the future of ihe linking domains across the enterprise dr. nikolaus wirsz - ihe planning committee...

The Future of IHEThe Future of IHE

Linking Domains Across the EnterpriseLinking Domains Across the Enterprise

Dr. Nikolaus Wirsz - IHE Planning CommitteeDr. Nikolaus Wirsz - IHE Planning Committee

Siemens Medical SolutionsSiemens Medical Solutions

RSNA 2002The Future of IHE – Linking Domains Across the Enterprise

HIMSS / RSNA2

• IntroductionIntroduction

• IHE Over TimeIHE Over Time

• IHE Vision for GrowthIHE Vision for Growth

• IHE Future PlansIHE Future Plans

• IHE ParticipationIHE Participation

• IHE InternationalIHE International

• ConclusionsConclusions

Future of IHEFuture of IHE


HIMSS / RSNA3

• Integration solutions available today - BUT:Integration solutions available today - BUT:• Proprietary departmental solutions leave Proprietary departmental solutions leave

many problems unresolved:many problems unresolved:– Communicating Medical Data Across Multiple Communicating Medical Data Across Multiple

Systems from Different VendorsSystems from Different Vendors– Access to the Complete Medical InformationAccess to the Complete Medical Information– Consistency of Medical InformationConsistency of Medical Information

Across Departments and InstitutionsAcross Departments and Institutions– No Long-term Guarantee of Viability or No Long-term Guarantee of Viability or

Evolutionary PathEvolutionary Path

IntroductionIntroduction


HIMSS / RSNA4

Nov. 1998 HIMSS & RSNA Launch a New Initiative: Nov. 1998 HIMSS & RSNA Launch a New Initiative: ““IIntegrating the ntegrating the HHealthcare ealthcare EEnterprise (IHE)”nterprise (IHE)”

An Incremental Multi-Year ProjectAn Incremental Multi-Year Project• Speed Up the Integration in Healthcare EnvironmentsSpeed Up the Integration in Healthcare Environments• Foster Communication Between Vendors of Medical ITFoster Communication Between Vendors of Medical IT• Prove that Integration is Attainable Based on StandardsProve that Integration is Attainable Based on Standards• Participants:Participants:

– Representatives of Healthcare ProvidersRepresentatives of Healthcare Providers– Information Systems VendorsInformation Systems Vendors– Imaging Systems VendorsImaging Systems Vendors– Standardization GroupsStandardization Groups

IntroductionIntroduction


HIMSS / RSNA5

Who Is IHE ?Who Is IHE ?

• Societies / Associations:Societies / Associations:– Healthcare IT: ........................Healthcare IT: ........................ HIMSSHIMSS– Radiology: .............................Radiology: ............................. RSNARSNA– Other Clinical Specialties: ...Other Clinical Specialties: ... The Appropriate SocietiesThe Appropriate Societies

• Vendors:Vendors:– Healthcare IT: ........................Healthcare IT: ........................ IS VendorsIS Vendors– Radiology: .............................Radiology: ............................. RIS Vendors, Imaging: Modalities, PACS, ...RIS Vendors, Imaging: Modalities, PACS, ...– Other Clinical Specialties: ...Other Clinical Specialties: ... Suppliers of Departmental Suppliers of Departmental

Systems/ProductsSystems/Products

• Users:Users:– Healthcare IT: ........................Healthcare IT: ........................ CIOs, AdministratorsCIOs, Administrators– Radiology: .............................Radiology: ............................. RadiologistsRadiologists– Other Clinical Specialties: ...Other Clinical Specialties: ... Clinicians, Medical StaffClinicians, Medical Staff

IHE ParticipationIHE Participation


HIMSS / RSNA6

Year 1Year 1Initial Functional System ArchitectureInitial Functional System Architecture

Integrate Radiology with HISIntegrate Radiology with HIS

• Patient Registration & ADTPatient Registration & ADT• Order Entry & SchedulingOrder Entry & Scheduling• Image Communication:Image Communication:

– Image AcquisitionImage Acquisition– Image StorageImage Storage– Image RetrievalImage Retrieval

IHE Over TimeIHE Over Time


HIMSS / RSNA7

Year 2Year 2Expand Radiology TransactionsExpand Radiology Transactions

Initial Interdepartmental Information SharingInitial Interdepartmental Information Sharing

• Image Availability Information ( Location ) toImage Availability Information ( Location ) toEnable Subsequent Process Steps ( Reporting )Enable Subsequent Process Steps ( Reporting )

• Access to Radiology Information ( Reports and Images) Access to Radiology Information ( Reports and Images) within Radiology and within Other Departmentswithin Radiology and within Other Departments

• Access to Non-Radiology Information ( e.g. Lab Data )Access to Non-Radiology Information ( e.g. Lab Data )

• Patient Information Reconciliation ( “John Doe” / Trauma )Patient Information Reconciliation ( “John Doe” / Trauma )

• Consistent Presentation of ImagesConsistent Presentation of Images

• Report ManagementReport Management



HIMSS / RSNA8

Year 3Year 3Consolidation Year for RadiologyConsolidation Year for Radiology

Drive IHE into Market and into Real WorldDrive IHE into Market and into Real World

• Improvements Based on Year 1 and 2 Experience:Improvements Based on Year 1 and 2 Experience:– Order Tracking ( Order Status Updates )Order Tracking ( Order Status Updates )– Clinical Data and Alerts Available to Medical StaffClinical Data and Alerts Available to Medical Staff– Templates for Structured ReportsTemplates for Structured Reports– Rules to Link Reports to Studies / ImagesRules to Link Reports to Studies / Images

• Include Other Clinical SpecialtiesInclude Other Clinical Specialties• Advance Integration with Enterprise Information SystemsAdvance Integration with Enterprise Information Systems• Encourage IHE Initiative WorldwideEncourage IHE Initiative Worldwide



HIMSS / RSNA9

imagesstored

Filmimagesprinted

reportRegistration

patientinformation

Orders Placed

RISexamination orders

Orders Filled

imagesretrieved

FilmFolder

ReportRepository

HIS

Image Managerand Archive

PACS

procedurescheduled

Prefetch any relevantprior studies

modalityworklist

Patient and procedureinformation retrievedby the modality

Modality

DiagnosticWorkstation

report

report

acquisitionin progress

acquisitioncompleted

acquisitioncompleted

IHE Success – Closing LoopIHE Success – Closing Loop

FilmLightbox


HIMSS / RSNA10

Presentation ofGrouped Procedures

Subset a single acquisition

Patient Information

Reconciliation

Unknown patients and unscheduled

orders

ConsistentPresentation of

Images

Hardcopy and softcopy

grayscale and presentation state

Access toRadiology

Information

Consistentaccess to

images andreports

Key ImageNotes

Exchange flaggingsignificant images

Simple Image andNumeric Reports

Exchange simplereports with image

links and, optionally,measurements

Scheduled WorkflowAdmit, order, schedule, acquire images, notify of completed steps

IHE Success - Integration ProfilesIHE Success - Integration Profiles


HIMSS / RSNA11

Year 4Year 4

Radiology Resumes Vertical GrowthRadiology Resumes Vertical Growth

• Improving the Reporting and Reviewing Workflow:Improving the Reporting and Reviewing Workflow:– General Purpose Worklist for:General Purpose Worklist for:

• Interpretation / Reporting ( Radiologist’s Worklist )Interpretation / Reporting ( Radiologist’s Worklist )

• Post-ProcessingPost-Processing

• Initial Security Features:Initial Security Features:– Audit / Authentication ControlsAudit / Authentication Controls

• Charge Posting ( Billing / Financial Transactions)Charge Posting ( Billing / Financial Transactions)• Error Management (fixing operator errors and other Error Management (fixing operator errors and other

exception cases using modality worklist)exception cases using modality worklist)

IHE Future PlansIHE Future Plans


HIMSS / RSNA12

Long-Range Radiology and IT Infrastructure IssuesLong-Range Radiology and IT Infrastructure Issues

• Integrated Clinical Desktop Linking Radiology and Other Integrated Clinical Desktop Linking Radiology and Other Clinical ApplicationsClinical Applications

• Master File UpdatesMaster File Updates• Hanging Protocols (Radiologist’s Preferences)Hanging Protocols (Radiologist’s Preferences)• Enhanced Queries for Structured ReportsEnhanced Queries for Structured Reports• Integration with the Master Patient Index (MPI)Integration with the Master Patient Index (MPI)• Interdepartmental Information Sharing (Results, Images)Interdepartmental Information Sharing (Results, Images)• Standardized Codes and TerminologyStandardized Codes and Terminology• Relevant Information Management (Historical Studies)Relevant Information Management (Historical Studies)



HIMSS / RSNA13

Integration Beyond BoundariesIntegration Beyond Boundaries

• Encourage Other Clinical Fields to Attain Internal Encourage Other Clinical Fields to Attain Internal Vertical IntegrationVertical Integration

• Expand Enterprise IT InfrastructureExpand Enterprise IT Infrastructure

• IHE Year 5 Achieves Integration of:IHE Year 5 Achieves Integration of:– Multiple Clinical SpecialtiesMultiple Clinical Specialties– Significant IT Infrastructure FeaturesSignificant IT Infrastructure Features



HIMSS / RSNA14

A Multidimensional Expansion of IntegrationA Multidimensional Expansion of Integration

IHE Vision for GrowthIHE Vision for Growth

DeptSched.

ADT

OrderMgt

ImageMgr

Modality

11stst Dimension: Dimension:Vertical Integration for RadiologyVertical Integration for RadiologyIHE Years 1, 2, 3, 4, ...IHE Years 1, 2, 3, 4, ...


HIMSS / RSNA15



22ndnd Dimension: Dimension:Growing the HorizontalGrowing the HorizontalHealthcare Enterprise IntegrationHealthcare Enterprise Integration

Master Patient Index

Clinical Patient Record

Ordering Process

. . .DeptSched.

ADT

OrderMgt

ImageMgr

Modality

Patient Registration


HIMSS / RSNA16



33rdrd Dimension: Dimension:Increasing the Number ofIncreasing the Number ofVertically IntegratedVertically IntegratedDepartmentsDepartments

Master Patient Index

Clinical Patient Record

Ordering Process

. . .

Patient RegistrationR

a d

i o

l o g

y

C a

r d

i o

l o g

y

Lab

orat

ory

Ad

d’l

Cli

nic

al F

ield

s


HIMSS / RSNA17

Shaping the Future of IHEShaping the Future of IHEIHE Strategic Development Committee Est. July 2002IHE Strategic Development Committee Est. July 2002

• Expansion of IHE process to meet integration needs of entire enterprise

• Engage leading medical professionals and associations from other Engage leading medical professionals and associations from other key domains to help move IHE beyond Radiologykey domains to help move IHE beyond Radiology

• Identify integration needs / barriers and problems / solutions Identify integration needs / barriers and problems / solutions within and across domainswithin and across domains

• Identify and recommend clinical and operational domainsIdentify and recommend clinical and operational domains• Populate domain specific sub-committees:Populate domain specific sub-committees:

– CardiologyCardiology– LaboratoryLaboratory– Pharmacy / Medication AdministrationPharmacy / Medication Administration– Interdepartmental Information Sharing:Interdepartmental Information Sharing: Ad-hoc Query/RetrieveAd-hoc Query/Retrieve

Master File UpdatesMaster File Updates


HIMSS / RSNA18

IHE Goes InternationalIHE Goes InternationalIHE International Steering CommitteeIHE International Steering Committee

• IHE North AmericaIHE North America

• IHE Europe:IHE Europe:– IHE France:IHE France: Demo at JFR Oct. 20-24, 2001Demo at JFR Oct. 20-24, 2001

– IHE Germany:IHE Germany: Demo at DRK May 8-11, 2002Demo at DRK May 8-11, 2002

– IHE France:IHE France: Demo at Hospital Expo May 21-24, Demo at Hospital Expo May 21-24, 20022002

Demo at JFR Oct. 19-23, 2002Demo at JFR Oct. 19-23, 2002

– IHE Italy:IHE Italy: Demo at SIRM May 24-28, 2002Demo at SIRM May 24-28, 2002

• IHE Japan: Demo at JMCP Apr. 2002IHE Japan: Demo at JMCP Apr. 2002

IHE InternationalIHE International


HIMSS / RSNA19

IHE EuropeIHE Europe

• To address European-based healthcare information To address European-based healthcare information system vendors ( RIS, HIS )system vendors ( RIS, HIS )

• To provide information to, and get feedback from To provide information to, and get feedback from European healthcare providers.European healthcare providers.

• To facilitate European influence in the IHE and avoid To facilitate European influence in the IHE and avoid local European solutions if global solutions are local European solutions if global solutions are adequate.adequate.

Why IHE in Europe ?Why IHE in Europe ?


HIMSS / RSNA20


• Healthcare information system vendors often address Healthcare information system vendors often address only national markets in Europeonly national markets in Europe

• Most imaging vendors have a global presence. Most imaging vendors have a global presence. However: integration with European IS vendors is However: integration with European IS vendors is needed.needed.

• Provide European vendors with a platform to develop Provide European vendors with a platform to develop and test world-class interoperabilityand test world-class interoperability

European Healthcare Information Systems European Healthcare Information Systems Market Is Different:Market Is Different:


HIMSS / RSNA21


• Sponsors:Sponsors: COCIR (European imaging vendors),COCIR (European imaging vendors),ECR,ECR,EAR,EAR,National Societies (e.g. SFR, DRG, ...)National Societies (e.g. SFR, DRG, ...)

• Formation of IHE-Europe Formation of IHE-Europe PlanningPlanning Committee Committee

• NoNo IHE-Europe IHE-Europe TechnicalTechnical Committee: re-use of IHE Committee: re-use of IHE Technical FrameworkTechnical Framework

How To Implement IHE In Europe:How To Implement IHE In Europe:


HIMSS / RSNA22

GlobalTechnical Framework …

National ExtensionsNational Extensions

National SpecificitiesFeed the Global TF During its Definition/Review.

Evolution of the Technical Framework (1)J

apa

n

US

Fra

nc

e

Ger

man

y


HIMSS / RSNA23

…

Japan

US

France

Germany

…

Technical FrameworkYear N

Global

Evolution of the Technical Framework (2)Evolution of the Technical Framework (2)

Global

US

Germany

France

JapanTechnical Framework

Year N+1

• National Extensions should not contradict the Global TF

• Year N+1 should include general purpose local extensions of Year N


HIMSS / RSNA24

IHEin theUSA

European IHE European IHE CommitteeCommittee

IHE in France IHE in France Planning Planning

CommitteeCommittee

IHE in IHE in Germany Germany Planning Planning

CommitteeCommittee

IHE in ……. IHE in ……. Planning Planning

CommitteeCommitteeDemonstrations

Education

National extensions

ComprehensiveTechnical Framework

Connect-a-thon

European Coordination

European-level exhibitions, marketing and education

Vendor Participation



HIMSS / RSNA25

Healthcare Needs Addressed by IHEHealthcare Needs Addressed by IHE

• Continuity and Integrity of Patient InformationContinuity and Integrity of Patient Information

• Clinical Workflow OptimizationClinical Workflow Optimization• Fostering Communication Among DiverseFostering Communication Among Diverse

Medical Information SystemsMedical Information Systems

• Avoid Repeating TasksAvoid Repeating Tasks

• Eliminating Gaps and Redundancies in Data Eliminating Gaps and Redundancies in Data AccessAccess

• Driving the Use and Evolution ofDriving the Use and Evolution ofHealthcare Communication StandardsHealthcare Communication StandardsImproving the Patient Care ProcessImproving the Patient Care Process


HIMSS / RSNA26

Questions?Questions?

• Information Available On the Web at:Information Available On the Web at:

www.rsna.org/IHEwww.rsna.org/IHE

www.himss.orgwww.himss.org

www.rsna.org/IHEwww.rsna.org/IHE

www.himss.orgwww.himss.org

• Home Page of IHE Europe:Home Page of IHE Europe:

www.IHE-Europe.orgwww.IHE-Europe.orgwww.IHE-Europe.orgwww.IHE-Europe.org

the future of ihe linking domains across the enterprise dr. nikolaus wirsz - ihe planning committee...

Documents

radiology information

medical data

radiology drive ihe

healthcare enterprise

medical stafftemplates

clinical ap

rsnaother clinical specialties

vendors of medical itprove