September, 2005 What IHE Delivers
IHE Eye Care Integration IHE Eye Care Integration ProfilesProfiles
Andrew Casertano Andrew Casertano Department of Veterans AffairsDepartment of Veterans Affairs
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Learning ObjectivesLearning Objectives
How to read the IHE Eye Care Technical Framework
What is an Integration Profile? They are a practical way to communicate integration problems and solution requirements precisely.
How IHE Eye Care Integration Profiles simplify the integration process.
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The Goal of IHE Eye CareThe Goal of IHE Eye Care
Any Eye Care Image, Any Eye Care Image, Anywhere, Intact, AnytimeAnywhere, Intact, Anytime
Seamless integration from Seamless integration from check-in to acquisition check-in to acquisition through archive and billingthrough archive and billing
Standardization and Standardization and guidelines for Quality guidelines for Quality Assurance & Patient Assurance & Patient SafetySafety
Protection of the integrity Protection of the integrity of the dataof the data
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What is IHE Eye Care?What is IHE Eye Care?
IHE is a proven systems integration IHE is a proven systems integration processprocess – – eight years of experienceeight years of experience
A collaboration of clinicians and vendorsA collaboration of clinicians and vendors Promote integrated solutions based on Promote integrated solutions based on open standardsopen standards International and multi-specialtyInternational and multi-specialty
Produces results on a yearly cycleProduces results on a yearly cycle
1.1. Clinicians identify and prioritize clinical problems (Use Cases)Clinicians identify and prioritize clinical problems (Use Cases)
2.2. Engineers from industry define solutions (Technical Framework)Engineers from industry define solutions (Technical Framework)
3.3. Participating vendors implement and test at “Connectathon” Participating vendors implement and test at “Connectathon” (Test)(Test)
4.4. Vendors publish “Integration Statements” for products;Vendors publish “Integration Statements” for products;users request in RFPs (Products)users request in RFPs (Products)
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Why IHE Eye Care?Why IHE Eye Care?Multiple devices and systems from multiple vendorsMultiple devices and systems from multiple vendors Need to integrate data sources for comprehensive view of patientNeed to integrate data sources for comprehensive view of patient List of Different EquipmentList of Different Equipment Multiple specialists cooperating on single patientMultiple specialists cooperating on single patient
Multiple locationsMultiple locations Individual patient is seen in multiple locations – distributed patient Individual patient is seen in multiple locations – distributed patient
recordrecord Individual clinician practices in multiple locations – across Individual clinician practices in multiple locations – across
organizational boundariesorganizational boundaries Office, small and large clinics, linking to hospitalsOffice, small and large clinics, linking to hospitals
Chronic DiseaseChronic Disease Long term patient care – persistent and evolving patient recordLong term patient care – persistent and evolving patient record
Lots of Lots of hardhard data integration problems data integration problems
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Costs of non-integrationCosts of non-integration
QualityQuality - Less accurate care due to lack of - Less accurate care due to lack of relevant patient records at point of carerelevant patient records at point of care
TimeTime - Delay in treatment due to unavailability of - Delay in treatment due to unavailability of critical informationcritical information
MoneyMoney - Higher costs needed to support manual - Higher costs needed to support manual rather than automated record keeping processesrather than automated record keeping processes
EmotionalEmotional - Patient dissatisfaction with provider; - Patient dissatisfaction with provider; clinician frustration with data environmentclinician frustration with data environment
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Why Is Integration Hard?Why Is Integration Hard?
The Different Systems Don’t Use a Common Vocabulary
The Different Systems Don’t Use Common Communication Standards Consistently
The Flow of Information Through the Enterprise Changes With the Circumstances of the Case
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Benefits of IntegrationBenefits of Integration
Reading efficiency: user-friendly, Reading efficiency: user-friendly, intuitive,intuitive, multi-modality, universal multi-modality, universal workstation that will display and workstation that will display and lay-out images from an eye care lay-out images from an eye care acquisition device as needed for acquisition device as needed for the the complete integrated imaging complete integrated imaging evaluation.evaluation.
Quality: Quality: preservation ofpreservation of rendered rendered image quality image quality on multiple displays.on multiple displays.
Quality/SafetyQuality/Safety: : patient and image patient and image identifiersidentifiers are available and are available and properly located.properly located.
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Electronic Health Record
Cardiology
Laboratory
Radiology
Oncology
IT
Infrastructure
Eye Care
16 Integration Profiles
5 Integration Profiles
4 Integration Profiles
1133 IInntteeggrraattiioonn PPrrooffiilleess
Patient Care Coordination
1 Integration Profile
Patient Care
Devices
Pathology
33 IInntteeggrraattiioonn PPrrooffiilleess
IHE 2006 – Integrated EHRIHE 2006 – Integrated EHR Over 100 vendors involved world-wide,Over 100 vendors involved world-wide, 6 Technical Frameworks6 Technical Frameworks
39 Integration Profiles, Testing at Connectathons, 39 Integration Profiles, Testing at Connectathons, Result in an Integrated Electronic Health Record Result in an Integrated Electronic Health Record
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Use Cases Use Cases ➨ IHE Profiles➨ IHE Profiles
IHE develops incrementally
Use cases are developed for specific data sharing problems with practical solutions in 1-2 year timeframe
Use case becomes an IHE Profile with a technical solution in the Technical Framework
IHE Eye Care Profiles: Scheduled Workflow Charge Posting Evidence Documents
More coming next year, and next …
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What is the Big Picture?What is the Big Picture?
IHE Defines Integration Profiles to Group Related Transactions and Connects Them With Real-world Functions
Integration Profiles Allow the Customer to Focus on High-level Integration While IHE handles the details
Proprietary Solutions create instant legacies
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IHE Technical Framework ComponentsIHE Technical Framework Components
IHE defines a set of Integration Profiles which describe a problem and provide a packaged Solution containing Integration requirements and functionality
IHE defines a set of Actors which represent the roles systems can play in a Profile
IHE defines a set of Transactions precisely define interactions between Actors
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TF Vol. I – Integration ProfilesTF Vol. I – Integration Profiles
Integration Profiles are a clinical problem defined and a description of its solution.
Each problem’s use case and process flow consists of IHE Actors and Transactions.
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The Integration ProfileThe Integration Profile
Actors cooperating
through TransactionsTransactions to solve the
problem
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]
Image Display
Storage Commitment
[CARD - 3]
Performed Procedure
Step Manager
Modality PS in Progress [RAD-6] Modality PS Completed [RAD-7]
Order Placer
Acquisition Modality
Image Manager
Image Archive
DSS/ Order Filler
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/Pt. Registration
Query Images [RAD - 14] Retrieve Image [EYECARE-3]
Image Display
Modality Image/Evidence Stored [EYECARE-2]
Storage Commitment
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Query Modality Worklist [EYECARE-1]
Performed Procedure
Step Manager
Modality PS in Progress [RAD-6] Modality PS Completed [RAD-7]
Modality PS in Progress [RAD-6] Modality PS Completed [RAD-7]
Order Placer
Acquisition Modality
Image Manager
Image Archive
DSS/ Order Filler
Storage Commitment [CARD-3]
Modality Images /Evidence Stored [EYECARE-2]
Evidence Creator
Procedure Scheduled [RAD-4] Image Availability Query [RAD-11] Procedure Updated [RAD-13] Instance Availability Notification [RAD-49]
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TheThe Vocabulary FoundationVocabulary Foundation
IHE Defines a Common Vocabulary for Patient and Administrative Information
• Order• Requested Procedure• Accession Number• Procedure Step• Others
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Identifying TransactionsIdentifying Transactions
IHE Defines the Eye Care workflow from from patient check-in to patient check-in to acquisition through acquisition through archive and billing …archive and billing …
IHE identifies the transactions required to make integration work
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The Right SelectionThe Right Selection
IHE Selects an Existing Industry Standard for each Transaction and Specifies the Transaction Unambiguously
• HL7 Patient Registration and Order
• DICOM Modality Worklist• DICOM Objects
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Mapping to Real-World ProductsMapping to Real-World Products
The IHE Actors and transactions are abstractions of real products in the real-world eye care information system environment. The order placer may be realized in either the
practice management system or the Electronic Medical Record (EMR) products.
The Performed Procedure Step Manager may be realized in either the Picture Archive and Communications System (PACS) or the Electronic Medical Record (EMR) products.
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Six Key ActorsSix Key Actors
A Patient registration system (also known as Admit, Discharge and Transfer (ADT) system is responsible patient demographic and encounter information.
An Order Placer generates eye care orders and distributes those orders. This may be hospital level system.
A Department System Scheduler/Order Filler provides worklists and monitors progress.
An Acquisition Modality acquires and creates DICOM objects.
An Image Manager/ Image Archive provides long-term storage.
An Image Display offers browsing of patients’ studies.
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Dependencies between Integration ProfilesDependencies between Integration Profiles
Eye Care Workflow
Manage eye care Workflow (IHE Eye Care)
Scheduled Workflow Admit, order, schedule, worklist, status, create, manage, store, display images, etc. (IHE Radiology)
Charge Posting
Collect and post timely billable procedure details (IHE Radiology)
Eye care Evidence Document
Create, store, retrieve & use objects to record Eye Care evidence (IHE Eye Care)
Evidence Document Create, store, retrieve & use objects to record evidence (IHE Radiology)
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Process Flow DiagramsProcess Flow Diagrams 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
Schedule Procedure
Patient Registration [RAD - 1]
Select Patient
ADT Order Placer
Image Manager
Acquisition Modality 1-n
Placer Order Mgmt - New [RAD - 2]
Department System Scheduler/ Order Filler
Procedure Scheduled [RAD - 4]
Admit Patient
Schedule Procedure
Patient Registration [RAD - 1]
Select Patient
Query Modality Worklist [EYECARE-1]
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TF Vol. II - TransactionsTF Vol. II - Transactions
Vol. II defines eye care transactions in detail, specifying the roles for each actor, the standards employed, the information exchanged.
The appendices provide clarification of technical details of the IHE data model and transactions.
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We care!We care!
The AAO and the VA have made fixing the Eye Care data integration problem a priority
The IHE participating vendors have responded to cooperatively develop data interoperability
OurOur success is measured success is measured by by youryour success success
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To find out moreTo find out more … … www.ihe.netwww.ihe.net
Join and participate in IHE Eye Care Join and participate in IHE Eye Care
IHE Technical Frameworks leveraged by Eye CareIHE Technical Frameworks leveraged by Eye Care CardiologyCardiology IT InfrastructureIT Infrastructure Radiology Radiology
Standards used by IHE Eye CareStandards used by IHE Eye CareDICOM Standard DICOM Standard www.nema.medical.orgHL7 Standard HL7 Standard www.hl7.org
IHE Connectathon 2006 at RSNA HQIHE Connectathon 2006 at RSNA HQ
IHE Showcase at 2006 AAO ConferenceIHE Showcase at 2006 AAO Conference
Vendor Products Integration StatementsVendor Products Integration Statements
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