Integrating the Healthcare Enterprise
– Achievements & Future Goals –
– Introduction
– Current Status – Achievements
– Future Directions – Next Steps
Dr. Nikolaus Wirsz – Siemens Medical Solutions
• Integration Solutions Available Today from
Several Medical Systems Vendors - BUT:
• Modern Healthcare Enterprises Are Still
Confronted with Problems:
– Lack of Access to Complete Medical Information
– Inconsistent Medical Information
Across Departments and Institutions
– Inadequate Communicating of Medical Data
Across Multiple Systems from Different Vendors
– Risky Investments in Proprietary Solutions
Nov. 1998 HIMSS & RSNA Launch a New Initiative:
“Integrating the Healthcare Enterprise (IHE)”
An Incremental Multi-Year Project
• Speed Up the Integration in Healthcare Environments
• Foster Communication Between Vendors of Medical IT
• Prove that Integration is Attainable Based on Standards
• Participants:
– Representatives of Healthcare Providers
– Information Systems Vendors
– Imaging Systems Vendors
– Standardization Groups
Who Is IHE ?
• Societies / Associations:
– Healthcare IT: ... HIMSS, COCIR, GMSIH, ...
– Radiology: ... RSNA, EAR, ECR, DRG, SFR, ...
– Other Clinical Specialties: ... The Appropriate Societies
• Vendors:
– Healthcare IT: ... IS Vendors
– Radiology: ... RIS Vendors, Imaging: Modalities, PACS, ...
– Other Clinical Specialties: ... Suppliers of Departmental Systems/Products
• Users:
– Healthcare IT: ... CIOs, Administrators
– Radiology: ... Radiologists
– Other Clinical Specialties: ... Clinicians, Medical Staff
IHE Participation
IHE International
• IHE North America
• IHE Europe:
• IHE France
• IHE Germany
• IHE Italy
• IHE UK
• . . .
• IHE Japan
IHE System Transactions Overview
RIS
HIS
IMAGING:
•PACS
•Workstations
•Modalities
IHE System Transactions Overview
RIS
HIS
IMAGING:
•PACS
•Workstations
•Modalities
RIS
HIS
IMAGING:
•PACS
•Workstations
•Modalities
ADT
Patient Registration
Image Archive
Image Manager
Image Display
Image Creator
Acquisition
Modality
Department
System Scheduler
– Order Filler –
Order Placer
Performed
Procedure Step
Manager
Modality Worklist Patient Registration Patient Update Procedure ScheduledImages Availability Query Patient Update Procedure Update Images Stored Storage Commit Q /R Key Image Note Q /R Presentation Sates Storage Commit Images Stored PPS In-Progress / Completed PPS In-Progress / Completed PPS In-Progress / Completed Fill er Order Management Placer Order Management Present. State Stored Q /R Images Key Image Note Stored Present. State Stored Key Image Note Stored
HIS
RIS
PACS
Mo d ality
HIS
HL7
HL7
––
––
RIS
HL7
HL7
HL7 / DICOM
DICOM
PACS
––
HL7 / DICOM
DICOM
DICOM
Mo d ality
––
DICOM
DICOM
DICOM
IHE Goes Beyond Standards
IHE =
+ Multi-Vendor
+ Workflow-Driven
+ INTEGRATION
based on established medical IT Standards
Integration Profiles 4 Actors 4 Transactions 4 Standards
Integration Profile
Actor
Integration
Profile
Actors
Transactions
Actor
T ras ac tion T ras ac tion T ras ac tionActor
T ras ac tion T ras ac tion T ras ac tionReferenced
Standards:
DICOM & HL7
Role
Detailed
Messaging
Info
T ras ac tion T ras ac tion T ras ac tionUser Focus:
Solutions to Clinical Problems
Implementation:
• Integration Profiles - Group related transactions
and associate them with real-world functions
• Integration Profiles allow the customer to focus on
high-level integration while vendor products handle the details
• Reduce Ambiguities
• Manage Customer Expectations
IHE Integration Profiles: http://www.rsna.org/IHE/iheyr3_integration_profiles.shtml
IHE Year 5 (2003 / 2004) Integration Profiles
Patient In
for
m
ation Reconciliation
Access to Radiology Information
Consistent
Presentation
of Images
Workflow
Basic Security
Evidence
Documents
Key Image
Notes
Simple
Image &
Numeric
Reports
Presentation
of Grouped
Procedures
Post-Processing
Workflow
Reporting
Workflow
Charge
Posting
Scheduled
NEW !
NEW !
More Candidates for New IHE Integration Profiles
• Extended Archiving:
– Multi-Institution Image Managers / Archives
– Splitting of Image Manager / Archive Actor
• Profiling Removable Media
• Integration of Nuclear Medicine
• Teaching Files & Clinical Trials
& A.L.I. Technologies Inc. & Agfa Medical Imaging & Agilent
& Algotec Systems Ltd. & Cedara Software & Cerner
& CSIST
& Eastman Kodak Company & Emageon
& Fujifilm Medical Systems & GE Medical Systems
& Hologic - Direct Radiography & IDX Systems Corporation & IMCO Technologies & Konica
& Marconi Medical Systems & Marotech
& Medical Manager Health Systems & Mediface
& Merge Technologies Inc. & Mitra Imaging Inc. & Philips Medical Systems & RASNA Imaging Systems & Siemens Medical Solutions & Softmedical
& StorCOMM, Inc.
& Swissray International, Inc. & Tiani Medgraph GMBH & Toshiba
& Vital Images, Inc. & Agfa Gevaert n.v.
& Algotec
& Aycan Digitalsysteme GmbH & ConVis Med. DV GmbH & Co KG & Eastman Kodak Company
& EBIT Sanita S.p.A & EDL
& Ferrania & Fuji
& GAP Medical Systems & GE Medical Systems & GIE Convergence-Profiles & GWI Research GmbH & Image Devices GmbH & Inovit & Med2Rad & Medasys & Medavis & Medigration GmbH & Medos AG
& Merge Technologies Inc. & Philips Medical Systems & Quadrat
& RASNA
& Sectra Imtec AB
& Siemens Medical Solutions & Swissray Medical AG & Symphonie Online & Synapsis SRL & Tiani Medgraph AG
& Toshiba Medical Systems Europe & WAID & XRPartner
USA 2001/2:
30 Vendors
Europe 2002:
33 Vendors
Europe 2003:
~50 Vendors !
• Connectathons – Proof of Concept / Validation:
– IHE North America:1999 – 2003 – …
– IHE Europe:
2001 – 2003 – …
• Live IHE Demonstrations:
– North America
– Europe: France, Germany, Italy, UK, (Norway, Denmark, Spain, …)
– Japan
• User Success Stories – Real Products in Clinical Settings Using IHE:
– RSNA 2002: 13 Stories Presented
– JFR 2003: ~ 15 Stories to be Presented
• Connectathons – Proof of Concept / Validation:
– IHE North America: 1999 – 2003 – …
– IHE Europe:
2001 – 2003 – …
• Live IHE Demonstrations:
– North America
– Europe: France, Germany, Italy, UK, (Norway, Denmark, Spain, …)
– Japan
• User Success Stories – Real Products in Clinical Settings Using IHE:
– RSNA 2002: 13 Stories Presented
– JFR 2003: ~ 15 Stories to be Presented
IHE Achievements / IHE Success
IHE
V
isi
on
Be
co
me
s R
ea
lity
!
• Connectathons – Proof of Concept / Validation:
– IHE North America: 1999 – 2003 – …
– IHE Europe:
2001 – 2003 – …
• Live IHE Demonstrations:
– North America
– Europe: France, Germany, Italy, UK, (Norway, Denmark, Spain, …)
– Japan
• User Success Stories – Real Products in Clinical Settings Using IHE:
– RSNA 2002: 13 Stories Presented
– JFR 2003: ~ 15 Stories to be Presented
• IHE Integration Statements – Available Products with IHE Features:
http://www.rsna.org/IHE/participation/index.shtml#int_statements
• Connectathons – Proof of Concept / Validation:
– IHE North America: 1999 – 2003 – …
– IHE Europe:
2001 – 2003 – …
• Live IHE Demonstrations:
– North America
– Europe: France, Germany, Italy, UK, (Norway, Denmark, Spain, …)
– Japan
• User Success Stories – Real Products in Clinical Settings Using IHE:
– RSNA 2002: 13 Stories Presented
– JFR 2003: ~ 15 Stories to be Presented
• IHE Integration Statements – Available Products with IHE Features:
http://www.rsna.org/IHE/participation/index.shtml#int_statements
IHE Achievements / IHE Success
IHE Integration Statement
Vendor
Product Name
Version
Date
A Medical Systems Company
IntegrateRAD
V2.3
12 Oct 2002
This product implements all transactions required in the IHE Technical Framework to support
the IHE Integration Profiles, Actors and Options stated below:
Integration Profiles
Implemented
Actors Implemented
Options Implemented
Image Manager/Image Archive none
Image Display
none
Image Creator
Performed Procedure Step
Scheduled Workflow
Order Filler
PPS Exception Management
Simple Image and Numeric
Report
Report Creator
none
Link to the vendor IHE page
www.amedicalsystemsco.com/ihe
Links to Standards Conformance Statements for the Implementation
HL7
www.amedicalsystemsco.com/hl7
DICOM
www.amedicalsystemsco.com/dicom/integrateRAD.pdf
For general
Information
on IHE
In America:
www.rsna.com/ihe
In Europe:
www.ihe-europe.org
In Asia:
A Multidimensional Expansion of Integration
Dept
Sched.
ADT
Order
Mgt
Image
Mgr
Modality
1
st
Dimension:
Vertical Integration for Radiology
IHE Years 1, 2, 3, 4, ...
A Multidimensional Expansion of Integration
2
nd
Dimension:
Growing the Horizontal
Healthcare Enterprise Integration
Master Patient Index
Clinical Patient Record
Ordering Process
. . .
Dept
Sched.
ADT
Order
Mgt
Image
Mgr
Modality
Patient Registration
IHE Roadmap
A Multidimensional Expansion of Integration
3
rd
Dimension:
Increasing the Number of
Vertically Integrated
Departments
Master Patient Index
Clinical Patient Record
Ordering Process
Patient Registration
R a d i o l o g y
C a r d i o l o g y
Laboratory
P h a r m a c y
O t h e r s . . .
IHE Vision for Growth
ADT/ Reg Lab/Path Radiology Cardiology Int Med Endoscopy Ophthalm Dental ERStrategic Development Committee Radiology Planning Committee Radiology Technical Committee IHE Europe Planning Committee IT Infrastructure Planning Committee IT Infrastructure Technical Committee IHE Japan Planning Committee
……
Sub-Committee Pharmacy Sub-Committee Laboratory Cardiology Committee IHE France Planning Committee IHE Germany Planning CommitteeIHE ItalyPlanning CommitteeIHE UK Planning CommitteeIHE …
Planning Committee
IHE International Steering Committee
JAPAN EUROPE North America
JIRA COCIR EAR ECR HIMSS
JRS SFR DRG SIRM RSNA
… GMSIG ZVEI BIR … …
