DICOM and IHE Integrating the Healthcare Enterprise Cor

DICOM and IHE, Integrating the Healthcare Enterprise Cor Loef Program Manager Interoperability Co-chair DICOM Strategic Advisory Committee Philips Medical Technical Member IHE Planning and. Systems Committee May 5, 2002

Contents • • • Goal of IHE process Integration Profiles and the role of standards in IHE DICOM’s use in the IHE Integration Profiles Current topics Questions and answers May 5, 2002 2

Integration Hell in the Enterprise RIS / HIS • Different information islands: Modalities, PACS, HIS, RIS, Modalities EPR PACS • Different standards and information models : DICOM, HL 7, XML EPR • Different (proprietary) interpretations and implementations May 5, 2002 3

Goal of IHE Ø Ø It’s an initiative promoting and supporting the integration of systems in the healthcare enterprise Integration Goal: Improve the efficiency and effectiveness of clinical practice by: Ø Ø Ø Improved Information Flow Advanced Multi-System Functions With minimal “integration project pain” May 5, 2002 4

IHE process • Users and vendors work together to identify and design solutions for integration problems • Intensive process with annual cycles: – Identify key workflows and integration problems – Research & select standards to specify a solution – Write, review and publish Technical Framework – Perform cross-testing at “Connectathon” – Demonstrations at tradeshows: RSNA/HIMSS, and also JFR, DRK, JMCP May 5, 2002 5

The (multi-vendor) Integrated Imaging Solution Modalities Image Server Radiology Information System Diagnostic Workstation May 5, 2002 Web Distribution Connection to other Network and/or Tele. Radiology CD Exchange 6

Role of standards in IHE • IHE attacks real world radiology integration problems • Standards such as HL 7 and DICOM provide dictionaries • IHE defines a “phrasebook” that solves real world problems by assembling pieces provided by DICOM/HL 7 • IHE is also a way to promote and advance the implementaion of standards May 5, 2002 7

IHE: Relation to Standards Integration Solution C B A IHE Technical Framework Selection of options DICOM May 5, 2002 Common information model HL 7 8

Use Case Roles & Interaction Diagrams Actor 1 Actor 2 Actor 3 • Examples of Actors: - ADT / Patient Registration - Acquisition Modality TRANSACTIONS Actor 1 Actor 2 Message 1 • Examples of Transactions: Actor 3 - Register Patient - Images Stored Message 2 Message 3 May 5, 2002 9

• • • Goal of IHE process Role of standards in IHE DICOM’s use in the IHE Integration Profiles Current topics Questions and answers May 5, 2002 10

IHE Integration Profiles • Integration solution for real-world integration problems • Set of related transactions among systems • Allow buyers to focus on high-level integration, cornerstone for defining requirements in RFP’s • Implementation is defined by the IHE Technical Framework May 5, 2002 11

Year 4 Integration Profiles Scheduled Workflow Patient Information Reconciliation Admit, order, schedule, acquire images, notify of completed steps Unknown patients and unscheduled orders Post- Processing Workflow Schedule, perform, & notify image processing & CAD steps Charge Posting Collection of billable procedure details Consistent Presentation of Images Key Image Notes Simple Image and Numeric Reports Hardcopy and softcopy grayscale presentation state Flag significant images Simple reports with image links and, optionally, measurements Presentation of Grouped Procedures Subset of a single acquisition Access to Radiology Information Consistent access to images and reports Basic Security Audit Trail Consolidation & Node Authentication May 5, 2002 12

1. Scheduled Workflow DICOM: • Modality Worklist Query Requirements, with Acquisition Protocol Setting option • Required attribute mapping from Worklist to Images • Modality Performed Procedure Step, with Exception Management option • Store • Storage Commitment acquisition completed acquisition in progress May 5, 2002 13

2. Patient Information Reconciliation Enter patient as J Doe Patient later identified enter proper data report HIS RIS examination orders for J Doe May 5, 2002 14

3. Consistent Presentation of Images What the Radiologist Displays: Area Of Interest Annotate Zoom Flip What the Reviewing Physician Sees: Original Image & Presentation State &Grayscale Standard The Radiologist’s Transformations Are Saved Area Of Interest Prepared Image Original Image Window Level Original Image May 5, 2002 The Radiologist’s Transformations Are Lost Original Image 15

4. Presentation of Grouped Procedures Head View Requested Procedure: HEAD Report: HEAD RIS / PACS Requested Procedure: Chest View CHEST MODALITY Performs a single exam Operator groups 2 procedures May 5, 2002 Head View Report: CHEST DICOM: • Presentation State • Modality Performed Procedure Step Chest View 16

5. Simple Image and Numeric Report Verification DICOM: • Basic Text SR • Enhanced SR • Template TID 2000 • Codes from DCMR Verified Report Preliminary Report Images and Exam data presented for diagnosis Report stored for Network Access Report & Images retrieved Report and Image Review for Patient Care Images retrieved Image Manager and Archive May 5, 2002 17

6. Key Image Notes Radiologist Flags Images: Referring Physician Sees Key Images First: Note 1 for refering physician This image shows the renal rupture. For referring physician: This image shows the renal rupture. Note 2 For referring physician: This image has the hematoma. May 5, 2002 Study & Key Image Notes Note 2 for refering physician This image has the hematoma. DICOM: • Key Object Selection Document SOP Class 18

7. Access to Radiology Information Emergency Department Referring Physician Radiology Department – Images and Reports Remote Clinics Electronic Medical Record May 5, 2002 DICOM: • C-FIND with required matching and return keys • C-MOVE • Images and SR Other Departments: - Oncology - Surgery - Neurology - Pediatrics - etc. 19

8. Charge Posting ADT Account Management DSS/ Order Filler Charge Posted Reporting Completed PPS In Progress/ Completed Acquisition Modality May 5, 2002 Charge Processor DICOM: • required billing info in MPPS • Film consumption Report • Procedure Type Manager • Supplies and devices 20

9. Basic Security • Local access control (authentication of user) • Strong authentication of remote node (digital certificates) • network traffic encryption is not required • Audit trail with: • Real-time access • Time synchronization Secured System Secure network System A System B DICOM: • Basic TLS Secure Transport Connection Central Audit Trail Profile Repository • well-known port 2762 May 5, 2002 21

10. Post-Processing Workflow Post. Processing Manager PP worklist Provided PP Workitem Claimed PP Workitem Completed PP PPS Started DICOM: PP PPS Completed Image Creator May 5, 2002 • General Purpose Worklist • Images • Evidence Documents: • Mammography CAD SR • Basic Text SR • Enhanced SR • Comprehensive SR 22

10. Post-Processing Workflow: use case Acquisition Modality Image Manager MPPS Complete Store Images Department Scheduler/ Post-Processing Manager Image Creator Create Worklist Item Post-Processing WL Provided Post-Processing Task Claimed Query/ Retrieve Images Post-Processing PPS Started Creator Images Stored Post-Processing PPS Completed Post-Processing Task Completed

• • • Goal of IHE process Integration Profiles and the role of standards in IHE DICOM’s use in the IHE Integration Profiles Current topics Questions and answers May 5, 2002 24

Current topics • • Reporting workflow Security Standard for Audit Records Extension to other clinical domains: Cardio, NM Desktop Integration May 5, 2002 25

Integration: back-office and/or front-office Back-Office Clinical Information System messages Integrated Clinical Viewing at the desktop Front Office May 5, 2002 Efficiency Clinical Information System Improve Clinical Decisions 26

CCOW approach A Federated System of Context-Managed Applications May 5, 2002 27

Integration: the EPR approach HIS Other Clinical System RIS Cardiology PACS Radiology PACS Electronic Patient Record URL / URI? Webserver VL, US, NM PACS Header: : Thorax Report Type: …. . Findings: Mass …. . Daim Conclusions: . . Infiltr …. . Ima (Poi …. . gn e t e Rr e ) f s. : Web Viewers May 5, 2002 28

DICOM and IHE, Integrating the Healthcare Enterprise Questions? May 5, 2002 29