Image Sharing- the NIBIB RSNA image sharing project employing

Image Sharing- the NIBIB/RSNA image sharing project employing IHE solutions IHE-Providing the Foundation for Interoperability David S. Mendelson, M. D. Professor of Radiology Chief of Clinical Informatics The Mount Sinai Medical Center Co-chair IHE International Board Fourth China. U. S. Roundtable Meeting on Scientific Data Cooperation:

Presentation Objectives Integrating the Healthcare Enterprise (IHE) Overview- How is IHE organized? Healthcare Interoperability in the United States Challenges ARRA (American Recovery and Reinvestment Act) Image Sharing Via HIE Image Sharing Project- Personal Health Records (PHRs)

Integrating the Healthcare Enterprise The state of IHE - 2010 David S. Mendelson, M. D. Chief of Clinical Informatics The Mount Sinai Medical Center Co-chair IHE Board

International Adoption of IHE q q Austria Local Deployment National Extensions (Local Adaptions) Promotional & Live Demonstration Events Funding China Spain Holland Norway Taiwan Korea Canada Japan UK Italy France Germany 4 Pragmatic global standards harmonization + best practices sharing Year 8 (2006) Year 7 (2005) Year 6 (2004) Year 5 (2003) Year 4 (2002) Year 3 (2001) Year 1 (1999) Year 2 (2000) USA

National and Regional Projects Using IHE Profiles Lower Austria Netherland Amsterdam UK Cf. H (Radiology WF) France DMP Denmark (Funen) Italy (Veneto) Spain (Aragon) Italy (Conto Corrente Salute) Austria Quebec, Toronto, Alberta, British Columbia Canada Infoway VITL-Vermont Boston Medical Center - MA Philadelphia HIE CPHIC – Pennsylvania Care. Spark – TN & VA South Africa CHINA-Shanghai 5 Imaging Info Sharing Malaysia CHINA-Mo. H Lab results sharing JAPAN-Nagoya Imaging Info Sharing THINC- New York NCHICA – N. Carolina

IHE Organizational Structure IHE International Board Global Development Regional Deployment IHE North America IHE Asia-Oceania China Japan Korea USA Taiwan Radiology IT Infrastructure Laboratory Cardiology Canada Patient Care Coordination Pathology Radiation Oncology Patient Care Devices Eye Care IHE Europe Austria Italy France Norway Germany Spain Netherlands Sweden UK Professional Societies / Sponsors ACCE ACEP ACP GMSI HIMSS RSNA SFR SFIL COCIR SIRM ESC EAR-ECR BIR DRG Euro. Rec JAHIS JIRA JRS METI-MLHW MEDIS-DC JAMI Contributing & Participating Vendors 6

IHE China: http: //www. ihe-c. org Thank You for Your Attention Prof. Jianping Dai, MD 7

Events: Promotion Education and Promotion by Journals 8 Education and Promotion by Workshop

Events: Connectathon Dr. Zhu, Chairman of IHE China, past vice Minister of Healthcare attended There are 7 companies attended The IHE-C Connectathon was held at April 26, 2008 in Beijing Tiantan Hospital 9

Events: Connectathon The IHE-C Connectathon was held at April 26, 2008 in Beijing Tiantan Hospital 10

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 11

Problem to Profile Problem Domain Patient Identity across multiple settings IT Infrastructure Patient Identity Identifier Cross- feed Referencing (PIX) Patient Identity Source Radiology Evidence Creator (Post Processing Workstation Make CAD results available with images Integration Profile Evidence Documents Transaction Evidence Document Stored Actors Patient Identity Cross Reference Manager Image Manager/Image Archive 12

Interoperability in the USChallenges Privacy rights HIPAA No Single identifier

Office of the National Coordinator for Healthcare IT (ONC) Health Information Technology Standards Panel (HITSP) Certification Commission for HIT (CCHIT) American Recovery and Reinvestment Act (ARRA) Includes financial incentives for adoption of the Electronic Health Record throughout the US Interoperability is a cornerstone Funding for related research- NIH Quality -Comparative Effectiveness EHR

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

XDS-I

NIBIB contract summary Consumer Control Employ IHE solutions whenever possible IHE generally has not focused on consumer driven solutions but rather on institutional and enterprise workflow 5 Academic Institutions Mayo Clinic Mount Sinai Medical Center University of California San Francisco University of Chicago University of Maryland Establish a clearinghouse Engage PHRs 300, 000 patients over 2 years

Elements of Solution Edge Server Register a patient Listens to a Radiology Information System (RIS)- looking for a complete exam Retrieves Image set from PACS and Report from RIS Send both to clearinghouse Clearinghouse – functions as a secure router Transiently hold encrypted patient data PHR Consumer controls upload and future access Develop web based viewers Download full DICOM data set

XDS (Cross-Enterprise Document Sharing) XDS. a XDS- I. a XDS. b ? ? XDS-I. b

Software architecture Prepare content Poll database, get report, get exam, prepare big fat file Background java srvlet 25 days Transfer content Poll database for transfer out, package content into xds. b Background java srvlet 35 days HL 7 receiver Receive HL 7 A 04 messages, extract reports and store them in database Mirth HL 7 Channel. Let Mirth create its default database, all script work-but may have to customize per site 65 days for 5 sites Token App Create new tokens based on two parts, associate token with accession numbers, update database, user interface with login, get patient info, create job Ajax based web front-end , Java. Servlet for CFIND using dcm 4 che, creating job in the RSNA database, creating tokens using kerberos – tokens generated locally 30 days Database Store reports, logs, audit trails, user accounts, etc. Mirth instance for HL 7 & DICOM, RSNA instance for everything else 50 days – 2 databases Management App Create users, monitor logs, check health Ajax gui front end, backend servlet, dicom targets etc. 45 days

Future Directions Refine Workflow Initial workflow is to replace a CD Exam updates Download DICOM data and archive in a local PACS Edge server as a platform Radiation Monitoring Peer Review Quality Metrics

Radiation Exposure Monitoring Profile REM Supplement to Technical Framework for Trail Implementation Acquisition modalities inlcudes information regarding dose exposure Estimates Permits communication of that information to other systems Useful for Individual lifetime estimates as well as Population analysis 30

Radiation Exposure Monitoring (REM) Includes CT Plain X-Ray Mammography Current Exclusions Nuclear Medicine RT Brachytherapy 31

DICOM Dose SR objects DICOM 2008 PS 3. 3: A. 35. 8 X-Ray Radiation Dose SR IOD