Post on 27-Mar-2015
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1September, 2005 What IHE Delivers
Cor Loef –Cor Loef – Board Member IHE International Board Member IHE International
Acknowledgement for presentation input to:Acknowledgement for presentation input to:
Christoph Dickmann – Christoph Dickmann – Member IHE Rad TCMember IHE Rad TC
Charles Parisot –Charles Parisot – Co-chair IHE IT-I PC Co-chair IHE IT-I PC
Integrating the Healthcare Enterprise:Integrating the Healthcare Enterprise:Building the Building the
Electronic Health RecordElectronic Health Record
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Business need: share in the Care settingBusiness need: share in the Care settingRadiology Reports and ImagesRadiology Reports and Images
Between Radiology andBetween Radiology and
imaging specialistsimaging specialists non-imaging professionalsnon-imaging professionals
Within an enterpriseWithin an enterprise
Cross-enterprise in a healthcare regionCross-enterprise in a healthcare region
By network or mediaBy network or media
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Care Cycle DefinitionCare Cycle Definition
The array of health services and care settings The array of health services and care settings that address:that address:
health promotionhealth promotion disease preventiondisease prevention diagnosis, treatment,diagnosis, treatment, management, and rehabilitation management, and rehabilitation
of a disease, injury, and/or disability…. of a disease, injury, and/or disability…. Source: CDC, US governmentSource: CDC, US government
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The Care Cycle ApproachThe Care Cycle Approach
Set of tools to identify:– Different paths someone may follow
through the care cycle– Disciplines and roles– Sites of care – Technology requirements– Information needs– Clinical decisions taken– Social and political changes
required
Screening
Home MonitoringPrevention
Healthcare ITDecision Support
Imaging
StagingTherapy Planning
Therapy Delivery
Intensive CareUnit
Step Down FacilityMonitoring
Rehabilitation
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Clinical guidelinesClinical guidelines
Observations Observations
LiteratureLiterature
Deriving Care CyclesDeriving Care Cycles
PCPoffice
ED
Cardiol-ogistoffice
ICU/CCU
Non-imagingtesting
Home FloorOR /
Cath Lab
Non-invasiveImaging
Rehab
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Focus: Image-enabled EHRFocus: Image-enabled EHR(connect two “worlds”)(connect two “worlds”)
Non-imaging dataNon-imaging data Patient dataPatient data Clinical dataClinical data
• Laboratory resultsLaboratory results• Surgery reportsSurgery reports• Prescriptions, medsPrescriptions, meds• Letters or notesLetters or notes
Integrate with imaging Integrate with imaging data and processesdata and processes
Imaging dataImaging data Patient dataPatient data Images and evidenceImages and evidence
• RadiologyRadiology• CardiologyCardiology• Nuclear MedicineNuclear Medicine
Integrate with non-Integrate with non-imaging data and imaging data and processesprocesses
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Potential use cases of an image-enabled EHRPotential use cases of an image-enabled EHR
Using imagesUsing images
NeurologistNeurologist: reviewing : reviewing stroke patient transfer to stroke patient transfer to wardward
NurseNurse: preparing GI ward : preparing GI ward round for Dr. Xround for Dr. X
GPGP: seeing a post-MI : seeing a post-MI patient after hospital patient after hospital dischargedischarge
PatientPatient: be prepared for an : be prepared for an obstetric visitobstetric visit
Producing images/ evidenceProducing images/ evidence
CardiologistCardiologist: during catheter : during catheter interventionintervention
RadiologistRadiologist: starting an : starting an abdomen CTabdomen CT
PhysicianPhysician: counseling at : counseling at diabetes outpatient clinicdiabetes outpatient clinic
OncologistOncologist: planning : planning radiotherapyradiotherapy
Information need may include current or longitudinal evidence
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Image-enabled EHRImage-enabled EHRPregnancy outpatient clinics encounterPregnancy outpatient clinics encounter
acquireevaluate
index
Image/ ReportRepository
storenew data
Ultrasound reportand images
DocumentRegistry
register
(XDS architecture)
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Image-enabled EHRImage-enabled EHRChildbirth inpatient stayChildbirth inpatient stay
registerindex
evaluate
DocumentRegistry
Image/ Report/ Document
Repositories
index
query
retrieve
DocumentRepository
storenew data
Report, letters(incl. images)
(XDS architecture)
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Sharing Imaging Documents (XDS-I)Sharing Imaging Documents (XDS-I)
Document Registry
Register report & image references
Retrieve selected imaging report references
Radiologydepartment
patient
Query for re-ports
Documentavailability
Shared re- pository
Onco-logist
GP(follow-up)
Images, report(PACS, RIS) report
Longitudinal record system: across encounters
Care record sys-tems: specific care deliveryRetrieve
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Electronic Health Record
Cardiology
Laboratory
Radiology
Oncology
Future
Domains
IHE
IT Infrastructure
19 Integration Profiles
3 Integration Profiles
8 Integration Profiles
17 Integration Profiles
Patient Care Coordination
5 Integration Profile
Patient Care
Devices
Eye Care
1 Integration Profile
1 Integration Profile 1 Integration Profile
Pathology
IHE contributions to EHR implementation IHE contributions to EHR implementation
Each TF can contribute to EHR scenarios with Integration Profiles for• Data access• Workflow
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Basic requirements of EMR/EHR systemsBasic requirements of EMR/EHR systems
Integrated healthcare provider systemsIntegrated healthcare provider systems EHR sources/ users, user interactionEHR sources/ users, user interaction
Document handlingDocument handling Storage and retrieval of EHR documentsStorage and retrieval of EHR documents
Infrastructure servicesInfrastructure services Basic data and application integrationBasic data and application integration
NetworkNetwork EHR storage, inquiry, and retrieval pathEHR storage, inquiry, and retrieval path
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DesktopIntegrationas an EHR enabler
Backend integration (services, data)
EMR/EHR interoperability examplesEMR/EHR interoperability examples
Appl. 1
Appl. 2
Appl. 3
Patient identifier matching
Common person data or services
Samepatient selected
Patientdemographics
Source 1
Source 2
Personnel/staff data
Any user Single
sign on
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IHE - Radiology IHE - Radiology imagesimages and reports for an and reports for an EMR/EHR systemEMR/EHR system
Access to Radiology Access to Radiology InformationInformation (Rad ARI)(Rad ARI)Retrieve diagnostic quality images, evidence, reportsRetrieve diagnostic quality images, evidence, reports
Evidence DocumentsEvidence Documents (Rad ED)(Rad ED)Create and use measurement or CAD objectsCreate and use measurement or CAD objects
Simple Image and Numeric Reports Simple Image and Numeric Reports (Rad SINR)(Rad SINR)Access or export reports and related imagesAccess or export reports and related images
Key Image Notes Key Image Notes (Rad KIN)(Rad KIN)Mark, annotate, retrieve selected imaging evidenceMark, annotate, retrieve selected imaging evidence
Portable Data for Imaging Portable Data for Imaging (Rad PDI)(Rad PDI)Export/ import/ view media dataExport/ import/ view media data
Nuclear Medicine Image Nuclear Medicine Image (Rad NM Image)(Rad NM Image)Capture and use complex NM result screensCapture and use complex NM result screens
Mammography Image Mammography Image (Rad Mammo Image)(Rad Mammo Image)Capture and use complex Mammography screensCapture and use complex Mammography screens
Consistent Presentation of ImagesConsistent Presentation of Images (Rad CPI)(Rad CPI)Consistent image viewing on all review stationsConsistent image viewing on all review stations
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IHE – Cardiology images and reports for an IHE – Cardiology images and reports for an EMR/EHR systemEMR/EHR system
Cardiac Catheterization / Echo WorkflowCardiac Catheterization / Echo Workflow (Card CATH, ECHO) (Card CATH, ECHO)Retrieve catheterization and echocardiography Retrieve catheterization and echocardiography imaging evidenceimaging evidence
Retrieve ECG for DisplayRetrieve ECG for Display (Card ECG)(Card ECG)Retrieve ECG summaries and resultsRetrieve ECG summaries and results
Displayable ReportsDisplayable Reports (Card DRPT)(Card DRPT)Create and access reports for viewingCreate and access reports for viewing
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IHE - common interoperability servicesIHE - common interoperability services
Common patient identification Common patient identification (ITI PIX)(ITI PIX)
Common patient demographics Common patient demographics (ITI PDQ)(ITI PDQ)
Desktop integration Desktop integration (ITI PSA)(ITI PSA)Running applications work on the same patientRunning applications work on the same patient
Single sign on Single sign on (ITI EUA, (ITI EUA, XUA)XUA) Enterprise-wide or cross-enterprise user handlingEnterprise-wide or cross-enterprise user handling
Security and privacy Security and privacy (ITI/ RAD ATNA, (ITI/ RAD ATNA, Accountability, document integrityAccountability, document integrity DSG) DSG)
Common staff data Common staff data (ITI PWP)(ITI PWP)Health professionals are commonly recognizedHealth professionals are commonly recognized
Fundamental enablers of cross-system health record system functions.Gradual enhancement and combination is the key.
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IHE – documents for general purpose IHE – documents for general purpose EHR functions EHR functions
Cross-Enterprise Document Sharing for Imaging Cross-Enterprise Document Sharing for Imaging (Rad XDS-I)(Rad XDS-I)Share DICOM instances via web or DICOM connection;Share DICOM instances via web or DICOM connection;share imaging information via webshare imaging information via web
Cross-Enterprise Document SharingCross-Enterprise Document Sharing (ITI XDS)(ITI XDS)Store & retrieve documents and summaries Store & retrieve documents and summaries (focus: longitudinal data)(focus: longitudinal data)
Retrieve Information for DisplayRetrieve Information for Display (ITI RID)(ITI RID)Query and retrieve documents and summaries/ listsQuery and retrieve documents and summaries/ lists
Needs common services as a basis (e.g. security, patient identification)
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IHE - clinical/context information for an IHE - clinical/context information for an EMR/EHR systemEMR/EHR system
Simple Image and Numeric ReportsSimple Image and Numeric Reports (Rad SINR)(Rad SINR)Access original or exported reports Access original or exported reports
Cross-Enterprise Document SharingCross-Enterprise Document Sharing (ITI XDS) (ITI XDS) Cross-Enterprise Doc. Sharing for ImagingCross-Enterprise Doc. Sharing for Imaging (Rad XDS-I)(Rad XDS-I)Store & retrieve documents, summaries or reports Store & retrieve documents, summaries or reports with longitudinal datawith longitudinal data
Cross-Enterprise Sharing of Medical Summaries Cross-Enterprise Sharing of Medical Summaries (PCC MS)(PCC MS)
Emergency Department Referral Emergency Department Referral (PCC EDR)(PCC EDR)
Pre-procedure History and Physical Pre-procedure History and Physical (PCC PPHP)(PCC PPHP)
Retrieve Information for DisplayRetrieve Information for Display (ITI RID) (ITI RID) Access documents and summaries Access documents and summaries (e.g. imaging, lab, discharge, medications, prescriptions)(e.g. imaging, lab, discharge, medications, prescriptions)
Sharing Laboratory reportSharing Laboratory report (Lab XD*-LAB)(Lab XD*-LAB)Access to Access to laboratory resultslaboratory results
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IHE - workflow / patient management supportIHE - workflow / patient management support
Workflow integration Workflow integration (Rad, Card, Lab)(Rad, Card, Lab) Scheduled WorkflowScheduled Workflow
• Ordering, scheduling and tracking of image acquisition stepsOrdering, scheduling and tracking of image acquisition steps• Appointment tracking to order placerAppointment tracking to order placer
Import Reconciliation WorkflowImport Reconciliation Workflow• Import CDs into the local Patient/Study foldersImport CDs into the local Patient/Study folders
Reporting WorkflowReporting Workflow• Scheduling and tracking of report creation tasksScheduling and tracking of report creation tasks
Patient data integrationPatient data integration (Rad, Card, ITI)(Rad, Card, ITI) Patient Information ReconciliationPatient Information Reconciliation
• Modification and matching of patient data and imaging evidenceModification and matching of patient data and imaging evidence Patient Administration ManagementPatient Administration Management
• Creating and changing patient identifiers and encounter dataCreating and changing patient identifiers and encounter data
Notification of Document Availability Notification of Document Availability ((ITI NAVITI NAV)) Send notification/ reference to new shared documents Send notification/ reference to new shared documents
Overall concept (Rad whitepaper)Overall concept (Rad whitepaper) Departmental workflow and interfaces to the enterpriseDepartmental workflow and interfaces to the enterprise
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Envisaged IHE developmentEnvisaged IHE development
Extend XDS’ document contentExtend XDS’ document content
Harmonize IHE domain-specific workflow and Harmonize IHE domain-specific workflow and document contentdocument content
Realize overall workflow conceptRealize overall workflow concept
Link departmental documents, in particular Link departmental documents, in particular diagnostic reports, to the enterprise EMR diagnostic reports, to the enterprise EMR
Code sets and master filesCode sets and master files
Configuration supportConfiguration support
Security details, e.g. access controlSecurity details, e.g. access control
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Image-enabled EHR – ConclusionImage-enabled EHR – Conclusion
IHE Integration Profiles from different domains can IHE Integration Profiles from different domains can be combinedbe combined
Combinations of current profiles can cover many Combinations of current profiles can cover many EHR scenariosEHR scenarios Information integration (imaging, textual)Information integration (imaging, textual) Enhanced functionality beyond one departmentEnhanced functionality beyond one department Intra- and cross enterprise communicationIntra- and cross enterprise communication
Scenarios enable system evolutionScenarios enable system evolution
IHE ensures integration testing and future IHE ensures integration testing and future Integration Profile developmentIntegration Profile development
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