rsna 2007 – informatics classroomwhat ihe delivers 1 kevin odonnell, toshiba medical systems chris...

1RSNA 2007 – Informatics Classroom What IHE Delivers

Kevin O’Donnell, Toshiba Medical SystemsKevin O’Donnell, Toshiba Medical Systems

Chris Lindop, GE HealthcareChris Lindop, GE Healthcare

Your Problems;Your Problems;IHE SolutionsIHE Solutions

2RSNA 2007 – Informatics ClassroomRSNA 2007 – Informatics Classroom

Learning ObjectivesLearning Objectives

Review well-known sources of pain still commonly afflicting radiologists, department managers, PACS administrators and referring physicians in practice today

Enumerate some of the specific ways the quality, speed, cost and efficiency of the care you provide may be being degraded

Understand how you should be benefiting from new electronic infrastructure and integrated systems

Learn which IHE Integration Profiles would be good first steps for each problem


Images on CDsImages on CDs

Scenario: “A referred patient arrives with relevant prior

imaging on a CD”

And then the fun starts…


Your Problems with CDsYour Problems with CDs

“I plug the CD into my workstation and nothing happens” The CD format is not compatible with my workstation The images are not in DICOM The images are DICOM but are not properly encoded The CD tries to auto-launch a viewer that collides with the one

on my workstation

Impact Time is wasted Relevant clinical data is inaccessible



“Every CD seems to have a different viewer”

It costs me time trying to learn them all

I don’t work as quickly when I don’t know how to use them

The viewers lack specific features I need

The viewers require additional software that I do not have

My IT group has security concerns about running “unknown” software

from CDs

Impact More wasted time Less effective review of data



“The Images are in the PACS but are messed up”

The patient ID is wrong, it doesn’t come up in a query

I can’t display the new images with the old

The unknown procedure codes mess up my hanging protocols

Impact: More lost time More drags on effectiveness


How It Should WorkHow It Should Work

I insert the CD into my workstation The DICOM Viewer installed on my workstation displays the CD

contents my way

I decide to import the data into my PACS The CD content is retrieved from the disk The content is reconciled and automatically prepared for importation

into the patient’s electronic medical record The images and reports are reviewed on PACS in the

context of the current patient encounter

I insert the CD into a “random” PC (uncommon) CD may have a DICOM viewer CD may have “Browser” versions of images and report


IHE SolutionIHE Solution

Two relevant Integration Profiles

(PDI) - Portable Data for Imaging Uses only the most common, most compatible DICOM CD

format Adds requirements to remove common sources of problems Based on cross-testing between vendors

(IRWF) – Import Reconciliation Workflow During image import, the details are fixed to match (or not

conflict with) local values• Patient IDs, Name• Procedure Codes, Accession Numbers, etc.


Acquisition WorkflowAcquisition Workflow

Scenario: “ I order an imaging procedure for my patient.”

Really, what could be simpler?


Your Problems with WorkflowYour Problems with Workflow

“Why are my techs entering patient and procedure information on all the systems?” Why is this a manual task?

• My techs should be doing scans, not duplicating data entry All too often, data entry mistakes are made

• Patient records get fragmented• Priors are not always available at time of reading

Impact Degraded care, reduced productivity



“Why is it so hard to close an order?” Somewhere in the process of getting the images and distributing

the reports, the accession # keeps getting messed up Studies get disconnected and go unread Billing details don’t match what was actually performed

(so the payor doesn’t want to pay)

Impact Delayed care, reduced productivity, lost revenues



“Why aren’t my images showing up on PACS?” If patient info was mistyped at acquisition, the query won’t match

• Someone spends time searching or we re-scan

Network failure; modality didn’t know they weren’t on PACS and deleted them

We make techs manually confirm all images are on the PACS• It only takes a couple minutes• At 100,000 studies per year, that’s only 416 8-hour shifts of work

Impact Delayed care, increased dose, reduced productivity



“When a name needs to be fixed I never know when/if the patient record will be properly reassembled.” John Doe’s get scanned and identified later

• images/report needs to be reintegrated

Patients get incorrectly entered (or mis-selected in a worklist) Peoples names change (e.g. marriage) People are changing things on the modality, in the PACS, in the RIS,

sometimes inconsistently, or at different times So their clinical history is missing, or their images have been moved

and I can’t find them, or both

Impact Delayed care, incomplete information, reduced productivity


How It Should WorkHow It Should WorkRegistration feeds the Scheduling System Patient demographics are entered once at registration & centrally

managedModalities download Worklists Patient demographics & Procedure detail entry is automatic, fast,

accurate & up-to-the-minute Relevant clinical and protocol information details are included Procedure code in worklist can optionally trigger protocol selection

PACS is notified of scheduled procedures Relevant priors can be automatically pre-fetched

Modalities report procedure progress to RIS and PACS

Accession # consistently replicated in Images and Reports Better tracking/closure of orders, better billing

PACS receipt of Images is automatically confirmed by Modality Fewer Lost Studies



Two relevant IHE Integration Profiles

(SWF) – Scheduled Workflow Integrates Registration, Scheduling, Acquisition Workflow and

Image Content Bridges HL7 and DICOM spaces properly Most current products support it (but ask for it to be sure)

(PIR) – Patient Information Reconciliation Facilitates coordinated reconciliation between PACS, RIS and HIS Handles John Does, fixing mistakes and back-filling orders for

unscheduled exams


Cross-Enterprise Image SharingCross-Enterprise Image Sharing

Scenario

An ER patient with abdominal pain has a lesion on their x-ray.

The H&P noted an earlier x-ray (in another state) with an

abnormal finding. I need the prior images STAT!

OK, no one expects this to be easy…


Your Image Sharing ProblemsYour Image Sharing Problems

“How do I even find out who has the images?”

Patient said it was “an imaging center in downtown LA”

How many imaging centers are there in downtown LA?

Patient was not sure of the name of the PCP

Impact

Time wasted trying to track down and obtain the images

Potentially unnecessary procedures (imaging, surgery)



How do I find the matching Patient Record at the other institution? Patient doesn’t know their patient ID from the other site

I only have the Patient ID for my institution

The other site doesn’t really want to let me go browsing their patient database

Impact More delays and uncertainty



How do I get the Images? Mail? No - need images STAT Fax? Not good for sending images E-mail? Do we both have secured e-mail systems? How

do I view them? Their web viewer? No account on their system - No

experience with their product

Impact Delayed care or incomplete information



What about security and privacy policies? I don’t have privileges at the other hospital. Who do I have to talk to to get access to the data? Isn’t there some way to get emergency access?

I’m just trying to treat the patient.

Impact Delayed care and/or incomplete information


How It Should WorkHow It Should Work

My EHR Terminal handles everything:

I select my patient on my system I select the RHIO that supported my patient’s care My system automatically matches the patient and lets me confirm

(either by ID cross-reference table or demographics matching) I ask for a list of relevant priors. Success! We have no BAA with the other site so I click “Break Glass”.

My ID and access of the data is logged for later security review. My system pulls the images and reports electronically from the

other system for my review

I determine there is no change in the lesion & diagnose an Aortic Transsection, avoiding unnecessary surgery



(XDS-I) Cross-Enterprise Document Sharing for Imaging Shares images, diagnostic reports and related information

between healthcare enterprises

(PIX) Patient ID Cross-referencing Cross-index patient IDs across multiple sites

(PDQ) Patient Demographics Query Query and retrieve a patient’s demographic and visit information

(ATNA) Audit Trail and Node Authentication Systems Authentication PHI-related audit events management

(BPPC) Basic Patient Privacy and Consent Patient privacy consents & enforcement


Teaching Files or Clinical TrialsTeaching Files or Clinical Trials

Scenario: This study I’m reading would make a good case for my/our

teaching files

or

This study should be included in a clinical trial we are participating in

It seems so simple…


Your Teaching/Clinical Trial ProblemsYour Teaching/Clinical Trial Problems

“Where did I put my notes?” Why am I the one digging through PACS for the studies? Tracking down images after the fact is a pain

Impact Inefficient use of time Can’t find study later Lower participation in clinical trial No cool images to share



“How am I supposed to get the images to the clinical trial, or to my teaching file account?” The images are raw material; I need to get them to a system

where I can work up a proper teaching file We’re in 5 clincal trials, each with their own file server; I need to

get the images to the right one.

Impact Inefficient use of time Becomes “more trouble than it’s worth”



“De-identifying the data for HIPAA is painful” What are “DICOM Attributes” and why is PHI hiding in so many of

them? The tools provided require an IT savvy that I do not have PACS Admin says I screwed up the images when I edited them

Impact Inefficient use of time Becomes “more trouble than it’s worth” Might fail to protect patient privacy


How should it work?How should it work?

I flag the image(s) of interest

I identify the clinical trial and/oradd a few notes about the clinical context (optional)

Images are de-identified automatically

Images and supporting information are bundled and automatically routed to the appropriate destination Teaching File Authoring System; Clinical Trial Export Node

Later, I login to my Teaching File account: My images and notes are waiting for me I finalize the teaching case and put it in our repository



(TCE) – Teaching File & Clinical Trial Export

Automatic De-identification Automatic Routing Can include brief notes Compatible with free RSNA MIRC tools

• Teaching File Server• Teaching File Authoring Tool• Clinical Trial Node• mirc.rsna.org


Integration ChallengeIntegration Challenge

Notice the pattern?

Scenario: I want to do something that requires some of the (literally)

dozens/hundreds of systems in my department to collaborate…


Your Integration ProblemYour Integration Problem

“My systems claim to be standards-based, but they still can’t integrate to do what I want.” Some of my systems use different parts of the same standard Some of my systems use the same standard in different ways Some of my systems use multiple standards Some of my systems use the “enhanced proprietary standard”

preferred by the vendor My vendors have different ideas about what each other should do Many of my vendors products have never been directly tested

together

Impact Lack of interoperability Costly point-to-point integration Long install & deployment cycle Have to do it over again with each new system



Working with vendors, care providers and standards

organizations, IHE:

Distills a clear description of the problem

Determines the right way to solve it using standards

(IHE Profile)

Documents the solution in an implementation guide

(IHE Technical Framework)

Coordinates cross-vendor testing of the solution

(IHE Connectathon)

Go see the rest of the profiles


IHE in ActionIHE in Action

Visit IHE Demonstrations at RSNA 2007 Cross-Enterprise Document Sharing for Imaging [XDS-I] Teaching File & Clinical Trial Export [TCE] IHE Product Showcase and participating Vendor Booths

Visit IHE Demonstrations at HIMSS 2008 Integration Showcase Covers IT, Radiology, Cardiology, ….

Visit www.ihe.net/profiles There are MANY more Profiles Start learning about them and IHE


SummarySummary

Become familiar with the IHE Profiles that address your pain points

Make IHE Profiles part of your purchase and upgrade requirements; List them in your RFP

rsna 2007 – informatics classroomwhat ihe delivers 1 kevin odonnell, toshiba medical systems chris...

Documents

effectiveness slide

inaccessible slide

problem slide

reduced productivity

dicom viewer cd

cd contents

new images

informatics classroomwhat