The Essentials Integrating the Healthcare Enterprise G. Claeys Agfa Healthcare R&D, Technology...

The Essentials

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

G. ClaeysAgfa Healthcare R&D, Technology Manager

Vendor co-chair

IHE Europe

Prof. Dr. med. B. WeinPraxisgemeinschaft im Kapuzinerkarree

User Co-chair

IHE Europe

Courtesy of IHE Committees

7 February 2005 IHE Europe Educational Event2

Healthcare IT – Main ObstaclesHealthcare IT – Main Obstacles

Lack of financial funding : IT : 2.3% of hospital budget (in other industries : 2.8%)

[Gartner]

Lack of national/regional guidelines & incentives

Lack of access to IT infrastructure

Lack of solutions that meet clinical needs

Lack of adequate healthcare IT standards and interoperability Integration cost : 20% of hospital IT budget

IHE scope


IHE MissionIHE Mission

Improve the quality and cost of healthcare by removing the interoperability barriers Access to Patient Information Clinical Workflow

Provide an open interoperability framework, based on existing standards

Enable cross-vendor environment (best-of-breed)

Leverage the interoperability solutions in multiple domains (radiology, cardiology, clinical lab, enterprise)

IHE = Integrating the Healthcare Enterprise


IHE

EHR- Longitudinal Record

IHE Cardiology

IHE Laboratory

IHE Radiology

IHE

Future Domain

IHE

Future Domain

IHE

IT Infrastructure Intra-Enterprise

Cross-Enterprise

17 Integration Profiles

3 Integration Profile



IHE Expanding Scope IHE Expanding Scope


IHE ApproachIHE ApproachSolve real-world integration problems

Close co-operation between users and vendors Users identify the integration problems Vendors provide technical solutions

Incremental development & deployment process with an annual heartbeat

Common technical framework, based on established standards (e.g. DICOM, HL7,..)


IHE Development & Deployment IHE Development & Deployment processprocess

Identify critical healthcare workflows and integration problems

Research & select existing standards to implement a solution

Write, review and publish IHE Technical Framework

Develop trial implementations

Perform cross-testing at “Connectathon”

Demonstrate at tradeshows (HIMSS/RSNA…)

IHE Domains Milestones – 20 month cycleIHE Domains Milestones – 20 month cycleDevelopmentDevelopment and and DeploymentDeploymentProposed Scope

Approved Scope

Public Comment Intgr-profile Sponsors announce Connectathon/Demos with set of

Implementation Profiles

Final Intgr-profile + 9 ---

- 10 ---

- 7 ---

- 2 ---

Trial Implementation Intgr-profile 0 ---Connectathon/Demo Vendor Participant Registered

+ 2 ---

Vendor Participant passed Connectathon

+ 5 ---

+ 6 --- Demo &Education Material

Vendors release products with IHE Integration

Statements---


IHE Building BlocksIHE Building Blocks

IHE Technical Framework

IHE Validation Process

IHE Integration Statements


IHE Technical FrameworkIHE Technical Framework

Describes the different integration solutions (domain specific) Radiology, IT Infrastructure, Cardiology, Lab

Key concepts are domain neutral Integration Profile Transactions Actors Data model

Country & Regional specialization Limited : max. 5%

Based on existing standards

IT

Standards

(http, ebxml)

Healthcare

Standards

(HL7, DICOM)

IHE

Integration Profiles

eHealth

Application

eHealth

Application


IHE Technical Frameworks – IHE Technical Frameworks – The booksThe books

One Technical Framework for each one of the IHE Domains:

Cardiology IT Infrastructure Lab Radiology


IHE Integration Profile - ScopeIHE Integration Profile - Scope

Integration solution for real-world problems

Coherent set of integration functionality

Allow users to focus on high-level integration


IHE Integration Profiles – ExamplesIHE Integration Profiles – Examples

Streamline the workflow sub-processes Patient ADT – Ordering – Data creation & processing– Reporting –

Treatment - Billing Cross referencing patient id’s among hospitals (MPI)

Access to clinical data from workstations and browsers Departmental reports (e.g.. Clinical lab, cardiology, radiology),

measurements, images

Quality control Consistent presentation of images on displays & printers

Security : authentication, auditing

Access to common longitudinal health record (EHR) Focus on sharing of health record among healthcare institutions


IHE Integration Profiles - ContentIHE Integration Profiles - Content

Set of Transactions among Actors

Actor = logical entity (e.g. modality, image manager, order filler)

Transaction = Sequence of messages among Actors

Messages : e.g. HL7, DICOM, ebXML,.

Profiling existing communication standards Map data models, message content “Restrict the options” Clarify the semantics : accession nr

ADT PatientRegistration

OrderPlacer

DeptScheduler

ImageManager/Archive

Modality


IHE Integration Profile - ExampleIHE Integration Profile - Example


IHE Transactions - ExampleIHE Transactions - Example


The IHE The IHE WWorld….orld….

IHE ActorIHE Actor

ActorActorActorActor

ActorActor

IHEIHETransactionTransactionIHEIHE

TransactionTransaction

IHEIHETransactionTransaction

IHE ActorIHE Actor


The Product World…..The Product World…..

Product XYZfrom Vendor T


Mapping IHE to ProductsMapping IHE to Products

IHE ActorIHE Actor

ActorActorActorActor

ActorActor

IHEIHETransactionTransactionIHEIHE

TransactionTransaction

IHEIHETransactionTransaction

IHE ActorIHE Actor

Poduct XYZfrom Vendor T


IHE Validation ProcessIHE Validation Process

Goal : Validate implementations of IHE TF in products

Approach IHE is not a certification authority IHE stimulates auto-validation

• Vendors are responsible for validating and documenting IHE implementations

• IHE provide tools and infrastructure

IHE Validation tools Mesa toolkit Connectathon IHE Integration statement


MESA Test ToolkitMESA Test Toolkit

Software library

Emulate the various actors in the different implementation profiles

Supports single product, single vendor testing

Pre-requisite for connectathon participation Implementers submit test logs prior to connectathon


Connectathon Connectathon Connectathon = connectivity marathon

Validate the Integration Profiles for a particular IHE demo Pre-requisite for participating at IHE demos

1 week validation session in Europe, USA and Japan End-to-end scenario testing Multi-product; multi-vendor; multi-domain

Multi-vendor, multi products 2004 : 50 companies, 100 systems 2005 : 77 companies, 118 systems

Multi-domain Integration Profiles Rad, ITI, Lab, Cardio

European connectathon’s : Paris (2002), Aachen (2003), Padua (2004) Noordwijkerhout (April 2005)

Results are published on www.ihe-europe.org


2003 Aachen

Connectathon at workConnectathon at work


Connectathon resultsConnectathon results


Connectathon results (simple)Connectathon results (simple)


Connectathon results (advanced)Connectathon results (advanced)


IHE Integration StatementsIHE Integration Statements

Vendors Document the IHE implementation

per product Content :

• List of supported actors• List of supported integration

profiles (per actor) “contractual” commitment

Buyers Uniform mechanism to compare

product integration capabilities Enables validation on paper


IHE Integration Statement

Vendor Product Name Version Date

Huge Imaging Medical Systems IntegrateRAD V2.3 12 Oct 2002

Integration Profiles Implemented

Actors Implemented Options Implemented

Scheduled Workflow Image Manager/Archivee none

Image Display Performed Procedure Step

Order Filler PPS Exception Management

Simple Image and Numeric Report

Report Creator none

Link to vendor IHE page www.HImedicalsystems.fake/ihe

Links to Standards Conformance Statements of the Implementation

HL7 www.HImedicalsystems.fake/hl7

DICOM www.HImedicalsystems.fake/dicom/integrateRAD.pdf

IHE Integration Statements - ExampleIHE Integration Statements - Example


IHE Integration Statements - ResourcesIHE Integration Statements - Resources


IHE Integration Statements - ListIHE Integration Statements - List


IHE Market AdoptionIHE Market Adoption

40+ companies / 100+ Products with IHE Integration Statements www.ihe-europe.org -> Product IS www.rsna.org/IHE/integration_statements

IHE support is requested in RFPs

IHE User Success Stories in North American and Europe


IHE User Success Stories – Submitted since 2002

IHE measures success on:

Compliant products availability

Provider deployed integrated systems

IHE Becomes realityIHE Becomes reality


IHE Europe Success StoriesIHE Europe Success Stories


IHE OrganizationIHE Organization

Global Structure

Why IHE Europe


IHE Europe

IHE North America

France

USA Canada

IHE Asia-Ocenia

Japan

KoreaTaiwan

Netherland Spain Sweeden

UKItalyGermany

Norway

Regional Deployment

RadiologyPlanning Committee

RadiologyTechnical Committee

IT InfrastructurePlanning Committee

IT InfrastructureTechnical Committee

Pharmacy ExporatorySub-Committee

Global Development

CardiologyPlanning Committee

CardiologyTechnical Committee

LaboratoryPlanning and technical

Committee

IHE Strategic Development Committee

ACCHIMSSRSNA

JAHISJIRAJRS

METIMEDIS-DCJAMI

GMSIHSFRSFIL

SIRMBIREuroRec

COCIREAR-ECRDRG

ESCProfessional Societies / SponsorsProfessional Societies / Sponsors Contributing and participatingContributing and participating

VendorsVendors

IHE Organizational StructureIHE Organizational Structure


IHE Members IHE Members

Users Clinicians, Medical Staff, Administrators, CIOs, …

Vendors Information Systems & Imaging Equipment (80 vendors)

Societies Representing Healthcare Segments EAR, ESC, Other Professional Societies…

Governmental agencies e.g. GMSIH

Active liaison with Standards Development Organizations (SDOs) HL7, DICOM, ASTM, others …

Stakeholders of healthcare interoperability solution


AGFA Healthcare

AISoftw@re Medical Solutions

Algotec

ARES SA

aycan Digitalsysteme

ConVis

DEDALUS

Dianoema

Eastman Kodak Company

Ebit Sanita

EDL

ELFIN s.r.l.

Engineering Sanità Enti Locali

ESAOTE

ETIAM

Ferrania

Fujifilm

GE Healthcare

GMD

GIE Convergence-Profils

Rogan-Delft

Sago spa

Sectra Imtec AB

Siemens Medical Solutions

Soluzioni Informatiche srl

Stentor Inc.

Swissray Medical AG

Symphonie On Line

Synapsis

TELEMIS S.A.

TIANI MEDGRAPH AG

TOREX GAP Medical

Toshiba Medical Systems

TSI groupe europMedica

VEPRO AG

VISUS Technology Transfer

WAID

XR PARTNER

GWI Research

IASI Srl

IdeoPass

Image Device-Cerner Company

INFINITT

INOVIT

McKesson

MED2RAD

MEDASYS SA

Medavis

Medigration GmbH

MEDIMON Ltd.

MEDOS AG

Merge eFilm

METAFORA

Minolta Europe

Omnilab

Philips Medical Systems

Rasna Imaging Systems

RAYPAX INC.

In yellow, companies with IHE Committees Chairs (Summer 2004)

Participating and Contributing Vendors (Europe)Participating and Contributing Vendors (Europe)


IHE in Europe - WhyIHE in Europe - Why

Similar integration problems ask for similar (IHE) solutions

Provide European vendors (RIS/HIS) with a platform to develop and test world-class interoperability

Address European specific requirements :

Multi-language aspect Limited acceptance of HL7 Country specific RIS vendors Country specific congresses & exhibitions

Represent European needs in the different global IHE Development committees


IHE Netherlands IHE Netherlands CommitteeCommittee

IHE Germany IHE Germany CommitteeCommittee

IHE xxx IHE xxx CommitteeCommittee

Demonstrations

Education

National TF extensions

Vendor Participation

IHE Europe IHE Europe CommitteeCommittee

Strategic Development

Connectathon

New Integration Profiles

Education and promotion

IHEInter-

national

IHE Europe vs. NIHE Europe vs. National IHEational IHE


IHE-Europe – Deployment ActivitiesIHE-Europe – Deployment Activities

National IHE Committees (8) 2001 : France, Germany 2002 : Italy, UK 2003 : Norway, Denmark, Netherlands 2004 : Spain

Demos : Radiology centric demos : JFR, DRK,

SIRM, UKRC, ECR Hospital centric demos : Hopital Expo,

Medica, HCC

400 visitors/demo (average)

40% local vendors; 60% international vendors


IHE Europe Development ActivitiesIHE Europe Development Activities

Participate in global IHE Development activities National extensions of Technical Framework

Champion of IHE Clinical Lab : Joint effort of IHE France and IHE Japan Other countries join : USA, Germany

Assess new IHE initiatives in Pathology & Surgery

IHE test tool development: Extensions of MESA Test tools for clinical lab Web based test management tool


IHE Europe – Activities 2005IHE Europe – Activities 2005

IHE Connectathon Noordwijkerhout, 25-29 April 2005 All IHE domains : Radiology, IT Infrastructure,

Cardiology, Clinical Lab

IHE Demos : Radiology : UK, ECR, France, Germany Cardiology : ESC congress (Stockholm) Lab : France, Italy Enterprise : Italy, France


How to participate to IHE?How to participate to IHE?

As a VendorImplement IHE profiles in your products

Participate to Connect-a-thons and Demonstrations

Respond to Public Comments of Domain Supplements

Participate in IHE development / deployment committee

As a User/ConsultantInclude IHE Integration Profiles in your RFPs and Integration Projects

Respond to Public Comments of Domain Supplements

Attend Demonstrations.

Participate in IHE development / deployment committee


IHE, IHE, the effective bridge the effective bridge

betweenbetweeninformation exchange standards information exchange standards

and and their practical use in healthcaretheir practical use in healthcare


More information….More information….

IHE Web sites: • http://ihe-europe.org• http://www.rsna.org/IHE• http://www.acc.org/quality/ihe.htm• http://ihe-nl.org

Technical Frameworks:• ITI V1.0, RAD V5.5, LAB V1.0, CARDIO V1.0

Non-Technical Brochures :• IHE Europe Business Case• IHE Fact Sheet and FAQ• IHE Integration Profiles: Guidelines for Buyers• IHE Connectathon Results• Vendor Products Integration Statements

The Essentials Integrating the Healthcare Enterprise G. Claeys Agfa Healthcare R&D, Technology...

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