IHE Tutorial Geneva Oct. 10th, 2006IHE Tutorial Geneva Oct. 10th, 2006

IHEIHE OverviewOverview

Peter Künecke, SIEMENSPeter Künecke, SIEMENS

Emmanuel Cordonnier, ETIAMEmmanuel Cordonnier, ETIAMIHE-Europe „vendor“ co-chairsIHE-Europe „vendor“ co-chairs

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

Professional Societies Sponsorship Healthcare Providers & Vendors

Healthcare IT Standards HL7, DICOM, etc.

General IT Standards Internet, ISO, etc.

Interoperable Healthcare IT Solution Specifications

IHE Integration Profile Interoperable Healthcare IT

Solution Specifications IHE Integration Profile

Interoperable Healthcare IT Solution Specifications

IHE Integration Profile Interoperable Healthcare IT

Solution Specifications IHE Integration Profile

IHE Process

IHE : Integrating the Healthcare Enterprise IHE : Integrating the Healthcare Enterprise IHE : Integrating the Healthcare Enterprise IHE : Integrating the Healthcare Enterprise

IHE Organizational StructureIHE Organizational StructureMulti-Domain & Multi-NationalMulti-Domain & Multi-NationalIHE Organizational StructureIHE Organizational Structure

Multi-Domain & Multi-NationalMulti-Domain & Multi-National

Participantscontribute

Global Development:Radiology,IT Infrastructure,Cardiology,Lab, etc.

Delegates

IHE Europe

IHE North America

IHE Asia/Oceania

Regional &NationalDeployment

supervises reports

IHE (International) Strategic Development Committee

SponsorCo-Chairs Global

Interoperability

IHE Domain-related Planning and Technical

Committees

Who is IHE?Who is IHE?IHE is a joint initiative among:

Radiological Society of North America (RSNA) Healthcare Information Management Systems Society (HIMSS) American College of Cardiology (ACC) GMSIH, HL7-France-HPRIM, JAHIS (laboratory) American Society of Ophthalmology And many more….

Began in 1997 in Radiology (RSNA) and IT (HIMSS)

International effort: IHE- Europe and IHE-Japan

What is IHE NOTWhat is IHE NOT

• IHE is not a standard• You conform to a standard• You comply with IHE integration profile and actors

• IHE is not a standards development organization• IHE is not a certifying authority• IHE is not simply a demonstration project

• Demos are only one means to the end: Adoption• Backed up by documentation, tools, testing, and publication of

information• IHE is not just for radiology

IHE SynergiesIHE Synergies

Users are defining their needs, sponsoring the common events, controlling the tests and making the IHE based RFPs

Vendors are defining the specifications, selecting the standards, participating to the tests, claiming for integration statements and providing the IHE compliant products

A “balanced” organization, IHE, is driving the IHE process

The user‘s needsThe user‘s needs

Connect to distributed IT in healthcare (best of breed)

Access complete medical patient information (medical summary)

Support streamlined medical pathways (workflow)

Overcome limited budgets (lack of money)

Follow organizational concentrations (resources)

The vendor‘s needsThe vendor‘s needs

identify the users needs and, more, minimize local specificities

make the right choice among the multiple standards than apply, form medical, IT or medical IT

test its products with other, in different contexts, and prove to its client the quality of its product interoperability

The IHE ProcessThe IHE Process

User Site

RFP

Standards

IHE Integration Profiles in the core of IHE: Detailed 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 Process started in 1998; continuously improved

IHEDemonstration

IHEConnect-a-thon

IHE Connect-a-thonResults

IHETechnical

Framework

IHEIntegrationProfiles B

IHE IntegrationProfile A

Userneeds Easy to

IntegrateProducts

Easy toIntegrateProducts

Product IHE IntegrationStatement

ProductWith IHEProductWith IHE

IHE, Annual CycleIHE, Annual CycleInstallationInstallation

on siteon siteDemonstrationDemonstration(National show)(National show)

Vendors implementVendors implementthe profile in theirthe profile in their

productsproducts

Multi-vendorsMulti-vendorstest at the annualtest at the annualConnect-a-thonConnect-a-thon

Engineers from vendorsEngineers from vendors collaborate to define collaborate to define

technical specification technical specification

Clinicians identifyClinicians identifyclinical problemsclinical problems to be addressed to be addressed

Choice of relevantChoice of relevantstandards (HL7, DICOM,standards (HL7, DICOM,

W3C, Oasis…) W3C, Oasis…)

Assurance for Users: Connect-a-thonAssurance for Users: Connect-a-thon

Annual validation (Connect-a-thon): Real work validation, not only test on protocol level or on paper work.

Better than a pure certification.

Paris, Aachen, Padua, Nordwijkerhout, Barcelona2002 2003 2004 2005 2006

IHE demonstrationsIHE demonstrations

Request for Proposals (RFPs)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

Locations of Success (USA)Locations of Success (USA)Bethesda Healthcare Systems Cleveland Clinic FoundationDetroit Medical Center Grossman Imaging Centers Magic Valley Regional Medical Center Mayo Clinic Jacksonville McKay-Dee Hospital MeritCare Medical System Montefiore Medical Center Our Lady Of The Lake Regional Medical Center (OLOL) US Dept. of Veterans Affairs VA Puget Sound Health Care System St. Vincent Hospital and Health ServicesMayo Clinic Clinic Jacksonville Sinlau Hospital University of WisconsinWarren Hospital

17

Locations of Success (EUR)Locations of Success (EUR)

Hôpitaux Universitaires de Genève

Johannes Gutenberg University Hospital, Mainz

Klinikum Nürnberg

Staedtisches Klinikum Goerlitz

Steinberg Diagnostic Medical Imaging

University of Pisa

Centre Hospitalier Centre Hospitalier d Alès

Centre Hospitalier Centre Hospitalier d'Arras

Centre Hospitalier de Centre Hospitalier de Beauvais

Centre Hospitalier de Centre Hospitalier de Cahors

Centre Hospitalier Intercommunal et Clinique de Saint-Benoît

Val d'or Hospital

12

View BeyondView Beyond

****

Active Domains

• Radiology• IT-Integration• Laboratory• Cardiology• Patient Care Coordination• Patient Care Devices• Eye Care

• Pathology• Endoscopy• Dermatology

• Pharmacology

**

Evolution of IHE DomainsEvolution of IHE Domains

Radiology

IT Infrastructure for Healthcare

Cardiology

Laboratory

Radiation Oncology

Patient Care Coordination

Patient Care Devices

Pathology

Pharmacy

IHE Global Developments

Integration Profiles – Solutions to Real-World Needs & Problems:

Within Clinical Departments e.g.:o Radiologyo Cardiologyo Labo ...

Across Departmental &Institutional Boundaries – XDS

o RHIOs (Regional Healthcare Information Organizations)

o EHR Enablers

Veterinarian

Endoscopy

Eye Care / Ophthalmology

Yea

r 1

(199

9)

Yea

r 2

(200

0)

Yea

r 3

(200

1)

Yea

r 4

(200

2)

Yea

r 5

(200

3)

Yea

r 6

(200

4)

Yea

r 7

(200

5)

Yea

r 8

(200

6)Y

ear

8 (2

006)

Integration Profiles (3)Integration Profiles (3)

Solutions exist already in different domains:

Number of existing Integration Profiles

RAD Radiology: 17ITI Information Technology Integration: 9LAB Laboratory Medicine: 6CARD Cardiology: 6PCC Patient Care Coordination: 1

... and more are coming... and more are coming

IHE Technical FrameworkIHE Technical Framework

Detailed standards implementation guides Cardiology IT Infra Lab Radiology

Pt. Registration [RAD-1] Patient Update [RAD-12]

Pt. Registration [RAD-1] Patient Update [RAD-12]

Placer Order Management [RAD-2] Filler Order Management [RAD-3]

ADT

Query Images [RAD-14] Retrieve Images/Evidence [CARD-4]

Image Display

Modality Image/Evidence Stored [CARD-2]

Storage Commitment

[CARD-3]

Procedure Scheduled [RAD-4]

Procedure Updated [RAD-13]

Query Modality Worklist [RAD-5]

Performed Procedure

Step Manager

Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]

Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]

Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]

Order Placer

Acquisition Modality

ImageManager

ImageArchive

DSS/ Order Filler

Patient Update [RAD-12]

Modality Image/Evidence Stored [CARD-2]

Storage Commitment

[CARD-3]

Evidence Creator Modality PS in Progress [CARD-1]

Modality PS Completed [RAD-7]

Instance Availability Notification [RAD-49]

Pt. Registration [RAD-1] Patient Update [RAD-12]

Pt. Registration [RAD-1] Patient Update [RAD-12]

Placer Order Management [RAD-2] Filler Order Management [RAD-3]

ADT

Query Images [RAD-14] Retrieve Images/Evidence [CARD-4]

Image Display

Modality Image/Evidence Stored [CARD-2]

Storage Commitment

[CARD-3]

Procedure Scheduled [RAD-4]

Procedure Updated [RAD-13]

Query Modality Worklist [RAD-5]

Performed Procedure

Step Manager

Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]

Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]

Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]

Order Placer

Acquisition Modality

ImageManager

ImageArchive

DSS/ Order Filler

Patient Update [RAD-12]

Modality Image/Evidence Stored [CARD-2]

Storage Commitment

[CARD-3]

Evidence Creator Modality PS in Progress [CARD-1]

Modality PS Completed [RAD-7]

Instance Availability Notification [RAD-49]

Query Modality Worklist [RAD-5]

ADT Order Placer

Register J.Doe

AcquisitionModality

Placer OrderManagement –New [RAD-2]

Patient Reconciliation

Department System Scheduler/Order Filler

Schedule Procedure

Procedure Scheduled [RAD-4]

Modality Procedure Step Completed [RAD-7]J.Doe ->

J.Smith

Patient Update/Merge [RAD-12]

Modality Procedure Step Completed [RAD-7]

PatientRegistration [RAD-1]

Patient Update/

Merge [RAD-12]

Modality Procedure Step In Progress [CARD-1]

Modality Procedure Step In Progress [CARD-1]

Perform Acquisition

Filler Order Mgmt - Status Update [RAD-3]

Filler Order Mgmt - Status Update [RAD-3]

ImageManager/

PPS Manager

Filler Order Management -New [RAD-3]

One or the other methods of creating an order is used

Query Modality Worklist [RAD-5]

ADT Order Placer

Register J.Doe

AcquisitionModality

Placer OrderManagement –New [RAD-2]

Patient Reconciliation

Department System Scheduler/Order Filler

Schedule Procedure

Procedure Scheduled [RAD-4]

Modality Procedure Step Completed [RAD-7]J.Doe ->

J.Smith

Patient Update/Merge [RAD-12]

Modality Procedure Step Completed [RAD-7]

PatientRegistration [RAD-1]

Patient Update/

Merge [RAD-12]

Modality Procedure Step In Progress [CARD-1]

Modality Procedure Step In Progress [CARD-1]

Perform Acquisition

Filler Order Mgmt - Status Update [RAD-3]

Filler Order Mgmt - Status Update [RAD-3]

ImageManager/

PPS Manager

Filler Order Management -New [RAD-3]

One or the other methods of creating an order is used

Organization of TFsOrganization of TFs

Volume 1: Integration Profiles

Describes clinical need and use cases Identifies the actors and transactions

Volume 2+ of Technical Framework

Provides implementation specification for each transaction by specific reference to Standards

Integration Profiles (1)Integration Profiles (1)

Based on real use cases of a real users

Easy to understand functional units using and specifying commonly used standards

Describing actor / transaction relations

Giving solutions to interoperability problems

Independant on vendors or providers

Integration Profile (2)Integration Profile (2)

24: Report SubmissionStructured Report Export: 28

25: Report Issuing

Report Creator

26: Query Reports27: Retrieve Reports

Report Repository

Report Reader

External Report Repository Access

Report Manager

Enterprise Report Repository

ActorActor

TransactionTransaction

Integration Profile (2)Integration Profile (2)

24: Report SubmissionStructured Report Export: 28

25: Report Issuing

Report Creator

26: Query Reports27: Retrieve Reports

Report Repository

Report Reader

External Report Repository Access

Report Manager

Enterprise Report Repository

Product I

Product II

All products will All products will meetmeetneeds of the usersneeds of the users in inreal life and are on technicalreal life and are on technicaland workflow level and workflow level interoperableinteroperable..

imagesstored

patientinformation

RIS

examination orders

imagesretrieved

HIS

PACS

procedurescheduled

Prefetch any relevantprior studies

modalityworklist

report

report

Registration

Orders Placed

Orders Filled

Film

FilmFolder

Image Manager& Archive

FilmLightbox

report ReportRepository

DiagnosticWorkstation

Modality

acquisitionacquisitionin-progressin-progressacquisitioncompleted

acquisitioncompleted

imagesprinted

AcquisitionModality

Example 1: Scheduled WorkflowExample 1: Scheduled Workflow

Schedule Workflow DiagramSchedule Workflow Diagram

Order Placer

PerformedProcedure Step

Manager

ADTPatient Registration

Image Archive

Image Manager

Image Display

Image Creator

AcquisitionModality

DepartmentSystem Scheduler– Order Filler –

Modality Worklist

Patient Registration

Procedure Scheduled

Images Availability QueryImagesStored

StorageCommit

StorageCommit

ImagesStored

PPSIn-Progress/ Completed

Fil

ler

Ord

erM

anag

emen

t

Placer Order Management

Q /RImages

PPSIn-Progress/ Completed

PPSIn-Progress/ Completed

HL7

DICOM

Profile example 2: XDS (Document Sharing)Profile example 2: XDS (Document Sharing)

Acute Care (Inpatient)

PCPs and Clinics (Ambulatory)

Long Term Care

Other Specialized Careor Diagnostics Services

EHR-CR: Care Record systemssupporting care delivery

Documents Registry

DocumentRepository

EHR-LR:Longitudinal Recordas usedacross-encounters

Submission of Document References

Retrieve of selected Documents

Document Consumer

Retrieve Document

Query Documents

Patient Identity Source

Patient Identity Feed

Document Source

Document Registry

Document Repository

Provide & Register Document Set

Register Document Set

XDS Actors and TransactionsXDS Actors and Transactions

IHE Integration StatementIHE Integration Statement

Challenges for a vendorChallenges for a vendor

Healthcare is one of the most promising market for IT

National Markets for Health IT products in Europe are too small to justify required R&D investment

Interoperability is not only increasingly useful but it becomes now a condition for surviving

IHE is the best response to these constraints

IHE Cost / Benefits for VendorsIHE Cost / Benefits for Vendors

Costs: All Technical Framework, publication of IHE

Integration Statement: free Participants to the Connect-a-thon: ~2k€ fees + travel

+ software development (the real expense!) Contributors to the Technical framework: time & travel

expenditure / t-con participation

Benefits: Conformance to the user demand and proof (all) Tests with multiple vendors, (participants, not

customers) Access to international expertise (contributors)

In ConclusionIn Conclusion

IHE is dedicated to interoperability of IT systems in healthcare

IHE is a user & vendor driven initiative

IHE is already working worldwide

Users and vendors already benefit

Thank you

for your attention!www.ihe-europe.orgwww.ihe.net