applied within a context
• Workflows cross Standard borders
• IHE specifies how to apply Standards (DICOM, HL7,
  Web) to real world scenarios integration
  problems
• IHE defines a practical phrasebook

5
What is the Result?

• Vendors implement well-defined subsets of IHE
  (actors profiles) on their systems
• IHE is not a product
• it is introduced by a software feature or
  upgrade
• Customers can request specific IHE Integration
  Profiles in a tender for clinical systems
• The systems have been pre-tested at the
  Connectathon

6
IHE Connectathon

• Unique test platform for vendors
• Peer to peer tests
• Workflow tests
• New collaboration culture for engineers
• They learn to know each other
• Warranty for users

7
The IHE process
We define
IHETechnical Framework
We manage
Planning Committee
IHEConnectathon
IHEDemonstrations
We test
We show
8
Technical Framework Document Organization

• Domain technical frameworks
• RAD, CARD, LAB, IT-I
• Vol 1 Actor and Integration Profiles
• Vol 2,3,.. Transactions
• Maintenance
• Change Proposals
• Supplements

9
Technical Framework

• The IHE Technical Framework is based on actors
  that interact through transactions.
• Actors are information systems or components of
  information systems that produce, manage, or act
  on information associated with operational
  activities in the enterprise.
• Transactions are interactions between actors that
  transfer the required information through
  standards-based messages.
• Specific sets of actors and transactions are
  specified in the Integration Profiles

10
Actor descriptions examples

• Acquisition Modality A system that acquires and
  creates medical images, e.g. a Computed
  Tomography scanner or Nuclear Medicine camera. A
  modality may also create Grayscale Softcopy
  Presentation States for the consistent viewing of
  images and create Key Image Notes.
• ADT Patient Registration A system responsible
  for adding and/or updating patient demographic
  and encounter information. In particular, it
  registers a new patient with the Order Placer and
  Department System

11
Transaction descriptions example

• Patient Registration The ADT system registers
  and/or admits a patient and forwards the
  information to other information systems.
• Placer Order Management The Order Placer
  informs the Order Filler of the initiation or
  cancellation of an order. The Placer/Filler Order
  Management transaction will sometimes be referred
  to as -New when a new order is being initiated,
  or as -Cancel when an existing order is
  canceled.

12
Integration Profiles

• Description
• Actors/Transactions interaction diagram
• Actors/Transactions requirements
• Process flow

13
Integration Profiles Description

• The Scheduled Workflow Integration Profile
  establishes the continuity and integrity of basic
  radiological data. It specifies a number of
  transactions that maintain the consistency of
  patient and ordering information as well as
  providing the scheduling and imaging acquisition
  procedure steps. This profile also makes it
  possible to determine whether images associated
  with a particular performed procedure step have
  been stored (archived) and are available to
  enable subsequent workflow steps, such as
  reporting.

14
Integration Profiles Interactions diagram
15
Integration Profiles Actors / Transactions
table
16
Integration Profiles Process Flow
17
Transaction descriptions

• Scope
• Use case roles
• References to standards
• Interaction diagram

18
Transaction Scope

• Defines the scope of application of the
  transaction
•  This transaction involves the patient
  information, including demographics, captured at
  the point of encounter. This may occur when the
  visit is scheduled, if that precedes patient
  arrival at the institution. This transaction is
  used for both in-patients (i.e., those who are
  assigned a bed at the facility) and outpatients
  (i.e., those who are not assigned a bed at the
  facility). 

19
Transaction Use case example
20
Transaction References to standard

• Example for transaction 32  Authenticate Node 
• DICOM 2001 PS 3.15 Security Profiles. Annex B1
  The Basic TLS Secure Transport Connection
  profile.
• IETF Transport Layer Security (TLS) 1.0 (RFC
  2246)
• ITU-T Recommendation X.509 (03/00). Information
  technology - Open Systems Interconnection - The
  directory Public-key and attribute certificate
  frameworks"

21
Transaction Interaction diagram
22
IHE Radiology Integration Profiles


Scheduled Workflow

-
Patient Info. Recon-ciliation
Post-Processing Workflow
New
New
Basic Security


23
Workflow

• Most critical issue in a Radiology Environment
• Inter- or corrupted information chain
• Paper based information -gt multiple re-entry of
  data
• Different non adapted subsystems dont cooperate
• Error correction takes huge amount of time
• Stale information
• Brandnew information not known (cancellation,
  change)
• Status update information
• Exam registered, finished, archived, reported,
  delivered

24
IHE Scheduled Workflow in Radiology
RIS
PACS Archive

• A Closed Loop
• Update IS Scheduling
• Match Procedure with Order
• Support Billing Based on MPPS
• Avoid Reading Incomplete Procedures

25
Scheduled Workflow
HL7
DICOM
26
Patient Information Reconciliation

• Trauma patient
• Manual wrong data entry at the modality
• System crashed
• VIP person

27
Patient Information Reconciliation
28
IHE-Laboratory
Laboratory Patient Information Reconciliation
(Future)
Provide users a single nameandcentralized
authentication processacross all systems
Updates resulting from unidentified or
misidentified Patient
Point of Care Testing(Future)
Provide users a single nameandcentralized
authentication processacross all systems
Extend laboratory testing with bedside testing
devices
Patient Synchronized Applications
Outside Healthcare Enterprise Testing (Future)
Synchronize multiple applications on a desktop to
the same patient
Cooperation with external laboratory
29
IHE IT Infrastructure
New
Patient Synchronized Applications
Synchronize multiple applications on a desktop to
the same patient
Patient Identifier Cross-referencing for MPI
Patient Identifier Cross-referencing for MPI
Map patient identifiers across independent
identification domains
Map patient identifiers across independent
identification domains
30
Audit Trail Node Authentication ATNA

• Protect Patient Privacy and System Security
• Meet ethical and regulatory requirements
• Enterprise Administrative Convenience
• Unified and uniform auditing system
• Common approach from multiple vendors simplifies
  definition of enterprise policies and protocols.
• Common approach simplifies administration
• Development and support cost reduction through
  Code Re-use
• Allows vendors to leverage single development
  effort to support multiple actors
• Allows a single development effort to support the
  needs of different security policies and
  regulatory environments.

31
Patient Identifier Cross-referencing for MPI PIX

• Allow all enterprise participants to register the
  identifiers they use for patients in their domain
• Participants retain control over their own
  domains patient index(es)
• Support domain systems queries for other
  systems identifiers for their patients
• Optionally, notify domain systems when other
  systems update identifiers for their patients

32
Patient Synchronized Applications PSA

• Patient Synchronization of Multiple Disparate
  Applications
• Single Patient Selection
• When combined with PIX Profile, allows patient
  synchronization across patient identifier domains
• When combined with EUA Profile, provides user
  Single Sign-on (SSO)

33
Retrieve Information for Display RID

• Simple and rapid access to patient information
• Access to existing persistent documents in
  well-known presentation formats CDA, PDF, JPEG.
• Access to specific key patient-centric
  information for presentation to a clinician
  allergies, current medications, summary of
  reports, etc..
• Links with other IHE profiles - Enterprise User
  Authentication, Patient Identifier
  Cross-referencing and Cross Enterprise Document
  Sharing

34
Enterprise User Authentication

• Support a single enterprise governed by a single
  set of security policies and having a common
  network domain.
• Establish one name per user to be used for all IT
  applications and devices.
• Facilitate centralized user authentication
  management.
• Provide users with single sign-on.

35
Patient Demographics Query PDQ

• Allow quick retrieval of a patient list including
  common patient names, identifiers, contacts, and
  visit information
• Enable selection of correct patient when full
  identification data may not be available
• Limits access to only a subset of demographic and
  visit information

36
Personnel White Pages PWP

• Provide access to basic information about the
  human workforce members
• Does not include Patients
• Defines method for finding the PWP
• Defines query/access method
• Defines attributes of interest

37
IHE Integration Statement

• Product UVW supports the
• IHE K Actor with the
• IHE X and Y Integration Profiles
• IHE J Actor with the
• IHE T Integration Profile

38
IHE Integration Statement
39
Connectathon Results Browser
40
More Information

• Links
• http//www.ihe-europe.org
• http//www.rsna.org/IHE
• http//www.ihe-uk.org
• Technical Frameworks

Thank you