DICOM and IHE, Integrating the Healthcare Enterprise

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DICOM and IHE,Integrating the Healthcare
Enterprise
Cor Loef Program Manager Interoperability
Philips Medical Systems

• Cor Loef
• Co-chair DICOM Strategic Advisory Committee
• Member IHE Planning and Technical Committee

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Contents

• Goal of IHE
• IHE process
• Integration Profiles and the role of standards in
  IHE
• DICOMs use in the IHE Integration Profiles
• Current topics
• Questions and answers

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Integration Hell in the Enterprise

• Different information islands Modalities, PACS,
  HIS, RIS, EPR
• Different standards and information models
  DICOM, HL7, XML
• Different (proprietary) interpretations and
  implementations

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Goal of IHE

• 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
• With minimal integration project pain

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IHE process

• Users and vendors work together to identify and
  design solutions for integration problems
• Intensive process with annual cycles
• Identify key workflows and integration problems
• Research select standards to specify a solution
• Write, review and publish Technical Framework
• Perform cross-testing at Connectathon
• Demonstrations at tradeshowsRSNA/HIMSS, and
  also JFR, DRK, JMCP

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The (multi-vendor) Integrated Imaging Solution
Modalities
Connection to other Network and/or TeleRadiology
Image Server
Radiology Information System
Diagnostic Workstation
CD Exchange
Web Distribution
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Role of standards in IHE

• IHE attacks real world radiology integration
  problems
• Standards such as HL7 and DICOM provide
  dictionaries
• IHE defines a phrasebook that solves real world
  problems by assembling pieces provided by
  DICOM/HL7
• IHE is also a way to promote and advance the
  implementaion of standards

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IHE Relation to Standards
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Use Case Roles Interaction Diagrams

• Examples of Actors
• ADT / Patient Registration
• Acquisition Modality
• Examples of Transactions
• Register Patient
• Images Stored

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• Goal of IHE
• IHE process
• Role of standards in IHE
• DICOMs use in the IHE Integration Profiles
• Current topics
• Questions and answers

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IHE Integration Profiles

• Integration solution for real-world integration
  problems
• Set of related transactions among systems
• Allow buyers to focus on high-level integration,
  cornerstone for defining requirements in RFPs
• Implementation is defined by the IHE Technical
  Framework

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Year 4 Integration Profiles
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1.Scheduled Workflow

• DICOM
• Modality Worklist Query Requirements, with
  Acquisition Protocol Setting option
• Required attribute mapping from Worklist to
  Images
• Modality Performed Procedure Step, with
  Exception Management option
• Store
• Storage Commitment

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2. Patient Information Reconciliation
report
HIS
RIS
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3. Consistent Presentation of Images
What the Radiologist Displays
What the Reviewing Physician Sees
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4. Presentation of Grouped Procedures
Requested ProcedureHEAD
RIS / PACS
Requested ProcedureCHEST

• DICOM
• Presentation State
• Modality Performed Procedure Step

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5. Simple Image and NumericReport

• DICOM
• Basic Text SR
• Enhanced SR
• Template TID 2000
• Codes from DCMR

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6. Key Image Notes
Radiologist Flags Images
Referring PhysicianSees Key Images First

• DICOM
• Key Object Selection Document SOP Class

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7. Access to Radiology Information

• DICOM
• C-FIND with required matching and return keys
• C-MOVE
• Images and SR

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8. Charge Posting
ADT
Account Management
Charge Processor
DSS/ Order Filler
Charge Posted

• DICOM
• required billing info in MPPS
• Film consumption
• Procedure Type
• Supplies and devices

Reporting Completed
PPS In Progress/ Completed
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9. Basic Security

• DICOM
• Basic TLS Secure Transport Connection
  Profile
• well-known port 2762

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10. Post-Processing Workflow
Post-Processing Manager
PP Workitem Claimed PP Workitem Completed PP PPS
Started PP PPS Completed
PP worklist Provided

• DICOM
• General Purpose Worklist
• Images
• Evidence Documents
• Mammography CAD SR
• Basic Text SR
• Enhanced SR
• Comprehensive SR

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10. Post-Processing Workflow use case
Department Scheduler/ Post-Processing Manager
Acquisition Modality
Image Manager
Image Creator
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• Goal of IHE
• IHE process
• Integration Profiles and the role of standards in
  IHE
• DICOMs use in the IHE Integration Profiles
• Current topics
• Questions and answers

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Current topics

• Reporting workflow
• Security Standard for Audit Records
• Extension to other clinical domains Cardio, NM
• Desktop Integration

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Integration back-office and/or front-office
Efficiency
Improve Clinical Decisions
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CCOW approach
A Federated System of Context-Managed Applications
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Integrationthe EPR approach
HIS
Other Clinical System
RIS
Cardiology PACS
VL, US, NM PACS
Electronic Patient Record
URL / URI?
Webserver
Web Viewers
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DICOM and IHE,Integrating the Healthcare
Enterprise

• Questions?