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