1RSNA 2004
Christoph Dickmann – Member IHE Rad TC
Glen Marshall – Co-chair IHE IT-I PC
Charles Parisot – Co-chair IHE IT-I TC
Image-enabled Health Records:IHE Progress and Plans
Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise
RSNA 20042
Pragmatic definition of “EHR”Pragmatic definition of “EHR”
Integrated data and workflow functionality– Multimedia data access
text, image, waveform, …
– Communication among stakeholders clinicians, caregivers, consumers, …
Support different views of data– Clinical records
Details: episode, visit, study
– Longitudinal records Summaries: episode, visit
cross-department or cross-enterprise users
Linking summaries and clinical details
RSNA 20043
What an EHR can do for youWhat an EHR can do for you
Combine multiple sources of patient data Enhance functionality by
– Connecting to specialized systems – Augmenting the data sources by combining them
Provide timely, relevant, comprehensive data– Surgeon preparing an operation by viewing an
abdomen CT and lab values– General practitioner receiving cardiac films via CD– Neurologist reading a brain MR report and viewing
an EKG
RSNA 20044
EHR goals in IHEEHR goals in IHE(compatible with U.S. NHII goals)(compatible with U.S. NHII goals)
Informed Clinical Practice– Leverage existing IHE basis to ease EHR adoption
Interconnected Clinicians– Beyond the department: community or regional scope
Personalized Care– Web-based data access and summary data
Support for higher-level goals– Better outcomes– Increased patient safety– More efficient healthcare operations
RSNA 20045
EHR complexityEHR complexity
Business dilemmas– Significant, long-term investment – Investors may not be main beneficiaries
Coordination and cooperation– Active collaboration among multiple stakeholders– Identify and work out commonalities and barriers
Integration and interoperability– Implement existing standards– Develop additional standards
Focus on selected aspects
RSNA 20046
Focus: Image-enabled EHRFocus: Image-enabled EHR(connect two “worlds”)(connect two “worlds”)
Textual data & functions– Patient data– Clinical data
Laboratory results Surgery reports Prescriptions, meds Letters or notes
Integrate with imaging data and related processes
Imaging data & functions– Patient data– Images and evidence
Radiology Cardiology Nuclear Medicine
Integrate with clinical data and related processes
RSNA 20047
Potential use cases of an Potential use cases of an image-enabled EHRimage-enabled EHR
Neurologist: reviewing stroke patient transfer to ward
Nurse: preparing GI ward round for Dr. X
Surgeon: planning gall bladder surgery
GP: seeing a post-MI patient after hospital discharge
Patient: preparing an obstetric visit
Cardiologist: during catheter intervention
Radiologist: starting an abdomen CT
Physician: counseling at diabetes outpatient clinic
Lab technologist: for immune-deficiency testing
Ophthalmologist: during history-taking with a new patient
Information need may include current or longitudinal evidence.
RSNA 20048
Image-enabled EHRImage-enabled EHRPregnancy outpatient clinics encounterPregnancy outpatient clinics encounter
acquire
index
evaluate
Image/ ReportRepository
store
Ultrasound reportwith images
DocumentRegistry
register
(XDS architecture)
RSNA 20049
Image-enabled EHRImage-enabled EHRMicrobiology test encounterMicrobiology test encounter
index
acquireanalyze
Document/ Report
Repository
store
Microbiology reportwith images
DocumentRegistry
register
(XDS architecture)
RSNA 200410
Image-enabled EHRImage-enabled EHRChildbirth inpatient stayChildbirth inpatient stay
registerindex
evaluate
DocumentRegistry
Image/ Report and DocumentRepositories
index
query
retrieve
DocumentRepository
store
Report, letters(with images)
(XDS architecture)
RSNA 200411
Primary existing IHE mechanismPrimary existing IHE mechanismSharing documents (XDS)Sharing documents (XDS)
DocumentRepository
Longitudinal record system:across encounters
Care recordsystems:specific care delivery
Document Registry
Register documents (references)
Retrieve selected document references
Acute ambulatory care
patient Acute inpatient care Long term
care Specialized or diagnostic services
Query
Note: specific imaging documents are work in progress
Retrieve documents
RSNA 200412
Existing IHE contributions for Existing IHE contributions for EHR implementationEHR implementation
IHE Laboratory
IHE Radiology
EHR realization IHE IT Infrastructure
6 Integration Profiles
5 Integration Profiles
1 Integration Profile
3 Integration Profiles
Each TF can contribute to EHR scenarios with Integration Profiles for• Data access• Workflow handling
IHE Cardiology
RSNA 200413
Basic requirements of EHR Basic requirements of EHR systemssystems
Healthcare provider systems– EHR sources and users
Document handling– Storage and retrieval of EHR documents
Infrastructure services– Basic data and application integration
Network– EHR storage, inquiry, and retrieval path
RSNA 200414
IHE contributionIHE contributionProfiles for interoperable data and applicationsProfiles for interoperable data and applications
Common patient identification (IT-I PIX) Common patient demographics (IT-I PDQ) Desktop integration (IT-I PSA)
running applications work on the same patient Single sign on (IT-I EUA)
enterprise-wide user handling Common staff data (IT-I PWP)
health professionals are commonly recognized Security and privacy (IT-I ATNA, Rad SEC)
RSNA 200415
EHR interoperability examplesEHR 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
Single sign on
DesktopIntegrationas an EHR enabler
Any user
Backend integration (services, data)
RSNA 200416
IHE contributionIHE contributionProfiles for access to images and reports (1)Profiles for access to images and reports (1)
Radiology– Access to Radiology (Rad ARI)
Retrieve diagnostic quality images and reports– Simple Image and Numeric Reports (Rad SINR)
Access or export of reports and related images– Key Image Notes (Rad KIN)
Mark and annotate relevant imaging evidence– Portable Data for Imaging (Rad PDI)
Export/ import/ view media data– Nuclear Medicine Image (Rad NM Image)
Capture and use complex NM result screens
RSNA 200417
IHE contributionIHE contributionProfiles for access to images and reports (2)Profiles for access to images and reports (2)
Cardiology– Cardiac Catheterization Workflow (Card CATH),
Echo Workflow (Card ECHO) Retrieve catheterization and echocardiography imaging evidence
– Retrieve ECG for Display (Card ECG) Retrieve ECG summaries and results
IT Infrastructure– Retrieve Information for Display (IT-I RID)
Query and retrieve documents and summaries/ lists– Cross-Enterprise Clinical Document Sharing (IT-I XDS)
store & retrieve documents and summaries with longitudinal data
RSNA 200418
IHE contribution IHE contribution Profiles for access to clinical/ textual information (1)Profiles for access to clinical/ textual information (1)
Radiology– Simple Image and Numeric Reports (Rad SINR)
Access original or exported reports
IT-Infrastructure– Cross-Enterprise Clinical Document Sharing (IT-I XDS)
Store & retrieve documents or summaries with longitudinal data– Retrieve Information for Display (IT-I RID)
Access documents and summaries (e.g. imaging, lab, discharge, medications, prescriptions)
RSNA 200419
IHE contribution IHE contribution Profiles for access to clinical/ textual information (2)Profiles for access to clinical/ textual information (2)
Cardiology– Retrieve ECG for Display (Card ECG)
Access ECG summaries and results or reports
Laboratory– Lab Scheduled Workflow
Notification of lab results
RSNA 200420
IHE contributionIHE contribution Profiles for workflow / patient management supportProfiles for workflow / patient management support
Workflow integration– Scheduled Workflow (Rad SWF, Card CATH/ ECHO, Lab)
Ordering, scheduling and tracking of image acquisition steps Appointment Notification (Rad SWF option): report back to the order
placing system the date and time of the scheduled steps– Reporting Workflow (Rad RWF)
Scheduling and tracking of report creation tasks
Patient data integration– Patient Information Reconciliation (Rad PIR, Card CATH/ ECHO)
Modification and matching of patient data and imaging evidence
Overall concept (Rad whitepaper)– Departmental workflow and interfaces to enterprise
RSNA 200421
Planned IHE developmentPlanned IHE development
Harmonize IHE domain-specific work Extend XDS’ document content (Rad, Card) Additional EHR contents Code sets and master files Realize overall workflow concept Configuration support Security details, e.g. access control
RSNA 200422
Image-enabled EHR – IHE Image-enabled EHR – IHE progress and plansprogress and plans
IHE Integration Profiles from different domains can be combined
Combinations of current profiles can cover many EHR scenarios– Information integration (imaging, textual)– Enhanced functionality beyond one department– Intra- and cross enterprise communication
Scenarios enable system evolution(organizational change management not to be forgotten)
IHE ensures integration testing and future Integration Profile development
23RSNA 2004
Thank you!Thank you!
Questions?Questions?
More information: http://www.rsna.org/IHE