1 integrating the healthcare enterprise ihe for administrators: confronting deployment obstacles...

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Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

IHE for Administrators: Confronting Deployment Obstacles

Ellie Avraham, Kodak Health Group Paul Nagy, PhD University of Maryland

RSNA 2006 2 for Administrators Classroom Sessions

Modern HospitalModern HospitalInformation FlowInformation Flow

MPI

ADT

RIS

PACSModality Display & Print

HIS

Billing

Lab Cardio


Institute of Medicine Model of Institute of Medicine Model of Service Redesign of HealthcareService Redesign of Healthcare

SafetyEffectiveness Patient centeredness TimelinessEfficiency Equity

Align to the patientSource: Insititute of Medicine, Crossing the chasm


… a new generation of Healthcare IT solutions that have an order of magnitude greater level of integration.

… a whole new level of Complexity Management to manage these interfaces.

… we need to Decrease the time for integrating the Multi Vendors systems.

… we need the capabilities for plug and play interoperability of systems.

… we need to lower the total cost of integration

To achieve these goals we need To achieve these goals we need ……


Standards Exists: DICOM, HL7Standards Exists: DICOM, HL7

The main purpose of standards is to lower the cost of integration between systems.

The more plug and play integration the lower is the cost of the implementation.

However Standards are broad and include options that reduce the interoperability

So we need to constrain the Standards in order to improve the interoperability


What is IHEWhat is IHEJoint Initiative from HIMSS and RSNA since

1998IHE is a specification of transactions between

systems that defines integration profiles solution (SWF, PIR, RWF) based on standards

Uses a combination of standards to achieve a fully Interoperable workflow

Reinforces constrained standards to achieve fully Interoperability


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

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

Participants

contribute

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


IHEIHE Process Process

IHEIntegrationProfiles B

IHEIntegrationProfile A

Easy toIntegrateProducts

IHEConnectathon

ProductWith IHE

IHEDemonstration

User Site

RFPRFP

Standards

IHETechnical

Framework

Product IHE IntegrationProduct IHE IntegrationStatementStatement

IHE IHE ConnectathonConnectathonResultsResults

IHE Integration Profiles at the heart 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


The “Connectathon”The “Connectathon”

Voluntary Participation Neither a Demonstration nor

a Certification Well Designed End-to-End

Scenarios Advanced Testing Tools Unprecedented Cross-

Vendor Testing Unprecedented Pool of

Technical Talent


IHE Connectathon ResultsIHE Connectathon Resultshttp://www.rsna.org/IHE/connectathon.shtml http://www.rsna.org/IHE/connectathon.shtml

http://www.ihe-europe.org/con_resulthttp://www.ihe-europe.org/con_result


IHE Integration StatementIHE Integration Statement


Store ImagesStore Images PACS &PACS &ArchiveArchive

RISRIS

Today’s - Legacy WorkflowToday’s - Legacy Workflow


Patient Registration/UpdatePatient Registration/UpdateOrder ManagementOrder Management

Order Order Protocol Protocol DefinedDefinedStore ImagesStore Images

Storage CommitmentStorage CommitmentStorageStorage

CommitmentCommitment

List of ImagesList of Images

PACS &PACS &ArchiveArchive

RISRIS

A Closed LoopA Closed Loop•Update Scheduling ISUpdate Scheduling IS

•Match Procedure with OrderMatch Procedure with Order•Support Billing Based on MPPSSupport Billing Based on MPPS

•Avoid Reading Incomplete ProceduresAvoid Reading Incomplete Procedures

IHE WorkflowIHE Workflow

Modality Modality WorklistWorklist

Procedure Scheduled Procedure Scheduled

Proposed Protocols

Loaded and Reviewed

WorklistWorklistPt A, …, Pt A, …, SPS=P1, P4SPS=P1, P4

Pt C, …, Pt C, …, SPS=P1, P5SPS=P1, P5

Pt B, …, Pt B, …, SPS=P2SPS=P2

Pt E, …, Pt E, …, SPS=P4SPS=P4

ModalityModalityPerformedPerformedProcedure Procedure StepStep

With Performed With Performed Acquisition Acquisition ProtocolsProtocolsPerformed Step:Performed Step:

Status = CompletedStatus = CompletedPerformed Procedure: CT HeadPerformed Procedure: CT Head Performed Protocol Code=P1Performed Protocol Code=P1

Pat Name/ID, Dose, Pat Name/ID, Dose, Accession #, Study UIDAccession #, Study UIDComplete List of ImagesComplete List of Images

Scheduled Protocol Code=P1, PScheduled Protocol Code=P1, P55


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 Scheduled Workflow ProfileIHE Scheduled Workflow Profile

FilmLightbox


ADT^ Scheduled WorkflowADT^ Scheduled Workflow

A01 Registration A04 Admission A05 Pre adminission A11 Cancellation A38 Cancellation of pre admission DICOM C-Store DICOM Modality Worklist DICOM Modality Performed Procedure DICOM Storage Commitment


IHE Deployment – Testing the IHE Deployment – Testing the Integrated System SolutionsIntegrated System Solutions

For Healthcare to succeed in the digital transformation it will need much better integration between its systems.

IHE is an open standards approach to lower the cost of integrating healthcare and exposing many more processes.

Open Source can accelerate the adoption of IHE by helping to educate administrators to learn how to test the integration


Open Source - Integration testing toolsOpen Source - Integration testing tools

There are many (dozens) of DICOM and HL7 tools. Too many to mention.

The web site “openrad.com” has a repository with all the main open source Integration testing tools


Open Source ToolbeltOpen Source Toolbelt

IHE MESA ToolsDCM4JBOSS – Enterprise PACS ArchiveDVTK – Dicom Validation ToolkitHL7Browser – HL7 Message ViewerMIND – GUI DICOM query toolCTN – DICOM Send


Today’s LessonToday’s Lesson

Build an IHE Testing EnvironmentTest IHE Scheduled Workflow ComponentsOn a windows laptop


Standard Documentation Standard Documentation RecommendationRecommendation

IHE Technical Framework: volumes #1, 2, 3– Scheduled Workflow

DICOM standard– Information Object Definition Pt.3– Services Pt.4– Data Dictionary Pt.6– Medical.nema.org

HL7 v2.3.1 standard


IHE “Medical Enterprise Simulators and Analyzers” (MESA)IHE “Medical Enterprise Simulators and Analyzers” (MESA) http://ihedoc.wustl.edu/mesasoftware/index.htmhttp://ihedoc.wustl.edu/mesasoftware/index.htm

Provides the Test Procedures and Simulation of all the IHE Profiles and Actors. Excellent Documentation.

Developed by the Mallinckrodt Institute of Radiology MESA Tools runs on different operating systems:

Windows 2000, Windows XP, Solaris 7.0, Red Hat Linux 7.0 & 9.0 from Intel.

The MESA tool is organized for particular IHE actors as defined in the IHE Technical Framework


Step 1. Install MESA toolsStep 1. Install MESA tools

Decide What Actors/Systems you need to test Read the Installation Guide for installing the tools you

need to test your Actors/Systems Precompiled and Source Codes are available Recommend to Install the preferred Windows 2000

precompiled MESA s/w ready to be used


Step 2: What & How to Test Step 2: What & How to Test

List your Actors/Profiles that you need to testReview the MESA Test Procedures applicable

for each actor that need to be testedReview the Test Procedures for the Peer to

Peer testing applicable actors.


Query Modality Worklist [RAD-5]

ADT Order Placer

Image Manager

Acquisition Modality

Placer Order Mgmt – New [RAD-2]

Department System Scheduler/ Order Filler

Procedure Scheduled [RAD-4]

Register/Admit Patient

Create Order

Schedule Procedure and/or Assign Protocol

Continued in Figure 3.3-2

Patient Registration [RAD-1]

Test Example – Test Example – Scheduled Workflow Profile (SWF)Scheduled Workflow Profile (SWF)

Figure 3.3-1. Administrative Process FlowFigure 3.3-1. Administrative Process Flow

This case covers both inpatient and outpatient procedures. The patient may be new or known to the current healthcare facility. The following sequence of steps describes the typical process flow when a request is made to perform an imaging procedure on a patient


Image Manager/

Image Archive

Acquisition Modality /

Department System Scheduler/ Order

Filler

Modality Procedure Step Completed [RAD-7]

Perform Acquisition

Modality Images Stored [RAD-8]

Modality Presentation State Stored [RAD-9]

Storage Commitment [RAD-10]

Modality Procedure Step In Progress [RAD-6]

Images Availability Query [RAD-11]

Modality Procedure Step Completed [RAD-7]

Modality Procedure Step In Progress [RAD-6]

Print Composer

Print Request [RAD-23*]

Print Server

Order Placer

Order Status Update [RAD-3]

Figure 3.3-2. Procedure Performance Process Flow


Identifier Description [Transaction] Source Destination

131.102.a04.adt A04: Register BLACK as OutpatientPatient Class = ‘E’ [1]

ADT Ord Plc, Ord Fil

131.104.o01.orm ORM: Order P1 for BLACK [2] Ord Plc Ord Fil

131.106.o01.orm ORM: Schedule X1 [4] Ord Fil Img Mgr

131.108.dcm MWL C-FIND [5] Modality Ord Fil

131.110.dcm PPS: Begin Procedure X1 [6] Modality PPS_Mgr

131.112.dcm PPS: Begin Procedure X1 [6] PPS_Mgr Ord Fil or Img Mgr

131.114.dcm PPS: End Procedure X1 [7] Modality PPS_Mgr

131.116.dcm PPS: End Procedure X1 [7] PPS_Mgr Ord Fil or Img Mgr C-Find: Images Available Query [11] Ord Fil Img Mgr

131.118.dcm C-Store: Images [8] Modality Img Mgr

131.120.dcm C-Find: Images Available Query [11] Ord Fil Img Mgr

131.122.dcm Storage Commitment: N-Action [10] Modality Img Mgr

131.124.dcm Storage Commitment: N-Event-Report [10] Img Mgr Modality

131.117.dcm

MESA Test case #131MESA Test case #131 – Administrative & Procedure Prerform Process (SWF) – Administrative & Procedure Prerform Process (SWF)


MESA Testing Environment MESA Testing Environment


Starting MESA Test Starting MESA Test case #131case #131


Running Several Transactions TestRunning Several Transactions Test case #131case #131


Evaluating MESA Test Result Evaluating MESA Test Result case #131case #131


Where Is More Information Where Is More Information Available?Available?

http://www.ihe.net

Non-Technical Brochures:– IHE Radiology Users Handbook– IHE Primer and IHE FAQ– IHE Integration Profiles: Guidelines for Buyers– IHE Connectathon Results

1 integrating the healthcare enterprise ihe for administrators: confronting deployment obstacles...

Documents

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healthcare enterprise

interoperability slide

ihe joint initiative

p5 slide

stability slide

chasm slide