RSNA 2014

IHE Profiles for Radiology Applications

Written by: David S. Mendelson, M.D.

Professor of Radiology

The Icahn School of Medicine at Mount

Sinai

Senior Associate - Clinical Informatics

The Mount Sinai Medical Center

Co-chair IHE International Board

Adapted and presented for the IHE Colombia IHE Workshop by:

Elliot B. Sloane, PhD, CCE, FHIMSS

Co-chair IHE International Board

President, Center for Healthcare Information Research and Policy

(CHIRP)

Integrating the Healthcare

Enterprise

The state of IHE - 2014

Integrating the Healthcare

Enterprise

The state of IHE - 2014

X

What is IHE?

IHE is International Provides for local variation

IHE includes participation from Professional organizations Vendors End users

1997: Founded in Radiology (RSNA) and IT (HIMSS)

Many professional societies (stakeholder representation) American Academy of Ophthalmology

(AAO) American College of Cardiology (ACC) American College of Physicians (ACP) American College of Clinical Engineering

(ACCE) American College of Emergency

Physicians (ACEP) American Society for Therapeutic

Radiation Oncology (ASTRO) GMSIH (IT France), JAHIS (IT Japan), SFIL

(laboratory) Healthcare Information Management

Systems Society (HIMSS) Radiological Society of North America

(RSNA) And many more….

5

IHE: A Framework for Interoperability

A common framework for harmonizing and implementing multiple standards Application-to-application

System-to-system

Setting-to-setting

Enables seamless health information movement within and between enterprises, regions, nations

Promotes unbiased selection and coordinated use of established healthcare and IT standards to address specific clinical needs

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Stakeholder Benefits

Healthcare providers and health authorities Improved workflows Information whenever and wherever needed Reduced implementation costs

Vendors Align product interoperability with industry consensus Decreased cost and complexity of interface installation and management Focus competition on functionality/service not information transport

SDOs- Standards Development Organizations Rapid feedback to adjust standards to real-world Establishment of critical mass and widespread adoption

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Standards: Necessary…Not Sufficient

Foundational - to interoperability and communications

Broad - varying interpretations and implementations

Narrow - may not consider relationships between standards domains

Plentiful - often redundant or disjointed

Focused - standards implementation guides focus only on a single standard

IHE provides a process to implement an

integrated solution based upon multiple

standards

Over 650 Contributing

Vendors & Organizations

21 Societies Serving as Sponsors

Finland

Brazil

New Zealand

Israel

Malaysia

Poland

Switzerland

Saudi Arabia Colombia

Global Adoption of IHE

Coordination of Deployment Activities3-Tier Model

Global Deployment Coordination Committee (GDC)

Continental Mirror Committees

IHE Americas IHE Europe IHE Asia

Representatives from each

Continental Mirror CommitteeMeet regularly by Tcon

Others …

IHE World Summitrotating country/continent, e.g. aligned with another global event like ISO

All Deployment Committees are

invited to an annual World Summit

Org

an

ize

s

US CDN FRA TUR JPN CN

IHE – the process

Identify Interoperability issues

Develop Integration Profiles

Actors and Transactions

Workflow

Gather relevant standards

Connectathon Testing

Publish Integration Statements

Vendors list tested profiles

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IHE terminology

Integration Profiles Describe workflow use cases, standards and the overall

relationships to achieve transparent interoperability

Integration Statements Tell customers the IHE Profiles supported by a specific

release of a specific product.

Technical Frameworks The documents for each “domain” that specify the

Integration Profiles and the associated systems (actors) and transactions.

Connectathons Testing events ? Certification

Actors and Transactions

Development - IHE Domains

• Anatomic Pathology

• Cardiology

• Dental

• Eye Care

• IT Infrastructure (ITI)

• Laboratory

• Patient Care Coordination

• Patient Care Devices

• Pharmacy

• Quality, Research and Public Health

• Radiation Oncology

• Radiology• Mammography

ITI Profiles

XDS, XDS- I Cross Enterprise Document Sharing

XCA, XCA-I Cross Community Access

XDR, XDR-I Cross-Enterprise Document Reliable Interchange Document sharing in the absence of a registry and repository

XDM Cross-enterprise Document Media Interchange

XUA Cross Enterprise User Assertion Integration Profile

XDS-SD Cross-Enterprise Sharing of Scanned Documents

BPPC Basic Patient Privacy Consents

ATNA Audit Trail and Node Authentication

ITI- Trial implementation

Cross-Community Fetch (XCF) - Published 2011-08-19

Cross-Community Patient Discovery (XCPD) -Revised 2012-08-31

Cross-Enterprise Document Workflow (XDW) - Revised 2013-09-20

Interoperability Profiles-Radiology specific

PDI Portable Documents for Imaging IRWF Import Reconciliation Workflow TCE Teaching File and Clinical Trial Export

Trial Implementation IOCM Imaging Object Change Management MIMA Multiple Image Manager/Archive IID Invoke Image Display

Development Mobile Access to Health Documents - Imaging

Radiology Profiles

PDI Portable Documents for Imaging

IRWF Import Reconciliation Workflow

REM Radiation Exposure Monitoring

TCE Teaching File and Clinical Trial Export

MAWF Mamography Acquisition Workflow

IOCM Imaging Object Change Management

MIMA Multiple Image Manager/Archive

Major Radiology IT Themes-Meaningful Use for the Radiologist

Radiation Exposure- REM Aggregating and monitoring patient and population

exposure ACR DIR mapping tool

RadLex Playbook- vendors are interested in making this part of an IHE profile

Image Sharing- XDS IHE XDS; Personal Health Records as a vehicle

Reporting Teaching and Research- TCE

MIRC CTP

Meaningful Use – ONC/CMS

New Radiology Profiles

MRRT

Management of Radiology Reporting Templates

IID

Invoke Image Display

Radiation Exposure

Evaluating legacy dose information OCR solutions

Evaluating dose today Within the institution

Comparing multiple instruments

Patient Site comparison

IHE- REM profile ACR registry- Dose Index Registry (DIR)

Site to Site comparison as well as within an enterprise Radlex terms- RadLex Playbook mapping tool

REMActors and Transactions to move dose information stored as DICOM SR

TCE- Teaching File and Clinical Trial Export How to get images directly out of PACS as a

part of your normal workflow

MIRC compatible

Image Selector

Image Exporter

Receiver

TCE

TCE – Actors and Transactions

MIRC compatible

IHE-XDS (Cross-Enterprise Document Sharing)

XDS.a

XDS- I.a

XDS.b

XDS-I.b

a vs. b

Related to web standards and transactions

XDS-I.b

NIBIB/RSNA Image Sharing Project

Consumer Control-Patient Engagement Diminishes the need for BAAs

between enterprises Imaging Site to Clearinghouse Clearinghouse to PHR

Bootstrap an IHE based network Employ IHE solutions whenever

possible IHE generally has not focused on

consumer driven solutions but rather on institutional and enterprise workflow

Can be extended to other forms of sharing HIE

Security, Security…….

5 Academic Institutions

Develop a solution for all Radiology Sites

Establish a clearinghouse

Engage PHRs Primary emphasis is Consumer

Control through PHRs

Security and Confidentiality are drivers

Replacement / Alternative to CD

A Standards Based Solution

Technical Framework

Planning Committees identify the work to be done in a yearly cycle

Technical committees develop a solution

Public Comment

Refined solution is released for “Trial Implementation”

Final Text is published as part of the Technical Framework

Technical Framework• http://www.ihe.net/Techical_Framework/index.cfm

Document Use Case

Requirements

Identify available

standards (e.g. HL7,

DICOM, IETF, OASIS)

Develop

technical

specifications

Testing at

Connectathons IHE

Demonstrations

Products

with IHE

Timely access to

information Easy to integrate

products

IHE Deployment Process

Connectathons- Testing

How does the end user know that a system is compliant?

Vendor develops a solution following the specifications of a profile

Vendors test their solutions with one another at a Connectathon

“Monitors” judge success

Modules are tested

Vendors that pass testing can then implement these modules as part of larger systems

The first Connectathon was held in 1999 in Chicago, IL, within the basement of the Radiological Society of North America's (RSNA) parking garage.

At the first Connectathon there were 23 vendors, 47 applications tested, and 1 IHE Integration Profile tested.

The IHE NA Connectathon 2012 held over 150 organizations and has grown dramatically to include over 450 participants, which is held annually at the Hyatt Regency Chicago.

IHE Connectathon 2011

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Events: Connectathon

The IHE-C Connectathon was held at April 26, 2008 in Beijing Tiantan Hospital

There are 7 companies attendedDr. Zhu, Chairman of IHE China, past vice Minister of Healthcare attended

After the Connectathon

Vendor may publish an “Integration Statement”

IHE maintains a product registry

End Users can use this information when evaluating an RFP response

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IHE Product Registry

http://product-registry.ihe.net/

IHE Product Registry

Integration Statement

Certification- IHE Profiles

Currently Connectathon testing results in a vendor being

able to state they are compliant. IHE USA has

embarked on a formal certification process. Trial

Working Group – IHE International wished to provide

more structure for all such activities and created a

working group

Conclusions

IHE provides workflow driven standards based interoperability solutions

Easier to implement

Promotes transparent interoperability between disparate systems

Diminishes costs

Promotes quality

www.ihe.net