Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise
Transforming the Radiologic Interpretation Process (TRIP™)
Using IHE™
Sanjay Jain, Kevin O’Donnell, Dave Channin IHE Radiology Planning Committee
RSNA 2003
DisclaimersDisclaimersSanjay Jain is an associate of Cerner
CorporationKevin O’Donnell is an employee of
Toshiba America Medical SystemsDr. Channin, Northwestern
Radiology, receives a portion of his research funding from GE Medical Systems
RSNA 2003
What is TRIP™?What is TRIP™?An initiative of the Society for
Computer Applications in Radiology (SCAR)
Supported by RSNA and IHE™
Radically change the way we think about the radiology process given the ‘digitization’ of radiology, and the role of technology in delivering healthcare
RSNA 2003
Why is this important?Why is this important?
Application of technology Can:Reduce Errors and/or Delays in
TreatmentProvide complete Information for
Decision-makingImprove efficiencies in Utilization of
Staff and Equipment
RSNA 2003
This is your healthcare provider in healthcareThis is your healthcare provider in healthcare
Any Questions?Any Questions?
This is healthcareThis is healthcare
RSNA 2003
What’s driving the Rat What’s driving the Rat Race?Race?
Volume of procedures is growing– New procedures / modalities– New uses for existing technologies– Aging population
Size and complexity of studies is growing– Implications for technology, but…– More important implications for human interpretation
Data set navigation Timely delivery of radiologist value-add back to referring
physician Shortage of radiologists and technologists
RSNA 2003
Why Does Anything in Why Does Anything in Radiology Matter?Radiology Matter?
Improve service to patients Improve service to referring physicians Improve efficiency and workflow Enhance the academic mission Modernize information systems
RSNA 2003
How Can IHEHow Can IHE™™ Help? Help?Integrating the Healthcare Enterprise
is an initiative to:– Enhance the Access to Clinical Information– Ensure Continuity and Integrity of Patient Information– Speed Up the Integration in Healthcare Environments– Foster Communication Between Vendors of
Medical Information Technology– Prove that Integration is Attainable Based on Standards
Yes, but… what does IHE™ really do to help?
RSNA 2003
IHEIntegrationProfiles B
The IHEThe IHE™™ Process – Integration Profiles Process – Integration Profiles
IHE Integration Profiles:– Detailed selection of standards and options each solving a
specific integration problem– A growing set of effective provider/vendor agreed solutions– Vendors can implement with ROI– Providers can deploy with stability
Standards
Easy toIntegrateProducts
IHEIntegrationProfile A
IHEDemonstration
IHEConnectathon
ProductWith IHE
User Site
RFP
IHETechnical
Framework
RSNA 2003
IHEIHE™™ Integration Profiles Integration Profiles 12 Profiles in Radiology 5 Profiles in IT Infrastructure 1 Profile in Lab
(Complex, problematic) workflow processes that involve cooperative manipulation of healthcare information by various information systems
RSNA 2003
Pat
ient
Info
rmat
ion
Rec
onci
liatio
n
Access to Radiology Information
Consistent Presentation
of Images
Workflow
Basic Security
Evidence Documents
Key Image Notes
SimpleImage &Numeric Reports
Presentation of Grouped Procedures
Post-Processing Workflow
Reporting Workflow
Charge Posting
Scheduled
IHE™™ Success – Radiology Profiles
RSNA 2003
Consider the ‘Workflow Consider the ‘Workflow Profiles’Profiles’
Scheduled Workflow– Efficient, integrated acquisition
Post-Processing Workflow– Efficient, integrated 2D, 3D and CAD
Reporting Workflow– Efficient, integrated reporting
RSNA 2003
CommonalitiesCommonalities Generate a work list of work to be done Claim work list items (with pointers to
inputs) Do the work Tell what you did and when you are done Loop closure (for local or distributed
workflow) Positive hand-offs
Efficient, error-resistant operations
RSNA 2003
Now Add…Now Add… Assisted Protocol Option to SWF
– Decreased variance in performance of procedures
– Procedure tailoring only when it makes clinical sense
Patient Information Reconciliation Profile– Manage information gaps & recovery
Unavailable computer systems (downtime) Unknown patients (trauma, Doe, VIPs) Operator errors
RSNA 2003
That cover’s the basics;That cover’s the basics;
Now,Now,
How do we kick it up a How do we kick it up a notch?!notch?!
RSNA 2003
Pat
ient
Info
rmat
ion
Rec
onci
liatio
n
Access to Radiology Information
Consistent Presentation
of Images
Workflow
Basic Security
Evidence Documents
Key Image Notes
SimpleImage &Numeric Reports
Presentation of Grouped Procedures
Post-Processing Workflow
Reporting Workflow
Charge Posting
Scheduled
IHE™™ Success – Radiology Profiles
RSNA 2003
Make the radiologist more Make the radiologist more productive on the PACS workstationproductive on the PACS workstation
Use Key Image Notes to ‘filter’ ‘significant images’ for referring physicians, QA, teaching, etc.
Use Evidence Documents to capture measurements, procedure logs & CAD results as structured study data and feed into reporting system.
Generate Simple Image and Numeric Reports in DICOM S/R; avoid dictation (even voice recognition) whenever possible.
RSNA 2003
IHE™™ ITI Integration Profiles
Enterprise User Authentication
Provide users a single name
andcentralized
authentication process
across all systems
Enterprise User Authentication
Provide users a single nameand
centralized authentication
processacross all systems
Retrieve Information for Display
Access a patient’s clinical information and documents
in a format ready to be presented
to the requesting user
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Patient Identifier Cross-referencing
for MPI
Map patient identifiers across independent
identification domains
Patient Identifier Cross-referencing
for MPI
Map patient identifiers across independent
identification domains
Consistent Time
Coordinate time across networked
systems
Consistent Time
Coordinate time across networked
systems
HL7 CDA / PDF / JPEG
HL7 2.x ADT Triggers / Queries Kerberos (RFC 1510) / HL7 CCOWNTP (RFC 1305)
Synchronize multiple applications on a desktop to the same patient
Patient Synchronized Applications
HL7 CCOW
RSNA 2003
Use the IT Infrastructure ProfilesUse the IT Infrastructure Profiles Use Retrieve Information for Display (RID)
– Facilitate access by radiologist to EMR details– (ARI Profile facilitates access to radiology
information) Use Patient Synchronized Applications (PSA)
– Share context with other applications that radiologist needs
Enterprise User Authentication (EUA)– Provides for single sign-on
Patient Identifier X-ref (PIX)– Allows radiologist to access information across
multiple enterprises
RSNA 2003
ConclusionConclusionIHE™ provides a platform upon which
to build new concepts to transform the radiologic interpretation process (TRIP™)
With integration reliably distributing relevant information, Vendors can compete on providing new features and functionalities to make radiologists much more efficient
RSNA 2003
More information…More information… SCAR / TRIP™
– www.scarnet.org IHE™
– www.rsna.org/ihe– www.himss.org/ihe
IHE Rad Technical Framework for Year 5 - V5.5 IHE IT Technical Framework for Year 1 - V1.0 IHE Lab Technical Framework for Year 1 (Public
Comment) Non-Technical Brochures :
– IHE Fact Sheet and IHE FAQ– IHE Integration Profiles: Guidelines for Buyers– IHE Connectathon Results– Vendor Integration Statements
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