DICOM andDICOM andIntegrating the Healthcare Enterprise:Integrating the Healthcare Enterprise:

Five years of cooperation and mutual influence

Charles ParisotChair, NEMA Committee

for advancement of DICOM

GE Medical Systems-IT

Andrei LeontievChair, DICOM WG6IDX

IHE MissionIHE Mission

IHE is an initiative promoting and supporting the integration of systems in the healthcare enterprise.

IHE Integration GoalsIHE Integration Goals

Improve the efficiency and effectiveness of clinical practice:

Improve Workflow Improve Information Accuracy Improve Information AvailabilityEnable Cross-System Functionality

IHEIntegrationProfiles B

A Proven Standards Adoption ProcessA Proven Standards Adoption Process

IHE Integration Profiles:– Detailled selection of standards and options each solving a specific

integration problem– A growing set of effective provider/vendor agreed solutions– Vendors can implement with ROI– Providers can deploy with stability

Standards

Easy toIntegrateProducts

IHEIntegrationProfile A

IHEDemonstration

IHEConnectathon

ProductWith IHE

User Site

RFPRFP

IHETechnical

Framework

IHE Integration profilesIHE Integration profiles

Access to Radiology Information

Basic Security

Consistent Presentation

of Images

Evidence

Documents

Key Image

Notes

Simple

Image and Numeric Reports

-

Presentation of Grouped Procedures

Post-

Processing Workflow

Reporting Workflow

Charge Posting

Patient Informa-

tion Reconci-

liation

,

Scheduled Workflow

IHE IT InfrastructureIHE IT Infrastructure5 Integration Profiles5 Integration Profiles

Enterprise User Authentication

Provide users a single nameand

centralized authentication process

across all systems

Enterprise User Authentication

Provide users a single nameand

centralized authentication process

across all systems

Retrieve Information for Display

Access a patient’s clinical information and documents in a

format ready to be presentedto the requesting user

Retrieve Information for Display

Access a patient’s clinical information and documents in a

format ready to be presentedto the requesting user

Patient Identifier Cross-referencing

for MPI

Map patient identifiers across independent

identification domains

Patient Identifier Cross-referencing

for MPI

Map patient identifiers across independent

identification domains

Synchronize multiple applications on a desktop to the same patient

Patient Synchronized Applications

Synchronize multiple applications on a desktop to the same patient

Patient Synchronized Applications

Consistent Time

Coordinate time across networked

systems

Consistent Time

Coordinate time across networked

systems

IHE GrowthIHE Growth Radiology

– 5 years – Extensive integration with IT IT Infrastructure

– 1 Year – Strong start with critical infrastructure issues addressed: authentication, linking patient ids, CCOW, retrieve info for display.

HIMSS Feb 2004 HL7-IHE Joint Demo. Laboratory

– 1 year – Lab Scheduled Workflow goes to public comment Oct 15th for demos mid 2004.

Cardiology– ACC and ESC have solid plans – launch imminent.

Strong influence from the DICOM Efficiency CultureStrong influence from the DICOM Efficiency Culture

IHE & DICOM / HL7IHE & DICOM / HL7Standards are vital (HL7, DICOM, ICD,

…)– They provide tools & technologies

But Standards alone are insufficient– They are open to interpretation– There is room for optional variations– They avoid specifying how to apply them to

particular real world scenarios

IHE Stimulated adoption of IHE Stimulated adoption of DICOM featuresDICOM features

By 1998, DICOM Storage and Query Retrieve SOP Classes have been implemented and actively used by dozens of vendors

However, some features were interpreted differently (scout lines, query keys)

IHE established common interpretation

Use of DICOM in Workflow Use of DICOM in Workflow ManagementManagement

DICOM MWL and MPPS were defined but not well implemented because their use without correlation with overall information flow in Radiology Department was limited

IHE defined use cases and established mechanisms to use these DICOM SOP Classes via Scheduled Workflow Integration Profiles

IHE researched DICOM data modelIHE researched DICOM data modelPatientPatient

Imaging Serv. Req. (Order)Imaging Serv. Req. (Order)

RequestedRequestedProcedureProcedure

ScheduledScheduledProcedure StepProcedure Step

1:n

1:n

0:n

SchedulingScheduling

Image

Study

Series

Series

ImageImageImage

Image

1:n1:n

1:n

Work ProductsWork Products

Study MgtStudy Mgt

PerformedPerformedProcedure StepProcedure Step

Work TrackingWork Tracking

n:m

IHE Integration Profiles based IHE Integration Profiles based on DICOMon DICOM

Most IHE Radiology Integration Profiles are based on one or more DICOM SOP Classes

IHE spearheaded implementations of several recently defined DICOM capabilities spending time and effort to build practical implementation framework for them

IHE ProfilesIHE Profiles vs. vs. DICOM SOPsDICOM SOPs

Consistent Presentation of Images

Simple Image and Numeric Report

Key Image Note

Grayscale Presentation State

Structured Reporting

Key Object Selection Document

IHE ProfilesIHE Profiles vs.vs. DICOM SOPs DICOM SOPs

Post-Processing Workflow and Reporting Workflow

Evidence Documents

General Purpose Worklist and PPS

Mammo CAD, Chest CAD, etc.

IHE initiated development of IHE initiated development of DICOM featuresDICOM features

IHE actively influenced development of DICOM:– Correction proposals for better consistency

of MWL/MPPS– Development of Key Object Selection

Documents– Development of common audit messaging

Operational influencesOperational influences

DICOM influenced development process of IHE Technical Framework:– Supplements, Correction Proposals

DICOM adopted IHE approach to definitions of use cases:– Actors, transactions…

SummarySummary

The development of DICOM has influenced the development of IHE Technical Framework, and in turn, was influenced by user needs that are advocated for by the framework developers.

Cooperative effort of two bodies have proved very effective and will continue in the future, allowing for further advancement of DICOM and its acceptance in user and vendor communities.

Where Is More Information Where Is More Information Available?Available?

IHE:• http://www.himss.org/IHE• http://www.rsna.org/IHE

DICOM :– http://dicom.nema.org